I I LIBRARY OF THE UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN 301.435 Un3372to v.l The person charging this material is re- sponsible for its return on or before the Latest Date stamped below. Theft, mutilation, and underlining of books are reasons for disciplinary action and may result in dismissal from the University. University of Illinois Librar; 04 W| m FEB IIP TO AMEND THE OLDER AMERICANS ACT OF 1965 HEARINGS BEFORE THE SELECT SUBCOMMITTEE ON EDUCATION OF THE COMMITTEE ON EDUCATION AND LABOR HOUSE OF REPRESENTATIVES NINETY-SECOND CONGKESS FIRST SESSION ON H.R. 12017 and Related Bills TO STRENGTHEN AND IMPROVE THE OLDER AMERICANS ACT OF 1965 HEARINGS HELD IN WASHINGTON, D.C., SEPTEMBER 22, 24, AND OCTOBER 1; CHICAGO, ILL., NOVEMBER 2; NEW YORK, N.Y., NOVEMBER 20; AND BOSTON, MASS., NOVEMBER 22, 1971 PART 1 Printed for the use of the Committee on Education and Labor Cabl D. Perkins, Chairman TO AMEND THE OLDER AMERICANS ACT OF 1965 HEARINGS BEFORE THE SELECT SUBCOMMITTEE ON EDUCATION OP THE COMMITTEE ON EDUCATION AND LABOR HOUSE OF REPRESENTATIVES NINETY-SECOND CONGRESS FIRST SESSION ON H.R. 12017 and Related Bills TO STRENGTHEN AND IMPROVE THE OLDER AMERICANS ACT OF 1965 HEARINGS HELD IN WASHINGTON, D.C., SEPTEMBER 22, 24, AND OCTOBER 1; CHICAGO, ILL., NOVEMBER 2; NEW YORK!, N.Y., NOVEMBER 20; AND BOSTON, MASS., NOVEMBER 22, 1971 PART 1 Printed for the use of the Committee on Education and Labor Cabl D. Pebkins, Chairman 71-272 O U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 1972 COMMITTEE ON EDUCATION AND LABOR CARL D. PERKINS, Kentucky, Chairman EDITH GREEN, Oregon FRANK THOMPSON, Jr., New Jersey JOHN H. DENT, Pennsylvania ROMAN C. PUCINSKI, Illinois DOMINICK V. DANIELS, New Jersey JOHN BRADEMAS, Indiana JAMES G. O'HARA, Michigan AUGUSTUS F. HAWKINS, California WILLIAM D. FORD, Michigan PATSY T. MINK, Hawaii JAMES H. SCHEUER, New York LLOYD MEEDS, Washington PHILLIP BURTON, California JOSEPH M. GAYDOS, Pennsylvania WILLIAM (BILL) CLAY, Missouri SHIRLEY CHISHOLM, New York MARIO BIAGGI, New York ELLA T. GRASSO, Connecticut LOUISE DAY HICKS, Massachusetts ROMANO L. MAZZOLI, Kentucky HERMAN BADILLO, New York ALBERT H. QUIE, Minnesota JOHN M. ASHBROOK, Ohio ALPHONZO BELL, California OGDEN R. REID, New York JOHN N. ERLENBORN, Illinois JOHN R. DELLENBACK, Oregon MARVIN L. ESCH, Michigan EDWIN D. ESHLEMAN, Pennsylvania WILLIAM A. STEIGER, Wisconsin EARL F. LANDGREBE, Indiana ORVAL HANSEN, Idaho EARL B. RUTH, North Carolina EDWIN B. FORSYTHE, New Jersey VICTOR V. VEYSEY, California JACK F. KEMP, New York PETER A. PEYSER, New York Select Subcommittee on Education JOHN BRADEMAS, Indiana, Chairman PATSY T. MINK, Hawaii LLOYD MEEDS, Washington JAMES H. SCHEUER, New York JOSEPH M. GAYDOS, Pennsylvania WILLIAM (BILL) CLAY, Missouri SHIRLEY CHISHOLM, New York ELLA T. GRASSO, Connecticut ROMANO L. MAZZOLI, Kentucky JAMES G. O'HARA, Michigan JOHN H. DENT, Pennsylvania OGDEN R. REID, New York ALPHONZO BELL, California EARL F. LANDGREBE, Indiana ORVAL HANSEN, Idaho EDWIN D. ESHLEMAN, Pennsylvania JACK F. KEMP, New York PETER A. PEYSER, New York (H) \ r\r CONTENTS tarings held in-- p Washington, D.C.: pa * e September 22, 1971 1 September 24, 1971 65 October 1, 1971 J17 Chicago, 111., November 2, 1971 333 New York, N.Y., November 20, 1971 625 Boston, Mass., November 22, 1971 747 extof H.R. 12017 2 batement of — -*. . . « . ^j.- ^u- Ahrens, Robert J., director, Division for Senior Citizens, Chicago Department of Human Resources 335 Allen, Miss Fannie, director, United South End Settlements, accom- panied by Mrs. Virginia Jeffries, Women's Educational and Indus- trial Union --- -.--- ---^-.-z-^r-zf- 776 Backman, Hon. Jack H., chairman of Joint Legislative Social Welfare Committee, Massachusetts Legislature _ 748 Ballard, John H., executive director, Welfare Council of Metropolitan Bechill, William, associate professor, Maryland University, former Commissioner on Aging, Department of Health, Education, and Welfare 66 Berg, Murray, executive director, Schwab Rehabilitation Hospital. _ 382 Brophy, Alice M., director, Office for the Aging, Office of the Mayor, City of New York (Presented by James T. Warrack) 644 Callahan, James J., Jr., Ph. D., assistant commissioner for medical assistance, Massachusetts Department of Public Welfare 780 Cannata, Mary, Ann Chapman, and Fred Yaeger 667 Coard, Robert M., executive director, Action for Boston Community Development, Inc 781 Cohen, Elias S., assistant professor, Department of Community Medicine, School of Medicine, University of Pennsylvania 83 Connolly, Miss Jane, director, Senior Centers of Metropolitan Chi- cago 379 Dwight, Mrs. William, and Dr. James F. Cummins 771 Flemming, Arthur, Chairman, White House Conference on Aging, and Former Secretary of HEW, accompanied by Webster Todd, Jr 37 Griesel, Miss Elma, Public Interest Research Group 321 Harrison, Dr. G. Lamar, director, senior aides project, Chicago Com- mittee on Urban Opportunity 376 Havighurst, Robert J., professor emeritus, University of Chicago Committee on Human Development, Chicago, 111 94 Henry, Mrs. Mary Alice, community organizer, West Side Health Planning Organization; Miss Dora Nelson, founder, DuPage Chapter 500, American Association of Retired Persons; James Roach, associate editor, Chicago Voice; and Arthur Weed, director, North Shore Senior Center, a panel of elderly 369 Holbrook, Msgr. Thomas J., associate administrator and program director, Catholic Charities of Chicago 351 Holleb, Marshall M., acting chairman, Illinois State Council on Aging 3 46 Howell, Sandra C, M.P.H., Ph. D., Levinson Gerontological Policy Institute, Heller School, Brandeis University 99 Hutton, William E., Executive Director, national council, by Rudy Danstedt, assistant to the president, National Council of Senior Citizens 234 (in) IV Statements — Conti| Johnson, Elmer, presented for""Will C. Rasmussen, director, Division Page of Care of the Aged, Lutheran Welfare Services of Illinois 343 Leith, Paul 695 Liederman, Hon. David S., Massachusetts State representative 758 LoMolino, Lawrence, George Dimond, and Walter Newburgher 675 Miller, Jerry, president, St. Joseph County Board of Commissioners, South Bend, Ind 76 Nash, Bernard E., executive director, National Retired Teachers Association and American Association of Retired Persons 118 O'Malley, James, acting director, New York State Executive Depart- ment, Office for the Aging, Albany, N.Y 642 Sargent, Hon. Francis W., Governor, Commonwealth of Massachusetts 764 Scbott, Elihu, coch airman, Committee on Aging, Community Service Society, New York, N.Y 249 Shroder, Jerry, executive secretary, Citizens Committee on Aging, Community Council of Greater New York 646 Sugarman, Jule M., administrator, Human Resources Administra- tion, New York City 626 Warach, Bernard, Jean Wallace Carey, and Caspar W. Rittenberg__ 672 Weismehl, Ronald, director for the Jewish elderly, Jewish Federation of Metropolitan Chicago 363 Statements, letters, supplemental material, etc.: Ahrens, Robert J., director, Division for Senior Citizens, Chicago, 111.: Statement of 425 "The White House Conference on Aging in Cook County, 1970- 1971," an article entitled 428 Allen, Fannie L., director, Services for Older Adults, United South End Settlements, Boston, Mass., statement of 787 Ballard, John H., executive director, Welfare Council of Metropolitan Chicago: Position statements: Architectural Barriers in Public Transportation Facilities. _ 493 1 Design and Location of Public Housing 494 Elimination of Architectural Barriers to the Handicapped. _ 496 Employment Discrimination by Reason of Age 498 Guaranteed Annual Income 498 Public Aid Ceilings 496 Special Transportation for the Handicapped 497 Statement given at a press conference, March 18, 1971 449 Statement of 446 "Third Year Report: Information Center for the Aging," a com- pilation entitled 45C Bartley, Hon. David M., speaker, Massachusetts House of Repre- sentatives : Elderly legislation passed by the House 794 Notes on hearing of elder affairs 79E Statement by --- 795 Breagy, James, associate director, Citizens Housing and Planning Association, and chairman, Housing Task Force, Governor's Com- mission on the Elderly, remarks of 79C Brophy, Alice M., director, Office for the Aging, Office of the Mayor of the City of New York, testimony of 69? Cannata, Miss Mary, project director, meals-on-wheels program, Stanley M. Isaacs Neighborhood Center, prepared statement of__ 65« c Callahan, James J., Ph. D., assistant commissioner of the Massa- chusetts Department of Public Welfare, testimony of 78( Carey, Mrs. Jean Wallace, staff associate for aging, Community Service Society: Letter to Chairman Brademas, dated December 2, 1971 704 Staff memorandum dated August 6, 1971 70( Statement on H.R. 1— Social Security Amendments of 1971 70' Chapman, Mrs. Robert J., board member, Stanley M. Isaacs Neigh- borhood Center, Inc., testimony by 65( Chaskes, Charles H., president, National Association of State Units on Aging, statement by 32S Statements, letters, supplemental material, etc.- -Continued Coard, Robert M., executive director, Action for Boston Community !'««« Development, Inc., statement of 785 Cohen, Elias S., assistant professor, Department of Community Med- icine, School of Medicine, University of Pennsylvania, statement of _ 88 Cohen, Steven P., mayor's staff, statement on behalf of the city of Boston 797 Collins, John A., Cambridge, Mass., letter from 791 Connolly, Miss Jane, director, Senior Centers of Metropolitan Chicago, Affiliate Hull House Association: "Outreach: Bringing Services to the Elderly," a report entitled.. 590 Statement of 379 Dwight, Maria B., Holyoke, Mass., letter to Chairman Brademas, dated November 22, 1971 789 Flemming, Arthur, Chairman, White House Conference on Aging, and former Secretary of HEW, summary prepared by staff of White House Conference on Aging, September 1971 41 Grasso, Hon. Ella T., a Representative in Congress from the State of Connecticut, statement of 327 Harrison, Dr. G. Lamar, director, Chicago senior aides project, pre- pared statement of 376 Havighurst, Robert J., professor emeritus, University of Chicago Committee on Human Development, Chicago, 111., statement of_._ 100 Havighurst, Robert J., chairman, Committee on Human Develop- ment, University of Chicago, "The Status of Research in Applied Social Gerontology," a status report 50 1 Henry (Ma), Mary Alice, West Side Health Planning Organization, "What the Government Should Do for Senior Citizens," an article entitled 421 Holleb, Marshall M., acting chairman, Illinois State Council on Aging, statement of 424 Howell, Sandra C, M.P.H., Ph. D., Levinson Gerontological Policy Institute, Heller School, Brandeis University, statement of 107 Hutton, William R., executive director, National Council of Senior Citizens, prepared testimony of 234 Kemp, Hon. Jack, a Representative in Congress from the State of New York: Department of Health, Education, and Welfare activities serving older Americans, 1970 266 Facts and figures on older Americans — Federal outlays in aging, fiscal years 1967-72 257 Remarks of 255 "White House Report/ Conference on Aging Seeks Changes in Attitude Toward the Elderly," article by Judith Axler Turner. 315 Miller, Jerry J., president, Board of County Commissioners, St. Joseph County, Ind., statement of 77 Morris, Robert, director, Levinson Gerontological Policy Institute, Brandies University, Waltham, Mass., statement of 798 Nash, Bernard E., executive director, National Retired Teachers Asso- ciation and American Association of Retired Persons: Prepared testimony of 118 "The Issues— Where We Stand," article entitled 226 "46 National Leaders Speak Out on Options for Older Ameri- cans," publication entitled 135 Nelson, Miss Dora, retired social worker, business woman, organizer of AARP Chapter 500: "Adult School Gets Reprieve; Students to Return January 3," a newspaper article entitled 387 "End Adult Education?", a newspaper article entitled 385 "End Adult Education? Tragedy for Blacks," a newspaper article entitled 386 "Harvest Years: A Time for Learning," a publication entitled... 389 Letter to Chairman Brademas, dated December 11, 1971 385 "Save Adult Education," a newspaper article entitled 385 "Shattering Hopes or Saving Dollars?," a newspaper article entitled 386 Statement of 388 VI Statement, letters, supplemental material, etc. — Continued Newburgher, Walter, president, Congress of Senior Citizens, New York, "White House Conference on Aging: A platform for the Seventies P a se for all Older Americans, " an article entitled _.. 676 O'Malley, James J., acting director, New York State Office for the Aging, testimony by 730 Pepper, Hon. Claude, a Representative in Congress from the State of Florida, letter to Chairman Brademas, dated July 15, 1971, en- closing letters received in response to a mailing, favoring H.R. 5017_ 600 Pingree, D., Andover, Mass., letter to Chairman Brademas, dated November 22, 1971 792 Rasmussen, Will C, director, Division of Care of Aged, Lutheran Welfare Services of Illinois, statement of 423 Rittenberg, Caspar W., member, Committee on Aging of the Com- munity Service Society of New York, statement by 70 1 Roach, James, associate editor, Chicago Voice, statement of 422 Shroder, Jerry A., executive secretary Citizens Committee on Aging, Community Council, New York, statement of 702 Stein, Edith, coordinator of elder programs, Allston-Brighton APAC, letter from, including statement 79 1 Sugarman, Jule M., administrator, Human Resources Administration, New York City, testimony of 696 Trebony, Mrs. Elizabeth Stecher, director, Project FIND and FINF Aid for the Aged, Inc. : "Bus Terminal Habitues Get Own Coffeehouse," article in the New York Times 660 "Health, Food, and Rent: Three Crises for the Elderly," article in the Chelsea Clinton News 661 "Project FIND: Seeking Out the Isolated," article in the Chelsea Clinton News 662 "Soon To Be Forgotten?" article in Newsday 664 Statement by 656 Van Lare, Barry L., executive deputy commissioner, Department of Social Services, State of New York, letter to Chairman Brademas, dated December 13, 1971 649, Weed, Arthur R., consultant on retirement, Department of Human Resources, Chicago, 111. : Letter to Chairman Brademas, dated November 3, 1971 436 Letter from Chairman Brademas, dated November 8, 1971 436 "News from the Field of Pre-Retirement Preparation," an article entitled 437 "Pre-Retirement Planning," a pamphlet entitled 440 "Preparing for Retirement at Abbott Laboratories," a pamphlet entitled - 444: "Preparation for Retirement at Carson Pirie Scott & Company," j a pamphlet entitled 442 "Prudential and Jewel Help Employees Plan," a pamphlet entitled. 440 Statement of 436 Weismehl, Ronald, director, Council for Jewish Elderly, Jewish Federation of Metropolitan Chicago, statement of 588 Women's Educational and Industrial Union, Boston, Mass., testimony of 783 Yaeger, Fred, executive director, Bronx Foundation for Senior Citizens in the Bronx, N.Y., statement by 666 TO AMEND THE OLDER AMERICANS ACT OF 1965 wednesday, september 22, 1971 House of Representatives, Select Subcommittee on Education of the Committee on Education and Labor, Washington, D.G. The subcommittee met at 2 p.m., pursuant to call, in room 2175, Ray- burn House Office Building, Hon. John Brademas (chairman of the subcommittee) presiding. Present: Representatives Brademas, Scheuer, Reid, Landgrebe, Hansen, and Peyser. Staff members present: Jack G. Duncan, counsel; David Lloyd- Jones, professional staff; Martin LaVor, minority legislative associ- ate; Gladys Walker, clerk; and Christine Orth, staff. (Text of H.R. 12017 follows:) (i) 92d CONGRESS 1st Session H. R. 12017 IN THE HOUSE OF REPRESENTATIVES . December 2,1971 Mr. Brademas (for himself, Mr. Perkins, Mrs. Mink, Mr. Meeds, Mr. Scheuer, Mr. Gaydos, Mr. Clay, Mrs. Chisholm, Mrs. Grasso, and Mr. Dent) intro- duced the following bill ; which was referred to the Committee on Education and Labor A BILL To strengthen and improve the Older Americans Act of 1965. 1 Be it enacted by the Senate and House of Representa- 2 tives of the United States of America in Congress assembled, 3 That this Act may he cited as the "Older Americans Act 4 Amendments of 1972". 5 FINDINGS AND PURPOSES 6 Sec. 2. (a) The Congress finds that millions of older 7 citizens, particularly those over sixty-five years of age, in 8 this Nation are suffering unnecessary harm from the lack of 9 adequate services. It is therefore the purpose of this Act, 10 in support of the objectives of the Older Americans Act of 11 1965, to— •I 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 (1) make available comprehensive programs which include a full range of health, education, and social f services to our older citizens who need them, (2) give full and special consideration to citizens with special needs in planning such programs, and, pending the availability of such programs for all citizens, give priority to the elderly with the greatest economic and social need, 1 (3) provide comprehensive programs which will deliver a full range of essential services to our older citizens, and, where applicable, also furnish meaningful employment opportunities for many individuals, includ- ing older persons, young persons, and volunteers from the community, and (4) insure that the planning and operation of such programs will be undertaken as a partnership of com- munity, and State and local governments, with appropri- ate assistance from the Federal Government, (b) Section 101(8) of the Older Americans Act of 1965 (hereinafter referred to as "the Act") is amended by inserting after "services" the following: ", including access to low-cost transportation,". EXTENSION OF PEOGRAMS Sec. 3. (a) Section 301 of the Act is amended by strik- ing out "and" after "1971," and inserting after "1972" the 1 following: ", $150,000,000 for the fiscal year ending June 2 30, 1973, $200,000,000 for the fiscal year ending June 30, 3 1974, and $250,000,000 for the fiscal year ending June 30, 4 1975,". 5 (b) Section 305(b) of the Act is amended by striking 6 out "and" after "1970," and inserting after "1972" the 7 following: ", and such sums as may be necessary for each 8 succeeding fiscal year ending prior to July 1, 1975". 9 (c) Section 603 of the Act is amended by striking out 10 "and" after "1971," and by inserting after "1972" the H following: ", and such sums as may be necessary for each 12 succeeding fiscal year ending prior to July 1, 1975". 13 (d) Section 614 of the Act is amended by striking out M "and" immediately after "1971," and inserting after "1972" 15 the following: ", and such sums as may be necessary for each 16 succeeding fiscal year ending prior to July 1, 1975". 17 (e) Section 703 of the Act is amended by striking 18 out "and" immediately after "1971," and inserting after 19 "1972" the following: ", and such sums as may be neces- 20 sary for each succeeding fiscal year ending prior to July 1, 21 1975". 22 AMENDMENTS TO TITLE II 23 Sec. 4. (a) Section 201 (b) of the Act is amendf 24 adding at the end thereof the following: "'The Commis- 25 sioner on Aging shall be the principal officer of the Depart- 1 ment of Health, Education, and Welfare for carrying out this 2 Act. In the performance of his functions, he shall be directly 3 responsible to the Secretary and not to or through any 4 other officer of that department. The Commissioner on 5 Aging shall not delegate any of his functions to any other 6 officer who is not directly responsible to him." 7 (b) (1) Section 202 of the Act is amended by striking 8 out "and" at the end of paragraph (7) , by striking out the 9 period at the end of paragraph (8) and inserting in lieu 10 thereof "; and", and by adding at the end thereof the 11 following new paragraphs : 12 " (9) develop basic policies and set priorities with 13 respect to the development and operation of programs 14 and activities related to the purpose of this Act; 15 " (10) provide for the coordination of Federal pro- 16 grams and activities related to such purposes; 17 "(11) coordinate, and assist in, the planning and 18 development by public (including Federal, State, and 19 local) and nonprofit private agencies of programs for 20 older persons, with a view to the establishment of a 21 nationwide network of comprehensive, coordinated serv- 22 ices and opportunities for such persons; 23 "(12) call conferences of such authorities and offi- 24 cials of public (including Federal, State, and local) and 25 nonprofit private agencies or organizations concerned 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 with the development and operation of programs tor older persons as the Secretary deems necessary, or proper for the development and implementation of poli- cies related to the purposes of this Act; "(13) develop and operate programs providing services and opportunities related to the purposes of this Act which are not otherwise provided by existing pro- grams for older persons; " (14) carry on a continuing evaluation of the pro- grams and activities related to the purposes of this Act with particular attention to the impact of medicare and medicaid, the Age Discrimination Act, and the pro- grams of the National Housing Act relating to hous- ing for the elderly and the setting of standards for the licensing of nursing homes, intermediate care homes, and other facilities providing care for older people; " (15) serve as a clearing house for applications for Federal assistance to private nonprofit agencies and insti- tutions for the establishment and operation by them of programs and activities related to the purposes of this Act; and " (16) develop, in coordination with other agencies, a national plan for meeting the needs for trained per- sonnel in the field of aging, and for training persons for carrying out programs related to the purposes of this 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Act, and conduct and provide for the Conducting of such training." (2) Section 202(4) of the Act is amended to read as follows : " (4) develop plans, conduct and arrange for re- search in the field of aging, and carry out programs designed to meet the needs of older persons for social services, including nutrition, hospitalization, preretire- ment training, continuing education, and health serv- ices;". (c) Title II of the Act is amended by adding at the end thereof the following new sections : "federal agency cooperation "Sec. 203. Federal agencies proposing to establish pro- grams related to the purposes of this Act shall consult with the Administration on Aging prior to the establishment of such programs, and Federal agencies administering such programs shall cooperate with the Administration on Aging in carrying them out. "material information and resource center for the aging "Sec. 204. (a) There is hereby established, within the Administration on Aging, a National Information and Re- source Center for the Aging (hereinafter referred to as the "Center") . The Center shall have a Director and such other 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 personnel as may be necessary to enable the Center to carry out its duties and functions. " (b) (1) It shall be the duty and function of the Center to collect, review, organize, publish, and disseminate (through publications, conferences, workshops, or technical consultation) information and data related to the particular problems caused by aging, including information describing measures which are or may be employed for meeting or overcoming such problems, with a view to assisting older individuals, and organizations and persons interested in the welfare of older persons, in meeting problems which are peculiar to, or are made more difficult for, older individuals. "(2) The information and data with respect to which the Center shall carry out its duties and functions under paragraph (1) shall include (but not be limited to) infor- mation and data with respect to the following — " ( 1 ) medical and rehabilitation facilities and serv- ices, including Medicare, Medicaid, and other programs operating under the Social Security Act ; "(2) education; "(3) vocational training; "(4) employment; " ( 5 ) transportation ; " (6) architecture and housing (including household appliances and equipment) ; 8 1 "(7) recreation; and 2 " (8) public or private programs established for, or 3 which may be used in, solving problems of older persons. 4 "(c) (1) The Secretary shall make available to the 5 Center all information and data, within the Department of 6 Health, Education, and Welfare, which may be useful in 7 carrying out the duties and functions of the Center. 8 "(2) Each other department or agency of the Federal 9 Government is authorized to make available to the Secretary, 10 for use by the Center, any information or data which the 11 Secretary may request for such use. 12 " (3) The Secretary shall, to the maximum extent feasi- 13 ble, enter into arrangements whereby State and other public 14 and private agencies and institutions having information or 15 data which is useful to the Center in carrying out its duties 16 and functions will make such information and data available 17 for use by the Center. 18 "(d) There is authorized to be appropriated for carry- 19 ing out this section for the fiscal year ending June 30, 1973, 20 and for each succeeding fiscal year ending before June 30, 21 1975, such sums as may be necessary." 22 AMENDMENTS TO TITLE III 23 Sec. 5. Title III of the Act is amended by adding at the 24 end thereof the following : 10 9 J- ADDITIONAL CONDITIONS FOR PROGRAMS INCLUDING 2 CONSTRUCTION 3 "Sec. 307. (a) Applications under this title including 4 construction may be approved only upon a showing that 5 construction of such facilities is essential to the provision of 6 adequate services for the elderly, and that rental, renovation, ? remodeling, or leasing of adequate facilities is not practicable. 8 " (b) If within twenty years after completion of any 9 construction for which Federal funds have been paid under 10 this title the facility shall cease to be used for the purposes 11 for which it was constructed, unless the Secretary determines 12 in accordance with regulations that there is good cause for *** releasing the applicant or other owner from the obligation to 14 do so, the United States shall be entitled to recover from the 15 applicant or other owner of the facility an amount which 16 bears to the then value of the facility (or so much thereof 17 as constituted an approved project or projects) the same 18 ratio as the amount of such Federal funds bore to the cost of 19 the facility financed with the aid of such funds. Such value 20 shall be determined by agreement of the parties or by action 21 brought in the United States district court for the district in 22 which the facility is situated. 23 " (c) All laborers and mechanics employed by contrac- 24 tors or subcontractors on all construction, remodeling, reno- 11 10 1, yation, or alteration projects assisted under this title shall be 2 paid wages at rates not less than those prevailing on similar 3 construction in the locality as determined by the Secretary of 4 Labor in accordance with the Davis-Bacon Act, as amended 5 (40 U.S.C. 276a-276a-5). The Secretary of Labor shall 6 have with respect to the labor standards specified in this sec- 7. tion the authority and functions set forth in Eeorganization .8 Plan Numbered 14 of 1950 (15 F.R. 3176) and section 2 9 .; of the Act of June 13, 1934, as amended (40 U.S.C. 276c) . 10 t " (d).In the case of loans for construction, the Secretary 11 shall, prescribe the interest rate and the period within which 12 such loan shall be repaid, but such interest rates shall not be 1.3 ,, less than 3 per centum per annum and the period within 1£ which, such loan is repaid shall not be more than twenty-five 15 years v 16 . rl "(e) The Federal assistance for construction may be in .17 the form of grants or loans, provided that total Federal funds 18 to be paid, to other than private nonprofit agencies and or- ,1$ ganjzations will not exceed 50 per centum of the construction 20 ...post* and will be in the form of loans. Repayment of loans ,21, shall, to the extent required by the Secretary, be returned 22 to the applicant from whose financial assistance the loan was 23 ; n^ade, or used for additional loans or grants under this 24 . Act." ' . 71-272 O - 72 - pt. 1 - 2 12 11 1 AMENDMENTS TO TITLE IV 2 Sec. 6. Title IV of the Act is amended by redesignating 3 sections 401 and 402 as sections 451 and 452, respectively, 4 by striking out " title" each time it appears and inserting 5 in lieu thereof "part", and by striking out the center heading 6 of the title and inserting in lieu thereof the following: 7 -TITLE IV— EESEARCH AND DEVELOPMENT 8 "Paet A— Gerontological Research Plan 9 "establishment of gerontological research center 1° "Sec. 401. (a) Eor the purposes of developing a coordi- 11 nated national program for research on the biological aspects 12 of aging, there is hereby established an independent agency 13 to be known as the Gerontological Eesearch Center (here- H inafter referred to as the 'Center') . The Center shall be 15 located within the Department of Health, Education, and 16 Welfare for administrative purposes only. H "(fc) The Center shall be headed by a Board which 18 shall be composed of five members appointed by the Presi- 1 9 dent. Two members of the Board shall be biological scientists, 20 one shall be a behavioral scientist, one shall be an adminis- 21 trator, and one shall be a physician. Each person nominated 22 and appointed shall, as a result of his training, experience, 23 and administering, be especially qualified to formulate and 24 appraise programs and activities related to the biological 25 aspects of aging. 13 4 5 (i 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 12 " (c) The President shall designate one of the members of the Board to serve as Chairman and one to serve as Vice Chairman. The Chairman shall receive compensation at the rate prescribed for level II of the Executive Schedule under section 5313 of title 5, United States Code. Each of the other four members shall receive compensation at the rate prescribed for level IV of the Executive Schedule under section 5315 of such title. "(d) Vacancies shall be filled in the same manner in which the original appointments were made. Any vacancy in the Board shall not affect its powers, and three members of the Board shall constitute a quorum. "functions of the boaed "Sec. 402. (a) The Board shall be responsible for preparing a program, to be known as the gerontological research plan, designed to promote and conduct intensive coordinated research in the biological origins of aging on a continuing basis. "(b) The Board shall carry out the following duties: "(1) the collection, analysis, interpretation, and evaluation of information and statistical data related to the biological aspects of aging; "(2) the appraisal of programs and activities re- lated to the biological aspects of aging; "(3) the development of priorities for new pro- 14 grams designed to increase knowledge of the biological y aspects of aging; "(4) the development of legislative reports and proposals for new programs to provide greater insight into the biological aspects of aging; and "(5) conduct research in the biological aspects of aging. "board staff "Sec. 403. (a) The Board is authorized to employ such 10 officers and employees as may be necessary to carry out its 11 functions under this part. 12 " (b) The Board is authorized to obtain services of con- 13 sultants in accordance with the provisions of section 3109 14 of title 5, United States Code, at rates for individuals not 15 to exceed $100 per diem. 16 ''powers of board 17 "Sec. 404. To carry out this part, the Board shall have 18 the authority — "(a) to prescribe such rules and regulations as it deems necessary governing the manner of its operations and its organization and personnel; "(b) to obtain from any department, agency, or instrumentality of the United States, with the consent of the head thereof, such services, advice, and informa- 19 20 21 22 23 24 15 3 4 5 (> 7 8 rfe 10 Jl 12 13 14 15 16 17 18 19 20 21 22 23 24 25 14 tion as the Board may determine to be required by it to carry out its duties; "(c) to acquire by lease, loan, or gift, and to hold dnd dispose of by sale, lease, or loan, real and personal property of all kinds necessary for, or resulting from, the exercise of authority under this part; "(d) to enter into contracts or other arrangements, or modifications thereof, with State and local govern- ments; and institutions and individuals in the United States, to conduct programs the Board deems necessary to carry out the purposes of this part, and such contracts or other arrangements, or modifications thereof, may be entered into without legal consideration, without per- formance or other bonds, and without regard to section 3709 of the Revised Statutes, as amended (41 U.S.C. .5), or other provision of law relating to competitive bidding; "(e) to make advance, progress, and other pay- ments which the Board deems necessary under this Act without regard to the provisions of section 3648 of the Revised Statutes, as amended (31 U.S.C. 529) ; "(f) to receive money and other property donated, bequeathed, or devised to the Board, without condition or restriction other than that it be used for the purposes of the Board ; 16 15 "(g) to accept and utilize the services of voluntary and uncompensated personnel and reimburse them for travel expenses, including per diem, as authorized by section 5703 of title 5, United States Code ; and " (h) to make any other expenditure's necessary to carry out this part. Part B— Research and Development Projects/' PRERETIREMENT PROGRAMS Sec. 7. Title V of the Act is amended by (1) changing 10 the title to read "TRAINING", (2) redesignating section 11 503 as section 504, and (3) by inserting the following new section : "preretirement programs "Sec. 503. For the purpose of easing the frequently 15 difficult social and economic adjustments which must be 16 made at some time by most Americans as they pass from 17 the highly productive period of the middle years 1 to' the 18 new retirement status of the older citizen, and' to assist 19 them in achieving health and dignity in' retirement living, ... i\,. y r 20 the Secretary is authorized— 21 " (a) to develop and operate 1 , in cooperation with 22 • any public or nonprofit private agency, organization, 23 or institution, preretirement programs 'providing edu- 24 cation, information, and relevant services to persons 25 planning retirement; 12 13 14 17 4 5 (5 7- 8 9 10 11 12 13 14 15 16 17, ia 19 20 21 22 23 24 16 "(b) to collect and disseminate, through publica- tions and other appropriate means, information concern- ing research, studies, findings, and other materials developed in connection with activities under this sec- tion; and "(c) to make grants to any public or nonprofit private agency, organization, or institution, and con- tracts with any agency, organization, or institution, for the evaluation of preretirement programs, the training of personnel to carry out such programs, and the con- duct of research with respect to the development and operation of such programs." SPECIAL IMPACT PROGRAMS Sec. 8. (a) The Act is amended by redesignating title VII as title VIII, by redesignating sections 701 through 703 and references thereto as sections 801 through 803, respectively, and by inserting after title VI the following new title: , "TITLE VII— SPECIAL IMPACT PEOGRAMS "Part A— Service Roles in Retirement "grants and contracts for service projects "Sbc. 701. (a) The Secretary is authorized to make grants to or contracts with public and nonprofit private agencies and organizations to pay not to exceed 90 per centum of the cost of the development and operation of 18 17 1 programs designed to provide opportunities for persons aged 2 sixty or over to render public service. 3 " (b) Payments under this title pursuant to a grant or ■4 contract may be made (after necessary adjustment, in the 5 case of grants, on account of previous made overpayments 6 or underpayments) in advance or by way of reimbursement, 7 in such installments and on such conditions, as the Secre- 8 tary may determine. 9 "conditions of grants and contracts 10 "Sec. 702. The Secretary shall not make any grant or 11 enter into any contract under this part unless the grant appli- 12 cation or contract proposal — " (1) has been submitted by, or has been submitted for review and recommendations to, the State agency (if any) established or designated as provided in sec- tion 303 (a) (1); " (2) provides for the use of unpaid, volunteer serv- ices, if available ; and "(3) provides that the program will not result in the displacement of employed workers or impair exist- ing contracts for services. "interagency cooperation "Sec. 703. In administering this part, the Secretary 21 shall consult with the Office of Economic Opportunity, the 25 Department of Labor, and any other Federal agencies admin- 13 14 15 1G 17 18 19 20 21 22 2?> 19 18 1 istering relevant programs with a view to achieving optimal 2 coordination of the program under this part with such other 3 programs and shall promote the coordination of programs 4 under this part with other public or private programs or proj- 5 ects carried out at State and local levels. Such Federal agen- ts cies shall cooperate with the Secretary in disseminating in- 7 formation about the availability of assistance under this part 8 and in promoting the identification and interest of older 9 persons whose services may be utilized in programs under 1° this part. 11 "appropriations authorized 12 "Sec. 704. Such sums as may be necessary are au- 13 thorized to be appropriated for grants or contracts under 14 this part for the fiscal year 1973, and each succeeding 15 fiscal year ending prior to July 1, 1975. 16 17 18 i9 NUTRITIONAL SERVICES FOR OLDER AMERICANS 20 "Sec. 711. For the purpose of improving the nutri- 21 tional level of older persons, there are authorized to be ^ appropriated such sums as may be necessary for the fiscal 23 year 1973, and each succeeding fiscal year ending prior to July 1, 1975. Sums made available under this section 25 shall be utilized by the Secretary to make grants to any "Part B— Nutritional Services for Older Americans "authorization of appropriations; grants for 20 19 1 State which has in effect a State plan approved under 2 section 303, to assist (as provided in this part) in the 3 planning, establishment, and operation of a program de- 4 signed to meet the dietary needs of older persons, particu- 5 larly those of low or moderate income. Such a program 6 shall provide for the establishment and operation in the 7 State of projects providing such services as — "(1) hot, nutritionally balanced meals for older persons in multipurpose senior centers, in neighborhood centers, and in residential housing for persons of low or middle income ; "(2) home delivered meals for individuals requir- ing such services because they are homebound or dis- abled or for other health reasons ; and "(3) nutritional counseling, information, and edu- cation for older persons. "allotments "Sec. 712. (a) Not to exceed 1 per centum or 19 $200,000, whichever is larger, of the sum appropriated for 20 any fiscal year under section 711 may be reserved by the 21 Secretary for evaluation (directly or by grants or contracts) 22 of programs assisted under this part. 23 "(b) (1) From the sum appropriated for any fiscal 24 year under section 711, (A) the Virgin Islands, Guam, and 25 American Samoa shall be allotted an amount equal to one- 8 9 10 11 12 13 U 15 1G 17 18 21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 20 half of 1 per centum of such sum, and (B) each other State shall be allotted an amount equal to 1 per centum of such sum. " (2) From the remainder (as determined after appli- cation of subsection (a) and paragraph (1) of this subsec- tion) of the sum so appropriated each State shall be allotted an additional amount which bears the same ratio to such re- mainder as the population aged sixty or over in such State bears to the population aged sixty or over in all of the States, as determined by the Secretary on the basis of the most re- cent information available to him, including any relevant data furnished to him by the Department of Commerce. " (3) A State's allotment for a fiscal year for programs assisted under this part shall be equal to the sum of- the amounts allotted to it under paragraphs (1) and (2) . "(c) The amount of any allotment to a State under subsection (b) for any fiscal year which the Secretary deter- mines will not be required for carrying out the purposes of section 711 shall be available for reallotment, from time to time, on such dates as the Secretary may fix, to other States which the Secretary determines (1) have need in carrying out such purposes for sums in excess of those previously allotted to them under this section, and (2) will be able to use such excess amounts during such fiscal year. Such re- allotments shall be made on the basis of the State plans 22 21 1 approved under section 303, after taking into consideration 2 the population aged sixty or over. Any amount so reallotted 3 to a State shall be deemed part of its allotment under sub- 4 section (b). 5 " (d) The allotment of any State under subsection (b) 6 for any fiscal year shall be available for grants to pay not 7 exceeding 90 per centum of the cost of planning, establish- 8 ing, and operating programs assisted under this part which 9 are approved by the Secretary prior to the end of such year. 10 "use of allotted funds 11 "Sec. 613. Funds allotted to any State under this part 12 may be used for (1) the administration of projects de- 13 scribed in section 701 directly by the State agency estab- 14 lished or designated as provided in section 303 (a) (l) , or 15 (2) the award, in accordance with criteria established by 16 the Secretary after consultation with such State agencies, 17 by such State agency of grants or contracts to any public 18 or nonprofit private agencies or organizations for the admin- 19 istration of such programs by such agencies or organizations. 20 " (c) In allocating funds received under this part, the 21 State agency shall give preference to programs to be estab- 22 lished in geographic areas or in institutions having a higher 23 concentration of older persons of low income. 24 "payments 25 "Sec. 714. Payments under this part may be made (after 23 22 1 necessary adjustment, in the case of grants, on account of 2 previously made overpayments or underpay ments ) in ad- 3 vance or by way of reimbursement, and in such installments, 4 as the Secretary may determine. 6 PUBLIC ASSISTANCE PURPOSES I? "Sec. 715. Notwithstanding the provisions of titles I, 8 IV, X, XIV, XVI, or XIX of the Social Security Act, s.rv- 9 ices or other assistance provided to any older persons pur- 10 suant to this part or pursuant to any grant made under this 11 part shall not be regarded (1) as income or resources of 12 such person in determining his need under a State plan ap- 13 proved under any such title, or (2) as income or resources 14 of any other individual under such approved State plan. 15 "regulations 16 "Sec. 716. (a) The Secretary, after consultation with 17 the Department of Agriculture with respect to standards 18 relating to food distribution, handling, and storage and equip- 19 ment used for food distribution, handling, and storage and 20 with respect to the incorporation of the results of tested 21 nutritional research in the operation of projects assisted un- 22 der this part, shall prescribe general regulations concerning 23 the determination of eligible costs with respect to which 24 grants may be made Under this part and the terms and 25 conditions for approving such grants. 24 2S 'Tart C— Construction of Multipurpose Senior Centers "authorization of appropriations "Sec. 721. There are authorized to be appropriated such 5 sums as may be necessary for the fiscal year 1973, and each 6 succeeding fiscal year ending prior to July 1, 1975, for 7 grants by the Secretary to public and nonprofit private agen- 8 cies and organizations to pay not to exceed 75 per centum of 9 the cost of construction of multipurpose senior centers, ex- 10 cept that the total of such grants in any State for any fiscal 11 year shall not exceed 10 per centum of the total amount 12 appropriated for that year for purposes of carrying out this 13 part. 14 "requirements for approval of applications - 15 "Sec. 722. (a) A grant under this part may be made 16 only if the application therefor is approved by the Secretary 17 upon his determination that — 18 " ( l ) the application contains or is supported by reasonable assurances that (A) for not less than ten years after completion of construction, the facility will be used for the purposes for which it is to be constructed, (B) sufficient funds will be available to meet the non- Federal share of the cost of constructing the facility, and (C) sufficient funds will be available, when con- 19 20 21 22 23 24 25 24 struction is completed, for effective use of the facility for the purpose for which it is being constructed; " (2) the plans and specifications are in accordance with regulations relating to minimum standards of con- struction and equipment; and "(3) the application contains or is supported by adequate assurance that any laborer or mechanic em- ployed by any contractors or subcontractors in the per- formance of work on the construction of the facility will be paid wages at rates not less than those prevailing on similar construction in the locality as determined by the Secretary of Labor in accordance with the Davis-Bacon Act, as amended (40 U.S.C. 276a-276a5) . The Secre- tary of Labor shall have, with respect to the labor standards specified in this paragraph, the authority and functions set forth in Reorganization Plan Numbered 14 of 1950 (15 F.R. 3176; 64 Stat. 1267), and sec- tion 2 of the Act of June 13, 1934, as amended (40 U.S.C. 276c) . " (b) In making grants under this part, the Secretary 21 shall— " ( 1 ) give preference to the construction of multi- purpose senior centers in areas covered by approved comprehensive city programs assisted under the provi- 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 26 25 sions of section 105 of the Demonstration Cities and Metropolitan Development Act of 1966; and "(2) consult with the Secretary of Housing and Urban Development with respect to the technical ade- quacy of any proposed construction. "payments "Sec. 723. Upon approval of any application for a grant 8 under this part, the Secretary shall reserve, from any appro- 9 priation available therefor, the amount of such grant; the 10 amount so reserved may be paid in advance or by way of 11 reimbursement, and in such installments consistent with con- 12 struction progress, as the Secretary may determine. The 13 Secretary's reservation of any amount under this section may 14 be amended by him, either upon approval of an amendment 15 of the application or upon revision of the estimated cost of 1 6 construction of the facility. IT "recapture of payments 18 "Sec. 724. If, within ten years after completion of any 19 construction for which funds have been paid under this 20 part— " (a) the owner of the facility ceases to be a public or nonprofit private agency or organization, or "(b) the facility shall cease to be used for the pur- poses for which it was constructed (unless the Secre- tary determines, in accordance with regulations, that 21 22 23 24 25 27 26 1 there is good cause for releasing the applicant or other 2 owner from the obligation to do so) , 3 the United States shall be entitled to recover from the appli- 4 cant or other owner of the facility an amount which bears to 5 the then value of the facility (or so much thereof as consti- 6 tuted an approved project or projects) the same ratio as the 7 amount of such Federal funds bore to the cost of the facility 8 financed with the aid of such funds. Such value shall be de- 9 termined by agreement of the parties or by action brought 10 in the United States district court for the district in which 11 such facility is situated. 12 "moktgage insurance for multipurpose senior 13 centers 14 "Sec. 725. (a) It is the purpose of this section to assist 15 and encourage the provision of urgently needed facilities for 16 programs for the elderly. 17 " (b) For the purpose of this part the terms 'mortgage', 18 'mortgagor', 'mortgagee', 'maturity date', and 'State' shall 19 have the meanings respectively set forth in section 207 of 20 the National Housing Act. 21 "(c) The Secretary of Health, Education, and Welfare 22 is authorized to insure any mortgage (including advances on 23 such mortgage during construction) in accordance with the 24 provisions of this section upon such terms and conditions as 25 he may prescribe and make commitments for insurance of 71-272 O - 72 - pt. 1 - 3 28 27 1 such mortgage prior to the date of its execution or disburse- 2 ment thereon. 3 "(d) In order to carry out the purpose of this section, 4 the Secretary is authorized to insure any mortgage which 5 covers a new multipurpose senior center, including equipment 6 to be used in its operation, subject to the following conditions : 7 " (1) The mortgage shall be executed by a mortgagor, 8 approved by the Secretary, who demonstrates ability suc- 9 cessfully to operate one or more programs for the elderly. The 10 Secretary may in his discretion require any such mortgagor 11 to be regulated or restricted as to minimum charges and 12 methods of financing, and, in addition thereto, if the mort- 13 gagor is a corporate entity, as to capital structure and rate of 14 return. As an aid to the regulation or restriction of any mort- 15 gagor with respect to any of the foregoing matters, the Sec- 16 retary may make such contracts with and acquire for not to 17 exceed $100 such stock or interest in such mortgagor as he 18 may deem necessary. Any stock or interest so purchased shall 19 be paid for out of the Multipurpose Senior Center Insurance 20 Fund, and shall be redeemed by the mortgagor at par upon 21 the termination of all obligations of the Secretary under the 22 insurance. 23 " (2) The mortgage shall involve a principal obligation 24 in an amount not to exceed $250,000 and not to exceed 90 25 per centum of the estimated replacement cost of the property 29 28 1 or project, including equipment to be used in the operation of 2 the multipurpose senior center, when the proposed improve- 3 ments are completed and the equipment is installed. 4 "(3) The mortgage shall— " (A) provide for complete amortization by periodic payments within such term as the Secretary shall pre- scribe, and "(B) bear interest (exclusive of premium changes for insurance and service charges, if any) at not to exceed such per centum per annum on the principal obligation outstanding at any time as the Secretary finds necessary to meet the mortgage market. " (4) The Secretary shall not insure any mortgage un- 14 der this section unless he has determined that the center to 15 be covered by the mortgage will be in compliance with mini- 16 mum standards to be prescribed by the Secretary. 17 " (6) In the plans for such Multipurpose Senior Center, 18 due consideration shall be given to excellence of architecture 19 and design, and to the inclusion of works of art (not rep- 20 resenting more than 1 per centum of the cost of the project) . 21 "(e) The Secretary shall fix and collect premium 22 charges for the insurance of mortgages under this section 23 which shall be payable annually in advance by the mort- 24 gagee, either in cash or in debentures of the Multipurpose 25 Senior Center Insurance Fund (established by subsection 30 29 1 (h) ) issued at par plus accrued interest. In the case of any 2 mortgage such charge shall he not less than an amount 3 equivalent to one-fourth of 1 per centum per annum nor 4 more than an amount equivalent to 1 per centum per 5 annum of the amount of the principal obligation of the 6 mortgage outstanding at any one time, without taking into 7 account delinquent payments or prepayments. In addition 8 to the premium charge herein provided for, the Secretary 9 is authorized to charge and collect such amounts as he may 10 deem reasonable for the appraisal of a property or project 11 during construction; but such charges for appraisal and in- 12 spection shall not aggregate more than 1 per centum of the 13 original principal face amount of the mortgage. 14 " (f ) The Secretary may consent to the release of a part 15 or parts of the mortgaged property or project from the 1 6 lien of any mortgage insured under this section upon such 1 7 terms and conditions as he may prescribe. 18 "(g) U) Tne Secretary shall have the same functions, 1 9 powers, and duties (insofar as applicable) with respect to 20 the insurance of mortgages under this section as the Secre- 21 tary of Housing and Urban Development has with respect 22 to the insurance of mortgages under title II of the National Housing Act. "(2) The provisions of subsections (e) , (g) , (h), (i), (j) , (k) , (1) , and (n) of section 207 of the National Hous- 23 24 25 31 30 1 ing Act shall apply to mortgages insured under this section ; 2 except that, for the purposes of their application with re- 3 spect to such mortgages, all references in such provisions to 4 the General Insurance Fund shall be deemed to refer to the 5 Multipurpose Senior Center Insurance Fund, and all refer- 6 ences in such provisions to 'Secretary' shall be deemed to 7 refer to the Secretary of Health, Education, and Welfare. "(h) (1) There is hereby created a Multipurpose Senior 9 Center Insurance Fund which shall be used by the Secre- 10 tary as a revolving fund for carrying out all the insurance H provisions of this section. All mortgages insured under this 1 2 section shall be insured under and be the obligation of the 1 3 Multipurpose Senior Center Insurance Fund. 14 « ^) The general expenses of the operations of the De- 1 5 partment of Health, Education, and Welfare relating to 1 6 mortgages insured under this section may be charged to the 17 Multipurpose Senior Center Insurance Fund. 1 8 " (3) Moneys in the Multipurpose Senior Center Insur- 1 9 ance Fund not needed for the current operations of the 20 Department of Health, Education, and Welfare with respect 21 to mortgages insured under this section shall be deposited 22 with the Treasurer of the United States to the credit of such 23 fund, or invested in bonds or other obligations of, or in bonds 24 or other obligations guaranteed as to principal and interest 25 by, the United States. The Secretary may, with the ap- 32 31 1 proval of the Secretary of the Treasury, purchase in the 2 open market debentures issued as obligations of the Multi- 3 purpose Senior Center Insurance Fund. Such purchases shall 4 be made at a price which will provide an investment yield 5 of not less than the yield obtainable from other investments 6 authorized by this section. Debentures so purchased shall be 7 canceled and not reissued. 8 "(4) Premium charges, adjusted premium charges, (J and appraisal and other fees received on account of the 10 insurance of any mortgage under this section, the receipts 11 derived from property covered by such mortgages and from 12 any claims, debts, contracts, property, and security assigned 13 to the Secretary in connection therewith, and all earnings 14 as the assets of the fund, shall be credited to the Multipur- 15 pose Senior Center Insurance Fund. The principal of, and 16 interest paid and to be paid on, debentures which are the 17 obligation of such fund, cash insurance payments and adjust- 18 ments, and expenses incurred in the handling, management, 19 renovation, and disposal of properties acquired, in eonnee- 20 tion with mortgages insured under this section, shall be 21 charged to such fund. 22 "(5) There are authorized to be appropriated to pro- 23 vide initial capital for the Multipurpose Senior Center Insur- 24 ance Fund, and to assure the soundness of such fund there- 2 '^ after, such sums as may be necessary. 33 32 "definitions "Sec. 726. For purposes of this part — " ( 1 ) The term 'multipurpose senior center' means a 4 community facility for the organization and provision of a 5 broad spectrum of services (including provision of health, 6 social, and educational services and provision of facilities for 7 recreational activities) for older persons. 8 "(2) The term 'construction' includes construction of 9 new buildings, acquisition of existing buildings, and expan- 1° sion, remodeling, alteration, and renovation of existing build- H ings, and initial equipment of such new, newly acquired, 12 expanded, remodeled, altered, or renovated buildings. 13 "(3) The term 'cost of construction' includes the cost 14 of architects' fees and acquisition of land in connection with 15 construction, but does not include the cost of offsite improve- 16 ments. 17 "Paet D — Transportation Services for Older Americans "program authorized "Sec. 73 1. The Secretary, after an appropriate investi- 21 gation and study, shall develop and carry out a program to improve the transportation services available to older per- sons. Such programs may include one or more of the 24 following : "(1) special transportation subsystems for older 18 19 20 22 23 34 33 persons or similar groups with similar mobility restrictions ; "(2) portal-to-portal service and demand actuated services ; "(3) tho payment of subsidies to transportation systems to enable them to provide transportation serv- ices to older persons on a reduced rate basis. " (4) payments directly to older persons to enable them to obtain reasonable and necessary transportation services; and "(5) any other program which the Secretary de- termines shows promise of facilitating the provision of transportation services to older persons. "APPROPRIATIONS authorized "Sec. 732. There are authorized to be appropriated for 16 the fiscal year 1973, and for each succeeding fiscal year end- 17 ing prior to July 1, 1975, such sums as may be necessary 18 to enable the Secretary to carry out the provisions of this 19 part. 20 "Part E— Continuing Education for Older Persons 21 "programs authorized 22 "Sec. 741. (a) The Secretary, after appropriate inves- 23 tigation and study, shall develop and carry out a program 24 for providing continuing education to older persons. Such 25 programs may include one or more of the following: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 35 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 84 "(I) programs to provide rehabilitation for older persons to enable them to lend more productive lives, "(2) programs designed to retrain persons who are shifting to new employment by reasons of age or other conditions, "(3) Programs to upgrade the skills of older per- sons to enable them to obtain more rewarding- em- ployment, and "(4) programs designed to broaden the educa- tional, cultural, or social awareness of such older persons so that they will be better able to lead more produc- tive and rewarding lives in retirement. "(b) The Secretary may carry out the program pro- vided for in this part through grants or contracts with public and private agencies, including other Federal agencies, State educational agencies, local educational agencies, the voca- tional educational agencies of the States, the vocational re- habilitation agencies of the States. "appeopeiations authoeized "Sec. 742. There are authorized to be appropriated for the fiscal year 1973, and for each succeeding fiscal year end- ing prior to July 1, 1975, such sums as may be necessary to enable the Secretary to carry out the provisions of this part." 36 Mr Brademas. The Select Subcommittee on Education will come to order for the purpose of hearings on the subject of how best to meet the needs of the older citizens of our country. *•„«.« While the generation gap between the young and their parents is the subject of mlch discussion in the United States, less attention has per- haps been paid to the gap between older Americans and the rest of our ^t stems to the chairman that the time has come to realize that far from being a burden, America's retired men and women are one at our country's greatest untapped resources beyond, of course the pri- Zry importance of our considering the quality of the lives they lead ^WhX toeTJSlative work in the subcommittee has been helpful in the makine it possible for many older Americans to play a more vigor- ous produftive P and satisfying "role in the life of our society *e hard feet remains that in the American society we have for the most part, treated our older population in accord with the adage "out of sight, ° U AlthOTgh'the Older Americans Act has demonstrated the validity of the value of a Retired Senior Volunteer program, the » P>™cipJ author being a member of this subcommittee, there has been fer too tew such programs across the country. . " . The Foster Grandparents program has given satisfaction to both retired men and women and young people who bene fit from ttierr attention and care, but there have been no extensions to that program on the part of the administration. In recent months we have seen an effort on the part of the present administration to dismember the Administration on Aging V™g™™ removing its budget and programs into the new Action Agency and to other parts of the services of HEW. '■ ■ . This subcommittee, earlier this year on March 10, conducted public hearings in order to make it clear to the Administration that such an effort would be contrary to the wishes and stated intent of Congress ^Continued Rhetoric and raises in social security benefits alone will not meet the needs of older citizens. Congress must commit itself and then act to insure adequate income for older persons job opportunities without discrimination because of age, proper health care mclud mg adequate nursing homes, decent housing at reasonable cost, the assur- ance that lifelong homes will not be lost because of excessive local tax rises after an owner no longer has any resources but a pension; recre- ational and social programs so that older citizens will not ^be cut oil from community life, low-cost transportation for the aging so they will not be imprisoned in their homes far from shopping and enter- tainment facilities; and proper utilization of a valuable and needed national resource, the older people of our country. Legislative programs to meet virtually all these ^*tenheen submitted to Congress year after year, yet little action has been taken. In this, the year of the White House Conference on Aging I assure you that the members of this subcommittee will agree that we do not wish to see this not very proud record be repeated. In order to encourage prompt action on the kinds of initiativesthat have here been suggested, and I am sure there are others, the subcom- 37 mittee today begins a series <>f what we trust will Ix* extensive hearings around the country to listen to a diverse group <>f men and women speak on their concerns for our older citizens. The Chair would like to observe that because of a markup session on the very important higher education bill in another subcommittee, it will be necessary for us to adjourn ourselves from here today at 3 o'clock. We shall ask that Mr. Nash, as well as Miss Griesel and her asso- ciates, if they would be kind enough to plan to come on Monday of next week at a time to be set. It is a very particular pleasure to be able to welcome as the first witness of our hearings today a very distinguished American who has been a leader in American higher education as president of colleges and universities, who is certainly a leader in the National Council of Churches, who served as Secretary of Health, Education, and Welfare, and in a number of other very important positions of responsibility. We on this committee know him well from his appearances before the committee on a number of occasions. We are honored to hear from Mr. Arthur Flemming, who is the Chairman of the White House Con- ference on Aging. Mr. Flemming, we are especially pleased you are able to be our first witness. STATEMENT OF ARTHUR FLEMMING, CHAIRMAN, WHITE HOUSE CONFERENCE ON AGING, AND FORMER SECRETARY OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY WEBSTER TODty JR. Mr. Flemming. Mr. Chairman and Congressman Hansen, I am indeed grateful to you for the opportunity of appearing before your subcommittee as you start a series of what I am sure will be extremely helpful hearings and hearings that will stimulate action in this area. I am submitting for the record of this hearing a detailed statement relative to the Second White House Conference on Aging. This state- ment was prepared by my associates on the staff of the White House Conference. It provides background information relative to the steps that have been taken in preparation for the Conference, and information as to the manner in which the Conference- will be organized and conducted. It is my purpose in this opening statement to discuss some of the matters included in the memorandum and to share with you some of the experiences I have had since becoming the full-time Chairman of the Conference. First of all, however, I desire to pay tribute to the work of Hon. John Martin, the Commissioner on Aging and the Director of the Con- ference. It was under his leadership that the concepts for the Con- ference which are set forth in the accompanying memorandum were developed. The development of these concepts and their implementation in 1970 and 1971 means that the discussions which will take place at the Con- ference will reflect a genuine understanding of the basic issues that confront our Nation in the field of the elderly. 38 We are deeply indebted to Commissioner Martin and his associates. I likewise desire to express my gratitude for the assistance I have re- ceived from Bertha Adkins, who served with me as Under Secretary of Health, Education, and Welfare when I served as Secretary of that Department and who is now serving as Vice Chairman of the Con- ference, and from Webster Todd, Jr., former Assistant to the Chair- man of the Civil Aeronautics Board, and who, since I became Chair- man, has served as Executive Director for the Conference. I am ffoin°- to make two comments relative to the Conference and will amplify each comment. The White House Conference is not an end in itself but instead is one step in a continuous process of bringing about a change in our society's attitudes toward and treatment of older Pe Toput it another way, the White House Conference is one step in a process designed to replace talk with action in the area of the elderly. President Nixon has provided an excellent illustration of this process in the emphasis which he has been placing and which Delias requested the White House Conference to place on the issue of substandard nursing; homes. . . . ... . T OK In an address to a group of elderly citizens in Chicago on June 25 the President made a number of significant statements: He paid tribute to "outstanding" nursing homes. He labeled some substandard homes as "little more than warehouses for the unwanted, as dumping ^He^set forth e a potior; namely, "I do not believe that medicaid and medicare funds should go to substandard nursing homes in this coun- try and subsidize them." r>™ ;,i<™f In a statement issued at Nashua, N.H. on August 6, the President outlined an eight-point plan for action designed to implement the policy he set forth in his Chicago address. He clearly identified the objectives to which his plan of action are directed when he said, "The interests of the elderly are far better served when a home is reformed and renewed than when a home is 3 ^ut let there be no mistaking the fact that when facilities fail to meet reasonable standards, we will not hesitate to cut off their medi- care and medicaid funds." ^i^wU^ The President has talked with me about his deep concerns regarding this issue and, as a result, I have no hesitancy in saying that between now and the time for the White House Conference the Nation will wit- ness vigorous and effective action in this area. m < The House of Representatives has likewise taken significant action in this area when, in H.R. 1, it included a provision authorizing the Secretary of Health, Education, and Welfare to set and enforce stand- ards for intermediate-care homes. . .,, Here again, some of these homes render excel ent service to the elderly. Here again, however, some can accurately be described as warehouses for the unwanted. I hope, therefore, that the Senate will take action in this area comparable to the action taken by the House. This means that when this issue comes before the White Mouse Conference it will be discussed in the light of the actions taken under the President's plan for action and in the light of action taken by the Congress. 39 Some of the delegates will agree with what Has been done; some will feel that the Government has gone too far; some will feel that it has not gone far enough. But the findings and recommendations of the Conference for further action will be based on actions already underway. Then, it will be our job in the post- Conference year of 1972 to do everything possible to bring about the implementation of the new recommendations for action. This is what we mean when we say that the White House Conference must be thought of as a part of a con- tinuous process of bringing about change in society's attitudes toward and treatment of older people. In the passage of H.R. 1, the House of Representatives has pro- vided another excellent illustration, this time in the income area, of the continuous process of which the White House Conference is a part. The following provisions in H.R. 1 — provisions which have had bipartisan support in the Congress and the support of the President — will have a major impact on the income of the elderly. First, provision for automatic adjustments — based on increases in the cost of living — of benefits, the contribution and benefit base, and the retirement test. Next, provision for increasing aged widow's and aged dependent widower's benefits to 100 percent of the benefit the insured worker was receiving when he died or, if the worker was not receiving benefits, to 100 percent of the benefit he would have been eligible for at age 65. Third, provision for increasing the annual exempt amount of earn- ings under the retirement test to $2,000 and for withholding $1 in benefits for each $2 of all earnings above the annual exempt amount ; namely, the proposed $2,000. Fourth, provision for federalizing the adult categories under public assistance, including aid to the aged, and providing an income floor which would reach, within 3 years, $150 for single persons and $200 for a couple. Then, finally, a 5 -percent increase in social security benefits, effec- tive June 1972. There isn't any doubt, I am sure, in the minds of any of us that income continues to be the No. 1 concern of the elderly. The delegates to the White House Conference will be considering this concern in the light of significant action hopefully taken or about to be taken. They will undoubtedly have additional recommendations to make, but the important thing again is, they will be considering their rec- ommendations within a framework of action rather than inaction. The conviction that I hold, that we must do everything possible to replace talk with action in the area of the elderly, led me to decide soon after accepting the President's invitation to become full-time Chairman of the Conference in each of the 10 Federal regions. At these conferences, I asked the chairman of each State White House Conference in the region and each State executive on aging to discuss with me the major recommendations of the State conferences. I likewise requested the field representatives of the major national organizations of olderly persons to share with me their major con- cerns. Participation in these 10 regional meetings has resulted in my reaching four general conclusions. The elderly recognize that our society has placed them in an inferior or secondary position. 40 Finally, the elderly recognize that there is a wide gap between what we as a society have said and would do in the area of aging and what we have actually done. Third, the elderly want to be deeply involved in life— they don't want to be put on the shelf . . . The elderly want to be treated with dignity. It is in the light ot these conclusions that we are continuing our preparations for a thor- ough consideration by the delegates to the White House Conference of the results of the deliberations of the State conferences and na- tional organizations. . i-i A u„ ftVflW These preparations will concentrate on the objectives of doing every- thing possible to help the delegates consider, and hopefully agree on "plans for action." For example, many of the States have underlined the role that voluntary organizations can play in meeting some ot the maior needs of the elderly. . . , Therefore, we have invited the approximately 400 national or- ganizations that have been participating in preparations tor the Con- ference to send representatives to a meeting in Washington on Oc- tober 22 to consider a specific plan of action on the part of voluntary organizations for assisting the elderly in a number of important areas. If this succeeds, it means that the delegates to the Conference, in- stead of indulging in generalizations relative to the need for partici- pation by voluntary organizations in dealing with situations confront- ing the elderly, will be considering a plan for action. The second comment I desire to underline relative to the White House Conference is that it will be an open conference. This is being stressed in the preparations for section and subsection meetings. The chairman of the section and subsection meetings will have before them a workbook which, in effect, will constitute an agenda for the meeting. At the same time, however, they will be instructed to permit the introduction of new ideas and new programs for con- sideration by the subsections and for consideration by the section. In addition, we are planning for an open forum *°r the Monday evening of the Conference week which will be chaired by the retired Chief Justice of the United States, Earl Warren. A steering commit- tee will be establishing the rules of the game for the forum. The chairman of that committee will be Charles Schottland, who at the present time is chairman of Brandeis University, who, when I served as Secretary of Health, Education, and Welfare, was Commis- sioner of Social Security. ' . ' c+^^Poli'^r In addition, he served as director of welfare m the State ot Califor- nia at the time that Chief Justice Warren served as Governor of that Then, finally, we are planning sessions on special concerns for the Wednesday morning of the Conference week. At this point, I would like to refer to page 16 of my background memorandum which 1 submitted to you, and on that page I discuss the special concerns sessions : In order to provide organizations that have requested an opportunity to de- velop and recommend policies related to a particular aspect of aging ore nrcums- stances of particular older population groups, the White House Conference on Smg plan has been expanded to provide for a series of special concern sessions^ A Thlse will be held simultaneously from 8 to 12 on W^^mo™^ Conference week. Delegates will attend the session of their choice. The number of special concern sessions will be limited to 20. 41 Those requested to date and that arc in process of being Implemented arc, "The Elderly Blind," "Older Consumers," "Homcmakcr and Health Aide Services," "Long-Term Care of the Elderly," "('are of the Mentally 111," "The Spanish- American Aged," "Elderly Indian Problems," "The Rural Aged," "The Elderly Poor," "The Older Black," "The Religious Community and the Elderly," "The Elderly Family," "Rehabilitation of the Elderly," "Youth and Age," "Legal Services for Older People," and "Older American Volunteers." Each special concern session is being planned by a committee made up of representatives of national voluntary organizations requesting the session. The committees are being assisted by representatives of appropriate Federal agencies. The policy proposals developed by the special concern sessions, like those of the sections, will be reported and distributed at the general Conference session on Thursday morning. Personally, I believe, Mr. Chairman, that it is significant that one of the major sections of the Conference will be devoted to the area of spiritual concern. We, as a Nation, know what needs to be done in the area of the elderly. The question is, Do we, as a Nation, have the will to act ? Personally, I believe that this question will be answered in the affirmative only as increasing numbers of citizens are willing to apply in their own lives the commandment; "Thou shalt love thy neighbor as thyself." It will happen only as we realize that we can not rely solely on our own strength, and then, realizing that, seek, discover, and draw up the spiritual resources that are available to us at all times. I appreciate, Mr. Chairman, the oportunity of making this open- ing statement. I will be very happy to endeavor to respond to any of the questions that you or your colleagues may address to me. Mr. Brademas. Thank you very much indeed, Mr. Flemming. That statement is a most useful way to begin these hearings. The Chair would like to ask unanimous consent that the text of the summary describing the second White House Conference on Aging, to which you referred, be included at this point. (The document referred to follows :) The Second White House Conference on Aging — A Summary Prepared by Staff of White House Conference on Aging, September 1971 On October 6, 1969, the President issued the proclamation which called for the second White House Conference on Aging (WHCOA). He directed that the Conference achieve a precise set of recommendations aimed at both the govern- ment and nongovernment sectors which, when implemented, would achieve a more adequate national policy for older Americans. The President also asked that careful advance planning for the Conference be made the responsibility of a broadly representative group of the nation's population and that the focus be on all those factors adversely affecting the lives of older people. A. BACKGROUND In accordance with the President's proclamation, the following plans and procedures have been evolved. The conference objectives To initiate the development of specific guides and recommendations for policies and actions in aging at community, State and national levels. To draw these guides and recommendations from cross sections of older people including the minority groups, providers of services, specialists on aging, youth, and decision makers, in order that they may represent a broad and effective consensus. To broaden the understanding of the needs of older people, in order to strengthen the base of public support for the new or modified policies that will be recommended by the White House Conference at all levels. 42 Definition of social policy In order to establish a common understanding of the task of achieving a na- tional policy on aging as requested by the President, the following definition was adopted : Social policy is a set of focused, strategically feasible principles and plans for social action aimed at improving the quality of life for the older population. Selection of the 14 subject matter areas Altogether, 14 areas were selected to provide the subiect matter organization of the Conference. Of these, 9 were identified as Needs and five as Needs Meeting Areas. These are : Transportation. Needs Meeting Areas : Facilities, Programs, Services. Government and Non-Government Organization. Planning. Research and Development. Training. Needs Areas: Education. Employment and Retirement. Health and Mental Health. Housing and Environment. Income. Nutrition. Retirement Roles and Activities. Spiritual Weil-Being. The Needs Areas were selected as the principal areas within which policy and action are required if older people are to enjoy healthful, active, and mean- ingful lives. The Needs Meeting Areas identify the principal means through which action can be brought about. Variables in circumstances among older people In order to emphasize the enormous variations in the nature and circumstances of the older population, the following variables were identified as the principal ones to be considered in each of the Needs and Needs Meeting Areas : Stage of Later Life (middle age, later maturity, old age) . Level of Wellness (or health) . Employment-Retirement Status. Urban-Rural Residence. Maximum Freedom of Choice. The three-year plan In order to avoid making the second White House Conference an event in place of one step in the process of bringing about change in society's attitudes toward and treatment of older people, the second WHCOA was conceived as a 3-year Pe The' 3-year timespan allowed for the correction of the major deficiencies of the first (1961) WHCOA. One of the most glaring of these was the failure to consult older people themselves and learn first hand what they considered their problems to be. Their involvement in the 1961 conference was limited to a sparse representation at the State and national level. At neither event did they have the opportunity to speak with a common voice. The 3-year period provided the time for the Conference process to be initiated by the older people. The other deficiency of the first WHCOA was the failure to plan for a sys- tematic and intensive f ollowup of the National Conference at the State and local levels In part, this failure reflected the fact that most States lacked a per- manent agency on aging. For the purpose of the White House Coherence they had appointed only temporary committees whose function ceased when the national meeting adjourned. The 3-year plan insures a pla nne d^w trough to the initiation of action based on the outcomes of the National Conference. The major tasks allotted to each of the 3 years are as follows : The first year (1970) was allocated to older people themselves. They were invited to speak out and tell America what their needs are and what steps they recommend to satisfy them. Nearly half a million of ^t ^m did speak out at the several thousands "Older American Forums held throughout the Nation. Their ideas thus became the first order of input into the identifi- cation of the priority needs of the elderly as seen by them. . The second year (1971) was a year of conferences when local community and State Conferences and Task Forces of National Organizations met and developed their policy recommendations which were sent forward for con- 43 sideration ut the WHOOA. The National Conference to be hold Late In the year will usher in the third year with a set of policy proposals, supported h.v the broad cross section of the population called for h.v the President , ready for implementation h.v the appropriate sectors of the society. The third year (1972) is therefore designated as the year of action. Be- cause the Conference will have taken place in a climate of action already initiated by the Forums, the Community and State Conferences, by Regional meetings, and by the Administrative Branch of Government, the policies developed by the WHCOA should find channels readily available for their implementation. The conference planners Government and nongovernment personnel are working together, but, because WHCOA is conceived as a citizen effort, the non-governmental groups have played a major role in its planning. Following is a list and brief description of the various planning groups in- volved at the national level; those involved at other levels, local, State, and regional, would number in the thousands. A White House Conference on Aging staff was established by D/HEW work- ing through the Social and Rehabilitation Service and its Administration on Aging for the purpose of drawing up the specific objectives of the Conference and the plans for achieving them. The staff includes the following components : Administration. National Organization Relations. Personnel Office. Technical Planning. Public Information. Conference Logistics. State and Regional Relations. A Conference Planning Board was named. It has responsibility for deci- sions on broad Conference policies. Its membership of nearly 100 represent the following groups: No. of persons WHCOA National Advisory Committee 28 D/HEW Older Americans Advisory Council 13 National organizations of older people ~_ io National association of State units on aging 10 Youth representatives 14 Consultants on minority problems 10 Technical committee chairmen 14 Total _ ^ An Executive Committee of 17 members of the Planning Board transacts the business of the Board between full meetings. Subject Area Technical Committees, averaging about 14 persons, were ap- pointed for each of the 14 Subject Matter areas. The membership of these com- mittees include consumers as well as technicians and professional specialists. Each Technical Committee has had or will have the following responsibilities : •Approval of a "Background and Issues Paper" in its area. • Development of the major issues in its area. •Approval of the "Community and State Work Books" which included the issues developed by the Committee. •Consolidation of the recommendations from the 52 State and Technical Conferences and from the 20 National Organization Task Forces. • Selection of the materials to be included in the "Delegate Work Book" which, along with the "Background and Issues Papers" will be the work- ing documents to be used at the National Conference. •Assistance with the preparation of the final report of the Conference. A Secretariat made up of appropriate representatives of various Federal Government agencies, was appointed for each Technical Committee. In addi- tion to supplying the committees with up-to-date information and data, the Secretariats carried the very heavy load of receiving, collating, synthesizing, and analyzing the recommendations and reports from the States and the National Organization Task Forces. These analyses were made available to the Technical Committees, along with an organized file of the original reports, for their use in selecting the major recommendations to be presented for consideration by the delegates at the National Conference. The Secretariats, also prepared the initial 71-272 O - 72 - pt. 1 - 4 44 draft of the delegate Work Book for their sections, following the directions of the Technical Committees. The Secretariat members are now assisting in identifying Government resource personnel and at the National Conference will assist the co- chairmen of the subject area section they serve. Authors of "Background and Issues" papers were selected for each subject matter area. This phase of the work was carried out under a grant to Brandeis University. The authors authorized the materials for their field according to the following standard format : The Need. Knowledge Available. The Present Situation. Issues for Discussion. Long-Range Goals. Training State and community leadership A number of persons have characterized the 1971 WHOOA as an extraordinary educational undertaking. Many thousands of persons have been trained in the difficult task of undertaking and formulating policies. The training has been provided by two units of the staff: (1) State and Re- gional Relations Staff and (2) The Technical Staff. The former visited all the States and Regions explaining the Conference plans and outlining the roles the committees and States were to play in the development of the 3-year plan. The WHCOA Technical Staff developed the following instructional materials for the guidance of State and community leaders : Technical Guide for Community and State WHCOA on Aging. Handbook for Community Conference. Leadership Training Guide in Policy Formulation. .«.«_-.«,.* Representatives of the Technical Staff met, on a regional basis, with the State Directors of Units on Aging for a full day during which specific training in policy formulation methods was provided, along with training in how to teach the same information to leaders of community and State Conferences. Although training sessions were not held for members of the National Organi- zation Task Forces, the "Leadership Training Guide in Policy Formulation was adapted for their use. It was distributed by the State and National Organization Relations Staff prior to the meeting of the Task Forces. State and territorial conferences 1 All States and Territories, with the exception of Wyoming and Guam held White House Conferences during the spring and early summer of 1971. Most States were able to use funds from their regular Federal appropriations to help finance the planning of their State conferences. The WHCOA provided staff time and materials to all States. . The State conferences followed, in general, the pattern recommended by the WHCOA. All of them considered the 9 Needs Areas, and 42 also included one or more of the Needs Meeting Areas in their programs. The States apparently felt less well equipped to deal with the broader problems embodied in the Needs Meeting Areas. From reports, it appears that they were also influenced by the fact thev had organized the Older Americans Forums around the Needs Areas and so followed the same plan for the local and State White House ^ferences Most States prepared for their State conferences by appointing Task Forces for the various subject areas. These task forces were provided with ^rte f rem the Older Americans Forums held in their States and with the "workbooks" pre- pared by the Technical Committees of the WHCOA. Using these basic materials, the task forces identified the issues to be considered at the State meetings. The State conferences varied in size from a few hundred to over three thousand persons. Although often limited in time, they were very well organized by the State Units on Aging working through many local planning «^>^** result that the output of all State Conferences was a set of cogent and often imaginative and innovative policy recommendations. These reeomm^faUons were reported to the WHCOA on forms developed for the purpose and became the materials out of which the Technical Committees have developed the policy recommendations which will be considered at the national meeting. National organization task forces The Older Americans Forums and the community and State WhiteHojwe Conferences resulted in the involvement and commitment of a very significant iThe 50 States plus Guam, Puerto Rico, D.C., American Samoa, Trust Territories, and the Virgin Islands. 45 number of the general public. To give the organized groups with interest In the social problems of older people the same opportunity, the WHCOA Instituted a plan to assemble national organiiation task forces in each of the '•> Nwds Areas. Almost 400 national organizations appointed representatives and l>oro the cost, of their participation in Task Force meetings. For logistic reasons, several task forces were appointed in each Needs Area. These met. separately, but their recommendations were consolidated by the chairmen of the several Task Forces, so that a single report was issued for each Needs Area. The task forces considered the same issues as the States, and like the States, were free to propose additional issues and recommendations not provided by the Technical Committees. Recommendations from the task forces were reported on the same type form as those from the States and they were consolidated with the State recommendations and are so reported in the delegate workbooks. In summary of the preparatory phase of the 1971 WHCOA, it may be pointed out that many of the delegates named to the Conference will be unusually well prepared for their task. Many will be representing the thousands of their fellow citizens with whom they have worked in the preparatory phases of the Confer- ence. They have a keen sense of responsibility for bringing that work to fruition and for returning to their communities with a new vision of action to be taken on behalf of the elderly. Another unique factor for the 1971 WHCOA is that it will provide financial assistance to the delegates. The consumers — the old people themselves — will, therefore, be w r ell represented in the delegate body. These are the persons to whom problems under discussion are a reality. B. THE 1971 WHITE HOUSE CONFERENCE ON AGING Date and place The national meeting will be held Sunday, November 28 through Thursday, December 2, 1971, in Washington, D.C. Headquarters for the Conference will be the Washington Hilton Hotel. Addi- tional meeting space will be used at the Statler Hilton, Shoreham, and Sheraton Park. Organization of the conference The format of the Conference provides for 3 types of meetings: general ses- sions, working sessions, and special events. General Sessions. — There are 2 of these. One will open the Conference on Sunday evening where the delegates will be instructed in their opportunities and responsibilities, and will view a multimedia presentation on the various aspects of aging. The second general meeting will be a final report session and will close the Conference. Work Sessions. — Work sessions include those organized around the Needs and Needs Meeting Areas and those devoted to Special Concerns. a. Needs and Needs Meeting Sections and Subsections. — There will be a Conference Section for each of the 14 subject areas listed earlier. Delegates have been assigned to these sections by their Governors, a national orga- nization, or other responsible source. Sections will vary in size from just over 100 to approximately 500. The Sections will each meet twice, once on Monday morning for an orientation period and again on Wednesday afternoon for final consideration of and voting on the policy proposals to be recommended by the Section. Sections will be organized into subsections of approximately 35 delegates each. The subsections will meet Monday and Tuesday for a total of from 10 to 13 hours during which time they will consider and formulate policy proposals in the subject area of their concern. The policy proposals from each of the subsections will be consolidated by a Section drafting committee. The draft will then be considered for approval by a Section Policy Coordinat- ing Committee on Wednesday morning and for action by the Section on Wednesday afternoon. The Section report will be presented and distributed at the General Session on Thursday morning. b. Special Concerns Sessions. — In order to provide organizations that have requested an opportunity to develop and recommend policies related to a particular aspect of aging or circumstances of particular older population groups, the WMCoA plan has been expanded to provide for a series of 46 Special Concerns Sessions. These will be held simultaneously from 8-12, Wednesday morning, December 1. Delegates will attend the session of their choice. The number of Special Concerns Sessions will be limited to 20. Those requested to date are : The Elderly Blind. Older Consumers. Homemaker and Health Aide Services. Long Term of the Elderly. Care of the Mentally 111. The Spanish American Aged. Elderly Indian Problems. The Rural Aged. The Elderly Poor. The Older Black. The Religious Community and the Elderly. The Elderly Family. Migrants in Old Age. Rehabilitation of the Elderly. Youth and Age. Legal Services for Older People. Older American Volunteers. Each Special Concerns Session is being planned by a committee of representatives of national voluntary organizations requesting the session. The committees are being assisted by representatives of appropriate Federal agencies. The policy proposals developed by the Special Concerns Sessions, like those of the Sections, will be reported and distributed at the general Conference sessions on Thursday morning. Special Events Sessions.— These sessions have been included in the Conference to broaden its scope and to provide for interchange of ideas among groups and personalities not otherwise an official part of the Conference plan. a. Ecumenical Religious Services are being planned for Sunday afternoon, November 28. . . . , b A Public Forum will be held on Monday evening at which representa- tives of many organizations may make brief presentations of their views related to the subject of the Conference. Former Chief Justice Earl Warren will preside. .„ , , ■ __ , c. Conference Luncheons for Section Participants will be held Monday, Tuesday, and Wednesday at which government leaders and members of Congress will be invited to present their views on controversial and timely topics in the field of aging. Not only will these meetings provide information, they will add reality to the art of policy formulation as a plan for feasible action. The conference participants There are four categories of participants : official delegates, observers, honored guests, and Conference staff. Altogether, it is anticipated that 4,000 persons will participate in the Conference. Only official delegates will be allowed to vote at the Conference. In addition, speakers, Congressmen, Governors, and other dignitaries will be designated as honored guests. The following Chart I shows the distribution of participants by category (or role). Chart I Delegates: State: 1 ^^ Quota, plus youth and State staff L > »'* Member of conference planning groups — - |£> National organizations Vr Delegates at large named by the President *w Total 3 ' 494 Observers : k Federal officials rr Foreign scientists and officials °V Directors and 1 student each, geronotology training eu Directors of foster grandparent program &° Total _j^ 47 Staff: Government resource personnel 125 Staff assistants . 50 Associate regional commissioners, aging services 10 Congressional committee staff representatives 25 WHCOA staff 50 Total 260 Grand total 4, 002 Delegates a. State Delegates — (1,974). — Each State was allocated a quota of not less than 14 and not more than 125 delegate places based on the proportion of persons over 65 in their population. In addition, they were asked to name 2 youth delegates, and 2 representatives of the State unit on aging. Persons who are serving in the various planning groups for the WHCOA are also considered to be delegates from their respective States. Funds have been specifically appropriated by Con- gress to provide travel and a per diem allowance for State delegates. b. National Organization Delegates — (700). — Approximately 400 national organizations that participated in the preparation for the WHCOA, were allocated a total of 700 delegate places. The major Organizations of Old People were allocated a larger proportion of places than were other groups. National orga- nizations are funding their delegates attendance at the Conference, except for a group of 56 old people to be funded by WHCOA. c. Delegates at Large — (400). — In order to insure an appropriate proportion of minority groups and of the elderly, 400 places have been reserved for Delegates at Large to be appointed by the President. The makeup of these groups will be determined after the other delegate appointments have been completed and can be analyzed. WHCOA funds will be used to support Delegates at Large who lack funds to attend the Conference. Observers — (248) a. Federal Officials (50). — These will be the Secretaries, Commissioners, Ad- ministrators and other officials of agencies with special responsibility for aging. b. Foreign Professionals, Officials, and Scientists (50) The major part of this group will be persons invited by SRS-AoA and the Gerontological Society to par- ticipate in an International Gerontology Research Symposium which includes attendance at the WHCOA as part of the Symposium program. Others being in- vited include representatives of governments that have requested opportunity to send observers and other persons internationally active in the field of aging. c. Gerontology Training Programs (80).— There are approximately 50 training programs in gerontology located at many universities and colleges. These have each been invited to send, at their own expense, a faculty and student representa- tive to the Conference as Observers. d. Directors of Foster Grandparent Program (68). — ACTION has offered to underwrite the travel and living expenses of these Directors of one of the most effective of older people's volunteer programs. Task of the delegates The delegates will have the responsibility for the formulation of a set of policy and action proposals in the various subject matter and special concerns areas. These will be reported and transmitted to the President, the Secretary, the Con- gress, and to the private and voluntary sectors along with a request for their translation into action. The 18 months of preparatory work at the local and State levels and by Na- tional Organizations have produced recommendations for consideration by the National Conference which are of major importance to every unit of Government. The delegates will be debating and adopting in their Sections policy proposals on such vital issues as the following : National Health Insurance. Extension of Medicare and Medicaid benefits at a reduction of cost to the consumer. Organization of a comprehensive health delivery system including mental health as an imperative component. The alternatives to nursing home care for the elderly. The development of better standards and their enforcement for nursfng homes. 48 The delegates will be concerned further with policies relating to income and housing and will consider such questions as : What constitutes an adequate retirement income? What role should social security have in providing an adequate income? What part do private pensions have in providing an adequate income, and what policies should be adopted to protect the consumer from loss of pension rights or of the purchasing power of pensions? Should the policy be changed to eliminate the retirement test under social securitv ? Is there necessity for earmarking Federal funds for housing the elderly? Should the policy of limiting occupancy in low cost housing be given to those in severe economic need, or should consideration also be given to social need? Should the policy which prohibits the inclusion of services and staff in funding of housing be continued? What policies can be adopted to provide some relief in property taxes ; and can the young afford to assume the additional cost of such relief? In the area of employment there are questions and issues related to continuing employment beyond the normal retirement age, to early retirement, and to the transition from an employed to a retirement status. These will be debated in such terms as : . . Should the Department of Labor allocate more job training and placement funds to older job seekers? Is it desirable or feasible to adopt employment policies which would limit the freedom of employers in the labor market and open up employment pos- sibilities to older workers? Should such liberalized employment policies be legally enforceable or can they be brought about through educational efforts among employers? Can the country afford either financially or socially to foster early retire- ment from the labor market? These represent only a few of the basic policy guidelines which will concern the delegates. The urgency of the problems of transportation to take advantage of opportunity ; the need for adequate amounts of proper food to maintain health ; the search for meaningful retirement roles ; the need for adequate numbers of trained personnel to serve the needs of older people ; the question of the exten- sion of life through research at the expense of research to improve the quality of life • all these factors will trigger discussion and direct final decisions on recom- mended policy. Concern will also extend to the nature of organization of govern- ment and the private and voluntary sectors at all levels which will insure that the older population has priority and resource allocations commensurate with other age groups within the population. v. - m v.' Consideration will be given in all Sections to the particular needs of minority and other at risk elderly populations. And in the Special Concerns Sessions, these groups will be the major focus of discussion and recommended action. Preparation of delegates for work at the conference sections The majority of the delegates to the National Conference will already have had experience in a community and State White House Conference on Aging, or on a national organization Task Force. They will have read the background materials provided for use in these earlier conferences and will have participated formulating policy recommendations. To increase even further the level of their preparation for the work of the Conference, the following preconference prepara- tion is planned : <«W«i« Two basic documents— "The Background and Issues" paper and a Dele- gate Workbook" in the appropriate subject area— will be sent to each delegate a month in advance of the Conference. The "Delegate Work Book in a subject area reviews the need, the long range goals, and identifies some of the principal questions to be discussed along with the consolidated recom- mendations from States, Territories, and National Organizations- This book will be the principal working tool of the delegate throughout the National Conference. The "Background and Issues" paper will be of value to those delegates who wish to prepare in depth for the discussions or who may wish to formulate policies for presentation to their Sections at the Conference. Included with the two basic books, mentioned above, will be the follow- ing Fact Books prepared by several Government agencies : 49 Resources of People (>f> or Over — SSA. Health of the Aging— PHS. Housing the Elderly HUD. 1970 Census Data — AoA. 1970 Developments In Aging- Senate Committee. Economics of Aging- -Senate Committee. Toward a Brighter Future for the Elderly — President's Task Force. These, like the "Background and Issues" paper are important reference materials and will he as useful in the postconference phase of the WHCOA as in preparing for the Conference itself. The various government agencies are funding the publications they are providing, except that it may be neces- sary to purchase from GPO an additional 1500 copies of the U.S. Senate Special Committee on Aging "1970 Developments in Aging." The Committee has been able to provide only 1900 copies. State Pre-White House Conference Delegate Meeting — In late September, Mr. Flemniing will brief the directors of the State units on aging on the National Conference plans and on what will be expected of the delegates. The directors, in turn, will convene their State delegations in late October or early November for a day of orientation about the Conference plans and explain their roles at the Conference. At this time they will also discuss initial plans for postconference State and local community activity. Youth Delegates will attend the State orientation meetings. They will also attend one preparatory Regional meeting where they will focus especially on the plans and programs for the Special Concerns Sessions on Youth and Age- In October, delegates representing the National Organizations will meet in Washington to plan for the ongoing cooperation and coordination of the voluntary sector and government, focusing on the provision of alternatives to institutionalization of the elderly. Since this topic will be one of the major concerns of the National Conference, the preparatory meeting and the con- cept of continuing partnership of the voluntary and government agencies will tend to enhance the recommendations related to resolutions of this problem. Preparation of section and subsection staff Each Section will have cochairmen. One, named by the Executive Board, will be the presiding officer for the Section meetings. The other one, who is the chairman of the Technical Committee in the subject area, will work with the delegates in developing procedures and goals to be achieved during the work sessions. Each section will also have a recorder, consultants, and resource per- sonnel drawn from government agencies. Each Subsection will have a similar staff pattern except that there will be an elected vice chairman in place of a cochairman. In order to prepare Conference staff at all levels, a "Guide for Section and Subsection Leaders" is in preparation and will be distributed at precon- ference training sessions. Pre-Conference training of Section cochairmen, recorders, and resource personnel will take place during early October when they will be convened in Washington for this purpose. The "Guide," including the rules of conduct for the Section and Subsection meetings adopted by the Planning Board, w T ill be distributed and used in this training program. Pre-Conference training of subsection personnel will include (a) early distribution of the Guide, and (b) a day of training on the day before the National Conference convenes. Section and subsection working agenda 9 :00-10 :00 10 :30-12 :00 12 :30- 1 :45 2 :00- 5 :00 Monday, November 29 Section Plenary Session I. Organization and Task Setting. Subsection Meeting — 1. Introduction. Planning Subsection Work Schedule. Conference Luncheon. Selected Speaker. Subsection Meeting — 2. Policy Formulation. 50 9 :00-12 :00 12 :30- 1 :45 2 :00- 5 :00 5 :00- 7 :00 7 :00-10 :00 7 :00- 9 :00 8 :00-10 :00 10 :00-12 :00 12 :30- 1 :45 2 :00- 5 :00 7 :00- 8 :00 8 :00-10 :00 Tuesday, November 30 Subsection Meeting — 3. Policy Formulation. Conference Luncheon. Selected Speaker. Subsection Meeting — 4. Policy Formulation. Subsection Drafting Committee. Prepares report and submits to the Section Drafting Committee. Section Drafting Committee. Consolidation of Subsection Recommendations. Subsection Meeting — 5 (if neded) Complete unfinished business. Wednesdy, December 1 Section Policy Coordinating Committee. Prepares Report for the Consideration by the Section. Duplication of Section Report. Conference Luncheon. Section Plenary Session II. Consideration and adoption of Section Report. Continuation of Section Plenary Session II (if needed). Prepare text of report for reproduction for distribution at the General Session, Thursday morning. Special concerns session agenda Program and procedures will vary among the several sessions. The goal of each, however, is a common one so that the general agenda for all sessions will be as follows: " Wednesday, December 1 8 :00-10 :30 10 :30-ll :30 11 :30-12 :15 Presentation of Prepared Statements. Development and adoption of Recommendations. Preparation of Report for Duplication and Distribution at the Final Session of the Conference, Thursday morning. Mr. Brademas. Let me preface my first question by saying I ap- plaud the statements you have made indicating that after 2 years of discussion and listening and dialog about problems of the .agmg, that it is your determination that those who are associated with the White House Conference on Aging assure that 1972 be a year ot action. In this connection, I would ask if you could tell us something of the status of the recommendations of the White House Conference on Food, Nutrition, and Health of October 1969, with respect to problems of the aging. Mr. Flemming. Mr. Chairman, personally, I am not aware ot the status of action taken or not taken on those recommendations. One of the things that I am requesting, however, is the development ot a position paper on just that point so that that paper will be avail- able for the delegates to the White House Conference so that they will know what has happened or hasn't happened. . As you know, one of our major sections deals with the area ot nutri- tion, and I think this is a tremendously important area as far as the elderly are concerned. As soon as that paper is available, I will be very happy to submit it to this committee. Mr. Brademas. I appreciate that indeed. I might observe, just quoting from the language of the White House Conference on Food, Nutrition, and Health, "The U.S. Government, having acknowledged the right of every resident to adequate health and nutrition, must now 51 accept its obligation to provide opportunity for adequate nutrition for every aged resident. "Immediate attention must be given to developing a new system of food delivery based on modern technical capability, by which meals supplying a substantial proportion of nutrient requirements can be distributed to the aged through restaurants, institutions, and private homes where this is necessary," and so on. I call that to your attention because we are sensitive on this com- mittee, as practicing politicians and as elected Congressmen, about these gaps between rhetoric and action to which both of us have made reference in our opening statements, and I would simply state here, without making a speech on it, that although this subcommittee has made a continued consideration of Mr. Pepper's bill to establish a nutritional program for the elderly, that the administration's wit- nesses came up to testify against it. I would hope that, after having availed themselves of some of the spiritual ministrations which you so eloquently made reference to, the delegates will come out very strongly for some sort of action to make good on the rhetoric represented in that 1969 Conference. Mr. Flemming. Mr. Chairman, I would like to say this. In the 10 regional meetings that I have just finished holding, the question of nutrition was brought up quite a number of times. My attention was called to one of those specific situations. For example, if I have been given the correct information, I under- stand that under existing law, food stamps are available to the elderly in connection with needs that they may have in their homes. I also understand that when the elderly are brought together in what sometimes is referred to as a senior center, it isn't possible to make the same use of food stamps. I don't know whether that is a matter of basic law or regulation. I haven't had the opportunity of finding that out. Personally, it doesn't make sense to me to draw that distinction in the use of food stamps. Mr. Brademas. I appreciate that response, Mr. Flemming, and I might also observe, having alluded to the October 1969 Conference, that there was, as you better than anyone in this room will realize, an April 1970 report of the President's Task Force on Aging. In recommendation No. 23 it urged that the President direct the Adminis- tration on Aging and the Department of Agriculture to develop a pro- gram that would result in nutritional programs for the elderly. The reason I draw attention to this particular issue, aside from the fact that our subcommittee has been considering it and knows a little something about it, is that it represents a danger to which I would re- spectfully call your attention. I hope you are not just going to have one more conference with a lot more fine reports and a lot more fine recommendations but no more action. It is not persuasive, certainly for this member of the subcom- mittee, to have good rhetoric with respect to the elderly coming out of one door downtown, but the witnesses for the administration walking in the other door to announce the opposition of the administration to the action, which I think both of us have agreed is so essential in this respect. So I plead with you, in this program that has been under more than one administration, with commission, task forces, and committees, not to give us just one more report without action. 52 Mr. Flemming. Mr. Chairman, one of the reasons why I am as happy to respond to the President's invitation to come into this Commission was because I hoped that it might be possible to draw on experiences in our Government and to work with both the legislative and executive branch as well as persons from outside of Government in such a man- ner as to make sure of the fact that this conference would lead to action. . . . I have called on quite a number of Commissions. I have participated in quite a number of conferences. I was a member of both of the Hoover Commissions. The chairman of that Commission, early, wise in his understanding of the way our society operates, insisted that when we completed the work of the Commission that there should be a citizens' commission for the Hoover report, and I participated with him in the development of the work of those committees. As a result, we did get some action. Not all of the recommendations gathered dust on shelves. I believe that our system lends itself to a conference such as this, motivating both government and people out- side of government to act in terms of very specific action programs. This is why I am bringing the representatives of the voluntary or- ganizations together and asking them in advance of the Conference to focus on a possible action program in terms of being of assistance to the elderly in the community in the hope that it will be that action program that the Conference will be talking about and making recom- mendations on. , I am, frankly, sick of the generalizations about failing to tap the resources of the voluntary sector. All they have been are just basically generalizations. I believe that we can replace the generalization with specific action programs to which I believe people will respond to the opportunity. , Mr Brademas. I am very encouraged by your response to that ob- servation, Mr. Flemming, and may I say that your presence in the position of responsibility vou have is one of the brighter spots I have seen in this whole picture, because I know of the integrity of your own personal commitment. m I may say, and I have just one other question before yielding to a colleague, that with respect to the encouragement of voluntary service by older citizens, it was this committee not anybody downtown, in all candor, which exercised the initiative. ^ OTTn To reiterate, Mr. Reid, who initiated the idea of the RS VP program, and I found that it was like pulling teeth to get the Administration to give us any money for the program. We were simply trying to do what the President said in 1968 he wanted to do; harness the resources ot volunteers. . _ . . , , . We are just trying to be helpful on 'both sides of the aisle in helping the President make good on his own campaign speeches. Mr. Flemming. Am I correct in my reflection, however, that the budget was reopened and additional funds were requested and made available? . ■■; , Mr Brademas. Yes, I think the attention of this committee has, in some cases, proved to be effective on the Office of Management and Budget. . , Mr. Flemming. Could I also pav tribute to my successor, Secretary Richardson because I think he took some initiative, and as a former 53 Cabinet offioer I know it is a Little bit difficult to get a budget reopened within the executive branch once it lias been submitted. Mr. Bkadkmas. Just one other question, Mr. Flemming. I hope it is a significant one. You know, Congress, if you look at the legislative record, shows very clearly its strong conviction that there should be an Administration on Aging in the Government to serve as the champion an advocate of some visibility for the interests of older Americans. We have been concerned on this subcommittee, on both sides of the aisle, that an effort has been made to whittle away at that. Do you re- gard the Administration on Aging as paying tribute to Mr. Richard- son? I think we on the subcommittee regard ourselves as his champion to those who would seek to undo the administration. Do you regard the AOA as an effective advocate for the interests of the aging, and if you do not, what kind of structure do you think could serve that important role and not allow the interests of the aging to get buried someplace in a huge Federal bureaucracy ? Mr. Flemming. Mr. Chairman, soon after I came back into the serv- ice, Secretary Richardson recognizing the importance of this particu- lar issue, asked me if I would establish a task force to take a look at the issue that you have very clearly identified and to make recommenda- tions to me and to him for transmittal to the President. I have established that task force. The chairman of it is Garson Meyer, who served as chairman of the task force to which you have already referred. The other members are former Governor Blue of Iowa, Hobart Jackson of Philadelphia, John Perkins, a former Under Secretary of HEW and Bertha Adkins, who I indicated is associated with me. I asked this group to take testimony from organizations of elderly persons, to take testimony from the relevant departments in agencies of the Government and from other interested citizens. I then asked them to file a tentative report dealing with these issues prior to the White House Conference. Then I requested that they consider the findings and recommenda- tions of the Conference and submit a final report to me for transmis- sion to Secretary Richardson and to the President within 30 days of the adjournment of the Conference. In view of the fact that I have set up a task force, I have given him this kind of a chart, I would prefer to wait until I have the benefit of their report until I state my own convictions on this issue. It is an issue in which I am very much interested and I may say again, in the 10 regional meetings it was an issue that came up in every meeting. People generally are concerned about this matter. I hope that we will get, and I feel sure we will, a constructive and helpful report from this task force. We may agree or disagree with it in parts of it but I think it will be very helpful. Then I can assure that within 30 days of the adjournment of the Con- ference, I will have transmitted it together with my own conclusions and then I will be more than happy to meet with the committee on this issue. Mr. Brademas. I appreciate that response and I have no wish to make life difficult for you. I do hope, Mr. Flemming, that, although you have accepted this invitation from the President and you are giving service to the Nation thereby, we shall have, to the extent pos- 54 sible in these circumstances, the benefit of your own very perceptive views and great experience in these matters. Mr. Flemming. I will be more than happy to respond at any time and try to draw on the experiences I have had. Mr. Brademas. Thank you. Mr. Hansen. Mr. Hansen. Thank you, Mr. Chairman. Let me also extend a warm welcome to you from the committee, Mr. Flemming. I must say that I share somewhat the frustrations referred to by the chairman over some of the gaps that have developed between the needs of the elderly and our capability and willingness to respond to them. I would say that it is something that is not exclusively the result 01 executive inaction. I think there has been inaction at this end of the avenue also-; we do have the responsibility for the final allocation of resources through the appropriations process. . Perhaps the blame for some deficiencies can be widely shared. In any event, I am more optimistic now than I have been for some time. I would say that much of that optimism stems from the knowledge of the enthusiasm and experience that you will be bringing to this new assignment. , . I was much encouraged by a recent conversation wherein you out- lined some of the initiatives that are under consideration that appear to me to be responsive to the obvious needs of the elderly. This is very helpful, a very helpful sign. You made reference, in the course of our conversations, and also several times in your testimony here, to the need to translate rhetoric into action. I would ask you if you could be more specific in terms of the plans for the White House Conference and describe the way the Conference is being structured and the plans for steps to be taken fol- lowing the Conference that will help to identify the responsibilities both for the executive and the legislative branches and to help trans- late the recommendations into action. _ , Mr. Flemming. Mr. Hansen, I shall be very glad to respond to that question and to share with you some of my own personal views on this very important aspect of the process that we have been talking about. Congress, in authorizing the Second White House Conference on A "in", did make provision for what, in effect, is a post- Conference year of 1972. The Congress specified that within 120 days of the con- clusion of the Conference a report should be filed with the President and with the Congress. ■ • It also specified that within 90 days after the filing of that report that the President should submit his findings based on the report to the Conference. m _ , . , , . , T Within that frame of reference I have a number of ideas wnicn I think may help in the followup process and may help to get action. I would hope that the Federal Government would be able to exercise leadership, provide some incentives which would enable each State to have a followup White House Conference. As you know, each State has had a pre-White House Conference session and the recommendations that have come out of those State conferences are going to play a major role in the discussions ot the Conference. . . . , , , I would like to see each State in a position where it would have a followup conference, where it would consider the findings and recom- 55 mendations of the national Conference, where it would indicate sup- port for the type of Federal action that might be recommended By the national Conference, but where it would also focus on the recom- mendations for State and local action and for action on the part of voluntary groups. 1 would also hope that those State conferences would be followed by community conferences just as 6,000 community conferences had played a major role in the preparation for the White House Conference. Personally, as I look at this task of submitting a report, my hope is we can divide the report up into sections and that 30 days after the conclusion of the Conference we can submit findings and recommenda- tions on one of the areas. My hope would be that the executive branch would be in a position to respond rather quickly to those findings and recommendations and that the appropriate committee for the Congress would be willing to take them under consideration. That may be 15 or 30 days later that we issue our report in another area of the Conference. In that way, it seems to me, we can get continuous consideration of plans for action and hopefully continuous acceptance of some of these plans for action. Mr. Brademas. I wonder if the gentleman from Idaho would mind yielding to the gentleman from New York, Mr. Scheuer, who has to go to a 3 o'clock meeting? Mr. Hansen. Yes. Mr. Scheuer. Mr. Flemming, we appreciate your testimony. I do want to refer to the subject to rhetoric without meat in the skillet that you and Congressman Brademas referred to. It occurs to me that we have radically reduced appropriations for the aging by about 40 percent and that in my district in the Bronx, that is the St. Petersburg of the north, we have had to cut out the Meals on Wheels because of the decimation of appropriations. To me, it is an act of almost wanton cruelty and intellectual dis- simulation of a most crude type to have White House Conferences on Aging with sincere, knowledgeable people like you giving your leader- ship while, at the same time, the executive branch is slashing and gutting appropriations for programs on the simplest, most trans- parently necessary level for the benefit of the aging. I know this is none of your doing, and I am not, in any sense, trying to lay the blame for this intellectual dishonesty on your shoulders, but I very much hope you will find, or acquire from this Conference, resources to match the rhetoric. I would like to ask you one question that was provoked by your very interesting testimony yesterday before the Government Opera- tions Committee. You mentioned in that committee that compulsory retirement contributes to an enforced lack of involvement, that, you said, frequently leads to alienation and senilh^. You advocated that we have some kind of program for senior citizens in training for second careers and, I would presume, employ- ment for second careers. You strike a very hearty bell of approval in me because I was the author of the new careers program in the House of Representatives for employment of neighborhood people in public services. 56 While that program has served mostly young people, I have spon- sored several pieces of legislation that are being considered now that would provide training and employment of senior citizens, on a lull- time or part-time basis, for employment in public service where their life experience, wisdom, and sensitivity and their compassion really can be brought to bear, not only to help their fellow senior citizens but to help young kids in preschool years who may not have grandfathers. For many of the men and women who have had lifetimes of successful work in 'professions and vocations, it seems to me they have a great deal to offer in terms of manpower training programs and the like. Is this the kind of specific formula you had in mind, and it it isn t, can you tell us exactlv the kind of manpower training and employ- ment programs that you would advocate for the elderly to give them the sense of dignity and a sense of being wanted, a sense of oppor- tunity to participate in the mainstream of life that you quite correctly and eloquently state is necessary ? . Mr Flemming. Congressman Scheuer, in my testimony yesterday, I did identify this as one of the major issues that have been presented to me in the 10 regional meetings to which I have already referred. There isn't any question in my mind at all but that this is going to be the subject for active discussion and for very specific findings and recommendations on the part of the national White House Conference. All I will say at this point is that as an individual, I will be more than happy to get back findings and recommendations in that particu- lar area because I regard it as one of the major problems confronting us if we are going to do more than pay lipservice to the idea of com- miting the elderly to continue to be involved instead of being put on the shelf. So, this is one of the areas where I will work and do everything I can to get action. Mr. Scheuer. Thank vou verv much, Mr. Flemmmg. Mr Flemming. Mr. Chairman, could I just make one observation which goes on really to Mr. Scheuer's observation and some of your observations, and some of the observations of Congressman Hansen * Regardless of the past, regardless of inaction, whether there should have been action on the part of the private sectors, on the part ol the Congress, on the part of the executive branch, after going through the experiences of these 10 regional meetings, I am convinced there is in this country today a mood for action, and as I worked within the executive branch, as I had the opportunity of talking with the Mem- bers of Congress, as I have the opportunity of participating in sessions such as this, I am convinced there is this need on the Hill. When I talk about action, you know I try to think m terms ol today's elderly, the people who are out there in society right now, right at the present time, confronting a lot of these issues that we have identified. __ T1 . „ Somehow or other I have the feeling that through the White House Conference and in other ways, if we can just focus on what we can do within Government and outside of Government to help those elderly, that we have got a chance of getting action over a period ol the next few months, the kind of action that will mean something to todav's elderly. , , I don't want to underline it to the extent that you may think 1 feel it is the only issue, but I am encouraged— forget the past--by what 57 is happening in the nursing home area. I made my statement here as to what I (h'mk we can look forward to in that particular area. Now, this is action even bo tore the Conference, and because we get some action before the Conference, I think we will get better findings and recommendations out of the Conference. Then I think we will have more momentum to get further action after the Conference. I hope there will be some activity of this kind in other areas even before the Conference. Mr. Brademas. Thank you very much, Mr. Flemming. The Chair would like to yield the Chair to the distinguished ranking minority member of the subcommittee, the gentleman from New York, Mr. Reid, and express the appreciation of himself and Mr. Scheuer and our apologies for having to go off to another subcommittee on higher education. Mr. Reid. Thank you, Mr. Chairman, and I am terribly sorry, Mr. Flemming, that I was delayed and could not hear your opening remarks, but I certainly liked your emphasis on talk that results in action. I would like to yield now, if I may, to my distinguished colleague, Mr. Hansen. Mr. Hansen. Thank you, Mr. Chairman. Dr. Flemming, in my own congressional district, each year it has been my practice to conduct a series of what I call senior citizens seminars, wherein I have invited all of the senior citizens in the area, with some resource people and others who can help to answer questions. These have been extremely useful forums as far as identifying the real needs, the needs that are there today to which you made reference in your remarks just a moment ago. To provide some basis for a comparison of my district and the rest of the country, I would be very much interested in having your assessment of the highest priority needs, the most urgent needs that you determined were there as a result of these regional meetings to which you made reference, and which I gather must have been very productive. At those meetings, what struck you as being the most urgent needs for which there should be Federal leadership ; that is, both the Execu- tive and Congress? What should we be responding to in order to reach those people and do something that will help them now? Mr. Flemming. Mr. Hansen, I am very happy to respond to that question. I will do it quite informally on the basis of the impressions that I have brought back from these 10 regional meetings. As I have indicated in my earlier testimony, those who made presen- tations to me didn't leave any doubt in my mind at all but that they regard income as the No. 1 issue. I was interested, however, to note that those who made presentations on this point were encouraged by the action that is reflected in H.R. 1 in connection with some of the hearings at that time, the Ways and Means Committee report which was made to the House and was pending House action, but in other conferences, the House had already acted. For reasons I indicated in my testimony, they feel that many of the provisions of H.R. 1 constitute a giant step in advance in terms of providing more adequate income. I am sure that they feel the Gov- ernment should go further than that proposed in H.R. 1. At the same time, I am sure they recognize progress and are very appreciative of the fact that those provisions of H.R. 1 have vigorous 58 bipartisan support within the Congress and vigorous support from the President of the United States. This gives some real encourage- ment in this area. . , The second area that came in for consideration at all ot tne regional meetings was that related to health. A good deal of emphasis was placed on medicare. We are glad we have medicare, but at the same time, they recognize some imperfections in medicare as it stands at the present moment. . l For example, they were very unhappy over situations where people would receive treatment in a nursing home, where the nursing home and the individual were feeling that the person was covered by medi- care, then, about a year later, an audit by Government auditors would establish the fact that the person was not entitled to medicare and so the nursing home would be asked for reimbursement. In some instances, I understand, those requests for reimbursement may run as high as $20,000 and $25,000. There are some provisions, as I understand it, in H.K. 1 that will help on that. Also, they talked a great deal about the desirability of adding pre- scription drugs to the medicare package. Likewise, they talked about the desirability of dental care, care of eyes. Also, I listened to some discussion on mental health ; whether or not this was adequately cov- ered under medicare. Then I was also interested in the fact that, although the elderly recognized that they have a program in medicare and another pro- gram in medicaid, there seems to be a universal interest in national health insurance. , I did not detect any argument at all as to the question ot need. Whatever discussion took place, took place over the question of what is the best method to follow in order to meet this need. I did listen to a fair number of representations to the effect that they didn't feel the elderly were getting quite the consideration or atten- tion they should in connection with the discussion of national health insurance. __ _ -, That clearly was a No. 2 concern. As far as No. 3 was concerned, sometimes it seemed to me it was transportation and sometimes it seemed to me it was housing. They run very close together. The need for transportation is underlined time and time again. We talk about the elderly being isolated. I think it was the chairman ot the committee who talked about the elderly being out of sight out of mind. There isn't any doubt in my mind at all but that the elderly feel this isolation, feel this ostracism to a very considerable extent and they know that somehow or other they have got to be pro- vided with transportation if they are going to get back into the stream of life, if they are going to have the opportunity of attending church, if they are going to have the opportunity of shopping, if they are going to have the opportunity of participating in cultural events. Here is an area where you don't listen to too many specific pro- posals. The need is clear. It is just how to meet the need In every con- ference, schoolbuses were mentioned. They were identified as a resource that is idle during the hours of the day when the elderly could use the resource in a very effective manner. # The people making that suggestion recognize that you have got the issue of liability. It is a difficult one and it has got to be resolved m 59 some way or another. Then there were those who tossed out this idea and when we tried to explore it they said, when grants are made for lervices to the elderly, why doesn't the Government, before it makes the grant, make sure of the fact that the transportation resources are ibvailable so that the elderly can go where the services are or so that the services can be delivered to the elderly. 1 think maybe there is something there we could work on and do something about. In the held of housing, of course, there was the constant emphasis an the need for additional housing facilities for the elderly. There was emphasis on those facilities being operated in such a manner that Ertain services could be made available to the elderly. 1 f 1 may. Congressman Hansen, I would like to go back a moment to the health area and identify one point that was made quite often. Namely that when the House of Representatives passed H.E. 1, it included in it a provision which prohibits the Social Security Admin- istration from including as part of its criteria for a satisfactory nurs- ing home the availability of social service, I hope the Senate will strike that particular provision, and if they io, I hope the House conferees will go along with the Senate. It seems to me this is a step in the wrong direction. I have identified the issue [>f isolation and ostracism. Those rendering social service in these nursing homes are the per- sons who can build bridges between the residents of the home and the immunity and we desperately need people who will work on the building of those bridges. I go back to it because it is an item that same up time and again. Mr. Hansen. What about nutrition ? Is that a part of the health or would you treat that as a separate need ? Mr. Flemming. In the setting up of our sections we are treating it is separate. In response to Congressman Scheuer I indicated that this was a major concern on the part of the elderly. There is no question ibout it at all. Another issue that he identified that was of major concern was em- ployment. People are unhappy over the fact that currently not suffi- cient resources have been set aside to bring about a vigorous enforce- nent of the 1967 act against discrimination on the basis of age. There is a feeling that we have experimented with a number of pro- grams, green thumb and so on, through the Administration on Aging, hrough the Department of Labor, that they proved to be successful tnd we ought to do more toward implementing them on a wider basis han we have up to the present time. There isn't any doubt at all that those who talk to me, of course, ire opposed to compulsory retirement age requirements. I happen to hare that feeling. At the same time, I have the strong feeling that he trend is against us on that one, that more and more employers ire making provisions for compulsory retirement at a particular age md that, unfortunately, they are moving that age down from 70 to )5 and even down to 62. If society is going to move in that direction and if society, at the lame time, is going to say that it is going to try to make it possible ! or the elderly to be involved in life then it has got to place far more emphasis than it has on this concept of second careers. 71-272— 72— pt. 1 5 60 From society as a whole, both government and nongovernment sources, there has got to be more counseling, training, and placing. This is an area where the religious community, to some degree, has been providing leadership. We know that at large local churches and church boards there has been a trend in recent years in using laymen in these positions and oftentimes there are laymen who have retired from another career and there are even training programs now to help train people for careers of this kind. But we need more and more of this. This was said time and again. I think those are some of the major issues that were brought to my attention. Mr. Hansen. Have you or will you be compiling a summary that reflects the impressions and recommendations of these regional meetings? Mr. Flemming. I do intend to do that, as much as anything, tor a personal checklist. But to the extent that it is helpful to others, of course, I will be glad to make it available. Mr. Hansen. I would be very much interested in receiving a copy and possibly it might be useful to include it in the hearing record. Thank you very much. Mr. Eetd. Mr. Flemming, in the light of your last colloquy, I quite agree that chronological age is a very poor measure of capacity and ability to serve the community and make a meaningful contribution to the Nation. Do you have any suggestions as to how it can be broadcast more clearly throughout our land that senior citizens perhaps have got their most productive years ahead of them, not behind them, and that we should try and get a variety of institutions to look at the capacity and not just chronological age? Mr. Flemming. I indicated yesterday morning that soon after I became a member of the U.S. Civil Service Commission back m 1939 my attention was called to this because of the fact that, of course we had the responsibility for the administration of the Eetirement Act, At that time I took the position that I have taken here and I know that others have taken that position. I suppose that we shouldn't get too discouraged because of the fact the trend appears to be in the othei direction. i In my judgment, the very best method for trying to offset that trenc would be for some employers, both public and private, to set the ex- ample. Like you, I am confident of the fact that if they decided to d( that they would have some positive results and they would begin t( talk about those positive results, and in turn, might get others t( follow. I think the Federal Government has got to be very careful in term of its own employment practices. Actually, in today's world the Fed eral Government is among the more liberal employers when it com© to a matter of this kind because we know compulsory retiremen typically is 70 and there is opportunity for extension beyond tha period or even provisions of law which make it possible to employ persons who are fairly well up in years. Although the legal authority exists within the Federal Govern ment, I am not sure whether or not that authority is exercised to tin fullest possible extent. I have been away now for 10 years so I am J little rusty on that particular point. 01 But if the Federal Government would help fco set the example, that certainly would stimulate other employers to do the same thing. Mr. Keid. I am aware that the questions oi* budgets and money are not totally clarified within the administration, and equally, that some of this would depend on the recommendations of the White House Conference, but might 1 ask you to touch a bit on the magnitude of the commitment we ought to be thinking about in terms of money, in terms of where we need large changes in appropriaf ions, and where we need new social service delivery systems, and how much money might be needed to really start to tackle some of these problems. I know you and I have discussed in the past what would happen if income limitation was reviewed under social security. The magni- tude of the effort would be helpful to the committee. Mr. Flemming. Mr. Chairman, I am not in a position to attach price tags to many of the proposed programs in this area. Prior to the White House Conference, however, I am going to see if we can get some price tags attached to some of the basic proposals that I know will be under consideration at the Conference. I know they will be under consideration because the States have made recommendations which will result in their being under con- sideration. I agree with you that it is not going to be possible for the delegates to the White House Conference to do an intelligent job of picking, choosing, and establishing priorities unless they have the opportunity of at least considering the order of magnitude of prices, and I am going to see what can be done along that line. The illustration that you mentioned, of course, is an excellent one. When I was Secretary, I became very much concerned about the retire- ment test, and I so indicated to the members of the Social Security Administration staff and I recall a staff meeting where they responded by giving me a price tag. They made it very clear that if we eliminated the retirement test as of that time that it would cost the system $3 million. Then they very properly asked me if I didn't think that some of that $3 million could be spent more meaningfully to strengthen other parts of the social security system. I had to agree that it could. But at that point we then began to move in the direction of liberalizing the test/Of course, H.R. 1 does an excellent job of liberalizing it. It not only raises the ceiling to $2,000 but it also eliminates that $2,880 ceiling after which people would lose dollar for dollar. That isn't the picture at all now. After you go beyond the $2,000 ceiling people would lose a dollar for every $2 earned. That is going to cost the system some money. I had the opportunity of serving as Chairman of the Social Security Advisory Council for the last 2 years. This is one of the issues we iooked at and this is one of the recom- mendations we made. At one time I had in mind a price tag there but it has been put into a package and the package has been priced out and provision made for taking care of the cost. Mr. Eeid. Have you given consideration to tax credits of one kind or another to industry to help pay for housing or other kinds of serv- ices that would facilitate programs for the elderly or, conceivably, centers in certain towns or things of that kind ? Mr. Flemming. I have not as yet, but that is the kind of area where I would like to see some price tags developed. There won't be agree- 62 merit on those price tags I am sure. That is all right. A conflict on something like that is helpful but I do think we owe it to the delegates to the Conference to give them a feel of what is involved m here. Mr. Reid. I would like to commend you and the President for a very clear commitment on nursing homes and on rectifying the shocking conditions some of them are in. As I understand it, there are some- where between 900,000 and a million people in nursing homes, some that have been described as being hopelessly substandard. What level of effort are we talking about there in the kind of home that goes beyond the area of rehabilitation? You are talking about new struc- tures of some kind I presume, v . i v Mr. Flemming. Certainly in some instances that is the case. You probably recall that in the President's statement in New Hampshire he said in referring to the nursing homes, "We are particularly hope- ful that our efforts will bring reform since any reasonable expense is incurred as a result of improving care can often be financed under the existing medicare and medicaid programs." "We are fully prepared to budget the necessary funds to meet rea- sonable cost increases which result from such a program." In this instance, I think his statement is referring especially to operating ex- penditures but I think, in that paragraph in his statement, the Presi- dent is reflecting his determination to do what is needed to be done in order to clean up a bad situation. Mr Reid. That deals not only with the structure but the whole con- cept, the kinds of health care available, nutritional and other factors that might be substandard, along with the structure itself i Mr Flemming. That is correct. Of course, your comment relates to what I said earlier about social service. The requirements for social services in nursing homes. You can have a nursing home that is an excellent facility, that is rendering good medical and nursing serv- ice but it can still be a nursing home where the elderly are isolated and ostracized from society. m I think it is equally important for the nursing home to endeavor to build these bridges between the elderly people and the community. Mr Reid. That is one of the reasons I am such a believer m the RSVP program and others because I think there is a capacity and desire to participate much more fully in the communities ot our °I amdeliffhted the administration has provided $5 million as a start but I hope it is only a start because I think a modest investment there would pay quite large dividends in many other respects. Mr Flemming. I agree with you on that. I think that is a program where if we made the kind of investment that we should it will produce tremendous dividends. I am confident the results from the start will be such as to encourage further investments. Mr Reid. Have you done much thinking— I am sure you have per- sonally—but has the administration done some thinking on the kinds of ma'jor and meaningful research that might be undertaken or pulled together ^ Mr Flemming. I believe that this is an area that is going to get careful consideration in the White House Conference, I believe that there are going to be findings and recommendations that will come from the Conference on this point. I believe that those findings and recommendations will be given very careful and very sympathetic consideration. 63 As an individual, I will be interested in what they come up with along that line. 1 will be interested in doing what 1 can to get implemental ion on recommendations in that area with particular emphasis on the pro- duction aspect of it. Mr. Reid. In relation to the matter of transportation for the elderly, can von tell us what, if any, programs can be developed? Mr. Flemming. In regional meetings I have had, attention has been called to a number of programs that are underway in many parts of the country, under which the senior citizen, the elderly person lias keen able to use public transportation during certain hours of the day fora charge that is under the normal charge. Programs of this kind apparently are accepted with a great deal of enthusiasm and they do help to contribute to the solution of the prob- lem that you have identified. Also, I found there was a considerable amount of interest in a pend- ing proceeding before the Civil Aeronautics Board which would ex- tend to elderly people some of the same privileges that are extended to youth who desire to use air transportation. Again, even in connection with the cities, however, there was a good deal of emphasis on the possibility of utilization of schoolbuses and church buses, provided we could solve this problem of liability. Another thing that struck me, however, is we have a great many cities and communities in this country where public transportation is nonexistent. I recall talking about a city in Iowa of 35,000 population that has no bus transportation. There are four taxicabs that operate from 1 o'clock in the afternoon until midnight. That is all there is in the form of public transporta- tion. This brings you back again to the possibility of utilizing a re- source such as schoolbuses because oftentimes they are owned by the school board, so in that sense, they are a public resource. In other cases the school board enters into a contractual arrange- nent for the furnishing of the service. Congressman Reid, here is mother area, however, where I think we can do a better job of pooling ^sources in the private sectors than we have done up to the present ime. What we need are specific plans, specific proposals. I believe people n the private sector will be responsive to those proposals. Again you lave got the question of liability. Mr. Reid. Have you considered the Government guaranteeing or underwriting insurance or the liability ? Mr. Flemming. This is one of the questions I am asked within gov- ernment, to see what the possibilities might be there. This is a new irea as far as I am concerned and I need staff work before I arrive at my conclusion, but I think that possibility ought to be explored. Mr. Reid. I certainly want to thank you most warmly for testifying tere. I would like to thank Mr. Todd for accompanying you. I don't 3iow whether he has any word he would like to add by way of hope »r inspiration but we are very grateful to you both for appearing to- iay. Unless there are further questions the hearing will stand adjourned intil tomorrow afternoon at 2 o'clock. (Whereupon, at 3 :30 p.m. the subcommittee recessed, to reconvene t 10 a.m., Friday, September 24, 1971.) TO A31END THE OLDER AMERICANS ACT OF 1965 FRIDAY, SEPTEMBER 24, 1971 House of Representatives, Select Subcommittee on Education of the Committee on Education and Labor, Washington, D.C. The subcommittee met at 10 a.m., pursuant to notice, in room 2175, Ray burn House Office Building, Hon. John Brademas (chairman of the subcommittee) presiding. Present : Representatives Brademas and Reid. Staff members present: Jack Duncan, counsel; Martin LaVor, minority legislative assistant ; David Lloyd Jones and Christine Orth, staff, and Gladys Walker, clerk. Mr. Brademas. Today the Select Subcommittee on Education is holding the second day of our inquiry into the need for comprehen- sive services for older Americans. As members of this subcommittee and others will know, on Wednes- day we heard the distinguished chairman of the White House Con- ference on Aging, Dr. Arthur Flemming, tell us of the status of plans for the Conference and it became very clear that from Dr. Flemming's testimony that if the administration were to plan policy for the aging is well as they plan conferences for the aging, why, the aging prob- ibly would not have too much to worry about. Today we look forward to hearing some other experts and to meet- ng again with some old friends of the subcommittee. Mr. William Bechill, a former Commissioner on Aging, now an as- sociate professor at the University of Maryland, will be giving us the Denefit of views and his experience. A distinguished panel of researchers : Dr. Robert J. Havighurst of :he University of Chicago, Dr. Elias Cohen of the University of Penn- sylvania, and Dr. Sandra Howell of Brandeis Universitv, represent- ing the Gerontological Society, will be talking to us, and as will Mr. Jerry Miller, an old friend of the chairman, and presently the presi- lent of the St. Joseph County Board of Commissioners, about the leeds of aging in the area that he represents. We look forward to hearing from all of you. Our first witness this morning will be Mr. Bechill. Mr. Bechill, we look forward to hearing from you, sir, and we are iware of the splendid leadership you gave as Commissioner on Aging n the Department of Health, Education, and Welfare, and know of four continued interest and concern with this problem. Would you go right ahead, sir. ( On ) 66 STATEMENT OF WILLIAM BECHILL, ASSOCIATE PROFESSOR, MARY- LAND UNIVERSITY (FORMER COMMISSIONER ON AGING, DE- PARTMENT OF HEALTH, EDUCATION, AND WELFARE Mr. Bechill. Thank you very much, Mr. Chairman, for those :1 TaniTerTpleased to have the opportunity to again appear before this subcommittee as you begin your reviews of proposals and ideas around strengthening the Older Americans Act. This is a critical period in the history of public policy affectml older people. Only a few short weeks from now the 1971 White Houj Conference on Aging will be held. The major objective of the Con. ference is the development of a more adequate national policy 01 aging. Like many other fields of human endeavor, there has not ye emerged to date any clear and overriding policy or set of policies 01 aeine, at least in the strictly operational sense. j The White House Conference on Agmg can be a great catalyst t, this end, to be sure, but I also happen to believe that public poke; more often develops out of the crucible of debate about specific polic. proposals through the workings of the legislative process P My testimony will center on two issues winch appear central to th development of a more adequate national policy on agmg. The firs issue i what role and functions should the Administration i on Ag n ; have in the future. We are the only nation in the world that ha established an agency at the national level solely concerned with tt well-being of older people. This is an action which I still think is credit to every Member of Congress who voted for the initial a< 6y The S s a e g cond issue is whether we should move toward the creatio of a more comprehensive system of community and social service By "comprehensive," I mean one that is universal in its coverag features £ preventive approach; acts, when necess »^»f "* j£^ for older people; provides choices to older people and their famili. through a range of available services; and is based upon clear stati '°We do'not have such a universal system now in the United States fc a variety of reasons. In its absence, we are often hurting older peopl< steering them sometimes into institutions when they could be care for in their own homes by their families and others, neglecting the normal needs for protection and support against the frailties ai informities that often come as people get older and less mobile ove looking conditions of physical and social isolation and neglect sin there are few agencies in place with the authority and responsibiln to act, and, at the same time, failing to use, on a wider scale, the mar new and innovative ways of delivering services tc • older .people th have been pioneered under the Older Americans Act and other pr grams. This includes particularly the experience of services provid. bv the elderlv themselves. ,. . . I hone that these two issues, the role of the Administration on Agn and the need for a comprehensive system o I community _servic receive major attention at the White House Conference. Both a basic to the work of this committee, and to any discussion of futu changes in the structure of the Older Americans Act. I want to co centrate the balance of my testimony on four points : 67 1. The need to clarify the focal point authority :m Administral ion on Aging. 2. Restorat ion of the independenl status of AO A. 3. The development of comprehensive system of community services under the Older Americans Act. 1. The need for a renewed national commitment on aging. The need to clarify the local point role of the administration on aging: Today, as you well know, there is serious concern with the present status of the Administration on Aging. In the other house, the Senate Special Committee on Aging has conducted extensive hear- ings on the evaluation of the performance of the Administration on Aging. The testimony in those hearings has been very critical of the Administration on Aging and its efforts in the areas of coordination, policy development, and policy leadership. Also, a Presidential task force last year issued a report which gave their highest priority to the question of government organization for the elderly. While one may seriously question whether this is the highest priority facing older people today, the task force presented to a forceful argument for its position. It stated : "Congress intended the Administration on Aging to serve as the Federal focal point on aging. The experience of the Administration on Aging during the last 4 years, however, makes it abundantly clear that interdepartmental coordination cannot be car- ried out by a unit which is subordinate to the units it is attempting to coordinate.*' As their remedy, the task force proposed that the President establish an Office on Aging within the Executive Office of the President, and that this be accomplished, first by Executive order, and later by an amendment to the Older Americans Act, I am not yet convinced of the need for an executive office arrange- ment. However, it is clear that the Administration on Aging is now in a very difficult position. Its role as a focal point on aging is under at rack from all sides. Moreover, it has lost many of its functions as a direct program operator to others for the focarpoint roles of coordi- nation, advocacy, and policy leadership. I do not think that this stra- tegy is working very well. AOA's position reminds me of an analysis once made of another beleaguered organization that was described this way: "There is no more forlorn spectacle in the administrative world than an agency and a program, possessed of statutory life, armed with executive orders, sustained in the courts, yet stricken with paralysis and deprived of power." In my view, Congress intended that the Administration on Aging be both an operating agency and carry major responsibility in co- ordination and policy leadership at the Federal level. The focal point roles proved difficult from the beginning. As the first Commissioner, I take much of the responsibility for concentrating on the administra- tion and building up of the grant programs established under the Act and the Foster Grandparent program. These were about all our resources would then permit, although we did have some impact and made direct contributions to the shaping of policy during its early years at both the Secretarys level and at the White House level. Mr. Chairman, while the legislative intent has been clear as to the iesire of the Congress to have a strong Federal agency that could in- fluence both national policy, I have long felt that the Act needs to be more explicit about these responsibilities, as well as the type of rela- 68 tionship that the Administration on Aging should have to other pro- grams in the Federal Government whose services benefit and reach older people. m , . ^ , , Specifically, I would urge that title II of the act be amended to include the specific functions of coordination of Federal programs. This would include the continuing evaluation and monitoring ot pro- grams related to the purposes of the Older Americans Act, with par- ticular attention to the impact of medicare, medicaid, Social Security, the Ao-e Discrimination Act the provisions of the National Housing Act related to housing the elderly and the standard setting and licen- sure of nursing home, intermediate care homes, and other such facili- ties now providing care to the aged. I also would urge that the Administration on Aging be given the clear authority to plan, develop, and operate a comprehensive system of national, State, and community services and facilities for older people. I would also recommend that the Secretary of Health, Education and Welfare, in tandem with the Advisory Committee on Older Americans, submit an annual report to the Congress setting forth the specific progress that the Nation is making towards ihe achievement of the Declaration of Objectives now set forth m title I of the act. These recommendations are made with the utmost sincerity. Unless the Congress clarifies the role of the Administration on Aging, the agency will continue to remain in its present position of having great expectations placed upon it and the minimum of authority, and resources to carry out such a broad and important assignment. I would urge the Congress to reaffirm its clear interest to have AO A an independent operating agency within HEW. No doubt this recom- mendation will be opposed by those who would hold that it violates orthodox theories of public administration to have an agency with combined roles of program operator and policy and program coordi- nation at that level. Perhaps, but nothing could be more unorthodox than the experiences that the Administration on Agmg has gone through in recent years. Coordination is a myth without any reaJ status! authority, and actual administrative responsibilities that inter- act with those of other programs. I do not think the Congress woulc have established Administration on Aging in the first place had H been entirely satisfied with the efforts that other agencies had beer making in behalf of older people. *-,... Specifically, I would urge the transfer of the Administration 01 Aging to the Office of Secretary of Health, Education, and Welfare The transfer should be accompanied by sufficient funds to enabli AO A to fully carry out its dual roles. Third, comprehensive community services for all older people : One of the specific objectives of national policy for older peopl should be the availability of a comprehensive system of communit; services, conveniently located and available in all parts ot the JNatior I would propose that the title III authority of the Older American Act become the major vehicle for the design and the delivery of sncJ a service. It would' be a logical step, especially if the provisions o title III could be restructured with such an objective in mind. Specifically, I would urge that title III be amended to read Grant for Statewide Planning and Coordination, and Coordination an Comprehensive Community Planning and Services for the Aging. 69 While retaining; the present authority and authorizations for the statewide planning function now found in the act I would suggest separate authorizations be made available on an 80 20 continuing support basis for the provision of comprehensive community services. Using a model already proposed in a hill introduced earlier this year by Senator Percy of Illinois, the key local agency for the sys- tem could be either a multipurpose senior center, or the State agency t"i aging itself, area wide, county, or city offices operated by local government, or nonprofit, agencies able to' perform such a role under contract with the State. What sorts of services would he made available through such cen- ters or offices? Primarily, I would see them providing basic linkage or liaison services. These are information and referral, counseling services, "reach-out' services to locate isolated older persons in need of health, social, and other services; special transportation service for those who do not have access to regular transportation to g^t to service agencies, advocacy services for those who might not be able to explain their need for services, and systematic followup services to determine whether the older person actually received services. These linkage or liaison services would be the main base for, a comprehensive system. However, direct services such as homemaker services, some help services, opportunities for social activities, nutri- tion services, protective services, and many others would need to be a part of such a system. In the main, I would propose that these direct service be provided under arrangements made by a multipurpose senior center or an agency designated as a senior information and services center. For example, funding for many direct services, at least for the low-income elderly, could be financed under the public social services provisions of the existing Social Security Act. A core part of the system would be a requirement that the designated multipurpose center of Senior Information and Services Agency con- tinually update a plan for the development of comprehensive services for all older persons within its geographic area. That plan should re- flect local needs, but also, it should have some relationship to the overall priorities developing out of the planning, coordination, and, evaluation activities of the States. If senior centers are given such a key role, it would also be im- portant to provide specific funding for the construction, renovating, and staffing of such centers designated to serve in this capacity. The cost of a comprehensive system would not be minimal. I have m mmd an annual expenditure and investment of some $400 million a year for the next 3 years in total Federal, State, and local moneys. Approximately half of this amount would be for the building of a national network of the linkage service and strengthening the senior centers utilitized in that network, and half would be for the additional direct services. The actual cost could be lower, since there would be offset ranging between $50 to $60 million annual from the anticipated levels for the public social services under the Social Security Act, and for areawide and community grants under the Older Americans Act over the next 3 years. We are spending currently in title XIX medicaid approximately $5 jhon, and $2 billion of that sum approximately is going for essenti- ally institutional care, care provided older people in nursing homes, intermediate care homes, and the rest. billi 70 Two years ago when the medicaid program was under review in the other house, Dr. James Houghton, the deputy administrator for the New York City Health Services Administration, testified, and I quote : ''Institutional care for the aging has been and continues to be under both titles XVIII and XIX a major expenditure. Much of this expend- iture is inappropriate and related to our serious lack of appropriate social alternatives for the care of the aging. It is estimated that 10 percent of the nursing home residents" — he is referring to New York City — "are unnecessarily institutionalized for this reason." Dr. Houghton is correct, Mr. Chairman. There would be additional savings by the investment of this type of funding for social services decided to be alternatives to unnecessary institutional care. I appreciate that you may want to study this proposal for a com- prehensive svstem carefully. Certainly, there are other alternatives to what I have suggested. One would be to have such services become an integral part of the responsibility of the Social Security Adminis- tration. Pending legislation would transfer the administration ^ of adult assistance programs to SSA, but I have seen no accompanying push for administration of services under the same auspices. Another possible vehicle is the existing Federal-State public welfare programs, if they can be converted into a general public social service agency serving all people. j Any route to building such a system will be difficult, but I think it will be worth while. If such a system were in place now, I am con- vinced that we would reduce the institutionalization of older people to the minimum, as well as prevent and minimize some of the hardships now experienced by many older people for lack of access or knowledge about existing services to which they are entitled. I am also convinced that a full range of community services, acces- sible on a neighborhood basis and tailored to meet the actual needs of the elderly, would result in more meaningful participation for older people in our society. It is a mistake, it seems to me, to continually define the problem of older people as much as we do in health or medical terms. The social dimensions of aging are just as critical. Loneliness, lack of a useful role, poor mobility, loss of friends and •family, and nothing to do or no one to care for anymore are social cancers that need to be addressed in developing future national policy for the aging. ... ,. I hope that in the future work of the Congress in shaping policy in behalf of the Nation's older people, and in the forthcoming White House Conference on Aging, that all concerned will think specifically of the kind of goals and quality of life that the Nation should strive for in this field. An adequate retirement income, expanding health care, improved housing, comprehensive community services, continued opportunities for employment, and a wider range of educational and social activities in retirement are not impossible to achieve in this very dynamic society. m ±i Crucial to their achievement, as I have suggested, is to reaffirm the national commitment to older people now set forth in title I of the Older Americans Act, by restoring and clarifying the functions 01 the Administration, giving it a clear and major responsibility for building a national network of community services that would serve and be a strong representative of older people to other agencies. It is 71 in the spirited debate of specific proposals such as I have proposed that such social policy finally is made. I hope thai the result of thai debate will be a renewed and stronger commitment to older people than we have been able to mount in the past. As a parting comment, lei us no! be deluded that many of the needs of older people can be ameliorated or met. through the technique of reorganization and the accompanying rhetoric about increased effi- ciency and coordination. In the final analysis, only clear policies, specific programs, and adequately funded and supported services can make an impact. More than ever before, we need a strong Administra- tion on Aging geared to these purposes if we are to meet such a commit- ment to older people. Thank you. Mr. Brademas. Thank you very much, Mr. Bechill, for a really splendid statement. I think that the parting comment that you have given us, sums up very well. May I say my own concern, as one looks at the problems of the aging— and I think Dr. Flemming himself stressed in our subcommit- tee meeting earlier this week the importance of following conferences and dialog with action— is that we have too often allowed ourselves the luxury of moving around pieces on the chessboard as if doino- so would really make some significant difference in policy. In this subcommittee we have had to cope with that problem in the last couple of years with respect to the Administration on Aging more I dare say, than with respect to most other subjects that have come to the attention of this subcommittee. I is all very well for us to be told as members of the authorizing committee how important it is to have more coordination and increased effectiveness, and increased efficiency, but one is alwavs struck by how often that kind of phraseology seems accompanied "by proposals or attempts to cut back program money. I think, therefore, you have given us as lucid an analysis of the problem of how to meet some of the problems of the aging, so far as the responsibility of the Federal Ijovernment is concerned, as I have heard. Now you have suggested that we first of all must strengthen the role 3t the Administration on Aging and that one Way to do that would be £L get ^ ? ut ^ of the Social and Rehabilitation Service and into the l)tfice of the Secretary of Health, Education, and Welfare. You have a ^ > A^ lggested that you Mt that would be Preferable to mo vino- the A.OA into an Executive Office arrangement. to In your judgment, Mr. Bechill, do you feel that putting AOA into :ne Secretary's office would be the most effective administrative ar- rangement over the long haul for focusing on the problems of the ao tar as Federal policy is concerned, and for carrying out the kind )t comprehensive services program that you have suggested ? Mr Bechill. In the first place, I am still weighing in mv own mind he advantages of an Executive Office arrangement. I certainly have lot dismissed that. In my testimony I said that I was not yet con- vinced primarily because there has not been any clear articulation of low that kind of office would function and operate. This is the reason why at this stage, I would ur^e that AOA could >e elevated, to the Office of the Secretary. It would give the agency nuch greater leverage and much greater opportunity to participate in 72 the decisionmaking about the allocation of resources that goes on at that level in that Department affecting older people. HEW is the maior Department in the Federal Government whose services and programs in the main reach people I thmk that to be located at that level, to have the opportunity to discuss specific ideas ■' ,i«l Specific proposals and influence the thinking of the policymakers within the Department at that level is very important. Mr. Beademas. Is it not fair to suggest that one of the ^reasons that you might make a proposal to elevate the AOA either to the Secie arv-s Office or to the Executive Office of the President is a sense of frustration that where it is located it has not had enough political ^fW ^matter another way, if the. administration, of the President were giving the support to the operations of the Administra- tion on Aalng, which it is quite clear from the legislative record that Congress ^intended it be given, one would not be having to pre- occupy himself very much with the'location of the AOA I In other words, if the President were doing what Congress said should be done, providing enough public support, enough money, it would not perhaps make that much difference where it were located Mr Bechiel. The observation you make, Mr. Chairman, is 'obviously correct It seems to me that there would be probably much less con- cern about the organizational placement of the Administration on l™„o if tlie funding for the program had been close to the authoriza- tion levels in the act. That has not happened. ■ Mr Beademas. I suppose that in like fashion one might say, trvmg to bring a somewhat open mind to these matters, that simply putting the wolds "White House" as a label in front of a conference entitled Conference on Aging is no guarantee that effective action for the ag- fngwm come out ofit. I would like to think that, but I guess I am fef rM-and I don't think I am at odds with what you are; saynig- am fearful that we may get into a position where we say. Well, if thi Commissioner is an appointee of the President of the United fetate thaTt at wm be enough." So what we really have to focus on is botf location wTthin the administrative hierarchy and the substance of th< ^T—lW£fc House Conference on Aging i J maior stimulant, a catalyst, to advancing national policy The pom that I was attempting to make is that any conference of this kind ha to hav^me^lcifif proposals. I think we have to get away Mi Chafrman° from discussing the needs of older people in generalities hope that during the Conference there can be many specific & -oposal made about how we reach some of these very broad objectives that th C Tfm S co h n a vinced that Mr. Flemming, for example the Director c the White House Conference on Aging is of that mind. Mr. Beademas. Well, I appreciate that observation and agree wit *" Let me just ask a couple of other questions, Mr. Bechill. The thrust of your testimony, as I understand it, is, one, that v. .ive Greater visibility to the Administration on Aging and, secon that we give Consideration to.the development of a program of con prehensive services for the aging. 73 Mr. Bechill. Yes. Mr. Brademas. And in the Latter connection you suggest, as I under- stand it, a sort of double approach; one, a program of linkages which would in large measure be a question of information and, second, direct services. You estimate that $400 million an annual basis would be the cost of the provision of both these kinds of systems, if I understand your tost i mony correctly. Mr. Bechill. Yes. Mr. Brademas. I want to get some general ball park judgment of the relationship between this proposed linkage plus direct services programs on the one hand, and other services for the aging which may not be included within those two systems on the other hand. In other words, are we talking about a new $400 million program in your view added to what, social security ? Sir. Bechill. I don't think we are talking about a new $400 million annual expenditure. We are talking, though, of large sums. The goal is to establish a system of linkage services using the ex- perience that we have had in title III with other sources of provid- ing and funding social services for older people. The major ones that come to mind are the existing public social services provisions, which are on an open-end matching basis in the Social Security Act, and some of the other kinds of service funds that are being provided through the model cities program and OEO. That is why I stressed the linkage idea, but at the same time Mr. giairman, I do not want to minimize the fact a substantial amount jf new money would be needed for the linkage system and for the strengthening of other social services funding. Mr. Brademas. Mr. Bechill, this has been very helpful, indeed. I iiink if we could move in the direction of a program of comprehen- sive social services along the lines of your general observations, we should have rendered a great service indeed to the country. If I read |ght some of the predictions of the geriatrics researchers, we are go- ng to have more and more people in our country living longer and onger, and unless we give attention now to the development of the find of system that you have outlined, I fear we are going to face still nore profound social dislocations and distress on the part of a good nany people in the American society than is even today the case with aspect to the aging. The Chair is glad to call on the distinguished ranking minority nember of this subcommittee who has been a great champion of the Administration on Aging, and as you know, is the father of the ES VP program, Mr. Reid of New York. Mr. Reid. Thank you, Mr. Chairman. Good morning, Mr. Bechill. I appreciate your testimony. Might I ask you two questions of a general character : One, what do you think can be done with regard to some of the egal requirements of retirement to give effect to the concept that many lenior citizens who, chronologically, are at the required age of retire- nent, but who are, in fact, at their most productive time in life, with , great opportunity perhaps to contribute more to the Nation and their immunity than at any other time? 74 In other words, chronological age and capacity are frequently two different things. How can we bring them together ! A second question : I welcome any thoughts you have on medical re- search of a preventive kind, whether it is greater use of trace ele- ments or whatever it may be to deal with some of the crippling diseases that affect some of our senior citizens such as arthritis. What can we do to prevent much of the physical difficulties that result m people not always being ambulatory and so forth, not being able to again maxi- mize their potential. T Mr. Bechill. Mr. Reid, those are two very profound questions. 1 am very concerned, as you are, that we have not been able to develop an outlook in our society for a more orderly transition from full-time work to full-time leisure. I think we should be much more humane about this. It is a tremendous educational challenge. It seems to me one of the reasons we get into this kind of an issue is that we are not inf orming all people in the country well enough, not using the exist- ing educational system well enough, to discuss this matter of retire- ment. There should be much more choice available to the individual. Frankly, Mr. Reid, I don't know how to do this through legislation. There have been some studies trying to get at how do you determine when a person is ready to retire, and there does not seem to be much consensus about the criteria for retirement. Mr. Reid. Well, apropos of that, I was impressed with three men I had some acquaintance with, two a fair amount, but three I mention are Churchill, Adenauer, and Ben-Gurion, and in many respects they were at the top of their powers in their mid to late 1970's, and had there been an arbitrary cutoff to their career it would have made ab- solutely no sense whatsoever. Ben-Gurion at a certain point when he was approaching the 80's was worrying whether he could be at peak capacity, but I notice he did the work of three men most of the time. Mr. Bechill. We have to work at creating some more defined roles for people in retirement. You see, the people you mentioned were not as limited obviously as most people are, they had certain options avail- able to them— the political option for one. For a lot of people that is not the case. Mr. Reid. What I am trying to get at is the question of attitude and I think a cutoff based on chronological age is intellectual laziness on the part of Government or business or whatever it is, and what we should concern ourselves with is retirement when that is a matter od incapacity or inability and I think most people if they genuinely car not do the job would recognize it. We make just a flat cutoff, whicl is a rather poor standard; I think it bears very little relationship t< the facts. Mr. Bechill. It does, and it has major implications any time w< make that kind of fixed arbitrary decision. Mr. Reid. As I observe it, it does not relate just to 65, but whei someone starts getting into their 40's, well, he only has so many year left^-or the 50's— and it really reaches down into areas of peak ability and capacity. I think it is a mischievous kind of thing. I suppose the argument f o it is to open jobs for younger men coming up and there is no reasoi that they should not advance as fast as their capacities should permil /.) It should he a question of ability and capacity and not iusi a flat Bgure, it seems to me. Mr. Bechill. I agree. On the second point, medical research, the immediate answer of bourse would In 1 to place more emphasis on additional funding, but 1 think that accompanying that has to come a greater awareness of the kinds of contributions that the National tnstitute of Child and Human .Development could make, to some of the other parts of the NIH. If we were able, as some people have been saying for years, to re- duce substantially the incidence of the diseases of old age, or at least their heavier incidence in old age, we would of course be creating in the process another kind of problem, and that is a good kind of prob- lem : What to do with the extended years of life that would come by a substantial reduction in cancer, heart disease, and stroke. Mr. Keid. I am not worried about that because I think there are so many things that are needed in this country, and I think govern- ment has been quite poor and perhaps industry as well in leading the Way into areas where there is a need for all kinds of work, whether it is paid or voluntary, but there are a great many things that could be done for the benefit of everybody that we are not doing. What I am concerned about is being sure that people as they reach a certain age will maintain their fitness as well and obviously crippling arthritis limits what someone can do. Mr. Bechill. Right. Mr. Reid. Do you know of any significant areas of medical research in this country or elsewhere that hold the possibility of some break- throughs in this ? Mr. Bechill. I would have to do more research myself to answer that question. Mr. Reid. How much research do you reckon we are undertaking either at the Federal level or privately, or in the States ? Mr. Bechill. Well, the major research is located in the National Institute of Child and Human Development. Their exact budget figure escapes me but, it is not nearly enough. Mr. Reid. Do you know any country that is doing research ? I am not talking about just cancer, heart, and stroke, which I think are underfunded, but equally on some of the problems that may be of easier solution. Arthritis may be one, there are others. There are some— diet, better nutrition, and trade elements — which help very sub- stantially in this area. What I am saying is that a modest amount of money in some aspects of this might pay very big dividends. Mr. Bechill. Mr. Reid, I have to be very candid with you and in- dicate to you that this is not one of my areas of real knowledge. All I can give you at best is an impression. Mr. Reid. Thank yon very much. Thank you, Mr. Chairman. Mr. Brademas. Mr. Bechill, thank you very much indeed. This has been a really splendid opening statement today and I hope you will let the subcommittee call on you again for counsel and advice as we seek to shape some legislation along the lines of your testimony. Mr. Bechill. Thank you. Mr. Brademas. Our next witness is an old friend of the chairman, and one of his constituents, Mr. Jerry Miller, who is president of the St. Joseph County Board of Commissioners in South Bend, Ind. 71-272— 72— pt. 1—6 76 Mr Miller, because we do have a panel of others who are following you, the Chair would like to suggest that you might like to summarize your prepared statement and all of it will be included in the record, and then we can put questions to you. Mr. Miler. I have done so, Mr. Chairman, and I have presented it to the clerk. , _. , ,, , j Mr. Brademas. We are glad to have you here. Please go right ahead. STATEMENT OF JERKY MILLER, PRESIDENT, ST. JOSEPH COUNTY BOARD OF COMMISSIONERS, SOUTH BEND, IND. Mr. Miller. I just would like to summarize my statement very, very Vccordino- to the census of 1970, the total population of St. Joseph County is just over 245,000, of which 24,147 or 10 percent are oyer age 65 I will briefly outline four major areas of concern facing this impor- tant segment of our population. These are transportation, productive use of free time, housing, and nutrition. We feel transportation is a most important area, and a most complex problem to solve, When an older adult is without transportation, his mobility is reduced and this can lead to isolation. We would like to see a transit system for older adults that would resemble a taxi service, or perhaps funding to subsidize existing taxi companies. We leel there would be no scheduling problems, door-to-door service and we could provide older adults with a high degree of mobility. As always the major drawback is cost. Yet, the gap between what exists and the ideal are so great that improvement is vitally necessary. Whenever we talk of improving the services for older adults, we must take into consideration transportation problems. The best de- signed and funded program accomplishes little if the recipients car not use it. ., ,. . » Next, I would like to turn to the problem of productive use of tree time. Basically, this area can be divided into two sectors : employment and volunteer service. m • ■ We have found that over 1,500 adults m St. Joseph County want em- ployment and another 3,000 would accept a job if it were available We are most grateful and excited to have received $23,121 to tunc an older adult employment program. However, early returns from th( program which started August 1 indicate we have a long way to go t< reach full success. Since a retired person's desire for employment u usually related to a very low income, it would seem desirable simply to raise their income to a point where they could achieve a comfortabl< standard of living. But we would also like to see existing program under the Older Americans Act such as the ESVP program and thi foster grandparents expanded so that St. Joseph County and all othe: communities who desire can fully participate. m In the area of public housing, we find that construction has mam tained a pace to keep waiting lists at a minimum. Ideally we shouh provide public housing for all those who need it and enable others wh< wish to remain in their home. Yet with high property taxes and tn cost to maintain a home, we are forcing many to move. True, most ma. be happier once they adjust to their new living quarters, but we ques tion whether economic pressure is justifiable in forcing these peopl to move. 77 Many arguments are advanced to support the desirability <>l" public housing for older adults. Of course, if ill health or disability filters into the picture, then it may be more desirable to move into public facilities. We must also recognize that a problem of isolation can develop for those who remain in their own home. However, all arguments aside, we still feel that economic pressure should be relieved so that the older adult is free to make a choice. In the area of nutrition, I would like to report that we are very proud of the success of the meals on wheels, recreation, and socializa- tion programs, but again there is certainly room for expansion. We Hnd it most ironic that Federal dollars received must purchase food at retail or wholes prices. Because of a quirk in the law these funds can- not be used to purchase surplus food from the Federal supply of food- stuffs. If this were not the case, and we could tap the surplus supply, we would have an immediate expansion of purchasing power and could serve more meals for the same price. In conclusion, I wash to sincerely thank you for this opportunity to speak on the problems of the older adult in St. Joseph County, Ind. 1 believe we have the most dedicated and talented people available to work with the older adult. I think our present facilities provide a sound foundation for expansion. We stand on the threshold of full suc- cess. And yet it is indeed a crushing blow to the older adult that we are stymied simply because we lack the funds to transform the dreams of the "golden years" into realities. I feel that we have a tremenodus amount of successful people who have helped us in these areas, so with your help we can expand. Thank you, Mr. Chairman. (Mr. Miller's prepared statement follows :) Statement of Jerry J. Miller. President, Board of County Commissioners, St. Joseph County, Ind. Mr. Chairman, I am Jerry J. Miller, President of the St. Joseph County Board of Commissioners in St. Joseph County, Indiana. I wish to thank you for this opportunity to relay to you some of the problems and needs of the older adult in the South Bend and Mishawaka area of Indiana. We recognize that much has been done in the past decade to try and cope with the problems of the older adult and we are grateful f@r the benefits we have re- ceived from legislation passed since 1965. Yet, it is only when we achieve a small degree of success that we can truly understand what remains to be accomplished. Perhaps the situation was best described to me by one of the planners at United Community Services when he said, "I can't say we're optimistic but we haven't slipped into pessimism either. Let's just say we're doggedly determined." According to the 1970 census, the total population of St. Joseph County is just over 245,000, of which nearly 10% (24,147) are over 65. I will briefly outline four major areas of concern facing this important segment of our population. These are transportation, productive use of free time, housing, and nutrition. Throughout this presentation, I will frequently rely on statistics provided by a survey completed by REAL services in 1969. These figures are still considered fairly accurate since the older population is a stable group and has continued to grow at a steady pace. I am not using the figures to establish a head count but rather to identify the scope of the problems. Experience shows us that these prob- lems are still with us. We feel transportation is a most important area and a most complex problem to solve. When an older adult is without transportation, his mobility is reduced and this can lead to isolation. In St. Joseph County, almost half (45%) of older adults feel that transporta- tion is a problem. The big difference for them is whether thev own a car Yet of those who do, 10% indicate they would prefer other means. Presently, their only alternative is the public transit system. 78 Older adults are entitled to reduced fares (15tf ) on city buses. However, exper- ience shows us that the buses are only useful to those who live on a route and are proceeding to a destination just as accessible. Many older adults may locate close to the center city because services are closer but may then have difficulty reach- ing family and friends in the suburbs. Another difficulty is long waits at the bus b One possible solution could be special routes of city buses established to pro- vide transportation especially for older adults. However, there are drawbacks to such routes We feel thev would be destined to limited success because it would be difficult to obtain a reasonable load factor, adequate scheduling, and con- venient pick-up and delivery. Preferably we want to get as close to the door as P °Hence smaller vehicles, such as mini-buses or station wagons, are required that can' weave in and out of neighborhod side streets. The size would be sufficient since the load would be small, sometimes five or less. In addition, scheduling would be very flexible ; ideally on a call basis. But we question the desirability of establishing an entirely new transit sys- tem when we already have one which fills the need. We are speaking of the taxi companies We would like to see a program to subsidize this idea. Hopefully, the older adult who finds transportation a serious problem, would receive a book of tickets which could be redeemed with a taxi serive. The benefits are obvious. No scheduling problems, door-to-door service, and a high degree of mobility. Obviously, the major drawback is cost. Yet, the gap between what exists and the ideal are so great that improvement is vitally necessary. Whenever we talk of improving the services for older adults, we must take into consideration transportation problems. The best designed and funded program accomplishes little if the recipients cannot use it. Next I would like to turn to the problem of productive use of free time. Basi- cally this area can be divided into two sectors : employment and volunteer services. " At first glance, employment may not appear too serious a problem since over 80% of our older adults indicate they are not seeking nor would they accept work This is not really surprising since most wish to retire when they reach later years. However, this does not necessarily mean income is adequate. Con- sider these figures indicating basic incomes : Less than Perc ^ n V $1, 000 bl.o 3) 0(X) 94*1 :::::::::::::::""""-"- ±> °°° The average income hovers near $1500. Most important is that at least 5% desperately want employment. They have the lowest incomes and need help the most. This translates into a figure ap- proaching 1500. We have also found that another 3000 would accept employment South B^nd and St. Joseph County are most grateful and excited to have just received a~$23,121 grant from HEW unnder Title III of the Older Americans Act to fund an older adult employment program. We are proud that this is the first orant of its kind approved in Indiana. The program will provide job infor- mation job counseling, job development, and job placement services. It is par- ticularly geared toward jobs of a temporary nature and of such low pay (mini- mum wage) that the market would be found uncluttered. J The office began operation August 1. Results for the first month show 70 employers contacted and 47 interviews arranged. From this, 13 were placed od iobs from 200 who either requested information or registered for work. Certainly, it is too early to grade the program. Yet, if we project the firs month of "operation, we see placement of 150-200 older adults in the initial twelve months of the program. In other words, we've placed less than o% oi those who want and need work and are still left with approximately 43000 oldei adults who need help. The older adult employment program in St. Joseph Count* is an important step, but admittedly, the distance left to travel to reach ful success is still great. In addition, we have reason to believe that as the rea] value of fixed incomes decrease, the number who seek work could grow. m Since the desire to seek work is directly related to a low income, and a desire to remain independent, the most urgent and obvious solution is an increase ir benefits to these people. 79 We also Peel other steps are possible, We would like to sec ,-i program estab- lished to utilize the skills and services of retired persons to benefit other older adults and most importantly, provide remuneral iton for services rendered. For example, retired plumber, painter, mechanic, etc. could provide maintenance for homes of older adults. The advantages are many. First, by providing remu- neration we immediately supplement the income. Second, by keeping up the maintenance, we improve the housing of many and in some extreme cases prevent deterioration winch could force the occupant into a nursing home or similar institution at a much higher cost to taxpayers, not to mention permitting some- one to remain in their own home. Thirdly, such a program could conceivably Increase interaction in the older adult community and lead to new friendships and activities. Finally, the payment of at least a minimum wage would make the worker feel more productive. We recognize that this idea needs a great deal of development, but we do not submit it as a finalized proposal but rather as a fair example that those working with older adults in St. Joseph County are actively trying to solve the problem of low and insufficient incomes, but are severely limited without the proper finan- cial resources. Again, we feel that when a person reaches retirement age he should be able to retire without the crushing burden of insufficient income. The preceding idea closely resembles the RSVP proogram under Title VI of tlie Older Americans Act, except that it seeks to provide some remuneration for those involved. However, we plan to actively seek a grant to establish an RSVP program in St. Joseph County. Surveys indicate the potential is real. Already, 15% (Over 3500) are engaged in some volunteer activity and it is esti- mated that the figure could quickly double to over 7000 if the persons who indi- cate willingness w T ere asked and resources were available for such a program. Most amazing is that the figure could be much higher after the program becomes established since older adults tend to be somewhat hesitant in this area but could quickly participate once their friends become involved. Lester Fox, direc- tor of REAL services, is most hopeful that we can have an RSVP program in St. Joseph County but he admitted to me, "We are realistic enough to know that when federal dollars are limited it can be difficult getting to the table the first time — let alone going back for seconds." Inquiries have already been made con- cerning the Foster Grandparent program, also under Title VI of the Older Americans Act, and the reply was simply that funds are not available. It is our hope that these programs can be expanded so that St. Joseph County, and all other communities who desire, can participate fully in the Older Americans Act. Xext, I would like to briefly report on the public housing situation in South Bend. At the present time, there are 327 units exclusively for older adults. These ire in two locations of 141 and 186 units. There is presently a waiting list of between 25 and 30. Previously, this was up to 200, but the recent opening of the L86 unit facility eased the pressure. Hopefully, funds will be released for con- struction of an additional 179 units. It is recommended that a minimum of 50 units be reserved exclusively for older adults. The cost per unit is $100 a month, but occupants pay according to income. Hence, some pay as little as $10 per month, with the average around $30. This includes all utilities. To be eligible, a person must not have assets greater than §8000, nor an income exceeding $3000 a year. This means that over 80% of the )lder adults in St. Joseph County would qualify (or over 20,000) for some type )f public housing. Most of the people in public housing are forced to move because the cost of naintaining their home becomes too great a burden. Older adults often go to extremes (such as not eating) to hold on to their home. However, it must be loted that once a couple or a single person decides to make the move, which n itself can take a year, and overcome a certain period of adjustment, they are nuch happier. As one lady commented, "I'm so relieved. I never thought I would wer live in such comfort at this stage in my life." Indications are that over 85% of older adults in South Bend are satisfied with their housing. Yet, this translates into over 3.000 who are not happy. 3ence, with present public housing, we are satisfying the needs of slightiy )ver 10% of the older adults who need or desire better housing. St. Joseph County has not participated in the housing provisions of the 31der Americans Act. We feel this is primarily due to the problems of federal funding already noted before, and a shameful lag in the establishment of a Commission on The Aging and Aged in Indiana. It is apparent that the needs are present in this area too. 80 Ideally, we should provide public housing for all those who need it and enable others, who wish, to remain in their home. Yet, with high property taxes, and the cost to maintain a home, we are forcing many to move. True, most may be happier once they adjust to their new living quarters. But we question whether economic pressure is justifiable in forcing these people to move. Many arguments are advanced to support the desirability of public housing for older adults. Of course, if ill health or disability enters into the picture, then it may be more desirable to move into public facilities. We must also recognize that a problem of isolation can develop for those who remain in their own home. However, all arguments aside, we still feel that economic pressure should be relieved so that the older adult is free to make a choice. Finally, I would like to report on the progress we have made in the area of nutrition. First, the Meals on Wheels program for the first eight months of 1971 This is a component program which provides nutritious noon and evening meals— 5 days a week— to homebound persons who cannot prepare, or have prepared, adequate meals for themselves. This component is housed in the YWOA. Meals are purchased from Memorial Hospital and delivered by volunteers to the persons being served. Volunteers serve extensively in the administration and implementation of this service. Days of operation ^ Persons served J °2g Meals served 6 *< j£- Volunteer assignments 4 > f dollars. Even if there were willingness to make the investment, here is no effective organizational structure with sufficient power fad influence to undertake the kind of oversight suggested by the fcbove. The accusation that our failure to invest in research, demon- stration, and training- has cost us millions of dollars is not an idle one. The Federal Government, it is claimed, is spending $46.4 billion For programs of special interest to the aging. The total claimed for tesearch and trainmg is $82.4 million or 0.18 percent— less than one- iftli of 1 percent. Actually, it is less than that since the report itself s questionable. However, I would go on to suggest that many programs have taken fiace, have been undertaken with little planning, less control and -lrtually no evaluate research. No other enterprise in our society tould so ignore the research, development and evaluation function, rust a few examples very quickly. t Medicaid. One-third of all medicaid expenditures are being spent br long-term care. Virtually no evaluative research on what is hap- pening to that money. ^ledicare. Millions of dollars are being spent for extended care. S T o study of the impact on hospital cast. Another item, the most prevalent disease among the elderly and n-obably the most devastating is cerebral arteriosclerosis. While there 1 considerable research being undertaken on arteriosclerotic heart lisease, the amount of research being undertaken in the areas of ■ironic brain syndrome, cerebral arteriosclerosis, chronic brain dis- ease, or whatever it may be called is minimal, and vet more older Americans are afflicted with this problem than any other single me. In my prepared testimony I go on to cite some others, and in the nterest of time I will pass over those. We would like to say if a program is worth spending money on, hen we ought to know to what extent it is worth spending money on. limply to spend millions of dollars on activities we feel are worth- fehile is no longer sufficient in a time when there are so many competing md pressing needs. The Office of Management and Budget is properly calling for the application of the principles of program-planning-budgeting systems, rhe OMB wants to know, and quite properly, what are the goals of |e program, what are its long and near-term objectives, what are he measures by which we will know the extent to which the objec- lves have been reached, and what are the activities in which the Lgency will engage to secure those objectives. This will furnish the )asis for evaluation. 86 I would suggest that this kind of research — evaluative or impact research — is extremely important from a political decisionmaking point of view. I hasten to add it is not the only kind of research. For it to be effective, however, there must be an adequate base of infor- mation developed through the research laboratories, universities, and service agencies and organizations that have what small supply of researchers, investigators, and technicians that there are in the country. Xow just a few final words on the budgetary implications. I spent some time in my testimony somewhat critical of the publica- tion entitled "Facts and Figures on Older Americans — Federal Out- lays in Aging for the Fiscal Years 1967-72." Xow this document makes the astounding claim that 20 percent of the total Federal budget is devoted to aging for fiscal 1972. Mr. Brademas. This was not prepared for the Department of Justice, was it ? Mr- Cohen. No, sir, it was prepared by HEW. The report goes on to suggest that of the $46.4 billion devoted to aging, $82.4 million will be spent in fiscal 1972 for research and training. It appears that the Veterans' Administration is really the agency doing all the research on aging since it is doing three times the amount as the rest of Federal Government combined. The Department of Transportation claims it is doing $2 million worth of research on transportation for the aging and yet nobody can find out how they arrived at that figure. Mr. Brademas. if that were true, then there would not be any point in having the action-oriented White House Conference on Aging, would there ? Mr. Cohen. Precisely. Mr. Brademas. On the seventh day we could all rest. Mr. Cohen. That is quite right, sir. It is clear from the diversity of agencies claiming to conduct or sponsor research there is little in the way of a coordinated approach to research activities within the Federal Government, and this is all the more strange when one considers that the Congress made it clear in the Older Americans Act that it intended the Administration on Aging to be the responsible agency for assuring that the Federal Government made every effort to meet the objectives spelled out in title I of the act. The budgetary implications in this are clear. First, there must be a research and education strategy. Second, there must be responsibility fixed for carrying that strategy out or seeing to it that the strategy is carried out. Third, it appears that adequate funding must be provided to carry out the strategy and these funds be made available to agencies geared to undertake or sponsor research in education for the field of aging. And fourth, it is clear that as long as questionable reporting oi expenditures in budgets takes place at least in the field of aging that this will serve only to confuse and perhaps divert appropriate atten- tion from the field of aging and the research and education needs in it. We would like to place before you four recommendations foi research and education in the field of aging. 87 1. We recommend the development of a research strategy foraging proving out of today's facts and what we already know will be tomor- rows realities. The Gerontological Society lias begun such an effort bid while we would not claim that it is by any means the last word \e would recommend that the Federal Government should begin to ft upon it, utilize it, or develop a new strategy. Dr. Havighurst has been very active in that particular category 2. We recommend that the Federal Government develop a method br carrying the research strategy into effect. This will require a iudi- ious mix ol intramural and extramural research conducted in" and trough various agencies of Federal Government. A major focus lowever, should be within an Institute of Gerontology located within he National Institutes of Health framework. We recommend that ferious consideration be given by the Congress to the creation of such n institute, the provision of an authorization of $15 million, and >rovision tor an appropriation for fiscal 1973 to initiate planning for ^rations to begin m fiscal 1974. Much of this money could and hould derive from funds already authorized and appropriated to the lational Institute of Child Health and Human Development ear- larked for ao-incr. 3. A review should be made of previous manpower need assessments, nd conclusions reached about the estimated manpower needs for the ext 15 years. This should lead to the development of a strategy for leeting those needs in aging at all levels of service, research, and iucation. 4. We recommend assignment to the Administration on Aging of fcponsibility for impact research of major Federal programs having ) do with aging. However, we hasten to add that such impact re- iarch cannot be carried out without very substantial additional sources. For example, we recommend evaluation by the Administra- te on Aging of the medical assistance program for long-term care, his should include evaluation of the program of providing Federal ayments for long-term care in mental hospitals furnished under the ong amendments of the Social Security Act, The Administration on Aging additionally should have responsi- bly for evaluation of the operation of State plans for adult services rovided under title I of the Social Security Act. Furthermore, the clmmistration on Aging should be charged with the publications on l least a quarterly basis of a series of statements on the true condi- on ol the elderly people in America with emphasis on the economic, xising, and health care status, and programs designed to alleviate roblems. In addition, there should be specific indication of the proo-- iss that the particular programs of the Federal Establishment are ivmg on these problems. In summary, we recommend that the Federal Government begin look upon expenditures for research and training as investments protect its very substantial expenditures in the health and social el tare area in behalf of the elderly. An investment in these areas Ji have the potential for an improved quality of life in old ao- e lalogous to the quest for the Foundation of Youth. Our quest Is >me what simpler but perhaps no less elusive. It is simply the search r a way to make old age a desirable time of life. (Mr. Cohen's prepared statement follows:) 88 Statement of Elias S. Cohen* Chairman, Policy Committee, the Gerontological Society My name is Elias S. Cohen. I am appearing before you in my capacity as Chairman of the Policy Committee of the Gerontological Society. Currently I am Assistant Professor of Social Administration in the Department of Com- munity Medicine, School of Medicine, University of Pennsylvania. Prior to joining the University of Pennsylvania, I served as Commissioner for the Aging for the Commonwealth of Pennsylvania for 12 years. From 1968 to 1970 I was the Commissioner of Family Services for the Pennsylvania Depart- ment of Public Welfare where I had responsibility for the administration of public assistance, child welfare, juvenile delinquency, services for the blind, and the programs provided for under the Older Americans Act. The Gerontological Society which I am representing here today is the National organization of researchers, educators, and professionals in the field of aging. The members of our Society comprise the expertise on aging in the United States. Most of the new knowledge and information in this field are produced by those who belong to our Society. Appearing with me are Dr. Sandra Howell of Brandeis University and Dr. Robert J. Havighurst of the University of Chicago. Doctor Howell has under- taken some analysis of various projects on nutrition which have been funded by the Federal government and will speak to the importance of research and its utilization in that area, while Doctor Havighurst will speak from his experience as Chairman of the Gerontological Society Committee on Research and Develop- ment Goals in Social Gerontology. My testimony today is concerned with 3 elements : 1. The fundamental elements that comprise the pressing need for a research and training strategy in aging by the Federal government. 2. Consideration of administrative responsibility for research and education activities. 3. Budgetary implactions for research and education in the coming years. It is the conviction of the Gerontological Society that the delivery of services for the elderly must be based upon a secure foundation of knowledge and carried out by those trained to deliver services effectively and efficiently. We are very much aware of the concern of the Congress and the Office of Budget and Management for improved accountability in our service delivery systems Accountability, cost efficiency, quality, and utilization controls are all terms common in the world of commerce and industry. The world of commerce anc industry has learned that investments in research and development and in train ing produce substantial payoffs — not only in the conventional terms of "th( bottom line" but also in terms of producing better products and services. The thrust of our testimony is that the Federal government must begin t( look on expenditures for research and training in aging as an investmen necessary to enable the Federal and State governments to achieve the goals o: what can be a truly great social system. We look toward the day when ol( age will be a desirable time of life. the trends One of the blessings of our society is the unprecedented growth in the numbe of elderly persons. From 1900 to 1970, the number of persons 65 and ove grew from a little over 3,000,000 to approximately 20,000,000. Between now am the end of this century assuming no significant assaults on the major killers o the elderly, the number of those 65 and over will grow to almost 30,00,00( However, if as some of us anticipate, major medical conquests are made oi cancer, heart disease, and cardiovascular renal disease, 15 additional years o life will be added to life expectancy at age 65. This means that average lif expectancy for those achieving the age of 65 will be a little over 30 years fo women and just a little under for men. Assuming major improvements in th life situation of the American black, brown, Chicano, and Indian populatior there will be significant increases among the elderly from these groups. A the present time, the elderly in minority groups are only about 5% of the tots population from which they are drawn as opposed to 10% of all elderly as proportion of the general population. What this means is that the potentials for a rise to 50 or 60,000,000 elderl is not beyond near-term possibility. Furthermore, there will be significant shift * Assistant Professor, Department of Community Medicine, School of Medicine, Universil of Pennsylvania. 89 to the older elements in the aged population; that is, those in the 9th and 10th decades of life. Already critical problems are more and more evident. Indeed, many are the problems with which the Congress is wrestling today. Let me lisl just a few ■ Income maintenance.— approximately % of all of the elderly fall below the poverty line, a line which even if reached does not represent Income sufficient to maintain health and decency. Over 2,000,000 must rely on old age assistance, 35 years after the passage of the Social Security Act which we hoped would see only a tiny proportion of the elderly relying on public assistance for income. What is even more shocking is that the position of the elderly relative to the rest of the population has deteriorated The elderly have not been able to share in the general prosperity even propor- tionately. They have lost ground over the years. Their median income is a smaller percentage of the medion income of the general population than it was a decade ago. Even now the Congress will be considering a monu- mental piece of legislation, H.R. 1, which only begins to address the problem and does not offer much in the way of hope in lifting any significant num- ber of elderly out of poverty or of improving their status relative to the rest of the population. Long-term care.— One-third of all Medicaid expenditures are currently made for long-term care. Long-term care is a program consumed almost entirely by the elderly. Both houses of the Congress have been otutraged at conditions their individual members have found in long-term care facilities in the United States and have worried over the rising expenditures and the apparent failure to produce signifiant improvements in quality Further- more, what the Congress had hoped for when it first passed Medicare and provided extended care benefits has not developed, i.e. relief of hospital utilization. What the Congress had sought when it provided for Federal reimbursement of expenditures for elderly patients in state mental hospitals under the Medicaid Program has not been achieved. Alternatives to lon°- term care and how they can be implemented have not been developed The Congress is properly concerned about what has happened and what has not happened in the area of long-term care. Housing.— The housing conditions of older Americans are poorer as a rule than those of their younger counterparts. More than that, however the debate goes on over types of living arrangements that are best suited- high-rise versus low-rise, congregate housing with meals or without meals residential units with associated long-term care units or without what kinds of provisions for the mentally impaired elderly— the questions so on and on, and the answers are not forthcoming. But the Congress never- theless, is asked to provide funds for varieties of housing, nursing' homes mortgage insurances, and other programs without having the benefit of some answers to which it is entitled. Minority group aging.— The special problems of minority aged are critical The simple fact of the matter is that minority group members have less than half the chance of their white counterparts of living to an old age Minority groups members are robbed of years of life. While blacks onlv have half the chance that whites do to reach the magic vear of 65 Chicanos and Indians have even less. We need to know more about how we can give these groups the same opportunities that we give to whites and why it is that their chances for old age are so poor now Older Negroes' Chicanos, and Indians are more than twice as likely to be poor than aged whites Fifty percent or more are in poverty. Utilization of health resources is less than whites, although health problems are more intense and housing conditions clearily worse. Health.— Congress recognized the health problems of the elderly in a majorway when it passed the Medicare legislation in 1965, and' in its provisions under Medicaid for long-term and certain other supplementary benefits for the poor in general. However, both the health status and the problem of providing for health expenditures are unresolved. The out-of- pocket expenditure by the elderly, that is the amount that the elderly have to spend on the average from their own pockets that is not covered by Medicare Blue Cross, Blue Shield, Medicaid, or other third-party payments is equivalent to the total amount spent by those under 65 for all of their medical care. The Congress has before it a plethora of proposals for new national health insurance programs. The experience in Medicare and Medi- caid indicates to us the need for providing the Congress with more rather 90 than less information about the health condition and health economics, not to mention the systems of services that the ^ll^^,%^ _ f the elderlv rranmnrtation— Finally, we must take note that about ^0% ot tne eiaeny imv^prob ems to moMUty 'ranging from complete confinement to difficulty in -ettin" around alone. This is probably a conservative estimate based lar^elv o.° pbvSl disability without considering the additiona problems of mental impairment and environmental factors such as exist in areas with Ti-h crime rates where the mobility of elderly, weak, and fragile arsons is severelv limited. There has been very limited research under- teken ahout Transportation needs and the impact of lack of mobility on the Thetbove represent only the briefest kind of summary of problems concerning ^t^^Te^oZ^U.e needs are so great that immediate action 1S Hmvlver action based upon hunch and impressions rather than facts may cre^rmonstrousMirograms. Programs and research without adequately trained ^^etsmfntTneed for trained workers in aging conducted trough thj AdmTnisSation on Aging indicated that by ^Z^ritiXvZott „„- t( ,.., wi ii he at a level 2 and 3 times above that of 19o8. A similar report Ssued bv the National Institute of Child Health and Human Development in iffi" indfcated that the number of trained researchers and educators needed to he TZl^l^°~T^itn^ an increased investment in t^lnel .nil nd research in aging. Some studies have indicated that at least 25% S tT~rowth rate" n soc al sciences in the next 5 years should be in gerontology. TlfttenSof'actiye researchers is at about 1000 with a very limited erJw h anticipated A 1967 study indicated that a realistic 10-yeai -goal for Search and education in gerontology would be 5000 doctoral candidates in order to bring the total of active researchers in the field of aging to a level 0l Tho°need for researchers and teachers, however, is just the tip of the iceberg imatiinS of medicine, current and anticipated, have created needs ^r^^J^fndv^TSiVToiessloJials in ^ ins beyond 0Ur current capacities. ing home administrators, and community workers in the field of wn to are eXcaTior [Lategyto produce the needed trained personnel estimated as the requirements for 1980 by the Administration on Aging. CONSIDERATIONS FOR ADMINISTRATIVE RESPONSIBILITY in iTYmr0 vement in the quality of life for elderly people will come about from th" P X exercise of influence and power within the '^^"""j The elderly are affected by many agencies and many policies «f th ^ Federa government The creation of a single agency or a single policy will not resolve government, inec Certain programs are directly concerned with oldei peopfe- SocLl P Secur^, Medicare^ housing for the elderly, old age assistance nZ Medicaid are a few Such programs must be shaped specifically with th mJ^V^S^U^^ their ellments are concerned only with those whe h To T !^S"^e^ire those programs which inMrecUy affect J elderly These include our basic economic policies which exercise control o J inflatmn and employment, programs designed to induce savings or defer income nrolrams to improve nutrition, pollution control (which can have a majoi SK^dteSpSSL. with emphysema, respiratory problems, cardiac : disease and soon), and [support for basic medical, biochemical, biophysical, psychological a ^hT7mUcXns-for administrative responsibility become clear in tins lane of a consideration First, the problems of aging are such that a power J sLial interest advocate within the Federal government is neded. Such an adyo cate must hive the ability to effectively shape policy and program dimension for those programs which concern elderly people directly. Second, it must ha| «.)! he kind of power and influence so that in all programs which may effect elderlj eoplo indirectly, it has an opportunity to participate in the decision-making. »oliey makers thus are confronted with the necessity for making consious deci- ions to opt for or against the interests of elderly people with (he full under- tanding of what the tradeoffs may be. The implications for this in a research and demonstration and education trategy are significant. If we accept the fact, that resources to invest in ;ill irograms are limited and must compete, then we accept the fact that the ollars invested in any program should produce the best payoff. In that con- ext, research, demonstration, and training must he viewed as investments esigned to assure production of services that are accountable, cost efficient, f high quality, controllable, and responsive to need. There has been a general uilure to recognize that research, demonstration, and training make that kind f contribution. The failure to invest in research, demonstration, and training has cost the .merican taxpayers millions of dollars. However, even if there were willing- ess to make the investment, there is no effective organizational structure with ufficient power and influence to undertake the kind of oversight suggested by le above. The creation that our failure to invest in research, demonstration, nd training has cost us millions of dollars is not an idle one. The Federal government, it is claimed, is spending $46.4 billion for programs f special interest to the aging. The total claimed for research and training is 82.4 million or .18% — less than one fifth of one percent ! ! ! Actually, it is less lan that since the report itself is questionable. However, major programs have Ben undertaken with little preliminary research and planning, less control, nd virtually no evaluative research. No other enterprise would so ignore the ^search, development, and evaluation function. A few examples should suffice : Item : Under Medicaid, millions of dollars have been spent in behalf of elderly people in State mental hospitals. There is no research to indicate what good, if any, those millions of dollars of Federal funds, new money as it were, has produced. Furthermore, before the program was intro- duced, no planning or research was undertaken to indicate what was the best way to spend the money or where would it produce the most for older people in state hospitals. Item: Almost one-third of the Medicaid expenditures are being poured into long-term care for the elderdly. The President, members of the House of Representatives, Ralph Nader, and the public at large are properly disgusted and upset with the quality of care in American nursing homes. I suggest that the failure to invest in some research on a fairly massive basis has resulted in the current mess that confronts us. Item: The failure to examine the impact of Medicare on hospital costs and the failure to undertake research on most appropriate methods and packages of treatment to care for the elderly has contributed in no small part to the rapid escalation of costs. Item : The most prevalent disease among the elderly and probably the most devastating is cerebral arteriosclerosis. While there is considerable research being undertaken on arteriosclerotic heart disease, the amount of research being undertaken in the areas of chronic brain syndrome, cere- bral arteriosclerosis, chronic brain disease, or whatever it may be called is minimal. America's nursing homes, homes for the aged, state hospitals and, indeed, the community at large have thousands and thousands of people afflicted with the disabilities that ensue from this disease process. Research into a better understanding of the impact of this disease, its etiology, methods of coping with it from a medical, social, and psycho- logical standpoint are critical to the alleviation of suffering and distress and the wisest allocation of Federal resources toward that end. Item : In the area of medical research the issue is not merely to conquer disease and dysfunction but to delay the aging process which thrusts so many people into medical care facilities and the requirement for expensive medical treatment. Item: Under the service amendments of the Social Security Act, Title 1, states are entitled to reimbursement in the amount of 75% of expenditures for services rendered to old age assistance recipients, former recipients, or those likely to become recipients. Virtually no research has been under- taken relative to the impact of these programs. Undoubtedly, those who have extended services to the elderly claim that they have been beneficial. However, it is virtually impossible to determine in what ways they have 71-272— 72— pt. 1 7 92 been beneficial, whom they have benefited, what alternatives to institu- tional care have been furnished, and so on. How much of it "saved" dollars, and how much of it simply represented the alleviation of suffering? I submit that here, too, the American taxpayer has been shortchanged. Item: In the area of housing, failure to properly research the impact of programs like public housing for the elderly, 202 housing, and 236 housing leave us with the feeling that we're not sure whether these programs should be expanded, contracted., left the same, encouraged, or what. If the program is worth spending money on, then we ought to know to what extent it is worth spending money on. Simply to spend millions of dollars on activities that we feel are worthwhile is no longer sufficient in a time when there are so many competing and pressing needs. The Office of Management and Budget is properly calling for the application of the principals of program-planning budgeting systems. The OMB wants to know, and quite properly, what are the goals of the program, what are it's long and near- term objectives, what are the measures by which we will know the extent to which the objectives have been reached, and what are the activities in which the agency will engage to secure those objectives. This will furnish the basis for evaluation. I would suggest that this kind of research — evaluative or impact research — is extremely important from a political decision-making point of view. I hasten to add it is not the only kind of research. For it to be effective, however, there must be an adequate base of information developed through the research laboratories, universities, and services agencies and organizations that have what small supply of researchers, investigators, and technicians that there are in the country. Dealing with critical problems such as we outlined above requires a supply of trained personnel. As we indicated, the shortages are substantial, particularly in the light of what we suspect may be coming in the field of aging and with the growth of an aging population. BUDGETARY IMPLICATIONS The Administration on Aging has recently published a document entitled, Facts and Figures on Older Americans— Federal Outlays in Aging for the Fiscal Years 1967 to 72. The document makes the astounding claim that 20% of the total Federal budget is devoted to aging for the fiscal year 1972. According to this report, $46.4 billion are devoted in some way or another to aging. The report goes on to suggest that $82.4 million will be spent in fiscal 1972 for research and training (See Table 1). If this were indeed true, one could be very pleased with the efforts being made by the Federal government. However, the material on research like the rest of the report requires considerable scrutiny. TABLE 1. -ESTIMATED FEDERAL OUTLAYS FOR RESEARCH AND TRAINING IN AGING, FISCAL YEARS 1971 AND 1972 BY AGENCY i [Millions of dollars] Fiscal year Fiscal year Agency and program 1971 1972 Differen Agriculture, - 0-5 0.5 Health, Education, and Welfare: Office of Education .. -° •& ■ Public Health Service: NIMH - - 4.0 3.2 -0.1 Health services R.& D.... - .6 .3 -.. NICHD 8.8 7.2 -1.1 Social and Rehabilitation Service: Rehabilitation R. & D - - -6 .3 -.. Research and training (foreign currency) .3 .5 +.< Administration on Aging: Research and demonstration - 2.8 Z.8 Training 3.0 3.0 Housing and Urban Development - -2 . . Transportation -- J-l £}J +■ Veteran's Administration: Medical and prosthetics research. 6L7 62^0 -h Total — - - - - 84.2 82.4 -1. Total omitting Transportation and VIA.. 21.4 18.4 -3. i Fiscal year 1971 estimated as of April 1971; fiscal year 1972 estimate based upon budget request as amended June 1 1971. Source: Facts and Figures on Older Americans— Federal Outlays in Aging 1967-72, No. 4, USDHEW, SRS, A0A (DHE\ publication No. (SRS) 72-20004. Washington, D.C. 1971.) 3 The Veterans' Administration, it would appear, is the agency of the Federal government thai is carrying out the major part of research on aging, indeed for fiscal 72 it claims to be spending (>2 million or more than 8 limes what Hie rest of the Federal government Is spending combined. We respectfully suggest thai (he Veterans Administration is overstating the case claiming that all of its research on prosthetics, medical care, long-term care, and so on is of general use and had some use to the aging. Therefore, it apparently feels justified in Claiming that the bulk of its research activities are activities In pursuit of interests congruent with those of the aging population. The Department of Transportation claims that it is spending $2 million in 1972 on research in transportation for the aging. We respectfully suggest that tbe research being done is for the population at large and that the Department of Transportation is assuming that it will do elderly people some good. If one removes Transportation and the Veterans Administration, we find that the total expenditure for research on aging, granting everything else that is claimed, drops from $82.4 million to $18.4 million. The $18.4 million is $3 million less than the amount expended in fiscal 1971 or approximately a 14% reduction. It is clear from the diversity of agencies claiming to conduct or sponsor research that there is little in the way of a coordinated approach to research activities within the Federal government. This is all the more strange when one considers that the Congress made it clear in the Older Americans Act, that it intended the Administration on Aging to be the responsible agency for assuring that the Federal government made very effort to meet the objectives spelled out in Title I of that Act. The budgetary implications in this are clear : first there must be a research and education strategy. Second, there must be responsibility fixed for carrying that strategy out or seeing to it that the strategy is carried out. It is respect- fully suggested that this responsibility be placed upon the agency designated by the Congress as the agency responsible for concern about the elderly. Third, it appears that adequate funding must be provided to carry out the strategy, and that these funds be made available to agencies geared to undertake or sponsor research and education for the field of aging. Fourth, it is clear that as long as questionable reporting of expenditures and budgets take place at least in the field of aging, it will serve to confuse and perhaps divert appropriate attention from the field of aging and the research and education needs. RECOMMENDATIONS The Gerontological Society would like to place before you the following recommendations for research and education in the field of aging : 1. We recommend the development of a research strategy for aging grow- ing out of today's facts and what we already know will be tomorrow's realities. The Gerontological Society has begun such an effort and while we would not claim that it is by any means the last word, we would recom- mend that the Federal government should begin to act upon it, utilize it, or develop a new strategy. 2. We recommend that the Federal government develop a method for carrying the research strategy into effect. This will require a judicious mix of intramural and extramural research conducted in and through various agencies of Federal government. A major focus, however, should be within an Institute of Gerontology located within the National Institutes of Health framework. We recommend that serious consideration be given by the Congress to the creation of such an Institute, the provision of an authorization of $15 million, and provision for an appropriation for fiscal 1973 to initiate planning for operations to begin in fiscal 1974. (Much of this money could and should derive from funds alreadv authorized and appropriated to the National Institute of Child Health and Human Develop- ment earmarked for aging. ) 3. A review should be made of previous manpower need assessments and conclusions reached about the estimated manpower needs for the next 15 years. This should lead to the development of a strategy for meeting those needs in aging at all levels of service, research, and education. 4. We recommend assignment to the Administration on Aging of responsi- bility for impact research of major Federal programs having to do with aging. However, we hasten to add that such impact research cannot be carried out without very substantial additional resources. For example, 94 we recommend evaluation by the Administration on Aging of the medical assistance program for long-term care. This should include evaluation of the program of providing Federal payments for long-term care in mental hospitals furnished under the Long Amendments of the Social Security Act. The Administration on Aging additionally should have responsibility for evaluation of the operation of state plans for adult services provided under Title I of the Social Security Act. Furthermore, the Administration on I Aging should be charged with the publication on at least a quarterly basis of a series of statements on the true condition of the elderly people in America with emphasis on the economic, housing, and health care status, and programs designed to alleviate problems. In addition, there should be specific indication of the progress that the particular programs of the | Federal establishment are having on these problems. In summary, we recommend that the Federal government begin to look upon expenditures for research and training as investments to protect its very sub- stantial expenditures in the health and social welfare area in behalf of the elderly. An investment in these areas can have the potential for an improved quality of life in old age analogous to the quest for the Fountain of Youth. Our quest is somewhat simpler but perhaps no less elusive. It is simply the search for a way to make old age a desirable time of life. Thank you very much for the opportunity that you have given to us to testify before you. Mr. Brademas. Thank you very much, Dr. Cohen. That is really a very exciting statement and gives Mr. Keid and me all kinds of interesting ideas. Who would like to be next ? Dr. Havighurst, we are glad to see you again, sir. You may proceed. STATEMENT OF ROBERT J. HAVIGHURST, PROFESSOR EMERITUS, UNIVERSITY OF CHICAGO, COMMITTEE ON HUMAN DEVELOP- MENT, CHICAGO, ILL. Dr. Havighurst. You have my prepared statement, and conse- quently I will not read any of that. I will comment on the major questions that your committee has asked and that have been covered already this morning to some extent. I will speak from the point of view of a person who is interested in research and social gerontology, the application of the social sci- ences to the problems of middle-age and aging and as one who is the chairman of the Gerontological Society's Committee on Research and^ Development Goals in Social Gerontology. , We have had modest support from the Administration on Aging for 3 years; we are just finishing our 3-year term of life this fall. The needs for comprehensive social services for the elderly, I think, are clear; nobody seems to debate them anymore. The only question is to what extent should the Federal Government support such serv- ices to what extent should State and local government, and to what extent should the support come from the so-called private sector? I think that it is useful to make a distinction which Dr. Cohen has made in another context between residual support for the elderly or residual aid to the elderly and institutionalized aid. Until about 1950 in our society we regarded the job of assisting older people with their problems as residual— that is, after the familj and after the local community and after the church had done its partr- then those who were still in desperate need were to be helped out by the public purse. 95 The North European countries had long since, abandoned that notion and were already giving systematic institutionalized social services for the aging. Examples of residual aid are old age assistance; that is, welfare aid to older people who are in desperate poverty — and medicaid; that is, paying the medical expenses of people who are in poverty. Since about 1950, wo have moved toward the other notion that social welfare programs should be maintained and supported largely by the public agencies ; that is, that such support should be a normal I irst -line function of a modern industrial society through its govern- mental and also to some extent through private foundations and through the institutions of the church, et cetera. Examples of our movement in that direction are : Social security, which instutionalizes the economic support of older people; pensions provided by both public and private employers; medicare; and we are now moving into the field of what we are calling here the social serv- ices, services to help people live independently at home, with the aid of visiting nurse services, for example, and" transportation serv- ices to enable people to move about more easily and still live at home. So we are committed, I believe, now to the policy of providing a substantial program of social services mainly with public support. There is, however, a problem here in that just as the problem of the medical treatment of the ailments of elderly people is a complex one— < I could go into that maybe if you want to discuss it later. I would, however, have to disagree with Dr. Cohen on some of his points about the possibilities of increasing longevity, but within the area of the social services it is a very complex problem now. Mr. Keid. Let me ask about just one very current problem, Dr. Havighurst. Dr. Havighurst. Yes. Mr. Keid. It is my understanding we have about 900,000 or a million people in nursing homes in the United States, many of which are ' substandard and some are described as being hopelessly substandard. My query: What should we do in terms of new construction here because we are faced with an immediate problem, it seems to me, of people who are now in nursing homes that are a disgrace, firetraps with inadequate medical services, and the like, quite aside from the problem of what we do generally about senior citizen housing? Dr. Havighurst. With respect to the care of people in nursing homes, I don't want to talk as an authority at all. I agree with the group of people who believe that somewhat more careful State stand- ards should be put into effect and laws should be changed in some states with respect to financial support. Obviously there is going to have to be a considerable increase in 1 public support of people in nursing homes who can't afford to pay the costs. I can't indicate how much money. Mr. Reid. What I am trying to reach for is the concept. I think we have treated many medical patients, including the elderly, in a way that can perhaps be called sort of very poor institutionalized care, with buildings that are repulsive, very little concept of developing mixes between the community and those in these institutions who are ;reaHy being put on the shelf and on a bad shelf at that. 90 I was always interested in some of the hospital ideas in Israel where they tried to have a medical institution almost like small homes and sort of part of the community, a very different kind of concept. I am told that the administration now is looking at the possibility of using Army hospitals for those that would be moved out of unsatisfactory nursing homes. It seems to me this is rather the wrong idea. It seems that would be the wrong kind of spot to be. Dr. Havighurst. Yes, I agree it would be only an emergency mea- sure to put nonambulatory elderly people in a large institution. For example, in Cook County we have such an institution. These people are seldom visited by anybody; many of them are entirely alone, anyway. By and large, however, I think that nursing homes have improved a great deal in the last 10 years in our society, and they will go or improving as long as we simply keep alert to the problems. I don't regard the problem of nursing homes as one that is near!} as complex or as difficult as the problems of providing adequate serv- ices to ambulatory people, people who are trying to stay independent and stay in their own homes. Mr. Reid. Thank you. ' . Dr. Havighurst. With respect to the broad area of social service: for people who are not confined in institutions, we are just starting with this. We have not had more than about 10 years of real experience with such services. To a large extent they have come into existence under the auspices of Model Cities programs with some Model Cities support and some financing from the Administration on Aging foi these elements of Model Cities projects. Already now we are finding that there are major problems of providing a battery of social serv ices for the elderly in a county seat, in a rural area, or m a large city For one thing, many of these services get in the way of each other There is competition among the staff members of various services and i has been very difficult to get reasonable coordination m the Mode Cities projects, say, between a nutrition project and a home servic project and a housing project. Mr Reid. I think that is true right up and down the line, and tn Federal level has really no meaningful coordination of various depart ments. T)y TT a VTCITURST. Jl eS. Mr Reid. I, unfortunately, have to go to another function. CouL I ask one general question, not alone of you but equally of Dr. Cone: and Dr. Howell ? . r J I ask you to look at the testimony of Dr. Cohen on pages 10 and 1 of his remarks where he touches on medical research being undei taken in the areas of chronic brain syndrome, cerebral artenosclerosn chronic brain disease, heart disease, and the like. Might I ask just two questions? One, what do we know today aboi this? Is it possible to encourage brain regeneration, if that is a correc term ^ What should we be doing ; what kinds of money should we be spenc ing in research ? What are the hopeful areas ? m t . If we are adding 15 years of life, it would be a very exciting thin* Equally, if we can keep people at a maximum potential more or les 97 llll during those additional 15 years, il would be equally exciting. I just asking a genera] question. One of the problems that I wish you would always recognize, and the reason this testimony is so helpful (his morning, is that the Con- gress' research is very poor, it is minimal. We really need to know what the experts in the hold do know, what we don't 'know, and what, we should do because when we don't know; I think the Congress is fre- quent lv acting in a vacuum. Dr. Havighurst. Well, we social scientists are not experts on the biological aspects of aging, and my own feeling is that Dr. Cohen has exaggerated the possibilities here. There is a controversy among the biologists on (his matter. Dr. Alex Comfort, head of the Group on Aging, I Tni versit y ( tollege London, the English medical specialist in the field of geriatrics, has a somewhat different view than many of the biologists in this coun- try. In a rather useful small article that he has written recently, he has calculated the increased expectation of life that we would get if we solved the problem of cancer and the problem of heart disease and bram-vessel disease and it comes to 2 years, I believe, beyond age 65. There is, we would get a little more longevity but not very much because people die from something else, if they are spared f roni cancer or heart disease and cerebral arteriosclerosis. Many of the more optimistic estimates don't take account of the fact that people must die from something. There are two broad theories of how to extend life. The one is to work on the specific diseases such as cancer and heart disease. My own judgment is that we are already putting substantial amounts of money m this area, and we should continue to do so, but I doubt if we should put much more. Mr. Brademas. I think Mary Lasker might disagree, but be that is it may. Dr. Havighurst. Is t ow the other view, the one that Dr. Comfort and others carry, is that the aging process within all the cells of the body can be altered, can be slowed down by appropriate medicines or elixirs, and we are just beginning to get some notion of how to do :lus. Dr. Comfort, who I think is overoptimistic, says that if we put sub- stantial money into that area of research, we could extend the age expectation of life for people at age 60 by about 15 years. You see, you have a real controversy within the biological group, the dea being that once we get rid of death from things like pneumonia tncl other critical, acute conditions, death usually comes from a kind )t general wearing out of the body cells, and then the most vulnerable rives away, and that the attempt at slowing down the aging process fithin the cells is the way to do it. Mr. Reid. Might I ask Dr. Cohen to comment, because I think he had t view on this matter also, and also Dr. Howell. Dr. Cohen. Well, the point I would like to make, whether one grees with whether it is going to work on extending life by virtue i c 1 on( l uerm g neart disease, cancer, and kidney disfunctions, or whether it comes through improvement in developing the ability of ells to withstand normal aging, the result may well be the same. 98 But that does not take into account the problem of cerebral arterio- sclerosis, about which relatively little research is undertaken. There is one exciting project that is underway, has been underway for some time, that suggests that maybe what we call cerebral arterio- sclerosis is not that at all but is an entirely different kind of disease process called amyloidosis, which is the deposit of certain waxy sub- stance in the brain. This work has been going forward at Warren State Hospital in Pennsylvania under Dr. Phillip Schwartz, who has done a great deal of the preliminary research in this area. A would think that even at this preliminary stage it deserves considerable support. ,.',,. i xi I have suggested that this is the most disabling and the most prev- alent disease among elderly people, and it is certainly one of the areas that elderly people fear most. Virtually no research is going on in terms of the management. Wna is the impact of this disease disability on elderly people, and what 1 the best kind of program ? Mr. Eeid. When does it start to take effect, if you were to guess < Let me ask another question: Allegedly we do not ™f e yen a trac tion of our brain capacity. Is this a disease that would inhibit tn< utilization of all of the capacity? Does it go across the board* Doe it appear to affect only certain portions of the brain « Dr Cohen From what little we know about it, it results irom tn< reduced blood flow to the brain, the dying off of brain cells in mart areas. With some people it has the result of reducing memory, intel lectual functioning. It hits language, and then can go on to anectm| sense of touch, smell, taste, and so on. It can be accompanied by smal strokes as the rupture of small blood vessels, which don't necessarily affect motor and speech and so on, but may affect one emotionally. We don't know very much about the impact or the relationship be tween education and this. There have been some suggestions that edu cation tends to mask the true degree of devastation. We don t kno^ the relationship between this kind of disease and other physical ail ments because we often feel that the mental impairment masks th physical impairment. g # Mr Keid. How do you care for the individual who at certain mo ments is feeling better, has a good night's sleep, or whatever it is, am suddenly is just as clear as a bell ? Going back to Churchill for a moment, I was told that he wa failing, and Bernie Baruch told me that was nonsense, he would no wear a hearing aid and he frequently didn't hear. I spent, I guess, or 6 hours with him one night past midnight, and lie ranged ove the entire world, his memory was very acute, he knew a hell ot a lo more about the War of 1812, for example, than I did. I had no sens at all that there was any real impairment there. I have seen people, even people at death's door, who suddenly nav total recall or are clearly articulate, know exactly what they want t say. This suggests to me that it is not a total impairment because the could not comment the way they do at some moments and not in othei if the impairment was total, it seems to me. Dr. Cohen. Memory is one of the areas we know very little abou how we actually store things in the brain. Mr. Keid. Now you are talking memory; I am talking tunction. have seen people that at moments are not functioning well and l 99 others their functions are absolutely first rate, their coherence is clear, fchey can articulate, they know what they want to say, their power 01 analysis is just as good as ever. I)i\ Cohen. 1 can't answer (hat. I suspect that this is an area in which we roallv know very, very little, and there lias been relatively Little money that has gone into the impact of cerebral arteriosclerosis on the elderly person. Mr. Reid. Thank you. Dr. Howell, would you want to comment a little? STATEMENT OF SANDRA C. HOWELL, M.P.H., PH. D., LEVINSON GERONTOLOGICAL POLICY INSTITUTE, HELLER SCHOOL, BRAN- DEIS UNIVERSITY Dr. Howell. As a psychologist, I would like to sec, in this area of research, along with sensory losses that you are talking about, such as auditory losses which we play down with regard to the aged, some nice, healthy competition with the Russians as with the space race. Shortly after World War II they became very concerned about the return of function of some of their own veterans who had been brain- injured in the service. A physician by the name of Luria did some very creative work in retraining of brain-injured veterans from World War II in the Soviet Union. It is only now becoming somewhat acceptable for physicians, psychologists, psychiatrists with, for example, eld- erly stroke patients to talk about retraining. As you mentioned, we have many of what we call redundant cells in the brain, many of them not ever used. Now the question comes up of how can we go about preparing a per- son very early on in life for the possible use of his brain in an expanded fashion as the dropoff occurs, because brain cells do not rejuvenate themselves like other cells in the body. Mr. Reid. What do we know about the life cycle of brain cells ? Dr. Howell. I think a cellular biologist would be the person to ask that kind of a question of really. I would like to address myself, sir, to one other aspect, and that is some experimental service aspects of what we might potentially do for these kinds of people. One is that, because of the dependence that human beings have on communications and on their brains, any behavior which reenforces their incapacity, such as a locked institutional framework, is going to make whatever their symptoms are worse. I think that we know. Secondly, there are some beginnings of breakthrough in activity re- search at an agency, well known for geriatric servioes,"callecl the Phila- delphia Geriatric Center. They have been bringing these chronic brain syndrome patients together in activity situations which was unheard of a couple of years ago. These are the patients that you left in the back ward in bed, you didn't try to bring them together, you didn't try to dress them, and so forth. We are finding that there is some rather remarkable behavior that comes out in such situations where the opportunity to touch a plant again, to move over cloth again, goes on. So I think Ave have to do much more of that, of looking at these people in service contexts. 100 That is the extent of my comments on that issue. Mr. Reid. Let me just mention one idea that has always intrigued me Some of you have heard Professor Shalit, who was a brilliant youn^ scientist and often studied at the Weitzman Institute and studied a Princeton, but basically his base was the Weitzman Institute in Israel He concluded from studies of his — he was also an expert on som instinct theories — that the nucleus of the atom had a capacity to think And by that he meant that there was a response by the nucleus of th atom which was not a reaction but a choice mechanism wherein ther were several choices which led people to start wondering what is th function of the cell in thought processes. Ben-Gurion used to ask occasionally whether a table could think am what constitutes thought. I don't know whether any of you have stuclie< any of this area, but it is one that always intrigued me a little bit be cause it does suggest things that we don't know about the whole though process and maybe new lines of inquiry that we have not yet dreame< of. That evokes total silence. Thank you very much, Mr. Chairman. Mr. Brademas. I know that we have not heard your complete state ment, Dr. Havighurst ; and, Dr. Howell, we have not heard you yet o: yours, but I do have a number of questions. Would you mind, Dr. Howell, if we included your statement ? Dr. Howell. Not at all. Mr. Brademas. And Dr. Havighurst. Your statements will be inserted in the record in full. (The statements referred to follow :) Statement of Robert J. Havighurst,* Professor of Education and Hum a Development, the University of Chicago, and Chairman, Committee o Research and Development Goals in Social Gerontology, Gerontology Society I am going to stress in this Hearing the need for a program of comprehensb social services for the aging. I will summarize these needs ; comment on the extei to which existing community and government programs meet or promise to me< these needs ; and discuss the importance of scientific evaluation of the varioi service programs. Beyond this I will discuss briefly the place of programs on Aging in the Exec tive Department of the national government; the shortcomings of programs i support of research on Aging ; and the proposal for an Institute on Aging. needs for comprehensive social services for elderly people There is no special value to proving the existence of needs for Comprehensr Social Services for the aging. Several major survey researches give the releva] data. Several national organizations (American Association of Retired Person Notional Council of Senior Citizens, National Council on the Aging, Nation Association of Retired Civil Employees and National Farmers Union) are favo ing such programs. One of the Sections of the White House Conference on Agii (1971) entitled Facilities, Programs, and Services has prepared a Backgroui Paper for use by the Conference, and major recommendations for expanded ser •Research on Social-Psychological Aspects of Aging, 1945 to the present. Chairman Professor of the Committee on Graduate Study in Human Development of the University Chk-aeo since 1941. This Committee has awarded 40 Doctor of Philosophy degrees graduate students in the field of Gerontology since 1948— the highest number among t universities of the country. President of the Gerontological Society, 1957 ; Member of t Governor's Committee on Aging under Governor Adlai Stevenson of Illinois; Current] Member of Advisory Council to the Division for Senior Citizens, Department of Hum; Resources, City of Chicago ; Member of the American Psychological Association s Task For on Aging, 1971 ; Member of the Planning Board and its Executive Committee, The Whi House Conference on Aging, 1971. 101 Ices will certainly conic from the Conference In I December. The U.S. Senate Special Committee on Aging has held numerous Hearings all over the country and heard evidence from people in all walks of life. The Needs. There are three needs of elderly people thai make the difference for them between a reasonable degree of life satisfaction and a life of depriva- tion and despair. These are: 1. Mutually supportive emotional relations with other members of the family. 2. Independent and self-dependent living arrangements. 3. Participation with others in neighborhood, social, church and com- munity affairs. Before these needs can be met, there must be three basic supports: Income enough to purchase the necessities of life and to pursue the activities named above. Health and vigor sufficient to maintain the activities named above. Care by others, when it finally becomes necessary, in family homes, old people's homes, and nursing homes. These three basic supports are not yet provided adequately in the United States. But progress is being made, and therefore it is useful to take the next stei>— which is to provide services that meet needs in the three broad areas named above. THE SERVICES The White House Conference Background Paper on Facilities, Programs, and Services presents the following list of Services which are provided to some extent and needed to a greater extent. Health services Health Services for screening, diagnosis, and treatment of elderly people who can get to a medical center or a doctor's onice. In the national health program which will be enacted by the Congress in the near future, there should be either : (1) the provision of specialized health programs and activities directed solely to the elderly, or (2) special steps to assure that general purpose health services give full and adequate attention to the needs of the elderly in comparison with the needs of children and of other adults. It is clear that the low income elderly have the least adequate health services of any large sub-group in the country in spite of the assistance given by Medi- care and Medicaid. They need eye care and dental care, especially. It is estimated that half of the population over 60 suffer from defective vision which prevents their reading beyond a bare minimum; and that the great majority of them could regain satisfactory vision with appropriate glasses. Also, at least half of the elderly population do not have teeth or dentures which permit efficient eating. Liv ing arrangements Approximately half of the people over 65 live in housing which is either dilapi- dated, too large to care for, or too expensive for their income level. This is 10 million people. The federal government, between 1956 and 1969, constructed or restored special housing for 408,000 older persons. There is an acute problem of housing for at least half of the older persons living in big cities. About one-fourth of all older persons (whether they live alone, with relatives, or with others) are limited in their major activity .This totals between four and five million older persons. To meet their needs, the Administration on Aging supports 447 projects— excluding health services — wiiich reach some 130,000 persons at most. Nearly three-fourths of this total represents friendly visiting and reassurance services ; only 9500 persons receive concrete home help services. A sample study of two million Old Age Assistance recipients (1969) reveals that, m 1965, 85 percent received no services of any kind— other than a relief cheek. Four percent, or 80,000 elderly, received some service to help them main- tain their own homes. Transportation As the needs of the elderly have been explored during recent years the easily- ignored need for safe and convenient transportation has rocketed into promi- nence. The majority of people over 65 do not drive automobiles or are unwilling 102 to drive them. And when they seek to use public transportation, they find this to be less and less available. Thus they are forced into isolation from friends, social activities, and social services. Some experiments have been undertaken in recent months to provide better transportation. The most extensive involve reduced fares on public transportation systems at off-peak hours. Since public transportation has not kept pace with either the spread of cities or the increase in population, such programs hardly touch the basic mobility requirements of an older population. Efforts by the Administration on Aging to stimulate attention to this subject have led to 300 experiments which reach some 75,000 persons. One well-publicized experiment in Chicago succeeded in providing an average of six trips a year for 1600 persons to visit health centers or welfare agencies, to shop, or to go on social outings— an average of once every two months. Nutrition Good nutrition depends on income, access to a well-prepared variety of food, ability to chew the food, and healthy food habits. It is the key element of health maintenance for the majority of older people. Many older people do not provide adequate food for themselves, because they do not have the money, or the kitchen facilities, or the knowledge, or the moti- vation. Therefore the provision of a basic minimum diet has become recognized as a major service need. There are two ways of meeting this need. One is to deliver hot meals to the elderly at home. This "meals on wheels" program has remained at a demonstration and experimental level despite efforts of the Administration on Aging to increase funds for this purpose. There were, in 1970, only 23 such programs supported by the AoA, serving 18,000 hot meals each week. None of these provides more than one meal a day for a part of the week. These numbers may be seen against the two million elderly who are eligible for public assistance. The other major nutrition program is the provision of low-cost meals at vari- ous centers in the cities: housing projects, senior centers, restaurants. This appears to be the most promising way of improving nutrition for ambulatory people. It has the great advantage of providing social contacts, which may be as important people living alone as the calories and proteins and vitamins in the food. Recognizing the importance of this service, the Administration on Aging fi- nancd a number of nutrition projects under Title IV (Research and Demonstra- tion) of the Older Americans Act. On April 27, 1971, Secretary Richardson said that HEW would not extend further funding for 21 nutrition projects. This decision was reconsidered, and on June 14 it was announced that these projects would be continued, with a heavy research component. This announcement came during a hearing on Senate Bill S. 1163, which would establish a national nutrition program for the elderly. The HEW spokesmen opposed this Bill, on the ground that a broad service program for the elderly is needed, not "another categorical program with a focus on only a small piece of the problem." In August, Secretary Richardson announced that HEW would provide $4.1 million to support the 21 nutrition projects and to support two comprehensive social service programs, with nutrition elements. One of these was a program in the State of Florida for programs in the counties: Dade, Palm Beach, and Pinellas. The other was a grant of $1.2 million to the Division of Senior Citizens, of the Department of Human Resources of the City of Chicago. This Chicago project, known as Senior Central, is projected as a 3-year research and demon- stration project under Title IV of the Older Americans Act, at a cost of about $3.6 million over 3 years. Senior centers Places where older people can pass the time pleasantly have been established in cities all over Europe and the United States. They are variously called: Se- nior Centers, Old People's Clubs, Golden Age Clubs, Neighborhood Centers ; they are supported by churches, community organizations, and municipalities. In 1969 there were about 1500 of them in the United States. Many of the projects supported under Title III of the Older Americans Act involve some financial support of Senior Centers. There has also been some AoA support of research to evaluate the effectiveness of Senior Centers. For example, a study of the Charles Weinstein Geriatric Center, which is operated by the Amalgamated Clothing Workers of America, concluded that: the Center serves the relatively healthy among the aged ; the Center is especially useful to elderly L03 men, as a kind of social club; and the function of serving as an activity center which stimulates social activities, handicrafts, arts, etc., does not work very- well with a working-class clientele. The activity center seems to meet, needs Of middle-class rather than the working class people. Multipurpose centers with facilities for health services, employment, recrea- tional activities, and educational activities will probably increase in number; but it is not clear how they can best be financed on a continuing basis; and a good deal of experimentation is needed to lind the most effective programs for various groups of people and various urban locations. Protective and legal services It has been claimed that older people are especially in need of information and legal help to obtain the services and protection that are rightfully theirs. Too many communities leave to chance what happens to an elderly person who tots lost, forgets to eat regularly, loses or squanders his money, or otherwise shows that he needs assistance in managing his affairs. Some of the help that is needed can only come from lawyers. The American Bar Association has a Committee on Legal Problems of the Aging which has made recommendations. The federal government has underwritten demonstra- tion programs of protective services in local public welfare agencies, and about 40 states have provided such services through their public welfare departments. On a more general level, the Office of Economic Opportunity has financed 12 projects under the direction of the National Council of Senior Citizens, begin- ning in 1968. These projects have found ways of using existing legislation to serve older people, and they have helped to get new local and state legislation that helps older people to improve their economic position. VOLUNTARY SERVICE PROGRAMS Many older persons would like to engage on a part-time basis in service programs, either as paid staff members or unpaid volunteers. People are increasingly needed to manage and service retirement housing projects, Senior Center programs, and programs of service to older individuals ; and many people have time, energy, and the economic need to work in such programs. There are economic and social needs to be met by Senior Programs. The several nils now in the Congress deserve the most careful and positive consideration Community service by the elderly should become a recognized role available to ivery older persons who wants to fill it. Small demonstration programs have indicated that the elderly can be constructively engaged in community services Experiments conducted in New York City and in Project FIND have demon- strated that older persons can be recruited and can significantly contribute to the community by helping to introduce Medicare, by providing volunteer serv- ces in institutions for retarded children, and so on. Two hundred programs of Senior Opportunities in Service, in 45 States, affect some 670,000 older persons. The Administration on Aging funds 625 projects tvhich give major volunteer opportunities to 41,000 elderly persons. Sixty-eight r*°S^ r Grandparent Projects placed 4,000 older persons in positions to help Lb 000 children a year. Project Green Thumb provides work for 3,000 low-income elderly m rural areas. It may be a good thing that seven previously separate federally-supported ^olunteer programs have been combined into one agency, ACTION These are • ; eace Corps, VISTA, Foster Grandparents, Retired Senior Volunteer Program' service Corps of Retired Executives, Active Corps of Executives Office of Voluntary Action. CONCLUSIONS CONCERNING FINANCING OF SERVICES There is general agreement, in and out of the government agencies, that all S these services are needed, and should be provided as far as possible It is riL g .T r £ V e f P 12 ? 4 tbat the cost of tbese services will have to be paid rimarily by the federal and state governments. If the services were offered for t^J? fit C0St ' ° nly a few people would P a y tne fe e. Those with adequate £ ™£Jl?f ^e services n ?w, though sometimes at exorbitant prices. Possibly rf thiJ If t?^\^° V l*x? the middle income ran ^ e could P^ at least part L?mo^^^^ not Pay anything, and they are the >nes most generally m need of the services. 104 Therefore we will have to find ways of providing these services under the conditions of the remainder of this century. It is not likely that the grown children of elderly people will provide or pay for more than what they are providing now. Probably the proportion of older people who can afford to pay for services will increase, as social security benefits and pensions increase in purchasing power. Some community agencies — especially churches and labor organizations — will continue to support services for some of their own members. But the major cost will have to be paid from government funds. Therefore a government policy for the support of services for the elderly will have to be worked out. We are now just about ready for the making of that policy. The White House Conference on Aging (1971) will lay the bases. The President has proposed to use the following year for the implementation of the Conference recommendations. We have about 5 years of substantial experimentation with services for the aging, mainly through programs supported by the Administration on Aging under the Older Americans Act. These have mainly been Demonstration pro- grams, through State agencies and through Model Cities projects. In most cases there was written into the budget a requirement for "evaluation," but very little useful evaluation has been done. Generally there has been a certain amount of useful record-keeping, and that is about all. This is part of a pattern that has developed in the United States during the 1960s. Under the War on Poverty and other programs for domestic improvement, such as the Elementary and Secondary Education Act. large sums were appro- priated and used for good purposes. Lip-service was paid to the principle of evaluation of these programs. When the first glow of enthusiasm was over, and the programs came up for re-financing, it became clear that the problems had not been solved, though some often ill-defined progress had been made. At this point, commissions and individuals were appointed by government agencies tc evaluate the programs and to find out what benefits were being derived from the expenditures. These evaluations have been useful, and government funds are now being usee more efficiently than they were five or ten years ago. But the task of evaluation has only just been started. Much remains to be done before we can say that the money spent on education of disadvantaged children and youth is used mosl effectively. Much evaluation is needed before we can say that we know how tc use public money effectually to reduce poverty and its attendant evils. And much evaluation is needed before we can say that we have an efficient program for use of public funds for services to elderly people. Secretary Richardson, speaking to the Special Committee on Aging of the United States Senate on April 27, 1971, said, in this connection : "I was struck in the week's following my return to HEW in June of last year, by the enormous amount of money that has been expended in the last decade for research anc development in all kinds of social problems with remarkably little tangible results. It seems to me, therefore, we should institute in the Administratior research and development fund some new requirement that would help, in the first place, to assure a rigorous assessment of such results and, where they die appear valid or useful, to assure also that they were adequately disseminated "This process has been ongoing and will continue for some considerable time. It has forced a reassessment of the effectiveness of the use of all th( moneys for research and development in the whole range of social services from Foster Grandparents through foster care for children, and from nutritioi through problems of dependency and so on." NEEDS FOE RESEARCH AND EVALUATION In speaking of a need for reassessment of the effectiveness of money used fo: research and development concerning social services, the Secretary was undoubt edly aware that the great bulk of government money for R and D (research ane development) in the area of social services as well as educational and anti poverty'services has gone to pay for "development" and "demonstration" project! which were justified because they proposed to meet an obvious need. Very littl< money was spent on research either to study the lives and needs of older peopl< or to' evaluate the effects of the demonstration projects funded with govern ment money. Thus, in this area of services for the elderly, as well as in a variety of anti poverty projects and projects for education, the Congress has tended to plac< money on programs that looked good, at the start, and then to decrease the leve of support when the results were not all that had been hoped for. 10; Lately in the Administration on Aging and in other government agencies, then 1 lias been more emphasis on the need for research to define the problem more clearly, and to measure the results of experimental projects. This i the meaning, l believe, of the HEW spokesman who told the Senate committee thai the nutrition projects would be financed next year "to Include n heavy research component." in this connection I will report on the work of the Committee of the Geron- tological Society of which I am Chariman — The Committee on Research and Development Coals in Social Gerontology. Our committee has been funded at a moderate level for three years under Title IV of the Older Americans Act, to survey research needs and make recommendations for the support of research in applied social gerontology. We are now writing our third and final annual report. The content of our three reports is described in the Appendix to my statement. About L»r» people who are active as researchers in social gerontology have constituted this committee. We have identified a number of research problems and research areas which we think should have priority for support by funding agencies. We have summarized and evaluated the research already done in the areas, and recommended what we regard as useful next steps. The research areas are : PRIORITY AREAS FOR RESEARCH ON PERSONAL-SOCIAL ASPECTS OF AGING 1. Flexible Employment and Retirement, from ages 40 to 75. 2. Income and Economic Security of Elderly People. 3. Evaluation of Social Services for the Elderly. 4. Living Arrangements of Older People. 5. The Elderly of Minority Groups. 0. Elderly Widows. 7. The Elderly Poor of the Great City. 8. Attitudes of the Population Toward Old Age. EVALUATION OF SOCIAL SERVICES FOR THE ELDERLY A principal concern of our Committee has been the evaluation of Social Serv- ices for the Elderly. In our first report, Dean Walter Beattie of the University of Syracuse School of Social Work wrote a chapter on Social Services for the Aged and Aging: Suggested Research Priorities. Since then we have had a task force studying the problem of evaluation of the services that are now being provided with federal, state and local government support. There are two phases of evaluation of a service program. The phase of process evaluation assesses the conduct of the program without concern for its end re- sults. It asks how well the program was planned and staffed, how much money was spent on one or another part of the program, how one kind of service was coordinated with another kind, how the staff members feel about their work and how well they cooperate with each other. It is aimed at finding out how effi- ciently the program is administered. The other phase— that of product or impact evaluation— tries to find out what effects the program has upon the persons it is supposed to serve. It answers the question— what is the product of the program and does it meet the goals that were set for it? Most of the evaluation research that has been done on social services for the elderly has been process evaluation. This tells us something about the efficiency ot administration of a program, but not much about the effects of the program on the persons it is supposed to serve. There is a special difficulty about impact evaluation. When it seeks to find out what changes have taken place in the per- sons served, often it does not find out what would have happened to these persons it they had not been served. Would they have suffered, or would thev have found other ways of meeting their needs, or would they have gotten along just as well as those who received the service? To answer these questions it is useful to iden- tity and study a comparison or control group, who did not receive that service tfut this is very rarely done in evaluation of service programs. GOVERNMENT SUPPORT OF RESEARCH IN SOCIAL GERONTOLOGY nrt w belie 7 e ? er ?A s , far t0 ° little research bein S done on the social and personal adjustment of middle-aged and elderly people, which aims to lay a basis for effective use of our governmental and our personal resources for increasing the life-satisfaction of people in the latter half of their lives. 106 The comprehensive services that will certainly he provided increasingly by our society for its older people should be continuously monitored. Alternative pro- grams for meeting certain needs should be tried out and evaluated. The priority areas listed above should each be studied with substantial re- search funds. ,_ . . ., , , This will require substantially more research money than has been available through the Administration on Aging, the Manpower Administration of the De- partment of Labor, and the Social Security Administration— which are the gov- ernment departments that have been supporting research m Applied Social Ge in n add < itfon, the National Institute of Child Health and Human Development should either receive increased funds mandated for research in Social Gernotol ojrv or should be replaced as far as research on aging is concerned by a Nationa Institute of Adult Development and Aging. From its beginning the Institute 01 Child Health and Human Development has devoted relatively small amounts t( research in adult development and aging, and we are coming to the conclusioi that gerontology will have to take a very minor place if it is kept in direct com petition with research interests in child and maternal health, and child am adolescent development. Therefore, we favor the establishment of a new nationa institute for research on aging. APPENDIX Publications of the Committee on Research and Development Goals ii Social Gerontology, Gerontological Society REPORT NO. 1. SPECIAL ISSUE OF THE GERONTOLOGIST, WINTER, 1969 Introduction— Elias S. Cohen I Work Leisure and Education: Toward the Goal of Creating Flexible Lif ' styles.— Robert N. Butler, Ross A. McFarland, Jacqueline Falk, Robert J Havighurst II. Living Arrangements of Older People. Ecology.— Sandra Howell, Louis E Gelwicks, Thomas Byerts, Elaine Brody, Irving Rosow III Social Services for the Aged and Aging: Suggested Research Priorities.- Walter M. Beattie, Margaret Blenkner, Robert H. Binstock, Maurice B. Hamc vitch. IV. Economics of Aging.— Juanita M. Kreps, James H. Schulz, Dorothy M< Camman, Yung-Ping Chen. REPORT NO. 2. SPECIAL ISSUE OF THE GERONTOLOGIST, SPRING, 1971 Careers after fifty Career Options After Fifty : Suggested Research, by Juanita M. Kreps ; Wor and Leisure for Older Workers, by Ewan Clague ; Report of a Conference o Flexible Careers, by Robert J. Havighurst. The elderly in minority groups Variant Patterns of Aging, by Donald P. Kent; The Negro Aged by Donald I Kenf Negro Aged: Needed Research in Social Gerontology, by Jacquelm •Jackson; Mexican-Americans, by Joan W. Moore; Americans of East-Asia Ancestry : Aging and the Aged, by Richard A. Kalish and Sam Yuen ; Patten: of Airing Among the Elderly Poor of the Inner City, by Margaret Clark Widows as a Minority Group, by Helena Z. Lopata ; Notes on Anthropologl and the Minority Elderly, by Christie W. Kiefer REPORT NO. 3. SPECIAL ISSUE OF THE GERONTOLOGIST, WINTER, 1971-72 Flexible careers and life styles Personal and Situational Factors Producing Flexible Careers, by James Murra; Edward Powers and Robert J. Havighurst; Career and Leisure Patterns ( Middle-Aged Metropolitan Out-Migrants, by David Busch Oliver ; Career Pa terns of Middle-Aged Blacks in Kansis City, H. L. Hearn ; Career Patterns < Middle-Aged Women, by Helena Z. Lopata 107 Living arrangements: Relations of man-made environment to adjustment in aging Kermit Schooler, Leon Pastalan, Eva Kahana, Lucille Nanemow, Powell Law- ton, Marshall Graney Perceptions of aging Warren Peterson, David Adams, Ellon Robin, Vivian Wood, Vern Bengtson, George Peters, Don McTavish Evaluation of Social Services for the Elderly Jack Sigler, John O'Brien, Merlin Taber, Maurice and Carla Jackson, Marilyn Flymi, Sheldon Tobin Prepared Statement of Sandra C. Howell, M.P.H., Ph. D., Levinson Geronto- logical Policy Institute, Heller School, Brandeis University My testimony last year before this committee related to the surveyed problems and benefits of Federally funded meals programs for the older citizen. I commented, at that time, on the evident pscho-social value of these demon- strations to communities of elderly in those areas of the country chosen for projects. As I recall, I also reported that a preliminary study of problems of these projects indicated an apparent, need for continued public subsidy of meals them- selves, and a particular urgency about additional moneys for some form of trans- portation services to assist the less ambulatory and more geographically isolated aged to gain access to the activity. At this juncture a number of the demonstration group meal programs have been discontinued, some money has been allocated for the continuation of others for one more year on the grounds that an additional year's experience will pro- vide material for evaluation and the development of sounder program models. My appearance today, on behalf of the Gerontological Society, an association or researchers and professional practitioners in the field of aging, is directed pre- dominately at the issue: How do we learn from Research and Demonstration Programs ? This is not intended to be either a short course on the methodology of program evaluation or a criticism of the agency which funds projects for the aging Amer- ican. It is intended as a general statement on change research and its place in public programming as well as a recommendation for policy and organization with regard to programs for the aging American. The meals programs are here being used only as a case example of limited demonstration and less research. As one reviews the 30 some individual grant proposals for group meals programs which were submitted to and funded three years ago by the Administration on Aging, it becomes apparent that a schizophrenia of objectives reigned. As is char- acteristic of this disorder, the dominant feature was a crisis in identity. I will briefly read from several of these objectives, without identification, in order to make the point : 1. "The primary objective of this program is to demonstrate alternative de- livery systems for the provision of nutritious meals for older adults in a setting of congenial social interaction, leading to improved nutritional and social well being." 2. "This demonstration has as its goals a. to determine what activities stimulate elderly . . . rural people . . . to come together b. to investigate and, if possible, alleviate some of the conditions of lone- liness and non-belonging . . . c. to determine whether ... old activities and interests . . . retain suf- ficient cohesive power to bring (people) together on regular occasions d. to demonstrate the relationship between the meal, the activities, and the total sense of well-being and belonging of elderly, isolated rural people. 3. (This program) will provide a nutritional demonstration of means to evalu- ate dietary deficiencies within this aging group and present documented results of the new patterns of nutrition in its educational, social and nutritional aspect, stimulate the aging to desire a meal of nutritional value. 4. Groups will be compared on the basis of changes in attitude and performance, to gain an indication of the time required and the best possible setting for the achievement of changes in (nutritional) attitudes and habit patterns. 5. To demonstrate the effectiveness of the community school concept for senior citizens and to develop guidelines for involvement of seniors in such school pro- 71-272— 72— pt. 1 8 108 grains. To effectively combat loneliness and a sense of isolation by developing means of involving seniors in a wider range of activities and age groups within their familiar neighborhood areas. Although slightly paraphrased, these vignettes of goal statements indicate a responsiveness on the part of communities to the needs of the elderly, on the one hand, and the requirements of the public agency for measures of program effectiveness on the other. You will note that the three major areas of demonstration to winch these projects addressed themselves were : ( a ) Behavior Change (b) Alternative Delivery Systems and Settings, including staffing and Costs (c) Community Impact. The schizoid features of the proposals became manifest in the program per- formances and the reports which emanated from them over the granting period. It has become clear that in an atmosphere of impoverished services to the aged, the provision of socially oriented meals to even a small segment of the population in need became the primary operating objective of virtually every project direc- tor. I would like to explain what is involved in establishing a measure of changed behavior in a relatively difficult-to-control service delivery program and then try to describe what inputs on the part of the Federal and/or state governments would be required to produce effective research and demonstration efforts. BEHAVIORAL AND EVALUATIVE RESEARCH My colleague Frank Caro at Brandeis has written in a recent article that "to assure that changes in measured behavior can be attributed exclusively to the program at hand, evaluative researchers prefer to employ some form of an ex- perimental design. From an evaluation perspective, it is desirable that clients be assigned randomly to treatment and control groups. Adequate control, how- ever, is difficult to achieve in an action setting. There are two obstacles to the effective use of control groups: (a) service orientation — administrators, practi- tioners, and client representatives are reluctant to allow services to be with- held from those who might benefit from them; and (b) self -selection — it is diffi- cult to either refuse service to those who seek it or provide service to those who resist it." He further remarks that "evaluation should be based on the population in need of services" rather than on those who complete the "treatment." We note with concern that the elderly populations in need of nutrition and socialization assistance have not been explicitly designated among either poten- tial or actual participants in meals programs. We also observe that the alterna tive of using comparison rather than control groups, where comparison groups are matched and different treatment inputs or settings are employed, has not been able to be adhered to in the demonstration programs. Behavioral researchers use the term operationalize to denote specifying exactly what we mean by a measure or a criterion. Thus, in nutrition demonstration and research, it would be important to describe just what behavior is to be operated upon and how it is to be measured. For example, if we want to know whether group meals programs increase social interaction among older people we have to have measures of such interaction for participants and non-partici- pants before during and after the program. In addition to carefully designed interviews which sensitively probe such a question, supplementary observation of social interactions is now typically recommended. Service personnel in existing demonsration programs had neither the time nor the training to conduct such systematic behavioral observations. INPUT NEEDS Solicitation of grant proposals from communities representing differing geo- graphic and social characteristics was conducted by the AoA staff. To their credit an attempt was made, despite the inadequacy of funds earmarked for that purpose, to stipulate that evaluative research components be built into each of the demonstration projects. Unfortunately, however, the grant recipients who appeared to be most likely able to organize the service aspects of the program were totally unprepared to conduct a systematic evaluation of its varied seg- ments. L09 quality evaluative p ivh could There are two major ways in which big] be buill into demonstration programs. 1. By provision of a separate trained evaluation team who, from the projecl planning, pro funding phase, would carry oul the full gambit of research ob- jectives, cooperatively but separately from the servicing agencies. 2. By pre-program training of projecl directors and any of the complement of professional program personnel who would be involved in design, maintenance and analysis of records of project activities. I am particularly concerned with the lack <>f research skills among (lie corps of practicing nutritionists, dieticians and social workers in the country. In the social and behavioral sciences we have systematically separated the education Of the practitioner from that of the researcher. Nowhere has the negative im- pact: of that separatism been felt more than in the area of evaluation of social programs. Thus we cannot disparage the client-oriented practitioner for Im- patience and intolerance toward record keeping and research or criticize such practitioners as incompetent, they are not. If the federal government recognizes the need for subsidization of services, let such services be funded openly and an accounting of disposition of funds, only be required for control. If, on the other hand, measures of effectiveness and impact are to be required in order to best allocate scarce public resources, then it is the government's obligation to assure sound and properly financed technical services in each and every demonstration package. In summary I wish to state my position quite clearly with regard to programs for the older American, and particularly meals programs. 1. Income and social-psychological data that we have already amassed indicates, without question, the need for food and group activity programs in virtually every community in the country. These programs ought to be provided as subsidized services on a continuing basis without the mask of demonstration-research. 2. Demonstration-research should be conducted which raises very narrow questions in very controlled setting by trained social researchers. The two objectives, albeit complimentary, must be seen as distinct and sepa- rable functions of government in the field of aging. Mr. Brademas. I will put some questions to all of you. What I was especially struck by as I listened to all of you, especially Drs. Cohen and Havighurst, commenting upon the lack of capacity for research and development in the field of the aging, was the analog I between that deficiency in the gerontological field and the deficiency in research and development in the field of education in the United States. As you may know, this subcommittee has been working on President Nixon's proposed National Institute of Education which has as its purpose the support of R. & D. in the teaching and learning process. And it is my hope that our subcommittee will have been able next week to report a bill out and that we shall consider it when we take up the higher education in the full committee on Tuesday. You, I believe, said, Dr. Cohen, if I recall just from memory, that one-fifth of 1 percent of all of our expenditures on aging are earmarked for research and development in the field. Is that accurate ? Dr. Cohen. That is correct. Mr. Brademas. The analogous figure in education is three-tenths of 1 percent. You may be interested to know we spend about 10 per- cent of all of what we put into the military in this country on R. & D VV e spend at least, I was told, 4.6 percent of all we put into health on research and development in the health field. 1 It ought, therefore, to occasion no great surprise that we don't know as much as we ought to know about the field of the agino- or about the field of education. We are not doing very much about it 110 I was especially struck, also, by your talk about the importance of evaluative research, and I appreciated the quotation of Secretary Richardson's observation at that point. As you were talking, two or three observations came to my mind, of which I will just unburden myself, and you make any comment vou may wish. I had just written down a national institute of aging and obviously was thinking of the model of the ME on which we have been working immediately before you proposed a National Institute of Adult Development in Aging. Then I note, also, that there has been referred to this subcommittee a bill which I introduced, by request as it were. H.R. 3605, the Research on Aging Act, which is advancing biological research in aging. Then I recall, Dr. Havighurst, your expression of concern about what you described, I believe, as social gerontology because my own instinct, and I don't pretend to have expertise in this field, is that biological research is rather too narrow a focus, that what we require here is a research effort that clearly must take into account the bio- logical aspect of the problem and other aspects as well. I would be grateful, therefore, for any comments that any of you may wish to make about this wisdom of our undertaking expanding the suggestion of a biological research institute, which in this bill is described as the Research Commission on Aging, to embrace the broader concept which I think both of you gentlemen were indicating. Could you elaborate on that ? Have I given you enough lead ? Dr. Havighurst. First, let me comment a moment on the Institute of Child Health and Human Development which some people say al- ready covers this field. I came here at the time legislation was pending for the establish- ment of that Institute, at that time I was president of the Gerontologi- cal Society and I spoke in favor of that Institute. Then and even more now it has become clear that that Institute tends to concentrate on maternal health and child and adolescent development, and the sup- port of research and development in the area of a adult development and aging has been minimal in that Institute. Those of us with an interest in adulthood and aging, as well as child development, have been uncomfortable about NICHD. Several times some of us have gone to the directors at the Institute and said that we thought there should be more support of research on aging. The difficulty, as I see it, is that we have this plan within the Gov- ernment institutes of peer, p-e-e-r, scrutiny of research proposals. There is a committee or council that looks at all research proposals and approves or disapproves and gives rankings. Now one understands why that is done, particularly in Government agencies or in Government-supported agencies, but it is almost a sure indicator that you get conservative policies with respect to research because what you have on these councils are people of some estab- lished reputation who naturally judge new projects in terms of their own accomplishments, and the result always is that the safe things get support. The private foundations have been much better in this connection because they have been able to employ people and keep them on the job for a long time and encourage them to take chances. This is a Ill major problem, I think, with respect to research activities supported by the Government, and that is why I go along with my colleagues here and say that I think we must have a Research Institute on Aging because of the fact that Ave are lower in the picking order than re search on maternal health, child development, and adolescent develop- ment. With respect to the combination of support for biological and the social science research in one institute I think that is quite feasible and my own view is that it would be a mistake to set up an institute on the biological aspects of aging alone. There would be severe competition to the Cancer Institute and the Dther institutes already working — heart, and so on — whereas an in- stitute concerned with broad problems of aging I think could prob- ably get a reasonably good balance between the biological and the social science aspects. Mr. Brademas. Two observations on that point before hearing from your colleagues. If it is any encouragement to you, I took part last weekend in a conference on adulthood which was inspired and chaired by Eric Erikson, who, of course, is concerned with childhood. So he appears to be sensitive to the specter. The other observation I would make is that it seems to me as a lay observer that the present fight that is going on in Congress concerning :he establishment of an independent cancer institute may have some iessons for us here because, without trying to pronounce on who is right and who is wrong, the drive for an independent cancer institute seems to this Member of the House to reflect the frustration of many persons in the country at the almost total emphasis placed on basic research in NIH in the field of cancer, if I do not misrepresent the tacts, without adequate attention being given to channeling or apply- ng the fruits of that research to the needs of people in the country. Now, it ought to be obvious we have to have both. I think, Dr. Cohen, you talked about the need for evaluative re- search, but you went on to say that it must be rooted in a data base. Dr. Cohen. That is correct. Mr. Brademas. I think both politically and humanly, substantively is it were, I get apprehensive if we get too narrow in our focus, and [ could just see an institute that was confined to biological research )btaining encounters with some of the same groups that I have sug- gested the cancer researchers are now 7 facing. I don't know if what I have said makes any sense or not. Dr. Cohen. Yes, I would quite agree with the point of view that you lave expressed. Without going over the same ground, I think that vhat we must achieve is a balance. One of the biggest problems we lave in the whole health and human service area is in this region of ■©search utilization, that is, the translation of what the researchers Lre coming up with and its application. If one were to look at the field of agriculture, it would appear at least hat at the industrial farming level we have been able to bridge that rap. Many of our farms are farming as good as we know how, to >araphrase the old saw. So I would urge strongly that if an Institute on Gerontology should )e created, that I would hope that the Congress, whether through its 112 debate on the subject or whether through explicit reference on any authorizing legislation, would make it clear that they intended that this balance exists, that it concentrate not too much on the basic re- search, although certainly yielding that that is important. Xor should it simply undertake evaluation research or impact on what is applied and on the basis of some gut reaction of program framework. Dr. Howell, do you want to comment. Dr. Howell. Just to reenforce what both of my colleagues have said, and to expand in just one area, and that is this business of research utilization. I touched on my own testimony, which you have before you, on the issue of demonstration research or research and demonstration pro- grams within the orbit of service programs. I want to tell you on the basis of some recent experience of my own in the area of environmental planning and housing, that our colleagues in other fields — and I am thinking particularly now of architecture and urban planning, but I refer to this in my testimony with regard to nutritionists and practicing social workers, have very little opportu- nity for this translation of research into their practice. One of the problems we have of measuring the effectiveness or the impact of housing for the elderly, of nutrition programs which are supposed to assauge loneliness is that there is no real contact between the practitioner professional and the researching professional on a continuous basis. So we have a very difficult time getting feedback from the practic- ing architect in the case of housing, from the practicing nutritionist or social worker as to what, in fact, they have done in the way of in- tervention in a program and what kind of effect this has had. We need to have some opportunity, some media, for more communication in these areas between researching gerontologists and the practitioners in other fields who are working directly with the elderly or with prob- lems that have to do with the elderly, and a research institute could facilitate that very well. Mr. Brademas. That is very helpful, and I sense that you are all or pretty much the same wave length here. I wonder, Dr. Havighurst, if you would make available for the sub- committee the reports, the titles of which you have listed in youi appendix ? Dr. Havighurst. They are much too long to reprint. Mr. Brademas. I wanted a set to see if any of them ought to be printed as part of our hearing transcript. Dr. Havighurst. I will be glad to do that. The first two run IOC printed pages, and the one we are working on will be of similar length, I will be glad to send Mr. Duncan two or three copies of the ones that are already out. Mr. Brademas. Thank you. We might not want to put all of them in, maybe simply summarize some of their findings. Just a couple of other questions, if I may. First, you heard what Mr. Bechill said earlier at two points : One the importance of strengthening the role of the Administration or Aging as a policy planner and as operator of programs and as advocate n 1, his call for a program of comprehensive for the aging, and, secoiK services fori he aging. I take it as I listened to your testimony that the three of you would be sympathetic to those two recommendations; in fact, I think some of your testimony, in other words, echoed those recommendations. Dr. Howell. 1 would like to speak to Mud for just a moment because at the Levinson Gerontological Policy Institute at Brandeis we arc trying to plan a pilot of what Mr. Bechil] was talking about with regard to a comprehensive service program in cooperation with the Massachusetts State Department of Welfare. On the grounds that i f we really mean what we say when we say there are people in nutfsing homes and institutions who ought to be in the Community, then we have got to find a systematic way to provide a range of alternatives in services and in living environments out in the community for these people. This can be done, but it requires some piloting, and I would say that if we could do some of this kind of piloting of a comprehensive service program and begin to specify just what the components are and how they need to be allocated, it would be a very helpful thing. Mr. Brademas. It would be very helpful, Dr. Howell, if you would be willing, you and your colleagues at Brandeis and in Massachusetts, to keep our subcommittee posted on what you are doing because I take it you can judge from the tenor of my own questions and those of Mr. Eeid that we are sympathetic to your general lines of recommenda- tions. Would you gentlemen care to make any comments? Dr. Havighurst. I will just say a couple of sentences and then I think Mr. Cohen probably should give the definitive answer to your last questions. With respect to the Administration on Aging, my own view is that it should be increased in its importance in the Department of Health, Education, and Welfare, probably as you had indicated. I also believe that it should continue to have money for research and development even though we might have an Institute on Gerontology. It should continue to have certainly as much or more than the present $2.8 million for research and development in the field of applied social gerontology. One thing that Mr. Bechill didn't say that I would like to add. My own judgment is there should be a position in the Office of the Presi- dent in the White House which is independent of AOA, and the person m this position should have the obligation of studying provisions for the elderly in Government department, particularly in Labor and in Transportation and in HEW. This persons should have the obligation to ask for reports from each of the Cabinet officers as to what is being done in the area of aging and, if dissatisfied with the report, should have the right to ask for an in- quiry. Mr. Brademas. I think I am right in saying, Dr. Havighurst, that there exists, though m rather dormant fashion, a President's Council on the Aging. My spies also tell me that the interest that is generated by this subcommittee during these hearings has been felt at the other end of Pennsylvania Avenue and that if you look at your friendly 114 neighborhood newspaper any day now you may see a new lease on life downtown, at least a new expression of interest in that particular organization. Dr. Cohen? Dr. Cohen. I would like to comment on what Dr. Howell has said. I think that if we embark upon a new program of comprehensive services for the elderly, we will find that we have moved, without any kind of experimentation of knowing what we are after or what we hope to achieve, we find that we have started in on the expenditure of funds where the pit will be bottomless. The Congress is currently dissatisfied, and I think properly so, with what has happened or what has not happened with the service amendments to the Social Security Act. We have an open-end appro- priation for services to go to former, present, and potential recipients of public assistance, We have no idea of what we have done, where the money has gone, what it has gone for, and what the results have been, and so on. I would suggest that if we are talking about the elderly, not that I embrace an entirely utilitarian approach, that we must give this some structure at the beginning, not administrative structure, but program- matic structure, so that if we are going to spend the $400 million that Mr. Bechill suggests, that we have some idea whether it was the best way that we could have spent it, and what did it produce. How did it make life better for the elderly ? I think that one of the ways we can begin to address this is by usfc of the device that Dr. Howell suggests, and I am sure that when she suggests the development of pilot programs, she is also suggesting the early development of a whole set of hypotheses in terms of what these produce and the incorporation of what little knowledge there is in the field, and I think there is a rather deliberate way that we can go about that. As for the issue of structure, I am not terribly keen on the notion that change in structure is going to change the situation. It may have some impact, but in the absence of leadership and commitment from high levels and in the absence of adequate resource allocation, all the change in structure in the world is really not going to amount to a great deal. I intend to stay much looser on the issue of structure. I think that one can make love in a hovel, if I am permitted the metaphor. Mr. Brademas. I just have one other question. You remarked on the shortage of researchers and teachers in the field of the aging. What are the principal institutions who educate the persons who wish to become specialists in this field ? Dr. Havighurst. There is a good report on that in the White House Conference background papers on training by Dr. Birren of the University of Southern California. He lists the 18 or 20 universities that have produced the largest numbers of Ph. D.'s in this field. Mr. Brademas. Well, let me thank all of you— Dr. Cohen, Dr. Howell, Dr. Havighurst. I must say I found your testimony and that of Mr. Bechill and Mr. Miller extremely useful. You have given us some very stimulating ideas which I am going to be sure to share with my colleagues. 115 I must apologize that more of them were no! able to be here) but this is an extremely busy subcommittee and committee, so we must work whenever we can. I hope very much that you will allow our stall' and members of our Subcommittee to be in (ouch with you as we seek to develop some, legislation along the lines of some ol (lie proposals you have given us here today. Dr. Cohen. I would like to call your attention to Dr. Howell's testimony which was developed in the area of requests of staff of some ol' the projects on nutrition in which we understand the committee is interested. Dr. Howell has prepared an analysis and I hope that if you do have some questions on that, you won't hesitate to get in touch with her directly. She is one of the very competent scholars in the field, and we are delighted that we could bring her along. I am sorry that time didn't permit you to hear from her. Mr. Brademas. We have exploited her expertise in a broader way. I )r. Howell, when we get back to Mr. Pepper's bill, you can be sure we will be getting back to you as well, if we may. Thank you all very much. Dr. Cohen. Thank you. Mr. Brademas. We are adjourned. (Whereupon, at 12:15 p.m., the select subcommittee adjourned, subject to the call of the Chair.) TO AMEND THE OLDER AMERICANS ACT OF 19f>5 friday, october 1, 1971 House of Representatives, Select Subcommittee on Education of the Committee on Education and Labor, Washington, B.C. The subcommittee met at 9:45 a.m., pursuant to call, in room 2175, Rayburn House Office Building, Hon. John Brademas (chairman of the subcommittee) presiding. Present : Representatives Brademas, Kemp, and Peyser. Mr. Brademas. Today the Select Subcommittee on Education con- tinues hearings on the provision of comprehensive social services to the 20 million Americans over the age of 65. t In our previous days of hearings, we have heard testimony of dis- tinguished academics in the field of gerontology and also heard from Dr. Arthur Flemming, chairman of the forthcoming White House Conference on Aging. We have also heard testimony of William Bechill, a former Com- missioner of Administration on Aging, who is now at the Universitv of Maryland. J Today we are looking forward to heairng from four witnesses who we are confident will help deepen our understanding of the needs of the aging in the American society and of action which may be neces- sary to fulfill those needs. Mr. Elihu Schott, cochairman of the committee on aging of the Community Service Society of New York, comes to us with hio-h credentials. The society with which he is associated pioneered Project Serve. I understand that my good friend, the distinguished ranking minor- ity member of this committee, Ogden Reid of New York, has been frequently advised by members of the Community Service Society, and to that extent this group has certainly been helpful to our subcommittee m its deliberations on this subject. Miss Elma Griesel, of Ralph Nader's public interest research group, has taken part in studies on the plight of the aged in substand- ard nursing homes, and she continue her dedicated work in organizing a retired professional action group as an advocate for the retired. < The Chair would like to observe how pleased he is to see young Amer- icans involved in such important work that affects older Americans Mr. William R, Hutton, an old friend of this subcommittee, will testify this morning on behalf of the National Council of Senior Citi- zens, an organization which has done exemplary work in protectino- and serving as advocate for the interests of the aging. (117) 118 Our first witness this morning is another old friend of members of this subcommittee, Mr. Bernard Nash, executive director, American Association of Retired Persons, and National Retired Teachers Association. . Mr. Nash, we are very pleased to see you and look forward to hearing from you. STATEMENT OF BERNARD E. NASH, EXECUTIVE DIRECTOR, NA- TIONAL RETIRED TEACHERS ASSOCIATION AND AMERICAN ASSOCIATION OF RETIRED PERSONS Mr. Nash. Thank you, sir. Mr. Chairman, this morning I am accompanied by Mr. Peter Hughes and Mr. Robert Sykes of our legislative staff, and by over 40 members of our association from the local area. This is especially significant in view of the rush hour traffic and problems of mobility that we have been talking about for persons in retirement. Mr. Brademas. We are very glad to see all of you here with us this morning. . Mr. Nash. Mr. Chairman, we have a rather extensive document which we wish to submit for the record. However, I am well aware that you and other members of the subcommittee are some of the greatest experts in America today on problems of the aging. I am aware of your records and of the bills which you have submitted and fought so hard for in the past. Therefore, I don't want to spend a great deal of time going over old material. Rather I wish to give to you some of the feelings and some of the findings of the members of our two associations. Mr. Brademas. If it would be appropriate and agreeable with you, Mr. Nash, we might include in the record the complete text of your statement as if read and allow you simply to go ahead and summarize and make any observations you would care to make. Mr. Nash. Thank you. I would like to do that, Mr. Chairman. (The statement follows :) Testimony of Bernaed EL Nash, Executive Director, National Retired Teach- ers Association and American Association of Retired Persons My name is Bernard E. Nash. I am Executive Director of the 3 million member National Retired Teachers Association and American Association of Retired Persons. No one, capable of contemplating the manifold problems with which we are beset in this country today, could fail to conclude that our society is gravely threatened. War, crime, poverty, unemployment, inflation, environmental pollu- tion, drug addiction, urban decay, consumer safety, constitute but a small part of the seemingly endless and overwhelming litany of current disorders. Each one is a crisis in itself. Indeed, so numerous are the problems deserving the highest priority, that they must compete among themselves for recognition and attention. . Societies which fail to deal effectively with their political, social, and ecomonic problems pass into history. But no society has ever had at its disposal the intel- lectual, technological, and physical resources at the disposal of ours. We are convinced of our ability to master any problem ; only a forming of our will ancl a marshaling of our assets are required. But we are also convinced of the limi- tations of these assets and of the need for selectivity in their allocation. The responsibility for determining the priority structure for resource alloca tion ultimately inheres in Congress. Our priority structure is in need of change and our Associations have repaired to Congress to seek such change. 11!) We are here today to focus the attention of Congress on an Increasingly large and unfortunately neglected segment of our population — the older American. Sit-ins, mass demonstrations, picket linos, and civil disorders are not the meth- ods of the older generations, especially the 3 million persons we represent. We prefer to point to facts, to describe the problems, to offer knowledge and assist- ance, and to rely upon the good judgment of Congress to act responsibly and effectively. Our method is rational appeal ; our goal — education and action. A social crisis is upon us. In the first 30 years of this century, the over 66 age group in the United States increased by 3 million people. From 1930 to L960, the population of that age group increased from 6 to 17 million — an increase of almost 300%. The federal government now predicts an increase of from 33 to 38 million by the year 2000. Dr. Philip Hauser of the University of Chicago expects an even greater increase — 55 million by 2011 — because the children born during the post-war baby boom will have entered this age group by then. Moreover, the impact of increasing longevity, largely a function of developments in medi- cine, is yet to be determined. Significant development in treatment of diseases of the aging has barely begun. Only during the past decade have substantial funds been allocated for research in degenerative diseases — cancer, arthritis, emphy- sema, heart ailments, and bronchial conditions. The projected increases in the senior citizen population will be measured not only in real numbers, but also as a proportion of the total population. Persons under the age of 26 now constitute half the population of the United States. But the most recent demographic predictions indicate a gradually decreasing rate of population growth. As people continue to live longer and fewer persons are born, the percentage of persons in the older age categories should drastically increase, by the year 2011 the proportion of the population in the various age groups may well be reversed. It is imperative that society begin to think about the elderly in new dimensions. The time has come to make aging — the impact of increasing numbers of persons in the retirement age group — a national and com- munity priority. Our present attitude and programs are in need of revaluation, and an emphasis must be placed on improving the quality of life for our burgeoning population of older citizens. Early in the 1950's, school boards and administrators were well aware of the need for substantially expanded facilities to accommo- date increasingly large numbers of children. Yet, the products of the post-war baby boom found the schoolhouses unprepared to accommodate them. If the present trend of inadequate response to the needs of older persons continues, that very generation that was deprived of adequate educational facilities as children, will be deprived of adequate solutions to their needs as older citizens. Our society must undertake an investment of technical and financial resources in solving more pressing human needs. Relief from the poverty of means and the paucity of meaning in the lives of our older citizens must be provided. But perhaps one of the most critical points to be made is a realization of the approaching advances in biochemistry and medical research which will be upon us within the next 5 to 10 years. Although it may seem as if we have generated numerous and complex problems as a result of our conquering the most dreaded of the communicable diseases, these problems cannot approach the significance of those which will flow from a conquest of the degenerative diseases. The potential impact of this achievement, politically, socially and economically, is such that it demands we turn our attention to this matter now rather than waiting until the situation is a reality. We must develop those types of alternatives which will allow social advances to parallel, and be equal to, advances in the medical and biological sciences. NRTA-AARP are deeply committed to success in the development of a na- tional philosophy on aging by this year's White House Conference. We hope that such a philosophy will recognize that older Americans are a national asset— a valuable human resource, whose talents, skills, and abilities should be utilized in solving the problems which plague and perplex our society. But a philosophy alone will not suffice. Too often has the thin veneer of verbal commitment been used to obscure neglect. The problems of aging constitute a major challenge. Success in meeting that challenge will depend upon the commitment we make in redistributing our resources and the prescience we manifest in the strategic application of those resources. A strategy is needed which will comprehend not only the physical needs of the elderly, but their emotional and psychol*gical needs as well. The goal of such a strategy should be harmonious with the aim of our national philosophy — the development of a life of quality for our senior citizens. 120 In its simplest form, a quality life for the older person should permit ful- fillment of basic human physical, social and psychological needs, and a maxi- mum opportunity to pursue individual aspirations. Unfortunately, current reality for the retiree consists of a reduced living standard, loss of activity through degenerative disease, isolation, immobility, loneliness, and rejection. Our society has been prodigal in coercing the aging down the retirement path to depend- ency : the sheer numbers of our increasing elderly population militate against a continuation of this practice. Most older people hope for an opportunity to remain participating, self- sustaining, and respected individuals. Our society must provide a framework for the participation and independence of the older person. In old age, as in all ages life should be filled with hope, confidence, and freedom to act. The development of an effective strategy for enabling the aging to grow, instead of merely growing old, is a necessity. It is up to us now to provide the leadership, virion and creativity essential in shaping the environment in which the older individual may both aspire to a life of quality and possess the capacity to achieve it The challenge is here, and with each pasing day, all of us move inevitably closer to benefiting from, or being victimized by, our own efforts to lirovide a good life for our older citizens. A quality life for older Americans is predicated on the development and implementation of effective programs under the various components of our national strategy. These components should include economic security, adequate health care facilities and services, adequate housing at affordable prices, im- proved transportation services, a rejection of policies of age discriminat ion and new social roles that will utilize the wisdom and experience of older persons To aid in the development of programs under these categories, our Associations offer for your consideration the following observations and recommendations. ECONOMIC SECURITY Mr Chairman, our Associations first wish to direct the attention of this Com- mittee to the single most important problem confronting our older citizens- economi^ ^ security NRTA-AARP expect that an adequate standard of living a trowing problem for today's elderly, will be a major crisis for the elderly of to- So^-Zl^^yejoomvrehe^e and even radical action is soon under- ta 1^1969 the U S Senate Special Committee on Aging reported that the mediJ SSHHBSS »tS»s2 Aging of the U.S. D ^ mr ^ n ] R or TT - 1 ^^ n ' le age sixty-five and over, were that, in 1969, appro™oate£ £8 mdhor people, age y ^ ^ n living in poverty. Although ^he ten y ear d £ d by about one-fifth from sil age 65 or over increased toii«0£t 10 je* rj^ constituting onl; 1°0% Ke P ?S popuSa^but"^ of those" living below the poverty level ^t^W^Wr^&BI&FSZSXS in Poverty. Betwee, Within the older population, e ^ry fourth person lryes in P ov y tinue( 1968 and 1969, while the number of poor person^ an der tb * age^o ^ ^ ^ to decrease, by about 1.2 million or 6%, the number or P » l> appr oximatel: SKffpME S°« overwtre^ow fbe £& level-nearly 75,000 mor, °% SSLtiaties and the t«^^«-1 Perhaps we have been so bombarded with stetabes w^na nrta t^sffi&&s&¥£&*te* system ' s re£usal to all ° 121 eate the resources necessary to save the most, helpless and Least risible portion of our society from the misery and humiliation of poverty. \or do wo And comfort in the projections made fori ho future. More Americans are expected to .spend more years In retirement, ;md the hiatus between retire- ment and employment income is increasing. Medical needs and the burgeoning costs of accommodating those needs, rise with declining health; despite the presence of Medicare and other public programs, thirty-three cents out. of every dollar spent on health care for an aging person in fiscal year L970, came out of the already grossly inadequate income of that, person. Moreover, the eroding impact of Inflation continues to Increase over the ever longer retirement periods. A L969 Report issued hy the Senate Special Committee on Aging Indicates that an annual rise of only 12% may he expected to reduce the purchasing power of fixed incomes hy \s% after ten years and hy 33% after twenty. In addition, private assets possessed hy aging persons are suhject to depletion— a depletion for which no tax allowance is available. Homeownership, usually the most important asset of the elderly, becomes increasingly difficult to maintain with the advance of age, the rise of maintenance costs, and the ravages of prop- erty taxes. Will it take the recurring sight of elderly people with their personal possessions thrown out on the streets before this society and its Congress are moved to action? It would seem that inadequacies in retirement income and the policies and trends that contribute to their perpetuation, should be of direct concern not only to today's older person, but to the middle age worker as well. Low income is not a problem which, given present trends, will solve itself. Certainly it is unrealistic to expect that the majority of workers will voluntarily cut back on his level of consumption in order to save for an uncertain and distant old age, if to do so would require a significant reduction in his standard of living. Timid and tepid measures will not solve the intensifying economic problem con- fronting millions of aging Americans. The absurdities are apparent. Not only does our society coerce the aging into ever earlier retirement with policies and prac- tices of age discrimination and mandatory retirement, but it awards them with poverty when they get there. Nothing can justify such cruel and unusual punish- ment for the crime of growing old. If old age is ever to be more than a period in which people decline and die means must be found whereby the aging, who made their contribution to the S-o e T^ ^irS A ai l d ?S> are guaranteed an equitable share of the fruits of that standard. NRTA-AARP recognize that such guarantee can only be provided through government programs, particularly Social Security, that carry com- mitments for present and future generations of older citizens Ideally, adequacy of income should be defined in terms of preretirement levels of income, but minimally, income should be adequate to permit participa- tion in this country's rising living standard. In the past, income maintenance programs have been designed to keep the elderly population above the poverty level. The past efforts were inadequate; moreover, they failed i The Social Security system must be considered the primary means of improv- !h! * % income position of the aging population. The system, as presently con- stituted, is contributory, with the benefits received by retired workers related to the amounts and length of time these workers contributed to the fund through taxes on their earnings. The Social Security Program was designed to provide a basic income floor under older Americans ; it does little to prevent iTrfr Jn^°%l ° lder , P ?° ple ^ h ° had no ' or only limited ' Participation in the S^Sh f eX ?™ relian , Ce ° n the contri *>utory system must be aban- doned. To the extent necessary, funds from the general revenues must be used nr£ ff neratl0n 7 the conclusion thai whal was required was not merely more medical personnel bul an overall structural change; Unless we improve the system through which health care is provided, care will continue to become less satisfactory even though there are massive in- creases in costs and in numbers of health personnel. Without citing the now familiar statistics about the distance the United States Lags behind many other countries in life expectancy in general, in the mortality rates for middle-age males and infants, and the failure of life expectancy to increase significantly in almost a generation, it is safe to say that, the present medical care system is inadequate to meet demands made upon if, The elderly in particular have been hit hard by the general inflation. When wddiHl to tin 4 general increases in the cost of living, the still more rapidly rising i-ost of health care and the inability of the elderly who are on fixed incomes and who are among the most deprived population in the Country have emphasized (he present inadequacies. By 1970, personal health expenditures 1 for every man, woman, and child in the United States reached $280 per year. Those costs were rising at a rate exceeding 10% annually. As noted above, annual personal health •are expenditures for the elderly population were $791. The elderly are only ("0 well aware that medical costs have been rising at a faster rate than virtually ;my other component of the price index. Since 1959, doctors' fees have risen at twice the rate of the consumer price index, while hospital charges have soared ;if five times the rate. A better educated population has demanded more and more are and higher quality care. 'The system has been placed under severe pressure. While more and more people are covered by one form or another of some kind of tiealth insurance, the fact of the matter is that the rise in the cost of health care s outpacing the budget increases of too many families. If this is true for the general population, it is, in spite of Medicare, especially true for the elderly. The problem is complex. Demand has increased. The number of physicians is nadequate to meet the demand. While there has been a slight increase in the ratio of physicians to population since 1950, fewer physicians are directly en- gaged in patient care. Specialization has drawn a larger proportion of physicians nit of the primary care role. Even if we could arrange for a rapid increase in lie supply of practicing physicians, the demand would not be met. In light of his fact it is unacceptable that laws exist which prohibit the utilization of listing medical manpower resources. For example a physician who retires to mother state is generally prohibited from even a limited practice within that ;tate. For the elderly, the problem is compounded by their increasing economic lisadvantage in the competition for medical attention. By and large, the elderly ire on fixed incomes, and the inflation of 6% or more per year places them in. i disadvantageous position. The inadequacies of the health care system — inadequate funding, maldistri- >ution of service, insufficient personnel, inappropriate delivery systems, in- dention to prevention — all converge on the aging population. Moreover, in many 'ommunities these services are not available at all. The Associations are in agreement with the fundamental proposition reflected n virtually all major plans receiving attention in the current and most recent )ast sessions of the Congress : the medical care system requires substantial and najor revision. These revisions will cover such categories as the benefit to be •eceived by the user, the manner of delivery through which medical services are o be received by the user, the manner of delivery through which medical serv- ces are to be rendered, the quality of those services and care and financing of such a system. The two plans receiving the major attention currently are the Partnership for lealth Plan proposed by President Nixon and the Health Security Act sponsored >y Senator Edward Kennedy. The Associations in developing their own position lave evaluated these two plans on the basis of the benefits they would provide o the older person and the systems they propose for the delivery of health services. While the Nixon plan holds the promise of many benefits for those under etirement age, we have found it totally lacking in provision for — in fact, dis- riminatory against — the individual 65 and over. In addition it omits provision or catastrophic illness for older people, perhaps the most feared eventuality fOr ill persons. This plan also calls for the younger worker to pay only 25% of his „ X K£ ei ! on ?L he ? lth expenditures exclude expenditures for health facilities construction, Uituic health education expenditures, administrative expenditures not related directly to ersonal health care. 71-272 O - 72 - 124 health care premiums, while the older person would continue to be required to pay 60% or more of his health costs. In other words, those with the greatest needs and the most limited means would be the least favored under this proposal. The Kennedy bill, on the other hand, of all the proposals set forward to date contains the broadest benefits for all Americans including those who have reached retirement age. It would provide comprehensive health care, including preven tion and disease-detection services, care and treatment of illness, long-term care and medical rehabilitation for all, regardless of iage or ability to pay. We supporl this approach, viewing quality health care as the right of every American. How ever, we realize that immediate implementation of the Kennedy plan in full woulc be so costly that it could only be achieved through a sweeping reordering of nia tional priorities, which we fear unlikely. It would be possible, though, to imple ment its provisions for the group most urgently in need of such coverage, namelj those receiving Social Security. For those under Social Security age, the Nixoi plan would achieve significant progress at a cost that would probably be mor( acceptable at this time. On the vital subject of delivery of health care services, both the President's proposal and the Kennedy bill encourage health maintenance organization! (HMO's) — 'professional groups organized to provide comprehensive medical car< on an on-going basis to the individual who holds a prepaid contract with tin group. Numerous studies have shown that HMO's are cost-efficient and affor< greater control of the quality of health care provided. In addition, they have th< virtue of a built-in incentive to keep the patient well, not to just treat him whei he is ill. The President's proposal, in our view, makes great progress in the area o health care delivery, allowing the individual freedom of choice in selecting hii source of medical assistance. This permits competition in the field, which is es sential to the maintenance of high standards of health care, and would also serv as an inducement to the improvement of equally essential social services. In essence, the Associations vigorously support the concept of a national healtl plan, but must reject any proposal which fails to meet the urgent needs of olde people. We would enthusiastically endorse a plan which includes the compre hensive care benefits for the elderly contained in the Kennedy bill and the deliver; of services system recommended in the Nixon proposal. I must caution, however, that the promise of action on some form of nationa health insurance does not provide an answer to another critical health problec of particular concern to older persons. Nursing homes Over one year ago, I disussed the serious deficiencies which existed in man; of our nation's nursing homes in an article in our Associations' magazines, Moa cm Maturity and the NRTA Journal. That account carried the title, "The Nurs ing Home Scandal." In the ensuing months, our Associations have been in th forefront of a campaign to correct this major blight in our nation's social syj tern. In an editorial in this month's Association News Bulletins, we note th recent actions by the Administration to tighten up inspection programs an strengthen training programs for nursing home personnel. It expresses on hope that finally the nation may be willing to substitute action for rhetoric i dealing with this cruel social situation. But much action is still needed. What disquiets our Associations, our members, elderly Americans and thei families is that there has been no lack of publicity and public awareness c documented instances of neglect and disregard for personal dignity, non-profes sional and untrained administrators and personnel, federal funds illegally flo\* ing to substandard homes, physicians with inadequate geriatric training, and th absence of compassionate treatment, necessary services and normal activities fc the Institutionalized elderly. There has been no lack either of investigations or recommendations by Coi gressional committees and subcommittees, Executive Branch task forces, intei agency committees and study groups, and public interest organizations. Neither has there been any lack of expressed concern and efforts by our tvv Associations and their three million members. Among our Associations' Legii lative Objectives for 1971, no less than 6 are concerned in one way or anothe with long and intermediate-term non-hospital care. Arkansas Congressman Davi Pryor, whose nursing home crusade is well known to each of you, has conducte special hearings on the subject at three of our Associations' area conferences s far this year. President Nixon selected our Chicago area conference in June t 125 disclose that the federal government was moving to cut off Medicare and .Medicaid funds to sub-standard nursing homes. .Mr. Chairman, l am pleased to announce that next month our Associations', in our continued fighl to improve t In- nursing home situation in this country, ;irc sponsoring, in cooperation with Duke University, a symposium on nursing homes. We feel this meeting, whose participants will be the leading experts in this held, will point the way tow aid real progress in solving the problems so overwhelmingly documented in the past. The results of this symposium will be made available to the participants at the White House Conference on Aging and Other interested individuals. Neither are we unaware nor ungrateful for the past efforts of Congress, the Administration, the Department of Health. Education and Welfare, the Administration on Aging and some progressive states to enact laws and promul- gate regulations for improving nursing homes. Nevertheless, however well-in- tentioned have been our Government officials, the results have been piecemeal laws, many of which unimplemented or unenforced several years after their passage. Again, no action. We are heartened by the President's eight point nursing home program set forth last month in New Hampshire and the new Areawide Model Projects Initiatives, several bearing on nursing home activities, to be operated by the Administration on Aging. While we are optimistic, our experience warns us to be cautious. We will be watching to see whether performance matches promise and commitment overcomes obstacles. I hope it is apparent from the foregoing remarks that we believe recom- mendations for betterment of nursing homes exist in plentiful supply. What has not been evident is action. There are four overriding considerations which I believe are essential to action and applicable to the entire spectrum of nursing home problems. First, we believe it is absolutely vital that there be a single, identifiable na- tional goal embracing both policy and objectives with respect to nnursing home care of the elderly. Piecemeal legislation, half-way measures, and ad hoc efforts are no longer tolerable. Second, we feel it is necessary that responsibility in this area be delineated and consolidated in federal and state governments in order to achieve maxi- mum action, efficiency and an opportunity for redress of patients' grievances. At the same time, we see the federalization of responsibility as the only logical and effective means of eliminating many abuses, setting and enforcing uniform standards, preventing escalating charges, providing training for in- spectors and nursing home personnel, improving and expanding needed services, and encouraging additional nonprofit institutions. This is hardly an unreason- able objective when the taxpayers realize that in 1970 the $2.6* billion nursing home industry was subsidized by more than $1 billion of their federal tax money. Third, while progress hopefully goes forward in bettering the entire milieu of nursing homes — physical, medical, psychological and economical — steos need to be taken to provide viable alternatives to nursing home care. The some- what more than 1 million elderly who comprise 90 percent of nursing home patients, represent about 5 percent of the nation's population over 65 years old. The problem with this statistic is that it does not tell us how many older Americans, who are not in nursing homes for various reasons, are in need tf that service, or how many presently in nursing homes should not be there because they could receive better care at home if the required personnel and programs were available. The shifting emphasis of care from the institution to the home, now transpiring in other countries, should lead us to more intensive investigations into neglected areas of home health, meals, occupational, visita- tion, and housekeeping services. Fourth, and finally, I would challenge government at all levels to give substance 'o the rhetoric of its officials that the elderly are an important national asset. rhe aim of our Associations' members— "to serve, not to be served"— affirms our >wn view that the more than 20 million older Americans are a great resource isking to be utilized. Let Government hire the elderly to help administer pro- grams for the aging, place them on joint councils overseeing nursing home opera- ions, employ them as inspectors, and use them as consultants. You would be lelping them to lead the normal lives they seek besides benefitting from their rast personal and collective reservoir of talents, imagination and experience. Government has nothing to lose but its prejudice. 126 Of course, Mr. Chairman, while it is true that a significant number of old< persons are confined to nursing homes, there are millions more who neither r quire nor desire this type of living arrangement. HOUSING The efforts in the 1960's to produce new housing for lower-income famili through special governmental housing programs yielded less than 50,000 uni a year. Likewise, programs for rehabilitation of housing fell far short of i quirements during the same period. With the rise in population and correspon ing rise in absolute numbers of lower-income families, the need is even great than it was in the early sixties. This increasingly serious problem has had direct affect on housing for the elderly. Figures for the past decade show th even with programs specifically oriented to housing the elderly, supply has n kept pace with demand. It was noted by a Department of Housing and Urb* Development (HUD) spokesman that "in a time when more than 5,000,000 old Americans are estimated as living below the poverty level, and nearly % of the dwelling are found to be substandard, the need for action on the housing pro lem on as many fronts as possible is without question." One approach by the administration has been to phase-out the clear identi of housing for the elderly as special programs. A comprehensive approach wou provide for an across-the-hoard attack on national housing problems and elder housing will increase proportionally as national housing levels increase. A spoke man for HUD has said that "present Housing Assistance Administration poll emphasizes the provision of housing for families with children. While this poli MAY DECREASE THE PERCENTAGE of all public housing units specifical designed for elderly occupance, the number of units for elderly will continue increase." However, as a result of this approach, identity of housing available for t: elderly becomes difficult. Recent reports by HUD show that even now they are i quired to resort to vague statements regarding the amount of housing for t elderly which is being supported by the broad housing programs. In view of 1 years of fighting the Associations and other interest groups have spent trying give the problems of the elderly visibility, to put housing for the elderly into t housing for the general public dilutes the position of the older American to whe he was many years ago. This was not the case prior to the phase-out of the Section 202 housing pi gram. Of all the various federal programs which could have provided additior housing units for the 70's, this program held the most promise and had the mc success. The Section 202 program was specifically designed to meet the needs the elderly. Housing locations where selected on the basis of such factors proximity to transportation, health facilities, and shopping centers. These a important factors if older Americans are to retain their independence. In ad< tion, funds were authorized to be expended for the construction of 'specializ designed features to meet the needs of the older resident, since the requiremei for elderly housing should consider their special needs, loss of identificati within other important programs beyond the purview of HUD. It is important to keep in mind, however, that all of the elderly do not live public housing units. Nearly 70% of them own and occupy their own homi 80% of which are free of mortgages. Unfortunately, many of those are "nous poor" due to low retirement income. Rising property taxes, maintenance, ai other costs are making it increasingly difficult for the elderly homeowner hang on to his home. Real estate taxes plus maintenance costs often exceed t old mortgage payment. Thus, without some sort of assistance, these homeowne may lose their homes, possibly their only asset after a lifetime of work. The loj cal answer, then, is to reduce the burden of property taxes by providing financi incentives to make possible local property tax relief for the elderly-homeown and renter. Because this focus of housing programs for the elderly over the past 10 yea has been to house the poor or near poor through such programs as public hoi; ing and the Section 202 program, a move in the direction of congregation of tl elderly has occurred. But we must remember that the elderly are as varied their living tastes as any other group of Americans. Thus, a paramount requirement for programs directed toward fulfilling ti housing needs of the elderly, as well as all Americans, should be a policy of fr( dom of choice which gives the elderly person the option of apartment or priva 127 residence living, or residing exclusively with his own age group <>r Integrating Into a community with persons of nil ages. We must bear In mind, however, thai do matter what type of housing is made available, wherever large concentrations of elderly persons exist, special services will be required: new housing develop- ments for the elderly ninsl not be allowed to become new "islands of isolation." TRANSPORTATION A real hardship faced by millions of older Americans and so often cited as one Of the major concerns of the elderly, just behind Inadequate income and Hie high cost of health care, is lack of mobility caused by Inadequate or Inaccessible transportation. While our society becomes more mobile with each passing year, the older person becomes less mobile. This transportation crisis results not only in forced isolation of the elderly but intensifies many other problems experienced h.v older Americans. Lack of mobility can result in poor nutrition because it is inconvenient to go to the grocery store, disassociation, withdrawal and loneli- ness it is inconvenient to attend church, visit friends or relatives, or participate in other group or community activities. Lack of mobility may also result in poor physical and mental health because it is inconvenient or impossible to visit the doctor's office, community health centers or outpatient clinics. Transportation problems experienced by older persons fall into three major categories: design, economics and availability. It is a problem of design since many older persons are severely limited in their ability to walk, climb steps or stairs, stand, see, hear, or even to open doors. These physicial limitations have not been a consideration in vehicle or terminal design. It is a problem of econom- ics In that many persons over 65 live in or near poverty and the cost of public or private transportation is prohibitive. It is a problem of availability in that mass transit systems which provide the least expensive mode of travel, are nonexistent in many areas of the Country. Moreover where available, routing, scheduling and location of points of access are determined with the worker, commuter and the younger more mobile shopper in mind. The President's Task Force on Aging, in recognizing the transportation needs of the elderly stated that "it is as important for the nation to develop or have developed special transportation arrangements for older persons as it is for the nation to meet their income, health and other needs." We w T ere particularly pleased that the Urban Mass Transportation Assistance Act. signed into law last year, took special recognition of the problems of the elderly and handicapped. This recognition that new and existing mass transit systems must meet the unique needs of the elderly is a step in the right direction. The special motorsensory problems of the elderly require a program to effect better vehicle and terminal design and afford better information services to the elderly on transit systems as well as on highways. Some contend that it is much too costly to do these things for just one group. Others reply that the benefits accrue to all users. For example, improved hand-holds in buses or transit vehicles, wider doors, better signals and improved information flows, though important and vital for the elderly, provide considerable improvement and benefits to all users. From the standpoint of economics many localities have instituted programs of reduced fares for older riders during non-peak travel periods. We applaud these programs and urge their adoption on a nationwide basis. Likewise we encourage the adoption of similar interstate modes of transportation. In the area of availability, clearly more public transportation is needed. Moreover when planning the location of public transit systems, concentrations of older persons should be taken into account. Lewis Mumford, in an essay on transportation which appeared in The New York Times for Monday, March 15, 1971, said : "The prime purpose of passenger transportation is not to increase the amount of physical movement, but to increase the possibilities for human association, cooperation, personal intercourse, and choice. "A balanced transportation system, accordingly, calls for a balance of resources and facilities and opportunities in every other part of the economy." What Mr. Mumford says about transportation in general is especially perti- nent when we talk of transportation and the older people. No one approach- not dial-a-bus, not reduced fares, not car pools, most certainly not escalators or moving sidewalks or fast-cycled elevators— is going to penetrate to the core of the problem. 128 Mr. Chairman, what we are really concerned with here is the mobility of the older person. While we have addressed our remarks primarily to the area of mass transit and public transportation, we must be cognizant of the fact that mobility also implies concern with the design of public housing, public buildings, pedes- trian crosswalks, the opportunity to operate one's own automobile when able to do so, and a general recognition of the special needs of the older person. Society must take into account the impairment of sensory and motor perception in the aging person and the psychological barriers which make him fearful of leaving home ; in short, society must undergo a change in attitude to effect a realistic, lasting solution to the problem of mobility of the elderly. The elderly are first people ; second— elderly. We must take into account their right to service. SOCIETAL ROLES Turning now to the subject of societal roles for the elderly, I should like to cite the Foster Grandparent Program, one with which I know the Committee is very familiar, as an example of the type of activity and role which can be undertaken by the older person. This program, originally funded by the Office of Economic Opportunity and subsequently administered by the Administration On Aging, has been one of the most successful programs of its type ever initi- ated. It has had a significant impact on the participating older person, on the institutionalized children, and on the community in which the program has operated. The entire concept of Foster Grandparents is to provide children with the companionship of an adult who has the time to give them individualized atten- tion and to assist them in the process of early development. This, of course, is critical in an institutional setting where the pressures on staff are so great that they must devote most of their time and energies to maintenance and disci- pline. The entire institutional routine is designed for efficiency and economic operation. The children eat by the bell, go to sleep by the bell, and behave as a member of the herd. This does not make for the development of strong, healthy adult Americans. The Foster Grandparents are each assigned two children and work with these same two youngsters 4 hours a day, 5 days a week. Their job is to assist them in the process of socialization and accultura- tion. Their love and their affection for these children is contagious. Dramatic results occur. Doctors and hospitals say that their little patients are recovering faster. Directors of institutions for the mentally retarded find that they are able to release children back to the community or even discover that some of these children are indeed not mentally retarded but socially retarded. Thus, we save the county thousands of dollars from lifetime institutional care of such poorly diagnosed individuals. This is critical. Most people think of tender loving care in connection with the Foster Grandparent Program, but as you well know, Mr. Chairman, the program is designed to meet a need. It is actually almost a therapy program but it is a therapy whose benefits are enormous. Dr. J. Iverson Riddle, Director of the Western Carolina State School, did a cost benefit study for a period of one year. He found that the tangible, measur- able benefits of the Program are twice the amount that the project itself cost. He pointed out a savings of some $131 thousand were the actual outlay for the Program was $69 thousand. Other similar reports have been made by direc- tors of other institutions, day centers, school programs, etc., utilizing the elderly to work with the young. In addition, it was found by the Utah Medical School that the older individuals serving as Foster Grandparents were sleeping better, eating better, using less medication, and had less health care cost. Is this not an example of the type of goal which we are seeking for both children and older adults in various programs funded by the federal government? In any discussion of societal roles for older persons we must keep two ob- jectives in mind; they are providing services for older people and providing older people with opportunities for service. I have discussed the Foster Grand- parent Program as an example of the type of service which can be provided by older people. A comprehensive nutrition program would be an example of the type of service which can be provided for the older person. Such a program should not only provide a daily, adequately nutritious meal, but it should also fulfill related needs such as recreation, consumer education, health counseling, welfare referral, social inter-action, etc. What is important here is not just the establishment of a program, but the necessity for a follow through on all related aspects. 129 [t is not enough to set up special programs for the older persona and then Ignore this resource when designing other programs. A recognition of the cod tribution which can be made by the older persons si be built Into all govern mental undertakings. The older American is one of thegreal untapped resources of the Nation. We must realize this fact and respond accordingly. To do other wise is a disservice to our country and to countless older persons who will con tinue to suffer early senescence or institutionalization due to forced withdrawal, inactivity, and loneliness. AGE DISCR] MI NATION The primary responsibility for enforcing the provisions of the Age Discrimi- nation in Employment Act of L967 was placed hy Congress upon the Secretary of Labor; a failure to discharge effectively that responsibility is indicated by the record of performance (see Secretary of Labor's Report to Congress- January 29, 1971). In fiscal year 1970, over two thousand Investigations of in- stances of alleged discrimination were undertaken hy the Department of Labor; yet, from the June 1968 effective date of the Act, less than twenty suits have been initiated pursuant to that law. Admittedly, age discrimination may he very subtle and difficult to investigate and prosecute under the Age Discrimination Act in its present form ; but diffi- culty in enforcement is no justification for an abdication of responsibility. It is for the Congress to determine by appropriate investigation whether the Act is ineffective and unenforceable and, therefore, in need of amendment. The present record of performance is clearly unsatisfactory ; the intent of Congress— largely ignored. NRTA-AARP have come to recognize that despite our continuing efforts to gain increased social security and railroad retirement benefits for retirees, any such gains are quickly eroded hy inflation with the net result that the unat- tractive and often unacceptable economic position of retirees remains static. This cycle must be broken. Our Associations recognize that substantially better coordination and more imaginative manipulation of this country's monetary and fiscal policy will be necessary if the United States is to achieve and maintain the rate of growth necessary for a "full employment" economy. Obviously, an economy in which jobs are plentiful will be the most effective remedy 'for ameliorating the problem of age discrimination and mandatory retirement. NRTA-AARP intend to scrutinize Executive Department and Federal Reserve Board actions and Congressional legislation (i.e. appropriations, revenue shar- ing, welfare, tax, public works, etc., to determine its probable impact on the economy and its ultimate effect on inflation and job availability. Morever, we intend to continue our efforts to obtain federal funding of effective job training programs open to elderly workers— that the full potential of our older citizens willing and able to work will be utilized. It will remain the policy of our Associations to vigorously oppose any practice if age discrimination. Specifically, we urge Congress to undertake a thorough investigation of the effectiveness of the Age Discrimination in Employment Act of 1967 and of the effectiveness of the administration and enforcement of that Act by the Secretary of Labor. Moreover, we shall continue to oppose and urge the repeal of any upward age limit on eligibility for protection against discrimination on the basis of age alone. NRTA-AARP are presently, considering the adoption of a program to support any of our members' legitimate claims of ase discrimination under the provi- sions of the present Act before the Wage and Hour Division of the Department of Labor. Supplementing our policy on age discrimination, NRTA-AARP intend to de- vote special attention to the growing practice of mandatory retirement. On July 29. 1971. the House Committee on Po«t Office and Civil Service favorably reported H.R. $085 which proposes to pive the President authority to estab'ish maximum ige limits for federal jobs. We decry this attempt to delegate authority to dis- ?riminate, and urge the Congress to defeat this insidious bill. The widening grap between retirement and employment income, the prevalence 3f poverty and near-poverty among millions of older Americans, and the absence ■>f prospects for any substantial improvement in the income position of retirees nake the status of retirement unattractive and often unacceptatfe. Yet, the miplovrnent alternative is becoming less available. The United States still lacks i definitive, effective poMcy to achieve the maximum utilization of older work- ers ; both the government and private industry seem to regard ever earlier re- 130 tirement, which, in many cases, is coerced unemployment, as inevitable or ever desirable. To argue that mandatory retirement will provide more jobs for younger work- ers is to admit that our society cannot effectively utilize the talents, skills and abilities of an increasingly large number of its citizens who must, consequently, be relegated to a position of dependency — an ever increasing burden to those remaining in the labor force. Such waste is intolerable. The remedy for anj paucity of jobs should be proper stimulation of the economy, that all who are able and willing to work, may have the opportunity to do so. The prospect of inadequate retirement income and the absence of an ac ceptable alternative contribute to the economic insecurity of workers approach- ing retirement. Rather than considering the enactment of mandatory retirement statutes, the federal and state governments should take appropriate action tc increase employment opportunities for older Americans. Society suffers fron this failure to adopt and implement policies to assure a lifetime of satisfying and productive employment to all who wish to avoid the usual retiremenl pattern. NRTA-AARP believe that much of the retirement taking place in the economj and society is counter-productive, wasteful, arbitrary and often disfunctional tc the individual. The right of the individual to pursue his life's work and therebj realize his full creative potential must not depend solely on the arbitrary anc often irrational factor of age. Our Associations are not against retirement ; w< are against forced retirement. There is much to be gained from a national efforl to raise our productive capacity and simultaneously provide meaningful jol opportunities for older people. NRTA-AARP favor a society and economy ii which the individual worker will have choices and alternatives under acceptable conditions — this, we think, is the essence of freedom. Before leaving the subject of discrimination, I should like to bring to th< Committee's attention a situation which is in need of investigation. The fact that older people are being discriminated against in the matter o: credit has been strongly indicated through our membership correspondence. W< found that credit cards are often unavailable to people over 65, and loans an( mortgages are not granted generally to older people. The casual buy-now-pay-later tone of the American marketplace touches thi lives not only of those who habitually use credit but also of those who clinj tenaciously to old-fashioned cash buying. Lately, everyone has suffered the in flationary effects of what may well be an overdose of consumer credit. Despite the highest interest rates in history, installment credit contracts continue t< finance vast amounts of buying. In the second half of 1970, consumers wer< plunging deeper into debt at the rate of $126,802,000,000 on installment credi extensions, and by the end of June 1971, the total consumer installment credi picture was $127,388,000,000. Much has been said of the way consumer credit accelerates economic growtl and provides the material comforts of an affluent society. But little has beei said of the hardships of the older citizen who is denied credit because presen loan criteria discriminate against him. For example, banks, credit unions, de partment stores and mail order houses are reluctant to extent credit to a persoi who has reached the age of 65 regardless of credit rating. Credit discriminatioi is degrading particularly to the elderly who tend to be extremely responsibl and scrupulous in the conduct of their financial affairs. Our Associations do not have the authority to look into the nation's credi discrimination policies, but we are deeply concerned about a policy which re stricts credit to those over 65, and we urge Congress to utilize its power ti investigate this situation. CONCLUSION In conclusion, Mr. Chairman, we 'believe that the nation must move — an< quickly — from rhetoric to resolution of the social crisis created by the burgeon ing population of older Americans. To do so, we cannot longer tolerate a piece meal armroach to the problems I have discussed. All of these issues — income, housing, health care, transportation, employmen and societal roles — are now comoonent parts of a mosaic of need. The need wil not be met until we discard component resoonses and adopt a systems approacl to deal with the problems of aging in America. Many of us hoped that the creation of the Administration on Aging in 1961 would provide such a coordinated approach. It has not done so for lack of au thoritv. funding, leadership and Executive and Congressional support. We al bear part of the blame. 131 The Administration on Aging Is m beginning. A partial structure baa been ere ated. However, we have learned ilia! there is now needed an additional com- ponent to thai structure so thai the structure will become a system. An authority is needed at the highesl level oi* government to fulfill the functions of national planning, coordintion, budget development and review and overall program eval- uation. This authority must work with a Presidential council composed of repre- sentatives of both the departmental secretaries' offices and non-governmental in- terests in the fleld, the Office of Manpower and Budget and with the Executive and Congressional branches. The Administration on Aging should he retained hut must he upgraded and strengthened. It should carry the principal responsibility for fulfilling at the op- erational levels the objectives identified in the Older America/is Act and the recommendations of the 1961 and the upcoming 1971 White House Conference on Aging. It must, he given the authority to establish standards and regulations in areas affecting older and retired Americans and it must he given enforce- ment authority to assure that our national goals are achieved. It must con- tinue to he the agency to work with the state governments hut also much more attention must he given to non-governmental organizations in the development of programs and the delivery of services. A beginning has been made. Let us as a nation now move with the decisive- ness and creativity required to make this "the end of the beginning." Mr. Nash. Mr. Chairman, I am deeply concerned not only with pres- ent problems but with the direction in which we are going in the field of aging, and I would like to set a conceptual frame of reference for us today so that you will understand some of the concerns, the frustra- tions and desires of our 3 million members. Our society has been dealing with this problem for quite a number of years now. The first conference in Washington was in 1950, and here we are 21 years later calling another conference and hoping that it will do some good, but having some serious questions in the back of our mind. I returned recently from Zurich, Switzerland, where there was an international symposium. The principal subject there was the control of the human aging process. The scientists were discussing not whether we would have a breakthrough in extending man's life, but when. It was a general consensus at that meeting that we may have an extension of life of up to 10 or 15 years, within 10 or 15 years. There was practically unanimous agreement among biochemists and physicists and physiologists at this meeting that if we didn't extend life, at least we would improve the health of people during the prime years of their life. This brings the social scientist to some very sharp and serious ques- tions as to whether or not we are dealing with aging in component parts or whether we are dealing with its impact by and on the entire system of our society. Let me use an analogy here. When you are in this room and a light goes out, you can change the light bulb. That is changing a component, and you will increase the light in the room again. But if all of the lights go out m this room, we cannot change all of the light bulbs and get light again. We have to take a look at the system, not the components. A generator may be out, the wiring may be bad, there could be too much stress— an overload— on the system that needs attention. Our contention at this point is that our society needs to look at the :otal system in relation to the retired and older person rather than simply tinkering with the various component parts independently. If we do not do this, sir, I am very concerned that not only will the oresent generation of older and retired persons continue to suffer the nequities that they do, but that we will, in fact, have a serious crisis— 132 economic, social, political — on our hands within 15 to 30 years. It wil be one with which we cannot deal, component parts, or with a band-ai< approach or in a crisis environment. This is why we are so pleased that this particular committee is doin^ all that it can to try and approach the problems in a broad system manner rather than simply on an individual component basis. In 1900 our Nation was approximately 125 years old, and ther were 3.3 million people over age 65. Within the next 30 years tha number doubled. Mr. Brademas. Would you repeat those figures? Mr. Nash. Yes, sir. In 1900, when our Nation was 125 years olc approximately, we had 3.3 million people over the age of 65. Withi: the next 30 years, we doubled that figure. We went to 6.7 million. From 1930 to 1960, we went from 6.7 to 16.7 million persons, an from 1960 to 1970, from 16.7 to 20 million people. A 3.3-milhon m crease. After 125 years of our history we had 3.3 million and afte 10 years of our most recent history also a 3.3-million increase. Th number of retired persons in America today is increasing at th rate of over 800 per day net gain. This is especially startling when you note that all of the majc labor contracts negotiated during this past year, called for a reduce age of retirement, often in the 50's. So that not 800 per day, but perhaps in the thousands per da: will be entering the retirement age group in the very near futur And the average time spent in retirement on a fixed income will t 25 or 30 years rather than the present 15 years. As a matter of fact, the Federal Government this past year h* encouraged early retirement by civil servants by offering financii inducements and other special benefits. Now, if this trend continues, our society must be prepared to coi structively utilize the knowledge, the skill, and the free time of persoi in this age group or we are going to be increasing the cost of media care, the cost of mental health problems, and other costs related 1 idleness, boredom, and purposeless existence. This is already evident, sir. Studies that have been done m tl welfare system indicate that individuals who are kept active ten to be healthier. Persons working in a foster grandparents prograr for example, were given physical examinations prior to their enti into that program and each year for 3 years, under the guidance < the medical school at the University of Utah. Findings are that the are eating better, sleeping better, are more mentally alert, and partic pating more in the community in addition to the contribution the are making as workers in the program itself. , The New York City Welfare Department has recognized U economy and the necessity for meaningful activity for good ment and physical health. They finance over 50 centers in the city ot JNe York where persons can engage in a variety of activities. The individuals utilizing those centers are taking less medicatio are less cost to the welfare department for mental and physical ser ices than those who are not participants, who are not active in the programs. A So it is obvious that we need to come up with some answers to tJ problems of longer life and earlier retirement. 133 Today's retirees are very much concerned with our entire society. As persons age, they broaden their scope of* concern from self to their children and their grandchildren and for the kind of heritage that they are Leaving to t hem in society. So numerous are the problems deserving priority today that, un- fortunately, older persons are not given the appropriate attention and recognition that is critical to the well-being, not only of themselves, but of our total society. A responsibility for determining the priority structure for the allot- ment of services and the activities and programs in the United States ultimately lies with the Congress. At least they are looked to by the average citizen. Congress can also set the stage, Mr. Chairman, for a partnership among the total community, a sense of priority among the people of our society. Government programs on aging to date have not been effective in leading to this kind of a relationship. There has been much talk but relatively little effective action. We believe that our associations have been very effective in bring- ing about a partnership with Government agencies in a few areas. I would like to describe two or three programs to you for these are ex- amples of dealing in systems changes rather than focusing only on component parts. For example, in consumer affairs, members of the associations have taken instructions on handling consumer problems and we have de- veloped a consumer desk program. We have worked with the Presi- dent's Council on Consumer Affairs, with the American Banking As- sociation, with the Social Security Administration, and with HEW. Our volunteers, persons in the retirement age group receiving no in- come, are manning desks in various parts of this Nation at the present time. It is only beginning. There are only five cities that have these desks at the moment, but there are several others that we are working with. Individuals that have problems can come in and, from their own peers, get information or direction on how to obtain relief from their problem. The Internal Eevenue Service, 2 years ago, indicated that older persons were not taking advantage of some of the tax laws designed for them and that some were in fact cheating themselves out of right- ful returns in their taxes. They were also making mistakes in the forms they were submitting. Thus, we asked our members to volunteer to take training from the Internal Eevenue Service and then offer their advice and guidance to fellow members in helping to complete tax I forms. Last year this program got off the ground and 20,000 individuals (were helped through this voluntary cooperation of the Internal Revenue Service and our membership. They have been so effective that our associations received com- mendation from the Internal Revenue Service. | It is not the total answer, but it is one answer within the system :hat we need to develop to a greater extent. Mr. Chairman, I believe that if we can devise a variety of programs pf this nature, both with the Government taking a look at the systems md our associations working in cooperation with you, that we can 134 begin to attack two of the fundamental problems: the poverty o1 means and the poverty of meaning in the lives of so many persons in the retirement years. Too frequently we address ourselves to one and not the other, ye they are closely interrelated. I would like to address some specifics with respect to the kind o: issues paramount in our society at this time. Obviously, economi< security is No. 1. We have done much to identify the basic needs of people and tin numbers in need, and other such "facts," but I fear that at times w< have given so much emphasis to statistics that we have forgotten wi are talking about human beings. We have also forgotten what ou real objective is. For example, we have been addressing ourselves ii the social security system to establishing a basic floor for payment- yet we have been so desperate that we set that floor at the povert; level. In a publication, which the chairman contributed to, that came ou recently, our association reported interviews with 46 national leaders We asked them what they think the basic problems, barriers, am potential solutions are re options for older Americans. I want t underscore the word "options," for we are seeking alternative ways t solve problems and for alternative choices from which the 20 millio] older Americans might choose. Mr. Brademas. That is an impressive document to which you hay made reference, Mr. Nash, and unless there is objection, and I thin] there will be none, I am going to ask that it be included as a part o the transcript of our hearings. (The document follows:) 135 46 NATIONAL LEADERS SPEAK OUT ON OPTIONS FOR OLDER AMERICANS (Prepared for the 1971 White House Conference on Atfin*>- by The National Retired Teachers Association and The American Associ- ciation of Retired Persons) THE BOOK To make this book possible, 46 leading Americans granted spe- cial interviews to discuss spontaneously and in depth their thoughts and feelings on one of the most urgent issues of our national life today— growing old in America. The book is made up entirely of excerpts from these inter- views. It culminates a project begun almost a year ago when the National Retired Teachers Association and the American Associ- ation of Retired Persons set out to "bring together the views of America's most perceptive thinkers and shapers of action" as a jnique contribution to the 1 971 White House Conference on Aging. The purpose of the book is to probe, with the help of these Dutstanding participants, what attitudes and institutions form the stumbling blocks that prevent even the most basic needs of our Dlder population from being met. The book grew out of the NRTA/AARP conviction that the real work of the 1971 White House Conference on Aging must not be merely to restate the "needs" of older Americans, which were exhaustively established at the White House Conference of 1961. Instead, the prime goal of the Conference should be to identify Darriers to action and to seek ways of removing these barriers. In order to achieve the most balanced judgments possible, :he interviewees were chosen almost equally from within the field Df aging and outside it. Thus, it would be possible to show the Droblems of aging in their own terms, but also in the context of he wider world where they must compete for attention and com- nitment. We were, quite frankly, overwhelmed at the response we received in both categories— at the willingness of the experts both n and out of the field to give so generously of their time and to delve so deeply into their own basic attitudes about aging in our society. We would like, at this point, to comment briefly on the format )fthe book that resulted. In editing the material, our intent was to cluster a variety of hought and reaction around each issue, almost in the manner of 136 a dialogue by proxy. Therefore, we divided the excerpts into statements dealing with only one question at a time, and so an individual may be quoted several times in the same section, 01 variously throughout the book. To gain full impact from this inter- play of the ideas of our distinguished participants, we arrangec the quotations entirely according to their relevance— to each othei and to the issues. We chose to develop the book in this form because there is something compelling about thought-in-flight. From the re- sponses recorded here, we feel that the whole complex many- faceted reality of growing old in America emerges— briefly bu vividly— suggesting, perhaps, new combinations, new approaches new solutions. Suggesting ways to remove stumbling blocks, to crumble barriers. This was our sole aim for the book. Naturally, as the larges membership organizations for older people in the nation, NRTA, AARP have strong positions on all the crucial issues confronting the Conference. But these have been documented and are beinc distributed separately. For the volume at hand, the Associatioi viewpoint has been reflected only through inclusion of Bernan E. Nash, NRTA/AARP Executive Director, among the interviewees And so, the statements stand entirely on their own, and con tinually revealing. Sometimes the quotations form a concensus, sometimes i controversy. Some are sharply negative, some guardedly opti mistic, some are full of hope. The entire spectrum is here and W( have endeavored to present it exactly as it emerged. But to us, the most exciting thing about the book— and fo the White House Conference, surely, the most important thin* about it— is that overall the feeling of hope prevails. We dedicate this book to that hope, to nurturing it and help ing it mature into action that will bring real and measurable bene fits to all older Americans. 137 "...a share in abundance. jj The Income Crisis Retirement Employment We haven't yet decided what we expect as a culture of the older retired persons, and I think, in addition to that, we haven't decided what we will permit him to do. Traditionally, the older person in the community had a role in that he had lived longer, he therefore had more experience, he was wiser... he knew where the tigers were in the jungle. -Nathan W. Shock 138 Income Crisis It might be feasible now to get all of the older people above the poverty line. —Clark Tibbitts Poverty is a pretty low goal. Who wants to reach poverty? —Elias Cohen The Income Crisis in Aging Means: Living below the poverty level for 5 million Americans over 65 —one-fourth of that age group. Living below the near poverty level for another 5 million. Being "poor" for the first time for one in two retired workers. Receiving an average monthly Social Security payment (in 1969) of $100.40 Economically we are creating a situation in which we fear growing old because we will be poor. So economic changes in society have to occur. — Bernice Neugarten Imagine, it has been estimated that in the Nation's capital 44 out of every 100 older citizens have access to less than $1,000 a year. It's really criminal. —Robert N. Butler It is criminal in a country like ours to expect people to live on $70 a month. It's inhuman. -Ethel Shanas 139 We are extremely far behind the times . . . Unless we can begin to get that message across to people who pay the bill, we can't overcome these obstacles. For ex- ample, 22 nations of the world had Social Security before the United States went into it in 1936. And when we went into it in 1936, these 22 nations had medical care too in some measure. -Robert N. Butler What I'm contending is that man, as the only complex animal on the face of the globe, has created a 20th Century demo- graphic and technological world in which he is still trying to learn how to live and thus far not too successfully . . . that this demographic and technological world has precipitated many problems: environmental, physical, personal, social, economic, and governmental ... and that the chaos which afflicts the world today, including the United States, of which the prob- lems of aging are simply one element, is likely to get a lot worse before it gets better because we are attempting to deal with our 20th Century problems with 19th Century atti- tudes, values, institutions, governmental structures and proc- esses. And my hope is that by the 21st Century, our leadership and the American people will hopefully have entered the 20th Oentury. -Philip M. Hauser People can't possibly live on Social Security, which is an inadequate support system. -Robert N. Butler The assumption is that Social Security will continue to in- crease, mainly to take care of the increases in the cost of living. There has been no major increase in real benefits. That's been the problem in Social Security. It's inadequate and has to change. -James H. Schulz Assuming the enactment of H.R. 1, you will have had a fifty percent increase in the level of Social Security benefits since January of 1968. I don't necessarily mean that's going to be our final answer to the proper level of Social Security benefits, but it's a very substantial improvement, considering that since January 1968, we have had a price increase of about eighteen Percent. -Robert M. Ball Social Security has confused purposes. It's not clear whether it's a pension plan or an insurance program. It ties up lots of funds, billions and billions of dollars worth of funds which are not being used adequately. -Anthony J. Wiener 71-272 O - 72 140 The guaranteed minimum income- confronted by: an Economist the Commissioner of Social Security the Chairman of the Senate Special Committee on Aging *\....the contributory system ought to be abandoned. It should never have started. The only reason I don't advocate abandon- ing it in total is because it would be too difficult to do. There are two basic ways to help people who have retired. One way, which I have advocated for many years, is to have a universal minimum income support administered and operated by the federal government, financed entirely out of progres- sive taxation on a pay-as-you-go basis. This is simple, direct, fair and easily supportable by the reve- nue resources of the federal government. A second basic approach would be for everybody receiving a pension or annuity under any federal legislation to have that adjusted to two factors: (1) the changes in the cost of living plus (2) an allowance for a productivity factor, regardless of whether they were working or not, the concept being that they should not only get adjustments for the cost of living, but should have a real payments rise with the increasing output of productivity of the economy per capita. This would be the same idea as a wage earner getting a wage increase based upon nationwide productivity and the cost of living. Actually, I don't propose to go into the new system entirely. I've already said that it seems to me impractical to try and wipe out the existing Social Security contributory system be- cause it's too deeply vested. So I'm not suggesting that it be wiped out. I ask that this new system be superimposed upon that to make up the difference between what it yields and what ought to be yielded and that the difference should be financed by the new method-on a pay-as-you-go basis out of progres- sive taxation. How quickly could it be done? That's almost like asking how long will it take to get rid of poverty, or how long will it take to have a peaceful world. It could be done quickly if we had the right federal leadership. If I could pick six people in the country of political importance or other importance and get them to really educate and agitate on these problems— in other words, if they simply had the guts to do so— the country would accept the proposals within two or three years. —Leon H. Keyserling 141 2. / think there are several very exciting things that are right now under discussion and I would certainly think the Confer- ence would react. One proposal that the Administration recommended, and that is in H.R. 1, is for the first time in our history, to have the federal government say it will have a program 100 percent federally financed, 100 percent federally administered for the aged of the country, which will guarantee a minimum level of living. At the present time, about 20 percent of all the people in the country who fall below the Social Security measure of poverty are people over 65. Now this is a major step in the direction of saying that, over time, the federal government will establish astandard below which noonecan fall. Of course, this is a standard which takes into account other income. So, I would hope that when you look at the Social Security system —combined with this guarantee on a means test basis— that you have between those programs, really for the first time, the basis for saying we are on the verge of abolishing poverty for the older people in this country. —Robert M. Ball 3. All at once it became apparent that there was a way to con- nect Social Security and Old Age Assistance to abolish wel- fare for the aged in one stroke. One of the problems that we haven't been able to overcome in the past has been built in the Social Security system itself. There has been a strong reluctance to fund Social Security benefits out of general revenues; the feeling being, I think, that once we depart from the system of connecting benefits with the payments actually made into the fund, that the sky would soon become the limit. And therefore the proposals in the past to substantially increase benefits, particularly for those in the lower levels, have run afoul of this issue. Now I think we have come up with a formula that probably would not have been forthcoming but for the general concern over the need for welfare reform. At present, welfare is administered by 50 different agencies in 50 different states with 50 different sets of standards and this would be no loss. But, in proposals to eliminate welfare, which is funded directly out of the na- tional treasury, a bridge was brought into view. And that was to substitute for welfare a supplemental payment funded out of general revenues, thus leaving the Social Security fund itself intact so that it remains actuarily sound and subject to the same internal discipline as before. So I think the review of welfare as a whole gave us the key, this year, for actually making Social Security do what was intended when we first passed it thirty years ago: mainly to permit all retired people to have at least a minimum income above the poverty line. —Sen. Frank Church 142 And meanwhile . . . we tend to rely on the combination of Social Security and the welfare system, or the welfare system alone, to guarantee a minimum income for old people, but lots of old people won't apply for welfare. -Juanita M. Kreps ... but lots of old people won't apply for welfare. Only 2 million of the 7 million elderly who are impoverished are on public assistance, and I've been trying in this city (Washington, D.C.) to get those who are not registered, regis- tered. We have even a worse situation. Of our 31,000 who are believed eligible, we only have 8,000 registered. It's partly out of pride. Some of our laws have to be changed. There are liens on one's home, one's burial insurance, life insurance; there is a responsible relative clause which gets into the act. Let's say that you have a son who makes $9,000 a year (about typical American income) with three children and you know that if you ask for public assistance, the public assistance will simply get in touch with him and ask that he help take care of you. Chances are that you won't even go to public assis- tance and you won't go to your son, either, to try to get him to help you. So, the responsible relative clause is a very signifi- cant obstacle. Those kinds of practical things I would love to see come out of the Conference. I'm just not very optimistic that practical steps like the elimination of certain types of statutes, anti-group practice statutes, public lien statutes, re- sponsible relative statutes, segregation pattern statutes, will get attention. -Robert N. Butler We do a great disservice to our nation and to the potential of its older people if we see the problems of aging only in terms of poverty. One issue I would call your attention to is that you can't gen- eralize about 20 million people over 65. What we can say is that economics are the most critical concern of people when they get into a life period where they don't know the length of that period, but do know the limits of their earning power and savings. That makes economics a more pertinent concern in the decision-making of your advancing years. Obviously, it has to be considered the Number One priority. —Bernard E. Nash 143 We've never agreed in this country on the definition of poverty, whether it's an absolute or relative concept, and I sympathize with the person who's always had a good income and who has adjusted to his standard of living, who finds that on retirement his wife must cut back substantially. I don't think we ought to reason that those people are not suffering, because that's exactly what they're doing in terms of the solution of that problem. -Juanita M. Kreps The poverty question doesn't have any age. There are poor people, young and old, and the program that deals with that has to be an anti-poverty program and it shouldn't have any age relationship, and a negative income tax would provide basic incomes to people regardless of age. —James H. Schulz The point is that you simply have to accept less income dur- ing the working years if you want more in the non-working years . . . People who have been highly productive all their lives and had good incomes have to be willing to spread their lifetime earnings more evenly during their lifespan so that they don't concentrate it heavily during the working period and then have too little for retirement. To reallocate income, you could do it only on a year-to-year basis. That is to say, this year you've got a trillion dollars in consumable goods, and it's going to be shared by all the people who are living this year. The distributive mechanism that you adopt will allocate this year's supply of goods and services in terms of the income claims people have. You can give more income claims to retirees through the Social Security mechanisms; but if you do, you must tax it away from the taxpayer. If you don't do that and try to raise all in- come faster than the productivity provides, of course you get inflation. How do we get people to agree that those who have lower incomes should have them raised and those who have higher incomes should have them lowered? I think the difficulty we have in understanding redistribution is created by the way the Social Security system works. We reason that we pay into a fund and, 20 years from now we get it back. 144 Well, for bookkeeping purposes we do that, but in reality when I pay my Social Security tax this year, that is a drain from my purchasing power (which presumably reflects my productivity) and into the purchasing power of, let's say, my parents. Now, my parents have the dollars and I don't. When I get to be old, my children— or somebody else's children— will pay the tax and I will have the dollars. The only question at issue really is how many dollars you want this group to have relative to how many dollars you want. You can make it come out any way you want through the tax mechanism. -Juanita M. Kreps / advocate a pension system that's based, not upon the elimi- nation of poverty, but upon guaranteeing the worker a certain minimum replacement of earnings in retirement . . . For instance, I would like to see a 50 percent earnings replace- ment as a standard of the Social Security system as a matter of policy, and this would be a very important change. It would mean that the guy who got $10,000 would be guaranteed $5,000 from Social Security, which is much above the poverty level. Unless there is a fundamental change in the pension system, we will have with us people who are middle income and up- per-middle income retiring with pensions which are a very low proportion of their prior earnings. These people are feel- ing the pinch, not because they are living in poverty, but be- cause their preparation for retirement has been inadequate. They are poor, relative to their previous standard of living. They retire and their income is cut back sharply. They may be getting $4,000 a year which, by present day standards, is above poverty. If that $4,000 is related to a standard of living based on pre-retirement earnings of $10,000, then that person is suffering a relative deprivation as a result of the fact that the pension system does not replace a sufficient amount of earn- ings. Their cost of living did not drop dramatically when they went into retirement. Therefore, they experience a sharp drop in living standards. This is a very real problem and, unless there is a fundamental change in the pension system, one that is going to stay with us for a long time to come. 145 Now some people are solving that problem. For example, the United Auto Workers, have private pensions which, when added together with Social Security, would mean good earn- ings replacement. But, this is only a small minority of the peo- ple retiring in the future. -James H. Schulz The private pension system militates against mobility . . . Many of the private systems provide for complete loss or high forfeiture if you move from one job to another. This isn't sound. -Leon H. Keyserling A great many people arrive at the end of a working career in our mobile culture, having worked for substantial periods of time for several employers, but without having accumulated any private pension rights at all. This is unfortunate and ought not to be possible; and yet private pensions are just what the name implies, they are pensions established by private com- panies and there is a certain reluctance to move into that field and say to private pension funds, "You have to do so-and-so, or you have to do this or that," tending to bring governmental intervention into the picture. On the other hand, the private pension field is too important not to be sure that private pen- sion funds are protected. —John B. Martin So, the private pension system, if it's going to survive, has got to improve these provisions to allow workers, as they move from job to job, to retain their pensions. —James H. Schulz Okay, we can talk about mainstream, middle-class America and we can do nice things for mainstream middle-class Amer- ica in aging, but let's not think for one bloody minute that it's going to solve any major problems for the vast bulk of the aged in this country, about 50 percent of whom live below or near the poverty level. Now, just forget it-it's not going to do jt - -Margaret Clark As these issues become identified, we find solutions and sometimes these are very inadequate solutions, but the fact that we've opened the door to the issue means that eventually we may resolve it. -Bernard E. Nash '. . . over the year of 1969, 200,000 older Americans fell below the poverty line. 200,000 more people!" -Robert N. Butler 146 Retirement Today's older American has better health, more skills, better education, and a more intense zest for life than his grand- father ever dreamed of. He should not— and will not— accept a philosophy of aging which puts him on the shelf. Society's leaders, in business, labor, government and the professions, should forget their own fears of aging and abandon the out- moded 19th Century concept of what aging is now and will be in the future. —Sen. Winston L. Prouty I wouldn't trade 15 Alexanders at 21 or William Pitts at 23 for a Holmes at 80, in terms of human values. If you took the human product through history— art, beauty and wisdom, and those who produced it at an age above 60— out of our civilization, it would just be a civilizationwide disaster. We can't write it off. —Ramsey Clark IS COMPULSORY RETIREMENT VALID? Six Experts Answer "No!" The notion that people must retire in order to make room for the younger people, I think that's quite obsolete now. The dynamics of our economy are such now that that need not be a problem. But we have made it a problem for the elderly. The Social Security system, for example, was devised originally in the depression years when half the justification was to get the elderly people out of the jobs and onto retirement rolls so that the young people could go to work. All of that has dis- appeared. You have the system that was devised in that period, that still retains the retirement test, that penalizes elderly people for working. And if you earn more than $1,680 in any given year, you begin to get penalized on your Social Security payments. This is utterly unrealistic with the prices being what they are. —Sen. Frank Church 147 I think what's happened over the last 70 years is that many arrangements have become too highly structured. By that I mean that something that was good for 55 or 60 percent of the people became the basis for 100 percent. What we are trying to say now is, okay if it's good for 55 or 60 percent let it still be good for them. But let the other 40 or 45 percent do something else. There is no need for these kinds of arrange- ments-everybody retire at 65, everybody live in the same kind of house, everybody go to Florida or California. Give people more choice, more options. Unstructure it, loosen it up a bit. -Wilbur J. Cohen The idea that you free a job by retiring people or by shorten- ing the work week is ridiculous. The provisions of some Social Security laws that you can't receive a pension if you work is wrong, and that you can't receive it if you earn income is wrong. Work-in valuable. There is no reason why complete idleness should be compulsory as a qualification for social assistance. _Le n H. Keyserling I would think myself that we ought to move toward voluntary retirement and some forms of phased retirement which would really look toward a substantial group staying in the labor market until they are 75. -Robert J. Havighurst The net effect is that you've got a tremendous proportion of older people who are forced to retire and who are no longer able to contribute to the economy or able to draw a share from it. I predict with certainty that we are coming soon to a flexible retirement age varying with the person rather than with auto- matic rules. I think we are going to see retirement go in two directions-the earlier optional retirement for younger people who age prematurely and much later retirement for older peo- ple who don't age at all. -Philip M . Hauser People stay healthier. So their contribution-if they want to work, for God's sake, let them. Now you may want to get them out of the key jobs; that is the real sense of getting the gen- erals out, you know. The argument is much shakier for the prime minister. With him you wouldn't want to do it But somehow work it out; if they want to work and really have ability there ought to be some way to avoid these automatic s y $tems - -Herman Kahn 148 ". . . at about age 50 the attitude shifted." I was on the Faculty Committee on Retirement here at the University of Chicago in the early '50s and we worked hard to promote the idea of flexible retirement. We made a questionnaire study that indicated that most faculty members below 50 thought they wanted to retire at age 65 or earlier. At about age 50 the attitude shifted. Before 50 they thought they themselves would want to retire at 65, and every- body else, too. When they reached age 55 their attitudes had begun to shift clearly. Almost nobody over 55 wanted to have to retire at 65. It was a good faculty committee. We had an economist mem- ber who helped us to formulate a rather strong recommenda- tion for flexible retirement. But the administration here, as in so many places, found that to be too difficult for them. We have had a string of presidents from Hutchins on who didn't want to be bothered with having to do the unpleasant job of telling some people they had to retire when others of the same age didn't. -Robert J. Havighurst Retirement: Changing Prospects and Perspectives The Retiree born in 1890 Somebody born in 1890 went to work in 1904 with what was then the social norm of a grammar school education. He was a little too old to be in World War I. By the coming of the Depression, he was 40 years old. He used up his savings. Social Security didn't come in until 1935. The war came in 1940, more or less, and he finally got a job, but his skills were not all that great. The war ended in 1945. In 1955, when he retired at the age of 65, he was unable to get any private health insurance because it didn't exist at that time. He did not get much support from Social Security because he worked relatively few years at low income. So, in 1955, he was retired with relatively little gross assets, with relatively little Social Security pension-very little pension from anything at all because, until 1935, private in- dustries did not have much in the way of pension plans-and with no health insurance. Now, this is the type of individual on which most of our geriatric, gerontological social legislation is based. 14<) The Retiree Born in 1905 But let me tell you about somebody born in 1905. By that time there had been a social revolution in which he had graduated from high school, so that, instead of going to work in 1918, he didn't go to work until 1924, and he was probably a little too young for the World War I draft. In 1930, he was a little younger than the 1890 men and had more train- ing so that he was more likely to hang on to his job. In 1940, he was still young enough to learn welding. He worked in the shipyards and aircraft plants. He made a good income and didn't retire until 1970. By 1970, he'd already gotten enough quarters at a decent salary so his Social Security was quite a bit higher. He had a higher degree of education so he had more intellectual resources. He had enjoyed a certain amount of social mobility upward as a result of his better economic position and better training. He was more likely to have worked into some health program. So, in just 15 years, the prototype of the aging individual changed tremendously. And yet very few people take this into account in their social planning. —Ralph Goldman The Retiree Born in 1920 ...or in 1945? The number of persons who will be in the upper age category when you and I retire, and certainly when our children retire, is going to be dramatically different than right now. Where we have one in ten persons over age 65 today, our children will retire into an era when there will perhaps be as many as one in five. Certainly, one in six or seven. By the year 2011, when the 1946 babies become senior citizens, retirement age may indeed be not age 65 but 55. If you can't accumulate enough money in your working lifetime between the ages of 22 and 65 today, then what would it be like if you cut ten earning years off that? Then, add a second factor, the phenomena of increasing the lifespan and healthier living in the upper ages, so you have more opportunity to get about, and when you get about you tend to have a more expensive style of living. You are raising a whole new set of questions-economic, social, political— that we aren't addressing ourselves to. So there has to be an awareness of what the future holds through technological advances that are permitting men to retire ear- lier, that don't need man as a producer but as a consumer. We can't plan according to the style of life today any more than our grandfathers could plan solutions to the problems that we are now experiencing. -Bernard E. Nash 150 Let's just talk about the whole concept of retirement . . . It's too soon for hundreds and thousands of people in minority groups in this country. For them retirement does not exist, only unemployment. You work as long as you can find work because, as soon as you stop working, you are not going to eat as well. Retirement as an institution is a very strange thing. It can occur only in the presence of a good deal of urbaniza- tion, a great deal of industrialization and quite a lot of affluence. —Margaret Clark Life doesn't end with work for most people. . . Society is shifting. For an enormous number of men in the society their sense of what they want in life is not continuing to work. We know that more and more men are choosing to retire earlier and earlier. Our data shows that. Retirement doesn't mean the end of the road for a lot of them. I mean work seems to be a more and more dull thing for more and more people. They choose to get rid of it as soon as they can-which means as soon as they have sufficient income without work. -Bernice Neugarten work forty years, then when you're too old or sick to enjoy it-retirement. We should interweave these activities continu- ously throughout life. We should begin, as a practical step, to make it possible for people to accumulate their 30 days an- nual leave. We should experiment with more and more sab- baticals and with changing your career. -Robert N. Butler some people ought to retire long before 65; some ought to work long after 75 or 80; and some people ought to retire and qo back to work and retire, or shift occupations. -Wilbur J. Cohen 151 Some companies are, for example, giving increasing time off so that it doesn't come as a sudden shock that one day when you awake you don't have to go to work again. You know the Kaiser plan, that after five years of work you get a sabbatical, and you can do what you will. An awful lot of people are going back to school to improve their ability, which really benefits their employer during the next five years. So it isn't a total loss to the company or to society that these people become idle for a while. —Bernard E. Nash . . . most employers haven't cared to operate that way and it will take a good deal of education and change in the institu- tional framework to accommodate it. I think it could be done, but look what we're up against. What if a man wants his sabbatical year when he is 35; he has to come out of the labor force and has to be supported for a whole year by somebody. Is industry going to give him a year's sabbatical and pay him, and, if so, when he goes to school can an individual firm be sure that it gets that man back and gets it money's worth; or is this going to be at the public's expense? You're not talking about a $2,000 Social Security benefit, but about an income of $12,000. The eco- nomics of it, further, is that if you're going to spread your leisure through your work life in that fashion, it, too, has got to be institutionalized. That is to say, when you're working with large groups of men and are going to phase in some of their leisure you have to have rules and regulations, and one of the rules and regulations we most oppose now is retire- ment at 65, which, you know, is institutionalized leisure. — Juanita M. Kreps We talk about partial retirement and that kind of thing but I don't think that's what's really wanted in terms of our culture. I'm not even sure that the older person himself wants this kind of a part-time never-neverland. -Nathan W. Shock 152 Employment Leisure is seen as something that you want to do that is of no use to anybody And I'm not impressed. I dislike the idea of leisure very much. I think a person should live. —Margaret Mead We've not yet really accepted the importance of voluntary work. With the male, we've still got a culture that says, basic- ally, unless you get a paycheck, what you're doing isn't worth doing. —Nathan W. Shock Work has changed tremendously. -Philip M. Hauser You have two trends which are conflicting— people are health- ier longer, but their skills are becoming obsolete sooner, and I suppose the obvious answer is there's got to be a lot more re-education. -Anthony J. Wiener There is evidence that workers are unwilling to adjust to the change in job requirements, that is, to make the necessary move, to take the necessary training, things like that. There is evidence that employers and public programs from the other side are not doing their job in encouraging and helping the workers to make this adjustment. —James H. Schulz What you describe, I think, is quite accurate. We have difficulty in keeping the training and skills and knowledge of the work force improving fast enough to keep itself employed, even if the economy is generating enough jobs. Actually, we can train older workers pretty well-it's just that the competition for our training resources has been very strong. We haven't been willing or able to devote a great deal of resources to job train- ing in this country. And since the resources are limited, they tend to go to younger men because the pay-off is greater. — JuanitaM. Kreps 153 We know there is an inverse relationship between age and education-the older the person, the less his formal education. One major reason for older males being literally booted out of the labor force in this country is that a relatively young and attractive and presumably meek and mild female has literally kicked the older male out of the market. I am putting it in dra- matic fashion, but it's happened as a result of technological development. Take the tremendous increase in the proportion of white collar workers-the clerk. This job, now performed by the younger female high school or college graduate, is one which the older male, with a trade school education, can't begin to do. Here alone you can account for millions of'trans- formations. -Philip M. Hauser An older man who loses a job in the process of technological advance will find it very difficult to get another one in competi- tion with a younger man. Also, we have a very large number in the military service who will be returning and who will have much more appeal to the employer than an older man. Many of us have argued in the past that the man who is dis- employed and cannot get a job in his 50s or 60s should not be encouraged to elect an early retirement under Social Secur- ity, which reduces the amount of the benefit and commits him to a long period of poverty. Rather, the means of taking care of his unemployment in that later work life should be some form of unemployment insurance because it is unem- ployment. -Juanita M. Kreps It is not obvious at this point what the program should be. It might very well be that workers when they reach a certain age, say 58 ... at that point if they are unemployed for a year or more, are eligible for special income support, to keep them at a very high level, because at age 58, it may not be worth it for society to invest to retrain them. That doesn't mean that that they can't continue working. They might be working in a part-time job or low-paying job. They would be supplemented. We just haven't worked with this problem long enough to know what the appropriate solution is. It could be one or the other, or a combination of the two-work plus income support As I say, this will depend upon the circumstances-the age of the worker and the nature of the displacement, his educational level, things of that sort. We don't have a program now and I don't think there's a simple answer. -James H. Schulz 154 The supplement says, "You weren't very farsighted. You didn't do enough. Come on now, we'll help." An enormous blow to pride and to the ego. How do we help older people get over this? I have a damn good answer. What- ever we have in the economy and whatever there is in the treasury really came from them. They contributed all the basis of our economy and therefore they aren't taking a supplement or a handout. In a very large sense it is theirs. And this helps older people look at the economy, not as some place where some magic figure says who gets what, but rather as a com- mon enterprise, and that we've produced so much and that out of it there ought to be enough so that we'd all get what's due us. That's my answer to older people. —James A. Peterson We have to abandon the antiquated notion that people cannot contribute to the economy by reason of their age. They might retire on a pension from one part of the economy and get some additional income from some other part, perhaps part- time work, reduced wages, and so forth. When I say reduced wages-this may mean education of the labor unions which, in my judgment, have become increasingly reactionary as time goes on. In England, a certain proportion of the work force over 65 work under reduced rates as well as reduced time input. You see, organized labor has always been opposed to this kind of thing because this is cutting into their high wages, but as enough of them get old, they will learn the hard way that certain jobs should be allocated to avoid the misery of poverty. -Philip M. Hauser Most people feel that if people want to work and earn a little extra money they ought to be encouraged to do so, not dis- couraged from doing so. The principal opponents of that seem to be the labor groups. The reason they give is that it would cost a couple of billion dollars just to do away with the retire- ment test and that this money is better used in other ways 155 since it would go to people who are already in the preferred class— those people who can supplement their income by earn- ings. The existence of the test tends to seem to most people unfair and undesirable and there is a great deal of pressure to do away with it entirely. But the reason it hasn't been is simply the one I gave you, that it would cost money to do and apparently the people who are concerned about that feel that the money can be spent better some other way. But there is also a feeling among many older people that this is unfair, that they really have earned their Social Security check when'they are 65; they have been putting money in for many years, per- haps, and they ought to be able to have their check and if they can supplement it by earnings they ought to be able to do that, and I must say I have some sympathy for that point of vjew - -John B. Martin Certain reforms would seem to be obvious-first and foremost, people should be allowed to work without penalty. —Herman Kahn The way the present Social Security retirement test works is that if you earn up to $1,680 you get your full benefits. Then there is a band of earnings for the next $1 ,200 in which you get $1 reduced benefits for every $2 you earn. But above that you get dollar for dollar reduction so it's really a disincentive to work above that point. The (Administration) proposal is to have a single basis for the reduction of benefits at the rate of $1 for each $2 of earnings after the first $2,000 earned in a year. Therefore, everybody gets greater total income; the more he works, the more he earns. And I think that is a very sensible change. -Robert M. Ball I would hope this year we can see that retirement tests in- creased at least to $2,000 or 2,400, and I would hope even- tually that we could eliminate it entirely from the Social Secur- 'ty system. -Sen. Frank Church 71-272 O - 72 - p t. 1 - U 156 OPENING CLOSED DOORS ... a proposal and variations / would like to see a program very carefully planned out at the national level, stretched out to the state level and the local level, of jobs which are peculiarly suited to the person past a certain age and which would become pretty much the province of that person. All kinds of services— the taking care of young people in, say, day care centers, this could be a tremendous field for the older person. Care is a very big field— care both for the old and young. There are all sorts of sub-professional jobs which the trained older person could do. In the teaching field, the older person could take over so many of the chores the teacher faces today. In the medical field, the possibilities are endless. —Sylvia Porter Here we have the possibility of using the younger-older to take care of the older-older. Here is a source that hasn't begun to be realized. If this were made attractive enough, with proper training, women between 55 and 65 who want to do something useful, could do this partly for income or as a pub- lic service or volunteer activity. —Philip M. Hauser You could think of services that are needed by many institu- tions that can't afford to pay the going wage for them on a regular basis who nonetheless could on a part-time basis hire elderly people, and it's obvious that everybody's interest would be served if we can work that out. —Sen. Frank Church I'll tell you one thing old folks could be doing — and that's spending a portion of their time talking into tape recorders, telling about the lives they've lived and what they've seen of the world. In short, creating oral histories, so to speak, of their experiences and times. Here is a potential reservoir of source material for future historians, and it wouldn't be very difficult to provide it. After all, the only real experience they need is the experience of their life. —Marshall McLuhan Most particularly, I hope we would look at this as an opportu- nity to tap a great national resource. There are retired business executives that could help all kinds of emerging industry in our disadvantaged areas. There are all kinds of doctors who could help in training paramedical personnel. It is really an unlimited area of participation, if we would set our minds to it. -Rep. OgdenR. Reid 157 As you look around you, you will see some occupations that have been taken over by the elderly. The low end occupa- tions with no special skills. In the area in which I live, all bakery sales people are either old ladies or high school girls. All people who take in dry cleaning are old ladies. Various kinds of service personnel-not so much old men, we seem to have dropped them. Certainly, we consciously have to con- sider what in our occupational structure can be done by old people, to provide them with income primarily.-Ethel Shanas We are finding that an increasing number of people who are being recruited into the service professions of the ministry and teaching are people who are retiring at younger ages from other occupations, such as military, where you can get out at age 50-52, something like this where you've got a good many years ahead. People are going to seminary training nd into college to get educational degrees. Another field that's getting a number of these folks is hospital administration. So I think as we have earlier retirement, we have greater oppor- tunities for second careers. —Bernard E. Nash I think we are going to find during the next 30 years, there will be room for more people to work 25 or 30 hours a week and for some people to work three days a week, for some people to work eight months a year-and there will be more of those kinds of jobs. The idea that an individual has to work 40 hours a week for 50 weeks a year is outmoded. -Wilbur J. Cohen This isn't the time to turn off ability. For a long time we thought that everybody should retire at a certain age to make way for younger men and women, but there are so many needs in our society, so many problems that are not being tackled in so many areas where the Amer- ican government, or society, or the school board, or the hos- pital just isn't responsive or catching up with what must be done. What we need to do is tap more ability, not reduce the amount of ability that's available. -Rep. Ogden R. Reid The most successful economy in the world is the Japanese- run by people in their late 60s and early 70s. You're just not anybody in Japan until you are in your mid-50s; mid-40s is y° un 9- -Herman Kahn 158 CHOOSING WHICH END OF THE TELESCOPE... Focusing the Search for Solutions at Home. An appraisal by The Hon. Elliot L. Richardson, Secretary, U.S. Deparl ment of Health, Education and Welfare Any assessment of priorities for the elderly would have to place at th head of the list the need for adequate income. But, adequate incom alone will not fulfill the need that each of us has to be with other people In this context, I think one could approach the question from a total! different perspective, one which emphasizes the problem of the isolc tion of the aged and the need for a greater degree of opportunity fc elderly people to participate actively in the life of the community aroun them. For one thing, we can improve and expand opportunities for pa ticipation in voluntary roles of various kinds. I think, with a little resource fulness at community level, leadership can be found that creates sue opportunities. We can reduce isolation through greater access to mean of transportation so that elderly people, otherwise isolated, may obtai greater contact with the community. And there are many things that w can do in the area of human services that can give elderly people a poir of contact with the rest of the community and help draw them into it. For instance, in some areas, volunteers, drawn from the retire community, staff information offices in public buildings. And there ar activities in volunteer agencies which can be performed, often on part-time basis, in day care centers or in workshops for the handicappe or in hospitals. There is an indefinite range of opportunity for the enlis ment of the talents and interests of elderly people in providing service to consumers, including informational services. Also, I have in mind th kind of contribution that could be made by the community school as 159 enter not only for continuing education, but for other services needed / elderly people which also bring them into relationship with younger lembers of the community. In a society which no longer maintains a so-called extended family, hich very widely applies fixed ages of retirement, which is highly rbanized and in which people increasingly are unacquainted with eir neighbors, the sense of feeling unwanted and unneeded and de- -ived of even basic human relationships can be acute. And this is a r oblem that we need to address in terms of how we organize our com- lunities. We're going to have to think, over the remainder of this 3cade, more about the design of communities in ways that not only Duse people and transport them, but provide them a more flexible mix- re of voluntary and paid employment, full-time and part-time, in activi- 3S ranging from cultural and leisure activities through productive roles, lis is going to involve considerations of land use on one extreme and )mmunity organization on the other. And I think we need to have as ill of the impetus for this kind of thinking-ahead a real concern with e place of older people in the community. Until and unless we are able kindle a real concern with this, much else that we do is only peripheral. Certainly, one of the things the White House Conference can accom- ish is, through representatives of successful programs, to bring to the tention of the other participants what is being done. I think if we were look for all the good examples of ways in which retired people have und useful roles in the community, if we could do as well in every immunity as some communities are doing, or replicate in many corn- unities the good examples that have been achieved in some, then the itional level of our effectiveness in responding to these problems would } far greater than it is. 160 the where and how to live questions The Community Shelter and Mobility Lifestyle Options I have more measure of feeling about aging when I see the people I was young with, at the university, and all of a sudden I see them in the version of old people. I may not have seen them for a long time, and then I see them after they've stepped over the threshold and are now looking old. I have never thought of them as older people and suddenly I see them as old and I gather a sense of their being different, and I have thought about this. To them, just like I am to myself, there is a consistent personality. I don't recognize that I was 20, 30, 40, 50, 60 and so forth. I just seem to be a consistent personality that's lived a whole life. I realize I look the same to them as they look to me. As far as my feeling is concerned, I don't have that sense. I have the same sense of being a whole person with spirit and interests that are consistent with my life. — Wilma T. Donahue 161 The Community Communities composed entirely of old folks ...or young folks, or of members of either sex . . . cannot be called communities. A community in which the elderly do not play an integral and central role is not really a community at all— Marshall McLuhan "So what we really end up with is good community planning instead of geriatric ghettos..." We are not planning older people in, we are planning them out, and architects and city planners, I think, have just totally neglected this field. I feel very strongly that planning for the elderly-in isolated terms-is wrong, and that we can find more ingenious ways of building them in. We have to stop building housing anyway, we have to start building communities. Housing by itself gives segregation of all life. Now I don't deny, in this world of confusion and frustration, the need for special facilities for the elderly. But I'm emotionally and practically, if you will, very much opposed to segregation of the elderly. I think we have to go back to a happier state of humanity when everything was integrated-work, religion, vari- ous age groups (the grandparents with the grandchildren), and you had everything that makes life worth living all together in the family unit. Now this has exploded out into the community and now the community has become the family unit. And the community, as such, has to recapture this totality of the life experience. In planning total living we have to, of course, and we are starting to do this, be considerate of elderly persons. Again, I don't say that special efforts shouldn't be made, but these special efforts and special designs and special services should be integrated with the total services, and I think every- body is going to be a whole lot happier. So what we really end up with, in my mind, is good community planning instead of special geriatric ghettos, which, I think, is a deplorable trend. -Wolf Von Eckhardt 162 This country is postulated on the two-generation family. All economics is set up that way so we force people to live by themselves. I've been objecting to this for the past 20 years; I've been objecting to it for the past 40 years! What I've proposed is that we would have a cluster. The center of the cluster would be a few young families with children and around them would be grouped older people and younger people and mates without children who would be living in the same cluster. The children would be provided with grandmothers or proxy grandmothers. And late adolescents who haven't married yet and people who weren't married would have a place where they could meet other people when they came home late at night, and there could be somebody to play chess with or talk about the day or watch television or make an omelet. The way this country is set up at present it isn't fit to live in for anybody except couples. The couples then are overbur- dened with their isolated responsibilities for themselves and their children. So, I think it's parents with young children who need both young people and old people as part of the whole show. They need the young people to play ball with the chil- dren and teach them astronomy, and what not; and they need the old people to give them a sense of life, to be eyes and ears on the playground, to be centers of information in a group of young families. Primarily it's a matter of town planning. You have to have buildings that are suitable. After we realize that a building that goes upward is a village set on end, there is no reason why it can't be perfectly human. —Margaret Mead 163 Right down at the foot of my street ... is Regency House which is the first public housing west of the park in the District of Columbia. At the public hearing the middle-aged neighbors were down at the school building stomping, screaming, yelling, not wanting to have all these old people in their area. They deny it had anything to do with blackness or whiteness. I am inclined to think that's partly true because when some public housing was being built in some middle-aged black neighborhoods, they, too, raised hell about having all those old people around. —Robert N. Butler There are not yet half a million older households in housing that has any federal support, FHA or public housing. But at least there's enough of it around the country now to show people that to have an apartment house for older people in a community is not going to downgrade that community or lower values. Really, the opposite has happened when such housing has been built. For the most part the community is ready to see more, eager to see more of it. -Clark Tibbitts "We don't, from Washington, say here's what you must do with your money." Now, where the Model Cities program differs is that it tells a community: you identify your local problems, your blighted areas that deal with your housing, transportation, educational needs-and you come up with the programs and projects that will address those needs. We don't, from Washington, say here's what you must do with your money. There are many pluses to that kind of process because obviously every com- munity is different, and one federal approach just won't work Now, the minus is what we're facing right now because we do not mandate from here and say to the cities: "Now you have to do a better job with the elderly." And because the elderly generally are not organized in most communities, not as vocal as other interest groups, we find that they have not fully been taken into account in the locally developed programs. So what do we do? The tightrope we have to walk is not to turn this into a federally designed program. But, on the other hand, we feel a rather strong obligation to nudge cities into dealing with their problems. So, that's the 164 reason we've entered into these joint agreements with Com- missioner Martin and the AoA, and why we have staffed people dealing exclusively with aging problems, to, what shall I say, kind of sensitize the local people in developing their programs not to overlook the needs of the elderly without mandating what they must do. I think we are somewhat encouraged. I think while we hoped to have seen every city come in with an aging program of some significance, the number we've seen is not too bad. Q: How many? A: 66. -Floyd H. Hyde "And so over this barrier nothing occurs . . ." At the present time, in every American city or county or state or regional agency, planners are on one side and developers are on the other side. The developers are, by and large, private developers and the planners are, by and large, governmental planners. They are not permitted by law to carry out any of their plans. So the developer comes up with his own plan and he goes looking around for a planning board that will let him do his plan. Then the planners try to exert some kind of leverage and modify this little plan and it's always for a little piece of the action; it's always for a little piece of the environment. It's always for a piecemeal approach— it's always some kind of "Gee, if I could just put up a nice housing for the elderly on this corner, it will be so nice and I will have a nice set-back and nice trees and benches. Why don't you let me do that?" And the planners say, "We need somebody to do the whole neighborhood within which elderly and young and middle- aged, and so on, can find some kind of new relationships and can communicate about life in a different way." The developer says, "I don't have the time or the money, I have to make a dollar, I have to make a return on my income, and I can only do a little plan. What is wrong with my little plan?" Nothing is wrong with it but we need the whole plan and so over this barrier nothing occurs. —Leo A. Molinaro 165 Shelter Some people get more of life's satisfactions, we are discover- ing, out of one kind of housing and some out of another, but, above all, housing ought to be planned so that it contributes to intimacy and friendship, and eliminates isolation. I think we say that either you give a person some intimacy or friends or he goes in a hospital. -James A. Peterson "I've always heard that solitary confinement is the worst form of punishment. Now I've seen what that means" —Testimony from a Community Action Worker before the U.S. Senate Committee on Aging There is no serious effort being made to meet the housing needs of older people . . . If we are really going to talk honestly-if we want to eradicate the poverty affecting the 7 million people who are over 65, it's going to be a multi-billion dollar proposition and I don't think America is ready for that. Secondly, I don't think it's able to move into housing. It hasn't been able to succeed in housing at all. -Robert N. Butler "Older people have been led to settle for much less than is even currently available . . ." Urbanization has been mindless. It has been hurting the people at the extreme ends of the population and those extreme ends are growing larger and larger-the very young, the very old, the handicapped, the minorities. Urbanization has been hurt- ing them. And the people who are in that category have been led to settle for much less than is even currently available. There is available much more of the good things in life, not only the material things but the good ways of living together, the good life support systems that can support life much better. But 166 we've all convinced them and they have convinced themselves that if they can just hang on to this tired old apartment, if they just hang on to the little neighborhood for all of its deteriora- tion, for all of its obsolescence, for all of its crime, and so on, it is still better than being displaced by some brutalizing ex- periences. And therein is the tragedy-there is a better way, there are better ways. —Leo A. Molinaro If older people live in an area that has an approaching high crime rate, then they ought to face up to some real questions. Is that a safe place to continue to live? Merely because they've lived there for many years and have family and other attach- ments, is it really desirable? I think those are hard questions for old people, but we know that their failure to face them has left many in jeopardy. Some we see come to relish fear. It's the excitement of their lives. It's the one thing they can talk about and think about. How many bolts you have on the door— not that you don't need bolts on your door, and un- happily the poorest are not going to have a door that will support a bolt. But the thing is, you cannot live a life of fear, you've got to seek happiness in life. —Ramsey Clark It's very hard if you've lived in a house and brought your children up there . . . It's not easy for these people to convert that big old house into some kind of annuity, nor is it easy psychologically for them to move out of a home they've lived in for 20 or 30 years. There are enormous problems associated with our housing patterns. -Juanita M. Kreps We must also do something about removing the property tax as a basis for financing most of our public services, like education . . . . . . because the property tax on homes bears inordinately large on older people. Their incomes are fixed and when property taxes start going up when they are 70 or 75, they not only find it difficult to care for the home, but can't even pay for it. —Wilbur J.Cohen 167 A great many older people are having to move out of their houses; they're certainly not maintaining them, because they can't meet the taxes and the special assessments. There are very few places where they get any consideration on their property taxes for being old. So, it's not hard to explain, I guess, why it is they vote against social legislation— more money for housing, although, in turn, a lot of that housing would be of direct benefit to them. -Clark Tibbitts On the other hand, an older person can't buy a house either. . . In FHA's largest program for home ownership, of all the new and existing units insured from 1960-68, only an estimated one percent of the mortgagors-about 37,000 out of 3,500,000 —were 60 or over. So we see, even if the house is there, the lending institutions are reluctant to enter into any kind of a long-range agreement with a person 55 or 60 or 65. Mortgage bankers tell us that the average mortgage is kept by one per- son only something like five years or less. Even the younger person turns over his mortgage in that period of time. So why should the older person be denied? But, again, the stereotype gets in the way. -Bernard E. Nash It seems to me that at some point in being old, not right at retirement, necessarily, it might be more advantageous and less expensive and more satisfactory to old people themselves to have housing provided. There comes a time when you're still not ill and you still don't need to go into a nursing home, but yet have housing. There is likely at this point to be only one of you. In any case, this is the sort of housing that's very hard to find in our society be- cause it requires some overseeing, some access to food al- ready prepared, somebody to check to see if you're all right every morning-this kind of thing. -Juanita M. Kreps When I talk about better housing, I must point out that it's not sheer housing that all the people need. It's housing which is really responsive to the needs of older people where they can get meals, health care, home-maker care-all the services, all the supportive services, so that they can truly live independ- ently and not have to go to a very drastically institutionalized ,ife - —Lester Davis 168 Mobility We have a mass transit problem, but it is clear also that what- ever solution we make of that, it is not going to favor the elderly unless somebody watches it. -Robert J. Havighurst We really have to make a massive commitment in the whole area of transportation. It's not going to be solved by some cities cutting a nickel off the bus fare or the automobile dealers of such-and-such towns making cars available for volunteers to drive, or individual churches arranging transportation pools to get the older members to the services on Sunday. It's got to be much more than this. It's got to be the design for the whole transportation system for all age groups. And one of the things you have to stop and think about is that public transportation, except in the metropolitan areas where people use it to get to work, is basically used most by the people who can least afford to have their own private transportation. So, the student, the older person and the handicapped person are the ones who most need the public transportation system. —Bernard E. Nash "The Easy Rider is a Mini-Bus . . ." Here, in Columbia [new town in Maryland] , we are experiment- ing with a system. You dial one of our roving mini-buses, which comes right to your door and takes you to the door where you want to go. For all practical purposes it is a taxi- cab, but it costs only 35 cents. Remember during World War II, it was just as cheap to go by cab as to go by bus because the cab would also pick up three or four other people. That's how it works. Then we have another system in Columbia called "Easy Rider". The Easy Rider is a mini-bus and you make an appointment with him. You say, I'll be at such and such a corner every morning at 8:15, and he stops there every morning for you. Now, you cannot get the economics for providing this kind of bus service on its own for the elderly or the working wife or for the handicapped. It will never come out. And this is what we continue to do in our cities; we endlessly plot direc- tions that are going to be isolated and, therefore, sub-economic and then they are going to be worse than sub-economic; they are going to be subsidies. And then when they become sub- sidies, they become the rejected children of that society, and that is because you are doing them one at a time instead of as part of an overall pattern. -Leo A. Molinaro 169 / think that in many instances the transportation resources are present in a community. The problem is to coordinate those resources in such a way as to direct them to the needs of the elderly. There are many people in the community that are motivated in such a way that they would be very happy to help eliminate the isolation of the elderly, but they really don't know how to go about it. They may know of some particular situations that they can do something about, but if, within the community, someone, in either the public or private sector, would take the initiative and try to work out the logistics prob- lems involved in relating the transportation resources of the community to the needs of the elderly, I think that we could go a lot further than we have gone in dealing with this issue within existing resources. -Arthur S. Flemming You're not going to get people going into business to provide transportation because it's very risky without the backing or guarantee of the government in terms of financing. If you went to someone now and said, "Here's a tremendous need. Older people need to have transportation to get around after they stop driving, and you really should establish a business," well, the point is you come right back to the fact that those with such a need can't pay for the service. So, nobody is going to go into a profit making business to provide the service. — James H.SchuIz Our society is geared, things are built, for the active mobile person. There used to be the railroad system that had porters, old people could travel. Now we have an air transportation system in which porters frequently are not available. And it becomes a real problem for an old person who can't carry a suitcase to travel. This system is made for people who can carry their own suitcases. —Anthony J. Wiener We discovered in looking at one of the new designs for the subway system in Washington that it had one single elevator in the entire system, and that was at the down- town stop. So, if I were an older or handicapped person who couldn't walk a flight of stairs easily because of a heart condition or a rheumatic hip, I would not be able to utilize that system. -Bernard E. Nash Physical barriers. Economic barriers. A little kid has a great deal of trouble just going through a revolving door and an old man or old lady has a great deal of trouble going through a revolving door. And the only people who don't are the people like you and me who can still apply a certain amount of pressure on that door with ease and get through it. -Leo A. Molinaro 170 Lifestyle Options If I were to select a single word describing needs of older Americans, I think that word would have to be "CHOICES." A second word might be "RECOGNITION." Among the 20 million persons past 65, there are 20 million sets of needs. They are as different as the individuals who face them. All of the aged however— rich or poor— have a legitimate, common desire and need for a choice. Older Americans have earned the right to choose how they shall live. But many are denied this right by social attitudes and policies which reject them. -Sen. Winston L. Prouty Multiplying the choices, and making them work . . . Now, through what pathway does the scientific information flow? Much of our research in social gerontology is devoted to in- creasing the choices available to older people. But what I call the "applications" system in aging is very weak. It's been apparent for some time that we don't have in the social sci- ences someone who would translate this research information for the social planning services. In the physical sciences you have the theoretical physicist and the experimental physicist. You have the chemist interlocked with the mathematician. In government, I'm not sure who plays the middle role of trans- lator. In the technical fields this individual is the engineer. He is the "applier", the translator, and his role is such that he knows when he needs to go back to the basic scientist and ask for more information; he knows exactly what he does in rela- tion to the sciences. It is possible that the social worker is the social engineer, but they would deny this. The social worker has been cast in the role of taking care of the dependent, indigent aged. So, they have not grown up in this. On occasion, the psychologist or sociologist is put into this position. But in a sense, what they are doing is practicing engineering without a license-because they really may be totally naive in terms of social systems in society. I think in the future the universities might take some leadership in establishing what I've been calling the social engineering role. In any case, we have in the field of aging a professional void and it ought to be filled. —James E. Birren 171 THE RETIREMENT COMMUNITY: Divided Opinion When older people are retired, they are usually not given any status by society. There's no further assignment made for them so they're left on their own and they don't get recogni- tion from other people in the community. But the minute you set up a retirement village, then what happens is that there is a new society. There are all kinds of organizations developed within it. You have another set of officers. And if you go into one of these and look at the bulletin board, you'll see a dozen or two organizations that are going to meet, so they do begin to make assignments of positions, or status, to people in the group, and people develop roles in the retirement community so that I thought that on that social psychological basis that kind of community is a useful one for some older people. -Clark Tibbitts The way I feel about it is the result of where my research took me. I found that people living in a retirement village almost doubled the number of friends they had. They have increased, statistically significantly, their activities; they're in touch with associations. Church, for instance— that goes way up in par- ticipation. They've done more things than they have done before, are much more engaged than they were before, and, finally, their life satisfaction, their pleasure in living, their morale goes up. Now this doesn't mean that we recommend that everybody get into a retirement community somewhere. But it says that for those who self-seek a retirement com- munity, for those who are socialized to others, the retirement community enables them to fulfill their need. —James A. Peterson 71-272 O - 72 172 Maybe there are people who would like to have only people of their own age group around them. I don't happen to be one of them. But certainly to encourage it, and in many instances enforce it, by building large blocks of apartments and whatnot containing nothing but elderly people, seems to me to be a mistake, both from the standpoint of the individual and cer- tainly from the standpoint of society. I think this only tends to isolate generations rather than having them participate in community activities. —Nathan W. Shock First of all, there are very few proportionately who choose to live in a retirement community. We really do not have any real good evidence yet as to whether the people who move into retirement communities are very different from people who don't, how they like it, and so on. But liking is variable, it changes rapidly too. I think, by and large, what you want to do is create numerous options for people, no matter what their age. There are some old people who enjoy segregated living in terms of age segregation. Others don't. What we need to do is provide lots of possibilities for change. Options which can also be changed through time. People want one thing at 65 and do not want it at 70 or 75, which tends to create boxed-in situations. Anything we can do to increase freedom of move- ment, the ability to change your mind, is all to the good. — Bernice Neugarten 173 The career of the elderly is the exploration of change . . . The elderly make the best explorers. Old folks have the free- dom from fear to explore, and are best equipped for adapting to change because they've already lived through so many changes. They can go back to school and learn a new lan- guage, or they can travel and discover new cultures. Mobility, you see, is at once an advantage and a disadvantage for old folks. It, and time, takes their families and friends away from them, but it provides them with the freedom to begin new lives. They no longer need to be tied down. They can just pick them- selves up and wander about the land in a house trailer. In fact, that just might be the coming lifestyle— roaming about like gypsies without ever leaving home because you're taking your home with you and never really getting out of touch be- cause the electric media make communication constant and pervasive. —Marshall McLuhan Exploration as a lifestyle? I think older people should be able to do that. And I think some of them are able to do so. In fact, there's no doubt that age provides emancipation for certain older people. But, I think all too often people become timid, and for what reasons I don't know. In this country while old people no longer have to make a living, no longer having to rear children, they should be free. But they are really timid about releasing the restraint on their behavior; it's very hard to get them to be unrestrained. So, it's a kind of negative free- dom they're exercising. It's a freedom not to do, rather than a freedom to do new things. —Margaret Clark 174 "You can get yourself into an incredibly nice lifestyle . . ." There are semi-tropical climates available that are very easy to live in. You can get yourself into an incredibly nice lifestyle. You can even think of setting up a series of small towns, like the towns now set up for old people in New Mexico. The thing has already started in Mexico. There has been no real financing of it yet, but my guess is that if it builds up gradually in the next five to ten years, and then becomes part and parcel of the inter-American program, I imagine it will be very big by 78. Or, on your own, you get yourself fairly near a resort— not too near, so expenses go down, but close enough so that you can rent the place for the summer for three months. That gives you an income to travel, to see your friends, see your children, do what you want. If you organize it properly, it turns out that everybody gains, except for the balance of payments problem which the United States has to handle other ways. I'll bet this is a kind of picture of the future for a rather high percent-five to thirty percent of retirees. What you are exploiting here is the fact that transportation costs get very low, food and shelter costs get very low, and for lots of retired people, it gets you over the hump. The pat- tern is very attractive. If you have about $3,000, you could probably do it today. We figured out that in places like Spain and Portugal, a couple could live reasonably, if they know how to do it, on about $1 ,500 a year; very well on about $3,000. But, you've got to know how to do it and many people don't, so that's something for the entrepreneurs. There's a whole pattern of living here which strikes me as not completely new. We've already seen it. The British used to do this a lot. Upper class Americans used to do it a lot— retire to France, or some place to see what's going on. What makes this new is for the non-traveling middle class American to just paddle. Living in places where living expenses are low, where they can move about the area and exploiting things like the vacation rental-this pattern is not old. It's becoming economically and socially and politically im- portant-just beginning to. I'll bet you it will be in ten years. —Herman Kahn I think a situation in which a country is driving its own elderly into other countries would be morally outrageous and, socially, enormously disadvantageous. And I say the latter because of the conviction that older people represent a great national resource whose wisdom and experience ought not to be driven from our shores. Rep. John Brademas 175 THE BIG CITY MAYORS CONFRONT THE PROBLEMS OF URBAN AGING Growing old in and with the cities- Older people want to live in dignity fulfilling all their respon- sibilities and exercising all their rights as citizens. They would prefer to pay all taxes, full fare, purchase food at the market prices, and enter a movie without a golden age card. They do not want to file for Medicaid and Medicare, Old Age Assistance and Food Stamps just in order to survive. They do not want to spend hours on lines in order to receive hidden income sup- plements. I must repeat my concern for a decent retirement income for all older people. I believe we have the wealth to guarantee all older persons a decent standard of living that will assure them security with dignity. It is time we made that guarantee. -John V. Lindsay John V. Lindsay, New York City I understand transportation is the "sleeper" in this White House inference on Aging. I strongly urge the Conference to recommend ubsidies for operating and capital expenses to insure the continuity and xpansion of half-fare programs. We know this program is vital. In New ork City, it produced a 27 percent increase in travel by the elderly Mthin six weeks of its inception. In New York City alone, a minimum of $15 million in rent subsidies i needed. While renting is the norm for New York, we can anticipate that will become a growing phenomenon throughout the country. With one-third of the elderly now 75 years and over, we need funds or housing with congregate dining facilities and a range of supportive rid recreational facilities. Our current programs will often pay $12,000 a year for a bed in a ome or hospital, but will not provide a $30 a week reimbursement for a ousekeeper, even though it would permit the older person to continue ) live in his own home. Finally, there must be an end to the restrictions and regulations tiich prevent cities from meeting the needs of all their citizens. Housing |i at a standstill as federal regulations set unrealistic cost limitations on jte construction of housing. Hospitals are overcrowded with elderly pa- ents shifted between Medicaid and Medicare as rules and regulations hange with little or no regard to human needs. 176 Kevin H. White, Boston • Boston's network of fifteen little city halls provides the focal points for the city's senior citizen program. Besides saving the elderly the cos and trouble of coming to the main City Hall in downtown Boston, the little city halls provide Social Security counsellors, housing advisors and senior citizen information and referral specialists. • A house is a special thing. It is more than just a shelter or a place to sleep. It is the setting for a lifetime of experiences. Boston has easec the burden of homeownership for elderly citizens by granting property tax abatements to people over the age of 70. • The city's rent subsidy and leased housing programs have helpec to ease the burden of high rents. Also, about one-third of the presen 15,000 public housing apartment units in the city are occupied by the aged. • The elderly have time to do things but often can't afford doinc them. A large part of the problem is the cost of transportation. Bostor was the first city in the nation to offer reduced fares for senior citizen* on a 24-hour a day, seven day a week basis. • A 43 percent senior citizens discount at branches of a city-wid( cafeteria chain has been arranged by the Commission on Affairs of the Elderly. Thousands of older people also buy healthy hot meals for onh fifty cents at four public schools and at five strategically located center; around the city. • Our senior citizens need food, housing, and financial security- three things that the richest society in the history of the world shouk certainly be able to give them. They need the kind of housing that ii moderately priced and safe. They need to share in our nation's surplui food. And they need economic security from the only source that has thi organization and the funds to give it to them— the federal governmenl 177 health care Delivery Systems Changing Roles Research Frontiers We want to live long, but we don't want to be old. -Clark Tibbitts We don't have really much to do with the elderly, we cast them aside. I think a civilization perhaps will be judged, not by how many roads it can build, but by how it treats itself, and we are going to be judged pretty harshly. —Rep. David Pryor 178 Delivery Systems -/ \ America's Medical Bill . . . America's medical bill in 1970 amounted to $70 billion, 11 per- cent more than in 1969 and approaching three times the amount 10 years ago ($26 billion in 1960). Of the growth in medical expenditures in the last decade, fully 60 percent can be attributed to inflation— not additional or better health services. Since 1960, medical costs have gone up twice as fast as the cost of living; hospital costs five times as fast. In the two year period ending June 30, 1969, health expendi- tures for the aged rose to 42.2 percent, twice as fast as ex- penditures for younger people. —Developments in Aging 1970 A report of the Special Committee on Aging, United States Senate \ / Many of us in medicine, including the medical faculties, have taken what is acute, interesting, exciting and high cost and left what was chronic and not so interesting— the dismal social problems, the grinding issues— to everybody else. In the field of medicine, the health field has got to revise its practices and its tradtional ways of delivering health services to accentuate lower cost service, the social issues and social roots of dis- ease. We, in medicine, should be in the forefront of fighting for better income for elderly people and for revision of Social Security. I think that we are in a watershed era in this country right now. We are in a slack tide, but this next decade is going to see much more emphasis on these things. —John H. Knowles, M.D. It is clear that we have to move on past Medicare. —Robert J. Havighurst 179 / don't think you can segment society and have people come into the health delivery system through different doors. There should be one door for all. Everybody should walk into the health delivery system through the same door . . . I see many changes taking place within the next four or five years, indeed, in this decade. I think you will see some very important and what might be considered radical changes in the delivery of health care. We will develop more efficient ways of providing health to our people, more effective ways of doing it more economically. I think some of these changes will be related to methods, including computerization of labora- tory work ... the computerizing of physical examinations and the studies so that they can be done simpler and at less cost to provide larger numbers of people more comprehensive health care, and better preventive care. I think these things, along with new knowledge in the offing, will change the whole health care system; and I see this coming, I would say, in the next several years and within this decade easily. -Michael E. DeBakey, M.D. We've been talking about changing the health care system for at least four decades . . . . . . dating to the Commission on the Cost of Health Care in 1929. I see now the possibility within the next four to six years of doing something fairly massive about this. I think that as a country we are becoming much more action-oriented, and we will get on with making some of these changes. -Robert D. Eilers 180 During the first two months of the 92nd Congress, about ten national health insurance plans were introduced— and over 400 senators and representatives indicated their support by either introducing or co-sponsoring the bills. But there's one thing we now have to watch carefully— we must make sure that in the great push to achieve universal health insurance, older people are not overlooked or short-changed. For in- stance, the Administration plan-the Partnership for Health Plan proposed by President Nixon — by keeping Medicare largely intact, would still require the older person to pay up to 60 percent of his health cost while the younger worker would pay only 25 percent of his. In other words, those with the greatest needs and the most limited means would be the least favored under this proposal. —Bernard E. Nash I think universal health insurance will inevitably come, and for the same reason that, after long resistance, Medicare came. The reason is that the United States is second to no nation in the world in the high level of medical science. But it is one of the most primitive nations in the world in the distribution of medical services, and this is becoming increasingly known to the American public, and they're just not going to stand for it. — Philip M.Hauser We are talking fundamentally about deliverance of health care regardless of where it is. This may be in Valdosta, Georgia, or on Fifth Avenue in New York. But I think this is the funda- mental problem. We have not really gotten to the point where we are concerned with delivering health care. —Edmund C. Casey, M.D. 181 "There are still millions of Americans who can't get into the System . . ." We are currently studying all of the programs that have been pushed forward, and we are very concerned and disappointed that the ones so far presented seemingly accent costs of care and have very little to say about delivery. This assumes, Num- ber One, you've got quality care in the country, and, Two, it's deliverable. Now across the board we know this is not a fact. And, as black doctors, we know damn well it'snot true because there are still some millions of Americans who can't get into the system. We're talking a lot now about primary care, how to prevent disease. There are a whole lot of old people who are not sick. In a sense they have the disease of age and so they are subject to acute colds, fractures, falling down. Then, the majority of them are subject to certain infirmities which represent wearing out of basic systems-the heart, the lungs, the kidneys. But you talk about strokes-and these are the ones, by and large, who get into the system. They are forced in because they have something happen to them. Now when something happens, two, three, or four o'clock in the morning . . . somebody's got acute abdominal pain, somebody's got a stroke... that's the entry into the system. Otherwise, they don't make entry into it. And the programs so far don't provide the entry we would like to see. They assume the entry, and their impetus seems to be on paying for the program and reimburs- ing the physician. We would like to turn it around, and address ourselves to the complaints from the grassroots the system is supposed to benefit. The person who has to wait in line to see a doctor . . . who doesn't get a doctor on a holiday or Sunday . . . who-even though the state may be paying for his medical care-doesn't receive that medical care. Our major concern is how this care is going to get to the people who need it. —Emerson C. Walden, M.D. 182 A major part of the problem has been our failure to combine financing and delivery. We think that we can have the two separate, and we should realize that one can't come before the other. I'm amused by the assertions of some people say- ing: "Let's not do anything about changing the financing of health care until we get our delivery system in order." So, pre- sumably, therefore, there is going to be some mastermind that sees all and knows all and will automatically shuffle the pieces and the way the pieces relate to each other. On the other hand, there are those who say, "Don't worry about the delivery system, just come up with more dollars and it will be all right." Well, you see the evidence of what happens when you come up with more dollars. Medicare has come up with more dol- lars and a substantial portion of it has gone for increased prices and not increased services. —Robert D. Eilers The issue in our society today is not whether to build more hospitals, nor whether to build more nursing homes, but what is the best kind of a program for older people that will adapt itself to their changing needs. Given the assumption that many older people will go through a series of stages in which they may well have to be in a hospital, in an extended care facility, in a skilled nursing home, then in a nursing home, then in a custodial care institution or in an intermediate care facility, and then maybe in a foster care home, and maybe then back into another one. This involves very, very complex problems of planning and arrangement of community facilities and we just can't run as fast as we ought to have gone in that because it remains a problem of financing, it remains a problem of community planning, and it remains a problem of the develop- ment of professional skills of competent people which take time to develop. —Wilbur J. Cohen 183 In the Future— Three Predictions: There will be less emphasis on solo practice and more on group practice. Both are private practice, but people today, in order to keep out of the hospital, are going to have to go to a facility where they have sophisticated equipment to take care of them. So I think there will be a great deal more groups on account of that and surveys show that 85 percent or 90 per- cent of the boys and girls in medical school today plan to go into group practice. So change the delivery system, but keep it in the private sector. We can do a better job and do it cheaper-cheaper and better. —Walter Bornemeier, M.D. You will begin to see the expansion of responsible group medical practice. People working together and not a cottage industry of solo practice distributing willy-nilly all over the place. So there will be these steps forward in terms of the structural aspects of medical care. -Robert N. Butler, M.D. It seems clear that, in the long run, any national program for financing health care should envision paying for a defined package of hospital and physician services on a capitation basis. In other words, the Medicare program should say that we will pay an organization that will deliver health care to the elderly — or whatever other group we're talking about — so much per year for providing those services. In the short run, though, it is obviously unrealistic to think we can move into that sort of system overnight. To do so would involve massive opposition on the part of certain portions of the health delivery system. But, at the very least, what we do need to do is to give the elderly under Medicare an option-so that if they choose to get health care through a group practice pre-payment plan (a Health Maintenance Organization, or HMO), they can do it. -Robert D. Eilers 184 / am not sure one can predict how we will practice medicine ten years from now. I still feel, at the present time anyway, the need for a doctor taking care of a patient, assuming responsibility for a patient, will still exist. Now, how he discharges that responsibility will change, in my opinion. But I still think he will have that respon- sibility for the patient and I think the patient will want him to have it. And I am really not talking about mass inoculations for preventive medical activities ... I'm talking about the patient who gets sick with an illness, an acute illness that requires management by a doctor. Now, there are certain forms of medical health delivery that don't need that. These include, for example, a thorough checkup examination. The doctor may come in, once the various studies are done, and analyze them and then tell the patient what the results are. He may not do all of these studies himself and he doesn't need to. So you see there must be allowed a certain freedom in develop- ing ways and means of achieving this. I feel strongly that we cannot direct a program from, say, a bureaucratic operation. I also feel strongly that to reach our goals some form of na- tional health insurance must be passed. Now, this doesn't have to be directed and operated by the government. (Per- sonally I'm opposed to that.) I think we can do it within our society in a way that utilizes the government solely as a me- chanism for achieving our objectives, but not to operate us, and not to direct us. If one looks down the road a bit and tries to visualize what is taking place and what is happening and what is going to happen, I think this is the only conclusion you can reach. —Michael E. DeBakey, M.D. "Look at his map, his road map, his face . . ." When I teach medicine, sometimes the students and the house staff, want me to sit in the side room and hear the history of the patient and they talk for an hour about what the tests showed. I say, "Come on, I want to go see the patient. I want to put my hands on him and talk to him, have a feel for him. Look at his map, his road map, his face. He didn't get all those lines by accident." The whole essence, even with technology, the essence of medicine, remains the personal involvement of a physician on an individual basis. If you let technology run it, you don't even see the patient any more, just run him through a machine. Technology does dehumanize a situation if it's allowed to run rampant. —John H. Knowles, M.D. 185 Changing Roles In one particular hospital, as geriatric cases got closer to death, they would be moved nearer to the nursing station, and it got to be a sort of signal to everybody in the ward. They knew, if you went from this end of the ward and came closer and closer to the station, everybody thought that the end was coming. This happened to one old guy and he had moved down into the bed very close to the nursing station. He had a habit of going to sleep and pulling the sheet up over his head. One night, the nurse looked and saw the sheet up over his head, and she came and pulled it back, and he said, "Not yet!" —Emerson C. Walden, M.D. We've been very much mislead by the idea that machines are going to take over for us. They certainly are not taking over in hospitals . . . With every advance of medicine, we have had to increase the number of personnel in hospitals. An acute hospital requires at least three, and maybe four, employees per patient in the hospital. And every time you develop a new technique you have got to hire somebody else. In the short run, what I'm saying is that you can talk about the appropriation of money, but money is only useful to the extent that one gets what one wants to get with that money. And if getting what you want is getting people, first of all you have to have the people who are willing, and then you have to have the people that are trained, and even beyond that you have to have the social commitment of the withdrawal of these people from other areas of activity. Now, the second main issue that I think is important right now is the fact that geriatrics is not really an attractive field for people to work in. I think that we've got far too many people interested in laying out systems of health care and not enough people who are willing to commit themselves to the dirty work of doing it. They know they are going to change the world, but they don't want to do the work that has to go on in the world once they have changed it. -Ralph Goldman, M.D. 186 "So what happens when he gets a cold?" You have many cases where an individual, as he gets old, be- comes widowed and is living alone. He may have good health still, although he may be very old, and mentally be very alert and active and able to manage his affairs. But what happens when he gets a cold, a 24-hour flu or something? Essentially, he has to take to bed. Well, currently, we are very poorly or- ganized to assist these people. If you look across the United States, you don't find communities set up to provide the sort of help that is needed to people who are alone, and this is particularly true of the very old. And I think this is one of the first places we could start. —James H. Schulz Medicine has taken, categorically, the position that a person is either well or sick . . . So, if you are ill you go into the hospital and then you come out and you are expected to go back home. But take the elderly widow. She's maybe living alone. She needs services that will enable her to go back and live in her small apartment. We need a health team which gets interested in a patient very early and follows the patient back into the home. Does the patient need some physical facilities in the home, a special bed? If so, give the person a bed because, if they don't have the bed, they may have to be in the hospital. Now, your per- sonal physician has no way of dealing with this. He throws it back on you. In Los Angeles, you go to Abbey Rents, but there is no public health nurse who comes over and tries to assess the situation; and only on Welfare, does the social worker come around. So, we don't have a continuity of service. This is costly but, on the other hand, it could reduce costs too, be- cause you keep more people out of institutions. —James E. Birren 187 "If there were somebody to do it . . ." Many people are in nursing homes who could be rehabilitated at home and could be kept at home if there were somebody to do it. There isn't anybody to give exercise programs at home or in nursing homes, for that matter. There isn't anybody to bathe these people and there isn't anybody to do these things that take special skills in rehabilitation. We should be able to do that for these people so that their families can have them a* home. -Ethel Shanas I think right now if we would really do a proper survey, you would see that more than half of the occupants of nursing homes really should not be in nursing homes. They can be cared for either at home or in an out-patient situation. I re- cently made the statement that 80 percent of the Medicare- accredited facilities in the country are operating in violation of federal regulations, and that they continue to be allowed to operate. One justification that is given by the government as to why they continue to operate while violating federal stand- ards, is that if you close the nursing homes down at this point, where do these people go? We certainly do not have a place for them to live. -Rep. David Pryor The health field very shortly will be the largest single employer in the United States . . . We are now going into the so-called post-industrial society in which three out of five new jobs are being filled by service industries: transportation, health, education, welfare, services to people. The new labor market looks to service industries for new jobs, including the health field which has captured the largest share of the labor market over the last ten years —John H. Knowles, M.D. We have to begin to understand the social care components of long term care facilities. We have to understand what their relationship is to the rest of the health care delivery system- the ambulatory care system. And we have to understand the relationship to a whole array of social services, like home- maker service or chore service, or some of the legal services. There are many elderly people who need an awful lot of help in managing their affairs. They are not so impaired that they need a conservator or a guardian, but they do need some help. — Elias Cohen 71-272 O - 72 188 Paraprofessionals as partial solution...? Much of our health problem is associated with inefficient use of resources. The Russians, for example, have a tremendous number of physicians who are less well trained than in the United States, but who are far more available. Then they have a professional category called the Feldsher, which is half-way between what we call a public health nurse and a physician, capable of do- ing all kinds of things— making house calls, always being avail- able at a clinic. —Anthony J. Wiener You know, in Denmark we get a lot of this home visiting taken by someone who is somewhat between the nurse and the physician— physicians' assistants. —Ethel Shanas Let's say, for example, when you have non-doctors go out into the field, the tendency is for them to behave like doctors and to make judgments as if they were doctors, and really they are not prepared to diagnose. I think the medical profession, whether you want it or not, is very cautious, and rightly so, in moving into this area. —James H. Schulz In some parts of the country, doctors are reacting quite posh tively to the idea of paraprofessionals. They are so put upon by increasing demands and increasingly long working days that they are struggling to find people who will help them do the things they shouldn't really be spending their time on. I think in times past the professionals resisted the changes quite heavily. I think in this present time we see much of that resistance is breaking down. Medical societies are trying to develop physician's assistants and other health workers to work in doctors' offices and hospitals to take things off their shoulders. —John H. Knowles, M.D. 189 We have many older retiring physicians who could be utilized in taking care of the older individual. I would like to see the concept developed since many older people feel more secure and at home with the older physician. For instance, in the city of Cincinnati, well over half of the black physician population is 70 or above. It would be very easy for them to have offices provided for them in senior citizen facilities where they could go, and take care of the older population. —Edmund C. Casey, M.D. "Aging is no longer a family issue . . ." We are not going to be helped by the people who wring their hands and say, "If we can only maintain the old value systems of kids being more concerned about their parents; and if only more people would take care of Mom and Pop, we wouldn't have the problems that we've got." This is not compatible. Aging is no longer a family issue. Hopefully, we will never lose the concern we have, the value that we hold, for the older generation. That, I am not denigrating in any way— I am very much for that. But I'm saying that the solutions that we seek have to be solutions based upon systems in which our society operates and not confined to the family or the individual's own capacities. The future is going to demand more. -Bernard E. Nash / know I want a stereo, I feel that, but I don't feel I need medi- cal care 30 or 40 years from now, and this is one of the prob- lems ... And, it's a serious problem. I mean, when you start adding together the costs of these various services, it means that the individual no longer can have his second or third car, or he can't have a new color TV set in three years-he has to wait five now. Clearly, the amount of taxes will have to go up and people are reluctant and there is this sort of myopic view of things, that I'll never get old and I'll never have these prob- lems. Just like the guy who never takes out fire insurance be- cause he says he will never have a fire, but there's a big dif- ference in the two. I know if the guy lives, he may not have a fire; but he's going to get old, and he's going to have some of these problems. -James H. Schulz 190 Research and Training Frontiers Priority: Aging and Mental Health There is a tendency to link growing older with the term senility and then with the confusion, poor memory and deterioration you see in some individuals, as though that were typical of us as a species. Most of us will live and die without ever having that kind of senility. About five percent of the elderly are in institutions now. That's a big number, of course, but it's not large statistically. Let's say one out of a hundred other people may develop a chronic brain syndrome of senile dimension. Now, if you have such a person in your immediate family, you begin to think about that as being aging. It's really an organic deterioration of the brain that's not typical. On the other hand, a great many older people do have great stress reactions of some kind. They have what we call reversible affective states. But in our community mental health centers, very few have any staff that is competent in the problems of aging. They love to deal with the problem of the child, the adolescent, theyoung married adult, and then.they dump the problems. They have almost no services for the aged, a population which supplies at least half of the major mental health problems. So, what you have is professionals who were never really trained— you can go through your entire training in the profes- sion without ever treating an older person— so that the psy- chiatrist, or the clinical psychiatrist or the psychiatric social worker may not know anything about aging. It's not in the training.You take some of these people out and put them in a Community Mental Health Center. They are very uneasy if they get a 60-year-old depressive patient. They don't know what to do. And so now what is happening, in view of the nursing home development since the Community Mental Health Pro- gram, these people are shuttled into nursing homes, conva- lescent homes, and then they are kept sedated. And they have less access to mental health care than they had before when they went to the State Hospital. So, what is ostensibly an im- provement in mental health in this country, through the Com- munity Mental Health Program, is actually a deterioration of the quality of service given to the older mental patient. —James E. Birren 191 Priority: Aging and Physical Health . . . We know that perhaps 70 percent of the patients who have had strokes in the past, developed the stroke for reasons that are now known to be correctible. And with proper knowledge about this, both in terms of the patient's understanding of the problem and the doctor's un- derstanding of the problem, we can now pick these things up before they have a full-fledged stroke, and actually prevent them from having a stroke and have them go on for years afterward without strokes. In my own experience, this has proven to be the case. We have good studies for a period of ten years on the follow-ups of these individuals, you see, showing what they can do and how long they can go on. We, as yet, are unable to control those factors that lead to what we call the aging process. By that I mean that once cer- tain types of changes have taken place as a consequence of aging, that we are unable to really control those factors very much, and I think that, at the present time, one must sort of relate them to the genetic programming in the individual. But within certain age groups, age categories, there is a way of improving the capability of function of the individual and this includes brain function, as well as other organ functions, and thus extending useful life by various medical and surgical means. Individuals who are in their fifties, let's say, and sixties, with certain disease processes that we know from past experience would inevitably lead to death ... we have now been able to overcome those conditions by surgical treatment and thus ex- tend that period of life for the individual for ten, fifteen or twenty years. I have, in my own experience, which is a fairly large experi- ence, perhaps in totality say some 15,000 patients, many in that age category. And I have done various types of corrective procedures with conditions that would otherwise lead to an early demise. And many of these people are back at work where they had had to stop work completely and were leading a life of very restricted activities. So, you see, they are back and are productive and are enjoying life again. —Michael E. DeBakey, M.D. 192 People keep looking for a one-to-one relationship— the dis- covery in the laboratory and how it benefits you. That's not the way science works. I mean, science is the bedrock of increased knowledge that permits a great many people to improve the way they're doing things and a lot of this falls into the action area in a very dif- fuse way. It's almost like trying to identify a given drop of water that arrives at the Mississippi. Or, to put it another way, research is a little like uranium prospecting. If you decide to look for uranium in the state of Nevada, you could get ten prospectors and send them out and in fifty years they'd cover the state of Nevada where the uranium was. The other ap- proach is to grub-stake a number of prospectors. Let's say, you grub-stake a thousand—not everyone is going to come home with a uranium strike. And you don't know which one— the chances are some of them will. The same kind of thing occurs in research. You can't predict where the important finding is going to be. —Nathan W. Shock The trend of the government to cut down grants for research comes at the very time when gerontology is finally beginning to know what questions to ask . . . At the moment, when gerontology and geriatrics have ma- tured enough to find out something on which to base action— at that moment, the valve is shut. We had nationally until 1968, 92 doctoral dissertations for a degree in gerontology. We've put out that many in child psychology in a year. You can't be- lieve how little attention has been paid to the aged. Therefore, in terms of accretion of knowledge on which to base action, the opportunity hasn't been there. Now that it's beginning, the research funds fade out. That contradiction is a very real one for all of us in gerontology. —James A. Peterson Unfortunately, at the present, we are suddenly confronted with a supply of younger people— four or five years ago, we put money into training programs and we've trained now a sub- stantial number of young scientists who went into the program because they wanted to pursue research in aging. Right at the time of their completing their training, we are getting cutbacks in research that are so severe that we find it questionable as to whether we can utilize now the trained people that we've produced right in the field of aging. —Nathan W. Shock L93 ?ROM A SPECIAL VANTAGE POINT — \ CALL FOR ACTION ton. Frank Church, Chairman, Senate Special Committee on Aging think there is no country, that has the means as we do, that has done is badly in providing for the elderly as we have here in the United States, "his is one of the greatest travesties, I think, of the contemporary Amer- can way. It's one of the most conspicuous of our failures. We have our uccesses, we have much to be proud of in this country, but this treat- nent of the elderly is something that we ought, by right, to be ashamed if, and I think that's why it cries out so for attention. Although the income furnished the elderly is basic, it's just the be- linning of an answer to all the problems that face them, and I'm dis- urbed that our federal experiments through the Administration on Aging iave been so limited in scope and so experimental in nature that they ave only touched relatively few. When you consider that all the budget Dr the AoA is less than the cost of a single bomber, it puts in perspective ow low a priority we have given to helping the elderly in this country. Perhaps it's partly due to our fast-paced lives that so many of our eople are unaware of the way so many elderly people live. Perhaps it's ue to the highly segregated character of our life which tends to put eople in homogenized neighborhoods. People of the same age, in the ame income brackets, involved in the same kind of life pattern all live )gether. The old tendency to mix people up that we found in the cities fty years ago, where everyone lived in a neighborhood which contained Ider people and people of different races, rich and poor alike, that has jnded to disappear in the segregation of our lives. Whatever the rea- ons are, the end result is clear that we have simply permitted very large umbers of elderly people in this country to live out their lives in fear of erious illness until Medicare, and now in destitution for lack of decent aternity. Older people are not nearly as unknowledgeable or naive as they sed to be. There was once the feeling that elderly people tended to be xtremely conservative in their political outlook. Now that's changing. I link that the meetings that I have attended having to do with the elderly, i my own state and elsewhere, reflected this tremendously growing kind f interest and there is an activist feeling— the elderly are getting to be ighly informed about the various government programs and the extent iat they are or are not being funded. They have become aware as to hether they are to live happy adequate lives in their last years, and so ley take action in their own behalf. It's quite a different picture today lan it was even five years ago. I think effective follow-up on the White House Conference on Aging iay depend to some extent on what we do in the Committee. We intend ) keep the pressure on. I think that if the Senate Committee on the Aging Dntinues to do its job, we can keep confronting the Administration on tese recommendations and asking for an accounting of what they are faning to do, and thus keep the heat on in that way. 194 in a framework of government Action for Older Americans Action by Older Americans There's a custodial attitude toward the young in this country and there is a custodial attitude about the poor, there's a cus- todial attitude about blacks, and a custodial attitude about old people. And I don't want to be in anybody's custody. Whether I am too young to take care of myself or too old to take care of myself, I resent the whole idea of being in some- body's custody. Leo A. Molinaro Is there any reason at present in the way old people are living in the United States that young people should want to face up to it? No. —Margaret Mead We really have a lot of answers we aren't using. —Bernard E. Nash 1!).') Action for Older Americans . . . and stumbling blocks to action: The basic problem, I believe, has been society's failure to recognize fully that in this century we have had a revolution in aging. Neither this, nor any other nation, has truly faced up to the implications of this revolution in aging. We have failed to see either its magnitude or its character— particularly with regard to heightened capacities for living by older persons. We glibly use the figure, "20 million older Americans", but really fail to understand how big this is. It contrasts with less than 7 million 40 years ago. Only one-fourth of the world's nations have individual populations so large. Of the more than 100 non-Asiatic nations, only 16 have as many as 20 million in their whole population. When one considers the talents, skills and experience among our senior citizens, the magnitude of this resource is enlarged further. We are short-changing both the United States and its older citizens when we refuse to give older Americans a chance to participate as fully as they can in our national life. —Sen. Winston L Prouty 196 Older Americans as a "Minority"— Two Views: We don't talk of middle-aged people as being problems that society doesn't know what to do about. Once old people are no longer segregated in this cultural stereotype sense, you will then be in a better position to meet individual needs. I don't think we should treat old people as a minority group. That does a disservice in the long run. Now, short run, you may have to call it a target population, which has a special meaning when you try to get legislative action. But you are more concerned with individual people, not age groups. — Bernice Neugarten The problem of aging itself is so unique that the whole general area has to be isolated from other issues. When we talk about the problem of the aged, we are talking about another atti- tude, another way of going about things, another way of going about living. These things are not related to any other issue that I can see right now. I think it has to be an isolated prob- lem. —Rep. David Pryor 197 INTENT OF CONGRESS In 1965 the "Older Americans Act" established The Adminis- tration on Aging within the Department of Health, Education and Welfare. Within the act, the Congressional declaration of objectives was as follows: "The Congress hereby finds and declares that, in keeping with the traditional American concept of the inherent dignity of the individual in our democratic society, the older people of our Nation are entitled to, and it is the joint and several duty and responsibility of the governments of the United States and of the several States and their political subdivisions to assist our older people to secure equal opportunity to the full and free enjoyment of the following objectives: (1) An adequate income in retirement in accordance with the American standard of living. (2) The best possible physical and mental health which science can make available and without regard to economic status. (3) Suitable housing, independently selected, designed and located with reference to special needs and available at costs which older citizens can afford. (4) Full restorative services for those who require institutional care. (5) Opportunity for employment with no discriminatory per- sonnel practices because of age. (6) Retirement in health, honor, dignity— after years of contribu- tion to the economy. (7) Pursuit of meaningful activity within the widest range of civic, cultural, and recreational opportunities. (8) Efficient community services which provide social assist- ance in a coordinated manner and which are readily available when needed. (9) Immediate benefit from proven research knowledge which can sustain and improve health and happiness." 198 THWARTING THE INTENT OF CONGRESS "From its inception, AoA was unable— through lack of man- power, money and executive branch support— to fulfill the vision and goals the Congress had for it. Congress intended, the record shows, for AoA to become a powerful, creative, central voice within government to insure that older citizens who have contributed so much to our society might continue to participate fully in its benefits in dignity and independence. That goal has not been achieved. And instead of seeing re- newed efforts, to achieve it, we see a dismantling of the AoA structure— a siphoning away of funds, programs and functions. And what remains is a facade— a symbol of concern with the impressive title "Administration on Aging", but with very little to administer. . . . Budgets — for individuals, businesses and nations-serve two important functions. They fix priorities. And they help in resource management. The Administration's budget proposals for fiscal 1972 programs under the Older Americans Act- calling for only some 28 percent of the $105 million in au- thorized funding and a $3.65 million reduction in community service projects— establishes, we must conclude, the Admin- istration's sense of priorities for older Americans. And from that wholly inadequate priority determination will inevitably flow not effective resource management, but a squandering of both financial and human resources which our country can ill afford." —Bernard E. Nash (In testimony before the U.S. Senate Special Committee on Aging, March, 1971) L99 The AoA— and low visibility . . . Well, it's there, and it's had relatively scant support. But until it plays a more significant role, it's just not ... I mean, we're dealing with a very large number of Americans who have great potential and yet the office charged with this responsibility is very modest in scope and aspect and doesn't loom very large on the Washington horizon. It should loom much larger. They don't have the clout of the White House and they don't have the resources back of them. They should have. — Rep. Ogden R. Reid They are really not powerful enough in terms of having money to have much visibility. Anybody who knows anything about how Washington runs knows that you'd better have some money to spend on some programs to administer with some substance; otherwise, even though your ideas may be quite exciting, they are not likely to get much attention. —Rep. John Brademas There are two kinds of opposition [to getting things done]- active opposition and default opposition. The active opposi- tion comes from the vested interest groups. That's common- place. But the more important opposition is the default opposi- tion—the opposition on the part of the people who have no great vested interest and who ought to know better and who may know better. -Leon H. Keyserling 200 Is Duplication a Problem? —Contrasting Answers Q: Do you think there is duplication within the federal gov- ernment and duplication between the federal government and state governments in administration of programs that are necessary to the aged?" A #1: No, I don't think there is. Programs are sufficiently limited so that we suffer less from overlapping and duplication than we do from any other reason, I think. The federal gov- ernment, of course, in the Administration on Aging has a limited supply of funds which it makes available through the states, the units on aging, for the development of service proj- ects of one kind or another, and this is a relatively small amount— there's no overlapping there. The money goes out on a formula basis, it's almost a block grant basis, and the states use it as they see fit within the framework of doing something for the older people. -John B. Martin A #2: I think one of the real problems is probably we like to think of government as being a great friend to mankind, a helper of the needy and the poor, the old and the sick. Right now, government per se could well be the worst enemy that the elderly American has. I think right now we have too much government with regard to various programs that are designed to benefit the elderly. For example, we have in Congress, I imagine, in the Senate and House side, some 20 committees and subcommittees that deal with regulations and areas of finance which relate to nursing home care. Right now, the elderly people in our so- ciety have themselves caught in a thicket of bureaucracy on the local, state and federal levels which really smothers out any creativity or any desire to be producers within our society. —Rep. David Pryor 201 America can do anything. I'm convinced America can do just about anything. But the thing is, right now, our priorities are all mixed up. Our country is floundering. You can talk about when the war in Vietnam is over you will be able to get everything right. That's where you make the mistake. What you've got to do is to begin to organ- ize and watch where the money is going to go. It's a whole question of money. If you don't have the money where are you going to get it? The cities are dying. City governments are not getting back the money from the state governments, the state governments aren't getting the money from the federal. Look, you can't do anything about it but talk about it until the Viet- nam war is over, because when you look at the percentage of money that is going out in that direction and you realize what that money can do, you know you can only talk about these things until the war is really over. But you have to be ready. —Rep. Shirley Chisholm A Question of Money: Each individual should pay his fair share of the cost of govern- ment on a progressive basis. There is no difference between paying for young people and paying for retired people. I don't see any difference in philosophy or tax administration be- tween providing for the elderly and the fact that I may be pay- ing for somebody else's public schooling if I don't have chil- dren, or paying for someone else's roads if I don't drive a car, or paying for someone else's national defense if they have more people to be defended, or paying for someone else's police protection. I don't see any distinction on these matters between the public and social obligation to take care of re- tired people or the public and social obligation to take care of school children. The separation of this particular obligation into a special category supported by a special tax system— and the wrong one at that-never had any justification, and doesn't have any justification now. —Leon H. Keyserling 202 There's been no public effort to make clear that we are, In fact, an undertaxed country. Compared to all industrial societies, we pay less taxes, and yet I think the average American is un- der the impression that he's unusually taxed. Whether it's a consequence of not being fully taxed, we don't have the serv- ices which we require. —Robert N. Butler First, there is the opposition of those people who do not want to pay more taxes for anything, no matter how good. We do have at the present time a kind of taxpayers' revolt about many things in our society and this is understandable. But I believe that as our incomes go up, we are going to be able to do more and I think we can generally do more. I do recognize that em- ployers and many people, low income people, middle income people, higher income people don't like to pay more taxes. —Wilbur J. Cohen Again, you're right back to the legislative process, where, es- sentially, people delegated to legislators the power to think ahead for them and, of course, every time they do and they raise taxes, people vote them out. But, hopefully, through courageous legislation, you make progress in this area. — James H.SchuIz Now I am perfectly convinced the government can never do it completely— that we have to organize life in ways that people care for each other. It doesn't have to be paid for all the time. —Margaret Mead 203 Action by Older Americans Older people wondering from one day to the next, "What's go- ing to happen to me?"— I see so much of this in the commu- nity. I see a great deal of this in our country. —Rep. Shirley Chisholm How can we make a difference in how people live next year, the year after, and so on? People approaching old age as well as people who are in their old age can't sit and cheer for the Year 2000 Plan. -Leo A. Molinaro I don't think old people are going to be as passive a group in society as they have been in the past. — Bernice Neugarten "You don't become a beggar and then tell people that this is a dignified way of life." If you really want to worry about something worry about this. Older people say, "They've got to give us free buses or else they've got to let us ride free. They've got to give us this, they've got to give us that." And in the same breath almost, "We've got to have dignity." This doesn't make sense. You don't become a beggar and then tell people that is a dignified way of life. I cannot understand why they don't pick up the cudgel saying, "We don't want cheap houses, we don't want this way of life. What we want is to be able to have an ade- quate income so that we can be on the open market." They do not assert themselves. We had hearings in Michigan, and then one of our graduates did her doctoral thesis on how older people perceive their situations. We asked how much more money they really wanted or how much more income they really would need. They asked for a pittance, like $15-$20 more a month. They were not going to live anything but mar- ginally on it, but still they will just settle for so little. And so, everybody is saying, "Oh, we'll help you get these cheap fares, the cheap this and that; you deserve it," and so forth. Very patronizing for the old people. "Keep them as cheap as we 71-272 O - 72 - pt. 1 204 can with a little advantage here and there and they really don't want very much." Twenty cents a week for bus fare or some- thing to keep them quiet. "We'll work on them that way- something simple." But they don't translate it like that, and if only they weren't satisfied. If only they would get up and clamor and make a big ruckus about it... instead of staying in this horrible state of just seeking charity, advantages, and so forth. I don't think that's compatible with everybody's talking about let's give them dignity— doing everything we can to maintain their dignity, and they themselves saying, "We want to live a dignified life." — Wilma T. Donahue / want the political parties to start to compete for the affection of older people. I want older people to make some noise. I want them to be involved in the political process. They constitute close to 25 percent of the eligible voters. They've got time. And they ought to be wooed by the political parties. I want older people to come to political parties and say, "We have something that you want and we're very concerned." Maybe we need a focus ...like Medicare, that will galvanize elderly people. Maybe this issue ought to be for minimum income for all single elderly of $3,600 a year and $5,500 for couples, something of that sort- something around which elderly people and their adult chil- dren can rally. Maybe it's too diffuse when we say we want to solve the problem of loneliness. We have to have an issue that we can cost out, benefits must be readily understandable. — Elias Cohen Older people haven't made their political power felt. There are professionals working in the field— we are only one vote. If I am in favor of better pensions for the elderly, I am only one voter. My Congressman is not going to pay much attention to one vote, but if the voters in his constituency communicate with him, then we see some action. I think we now have a pop- ulation of older people who are better educated than they were 25 years ago, more sophisticated, and these people would have to organize. I am sorry to say this because I was one of those who do not want to see hardening of the lines between age groups, but I feel that older people have to do it in self defense. —Ethel Shanas 205 There are now 20 million aged people and if you take into account the other people who are dependent upon them or upon whom they are dependent, you can see that it represents a very substantial proportion of the population. Now, as I said on many occasions, to me it was always inevitable that Medi- care was going to be enacted into law because Medicare was a program that received the support of not only the older people themselves but of their children. Whenever you get into a problem where you do not adequately meet it for the senior citizen, the burden is going to fall upon their children. You have a natural political alliance between the 10 percent of the population who are aged, plus another 15 to 20 percent of the population who are children or relatives and that makes it a very big proportion of the total population. —Wilbur J. Cohen The older person himself should be brought into decisions being made about older persons. We are doing this with younger people, serving on the Board of Trustees in some colleges, and on faculties. In terms of decisions, it is really abhorrent to me that we would try to find solutions for older persons in which they themselves were not involved in the process. —James A. Peterson My observation is that most of these older people fake a very fair attitude toward some of the things that they think ought to be done . . . and that they're not talking solely on a selfish basis about what they want. They recognize that many of the things that they want are things which other portions of the popula- tion need also. They are not putting it on the basis of— give us ours and forget about it, but rather on the basis of— we're concerned with social needs, as affecting us or affecting other parts of the population. I think this is a hopeful sign. Essentially what they're saying is; give us our fair share, whether it's housing or health care, or whatever it may be. —John B. Martin 206 I've put on a couple of conferences specifically directed to older citizens and we've tried to mail out thousands of invita- tions to people telling them of these conferences on Medicare, on problems of aging generally, and we've conducted Con- gressional hearings in my own Congressional district, and you cannot say we had a very big turnout, not even of older people. So, it isn't that some of us have not made an effort to generate interest in these matters, but even when you target your invi- tations on old citizens, the response, I must say, has been very discouraging. —Rep. John Brademas I think that large numbers of the elderly are defeated. This is a terrible problem. We are dealing with defeated people, large numbers of defeated people. Now I don't think that is a condi- tion that must persist, it certainly is not appropriate. It is understandable for some people. Some people are ground down. When you're 80 years old how much protesting can you do? -Elias Cohen One of the strange things to me is that older people some- times seem to vote against themselves. I think that one of the reasons older people don't support more social legislation, much of which would be useful to them, is that they feel so financially insecure and they are afraid to vote for measures that are going to cost money. —Clark Tibbitts Those of us in the field are probably the most guilty... of hav- ing created the image of aging that exists. In our zealousness to try and promote support for a better life in retirement, to put some gold in the golden years, if you will, we've played up the hazards of being old to the point where most folks are beginning to believe that that, indeed, is what they can expect in their life. And rather than join the ranks of trying to change it, they have joined those who deny age. —Bernard E. Nash Stereotypes will break down by all kinds of formal and informal education. As old people change and are not any longer this desolate, passive, isolated group, attitudes are going to change. We need a great deal of input in terms of the mass media. We are creating the stereotypes that we object to and I think the mass media do it as much as any other major force in the society. For example, the generation gap is highly a creation on the part of the mass media, I believe. The mass media does very little to break down the stereotypes of the old, and they could do an enormous job. — Bernice Neugarten 207 A City-Planner Reflects on Aging: We never identified ourselves as old people We never got up and said, "We, the people over 65 years of age, living in such and such a neighborhood, are opposed to this." • That's a mistake because when we draw a boundary line about ourselves we permit that political leader to know how to handle us. If you will tell me where your boundaries are, I will enter into diplomacy to get a treaty— I know I can neu- tralize you somewhere. It's the person who says, "I'm a human being. I am very dynamic. I am very volatile. I've got all kinds of interests. I am not only growing older, but I am also growing more complicated. I want to grow, my one objective is to grow!"— that's the kind of person that I have to engage with much more creativity, I've got to really understand there's going to be creative tension between us. • You know, it is very interesting— older people have the time, they have the inclination, and they have a very good radar system in listening at public hearings. They don't go with their own agenda quite as much as people in the vigorous middle years. I found the older people that I recruited to go to public hearings, zoning hearings, to city council meetings, to board of education meetings, and so on, a much more reliable recorder with a much broader antenna system. They heard more, they listened more,, they took in more objectively, and they were able to report it without as much bias, without try- ing to make it support their little agenda. • Shadow government has often meant the outs; instead of having just the mayor, you have also the guy who has been defeated for mayor. I'd like to see some new form of shadow government conceived and at least experimentally tried out, in which the elderly had an honest-to-goodness role to play. I think they do. I think the civic statesman is a real concept. The Romans and Greeks thought of it as the tribunes of the city. Who are the tribunes of the city? They are not a group of young men. They are usually the people who have passed beyond the quest of their own personal wealth and power, and so on, and in which now is left the common weal, the inter- ests of the public sector. I don't know how to tap that. I don't know how to augment that. By the time I'm 65, I'm going to find a way to augment it. -Leo A. Molinaro 208 OPTIMUM EXPECTATIONS : Arthur S. Flemming, Chairman, 1971 White House Conference on Aging My own emphasis, as I approach the work, is to try to help everybc concerned with the Conference identify action programs that have good chance of being implemented very quickly. I feel that to a greater extent than is warranted we're a society that could be describ as futuristic. We are constantly saying— well, if we do some planni now, some years from now it may be possible for us to deal witr particular issue. But those who are elderly now haven't got the slight interest in that kind of talk, and my hope is that we will see coming < of the Conference action programs that can be implemented witl fifteen months, so that those who are now elderly will have opportunit for growth and development that otherwise would not be present. • I think that the climate is more favorable for action in the field aging than at any other time in our history. I believe that there ii greater understanding and recognition of the issues that confront us this field than ever before, and I also feel that there is more poten support for programs designed to deal with these issues than e before. • I think the executive branch will be responsive to recommen tions which involve utilizing its existing authority and its existing sources in a more effective manner. It seems to me that the test t should be applied in evaluating what may happen as a result of the C ference is whether, in a particular instance, a department or a group departments can develop an action program which will result in elderly population obtaining better service than they have been obtc ing up to the present time. I think that has to be the measure of succe • The provision in the law authorizing what amounts to a follow year is somewhat unique as far as conferences of this kind are c cerned. As soon as the Conference is over, the actual programs t have been recommended which relate to the federal government will considered within the executive branch. This means that ultimately a series of recommendations relatinc these action programs will be submitted by the President to the C gress. In addition, however, the Congress on its own initiative is v apt to pick up some of the recommendations, and act favorably on thi Undoubtedly some recommendations are going to be made to the st and local governments; and in view of the fact that the federal gove ment called the Conference, it will have an obligation to take th recommendations and transmit them to state governments for con* eration and action. Likewise, some recommendations are going to made to the private sector and, again, as the convenor of the Con ence, the federal government will have the obligation to get these r ommendations to the private sector, with the hope that it can urge t\ consideration in such a manner as to lead to action by the private sec 209 White House Conference on Aging: prognosis There are problems in society that don't really get any resolu- tion unless they become matters of political controversies. If this White House Conference on Aging can be used to politi- cize the issues, then we have some chances of success. I would say, let's use the Conference to see if we can make some impact on the value system that disadvantages the elderly. -Elias Cohen No matter how you structure a Conference, it's one thing to get recommendations and it's another thing to get action. -Clark Tibbitts 210 The 1961 Conference defined the broad range and the long range goals. What I want to see the 1971 Conference do is to take these goals and translate them into policy proposals that make sense in light of what the need is and what the resources are. That's a more difficult job than just stating the long range goals. —John B. Martin It will be disappointing to many people if the Conference comes out only in policy statements. And they will feel that they should have said, "Well, if you are going to provide this much of something, then do it this way." But that doesn't really give you direction. It doesn't put the policy down and integrate it with all other policies to be sure that it's not un- fortunate action in relation to other segments of the popula- tion, that we can genuinely achieve it, and so on. We're going to have to build in the understanding that these policies are not something that, the day after the White House Conference, are going to be in action, but that the third year of the Confer- ence is planned so that this action can be gotten into. And this is when everybody has got to go to work, and all the people that have been saying "We want this and we want these things!" are going to have to work at it, too. If we've had any impact from the Conference-at federal, state or local level- then this should be more feasible and easier to achieve. — WilmaT. Donahue Looking Back: Having vented our feelings, we went home and addressed ouselves to the crab grass. This is unforunate because three million dollars of the taxpayers' money was spent on it. I don't think the 1961 Conference anywhere near achieved what the 3,000-plus delegates who were there envisioned for it. But we have to blame ourselves and not the government or any particular culprit. And we can learn a lesson from that conference, which, I think, will lead to more of the dreams we had becoming reality. The idea is that we must have some organization to our recommendations. We must identify who is responsible for what— not just say that something has to be done, but who should do it and put forth some techniques for accomplishing it. -Bernard E. Nash Well I don't remember too well what those 1961 recommenda- tions were, but my assessment of the intervening years is very clear. We lagged tremendously, not only lagged as against our resources, we even lagged on the basis of comparability with some industrial nations. Some are way ahead of us in this area. —Leon H. Keyserling 211 You can only get what's feasible. And in 1961 many of us thought that the moment had come for medical insurance for the aged and this was our moment and we were not going to divide our energies by running around and saying "I also waltzed!" You have to take what you can get in the real world, not in the world of good intentions. —Ethel Shanas First of all, I think the fact that there were 600 recommenda- tions in 1961 was a road block to action in itself. You dump that many comments or recommendations on the public or on Congress and the tendency is to throw up the hands and say, "This is too complicated. We just won't do anything." In 1971 we hope to be more selective . . . and try to isolate the things that most need to be done, and which, realistically speaking, there is a chance of getting done. —John B. Martin Looking Forward: // / could see one thing come out of the 1971 White House Conference on Aging I would like to ask for a commitment. I would like to see the pressure so great that the administra- tion and the leaders of Congress would commit themselves to adequate income for old age, preferably using the Social Security mechanism. I would like to see the pledge made— we are ready to program something in stages so that by 1976 we could say, yes, we have eliminated poverty in old age for all Americans. And when you do that an enormous amount of other problems will be solved. — Elias Cohen Older people really don't have very many spokesmen for them. They don't generate the lobby themselves like farmers or the AMA or any other group and they don't have many others who have enough interest to do it. Also, I think, it's quite important that they don't have much with which to bargain. Most any other group can say, "If you do something for us, we'll return it." But older people don't have much, at least as we see it now. So one of the things we're trying to tell people in connection with the White House Conference is, "when you make a policy recommendation, try to show in it that there will be some benefit to other people than the older people, be- cause then it's more likely to get some acceptance." This is kind of hard to do. You could sell Health Insurance and you could sell Social Security and Old Age Assistance in part because they took a load off the middle generation. But I don't know if you can sell housing or recreation on that basis, cer- tainly not in a very real way. —Clark Tibbitts 212 It is too bad if old people are going to be taken care of and have their status improved only when we get all the other problems solved. This is to say that we will never do anything. — JuanitaM. Kreps No, I'm not at all sanguine about the prospects for the White House Conference on Aging . . . You know, we're seeing a number of other things take place at the federal level. We are seeing the Administration on Aging dismantled. We are seeing the amount of money allocated and that's the best way to tell what the administration thinks. We've seen the amount of money actually available for proj- ects under Title 3 of the Older Americans Act cut drastically. We see efforts by the administration to significantly limit social services expenditures under Title 1 and Title 16 of the Social Security Act. We've seen efforts to cut back on some of the research activities in aging. You've got the thorough rehear- sal there. This, better than any opinions of mine, these facts lay out in what kind of esteem the elderly are held by the national administration. At the same time we're doing that, how can we say that the White House Conference is going to produce the dawn of a better day for elderly people in the United States? -Elias Cohen We've had what I believe are 40-year cycles of national loss of nerve and a real sinking spell of heart failure, a failure of heart . . . We are having one right now. We've had one in 1930, one in 1890 and one in 1850 in this country. In 1850 it was economic, as well as human, surrounding Civil Rights. In 1890 it was largely economic. In 1930 it was largely economic. In 1970 it's both economic, as well as a more hard-to-define hard-to- describe crisis of values in the country. In 1930 and 1890 these crises responded largely to economic moves on a na- tional base. In 1970 it is both an economic move that has to be made as well as a somewhat radical, peaceful redistribu- tion of power which is going on in the political arena right now and those who understand what's going on, I think, will have confidence that this country can do the right thing. The time scale is critical; we need leadership, but I think the coun- try will ultimately produce it. -John H. Knowles, M.D. 213 There could be nothing worse than silence on the issues The White House Conference comes less than a year before the presidential election of 1972. If that Conference is well in- formed, motivated, and action oriented, it may not, like the proverbial tree in a dead forest, fall unheard. We hope, rather, for a demonstration of leadership motivated by grass-roots concern and demand for results. This will not happen if the forthcoming Conference is primed for "smooth- ness" with attendance geared to political and professional favorites who won't rock the boat. Moreover, if the 1971 Con- ference, as was its 1961 predecessor, is designed NOT to make action recommendations as a body, the Conference will be regarded as a sterile exercise. The 1961 meeting issued sectional positions but never voted as a whole. It is technic- ally inaccurate, therefore, to say the 1961 Conference recom- mended anything. In addition to an action-oriented agenda, the Conference should consider how to make recommendations really count. It is not enough to recommend and hope for consideration and action by government and other agencies. If the past tells us anything, it is that pressure interrupted is pressure wasted. Should the Conference break new ground and establish a non-governmental "gadfly" panel to report periodically on what happens — or doesn't happen — to Conference recom- mendations? Phope they would. Such a departure from White House Conference tradition is entirely justified. Indeed, it is the very lack of substantial responsiveness to the needs of the aged and aging that underlies the calling of the Conference in the first place. -James E. Birren Since these problems are man-made, it seems to me almost by definition that they can be man-solved . . . I am not pessimistic about this country being able to solve whatever problems people see in connection with handling our aged. I think they are all soluble. I see them as problems not inherent in the physiology of aging. The ultimate terminal events are, but this isn't the area that causes the most talk. But since these problems are man-made, it seems to me al- most by definition that they can be man-solved, given the will, and the energy, and the application of talents. -Nathan W. Shock 214 AFTER WORD The National Retired Teachers Association and the American Ai sociation of Retired Persons share the feeling that this 1971 Whil House Conference on Aging has a crucial, almost a last chanc importance. Many questions facing the Conference will reach crisis pr< portions within the next ten years. Yet, not for another decac will such a concentration of effort, thought and interest be brougl to b6ar on the subject of aging. Not for another decade will thei be such a marshalling of public concern, such a climate of rece| tiveness toward identifying and removing the barriers and stun bling blocks to large-scale action on behalf of the nation's old( population. In the foregoing pages, 46 of America's leading thinkers ha\ begun this process of identifying barriers and identifying ways ! eliminate them— a process we hope to see intensively pursued the Conference itself. But that is only the first step. Recognizing the barriers to a tion, removing the barriers to action still are prologue. Then must come action itself. And that's what the White House Conference 'Third Yea is about— the year of follow-up, of expediting and implementin The year of hard work and new beginnings. Unless we resolutely fill this "Third Year" with action, v lose a great momentum, a singular opportunity. And once aga we will see the draining away of vital energies and enthusiasn which could have been transformed into concrete gains for Ame ica's elderly. We cannot allow this possibility. The problems are too acute, the human need too sever unwarranted and poignant, to hold out hope of change and th< withdraw it. The change must be forthcoming. For our own self-respect « a people, for our own viability as a nation, we must begin now change what it means to grow old in America. 215 BIOGRAPHICAL NOTES ROBERT M. BALL: Commissioner of Social Security since 1962; associated since 1939 with various offices of Social Security Administration, and other governmental units relating to it. JAMES E. BIRREN, Ph.D.: director of Gerontology Center, and professor of psychology, University of Southern California; formerly director of Aging Program, National Institute of Child Health and Human Development, and chief of Section on Aging, National Institute of Mental Health; past president of Gerontological Society, currently editor of its Journal of Gerontology. WALTER BORNEMEIER, M.D.: Chicago surgeon; immediate past president of the American Medical Association. fOHN BRADEMAS (D-Indiana): member of the U.S. House of Representatives; co-author (with Ogden R. Reid) of 1969 legislation amending and expanding the Older Americans Act of 1965, thus extending life of Administration on Aging; chairman of Select Sub-Committee on Education of House Committee on Education and Labor. ROBERT N. BUTLER, M.D.: practicing and research psychiatrist; chairman of Mayor's Advisory Committee on Aging, Washington, D.C.; assistant clinical crofessor of Psychiatry, School of Medicine, George Washington University; nstructor, Problems of Middle and Later Life, Washington Psychiatric Institute. EDMUND C. CASEY, M.D.: Cincinnati internist with a special interest in chest Jiseases; immediate past president of the Board of Trustees of the National Medical Association. 5HIRLEY CHISHOLM (D-New York): member of the U.S. House of Representatives; member of House Veterans Affairs Committee. ;, RANK CHURCH (D-Idaho): member of the United States Senate; chairman )f the Senate's Special Committee on Aging. MARGARET CLARK, Ph.D.: anthropologist, research director of Adult Development in Sub-cultural Studies in Aging at the Langley Porter Neuro- jsychiatric Institute in San Francisco. IAMSEY CLARK: New York and Washington lawyer; former U.S. Attorney aeneral; author of the best-selling "Crime in America." SLIAS COHEN: assistant professor of Community Medicine at the University of ^nnsylvania School of Medicine; former Commissioner of the Pennsylvania Office or the Aging, and of Family Services. VILBUR J. COHEN: dean of the University of Michigan College of Education; ormer Secretary of Health, Education and Welfare. 216 LESTER DAVIS: executive director of the American Association of Homes for th Aging, an organization of voluntary non-profit and governmental residences and institutions. MICHAEL E. DeBAKEY, M.D.: pioneering vascular surgeon; president, Baylor College of Medicine, Houston, and chairman of its Department of Surgery; director, Cardiovascular Research and Training Center, The Methodist Hospital, Houston. WILMA T. DONAHUE, Ph.D.: retired co-director of the University of Michigan- Wayne State University Institute of Gerontology; chairman of the International Center of Social Gerontology, Paris; technical coordinator of the 1971 White Hous Conference on Aging. ROBERT D. EILERS, Ph.D.: executive director of the Leonard Davis Institute of Health Economics, and professor of Insurance at the Wharton School, University of Pennsylvania. ARTHUR S. FLEMMING, J.D.: chairman of the 1971 White House Conference j Aging; Secretary of Health, Education and Welfare during the last years of the Eisenhower administration, and organizer of the first White House Conference on Aging in 1961 ; most recently president of Macalester College in St. Paul, Minneso RALPH GOLDMAN, M.D.: professor of Medicine, chief of the Division of Nephrology, and chief of the Division of Gerontology, School of Medicine, University of California at Los Angeles. PHILIP M. HAUSER, Ph.D.: demographer, professor of sociology, and directoi of the Population Research Center at the University of Chicago. ROBERT J. HAVIGHURST, Ph.D.: professor of Education and Human Develop ment, University of Chicago; past president of the Gerontological Society, and currently chairman of its Committee on Research and Development Goals in Social Gerontology. FLOYD H. HYDE: assistant Secretary For Community Development, Department of Housing and Urban Development; in charge of Model Cities program; formerly mayor of Fresno, California. HERMAN KAHN: "the dean of American futurologists"; director of the Hudson Institute, a Croton-on-Hudson, N.Y., think tank; author of On Thermonuclear War, The Emerging Japanese Superstate, and (with Anthony J. Wiener) The Year 2000. LEON H. KEYSERLING: former chairman of the Council of Economic Advisers consulting economist and attorney in Washington, D.C.; president of the Conferen on Economic Progress. JOHN H.KNOWLES, M.D.: general director of Massachusetts General HospitJ in Boston; professor of medicine at the Harvard Medical School. 217 JUANITA M. KREPS, Ph.D.: professor of economics and dean of The Woman's College at Duke University; member of the Senate Special Committee on Aging's Task Force on the Economics of Aging; member of the Technical Committee on Income for the 1971 White House Conference on Aging. JOHN V. LINDSAY: Mayor of New York City; former member of the House of Representatives. JOHN B. MARTIN: Commissioner of the Administration on Aging, a division of HEW; Special Assistant to the President for the Aging; director of the 1971 White House Conference on Aging. MARSHALL McLUHAN, Ph.D.: communicologist; professor of English and director of the Centre for Culture and Technology, at St. Michael's College, University of Toronto; author of Understanding Media, The Medium is the Massage, War and Peace in the Global Village. MARGARET MEAD, Ph.D.: anthropologist and social critic; curator emeritus of ethnology at the American Museum of Natural History; adjunct professor of anthropology at Columbia University; recently retired as chairman of Fordham University's social sciences division; author of Coming of Age in Samoa, Growing Up in New Guinea. LEO A. MOLINARO: president of The American City Corporation, an urban redevelopment subsidiary of The Rouse Corporation, developers of the "new town" of Columbia, Maryland. BERNARD E.,NASH: executive director of The National Retired Teachers Association and the American Association of Retired Persons; former U.S. Deputy Commissioner of Aging; originator of the Foster Grandparents Program. BERNICE L. NEUGARTEN, Ph.D.: psychologist; professor and chairman, Committee on Human Development, University of Chicago, former member of the Training Committee on Aging, National Institute on Child Health and Human Development; past president of the Gerontological Society. JAMES A. PETERSON, Ph.D., H.L.D.: professor of Sociology, Gerontology Center, and executive director, Training Program for Marriage and Family Counsellors, University of Southern California; executive director, Peterson-Geudel Family Center. SYLVIA PORTER: writer of nationally syndicated column on economic matters and consumer affairs appearing in approximately 400 newspapers in the United States. WINSTON L. PROUTY (R-Vermont) : member of the United States Senate; ranking minority member of the Senate's Special Committee on Aging; author of Prouty Amendment to the Social Security Act. 218 DAVID PRYOR (D-Arkansas): member of the U.S. House of Representatives; investigator of nursing home abuses; member of House Appropriations Commits author of legislation to create Select House Committee on Aging (still awaiting action). OGDEN R. REID (R-New York): member of the U.S. House of Representatives; co-author (with John Brademas) in 1969 of legislation amending and expanding the Older Americans Act of 1965, extending the life of the Administration on Aging; ranking minority member of Select Sub-Committee on Education of House Committee on Education and Labor. ELLIOT L. RICHARDSON: Secretary of Health, Education and Welfare; previously U.S. Under-Secretary of State; formerly Assistant Secretary, HEW (1957-59), and Massachusetts Attorney General. JAMES H. SCHULZ, Ph.D.: associate professor of Welfare Economics, Brande University; member of the Senate Special Committee on Aging's Task Force on Economics of Aging; economic consultant to NRTA/AARP; general editor and coordinator of background papers for the 1971 White House Conference on Agir ETHEL SHANAS, Ph.D.: professor of Sociology, University of Illinois in Chics secretary to the executive committee, American Branch of the International Association of Gerontology; vice president, psychological and social sciences, Gerontological Society. NATHAN W. SHOCK, Ph.D.: research gerontologist; Chief, Gerontology Branch, National Health Institute, National Institute of Health, and the Baltimore City Hospitals; past president of the Gerontological Society. CLARK TIBBITTS, Sc.D. (Hon.): gerontologist; director of training for the Administration on Aging; professorial lecturer at George Washington University associate coordinator for technical committees for the 1971 White House Conference on Aging; director of 1950 National Conference on Aging. WOLF VON ECKHARDT: urban planning and architecture critic for The Washington Post; author of The Challenge of Megalopolis, A Place To Live. EMERSON C. WALDEN, M.D.: Baltimore surgeon; president of the National Medical Association. KEVIN H. WHITE: Mayor of Boston, Massachusetts; formerly Massachusetts Secretary of State. ANTHONY J. WIENER: chairman, Hudson Institute's Research Management Council; deputy project leader of Institute's on-going study, "The Corporate Environment, 1975-1985"; author (with Herman Kahn) of The Year 2000. 219 BIOGRAPHICAL NOTE ON NRTA/ AARP rhe National Retired Teachers Association and the American Association of Retired Persons are non-profit, non-partisan Asso- ;iations whose three million members make them the largest nembership organizations for older people in the nation. As such, they increasingly are called upon by Congressional lommittees and government agencies to fill a spokesmanship ole, not just for their own membership, but for 20 million older Americans. This strong leadership also is being expanded in the field of letirement Preparation to prevent those approaching retirement rom being mired in many of the pitfalls that faced America's first etirement generation. It is the members of this first retirement generation— now in leir mid-seventies to mid-eighties— who formed the founding- lember nucleus around which NRTA/AARP have grown. When it became clear that retirement and America's re- ponse to aging, itself, were forcing the nation's older people to ccept a devalued, outcast view of themselves, something had ) be done. And one of those who set out to reverse the trend was thel Percy Andrus, a brilliant and visionary woman who had just nded a 40-year career as teacher and principal in Los Angeles chools. In 1947, she organized the National Retired Teachers Asso- iation for retired teachers and school administrators. In 1958, he organized a sister organization, the American Association of etired Persons, with membership open to all people past 55. As set forth in their certificates of incorporation, both organ- ations are dedicated to aiding the aged in their needs— social, hysical, economic and intellectual. They are further dedicated ) studying the meaning of a longer life in a society which offers lore and more free time, and to identifying those experiences lat lead to life fulfillment in our changing society. To help create the new affirmative patterns for aging, the associations established an outstanding group of publications, icluding the two bi-monthly magazines, NRTA Journal and 71-272 O - 72 - pt. 1 220 Modern Maturity, and monthly news bulletins for both Associ; tions. NRTA/AARP gained very quickly the reputation for beir pioneers and social innovators in their constant search for wa> to improve every facet of retirement living. Their pioneering pr< grams and projects relate to health, to conserving income, employment opportunities, to leisure time activity, to new learnir experiences for the mature, to community service opportunity at the local level. And constantly the Associations seek ways expand both the range and the variety of these programs. For example— illustrating their long-range commitment to better life for all older people-NRTA/AARP recently joined wi the University of Southern California to build the $4,000,000 Eth Percy Andrus Gerontology Center, a unique research and trai ing center now under construction on the USC campus. The whole credo of NRTA/AARP is summed up in two she mottos: "Independence, Dignity and Purpose" and 'To Serv Not to be Served." This book and other NRTA/AARP activities for the 1 971 Whi House Conference on Aging affirm the mottos. Instead of waitir to see what may be done for them, here are older people, ther selves, moving into the vanguard, bringing their own vigoroi mandate for action. 221 Mr. Nash. Thank you, sir. From the remarks of individuals and leaders who have seen it, rims far, beyond those who are quoted, there is a great positive reaction, even m the short time that this document has been out. In it, one of the outstanding quotes is by Elias Cohen, I believe he appeared before this committee recently representing the Gerontologi- cal Society. Dr. Cohen says, "Poverty is a pretty low goal. Who wants bo reach poverty?" Most would agree that the basic floor within our social security sys- tem should not be at the poverty level or even within the concept of that kind of living in retirement. The concept our associations would prefer as our Nation's objec- ne is a retirement standard somewhat equivalent to the standard of lvmg an individual had achieved during his lifetime. Certainly the )asic floor of payments must be above the poverty line even for those ndmduals who had not had the opportunity to achieve at least a mini- num standard of living during their working lifetime. Widows of aborers might be an example of such persons. The goal of adequacy, or of comparable living standards, in retire- nent means that we cannot depend totally on the social security sys- em or even on the present basis of funding the social security system. [t means that we are going to have to be more effective in our private )ension programs. Much more attention needs to be given to this by Congress. Only one-third to two-fifths of the persons in private industry to- lay paying into pension programs will be collecting from those pro- grams in 1980, 10 years from now. I repeat, only one-third to two- lfths. But the startling fact is not that. The startling fact is that three- luarters of those who collect will have an annual pension income of ess than $2,000 a year from their private pension programs. Indeed, we need to take a look at that component of our retirement ystem. JOB OPPORTUNITIES ^ Mr. Chairman, we were shocked recently to read that, indeed, our jovernment is proposing an age discrimination plan in several bills overmg Federal employees. H.E. 8085 is one of seven bills submitted >n age discrimination in employment. That bill vests administrative authority in the President or such gent as he may designate to establish maximum age limits for entry nto positions in executive agencies and the competitive service. If our Government is to provide leadership and to tell industry that Ji™ il t0 ° n the basis of com Petency, and physical health, ■atner than age, how can it turn around and have seven bills in which b is advocating age discrimination for its own employees? I here are other kinds of programs we could address ourselves to in he employment opportunity area. Some would require Government uosidization, but may indeed perhaps save millions of dollars at the ame time. Thus, we need to look at the benefits and not just the primary ost of certain programs. For example, Mr. Chairman, last Sunday I had the opportunity of ervmg as the transportation committee for my church. I went out 222 to pick up some elderly women who could not otherwise get to tl church. One of these lived in Northeast Washington where she ha resided all of her life. She told me that she cannot leave her home after 3 o'clock in tl afternoon. She is a prisoner in her own home, Mr. Chairman. She unable to go to any store but the one which remains in h( neighborhood because all of the other stores have been robbed so fr quently that they have closed. The present one has been robbed s: times in 6 months and is talking of closing. Now, what does this woman do? We have a responsibility, if \ are talking about helping people to remain in their own homes, assist them with these kinds of problems, and it may mean that ^ have a massive community service corps that, indeed, not only assis the aged, but assists other individuals; a good Samaritan corps, you will. Whatever you would call it, the focus would be on preservii human dignity in one's retirement years. We drove a little further out into the surrounding areas of Was 1 ington to pick up another individual. Her husband had died only a fe years ago. She said that she was getting along fine except that in t' past year she could not get on a chair to reach things in the upper cu board. Now those cupboards were useless to her and she could not sh< for as much when she goes out, yet she cannot drive and cannot shop frequently. She repeated the problem of finding stores to get to and having to ( her shopping within a limited time range during the day when it w safe. She spoke of her family that was now scattered and the difficulty going out and meeting new friends and replacing the ones she w losing. She said the church was the only real social contact that she nc had, and she was thankful for the transportation that was ma available for her visits twice a week to the church. Mr. Chairman, that what the golden retirement years are to be for future generate of older Americans ? We cannot overlook these kinds of life-styles that people are fore into because of the other problems in our society. We must addre ourselves again, I say, to the total system that influences our life retirement years. We believe that nce again the wonderful words of concern and compassion come out it one end, but at the other end come budgetary restrictions, cuts, slashes, and limitations. So I guess I come to the conclusion, and I have made a very good Faith effort to work with the administration on the child development Dill, but have learned from that experience if I needed no other lesson, mving been in Congress for 13 years, not to look with too much con- idence to their rhetoric but rather to their deeds. I think the White House Conference may well prove to be nothing )ut just a campaign convention to try to say to the older people of America that Kichard Nixon cares about old folks. So I wish the President would spend more time, energy, and money n addressing himself to the problems of older Americans and use jomewhat less of the taxpayers' money to set up fancy conferences to ;ry to bamboozle the American electorate into thinking that he really iares about older Americans' problems. If I have not made myself clear or as another politician in this town ikes to say, perfectly clear, then I will try to do so at some subsequent ;ime. Mr. Nash. May I give you one assurance for just a moment, Mr. chairman. Our two associations' boards of directors met 2 weeks ago tnd voted that our associations will have, probably in February 1972, 226 a national forum on implementation of the White House Conference o: Aging recommendations. We will sponsor an effort to bring togethe all of the Government and private agencies and take a look at wha was said at the Conference and come up with an action program an not just the words. ("The Issues— Where We Stand" follows:) The Issues — Where We Stand Delegates to the White House Conference will break up into 14 sections 1 discuss the same number of general topics. AARP has adopted a position in r lation to each topic. On this and following pages we list each topic (with su sections in some cases) and the Association's position. income 1. Private pensions A Pension Commission, as recommended by the President's Task Force ( Aging, should be created to safeguard the funds of all pension systems in Ameri< and should include some form of guarantee of pension benefits in case of d fault. Early vesting and portability rights of employes should be a condition all pension plans. The amount of individual pension plans should be a matt between employer and employe or his representative. 2. Assuring basic income The Association rejects the concept of a basic floor of Social Security incor at the poverty level. Income adequate for a moderate standard of living varies defined by the Bureau of Labor Statistics. Assuring retirement income at tli level is the primary issue to be resolved. Second is the method by which this financed. AARP supports a mixture of contributory Social Security and gener revenue. HEALTH 1. Insurance: Medicare and medicaid versus national health plan We support the enactment of a national health plan which would guarantee t availability of comprehensive, quality health care to all Americans regardle of age or the ability to pay. Until the national health plan is enacted, we urge t Congress to assure that all persons become eligible for Medicare upon attaini: age 65. We further support : — Consolidation of Parts A and B of Medicare, elimination of premium pa ments under Part B, and removal of all deductibles and coinsurance features both parts. — The elimination of restrictions on the duration of coverage of hospital a: extended care stays as well as the removal of the restriction of extended ca benefits to post-hospital cases. — The inclusion of prescription drug costs in Medicare. 2. Manpower Recognizing the urgent, critical need to increase the health manpower supp we urge Federal assistance for training professional and paramedical person! in geriatric medicine. We also urge that their training include a component care of the aged, eventually producing geriatric-aide specialists. NUTRITION National nutrition: Government versus private concern We urge the present Administration to effectively implement its commitment alleviate the problem of inadequate nutrition of the elderly, through permant nutrition programs for needy older persons and an intensive quality control a consumer information program for all Americans. HOUSING 1. Identification of housing for the elderly Policy on housing should make specific provision for the elderly. A fixed p portion of all funds allocated for housing should provide for housing for t elderly, both in separate units and in overall housing programs, and should identified as such. 227 I, Real (state taw abatement We believe In enhancing the possibility of maintaining Independent living. We, therefore, urge thai state and Federal governments provide financial Incentives to make local property tax relief for elderly homeowners possible. 3. Living arrangements The elderly have the right of freedom of choice in housing. Therefore, hous- ing programs should endeavor to provide various types of living arrangements and services to support t hat freedom of choice. TRANSPORTATION 1. Cost of transportation Although income assistance is certainly a good thing, we should take the position that, unless services are available, money will not take the individual very far, and support the idea of government-funded transportation service facilities. 2. Accessibility of transportation We feel that, with stimulating and imaginative leadership, society's attitude toward the elderly can be changed and that, with the Federal Government show- ing the way in interstate commerce, through financial help, demonstration projects, etc., the states and communities can offer individualized, flexible trans- portation to older citizens. 3. Physical harriers in transportation We recommend that the Federal Government provide leadership and set na- tional policies, but that the diverse needs of older persons for safe and con- venient transportation be met by local and state governments. EMPLOYMENT AND RETIREMENT 1. Age discrimination We are opposed to mandatory retirement for reasons of age alone ; therefore, we urge strongly that a study be undertaken immediately to establish the ef- fectiveness of the Age Discrimination in Employment Act as it now stands. If findings show that the law does not properly protect those now covered, steps should be taken to insure its enforcement. When that action has been taken, or if initial studies show that the law does what it was set up to do, the Act should be extended to all older workers with no age limitation. 2. Placement and training programs With our unique and proven interest in the useful employment of the elderly, we recommend that specific placement, training and job assistance programs be designed and implemented to allow older workers who so desire to be gain- fully employed. 3. Forced retirement We urge that no situation such as health, plant shutdowns, etc., be used as a guise for discriminating against older workers. When workers are forced to retire before retirement age, the Federal Government should have a program to help them. k- Preretirement education We, who through publications and nationwide seminars have long been in the vanguard in preretirement education, urge Federal leadership in preretirement training in the private sector. EDUCATION Start new or improve the old programs? Although a certain amount of research is always necessary, recalling the suc- cess of the Foster Grandparent Program, we feel that existing programs that naye been successful should be continued and extended to realize their full potential. ROLES AND ACTIVITIES /. Responsibilities for role development The development of satisfactory roles for older persons is the combined re- sponsibility of the older persons themselves, their families, voluntary organiza- tions and government agencies. Opportunities and resources to engage in such 228 roles must be fostered to the extent of the capacity of the individuals and fan ilies involved, but they must be aided and underwritten by the two basi sources — voluntary associations and government units. Older persons should nc be left solely to their own initiative and resources to develop and pursue appr< priate and meaningful retirement roles. In our social system based on a mix c government and voluntary effort, all four sources— individual, familial, vountar organization and government— have a responsibility. Bach must contribute witl in its appropriate means to the effort of fostering or engaging in those activitie and functions which provide the most satisfactory role for the aged. 2. Role activity priorities All sectors of the aging can be provided with programs to meet their role prol lems or for creating new role opportunities. In periods of severely limited n sources, the reductions in programs when necessary must be equitably applie to all older persons. The greater likelihood is that our country can aid both tho« in greater need and in lesser need if it but has the commitment and will. It shoul not be necessary to pose alternatives which provide for the aged most in nee at the expense of the other sectors of older persons. SPIRITUAL WELL-BEING Government cooperation Given the pluralistic nature of American society, we recommend that the Fe> eral Government provide informational and technical assistance where requin and cooperate closely with churches in community-oriented programs ; howeve this should in no way impinge on our tradition of separation of church ar state. PLANNING Planning mechanisms The planning mechanisms that have been developed in communities, states ai nationwide must continue, but must become much more effective in their respon to the concerns and needs of older persons. We take this position because we reco nize that for the immediate future the basic form of organization will be if a ge eral-purpose, functional type responsible for specific functions for the total po ulation. However, alongside these functional units the continuing efforts special organizations for the aging are needed to induce the functional orgamz tions to pay greater attention to their responsibilities for the aged. Just as in V community, special committees or units on planning for the aged, under the ui brella of a total community planning function, can be effective if properly stru< ured and empowered, so for the states and nation, special units and agencies a necessary. This applies to both government and voluntary efforts. Strong, visit special units for and of the aging, under the umbrella of existing central and fur tional planning bodies, are necessary to stimulate the existing planning mec* nisms to do a better job planning for the aged. FACILITIES, PROGRAMS AND SERVICES 1. Central position of the elderly Maximum opportunity should be accorded old people to participate in poli formation of service programs for the elderly. All older people who want to p* ticipate in these efforts should have this course of action (available to fchein. Old persons should be encouraged to participate, particularly in policy formation, the maximum feasible extent, both employment opportunities and volunteer op< ings should be made available to older persons in the operation and manageme of services to the elderly. Policy formation and staffing of programs for old peo] cannot and should not be the exclusive domain of old people themselves. The acti promotion of a greater role for old people in these efforts does not contravene t use and employment of other age groups. The avenues must remain open for interested persons, regardless of age, to participate in the program and poli determination, and the management and operation of facilities and services 1 old persons. 2. Own home residence Older people should not be forced into congregate facilities that demean tb personality and decrease their opportunities for independent living, unless th< disability and isolation become such that further independent living is hazardc to themselves or others. Home care, house maintenance and housing aide servic 229 properly organized and controlled, should be expanded. Housing authorities pro viding large-scale bousing for (he <>id should be charged with the responsibility of increased financing, if not operating sponsorship, for these ty-i>es of sen Maximum efforts should he asserted and programs devised to maintain older peo- ple in their own homes to the extent that it is feasible to do so. histit utional care in nursing home facilities should he restricted to those elderly who require continuous nursing procedures. Better organized programs of supervision to en- force proper standards on nursing homes should he developed. Even with the best operated nursing homes for the elderly, the movement of old people to these facilities should be primarily of a "last resort" character. RESEARCH AND DEMONSTRATION 1. Facilities and services versus research and demonstration We wholeheartedly support that some proportion of public (and private) funds be allocated toward research and demonstration. We urge that, since pri- vate industry allocates 3-5 per cent of its funds to research and demonstration, and most HEW programs earmark approximately 7 per cent for this activity, an average of these percentages, 5 per cent, is a realistic allocation for the aged. In advance of such an increase in funds, we urge that current and future re- search and demonstration be monitored to avoid gaps or overlap in activity and insure that specific issues are being investigated. In sum. we believe that the basis for current and future facilities and services is responsible research and demonstration and its judicious application. 2. Organization: Fragmented versus centralized In light of the existing fragmented and under-financed approach to aging research, coupled with a rapidly increasing older population, we support an Institute of Gerontology and a coordinated, systematic approach to research on aging. TRAINING Level of instruction We feel that priority should be placed on advanced education of teachers and researchers, with equal emphasis on direct-service education of professionals and semiprofessionals. GOVERNMENT AND NONGOVERNMENT ORGANIZATION 1. Government advocacy for the elderly The interests of older people are best served by special organizations of, by and for the aging rather than undifferentiated, all-population agencies organized along functional lines. A reasonable resolution of the basic needs of the aged requires specialized government and voluntary organizations, each playing its proper role of advocacy and action, with all efforts concentrated on problem- solving rather than organizational devices. 2. A central agency for the aging A strong, visible and authoritative Administration on Aging is a necessary ingredient of Federal organization. Without a central Federal agency of this type, of recognized status, the beginning developments in better meeting the needs of the elderly will deteriorate. The proper organizational locus of this agency is within the Department of Health, Education and Welfare. The posi- tion of this unit within the department must make it adequately independent and self-determining if it is to work effectively. The primary assignments of the Administration on Aging should be promotional and operational. It is needed to administer aging programs, promote the interests of the aging, and centralize research and fact gathering. Our Association also proposes that an additional mechanism is necessary for the policy development, program planning and co- ordination aspects. We do not subscribe to the position that the proper place tor this function is the President's executive staff. To place these functions within this organizational format is to subject these activities directly to the political influences of changing administrations. The Office of Management and Budget has increasingly been given this role for all Government functions. We propose that a unit be developed in this office, staffed with gerontologists, with responsibiUty for policy, planning, coordination and management oversight of all activities on aging performed by the Federal Government. Insofar as gov- ernment organization within states follows comparable patterns, we recom- mend a counterpart type of organization at state levels. 230 3. Government-voluntary agency relations Our Association believes it is important for government institutions to listen and react positively to the viewpoint and the concerns of the voluntary associa- tions of and for the aging. Government grants should be made available to voluntary organizations foi specific uses. A balanced approach to the distribution of responsibility and the financing of programs must be our national goal. Government support by means of grants-in-aid to voluntary operations should be encouraged and expanded to the extent that the voluntary activities can make positive contributions o1 effort and results. The American system of providing services to the elderly b3 means of cooperating government and nongovernment associations is supported by our Association. Emphasis should be placed on financial support by govern ment for those voluntary programs which initiate and continue programs thai creatively expand services to old people. Mr. Brademas. I am encouraged to hear that because, as I have already said, from the brutal experience that some of us have had ir recent hours, my advice is ; Do not believe what they say ; believe onlj what they do. Now, having said that, I want to turn to the question of the role o: the Administration on Aging and the structure of the Federal Gov ernment for attending to some of the problems that you have outlinec in your splendid statement. You say that many of you had hoped that the creation of the Admin istration on Aging in 1965 would provide the coordinated approacl that you have urged on the Federal Government and you havi remarked that it has not done so for lack of authority, funding, lead ership, and executive and congressional support ; we all bear part of th blame. And then you go on to say that there is now needed a componen additional to the Administration on Aging to that structure so that th structure will become a system. An authority, you say, is needed at th highest level of government to fulfill the functions of national plan ning, coordination, budget development, and review and overall pro gram evaluation. This authority must work with Presidential council composed of represents tives of both the departmental secretary offices and non-governmental interest in the field, the Office of Management and Budget and with Executive and Cor gressional branches. I quote from your statement because you did not have time to do sc You went on to say that the Administration on Aging should b retained but must be upgraded and strengthened and that it shoul< carry the principal responsibility for fulfilling at operational level both the objectives identified in the Older Americans Act and th recommendations of the 1961 and upcoming 1971 White House Con ferences on Aging. I wonder, Mr. Nash, because this is a very important point on whic' you have touched and one with respect to which you have a great dea of experience and expertise, if you could spell out a little more clear! the kind of role you envisage for the Administration on Aging and i: particular indicate the sort of relationship you believe that it shoul have to the Presidential council that you have proposed. Mr. Nash. Yes, sir. The role I envision for the Administration o: Aging would be basically an operational role, fulfilling the objective that are sought within the Older Americans Act. 231 [t cannot do so at the level at which it presently exists in EIEWi It must be raised. It must have the authority to work with the various agencies within its own Department such as Social Security, Public Health, Office of Education, Food and Drug Administration, \ I II, and so fort li- lt must have some regulatory authority to he meaningful and significant as an agency. 1 know that many people feel that if it is given more money, that will be the answer. There never seems to he enough money for any given program. But certainly there is signi- ficance in regulatory powers— the establishment of standards, and enforcement of those standards in nursing homes, in educational programs, in medical services, and so forth. IIa\ r ing been the Deputy Commissioner I am well aware that the AOA has been so handcuffed by limited resources over the years that it was able to do little more than operate the titles 3, 4, and 5 programs. YVe made some efforts in longer range planning and providing Con- gress some of the background needed to make intelligent judgments about program advances but these were totally inadequate. AOA has to have much more in order to undertake what it was charged to do in the first place. In addition it should have greater re- sponsibilities in working within the total structure of HEW. You are well a^ware of the scope of the responsibilities in our society HEW has assigned to it. Older Americans need a strong advocate in those programs. The council that I suggested, working intimately with the Office of Management and Budget, would be one that has a coordinating role with the various departments. Each department would have a unit similar to AOA but not as broad in scope because they would be focusing on more specific issues affecting older and retired persons within their department. It would also have the responsibility for national long-range planning, budgeting, and program distribution. It would have program review authority of the various departments to assure that both the system and its component parts are responsive to current needs and pending changes. It would monitor proposed legislation for potential impact on the aging and would propose legis- lation where deemed necessary. For example, in 1967 Congress passed an Age Discrimination Act. In the act it created a structure to deal with age discrimination from 45 to 64. Mr. Chairman, our evidence indicates there have been 2,000 com- plaints registered, and only something like 15 or 20 processed in the period since 1967. In addition, the law requires that the Secretary of Labor submit a special report to Congress. That report has never been filed. That sort of thing has to be monitored. If we do come up with intelligent answers to our problems, then those answers should be implemented and an organization at the highest level of Government should be charged with this. We feel that with this kind of council and with its immediate place- ment with or in the Office of Management and Budget, that we would begin to see a reasonable distribution of the programs and resources throughout all Federal agencies. 232 We do not believe that the Administration on Aging can effectively perform the broad governmental task, particularly if it is going to be assigned regulatory powers and operative powers. Mr. Brademas. Let me ask you two other questions, only for you: comment. We have talked in this committee about putting togethei some comprehensive legislation that would seek to move toward th< total system of services of which you spoke. Can you give me any general reaction on that kind of thought Mr. Nash. Yes, sir; we are strongly in favor of this kind of pro posal and we have several ideas that we want to add to the tota system. We believe, for example, that there is a transportation problen and it is not going to be solved with reduced fares. The transports tion issue has to do with equipment design, with availability, wit! costs, with communities that don't have public transportation, an< other issues with which you are well aware. We believe, for example, that if we can subsidize the railroads an< airlines and schoolbuses in our Nation, why can't we provide a trans portation system that would make it possible for older people to ge out and participate more in the total community, in voluntary serv ices, in getting to the doctor when they need to and in recreation am leisure time activities that will not lead to the health problems an< mental health problems. In Switzerland I was told the system wen out of the red when reduced fares were given older users. Mr. Brademas. Let me ask you about one other question, Mr. Nasi I was very vigorous in my criticism of President Nixon and hi administration with respect to their policy on aging a moment age and I meant to be because, as I have suggested, I feel very strong! about this issue of the gap between rhetoric and action. We hear a good deal in our country these days about declinin credibility in government. I think this is one of the reasons. Pol: ticians go out and promise a lot of things and then when the tim comes to implement their promises, they turn tail and run. Now, there is a measure that has been proposed by Presiden Nixon of which I have been a very strong champion. As a matter c fact, I guess I can say I have been the most vigorous proponent o the President's proposal in the House or Senate; namely, the Presi dent's proposal for a National Institute for Education aimed at stiir ulating and supporting research and development in education i our country at every level from preschool through graduate schoo in formal institutions of learning and outside formal institutions c learning. This measure also, like the child development bill, was put tc gether with bipartisan support on this subcommittee., and I am ver glad to report that this measure, which was Mr. Nixon's initiative unlike the child development bill, which was our initiative, was favoi ably reported by the full Committee on Education and Labor thi week. I do hope the President will not be upset that we have taken hi words at face value and have acted on them. That we at times do s< seems to trouble him very much. It is perfectly all right for Presidents of the United States t urge Congress to act, but this one seems to get terribly nervous whe we do. 293 In any event, I do hope that the President will sign into law this hill ho has proposed. But having given you those opening comments, I turned to my more specific question. Since we have come to some judgment on thw com- mittee and in the White House on the wisdom of a Nat ional Institute of Education to carry out research and development in the field of education, I have observed with particular interest recommendations made to this subcommittee a few days ago by a distinguished geron- tologist that we ought to establish a National Institute of Aging which would devote itself, in I take it an analogous way, to research and de- velopment w T ith respect to the problems of the aging in American life. The dialogue we had last week suggested, I think, that it should be more than geriatric research, narrowly defined as biological research, although that, of course, is crucial to' this kind of research, but that such an Institute of Aging should go beyond that to include as well what one might call social research in the field of the aging. What I should like to ask, Mr. Nash, is your judgment on the wis- dom or the value or the utility of a National Institute of Aging with research and development responsibilities in this field. Mr. Nash. Yes, sir; our associations are very much in support of the Institute of Aging— I believe gerontology is the terminology that I have heard used. There are two factors, however, that should be made clear. One is that through our associations' efforts to assist the University of Southern California Institute of Gerontology and the fund rais- ing that our members have engaged in to provide a building there, we have become acquainted with some of the specific issues that needed attention. We found that if we wanted to get any kind of Government assistance in the construction of that facility, that we had to put in wet" labs, that is, laboratories that were interested in the life sci- ences, but there was no regulation or hope that we would get assistance with respect to the social sciences. Thus, if there is an Institute, I hope there will be a very specific congressional mandate written into the bill requiring that the social sci- ences have equal support and stature. This, sir, was also confirmed at the meeting in Switzerland that I mentioned. The physical and life scientists indicated their break- throughs and their time schedule while the social scientists there viewed with some consternation the fact that this was occurring with- )ut equal support and equal progress as to how we will cope with social, political, economic, and moral issues related to these breakthroughs. The second point is that you have heard manv arguments that if you create an Institute of Gerontology, that vou will detract from the pres- ent Institutes of Heart, Cancer, and so forth. It is our feeling that it is not an either-or proposition, that there are specific kinds of research endeavors that are necessarv but that there ire also generalized areas that are influenced and need attention. In other words, the components and the svstems again in the In- stitute of Gerontology can do this. Tne fi^l Point I would make is that there is research going on at Jie present time crying for support. It is not enough to simply create m Institute. You have an Institute in NIH under Dr. Nathan Shock 234 in Baltimore. You have a program that has been underway for oye 20-odd years in Framingham, Mass., on tihe impact of the aginj process. In both of these facilities this year there were inadequate researc] funds made available to continue, at the level necessary, these long range objectives, this long-range research. The two greatest endeavor in our society today on a study of the human aging process, and w failed to 'support them. And yet we are talking about creating anothe Institute, so we must be able to support it after brick and mortar i laid. Mr. Brademas. I appreciate that. I guess the problem you discuss© could apply with equal validity to the problem as to the strength am capacity of the Administration on Aging. Mr. Nash. Yes, sir. Mr. Brademas. Mr. Nash, you have been most helpful. We thank yo very much for having come. Our next witness is Mr. William R. Hutton, executive secretary o the National Council of Senior Citizens. We will modify the agend slightly, if that is agreeable, to accommodate his schedule. Mr. Hutton, we are pleased to see you again, sir, and I hope you wl go right ahead. STATEMENT OF WILLIAM R. HUTTON, EXECUTIVE DIRECTOR, M TIONAL COUNCIL OF SENIOR CITIZENS, ACCOMPANIED BY RUD" DANSTEDT, ASSISTANT TO THE PRESIDENT, NATIONAL COUNCI OF SENIOR CITIZENS Mr. Hutton. Thank you. Mr. Chairman, I have brought along Mr. Rudy Danstedt, assistar to the president of the National Council of Senior Citizens. If I may, sir, to conserve time, we do have a statement we would lit to submit for the record, and perhaps deal with a few highlights c that statement as we go along, and then have an opportunity fc questions. Mr. Brademas. That will be fine. (Mr. Hutton's prepared statement follows :) Testimony of William R. Hutton, Executive Director, National Council of Senior Citizens Mr. Chairman and distinguished members of the Subcommittee I wish to e: press on behalf of the National Council of Senior Citizens appreciation for th opportunity to outline the need to provide comprehensive services for older cil zens so they may fully share the living standard enjoyed by the majority I Americans. It is my opinion, Mr. Chairman, that the 3,000,000 members of the Nation Council heartily agree with your view that we have had far too much rhetor about the needs of the aging and that it is time to match the rhetoric wil effective action. Our membership is hopeful that the bold prediction of Dr. Arthur Flemmin Chairman of the approaching White House Conference on Aging who testify here last week, will be realized. In his prepared statement for the Subcommittee, Dr. Flemming said: "Tl President has talked with me about his deep concerns regarding this issi (problems of the aging) and, as a result, I have no hesitancy in saying thi between now and the time for the White House conference the nation will wi ness vigorous and effective action in this area." 235 If Dr. Flemmlng is right in his prediction, it would be a notable change from the previous record of Incredible footdragging on the pari of the Administration In dealing with problems of the retirement generation. Right here, I want to make clear that the National Council of Senior Citiaeni holds Dr. Plemming in the highesl esteem. Ho made a magnificent contribution to the nation as Secretary of the Department of Health, Education ami Welfare during the Eisenhower Administration and as the chief architect at the first White House Conference on Aging in 1961. We hope, however, that his loyalty to the President : "> sub-standard nursing bomes for a long time. The National Council of Senior Citizens and Other humanitarian orgnni/.a tions have made one appeal after another to get the Government to enforce rea- sonable standards for nursing homes receiving Federal funds under Medicaid and the Government has done litt le about this. If the President is really determined to do something about substandard nurs- ing homes, we need more than rhetoric. We need enforcement of Federal nursing home regulations in all nursing home establishments receiving Federal funds This won't happen overnight. There are 23,000 licensed nursing homes in the U.S. and it will take real effort and substantial funding to bring the many sub-standard nursing homes up to even the modest requirements just recently established by the Department of Health, Education and Welfare which is re- sponsible for Federal participation in the Medicaid program. The President's rhetoric in the area of nursing home standards is impres- sive and if the interest is genuine and permanent we are grateful for it even if it did take two and a half years for the Administration to recognize this problem. But we do not want this new-found Presidential interest in long term care to fade away into nothingness after the votes are counted next November. The absence of a program of coordinated, continuous and comprehensive medi- cal and social services — for the aged and those persons suffering from long-term chronic illness — is a grave national problem for which a solution must be found. The search for the most effective program need not be delayed until the re- sults of the White House Conference. It need not be postponed unt.il after the Presidential election. It can be started right now by this Administration calling on Congress to initiate the necessary studies. Present public programs for long-term health-care are divided among medical services ; hardship and deprivation ; inefficiencies and spiraling costs and a shortage of proper facilities truly capable of providing the differing levels and kinds of care and services required by this growing segment of the population. Present public prigrams for long-term health-care are divided among medicai facilities construction programs, housing programs, public assistance programs and programs specifically for the aged. Each, however, is addressed to only a facet of the problem. There is no coordination with respect to various kinds and levels of care required by different persons or the relative need for facilities of several types. Existing medical care and related institutional programs are not in them- selves efficient and effective mechanisms for dealing with all long-term care problems. This fact — coupled with the shortage of appropriate facilities — has resulted in much improper and wasteful use of acute care facilities. The Secretary of Health, Education and Welfare should be instructed to develop a program of coordinated, continuous, comprehensive medical and social services for the aged and those persons suffering from chronic illness, which could be integrated eventually with the federally-financed and administered national health insurance system which this nation decides it is going to have. Such a program must include a uniform benefit package which will guarantee both ambulatory and institutional care. Under the enabling law, we suggest, the Secretary of Health, Education and Welfare together with the Secretary of Housing and Urban Development should be instructed to conduct a joint study of the extent of the need for appropriate facilities of various kinds required by the program which is developed and of appropriate and equitable means of meeting both capital and operating costs of such additional facilities. We would hope these studies will enable the Secretaries to develop, and trans- mit to Congress not later than two years after enactment of the Act, a consistent and coordinated program to meet the needs of all elderly suffering from long- term chronic illness. While on the subject of medication and drugs, I would like to ask why the Administration has never acted on the recommendation of its own civilian study group which recommended inclusion of prescription drugs under Medicare, the Federal health insurance program for those age 65 or over? As Executive Director of the National Council and as a member, until recently, of the Health Insurance Benefits Advisory Council which monitors operation of the Medicare health insurance for the elderly, I have watched developments in this aspect of health care for the elderly. 238 In the last days of the Johnson administration, a task force of top H.E.'fl experts proposed inclusion of prescription drugs under Medicare. When tl Nixon Administration took over, it named a civilian group to review the finding of the Johnson Administration task force on prescription drugs. The civilia group, which included representatives of the American Medical Association an the prescription drug industry, approved the concept of adding out-of-hospit; prescription drugs to the Medicare program — but nothing more has been said t the Administration over the past two years. For an increasing number of elderly, the exorbitant cost of prescription dni| they need to keep going presents the problem of buying the needed drugs < going without eating. What has the Administration done about this very real problem of the elderlj Absolutely nothing. Yet this would be another positive step on behalf of oldi people. On being invited to come before this distinguished Subcommittee, I was to] that nutrition, housing, transportation, health care, volunteer service progran and geriatric research are among the subjects being explored at this hearing. I was a delegate to the ill-fated White House Conference on Food, Nutritic and Health of 1969. The section of the Conference report dealing with the nee< of the elderly called for an adequate income for the needy elderly, greati emphasis on preventive health care to keep people well instead of treating the when they are ill or disabled, and an outlay of $150,000,009 a year in Feder funds to finance public and non-profit private agencies to serve hot, nutritioi meals to the low income elderly as is done in European countries^ This report recognized that the nutrition problems of the elderly are often due to lack of adequate income and that the elderly often eat poorly becau: of ill-fitting dentures or because they cannot afford proper dental care. What has the administration done about the recommendations of this Confe ence? So far as the National Council of Senior Citizens can learn, absolu nothing. So much for nutrition. What has the Administration done to provide adequate housing for the elder!; Over the past ten years, Federally financed housing programs for the elderly ha 1 produced an average of 37,000 new units a year. There is a need for at lea 120,000 elderly housing units a year. We need decent homes at rents older peop can afford. The one program that has produced any substantial number of housing uni for the elderly — Section 202 — is being phased out by the Administration. Th program financed non-profit agencies loans from the Federal treasury at nomin interest rates. Research into the process of human aging could pay off handsomely in i duced health costs if given proper funding and priority. However, thisi resear< has been subsumed in the National Institutes of Health's Institute of Child Ca and Human Development and has had very low priority both under the Johnsx and Nixon Administrations. The National Council of Senior Citizens hopes the Nixon Administration w: change its attitude but there has been no evidence in the two and a half yea the Administration has been in office that it will do so. So far, I have confined myself chiefly to the economic needs of the elderly. As and when the economic needs of the elderly are met, society has an ob gation to satisfy the social and educational needs of older citizens. These nee cover the areas of political action and schooling in a context acceptible to tl elderly. It might even involve the return of the elderly to the classroom as teachei teachers' aides and counsellors to the young. Unhappily for the nation's elderly, Mr. Nixon vetoed legislation enacted 1 Congress last year, the manpower bill, that would have made possible a sta in providing new careers, including jobs as teachers or teacher aides, for tl elderly. The increasing number of senior centers across the nation are starting to me the social and economic needs of the elderly but, unfortunately, Federal fun for these programs are being cut back. These centers have demonstrated tl need for comprehensive social and educational services for the elderly. As you have so ably stated, Mr. Chairman, older Americans have made gre contributions to our society and deserve a reasonable share in the living stan ards they helped make possible for the majority. 239 Paraphrasing Historian Arnold Toynibee, l suggest that the measure <>f a national Administration is how it cares for Its elderly citizens. There is still time for tlu> Nixon Administration to match its rhetoric with action lint our experience is such thai we feel the need to come direct to the Congress and ask onr lawmakers to help our Older people. That Sir, is why we arc here today. Mr. Hutton. To begin with, sir, it is mv opinion that the 3 million members of the National Council of Senior Citizens heartily agree with your view that we have had far too much rhetoric about the needs of the aging, and that it is time to match that rhetoric with effective action. I was, like you, sir, notably struck by the statement made by Dr. Arthur Flemming before your subcommittee last week, and one of his statements in particular when he said that the President had talked with him about his deep concerns regarding the problems of aging, and then I quote Dr. Flemming. He says : As a result, I have no hesitancy in saying that between now and the time for the White House Conference the Nation will witness vigorous and effective action in this area. Now we believe that if Dr. Flemming is right in his prediction, it would be a notable change from the previous record of incredible foot dragging on the part of the administration in dealing with the prob- lems of the retirement generation. Now I want here to say, sir, that in our opinion the National Council holds Dr. Flemming in very high esteem. He is a fine gentleman. I hope his loyalty to the President and to the administration doesn't blind his eyes to some of. the record of this administration in dealing with the problems of the aging in the nearly 3 years in which it has been in office. As you know, sir, the National Council of Senior Citizens is a non- profit, nonpartisan organization. During the 1960's, we did our best to alert the Kennedy and Johnson administrations to the desperate plight of the Nation's elderly, and in 1970 we have done everything we know to try to convince the Nixon administration of the need for ac- tion on the multiplying problems of the elderly. We have made some gains but the measure of our failure and the measure of the Nixon administration's failure is seen in the 5 million men and women aged 65 or over who are impoverished and the millions of other elderly who are very close to the poverty line and getting closer day by day. Now we ask, what has the Nixon administration done for these un- fortunate men and women since they came into office 3 years ago? In all honesty, I want to say they have done absolutely nothing, in our opinion. When Mr. Nixon put the freeze on wages and in some categories of prices, my colleague, Nelson Cruikshank, president of the National Council, wrote to President Nixon asking him not to forsake the older American in this particular time. We are very much afraid, sir, that once again the heavy burden of an economic failure or setback is going to hang like a millstone around the necks of our poor older people. What Cruikshank did was urge Mr. Nixon to support a meaningful increase in social security benefits and the Federal takeover of aid to the more than 3.5 million indigent aged, blind, and disabled as proposed in the House passed H.R. 1, which is now before the Senate. Mr. Cruikshank told the President the economic freeze offers very little hope to the elderly because very few social security beneficiaries 240 are going to be dashing out to buy new cars, Mr. Congressman. Anc the freeze order, as many of the people from the national council wh( are in this room will tell you, it came much too late to save them f ron rent increasing which many landlords put into effect as soon as the las social security increase was granted which was before the freeze. Our President Cruikshank's letter was prompted by a deep con cern among the Nation's elderly because of President Nixon's recom mendation in his freeze message that Congress postpone welfare re form for a year. Mr. Cruikshank's letter pointed out to Presiden Nixon : Our elderly citizens contributed much to raising American standards to ud precedented levels and surely you wouldn't want any portion of the burde: of your administration's efforts dealing with the present economic situatio: to fall on the backs of our aged and blind and crippled people. Mr. Brademas. I might say in respect of the President's plea fo postponement of the effective date for another year of the welfar reform measure that I was present on the floor of the House when th President made that statement, and it was revealing to me as a prac ticing politician to see how the Republicans all appluaded when th President said he wanted to postpone the effective date of his own wel fare reform bill while the President then turned to the Democrati side and said piously : But I hope of course there will be no delay on the part of the legislature i enacting the proposal into law. That is just another instance of this President trying to have i both ways. Mr. Hutton. That is really a very similar thing to rhetoric but n action. In other words, please, get it on the books somehow but let : not give it to the older people. Now, we asked for assurance from the President that he would sup port the vital provisions of H.R. 1 affecting these older people. An we have received a noncommital acknowledgement from the Whit House staff but so far today the President has not responded to thi serious letter which the National Council sent to the President with! 5 days of the freeze. Despite the administration rhetoric, it is obvious from the Pres: dent's recommendation for this delay that the economic problem c the elderly has a very low priority with this administration. John Martin, Commissioner of Administration on Aging, testifie recently on pending Senate measures to provide employment oppoi tunities for jobless middle aged and older persons, Mr. Congressmai Martin told the Congress the administration could not support thes pending measures. Incidentally, they included Senator Kennedy's bil Senator Randolph's bill and Senator Percy's bill — all on empioymer opportunities for the elderly. He told them he could not support the* bills on behalf of the administration . . . "in view of the activitie which -are being carried out under present law, proposals pendin before Congress, and legislation being developed for early submit sion to Congress." We have no knowledge of that. He said they would also appear premature, these bills by both side of the House, sir, in view of the upcoming White House Conferenc on Aging. 241 Now, Mr. Cruikshank and I had a very Long conference with Secre kary of Labor only 2 days ago and after an hour and a half bead to head discussion, we could gel no promise whatsoever regarding ex- pansion or extension of any of the demonstration programs in the employment of the elderly which are now working. Now I leave it to yon, sir, and your distinguished members of your subcommittee, to try to recognize Commissioner Martin's nega- tive testimony and Secretary of Labor's nnent hnsiasm, with Dr. Kleni fang's vigorous and effective action on the problems of the aging. Asa matter of fact, after more than 2 years of foot-dragging and inaction, the spreading reaction of the low-income elderly finally did raise some concern at the White House. Last May the President sat down with representatives of the Na- tional Council of Senior Citizens and other national organizations of the elderly and heard the fact's on the problems of older people. The facts were forcefully but respectfully presented by President Cruik- shank and he left with the President's memorandum urging an im- mediate 20 percent social security increase. We are not vague about our figures. We want an extra 20- percent increase in social security now. A boost in the minimum social security benefit to $150 a month for workers with long years of social security coverage, comprehensive national health insurance and, pending its enactment, we want medicare improvements like the inclusions of out- of -hospital drugs, et cetera, under the medicare program. Cruikshank's memorandum which he left with the President pointed to the need for greatly stepped up housing, employment, transporta- tion, and consumer protection programs. Now, it seems to us that perhaps President Cruikshank made the real needs of the Nation's elderly uncomfortably clear to the Presi- dent, Mr. Chairman, because at a subsequent meeting with the Presi- dent held only just last week with representatives of consumer organi- zations at the White House, smaller senior citizen organizations were there but the 3-million-member National Council of Senior Citizens was not invited, which is the largest organization of organized groups of the elderly in this country. So it is obvious that Mr. Cruikshank made his views uncomfortably clear to the President but we noticed that Ralph Nader, the consumer advocate, was likewise not invited to the meeting, so we felt we were in pretty good company. Mr. Brademas. Senator Muskie wasn't invited to the WThite House for the signing of his air pollution control bill, so don't be distressed. Mr. Hutton. I want to highlight some of the statements. Recently the President said the Federal Government should not sub- sidize substandard nursing homes with Federal matching payments under medicaid, the Federal- State health care program for the elderly. The national council since its inception has been a strong fighter in the forefront of the battle to try and clear up the horror of the Na- tion's nursing homes and the Government has been paying vast sums to substandard nursing homes for many years, Mr. Chairman. We have made one appeal after another to get the Government to enforce reasonable standards for nursing homes receiving Federal funds and if the President is really determined to do something about substandard nursing homes, we need much more than rhetoric. We need 242 enforcement of Federal nursing home regulations in all nursing hom< establishments receiving Federal funds. This won't happen overnight There are 23,000 licensed nursing homes in the United States and i will take a real effort and substantial funding to bring the many sub standard nursing homes up even to the most modest requirements those just established by the Department of HEW. Mr. Brademas. I just infer that one possible action of the Presiden between now and the White House Conference on Aging of the kinc that Dr. Flemming suggested the other day might be in the field o nursing homes. I suppose in large measure of the great public attentioi generated by the fine work of my colleague, Congressman Pryor o: Arkansas, as well as of the fine work of Ralph Nader's task force whosi leaders we are hoping to hear later this morning. So I hope that we d< hear of action. Mr. Hutton. I have a specific proposal which I shall introduce now We say the President's rhetoric in the area of nursing home standard is impressive and if the interest is genuine and permanent, we an grateful for it even if it did take 2% years for the administratioi to recognize the problem but we don't like this new found presidentia interest in long-term care to fade away after votes are counted nex November. The absence of a program of coordinated continuous an( comprehensive medical and social services for the aged and those per sons suffering from chronic long-term illness is a grave national prob lem for which a solution must be found. The search for the mos effective program need not be delayed until the results of the Whit House Conference. It need not be postponed until after the presiden tial election. It can be started right now by this administration calling on Congress to initiate the necessary steps. The lack of such a pro gram has produced fragmented, uneven care and services, hardshi] and deprivation, inefficiencies, spiraling cost and shortage of prope facilities truly capable of providing the differing levels of care an< kinds of services required by this growing segment of the population Present public programs for long-term health care are dividec among medical facilities, construction programs, housing programs public assistance programs, program specifically for the aged, anc each addresses itself to only one facet of the problem. There is n< coordination with respect to various kinds and levels of care require< by different persons or the relative need for facilities of differen types. Existing medical care and relating institutional programs are no in themselves efficient and effective mechanisms for dealing with al of the long-term care problems. In fact, being covered with a shortag of the proper facilities, has resulted we believe in many improper an( much wasteful use of the acute care facilities in the hospitals, expen sive care, unnecessary expensive care. We believe the Secretary of Health, Education, and Welfare shouh be instructed now, sir, to develop a program of coordinated continuous comprehensive medical care and social services for the aged and thosi persons suffering from chronic illness. We believe this could be in tegrated eventually with a federally financed and national health in surance system which I hope this Nation soon decides it is going t( have. 243 Such a program must include a uniform benefit package which will guarantee both ambulatory and institutional care. We are submitting this program in more detail when we testify before the Senate Fi- nance Committee on an extension of U.K. 1. Under the enabling law we suo-ovst the Secretary of Health, Edu- lation, and Welfare, together with Secretary of [lousing and Urban Development should be instructed to conduct a joint study on the extent of need for appropriate facilities of various kinds required b}' the program which is developed and of appropriate and equitable means of meeting both capital and operating costs of such additional facilities. We would hope these studies will enable the Secretaries to develop and transmit to Congress not later than 2 years after enactment of the act a consistent and coordinated program to meet the needs of all elderly suffering from long-term chronic illness. While on the subject of medication, sir, I would like to ask in connection with the out-of - hospital prescription drugs why the administration has never acted on the recommendation of its own civilian study group wmich recom- mended inclusion of prescription drugs under medicare just over a year ago, 18 months ago. As executive director of the National Council of Senior Citizens and member of HIBAC, which monitors the operation of medical health insurance, I have watched development of this, and I was a member of that committee. You will recall, sir, in the last days of the Johnson administration a task force of top HEW experts proposed inclusion of prescription drugs and out-of -hospital drugs under medicare. When the Nixon administration took over it named this 19-member civilian group to review 7 the findings of the Johnson administration task force and this civilian group, which included members of AMA and pre- scription drug industry, approved the concept of adding out-of -hospi- tal prescription drugs to the medicare program, but nothing more has been said by the administration over the past 2 years. For an increasing number of elderly, the exorbitant cost of prescrip- tion drugs they need to keep going presents the problem sometimes of a cruel choice between buying the needed drugs to kill their pain from cruel arthritis or getting enough food to keep body and soul together. This is a choice we don't believe older people should have to make. Now I note that your committee, sir, is dealing also with nutritional problems. I was delegate to that ill-fated White House Conference on Food Nutrition and Health in 1969. A section of the White House Con- ference Eeport dealing with the needs of the elderly called for adequate income for needy elderly, called for greater emphasis on preventive health care to keep themVell, and it called for outlay of $150 million i year in Federal funds to finance public and nonprofit private agen- 3ies to serve hot, nutritious meals. This report recognized that nutrition problems of the elderly are too often due to lack of adequate income and they eat poorly because of ill-fitting dentures, et cetera. What has the administration done with ill of the recommendations in that special section on food and hunger? As far as the National Council of Senior Citizens can learn, the ad- ninistration has done nothing and it is not surprising that the next White House Conference on Aging will also be a talkfest and not an igency. 244 What has the administration done on housing ? There is a need f o: 120,000 units for the elderly. Our National Council of Senior Citizen: is on record by convention resolution 'appealing to the President an< to the Secretary of the Cabinet in charge of housing to build at leas 120,000 units. .You mentioned research into the process of aging. Of course, it need: research and we do support the Institute of Gerontology, sir, witl biological and social research which is vitally necessary. At the moment something like $7 million a year goes into that Insti tute of Child Care and Human Development, and gerontologica research is lost in there. We hope and we push the administration to change its attitude bu really it has not done much. My paper describes some of the economi needs of the elderly. And as I say, we have submitted the paper. Older Americans we believe, sir, have made a great contributio] to this Nation. They deserve a reasonable share of the living standard they have helped to make possible for the majority of us. Yet thei social security is so far behind, the health costs which still cover les than 50 percent of the health care costs of the person over 65 which i taken care of under the medicare program. We need foot care, ey care, dental care. There is so much to be done. Senior citizens need decent homes a rents they can afford, and need a meaningful retirement through em ployment programs. The administration's record on these problem is utterly abysmal and when they go to the electorate next year the are not going to be able to point with pride to anything except empt; words. Paraphrasing historian Arnold Toynbee, Mr. Chairman, we sugges that the measure of a national administration is how it cares for it elderly citizens. There is still time for the Nixon administration t match its rhetoric with action but our experience in the past is sue that we feel it vitally necessary to come directly to Congress and as them to help. Thank you, Mr. Chairman, for giving us this opportunity. Mr. Brademas. Thank you very much, Mr. Hutton, for an eloquer statement. I had not seen your statement before you gave it nor had had an opportunity to read it before I voiced some of my own crit: cisms of the what I described as the gap between the administratio rhetoric and its action. And I am sure that my friend and colleagu< the gentleman from New York, Mr. Peyser, will at the appropnat point want to respond. So I shall only reiterate that your testimon is an echo, as I have suggested, far more eloquent than were my word of my own concerns about the failure of the administration to come u with programs and funds to implement programs to make good on it rhetoric. Now having repeated that observation, I should like to put a que* tion tp you ; really, the question I put to Mr. Nash, to get your views Mr. Hutton. Can you give us your comment on the role of the Administratio on Aging and what you envisage would be an appropriate structui within the executive branch of the Federal Government for attendin to the concerns of older Americans? 245 Mr. Hutton. We had high hopes for the Administration on Aging when it was first created and it has gone lower and lower down the totem pole, and we do regret that it lias not functioned on behalf of the elderly to any degree of purposeful extent, although it has stimulated the States, through the State commissions on agin<^, obviously it has not realized the high hopes we had lor it. You will recall that late Con- gressman Fogerty, when he joined with Senator McNamara, had the idea to have an independent U.S. Commission on Aging, which would be outside of any one of the Government departments, and the problem with an Administration on Aging which has been sub- sumed at the bottom of Social and Rehabilitation Services is that it can't reach out from that lower hole very far up HEW, much less to other departments and stimulate them. It is also true that AOA has never been an advocate of the problems of the elderly. With the Administration on Aging's facilities to do research to know so much, and rapport with the many commissions on aging out there, I would have thought that the Commission of Aging would have been thumping to every committee of Congress telling them what they should do. Instead of that, they have not played any major role to directing our lawmakers to solve the problems. We do be- lieve that raising the administration from its current position to a posi- tion somewhere on the White House level, some separate entity of its own, would be helpful. I haven't really a great deal of hope for them to be reaching much into the departments, even from, as Mr. Nash suggests, such a high but secret Office of Management and Budget inhere very strange games are played. There is not much compassion around that office for dealing with problems of the elderly, it seems to me. Mr. Brademas. I can only add there is not much compassion for deal- ing with the problems of the very young, either, because that was the source of the greatest initiative to kill the child development bill yes- terday. But in any event, let me say two things : One, members of this subcommittee on both sides of the political aisle have, I think it is fair to report, been very warm friends and supporters of the Administra- :ion on Aging and have been its champion and have been the champion 3f Mr. Martin, even against those who would pull him down and clip his wings. Mr. Hutton. He is a nice gentleman. Mr. Brademas. He is a fine man, although every time he comes here :o a subcommittee, I feel he has been through another mine field and lost i leg, an arm, or something. We want an action to be strong and rigorous and so we want to help him. The other observation I would make is that while I believe it is fair :o say that it is terribly important to give attention to the shape and structure of the organ within the administration that would have 'esponsibiliy within the executive branch for concern with problems )f the aging, I don't care what kind of structure you have unless there s vigorous support for the operation, for the program, from the high- est level of Government, which in this case of course is the President. Jtherwise, the structure won't make any difference. Mr. Hutton. That is right. Mr. Brademas. We have perhaps a good enough structure in AOA f we had adequate support. Would you quarrel with that analysis ? 246 Mr. Hutton. I won't quarrel with it, no. I think if the President o any administration Mr. Brademas. What I have just said goes for Democrats, too, by th way. Mr. Hutton. If a President of any administration really believe and wanted to do something about the priorities, he would reach dow into a coal scuttle in the Congress and dig it out and it would becom important. I think the staffs of an organization within Governmer don't have much clout unless they have got money and much of th clout depends on how much money the President twisting the arms c his staff in OMB can do, and if the President would give the organize tion money perhaps it would have more clout and command moi respect. Mr. Brademas. Two other questions, Mr. Hutton. Do I take it f roi your testimony that you would be sympathetic to legislation that woul provide comprehensive social services for the aging ? Mr. Hutton. Yes, sir. The National Council is on record at evei convention to support comprehensive social services. Mr. Brademas. My last question is the same one I put to Mr. Nas^ I would invite your comment on the proposal that has been made 1 this subcommittee that there should be established a National Institui on Aging, or National Institute of Gerontology, that would attend 1 the problems of the aging in a research and development way, but thi would not be confined to geriatric research, more narrowly defined. Mr. Hutton. We have supported this bill and we have support* previous bills that would tend to increase the volume of research c aging. Very little of it is going on. The biologists alone tell us that v are on the threshold of very real and important discoveries. It is not just a question of making people live longer ; it is a questk of making people live better and have well-being as they live and th is very vital and the fact that it can be achieved, it seems to me we ha 1 to do more of it and we support every move. Mr. Brademas. Thank you. Mr. Peyser. Mr. Peyser. Thank you very much. First of all, allow me to apologize for not being on time in tl hearing this morning. As my good if riend, Mr. Brademas, knows, la night proved to be a late evening in Congress and, unfortunately, number of things were backed up that didn't break up quite as ear as I would have liked them to. But I am delighted to be here an Mr. Hutton, I am most appreciative of your testimony which I res through the colloquy going on between you and Mr. Brademas. I would like to interject a thought at this time, and then also mal some comments. The attack on the administration per se of the pro lems in aging, both by my good friend, Mr. Brademas, and some < the things that you have commented on, I don't find in a positr sense of accomplishing something for the aging, and I am ve] concerned about seeing something accomplished for the aging. I see very many immediate problems, and one of them was hig. lighted yesterday when the State of New York cut back its Medica program due to no money. By so doing, 165,000 senior citizens pi marily are losing benefits of being able to get such things as drug glasses, and other necessities that New York State has been providii 247 tader the medicaid outpatient care, which as of yesterday are being (iikcn away from 165,000 cit izens in ( hal State. Now (his to me is a deplorable situation, and one thai I intend personally to do something about within this next week in Congi However, one of the problems, in our administration today is thai fcere have been programs thai do not seem perhaps to relate directly to senior citizens. This adminisl rat ion has proposed a program of revenue sharing. Let me speak to it for a minute, because it has a very direct impact on exactly the kind of situation that happened in New York State yesterday. The people who suffered are the senior citizens. In revenue sharing, the administration is advancing the aim to put money back into the States, Federal money, so-called. New York State, for instance, would have received hundreds of millions of dollars under this program. Now this issue unfortunately has been bottled up in committee, in the House. The control of these committees, as you recognize, is under the control of the chairman and the majority party, which is :he Democratic Party in this House. It has been because of these ict ions, and this specific one, that the move that happened yesterday in New York State had to be taken. There just was not money in the mdget, that is, no money to continue this program. Now I would like to suggest in the practical vein that while I have >een very much involved in my own area in New York, I have met with the Council on Aging, the people who are getting ready to come lown to the Conference in Washington. Incidentally, my feeling from :hem, sir, has been one of enthusiasm and hope, and that is the way [ want it. I must say I came from hearing your testimony Avith your feeling of despair. Whereas, I think it should be a feeling of hope, frankly, because I am hopeful and I think there is no question that nen like Congressman Brademas and people who are working on this vho are most anxious to see these programs succeed and get legislation g) that is going to solve these problems. But I think despair is not the thing to be expressing frankly, at this ;ime. I hope that you really do feel on a more positive nature and I will Dut that in a form of question to you to respond to. Mr. Hutton. I would appreciate you putting it in the form of a mestion, sir. Actually, if you can see despair in meat any time, I would be staggered. I am not a man that is pessimistic or despairing, [t doesn't come easy to me. Administrations come and they pass away, Mr. Congressman, and in time I believe we will get these things done. We are not going to despair but you must not mistake open and frank criticism for despair. I am frankly disappointed at the moment with he Nixon administration and what it is doing for the elderly people )f this country, and as regards New York, I don't know enough about he situation except that my people in New York who were on the )hone this morning told me they felt New York State had priorities lefinitely mixed up. At the last time there was serious medicaid cut, he Government spent $400 million in that very wonderful mall that £ou were putting up in Albany and they w T ere very upset about money 'or the mall but no money for medicaid. Mr. Peyser. I would like to say, when you try to pick that kind of comparison, of course, you can pick a comparison in the Federal Gov- ernment at any level on any kind of program of different interests. 248 I am interested. I think the administration, frankly, is vitally inter ested. I don't want to bore you or the group by running through statis tical increases in the amount of money going into aged programs over all in the Federal Government. I don't want to argue what the Johnson administration did or di< not do for this area, or what the Nixon administration has done be cause I think we are now talking about what are we going to do, would really like to keep it in that context of a positive, I will with draw the remark that you are despairing. You say you express lac of hope in one of your sentences here, and so I interpreted that a despair. Mr. Peyser. You know the letter writing capability is somethin that is very proficient among many senior citizens. I know personal! many senior citizens who are very able to write and set forth action to be taken by the committee and their Congressmen. It would seem throughout your council, which is nationwide, the there could be a stimulus here to let the Congress know more and mor of their concerns for getting assistance to senior citizens. Yesterday on the floor, and now once again I mention this, becaus I think you should realize some facts. On the floor of the House yestei day, Mr. Scheuer introduced an amendment on OEO bill that ws calling for $50 million that would be directed really to helping senic citizen situations in this OEO bill, which I support. I think you migr know that they could not get enough people to rise to even have a vot on the question, and it was defeated. Now, I am trying to eliminate any partisanship because I don think we want to get into that. I hope we can move away from it, bi this is what happened yesterday afternoon on the floor of the Hous So I am looking for a response from your organization. Certain! a great spokesman like yourself is here to make his case, but there ai thousands and thousands of senior citizens who I think could haA an impact, a greater impact by using their letter writing capabilit; I find Congress does respond to this type of stimulus. I would ur£ more of it. You have a couple of very strong spokesmen for the senic citizen programs in the Congress who are very much concerned, as am, in this whole area. Do not give up hope. Mr. Hutton. We are not giving up hope. Thank you, Congressman Peyser. Actually, the national counc has many friends on both sides of the House, thank God, who ai trying to do something for older people in the House and in the Senat I just wish the administration would push more, that is all. I dor despair. I say I hope that the administration will. Mr. Peyser. Thank you very much, sir. Thank you, Mr. Chairman. Mr. Brademas. Thank you very much, Mr. Hutton. You have bee extremely helpful, and we are glad to have you with us. I wonder if Mr. Peyser would mind if we take a 5-minute reces The Speaker has called me, and I would like to answer his call, will be right back. (Brief recess.) Mr. Brademas. The subcommittee will resume. We will now hear from Mr. Elihu Schott, cochairman, Committi on Aging, Community Service Society, New York, N.Y. 249 I know, Mr. Schott. my good friend, Mr. Reid, who is noi able to bo with us today, would want me on his behalf as well as on behalf of the members of the subcommittee generally to extend bo von a particu- lar warm word of welcome. STATEMENT OF ELIHU SCHOTT, COCHAIRMAN, COMMITTEE ON AGING, COMMUNITY SERVICE SOCIETY, NEW YORK, N.Y. Mr. Schott. Thank you very much, Mr. Chairman. I must say I feel very humble for many reasons. One was the kind word you said about the work the Community Sendee Society has done in your opening remarks, and another is following the two very export and well-spoken gentlemen who preceded me. I am not a professional in this field. I have, however, worked as a volunteer on a public service committee of the Community Service Society, and hope that I have made some contribution, I and my col- leagues, to helping solve some of the problems. The Community Service Society of New York is a voluntary, non- profit, nonsectanan agency dedicated since 1848 to the strengthening Df family life and the betterment of community life. The Committee on Aging within the CSS Department of Public Affairs is a citizens' committee concerned especially with the well-being of the elderly. The committee consists of a broad cross section of busy men and women who, for more than 10 years and with the help of a highly competent professional staff, have collectively and voluntarily ievoted countless days to learning, understanding, and doing all that we as citizens can do to assist in ameliorating the problems of the 20 million elderly persons in the United States. One of the important things that we have learned is that, large as that number is, it would be a mistake to think that only 20 million Americans are affected. Many more millions of children and friends ire deeply concerned and directly affected by the quality of life of the slderly. The basic needs of older Americans are well known— their need for mcome adequate to insure a decent and dignified life, their need for ;omprehensive and continuing health services, emphasizing mainte- lance of physical and emotional well-being and guaranteeing access :o the appropriate kind and level of care in the event of physical or nental disability or impairment, their need for a variety of housing irrangements, providing a measure of choice and the degree of inde- pendence or protection that individual situations demand, their need tor outlets and opportunities to use their time and talents in ways ;hat are personally satisfying and socially constructive. Some of these needs are met through special service systems, others, presumably, through general service systems, but here all too often jhe elderly are unequal competitors with younger age groups for scarce iollars and scarce services. Awareness of the low priority accorded the aged, with the notable exception of the Social Security Administration, was a compelling reason for the enactment of the Older Americans Act in 1965. The Administration on Aging, and subsequently State offices or commis- sions on aging, came into being "to assist our older people to secure squal opportunity to the full and free enjoyment of (specified) ob- ectives." 250 We applauded these developments. We are on record not only in sup- port of the original Older Americans Act but in respect to amend- ments to strengthen it. We have urged — and along with others have been forced to urge — that appropriations and, hopefully, allocations be made at the level of authorizations, which were modest enough. A case in point is the situation for fiscal 1972. The authorization was $104 million which, given a 65-and-over population of 20 million, works out to a meager $5 per person. The original budget was $29.5 million or $2.5 million less than the budget for fiscal 1971. This was first revised upward to $39.5 million, and then, by heroic efforts inside and outside the Congress, to $44.75 million. We take small comfort from the fact that the final appropriation for programs under the Older Americans Act this year is the largest since its enactment in 1965. When the Administration on Aging was established, it was hailed as a national agency that would be a courageous advocate, a focus for Federal attention to the needs and capabilities of older Americans, a channel for funding a variety of programs on State and local levels. We view with dismay the downgrading and gradual dismantling oi the Administration on Aging. Instead of an independent agency witli direct access and responsibility to the Secretary of the Department oi Health, Education, and Welfare, AOA became a unit within the Social and Rehabilitation Service in 1967. AOA staff has been shifted over or assigned dual responsibilities within SRS. Most recently, the popular foster grandparents program and the hardly launched retired senior volunteer program have been movec out of AOA to become part of a mix in a new umbrella agency for al Federal voluntary action programs denominated ACTIOS. In this year of the White House Conference on Aging the situation is not reassuring. We speak out of first-hand experience in respect to the good that has come out of titles III and IV of the Older Americans Act as ad- ministered by AOA and the potential under part A of title VI for a nationwide SS VP program. We preface our pinpointed testimony about SERVE with apprecia- tion to you, Mr. Chairman, and to your colleague, Congressman Reid for your bipartisan sponsorship of legislation to establish a nation wide RSVP program modeled on the OSS-SERVE experience or Staten Island, and we are pleased to hand deliver to you both the fina report on this research-demonstration project titled "SERVE : Oldei Volunteers in Community Service," and subtitled "A New Role and i New Resource." For the record we summarize the accomplishments of SERVE or. Staten Island which was partially supported by a title IV grant anc SERVE in New York State which is now underway with substantial funding under a title III grant from the New York State Office for the Aging. Incidentally, the Community Service Society is continuing the pro gram on Staten Island in the hope that public funds including RSVP mo^evs, will be available for local takeover in 1972. SERVE on Staten Island was launched in 1967 as a 3-vear research and development project. Aim was to assess the utility of grout methods in recruiting,' placing, training, and retaining older men anc women as volunteers in community service. 251 The results of SERVE on Staten Island are impassive Over a period of 5 years, and beginning with 23 volunteers stationed at \\ lllowbrook State School, 875 individuals aped 60 to 93 years were recruited, and some (515 are active today, giving service at least once a week in 24 social, health, and educational agencies. The retention pate of 70 percent is high. Their hours of service augment and enrich the regular service of the agencies where individuals of all ages and varying needs are under care. The volunteers themselves, as the givers rather than the recipients of service, are eloquent as to the meaning and value of their efforts. They contribute their time and talent without any stipend whatsoever. Transportation is provided, and sometimes lunch. Two full-time paid coordinators are responsible for recruitment, super- vision of placements, and training programs. SERVE in New York State is a consultation program funded under tip AOA title III grant for a 3-year period. Aim is to see whether the lessons learned from the Staten Island demonstration are appli- cable elsewhere, and what modifications in methods are needed. Con- sultation with local communities began October 1 1969. Accomplishments of SERVE in New York State are encouraging. Some 765 volunteers are now registered and are giving a variety of services in 22 communities and in various settings, as, for example, the SERVE in Jamaica group, with placements at Creedmoor State Hospital, and the SERVE in Westchester group, with placements at Grasslands Hospital. There are groups engaged in a telephone reas- surance program to the homebound (telephone line to the community) , two of them in cooperation with local chapters of the National Mul- tiple Sclerosis Society. lively and real interest is apparent across the State from the Buffalo area in western New York on east to Westchester, Nassau, and Suffolk Counties. In very fact, interest in the SERVE concept and requests for how- :o-do-it information go far bevond our State boundaries. In part, ;his has come about because of the SERVE newsletter now mailed ;o some 4,000 agencies and individuals scattered all over the Nation md to persons in Canada, in Australia, and in some 10 European countries. In part, this stems also from the fact that the SERVE program on Staten Island is on the circuit for countless visitors to New York City and has been on the agenda for State, regional, and lational conferences. Inquiries can be met in part by the project report on group volun- eer service issued by AOA in February 1969, as one of its reports on uccessful projects described in the series "Designs for Action by Jlder Americans." Emphasized always is the fact that funds are needed to provide on- ute competent staff supervision and continuing transportation, if ommumties are to initiate successful SERVE-type programs. SERVE was not only fortunate but perhaps unique in being able o serve as a model for the RSVP legislation while the demonstration ros i still m progress. Subsequently, it was one of the major programs agnhghted m "Recommendations for regulations and guidelines for he retired senior volunteer program" prepared for AoA in June, •nil 71-272 O - 72 252 We join the Select Subcommittee on Education in a sense of prid and satisfaction about the accomplishments under the legislatioi And we were pleased to learn that the first 11 RSVP projects wer approved for Federal funding on June 30, 1971, out of the fiscal ai propriation of $500,000. From here on, the new ACTION agency will be responsible for cor sultation and technical assistance to communities and jurisdictior wishing to launch older volunteer programs. I would like to add one thing, that is, to emphasize the fact th* this program involves a double value. There are both givers and r< cipients of SERVE, and they both have benefited very greatly. Mr. Chairman, we are convinced from our own experience an review of reports and testimony submitted to the Senate Special Con mittee on Aging and the Subcommittee on Aging of the Senate Con mittee on Labor and Public Welfare, we conclude that there continued need for a strong Federal program for the aging as ei visaged in the Older Americans Act. The act should be extended. Today's situation is grave for 20 million older Americans wi continue to need a courageous advocate within the administratio: Where that high level advocate should be in the Federal scheme wi surely be debated in the months to come at the White House Co] f erence on Aging and elsewhere. Whatever the outcome, crystal clear is the need for a strong voi< and pressure from the Congress in legislative enactments and co] tinued watchdog efforts and vigorous followthrough by the Co] gress to be certain that substance is given to its evident intentions i attempt to meet the human needs of older men and women. We believe that the current dismal picture can be rectified — but will take a massive pooling of effort by the public and the priva sectors. Be assured of our help. We are in your debt for holding these hearings and affording i an opportunity to submit testimony. Mr. Brademas. Thank you very much, Mr. Schott. We will begin the questioning with Mr. Peyser of your own Sta of New York. Mr. Peyser. Thank you, Mr. Schott. I am glad to have had a chan to say hello a moment ago, and I officially welcome you here to t] committee. A question on the Community Service Society. Now, through yoi program, do I understand correctly that there are a great many vc unteers involved in working in the program? Is that correct? Mr. Schott. Yes. The Community Service Society, which starti really as a social agency, about 10 years ago determined to set up department of public affairs, and within that department of pub] affairs it created a number of committees, one of which is the comm: tee on aging. On the committee on aging, there are approximately 25 people who we'll call nonprofessional, because they are nonprofessional in the s cial service sense. They are lawyers, doctors, architects, business peop. and so forth. We are assisted by a competent professional staff and have unde taken a number of pilot research projects, one of which was SERV. Mr. Peyser. The Staten Island program ? 253 Mr. Schott. Yes; and thai has been an extremely successful one, and [think it lias been a lantern for future programs. Mr. Peyser. The reason for my question on tins is: Do \<>u feel from he experience of the Staten Island program that the more we can ffingin through the work of voluntary work of senior citizens them elves into the program, the better we are improving the lot ofthesenior itizens? In other words, has your group found this is a positive thing have senior eit l/ens participate in ( Mr. Schott. There is absolutely no question about that, Congress- man. It has meant an enormous amount to the participants, and we une a participant now continuing after several years who has reached he age of 94. Mr. Peyser. I think this is wonderful. I think involvement in this •rogram is one of the keys to making them successful. T would like > see as many programs as possible developed in this area, based n your Staten Island experience of utilizing volunteers. One other question I had deals with your experience with social wurity limiting the earning capacity of people after retirement age. n your opinion, having worked in this field, is this a major problem ? Mr. Schott. Yes; we feel that has been a problem, that it is a prob- im, and that relief is definitely needed. We have noted that H.R. 1 r ould provide some measure of relief. Mr. Peyser. Inadequate, I believe, incidentally. Mr. Schott. That is the view that w^e will be expressing. Mr. Peyser. You do feel, though, that this is an important area? /here senior citizens are in a position to contribute to their own sup- ort, I think they ought to have the right of doing it without being enahzed. If you have many people in this category, your organiza- ons should stress this point as much as possible, because Congress action to people who want to help themselves is becoming a very posi- ve thing. J l So I w^ould simply urge that more communication with your Con- ressmen be developed throughout the whole council. Mr. Schott. We are very cognizant of that problem, Mr ongressman. Before we go on, if I may refer to your previous question and the iportance of volunteer service, I do want to stress that the one ting we learned is that it does not happen by itself, that it takes lormous organization, finding the people, interesting the people, find- g work for them to do, get the institutions where they are working i welcome them, arranging transportation, and even a program as ccessful as the SERVE program on Staten Island still requires two ill-time paid people. Mr. Peyser. Thank you very much, Mr. Schott. Thank you, Mr. Chairman. Mr Brademas. Mr. Schott, I want again to commend you and CTTo ° n havm £ been > as y° ur testimony indicates, a model for Z>\? 'proposal which Mr. Reid initiated, and which I was very eased to join him m sponsoring, and which is now law, and which jam, quite candidly, was verv consciously shaped by Mr. Reid as in trt a response to President Nixon's 1968 call for a greater role for ►luntarism m the American society in meeting some of the problems our country. r 254 I am interested as well in what you have to say by way of express ing your concern at the "downgrading and gradual dismantling of th< Administration on Aging," and also at your expression of concen about the gross underfunding of programs administered by the Ad ministration on Aging. These observations impress me, I suppose, most of all, because yoi come to us as a man who has been a leader in dealing with problem! of the aging at the local level, at the community level, and not, there fore, as the spokesman, as some of our earlier witnesses have been, a a national level for organizations concerned with the problems of olde Americans. You speak, as it were, directly from the grassroots, and I can onl; tell you that I share your concerns, as you will not be surprised to learr from the earlier colloquy which I had with the other witnesses. So I want to add my own thanks to those of Mr. Peyser for your ex cellent statement. Indeed, I think I have not seen the document to which you made rei erence, but I should like to have a chance to look at it. It happens that I am a member of the board of an organization calle the Center for a Voluntary Society, which, as its name will suggesi is concerned to stimulate a greater degree of voluntary activities in a. sectors of our society, and I should like to bring to the attention of tha group the work of SERVE, if I may. Mr. Schott. May I leave this copy with you, Mr. Chairman ? Mr. Brademas. Yes, of course, Mr. Schott. This committee, M: Schott, is very rich in members from your great State of New Yorl and one of the most talented is Mr. Kemp, of Buffalo. Mr. Kemp. Mr. Kemp. Thank you, Mr. Chairman. Mr. Schott, I would like to welcome you and other witnesses wh have appeared before this committee. I regret very much that I w£ not able to be here. I have had in my office a continuing interest in the problems of tl aging. Another one of my other interests has been the question of ox prisoners of war and those missing in action, and I have had a numb* of conversations in my office this morning that precluded my beiii here at this particular session, but I can assure you and all of the peop. present today, that I am going to be very active in this problem, an I believe that the purpose for which we met, to expand opportunity and comprehensive social services for the aging, is a particular concei of mine. I thank you for your testimony. I will look forward to reading it ] the record. Along that line, I would like to say that, because I was not able to i here, under the rules of the committee, a single member cannot condu a hearing. I suppose that I could move to strike everything in the re ord up to this point; however, out of deference to the witnesses and 1 all of the people who I am sure traveled a great distance to appear hei this morning to be with us, I am just going to request that I be pe mitted to insert in the record immediately following the remarks of tl chairman, which were very critical of this administration and of ir party, any reply that I feel appropriate. 255 I hope that we will travel out into the Nation and country, since obviously all of your counterparts cannot come to Washington.] think I would Like to sec this committee go to Buffalo, to my area, to other parts of New York, and across this country, to bring (his very critical issue to the attention of the American public. So I will be supporting that, I can assure you, and I ask for unanimous consent, Mr. Chairman, to be able to reply to some of these remarks. I appreciate very much your consideration of my request. Mr. Brademas. Without objection, and I am sure there will be none, the gentleman's request will be agreed to. Mr. Kemp. Thank you very much. (Congressman Kemp's remarks and inserts follow:) Remarks of Hon. Jack Kemp, a Representative in Congress From the State of New York Mr. Kemp. Mr. Chairman, I am sorry that you feel it was the intention of the Nixon Administration to "kill the Child Development bill" yesterday. I do not think that this is the time or place to engage in a discussion of the relative merits of the Administration's position on Child Development, other than to say I don't think one can categorically criticize the President or the Administration for their efforts in attempting to correct a provision of the Child Development legislation which would have had the effect of holding out another empty promise to millions of people who are in need. I think that there can be honest differences of opinion as to whether the Administration focused its emphasies at the proper point and in the most advantageous manner regarding child development. I think, however, that it is totally unfair and -even intellectually dishonest to suggest that the President or his Administration is not living up to promises, or to use your term "campaign rhetoric" in behalf of children. I would point out that the President through H.R. 1 has committed $460 million in new money and $290 million in existing funds for child care services. The new iollar figure is greater than the total number of dollars presently being spent for Head Start. In fact, the total is as much as the Federal Government is now spending for all child development services. You may conclude or even charge that the President's approach is wrong, rat nonetheless the President has placed his priority in getting individuals to ivork, and providing services for their children to enable them to do so. I am sure ;hat the President has made this decision with the realization that it will be possible to get the maximum benefit from those dollars if they are spent in this nanner. At a time when the war in Vietnam is being wound down and defense expenditures are being cut, when we are now spending more money on human leeds than defense needs, and considering that there is a $30 billion deficit, lor the President to have made this commitment to child care is truly significant. The fact that he did not place this money behind your bill was rightfully his choice and was consistent with his intentions of trying to solve the greater needs )f this country. I do not think that it is fair for you to say that "the Nixon Vdministration made a last ditch effort to kill the Child Development bill which vas precisely aimed at implementing those wonderful words and phrases of \Ir. Nixon." The fact is the Administration did not attempt to kill the bill by )lacing an income eligibility level in it, rather it was focusing the available lollars in a positive manner. I would also observe that there is nothing in the Administration's amendment which precludes children above the poverty level [rom participating in child development programs, as it merely allows the Secretary to make judgments based upon needs and establish standards and •ther criteria accordingly. Therefore, I think it is fair to say that the Administration is making a substantial effort in the area of services for children and to say that a review >f the record will show it is also making a substantial effort in the area of aging. ls with child development, in the field of aging, you will find that the resident has placed his priorities for the elderly in a way which might differ nth the approach that you might take if you were in his position. It is unfortu- late that this Committee of the Congress does not have jurisdiction over all iging programs so that we might look at all programs for the aged. Since we 256 can only focus on the Administration on Aging and its related programs, some times there is a failure to look at the total picture. rt u«*J Therefore, to suggest that this Administration wants to kill, maun cripple and weaken the agency which the Congress of the United States established ii the Department of Health, Education, and Welfare to assure that there wouli be high visibility in the councils of the national government to the problem of the aging, namely, the Administration on Aging." I think that you are failin to look at the overall picture or the efforts of the President and the Admir 1St The°President, in his message of March 24, 1971, on the National Center fo Voluntary Action, proposed to put together all volunteer services in one agenc so that they might better be coordinated and at the same time eliminate som of the waste and duplication that invariably exists when individual agencie go their separate ways. (This is the same type of coordination that the Chairma and this Subcommittee was concerned about when it first began consideration c the Child Development legislation.) The transfer of the Foster Grandparenl program as well as the Retired Service Volunteer Program (RSVP) was cei tainly not an attempt to kill those programs, maim AOA, or cripple the Feden Government's efforts in behalf of the elderly. Quite the contrary, the placement of these programs and the visibility the they will have in that new agency will, in fact, help to enhance their function The President speaking in Chicago last June stated that "these programs wi be given high priority in ACTION." This certainly does not sound like an effoi to weaken or destroy them ! Jl On the matter of AOA itself— I don't think that it is accurate to state tht the Administration has downgraded the AOA because it hasn't done what tt Congress intended back in 1965. The placement of that agency and its relatii position in HEW was made over five years ago, long before this Administrate came into being. A look at the AOA's budget will show that it has been increase each year since 1966. Although you might question whether the increases ha^ been enough, the fact remains that the budget for those programs authorize under the AOA has increased. Furthermore, since 1964 there has been a standing executive order whi( established a President's Council on Aging. This Council was composed of sta representatives from agencies which met approximately eight times a yea These staff representatives enjoyed neither policy-making power nor the pow< to make any of its decisions an integral part of the individual departments < agencies which they represented. The full Council on Aging had not bee convened between 1964 and 1969. Under this Administration, concern for tl elderly has been upgraded. This has been done through the Domestic Counc and its special committee on aging. The Domestic Council on Aging is ma< up of: Secretaries Richardson, Hardin, Romney, Volpe, Hodgson and Stan George Shultz of OMB, Arthur Flemming of the White House Conference c Aging, and Directors Sanchez of OEO and Blatchford of ACTION. This Counc does meet. It does have a working staff and it does discuss and act upon tl needs and concerns of the elderly. I am inserting in the record at this point a booklet entitled Facts and Figun on Older Americans, No. 4. This document details the total. Federal Government effort in behalf of the elderly for the last five years as well as the projects f< this fiscal year. As you will note, the figures for "discretionary" programs (thoi programs over and above Social Security) are today almost triple the amouJ of money that was being spent in 1965, and in virtually every category tl amount of money that is going for the elderly is up. We all would like to s< those expenditures increased, and I am certain that the Administration will I moving in this direction. I am also inserting at this point a document prepared for the House Appropi ations Committee as a backup detailing all of the expenditures in the progran operated by the Department of Health, Education, and Welfare. 257 FEDERAL OUTLAYS IN AGING — FISCAL YEARS 1967-72 One way of measuring the Federal commitment to the well-being of :he older population is the amount and proportion of available resources [budget outlays) allocated to providing benefits, facilities, and services :o Americans aged 65+. Accordingly, after the presentation to the Congress of the budget proposal for Fiscal Year 1972 (July 1, 1971 through June 30, 1972), all Federal agencies having significant programs for older >ersons were requested to estimate the "outlays" for 65+ persons under iach of such programs for all of the Fiscal Years from 1967 through 1972. Each agency was instructed to include only those programs directed mtirely or to a major extent to the older population. Specifically xcluded are those programs which benefit older persons as a normal part if the total population. On an over-all basis, counting all of the outlays made with respect o programs meeting the above description and ignoring the source of the unds (whether trust fund or general revenue), total estimated outlays eported by the Federal agencies have risen consistently from year to ear and account for an increasing proportion of the total Federal budget, s follows: Fiscal year 1967 1968 1969 1970 1971 (est.) 1972 (est.) Outlays (billions of dollars) Aging Total Amount Percent of total 15.8 16.6 18.5 $158.4 $25.0 178.9 29.6 184.6 34.1 196.6 37.6 212.8 43.2 229.2 46.4 19.1 20.3 20.2 Thus, expenditures by the Federal Government for programs of special enefit to older persons increased faster than the total of all expendi- ures (86% vs 45%) between Fiscal Years 1967 and 1972 and the proportion f the total Federal budget devoted to the aging rose from 16% to 20%. 258 However, such comparisons of totals, ignore the fact that a large majority of Federal programs, mostly in the areas of income maintenance medical care and often funded through trust funds to which older persons have contributed, are based on specific legislation that provides no, or extremely little, room for the exercise of choice or discretion by the Administration. A more meaningful reflection, therefore, of the exercis of discretion or choices is the dollar outlay for "discretionary" progra such as in housing, food distribution and stamps, research and developme veterans' programs, and community poverty projects. The expenditures for the "discretionary" programs, in total, more t doubled (2.6 times) from $457 million (out of $25 billion) in FY 1967 tc $1.2 billion (out of $46.4 billion) in FY 1972. Housing and related pre grams In the Department of Housing and Urban Development and the food programs in the Department of Agriculture account for a large proportiot the "discretionary" outlays. Other "discretionary" programs showed varj patterns, some decreasing somewhat. Summary information on expenditures by agencies in all reported pre grams in aging and in the "discretionary" programs are shown in the att< two charts and in Part A of the table. Outlay figures for each program within each agency, with asterisks (*) to identify the programs consider "discretionary" are shown in Part B of the table. A separate table pro details on recent trends in Older Americans Act and White House Conferei outlays. 259 TOTAL FEDERAL OUTLAYS IN AGING FISCAL YEARS 1967-1972 LLIONS OF DOLLARS 1967 1968 1969 1970 1971 1972 260 MILLIONS 1,200 FEDERAL OUTLAYS IN AGING IN "DISCRETIONARY" PROGRAMS FISCAL YEARS 1967-1972 OF DOLLARS 1967 1968 1969 1970 1971 1972 261 ESTIMATED FEDKRAL OUTLAYS IN AGING, FISCAL YEARS 1967-1972 ' (Millions of dollars) Part A. Summary Agency FY 1970 FY 1972 Total, all reported proRrams , Departments Agricul ture Defense Health, Education, and Welfare. Office of Education Public Health Service Social and Rehabilitation Service Social Security Administration... Housing and Urban Development. Transportation Independent Agencies Civil Service Commission Office of Economic Opportunity. Railroad Retirement Board Veterans Administration 25,032.2 69.0 246.4 20,059.1 4.6 115.0 1,901.5 18,038.0 167.7 5.4 1,135.3 44.8 1,075.7 2,228.8 29,607.8 92.7 271.7 24,219.1 5.3 129.6 2,636.2 21,448.0 194.3 5.6 1,242.8 48.9 1,203.9 2,328.8 34,062.1 119.9 309.6 28,227.3 4.2 138.2 3,156.9 24,928.0 273.6 7.0 1,378.9 61.8 1,293.5 2,390.5 Total, "discretionary" programs ^ Departments Agriculture Health, Education, and Welfare.. Office of Education Public Health Service Social and Rehabilitation Service Housing and Urban Development, Transportation 456.7 69.0 134.2 4.6 115.0 14.6 167.7 Independent Agencies Office of Economic Opportunity. Veterans Administration 548.5 92.7 167.4 5.3 129.6 32.5 194.3 48.9 45.2 687.0 119.9 180.6 4.2 138.2 38.2 273.6 .6 61.8 50.5 190.6 341.0 31,169.7 3.0 129.6 3,295.1 27,742.0 328.5 7.7 1,571.5 131.1 1,331.6 2,548.9 878.9 190.6 168.7 3.0 129.6 36.1 328.5 .6 131.1 59.4 43,207.7 319.0 409.0 35,908.0 3.2 125.1 3,939.8 31,840.0 409.4 8.9 1,823.8 131.8 1,620.0 2,577.8 1,094.9 319.0 171.9 3.2 125.1 43.7 409.4 1.1 131.8 61.7 46,383.0 417.3 421.8 38,606.9 2.1 115.7 4,399.1 34,090.0 441.1 11.4 2,036.1 119.9 1,617.5 2,711.0 1,209. 417.3 167.5 2.1 115.7 49.6 441.1 2.0 119.9 62.0 1 Fiscal Years 1967 through 1970 = actual outlays; Fiscal Year 1971 = estimate as of April 1971; Fiscal Year 1972 = estimate based on budget request as amended, June 1971. I See text for discussion of "discretionary" programs concept and Part B, this table, for detail of Included programs. 262 ESTIMATED FEDERAL OUTLAYS IN AGING, FISCAL YEARS 1967-1972 J (Millions of dollars) Part B. Detail Agency and program FY 1967 FY 1968 FY 1969 FY 1970 FY 1971 FY 1972 Departments * Agriculture *Food Stamp f 21 ♦Commodity Distribution. *Farm Home Administration. ♦Research Defense Retired Military Personnel: Retired for service.... Retired for disability. Survivors Medical care 246.4 Health, Education, and Welfare . ♦Office of Education ^ 169, „ 67. 7, 20,059 4 ♦Research and training... ♦Library services ♦University Community Services. ♦Adult Basic Education... ♦Administrative costs .... W ♦Public Health Service. ♦Health Services and Mental Health Administration ♦Community Health Service.... ♦National Institute of Mental Health ♦Health Services Research and Demonstration ♦Regional Medical Program.... *Medical Facilities Construction ♦Disease Control 107 54, 4, ♦National Institutes of Health ♦National Institute of Child ^)S Health and Human Development... 7.3 92.7 34.6 30.5 27.2 .4 271.7 188.2 71.9 2.4 9.2 24,219.1 5.3 .4 2.1 .2 2.3 .3 129.6 121.6 53.8 4.1 2.7 60.1 .9 119.9 45.8 44.0 29.6 .5 309.6 217.4 79.5 2.7 10.0 28,227.3 4.2 .6 1.6 .2 1.4 .4 138.2 130.5 54.7 3.9 1.8 8.4 60.6 1.1 7.7 190.6. 93.7 59.3 37.2 .4 341.0 242.9 84.2 3.1 .10.8 31,169.7 3.0 .5 1.1 .2 .9 .4 129.6 121.5 39.4 4.0 .7 9.9 66.7 .9 8.1 8.1 319.0 231.4 49.6 37.5 .5 409.0 296.2 94.6 3.4 14.8 35,908.0 3.2 .6 1.1 .2 .9 .4 125.1 116.3 38.6 4.0 .6 9.1 63.2 .9 417.3 328.0 50.8 38.0 .5 421.8 313.3 88.9 3.6 16. C ,606.9 2.1 115.7 108.! 37. I 3.: 9.2 57.] 1 Fiscal Years 1967 through 1970 = actual outlays; Fiscal Year 1971 = estimate as of April 1971; Fiscal Year 1972 = estimate based on budget request as amended, June 1971. 2 See text for discussion of "discretionary" programs concept and Part B, this table, for detail of included programs. 263 ESTIMATED FEDERAL OUTLAYS IN AGING, FISCAL YEARS 1967-1972 (Millions of dollars) Part B Detail (Con'd) Agency and program FY 1967 FY 1968 FY 1969 FY 1970 FY 1971 FY 1972 Social and Rehabilitation Service. Public Assistance e* Maintenance payments Maintenance assistance admini- stration Medical assistance Social services 901.5 886.9 137.5 749.3 ♦Rehabilitation Services and Faci- lities ♦Rehabilitation Research and Demonstration ♦Rehabilitation Training ♦Research and Training (Foreign Currency) '♦Programs for Aging Social Security Administration Trust Funds Old Age and Survivors Insurance Disability Insurance (Depen- dents only) Hospitalization Insurance Supplementary Medical Insurance Special benefits to 72+ persons... Coal miners and widows ^Housing and Urban Development . ►Low-rent public housing , ►202 direct loan housing ►236 elderly (and 202 conversion), ►202/231 rent supplements Model Cities ►312 rehabilitation loans., ►115 rehabilitation grants, ►Neighborhood Facilities . . , ►Relocation payments ►Research and technology... 4.6 .7 9.3 ,038.0 ,838.0 ,657.0 9.0 ,508.0 664.0 200.0 167.7 90.5 73.0 .6 1.6 .1 1.8 Transportation . Coast Guard Retirement ►Transit Service Demonstration. 5.4 5.4 2,636.2 2,603.7 1,170.2 23.4 1,375.3 34.8 5.1 .3 .2 26.9 21,448.0 21,130.0 15,994.0 10.0 3,736.0 1,390.0 318.0 194.3 111.1 75.6 1.7 2.9 .6 1.7 5.6 5.6 3,156.9 3,118.7 1,208.9 63.2 1,803.4 43.1 5.6 .2 32.0 24,928.0 24,610.0 18,301.0 10.0 4,654.0 1,645.0 318.0 273.6 183.0 75.7 1.2 2.5 7.6 1.4 2.2 7.0 6.4 .6 3,295.1 3,259.0 1,361.1 79.5 1,765.0 53.4 7.9 .4 .1 27.8 27,742.0 27,433.0 20,638.0 12.0 4,804.0 1,979.0 304.0 5.0 328.5 217.0 74.9 3.8 13.4 3.0 13.7 .2 7.7 7.1 .6 3,939.8 3,896.1 1,566.7 91.8 2,169.2 68.4 9.1 .6 .3 33.7 31,840.0 31,406.0 23,503.0 13.0 5,820.0 2,070.0 290.0 144.0 409.4 284.0 60.0 3.8 2.5 4.3 4.9 19.7 3.9 26.2 .2 8.9 7.8 1.1 4,399.1 4,349.4 1,719.1 91.3 2,460.2 78.8 9.3 .3 .5 39.5 34,090.0 33,506.0 24,503.0 13.0 6,690.0 2,300.0 246.0 338.0 441.1 335.0 13.1 15.1 3.3 4.4 4.7 20.4 4.9 40.2 11.4 9.4 2.0 1 Fiscal Years 1967 through 1970 = actual outlays; Fiscal Year 1971 = estimate as of April 1971; Fiscal Year 1972 = estimate based on budget request as amended, June 1971. 2 See text for discussion of :, discretionary" programs concept and Part B, this table, for detail of included programs. 264 ESTIMATED FEDERAL OUTLAYS IN AGING, FISCAL YEARS 1967-1972 (Millions of dollars) Part B. Detail (Cont'd.) Agency and program FY 1967 FY 1968 FY 1969 FY 1970 FY 1971 FY 1972 Independent Agencies Civil Service Commission 1,158.8 1,268.9 1,405.0 1,596.5 1,867.9 2,093.2 Retirement and disability Annuitants and employees health 1,135.3 23.5 1,242.8 26.1 1,378.9 26.1 1,571.5 25.0 1,823.8 44.1 2,036.1 57.1 ♦Office of Economic Opportunity 44.8 7.7 48.9 8.6 61.8 10.5 131.1 34.0 131.8 27.6 119.9 ♦Administered by other agencies 27.7 " " 8.0 1.0 1.6 25.8 5.6 3.3 19.6 4.7 3.2 19. € ♦Concentrated Employment Program. . . 4.5 ♦Administered by 0E0 37.1 40.3 57.3 97.1 104.2 92.5 ♦Program Development and Demon- 21.0 27.1 1.3 30.6 1.3 56.2 1.6 55.8 l.j ♦Community Action Operations 53. ( 21.0 24.6 2.5 24.2 6.4 49.4 6.8 47.8 8.0 45. ♦Senior Opportunity Program 8.( ♦Health and Nutrition 11.6 9.8 12.6 25.9 30.5 21. ♦Emergency Food and Medical 1.0 10.6 3.0 6.8 7.4 5.2 11.0 14.1 .8 10.6 18.8 1.1 21. ^Special Indian Programs 1.9 2.6 1,075.7 1,064.1 6.9 4.7 2.9 3.0 1,203.9 1,174.9 25.1 3.9 3.2 3.6 1,293.5 1,251.3 38.1 4.1 4.6 2.5 3.2 3.4 1,331.6 1,279.0 49.0 3.6 5.4 2.8 3.7 4.4 1,620.0 1,551.3 65.5 3.2 4. 2. 3. 4. Railroad Retirement Board 1,617. Regular retirement and survivor 1,539. 75. 3. Veterans Administration 2,228.3 2,328.8 2,390.5 2,548.9 2,577.8 2,711. Disability and Survivor Payments . .VT. 1,788.1 92.1 40;9 9.9 1,841.8 95.5 44.7 10.2 1,850.0 98.1 53.6 10.4 1,919.7 100.0 63.7 11.5 1,930.3 103.8 66.0 11.6 2,045. 108. 69. 12. Medical care and treatment.. \S. *Medical and prosthetics research Medical administration and operating expenses 254.1 41.0 2.7 288.5 45.2 2.9 324.6 50.5 3.3 390.4 59.4 4.2 400.0 61.7 4.4 410. 62. 5. 1 Fiscal Years 1967 through 1970 - actual outlays; Fiscal Year 1971 = estimate as of April 197 Fiscal Year 1972 = estimate based on budget request as amended, June 1971. ♦ Programs included in "discretionary" category; see text for discussion of concept and Part A this table, for summary. 265 ESTIMATED EXPENDITURES, OLDER AMERICANS ACT AND RELATED PROGRAMS, FISCAL YEARS 1970-72 (Millions of dollars) Program otal itle III Community programs Planning and operation, Model projects itle IV Research and Development Grants.. Ltle V Training Grants Ltle VI 4 Foster Grandparents Retired Senior Volunteers lite House Conference FY 1970 27.8 9.0 4.0 3.2 2.6 8.8 FY 1971' 33.7 9.0 4.0 2.2 2.8 3.0 10.5 .5 1.75 FY 1972 39.5 9.0 4.0 5.2 2.8 3.0 10.5 5.0 (5) Actual Estimated Amended budget request to the Congress To be transferred to new volunteer agency (ACTION) as of July 1, 1971 Appropriation for FY 1971 remains available for FY 1972 266 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ACTIVITIES SERVING OLDER AMERICANS 19YO (Report compiled by the Administration on Aging) The Nation's elderly have a variety of needs in varying combinations. To meet this variety of needs, a vide range of programs were administered during 1970 by various agencies throughout the Department of Health, Education; and Welfare. This report describes, in the following order, the activities of agencies which administer the major programs serving Americans aged 65 and over. I. Social and Rehabilitation Service A. Administration on Aging B. Assistance Payments Administration C. Medical Services Administration D. Rehabilitation Services Administration E. Division of Research and Demonstrations F. Community Services Administration II. Public Health Ser vice A National Institute of Child Health and Human Development of the National Institutes of Health B. Health Services and Mental Health Administration III. Social Security Administration IV- Office of Education 267 I. SOCIAL AND REHABILITATION SERVICE Among the services and benefits for older Americans rendered by the Social and Rehabilitation Service are rehabilitation services, cash benefits, social services, and medical assistance for the needy aged; rehabilitation services for the handicapped aged; and a variety of programs and services to help the elderly solve their problems and take advantage of their oppor- tunities. Within the Social and Rehabilitation Service, the Administration on Aging, the Assistance Payments Administration, the Medical Services Administration, the Rehabilitation Services Administration, the Community Services Adminis- tration, and the Division of Research and Demonstrations all have responsibi- lity for programs serving older persons. The Administration on Aging, while maintaining overall responsibility for the aging, joins with and works together with the other components of the Social and Rehabilitation Service in meeting social and rehabilitation service needs of the aged. In the field, the activities of the Social and Rehabilitation Service are supervised by a Regional Commissioner, located in each of the ten HEW regions. Through these regional offices technical assistance is provided to States and other Federal agencies. SRS is thus able to provide a unified and comprehen- sive approach toward meeting the needs of older people in the communities, by making available to the States a broad range of technical expertise from one central source. The program activities in aging undertaken during 1970 by the components of SRS are described separately in the reports which follow. 71-272 O - 72 - pt. 1 - 1! 268 THE ADMINISTRATION ON AGING The Administration on Aging was created by the Older Americans Act of 1965 to provide assistance in the development of new or improved programs to help older Americans, and to serve as the focal point for the Federal Government's concern for the needs and problems of the aging. For the Administration on Aging, 1970 was, all in all, a busy and affirmative year, moving into what could be the most important year in Aging, 1971 • During the year, new State plans were approved for Alabama, Indiana, Vfyoming, and the Trust Territories of the Pacific Islands. This brings to 55; the total number of States and jurisdictions who are participating in and benefiting from programs under Title III of the Older Americans Act. Only one jurisdiction eligible under the law, American Samoa, is not currently participating in this program. Statewide Planning, Coordination, and Evaluation The anendments of 19&9 clarified ana emphasized the obligation of the States under Title III to carry out planning, coordinating, and evaluating programs and activities for the elderly. State agencies on aging during 1970 made signi- ficant strides in carrying out this obligation. In order to proceed with these activities most efficiently and in accordance with National and State objectives, various "tooling up" functions were necessary. Major processes involved were: 1. Significant increase in Staff capability - The average State agency full-time professional staff during Fiscal Year 1971 is estimated to be 5«5« During Fiscal Year 19^9 the average was slightly above three. 2. New State Plans - All States submitted new State Plans in 1970 which incorporate (l) the 1969 amendments, (2) provisions of the Inter- governmental Cooperation Act, and (3) the simplified State plan concept initiated by the Social and Rehabilitation Service. The State plans under the Older Americans Act were the first plans submit- ted under this new simplified concept. 3. Involvement of older persons - Each State is establishing or continuing an existing advisory committee on aging. At least one-half of the members of these committees are older persons themselves. k. Reorganization - There has been a trend for State Agencies to organize into multi-purpose departments dealing with a variety of health and welfare problems at the State level. Thirty-three State Agencies are now located in such multi-functional departments, and twenty- two are independent agencies. Coordination with other State Agencies - There has been a significant increase of State agency involvement with other State agencies, especially State planning agencies. State Aging agencies are in many States represented on inter-agency advisory committees. Such coordi- nated activity for programs to better benefit the elderly has already had positive results in legislative proposals, joint funding of projects, etc. 269 With the organizational and other basic function completed or wHl under way, States heran their actual planninr activities. The first phase of State agency planning is the collection and analysis of data on the aged population, and on programs for the aged in the State. These data collection activities arc set forth as requirements in the Federal regu- lations for all States. All States are therefore working on: ). The completion of a comprehensive study of the status and needs of the elderly in the State, and 2. The completion of a report on achievements of state programs for the Afine in the State. As one part of the data collection activities, all States have conducted public hearings on the problems and needs of the aged during the past year. Community Program Activities Title III also authorizes (and has autpori/.ed since it was originally enacted in 19oS) matching funds to support community projects for older persons. During fiscal year W/0, 1. ,;>00,000 older persons were serveu by 1,000 projects of this type. The following were anion," the services provided. I. Services for independent livin, - In 19Y0, J.(V?,26'< olcier persons were helped to maintain independent Livin/. arrangements through services which fostered independent living. These in-home and out-of-home services played an important part in helping older persons maintain their independence in the community in surroundings familiar and congenial to them, and often at considerably less cost than the more expensive alternatives of nursing home care, hospitalization or institutionalization. Homemal;er - home health aide services were provided to 19»^T7 persons by projects in 32 States, D.C., Guam, Puerto Rico, and the Virgin Inlands. Hone maintenance or "chore" services, friendly visiting and telephone reassurance were provided to over 100,000 persons. Many of these services were provided by older persons themselves. 2. Home delivered and group meals were provided for 25,912 elderly persons in 3c States, District of Columbia, Puerto Rico and the Virgin Islands. The average cost for home delivered meals was $1.25. However, the ma- jority of older persons receiving this service were unable to pay the cost and could not have received it without these programs. Adult day care programs in Baltimore, Maryland and St. Petersburg, Florida, provided valuable and flexible services for older persons such as meals, snacks, health services and therapy, and the oppor- tunity to participate in recreation, arts and crafts, ana educational programs. Because of these programs, their relatives or caretakers could continue to work without worry, shop for themselves and other members of the family, and obtain surcease from the constant daily care of elderly individuals. The elderly themselves benefited from the supervision, care, and help provided in the protected setting. Opportunities for participation in community life - Improved quality of life results from other services offered by many Title III projects, in seeking to provide opportunities for older persons to continue to lead active and meaningful lives in the community. 270 Employment opportunities were provided for older persons interested in or needing to supplement social security and other benefits, or utili- zing special skills to supplement income after retirement. Some 528,713 elderly persons participated in recreation and other leisure type activities under Title III. These activities were as diverse as the interests of the older persons themselves, and ranged from the opportunity to read a paper or a book in a quiet corner, to birthday parties, song fests, covered dish dinners, to trips to other centers or points of interest. Adult Education activities were offered to more than 100,000 older persons. Transportation services were provided to some 88,059 elderly individuals. Transportation is a major problem for the elderly, particularly in rural areas, as it limits the ability of older persons to obtain the necessities for daily living, such as medical and dental care, to visit friends or relatives, or to participate in a variety of activities with others having similar needs or interests. One project purchased surplus school busses to provide transportation to senior citizens at a nominal cost. Another project purchased a mini-bus to transport older persons to shopping centers, senior centers, clinics and hospitals for medical care. With assistance under Title III, State agencies also provided support for some U68 senior centers , which served some 600,000 older persons in Fiscal year 1970. These centers provided opportunities for parti- cipation and active engagement in community life, and offered many of the services needed to help the elderly maintain independent living arrangements. The senior center has often become the focal point for planning, developing, coordinating and delivering services to the aged in the community. It is frequently the channel for contact and commu- nication with the elderly in the community through its information and referral and outreach programs. The elderly, through participation and involvement, became aware of and knowledgeable about resources of the community and the gaps in the services which they as a group may help to meet. Senior centers are located in housing projects, churches, public and private buildings, and many provide a wide range of services and/or opportunities for older persons. Frequently, older persons themselves provide services to other persons, old and young. Some senior centers have satellite centers located in neighborhoods where older people live. These satellite centers provide and deliver a myriad of services tailored to the special needs of the elderly in the community. 3. Volunteer opportunities - The interest of older persons in volunteering in Title III projects has been significant. Some 50,000 older volun- teers are providing a variety of services in their own communities. The young, the aged, families, institutions and other community groups are the beneficiaries of these services. Senior volunteers assist in operating senior centers by directing leisure-time activities, staffing information and referral programs, making contacts with resi- dents in an outreach program, providing tutorial services for students, visiting and helping the homebound, providing transportation for the elderly so they may shop, obtain medical care, attend church, or obtain other needed services or resources. Volunteers also provide telephone reassurance to the isolated, ill and handicapped older persons. In serving others, older volunteers broaden their own interests and add new meaning to their own lives. 271 In one project in California, volunteers seek out hard-to-reach indi- viduals who are isolated economically, socially, culturally, or geographically. They provide in-home and out-of-home services, companionship, and a link to the resources and people in the community. In a number of centers located in housing projects, older volunteers teach arts and crafts, prepare and serve hot noon meals to residents, visit and assist the chronically ill in maintaining their own living arrangements, shop, cash checks, pay bills, and perform other necessary tasks. In Rhode Island, the Entertainment Program for Institutionalized Elderly is now in its fourth year of operation. It has provided entertainment programs for hundreds of institutionalized elderly persons who look forward to each performance with anticipation. In addition to those elderly who donate their talent, young talented performers such as dancers and choral groups, also donate their time. Business and community leaders provide money or goods to be used by performers or distributed to institutionalized persons. The Rhode Island Veterans Home and Veterans Hospital in Providence views this program as a needed service. Training - A total of 71 Title III training projects during the Fiscal Year 1970 provided short-term training for over 15,000 persons to serve the elderly. Many of the projects prepared specialized personnel, professional and non-professional, to better serve the elderly. Delaware's Geriatric Aide Program is training and locating employment for aides who serve the elderly in their own homes. In Washington, 50 persons were trained in two programs (lasting one week each) in basic biological, sociological, cultural and economic aspects of aging, so that they could work more effectively with programs for the elderly. In Arizona, 72 persons, including 35 older persons, were trained in general home care, to provide in-home services to the elderly in a rural county. Receipt of these services frequently enabled older persons to remain in their own homes and in many instances delayed institutionalization or nursing home placements. Community planning - lUl Title III projects were engaged in planning programs and services for the elderly in their communities during fiscal year 1970. In North Dakota, a statewide community organization project has initiated 73 activity programs through clubs and centers for older people in the State and is now developing county councils on aging. In New Jersey, the Pater son Office of Aging developed a senior center with no additional Federal funding but a great deal of volunteer help; developed a nutrition program, separately funded under Title III, which now serves lunch to 135 older people per day and delivers meals to 25 homebound elderly; and developed a podiatry program initially funded by the State Division on Aging out of State funds. Using this podiatry program as an example, the Division on Aging has now determined that similar programs can be funded by local health 272 departments as certified health services for which they receive on- going partial State health reimbursement. In Bergen County, New Jersey the local office of aging helped in the development of a small Title III grant to the County Department of Transportation. This grant not only provided summer transportation for the elderly, but also led to a change in the admission policy to county parks, which are now free to older people. The AoA activity in Model Cities programs is quite broad. AoA has its own task force on Model Cities, and within AoA, programs under Titles III, IV, and V have given high priority to Model City needs. AoA, through agreement between HEW and HUD, has moved ahead on programs for the elderly in concert with the Model Cities Administration. 116 Title III projects served Model City neighborhood residents in 1970. Federal funds in the amount of $2,U07,^80 were approved by State agencies for planning, services and training of personnel to serve the elderly in Model City Areas. State agency personnel, whose administrative expenses are met in part by Title III funds from AoA, have provided active leadership in identifying and meeting the needs of the elderly in Model City Areas. A number of State agencies have sponsored meetings on "Model Cities and the Elderly, " to bring together representatives from AoA, the Office of Economic Opportunity, the Departments of Labor and Housing and Urban Development, universi- ties, staff of the city demonstration agencies, elderly and other neighborhood residents. Action plans for assuring that the older Model City residents participate in the planning of the Model City programs were formulated in these meetings. Areawide Model Projects A program of Areawide Model Projects under Title III was authorized by the 1969 Amendments, but there were no appropriations for this purpose during 1970. Nevertheless, there were preparations during the year for implementing the program as soon as funds were available. $2,200,000 for this purpose was appropriated by the Labor- HEW Appropriation Act of 1971, signed January 11, 1971, and it is anticipated that the necessary regulations and guidelines will be completed and issued in time to launch the program well before June 30, 1971. Research and Demonstrations R&D project grants under Title IV of the Older Americans Act are contributing significantly to knowledge and improved practices in aging. During Fiscal . Year 1970, 6l new and continuation projects were funded at a cost of $3,082,000. Funds under this program have been used to support projects designed to examine the major needs and problems of the nation's elderly population, and to develop better ways of dealing with them. A number of pioneering projects are developing new techniques and accumulating previously unavailable information in the general area of aging and its relationship to social arrangements and organization within the larger society. Some major problems being pursued are: evaluation of the impact of Federal, state, and local research, development, demonstration, and service programs on older people; means of organizing areawide information and referral services 273 for older persons; development and testing of new approaches to planning and coordination of services to older people within Model Cities neighborhoods; development of a series of social indicators for state and local use in setting program priorities, goals, and formuiating policy for aging; and the evaluation of public and private organizational structures designed to 6erve older people. Significant new knowledge was developed by many of the projects. For the first time systematic information became available on transportation- related needs, problems, and behavior of older people; the efficacy of a variety of volunteer service roles for older people in implementing major Federal and other social programs in a variety of organizational settings were demonstra- ted; the complex legal-social area of protective services was further defined and clarified; and the effectiveness of group meal services for improving the nutritional status of older people, as well as their social and personal well- being, was verified through the results of a number of previously-funded projects. Seven different national seminars and workshops increased the prompt utilization of project findings by practitioners, researchers, policy- makers, and administrators representing a broad range of agencies, organiza- tions, and institutions. Title IV R&D projects have emphasized such subjects as nutrition, retirement living, mobility- transport at ion, and social isolation and social trends, as discussed below. 1. Nutrition. In 1968, Congress earmarked two million dollars to establish under Title IV a special program to improve nutrition services for the elderly. Ten projects of this type have already been completed, and twenty-two are now in operation. Techniques which are being tested include take-home meals for weekends, pot-luck dinners, weekend dining arrangements, delivery of meals, and mealtime companions and friendly visitors for the homebound. 2. Retirement living. A number of projects are supplying essential knowledge regarding means of sustaining the aged in meaningful and productive social roles beyond retirement from the labor force. Preliminary data from these projects indicate that viable roles, such as those of teacher aides, library aides, representative payee, outreach workers, etc., enhance the older person's opportunities to adjust to the social, economic, and psychological phenomena of aging and retirement, and significantly strengthen his ability to live an independent, active life in the community. There have also been studies indicating that pre-retirement counseling seems to positively affect the adjustment of retirees and contributed significantly to better morale and job related attitudes among employees in the last years before retirement. Mobility-Transportation . Two projects in the area of mobility- transpor- tation have indicated that the elderly increase their use of local public transit facilities when fares for this group are reduced. It has also been indicated that with the exception of employment-oriented trips, older people and especially low- income older people use public transpor- tation proportionately more frequently than the general population. Social Isolation and Social Trends . A research project in Kansas City, Missouri is focused on the relatively isolated and lonely older persons in the inner city, including a model cities neighborhood. A project in San Diego, California has demonstrated that an independent community 274 unit can serve as the coordinating mechanism for focusing a wide variety of protective resources on impaired older persons. In Nashville, Tennessee a pioneering research project is investigating whether, and to what extent the kinds of social relations sustained by elderly persons, especially the low-income aged, determine the style of their lives and thus the degree to which they are physically mobile and avail themselves of social and community services. A project designed to develop, test, and accumulate a set of social indi- cators for aging will assist in the ongoing assessment of the status of older Americans. These indicators promise to be extremely useful for guiding the formulation of Federal and state legislation, assisting state agencies in comprehensive planning and coordinating programs, identifying current needs of the elderly, assisting the evaluation of existing programs at state and Federal levels, establishing goals and priorities for services to the aging, and helping to focus national attention on problems of older people. Title V of the Older Americans Act of 1965, as amended, authorizes grants and contracts for training persons employed or preparing for employment in Aging programs. Training programs under this title became more solidly established during 1970. Graduates were employed in significant positions in an expanding range of agencies and organizations serving the older population. Opportunities for student internships increased markedly. Training for Service Careers in Aging Most of the funds available in 1970 were awarded for the support of career training during the 1970-71 academic year. Faculties in the training institutions demonstrated increased commitment to the field, the number of applicants far exceeded the traineeships offered, and most of the institutions reported enrollment of non-program students in gerontology courses. During 1970, Title V funds were distributed to 18 universities for 15 long-term programs and one short-term program. Two of the long-term awards were made to the University of Michigan- -Wayne State University Institute of Gerontology and to the jointly-operated University of Oregon- Portland State University program. The 13 other long-term programs are located at : Arizona, University of Brandeis University California, University of Chicago, University of Columbia University Minnesota, University of North Carolina, University of North Texas State University San Diego State College South Florida, University of Southern California, University of Washington, University of Wisconsin, University of All AoA- supported programs require students to obtain field placement experience as a part of their training. More than one-half of the programs call for a block placement of 3 to 9 months. The training institutions are reporting increasing success in locating agencies and organizations willing to accept students as interns. A significant break- through occurred in 1970 when the Social and Rehabilitation Service made available a number of positions for trainees of SRS-supported training programs, including those supported by AoA. Graduates of the advanced level programs now number well over 100. A study currently in progress reveals that they are being employed in Federal and State agencies on aging; State health and rehabilitation 275 agencies; community programs, including model city programs; housing projects and homes for the aged; senior centers; national voluntary organi- zations; universities; and in the United Nations. Several are working for higher degrees. The University of Michigan- Wayne State University Institute of Gerontology has inaugurated a nationwide Placement Service in Aging. The Service main- tains a list of Job openings and of personnel available. It has been instrumental in matching AoA-supported graduates and others with Jobs suited to their training and capabilities. Foster Grandparent Program The Foster Grandparent Program was first developed in 1965 as a cooperative effort between the Office of Economic Opportunity and the Administration on Aging. The program was administered Jointly from then until September 17, 1969, when the Older Americans Act Amendments of 1969 (P.L. 91-69) became effective. These amendments provided for the complete transfer of the program to the Depart- ment of Health, Education, and Welfare, where it is now being administered by the Administration on Aging. Various program activities have now been decentral- ized to the Department of Health, Education, and Welfare Regional Offices where the Social and Rehabilitation Service Regional Commissioners have responsibility for program review and funding as well as offering consultation and technical assistance to the Foster Grandparent Program grantee agencies. The national office of the program as part of the Administration on Aging continues to main- tain responsibility for planning, policy, evaluation, coordination, public information and legislative activities; it also offers consultation and techni- cal assistance to the Regional Offices. National authorities on child care have commented on the excellence of the Foster Grandparent Program. Dr. Maria Piers, dean of the Erikson Institute for Early Education and author of Wages of Neglect , has stated: "As a preventive program, Foster Grandparents is the best thing known to combat the pernicious influence of neglect. "Children who are Ignored, cut off from adult contact and love can face a total deterioration of the intellect with life-long crippling effects. "Foster grandparents give the children the warm, loving- contact with adults that is so necessary to their growth and development. "We have seen the positive results of this program. Every institution or agency caring for children could benefit from the work of a foster grandparent in every child care unit." Institutions and agencies caring for children have actively responded to the program; literally hundreds of requests for Federal help to start new projects are turned away each year for lack of funds. Since the funding of the initial twenty-one projects in 1965, the Program has expanded to include sixty-eight projects, in forty States and Puerto Rico. No new programs were funded in 1970. At the beginning of 1971, there were approximately 167 participating institutions and child care agencies in which ^,300 foster grandparents were serving d,000 children on any one day. Approximately 5,1*00 older persons serve as foster grandparents during any one year, serving as many as 22,000 different children. 276 There has been a noticeable trend for States and other employers to fund positions like foster grandparents without Federal assistance. For example, Illinois, Iowa, and Delaware have funded fal, 60, and 3h foster grandparent positions, respectively; and Pennsylvania has appraised the need for foster grandparents at about 5,000, and has funded 6l positions. The Administration on Aging knovs of a total of over 600 positions similar to Foster Grandparents which are not funded by the Federal Government. There are reasons to believe that other communities have developed similar opportunities that have not been brought to the attention of the Administration on Aging. This program has provided many insights into the potential utilization of the elderly in community settings. It has not only improved the standard of living of low- income older persons who have been enlisted, but has also demonstrated to communities that older persons have the talent, skill, experi- ence, ability and desire to serve their communities by meeting some of the unmet human needs in their communities. Thus, the benefits resulting from the Program extend far beyond the direct gains to the children and foster grand- parents who have participated. Retired Senior Volunteer Program The Retired Senior Volunteer Program was authorized by the Older Americans Act Amendments of 1969. $500,000 was appropriated early in 1971, permitting the Administration on Aging to initiate plans to establish one RSVP program in each of ten regions in 1971* A study of existing senior volunteer programs was initiated during the last six months of 1970, to assist in a realistic formulation of regulations and guidelines. Information Activities During the first half of 1970, AoA's Information Division concentrated on major items for Senior Citizens Month (May ly70). For Senior Citizens Month, some half-million pieces of mail — publications, posters, proclamations — were distri- buted by the AoA Information Division through regional offices of HEW, State agencies on aging, other Federal agencies, and national organizations. The year sav a great increase in media interest in aging. Time , Life the National Observer , the National Journal , the New York Times , Geriatrics , Harvest Years , The Gerontologist , the Red Cross Journal , the National Journal of Nutrition , the Wall Street Journal , Changing Time s, and the Los Angeles Times Syndicate featured articles on aging for which AoA providedassistance and materials. New publications—either issued during 1970 or at press at tne end of the year, with early delivery date — included: - The Older Americans Act of 1965, as Amended , with the I967 and 1969 amendments in place within the Act, accompanied by a short history; - Words on Aging , a new bibliography on aging; - A Plan to Span , which reports on a work- study program made possible by an AoA training grant to the University of Denver; Basic Concepts of Aging , a programmed learning booklet on attitudes developed by the University of South Florida with an AoA title V grant; 277 Aging magazine continued and expanded its service to the profeesional field of aging. Its present circulation is 16,1*71 copies. Church Involvement in Aging Early in 1970 AoA began exploration with religious denominations nationally of possible involvement of churches in community services for older Americans through technical assistance from AoA. It was agreed at a meeting of denomina- tional representatives that a pilot project would be desirable. For various reasons the denominational people recommended that Indiana be the pilot State. Simultaneously, the Indiana Commission on Aging was proposing a workshop on aging and the churches, and asking AoA assistance. The recommendation of the denominational group was conveyed to the Commission. The possibility was discussed with the Indiana Council of Churches, which expressed interest. By Joint agreement, AoA was invited to present the pilot program possibility to the annual clergy conference of the Council of Churches. The clergy agreed to participate. It was then decided to see if the denominations not affiliated with the Indiana Council of Churches would join in a combined pilot program in the State. A statewide meeting was held after the cooperation of most denominations was assured. AoA was asked to develop a program guide which could be used by indi- vidual churches or by groups of churches working together. The final draft of the guidebook was the product of the AoA staff, denominational representatives and the staff of the Indiana Commission on Aging. At the December 1970 meeting of the Indiana Commission on Aging, the State Council of Churches reported the establishment of a regional plan which inclu- ded cler/;y committees, regional conferences and development of programs for older people. White House Conference on Aging During 1970, AoA personnel worked closely with the staff of the White House Conference on Aging in preparing for the 1971 Conference. The Division of Older Americans Services (Title III) enlisted the cooperation of the network of State and local offices in Aging in planning and conducting the community forums and other local and regional activities needed to make the Conference a success. Time and again, it was necessary to call upon one or more members of the AoA staff for specialized advice or assistance. The location of most of the offices of the White House Conference staff near AoA offices facilitated communications and cooperation. President Nixon in calling the White House Conference on Aging on October 6, 19^9 used the phrase "develop a more adequate national policy for older Americans." John Martin, Commissioner on Aging and Special Assistant to the President for the Aging, as Director of the Conference pledged that the Confer- ence would work "toward a national policy on aging" and this has become the Conference theme and objective. The Conference has been structured to fulfill this objective. During the early part of 1970, the broad plan for the Conference was developed by the White House Conference on Aging staff. The broad plan was for a three- year effort. 1970 wa6 to be the year when older Americans speak out on their needs as they see them: in forums, hearings and meetings in thousands of communities across the Nation. 19/1 was to be the Conference year, the year when policy recommendations will be worked out, not only in community and 278 State White House Conferences during the first half of 1971, but also by National organizations. 1972 is to be the year when follow- through begins, a time for action by Federal, State and local governments. Implementing the plan for 1970, outlined above, each of the fifty States and several territories conducted White House Forums. Participating in these Forums was a wide array of older persons, broadly representative of racial, ethnic, cultural, economic and religious groups, and widely characteristic of the rural and urban areas. As of December, the State Agencies on Aging reported that they had conducted more than 6,000 Older Americans White House Forums. Most of these were held during the week of September 20-26; however, at the end of 19'|0 some States were continuing to hold forums as more communities asked to be involved in White House Conference activity. As stated above, 1971 was planned as the year during which policy recommenda- tions will be worked out. An effort will, therefore, be made by communities, States and national organizations during the first five months of 1971 to develop recommendations. Recommendations will be based on background papers prepared under the guidance of technical committees composed of competent persons assisted by governmental staff members and written by highly qualified individuals chosen for their expertise in the particular area. The technical committees are organized around nine needs areas: health, income, housing, nutrition, transportation, employment and retirement, education, roles and activities, and spiritual well-being; and five needs meeting mechanisms: planning, training, services and facilities, research and demonstration, and government and non- government organization. A background paper will be pre- pared by each of the 1^ technical committees. Each paper will conclude with issues offered as a basis for discussion and policy recommendation. In formu- lating recommendations, community and State Wnite House conferences and national organization task forces will not be limited to issues suggested by the techni- cal committees. At any point, new issues may be introduced and policy proposals formulated from these issues. Final determination of delegate sources and numbers was still under considera- tion at the end of 19 i 0. However, preliminary discussion indicated that States and national organizations will be represented. A total of 3,000 was considered to be the delegate limit. A series of regional hearings is being planned for early 1971. It is antici- pated that the subjects of the hearings will be one or more of the areas of need on which the Conference is based. Interagency cooperation During 1970, as in prior years, the Administration on Aging was alert to oppor- tunities to coordinate its efforts with activities in Aging of other Federal departments and agencies. The following are examples of such interagency cooperation: 1. A "Memorandum of Understating " was signed by Commissioner on Aging John B. Martin and Wage and House Administrator Robert. D. Moran, in which these two officials agreed to coordinate their efforts to implement the "Age Discrimination in Employment Act of 1967." 2. There were a series of discussions between the Administration on Aging, the Department of Agriculture, and the Office of Economic Opportunity in an effort to formulate a national nutrition program for the elderly. 279 3. A number of meetings were h ween AoA, the Community :>Tvices Administration, and the Social Security Administration on providing information and referral services to older people through the existing nationwide network of Social Security district ^ • AoA jointly funded a research project with the Departments of Transportation and Housing and Urban Development whereby a national workshop on Transportation and Aring was convened. Evaluation activities During 19/0, the Administration on Aging undertook several specific studies regarding the assessment and evaluation of its programs. A "Social Indicator System for the Aging" is being developed under a grant. The objective is to put into effect a system which could measure the status of the elderly popula- tion with respect to such factors as income, housing, health, etc. The application of these indicators will permit the assessment of a program's impact on the elderly population by providing a "before" and "after" picture. A second evaluation project currently in progress is "Evaluation of Community Programs Under the Title III State Grant Program," wnich will measure that program's success in meeting its objectives. 280 I. SOCIAL AND REHABILITATION SERVICE (Continued) B. ASSISTANCE PAYMENTS ADMINISTRATION In September, 1970 SRS's Assistance Payments Administration served 2,061,000 persons aged 65 or over through the Old-Age Assistance program. While this is a slight increase in number from the preceding year, it represents a marked decrease from the all-time high of 2,810,000 Old-Age Assistance recipients in September, 1950. The overall decline has occurred because a larger proportion of the increasing aged population have become eligible for Old-Age, Survivors, and Disability insurance cash benefits, and because such benefits have been rising in amount. An additional factor contributing to the decline of persons receiving Old-Age Assistance money payments is the development of the program for providing care in intermediate care facilities for a large number of aged persons. In most instances, these aged do not receive money payments. All 50 States, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands have Old-Age Assistance programs. The national average assistance grant in June 1970 was $7^.75* T nis represents an increase of six percent (or $lu20) over the preceding year. According to the latest study available the median age of Old-Age Assistance recipients is approximately 77 years of age. The proportion of assistance reci- pients living alone in their own homes is approximately 35 percent. Approxima- tely 27 out of every 100 aged persons receiving assistance require help from others in their daily living. More than two-thirds of the recipients are women. As a means of encouraging dependent elderly people to attain either partial or full self-support, 39 States now provide for a disregard of some portion of earned income in determining the amount of assistance payments. Additionally, 29 States allow for some disregard of income which is incurred from sources other than earnings. The Aid to the Needy Blind program is administered in all jurisdictions and served about 85,100 persons in September 1970, of whom approximately 32,000 were 65 and over. All States except Nevada have Aid to the Permanently and Totally Disabled programs, and served 910,000 persons in September 1970, of whom over 30,900 were 65 and over. This program has gradually increased since its beginning in October 1950. The 1967 amendments to the Social Security Act, effective January 1, 1968, made it possible for States to disregard up to $7-50 a month--rather than $5.00--of any income of aged, blind, or disabled recipients. As of September 1970, 20 States had adopted this provision; another 9 States have adopted the provision to disregard $5.00 of any income. Another amendment, effective January 1, 1968, permits the Federal government to share with the States in the cost of repairs made to homes of older persons re- ceiving assistance. The purpose is to enable the individual to continue to live in his own home. The limit is $500 for the repair of any home in a year, i.e., in any twelve-month period, half of which is Federal funds. Institutional Care Intermediate Care Facilities provide institutional care that is less than that furnished by a skilled nursing home but somewhat more than boarding home care. Standards for these institutions are set by the States and they have to be licensed by the States. In September 1970, 30 States made payments to aged 281 persons in intermediate care facilities. In addition, the 1965 amendments to the Social Security Act have also made possi- ble Federal sharing in payments to needy aged persons in institutions for mental diseases and tuberculosis. As of January 1, 1970, States claimed Federal finan- cial participation for payments to these institutions under Medicaid (Title XIX of the Social Security Act), but many States also provide a money payment lo such aged persons to meet the cost of personal incidentals. As of September 19T0, 27 Jurisdictions had adopted the provision for money payments to aged recipients in institutions for mental illness, and 25, the provision for a//ed recipients in tuberculosis institutions. C. MEDICAL SERVICES ADMINISTRATION Beginning January 1, 1970, all Federal support for medical assistance for the aged was provided under title XIX (Medicaid). Medical Assistance for the Aged (MAA), also known as Kerr-Mills, and medical vendor payments under old-age assistance programs (OAA), ended December 31, 1969. Seven States began title XIX programs on January 1, 1970, bringing the total of participants to hli States and four jurisdictions. The remaining States, Alaska and Arizona, which have special problems because of their large Indian and indigenous populations, had not put Medicaid into operation by the end of 1970. Medical services provided by the State of Alaska are considered to be better than those of many title XIX States. Nursing home services are negotiated by the State with nursing homes, and eligibility is flexible. The Indian Health Service, caring for Indians and Eskimos, is reported to be good. Arizona's public health services are sponsored by the individual counties, and neither care nor eligibility standaras are uniform throughout the State. Services of the Indian Health Service are also described as uneven. In fiscal year 1970, total expenditures for medical assistance under federally aided public assistance programs were $5.1 billion, of which $2.6 billion came from the Federal government. About ^C percent of the total expenditures was spent on the aged. (These figures include the last six months of Federal expendi- tures under MAA and OAA, July 1-December 31, 1969. ) Medicaid permits the Federal Government to contribute to the cost of care for Sped individuals in institutions for mental diseases when the State includes this service, and 35 States did so in fiscal year 1970. About 70,000 mental patients were enrolled in the program. The States involved received about $180 million of Federal funds to help them improve the care of patients and to develop comprehen- sive mental health programs. Final regulations establishing standards to be met by skilled nursing homes in order to qualify for payments under Medicaid were published in 1970, following publication of interim regulations in 1969. During the year interim regulations were published on State programs to license administrators of nursing homes, and on training programs to qualify administrators for licensure. In addition, pro- posed regulations were published on periodic medical review and medical inspec- tions in skilled nursing homes and mental hospitals. The proposed regulations cover (l) a regular program of medical review including medical evaluation of each patient's need for skilled nursing home care or care in a mental institution: 282 (2) periodic inspections in all skilled nursing homes and mental institutions serving Medicaid patients, to evaluate the care being provided, the adequacy of the services available to meet the current health needs of each patient, the necessity and desirability of continued placement of such patients in such faci- lities, and the feasibility of alternate institutional or non-institutional services; and (3) full and complete reports of findings by review teams. REHABILITATION SERVICES ADMINISTRATION As the Federal partner in the State-Federal program of vocational rehabilitation, the Rehabilitation Services Administration encourages State rehabilitation agen- cies to provide necessary services to physically or mentally disabled aging people so that they may be restored to gainful employment. The problems faced by the older worker in securing suitable employment are, of course, intensified when he suffers from a handicapping disability; and it is estimated that more than h million disabled individuals kO years of age and over are in need of vocational rehabilitation services. There has been a steady increase in the number of aging people served through the public program of vocational rehabilitation. In i960, for example, a total of 88,275 disabled people were rehabilitated by the State rehabilitation agencies, and of these 25,675 were aged U5 or older. By 1970 the total number of rehabili- tants had increased to 266,975* of whom an estimated 71,200 were aged U'j or over. Of this 71,200, an estimated U,700 were 65 years of age and over. State rehabilitation agencies have utilized Innovation grant and Basic Support resources to expand services for the aging disabled. For example, the Iowa rehabilitation agency has worked cooperatively with the Easter Seal Society in that State on a project for the homebound which serves a large number of older, disabled people. The Ohio agency has participated in a public housing project designed for the handicapped and senior citizens. The Rehabilitation Services Administration has used its Training grant authority to assist in program development for the aging. Long-term training grants in such fields as rehabilitation counseling, nursing, physical therapy, speech pathology and audiology, occupational therapy, and home economics yield benefits to the aging. For example, training in home economics includes home health care for the aging, home services for the aging in rural areas, and the preparation of specially designed clothing for the chronically disabled. Short-term Training grants have also been used effectively by RSA in developing services for the aging. This resource was used, for example, to conduct a course on Orthopedics and Gerontology in cooperation with the American College of Orthopedic Surgeons. The purpose of this was to introduce young surgeons to surgical techniques parti- cularly effective with the older orthopedic case. In the fall of 1970, RSA issued a short-term training grant to San Diego State University for the purpose of conducting a West Coast conference on rehabilitation of the aging, with special emphasis on interagency coordination. The Rehabilitation Services Administration cooperates with the Administration on Aging in such activities as senior citizens month and the foster grandparent program. At present, RSA staff are serving on several technical committees designated by AoA to plan the program for the White House Conference on Aging slated for 1971. 283 DIVISION OF KKSEAHOH AND DEMONSTRATIONS Ttu < monstration projects program in public assistance under section 111, ol Un- social Security Act provided grants for at least 2h differenl roJ< cti ui the calendar year 1970 which were total Ly or partially concerned with providing a variety of services to elderly recipients in public welfare. These projects' were carried out under the auspices of State public welfare agencies* Two projects are providing housing assistance to the aged. The Kentucky Depart- ment of Economic Security together with the programs of the Office of Economic Opportunity, Department of Labor, Department of Agriculture, and Housing and Urban Development is carrying out a project in four counties in eastern Kentucky. The homes of 900 aged, blind, and disabled are being repaired to make them safe and suitable for occupancy, thus enabling the recipient to remain in his own home rather than being placed in a nursing home or institution. A Model Cities project in Georgia is demonstrating the coordination of various types of housing aids and resources made available to local communities through HEW and HUD programs to improve the housing of aged recipients. [n rural northern Alaska, the Department of Health, Education and Welfare is sxperimenting with the use of human service aides to provide services to the iged which have previously never been available. The services include transpor- tation to medical facilities, arranging for fuel oil to be provided and delivered, ind homemaker help. Pwo projects in consumer affairs are currently in operation. A project in 3eorgia is providing educational materials and help to the elderly as well as rther low income families and individuals. A project in Michigan is operating 1 Consumer Information Center which provides consumer education, training infor- nation and referral services for the eider ly and low income residents in a Model :ity area. I regional experiment involving two projects is demonstrating the coordinated ind comprehensive delivery of social services to aged, blind, disabled and IFDC recipients. In Florida a one-stop information and referral center is :oordinating existing community services and developing new services while the iroject in New Jersey is operating a decentralized community organization in a ;urburban rural area to improve the delivery of such services as protective services, home management, housing, consumer education, etc. 'hree neighborhood service center projects serving elderly recipients are inducting experiments to determine which services are most wanted and needed it the neighborhood level. ;n one Model City area the State public welfare agency is experimenting with he use of grandmothers and grandfathers in providing family day care programs or AFDC children whose mothers are in training or employed. I new Model City project in Washington is operating a home Management Service enter to provide such services as money management, housekeeping skills, and amily management for aged and other public assistance recipients. Other tates demonstrating the value of providing homemaker services are enthusiastic -bout the results which include helping the elderly remain in their homes or eturn to their homes following hospitalization. In all instances, the States xperimenting with the provision of homemaker services have adopted the project ctivity into their ongoing program upon termination of the demonstration. ■272 O - 72 - pt. 1 - 20 284 Vocational Rehabilitation Research and Demonstration Projects A recently completed project evaluated a vocational rehabilitation program in which an inter generational relationship was used as a therapeutic intervention. In this program older disabled workshop clients were assigned through a "buddy" system to young retarded adults to assist them in their initial adjustment to the workshop setting. The program proved successful and applicable to other settings. A pilot project has completed a viable plan for a massive attack on the problems of aging through a system of industrial placement facilities for the aging in several locations of wide geographic distribution, with emphasis on poverty locations. Locations have been chosen and preliminary work done. A demonstration center has been set up to show that the needs and talents of older workers can be matched with specific job requirements and the needs of the general economy. Local businessmen are cooperating with social scientists to provide and evaluate temporary placements in a work center leading to jobs which have been identified as those in which demand exceeds supply and job characteristics are ideally suited to characteristics of older workers. Special Foreign Currency Program International research deals with special aspects of programs for the elderly— in such fields as income maintenance, health functioning, social welfare, work and leisure activities — where different forms of local action are possible and necessary to implement provisions originating at the national level, and to improve their efficiency through measures for active community participation. One program which has generated interest in participating countries is a "Foster Grandparents" program designed simultaneously to meet the needs of older people for more material security and the desirability of providing institutionalized mentally retarded children with care and greater closeness of grown-up persons. (Thousands) 1968 1969 1970 1971 1972 Rehabilitation research 267 1*21 39^ 642 325 and demonstrations Special Foreign Currency 197 207 100 300 500 Program F. COMMUNITY SERVICES ADMINISTRATION The Community Services Administration was established as a major component of the Social and Rehabilitation Service in September, 1969. Since then, through its Division of Services to the Aged and Handicapped, it has been responsible for policy and program development of services to the needy aged and handicappei The estimated expenditures for the provision of social services to the needy aged are increasing substantially. It is estimated that the amount spent for this purpose during the current fiscal year will be over twice that spent in FY 1969. 285 Xiring the quarter ending September 30, 1*69 ( the latest quarter f>r which lata are available) some 222,000 aged persons received a variety of services rhich helped them with such problems as meeting health needs and requirements or home maintenance, securing employment, locating adequate housing, and inding opportunities to participate in community activities such as adult duration anu recreation. About one-third of the above number required the ind of services which would help them find protective institutional place- «nt s . * uring the past year, the Community Services Administration completed the olicy revision of its social services to the aged, blind and disabled ersons. This revision which was published in the Fede ral Register on ovember 26, 1970, provides further incentives for expandi ng service programs or the needy aged by permitting greater Federal matching for service related xpenditures such as rent, office supplies, etc. For the first time, State elf are agencies providing services are required to establish Advisory Committees hich will be charged with reviewing and making recommendations on the effective- ess of service policies. Membership on these committees must include repre- sntatives from the needy aged. P i addition to the above, steps have been taken (l) to ascertain the extent 3 which the services of other community agencies can be used to extend the sope and to improve the quality of "in-home" services for the aged and handi- ipped anu (2) to evaluate the effectiveness of service programs in helping $ed and disabled use health benefits available under Medicaid (Title XIX)? s of December 31, 1970, approved service plans under Titles I, X, XIV, or VI enabled 38 States to provide Services to the aged at Y5 percent Federal itching. Under a provision in the Social Security Amendments of 1967 P.L. 90-2*<8), States administering the public assistance programs for the ?ed may elect to purchase services from other public and private agencies, 5 specified by the Secretary of Health, Education, and Welfare. This gives :ates the opportunity to develop more flexibility in the provision of services f public assistance agencies. le following paragraphs reflect the progress which has been made to date in sme specific areas. anemaker Services iny States are moving toward Statewide services for homemakers to the aged in le public assistance program. Most States have homemaker services specialists * other State staff with program responsibility for homemaker services. ;rvices to Meet Health Needs 1 increasing number of individuals have received services to meet their health feds either in their own home or as patients in medical institutions or in :her non-medical residential care facilities. As of the quarter ending iptember 30, 1969, for example, 120,000 older people received such services. 286 Services included arranging for transportation to and from hospital and health clinics, arrangements for physician's services, drugs and other ancillary health services and arrangements for alternate care for aged leaving medical institu- tions. Housing Cooperative efforts between housing and public welfare agencies to enable aged to improve housing and expand housing resources continue. Housing improvement and assistance services were provided to at least 81,000 adults in the quarter ending March 31, 1969. Such services include considerable continuing cooperatioi between public welfare agencies and the Farmers Home Administration to improve housing of aged recipients in rural areas; agreements between welfare agencies and Housing Authorities with respect to rents charged welfare clients in public housing, resulting in increased shelter allowances and assistance payments; and efforts to assist aged with home repairs under Section 1119 of the Social Securil Act. 287 II. PUBLIC KEALTH SERVICE A. NATIONAL INSTITUTES OF HEALTH National Institute of Child Health and Human Development Environmental and genetic factors are important in the diseases of older persons, but major factors in the origin of those diseases are aging processes as they relate to health. It carries out this part of its mission through one of its components-- the National Institute of Child Health and Human Development. This Institute supports extramural research on aging by scientists in university hospitals, research institutions, and industry. It also conducts intra- mural research on aging at its own research facility—the Gerontology Research Center (GRC) in Baltimore. The Center is located on the grounds of the Baltimore City Hospitals in a 7.5 million dollar Federal research building which has been occupied since 1968, Aging and Chronic Diseases Aging processes are thought to be causative factors in a great many older persons' diseases—atherosclerosis, cancer, osteoporosis, osteoarthritis, senile dementia, and others. These are multifactorial diseases, the outcome of genetic background, environmental agents, and aging processes. Progress in preventing and treating them depends in part on understanding the nature of the aging processes and the causative roles they play in diseases. The conversion of food into compounds necessary for healthy function and into energy deteriorates with age as do other important chemical processes within the body. Perhaps the best understood of these deteriorative changes is the decline with age in ability to utilize carbohydrate efficiently. The classical way of measuring this ability is by the glucose tolerance test. Fifty percent of persons over 50 years of age have a decrease in their ability to utilize glucose in this test. Similar decreases in young adults would suggest the diagnosis of diabetes mellitus. It cannot be said at present that all the affected persons have diabetes, and yet it appears quite possible that this deterioration in carbohydrate utili- zation may have serious effects on the health of those afflicted. Decreased aarbohydrate utilization, for example, is known to correlate with the development of atherosclerosis, the major disease of our time. Two types of studies of de- terioration in carbohydrate utilization are badly needed. We need to know the nechanism of the decline, and we need to know the eventual fate of those who show the decline. Studies of both of these problems are under way at the Gerontology Research Center. Studies there have shown that the defect in carbohydrate utili- zation in the elderly is due to decreased pancreatic secretion of insulin rather than to an increased resistance of the body tissue to the action of insulin. Studies involving the periodic examination of a large group of adults of all ages at the GRC will eventually give insight into the effect of a decline in carbo- hydrate utilization on the development of atherosclerosis. Outstanding biomedical scientists have met at two NICHD conferences, one at the University of Washington School of Medicine in Seattle in March of 1970, and the other in Vero Beach, Florida, in November of 1970, to discuss the various types of biochemical decline with age. In addition to carbohydrate metabolism, subjects such as calcium utilization, fat metabolism and immunological competence fere considered. Almost every area of metabolic decline with age is known to be related to the development of some disease. Decline in energy metabolism plays i role in the development of obesity so common in our country. Abnormalities of :alcium matabolism developing with age contribute to the bone fragility and Fractures occurring in many older persons. Decrease in immunological competence 288 with age may prove to be of great importance in the development of cancer in old persons . The effect of different levels of physical activity on certain physiological systems was studied in the ongoing prospective study of human aging, the GRC Baltimore Longitudinal Study. These male volunteers, ranging from approximately 20 to 100 years of age, estimated their daily activities for a period of one yea A two- fold difference in activity level was found between the high activity and low activity groups. There were, however, almost no measurable differences in physiological characteristics between these two groups. If physical activity is to influence physiological performance in man, it would appear that very high levels of activity will be required, higher than that which occurs spontaneously in a normal community- dwelling population. Aging and Mental Function The changes that occur in mental function with age are complex and knowledge about them is incomplete. There is evidence of relatively mild impairment beginning as early as the middle years and becoming more severe in old age. The elderly may have senile dementias characterized by disorientation, confusion, an loss of recent memory. These disorders are common and very disabling. They cau severe loss of mental function in about half of the one million old persons institutionalized in the U. S. There is evidence that about six percent of the non- institutionalized elderly have severe mental impairment due to the senile dementias. To what extent these disorders are due to the same processes that pr duce mild loss of function in the middle years is not known. It is important to know whether methods can be devised to reduce the decline in learning ability that occurs with age. Recent results at the Gerontology Research Center suggest that this is possible. There is evidence that learning decrements in older persons are not absolute but are related to the speed at whi learning occurs. By decreasing this speed it is possible to make the performanc of older persons more nearly equal to that of young persons. The next research step will be to identify other important conditions that improve learning by older persons. Biology and Aging An understanding of biological aging processes that contribute ment of diseases is needed to provide a base from which to attack of middle and old age. To encourage research in this area the Ins supports a summer course in the biology of aging designed to give biological aging and a detailed analysis of selected topics. The at the University of California at San Diego in 1969, taught by a scientists from many universities, and attended by 20 pre- and pos students. In 1970 it was held at Stanford University. to the develo chronic diseas titute current an overview of course was hel faculty of t-doctoral Important aging processes occur at the cellular level. The Institute will support a course on cellular aging at the W. Alton Jones Cell Science Center at Lake Placid, New York in the summer of 1971. Selected topics in cellular aging will be discussed, and there will be opportunities for laboratory experience wit tissue culture techniques and other methods important in the study of cellular aging. Aging in the entire organism is complex. Changes occur within individual cells and in the extracellular matrix in which they lie. Culture of isolated ce types may make possible an analysis of aging in a simplified system. One lead i this area is the observation made in the last decade that normal human cells do not live for an unlimited period of time when grown in tissue culture by current 289 methods. Elucidation of this phenomenon is being supported through a contract between Dr. Leonard Hayflick of Stanford University in California and the NICHD. An understanding of the failure of normal human cells to live indefinitely in tissue culture is important to our understanding of aging. Future studies may reveal that improved methodology will permit unlimited survival of such cells or that there are fundamental reasons why normal cells are not immortal in tissue culture. Either discovery would clarify our understanding of cellular aging. The Institute supports the production and distribution of a line of especially well characterized human cells for interested investigators. These cells are grown to various stages in their lifespan and then stored frozen at sub-zero temperatures. The central supply of such well characterized cells facilitates work in this area by reducing the work of individual investigators and by making it possible for different investigators to work on the same cell type. Another important subject for study is the molecular material containing the information that directs cellular activities — deosyribonucleic acid (DNA) , ribonucleic acid (RNA) , and related components of the system governing the synthesis of proteins in cells. To give interested investigators an opportunity to discuss their research in this field, the Institute supported a conference on nolecular biology and aging at the University of Miami. Plans were made for the attendance of a small number of scientists interested in the molecular biology of aging at the National Science Foundation molecular biology workshops which meet at the University of California at San Diego. The Institute supports training grants in the molecular biology of aging in the Biology Department of the Johns (topkins University and in the Biochemistry Department of the Boston University School of Medicine. It is widely believed that aging results in part from misreading of the genetic message as a function of age. All information required for the formation jf proteins and enzymes necessary for maintenance of the life of a cell is coded fithin the genetically transmitted molecules of DNA. These messages must be con- tinuously read throughout the life of each cell of the body. One way in which a nessage can be misread is through the misincorporation of ribonucleotides into )NA and deosyribonucleotides into RNA, processes that are induced by metal ions. Ihemical studies at the Gerontology Research Center have demonstrated that metal Lons are capable of differentiating between ribonucleotides and deoxyribonucleo- :ides under some conditions but not under others. Slight changes in concentra- tion of metal ions or in the acidity of the environment may interfere with place- Bent of the proper nucleotide within a nucleic acid structure and thus upset its lormal cellular function. These studies suggest a mechanism by which subtle :hanges in cells over time may have a marked influence on the accuracy of reading )f the genetic message and possibly produce some of the gross manifestations of iging. Additional evidence of the involvement of genetic material in aging has been round in studies on rats at the Gerontology Research Center. The major portion >f soluble rebonucleic acid in rat kidney shows a two-fold decrease in turnover rate with age. The half- lives were found to be 10 days for old and 5 days for roung rats. The soluble RNA of spleen also showed significant reduction in turn- >ver with age. A major problem in studying aging has been the difficulty of acquiring suit- ible experimental animals, a problem NICHD is attacking systematically. The lajor current need is for well-characterized, short-lived mammalian species. In- >red and random bred mice and rats appear most appropriate. The Institute raises its own animals at the Gerontology Research Center and has a contract with the Charles River Laboratories to produce young and old inbred rats free of pathogenic >rganisms. These animals at the Charles River Laboratories will be characterized 290 pathologically, microbiologically , and nutritionally and will in several years be available for sale and distribution to interested U. S. investigators. There is need for other vertebrates for research on aging, and the Institute is considerin; the problems involved in their production. Among these is the relatively long lifespans of most vertebrates and the costliness of raising them to maturity and old age. Planning in this area continues. Thought has been given to the selection of suitable invertebrates for aging studies. A major advantage of some invertebrates for research on aging is their short lifespan. Two conferences dealing with the use of invertebrates in aging research have been held. Successful methods for culturing large numbers of rotifers, a short-lived in- vertebrate, have been developed at the Gerontology Research Center. Marked age- associated changes were found to occur in these small animals. Three- fold in- creases in the total dry weight, protein, and acid phosphatase content of the rotifers were observed as they grew older. An increase in acid phosphatase activity was also demonstrated by histochemical techniques and found to be associ ated with a marked increase in inclusion bodies which have the enzymatic charac- teristics of lysosomes. These changes in enzymatic activities, as well as the in crease in total protein content, suggest a role for genetic processes in senescen Aging and Society Changes in birth and death rates have greatly altered the age structure of th populations of the highly developed nations. Never before have countries had sue high proportions of older persons. This change in population age structure has profound effects on the individuals in society and on society as a whole. Some of these effects are obvious. The totality of the implications of the changing age structure has not been fully evaluated. We have noted that 10 percent of the population of this country is over 65. I the number of persons in the country is held constant by birth control; if the ag specific death rates remain unchanged ; and if migration is negligible, then the population will come to have about 15 percent of its members over 65, 10 percent over 70, and 3 percent over 80 years of age. The present age structure of the population poses problems for society. The percentage of the population in its productive prime is reduced by the increase i persons over 65. These older persons have many needs- -economic support, medical care, housing- -all of which are expensive and should be met. To encourage investigation of the psychological and sociological problems of aging, the Institute has placed a number of its training grants in the psycho- logical and social sciences and has developed a contract to permit small meetings and interchanges designed to stimulate interest in research in this area. Training and Visiting Scientist Programs The Institute supported 211 students by 27 training grants in fiscal year 197 Of these, 68 percent were in the psychological and social sciences, 32 percent in the biological sciences. Eighty- two percent of the trainees were candidates for the doctorate and 18 percent were post-doctoral students. In addition, there wer 7 fellowships and 7 research career development awards. 291 B. HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION The Health Services and Mental Health Administration under the direction of thi Administrator, is responsible for providing leadership and direction to programs and activities designed to improve general health services and mental health programs for the total population, and for achieving the development of health care anc maintenance systems that are adequately financed, comprehensive, inter- related, and responsive to the needs of individuals and families in all socio- economic and ethnic groups. Obviously, the elderly along with the rest of the population benefit from program activities geared to meeting the neeas of all the people. However, a special attention to the needs of the elderly is required for certain facets of physical and mental health services and programs. The multipli- city of illnesses which often occur in the same individual making treatment more complex, the lack of mobility which serves as a barrier to obtaining available health services and the onset of senility are but a few problems which require special consideration in organizing health programs for delivering services to and preparing health personnel to deal with the aged. Particular attention to these and related problems is incorporated into the acti- vities of the major operating components within HSMHA. To coordinate and stimu- late such activities and to provide a focal point for the many diverse efforts in lealth services for the aged, the position of Coordinator for Health of the Aging rfas establishea within one of HSMHA's major components, the Community Health 3ervice, which is the organizational unit most specifically involved in health aspects of Medicare and the delivery of health services. In addition, an out- standing authority in gerontology was appointed as Consultant to HSMHA for the ipeoraing White House Conference on Aging (WHCA). Working in concert with the :oordinator for Health of the Aging, the Consultant is responsible for planning md coordinating HSMHA activities for this Conference. An inter-agency Federal Secretariat for the Technical Committee on Health of the WHCA was created, with he Consultant serving as director. Also, a HSMHA Committee on Aging was formed :o provide an additional resource for the Conference. It is anticipated that ifter the WHCA is over, both of these committees will continue to serve as effec- :ive mechanisms for exchange of information and coordination of efforts in develop- ment of health programs for the aged. 'articular attention to the problem of the aging is incorporated into the activi- :ies of a number of the major operating components within HSMHA: Community Health Service National Institute of Mental Health National Center for Health Services Research and Development Regional Medical Programs Service Health Facilities Planning and Construction Service Indian Health Service 'he following section of the report describes the activities of these programs in tore detail. immunity Health Service o achieve the National objective of the highest level of health attainable for he total population, Congress enacted the "Partnership for Health" legislation n 1966. This Act, which was subsequently amended in 1967 and 1970, introduced he concept of comprehensive health planning as a means of determining health eeds, establishing priorities and recommending appropriate courses of action. 292 The focus of this national health effort is the individual and his family living in his own community. This focus requires the cooperation of many agencies, institutions, health personnel and consumers, as well as that of Federal, State and local governments. The Community Health Service carries out its responsibilities under the "Partner- ship for Health" and its responsibility to provide professional support for the administration of Medicare through the program activities of four divisions: Comprehensive Health Planning, Health Standards, Health Care Services, and Health Resources. In general, they emphasize support for better organized and delivered health services; fostering comprehensive health planning on a State- wide and areawide basis; development and monitoring of medical care standards to insure the delivery of good quality health services in a safe environment; aiding in the improvement of health resources - especially through development of training programs, educational and informational materials for administrative, professional, and auxiliary health personnel as well as the general public. In all of these activities; recognition is given to the fact that the unique health needs of the aged often necessitate health services specially designed to meet these needs. At the same time, with the emphasis placed on planning and delivery of comprehensive health services, many individual activities which formerly would have been developed as free-standing programs for the aged are now being incorporated into comprehensive health programs for wider populations. 1. Comprehensive Health Planning In enacting the Comprehensive Health Planning and Public Health Service Amend- ments of i960, Public Law 89-7 L 9, the Congress declared: ". . . fulfillment of our national purpose depends on promoting and assuring the highest level of health attainable for every person, in an environment wnich contributes positive- ly to healthful individual and family living ..." and ". . . comprehensive health planning for health services, health manpower, and health facilities is essential at every level of government ..." The State and areawide health planning agencies established throughout the country are working toward that goal. Although planning activities are being carried out for all citizens, particular attention is being given to high-risk groups, including the aging and aged. Currently all States and Territories have comprehensive health planning services for more than 50 percent of the population. Some examples of specific CHP activities directed toward these the following: ;roups include A comprehensive health planning council (Dade County, Florida) in the South has established a Nursing Home Advisory Committee to carry out an in-depth analysis of trie county-wide nursing home situation and has set up criteria for certifi- cation of need for construction of new homes. A multi-county CHP agency in the north-east (CHIPS, Syracuse, N.Y. ), through its Task Force on Long-Term Care, has carried out several studies relative to the needs of the aged and chronically ill. One program funded by the Administration on Aging is related to comprehensive health planning in that funds have been granted to the Community Service Council, Inc. in Birmingham, Alabama, which is the designated Comprehensive Health Plannir Agency in that area. These funds are for the development of a comprehensive service delivery program for the aging, including social services, outreach services, volunteer training, assurance of health services, and various innova- tive approaches. 293 2. Health Standards When Medicare was enacted in I'M)',, the Secretary of HEW was required to establish national requirements for a variety of providers of services to protect tne health and safety of program beneficiaries. Prior to Medicare, little existed in the way of established professionally acceptable standards for some providers of services, and particularly for long-term care facilities, home health agencies, and independent laboratories. Qualifications required for many types of health care manpower were also inadequate to assure a safe level of quality of services. The Division of Healtn Standards, working with the Social Security Administration, was assigned principal responsibility for standard-setting and surveillance, and for other professional health aspects of Medicare of direct benefit to program beneficiaries. rhe ot.jective of the Division of Health Standards is the improvement of the lealth status of Medicare beneficiaries by assuring that the types, quality md quantity of services provided under the program are appropriate to patients' leeds. Medicare has helped to focus attention on problems of health manpower -- ["row physicians to nurses aides — including their supply and adequate surveil- Lance of trie services they provide. Various techniques for assuring quality of services without unduly limiting supply are undergoing study and experimentation, mu Medicare, through the Division of Health Standards, is in the forefront of :hese efforts. 3. Health Care Services The Division of Health Care Services promotes the development and utilization of .mproved methods of health services organization, delivery and financing at the lommunity level in both urban and rural settings. A special concern is the devel- >pment, support and evaluation of methods for organizing and financing group iractice arrangements as a community health resource. Priority is L iven to tne telivery of services to groups with special health needs, such as the urban poor md rural poor including the migrant worker. Approximately 39 family oriented ambulatory primary care projects have been "unaed, including Ih recently transferred from the Office of Economic Opportunity, 'hese projects support more effective ways of delivering ambulatory health services to individuals of all ages who live within a project area. k* Health Resources 'he Division of Health Resources encourages, assists, and supports appropriate .gencies and organizations in developing needed health care resources and ncreasing their capacity to provide for the delivery of qualitv effective ervices. Major emphasis during 1970 has been concentrate ..he Health Facili- ies Survey Improvement Program which is designed to improve tu.d standardize the erformance of State and Federal personnel engaged in surveying ana certifying ealth facilities for licensure and for participating in Medicare and Medicaid rograms, with delivery of high quality care in health facilities as the ultimate bjective. orking with the Association of State and Territorial Health Officers, the Program ssisted in the development and support of the National Association of Directors f Health Facility Licensure and Certification Programs. The purpose of the ssociation is the improvement of patient care through licensure and certifica- ion activities and improvement of coordination of health care programs among tate and Federal agencies. Four committees were established by the Association o work on a number of problem areas during the past year: Health Facility tandards and Guidelines; Patterns of Care; Surveyor Functions, Qualifications nd Training; and Utilization Review. The work of the Association has provided 294 new direction, thought, ideas, and perspective toward improving patient care and the development of a true State and Federal partnership working together on the many old and new health care problems. Recognizing the need for improving the quality of health facility surveys, the HFSIP developed the four-week Health Facility Surveyor Training Course. It is now being conducted at three universities, Tulane University, UCLA, and the University of New Hampshire. In addition, HFSIP is developing 12 different specialty courses designed to provide an in-depth understanding of the special- ty areas normally found in all health facilities. These areas include dietary services, nursing services, medical records, etc. These courses will be conduc- ted in each State and are to be attended by State surveyors, consultants and administrators of health facilities. Through programs encouraging hospitals to share needed services and to cooperate in centralized purchasing and other cost reduction methods, the Division's Hospital Branch has been sensitive to the quality and cost of hospital care available to older patients. The Nursing Home Branch continued during 1970 to direct its efforts toward improvement of health and social services of long-term care patients in nursing homes. Included were the following activities: staff support to the National Advisory Council of Nursing Home Administration; staging of a series of regional conferences to stimulate and support higher education opportunities for long- term care facility administrators; development of a licensure examination for nursing home administrators, through a contract with the Professional Examina- tion Service of the American Public Health Association, (examination now being used by 31 States); development of a curriculum to upgrade the quality of the licensed practical nurse who serves as the charge nurse; and the revision and updating of the publication "A Guide to Nutrition and Food Service" for nursing homes and homes for the aged. During 1970, the Home Health Branch emphasized improved quality of care and enhanced ability of Home Health Agencies to provide more comprehensive services with particular priority to those individuals over 65 years of age. Community Health Service central and regional office personnel and representa- tives of Social Security Administration met for a Home Health Conference on the improvement of home health program activities. A series of workshops was started for directors of Home Health Agencies' personnel which centers on the needs and problems impeding delivery of service and fulfillment of Social Security Regulations regarding certified home health care agencies. A series of memoranda has been distributed to all certified Home Health Agencies and interested professional persons containing technical information about regula- tions that apply to providers of home health services. 5. Professional Education In 1970, Volumes II and III of the four-volume series entitled "Working with Older People: A Guide to Practice" were released. Volume I, "The Practi- tioner and the Elaerly, " was first made available in I966: since that time more than 35,000 copies have been distributed or sold, and the demand for this publication remains heavy. Volume II, is entitled "Biological, Psychological and Sociological Aspects of Aging," and Volume III, "The Aging Person: Needs and Services." Volume IV, "Clinical Aspects of Aging," is expected to become available in the early part of 1971- According to reports, these Community Health Service publications, which contain a comprehensive body of knowledge in applied gerontology, are serving as valuable resource material in training and continuing education programs sponsored by medical organizations, schools of nursing and social work, and 295 other organizations concerned with health of the aged. The paucity of teaching programs in comprehensive health care is of particular importance to the aging and aged. For while this inadequacy adversely affects the health status of the total population, the impact is most severe among the aging and aged, the population segment most vulnerable to illness and disability. As a means of stimulating interest in developing undergraduate medical curricula that provide orientation in comprehensive patient management, the Public Health Service during the past 5 years has negotiated contracts with 10 medical schools to develop "blueprints" for teaching the concept and methodology of the compre- hensive management of patients. Five medical schools (University of Missouri, Tufts, Mt. Sinai, the University of Southern California and Baylor) have completed their "blueprints" and are in the process of implementing them. Two schools (Georgetown and Boston University) are completing their "blueprints," and three additional schools (University of Arizona, Tulane University and the University of Pennsylvania) are Just getting started on this activity. As a result of this program, five medical schools have initiated curriculum changes to incorporate the teaching of the principles and methodology of comprehensive care, and one school (Baylor) has created a new Department of Community Medicine which is serving as a focal point for introducing the new curriculum. 6. Audiovisual Material For the sixth consecutive year, two films on health of the aging prouuced by the Public Health Service continue to be in great demand, according to the National Audiovisual Medical Center in Atlanta, Georgia, which serves as distri- bution point for the films. "The Critical Decades" focuses on the need for health protection for individuals in their forties and fifties to insure good health in the later years. "Ready for Edna" gives historical perspective on development of health serviceb through the years, and describes the broad range of health services which ideally should be available in communities throughout the nation. The films were loaned for showing to approximately 1,000 organizations in 1970. Such organizations included: voluntary and governmental health agencies; a broad range of teaching institutions including schools of medicine, nursing, public health and pharmacology; hospitals; professional and voluntary medical organizations; and commercial and educational television. 296 National Institute of Mental Health Persons over age 65 are an exceedingly high risk group insofar as mental health problems are concerned. In 1967, the rate of first admissions per 100,000 popu- lation to public mental hospitals was 156.6 for persons 65 and over, the highest rate of any age group, and comprised 17.5 percent of the total first admissions. The rate per 100,000 resident population in mental hospitals was 682.9 for persons 65 years of age or over, or approximately 30 percent of all State mental hospital residents. Despite this demonstrated need for mental health services, persons 65 and over comprised only 2.1 percent of those persons utilizing out- patient psychiatric services during 1967, or a rate of about 82.1 per 100,000 population, the lowest rate for all age groups. Death rates from suicides betwe 1900-1964 indicate that persons 65 years of age and over are by far the highest. Various studies have estimated that anywhere from 10 to 25 percent of the person living in nursing homes and other facilities serving the aged have some degree o mental impairment. The NIMH goal, which is to improve the mental health of the people of the United States, is presently met through programs which seek knowledge about mental health and mental illness, through research, the training of professional man- power to perform services which will sustain and improve the mental health of al persons, demonstrations in state mental hospitals of ways to improve care of mental patients and through the development of community mental health centers t both treat and improve the mental health of persons in the community. The primary purpose of the Section on Mental Health of the Aging in the Division of Special Mental Health Programs is to coordinate programs for aging persons within NIMH and to act as an advocate for programs designed to improve and sustain the mental health of the aging. The Section has program responsibility for applied research projects concerning aging persons, acts as consultant to applicants in developing proposals which will carry out the aims of NIMH, and monitors funded applied research projects. 1. Research During 1970, there were 28 active applied extramural research grants in which tb major focus was on aging persons. Twenty-one other projects which were of some interest to mental health of aging persons were also active. These projects wer in the Center for Studies of Crime and Delinquency, Center for Studies of Metropolitan Problems, Center for Studies of Suicide Prevention, Clinical, Behavioral Sciences, and Psychopharmacology Research Branches. Recent final reports of applied research projects indicate that findings are being made by research investigators which should be of help in planning and developing services for the aging. The goal of one completed study was the development of services in public housing projects to make personal, neighborhoo and community resources, services, and facilities accessible to tenants 60 years of age and over through reaching out efforts and provision of information and referral and generally supportive efforts. The services were carried out by paraprofessionals under the supervision of a social worker. The findings indica a clear need for this type of service to help poor, uninformed, and old persons cope with the complexities of urban life, with a multitude of agencies, a com- plicated transportation system, and the confusions and perplexities of bureaucrac It also clearly indicated that mature persons, carefully screened and given in- service training and on-the-job supervision, can discharge circumscribed respon- sibilities with competence and relative independence. Results of this project have been widely disseminated throughout other governmental agencies. Another project provided comprehensive care for suspected mentally ill aged persons through the services of a multi-disciplinary team. This care included 297 diagnosis, planning, placement, and treatment utilizing a broad range of community resources. The sample included 100 persons 60 years of age and older, for whom a petition of commitment had been filed. It was found that though in previous years, 75 to 85 percent of such persons had been sent from the screening ward where this research took place to a State hospital, insofar as the group studied and served was concerned, only 23 percent went to a State psychiatric hospital. New applied research studies funded for the first time in 1970 include one which is assessing the effects of services and programs offered by an older adult pro- gram in a community center to aged individuals who have undergone various types and degrees of role changes. Another project provides an intensive case finding and service program which will yield information about the life style, attitudes, and social functioning of low income, urban, black aged. Ongoing studies during 1970 include a project concerned with developing and demonstrating improved methods of finding and serving impaired older persons in the community. Another project is studying the effects of a sheltered workshop for severely impaired brain syndrome patients residing in a home for the aged. Support is also being provided for various studies of housing for aged persons. Among these is one which investigates what specific type of housing arrangements the aged perceive as ideal. 2. Hospital Improvement Program The Hospital Improvement Program was established in 1963 in order to help the States improve their hospital services to the mentally ill. In 1970, 20 projects of this Program were concerned with aged persons. Most of these projects combined one or more of the following: reduction of the length of stay for aged patients in mental hospitals through placement in the com- munity, the restoration of a greater degree of social or physical functioning, and the developing of more adequate means of screening the aged inpatient population. 3. Training Currently there is increased interest in stimulating projects to train new types of nonprofessional workers to either help care for those aged who are already mentally impaired, or to prevent mental health problems in aging persons. At present the major proportion of NIMH training funds concerned with aging is being used for teaching grants and trainee stipends at social work schools. In 1970, 17 universities had training grants in the field of aging; 14 of these were in schools of social work and one training grant each was for geropsychiatry , nursing, and psychology. Social work schools consider themselves as graduating generalists in casework, community organization, or group work fields, and have a generic approach to the client. However, the NIMH stipends are given to trainees with career goals in aging who are being supervised in a setting where aging people are being served. Those interested in aging studies complete a field placement in an old-age institution, a family agency, a community center, a mental hospital, etc., where the primary emphasis is working with aging persons. Information concerning the availability of trainee stipends may be obtained from the schools of social work administering them. NIMH plans, administers, and coordinates a national program of training in the field of psychiatry. This support is given in collaboration with the Nation's training centers and includes grants made to medical schools, hospitals, and clinics approved for psychiatric residency in residency training, or research 298 training in special areas. Many of the programs include some involvement with care of geriatric patients whom the resident will serve. A program that NIMH is funding specifically for geriatric psychiatry is at the Duke University Medical School. It is a two-year residency for individuals who have completed three year of psychiatric residency. Training is given in five areas, and includes geropsychiatry, geriatrics, and social, physiological, and biological gerontology NIMH also has a program of support designed to expand and improve training in the field of psychiatric nursing. Grants are made for undergraduate training, and doctoral, graduate, and training in special areas. Applications for trainee support are made directly to the training institutions. Many NIMH training grant in the field of nursing include some aspects of caring for the geriatric patient, but the only NIMH-supported program specifically for geropsychiatric nursing is presently at the Duke University School of Nursing. This is a one-year program for nurses who already have a master's degree in psychiatric nursing, with the curriculum emphasizing the aging process and psychiatric disorders prevalent in old age. NIMH plans, administers and coordinates a program for inservice training, staff development, postgraduate education, and adult education to upgrade the efficienc of personnel currently employed in mental health agencies and other mental health allied personnel and citizen groups. Applications for funds to support continuin education programs may be made by any public or private nonprofit institution. One continuing education project grant has been awarded to the Gerontology Center at the University of Southern California, to cover a multidisciplinary group of professionals including general medical practitioners, psychologists, psychiatrists, city planners, architects, etc. The program aims at overcoming th unorganized nature of information on mental health problems of the aging. It includes one or two-day intensive seminars, five-day colloquia, and two courses on aging and mental health, organized into a single discipline. Another continuing education grant concerning the aging was given to the Gerontological Society to develop a program of education in gerontology and menta health. Its objectives are to improve and increase mental health services to the mentally ill elderly, apply the most relevant research data to practice, and stimulate and involve more professionals in conscious innovation of services to the elderly. Hospital staff development grants are designed to improve the quality of care of patients in mental hospitals. In 1970, NIMH funded 6 such grants which con- cerned aged persons. The grants are used for inservice training for aides, semi- professional and professional staff, and to meet identified treatment needs. Various kinds of training programs are supported, such as refresher and continua- tion training, and special training for staff who do the inservice training. An example is the hospital staff development program at Cushing Hospital in Boston, which admits patients 65 years of age and older on a voluntary basis and where the average patient's age is 83. This program is directed chiefly at developing the sociotherapeutic potential of the entire hospital staff, with the ultimate goal, the remotivation and social activation of the geriatric patient. Employees are provided with necessary and systematic training to enable them to translate knowledge into more effective services to patients. Research fellowships have been given directly to qualified persons in all mental health and related disciplines for research training related to the problems of aged persons. Such applications by individuals for predoctoral, or special fellowships are made under faculty sponsorship. 4. Community Mental Health Centers In view of the high vulnerability of the aged to mental impairment, much hope had 299 been expressed that the community mental health centers would be of assistance in helping the aged sustain themselves in the community. However, with the myriad problems that the centers face in staffing and serving those who, in cost benefit terms, may yield a higher return; e.g., the man who can go back to work with psychiatric help and thereby support himself and family, as compared with the aged person who may continue to need supportive help and care for the rest of his life, the actual investment of resources in staff has been limited. The aged have obviously not been of priority to the centers as can be seen from the following report for 1968 from a representative selection of community mental health center admissions. Of the total number of persons served, the elderly comprised 7 1/2 percent of those persons receiving 24-hour care, nearly 4 percent of patients receiving partial care, and over 3 percent in outpatient care. When such minimal utilization is compared with the demonstrated need among the elderly for mental health services, it is obvious that the aged are seriously underrepresented in use of community mental health centers. There are a few pro- grams in the centers which give special attention to the aged. The Section on Mental Health of the Aging in the Division of Special Mental Health Programs has made itself available for consultation to community mental health centers through the regions in order to attempt to raise the priority for care of the aged in the centers. However, in view of the financial pressures that the community mental health centers are feeling, it is doubtful that new developments for aging services can be hoped for in the near future. 5. Health Insurance and Medical Assistance The NIMH is concerned with the development and extension of mental health services for the aged through the health insurance and medical assistance programs, Titles 18 and 19 of P.L. 89-97. The primary goal is to make benefits for the mentally ill aged comparable to those available to persons who experience other kinds of illness. Implementation of standards for delivery of quality care, encouragement of additional resources and new approaches to services are major concerns. To assess the effect of the recent Federal legislation on the care of the mentally ill, a study was done of the utilization of the mental health facilities by the aged. Length of stay and other factors which affect utilization were reviewed to determine if the patterns of care are undergoing change. A study is underway of the types and availability of alternative methods of care for the geriatric long term patient usually found living in the public psychiatric institutions. The study includes an exploration of the elements of care that must be available to assist patients to remain in their home communities. NIMH participated with Community Health Service and the Bureau of Health Insurance (SSA) in pilot studies of the enforcement of standards and the evalua- tion of quality of care being provided mental patients in both public and private institutions. In cooperation with these two organizations, NIMH undertook a thorough review of the certification of the psychiatric hospitals under Medicare. This has resulted in the involvement in planning for changes in the special psychiatric requirements as well as planning for indepth training programs for the State survey personnel. Workshops have been held for regional office staff members assigned as regional office staff for Titles 18 and 19. Included in these sessions were central and regional office staff from Community Health Service and the Social and Rehabilitation Service. Resource materials have been distributed to both regional offices and State mental health offices concerning policies and standards af care. 71-272 O- 72 - pt. 1 - 19 300 6. Publications in Process Work is under way on a publication to bring together all research carried out by NIMH in the decade of the sixties. This publication will include summaries of all research projects funded by NIMH in this 10-year period for which results have been published. The booklet will include a review of the research and findings, the implications of the results or services, as well as a section which will discuss what these results mean in terms of goals in research on aging to which NIMH should address itself. It is hoped that this will be utilized for the 1971 White House Conference on Aging. Also in preparation is a handbook about community mental health services for the aged to be prepared with the help of the Group for the Advancement of Psychiatry. In collaboration with the Hebrew Home and Hospital for the Aged, Riverdale, New York, a document dealing with the treat- ment of the institutionalized older person is being prepared for publication. 7. Programs for Aged Patients at Saint Elizabeths Hospital Saint Elizabeths Hospital is a Federal hospital operated by the National Institute of Mental Health under the general umbrella of the National Center for Mental Health Services, Training and Research. The hospital functions in close association with the training and research divisions of the Center. It is in the process of reducing its inpatient census and providing community-based services, including the operation of a community mental health center for a certain segment of the District of Columbia. The hospital's bed capacity is approximately 3,900 and the average inpatient load for Fiscal year 1970 was 4,330. On June 30, 1970, there were 3,866 patients in the hospital and 39 percent of this number were 65 years of age or older. In addition at the end of the year there were 2,247 patients on leave from the hospital of which 14.1 percent were 65 years of age or older. Patients are eligible for admission under the District of Columbia Hospitalization of the Mentally 111 Act, Title 21, Section 501, of the District. of Columbia Code, certain Federal and D. C. Codes regarding criminal proceeding, and other Federal and district codes. Patients 65 years of age or older may be classified in two separate and distinct groups: those patients admitted to the hospital after their 65th birthday and those who have grown old in the hospital. Because of the decrease in the number of elderly admitted to the hospital, it is now possible to intensify efforts to treat and rehabilitate those who have grown old in the hospital and to return them to the community. One speical effort directed to the older age patient was a recent nursing care project which introduced activity programs. It resulted in an increase in the patients' personal competence in activities of daily living. Another special study of the older patient revealed that this group of patients should be integrated into the general patient population of the hospital by housing them in general wards on admission rather than segregating them in a special building for geriatric patients. This policy is being followed and found to be quite beneficial. At present, the geriatric patient who is admitted to Saint Elizabeths Hospital is assigned to an age-integrated ward which has an intensive treatment program. This ward is part of a hospital division which serves the catchment area of the city which encompasses the patient's community residence. 301 National Center for Health Services Research and Development The bulk of research in the provision of health services for the aged is currently being supported through the National Center for Health Services Research and Development. Current efforts are directed at improving and extending health services on a community-wide basis, with priority given to development of services for the disadvantaged, with the elderly regarded as an important subgroup. The National Center is supporting the creation, testing and demonstration of proto- type community health services systems. At the same time, it is attempting to improve the components necessary for such systems through development of: new types of health services manpower to extend the effectiveness of doctors; new financing arrangements; ambulatory and inpatient health care programs designed to provide comprehensive services to all people; and inter-institutional arrangements to link doctors' offices, hospitals and other facilities and services for con- tinuous care. In designing the components for ambulatory and inpatient care, special attention is being given to the comprehensive and continuous care of the chronically ill and the elderly. Similarly, in developing improved arrangements for financing patient care, the effects of removing or reducing the deductible and co-insurance features of Medicare and other insurance plans are undergoing study. During FY 1970, 24 projects directly concerned with health of the aged were being supported by the National Center for Health Services Research and Development. Approximately a half million dollars from 1970 appropriations were expended for these projects. The following are examples of this research: Production of a comprehensive State-by-State analysis of laws affecting facilities for the aged in the form of a written manual on Nursing Home Law, which it is contemplated, will be styled after the Hospital Law Manual, published by the Health Law Center. A project to assist nursing homes to meet new challenges to changing conditions, to help them find their roles as satellitesto hospitals and to assist them in becoming supporting facilities for rehabilitation centers for continuing patient care through the practice of active nursing care and activity programs of thera- peutic value. A study to provide information on the use of health resources by a group of males 80 years of age and over while covered by a moderate third-party payment health plan and then to describe the changes that occur in use of medical resources after the implementation of a comprehensive medical care program. An examination of the amount and type of medical services used by four groups of persons aged 65 and over in 1965 and 1968, and to estimate the amount of medical care which may eventually be expected to be demanded by the aged as a whole under Medicare. A study of the impact and an evaluation of the relative effectiveness of diagnostic evaluation services and follow- through services to applicants to a long-term care facility, including a cross-sectional and longitudinal study of these applicants. A review of the published literature and unpublished information about nursing homes and nursing home research with a view to defining research needs and possi- bilities. An examination of the transition from a classification reimbursement system for nursing home care to a cost-plus system by contrasting the payment systems as these affect the level of patient care in order to reduce and control medical care costs to the aged. Development and demonstration of improved methods of finding and reaching impaired older people and of serving their differential needs, using inter-agency coordi- 302 nated approaches, in order to formulate a set of recommendations, based on evalua- tion, for the provision of protective services on a continuing basis. Regional Medical Programs Service Regional Medical Programs Service, through grants and contracts, seeks to assist the nation's health institutions and the health professions to improve the organi< zation of health resources and accessibility of care, and to enhance manpower capability at the community level within a framework of voluntary cooperative relationships, in order to improve the quality of care to individuals -- especial! those threatened by or suffering from heart disease, cancer, stroke and kidney disease, and other related conditions. 1. Legislation By the end of 1970, 54 of the 55 Regional Medical Programs were in operational status. More than three-fourths of them had been operational at least one year, and five of these are in the fourth program period. The program was extended and amended (at the end of October 1970) with the enactment of P. L. 91-515 -- "Heart Disease, Cancer, Stroke and Kidney Disease Amendment of 1970." Significant changi in program scope are: specific mention of kidney disease and other related diseases, and prevention and rehabilitation through demonstrations. Additional emphasis is given to regionalization of health care resources and services in ordi to strengthen and improve primary care and the relationship to specialized care. Construction authority not to exceed $5 million per year is added, and multi- program service grants and contracts are expanded. 2. Operational Activities During the year, funds were available to the 54 programs for the support of about 600 component activities with a specific categorical disease or comprehensive multiple-disease focus, involving continuing education and training activities, demonstrations of patient care, research and program development. Also of signi- ficance to community services and with potential beneficial impact for the aging is the newly emerging relationship with the Model Cities programs of the Departmei of Housing and Urban Development. The program was established as a demonstration of new ways in which Federal, State and local cooperation and funds can make a substantial impact on the physical and social problems of the city. HSMHA has taken steps to improve coordination of its health planning and program developmeni functions involved in this concern with the Model Cities programs. In this fisca! year nearly $2 million in RMP grant funds have been earmarked for grant awards for model cities-related activities. These awards are made specifically for impai upon the model neighborhoods so as to improve the quality of health of the resi- dents. Most of the disease-oriented activities are not directed solely at the aging or t\ aged. Nevertheless, efforts aimed at improvement of care for the aging and lessening the impact of chronic long-term illnesses are appearing in a number of patient care demonstration activities and training such as: home health care, training and follow-up, rehabilitaion, especially for older patients following a crebrovascular accident, multiphasic screening and prevention, cardiovascular and pulmonary disease-oriented demonstrations, public education programs, and nutritional activities. Typical activities being supported by the Regions, which involve services for the aging and which are impacting on their health and cited in the brief descriptions which follow. 303 3. Screening In California two multiphasic screening programs were funded recently. In East Palo Alto the Neighborhood Health Center will sponsor the multiphasic health testing project which is receiving support from the RMP for consultation services from Stanford Medical School on clinical aspects and from the San Mateo County Department of Public Health. The multiphasic screening program for the poor in San Joaquin Valley (California) is being sponsored by the County Medical Society which will contract with Health Facilities Foundation to conduct the project. The purpose is to identify health needs and determine the extent and type of conditions requiring medical care, as well as demonstrate that mobile multiphasic screening can be linked between health needs and health services in a poverty community. Multiphasic screening activities, not all equally broad in scope but which reach a total community, are being supported in several other regions as well. Some screening projects are limited to a specific disease or related condition, but often include the aging as in the case of hypertension screening. 4. Rehabilitation Rehabilitation activities are associated with the majority of stroke demonstration projects. Some have as a primary purpose training and education of health pro- fessionals in the field of rehabilitation which indirectly will benefit the aging, others include training of home health aides and other allied health workers for :are of patients at home or in a nursing home, and consultation services. Illust- rative of these is the community-oriented continuing education project in stroke rehabilitation in Wisconsin. This aspect is one phase of a comprehensive stroke program. In selected non-urban areas, primary emphasis is given consultation services and postgraduate educational programs for physicians, nurses and allied lealth personnel. 5. Demonstration Activities lome health aide projects are directed at training of health workers and family nembers to care for chronically ill long-term patients with heart disease, cancer and stroke. Some of these activities are coordinated with the visiting nurses association; others involve public health nursing organizations and follow-up services after discharge from community hospitals. Practically every region is supporting a demonstration or continuing education project involving patients with cardiovascular disease. Some are based at com- nuni ty hospital coronary care units; others offer education and training courses it the medical center, and consultation services in smaller peripheral hospitals. r unds are available to a number of Regions for developing comprehensive pulmonary :are programs, including correlated educational activities. Some emphasize care for patients with emphysema and chronic respiratory disease in extended care facilities, and others are developmental. Although not specifically identified for the aging, several RMP projects have been cooperatively funded with a model cities program in conjunction with Neighborhood lealth Centers, such as those efforts in St. Louis and Kansas City, Missouri; Salt .ake City, Utah; and Tampa, Florida. In New Jersey urban health coordinators supported by RMP are working closely with citizen groups in developing health components of model cities plans. 304 Health Facilities Planning and Construction Service A primary objective of the Health Facilities Planning and Construction Service, which administers the Hill-Burton Program, is to stimulate the construction of facilities needed to bring about an efficient, well-coordinated network of service for the acute care, long-term, and rehabilitation of all persons, including the aged and aging. As of July 1, 1970, the Hill-Burton program has provided assis- tance for the construction of 93,749 long-term care beds in chronic disease hospi- tals, nursing homes, and units of general hospitals. The need for construction of long-term care facilities continues at a high level. As the aging population continues to increase, the demand for adequate nursing home care for them must be met. In addition, the enactment of the Medicare pro- gram partially removes the economic barriers to care of the aged. State agencies report that 419,000 long-term care beds, including extended care facility beds, must be constructed, remodeled, or replaced. In FY 1970, $63.6 million were appropriated for the construction of long-term care facilities. This level of financial assistance will stimulate the construction of approximately 8,900 long-term care beds. The aging and aged will benefit also from the construction or modernization of other health facilities under the Hill-Burton program. Hospitals, diagnostic and treatment centers, public health centers, and rehabilitation facilities are used extensively by the aging. Funds appropriated for these facilities totaled $108.6 million in 1970. In addition, the following services provided by the Hill-Burton program contribute to improved health care of the aged and others throughout the Nation: (1) tech- nical and professional consultation regarding all aspects of facility planning, design, and construction, which is available to States, public agencies, and nonprofit organizations; and (2) guide material relating to the planning, design, equipping, and construction of health facilities, which is continually being developed and distributed. Indian Health Service The Indian Health Service has statutory responsibility to provide comprehensive health services to all of the reservation Indian and Alaska Native population. It is estimated that approximately 60 to 70 percent of the identified needs of these approximately 415,000 persons are now being met. Indians and Alaska Natives are a young population with approximately 5 percent aged 65 and over, and about 12 percent aged 45 to 65. Indian and Alaska Native aging and aged persons are reached through IHS health activities focused upon the family constellation and upon Indian and Alaska Native communities. The special attention of the IHS health team to preventive health care combined with early identification of disease and health related problems has favorably affected the life span of the Indian and Alaska Native. Life expectancy of the Indian and Alaska Native in 1960 was 61.7 years and in 1967 was 64 years as compared with the U. S. all races totals of 69.7 and 70.5 for those same years. Federal and State services which are available to all other citizens are utilized along with IHS health care programs in order to more readily advance the health status of the Indian and Alaska Native people. Such services as available for the aged are coordinated with the IHS program in meeting the needs of the indi- vidual aged Indian person. 305 Environmental Control AdmtniBtratlon Aging programs in the Environmental Control Administration include research con- ducted or supported by the Occupational Safety and Health Program which is con- cerned primarily with the pathophysiologic response of man to his environment. In this connection, clinical studies are being made in which age 1b one of the most important non-occupational variables. Related projects now being supported are investigations of chronic chest diseases in bituminous coal miners, health hazards in uranium mining and milling, the effects of thermal stress, and problems of industrial noise exposure. One of the research efforts of the Bureau of Radiological Health deals with the long-term effects of low level radiation exposure. The relationship between radiation dose and the incidence of disease and disability in human population groups is being studied along with supporting experimental studies using animals. Shortening of the life span and acceleration of aging are among the most important consequences of long-term low level exposure to radiation. At Colorado State University a cooperative study is under way using experimental animals. This study deals with the growth and aging effects in dogs as a con- sequence of radiation exposure at various times as compared to a normal unexposed population of dogs. Knowledge gained through these studies and other sources i6 being used to help establish standards for maximum safe exposure for man to pre- vent unnecessary accelerated aging and increased incidence of disease. 306 III. SOCIAL SECURITY ADMINISTRATION Objective The Social Security Administration is responsible for administering the social security program which provides old-age, survivors, and disability insurance protection for over 90 percent of the workers and their families in the United States. It also provides hospital insurance protection for virtually all individuals in the United States who are age 65 or older, as well as voluntary supplementary medical insurance coverage elected by about 95 percent of those age 65 or over. Benefits to Older Persons Cash Benefits : Monthly benefits are paid: (l) To insured workers between the ages of 62 and 72 who have substantially retired from gainful employment and beginning at age 72 without regard to work status; benefits are also paid to wives of beneficiaries at or after age 62 and to widows of insured workers when they reach age 60. Children of retired, deceased, or disabled workers are also eligible for benefits when they are under age 18, and after age 18 if they have a severe disability which began before that age and which has made it impossible for them to work and support them- selves. For those children continuing to attend school at age 18 and over, monthly benefits are payable up to age 22. Benefits are paid to mothers (irrespective of age) when they have such children in their care, except for the students age 18 and over; (2) to insured workers up to 65 years of age who have worked a specified period of time in covered employment and have a medically determinable disability which can be expected to last for a continuous period of not less than 12 calendar months and so severe that it prevents them from engaging in any substantial gainful activity; (3) to certain individuals age 72 and over wh< are not insured under the social security program; and (k) to certain disabled individuals at age 50 who qualify as widows, v;idowers, or divorced wives of insurec workers . In addition, on December 30, I969 the President signed into law the Federal Coal Mine Health and Safety Act of 1969. Benefit payments are made under this law from general revenue to coal miners who are totally disabled due to pneumo- coniosis ("black lung disease") and to widows of coal miners who died due to pneumc coniosis. These "benefits are increased if the beneficiary has eligible dependents, Many of the beneficiaries are aged because the Act permits former coal miners and widows to qualify without any limitations on either age or how long ago the disability occurred. Benefit payments made by the administration were approxi- mately $10 million in fiscal 1970. Of the 25.9 million beneficiaires receiving monthly social security benefits at the end of August 1970, about I9.6 million were age 62 or over. By the end of 1971, approximately 93 percent of all persons age 65 and over will either receive old-age and survivors insurance benefits or will be eligible for benefits on retirement. This proportion will grow until practicall/ all aged persons are protected. The number of disabled workers and their dependents receiving benefits at the end of August 1970 totalled 2.6 million. The minimum monthly benefit for a retired worker who meets the regular insurance requirements is $6U; and $96 for a retired couple. This is subject to actuarial reduction if the benefit is taken prior to age 65. For those persons age 72 and older who qualify for uninsured (Prouty) benefits the payment to a single person is $U6 a month and for a couple $69 a month. 307 Monthly benefits which were being paid at the end of August 1970 for retired workers without dependents averaged $117; for a retired worker and his aged the average was $178; and for an aged widow, $101. For families with benefits computed on the basis of earnings after 1950, the averages were higher. Among these families the average benefits being paid at the end of August 1970 were $121 for a retired worker with no dependents, $200 for a retired worker and his aged wife, and $112 for an aged widow. Health Insurance Benefits In fiscal 1971 an average of 20.3 million persons aged 65 and over in the United States will be afforded basic protection against the costs of inpatient hospital services, post-hospital home health services and post-hospital extended care facilities under the hospital insurance program. In addition, an average of about 19.5 million persons aged 65 and over are expected to be on the rolls of the voluntary supplemental medical insurance program in fiscal year 1971, which covers physicians and related services. Both programs provide for payment of these costs subject to certain deductible and co-insurance amounts. Payments to hospitals, extended care facilities and home health agencies under the hospital insurance program are expected to total an estimated $5-8 billion in 1971 and $6.7 billion in 1972. Supplementary medical insurance payments for 197I and 1972 are estimated to amount to $2.1 billion and $2.3 billion, respectively. Services to Aged Individuals and to Community Groups rhe social security program is nationally administered. Local communities are served by 855 district offices and branch offices and 3,508 service centers, resident stations, and contact stations. Social security district offices give information to the public and answer inquiries about the benefits available to those who meet the conditions specified oy the insurance provisions of the Social Security Act. Old-age, survivors, and Usability insurance claims for benefits are received, developed, and initially adjudicated in the district offices. Applicants are assisted in securing the factual information needed to determine eligibility for benefits and are advised as bo their rights. Information and assistance is also provided inquirers and bene- ficiaries under the health insurance aspects of the social security program (Title (VIII of the Social Security Act). For adult beneficiaries who are incapable of nanagement of their benefit funds, a person other than the beneficiary is selected )y SSA to receive the checks and is held accountable for using the benefits in the 3est interest of the beneficiary. [nformation and referral services to other community programs and resources are provided in all district offices. In 1970 a review and evaluation of this service /as made to assess the extent to which the service is keeping pace with program jrowth and maturity. Findings will also provide a basis for judging the level of service provided to the public and whether it is responsive to the needs of the :ommunity in terms of locating related health and welfare services. Currently, ;SA and the Social and Rehabilitation Service are planning a limited number of .nformation and referral service projects in district offices to further test lethods of delivering services which will be most helpful to older people, as well is others who ask for help in locating needed services. 'he Social Security Administration also contributes to government -wide and immunity planning for the aged, the widowed, the ill, the disabled, and for chil- Lren. At the national level this planning is reflected through interagency Planning with the Department of Agriculture, Public Health Service, Social and rehabilitation Service, Department of Housing and Urban Development, and the Office >f Economic Opportunity, as well as with the American Public VJelfare Association, rational Council on the Aging, and National Assembly for Social Policy and levelopment, and other similar public and voluntary agencies. 308 SSA data on the numbers of aged, disabled, survivors, and health insurance bene- ficiaries assists in planning services to meet existing needs as well as for long- range planning. Such data also contributes to planning of special events such as the White House Conference on Aging and to congressional committees and other study groups concerned with the aged. With the advent of Medicare, there has beei increased interest at all levels of government and in the private sector in analysis of hospitals, extended care facilities, home care, and other health services. In this area SSA experience and data on incidence and trends are usefuJ to planning groups. At the State level, SSA provides assistance to State health departments to fulfil: Medicare requirements and to promote full potential for care of the aged in institutions, out-patient and home care facilities. At the local level, SSA participates in interagency community planning for develo] ment of resources with health and welfare councils and representatives of local government and welfare agencies. One hundred thirty-six district office managers and assistant managers are currently serving as Community Liaison Representatives in cities and communities selected for participation in the Model Cities program. The following are illustrative of ways in which SSA cooperates with other agencie: in planning programs for the aged which recognize their need for services as well as their role as participating members of the community. 1. Since January I969 the Trenton, New Jersey District Office has cooperated wit] the Department of Labor, National Council on the Aging, and the local United Progress, Inc. in a project to provide meaningful part-time employment for older people. Enrollees are paid $1.80 per hour plus 6Cp a day car fare by United Progress, Inc. The most significant work performed was screening of records at the New Jersey State Hospital for possible disability applicants and screening Bureau of Vital Statistics death records for females who might have been insured at death and were survived by children. The aged employees in this project performed so effectively that 35 others have since been employed in offices located in New York City; Portland, Oregon; Los Angeles and San Francisco, California; and San Antonio, Texas, to perform a variety of functions, including interpreting and sometimes translating foreign language documents. 2. SSA is concerned with the well being of the institutionalized beneficiary and it is a matter toward which much effort has been and will be directed. Polici and procedures relating to payments to people who are unprotected, i.e., wno have no relatives to look after them, are under constant review and study. SSA also encourages local agencies and groups to establish volunteer and other types of visiting programs to help improve the quality of life of aged nursing home beneficiaries. In Cincinnati, Ohio, SSA and the Administration on Aging are cooperating in 1 project entitled, Senior Service Representative Payee Project. Patterned after and operating under the administrative framework of the highly successf Foster Grandparent program, Senior Friends visit other elderly and incapaci- tated people in nursing homes and public housing facilities. In some cases the project acts as representative payee for incapable SSA beneficiaries where no preferred payee' is available. 3. Medicare Counseling - A free counseling service in the techniques of preparini applications for health insurance has been established in Clearwater, Florida The service is provided by a staff of senior citizens volunteers who want to contribute to the total effort of assuring that all eligible older people tato advantage of the health services available to them. 309 Retired persons needing advice and counseling can call at Senior Citizens Services and set up their appointments. The local district office cooperated with the project by providing training for the volunteers on Medicare eligi- bility and procedures for filing cla The above and other projects sponsored by the government and by private agencies have clearly demonstrated the effectiveness of older worker performance as well as advantages to the retiree and to the employing agency. As a result of these and other successful demonstrations, SSA now has a variety of models under considera- tion which would use the skills and abilities of elderly persons to work with incapable aged beneficiaries and for other clerical and community work. Research on Economic Security for the Aged rhe Social Security Administration research and statistical program provides information derived from the operations of the Social Security Administration system, from population surveys and from studies of related public and private income maintenance programs that is useful for continuous evaluation of the effectiveness of the social security program in providing economic security for the aged, including protection against the costs of hospital and medical care. Data are developed and published regularly in the Social Security Bulletin and its \nnual Sta tistical Supplement , in special published reports and in various other ways to meet user requests. Cndicative of the types of information made available and of interest to officials Hid groups planning programs for the aged are: Continuously reported data on :laims and benefit payments to retired workers and their dependents; the findings 3f surveys of the aged population, including OASDI beneficiaries, which provide Information as to the level of economic security that social security benefits support (information obtained on income includes sources of income of individuals ind families, level and types of assets owned, special demands on income such as aedical expenditures, etc.); special studies that show the changing share of the ;otal national output going to the aged, what measures of income adequacy are most ippropriate and meaningful, the relations between individual and family income over :he life cycle; continuing statistical series that are concerned with the totality )f public and private income maintenance protections and the relative weight of the social security program in that totality; and research to measure the impacts on >oth public and private health and medical care, to identify and define gaps and inmet needs under the health insurance program, and to examine and evaluate the iconomic consequences of the health insurance program. Social Security Ldministration research draws heavily upon basic data in the social security system, data from the population survey program, and upon data from the Bureau of ■he Census, Bureau of Labor Statistics, and other statistical sources. 310 IV. OFFICE OF EDUCATION Under the provisions of title I of the^ Library Services and Construction Act, the Division of Library Programs provides informat: and advice on programs oriented to the aging which are administered t State library agencies; assists training institutions with programs assigned to give librarians special skills Ineeded to meet the specia! library needs of older persons; maintains ljiaison with other Federal, State and local agencies and organizations jconcerned with the aging; assists in conferences of professional and lay leaders concerned witl library- sponsored activities for older people; and provides grants : the improvement of public library services. Under LSCA Title I, the Los Angeles Public Library has a project which provides bookmobile service to shut-ins in their homes and institutions; in 1969, they a< to this project a "books-by-mail" service to these shut-ins. The St Louis, Missouri, Public Library has a project, started in 1969 under 1 Title I and continuing in 1970, which is aiming for service to 85,001 persons over 65, the chronically ill and disabled shut-ins. Under tl program, book carts are taken into 30 nursing and retirement homes ai hospitals twice a month. A brightly painted, specially equipped van used to bring the 1,000-book collection, including many large print to those people who cannot visit the library themselves. Through fiscal year 1971, funds under title IV -A of the Library Services and Construction Act are for the purpose of establishing am improving State institutional library services. Homes for the aged i be included in a State plan if these homes are operated or substantia supported by the State. The many aged residing in other State insti are also beneficiaries under this program. Title IV-B of LSCA provi grants to States to establish and improve library services to the physically handicapped. Aged who are physically handicapped would a benefit from programs under this title. Most States are using some Title IV-A and IV-B funds to develop programs and provide materials services for the aged whether they reside in State institutions or a handicapped and live in their own homes, nursing homes, retirement h etc. Projects include such things as reading discussion groups, boo talks, story hours, film programs, music programs, etc. Beginning in fiscal year 1972, the Library Services and Constru Act, as amended, will provide library services to State institutiona persons and physically handicapped persons under Title I. It is est that approximately $400,000 will be used in fiscal year 1972 for pro involving the aging. Approximately 2 percent of the adults who participate in the ad education program are 65 years of age and older. Programs for these persons are usually designed to help them continue to manage their o affairs as a wholesome and economic alternate to other types of serv which make the older adult a recipient of benefits supplied by other 311 tates are encouraged to utilize qualified older adults in educational ervices in basic education as well as provide educational programs for lder persons with low educational attainment. In local adult basic iucation programs, retired persons may serve as recruiters, teachers, rid counselors and may provide different kinds of technical assistance, fforts are made to conduct these programs benefitting older adults in soperation with other Federal, State, local, and private sector programs ov example, the Community Action Programs. The number of persons, 65 years of agt and older, participating in is program is estimated as follows: fiscal year 1970, 12,200; fiscal ar 1971, 12,500; fiscal year 1972, 12,500. Vocational education training programs provide training and retraining r persons of all ages in occupations in health, technical, trades and dustry, office, distribution and marketing, home economics, and agri- lture. These programs serve older persons who need to learn basic ills, improve old skills, or develop new skills in order to advance eir employment opportunities. In the past few years there have been increases in the occupationally iented programs for adults in which persons who can be categorized as ged" have enrolled. With the need for training for such jobs as "Foster andparents," indigenous community health and welfare workers, teacher des, and similar occupations, an increasing demand for vocational ucation training programs is seen. Under Title I of the Higher Education Act of 1965 (P.L. 89-329), 71 ograms dealing directly with problems of the aging have been conducted ring the five years since its inception in fiscal year 1966. These ograms focused generally on: (1) increasing the intellectual and mmunity involvement of older persons, (2) broadening their economic owledge, (3) making available better health information and medical eatment, and (4) providing improved recreational opportunities. During e five year period about $1,080,000 in Federal funds were spent in is problem area, reaching some 60,000 people directly and over 100,000 a television series. In fiscal year 1970, 11 projects for the aging re initiated by 11 institutions of higher education in 9 States for out 4,000 people at a cost of approximately $150,000 in Federal funds. ere were many other institutional projects under Title I which nefitted older citizens but were not designed exclusively for them. 312 .1 X. u 715 $39,362 $38,574 $37,896 931 3,953 3,952 3,203 830 691 581 309 377 9,850 9,080 9,200 557 66,715 63,222 57,083 052 907 915 850 462 121,478 116,324 108,541 724 8,102 8,762 7,180 c oo CM vC CC O oo CJ* CM in vC O CM O co a> CO $53,817 $54 4,050 3 1 2,731 8 60,086 60 925 1 O r-. en <-H 1 vo in r in »h O Om O O cm en in en O CM 00 ejs ej\ oo CM 0> O^ ^D l-l •!-! in xi -h a e 41 -r-l C TJ TJ Pi J 3 < < 4-1 41 U U O AJ AJ C c «i o m I V4 u Q oo a> CO p 41 P- OS CO Cfl 41 4) 4J O J= Cfl O C 4-1 r-l CO -i-l O 313 § § £ § ■K3 w c CO 60 S c •H 60 W U B « ■g °3 w w o .15 « H. to X u u « U-l O f-t O "4i »-« o il *■ o o o o o o 8 « CO « u 1-. I ill! a I 3 « q as S ^ m -h i 314 0) *0 C -a £ 3 c CO CO 4J CO « H S 60 CO H I iH CU T3 O. O rH (0 3 O O CO X U ■H 3 CJ CO CU T3 T3 (0 c a. CO r>. o vo a *"•» to CN U ->» CO r* 'A CO en to O -O a cu o PL. ^-s /-s 0) ill Ci CO H M CN| 00 1 • * n o • a. Pm ^ •« CD •H (1) ^ 3 4J 0) 4J CO 1 4J M X CO M (x a a -h M co T3 i co cu 4-1 CO CO CO O cfl 4J SB J= CO o. Cu CO CU CO U CO H| m| 3 4J O O CO 3 ■*l ir,| 315 since Income Is really of primary concern bo the elderly, the Increase in Social iecurity expenditures Is significant. The figures Indicate thai lince L967 the fearlj expenditures under Soda] Security have almost doubled, so thai at this time over $34 billion is spent yearly. Finally, Mr. Chairman, i must truly take issue with your assessment of the Whiu> House Conference on Aging. I think bhat under the direction of Mr. Arthur B. Flemming, Conner Secretary of HEW, as Chairman of the Conference, a man whose service and dedication to the elderly is well known, nnich of the criticism thai had been leveled against the Conference during Its start-up months has been dissipated. I am looking forward to a very positive Conference one In which the issues of the aged are discussed and recommendations made. I am optimistic that the Administration will certainly study these recommendations carefully and will propose action upon which there will be follow-through not only by the Ad- ministration but by the Congress as well. I am inserting at this point in the rec- oni a copy of an article by Judith Turner which appeared in the National Jour- nal on September 25th entitled "White House Report/Conference on Aging seeks changes in attitude toward the elderly." I think that, this article is an ob- jective appraisal of the situation and it does indicate the many positive steps being taken so that the fears you have expressed will not materialize. White House Report/Conference on Aging Seeks Changes in Attitude Toward the Elderly (By Judith Axler Turner) The second decennial White House Conference on Aging mil convene in Wash- ington the week of Nov. 28 with renewed hope that it can produce major changes In national attitudes toward the elderly. No optimism was evident a few months ago when small differences among con- ference planners became matters of honor and larger issues caused some orga- lized groups to think seriously of pulling out altogether. The change in attitude came with the appointment in April of Arthur S. Flem- ning, former HEW Secretary (1958-61), as conference chairman. Flemming's deftness in dealing with planners and delegates has defused a po- entially explosive situation for the Nixon Administration and focused attention >n the issues rather than the mechanics of the session. The role of the conference will be to ratify rather than innovate. Major issues vill be largely financial — income, pensions, health insurance and nursing-home support — and legislation in each of these areas already is before Congress. "If I had to sum up the issue in one word, it would be 'attitude,' said John B. tfartin, commissioner of the HEW Department's Administration on Aging. "We lope at this conference to change the nation's attitude toward the elderly." early planning As acting chairman, Martin set out to get as many as possible of the 20 million Americans who are over the age of 65 involved in the conference. Forums : Six housand community meetings — called Older American White House Forums vere held across the country 'beginning in the fall of 1970. At these meetings, topics for subsequent discussion were brought into focus. I questionnaire, drafted by the conference staff, was circulated in an effort to iiscover the problems of greatest concern to the elderly. But the execution of the forum plan did not always measure up to the concept. Nelson H. Cruikshank, president of the National Council of Senior Citizens, rhich claims a membership of 2.5 million, attacked both the forums and the luestionnaire. He said the questionnaire was "superficial" and the forums could be reached nly by those elderly who had the means and mobility to get to the meetings, rhich were held in senior citizen centers, schools and churches. Transportation.— One result produced by the questionnaires, however, bore out ^ruikshank's complaint and surprised the conference staff. "Transportation was the sleeper issue" brought to light by the questionnaire, Martin said. Many of the 200,000 elderly who responded to the questionnaire said they could lot take advantage of available services, particularly in rural and suburban reas, because they did not have automobiles and because public transportation eas inadequate or nonexistent. 71-272— 72— pt. 1- -21 316 "We didn't know it would be ranked as high as it was in priority," Martin said. "It was almost number three with health and income and more important than housing." Contribution. — Martin said the American Association of Retired Persons con- sidered the forums so important that it contributed $1,000 for each state to pro- vide "pocket money" in setting up the meetings. "The idea was to provide such broad participation that, when the conference was held, broad public support would already exist for implementation of the results," Martin said. Technical committees. — Meanwhile, 14 technical committees, composed of what Martin called "informed professionals," were appointed to study background papers prepared earlier by "specialists on aging." The papers outlined the situation for older people in nine areas : Income, nutrition, retirement roles and activities, housing, education, spiritual well-being, health, employment and retirement. Other meetings. — After the forums, at Martin's urging, some states held re- gional or community meetings, but these were sporadically scheduled. In the spring of this year, each state unit on aging — the official state arms of the Administration on Aging — held a state White House conference. The state meetings were not centrally controlled and they varied in effective- ness and importance from state to state. The successful ones involved not only the elderly but volunteer organizations and government workers in the field of aging. Some consisted of "listening to five papers and going home," said Cruikshank. Ten regional meetings were held in early summer under sponsorship of the Federal Regional Councils. The councils are comprised of regional agents of four Cabinet departments— HEW, HUD, Labor and Transportation— and of local representatives of the Office of Economic Opportunity and the Small Busi- ness Administration. Direction. — At the outset, planning was done by the conference staff, sub- ject to review by the National Advisory Committee. But the 26-member advisory group was honorary rather than active and in October a 100-member working planning board was created. Members included Flemming, former Chief Justice (1953-69) Earl Warren the 10 members of the National Association of State Units on Aging, representa- tives of the large national elderly interest groups, the Older Americans Advisory Committee, several young people (appointed at the insistence of HEW Secretary Elliot L. Richardson), and the chairmen of the 14 technical committees. At Martin's recommendation, Flemming chaired the board, which concentrated its efforts on an already-rising number of complaints about the preconference activities. Dissension. — By March, there was a "developing restlessness over Martin's stewardship," said one member of the conference staff who asked not to b( quoted by name. "There had been the Senate hearings in March and the newspapers were writing stories about how the Administration was manipulating the conference and I think HEW and the White House finally said, 'What gives?' and decidec to look into it." "Things were coming apart at the seams," said Cruikshank. At that point, h( said, the best many participants hoped for was that the conference "would noi be a disaster." His own senior citizens organization gave thought at that time t< pulling out of the meeting. COMPLAINT The main objection to the conference at that point was a feeling that thi meeting was being used by the White House for political purposes. Some participants felt that all issues were being handed to them and tha their role would consist of meeting for four days, approving Adminlstratioi positions and going home. Martin, acting chairman of the conference from October 1970 to April 1971 said he had no orders from the White House except a general mandate fron his boss, Richardson, to "go* ahead and develop the conference." Nevertheless, a series of complaints produced a rebellious mood. Slots : Large national membership organizations complained about what Cruik shank called the "horse and rabbit sandwich" method of assigning delegate slots 317 There were several categories of delegates, each with Its own apportionment pan. Initially, each national organization was allotted two delegates with one fote apiece, whether It had a membership of 800 or three million. The planning board later drew now apportionment rules so thai the minimum lumber of delegates from an organization Is two, with a maximum of 30 for agger groups. states. State Units on Aging were angry because the apportionment of dele- gates Prom the states gave a majority voice in the conference to rural states and Ecause Richardson asked the Governors to propose hair again as many dele- fetes as thou- states could send, leaving the Qnal selection to the federal ■rvernment. The state apportionment was changed after a meeting of the planning board it which Karl Warren went through the list of states, relating the apportion- nout to the number of delegates. The board also persuaded Richardson to send a second letter to the Governors explaining that the Administration was not trying to usurp their right to choose felegates. Technical committees. — The committees which collected preconference m- 'orination and drafted recommendations were appointed by Martin and his staff vithout consulting the participants. Many delegates said they felt the chairmen >f the committees were establishment or academic or ultraconservative. William Fitch, executive director of the National Council on the Aging, said he appointment of an insurance man as chairman of the section on spiritual veil-being was the last straw. To meet those objections, the planning board appointed cochairmen for the jommittees who were acceptable to the participants. Mwicy— One major complaint concerned conference funding. Congress had appropriated $2.25 million for the first conference on aging in 901. Martin asked only $1 million for the 1971 session. Congress authorized $1.9 million hut initially appropriated only $1.25 million. "People were teed off all around the country," said an official of the National iVelf are Rights Organization, who asked not to be quoted by name. Congress later added $650,000 to the appropriation for travel. "If they hadn't done that, the conference would be limited to rich people," ;aid Cruikshank. Other. — Participants complained, that some members of the conference staff vere condescending to the point that they once held a chalk-talk for the heads )f national aging organizations on how to reach policy decisions. The National Welfare Rights Organiztaion and other more militant groups nterested in problems of the aging were not asked to participate in precon- ference activities and had no assurance they would be invited to attend the inference itself. "I couldn't tell where venality left off and ineptness started," said Cruikshank. "There was a lack of urgency that made people around the country nervous ibout the kind of conference it was going to be," said James Sullivan, assistant »xecutive director of the American Association of Retired Persons and its affili- ite. the National Retired Teachers Association. Hobart Jackson, chairman of the National Caucus on Black Aged, told a joint session of the Senate Special Committee on Aging and the Labor and Public Welfare Subcommittee on Aging in March that "all of this contributes to a feeling among participants of being used." FLEMMING Within weeks after Flemming's appointment, complaints about the conference >egan to subside. "Flemming listened to all the criticism," said Fitch. "It is fantastic how he made himself available. He found time to listen to tnyone who was uptight and concerned." "He has us a little bit boxed in because he met all our complaints," said Cruikshank. Flemming did more than just listen. He attended each of the 10 regional con- ferences. He met with the chairman of the state White House conferences on iging and the state executives on aging in each region and asked for suggestions m actions the Administration could take immediately to help the aging. 318 "Flemming was one of the best things that happened to his conference," Sulli- van said. "He met with the people in the field and gave them an opportunity to participate by talking directly to the chairman." • Opening up.— Flemining also organized the conference to be loosely structured. Open forum.— First, he established an open forum for the evening of the first day of the conference with Earl Warren as chairman. -Vnv delegate will be able to take the floor for 10 minutes to discuss any issue. The forum has no time limit; it will continue until everyone who wishes to speak has had a chance to do so, even if that means running into the early hours ° By 6 promising that all issues could be raised at the forum and by choosing Warren as chairman, Flemming has persuaded dissidents that the conference will not be manipulated. Special concerns.— Flemming also has instituted a special concern session for the morning of Wednesday, Nov. 30, at which time attention will be focused on particular problems of the aging that delegates may feel have not been ade- quatelv treated on the formal agenda. m Recommendations arising from the Wednesday meeting will be incorporated in the conference report ■ Flemming said he expects panels to take up questions of the blind, elderly blacks consumers, emotional problems among the aged, elderly family problems, homemaker services, aged-Indian problems, legal aid, long-term care, aging migrants, the religious community and the aged, and other subjects. Cabinet hearing.— Finally, Flemming set up a final session for the conference in which Cabinet officers would come to the conference and react publicly to the recommendations. Flemming had to use his influence at the White House to get approval for the session, which will require intensive preparation for the Cabinet officers and "Pm trying to convey a feeling that the people in a position to make decisions are giving thoughtful consideration to the conference," he said. Black cacus.— Flemming' s moves have met most of the objections of exclusion and rigging that have plagued conference planning. "While we are not yet convinced that the conference will be productive, said Hobart Jackson, "Mr. Flemming has brought a new posture which at least holds out some hope." . . . , Jackson's qualified approval of the conference is a feather m Flemming s cap. The National Caucus on Black Aged— a loosely structured ad hoc group not vet a vear old— originally planned to hold a rump conference several weeks before the White House meeting, derisively titled "The Black House Conference ^Thcfmeeting, according to one member of its planning committee, would have explored "what it means to be black and old in America." Jackson however, has repudiated the idea of a protest conference, although he still plans to hold a preconf erence meeting of black delegates. He insisted that the black house conference title was "just an m-house working name" for the caucus session. He said the meeting will provide the first opportu- nitv for member groups to plan national strategy as well as outline their posi- tions and recommendations on White House conference issues. Tar^kson said he does not believe he has capitulated to the establishment by agreeing to membership on several of Flemming's task forces and planning committees. ISSUES "There is no overriding issue at this conference," said John G. Veneman, HEW ^SebSsT thing we hope to get," said Sullivan, "is the opportunity once in a decade to get everyone interested in this field." Monev —Despite protestations that no one issue will dominate the meeting there is general agreement that the major issues will have finances in common —income, pensions, health insurance and nursing-home funds. Conference planners do not expect innovative ideas to emerge on any of these issues, and, in fact, legislation already is pending m Congress dealing with all f °Nor will' the conference become a lobby in suport of any particular bill. There is strong feeling pro and con on all issues. 319 Social security. — Conference planners anticipate debate over a welfare reform- social security bill (HB l), which would Increase benefits by r> percent. Jackson, Sullivan and other organization loaders said die Increase Is not enough. Jackson said be believes the problem would he dealt, with not through social security but through income maintenance. There win be similar debate on pension resting rights. Health. — -Health insurance Improvement is being approached on Capitol Hill in two ways — increased medicare payments and national health insurance. "There may be a coalition developed on health insurance and income mainte- nance," said Fitch, of the National Council on the Aging. "There is a melding of common interest that I haven't seen before." Nursing homes. — The Administration will draw criticism on nursing homes from two directions. The National Council of Senior Citizens believes President Nixon's recent call for a cutoff of funds to substandard nursing homes was an effort to correct a situ- ation created by the Administration in the first place. "Social Security and HEW have been prevented from enforcing the standards by the White House," Cruikshank said. "In fact, Mr. Nixon's statement was an ad lib in his speech. His speechwriters didn't dare put that in because they knew the situation." One conference official said that some organizations complained that Mr. Nixon acted too precipitously and that closing substandard nursing homes would mean putting many elderly persons into the street. He said that instead of abrupt closings, they would have preferred additional inspections and stricter enforce- ment of standards along with subsidies. Charles Chaskes, president of the National Association of State Units on Aging, said he doubts nursing homes will be a major issue during the conference, "al- though the Administration wants to make it so." Chaskes said 94 per cent of the nation's elderly can maintain themselves in their own homes "until a terminal illness." Administration on Aging. — One issue that will receive a great deal of atten- tion is the future of HEW's Administration on Aging. Originally conceived as a top-level spokesman for persons over 65, the AoA has been pushed around and ignored to the point where it is now an education and demonstration office in the Social and Rehabilitation Service of HEW. "The goals in the Older Americans Act (79 Stat 218) are very broad," said Commissioner Martin. (The Act created AoA.) "But the functions of the AoA are much more limited. The AoA was never given responsibility for carrying out in- teragency programs." DOMESTIC COUNCIL At the request of President Nixon, Flemming has created a Cabinet-level com- mittee on aging to work with the President's Domestic Council. The committee, he said, already has started work to initiate programs to help the elderly ; it also will work on implementing conference recommendations. In addition to Flemming, members include George P. Schultz, director of the Office of Management and Budget, and the Secretaries of HEW, HUD, Agricul- ture, Transportation, Labor and Commerce. "I'm in a unique position in a group of this kind," Flemming said. "The others have many things to think about, while all I have to concentrate on is the aging." Flemming said James W. McLane, staff assistant to the President, would pro- vide staff support for the committee and that there was "an understanding" that no department representative below the rank of assistant secretary would attend the meetings. I "One of the things we are interested in," Flemming said, "is maintaining elderly couples in their own homes rather than in long-term-care facilities. With inflation and increased taxes, even a home owned free and clear can be a burden to a couple on a fixed income." Flemming said some of the ideas he wants to explore include : The possibility that HUD could use its subsidized rent authority to buy homes from elderly couples and rent them back for nominal sums ; The possibility of increasing state use of a 1967 amendment (81 Stat 821) to the Social Security Act which provided authority to pay for services, in- cluding visiting nurses and homemakers. "Part of the problem for these old couples is transportation," Flemming said. "The Transportation Department has funds for capital expenditures. Maybe they 320 could buy a minibus, and the operation could qualify as a service under the wel- fare service program. ^ v - "The Emergency Employment Act of 1971 (85 Stat 146) has funds. Could some of these funds be used to strengthen programs and create jobs for homemakers and home health aids? Furthermore, could some of the employed be elderly people? . ... ,, "This is what the Domestic Council committee on aging would have the au- thority to put together : a package for independent living for the elderly under programs that already exist. "And I have other ideas." Arthur S. Flemming: A One-Man Lobby Arthur S Flemming, chairman of the White House Conference on Aging, is a one-man lobby for the proposition that big government can work. He intends to prove that proposition to his constituents— the 3,700 delegates to the conference Flemming, 66, is practicing what he preaches by putting into action some of the recommendations coming from local and state conferences in advance of the Nov. 28 Washington meeting. Flemming said he feels that if the delegates can see progress resulting from the early conferences, they will have a different psychological approach to the main conference. ... „ -i^J "Even if they are in complete disagreement with it, people will talk atooul what is happening already," Flemming said. nainn Flemming cited President Nixon's recent speeches in Chicago and New Hamp shire, which called for a cutoff of funds at substandard nursing homes, as one example of preconference action. J Despite the fact that only 5 per cent of Americans over age 65 are in long term-care facilities, concern about nursing homes came through on all levels of preconference planning. -h+jJ Conference officials attributed Mr. Nixon's interest in long-term-care facilities directly to Flemming's influence. Flemming plans to use the months after the conference to underscore th< point he is trying to make about big government in the preconference planning He said he will meet his statutory responsibility to get a conference repon to the President 120 days after the conference. "One of the exciting parts of this job is to see how ingenious I can be n getting the recommendations out," he said. He hopes to publish several reports, rather than just one, each correspond ing to a section of the conference. In each report, he would list recommendation and indicate the status of action on each one. Flemming said he hopes to be able to report the implementation of man: recommendations in the months immediately following the session. He said he feels that if the delegates know in advance that their recommen dations will receive immediate attention, they not only will produce good recom mendations but will learn that "the system lends itself to action. _ Background —Flemming said of his appointment as conference chairman "It is an exciting opportunity to draw on my 20 years in government and m; 20 vears in education." . . I Flemming's background provides a strong base for his self-appointed tas] as a spokesman for big government. He started out in government when it wa much smaller and he watched it grow. .„«„.,/. After a short stint as a reporter for David Lawrence's U.S. Daily (since merge into US. News & World Report), Flemming was appointed a member of tn Civil Service Commission in 1939 at the age of 34 and served on that body to ni During President Eisenhower's first term, Flemming was director of defens mobilization and was responsible for all nonmilitary aspects of defense— ^a 30 he said gave him a chance to see what government could do when it was pressec He was a member of the Presidential Advisory Commission on Governmeii Organization, whose report led to the creation of the HEW Department. H was Mr. Eisenhower's last HEW Secretary (1958-61). _ Flemming's government career is matched in length by his career as an edi cator. He was president of his alma mater, Ohio Wesleyan University (1948-5 and 1957-58), and subsequently held the same position at the Univers ity c Oregon (1961-68) and Macalester College in St. Paul, Minn. (1968-August 1J71, 321 Hifi volunteer activity Included presidencies <>r the National council <>r Churches, the World Council of Churches and the National Conference on Social Welfare. Hemming is reported to hare 44 honorary degrees more than anyone else In the history of the federal government except Herbert Hoover. Confirmation is impossible because it Is one subject, (hemming refuses to discuss. At work. — Flemmlng's coworkers describe him as Indefatigable. •■lie thrives on his work," said Bertha Adkins, his assistant chairman at the conference and a former undersecretary at HEW (1058-60). "He doesn't go In for sports like golf the way other men do. He doesn't need the usual forms of relaxation." Although he had been out of government for 10 years before accepting the conference chairmanship, Flemming said he does not feel that the increase in the size of the federal establishment has made it any different for him. "I think it is possible to adapt to size, provided you keep in mind your end objective," he said. "The thing I try to keep in front of me all the time is : 'What can help to elevate the status of the elderly in society?' " Flemming also finds his knowledge of government useful in making his budget stretch. He has $1.9 million to finance three years of work. "If you can obtain cooperation from other departments, you don't need a large amount of money for an operation like this," he said. Flemming casually borrows staff from other departments whenever he finds expertise he can use. "When you get into any issue, people begin to surface who have been working on it for months, maybe years," he said. Flemming said he feels that government is to blame for the feeling that it is not responsive to the public. He said he would like to see government agencies simplify their relationships with citizens. He is now toying with the idea of using local social security offices as clearinghouses of information of all kinds for the elderly. "It is fascinating how you can take authority and make it workable," he said. "There are outstanding opportunities in this field to demonstrate that the system can be made to work." Mr. Schott. If I may say one last word, Mr. Chairman and Mr. Kemp, the needs are very nonpartisan. Mr. Kemp. It should be nonpartisan, Mr. Schott, I agree. Mr. Schott. We appreciate this commitee has approached it that way. Mr. Kemp. May I add one final thing: No matter the color, reli- gion, or political party, the problems of the aging transcend those very parochial considerations. I want to asure you, sir, that I will approach this issue on that basis, and I appreciate, Mr. Chairman, the time, and I am going to have to run to my office, but I can assure you that I will be looking forward to reading your testimony, and testi- mony of the other witnesses. Thank you. Mr. Brademas. Thank you very much, Mr. Schott. We appreciate your coming. Mr. Brademas. Our final witness today is Miss Elma Griesel, rep- resenting the Public Interest Research Group. Miss Griesel, would you like to come forward, please. Please go right ahead, Miss Griesel. We are glad to have you with us this morning. STATEMENT OF MISS ELMA GKIESEL, PUBLIC INTEREST EESEAECH GKOTJP Miss Greesel. Good morning. My name is Elma Griesel. I am relatively new to gerontology. I have been working full-time in the field for 4 years. Prior to my work 322 as health associate for the National Council on the Aging, and con- sultant on aging for the Oklahoma State Department of Health, I was involved in 2 years of public health study, in which I specialized in gerontology. From the beginning of my endeavors, I have been concerned about the negative attitudes that people of all age groups have about be- coming or being old. I believe with others that there are abundant resources in our society which are untapped and misused. In the case of older people in our society, it seems to be a matter of abundant resources which are shelved and abused. This is obviously not a unique or new observation. However, in studying the history of gerontology, I have been amazed to find out just how long professed gerontologists and other concerned indi- viduals have been proclaiming this concern, without effecting a con- certed action to change the attitudes and conditions which allow it. With all the studies and evidence to indicate that older people want to remain active, contributing members in their communities, and that, precluding the onset of individual debilitating physical condi- tions, older people have the mental resources and the physical stamina to remain active, there is still an utterly senseless shelving of oldei people. I have recently joined Ralph Nader's Public Interest Research Group, located here in Washington, D.C. He is supporting the de- velopment of a retired professionals' action group. Because of mj interests and background, I will be the staff person for this grouj in its initial vear. An excerpt from a memorandum by Ralph Nader dated 18 February 1971 relates his thoughts which generated this effort : With shorter retirements and more people being able to retire from the! professions, the problem of living useful lives in still alert years is also a problen of under-utilizing potentially valuable human resources for a better society Leisure time, experience, community contacts, often sufficient financial security family grown up, and a situational potential for free thinking unencumberei by anticipatory ambitions or institutional restrictions all combine to suppor the likelihood and impact of such groups. Ideally, they can be established al over the country, particularly heavy retirement areas and (in) Washington D.C. They can include all skills such as accountants, financial analysts, phy sicians, lawyers, engineers, scientists, statisticians, writers, et cetera. At firs it would be advisable for them to concentrate on special problems of the elderly- social securitv consumer fraud, housing, taxes, medical care, nursing homes pensions— but' soon it would become apparent that our problems are seamles and ageless. Mr. Brademas. I wonder, because we find ourselves in an awkwan situation in having to go answer a quorum call, would you be will ing, Miss Griesel, to allow us to include your complete statement, an< summarize your major points, and then Mr. Peyser and I could ques tion you. Otherwise, we are going to have to leave shortly. (Balance of statement follows:) Mr. Nader has mentioned the possibility of the formation of these groups on couple of television shows and short news items have appeared in a few new! papers and magazines. The response has been astounding! In reviewing co. respondence from older people across the nation, I have been excited at ti enthusiasm which older professionals, indeed all older people, are expressin about this approach. Response has come from a wide variety of retired profe! sionals including businessmen, writers, lawyers, pharmacists, engineers, teacl ers, governmental employees, and retired military personnel— all are anxior to become involved or give their support. ;u:i l am quite aware of the significant action that baa resulted from activities )f older people in organisations such as the National Council of Senior Olti- fens and the American Ajssoclatlon of Retired Persons, Other progress has ken made by certain state groups such as the Florida Retirees Legislative brganizatlon and the Massachusetts Legislative Council tor older Americans, Local groups such as Hie Council of Elders, inc. of Roxbury, Massachusetts, ind Action for Older Persons, inc. of Binghamton, New York, have also Initiated significant activities. However, through a new and concentrated effort, the Retired Professionals' Vet ion Group will promote and permit full utilization of the expertise and Irisdom of groups of retired individuals who will confront and solve prob- lems in behalf of all older consumers. For example, one of the retired professionals will undoubtedly spend his or ler time focusing on the housing problems of older persons. This individual will 3ull together all available information on the subject, do original research as nec- essary, monitor the major agencies concerned with housing, consult with those igencies, suggest new solutions or approaches to solving problems, encourage leeded action, and possibly file lawsuits if necessary. Information regarding iiese housing agencies would, of course, be available for public use when appro- priate. The retired professional might also draft legislation. He would certainly ceep aware of any new housing legislation proposed, evaluate its contents, and ceep necessary groups and individuals informed of its progress. The impact of a group of professional advocates specializing in too often ne- glected problems will necessarily increase public awareness of these problems ind. consequently, pressure for their solutions. The retired professionals will be in a position to promote concerted action by voluntary and official agencies and the many older people across the country who lave expressed a desire for involvement. It is clear from the correspondence we have received that many older people, regardless of their occupational status, do support the beginning of the Retired Professionals' Action Group, and wish to participate in future activities. From lexas came this response, "I do not have the necessary qualifications to help out it this time but if and when you start "recruiting" the elderly I would like to get n on it. I may be wrong, but I think there must be millions of other old people vith limited education who would be happy to help . . ." From New York, "What Jan a retired 63 year old man with a good background in plastics do?" From a 100 member Villagers Senior Citizen Club in Santa Clara, California, ". . . we ivish you well in what you are trying to accomplish and if there is anything that ve, as senior citizens, can do or should do to help, please let us know." From Arizona, "I believe that I could serve in some corner of your vigilant organiza- ;ion. Being retired, on and off I miss the useful effort that was my companion all ;he years of activity." Another letter from a retired superintendent of manufac- nring, "My services are yours in whatever capacity you feel that I am quali- ied. No compensation required or expected as long as I am doing something that vill benefit my fellow-man." And from New York, "My admiration for your courageous defense of the public interest through the years makes me impose >n you some more. If you do not assist the aging retired or infirm citizens by ;aking legal action on their behalf, who will?" The major focus of all efforts will be action. On the whole, the special prob- ems which concern all older people have been revealed. Our files are already illed with numerous personal letters, newspaper and magazine articles (many several years old) which expose unjust and deplorable conditions to which too nany older people in our society are subjected. In fact, there is little that has not jeen uncovered. For over ten years, Congressional hearings have been filled with •eported injustices against our older population which remain, unfortunately ind inexcusably, uncorrected. Included in the letters coming from all over the ration are these special areas of concern : insurance abuses, medical care — mality and costs, involuntary retirement, pensions, social security and medicare, [n one letter a retiree wrote a convincing argument against the common situation )f highly polished floors in public buildings and institutions which could signifi- cantly affect the older person's safety and mobility. Many letters are concerned with the limit on the amount of income which social security beneficiaries may earn. One letter from a gentleman in Texas contained a copy of an open letter to his Congressman in which he expressed this sentiment : "Some 20 months ago I asked you why retired people 62 years of age md over are not allowed to earn more than $140.00 in any one calendar month 324 without losing their Social Security benefits for that particular month. At that time you advised me you had a bill before the House which would allow Social Security recipients to earn considerably more than $140.00 a month. May I ask what became of it?" Older people are concerned with the legislative process and representation of their special interests. It is clear that they have legitimate grievances and should, therefore, ask such questions of people they have chosen to represent them. It is common sense for the informed consumer to hold individuals, groups, and organizations accountable for their words and activities — or lack of the same. Retired Professionals can ask or relay the appropriate questions and can, at the same time, promote and effect action in behalf of themselves and their peer group. The Retired Professionals' Action Group will begin work in this area with approximately ten retired professionals. There are no preplanned action issues. Although the many concerns and suggestions from across the country will no doubt affect priorities which are national in scope, each individual will begin work with experiences which will enable him or her to delve fully into an issue which relates to his or her own interests and expertise. If the initial positive response continues, similar groups can soon be estab- lished in other parts of the country. We have already enlisted retired profes- sional consultants from several different cities. In Washington, D.C. as well as other areas retired professionals will, when necessary, act independently to solve local problems such as transportation and housing services and facilities or nursing home conditions. The priority issues will necessarily be different from community to community but all groups can be kept informed of the developments and progress of their counterparts in other areas. The Washington, D.C. group will also serve as a clearinghouse to channel information necessary to promote concerted action on issues of national interest. Public Interest Research Groups are now being formed in other cities. In the future, it is conceivable that, as in Washington, D.C, the Retired Professionals will be working daily at the sides of students and young professionals. I would be remiss if I did not indicate my elated feelings about the possibilities for cooperative endeavors by young professionals and their retired colleagues. I remind you of Mr. Nader's conclusion, ". . . soon it will become apparent that our problems are seamless and ageless." As a young person working in this particular field, I have had continual sup- port from older people. Although some skeptics may question age and motives at first, sincere younger people working with older people will be recognized and will always get the "go ahead" signal when it is needed. While employed by the National Council on Aging this past summer, I was designated to serve as a special consultant to the House Trailer Committee on Aging initiated by Congressman David Pryor. It was stimulating for me to see the energy and fresh approach which these students applied to the study of the problems of older people. The support which the students were able to generate and the cooperation they received from sumerous groups and organizations (including those com- prised of older persons) indicated several things : (1) Older people have respect and faith in what younger people can accom- plish ; (2) Specialization in gerontology is not necessary for people to discover prob- lems and propose solutions. Sincere effort and interest is necessary — no matter what the age ; (3) There is wide support for the efforts of Congressman David Pryor and his colleagues to establish a .Select Committee on Aging in the House of Representa- tives ; (4) It is obvious that there is ample support for new approaches to solving the problems related to growing old ; (5) Older people have the resources, are available, and are ready to become in advocacy movements. One of my main concerns is that older people will stand up and act (and also enable their less able or mobile neighbor to do so) when legitimate consumer concerns merit individual or collective action. Obviously, my observations this past summer, some of which are not new- just refreshing, have given me encouragement to embark on this new venture with active retired professionals and their concerned and involved older con- temporaries. 325 be taking a new approach in licit wisdom of the group of about 10 of Miss Gkikskl. Let me say, then, thai we are aware of all of the ac- :ion that lias been taken by other organizations such as the ones repre jented here this morning, the National Council of Senior Citizens bidAmericaii Association of Retired Persons. We feel very strongly that we wil we will be utilizing the talents and rctiml professionals, starting here in Washington, to solve som< :hcir own problems. These people will be experienced in transportation and housing and bther areas which concern older people, and they will be able to start iff with a great deal of wisdom and experience that will enable them :o get on the move fast. I wish I had time to quote from some of the correspondence that we lave received from across the country, because I think it is quite ap- propriate to indicate to you, first, that people are concerned, and, second, that people support a movement such as the Retired Profes- sionals' Action Group, and new approaches to solving problems of >lder people. Particularly what has been amazing to me is that people from all walks of life, people from all professions, want to join n this effort, and if they don't have the particular experience neces- sary regarding particular problems, they want to do anything from knock on doors to hand out petitions, and this kind of thing, in order :o get something done. I will give you an example of something that an older person or older retired professional would do. If an older person were interested in the area of housing, he would probably already be aware of the organizations and groups and governmental agencies that are work- ing on that particular problem, also the Congressmen who are inter- asted. This person would monitor those groups and agencies and persons that are expressing concern to, in effect, hold them accountable for some of their words, and to see that the words get turned into action. I did indicate that Mr. Nader hopes that these groups will be estab- lished across the country, and we have every indication that they^ will be. We have received stacks and stacks of letters from all States indi- cating that they want to be the people to set up that organization in their State. You might be aware that the public interest research groups that Mr. Nader sponsors are usually composed of younger professionals. What is very good to me is that these new groups will work side by side with the public interest research groups, and they will eventually become involved in solving problems which affect both the old and young. I would like to summarize and I want to indicate that I did work this summer with the House Trailer Committee on Aging that was supported by Congressman David Pryor. I was assigned to do this when I was employed at the National Council on the Aging. It was stimulating for me to see the energy and fresh approach which these students applied to their studies of problems of older peo- ple. The support that students were able to generate from groups, in- cluding those comprised of older persons, indicated several things. One, older people have respect and faith in what younger people can accomplish. 326 Two, specialization in gerontology is not necessary for people to discuss problems and propose solutions. Sincere effort and interest is necessary, no matter what the age. Three, there is wide support for efforts of Congressman David Pryor and his colleagues to establish a Select Committee on Aging in the House of Representatives. Four, it is obvious that there is ample support for new approaches to solving problems related to growing old. Five, older people have the resources, are available, and are ready to become involved in advocacy movements. One of my main concerns is that older people will stand up and act, and also enable their neighbor to do so, when legitimate concerns merit individual or collective action. Obviously, my observations this past summer are not new, just re- freshing. They have given me encouragement to embark on this new venture with retired professionals. Thank you. Mr. Brademas. Thank you very much, Miss Griesel, for a most stimulating statement. I have a couple of questions. You remarked that a motivating force behind the Retired Professionals. Action Group is action. For that reason, and since you are Washington based, have you any plans to monitor, as Mr. Nash I believe indicated he has, the results of the White House Conference on Aging? Miss Griesel. Yes, we have every intention of doing just that. Mr. Brademas. I would simply say with respect to the major thrust of your testimony, namely, the idea of a retired professionals' action group, that this is the first time that this suggestion has been brought to the attention of our subcommittee, and it seems to me to be a most exciting and commendable and constructive idea. It is on all-fours with the RS VP program, which goes beyond retired professional persons, but I would hope — and I don't know how you finance this kind of enterprise— that some support might even be generated from RS VP for the kind of effort in which you are engaged. 3 I should also be very grateful if you would be willing to let us, on the subcommittee know from time to time how the project is faring, and, at least speaking for myself, I would be interested in drawing to the attention of colleagues who are concerned with older Americans' problems your operation. Indeed, I might suggest that we might be able, in our own congressional districts, to be helpful in generating some interest in a retired professionals' action group or groups. I suppose my final point is to ask you a short question. As we shall be looking at the nursing home problem among the other problems that affect older Americans, I would hope we would be able to have as wit- nesses some of your colleagues who have worked with Mr. Nader in looking at the whole nursing home field. Do you think that would be possible ? Miss Griesel. Yes, that would be possible, and hopefully by that time we will have some retired professionals working on this problem who can appear. Mr. Brademas. That would be interesting, as well. Mr. Peyser. 327 Mr. Peyser. Thank von very much for being with us this mornirig and giving this testimony. I am delighted, of course, to sec someone like yourself involved in this Held, because Lt is a Held thai not only elderly people should be working in, but all of us, and 1 think you typify that. 1 am interested in the professional program that is being discussed. One question on it: Is there any method, for instance, through the National Association of Retired Teachers or through the National Council of Senior Citizens — for receiving information concerning this program that would go out through their own membership? Miss Griesel. Yes; these agencies have all been contacted. 1 have gone through the files and seen evidence of this, and we certainly would want to be working with all of these groups in the future. I have been on staff 2 weeks now. We hope to get a staff of retired professionals before we actually start contacting agencies and talking at great length, because we intend fully to utilize their talents in this effort. Mr. Peyser. I think that is a step to take, and I also would like to join with Congressman Brademas on this, that I think Congressmen them- selves, when you have got something that resembles a program that is identifiable, could be of real help in their own districts in promoting organizations that would want to take part in this. There are many people in this category whom I know would welcome this kind of opportunity. i thank you very much for being with us, and it has been a great help. Miss Griesel. Thank you very much. Mr. Brademas. Thank you very much, Miss Griesel, for coming. I want to reiterate our appreciation to all of the witnesses. We shall adjourn, subject to the call of the Chair. (Whereupon, at 12:15 p.m., the subcommittee adjourned, to re- convene subject to the call of the Chair.) (The following statements were submitted for the record:) Statement of Hon. Ella T. Grasso, a Representative in Congress From the State of Connecticut Mr. Chairman, in a society increasingly geared to the youth culture, the elderly are too often shunted aside and cast adrift. Older Americans make up a significant segment of this Nation. More than one out of every 10 citizens has reached or passed their 65th birthday, and some 70 percent of this group have joined since 1961. In the district I represent, the Sixth Congressional District of Connecticut, there are nearly 46,000 elderly. Throughout the Natiton their numbers will increase sharply in the future, along with numerous significant problems, unless we embark on positive, far- reaching measures. A National effort is necessary to meet the challenges which this decade presents in the area of aging. The problems of the elderly are clear. A rising cost of living and a fixed income are the bases of many. Social Security and pension payments have been unable to keep up with the ever-increasing spiral of inflation. Conse- quently, the old are often poor as well. According to the Bureau of Labor Statistics, two-thirds of the retired people in the United States fail to meet the standards of an "intermediate budget." The latest available figures for Connecticut show that the median income of persons between 65-74 years of age is $1785 a year, while the median income of those 75 years and older drops 328 to $1153. This means that 57.1% of the 65-74 year old age group and 73.4% of those over 75 have under $2000 a year to spend. Elderly Americans are now more than twice as likely to be poor as younger people, and, despite the in- creases in Social Security payments, the financial gap separating the older and vounger families has widened in the past decade. A number of the difficulties faced by elderly Americans arises from this finan- cial problem. For example, because of age, they are faced with ever-increasing medical costs. Their health bills are two and a half times higher than those of people in the 19-64 age bracket. . In many cases, they must sacrifice food in order to buy needed medication. Medicare the saving grace of many, pays less than half of the total medical bill of the average elderly American. This fact alone is reason enough for Congress to set about perfecting Medicare and to apply its lessons to a more general health program for all the people. Another difficulty facing the elderly is the lack of mobility. For most of them automobiles are too expensive to own and operate. But public transporta- tion 'where it exists, is usually geared to the commuting needs of the working people Therefore, the elderly must either remain at home or brave the crowds. The elderly need transportation so that their ability to receive food, medical care and social contacts will not be sacrificed. This Committee is presently considering legislation which would authorize funds to study ways of improv- ing transportation facilities for the elderly. These measures, H.R. <■ interested in this book, even though there are six ((>) pages <>i' the book de- voted to a description of the projects funded under Title IV of the Administra- tion on Aging. Again, what this points out is that here we have an administrator and staff, and I am sure that the administrator didn't just dictate a distribution memo without a discussion with staff of to whom this book should be distributed — to what agencies did it have value, etc. What makes this all the more disheart- ening is the fact that this administrator and his staff are knoweldeable, highly intelligent, sophisticated individuals, whose business is to concern themselves with the delivery of services to the community, and who are probably as well advised as to the social structure in each community, as any group of individu- als in the country. Yet, in their minds, aging has such little significance and priority that even after discussing the distribution, they could leave out the Aging offices in every State. If these people give Aging so little priority, how can we expect them to relay a sense of urgency to states and communities so that Aging needs would have a higher priority at the local level? This points out, beyond question, that unless we have a separate agency concerned with all aspects of the field of Aging — training ; research and demonstration ; community grant programs and an advocacy role, we will always be at the bottom of any priority list. We must have an agency, which by its structure, can serve as a focal point for the elderly within the Federal system and which has either a regulatory power or a veto power so that other agencies of the Federal government will continually bear in mind what services and responsibilities to the elderly, their agencies can provide and are indeed providing. We have learned from experience that whatever stature the Federal govern- ment gives to the Office on Aging, is duplicated at the State level. When the Administration on Aging was downgraded, broken up and several of its titles placed within the Social and Rehabilitation Service, some of the States did the same thing and the Office on Aging in these States was lowered or submerged in another department with diminished ability to perform the planning, coordi- nating and evaluating functions which are required by the Older Americans Act. The first recommendation of President Nixon's Task Force on the Aging, points out "that it is abundantly clear that interdepartmental coordination cannot be carried out by a unit of government, which is subordinate to the units it is attempting to coordinate." I think another thing that is very evident is that Congress in each of the years since the enactment of the Older Americans Act has authorized appropria- tions which were usually five (5) times as great as the Office of Management and Budget would allow for programs. On the other hand, there have been three (3) studies authorized — 1). A study which was completed but its findings never published, was authorized by the previous Administration and conducted by Dr. Robert Binstock of Brandeis University. Its conclusion was that in order to make a viable Administration on Aging and to have its impact felt, it must be adequately funded — something that has never been done. In my conversations with the co-ordinator of that study, he was talking about funding programs in the magnitude of $100 million to $200 million dollars for the elderly. The second study was authorized by the Administration on Aging and done by Greenblatt and Ernst of the State University of New York at Buffalo. They visited and investigated Title III programs in 18 States and in their report they use a parable from the Bible which says in effect — that unless one fertilizes a tree, it is not going to bear the maximum fruit. They were very critical about the totally, inadequate funding of the entire community grant program and the funding of the Administration on Aging generally. The third study was President Nixon's own Task Force on Aging which reported to him in April, 1970. Their number one recommendation was that there is a need for a strong agency. They go on to recommend that the agency should be a part of the Executive Office. I have recently been privileged to serve as a member of an Advisory Council to the Special Community on Aging to the U.S. Senate, which has concerned itself with just this question — whether the Administration on Aging should be 71-272 — 72 — pt. 1 22 332 replaced by another agency, and if so, what should the structure of this new agency be, "and where should it be located in the Federal system. That Advisory Council has met and has made its recommendations to the Special Committee, and I am sure that they will be made available to you in the near future. Also, the Administration has authorized Secretary Richardson to appoint such a committee, and he in turn asked Dr. Arthur Flemming, the Chairman of the White House Conference Planning Committee, to investigate the same question. Dr. Flemming asked Mr. Garson Meyer to head such a committee, and make recommendations regarding this point. It occurs to me that one other recommendation should be made and that is that the present Administration on Aging be reconstructed— put back together — all its titles responsible to the Commissioner and the Commissioner directly to the Secretary of HEW and the Agency funded at the levels that Congress has authorized. We might find that it can be a very effective agency if treated in this manner. TO AMEND THE OLDER AMERICANS ACT OF 1965 tuesday, november 2, 1971 House of Representatives, Select Subcommittee on Education of the Committee on Education and Labor, Chicago^ III. The subcommittee met at 10 a.m., pursuant to notice, in the city council chambers, city hall, Chicago, 111., Hon. John Brademas (chair- man of the subcommittee) presiding. Present: Representatives Brademas, Hansen, and Meeds, minority legislative associate and Christine Orth, staff member. Mr. Brademas. The Select Subcommittee on Education of the Com- mittee on Education and Labor of the House of Representatives will come to order. For the benefit of those who may not have before sat in on public hearings of a congressional subcommittee, the Chair would like to make a few opening observations with respect to our proceedings. The work of Congress, as you know, in both the Senate and the House of Representatives, is divided among several standing commit- tees of those two bodies, and bills that have been introduced and other matters that are to be considered are referred to one of the several standing committees. The standing committees, in turn, are divided into a number of subcommittees, each with more particular jurisdic- tion. The subcommittee meeting here in Chicago today is one of the seven subcommittees of the committee that handles both education and labor relations in the House. The Select Subcommittee on Education has, among the several legislative programs assigned to its jurisdiction, the Older Americans Act, which was enacted into law in 1965, and was subsequently amended in 1969. This subcommittee has also had referred to it a number of other legislative proposals that touch upon the problems of older Americans. The chairman of the subcommittee, which is I, John Brademas, Democrat, of Indiana. With us this morning also is Congressman Lloyd Meeds, to my left, of the State of Washington, Democrat, of Washington; and to my right, Congressman Orval Hansen, Repub- lican, of the State of Idaho. All three of the members of this subcommittee have worked hard on legislation for the benefit of older Americans, and we are very pleased to be able to be with you here in Chicago today for the purpose of hearings on the subject of how best to meet the needs of the older citizens of our country. While the generation gap between the young and their parents is the subject of much discussion in the United States, less attention has (333) 334 perhaps been paid to the gap between older Americans and the rest of our people. It seems to the chairman that the time has come to realize that far from being a burden, America's older men and women are one of our country's greatest untapped resources. But beyond even this is a force of still more importance, that we consider the quality of life of older persons as human beings. While legislative work in this subcommittee has been helpful in making it possible for many older Americans to play a more vigorous, productive and satisfying role in the life of our society, the hard fact remains that we have in our country for the most part treated our older population in accord with the adage, "Out of sight, out of mind." Although the older American has demonstrated the validity of the value of a retired senior volunteer program, the principal author of which, Congressman Ogden Reid (Republican, New York) was unable to be with us today, there have been far too few such programs across the country. . The foster grandparents program, to cite another one, has given satisfaction to both retired men and women and young people who benefit from their interest and care. There have been no extensions of that program on the part of the administration. In recent months we have seen an effort on the part of the present administration, in the opinion of the chairman and the subcommittee, to weaken the Administration on Aging, the principal agency within the executive branch of the Government with responsibility for focus- ing on the problems of older persons. This subcommittee earlier this year, on the 10th of March, conducted public hearings in order to make clear to the administration that if this effort continues, it will be contrary to the wishes and stated intent of Congress and public law. Continued rhetoric and increases in social security benefits alone will not meet the needs of older citizens. Con- gress must commit itself and then act to assure adequate income for older persons, job opportunities without discrimination because of age, proper health care through adequate nursing homes, and housing at reasonable cost, assurance of lifelong homes which will not be lost because of excessive local tax rises after the owner has— no longer has any resources but a pension, recreational and social programs so that older citizens will not be cut off from community life, low-cost trans- portation for the aged so they will not be imprisoned in their homes far from shopping and entertainment facilities, and proper utilization of a valuable and needed resource, the older citizens of our country. Legislative programs to meet virtually all these needs have been submitted to Congress year after year, yet little action has been taken. As you are aware, later this month there will convene in Washing- ton, D.C., the capital of our country, the White House Conference on Aging, which has been called by President Nixon. I hope very much, as chairman of this subcommittee, and I am sure that my colleagues on both sides of the aisle agree, that the White House Conference on Aging will be a forerunner of effective action to meet the needs of the older Americans, and that the White House Conference on Aging will not simply be a meeting characterized by talk without commit- ment to action. Therefore, in order to learn what we as members of the legislative committee with responsibility for older Americans' programs can learn 335 bout, the needs of older Americans, we nave come to Chicago today, k I hope we shall be able to do in other areas of our country, to listen 3 a diverse group of men and women who have already demonstrated oiKvrn about the problems of older Americans, and obtain their lews, with the hope that we may be able to write legislation that will Jeritthe support of both Democrats and Republicans of the ( longress fed of the President, to the end that we can help make life richer nd fuller for these millions of our fellow citizens. The Chair would like you to observe that we have a very lengthy :st of distinguished witnesses today, and we are anxious to hear from 11 of them, and put questions to them, and we hope, therefore, that it rill be possible for our witnesses, as effectively as they can, to sum- larize the major points of their statements in order that the three lembers of the subcommittee may put their questions to them. All of be statements, unless there is objection, will be included in the tran- cript of the hearings. Our first witness this morning is Mr. Kobert J. Ahrens, the director f the Division for Senior Citizens of the Chicago Department of luman Resources. Mr. Ahrens, we look forward to hearing from you, sir. TATEMENT OF ROBERT J. AHRENS, DIRECTOR OF THE DIVISION FOR SENIOR CITIZENS, DEPARTMENT OF HUMAN RESOURCES, FOR THE CITY OF CHICAGO Mr. Ahrens. Thank you, Mr. Chairman. As you said, my name is Robert J. Ahrens, and I am director of the ivision for senior citizens of the city of Chicago's Department of luman Resources. Mr. Brademas. Would you allow us to interrupt ? Would you come round here where we can see you ? Go ahead, sir. Mr. Ahrends. On behalf of Mayor Daley and the city of Chicago, would like to welcome the committee to Chicago and congratulate t for directing its attention to the needs for comprehensive services or the elderly. It is my estimation that in today's world the most disadvantaged ^roup in our society is that of the elderly. Yet, oddly enough, rich or >oor, black or white, talented or unskilled, men or women, or young oday — it is the one minority group that we shall all join. Considering he present status of the Nation's elderly, it is not a very happy nought unless, as Maurice Chevalier put it, you "consider the alterna- ive." The number of people age 65 or over, only 3.9 percent of our State's >opulation in 1900, is 10.1 percent today, and the numbers are grow- ng. There are now 20 million Americans age 65 and over. Of these !0 million, 1.1 million live in Illinois, and 600,000 of these senior :itizens are our neighbors in this city and its suburbs. I want to point >ut that only 4 percent of these 20-million people are institutionalized n our hospitals, nursing homes, homes for the aged and similar 'f acili- ies. Fully 96 percent of our elderly are living in the community. 3f these, 8 percent are homebound and bedfast and another 6 percent ire limited in mobility. The Nation needs to know these facts much )etter and to understand the changes that have taken place in our 336 population, in order to have a true picture rather than a false image , of aging and our elderly, and to understand and support the programs for them that must be gotten underway. The goal of the city of Chicago and the work of our division for and with the elderly, is to insure the quality of services and activities that will keep our older people independent and living in the com- munity for as long as it is possible and wise to do so. We conceive our role in Government to be that of an advocate agency for older people and our task to be that of making the systems work to serve them. It is a formidable task, for the systems serve them very poorly where they even serve them at all. m We can blame this, if we like, on a culture and a society that is youth oriented, if not obsessed. We can note the failure to grasp fundamentals of the process of aging, the overvaluation of sensation and feeling and the undervaluation of experience and the past, and the faulty premise— on which all too many courses have been taught— that human development is something that ends with youth. There is, after all, more to life than being a teenager. Basically, however, our difficulty is in the fact that we are faced with a very new problem. That problem lies in the figures that I cited earlier— the growth in numbers of older people in America. We joke that in 1900 people worked TO hours a week and died at 40, and today work 40 hours a week and are going strong at age 70. But it is true. The problem of numbers of older people in America is a relatively new problem. The medical field of geriatrics and the field of social gerontology are both also relatively new. This newness has important implications for community education in the problems of aging and for recruitment of professionals and other workers to these fields. Most importantly, the institutions of our society, private as well as public, have not yet adjusted their priorities to the realities of this new problem. As a consequence, the elderly are too often left out ot planning considerations, too frequently overlooked and underserved. One must battle for attention to the problem, battle again for re- sources to commit to it, battle still further to win the right to give undivided commitment to it and then, with what energy is left, try to do something about the problem itself. It is past time that we took up realistically the whole new problem of numbers of older people in our Nation, and of policies, programs, and priorities for them. It is, quite literally, a problem that concerns us all. . . You should be aware that by 1975, experiments that have been suc- cessful in delaying the aging 'process with animals, will be tried on human beings. There is a very good chance that by 1990 we shall have inexpensive ways of delaying the aging process and of extending the vigorous years of life by 5, 10, or 15 years, given Government sup- port of the level of research that is needed today. My friend, Dr. Alex Comfort, writes from London, where he is director of the Medical Research Council Group on Aging, at University College, that he has written an article "heavy on the research side," and placed it in the November issue of Playboy, rather than a scientific journal, trying to reach the widest possible audience with important findings that are relatively little known today. Dr. Comfort told me last spring, that with only a slight change in emphasis, the $100 million we have now 337 lirected into the fight against cancer, can haw crucial significance in >ur research on aging, as the problems and work are so much allied. What are the comprehensive social services for the elderly thai our ociety should provide? At 120 community forums held in Cook Bounty last fall, under the aegis of our division, the elderly met trough sessions of their own groups and clubs, and identified these fciorities: income; health care, housing, transportation; education, egislation — that is to say, social action; employment, leisuretime LCtivities; safety and police protection, nutrition, compulsory inyol- intary retirement, consumer protection and preretirement counseling. Let me indicate briefly how the elderly expressed some of their loncerns on only one of these topics — health care. They asked : "What lo you do about the many medical expenses not covered by medicare? ftThy isn't easily accessible comprehensive health care available at •easonable cost ? Why doesn't a comprehensive plan include such serv- ces as dental, opthalmic, and podiatric care, home health care, medica- ion and transportation when necessary?" The elderly are very clear >n the services they need. My office, at the request of the State of Illinois, surveyed existing jommunity resources for the elderly to identify unmet needs and serv- ce gaps for senior citizens in Cook County. Again, let me spell out ►riely what my staff reported on only one area, that of available ocial services and programs. They reported that these exhibited de- iciencies related to : The availability and number of social services, such as casework, ounseling, and protective services. The availability and number of home- delivered social services for hut-ins, including home health aides, homemaker/housekeeper aides, tome- delivered meals, companion sitters, chore boy services, home naintenance services, and friendly visiting and assurance services. The availability and number of enabling or supportive services vhich are critical to the accessibility of all services, such as threshold- o-threshold transportation for those with impaired mobility, leighborhood-based information and referral programs, shopping ;ervices for the homebound, and escort services for the confused and emotionally impaired elderly. The availability of community education programs in aging. The availability of trained staff and of training programs in the ieid of aging. If you multiply these kinds of specifics by the kinds of problem treas we mentioned — income, health care, housing, and so on — you *et a reasonable picture of what we mean by and what is needed in comprehensive social services for the elderly. I would like to offer i or the record of these hearings, our report on "The White House Con- ! erence of Aging in Cook County, 1970-71 : Recommendations for Policies, Programs and Priorities." It contains the observations I have ;ited and is, in its way, an outline for the kind of action on compre- lensive social services that we feel is needed. How do we achieve these programs? One thing is certain — not done. The job can only be done by a massive effort of the public tnd private sector, the elderly and others, working together in ways ve have still to invent. Above and beyond specific services, it is clear hat we must initiate great new social reforms. 338 Justice Holmes once said that "to live is to function." A society that takes away function, by cutting off activity and income, through compulsory retirement on the arbitrary basis of chronological age, is destructive of its own professed values and eventually of itself. It destroys the present basis of useful contribution to society— the job and work — around which the personal identity and lives of most people are organized. No two people age alike. It is a differential process. And human development and education are both lifelong processes. The time has come to end the universal lock step of one-third of life at school, one-third of life at work, and one-third of life in inactivity or retire- ment. We must reorganize our institutions of education, work, and leisure on a basis that is more sensible for all. Education/school, work and leisure should be three streams that flow through all of life, each broadening or contracting from time to time, to fit the needs and life style of the individual as well as the demands of society. In such a world a man might continue to hold a part-time job at the age of 80, if this is his desire; go back to school at 45 for a new career or delayed degree ; and interrupt his work life much more frequently to enrich it and himself with travel, leisure, and educa- tion for its own sake. The experiments with the 4-day week, the Xerox Corp. year sab- batical program for community activity, the new adult degree pro- grams in higher education, are all beginning steps toward the new work mix or flexible life style. It is not so much, I believe, a question of our young people drop- ping out of school or society today, as it is of offering all our people more and more varied opportunities to plug in. The world can at least be organized to recognize individual differences, and to take the measure of each person according to merit, performance, and in- dividual worth. Age is but one facet of that measurement. What we ought to share at ages 17 and 70 is not so much a point of view as a sense of purpose. That sense of purpose should flow from a fuller view of the potentials of human development. What shall I do with my life, we ask at 17? What have I accomplished with it, we ask at 70? And also — what more can I do, while time is left to me ? These are all questions of development and growth, no matter at what age we ask them. And so I would argue that while we must do much for those who are old today, and create vast new and comprehensive systems to serve them, the long-run view of our senior citizens must be that of a vast potential resource for our Nation and one that is largely untapped. It is, instead, a resource we have retired. A fellow Illinoisan, the late Adlai Stevenson, may have said about all we can on the subject when he remarked that : What a man knows at 50 that he did not know at 20 is, for the most part, incommunicable. The knowledge that he has acquired with age is not the knowl- edge of formulas or forms or words, but of people, places, action — a knowledge not gained by words but by touch, sight, sound, victories, failures, sleeplessness, devotion, love— the experiences and emotions of this earth and one's self and of other men and perhaps, too, a little faith and a little reverence for the things you cannot see. 339 I think we should put thai knowledge to work, not only in its own behalf, but inyoursand mine. Mr. Brademas. We want to thank you for a most practical and in lormative statement. At the outset Let me express on behalf of my colleagues, the subcommittee, and our stall', our great appreciation to you for your splendid help in making arrangements for our hear- ings here today. I have two or three questions to put to you. You observed that there are some 600,000 older persons that are 05 and older in the city of Chicago and its suburbs, and you have given us a list of some of the major concerns of the senior citizens of Cook County. Would you within that list of priorities assign a still more specific priority to what would be from your experience the three prin- cipal priorities of older citizens in this country ? Mr. Ahrens. Well, one is income. If we put more money in the pockets of the elderly we wouldn't need to have them here, as they could resolve a lot of their own problems. They have been respon- sible and self-sufficient all their lives and they know how to do it, and it would get us away from this time-consuming practice of special discounts, ride at reduced fares, reduced prices for different things. Better we should arrange for older people to have sufficient money in their pockets and to be able to buy what they need, then they would be on equal terms with evervone. No. 2. 1 think that it is essential that we develop some kind of sensi- ble system for long-term care in this country. Medicare does not han- dle this now ; I do not see, frankly, in any of the bills before Congress, either in Senator Kennedy's or in the administration's bills, the solu- tion to the problem of long-term care. Most of it is based on the need for acute hospital care, but I think we need much better systems for long-term care and home health care. Then there is another crisis, the one of housing. Chicago has done more than any city in the Nation; it has built many public housing units for the elderly, and yet there are 10,000 people, as a minimum, on the waiting list for that housing. Mr. Brademas. I note in your statement that you make reference to, among the other priorities, the availability of community education programs in aging. What do you mean by community education pro- grams in aging ? Mr. Ahrens. Well, we generally mean programs to alert the total community to what the needs are in aging. These programs range from the production of technical papers addressed to the professional communities, to the production of handbooks and guides for the elder- ly, but also to programs such as this hearing today, Congressman. The fact that you are in Chicago, and the fact that you want to listen to the elderly state their needs — that is community education. Mr. Brademas. My final question, Mr. Ahrens, derives from your observation that the medical field of geriatrics and the field of social gerontology are both relatively new in the United States. Tomorrow afternoon, hopefully a bill on which Mr. Hansen, Mr. Meeds and I have worked all year, will be approved by the House of Representa- tives to establish a National Institute of Education to support re- search and development in education. I wonder if you would comment on the following question : Would you see value in the establishment of a National Institute of Aging 340 or a National Institute of Gerontology, which would devote itself to research and development, not only to the field of geriatrics, medi- cally defined, although including that perhaps, but more broadly tc social gerontology and all of the problems that are associated with the concerns of older persons ? Do you understand my question ? Mr. Ahren. Yes, I do. And I would support such a bill a thousand percent. I think much too small a percent of our research money is devoted to training and there is indeed a great need to train people in this field — not a glamorous field, for some reason. As a result, ever in our office, where staff have graduated from the best universities we have to have our own training programs in gerontology. Any kind of Federal support along the lines you mentioned would be very wel- come indeed. Mr. Brademas. Thank you very much, sir. One of the notable members of this subcommittee is our colleagu< from Idaho, Mr. Hansen, who will now go on with questions. Mr. Hansen Thank you, Mr. Chairman, and I echo the chairman'! expression of appreciation for the extremely helpful statement. Turning to the list of priorities that you outlined on page 4 of youi testimony, are these listed roughly in order of priority of important or urgency ? Mr. Ahrens. They are listed, Congressman, in the order that thi elderly turned them in, in meetings of the 126 forums, as they iden tifiedthem. The reports of these forums came into our office. W< accumulated their votes. The decisions of the 126 forums were pu together. The priorities reported represent the rank order of the pro grams that the elderly felt they needed, in the order in which the} were named. Mr. Hansen. I might observe that they correspond very closely t< the priorities that have been identified in the course of senior citizei seminars that I conduct each year in my own district, for the purpose of focusing on some of the problems, providing a two-way communica tion that is essential between the public servants and the elderly in ou: population, and building the kind of public understanding of a prob lem that is a requisite to meaningful action. Let me now focus on a little different aspect of the question raisec by the chairman ; that is, in the area of research. It seems to me tha with many of the problems we face in Congress, there is a tendency t< retreat behind some supposed need to learn more about the problem, an< that this becomes a substitute for meaningful action. As I listened to you, and read your statement — let me see if I cai characterize your assessment of it correctly. We have some clearly iden tified priorities of the needs— and I assume that we don't need mon research before we act. We need to learn, of course, more about tb aging process. I gather from what you say the need for research noT is the kind that can be sponsored at the Federal level to develop tb kind of administrative structure within which we can organize thi massive effort that you refer to, both in the private and the publi sector, and identify the specific roles for the Federal^ State and loca governments as well as private industries or organizations. It seems to me — and would you agree — that this is one of the areai where we need to concentrate most of our attention in an effort t< learn what we do not now know ? 341 Mr. Aiirens. Yes, J would agree to that. I think the problem is crucial at the Federal level and also at the State level. AW don't have all the answers, dial's for sure, at I he local level. I was interested last Friday night in Houston to hear Dr. Flemminff, who is the chairman of the White House Conference on Aging, speak to the Gerontological Council. He indicated that President Nixon has now created a Committee on Aging, a new domestic council in the Cabinet, and he saw some hope m this interdepartmental committee. 1 think I agree with the recommendations that arc in the report just feven to the Senate committee by the Advisory Council that Senator Church appointed. They are very similar to the recommendations feven by the President himself on the needs of aging, and nothing seems to have happened on that. I think that programs for the elderly must command the attention, really, of the Chief Executive so that there can be some kind of a coordinating mechanism to make the vari- ous services, systems and departments function, because the elderly j ust do not have a very high priority at this time. Mr. Hansen. I might observe that one of the most encouraging signs, at least from my point of view, in this whole area is the emer- gence of Dr. Fleming, in the position he now occupies. We now have a great opportunity both within the executive and the Congress, and within the country, that is deserving of the enthusiastic and sincere support of all of us. Mr. Ahrens. I think that is a point that is most encouraging. Mr. Hansen. Thank you, Mr. Chairman. Mr. Brademas. Another of the able members of our committee is Congressman Lloyd Meeds of the State of Washington. Mr. Meeds. Thank you, Mr. Chairman. Mr. Ahrens, my commendations for a very fine statement. I, too, am very interested in the priorities which the elderly in Chicago have listed, and they also coordinate very well with myown findings. In line with this I would like to ask some questions about these pri- orities and how, perhaps, some of them might be combined, or at least solutions to these priorities might be combined. First, I get very upset by protestations of the administration and other people that we are going to solve all the problems of the elderly by providing more social security for them, and then saying, in effect, that we are doing our duty to the senior citizens of this Nation when we do so. I think it is a real fallacy because we know social security is an insurance system, and this is their money, so^ the Government is not doing anything for them at this juncture. It is a total insurance program and it seems to me that social security itself has to be supple- mented by some kind of program which will put the Government's money in people's pockets rather than putting their own money in their pockets. And in line with this, I would like to suggest, and then get your comments on the concept of additional public service employment for older Americans. It seems to me that the dignity of the job, increased self-esteem comes from being occasionally employed or at least em- ployed as long as one wants to be, combined with the very adequate services America can supply to them, and this would make for a very good combination of things, where government is indeed putting that money in people's pockets, and they are in return performing a serv- 342 ice for that, which will enhance the richness of this entire Nation. Would you think this would be a good combination ? Mr. Ahrens. Indeed it would, Congressman. We have initiated the foster grandparents program in Chicago, and, as Congressman Brademas mentioned, there are 600,000 people in the city and suburbs. We have 51 foster grandparents in the city of Chicago. We have just filed a new proposal in Washington asking that this number at least be doubled for the next year. There is an urgent need, and I hope that Dr. Harrison, who is to my right, and directs a senior aides program in Chicago, when he testifies later, will also comment on the need for such programs. But we can use 5,000 of these kinds of jobs in Chicago, and in my testimony I tried to mention the things we should consider such as compulsory retirement ; people have got to be useful, have got to be needed, and not in Mickey Mouse roles but to achieve things which are substantial and which really engage the experience, the wisdom and the talents that build up with age. Mr. Meeds. And then it seems also to me that you list a third pri- ority as housing, and a number of others, including nutrition, con- sumer protection, leisure time activities. But let me just ask how much has been done in the field of com- bining these activities of the senior citizen centers with the housing programs or projects, primarily for older Americans? Here, again there seems to be a very valuable chance for combining priorities. Mr. Ahrens. Well, I think that is correct — I can look at the lisl and I can look at some of the people present here today — to indicate that this is done. It is just not done in sufficient volume and quantity to serve the older people that we have. The Chicago Housing Author- ity, for example, provides apartments for the elderly. But manj other services are provided in these buildings by private agencies, as will be testified to by an employee of Hull House, Mr. Meeds. Do you have senior citizen centers at most of these housing programs ? Mr. Ahrens. Yes. Some are run by private agencies and in some the authority itself has the staff, but then our agency may come in witl a program, such as the nutrition program, for which we were re- funded again for a year. But the nutrition program may be offeree to the senior citizens of Chicago at a given site in public housing, and again it may be offered in another kind of site where educational pro- grams are available. Mr. Meeds. And then finally I would certainly have to join with mj colleague from Idaho in stating that while I think it is essential that we go forward with research in the processes of aging, it seems to me thai there is an awful lot we already know about what needs to be done, anc' that our priorities, for instance, in the expenditure of funds are a little askew when the third largest item in the total expenditure exceeding- volunteer programs exceeding housing programs and many others, h research and training. I think, for instance, we could be also doing a lot with the money ir the field of transportation for the elderly and in housing and in the centers, maybe, and an u,wf ul lot in food and nutrition programs ; anc I would agree that we need to change that priority a little on that and I would like to ask your comment on it. 343 Mr. Ahrens. Well, the amount of money spent under the title IV of the Old Americans Ad is so Little that I can'1 say we are spending too much for research and training. I can say this, thai when a research and demons! ration project such as ours in nutrition has proved its worth, in the only citywide demon- stration, at 35 sites, I don't think we need more research. I think we feed more money for more programs. And the same is true for the Foster Grandparents program. Mr. Meeds. Well, that is what I am saying. Mr. Brademas. Thank you very much, sir, we are very grateful to you. Our next scheduled witness was Mr. Will C. Kasmussen, director of the Division of Care of the Aged, Lutheran Welfare Services of Illi- nois. Mr. Kasmussen has been called out of town, and without objec- tion we shall therefore file his prepared statement for the record of the hearing, and in his stead Mr. Elmer Johnson, who is also of the Division of Care of the Aged, will testify. STATEMENT OF WILL C. KASMUSSEN, DIRECTOR OF THE DIVISION OF CARE OF AGED, LUTHERAN WELFARE SERVICES OF ILLINOIS, PRESENTED BY ELMER JOHNSON Mr. Johnson. Mr. Brademas. I am Elmer Johnson, of the Division of Care of Aged, Lutheran Welfare Sers ices of Illinois, and I would like to say that I was asked by Mr. Kasmussen to come and present his statement, since he was called out of town. The aging process is not understood by the vast majority of Ameri- cans today. This can be attributed to many aspects and characteristics of our multiculture society, but it is a sad fact that we as an American people do not prepare for being aged, either through our educational or experimental systems. As a result, we have a great ignorance about becoming older. We worship youth as that which is good, and we abhor being old. The aging process begins at birth and understanding this process beyond the youthful era is essential to knowing generally what needs older persons have and how problems which confront the older person can best be met by a system of services. Lutheran Welfare Services of Illinois is a demonstration of the church's concern for a system of service to people. With a specialized staff and multiple resources, our agency serves people, and this "faith in action" enriches the total life of the community. The objectives of the Division of Care of Aged are : To enable older persons to live in maximum independence ; to respect the individuality of each older person, his hopes, aspirations and capacities ; to provide special assistance for aging persons who are dependent or disad- vantaged ; to stress the importance — to them and to society — of their social and community participation rather than rejection and isolation because of age. I wish to emphasize it is the desire and plan of our church-related agency to be an active partner in the relationship of public and private agencies. We do not see the problems concerning aging confronting our country as the Government's problem or the church's problem, but 344 as our mutual concern. We have much to do together, as partners, to solve problems people have in our society as they become aged. Reference was made in the beginning to our minimal knowledge of the aging process. This is not said to demean the work of scholars, scientists, and organizations who have contributed much to a growing body of knowledge. Rather, I say it is time to build into our educa- tional system, and particularly for younger people, course material to help them understand the totality of the aging process. Our schools, if so challenged, would expand their curriculums beyond the limits of adolescence to young adulthood, middle age, old age. It is essential to our future we as a, Nation understand the aging process from every viewpoint. Beyond the school experience, the church, union, corporation, media, should plan to, through continuing education, help people to com- prehend the aging process. It is our premise with increased understanding of the aging process there will be less fear of what the years will bring. Knowledge will permit the orderly development of the kinds of programs we see as a continuum of services. It would be important for each community to offer social services of the type spelled out below : Counseling — for purposes of diagnosis and isolation of problems to permit problem solving process to begin. Problem solving resources : Referrel and information services. Par- ticipating problem solving resources would coordinate their services here. Personal services : Health — home health aides, visiting nurses, mo- bile medical teams; home — homemaker service, home maintenance service, domestic assistants, home delivered meals; individual- friendly visitors, management of income and assets, educational and social activity for individuals and groups. Housing — A large range of housing conditions should be provided, barrier free, dignified, reasonable in cost, in locations appealing to the needs and wishes of the older person. _ Institutional care — A range of settings should exist as a part of the community, providing for simple personal oversight, short- and long- term care, rehabilitory character, recognizing increasing dependency caused by chronic conditions, completing the range with skilled nurs- ing care. The organization model for delivery of service could very well allo\\ for participation of proprietary and nonprofit organizations. The pri- mary objective would be to make the services available to people. A large segment of our older population can pay fees for services rendered. Those unable to pay should not be denied service. Public assistance should be sought in the case of the financially disadvantaged, In conclusion, I wish to commend the Commissioner of Aging, John B. Martin, for his leadership role in behalf of aging. I believe the Ad- ministration on Aging has a vital leadership role to plav in the lives of older Americans. We, in the church-related agency, particularly look tc the AOA publications and especially the journal Aging for keeping abreast of today's issues. Thank you, Mr. Chairman. Mr. Brademas. Thank you very much, Mr. Johnson. 345 I just have one question f the shortcomings m many facilities. In a press conference held March is, L971 we offered a sot of recommendations, which are attached. Our statement again ■tressed the importance of in-home, community services to avoid un- necessary placement in overcrowded institutions. This emphasii fleets the fact more than 95 percent of the elderly live outside institutions. According to the council's information center for the aging, the single, most important problem faced by the aged is having to live without, adequate funds. Year by year the aged remain the one poverty group that continues to grow. Nursing homo abuses are directly related to the low priority our society places upon the needs of the aged. Whether it's nursing home care that is needed — or housing, home health care, supportive or pro- tective services, vocational rehabilitation or jobs — old people have few or no choices and, in fact, must compete with each other for the few resources that the community does provide. This in our estimation is a direct result of the conflict between the level of care and services which the community considers humane and the community's willing- ness to meet the necessary long-term cost. In 1967 we established an information center for the aged — the larg- est and most complete referral service for the aging in the Midwest. The fragmentation and scarcity of services, their long waiting list and complex eligibility requirements, present barriers to the aged that were beyond their energies to penetrate and make such a referral service essential. The center has assembled comprehensive information on health and social services, including nursing homes. It gives the elderly the choice of having a sympathetic counselor and advocate at their side as they enter the service system. From 1967 through 1970 this center has served approximately 25,000 older people. Through careful followup of its referral placements, the center has documented the unmet needs of the aging. These have been published in a 3 -year report to the community, which is attached. Many of the most acute needs — for decent housing, employment for the healthy, facilities for the handicapped and persons in failing health — have been incorporated into council position statements on public issues of governmental policy. These positions have been brought to the attention of the public officials, legislators, and the com- munity on many occasions through our public affairs program, and copies are attached for your information. Financing of our information center for the aged has presented diffi- cult problems. For 5 years it has been financed on a declining level by funds received under title III of the Older Americans Act, to which were added matching funds from the State of Illinois and from volun- tary funds obtained locally. Although we have made some progress, sustaining financing for this essential program is not yet assured. The simple fact is that validated demonstrations of new service programs, such as the information center for the aged, which are initiated with the aid of short-term Federal grants, can rarely generate sufficient added financing from local sources to continue beyond the demonstra- tion period. It is not possible to meet long-range needs of the aged with short-range financing. 358 In 1962 a council study found older people living in isolation, suffer- ing nutritional deficiency. Through the mobilization of voluntary agencies and volunteers and with funding from the U.S. Public Health Service, the council oper- ated a successful 3 -year demonstration program of home delivered meals to the chronically ill and aged. After certification and prescrip- tion by a physician, hot meals meeting 14 special dietary standards were delivered daily by trained volunteers who injected also the friend- ly visit into an atmosphere of aloneness. The final report of this project, which I am making available, out- lines its methods of operation, service standards, and the patterns of cooperation between voluntary service agencies which were developed. One. of the most important results of the project was to show that hospitals could discharge patients significantly earlier when a home- delivered meals service was available. One of the hospitals found means to continue this program on its own, as have a few of the cooper- ating agencies. But when overall funding ended after the demon- strationperiod, the project ended, and new funds to make this essential home health service available to the aged on a communitywide scale have not been available. Based upon our experience it is our conviction that meals delivered to the home under medical supervision should be recognized as a legiti- mate home health service and its costs reimbursed through medicare, medicaid, and private health insurance. An elderly person whose health becomes seriously impaired often has no alternative but to give up his or her home and enter an institution— either a costly nursing home or a State mental health facility, or occa- sionally, a home for the aged. In 1969 the council established a demonstration project in a Chicago community heavily populated with older people, to explore ways in which a comprehensive system of protective services could be designed and established so as to maintain seriously impaired elderly in the community as long as possible. After 4 years of making application to Federal sources, financing from the National Institutes of Mental Health and the National Center for Health Services Research and Development was finally granted. Two sources of funds were required in order to meet the needs at a reasonable level. This project has been successful in demonstrating a viable approach to delivering such services. Based on its findings, the council has devel- oped a model for utilizing the capacities of existing governmental and voluntary agencies to furnish a full range of protective and supportive care. Currently we are seeking financing under title XVI of the Social Security Amendments of 1967 to implement this model on a broad scale in the Chicago area. We urge this coordinated, purchase-of-care ap- proach as preferable to the costly alternative of establishing a single new agency or institution to meet this need. Let me emphasize that the services which are being offered in this comprehensive system are applicable in varying degrees to all aged— not just the seriously impaired. They include: Information, referral, and" short-term counseling; casework counseling and services; ful] medical, psychiatric, and social evaluation ; now available through the Public Health Hospital ; placement in sheltered care or nursing homes 359 when indicated; borne health care, which has been emphasized here fcoday, including arrangements for physicians house calls, arrange- ments for podiatry, optometry, et cetera, nursing ('arc, homemalEer Services, housekeeping services and personal care, home-delivered meals; financial management ; Legal guardianship ; otheT legal services; Emergency cash assistance; transportation; and Last but not Least, the assistance of volunteers. Based on what we have learned in developing a wide variety of services for the aging, the council submits the following points and suggestions for this committee's consideration. It is hoped they will help the committee advance the goal of a humane system of services to all elderly. Short-term financing to meet long-term needs is not a suitable means of supporting essential services and programs for the aged. The over- riding need at this time is for adequate and systematic long-term fi- nancing, which is consistent with the aged's long-term needs and problems. We endorse the concept of a coordinated, community system of com- prehensive services for the aged which utilize and upgrade the capac- ities of existing services to the fullest extent. The council urges that emphasis be given to the development of adequate systems of home-based services such as home health and nutritional services, homemakers and other home health aides, as Mon- signor Holbrook emphasized, which must be expanded if they are to- be^inemded in comprehensive service systems. We endorse in principle the report of an advisory council to the U.S. Senate Special Committee on Aging which was recently chaired by Dr. Harold Shepard. Agencies or offices, we believe, should be established at the highest levels of municipal, State, and Federal administration to serve as ad- vocate for the needs of older citizens. Any such agency should be ad- ministratively divorced from direct administration of services and grant programs for services. It should be provided with sufficient staff so as to permit it systematically to monitor and report the progress of operating programs for the elderly ; engage in long-term evaluation of the impact of operating programs ; and promote coordination and comprehensiveness among all such programs. Mr. Brademas. Thank you very much indeed, Mr. Ballard. We come to Chicago at a time when your television and radio and newspapers are full of stories about the problem you have on welfare cuts. Could you give the committee any comment about the impact of the proposed cuts, what the impact would be were they to go through, on older people in this county ? Mr. Ballard. The present crisis in public aid in Illinois, which is focused on the general assistance program, the general relief program, largely does not affect the elderly, over 65, who have qualified for old age assistance. The concept of who is an elderly person and when does aging begin, of course, is the broader one. Many older single persons who do not otherwise qualify for one of the categorical federally- assisted public aid programs will be hurt severely by any grant cuts in the general assistance program, at the present time. 360 The elderly, I believe, are going to feel some serious impact of the yet unofficial but announced intention of the State to reduce the reim- bursement to the health care system, particularly the hospitals for medical care, and to impose, if the Federal Government approves, the first dollar cost on welfare recipients — $1 they would have to pay for every physician's hospital, office or clinic visit. The people on general assistance, which includes some older persons, although it is a primarily smaller proportion of that program that are older persons, have already lost their green cards which authorized them to receive medical assistance from hospitals and clinics, and at the present time many of them are in danger of being completely without recourse unless physicians, hospitals, and health services can find a means to provide health care for them without reimbursement. It is a real crisis. Mr. Brademas. Thank you. I have just two other questions, both of which I have put to other witnesses : What comment can you give us with respect to the apparent very meager, modest effort on the part of the State of Illinois to provide support for programs to meet the needs of the elderly in the State ? Mr. Ballard. I would just add to what I said in my initial state- ment. I think the State, municipality, county, as well as the Federal Government, are all wrapped up in the problem that our society places an extremely low priority on the aged. Older citizens have been some- what dealt out, they are being isolated, they have been forgotten. We wish they would go away, and as a people we have been unable to tax ourselves sufficiently to provide adequate services. This inevitably ex- presses itself in the assignment of low priority by the legislative coun- cils of the State, Federal and municipal levels of government when it comes to appropriations. There is no clear priority being given to the needs of the aged at the State level, and only the most limited at the local level. Mr. Brademas. Well, my other question goes to the comprehensive delivery system of services for the aged. I don't agree at all with your final recommendation that any agency, Federal, State, or local, to be an advocate to the needs of local citizenship, that the agency be di- vorced from the administration or grant programs. I just thought I would tell you my own opinion on that. If you take away program money you are not going to have very much muscle for the advocate. The Administration on Aging in Washington has taken away our program money, and the Commissioner says Holbrook is still an advocate but he comes in with an arm loss on one day and a leg loss then the next day and it just doesn't get much strength to make an effective inroad on the disability problem to which you address your- self. If you would like to comment on that, please do, before I give you my question. Mr. Ballard. Well, I think to make it more clear, it has been my experience that grant programs and involvement in the direct admin- istration of certain programs, for whatever reason, that program is a competitor with other programs, whether it be for vocational reha- bilitation or public assistance or the employment service. There are many programs and stationary agencies dealing with the needs of the elderly or any other population group. When a special agency is 361 Established to advocate U>v a special group and to coordinate all serv- ices to that group those purposes tend to be defeated if it becomes a competitor of already established agencies in operating programs, I grant the muscle for money. I suggest that such an agency as I am emphasizing ought to be adequately financed, and should have funds available for innovation. But if it is going to be effect i ve in advocati ng its basic clout ought to be derived from being placed sufficiently high in the administration. It should report annually to the public, to the administration and to the legislature on the status of our failures and— it should be able to be a critic within the Government. Mr. Brademas. Do you know that the Commissioner on Aging is Presidentially appointed ? Mr. Ballard. Yes, sir. Mr. Brademas. That is up pretty high. Mr. Ballard. He is also accountable to the Secretary of HEW. Mr. Brademas. That is right, and to the Commissioner of SRS. Mr. Ballard. And he doesn't have any muscle in the administration. Mr. Brademas. No. No matter where you put him up in the clouds, he is floating up there because he has no money to tie him to the earth. Mr. Ballard. And some times the allocation, the appropriation of moneys is withheld. Mr. Brademas. I will withhold further questions. Maybe my col- leagues would have some. Mr. Hansen? Mr. Hansen. To pursue a point raised by the chairman focusing on the difficulties in the State of Illinois, and I might say difficulties that States across the country are having in the welfare program, I would like to hear your views on what you believe to be the need for basic structural reform of welfare? Also I would like to know whether you agree that the welfare reform proposal that is now pending be- fore the Senate, having been passed by the House, moves us in the right direction? Mr. Ballard. Mr. Hansen, that is a long question. First, I believe that the crisis in public welfare reflects itself throughout the country, highlights the fact that this is a national problem, and H.R. 1, with its initial elements of guaranteed minimum income for all, is the direction this country should go. Some aspects of H.R. 1 I don't agree with — the requirement, for example, that a mother who has children over six must work as a condition of employ- ment. I basically am not sympathetic with the fundamental distrust of anyone who is poor, which is reflected in some of those stipulations in the present bill. I think the general assistance program which, in Illinois and most other States, is still primarily a locally administered program, administered by the township or the county or the munici- pality, should become increasingly recognized as a State problem.. The administration of it should be assumed by the State. And I think the time should come when the noncategorical poor should be recog- nized as a national problem and be aided by the Federal Government because their condition of need is very largely a function of the na- tional economy. Our general assistance programs are intended to take up where people exhaust their unemployment compensation benefits or when they lose a job and haven't earned benefits — it is the line of last re- 362 sort. It is the grease that helps the free economy keep moving, and to the extent that I see a very important part of this long-term plan- ning for the economy and the problem of poverty as including a major continuing push in the development of what we now call public service careers or the use of the Government as a means of developing employ- ment opportunities for people who want to work and for whom the private competitive economy at any time does not provide opportunity. Mr. Hansen. One further question: I was interested in your de- scription of the information center for the aging, which, as you know, has been funded on a declining level basis under title III, and it strikes me from your testimony that the Senate has provided a service of value to the elderly. In view of that, why has not the State of Illi- nois or other funding agencies recognized that value and stepped for- ward to provide the continuing long-range funding that I agree is essential for the success of this kind of a program ? Mr. Ballard. Well, the answer to that is several fold. First, the State of Illinois has helped us. When the Older American Act was extended, the States had the authority to continue the support of title III projects that it felt merited continuing, and we have had a con- tinuation of support. Also, this year we entered into a contract with the Illinois Depart- ment of Public Aid, in which they are purchasing referral services from our center. Half of the people we serve are eligible for public aid in one form or another, so we have a purchase of service arrange- ment that frankly is considerably less than 50 percent of our costs. We have established a principle and we have to build on it. I think the general problem I see is that temporary infusions of Federal money on a demonstration basis — 3 years is a fairly short time — that altogether these are beyond the revenue capabilities of States and municipalities and revenue-generating capabilities of pri- vate, voluntary sector. It is a problem of timing in the addition of many competing de- mands on the public treasury at the State and local level, and that is what I mean when I say local moneys just can't be generated fast enough to replace the revolving fund of short-term Federal grants for service. Mr. Hansen. Thank you. Mr. Brademas. Mr. Meeds ? Mr. Meeds. Thank you, Mr. Chairman. Mr. Meeds. Mr. Ballard, just one quick question: I was struck by your example saying that people were kept in hospitals longer than necessary because there was no food delivery assistance. Can you give us other examples of how you feel savings might be made by programs that might be contained in the outline you have given us here, be- cause I think this is a clear example of false economy, and where great savings could be made by the adoption of local food programs — home food programs, and transportation, housing, other services. Could you give us an example of some of those ? Mr. Ballard. Mr. Meeds, the example I gave of the Protective Services for the Aged project is a good example, which also, Mr. Brademas, is an example of delivery system on a small scale, a new kind of delivery system. Our experience demonstrates that many dif- 363 ferent small, relatively inexpensive single services can be delivered in coordinat ion to help older persons remain in their own homes. This is really an investment in economy in the Long run. We heard just 3 days ago that the level of funding that we had orally been assured for the third year of that project has been cut by 25 percent. We may have to discontinue services short of the final year. The project includes evaluation, but we do not have in pro- vision for investigation of the cost-benefit comparison with the al- ternatives, which is placement in a nursing home. However, for many of these people our experience would make clear that on a case-by- case basis a modest investment in helping people to remain where they feel more comfortable, to help them achieve their own goals, is also saving the public funds, by giving them an alternative to solutions that are more costly as well as less humane. The dilemma is that our priorities have been such that we have made available means to finance only the services for the most urgent need, and therefore we have created a system which is like a self-fulfilling phophecy. You have got to get really bad and then you can be taken care of and go to a nurs- ing home, but we cannot pay for services which would help you avoid or at least delay this last resort. Mr. Meeds. A crisis-oriented society, is that it ? Mr. Ballard. That is it, so that in the short run, the supportive services that we are talking about cost more money and therefore are not so popular, but we are still able to meet the crisis of need — in other words we cannot pay the cost of preventing the crisis but we will pay the greater costs of meeting crisis needs we did not try to prevent. Mr. Meeds. Thank you. Mr. Brademas. Thank you very much, Mr. Ballard. This has been a very valuable statement, and I am especially grateful for your giving us your set of recommendations. The Chair would like to observe for the benefit of all of our guests in the hearing today — and we are very pleased to see so many of you here — that we shall hear from one more witness, and then we will have a break of a few minutes, when we shall resume with a panel of four persons, and then we will have our final three witnesses, for the benefit of all here. Mr. Ronald Weismehl is our next witness. Is he here ? Mr. Weismehl, would you come on over, sir ? Do you think you could summarize for us, Mr. Weismehl, would that be difficult? Mr. Weismehl. It would be difficult. Mr. Brademas. All right, read fast, then. STATEMENT BY RONALD WEISMEHL, DIRECTOR, COUNCIL FOR JEWISH ELDERLY, JEWISH FEDERATION OF METROPOLITAN CHICAGO Mr. Weismehl. Before proceeding with my statement, let me intro- duce myself. I am Ronald Weismehl, dirctor of Council for Jewish Elderly, of the Jewish Federation of Metropolitan Chicago. The Council for Jewish Elderly is a new organization which has been formed to plan, imple- 272— 72— pt. 1- 71- 24 364 ment, and maintain a comprehensive and coordinated program of serv- ice for the Jewish elderly of Metropolitan Chicago. Prior to being appointed director of this new organization, I was the executive secretary of the Gerontological Council of the Jewish Fed- eration of Metropolitan Chicago. The Gerontological Council was com- posed of lay and professional representatives from 10 affiliate agencies of the Jewish Federation and the board of directors of the federation The Gerontological Council examined the problems and the needs oi the aged, evaluated the effectiveness of the present system of providing service to the elderly, studied programs that were being initiated lr other communities, and sought new and innovative ideas related tc providing the best possible service and care to the aged. The counci plan published in the spring of 1970 and entitled "A Jewish Com munity Plan for the Elderly" is currently being implemented by th( Council for Jewish Elderly, and I will include copies for this record The Jewish Federation has for many years provided a broad spec trum of services to the aged. These services have been made availabh through federation's affiliate agencies : Jewish Family and Community Service, Jewish Community Centers, Jewish Vocational Service Drexel Home for Aged, Park View Home for Aged, Jewish Home f oi A<*ed, Michael Keese Hospital and Medical Center, Mount Sinai Hos pital, and the Schwab Rehabilitation Hospital. Approximately 4 year; ago, the Jewish Federation decided to reexamine its program of serv ice to the elderly. At that time it was determined that the special needi of the elderly and the changing characteristics of our elderly popula tion warranted a reexamination of our service program and a searcl for a new policy on aging. The planning study developed by the Geron tological Council not only involved all agencies of the Jewish Federa tion, but it also stimulated a new commitment on the part of our com mittee toward developing an overall community plan. In our agencies, like so many other community service agencies the needs of the elderly were being met in a piecemeal fashion. Eacl agency served a particular category of older person; that is, the ambu latory, the chronically ill, the elderly in crisis, et cetera, and eacl developed what was termed an internal policy on service to the aged This situation was described in the Gerontological Council Eeport : There is a general agreement that the present system of providing service am care for the aged can be conceptualized at the straight line leading from th home environment through a referral system of independent and largely uncooi dinated agencies directly to the nursing home or home for the aged. As we noted in our study, many changes were taking place withh the elderly community and the community service model that we wer utilizing was not responding to these changes. On a very practical level we observed that those agencies that serve* the elderly through programs that provided service for all age groups were continually being faced with the dilemma of making choice between whom to serve, how much service should be given to a partic ular group, or a particular category of need. In the area of long term care services, the Jewish Federation found itself facing anothe problem. Year by year, the Jewish Federation found itself in th position of carrying a greater financial burden for the delivery o care in the federation's three homes for aged. In 1966, prior to medi care and medicaid, the Jewish Federation appropriated $845,975 t« 3G5 meet the deficit of the three Federation Homes for Aged. In L971, the lewish Federation \u\* approved an allocation in excess of $1,800,000 to meet the deficit for homes Tor aged with no real change in stand- ards of service. The Gerontological Council observed that the commu- nities were allocating large sums for a type of service that served a limited number of people and served them in what was considered an inappropriate setting. To emote from the Gerontological Council Report : Institutions which are confined to traditional form, must accommodate every level of c^re within their four walls and, as a result, the individual becomes sub- ordinate to the setting. To be sure, the home for aged does not lack in com- passion and interest but, bound by its form of delivery, it becomes rigid and unable to respond to the problems of aging and social change. How then should we provide comprehensive social service to the elderly ? In our plan we concluded that we must be a coordinated pro- gram, providing a network of resources for the older person and his family. The Gerontological Council concluded that the overriding objectives of this coordinated program must be to maintain the in- dividual as an independent functioning person by making use of whatever resources and strength the older person and his family possesses. This calls for the rejection of those policies and institutions which tend to reinforce the weaknesses of the older person and thus hastens his deterioration. The main thrust of our new program is flexibility and availability of choice. The aged person must 'be considered a member of the community who, because of certain problems which develop with age, will from time to time, need assistance in one form or another to support him and his life within the community. The new service system which we are building now will be composed of eight interlocking components, at the peak of which is a central coordinating and planning organization, the Council for Jewish Elder- ly, which will serve as the governing organization for all services for the elderly. The service system's seven program units will be : Area service cen- ters; employment program; area transportation service; housing; evaluation-service center; community health center and education and training program. The evaluation-service center is the pivot service unit for the entire system. Through this regionally based unit, the older person and his family will be able to participate in planning and making choices which best strengthen the dignity of the older person and his family. Through the area service center, the elderly will be provided with a wide spectrum of services including emergency assistance, home- maker and shopping services, telephone reassurance, transportation services, home-meal services, employment counseling, health screening and in -home health services. In the area of housing a variety of different types is envisioned to meet the varied needs of elderly individuals. It is planned to provide, at rents which older people can afford, leased apartments in privately owned buildings; specially designed apartment building for the elderly and group living homes. The latter will be made up of two "households to a unit" — a "household" consisting of approximately 12 individuals with enough household 366 and, when needed, personal aides to fulfill the needs of the residents without undermining their own strengths and independence. Additional housing of a more specialized kind will be provided by the health service arm of the program. This would include a short- term crisis program and rehabilitation, aimed at moving the older person back into the community rather than institutionalizing him. The program also provides, of course, for long-term, inpatient care within a nursing facility for those who clearly are unable to care for themselves, even with assistance, in their own homes or the other forms of special housing to be provided. • . In our planning we have concluded that a totally conceived program must be put into effect as a unit to maximize the goals of both services and economy. To the degree that it is not done, the community will fail to deliver the best and most economic service. The basic premise underlying all of our recommendations is that we must go where the older person is located, give just the amount of service he truly needs to reinforce his strength, and give this needed service in the setting in which is most efficiently delivered. In doing this we have no intention of discarding valuable service concepts as developed by existing community agencies. In fact, many of these service designs will be reorganized and introduced into the new system, allowing us to move forward from our present level oi service to a new and better level of community service. We have nc intention of duplicating the services provided by our community agencies. Rather, we are asking these agencies to provide us with those skills and staff services that they have developed over the years but have asked that these skills and staff services be delivered with- in the context of the new program and under a policy mutually de- veloped by the agencies through the Gerontological Council. There are many gaps in the service resources currently available in our community and the general community. Therefore, we shall be introducing such new services as transportation services, housing, a crisis intervention program, home-help services, and nutritionaJ Pr The plan that I have described to you today cannot be attainec merely by superimposing new service functions on existing community organizations. If one accepts the principles that I have laid dowr in my presentation today, one must also accept the fact that we musl reexamine the forms of administration that exist within our com munity agencies. Where forms of administration are frurtlul anc productive they should be retained, but no restriction should be placec on forming new relationships with other community organizations if such relationships will result in the advancement of the principle! stated above In other words, one cannot achieve a comprehensive anc coordinated program of service for the elderly merely by adding son* new objectives to an existing organization or by developing a rev more services. • . . Jl We have the technology to deliver many kinds of services to th< elderly. However, we must not confuse technology with policy. The major issue before us today relates to the development of t policy on aging, a policy that allows us to open up our communities their institutions and their resources to the elderly so as to enable oui 307 Llder Americans to live in these communities as independent and brodud ive citizens. Mr. Brademas. Thank you very much, Mr. Weismehl, for a most perceptive and intelligent statement. Can you tell us in what way you see the relationship between (he Federal program of comprehensive social services and the kind of services which you arc directing, the kinds of services that you provide? You say here you are Council for the Jewish Elderly, and as one might use any other private society, we have asked several other witnesses about a proper delivery system, and Mr. Weismehl. 1 believe that private agencies,Jby the very nature of their position in the community, are in a position to continue to develop special skills and special techniques, and engage in demon- stration projects that can assist the larger community. My second observation relates to the principle that I laid down in my introductory statement, namely that we should attempt to serve Elder people within their own environment, that community, that neighborhood, amidst those relationships in which they have grown up and to which they feel most attached. Therefore, although I have seen excellent programs developed on the State level and municipal level, I would like to see community based programs implemented through the utilization of the skills available in private agencies. The key issue is this, if we might use our own experience at this point, we are not turning to our own agencies, the many agencies we deal with, just saying to them to deliver. We are saying that you have all helped us, mutually helped us to develop a policy on aging, and the service that you will deliver and we are going to ask you to deliver will be under that policy. I think the same thing just must be achieved on municipal, State, and Federal levels, where there is someone who takes responsibility with the assistance of all organizations involved, he develops a policy and then says, yes, we will allow you to utilize your skills and your knowledge and your experience, but we have all agreed to the policy on aging. Now, go with it. I think this is how the relationship should be formed. Mr. Brademas. My other question, Mr. Weismehl, is like the one I put to Mr. Johnson, with respect to the education programs of the Lutheran churches, for education of Lutherans on the problems of the aging. Is it part of the work of the Council for the Jewish Elderly here in Chicago to work with the temples and synagogues and other places of worship to encourage education there on problems of the aging ? Mr. Weismehl. It is our policy and intention to involve all types of community groups, including synagogues, churches and the like, and to educate them in regard to the problems of aging. We have also considered the question that as one moves out into the community, as one begins to enter into apartment buildings and one seeks to help the older person where he lives, the question of just assisting a par- ticular religious group becomes irrelevant. As one moves out into the community, one must be prepared to serve the broader community. Now this, as one can see, raises questions in regard to the role of sectarian agencies. How I am of the opinion that private agencies can come together and say : "If we are serving a community, the total community, there has to be interrelationship between us." Therefore although their private agencies may continue to relate to defined pop- 368 illation of aged — that is, specific religious groups — they must also be prepared to deal with a much broader population. Mr. Brademas. Thank you very much. Mr. Hansen ? Mr. Hansen. Thank you, Mr. Chairman. Let me also compliment you for a very fine statement. It seems to me a model that might very well be followed and adopted by others, other church groups, those whose efforts are more in the nature of a voluntary association. What is the source of the funds ? Are these all voluntary contribu- tions ? Mr. Weismehl. Yes ; this is a new organization, and we are working under a new model whereby we are coming up with services that have not even been defined under existing State and Federal programs. The funding of this program is basically being managed through volun- tary contributions. Mr. Hansen. I note among the services that you have is an employ- ment program. At several points you made reference to the need for employment opportunities, the opportunity for older people to become effectively engaged in some useful activity. Let me ask you sort of a two-pronged question. What are the kinds of specific services that you provide within this employment program, and also, on a broader scale, what do you see as the major step that should be taken at the Federal level to break down the barriers to employment for older persons ? Mr. Weismehl. Within our program we haven't attempted to pro- duce unnecessary work experience, but rather, have identified social service positions that we feel could best be filled by older people. For example, in the area of community outreach, we shall be organizing neighborhood groups, and self-help groups. Professional workers will be available to provide supervision as needed, as the community aids begin organizing and reaching other people in their neighborhoods. Other jobs arc being considered, which have been definedjas home help aids. For example, if an older person faces a crisis, a social crisis, an older aid might go into the home and stay with the older person through that social emergency until the other resources of the com- munity can be mobilized. We are talking about employing older people in the area of social and community services in jobs that are clearly defined in the plan as needed, not made-up jobs. In terms of the role of the Federal Government, I would have to say that many professionals who have been dealing with the employment problems of the elderly recognize the need to advance the notion of new career opportunities for the older person. There is no reason to be hopeful in regard to what we see in the cur- rent economy and what we see in the future, that the labor market will allow older people to compete with younger people. Eather, we must assume the position that there are many jobs (i.e. social and health service positions) that must be done in the community and are not cur- rently available, and that many of these jobs can best be done by older people. We hope for the support of the Federal Government not only in demonstrating this concept but in certain areas, providing ongoing support for such work programs. Mr. Brademas. Thank you. 369 Mr. Moods? Mr. Meeds. Thank you. Mr. Chairman. I would like to compliment you on presenting an excellent state- ment, and to observe, Mr. Chairman, that the three witnesses that have come down hardest on the individuality of the older American wore the Lutherans, the Catholics and now the Jewish community, and I would like to suggest that perhaps this would be — well, we are being subjected, this morning, to a little ecumenical enlightenment. Mr. Brademas. Thank you, Mr. Weismehl, we appreciate your excel- lent statement. And now, ladies and gentlemen, the Chair is going to call a recess for 5 or 6 minutes, and then we shall resume with a panel of the ilderly citizens. So we are in recess. Mr. Brademas. The subcommittee will resume. Now, we are very fleased to have a panel, and I wonder— is the panel over here on the right ? Would you like to come on over here and sit ? Would that be easier for you ? It might be easier for us to look you in the eye. I think what we will do, if it is agreeable, we will allow each of you x> make a short statement, then we will put questions to you. Our first panelist is Mrs. Mary Alice Henry, community organizer, West Side Health Planning Organization. Mrs. Henry ? STATEMENT OE MARY ALICE HENRY, COMMUNITY ORGANIZER, WEST SIDE HEALTH PLANNING ORGANIZATION Mrs. Henry. As a senior citizen, and a long-standing resident of the jity of Chicago, I have lived to see many of the shortcomings of society ;oward the elderly. This reflects in the huge numbers of senior citizens left suffering on $kid Rows all over America. We find our Government spending more noney on trips to the moon, highways, and foreign affairs, than on lelp and health care for the elderly. The consciousness of our elected officials must be aroused and sen- itized to the fact that a worthwhile plan to make life decent for the Jderly is not only the humane thing to do, for they too, if they are lorunate, will become a senior citizen someday. Problems — I cannot say I know all the problems on aging, but I mow some of them : Some senior citizens are living with families. Sometimes it poses ill kinds of problems, such as the grandchildren being ashamed for ;heir friends to see or know them. In-laws are jealous of them to the extent it makes them feel un welcomed. Some live alone in an apartment for seniors. Some are put in homes for the aged against their will, and they have ;o agree and sign over everything they have to the home. Because they lave the three "S's", Sick, Senile and plain Scared. They feel this is he last straw — the dumping ground. Some become senile when they have to live alone without family >r friends. Some will not take part in outside activities, because they are afraid hat they may make a mistake, so they withdraw. 370 Solutions for some of the problems : Their grant should be enlarged because the small amount of money and the high cost of living makes it very hard for survival. They should be allowed a discount card. The discount card should be for food, clothing and travel. There should be a mini-bus at the senior apartments to transport them to and fro. Those who are able to work should be allowed to work as long as possible, with some stipulations. They should have a mobile store for dry goods, groceries, et cetera. Because some are feeble, to bring a mobile store to them would give them something to look forward to, and it would be a blessing. Health problems.— All over this country we have urban progress centers and hospitals. Through the centers, we could have what is] called: Service in the Community — representatives SIC. A program could be set up between the centers and the hospitals, the people could be trained with a small amount of training, to do follow- ups on the senior citizen when discharged from the hospital. Such programs could be set up from churches or neighborhood orga- nizations in the communities. These SIC representatives would have to adhere to the four "W's" : Who to see for their assignment. Where to see the patient. When to see the patient. What they are seeing him for. We had better come up with some sort of program now in this coun- try before it is too late. We can use this slogan, "Not for myself, but for those that need my service." Mr. Brademas. Thank you very much indeed, Mrs. Henry. Our next witness is Miss Dora Nelson, the founder of the American Association of Ketired Persons, Du Page Chapter No. 500. Miss Nelson? STATEMENT OE MISS DORA NELSON, FOUNDER, 33TT PAGE CHAPTER 500, AMERICAN ASSOCIATION 0E RETIRED PERSONS Miss Nelson. My name is Dora Nelson. I was trained as a profes- sional group worker by one of the pioneer teachers in that field, worked as such with three different social settlements for about 25 years, and completed my full-time working life in a food industrial firm. I have worked for 5 years as a retiree with the Division of Senior Citizens and with its predecessor, the Chicago Commission for Senior Citizens. My concern about the need for many kinds of services especially available to older adults began 25 years ago when I was director of a settlement house in Detroit and was active in both the Detroit and the National Federation of Settlements. It was in national conferences around that time that we began to hear reports and to discuss the needs for the opening and extension of a variety of services. Settlements once again were among the first to recognize a need for new social services, as they had before in other fields. At a Detroit federation meeting, we also listened to Wilma Donahue describe the new courses in gerontol- ogy, which were getting underway at the University of Michigan. Ai our own settlement, we soon discovered that our "old neighbors" had 371 more enthusiasm about the activities opened up to them than many other age groups ; they could be depended upon to attend any gathering of the group, regardless of bad weather, sometimes walking Long dis- tances, in order to come. The next progression of my awareness of the multiple, problems one faces upon reaching retirement came when I reached the early 60's myself. At that time, I had been working in Du Page County for 12 years. 1 knew my company had good benefits, but I didn't know what they were for retirees, and it worried me. It is a large and nationally known food industry, with many employees reaching retirement age every year, and one you would expect would have a program of counsel- ing for its retirees. Upon inquiring, however, and stating my feeling of need, I was told that they were aware of such programs, but did not have qualified people to lead one. Another question which bothered me was about taxes. Why should retired people on fixed incomes have to pay for schools the same 60 per- cent of their tax money as younger adults with families and still work- ing? Since we were paying, why weren't there more educational opportunities for older adults who needed to be encouraged to develop new interests; and why, for example, couldn't public education be providing courses in retirement planning in every community where there are retirees ? Do those responsible for adult education know that almost half the persons over 65 years did not graduate from high school ; more than a million of them never had the benefit of any formal schooling ? These questions I am sure are typical of many which would be raised by people who have worked all their lives and for whom work is always s^oing to be a major source of satisfaction. It is imperative for them that they develop new interests and new outlets for their energies. All of my past experience and observations give me great faith in the value of senior citizen centers and groups. Because of the multiple services which they are in a position to provide. I would hope there 30uld be such a center within the reach of every older citizen. Club groups are equally important as a way of reaching many persons who ire isolated and often are unaware of needed social services which such group contacts can help them to find. Because most of the clubs ire lead by concerned and dedicated volunteers, they need especially bo have whatever help they need to develop as wide and interesting variety as possible. Volunteers able to do this are scarce, and this, therefore, is a particular area where new resources need to be found for programing that will have an appeal for more and more individuals. By making educational resources much more available to older adults, such resources could be tapped. For a fuller presentation, I urge that you read a series of short articles just republished by Harvest Years, a retirement magazine. It is entitled "A Time for Learning." It explores educational possibilities, examines formal and informal learning methods, educational profits md pleasures, and lists ways in which seniors can apply learning to mjoy living. Publishers are located at 104 East 40th Street, New York, N".Y. My copy is attached, and I would like to submit this to you. Mr. Brademas. Thank you very much, Miss Nelson. Our next panelist is James Roach, associate editor of the Chicago Voice. Mr. Roach. 372 STATEMENT OF JAMES KOACH, ASSOCIATE EDITOR, THE CHICAGO VOICE Mr. Roach. Since I first started working with senior citiens groups and clubs some years ago, I have seen many of the problems of oldei people on a first hand basis. Through my work as president of a senioi club, and my involvement in helping found the Northwest Senior Cen ter, I have closely observed both the needs and problems of oldei people. In my present capacity as associate editor of the Chicago Voice 1 see their problems of health, housing, education, and employ men continue to escalate as the solutions dwindle. For example, you know of the rule in driving which states how mam lengths you should stay behind the car ahead of you at specified speeds to be safe. Maybe you even tried it, and had other cars travel arounc and ahead of you to fill the space you had left open. This is the cas< with efforts for seniors. Seniors are allotted additional income; the] the city taxes go up (19 percent, we hear) , so your rent goes up accord ingly.The hospital costs go up, the cost of living goes up, your socia security check has a larger deduction for medicare, and you find yoi are not still the right distance in line from those ahead of you. This situation makes income the big headache. We have heard tha 14 areas are to be discussed at the Washington conference— 14— thin. of it. In an article I wrote for the Chicago Voice, I mentioned th amount of time it takes to get just one bill through Congress— 1 yeai 2 vears, or more; and I stated that it is possible that the children oi even grandchildren of today's seniors going to Washington, may h there at a later date with some of these same 14 major problems. However, while income is usually thought of first, reading over th proposals, some get a little silly ; for instance, proposal 1 of transports tion : "The available funds should be allotted to increase the incomes c older people so that they will be able to purchase the transportatio: they need." . . Chicago has transportation— a great many smaller towns and citi< have none — none at all — and giving seniors money for transportatio is like offering money to a drowning man to help him reach the shor Now, proposal No. 2 : "The Federal Government should provide fc the development of transportation systems for all users, regardless c age." No. 2 says everything— the rest is just an effort on the part of W people who drew up the proposals to get in on the act — hogwash. The seniors going to Washington might concentrate on fewer pr< posals with more success. Did you ever have a bum come up to you and ask for money. He ge right to the point, and I wish our representatives could do likewise- or i s that out of style ? We hear a great deal of conversation these days about the genen tion gap, about seniors not understanding juniors, yet when I attende the conference in Chicago, I noticed a large number of young peopl We don't understand them or so they say, yet they go to college, g» a piece of paper which says they know all about senior's problems, ar then will be attending the Washington Conference and presume speak for the seniors. But we don't understand them or they us. If v believe the many articles on the generation gap. 373 Anyway, we had to live several years to know our problems, and they will have to also. It is slightly inconsistent. Mr. Brademas. Thank you, Mr. Roach, very much. Our final panelist is Mr. Arthur Weed, the director of the North Shore Senior Center. STATEMENT OF ARTHUR WEED, DIRECTOR, NORTH SHORE SENIOR CENTER Mr. Weed. My name is Arthur R. Weed. Since 1964 I have been consultant on preretirement preparation for what is now the Divi- sion of the Senior Citizens of the Department of Human Resources, city of Chicago. I am currently president and temporarily acting director of the North Shore Senior Center. I also am cochairman of the commission of senior members of my church, so I associate with seniors nearly every day of the week. Several months ago I was with the leaders of several local groups of senior citizens when the question was raised "What is the chief problem of older persons?" Immediately and unanimously the an- swer — "inflation." Generally speaking, seniors live on fixed incomes and any deterior- ation in the value of the dollar means a tightening of the budget. There have been, as everyone knows, increases in social security, but this source of income was never intended as the answer to retirement living. Most of those drawing pensions (and they are a relatively small percent of the senior population) are included in plans that were drawn up before such things as "vested interest" and "cost-of- living increases" were considered. Many of those who thought they were going to receive pensions haven't received them, for reasons which have been well publicized, but the majority of those who do get a pension check find that it is for the same amount as it was the first month of their retirement — and it w r ill remain that way. Re- tirees can't strike for a 30 percent increase in wages. If their reserves are in securities, these, too have decreased in value. All of which bears out the oft repeated statement "The longer you live the more likely you are to be poor." Problem No. 1 as mentioned in several pre- White House Confer- ences is income, complicated by the decrease in buying power of the dollar. i A second problem is one that isn't nearly as obvious. As Tom Col- lins, then of the Chicago Daily News, in speaking before a group in Chicago some time ago said: "In this country people do not know how to retire," At a recent American management seminar on retirement one of the participants said: "Mr. Weed, isn't the word retirement nega- tive?" In reply I said it was not only negative but to many people actually repulsive. These people do not even want to think about it nor talk about it — yet the average person who retires at age 65 has from 14 to 17 years of living for which they should prepare, The phrase "retirement shock" is now quite well understood and it is preventable. It is necessary, however, to develop a changed atti- tude toward retirement as well as recognition that 80 percent of retirees are still active. They are not senile, doddering weaklings. 374 A third comment deals with those who wish employment in their senior years. Too much stress is put on chronological age. No two people are alike at age 65. Some people never have a new idea alter age 45 while others at 80 are capable of doing an acceptable day s work Whether because of income requirements or just because they need to feel useful, there should be improved opportunities for elim- inating the discrimination against the employment of older people. Since your committee includes education, may I comment on adult education for older people? Adult courses are available in most communities, loo oiten these courses are available only in the evening— a time when many seniors for varvino- reasons, stay home. Some experimentation has been done with day classes. At the North Shore Senior Center we have no dif- ficulty in securing enrollment in day classes m Spanish, French, and German with volunteer instructors. This indicates the interest. Top priority, if advance indications are correct, will probably be o-iven at the White House Conference on Aging to income, health, and housing. It is my belief that preretirement preparation, employ- ment, and education also deserve some real attention. I Mr. Brademas. Thank you very much, Mr. Weed, and we thank all you members of the panel. . Mr. Weed, both you and Miss Nelson have alluded to the importance of preretirement education, preretirement planning. I wonder if you could give us a little more specific idea of what you had m mind, perhaps from your own experience at the North Shore Senior Center. We Weed. Do you want half an hour or 2 minutes? We have 11 things that we talk about in preretirement prepara- tion. We talk about income, which, of course, is a thing you have to talk about, because everyone says, "When I retire, will I have the same style of living I've got now?" But the big thing is, "What the dickens am I going to do with those long hours?" _ We discuss legal problems, mental health, physical health, we discuss where to live. We discuss adult education, we discuss travel. There are, in all, 11 points that we cover, and not all 11 are applicable to every individual. But some of them applicable to all, and some of them are very important, much more important than you realize Mr. BRADEMAS.We would be very grateful, Mr. Weed, if you should find the opportunity to send us that list Mr. Weed. I would be very happy to. Mr. Brademas (continuing). And supporting the attitude that you have. Mr. Weed. It has been reprinted several times already. Mr. Brademas. All right. , Miss Nelson, would you care to continue on that point? 1 woulc like to monopolize the questions, but it wouldn't be seemly of me tc do so, so I will turn it over to Mr. Hansen. Mr. Hansen. Thank you, Mr. Chairman. Let me inquire about another aspect of the education need of botr of you, and this relates to the opportunities for education per se. J might observe that some years ago, over a period of years, I taugnl adult classes at the university level. They call it continuing educa 375 tion now. A number of my students were retired persons. Many had not been in a classroom for ;K) or 40 years. One of the most reward- ing experiences was seeing these older people, who didn't think they could learn any more, come into a classroom and master the ma- terial and do superior work. The transformation in the individual, in his assessment of himself, it seemed to me was one of the great values of this kind of education. Now, let me ask each of you, or any of the others that may wish to comment, through which institution or means can we best provide the opportunities for this kind of educational service — universities, col- leges, other educational institutions? Miss Nelson. I would like to speak to that, because I feel it is needed on all those. There are all kinds of peoples, all kinds of interests and backgrounds. Some will be able to get themselves to the universities where there are continuing education classes, and I speak particularly for the ones who are, for some reason, like classes that aren't available in the daytime, they may cost more than they are able to afford, or if they present it on too formal a level, it is not right for a great many people ; it is my belief that there is a great deal of experimenting — experimentation that needs to be done in the way of informal educa- tion and other methods of education which will have a, real appeal and make this subject, whatever it is, come alive to all kinds of people on all levels, whether training or retraining — it could be just hundreds of different subjects, but it is very important that the person who teaches such courses be someone who can communicate with the students. Mr. Hansen. It strikes me, I might say to the chairman, that this is a very fruitful area for the proposed National Institute of Education which we hope to authorize on the floor of the House tomorrow, to focus its energies. Thank you, Mr. Chairman. Mr. Brademas. Mrs. Henry ? Mrs. Henry. Mr. Chairman, I would like to speak to that, now, you take some of the people, they can't afford to attend universities, they can't afford the transportation, but I feel that if we had a course like this in the neighborhood, where you could reach the people, I feel it would be better utilized ; we should have teachers who help these peo- ple come to where some of the people live, especially in the neighbor- hood where I live ; I live in the university of a ghetto, so maybe that would be the university where the people can come ; if we would have teachers and instructors come to teach the people there, it would be a great help to the people. One thing, we have to make them feel that they are people, they are somebody, and we could utilize the service for them, Mr. Weed. One more comment : I happen to be on the advisory com- mittee of one of the city colleges of Chicago, and that particular col- lege is scheduling classes through the year in several different areas. Mr. Brademas. Mr. Meeds ? Mr. Meeds. Thank you, Mr. Chairman. I have been attempting to restrain myself all morning, but I can't let the occasion pass without getting off a good partisan dig, and therefore I should seize upon the statement of Mr. Weed with regard to the inflation problem : Not that President Nixon is totally responsible because we had some inflation 376 in the Democratic administration, but one-third of all the inflation we have had in the last 12 years occurred in about the last 26 months, and I think it has been one of the most harmful and hurtful things to the older Americans that has occurred. Clearly, people who are on fixed incomes, confronted with the inflation problems this country has been in, particularly in the past 30 months, are really placed in a dis- advantageous position, and I am very happy to note that the President has finally taken our advice, and put on pricing controls, and I hope that this will bring inflation under control. Mr. Brademas. I am sure I voice the appreciation of my colleagues when I say to all of our panelists here how very grateful we are to all of you for having prepared these thoughtful statements, and for having answered our questions and come up with further observa- tions, and I hope you feel free to send us off any further information that you feel might be helpful to us. Thank you very much indeed. Now, the Chair wants to observe that there are three other witnesses, so what I would like to suggest is the following, especially to Dr. Harrison and Miss Connolly. We have your statements, so would you allow us to begin putting questions, or would you like to give us a 1- minute summary. Dr. Harrison. I can give you a 1-minute summary. Mr. Brademas. All right, Dr. Harrison. This is Dr. G. Lamar Harrison, director of the Chicago senior aides project. STATEMENT OF DH. G. LAMAR HARRISON, DIRECTOR, CHICAGO SENIOR AIDES PROJECT (The prepared statement of Dr. Harrison, follows:) Prepared Statement of Dr. G. Lamar Harrison, Director, Chicago Senior AIDES Project The Chicago Senior AIDES Project is part of the National Senior AIDES Program of the National Council of Senior Citizens. The National Council chose to call the Program "Senior AIDES," the latter word an accronym: Alert, In- dustrious, Dedicated, Energetic Service. The program has two primary functions : To provide socially useful part-time employment for low-income elderly per- sons; To improve and expand existing community services and to create new services. The Executive Director of the National Council of Senior Citizens states that, "Underlying these objectives was the intent to develop a model for an effec- tive National Senior Community Service Program." The original contract provided employment for a total of 400 elderly per- sons — 40 persons in each of the 10 community projects. Since the beginning in June 1968, the number of projects has increased to include 19 cities and communities employing an average of 60 Senior Aides each or a total of approxi- mately 1140 senior citizens. The Chicago Senior AIDES Project is funded by the United States Depart- ment of Labor through the National Council of Senior Citizens and is sponsored by the Chicago Committee on Urban Opportunity (CCUO) which pays the Ad- ministrative cost and incidental expenses. CCUO has contractual arrangements with the Hull House Association, the Jewish Vocational Service, the Welfare Council of Metropolitan Chicago, and the Illinois State Employment Service — all of which are nonprofit agencies and serve as host agencies of CCUO. The purpose of the Chicago Senior AIDES Project is the same as that of the National Council's program. Chicago was allotted 60 Senior Aides. Each Senior Aide may work an average of 20 hours per week — usually 4 hours per day 5 377 lays per week. They arc paid $2.15 per hour. Those under the age of 72, who lraw Social Security, may continue to draw same without penalty until they ■arn $1,680 per year. Any earning above $1,680 per year by a Senior Aide under '2 is subject to (he regulations of Social Security which provide that "$1.00 n benefits will he withheld for each $2.00 earned up to $2,880. In addition $1.00 n benefits will be withheld for each $1.00 of earnings over $2,880." IN-SERVICE TRAINING The sponsoring and host agencies agree to provide Senior Aides with "On-lhe- ob Training" and assist them in preparing for and securing full-time or part- ime employment in the competitive labor market. To date approximately 10 >er cent of the Senior Aides employed in the Chicago Senior AIDES Project lave accepted full-time employment. However, I do find that the majority of the Senior Aides prefer to continue to work 20 hours per week as Senior Aides •ather than to become full-time employees at 40 hours per week. In addition, here is now considerable unemployment of persons of all ages — thus increasing he need for part-time employment for Senior Citizens. The Senior Aides in Chicago work in a wide variety of job assignments or ob classifications. They work under at least 26 job titles. See page 5. The sponsoring and host agencies employing Senior Aides make monthly re- torts to the Project Director. They are highly pleased with the Aides and their >erformance. The following are a few typical quotes taken from the monthly reports from igencies that employ Senior Aides : "Overall, the impact of the jobs upon Senior Aides have been extremely avorable." "These workers have gained a new confidence and a strengthening of self :onfidence." "In several instances, the Senior Aides position has been a ladder to successful ull-time employment." "The work assignments to Senior Aides and their willingness and often en- husiastic response is most gratifying." "The Senior Aides program has bestirred senior citizens as a whole and they ire becoming emotionally involved in what might be stated as a new lease on ife." Almost all Senior Aides are enthusiastic about their work and are pleased vith their assignments. The following are statements by Senior Aides : 1. This work has done much for me both physically and mentally. It makes ne feel wanted. 2. This job was heaven sent. I don't like accepting money I don't work for. 3. I felt rejected before I got this job. Now things look bright. I like what I im doing and I have learned to operate a computer. 4. I had given up and resigned to a dreary life. I feel much alive now and I im thankful for the job and I hope I will never have to leave it. 5. My work as supervisor of tutors has been rewarding far beyond the monetary jain. Of course the extra money has been a boon but helping inner city children las rejuvenated me. SUMMARY Since the Chicago Senior Aides Project began in July 1968 a total of 121 Senior Udes have enrolled and 61 have been terminated — thus leaving 60 presently employed. Of the 61 who have been terminated approximately 15 per cent accepted 'ull-time employment, 18 resigned because of illness, 8 moved away and the •emaining 26 resigned for a variety of reasons. With three exceptions, all Senior Aides have been rated by their supervisors ! rom good to excellent. These supervisors and other non-profit community sendee agencies are constantly asking for more Senior Aides. There are now 46 women and 14 men serving in the Chicago Project. The women *ange in age from 57 to 84 years and the men range in age from 59 to 85. Based on the inquiries we receive, the requests for Senior Aides, statistical lata from the Census report, and my experience with the program, it is my belief ;hat Chicago could employ several thousand Senior Aides in useful and mean- ngful part-time community service jobs if funds were made available through Congressional action- 378 The senior aides are assigned to the following jobs : Clerical work | Storekeeper ~ Clerk typist * Multilith operator File clerk * Record clerk . £ Information attendant - Assistant urban life interviewers Assistant program representative j Assistant community representative 1 Switchboard operator Employment clerk Assistant supervisor j Production control I Quality control j Statistical record clerk j Job inspection J Foliowup in research Inventory control Neighborhood worker j Program aide ' Teacher aide t. Clerk receptionist ; Community aide j Office aide * Division secretary Dr Harrison. One of the purposes of the senior aides program is t( provide socially useful part-time employment for low-income elderly We have a limited program; we have only 60 persons assigned in th< city of Chicago. I think a previous witness told you how many senio: citizens there were in Chicago, and almost 15 percent of those fall n the low-income bracket. We work with nonprofit agencies. We have a contract with the Wei fare Council of Metropolitan Chicago, Hull House Association, anc of course, we work for the Illinois State Employment Service, anc the Chicago Committee on Urban Opportunities sponsors the program Now, the program is financed by the National Council of benio: Citizens through the U.S. Department of Labor. . ; ,, , We employ those persons at $2.15 per hour ; they work about 4 hour a day, 5 days a week. The program is such that it enables the person 1 do an excellent job in their respective fields, and at the same time l does not overtax them. It enables them to supplement their earning in such a way that they feel that they are making a contribution. If you will look at the various job titles under which they work you will find that they work in a variety of very constructive ways and the reports from all of their supervisors are excellent reports oi more than 100 persons, only three have been classified as unsatisfac tory. The statements by some of the senior AIDES themselves include, here, I think, give the type of feeling they have. For those who nav been given an opportunity to earn a decent living— it means muct Now they only earn $2.15 an hour and are paid approximately $2,10< a year, but that means so much to them. Of course, they continue t draw social security, and when they earn over $1,680 per year the. social security is withheld according to the social security formula $1 for every $2 earned, but that still enables those persons to live in I much better way than they lived before. 379 Now, we also worked out a program to have on-the-job braining. Rome retired persons, if they wish, we try _ to put them in a full-time position, but we know that the overwhelming majority would rather continue to work on a part-time basis, 20 hours a week rather than 40, and earn less. I think the 40 hours a week is just a little bit hard on many of them. It doesn't bother me, although, incidentally, I am a senior citizen, but I go to work at 9 every morning and get off at 5. But that is not true of many of your senior citizens. Part-time employment, in my opinion, would do much to encourage those persons. Mr. Brademas. Dr. Harrison, let me interrupt and put a question to you, if I may. Is it my understanding that the Federal Government provides a certain amount of money and the employer provides the rest of the money ? Is that the way it works ? Dr. Harrison. Yes. Mr. Brademas. And what you are really asking is that there be greater Federal investment in order to make it possible to hire more than 60 out of 600,000 people ? Dr. Harrison. That is right. Mr. Brademas. People in Cook County? Thank you very much. Mr. Hansen, do you have something ? Mr. Hansen. No questions. Mr. Brademas. Mr. Meeds ? Mr. Meeds. No questions. Mr. Brademas. Well, that is a laudable project, Dr. Harrison, and I hope we can be helpful in generating some support for it. Thank you very much. Our next witness is Miss Jane Connolly, director of Senior Centers of Metropolitan Chicago. Miss Connolly ? STATEMENT OF MISS JANE CONNOLLY, DIRECTOR, SENIOR CENTERS OF METROPOLITAN CHICAGO; AFFILIATE, HULL HOUSE Miss Connolly. Thank you, Mr. Chairman. I see you have my written testimony, and I will be very happy to forgo reading it or giving a synopsis. Would you just go ahead with the questions? Mr. Brademas. Yes. (The prepared statement of Miss Connolly follows:) Prepaeed Statement of Miss Jane Connolly, Director, Senior Centers of Metropolitan Chicago, Affiliate Hull House Association A culture chooses whom it will help and in our technological, youth oriented society the aging have been dealt out. Many years ago somebody said (I believe it may have been Jonathan Swift) "All men would live long but no man would be old"! After almost six years of working exclusively in the field of Aging I know exactly what he meant. As a culture we have preferred not to think about aging, individually we deny it as long as it is possible and the end result of not facing up to and not planning for it has found us in a serious crisis. At least forty percent of our aging population are living under the poverty level. It is my belief that the most crucial problem facing our aged today is lack of adequate income. This inadequacy leads to other problems — housing, medical care, the gamut. The income deprivation of the aged while statistically significant is even more appalling in reality. Agencies in the service network are finding aged clients who are the poor grown old and more and more we are finding clients who are the old grown poor. These people have outlived their equity; inflation has made it impossible for them to manage on their retirement incomes ; and in many cases has forced them to apply for public aid supplementation. Supplementation of 71-272— 72— pt. 1- -25 380 income helps but rarely resolves their problem, for while public welfare can theoretically provide income supplements, in fact the highest budgets it permits are extremely low in relation to living costs. My former agency, The Information Center for the Aging, where our purpose was to refer the aged to the appropriate resource and to carefully monitor what happened to them, clearly documented that the present public welfare system is extremely impersonal and inefficient and for these reasons failing to help those people needing help. In the network of public and private agencies that now exist in our metro- politan area, parachialism prevails. The aged client goes to one agency for finan- cial assistance, another for medical services, another for casework counsel- ing, etc. The traditional patterns for delivering services are not sufficiently com- prehensive to cope with the multi-problem situations so often experienced by aging clients. The delays in the delivery of even these inadequate services are unbelievable. Too often traditional agencies insist on attempting to adopt people's needs to their available services. We must all immediately begin to adapt our services to people's needs. We are now faced with two problems — the first — to provide the services needed by our present aged population immediately ; the second — to begin long range planning for the future generations of aged so they will not experience similar dilemmas. This will not be easy, for we are now forced to establish serv- ices and move forward to meet the needs at a time of increased demands for services and limited funds (both public and private) for implementing them. It will not be easy — but somehow it must be done. My own expreince gives me confidence in the efficacy of the Older Americans Act Title III grants, administered through the Illinois Department of Public Aid' State Council on Aging. I am familiar with these grants because I have been responsible for three of them, the first was the Information Center for the Aging under the sponsorship of the Welfare Council of Metropolitan Chicago and presently, as Director of Senior Centers of Metroplitan Chicago, I am respon- sible for the direction of two Title III grants— the Lakeview-Uptown Outreach project and the Lakeview Get Together-Mini Bus project. I believe these projects vividly demonstrate what can be effectively accomplished when government and voluntary agencies work in tandem to resolve human problems. The Senior Centers of Metropolitan Chicago philosophy is that the role of Senior Centers is more than providing a piece of life's pleasures and new social roles for the "well" aged, but that to truly be a center for the aging we must radiate in all directions, providing paths of easy entry to our centers for those able to come and at the same time to provide outreach services to those less fortunate, isolated aged unable to come. It has long been known that persons with equal levels of disability are found in and outside nursing homes, the major differentiating characteristics being the availability of , financial means and of supportive services in the community W r e have found that the combination of our voluntary and public funds has mum it possible for us to improve our service mix and most importantly has helped us maximize service to the impaired aged and enabled them to remain in theii own homes. It is a horrifying thought that should Title III grants cease in the next year we will have to cut back our services and many of our aged clients will be without any alternative but to be placed in nursing homes. We can no longer afford to think in terms of three or five year grants where services are successfully demonstrated and then cease when government fund- ing ends. There must be increased and joint long term planning between the public and private sectors — with the end result — an improved integrated sery- ices delivery system. Private agencies will become greater resources for the public agencies that need the kind of services they have to offer. An example of the paradox of some of our present planning is our own Home Delivered Meals program. Hull House cooperated in the Home Delivered Me als project that emanated out of the Welfare Council of Metropolitan Chicago At the end of government funding of the project, Senior Centers of Metropolitai Chicago, Board, Staff and Volunteers determined to keep the program going 01 the basis that no alternatives existed for the clients except institutionalization A private contribution of $2,000 to help continue the service, plus permission t( utilize the Title III Mini-Bus to help in delivering spurred on the desire not t< The meals program presently runs at about a $6,000 annual deficit. Senior Cen ters Board of Directors works diligently to attempt to cover this deficit. Many o: the "meals clients" are Public Aid recipients. The costs for those meals is aboul 381 4.00 per client per day. Under the present Public Aid system they can pay only MBtauranl allowances for home delivered meals which Is $1.07 dally, [f Senior Jenters decided they could no long operate this program Public Aid would have i) pay for institutional care for the majority of their clients, it would seem much lore rational for Public Aid to pay for the actual cost of services as they musl do or institutional care, [f these inequities were corrected It might end the dearth of ome health services in the community. Summarily let Die end this testimony with the hope that any complaci ncy be estroyed by the revelation that much more is needed and that all the aged who eed help are not getting it ; with the hope that dedicated purpose and concern ill find creative new approaches to unsolved human problems; and with the ope that government and voluntary agencies and lay committees, can blend ex- ertise and influence, and vigor, in solving prohlems too Ion;.; ignored or tolerated. Surely we can and must develop pluralistic systems and organizations that are oth responsive to the needs of the consumers and capable of delivering the ariety of services that are fundamental to more dignified and independent living )r our aged. Mr. Brademas. One of the questions T would put to you I put to other ritnesses, the question, namely, of the most effective delivery system, ssuming that we run a program of comprehensive services for the ging. How do you visualize the delivery system that would involve lie State government, the county government, the municipal govern- lent, and/or private and voluntary agencies? Miss Connolly. I would prefer the Federal Government provide loney through the State and local governments, in tandem with the oluntary agencies. Mr. Brademas. If you were to single out the major problem you have bserved in your work with the older Americans here in Cook County, T hat is the biggest headache you have encountered ? Miss Connolly. Lack of adequate income. Mr. Brademas. Lack of income. Have you found sufficient respon- iveness on the part of the city administration to the problems of the Lderly? Miss Connolly. We have cooperated with the division of Senior Jitizens of the Department of Human Resources in working with the lderly, and look forward to doing more with them. Mr. Brademas. Thank you very much. Mr. Hansen ? Mr. Hansen. Thank you, Mr. Chairman. In looking toward possible solutions to what I think is generally onceded as the No. 1 priority problem, that is lack of income, where o you see the most promising sources of income, to the extent of icome opportunities that might be created versus income that may ome from social security benefits, pension plans, et cetera ? Miss Connolly. I think social security and private pension plans mst be improved. Employment is important, some people aren't iterested or able, others are, and employment is not realistic for all ur aged. Mr. Hansen. To what extent would greater employment opportuni- ies alleviate the problem of lack of income ? Miss Connolly. It would to a considerable extent. I employ aged lyself and I see the benefits of this, but there are many aged who are .ot able to be employed. Our longevity now is taking people up into the ighties, early nineties. This is unrealistic for them, and if we put verything into employment, this would mean these people would have 382 no choice but to go into institutions. So I would like to see a broader based kind of thing through social security or pension. Mr Hansen. And I gather from the thrust of your last comment that you would like to see the employment opportunities develop Miss Connolly. For those who are able. Mr. Hansen. And who can make a free choice ? Miss Connolly. Eight. Mr Hansen. But for those who are able and want to be employed then you would agree that there is a real problem in making opportu nities available? Miss Connolly. Yes. Mr. Hansen. Thank you, Mr. Chairman. Mr. Brademas. I wonder, before I call on Mr. Meeds, if you can tel me Miss Connolly, you say in your statement at least 40 percent of ou aging population are living at a poverty level. You have direct refer ence to what, Cook County or what ? Miss Connolly. This was national. Mr. Brademas. National. m , One other question : You have experience m title 111 grants 5 Miss Connolly. Yes, I have. Mr. Brademas. I judge from your testimony that you are distresses at the prospect that those funds will be terminated? § Miss Connolly. Yes, with nothing in their place, right. Mr. Brademas. Mr. Meeds ? Mr. Meeds. No questions. . Mr. Brademas. Miss Connolly, thank you very much indeed for you testimony. We appreciate your coming. J| Our final witness today is Mr. Murray Berg of the bchwab Kenabii tation Hospital, who is also a member of the Conference Committee o Behabilitation. Mr. Berg, we look forward to hearing from you, sir. STATEMENT 0E MURRAY BERG, EXECUTIVE DIRECTOR 0E TH SCHWAB REHABILITATION HOSPITAL, MEMBER 0E THE C01 EERENCE COMMITTEE ON REHABILITATION 0E THE ILLIN01 HOSPITAL ASSOCIATION Mr. Berg. Mr. Chairman and members of the committee, I appei without a written statement. I was requested to appear at the la moment, and somehow I found myself somewhat like a wound-! toy, I got ready to go and here I am, to present to this committee ai to members of the assemblage an issue, while it is not directly ai specifically related to your legislative function, I should appeal your advocacy role in behalf of the elderly. J It relates to the matter of the reimbursement denials to renabilit tion hospitals, and the restrictive limitation of rehabilitation servic under medicare and the process of retroactive denial of payments f rehabilitation services, due to a reinterpretation of medicare la Now, it is one thing to relate, acknowledge and ignore the burd of the elderly, and I think we have heard a lot about that today. is another thing to contribute knowingly to the burdens. Certainly t reversal of policy which we have been seeing in the last period of tir 383 las added to the credibility issue, the credibility of Government with Epect to its public policy position. In this connection I thought that perhaps for presentation. the nost poignant way to proceed with this matter is to read excerpts i rom fcrespondence, and I will do that expeditiously. I thought it would )e a summary w T ay of getting the message across, and then to make a pry brief statement at the end. . In February of 1971 I wrote the following letter to the director >f the Chicago Hospital Council, and copies went to representatives, Senators, and other interested parties: I am writing to bring an urgent matter to your attention for action. It. has >ecome clear from discussions with representatives of the Social Security Ad- ninistration and fiscal representatives that a retrenchment policy with respect ;o patients for rehabilitation services in general hospitals and rehabilitation lospitals is under way. Under the strict interpretation of the Medicare Act, ;he Federal Government has the evidence they need to reduce heretofore accepta- ile and, in fact, encouraged medical programs. We are now confronted by the fame of redefining previously acceptable criteria which is the instrumentality of >fficialdom, which has been instructed to retrench its services, in the interests >f rehabilitation medical service. The device which will be utilized is lack of specfic reference to this area in Medicare regulations. The implications are clear. Every hospital which maintains a program of rehabilitation and every rehabilitation hospital will face being scrutinized to ietermine whether patients fit an increasingly narrowly conceived definition of icute illness and need of hospital medical care. With professionalized hospitals [ike Schwab ind incidentally I would like to make mention here of the Relocation [nstitute of Chicago, The Institute of Physical Medicine, Eockford Memorial Hospital in Rockford, Holy Cross Hospital, and a host of other hospitals which have in the last 10 years devoted themselves to the development of this service— are confronted by this problem. With professionalized hospitals like Schwab Rehabilitation Hospital, any serious question of eligibility for Medicare payment will precipitate a financial crisis, since approximately 30 percent of the population falls into this category. Isn't it pardoxical and tragic that at a point in time where we need the room, that it is the need of elderly to become the victims and scapegoats of Federal fiscal policy? I am sure that any hospital with a program of rehabilitation will regard this situation as alarming. No hospital can budget an overall program in such a way that the balance of income from surviving programs can compensate for the loss of revenue in other areas. That was in February. I would like to read from a letter sent by Mr. Marita, the ad- ministrator of Holy Cross Hospital, to the Honorable Adlai Steven- son, with copies to Senator Percy and others : For several years this hospital has operated one of accreditations for re- habilitation facilities in the State of Illinois. The function of such facilities is to restore victims of crippling disease or injury to the fullest degree of independence permitted by their condition. We are very proud of the fact that many peoplfc today are pursuing active lives because of the facilities like ours that exist. Today the continued existence of your rehabilitation is being threatened be- cause of arbitrary and discriminatory rulings which have retroactively denied payment for rehabilitation services to Medicare patients. In recent months the dollar amounts of such denials total nearly $50,000. I should like to state as testimony that we haven't documented as of this moment the totalitv of the numbers of patients, the numbers of dollars and the reasons for the denial — that is in process — but we esti- mate that it is in the millions' that it is affeetinp; lives of hundreds of 384 elderly persons who are being subjected to a discriminatory practice in terms of medicare funds as against, let's say, younger patients whc are qualified under private insurance for whom the same services an being rendered. In denying these claims the position taken by the Social Security Administra tion seems to be that the rehabilitation services could have been provided outsid< the hospital. This indicates an appalling lack of understanding — And he goes on to describe in some detail what the rehab facility does in the terms of its medical program and resources. He then present! two eases, case histories that we find are a tragedy, because everj elderly person had for 5 years the benefit of rehabilitation services unti there has been a reinterpretation of the regulations of the act, and ir these two instances — a patient, age 69, was admitted to the rehab uni with a stroke, with no ability to speak, weakness in the left leg, and s< forth. After 15 days of full treatment the patient was rehabilitated The person went home and pneumonia, which was present at the time was cleared up. The entire bill of $1,490 was denied, and subsequently had to be presented to the elderly person. Now, maybe this is a good fiscal policy but the corollary is substitut< for pneumonia for stroke is not the answer, if I was to handle tin- elderly person. Now, this situation has endured, with documentation reaching i foint of the volume of material that you have before you, and wha hoped to achieve today was to bring this most serious situation t< your attention as Congressmen concerned with the problem of olclei persons, and present this so that the establishment would have som< estimate of what is going on. The matter has not as yet received wide publicity, as the number! involved are not as yet great, but it does represent a serious turn around of a promise that was supposed to have been the delivery of thi older population in the area of catastrophic expense and illness. Most recently a resolution was introduced before the Nationa Rehabilitation Association, it was passed by the body on October 12 in which the delegates voted to bring the resolution to the direct an( immediate attention of Congress, the Secretary of Health, Education and Welfare, in which it was urged in the strongest terms that i present and reasonable interpretation of health, insurance be re evaluated and rehabilitation be covered under Medicare. I know that you will in your deliberations recognize the relationshij of this area, the more specific area than is covered by your charge Mr. Bradem as. Thank you very much, Mr. Berg. Let me commen only in response to what you have said that this subcommittee ha! jurisdiction also over the Vocational Rehabilitation Act, and certainb we shall be heading into the vocational rehabilitation legislation som< time, I assume, early in the next session. I simply would like to assur< you that we shall indeed take into account the problem that you hav< brought to our attention. Mr. Hansen ? Mr. Hansen. No questions. Mr. Brademas. Mr. Meeds ? Mr. Meeds. No questions. Mr. Brademas. Thank you very much, Mr. Berg, and the Chair wants to reiterate our appreciation to everyone who has attended thes< 386 hearings, and especially Mr. Ahorns and all I hose who have helped us arrange them. The Chair also wants to invite all those who may wish to do so as to fool free to send us a statement, or any comment or tetters 1 hat i hey may wish to send for inclusion in our hearings. (The following material was submitted for I ho record:) Chicago, III., December 11, 1911. Hon. Joiin Bbademas, Chairman, Committee on Education and Labor, Select Subcommittee on Educa- tion, U.8. House of Representatives. 1. Clippings — newspapers since November 2nd — showing that even limited existing Adult Education classes are in jeopardy. 2. Sample of contribution to Education: (no personal return). Multiply this by 20,000,000 over 65 who have been making similar contributions in taxes alone on their dwelling place. Property tax paid on home bought at age 55 — still working full time $195 Property tax paid on home bought at age 65 — forced to retire because of age 286 Proi>erty tax paid on home sold at age 72 — 150% increase since purchase 492 Moved to apartment in October 1970, signed lease, monthly rent 159 October 1971, 12V 2 percent increase, monthly rent 179 With notice of additional to be due one year later 189 Reason for increase included property tax increase of 25%. Not known how much for additional for education next year. SUMMARY OPINION After reaching 65 — a person should be exempt from any tax increase unless their income is proportionately higher. Allowable exemption should be for other increases in cost of living. Older persons without jobs and with increased leisure time, need to be encour- aged to engage in a widening range of educational opportunities. Such courses should be available to them as free adult education and offered under conditions appropriate to the needs and interests of many older adults. Thank you for providing an opportunity for these additional remarks. It has been a satisfaction to me just to formulate some of my feelings on this subject. (Miss) Dora Nelson, Retired Social Worker, Business Woman, ( Organizer of AARP Chapter 500 while residing in a Chicago suburb). End Adult Education? Chicago — If it approves the proposed school budget, the board of education will eliminate all adult education classes at the end of this year. This is not just talk — it is for real. Anyone who has attended these classes knows how invaluable they can be. As taxpayers attending classes is one of the few ways you can directly feel the bene- fits of your tax dollar. Taxes will not be decreased by not having adult education classes. It just means the adult student will pay more in tuition somewhere else. He may not have the same job opportunities open without that education. Those interested had better bring pressure to bear in the right places now. "Save Adult Education" (By Raymond Carleton and Mayris Perlman) Chicago — If the Board of Education locks its doors to the more than 30,000 adults who are attending evening classes, it is anticipated that less than a third of the program can be salvaged by other educational institutions. The board will 386 have saved 2 million badly needed dollars, but Chicago will face a tragedy of major proportions. In our rapidly changing economy, automation inexorably wipes out simple jobs and puts a premium on education. Altho the number of people unemployed have more than doubled in the Chicago area during the last two and a half years, Chicago's unemployment rate is low when compared to that of other major cities — and the percentage of people on welfare is still only about half that of New York City, for example. However, if free educational opportunity is reduced, the wel- fare rolls will inevitably lengthen and the increased financial burden on the tax- payers of the city, the county, and the state will not be measured in millions of dollars but in hundreds of millions. We therefore call upon all agencies of government to work together to sup- ply the board with the $2 million needed to keep the doors of opportunity open. Failing this, we call upon public-spirited foundations and private citizens to come to the rescue of the future of our city. A dollar spent on education today is a hun- dred dollars saved in welfare costs tomorrow. End Adult Education? Tragedy for Blacks (Vernon Jarrett) You probably don't remember Willis Clayton Jr., that small, sad but visibly durable black man who appeared too stunned to cry after the murder of his son during a South Side gang recruitment drive three years ago. If you don't recall that incident, it's not entirely your fault. There have been so many murders in that category and they have been glossed over so easily by people in leadership positions that the murder of a 15-year-old black honor stu- dent can be accepted with a "too-bad" shrug as we go about our business as usual. . . , _. And were it not for the fact that a part of my business is remembering ordi- nary things, I, too, would have forgotten this man named Clayton whose picture appeared in the newspapers. I recall that nonplussed expression as he pondered the slaying of his first born, Willis III. He seemed to ask all of us— all of us— a battery of questions that we need to be asked today : A LACK OF HUMANITY "Do human beings count anymore?" he seemed to ask. "Do you realize that w« live in a society in which a boy is eating dinner with his mother and father anc his sisters and brothers and minutes later he is face down in the street with £ bullet thru his head— and nobody seems to care." Maybe Clayton didn't ask those questions out loud, but months later he tolc me how he was confused by the public reaction, and he included black leader ship. He knew that if his son had been killed by a white person, the slaying would have become a cause celebre. But since this was a black-on-black murder, it was soon forgotten. Uaytoi said he received no sympathy from even those black crusaders who have spokei so well against genocide. Clayton recalled that the only prominent black to show sympathy for him wa; Dr. Andrew Thomas, president of the Cook County Physicians Association. A the same time, when he would look on television or at the newspapers, he woulc see some of the most vocal black "crusaders" in apparent support or "working agreements" with street gang leaders. He knew most whites didn't care. Bu blacks ? Clayton, a very serious man, was terribly confused by all he saw during tha indescribable period. Shattering Hopes or Saving Dollars? (Vernon Jarrett) It appears that the public schools of Chicago have been given a tentativ reprieve by the Chicago Board of Education's willingness to "borrow" enougl money to keep the school doors open until next June. But the issue of educating the people of Chicago is far from settled even on a temporary basis. 387 It seems that 8 most worthy face! of the educative process will he dropped from consideration in the new scheme of financing public education, On page 77 of the board's projected budget Cor L972 you will find these words: Evening Schools: "planned appropriation, none." A.N0THEB iri'.M On page 93, item No. 7 is this recommendation: "reduce adults programs, eliminate evening schools, and Americanization programs." This means that around 30,000 adults, attending 37 evening schools, simply will have to teach themselves— you know, the old bootstraps axiom— if they are to improve their capacities to earn a living, interpret life, and become better [Several years ago I was passing Wendell Phillips High School and noted streams of 'adults rushing up the steps of the 39th Street entrance to the school. I a^ked a very fast-walking man if there were some sort of entertainment going on or a protest rally scheduled, since most of the people appeared very serious. The man grinned and said he reasoned that it was a protest meeting in a way of speaking because all of them were trying to prepare themselves to get more I followed the crowd into the school and it suddenly dawned that here was one aspect of the "ghetto experience" that rarely received any public mention. There were adults who appeared to be from 21 to 80 years old trying to graduate from high school. ' George Harris, retired president of Chicago Metropolitan Mutual Assurance Company, a famous black life insurance firm, had a similar experience. He was the graduation speaker a few years ago at Dunbar Vocational High School, and the sight of so many adult blacks triumphantly receiving their diplomas and certificates brought him to tears. m And it nearly caused a similar reaction in me when I visited with Richard hi. Stephenson, principal at Dunbar, last week. It was really something, the sight of tired, hard-working men in their forties rushing to the wash room and patting their faces with cold water in order to stay alert during their evening classes. Stephenson recalled that one of his most inspiring moments came two weeks ago at a bowling alley. A successful black filling station owner introduced himself as a former student who received a "second chance" thru the evening school. Stephenson says the closing of these classes will amount to a tragedy that cannot be measured. In agreement is Dr. Herbert Lehmann, Board of Education assistant superintendent for education extension, who over 40 years ago attended evening classes at Carl Schurz High. He said : "With the state of literacy being what it is in this city, the evening program is indispensable to the welfare of Chicago. Slightly more than 00 per cent of all adults over 25 years of age within the corporate limits of Chicago lack a high school diploma." THE VITAL QUESTION The present situation projects certain important questions for Chicago : What will happen to the 10,000 taking evening credit courses leading to diplomas? What about another 7,000 in vocational training classes? What about the 13,000 in Americanization classes [including 4,000 Spanish-speaking newcomers who are learning English] ? And what about that apprentice training program estab- lished at a Washburne Trade School after a long, long hassle over the race issue with the trade unions? But maybe the real question is: How many Chicagoans really care? Adult School Gets Reprieve; Students To Return Jan. 3 (By Jack Houston) All Chicago adult evening school students will be expected back in their class- rooms in January after a one-month closing starting tomorrow. Last week the Chicago Board of Education voted to keep the classes open until the end of the semester. Whether the evening program, which has been in existence for 90 years, will continue after then is yet to be considered by the board members. 388 Supt. James F. Redmond has recommended all adult evening classes be eliminated as an attempt to balance next year's budget. Classes will end tomorrow because of the early closing of Chicago schools to save money, but will reopen Jan. 3. The board meets tomorrow to begin considering Redmond's budget for next year. The board voted at its last meeting not to discontinue any school program until the end of the first semester. The action was taken "to quiet rumors that the evening school was to be discontinued." Tho Redmond has recommended the cut, the board has not con- sidered his recommendation. Actually, no program could be cut from the schools unless the board voted to discontinue it, but school personnel connected with the evening school program reportedly had been telling their students not to return in January. The board's action made it clear there would be no cutback in any program until the new budget is adopted at the end of January. Redmond estimated it would cost between $5 million and $6 million to carry the evening program through January. When the board adopts the new budget, it will have to adjust the budget to take care of the January expenditures. Statement by Miss Dora Nelson, Founder, American Association of Retired Persons, Dupage Chapter No. 500 My name is Dora Nelson, I was trained as a professional group worker by one of the pioneer teachers in that field, worked as such with three different Social Settlements for about 25 years, and completed my full time working life in a food industrial firm. I have worked for 5 years as a retiree with the Division for Senior Citizens and with its predecessor, the Chicago Commission for Senior Citizens. My concern about the need for many kinds of services especially available to older adults began 25 years ago when I was director of a Settlement House in Detroit and was active in both the Detroit and the National Federation of Settlements. It was in national conferences around that time that we began to hear reports and to discuss the needs for the opening and extension of a variety of services. Settlements once again were among the first to recognize a need for new Social Services as they had before in other fields. At a Detroit Federation meeting we also listened to Wilma Donahue describe the new courses in Gerontology which were getting under way at the University of Michigan. At our own Settlement we soon discovered that our ''Old Neighbors" had more enthusiasm about the activities opened up to them than many other age groups ; they could be depended upon to attend any gathering of the group regardless of bad weather, sometimes walking long distances, in order to come. The next progression of my awareness of the multiple problems one faces upon reaching retirement came when I reached the early sixties myself. At that time I had been working in DuPage County for 12 years. I knew my company had good benefits but I didn't know what they were for retirees and it worried me. It is a large and nationally known food industry with many employees reaching retirement age every year and one you would expect would have a program of counselling for its retirees. Upon inquiring, however, and stating my feeling of need, I was told that they were aware of such programs but did not have qualified people to lead one. Another question which bothered me was about taxes. Why should retired people on fixed incomes have to pay for schools the same 60% of their tax money as younger adults with families and still working? Since we were paying, why weren't there more educational opportunities for older adults who needed to be encouraged to develop new interests and why, for example, couldn't public education be providing courses in retirement planning in every community where there are retirees? Do those responsible for Adult Education know that almost half the persons over 65 years did not graduate from high school; more than a million of them never had the benefit of any formal schooling. These questions I am sure are typical of many which would be raised by people who have worked all their lives and for whom work is always going to be a major source of satisfaction. It is imperative for them that they develop new interests and new outlets for their energies. All of my past experience and observations give me great faith in the value of Senior Citizen Centers and Groups. Because of the multiple services which 389 they are in a position to provide I would hope there could be such a center within the reach of every older citizen. Club groups are equally Importanl as a way of reaching ninny persons who are Isolated and often are unaware of needed social services which such group contacts can nelp them to And. B< cause most of the Clubs are lead by concerned and dedicated volunteers, they need especially to have whatever help they need to develop as wide and Inter- esting variety as possible. Volunteers able to do this are scarce and this, there- fore, is a particular area where new resources need to be found for program- ming that will have an appeal for more and more individuals. By making edu- cational resources much more available to older adults, such resources could he tapped. Harvest Years: A Time for Learning A five-part series of articles exploring educational opportunities and possibilities for senior adults. Also, the series examines formal and informal learning methods . . . educational profits and pleas- ures . . . the many ways seniors can apply learning to enjoy living . . . Reprinted from June through Novemher 1968 issues of Harvest Years, the Magazine for Successful Retirement. June — with its promise of renewal and new beginnings — is the traditional time for graduation. But (as the picture at right shows) today's graduating senior is likely to be a senior citizen ! Why are we going back to school ? Many of us are finding that theoretical learning provides a firmer basis for applied living. And, as myths about aging and learning are exploding, we're pursuing quality, as well as quantity, of learning. Why bother? In the first place, man's mind cannot stagnate — it either moves forward or backward. Then, in this changing world, we need up-to-the minute information to make or save money . . . participate in community affairs . . . find suitable housing, hobbies, activities . . . enrich our lives. And, we've never before had so many opportuni- ties to learn. During the past year, HY editors have explored hundreds of educa- tional outlets to find what's available and how you can participate. This first part covers the "Retirement Revolution" and "Pre-and-Post Retirement Counseling." In subsequent issues we'll discuss "Formal Education" (schools, colleges, voca- tional training), "Learning About Aging" (the new science of gerontology), "Educational Outlets" (radio, TV, schools, correspondence classes, senior centers, etc. ) . We'll also examine reading aids, speed reading, reading skills, and reading lists. In all these ways we'll find that retirement is a time for learning — as well as a time for living. "When I was young," remarked Somerset Maugham in The Summing Up which he wrote in his sixties, "I was amazed at Plutarch's statement that the elder Cato began at the age of eighty to learn Greek. I am amazed no longer. Old age is ready to undertake tasks that youth shirked because they would teke too long." This best-selling novelist wisely discovered the leisurely satisfactions of maturity and continued to savor them until he was over ninety. So did Justice Oliver Wendell Holmes, another exponent of the full life, who regarded his later years as an opportunity for what he called "the subtile rapture of postponed power." Mrs. Caroline Wesley Cooper, a seventy-six year old co-ed at Fresno City Col- lege, deep in the study of (among other things) Spanish and the history of civilization, followed in Cato's footsteps. "I don't feel old," Ebony magazine quotes her as explaining. "I have too many things I want to do before I get old. I want to read Latin, to study French and English history — lots of things." Mrs. Cooper, like Somerset Maugham and Justice Holmes before her, would never be old in spirit, even if she lived to be a hundred. More and more of us are doing just that. There are 13 thousand centenarians in the U.S. at this moment, and almost 19 million people over sixty-five. The total is expected to go up to 28 million by the end of the century — an increase of over 50 percent. Transplants of hearts and other organs will probably be accepted medical practice by the early 1970's. And just as soon as medicine conquers the fatal illnesses — heart disease, cancer, the arterial diseases and so on — man w r ill have an extraordinary life-span. 390 Breathtaking isn't it? Yet not all of us are as well equipped as Mrs. Cooper to enjoy the prospect. So how will we react to a current theory that death may one day become simply accidental for most human beings? One answer is that many people, confronted with so much spare time, just won't know what to do with it. Even now some find it difficult after the pressures of a life of hard work to adjust, relax, switch to a new life. "Retirees are not ready in terms of either income or attitudes toward retire- ment." says Sen. Walter Mondale of Minnesota, chairman of the Senate Subcom- mittee on* Retirement and the Individual. "Often the retirement syndrome hits" individuals who suddenly face loss of status, of financial means, and of being in a j responsible position." Still another problem is the notion that as we get older our mental powers suffer a rapid decline. This myth dies hard, and that's one reason why we are so often humored and patronized, but not taken seriously. What are we to do about it? Are we to be put on the shelf, with our longer life-span and our problems, and left there? Not at all. Again science offers a way out — the new science of gerontology which studies the aging process from every point of view. As a result, we find ourselves in the middle of our own "retirement revolution," to use Senator Mondale's phrase. Admittedly, it's taking our youth-oriented society some effort to get back to the traditional belief that wisdom often grows with the years . . . that experience can make up for energy. But this is what gerontologists are now proving. They also point out that all age groups must be considered and made use of. if our society is to function properly . . . that our particular age group has enormous resources that simply aren't being tapped. Anne W. Simon, writing in McCalVs, eloquently states the case for those of us who stand on the threshold of the third phase of life : "Men and women now forty, fifty, or sixty are, in fact, a generation of pio- neers — the first to explore what is truly a new time of life. There's a lively opportunity for new use of intelligence, taste, imagination, knowledge, a new development of psyche and soma, new eminence for men of years. Change, fast and profound, in many aspects of the human condition, provides this generation with choices about home life, work life, sex life, that were uknown to grandparents, even to parents. There's a new way of getting older." The capacity for intelligent thought doesn't decline with the years, say the experts, unless it is affected by ill-health or psychological problems. But it has to be kept honed. "Our minds, so long as they keep their cutting edge, are not bound by our physical limits," remarked Arnold Toynbee, the noted historian, at the age of seventy-five. "They can range over time and space into infinity." Tt's true tbat we slow down, but to counteract that we have experience and acquired wisdom. On balance, we can count ourselves as bright as the youngsters — even brighter in some respects. In fact. Edgar J. Munter, M.D.. a leading specialist on aging, says: "The one organ we can depend upon to last us into old age is the brain. Even at age eighty your brain can learn at the speed of a thirteen-year-old — and that's darn fast!" "Age shouldn't make any difference." Mrs. Elizabeth Trimble, of Princeton. N. J., Family Service Agency, told the local Town Topics recently, "... a human being makes a certain journey through time, and it's important not to get stuck in sell pitv or fear, but always to be giving and living and self-expressing, and if this happens nobody thinks you're deteriorating because you're not . . ." Of course we didn't all have equal opportunities, weren't born with the same amount of intelligence, didn't acquire the same skills or training, haven't the same interests, differ in age. In fact, we're just as varied as the one-to-thirty age group. As John W. Gardner, former Secretary of Health. Education and Welfare, remarked : "Some will want to work until the day they drop: others will want to pitch horseshoes : others will want to watch someone else pitch horseshoes." Nevertheless, it's interesting to note that — according to a recent fi n din sr— peopj who are well educated tend to live longer than those who are not and acquire fewer ailments, possibly because they do something about their health and spend less time worrying about it. Another change is the relationship between the young and the old. Man? families today have three and even four generations, but we don't have to read the newsnapers to realize how far apart these generations can become. In some ea*es retirees go off to warmer climates or into retirement communities, leaving their 'children and grandchildren in other parts of the country. They lose touch with what the young generations are thinking. 391 One antidote lo this: education. Wlnnetka, ill., has an imaginative plan where- hy people from the Senior Center get together with the school children (two children per senior) for forty minutes each week. They develop projects thai lit into the school curriculum, and make use of the special skills of the senior citizens. The two generations frequently produce ideal partners. Teenagers, tOO, And themselves misunderstood as never before. "In the il.iin- boyant 'youth culture' which is America," says Dr. II. Lee Jacobs of the Univer- sity of Iowa Institute of Gerontology, "it is difficult to keep the generations from gross misunderstanding of one another, and from open conflict of Interests. Yet. it helps if both youth and age study the issue together. Today's retirees might well become pioneers in demonstrating, in conjunction with those of other age levels, the creative use of talents for the cultural advancement of all." Mrs. Lucia M. Andrews, a grandmother who went back to take her master's degree in botany at Columbia University, recounted in the Vasnar Alumnae Matjazinc the heartwarming story of her experience. The botany instructor emphasized field trips, so every Saturday in the fall and the spring he took his class on an expedition. "We walked miles in the woods and fields," she wrote, "clambered on wet stones in steam beds, clawed our way up steep rocky slopes, ate our hardboiled eggs and peanut butter sandwiches by the side of running brooks. Those long days, although a test of stamina, were the keenest pleasure to me and gave me a natural opportunity to become acquainted with my young companions, so different from the youths I had formerly known." So well did Mrs. Andrews get on with her fellow students that when examina- tion time came, they worried about her chances of passing. The night before, thinking that no one knew about it, she took a room in a women's dormitory. An hour or two later : "A knock on my door startled me like a gunshot. It was Marissa [one of her classmates]. 'Mrs. A., I live in this building and only just heard you were here. I thought perhaps you could explain some things to me before the exam.' Nothing could have been more tactful. The girl had a whiplash brain that had been working on Botany for years. ... It was clear she had come to be sure that I was on the right track." Formal education falls into the pattern of general understanding, with the old as with the young. Of course, it's better to begin in the early years. Dr. Wilma T. Donahue, Chairman of the Institute of Gerontology, University of Michigan, thinks that today's young people will have a much better chance to age suc- cessfully if they understand the process. She feels that teaching about it should begin in the primary schools and continue right up to the graduate level. "The child is father of the man," as Wordsworth said. One thing that education might do for all the generations would be to bring home the paradox pointed out by Somerset Maugham: The precious thing we retired folks have, and youth doesn't, is time. We have time to think, time to in- dulge our interests, time to help others, time to live, time to find a worthwhile niche in our expanding environment. "You've got to think a little nowadays to keep up with the times because everything is changing so much. Terrifique !" So says the ever-youthful Maurice Chevalier, who calls Methuselah his patron saint. In fact, it wouldn't be a bad idea to adopt as our theme one of Maurice's most popular numbers: "I'm so glad I'm not young any more !" In many ways we can help ourselves, as well as our society, and countless retirees yet to come if we — the pioneers — organize our thoughts about the needs and desires of our own generation, then make these thoughts known. Brandeis University, after studying the recruitment of older people as volunteers, reported that "the goal for older people must be to enable them to assume responsibility for directing efforts to improve their situations . . . little will be achieved un- less the elderly themselves take the initiative." Many of us are already active in organized groups, clubs, and institutions around the country. Universities interested in gerontology capitalize on the knowledge and experience of those best qualified to advance that science — we seniors. In the words of Dr. Donahue: "Older people must themselves take an active part in determining their needs and their own destiny. They must seek education to guide them in the efficiencies of living as well as in new roles of retirement." Those who like volunteer work, whether with the young or the old, generally find much personal satisfaction. Senator Harrison A. Williams (D.-N.J. ), Chairman of the Senate Special Committee on Aging, says : "We would enlist 392 older people themselves to administer to the needs of other older citizens through service." Time to indulge our interests — that's a good formula. The rub comes when we don't have any interests to indulge, and this often happens to people who have been completely wrapped up in their work, or have specialized in one subject to the exclusion of everything else. They're very susceptible to boredom when they retire. You can't just tell a man to take up a hobby ; he might well regard it as a chore. But if he's discovered one he likes before retirement, then the transition can be comparatively smooth. Time to think — that's another good formula. Americans are usually not the contemplative type ; most of us would feel like fish out of water at the Institute for Advanced Study, where they specialize in abstract thought. But it's not necessary to go that far. Almost everyone could benefit from a little extra study since the mind does not grow old as the body does, as long as it isn't allowed to. "One proven way of preventing mental decline is lifelong education," according to Dr. Jacobs. "This does not necessarily mean remaining in school for the rest of one's days, but it does involve continued learning of new things, as well as participation in meaningful activity. To sit is to die." Today, when we're being invited to join society and not be one of its problems education may be the key to the right use of leisure time. "A man of leisure,' according to Aristotle and Plato, "is a man who devotes the best of himself tc the state, and who believes that cultivating the mind, so important to the state is the brightest of all activities, the single one in which man was revealed as related to the gods, and in the exercises of which he celebrates the gods. Politics and religion are at the heart of leisure." So writes Sebastian de Grazia in his book Of Time, Work, and Leisure. However, not everyone in Greece was free to participate in the good life There were slaves in Greece. Nowadays technology is liberating us from enslave ment to work, science is curing our ailments, and soon a man of sixty can stib be in the prime of life. Money problems remain, but they are not as bad as thej once were. They will undoubtedly become less troublesome in the future as economists, in and out of government, work toward solutions. As a nation, we a J almost being forced back to the Greek view of a leisure society — except thai no one will be excluded. How long it will take us to get there is anybody's guess. To some extent, th( timing depends on us. But of more immediate interest to many of us is the oppor tunity to fulfill our yearning for learning — whether it be book learning or hand- icrafts, or whatever. As Mrs. Ella Walker — who has worked since she was seven, dreamed all hei life about learning to read, and finally, two years ago, began adult educatior classes at Lynwood Park Elementary School in DeKalb County, Ga. — declared "I knowed the Lord would let me go to school if I lived long enough." Mr. Walker is eighty-three years old now, and may be one of the oldest student! enrolled in a Georgia public school. Part I : Education — The Key Education for what? For the experience of living. To remain ori- ented, to move with the mainstream of human development. So that our life at every moment — whether age thirty-nine or age ninety-nine — is our opus magnum. (Dr. Maurice E. Linden to the 1963 Southern Conference on Gerontology). Secretary of Labor W. Willard Wirtz suggested not long ago that all ove: age sixty should go back to school for two years, free of charge. It would be i much better scheme, he thinks, than eventually lowering the retirement age Life, according to Secretary Wirtz, will someday be divided into three differen parts, "with service to a fellow man ... the final and most satisfying opportu nity of all." This makes sense. Why shouldn't we run some of the social services an< release those busy middleagers from the burden? Another proposal by Edwin F. Shelley, Vice President of U.S. Industries Inc. would give every worker a year's paid educational leave after twenty years oi the job. This would transfer 5 percent of the labor force to education and create a shortage, so there would always be jobs for all. 393 What these experts arc saying la that we can gel more out of life, and at ■he same time give more to other people. If we use our minds creatively. Ke- rnel. iher that education is for all of us, not just, those who've been more or Kss t -accrued with it all their lives. lint we must be realistic. We haven't reached Utopia yet, ami obviously not. many retirees can concentrate on a liberal education or gel too engrossed in telping others if they're in a constant state of anxiety about finances or worried IbOUt ailments. Meantime, nearly all of us need planning and counseling services of some kind and educational programs directed at solving money and health problems but even more important at preparing us for what should be a full and happy new way of lif»'. "Education should enable a person to engage in an active search for new and productive roles," says Professor Robert Morris of the Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University. "We need a system of flexible retirement, new ways of marketing handicraft produced by older people, and socially significant political and civic tasks for older people." The Older Americans Act of 1905 opened the door to many more such pro- grams than previously existed, and they are being developed all across the country. For instance, many of us have talents and skills we're not using . . . many want part-time jobs to supplement income . . . others w r ant to volunteer for the kind of social service we've been discussing. Yet others are anxious to write, to study, to learn to paint. How do we find out what is available? With so many different agencies, many still in their infancy, this is a problem in itself. HOW TO FIND THE KEY Educators recognize the need for central clearing offices and information centers, and various methods are being tried out. One popular new method in towns and cities is the Multipurpose Center which tries to combine in one central location as many programs and services as it can — recreational, social, educational, counseling and so on — and to coordinate its activities with those of other existing agencies. Such a center, apart from anything else, can employ many retirees and is especially useful to someone who wants to use his particular talent or skill in some kind of volunteer work or paid employment. At a Center in Chicago, for instance, "the man who came in offering to print signs is now employed on a weekly basis making signs for the whole center . . . our art and sewing instruc- tors are seniors . . . French is being taught by a former professor of French in Cairo . . . our part-time secretary would be put on full time if pension deduc- tions would not be involved. Yearly, we honor all seniors who offered their services to the community. . . ." In the city of Providence, R.I. the Multipurpose Center is an experimental project, with a grant from the Administration on Aging, to demonstrate how such an organization works. Already 3,000 people have used its services even though it is still establishing itself. A way of tackling the problem in rural areas is being tried out in York County, Maine, under another AoA grant. Forty retirees were trained to go out and find out what older people in the area really needed and wanted ; then four senior centers were set up in York County, and run according to their desires. Funds for operating the centers are being provided by the Maine Council on Aging, and the project will provide guidelines for the development of similar programs elsewhere. The first report of the project indicates that it is achieving significant results. The four centers are now reaching 1,200 persons. In Westchester County, N.Y. the Council of Social Agencies will provide infor- mation, referral, and counseling for the county's 75,000 senior residents. And Nassau County, N.Y., is centralizing its network of services for older people. These are just some examples of what's going on. Probably the day will come when we can walk into a Multipurpose Center in any city or country town and find out just what we want to know about our health, wealth, education, or whatever. But, just now, most of us have to do a little preliminary research to get the information we want. Aside from addresses mentioned in connection with the different kinds of available education, you can apply to your local, state, or national : Office of Education ; State Employment Office ; 394 Information service of your Community Council or Health and Welfare Federation ; Adult Education section of the U.S. Office of Education, Washington, D.C. ; National Education Association, 1201 Sixteenth Street N.W., Washington, D.C. 20036 ; Adult Education Association of the U.S.A., 1225 Nineteenth Street N.W., Washington, D.C. 20036 ; American Association of Retired Persons, Dupont Circle Building, fourth floor, Washington, D.C. 20036 ; State Commission on Aging ; National Council on the Aging, 315 Park Ave. South, New York, N.Y. 10010. Also, you can inquire at your local Family Service Agency or Committee on Aging . . . your minister, priest or rabbi. The local library, Y, Senior Citizens Club or Center, Salvation Army, Jewish Community Center, or Chamber of Commerce can often supply information about educational, training and other opportunities ... so can your union or company. If there's a university or college nearby, its extension division may have a counseling service. Most communities have Adult Education Schools, and you can watch for announcements in local papers, in columns for older citizens, and on radio and television. Often some group or asociation will compile a directory or pamphlet ; a good example is Princeton's Directory of Information and Services for Older Adults, put out by the Council of Community Services. If you live in Mississippi you may know that the University of Mississippi has been promoting a unique state-wide program to acquaint nursing home operators, legislators and public officials, as well as senior citizens themselves, with available programs and facilities. And the University of Florida at Gaines- ville has a program to help the general public better understand the problems of aging. BLUEPRINT FOR LATER LIFE The ideal time to begin preparing, or at least thinking, is well before we have to, so we have a kind of gradual evolution toward a new life. Former Secretary of Health. Education and Welfare, John W. Gardner, thinks mature or retired people themselves, after some training, would make the best retirement counselors. Some companies, he told the Senate Subcommittee on Retirement and the Individual, have recruited retirees for this purpose, with excellent results. More and more companies, corporations, and unions, are setting up pre-retire- ment programs for their employees. So if you're eligible for one of these you'd do well to participate. Retirees, as we've already pointed out, know better than anyone the benefits of these programs— or the disadvantages of not having them.. In fact, at least one retired group is sponsoring a course of its own for prospective retirees — an in- teresting switch. The Congress of Senior Citizens of Local 342 of the Amalgamated Meat Cutters and Butcher Workmen Union was inspired to make this move by a series of lectures on the subject given at Fordham University in New York City. And Fordham now has a program that trains people nearing retirement age themselves to go out and conduct pre-retirement programs in small labor unions and moderate-sized businesses, community centers, housing projects, church, and management groups. If you live in the vicinity of Des Moines. Iowa, you should inquire into a pro- gram going on at Drake University under a federal grant. It's a "first of its kind' case of a Pre-retirement Planning Center just getting under way, with a house near the campus, a regular staff, and a commitment to "develop and test various approaches to recruitment, counseling and active involvement in broad areas of concern for pre-retirees — legal and financial, health and welfare, continuing education and the use of leisure time ..." About 500 workers a year, ages fifty- seven to sixty -two, drawn from different groups, are expected to take part; wherever possible they'll get time off from work. State and city adult education departments offer counseling advice under such general headings as: financial aspects of retirement . . . turning your spare hours into cash . . . how to enrich your living . . . making the most of your health . . . where are you going to live? Churches, Y's, senior centers, etc. may have programs along those lines ; it s worth inquiring locally. 305 Some colleges and universities are offering pre- and post retirement counseling courses with the help of the Administration on Aging, or arc in process of setting them up. Things happen every day in this field, so it's as well to keep an eye on the loeal papers. For instance, Arizona State University (Tempe, Ariz.) is concent raling on consumer education hy means of counseling services and telecasts. So it you live in the Tempe area and your budget doesn't seem to work out, you can net eX Crowley^s Ridge College (Paragould, Ark.) goes in for educational programs and discussion groups, as well as job and retirement counseling. The University of Florida (Gainesville) has a counseling center. Oakland Community College (Bloomfield Hills, Mich.) contributes counseling for senior citizens "to update old skills and utilize wasted talents in preparation for second careers as volunteer workers." And so on. ... There's a particularly succesful and comprehensive program run by the Center for Community Educational Services at the State University Agricultural and Technical College at Farmingdale, N.Y. under a grant from the Higher Educa- tion Act of 1965, Title I. T ± xr „ It's a ten-session course called "New Horizons for Later Years" and discusses income maintenance, education, employment and volunteer activities, recreation and the use of leisure. The students are taken on field trips to a senior center and a college library. They vary in age from thirty to over sixty-five and are all enthusiastic about their experience. "I never graduated from high school," says one happy co-ed, "and here I am in college. I wrote to my son in Vietnam and he is so proud of me." Says another, "Since I am in this course I feel twenty years younger and the only thing wrong with this course is that it ended too soon." "In some cases," explains Mrs. Beverly Fuchs, Coordinator of New Programs for Later Years (there's also a Gericare Aide Training Program and one for mature women who want to take up a career), "the students in 'New Horizons' have gone on to take other courses, on our campus or in local adult education pro- grams. Others have found, through this program and the 'Gericare Aid Training,' new opportunities in the community, some paid and some volunteer, to use their skills and to increase their sense of self-worth, as well as to occupy some of their leisure time." . One organization, the Oliver Wendell Holmes Association, based in New York City, but extending its efforts throughout the country, looks after the pre-retire- ment interests of those at the administrative level in business, industry, and the professions. It offers informal ten-day seminars for groups of twenty to sixty people, ages sixty to sixty-five, who are either about to retire or have just done so. Beforehand, questionnaires and interviews with psychologists provide a broad-based view of the interests of each participant. Instructors, drawn from a panel of administrators, educators, and communi- cations experts are available to conduct sessions at any convenient university or recreational facility. For the first three days the leaders invite discussion of individual readjust- ment problems, so that new ideas and solutions may suggest themselves. Then there is a five-day "Experience in Learning" course, aimed at updating skills and interests and, also, at stimulating self-confidence. The "experience" takes the form of large-and-small group meetings, with assigned reading, and audio-visual aids. Finally there are two days of face to face "Exposure to Leadership in Civic and Public Life," including meetings with leaders in government, politics, public affairs, and community services. The results of all this are studied and each participant gets a report. After- wards the OWHA acts as liaison between him and whatever field he decides to participate in. The Association finds there's a great need for this kind of training and men- tions three main problems : (1.) Some of us are bitter at the idea of mandatory retirement. Indeed one expert, Dr. Irving S. Wright, clinical professor of medicine at Cornell Medical College and president of the American College of Physicians, recently stated that ". . . it's cruel and should be abolished. It's no use of having a longer life, if it's without meaning." If nothing else, he suggests Social Security laws be changed to allow retirees to work without losing benefits. (2.) Others look forward eagerly to a time of leisure but become bored and disillusioned. 71-272— 72— pt. 1- -26 396 (3.) Finally, there are those of us who look forward to developing new inter- ests but are not sufficiently aware of the adjustments we must make. All can be helped. There's one interesting program, run not by a company but by its employees themselves, that combines several advantages. It's the program of the Telephone Pioneers of America, a voluntary association of over a quarter of a million tele- phone employees all across the country and in Canada. The idea behind the association is fellowship and service, and its pre-retirement courses are only part of a much wider range of educational and other activities. But they're among the most popular. You don't have to be retired, or even close to it, to join the association ; all that's required is twenty-one years of service with any telephone company. All ages and ranks join in, 60 percent of the members still at work (active members), 40 percent are retired (life members). They pride themselves on this : '"Accountants, secretaries, assemblers, and engineers plan together for a social reunion. Repairmen, switchboard operators, and vice presidents share their talents in projects of community usefulness and in many educational ac- tivities. Together they keep retired employees in touch — not only with the latest developments in the business but also with their lifetime friends." The different chapters sponsor their own educational programs, according to what's needed in that particular area. The value of keeping up an interest in employees even after retirement is being noticed, and many companies now offer post-retirement counseling and programs, too. Another way of remaining in touch that's spreading is through newsletters and magazines put out by retirees themselves. For example the Pioneers have many of these, run by different Life Member Clubs (which are off -shoots of local chapters). Their reporters do a thorough job of rounding up news of members, both well and ailing, and of supplying information on all developments of interest to their readers. There's the Old Timer for instance, or the Tele-News. The West Penn Power Company, of Greensburg, Pa., has tried a similar idea and mails Watt's New twice a year to its retired personnel and its veterans of twenty years' service. Most of the material is supplied by retired employees who describe what they're doing now, and everyone's delighted to have news, not only of the company, but of all their pals. Editor's note: Next issue we'll bring you Part II of this series, "Completing Your Formal Education." This part will include sections on high school and college classes and vocational training. And in future issues, we'll bring you other educational outlets and opportunities ... the advantage of participating in them . . . how you can join in the fun and adventure. Part II : Back to School, Back to College, Back to Work In this second installment of the series of articles on educational possibilities and opportunities, HY editors report on what's avail- able through formal education : How you can go back to high school to get a diploma or add to your knowledge . . . the many kinds of adult education classes you can take . . . how to select and participate in correspondence school courses . . . college classes for credit or fun . . . the many vocational aids and training available that will not only add to your knowledge, but will put money in your pocket . . . Next month we'll discuss the science of gerontology: the study of the process and problems of aging . . . ". . . it is not enough to provide the fullest educational opportuni- ties for everyone; these opportunities must also be used by every- one:' {Adm. Hyman Rickover, quoted by W. W. Brickman, School and Society, March 18, 1967.) Formal education is neither the beginning nor the end of learning. And we could cite dozens of reasons for our age group's generally lower level of educa- tion as compared with today's youth. For instance, we could assert : The opportunities and need for formal education used to be more limited. Many of us, unfortunately, faced somewhat unique hurdles that prevented, or interrupted, our attaining an education in our youth. 397 Going on to high school, lei alone college, wasn't so popular in OUT day <»r else more of us would have found Inspiration or means i'or overcoming educational hurdles. On the whole, we grew UP in a loss affluent society with fewer educated people to permeate our surroundings and whet (or satisfy) our thirst for Learning. Because of prevailing economic factors and Limiting attitudes, most, of US were pressured "not to waste time on school" and had to get out and work at an early ige. Generally speaking, we were the older working/building generations. Now conies the younger learning/reaping generations. Some things sure have changed — educational opportunities being one of them ! When you get right down to it, the prime requirements for going to school nowadays are will-power and a desire to learn. Numerous opportunities now exist for everyone — of every age, educational attainment, circumstance, skill, and! interest — to continue his or her education. There's also an increasing ur- gency, for us and our society as a whole, that we do so. We may have to overcome some hurdles, but that's part of the challenge none of us should shun. There's a need, and there are opportunities for us — irregard- less of our present age or past education. The best place to begin — for either getting information about, or attending, classes — seems to be at the "grass roots." Local school boards usually conduct a variety of adult courses, and they can sometime give information about other. Neighborhood centers and organizations conduct numerous classes. Community colleges offer many adult education programs (not tests, no credits) as well as credit courses for both non-matriculated and matriculated students. Many adults have started with the less formal non-credit courses, and then moved on to prescribed 1 courses of study leading to a degree. More and more programs offered by local community organizations, neighbor- hood centers, school boards, and colleges are being identified as: "adult" and "continuing" education. Then, too, there are numerous self -instruction at-home courses. The nationwide Adult Basic Education program should interest you if you didn't finish grade school. The U.S. Department of Health, Education, and Welfare launched it to help all of us over eighteen reach an eighth-grade education level. It's sponsored in part by federal grants, but it's administered by state education agencies through local public schools. Both older students and teachers can find a niche in this program. About 13 percent of the teachers are "rehirees," and classes are con- ducted with adults — not children — in mind. For information, check with the Director of Adult Education in your local school system. One state alone reports it has enrolled 4,000 students between ages eighteen and eighty. "Many of our older students," says a teacher, "are doing this because they want to read the Bible or the newspapers. One of the happiest persons I've ever en- countered was a seventy-year-old woman who had just learned her alphabet." In many ways, most communities are seeking us out and bringing "school" right to our doorsteps. A novel experiment — "Adult Armchair Education" — has small student groups gathering in neighborhood homes for consumer education, literacy instruction, and self-improvement. Such programs can also use qualified retirees as volun- teer teachers. And this informal introduction encourages older students to move up to more formal education. Many local schools, "Y's," senior centers, churches, and other groups conduct classes like English for the foreign born and remedial reading for adults who already have a rudimentary education. (They usually also offer a wide variety of recreational/educational programs that might interest the highly educated.) Some communities offer remedial reading TV courses and even have staff centers that give additional help. Reading improvement — as distinguished from remedial reading — courses are also available for those of us who read fairly well but want to do better. Some- times public libraries and some universities conduct such classes. Check for pro- grams in your area. There are books on the subject for self-improvement home study, but it's easier with outside help. Then, there are the rapid- or speed-reading courses for those of us who are already pretty good but want to move up to the realms of "dynamic readers." Some universities have such courses, but the majority are offered by private agencies. (More on this in a future issue.) 398 HIGH SCHOOL DIPLOMAS Brushing up on your reading and improving your rudimentary education is highly commendable. Going back to school to get an eighth-grade level Adult Basic Education is an even more notable achievement. And we should all take our hats off to those among the 1 million over-sixty-fivers who never went to school and are just now learning to read and write. But what about the more than 9 million who represent about half of our sixty- five-plus ranks who don't have high school diplomas . . . yet? Are you one of our group's high-school dropouts ? Let's emphasize that we're talking about two things : (1) a lifetime accumula- tion of specific knowledge equivalent to a high school education and (2) a piece of paper certifying that you've accomplished this . . . a high school diploma. If you didn't finish high school, though, wouldn't you like to acquire this funda- mental education? Or maybe you'd just like to prove your stuff and get a di- ploma — either for your own self-confidence, or to go on to college-level studies, or to improve your "rehirement" potentials? There are several methods now available to get either the education or the certi- fied proof, or both. If knowledge is paramount and you hate tests, non-credit classes and home- study courses can help you gain the education. But getting the diploma — by one of several methods — would entail tests. Of course, getting a certificate and passing exams aren't education's main ob- jectives. And there is an art to taking and passing exams . . . something that very few people of any age can accomplish without adequate assistance and prepara- tion . . . one aspect of school, especially with time and multiple-choice tests, that hinder older age groups. But following a prescribed course (especially with a teacher's guidance and classmates' stimulation), working towards a specific goal, and even studying for and taking the tests themselves are all part of learning. One way to get your diploma is to pass certifying exams to prove you've ac- cumulated knowledge equal to a high school education. You can study on your own, and there are several books on "how to pass" the exams. Or you can take preparatory classes or home-study courses geared to adults that recognize ac- cumulated "life-experience" knowledge to some degree. Either of these two ap- proaches could lead to your diploma. High School Equivalency Diploma (also known as General Educational Devel- opment Tests diplomas) are issued by the State Departments of Education to peo- ple passing high school level exams in five areas of study. The certifying exams, prepared by the American Council on Education, are held each month at desig- nated centers in each state. The exams cover the following high school studies : (1) English, (2) math, (3) social studies, (4) natural sciencies, and (5) literature. The national passing average is 72, but each state sets its own passing grades. The most usual is an overall score of 45 correct answers out of 75 on all five tests, with a 35-point minimum on any one test. You can retake the exams as often as needed. Fees and other regulations- as previous enrollment in high school classes— vary from state to state. -such ADULT EDUCATION CLASSES Attending classes offered by local public school systems is still the most popular method of study. Some schools charge for their adult education programs, others have no fee. In some schools you can earn your diploma "as you go" by enrolling in and successfully passing the required classes. In other areas the classes are designed as preparatory study for the high school equivalency exams. (It might foe appropriate to note here that the group experience offered by attending classes — either formal educational courses or informal group discus- sions — can be one of the most stimulating aspects of learning.) The Adult High School in Lincoln, Nebr., for instance, offers more than forty academic classes, twice a week for each sixteen-week semester. By fulfilling all requirements, you can earn your diploma and become a graduating "senior." Most classes are held from 6:30 to 9:00 p.m. to accommodate the younger, working adults, too. Each course costs $15 per semester. The Warwick, R.I., adult program has two plans for would-be graduates: Plan I permits students to earn a diploma through college preparatory, or indus- trial arts, or business education courses ; and Plan II offers general equivalency diploma exams preparatory courses. Registration fees are $5 a course. The Standard Evening School of Pennsylvania's Butler Area Schools has a program of prescribed courses that leads to a diploma. Three credits a year can 399 bo earned by attending ilirec-aiiil :i half hour classes three Qightfl per week. (Hero you can even go on to your college degree with courses offered by Penn State University and Slippery Rock State College.) Flint, Mich., allows retirees to attend adult schools free. The school issues scholarship cards which allow students to attend any of L27 classes. Over 800 seniors have signed up. You can also earn a diploma by taking correspondence courses (see "corre- spondence school" part of Vocational Training section). Eighty-five-year old Enjor Mary Daley of the Salvation Army took a correspondence course and picked up a high school diploma last Christmas. Major Daley has been studying ever since she retired twenty years ago, after forty years as a Salvation Army Ifficer. Her studies included sociology, psychology, mathematics, world litera- ture, ancient history, British history, and word study. She says she'll go on with her studies after a year off. The accrediting commission of the NHSC adds a note on high school work feme this way : "Home study schools offering high school courses do express their work in units equivalent to the customary Carnegie units. Regulations differ widely anion- the fifty state education departments— some accept 16 units of home studv ; others accept none. In many states a limited amount of home study credit mav be applied toward resident diplomas. When such credit is desired advance approval should be obtained and the program may be validated by examination. Generally, however, home study high school students use these courses to prepare for state equivalency examinations and college entrance board examinations." You can also complete your high school education through university corre- spondence courses offered by the National University Extension Association. That's the path chosen by R. O. Scbill, a retired railroad accountant of Decatur, Ga., who started studying by mail before he retired. He got the equi- valent of a high school diploma from the University of Georgia, then started on college level courses. As he puts it : "My purpose in taking correspondence work is three-fold : to keep my mind from 'atrophying, to learn some facts concerning the many branches of knowl- edge I had no opportunity to study in my youth, and, if I live long enough, to win a college diploma which I might prize more highly now than if achieved a Iwilf -century ago." To see if vour state university offers a high school program, write to the uni- versity's extension division. Or write to NUEA for its list of member institutions (see address in correspondence school section). One of them, the Home Study Institute, offers seventh and eighth grade and elementary courses as well. If none of these methods please you, turn to TV— the newest way of all to prepare for the equivalency diploma. TV High School was developed in New York City by the Manpower Education Institute of the American Foundation on Automation and Employment. The pro- gram began last fall on national educational television in New York, Washing- ton, and other major cities. It's especially designed to help viewers pass the high- school equivalency test. It consists of sixty half-hour instructions in the five required areas already described (twelve lessons in each). You can easily participate whether or not you want to take the tests. Each of the five courses is shown on a separate night of the week to allow selective viewing. For the ten volume home-study book cost- ing $12.50 write to TV High School, Box 310, Grand Central Post Office, New York, N.Y. 10017. If all else fails, you could try what Ted Aufort of Santee, Calif., did. He simply called in at the school he'd dropped out of in 1939 — and asked if he could carry on. The staff was agreeable, and enthusistic Mr. Aufort wrote a poem about the whole experience which ends thus : Though you fine teachers may become aggravated, Keep in mind that chores are outweighted With this fact — In your hearts keep a thought of delight, That thru your efforts, some got ahead in life — Thru that gate lies a glim of hope, If one shuns it, he's a dope ! ! ! Thought I wouldn't he able to take it all, To tell you the truth, I'm havin a ball^- These school days to me are a real delight. Something I'll remember all the days of my life. 400 BACK TO COLLEGE People go back to college at nearly every age. No matter what your age, the first step is be accepted by the college of your choice. Lovejoy's College Guide, available in most libraries, gives a comprehensive list of American colleges and courses they offer. It's natural to have qualms when returning to college, as did Mrs. Audrey Schultz. She entered the University of Oklahoma law school three years ago in spite of her children's objections. Mrs. Schultz, who's in her seventies, found the students accepted her, and last summer she graduated with two degrees: Attorney-at-Law and Juris Doctor. After twenty-five years as a minister, Dr. H. Lee Jacobs decided at the age of fif ty-six to study for a doctorate in education. Dr. Jacobs got his doctorate, and he's now doing research on aging at the Institute of Gerontology at the State University of Iowa. Dr. Jacobs feels that he was hampered by certain facts about aging that had nothing to do with mental capacity. One was eyesight. "I'm convinced," he ex- plains, "that the normal loss of sight accounts for much of the slower perform- ance of older adults." Another stumbling block was the use of "new type" or "objective" tests. "Most younger people have grown up on these new examination procedures and are 'test-wise' ; the average older adult hasn't this advantage. Eventually he can learn, as I did, some 'secrets' that result in increasingly better scores. Mean- while, his performance may be slower in comparison to his youthful competitors, but this isn't due to any 'intellectual decrement' because of age." Not long ago Mary Ann Strehlein, an eighty-one-year-old Chicago woman, popped up in the news because she'd patented a garment fastener. Miss Strehlein, who spent most of her active life in the women's clothing industry, topped off her formal education eight years ago, at the age of seventy-three, with a Bachelor of Philosophy degree from Northwestern University. Among universities and colleges offering reduced fees or free tuition for retired people are the University of Rhode Island. Russell Sage College (in Troy, N.Y.), Boston University (Evening Division), the University of Dayton (Ohio), Utica College (at Syracuse University in N.Y.), Everett Junior College (in the state of Washington), and Manatee Junior College (in Bradenton, Fla.). The University of Kentucky offers special scholarships, the first of their kind in the country, just for seniors. The basic qualification is to be age sixty-five. Neither fees nor high school diplomas are required, and candidates can apply on a nation-wide basis. If you want more information, write to the Council on Aging, the University of Kentucky, Lexington, Ky. 40506. These scholarships were proposed by Herman L. Donovan, the late President Emeritus of the university, who argued that many older people could find in- spiration in the intellectual activities of college life. Donovan scholars take regular college courses. They don't have to aim at a degree, but some are working toward the B.A., while a few advanced students are finishing graduate programs started earlier in life. A new institution at Ithaca, N.Y., provides education without tuition to local people of all ages. Begun a few months ago by a group of students at Cornell, the Ithaca Neighborhood College has thirty-three courses from remedial reading to calculus and from vocational training to chemistry. Professors from Cornell and Ithaca College donate their services, and Cornell permits use of its library and laboratories. The 350 students aged fifteen to seventy who signed up were many times the expected number. One-third of the students are Negro. A Cornell professor of Western civilization is quoted by Time as remarking that "the older housewives can write a literate essay — which is more than I can say for most Cornell freshmen." Credit and non-credit courses for adults are offered by other universities like St. Louis . . . Boston . . . Texas Christian . . . Illinois . . . New Hamp- shire . . . Washington . . . Georgia . . . Massachusetts . . . Pittsburgh . . . Michigan . . . South Florida . . . George Washington . . . Harvard (Graduate School of Education). And some colleges like The City University of New York and the St. Petersburg (Fla.), Junior College seem particularly receptive. For instance, columnists Esther and David Elston, reporting on St. Petersburg Junior College, found : ". . . oldsters are mixed right in with young people and expected to do the same work. Everyone can now take classes in the daytime 401 or at night. This opeD schedule pleases many older folks who do not Like to travel at night and gives them all a chance Lo associate with ihc regular students. Most elders still come for the late classes, either out of hahit or convenience, but many of the young students attend at night loo. "Does it work having a sixty year-old man taking a course with a nineteen- year-old man? One counselor says: 'The older person picks up some youthful zest. and the teenager finds maturity.' it. seems that the young and old complement each other and a class with both is a well rounded group. . . . "A young instructor told US he looks forward to having some mature people in his classes. He said, 'Older folks don't goof off. They are serious about their studies, and this attitude rubs off on young students. The regular student has to work to keep up with the older one.' The competition can he exciting." When the Elstons questioned Paul Troville, head of Continuing Education at St. Petersburg Junior College, he stressed mental alertness as the critical factor for adults returning to college. Should seniors he treated differently than youth when courses are offered? "Mr. Wheeler, the assistant coordinator of Continuing Education, and a mature man himself, says — no. He feels that age should make no difference in college. . . . To get facts on how well older people are doing at college, Mr. Wheeler is in the process of making a student study going back over the last three years. He is comparing age versus grades. So far, all preliminary results look good — the study shows older students do equally as well as young students." Some colleges feel that adjustments should he made to meet the demands of the increasing number of mature men and women who would like a degree but find regular classroom and credit hour requirements unsuitable. Some schools main- tain degree programs with such innovations as : short-term residence, independ- ent study, credits for life experience, seminars, correspondence courses, taped lectures and programmed learning. This type of approach can be found at: Brooklyn College and Queens College of The City University of New York . . . Goddard College (Vt.) ... Mundelein College (111.) . . . Roosevelt University (111.) . . . Pacific Oaks College (Calif.) . . . Syracuse University (N.Y.) . . . the University of Oklahoma. A notable example of such programs is Harry Kelber — now fifty-four and a professor at New York Institute of Technology in New York City and visiting lecturer at New York State School of Industrial and Labor Relations of Cornell University. He started his Brooklyn College studies in 1960, when he was forty- five, and earned his BA degree in two and a half years. Then he went on to graduate work at New York University and earned his PhD degree in 1965. This former Netv York Post printer has had firsthand experience With adult education as both a student and teacher of different age groups. Professor Kelber remarked at a conference on Extending Education and Cul- tural Opportunities in New York City last April: "My Brooklyn College adult courses were some of my most exciting learning experiences. . . . There are many at-home and self-learning opportunities and tools, but group and formal educa- tion are the real heart and core — the experience part — of education. ... It is the teacher's role to stimulate and direct the class, but the give-and-take exchange of ideas depends upon people themselves in combination. . . . Older people bring a basis of reference to class that can enhance this process." Chancellor Samuel Gould of the State University of New York told Time magazine recently that the ability to understand and adjust to change is what higher education is all about. The university, he thinks, is bound to be "less structured and far more flexible than it has been before — more open to students of all ages who will be there to learn rather than accumulate degrees, and who will return throughout their lives for intellectual stimulus." # If that is the pattern of the future, then we will be participating in an educa- tional evolution, as well as a retirement revolution, of immense significance. You can enroll in numerous college-level courses by mail. Some states accept the results of a college proficiency examination which — if you achieve a good score — will allow you to skip some required freshman courses. The extension division of your state university will let you know its rnles and regulations. Two years ago Syracuse University began a home study program in the liberal arts for adults w T ho don't live near any campus. The University of Oklahoma has the same system. However, to get a college degree in most cases, you'll probably have to attend classroom lectures for at least two years. Another way of getting in, if you don't have the usual educational require- ments, is to take tests devised by the Educational Testing Service, a non-profit organization. The results also can be used to meet certain degree requirements. 402 The examination reveals your general level of knowledge— whether gained at school, at work, or on your own through independent study— and your com- petence in specific college-level courses. So lifetime experience counts. The "College Level Examination Program" is offered each month by several dozen colleges throughout the country. The charge is $15. Each test consists of ninety minutes of objective questions (scored by machines) and an optional ninety minute essay (graded by the colleges) . General tests cover: English composition . . . the humanities . . . mathe- matics ... the natural sciences . . . social sciences and history. You may obtain credit for specific courses through tests in: U.S. govern- ment . . . analysis of literature . . . English composition . . . general psychol- ogy . . . geology . . . introductory calculus . . . introductory economics . . . introductory sociology . . . money and banking . . . statistics . . . tests and measurements . . . Western civilization. Eventually the tests will be prepared for more than one hundred college courses including these subjects : marketing, U.S. history, educational psychol- ogy, and computers and data processing. For further information, write to: Educational Testing Service, Box 977, Princeton, N.J. 08540. If you live within the radius of the New York or Chicago network stations you can acquire college credits by watching television. In New York enroll at anv one of the participating colleges as a credit student of the University of the Air. Then, if you complete the course successfully, you can apply the credits from your University of the Air studies towards credit for a degree at the col- lege you're enrolled at. Of course— as a credit student— you must do assign- ments at home and take exams at the college. If you prefer to be a non-credit student and participate only for your own satisfaction, a fee of $2 per course entitles you to a guide with study hints, reading lists, questions, and self-tests. The subjects offered include: calculus and analytical geometry ... the humanities . . . major American books . . . the rise of the American nation ... the history of Latin America. Costs for credit students range from $8 to $18 per course, depending on the college. For a brochure, write to University of the Air, Box 4440, Grand Central Station, New York, N.Y. 10017. , ^ A1> , . Chicago is proud of its pioneering TV college which has been on the air since 1956 as a service of the Chicago City College. By watching these programs you can complete all, or part of, the first two years of college. And, if you work hard enough, you can become an Associate in Arts. Here, too, a credit student must follow a' prescribed study guide, do written assignment, and take exams. Fees for residents of Chicago are $5 for eight semester hours, $10 for nine semester hours, and so on. Other Illinois residents pay $13.50 per semester hour, plus service fee. Outside Illinois, you pay $25 per semester hour, plus service fee. Subjects include: art . . . biology . . . business . . . economics ... the humanities . . . social sciences. The address: TV College, 5400 N. St. Louis Avenue, Chicago, 111. 60625. Both New York and Chicago make special arrangements for students who are hospitalized or physically handicapped. BACK TO WORK To supplement retirement income, we may want jobs, but we may lack the necessary training. Through the Vocational-Technical Education Program the federal government aids states which provide free vocational training, realistic in terms of job openings. Vocational training is available in fields of agriculture, marketing and dis- tribution, health, home economics, industry and technology (see box). Classes are held in local schools, colleges and institutes. Each state decides what kind of training it will offer. In Florida the demand for insurance and real estate agents is great, so many retirees are trained for these jobs. Another program— this one under the Manpower Development and Training Act— gives advice to people forty-five and over before they retrain for a job. 4ifter training they're given assistance in finding a job. Recently, in New Or- leans, 200 people were trained under this program to be salesmen, typists, cooks, dry cleaners, etc. 403 The John F. Kennedy Family Service Center, Inc., Charleston, Mass. li.is tried new techniques In employment counseling and training. During a fifteen-month period, 479 job seekers used the program and 316 were placed. The center also formed a group named Talents which met weekly to discuss job problems. Members used outside contacts t<> help find job openings for fellow members. These suggestions have come out of all of the programs : establish neighborhood adult corps where adult work crews would be available for community services ; find out why older people are afraid to train for a new job and ways to counter- act this fear ; M , _ . train supervisors in companies to understand the problems of older workers ; organize forums so satisfied older workers can advise others. ADULT SCHOOLS Adult school studies range from creative woodworking to silk-screen print- ing . . . from ceramics to rug making . . . from steno, typing, and tailoring to landscaping. Decide where your interest and skills lie before you sign up for a course. Many school systems provide training programs especially for retirees or near- retirees. New York state and Los Angeles schools lead in this area. Often courses instruct how to turn a hobby or skill into a business. Many pos- sibilities exist — selling homebaked cookies to local supermarkets, old dolls or antiques, or making and selling jewelry. Courses teach all aspects of home Many women take refresher courses in shorthand or typing. Prospective house- keepers learn how to care for someone else's home and children and what rates of pay they can expect. Men and women are trained to be companions to invalids or older people who need help. After a little detective work you'll find what job openings are available in your community for your age and interests, and what training you'll need to get them. For instance, let's take home sewing. Mrs. Edna B. Bishop personalized the "Bishop Method of Clothing Construc- tion" which teaches basic steps of sewing that lead to making clothes in the minimum of time. The Bishop method is not unique nor is it geared to industrial sewing. The Bishop course is offered by the Mott Adult Education Program of the Flint, Michigan Board of Education in eight-week terms three times a year. There are also special two-week courses — costing $25 which qualify the par- ticipant to teach basic and intermediate steps of the Bishop method. For more information and application write to Mrs. Gertrude Harper, Director, National Teacher Training Institute, Bishop Method of Clothing Construction, 923 East Kearslev Street, Flint, Mich. 48503. CORRESPONDENCE SCHOOLS Correspondence schools have a wider range of vocational subjects than the uni- versity extensions have. Some universities have courses which are especially useful to retirees, though. Pennsylvania State University offers Commercial Food Service Management ($32) and Real Estate Theory and Practice ($24). Before signing up for a commercial correspondence course find out about the school's reputation. Four to six hundred correspondence schools exist in this country and the majority are reputable. But, the Post Office warns it is pro- secuting an increasing number of phonies for mail violations. Con men operate in states that have no laws to regulate correspondence schools. And when states pass laws to regulate these schools, the con-men simply move on. To be safe, check the list of schools accredited by the National Home Study Council, 1601 Eighteenth St. N.W., Washington D.C. 20009 or check with your Better Business Bureau or Chamber of Commerce for information about particu- lar schools. Or send 50 cents to the National University Extension Assn., 122 Social Science Bldg., University of Minnesota, Minn. 55455, for a copy of "Guide to Correspondence Study." 404 Consider the return value you'll get in relation to cost before you enroll in a correspondence course. Usually you're obligated to pay for the whole course whether von complete it or not. If you' can answer all the following questions affirmatively, correspondence courses can increase your retirement income and your intellectual vitality : Am T equipped from my background and experience to profit from this course? Is the school reputable? Do I have the incentive to finish the course? Tan I schedule my time and work on my own? Can I pa v for the course? Is it worth the price? Martin E. Shedd. Eugene, Ore., enrolled in a camera repair course when he retired at sixty-six. Before taking the course he had tinkered with cameras. He began to do repair work for a local photo shop, and after completing the course he opened his own camera repair shop. Today. Mr. Shedd is seventy-nine and is still repairing cameras although a vounger man has taken over much of his business. Mrs. Grace H. Rose. Tampa, Fla., studied small electrical appliance repair. She explains, "I'll fill a need by repairing small appliances. Men like to work on large appliances because they make more money on them. But, since my size handicaps me I'll stick to the small ones." Other retirees have learned profitable skills such as saw-sharpening, locksmith work, and hotel/motel management by mail. Once vou get in touch with the school of your choice, they'll send you a sample lesson, literature about the course, and a questionnaire about your scholastic background. After you sign a contract you'll get your first lessons. How quickly you com- plete the course depends on you — you can set your own pace. You can repeat exams as often as you wish. The instructor won't fail you. but he may refer you to additional material on the subject if he thinks you haven't done as well as you should. In high school programs local officials determine whether you can repeat examinations. Prices vary ( sixteen-unit high school courses cost around $250), but usually a correspondence course will cost less than one in school or college because cor- respondence schools don't pay for classroom maintenance. Correspondence in- structors — freed from meeting with scheduled classes — can handle many more students than can classroom lecturers. TV courses may also be a way of learning job skills. Depending on the offer- ings of vour local educational television station, you might be able to pick up a TV shorthand. The method taught is ABC Stenoscript (using the alphabet in- stead of special symbols), so it's less complicated. The main requirement for this course, apart from a knowledge of the alphabet, is plenty of practice. You should be able to work up a speed of 80 words per minute without too much trouble. Another TV course, Office Career Training, covers most phases of office proce- dure as well as typing. The two would constitute basic secretarial training. ABC Stenoscript is taught in many schools and colleges as well. Senior Centers and Y's offer many opportunities to learn a skill or craft, and some operate gift shops to help sell members' products ... so does the Salvation Army . . . business associations, like the Telephone Pioneers, and fraternal or- ganizations are other sources. Such community center classes— like the Eugene. Ore. cookins: class for men— "provide a happv combination of essential information and hobby-type interest." And the Kaplin center in Chicago offers such courses as languages, the arts, his- torv. philosophy, psychology, and sewing. There are also discussion groups on current affairs. William Siegel, the center's director, told the Chicago Tribune: "The thing that keeps the skin and bones together is engagement — with other people, with art, with social and political issues of the times." The American Craftsmen's Council is useful to know about, too. It's nonprofit and is devoted to stimulating interest in the work of handicrafts- men. In addition to operating a Museum of Contemporary Crafts at its Head- quarters in New York City and in San Francisco, it has a extension program which provides small exhibitions for regional circulation. Its bimonthly magi zine. Craft Horizons, reports on new work and technical innovations and lists regional craft events and competitive exhibitions. Its research and education de- partment maintains archieves of biographical and pictorial information on 405 American craftsmen and other data on the crafts that arc oj.cn to students and researchers. You can become a craftsman/sustaining member of the Council for $12 pearly (husband and wife, $15). A subscribing membership for $8 entities you to receive Craft Horizon*, the Council's newsletter Outlook, and free admission to its museum. The council is associated with the School for American Craftsmen, a division of the Rochester Institute of Technology, 05 Plymouth Ave. South, Rochester. N.Y. 14(108. Craft publications that may he purchased from the American Craftsmen Coun- cil, 20 West 53rd, New York. N.Y. 10019 are: 1. Craft Courses: a directory published annually as a "guide for the full- and part-time student of era lis in the U.S." This contains listings (by state), of universities, private workshops, museum schools, and art centers winch include craft courses in their programs. Information regarding specific courses taught, degrees given, accreditation by the National Association of Schools of Art, is in- eluded (e.g. — University of Hawaii has courses in ceramics, weaving, textile de- sign, awards degree of BA, BFA, MFA) . The directory costs 75tf. 2. Craft Shops USA: lists approximately 500 craft shops, galleries, and work- shop showrooms in the U.S. And it indicates which are interested in being con- tacted by craftsmen. Cost : $1.50. It's possible to earn money teaching the skills and hobbies you've mastered. Thousands of retirees do it in adult schools across the nation, for from three to fifteen hours a week, and thoroughly enjoy themselves in the bargain. Teaching of hobbies, crafts, and general interests often doesn't require formal training; plough in some states you must apply for state certification which is granted on the basis of experience. What you need is a good knowledge of the subject and a desire to teach. Wages vary from $2.50 to $15 an hour. The director of your local Adult Education De- partment can tell you what's available in your area. In general they seem to like retiree teachers. Jack Bobay, Director of Vocational and Adult Education in Fort Wayne (Ind.), reports, "Retirees are doing an outstanding job for us. We can point to them with pride." And in Texas, a superintendent says, "We don't employ retirees exclusively, but we employ a lot of them. We would hire more if they were available. You can't beat maturity and experience. It's important in teaching adults." Substitute teaching is another possible source of income for retirees with the relevant experience, though many systems allow retirees to work only a given number of days each year — and you must have a teaching certificate. Frank Whitney (Yakima, Wash.) teaches about fifty days a year and likes it. There are other tasks : special curriculum assignments, TV classes, teaching adult classes. Dade County Public Schools in Miami, Fla., have initiated a project, under the Older Americans Act, to recruit, train and employ senior citizens as part-time teacher-aides in the Dade County secondary schools. If the project is successful, this kind of training and work will open up for older people in schools through- out the country. For teaching jobs, or special curriculum assignments, you should go first to the school superintendent's office in your area and ask what credentials you need and what jobs are available. If you are an experienced teacher looking for a job, write to the National Teacher Corps, Office of Eduction, Washington, D.C. 20202. (Editor's note: For further information about job opportunities, placement agencies, and other ways to supplement your income — send for "How to Earn Money in Retirement," cost: 50 cents, from Harvest Years Publishing Co., 104 E. 40fh St., New York, N.Y. 10016) . Part III In this series on educational opportunities and possibilities, let's examine the field of gerontology — the scienceof aging — what we can learn about the aging process . . . the job possibilities in this field. The U.S. Administration on Aging and other federal departments such as Labor and Agriculture are trying to find ways to meet our educational needs. These departments work with state and local organizations, universities, colleges, and schools in developing new programs. 406 There's agreement that seniors need continuing education, part-time employ- ment, health and consumer information ... and that they should participate in C °Under 1 one program, the Community Service and Continuing Education Program of the Office of Education, plans are made for expanded adult education in uni- versities and colleges. The program stresses that classrooms and teaching meth- ods be organized to meet adult needs, and calls for research to solve com- munity problems including those of older people. Edward Warner Brice, confidential assistant to the Assistant Secretary for Education U S Department of Health, Education, and Welfare, says strides must be taken to deepen understanding of how to educate seniors. "Often we give our adults warmed-over versions of programs intended tor children " Brice savs. "Education for older persons should be education for re- newal creativity, and innovation. The pressing need is to educate both young and old so they can adapt to the accelerating rate of change in our society Dr Muriel B. Wilbur, director of gerontology at the University of Rhode Island, comments that it's silly to plan courses for seniors in undesirable ° She°asks how many people sixty-five and over will attend classes when they find that the nearest bus stop is six blocks from the school and the classroom is up three flights of stairs and equipped with seats designed for teenagers ? "Classes need to be accessible to many people and should meet during the day if possible," Dr. Wilbur adds. "Courses should be discussion rather than lecture periods. Seniors can serve as teachers in many cases." Dr Wilbur comments that self -exploration courses are popular because seniors want to understand their personalities, physical changes, and social situations. They're also interested in practical things— housing, finance, etc. During maturity many persons would appreciate the opportunity to study cul- tural and intellectual subjects, but Dr. Wilbur notes that bingo and television often become the primary activities. In San Diego, the Department of Adult Education had organized adult edu- cation courses, but the seniors weren't taking advantage of them. The planners began making changes. . . Free classes were arranged (lack of money had been a major deterrent for manv seniors), scheduled at more convenient times and locations. Class enrollment jumped. After a year project directors reported that continued high enrollment in most classes proved that older adults need and enjoy educa- tion They noted positive changes in attitude and in behavior patterns and agreed that it costs less to educate seniors than to accept apathy and withdrawal as being a natural part of aging. There's increasing interest in the universities and colleges m gerontology (study of processes and problems of aging). ., - The State of Michigan— a pioneer in gerontology— created the University oi Michigan-Wayne State University Institute of Gerontology. This research center informs and consults with interested organizations and communities. Other uni- versities including Duke. Southern California. South Florida, Penn State, Ore- gon, North Texas State, and Chicago now have comparable centers. At least twenty -five universities have graduate education in gerontology. Other schools that teach social work, nursing, public health, psychiatry, clinical psychology, and physical therapy have gerontology courses. To overcome the complaint from all directions that there's a serious shortage of trained personnel, seniors, along with others, are being drawn into the programs. , _ , The University of Georgia, for instance, has had conferences for men and women who are retired or preparing to retire. At the meetings they discussed wavs to "make retirement worthwhile for the individual, his family, his friends and his community," according to Robert P. Wray, chairman of the council on gerontology at the university. Thirty retirees attended the first conference and most of them volunteered to help carry the project further. Two of them went home to Cleveland. Ga. and organized the White County Achievement Council. Their third meeting was televised by a local station, and the group has planned several programs for seniors. ^ „ , _, „ . ,. The University of Kentucky, under the direction of Dr. Earl Kauffman or its Council on Aging, also has been studying education for retired people. 407 i>r. KnufTinan Included Donovan Bcholara and retired faculty membera La his project so that seniors would be represented. Tho objective of the project was to show that, seniors want to study problems that Interest them and that thev can help solve community problems. Dr. KaufCman wanted to formulate some guidelines for communities to use when organizing and conducting educational programs for seniors. Specially planned programs were given in four community colleges in Kentucky. The plan to involve seniors in community problems w;is activated. At the end of the course one of the four communities (Somerset) was adopting suggest ions from senior students to consolidate its library, health center, recreation building, etc. into a multipurpose unit which would serve all age groups. The Kentucky Welfare Foundation, impressed by the success of the first pro- gram, granted Somerset an award of $500 for a second course. Seventy-six people enrolled — fifty of them were over sixty-five. A general observation of persons in the Kentucky program was that seniors became conscious of themselves as a special group in society and that they learned about themselves, their society, and what they can give to their communities. The Iowa Commission on Aging and the state's universities, colleges and sec- ondary schools claim to be leaders in developing the idea that education on aging should begin e-irly and continue throughout life. The Adult Education Association of the USA received a federal grant for a National Pilot Institute in New England. Adult educators from university exten- sions public schools, rural educational programs, libraries, and labor unions met to develop plans for adult education programs. As a result of the initial experiment, a long-term program was established at the University of Rhode Island to serve adult educators through the region. Appropriately enough, volunteer and paid jobs and training are opening up for older workers in the field of gerontology. A few universities and colleges have begun programs to train pre-retirees and retirees for such work. The University of Tennessee together with Senior Citi- zens, Inc. of Nashville, Tenn., has a Training Institute for Adult Leaders. It's described as an "educational program for older men and women who wish to prepare themselves for service in the field of aging." To qualify you have to be fifty years of age or older, in good health, have a high school diploma or equivalent, previous experience in working with people, and a sense of dedication. Courses are given in the spring and fall and last eleven weeks. Besides field work there are classes two days a week. Tuition scholarships of $72 and up to $250 for out-of-town trainees are available. Applicants are screened by a com- mittee. If accepted you can enroll by paying a registration fee of $72 per quarter to the University of Tennessee, Nashville Center. The extension program at the University of California — Davis is well advanced on a three-year program to help community leaders and seniors initiate new facilities and programs in the twenty-four northern counties of the state. Dr. Glen Burch, program director, reports that retired seniors are demonstrating initiative and persistence in sparking new community services for their peers-. Fordham University, New York City, trains personnel workers and people nearing retirement to lead pre-retirement programs in labor unions, businesses, community centers, etc. Rutgers, the State University of New Jersey, trains mature people for work in community service projects. The Gericare-Aide Training Program at the Center for Community Educational Services at State University Agricultural and Technical College at Farming- dale, L.I. (New York) , operates under a federal grant under Title I of the Higher Education Act of 1965. It trains mature men and women to assist in the non-medical care of old peo- ple at home, in hospitals, and in nursing homes. After learning about older peo- ple's health, nutritional, and psychological needs, students use their new skills in either paid or volunteer employment. There are ten sessions of two hours and the fee for the course is $5. The San Diego Adult Education Department has developed a college level program on gerontology. They hope it will become part of a four year program on the San Diego campus of the University of California Extension. Other organizations besides universities have projects for seniors. The Inter- national Ladies Garment Workers Union in New York City, with some federal assistance, is training fifty seniors and paying them $1.50 an hour plus trans- 408 portation to call on at least two older people each day. They visit, help with household problems, and try to interest seniors in community' activities. The National Council on the Aging has organized FIND (Friendless, Isolated, Needy, Disabled) in some large cities. Senior workers are paid $1.50 an hour to visit lonely, poverty-stricken seniors and help them get hot meals and escort service. If you want to serve on Project FIND, contact the NOCA's regional field representative. There are regional offices in Atlanta, Ga. ; Chicago, 111. ; Kansas City, Mo. ; San Francisco, Calif. ; and the main office is : National Council on Aging, 315 Park Ave. So., New York, N.Y. 10010. Project TEAM provides three months' training for twenty-four older aides. The trainees then serve as a nucleus for teams which operate from three centers in the Chattanooga-Hamilton county area of Tennessee. These teams combine young and old workers. They consist of a volunteer worker, a Neighborhood Youth Corps member, a work-study student, and an aide trained under this project to coordinate the team. Each team will help needy seniors with informa- tion, services, and companionship. Training is also given by private organizations. Swaim Associates give the An- nual Short Course on the Organization and Administration of Homes for the Aging, Retirement Homes, Apartments and Villages in June at the Chalet Res- taurant, Dillsburg, Pa. Cost for the course is $30 plus room and board. For further information, write to Swaim Associates, Dillsbury, Pa. 17019. Senior centers are always looking for volunteers with skills and training. The Wagon Wheel Senior Citizens' Center in Syracuse, N.Y. seeks volunteers to aid the Blind ... A Christmas Seal Campaign, a Friendly Visiting Program, Meals on Wheels, fund raising for the Wagon Wheel, and numerous educational classes. In other centers seniors edit the newspapers, are responsible for the library, or conduct study groups. Some seniors prefer to work with youngsters and many opportunities for this exist. The National School Volunteer programs in the large cities are important and are practical for everyone concerned. Volunteers may be asked to help a teacher or to work with one child or a small group who needs special attention. Some areas have "teacher-moms" to help emotionally disturbed children. The School Resource Volunteers of Berkeley, Calif., believe that teachers can't be expert at eveything, and it helps if qualified specialists are available for classes. Volunteer recruiters locate specialists and ask them to help. Teacher requests have ranged from an expert on Russian literature to a folk singer. Senior citizen groups are one place where recruiters look for qualified volunteers. Project Headstart is another opportunity for both paid and unpaid volunteers to help educate children. The children are pre-school age from poverty homes. They need preparation before starting school because they haven't had as many educational experiences in their homes as other children have had. The Foster Grandparent program is for people of sixty and over whose income is low. They are employed up to twenty hours a week to give love and attention to needy children. The Administration on Aging (Dept. of HEW, Washington, D.C. 20201 ) can give information on this program. The Administration on Aging can also tell you about other volunteer programs such as VISTA (Volunteers in Service to America), The Peace Corps, Project Green Thumb, and the Teacher Corps (see "How to Earn Money in Retirement," HY. November, 1967). Volunteers are in great demand at Veterans Administration hospitals. You can write letters, run errands, feed and read to patients, etc. For further informa- tion, write to the Director, Volunteer Service Staff, Veterans Administration, Washington, D.C. 20420. And — especially at this time — there's a need for seniors to help out in political campaigns. Next month Harvest Years will show how many readers are helping their candidate to win elective office — and, in the process, helping themselves. Part IV In this series on educational opportunities and possibilities ex- plores the "liberal arts" approach to learning — whether you study at home, at forums or instiutes, senior centers or churches . . . Learning is experimenting with ideas and exploring ideals. And we can gain personal rewards and make a social contribution from simply sampling the joys of learning . . . for satisfaction, enrichment, or curiority. 409 SO, let our approach be that, of a "liberal artist" a humanist ic approach to learning as opposed to the professional, vocational, or technical. As "liberal artists,"' we'd be tree to delve inlo a wide diversity of knowledge to develop tun- general intellectual capacity, reason, and Judgment . . . Intended to bring about the improvement, discipline, or free development of our minds or spirits. Come to think of it, retirees are ahout the only ones who can afford to culti- vate their minds somewhat in the manner of the eighteenth century, when an educated man was expected to have a broad general knowledge of many things. One reader, Ruth Wood Cadmus, expressed it this way : "Yes, I'm seventy-two. And 1 am glad to he so hlessed ! At seventy-two, I finally have the leisure to read hooks 1 once shoved aside for lack of time ... to keep in touch with friends and kin ... to teach piano to eager young pupils ... to travel to the limits of my strained purse ... to explore the infinite stretches of my imagination . . . to write ... to ponder sage philosophies and new ideas. . . . "I find so many new ways to enjoy life. And each thing I do, I do for the love of it. So none of it ever seems like work.''' And Mrs. Grace Bennett — seventy-year-old mother of eight, grandmother of twenty-six, and 1968 graduate of Linfield College in Oregon — gave her reasons for putting her previous smattering of college courses together towards her new degree. She wanted to be an inspiration and felt that her own college-graduated chil- dren should continue their education to keep up. She pointed out, "They can't say that they are too old to do it when they see what mother has done." But perhaps more at the heart of it, is her sense of her place in, and ohligation to, our society as a whole and the contrihution seniors can work towards : "Old people should create a calm in the world. ... It would help a lot if all the older people with their years of experience would do the very best they can wherever they are now. ... As long as I can be useful, I will be." Those who relish the give and take of learning — the arguing, questioning, probing — would probably enjoy taking adult school or college non-credit courses. (See HY July's "Back to School" education section.) Some universities have non-degree schools for adults, although not all are as wide ranging as New York University's Division of General Education which enrolls more than 21,000 students in more than 1,200 classes. NYU's faculty is drawn not just from the academic community but also from leaders in the world of business, industry, and the arts. And there are no formal requirements for general admission, unless for advanced studies. Only one thing is mandatory says NYU : the wish to continue to learn. Fees vary widely but most are in the $50 to $75 area. The division also has a branch program called "Liberal Arts in Extension," for people living in over sixty suburban communities in the greater New York City area. There are lectures, study-discussions, workshops, and even residential weekend seminar programs in the humanities and public affairs. Some pro- grams are held in homes, community centers, and other convenient places. Weekend seminars at Onchiota Lodge in Sterling Forest, N.Y. offer "... a sojourn in the country, good food, and a chance to learn from and with a stimu- lating faculty in an informal, congenial atmosphere." For a catalog of courses or more information on the Liberal Arts in Extension, write to Division of General Education, New York University, 1 Washington Square No., New York, N.Y. 10003. If you live in New York City you can attend free lectures at the Forum of Cooper Union's Advancement of Science and Art. The Forum is the Adult Edu- cation Division of the celebrated institution founded in 1859 by Peter Cooper. For over 100 years the Cooper Union has been dedicated to helping people to "acquire useful knowledge, and to find and fill that place in the community where their capacity and talents can be usefully employed with the greatest possible advantage to themselves and the community in which they live." Even if you live far from Manhattan, you can still "attend" the Forum lectures by many of America's most brilliant teachers. They're broadcast by radio through- out the nation and published as books by Sheridan House. Courses, one night a week for twelve weeks, are given in spring and fall. There's a $5 registration fee for each course. The choice ranges from nutrition and diets to oriental philosophy. There's also a unified three-year program of courses in the social sciences and humanities, intended to provide "a continuing and cumulative 410 educational experience which, although leading neither to college credit nor to a degree, is conducted on the college level by a qualified faculty." For a catalog, write to : The Cooper Union Forum, Cooper Square, New Nork, N.Y. 10003. Last year the University of California at Santa Cruz came up with an imagina- tive new experiment— Methuselah I— in the education of "mature adults foi whom traditional academic institutions and procedures are eit&er irrelevant 01 inappropriate." , .. L .. . . , _^ If the program succeeds, a full-time school for adult studies is planned. Persons aged twenty-six to seventy-six attended the six-week pilot, and whole families were accommodated on campus. Study was either full or part time ; no degrees required no credits given. According to Dr. Maurice Natanson, director of th< program, "The only prerequisites are intelligence, openness to ideas, and a willing- ness to explore root problems." INSTITUTES FOE LEARNING We often think that professional people have nothing to worry about when thej retire. The doctors, dentists, lawyers, scientists, teachers, executives, and creative or performing artists appear intellectually prepared by their work. Still experience indicates that they can get just as bored, restless, an< depressed as anyone. And again the reason seems clear: a feeling of uselessness not understanding the full potentials of their new roles, or loss of self-identity. Ii some respects retirement is harder for such people. It isn't always palatable t< step down from a busy, perhaps distinguished, career and suddenly find oneself i SI However, there's less reason for this today. Institutes for older people an developing on the national scene. . Many institutes are sponsored by the Oliver Wendell Holmes Association. Char tered in 1962 bv the Board of Regents of the State of New York, this associate is supported as a public service by grants from the Administration on Aging ; am bv foundations like the United States Steel Foundation and the Paul A. McGhe Fund of the New York Foundation. Its aim is to help men and women retire grace fullv after an active business, industrial, or professional life. The solution: con tinuing education, combined with involvement in the contemporary world, am "wide? utilization of the valuable (but often wasted) human resources of retire X^^^e^SS^ organizes institutes, or seminar-institutes, fo periods of one to four weeks, mainly at resort communities with a preponderate of older people and at universities. Others have been held at Re n ssel a erviUe, K Y. Phoenix and Tucson, Ariz.: Lansing, Mich.; Clearwater and Hollywood, Fla. Lexfngton Ky. ; Boston, Mass. ; and Philadelphia, Pa. Eventually the country ma; *£S^&™K™t the Oliver Wendell Holmes Association, write t S ^lTS^5X^ ^r Social Researc (66 West 12th Street, New York, N.Y. 10011) is another pioneering organizatio. also set up in 1962. It provides retired professionals with "an opportunity fo continued inteuectual and cultural growth." (The word "professional" being intei PreterMberallv in order to attract a cross-section of talents and experience. The welcome mat is out for all professional people including men and wome "who have earned the major part of their income as actors, singers, dancen nmslcianl, industrial designers, writers, painters, composers, and as various spc ^S^^^aS^'Wilve to eighty-five, and courses are run b; DartiSpants If no one with the required expertise for a course is on hand th group sfmply details someone who is interested to bone up on the subject an ^For'tSeJrannuSlee of less than $100, members are entitled to attend one daj tim course at the ' New School each semester. This has the added advantage o Ip^ninVthem Tin touch with the "other half"— the nation's youth . The insmute's lounge also serves as a library and a gallery for displaying it member? artistic work. The informal program includes discusion and readin SSSoT tours of museums, participation in musical, theatrical, and social event* ^Sere^ a Community Service Committee, and volunteers put their time an k^owleaL to use in worthy causes like the Lighthouse, UNESCO, the New Yor. ffi^^te sSe^rviSTA, and so on. The institute also looks after its ow: atth£ ^members with visits, phone calls, and nursing care arrangements. 411 The Forum for Professionals and Executives, sponsored by the Washington School of Psychiatry, Is a virtually self-governing body. Formed Ln L966, It em- phasizes the liberating character of retirement, arguing that the vast reservoir of experience and ability Lying fallow In older professional people and executives can now be exploited, its members don'1 have to be retired some arc still work- ing and some arc engaged In second careers. Nor is it necessary to have a gradu- ate degree. Bui all are men and women between ages forty and eighty "with open minds who seek opportunities for creative expression." The Forum "cherishes traditions of interdisciplinary cooperation and hospital- ity to aew ideas. It hopes to feed hack into the community, to help alter the com- mon image of old age, channeling isolation into relatedness, stirring passivity to participation, transforming dependency into leadership." In other words, it's Working hard to do away with stereotyped notions of age. Forum projects include study of the unemployment prohlems of retired peo- ple, estimation of the standards of nursing homes, and a survey of preretirement prohlems for federal civilian employees. Some members particioate in the Sub- committee on Employment of the Elderly of the District of Columbia Inderde- partmental Committee. Others serve as consultants in other agencies. By getting involved with its community in this way the Forum "proposes to en- courage a more sensitive response to talent in persons of all ages, and the en- richment of our society through the restoration of elderly citizens to full partner- ship." Informal seminars are held fortnightly in the Sullivan Room, Washington School of Psychiatry (1610 New Hampshire Avenue, N.W., Washington, D.C. 20009), where all interested people are welcome. Subjects range from the "proper study of man" to "social security." The Forum's activities depend entirely on its own volunteer efforts. Annual registration and membership fees are $25. Yet another approach to the concept of continuing education is that of The Institute of Lifetime Learning (1346 Connecticut Avenue, N.W., Washington, D.C. 20036) restricted to members of the National Retired Teachers Associa- tion or the American Association of Retired Persons. It offers relaxed, informal, unpressured education of all kinds. The basic premise of these programs is that people with intellectual curiosity are ageless. Perhaps, smaller cities and towns don't have quite as many programs or as varied a selection, but you have similar opportunities to explore in just about every area of the country. INFORMAL WAYS OF LEARNING As you might expect, informal ways of learning — especially those designed with us in mind — seem to be most popular. Senior groups within the Y's often have their own informal lecture programs included in social meetings. Some churches have language classes (for ex- ample The Tower League of New York City's Riverside Church), as well as other interesting programs at their clubs and homes for the elderly. Many churches have formed XYZ (Extra Years of Zest) Clubs, with hobby centers, language programs, and group travel among their activities. The XYZ Club of the First Baptist Church of Los Angeles features an annual overseas and monthly local trips. The XYZ Club of Baton Rouge, La., concentrates on arts and crafts and sells members' work including baskets, birdhouses, and garden furni- ture for charity. Catholic, Protestant, and Jewish groups all hold retreats — varying from a weekend of meditation to a full week of conference-style activities— to help peo- ple gain insight. An interdenominational group called Camps Farthest Out also offers the op- portunity to join together in finding the "spiritual realities that lie beneath the surface." Each session lasts a week, and meetings are held at forty different places in the U.S. each year ... at resorts, park campgrounds, on church grounds, or college campuses. For a directory of these camps, write Camps Far- thest Out, 1569 Grand Ave., St. Paul, Minn. 55105. But it's probably safe to say that more and more "liberal artists" — at least in towns and cities— find their educational opportunities at local senior centers. At their best senior centers offer us a way of satisfying our social and educa- tional needs, as well as providing us with a springboard for volunteer service to the community. Some centers are part of community recreation programs for all citizens. Others are sponsored by voluntary agencies, churches, service clubs, or union groups. In some cities, interested citizens form a corporation to organize a center. Sometimes 71-272— 72— pt. 1 27 412 two or more groups combine to help . . . sometimes it's mainly a do-it-yourself' operation by seniors themselves. The building of the beautiful new center in Flint, Mich., for instance, was- financed through the City of Flint capital improvement fund, except for the golf wing. (Yes, it's got a golf course, clubhouse, lounge, and concession which it claims is a unique feature for senior centers in the U.S.) But the emphasis at the center isn't just on golf. The center is near Flint Com- munity College and the Flint branch of the University of Michigan, so a lecture series has been established ; also the International Institute at the college is spon- soring a series of luncheons, featuring the cuisine of a particular country. Flint's Senior Citizens Services is also located in the center building. The Wagon Wheel Senior Center of Syracuse, N.Y., on the other hand, appro- priately located in the remodeled Carriage House of a large estate, is the responsi- bility of the Corinthian Foundation, a group of 220 philanthropic women. The Center's members help raise funds as part of their volunteer work. It has a broadly diversified program of social, educational and community service (re- viewed continually by its steering committee) , details of which are to be found in Spokes its monthly newsletter. Of special interest are the Wagon Wheel's production of "Ever Since April" and their organ lessons. "Ever Since April" is a one-act play dealing with the prob- lems of a couple when the husband retires, and describing how they solve them. For this event three students from the College of Home Economics at Syracuse University acted as coaches. The organ lessons began in 1965 as an experiment with four other senior groups from Dallas, San Francisco, Cincinnati and Louisville. The project was sponsored by the National Council on the Aging and the Baldwin Piano and Organ Company to find out whether older people could learn to play a musical instrument suc- cessfully, and if so whether the organ was a suitable instrument for them. From the beginning, the seventy-three year old teacher, Mrs. Luella Wickham,. used two different methods of teaching ; one for those who could read music and one for those who couldn't. None of the nine pupils chosen had even played an. organ. Reports the Wagon Wheel's Executive Director, Mrs. Wayne M. Nelson, "Prac- tice was never a chore but an opportunity. The experience was a dream come true for those older folks— the fulfillment of a desire of many years." At the end of the fourteen weeks' experiment, the triumphant graduates gave a recital for over 100 members, friends, and relatives. All concerned with the project agreeed that the organ "gave a sense of power, wonder and accomplishment out of proportion to the effort expended" ; that none of the pupils could have learned to play the piano as weU ; that senior citizens have a great desire for musical expression, and can overcome handicaps to attain this when they get the chance. And look what these other senior groups are doing : The Senior Neighbors of Chattanooga Inc., formed the club themselves with the h^lp of commmunity leaders and volunteer organizations. Operating five days a week from a disused railway freight station which was loaned to them, they have an extensive program including classes, trips, and symphony presentations along with recreational and public service. | Senior Citizens, Inc., of Nashville, Tenn. came into existence because of local concern at the growing number of older people in mental hospitals. It's a private, nonprofit voluntary organization, with an advisory committee of older people themselves governed by a Board of Trustees consisting of forty-nine citizens from all walks of life, and gets help from the Tennessee State Department of Mental Health, as well as the United Givers Fund and the Metropolitan Deparmtent of Health Direct services, research, training, and consultation are combined in one center. At first this was on a three day a week basis but gradually expanded to five. The center moved into a new building in 1966 with branches radiating from there. Over 3 000 men and women, fifty-five years and older participate in center activi- ties, including talks on "Education in the Senior Years" and on the "Positive- Thinking of Aging." Hobbies are popular, and there's an annual hobby show (last year's highlights were antique collections and genealogy). An orchestra and chorus keep things lively. I Retirement communities offer many educational programs. In fact the manage- ment of one of the Leisure World communities finds the rush to classes so im- pressive, it's beginning to dream of its own university some day with a faculty recruited on the spot ! 413 The Deltona community In Florida has a twenty one course program sponsored jointly by the Deltona Corporation and the Adult Education division of the Day- tona Beach Junior College. Teachers Cor academic courses are provided by the college. The corporation looks after more sportive and recreational offerings (such as fishing, floral ar- ranging, bridge) and supplies the buildings. "Education Is supposed to be a goal In Itself," says Chuck McCarthy who man- ages Deltona and has a masters degree In education, "but our students have an awful lot Of fun, too. People Whose self educational interests have been dormant for years suddenly want to try everything." Whatever the method, clubs and centers have a common aim : enrichment of our lives and communities by helping us find new talents or use those going to waste . . . pointing out the many civic services we might undertake for the common good . . . providing a friendly atmosphere, not only for social meetings, but also for talk, discussion, and education. LEARNING AT HOME Some of us, for good reasons, don't like, or are unable, to attend classes. But this needn't prevent us from continuing to learn. Study at home is the answer — making full use of every means at our disposal, old and new. Did you know, for instance, that you can learn to play almost any instrument by mail? There's a home study school, devoted entirely to music. Budding artists, writers, and photographers can also find all the courses they need. Charles T. Steed, a machine shop foreman, was sixty-two when he took up art via the mail box. Now retired, he's found a whole new career — has pictures show- ing in several parts of the country and does sign work and billboard painting as well. If you need help choosing a creative course, Writers' Digest magazine, in its September 1967 issue, published a comprehensive list of University Extension Courses and Writing Schools, of interest to cartoonists, artists, and photographers as well as writers. It's a useful survey that could help you make up your mind on what's best suited to your particular requirements. You might write the maga- zine (at 22 E. 12th St., Cincinnati, Ohio 54210) for a back copy, or try one of the Back Date Magazines services. Another interesting possibility for home study is the Metropolitan Museum's Art Seminars in the Home, distributed by the Book-of-the-Month Club, 345 Hudson St., New York, N.Y. 10014. It's meant to replace illustrated museum lectures on art appreciation. They send you twelve portfolios, one a month, each dealing with a different aspect of art, and each containing twelve color reproductions of paintings to use instead of the slides you would be seeing at a lecture. In some ways this is better because you can use them over and over, study them as much as you like, in your own time, in conjunction with the text of the seminar. Recordings, either purchased or borrowed from the library, can yield much knowledge. You can study drama, or a language, or practically any aspect of music that appeals to you. Tape recorders have many uses. For instance, Miss Eunice Dyke, an eighty- year old resident of the Julia Greenshields Home in Toronto, Canada, proposed that older people in the Province of Ontario record their memories of the past in the interests of history. Several projects are under way in Canada and the U.S. Maybe there's a similar project in your state; if not why not get one started? Retired clergymen and teachers make excellent interviewers. W T hat about TV and radio — either educational or commercial? Both can be very enlightening without .being dull. It's all a matter of balance and judg- ment — two qualities we should have, You don't have to cut out your favorite weekly whodunit or western saga, but it's a good idea to plan listening or viewing at the beginning of each week for a proper mixture of entertainment and enlightenment. Unfortunately, some program schedules leave something to be desired. As Jack Gould, TV critic of the New York Times, said recently: "With better scheduling . . . there might well develop an expanding public hunger for taking courses that could round out a set owner's education or satisfy a latent yearning to know more about a specific subject." Since 95 percent of us spend five or more hours a day watching TV or listen- ing to radio, we ought to have some say in the matter. Too often the main emphasis in prime time is on programs aimed at the yo-yo set, and the rest 414 off us are neglected. So we'd be doing the entire community a service if we did a bit < program monitoring, then wrote to local stations to express appprecia- tion and/or dissatisfaction and make suggestions. In fact if we don't do this, the situation may get worse. According to a report in Variety, the Nielsen survey has decided that people aged nineteen to forty- nine watch more prime-time than the over fifties (although some doubt this), so future programming will be beamed at youngsters even more than it is now. However there's one program on an Educational Television (ETV) station entirely devoted to seniors. Its success has called attention to possibilities within this medium that are just beginning to be tapped. With the help of a federal grant, this experimental program called T^e Time of Our Lives, has been operating for some time now on WITF-TV m H The e nro £> /ram offers a weekly half -hour on everything of interest ... fron le-al advice and tips on hearing aids to talks on bell collecting and remimscenset by a member of a Pennsylvania college class of 1892 who compares college ^Eaclfproduction (broadcast in prime time, incidentally) is designed accordin* to the expressed views of the program's viewers. Nne retirees, employed as area coordinators, work with the show's producer! -is promoters of the program, analyzers, talent scouts, and sound out viewer! faction The host of the magazine-type program is a retiree. A voluntary "Com mittee of 100" aged anywhere from sixty-four to ninety-one-some active, son* Confined to bed, some fairly affluent, some less well off-also evaluate the offer in-s If a segment pleases these critics it will appear again. If not, it disappears Viewers are encouraged to write in, state their views, receive free literatur on subjects covered, appear on shows, and generally participate as much a P °The 1 main objective is involvement of the viewing audience ... to help seniors within the scone of the medium, to enjoy their later years to the fullest S Lr its been Tmmensely successful, so successful in fact that other BTV broad casters across the nation are interested in similar programs for oider people Meanwhile, St. Paul, Minn, (also with help from the government) is embari ing on an ambitious program of its own to develop statewide ETV Programs foi about and by older persons." About forty-two planning committees and more tha 500 Golden Age Clubs in the state are involved in promoting this organized grou ^Sraator Walter Mondale (D.-Minn.) remarked not long ago: "It should b plain that older Americans can gain much if their television sets serve them i concrete, down-to-earth fashion. -That's the goal, and we already have proof that it can be done. Now its u to Congress, television programmers, appropriate federal agencies, and— mo* important of all— the public, to make certain that it is done. Part V In this series on educational opportunities and possibilities explores new treasures at your libraries and museums . . . learning aids for the handicapped . . . If you visit your local library regularly, we don't have to tell you what chang. have been going on in the past few years. I library today is much more than a musty place to borrow detective stone Many a retiree has found the solution of his retirement problems at the librar Frank Atkinson is a good example. His problem was a common one . . . 3 u ronldn't settle down after his busy office life. One afternoon as he aimlessly drove downtown, he passed the public librai and wondered if they had any books on golf. He decided to have a look Frank started with the sports shelf. Then the librarian he'd consulted offer to show him around. She led him to the art room (pointing out the print c( lotion that could be rented) ... the music room (with its records &r borr* ing) the periodicals room (over 2,000 current magazines) . . .the nevs paper room . . . the foreign department (with books and records in twenty-fr languages). This library even had private booths for listening; some ha ea The°lit) S rarian told Frank that concerts were given every Wednesday. He w much impressed by the audio-visual service, consisting of 16mm films on mai 415 Objects, plus a Large collection of mounted pictures and micro-text materials. "But what really sold me," said Frank Later, "were those rows ol how to books in the science and" technology sections. I got so Interested 1 couldn I Leare them * By 'centering his reading around a central theme or subject, Frank found that one "book Led to another, and one subject Led to another. "It's Like going through a fascinating house of many rooms," says Frank. jean Stone, a retired high school teacher, joined the Great Hooks discussion group at her library. There are over three thousand of these groups in the I .S. Jean had just, lost her husband and felt the bottom had dropped out ol her Bv searching to undertsand great ideas, she regained a perspective on world. By se 1 "I'm more at peace with myself than I've ever been in my life," she says to- day -And I've rediscovered friendliness— my own and other people's. ' It costs nothing to join one of these chapters. You can find out about them by writing to the Great Books Foundation, 5 South Wabash Avenue, Chicago, 111. If vou don't fancy reading the Great Books but would still like to stretch your mind' with a tough subject, try something like the New York Public Library s "Today's American in an Age of Technological Change." It goes into the ettects of technology on all of us. What will he the effects on governments, labor manage- ment? On the individual, on education and cultural and moral values? It s worth your while to ponder these questions and to see the answers in the making. Genealogy is a subject that appeals greatly to older people and that libraries cater to. Seattle, for instance, holds Workshops on Family Trees (fee $10) to get people started on this fascinating hobby. Everyone gets a genealogy work- ship kit including family group sheets, pedigree charts, etc. Lectures are given on how to locate information in the library by using books, microfilm, nncrocards, card catalog indexes, and reference works. Instruction is given on how to inter- pret records and other documents. . Film program, family night programs, book review teas, dramatic readings (often by skilled pros), lunchtime shows, and concerts in the park (opera or pop) are only some of the many offerings. Not all these programs will be found in all libraries, of course, but a selection will be. Libraries sometimes have special courses for seniors, like the Detroit Library s series of eight weekly programs entitled "Retirement: a New Lease on Life." They're given in the spring and fall (so the weather will be good) and at a mid- morning hour (so retirees can use their discount transport passes). The Rochester, N.Y. Library has the "Live 'N Learners" one a month, an in- formal education program for folks over fifty-five, that begins with coffee and kuchen at 10 a.m. Then there's the "Live Long and Like It" library club of Cleveland, Ohio, which goes in for book reviews and discussions. Milwaukee, Wis., has started a bookmobile for senior citizens in that city which tours retirement homes, golden age clubs, senior centers, housing projects— in fact, wherever seniors live or get together. The Bookmobile, has a hydraulic lift to accommodate wheelchairs, or simply help anyone who has difficulty climb- ing its steps. A portable bookcart is taken into homes for the elderly, hospitals, or wherever there are people who can't get out to the bookmobile. The collection includes large-print books and recorded works, as well as ordinary -type books that have been carefully balanced to appeal to the wide range of seniors' interests. Seattle, Wash., in cooperation with other community agencies, runs demonstra- tions from time to time on nutrition for senior citizens, as well as discussions on other aspects of retirement living. The food demonstrations are very popular. In 1966 the Seattle Library also ran a course on creative writing for people over sixty which still carries on as "The Sunset Writers Club." "The emphasis in the course," says Miss Ellen L. Walsh, head of the Adult Education Depart- ment, "was on helping people to write for their own satisfaction and for the pleasure of families and friends rather than on the development of a professional career. Other libraries take the view that oldsters shouldn't be singled out but should take part in all library activities. New York City adopts this philosophy. But it maintains an extensive collection of large-print books for people with bad eyesight and has compiled a reading list called Retirement Years, covering preparation for retirement, second careers, money matters, where to live, keeping fit, "Society and the Senior Citizen," and so on. Also some of the library's branches have programs on Medicare, in 416 cooperation with the Social Security Administration. You can obtain the reading list by sending 25 cents to Manhattan Branch Library Book News, New York City Public Library, 5th Avenue and 42nd Street, New York, N.Y. 10018. Most libraries have a telephone reference and readers' service department. If you need the latest census figure for Boise, Idaho, or maybe a quote from Paradise Lost or an out-of-state address — all you have to do is pick up the phone and call your library. Many also have provisions for "home-bound" services for delivering material to the handicapped. At least one library — the Dayton and Montgomery County Library in Ohio — has held a successful, informal "workshop" on this very subject of how to use the library. Who knows, maybe your local library would be interested in doing the same. It's worth asking. MORE FROM MUSEUMS Museums, like libraries, can be a continuous source of pleasure and learning and also form a focal point for other activities. They may be crowded at peak times, but — unlike working people — seniors can choose their time to go. But it's wise to make up your mind beforehand about exactly what you want to see, not to let your enthusiasm run away with you and lead you into tramping through the whole museum. Better to spend an hour or two with a few pictures ... in the antiques wing . . . enjoying the glass and china ; or take in a single section of a natural history museum. Really learn something without becoming limp. Unless, of course, you're in one of the smaller places devoted to a particular subject: American Indians for example (New York City) or military history (West Point) . Don't forget to investigate gallery talks, lectures, films on art, concerts, re- corded tours, etc. Becoming a member of your local museum, if you have one, might open new horizons for you, and you get special privileges in the way of private viewings, lectures, and so forth. If you're planning a trip, whether here or abroad, you're practically bound to end up in museums somewhere along the line. The same rules of thumb apply : don't try to see too much at once . . . study ahead . . . make for the things that interest you, depending on your tastes, hobbies, avocations, If you haven't tried this before, you'll be surprised how much fun it can add to your trip. With increasing leisure time what's doing in all the arts should interest all of us — once we get involved. To prove the point, the AFL-CIO has launched "Demonstration Programs of Labor and the Arts" in four cities. In the fall of 1967, New York State (Cornell University) School of Industrial and Labor Relations' Metropolitan Center began developing a pilot program — Labor Explores the Arts — with three inter- ested New York City unions. These were : the Retail, Wholesale, and Department Store Union's District 65 ; the Amalgamated Clothing Workers of America's Local 169 ; and retirees of the Hospital and Drug Employees Union's Local 1199. Although few of us will be directly touched by these particular programs, we might find some correlation between Cornell labor program specialist Barbara Wertheimer's report and our own attitudes. Perhaps, it might even encourage us to do a little more exploring of the arts on our own — right around the corner at our local museum and/or library. The unions were interested because, as Mrs. Wertheimer noted : "Those who have been virtually untouched by the cultural wave are most of the country's workers and their families. . . . (But with) more leisure time than ever be- fore. . . . (and) an evergrowing number of retirees who constitute a group of healthy, active union members. . . . (there is) both the opportunity and the responsibility to develop exciting ways ... to utilize this leisure." However, this and some hindering attitudes, the debris of former barriers, might well apply to many of us who grew up during less affluent times : " . . . for several economic, social, and psychological reasons now no longer valid, workers have been slow to involve themselves . . . frightened away ... (by the past) high-cost image and aura of exclusiveness (the arts presented, and) . . . because they suspected the arts were primarily for the well-educated. They feared they would not understand and could not have an opinion about something with which they had so little experience. Though doors traditionally closed . . . are now open, the message has not as yet come through." The biggest challenge was getting people started : overcoming their inertia and winning them over from canned TV shows to live programming. 417 The philosophical approach was to demonstrate the Interrelatedness of the arts and Life experiences and the arts to Increase Intercultural understanding. The aim was to show tho universality of arts, stimulating participation and self-confidence through a combination Of Classroom work and field trips, and in- volving each individual in the art forms he experienced so he'd continue his Interest on lus own. The success of the seven-session course — attended by some twenty of Local HWs retired members can bo measured by some of their responses: "The course gave me a chance to participate and enjoy and learn." "... a chance to do something I couldn't do all my life." "People are apt to close doors on subjects they don't use. This keeps the doors of knowledge wide open." Admittedly, a well-organized group-learning experience can stimulate our initial interest. But, ideally, we could adapt a combination of whatever facilities we have at hand to reinforce our interest in, and understanding of, the arts . . . right at home ... on our own. LEARNING AIDS FOR THE HANDICAPPED The education evolution sweeping American is perhaps potentially more im- portant to those with handicaps than anyone else, for it could provide both their refuge and their eye on the world. Then, too, the unencumbered among us who want to perform some self -gratify- ing services for our handicapped fellows might find an educationally-oriented volunteer niche for ourselves. However, what has been accomplished thus far with visually or physically limited seniors offers an inspiring sort of lesson for all of us. "If my eyes don't last, I'll just take up braille," said Mrs. Caroline Wesley Cooper when faced with possible cataracts surgery. "I won't stop reading." Our seventy-six-year-old liberal arts student (introduced in the first of this series) already has to study her text books With the aid of a four-inch magnifying glass. There's little doubt this particular indomitable lady could, and would, continue her studies even if she lost her sight. And it's equally possible the rest of the country's handicapped could do like- wise, as there are many ways — old and new — to help overcome difficulties. More .are to come. Even now the Cleveland Society for the Blind is engaged in a three-year project •exploring home teaching as a means of meeting newly blinded seniors' social and personal needs. Graduate "Home Teachers" are currently concentrating on train- personal grooming . . . leisure activities . . . handwriting . . . reading braille . . . personal grooming . . . leisure activities . . . handwriting . . . reading braille . . . using the telephone and typewriter The Society intends to expand the program if such teaching proves effective in helping seniors adjust to their loss of vision. Another interesting experiment (telephonic intercommunication) in Long Beach, Calif., will benefit immobilized seniors. The Long Beach Jewish Community Center will use special telephonic equip- ment to link the center with about twenty seniors' homes. Two-way conversations will permit the people at home to hear and take part in center programs : dis- cussion groups, classes, concerts, plays, etc. You can see the possibilities if this approach turns out to be successful. It would mean much to oldsters in nursing homes and hospitals as well. Behind both of these projects is the desire to let handicapped people know they're not alone or forgotten and shouldn't feel their place in society has vanished. Active retirees can help by friendly visits to sick and homebound people of their own age . . . talking with them, reading to them, helping with letter- writing, advising about available educational aids and devices which they may not be aware of. Churches are active in this respect, often with imaginative innovations (not to mention the special churches devoted to the blind and deaf. ) One example is the Marian Visiting Project of the Catholic Church in San Francisco, which encourages young and retired church members to pair up — bringing two different outlooks on life— the youthful and mature — for their visits to shut-ins. It makes things more interesting all around, they find. More and more libraries are providing shut-ins with books, with the help of volunteers from the Boy Scouts or other civic or senior groups. Sometimes* — as in Dallas, Tex. — volunteers not only deliver books to senior homes and centers, hut give informal talks, review books, read aloud to residents. In Los Angeles 418 sick or disabled people can borrow any book from the circulation department of the public library. Milwaukee has a new "shut-in" service beginning this year, as well as its book- mobile. It uses paid assistants — recruited seniors — to visit shut-ins and find out what they want. They report back to the librarian, who then fills the requests and has the books delivered by bonded messenger. An advisory committee of seniors forms a liaison between their age group and the library — also acts as a sound- ing board for the content of the programs. Pierce County Library, Tacoma, Wash., under the direction of Mrs, Carolyn J. Else, has embarked on a library service for nusing homes . . . experimenting as it goes along, adapting its approach as needed. Twelve nursing homes are involved, so far. A wide range of films — travel, story films, hobbies, etc.. — is shown regularly wherever space in the nursing homes permits, sometimes even in hallways. This has proved to be very popular and often provokes lively discussion. Volunteers carry out much of the service under library supervision. These volunteers receive ten hours' training from the library and the local Red Cross, so that they know how to present books and what to do in the homes. They visit the homes twice a month, chat with residents, find out what interests them, then supply suitable books or other reading materials. The volunteers also read or tell stories to groups or individuals . . . show slides and play records. The Pierce County Library has other ideas in the planning stage — such as acquiring magnifiers, page-turners, an over-head projector to provide books from microfilm for those who are unable to handle a book. They also want to experi- ment with different kinds of reading materials, like cloth hooks. State Services for the Blind sometimes provide reading aids for those with very severely limited vision. Vermont residents, for instance, can borrow a kit of ten or more magnifying glasses in order to try out each kind. The glasses can be ordered locally at a cost of between $1.50 and $15. "talking" and large-print books Braille is, of course, the traditional way for blind people to read, but an easier way — especially if you don't know braille — is by using "talking books." These are recordings, played on special machines, that the Library of Congress has been providing free of charge to the blind for thirty-four years. Now, by Act of Congress, talking books can also be supplied free to anyone who can't read normal print because of bad eyesight, strokes, cerebral palsy, multiple sclerosis, muscular dystrophy, polio, severe arthritis ... in fact any physical ailment that makes the holding or reading of books difficult or impos- sible. You don't need an application form, but you must have a statement from your doctor or some other competent authority ( optometrist, registered nurse, profes- sional librarian or hospital staff member) to say you qualify. People who are totally blind need only a statement signed by a prominent member of the com- munity. Mail this statement to your state agency for the service, usually the Regional Library for the Blind or a state or public library. If, however, you don't know of a local agency you can send it directly to: Library of Congress, Division for the Blind and Physically Handicapped, Washington D.C. 20542. What kind of talking books can you get? Anything from the Bible (both King James and Catholic versions on 170 double-faced discs ! ) to space exploration. An average book is eight double-faced records and takes twelve hours to "read." Many classics, both new and old, have been recorded by stars of theatre, TV, and radio. You can bone up on history, science, archaeology, or lose yourself in a mystery. Magazines run the gamut from current events to chess to high fashion (and Harvest Years). And, you can buy "books" of your own, build a library of them, as indeed we all can, whether our vision is good or bad. For this Schwann's monthly catalog, available at most dealers, has a section devoted to spoken records; for a dollar you can order a 187 page booklet Comprehensive Listing of Speech, Lit- erature, Drama, Poetry on Recordings, from Sam Goody of 235 W. 49th Street, New York, N.Y. 10019. Nearly all the large companies make spoken recordings and some smaller ones specialize in this. Calliope, Caedmon and Folkway have some outstanding discs. There's no more comfortable way to learn a foreign langauge. And the Book- of-the-Month Club also produces its own "talking books" now. ■Ill) Vmi can do this on radio ami TV, too, and Cor more organized borne study there's the Uadley School for the Blind, TOO Elm Street, WiiniriU.i. III. ill the Directory Of Accredited Private Home Study Schools. II has "Over one hundred courses for blind students offered through braille and/or record,- and all are free. College courses are linked to the Correspondence Instruction Program of the University of Wisconsin and other universities. Those o\' us who just can't see as well as we used to, gel lots of help, too, through large print books. Many Libraries carry a good selection of the <;<><> lilies now available, and the list grows daily. The hooks are usually printed in is poinl about twice I he size of ordinary newstypo, sometimes <>n special dull paper to prevent shine. You can get any- thing from the King Tunes version Of the New Testament with Psalms (from the American Bible Society. 1865 Broadway, New York 10023) to crossword puzzles (in the New York Times Large Type Weekly, -\~> West. 43rd Street, fcew York, N.Y. 10036). The Weekly — the only large-type newspaper so far — gives a cross-section of features and important news from its regular daily editions. It's sold by sub* script ion and costs $7.25 every three months, or $29 per year. Often you'll find n copy in the recreation room of retirement homes or projects, in nursing homes or lihraries. Readers' Digest Large Type Edition is put out by the Xerox Corporation. P.O. Box 3300, Grand Central Station, New York, N.Y. 10017. It may be too much for your budget at $25.05 for six months or $48.60 per year, but maybe your library pas that, too. In books there's everything from Shakespeare to Steinbeck, Huckleberry Finn to The Spy Who Came In From The Gold. The pioneer publisher of large print books (Keith Jennison, 575 Lexington Avenue, New York, N.Y. 10022) runs a Large Print Book Society, which saves members two dollars on each book, if thev sign up for four a year. Other publishers are Harper and Row, Large Print Publications ; Macmillan, Ulverscroft Large Print Books ; and Walker and Company. Prices range between $4 and $10. There's even an Easy-See Cookbook, prepared by volunteers of The Woman's Club of Chevy Chase, Maryland Inc., for visually handicapped people. You can get this free by writing to Mrs. Maude Dismer, 6220 30th Street, N.W. Wash- ington, D.C. 20015. It's a good basic cookbook with short, simple recipes and helpful hints (e.g. "Ways to Make Soup Interesting"), enclosed in a three-ring binder. For serious students, large-print textbooks and dictionaries are handled by two nonprofit publishers: The American Printing House for the Blind (1839 Frankfort Avenue, Louisville, Ky. 30206) and National Aid to Visually Handi- capped (3201 Balboa Street, San Francisco, Calif. 94121). Some companies — like Xerox and Bell and Howell — can now enlarge standard books, magazines and sheet music. Ask your local library about this if you're interested. It costs between 10 cents and 17 cents a page — unless the book you want has already been filmed by the company and then the price is lower. The Library of Congress, Division for the Blind and Physically Handicapped, Washington, D.C. 20540, has a reference circular listing sources of large print books, periodicals, etc. — free for the asking. EDUCATION FOR THE DEAF Deafness, like failing vision, often afiiicts our age group, and no one can deny it makes communication with the rest of the world more difficult. Yet it has its compensations ; education is one of them. For example, Thomas Edison, the Wizard of Menlo Park, became deaf as a boy and couldn't go on with his schooling. So he took to reading, learned to rely on himself, and acquired the kind of education that made it possible for him to develop his inventive genius. Judging from the popularity of lip reading classes such as the one in San Diego, we seniors have ideas about education, too. A number of states have schools and adult education programs for deaf peo- ple — varying from driver improvement in Kansas City. Mo., to an elaborate pro- gram in Boston, Mass. including English, modern math, dactylology, lab. histol- ogy — even magic ! Uncle Sam provides educational films and material on free loan, as well as Hollywood-type recreational films with sub-titles. The recreational films are for groups of three or more, but individuals can get them "in cases of severe hard- 420 ship." You have to be certified as eligible for this film service, and can find out how by applying to Captioned Films for the Deaf, U.S. Office of Education, Wash- ington, D.C. 20202. One unusual institution, featured on a special documentary program by NBC television, is the National Theatre of the Deaf, a project of the Eugene O'Neill Memorial Foundation. It's a fully professional company of twelve actors, all deaf, who deliver their lines in "sign language" while a narrator and specially designed musical instruments convey their meaning to the hearing audience. New York critics raved about the Theatre when it made its debut last fall. Our last example comes from the Adriance Memorial Library in Poughkeepsie, N.Y. which has been looking after the reading needs of shut-ins since 1953, its clientele growing from fifty-five to over 300. Observing that reading was the only pleasure many of them had, the library last year initiated a Literary Social Guild for the Homebound, planning to meet every month. Sixty-three shut-ins, attended by two men to help them get on and off, were brought by bus to the first meeting. After a movie, The Golden Twenties, guests were regaled with sandwiches, tea and coffee (and dietetic cookies) while music from hits of the twenties played softly in the background. Next came a program of jokes and funny stories a la Bennett Cerf, then lots were drawn for the table centerpiece, a handsome basket of fruit. Sixty-three contented guests went home ; twelve of them had been out of their rooms for the first time in eight years. Within three weeks the word had spread — the mailing list had more than dou- bled. A larger building had to be found before the next meeting could be held. As one man remarked with fervor to librarian Esther Kando Odescalchi and her colleagues who had arranged it all : "God bless you all !" Now, why all the fuss and bother about what was traditionally the task and prerogative of the young? Change and the future, perhaps, should be reasons enough. These also were the keynotes of the University of Michigan's 1967 Conference on Aging at which some 500 representatives from all fields of aging discussed the changing role of education in awakening society to the full realization of total life-spans. "Education used to be the transfer of knowledge to those not yet in the know,"' Brandeis University professor Robert Morris pointed out. "Now we prepare for new roles. The nature of society is changing ; the foundations of education are- altering. . . . We must be concerned in the future not merely with information but in engaging with older people in developing new roles for the individual in society." "A realization that aging itself has changed is essential to effective education for and about the later year," stressed University of Michigan's gerontology division chairman Dr. Wilma T. Donahue. Speaking of the way technology has expanded our years since the turn or the century, she noted : Three new phases were added to the life cycle — a middle age oriented toward living for an extended period of time rather than toward impending death, a stage of later maturity oriented toward achieving maximum self -fulfillment, and old age itself." Dr. Donahue, therefore, feels we need an extensive education program — spreading over seventy or eighty years. And this can't be met by any single educational unit or at any one time in our lives. Our increasing numbers, as well as expanded years, makes the continuing fulfillment of our potentials a matter of national concern. Sen. Harrison A. Williams, Jr., chairman of the Senate Special Committee on Aging, remarked in the recently published 1967 hearings of the five sub- committees : "The older citizens of this nation are rich in talent and energies and wisdom. Many ways must be found to free such resources for public good or for private satisfaction. . . . Just as we now regard graduation from high school or college as the beginning of a career, so should we recognize that retirement can become the beginning of a rich and rewarding stage of life's ; development." Extending Educational and Cultural Opportunities for Older People was also' discussed at another of the many conferences dedicated to fulfilling our poten- tials and solving our problems. This one, held last April in New York City, was sponsored by the Central Bureau for the Jewish Aged in cooperation with other- interdenominational, private, and governmental organizations (too numerous to list). 421 New York Times education editor Fred Hechlnger opened this conference with this thought: "I think the problem) If there Is one central problem faced by society as a whole and n<»( just the aged — is the problem of fragmentation of our society. In all of (these 1 new educational opportunities) there is an important by-product . . . the creation of a greater cohesion of OUT society." And Sylvia Greenfield of New York City's Department of Social Services presented a survey noting a solution to the blessing/problem of Leisure: " . . it is recreation in combination with education which gives depth and meaning to time." It does seem that we should all concern ourselves with the quality and quan- tity of our knowledge as well as our years. For learning and living are inter- related. Both, even in their simpliest forms, engender some degree of change. Formal and informal learning situations can help us keep pace with change and the future. And continuing education prepares us to live contentedly with free, independent spirits and minds — while providing us with the means for improved social integration, participation, and satisfaction. So, irrespective of our present age or past education, isn't this truly a time for learning? What the Government Should Do for Senior Citizens (By Alice (Ma) Henry — West Side Health Planning Organization) As a Senior Citizen, and a long-standing resident of the City of Chicago, I have lived to see many of the shortcomings of society toward the elderly. This reflects in the huge numbers of senior citizens left suffering on Skid Rows all over America. We find our government spending more money on trips to the moon, highways, and foreign affairs, than on help and health care for the elderly. The conscious of our elected officials must be aroused and sensitized to the fact that a worthwhile plan to make life decent for the elderly is not only the humane thing to do. For they too, if they are fortunate, will become a senior citizen someday. PROBLEMS I cannot say I know all the problems on aging, but I know some of them : 1. Some senior citizens are living with families. Sometimes it poses all kinds of problems, such as the grandchildren being ashamed for their friends to see or know them. In-laws are jealous of them to the extent it makes them feel unwelcomed. 2. Some live alone in an apartment for seniors. 3. Some are put in homes for the aged against their will, and they have to agree and sign over everything they have to the home. Because they have the three "S's", Sick, Senile, and plain Scared. They feel this is the last straw — the dumping ground. 4. Some become senile when they have to live alone without family or friends. 5. Some will not take part in outside activities, because they are afraid that they may make a mistake, so they withdraw. SOLUTIONS FOR SOME OF THE PROBLEMS 1. Their grant should be enlarged because the small amount of money, and the high cost of living makes it very hard for survival. 2. They should be allowed a discount card. 3. The discount card should be for food, clothing, and travel. 4. There should be a mini-bus at the senior apartments to transport them to and from. 5. Those who are able to work should be allowed to work as long as possible, with some stipulations. 6. They should have a mobile store for dry goods, groceries, etc. 7. Because some are feeble, to bring a mobile store to them would give them something to look forward to, and it would be a blessing. HEALTH PROBLEMS 1. All over this country, we have urban progress centers, and hospitals. Through the centers, we could have what is called : Service in the Community — representatives for S.I.C. 422 A program could be set up between the centers and the hospitals, the people could be trained with a small amount of training, to do follow-ups on the senior citizen when discharged from the hospital. 2. Such programs could be set up from churches or neighborhood organiza- tions in the communities. 3. These S.I.C. representatives would have to adhere to the four "W's" : Who to see for their assignment. Where to see the patient. When to see the patient. What they are seeing him for. We had better come up with some sort of program now in this country before it is too late. We cas use this slogan, "Not for myself, but for those that need my service." Statement of James Roach, Associate, Editor, Chicago Voice Since I first started working with senior citizens groups and clubs some years ago, I had seen many of the problems of older people on a first hand basis. Through my work as president of a senior club, and my involvement in helping found the Northwest Senior Center. I have closely observed both the needs and problems of older people. In my present capacity as associate editor of the Chicago Voice. I see their problems of health, housing, education, em- ployment continue to escalate as the solutions dwindle. For example, you know of the rule in driving which states how many lengths you should stay behind the car ahead of you at specified speeds to be safe. Maybe you have even tried it, and had other cars travel around and ahead of you to fill the space you had left open. This is the case with efforts for senior*. Seniors are allotted additional income then the city taxes go up (19% we hear), so your rent goes up accordingly. The hospital costs go up, the cost of living goes up, your social security check has a larger deduction for medicare, and you still find you are not the right distance in line from those ahead of you. This situation makes income the big headache. We have heard that 14 areas are to be discussed at the Washington conference — 14 — think of it! In an article I wrote for the Chicago Voice, I mentioned the amount of time it takes to get just one bill thru Congress — one year, two years or more ; and I stated that it is possible that the children or even grandchildren of today's seniors going to Washington, may be there at a later date with some of these same 14 major problems. However, while income is usually thought of first, reading over the proposals some get a little silly, for instance, proposal 1 of transportation, "The available funds should be allotted to increase the incomes of older people so that they will be able to purchase the transportation they need". Chicago has transportation — a great many smaller towns and cities have none — none at all — and giving seniors money for transportation is like offering money to a drowning man to help him reach the shore. Now proposal number 2. "The Federal Government should provide for the development of transportation systems for all users regardless of age". Number 2 says everything — the rest is just an effort on the part of the people who drew up the proposals to get in on the act — hogwash ! The seniors going to Washington might concentrate on fewer proposals with more success. Did you ever have a bum come up to you and ask for money. He gets right to the point, and I wish our Representatives could do likewise — or is that out of style. We hear a great deal of conversation these days about the generation gap, about seniors not understanding juniors, yet when I attended the conference in Chicngo, I noticed a large number of young people. We don't understand them or so they say, yet they go to college, get a piece of paper which says they know all about senior's problems, and then will be attending the Washington conference and presume to speak for the seniors. But we don't understand them or they us. If we believe the many articles on the generation gap. Anyway, we had to live several years to know our problems, and they will have to also. It is slightly inconsistant. 423 Prepared Statement of Wij l 0, Rasmussen, Director of the i uvibioh 01 Care of Aged, Lutheran Welfare Ser\ [ces of Illinois The aging process Is not understood by the vast majority of Americans tod ij Tins can be attributed to many aspects and characteristics of our multl cu society, bul 11 Is a sad fad we as an American people do not prepare Cor aged, either through our educational or experiential systems. As a result, we have a great Ignorance about becoming older. Wo worship youth as that which is good, and we abhor being old. The aging process begins at birth and understanding I his process beyond the youthful era is essential to knowing generally what needs older persons have and how problems which confront the older person can best he met by a system of services. Lutheran Welfare (Services of Illinois is a demonstration of the Church S concern for a system of service to people. With a specialized staff and multiple resources, our agency serves people, and this "faith in action" enriches the total life of the community. The objectives of the Division of Care of Aged are : (a) to enable older persons to live a maximum independence (&) to respect the individuality of each older person, his hopes, aspi ra- tions, and capacities (c) to provide special assistance for aging persons who are dependent or disadvantaged (d) To stress the importance — to them and to society — of their social and community participation rather than rejection and isolation because of age. I wish to emphasize it is the desire and plan of our church-related agency to be an active partner in the relationship of public and private agencies. We do not see the problems concerning aging confronting our country as the Gov- ernment's problem or the Church's problem, but as our mutual concern. We have much to do together, as partners, to solve problems people have in our society as they become aged. Reference was made in the beginning to our minimal knowledge of the aging process. This is not said to demean the work of scholars, scientists, and organ- izations who have contributed much to a growing body of knowledge. Rather I say it is time to build into our educational system, and particularly for younger people, course material to help them understand the totality of the aging proc- ess. Our schools, if so challenged, would expand their curriculums beyond the limits of adolescence of young adulthood, middle age, old age. It is essential to our future we as a nation understand the aging process from every viewpoint. Beyond the school experience, the Church, union, corporation, media, should plan to, through continuing education, help people to comprehend the aging process. It is our premise with increased understanding of the aging process there will be less fear of what the years will bring. Knowledge will permit the orderly development of the kinds of programs we see as a continuum of services. It would be important for each community to offer social services of the type spelled out below : A. COUNSELING For purposes of diagnosis and isolation of problems to permit problem solving process to begin. B. PROBLEM SOLVING RESOURCES 1. Referral and information services. — Participating problem solving resources would coordinate their services here. 2. Personal Services: (a) Health. — Home health aides, visiting nurses, mobile medical teams (ft) Home. — Homemaker service, home maintenance service, domestic assistants, home delivered meals (c) Individual. — Friendly visitors, management of income and assets, educational and social activity for individuals and groups. S. Housing. — A large range of housing conditions should be provided, barrier- free, dignified, reasonable in cost, in locations appealing to the needs and wishes of the older person. k. Institutional Care. — A range of settings should exist as a part of the com- munity, providing for simple personal oversight, short and long term care, re- habilitory in character, recognizing increasing dependency caused by chronic conditions, completing the range with skilled nursing care. 424 The organization model for delivery of service could very well allow for par- ticipation of proprietary and non-profit organizations. The primary objective would be to make the services available to people. A large segment of our older population can pay fees for services rendered Those unable to pay should not be denied service. Public assistance should be sought in the case of the financially disadvantaged. In conclusion, I wish to commend the Commissioner on Aging, John B Martin for his leadership role in behalf of aging. I believe the Administration on Aging has a vital leadership role to play in the lives of older Americans. We in the church related agency, particularly look to the A.O.A. publications and especially the journal "Aging" for keeping abreast of today's issues. Statement of Marshall M. Holleb, Acting Chairman, Illinois State Council on Aging Mr. Chairman and Members of the Committee: I appreciate this privilege to come before you today to discuss an issue of great consequence to all Amer- icans. I welcome this opportunity to present my statement on "housing for elderly Americans." Although I come before you in my official capacity as Acting Chairman of the Illinois Council on Aging, I have had a particular concern with problems of the elderly for many years. I have been a member of the Illinois State Council on Aging since 1961 and have served as Chairman of its Technical Review Committee since 1969. That's the sub-committee of the Illinois State Council on Aging which makes the initial appraisals of applications for funds under the Illinois Act which, in combination with the United States Older Americans Act, has funds to distribute to organizations meeting requirements under such laws, and then makes recommendations for further and final action by the Illinois State Council on Aging. In addition, I am currently serving as Vice President and a member of the Board of Directors of the Hull House Association and as a member of the Board of Directors of the Welfare Council of Metropolitan Chicago. In both of these voluntary community service organizations, among others, I have had a special opportunity to view the plight of our older citizens. My knowledge of the plighl of the elderly was further expanded when I served as a chairman of the Welfare Council Special Committee to survey social welfare and health services in public housing. Although that study was not specifically directed at the elderly, we did get some insights into their needs at public housing facilities. From these various vantage points I can testify to the awful problems facing our elderly citizens to find adequate housing. Their needs for decent housing are becoming more critical each day. A combination of economic and social forces are causing the loss of housing units in the city, particularly at rents our elderly citizens could afford to pay. In order to maintain housing in decent physical con- dition, continuous increases in rents are required. Elderly citizens have the disadvantage of being unable to increase their income. Without capacity to pay higher rents, they are therefore forced to leave their residences or apartments and try to find decent housing at rents more commensurate with their fixed income. That seems to be more and more difficult For example, currently there are more than 10,000 persons on a waiting list for housing units designed for low income, elderly individuals and managed by the Chicago Housing Authority. The annual income of persons seeking admission to this program may not exceed $3,000 for a single individual and $3,600 for a couple. There are elderly in Chicago who have been waiting more than three or four years for placement within this program. Clearly, it is an absurdity to tell a 72 year old widow living on $125 a month Social Security that she must wait three of four years for suitable housing. I venture to say that that waiting list will continue to increase in numbers as the cost of normal housing increases and the number of elderly in our urban centers increases. The problem will become further aggravated unless we take bold steps for an immediate solution. It is essential that we act now to relieve the housing problem for the 30% of our elderly, or about six million people, currently living in dilapidated, deteriorated or deficient housing facilities. And that pertains simply to those who can qualify for public housing only. We ought also to look into the housing needs of moderate or middle income elderly persons who also are having a difficult time finding housing accommo- dations. These are persons whose income disqualifies them for public housing 425 but whose income, although above the Legal $8,000 or $8,800 limitation, cannot afford the escalating rentals In today's open market what, programs are avail- able to help these persons, Unfortunately, the most successful housing program m this area Section 202 of the National' Bousing Act of 1950, no longer is funded. The Section 202 pro- grnn you will recall, authorized direct, 100% loans from the government to non-profit sponsors to provide housing for the elderly. Such a loan could be repaid with 3% interest over 50 years. That was indeed the ingredient for a successful program. It attracted sponsors who were dedicated to providing decent living conditions for the elderly. These included, most frequently, church groups and other similar, not-for-profit organizations. A good example is the Mayslake Village located in Oak Brook, Ilinois, sponsored by the Laymen's Third Order of Unfortunately, Section 202 funds have now been channeled into Section 236 of the National Housing Act of 1968. This has constituted a serious blow to the future of senior citizen housing. Section 236 is a mortgage insurance program whereby the federal government covers the difference between the 1% interest rate paid by the sponsors and the current market interest rate, which is now in the area of 7y 2 % to 8%%. A preliminary investigation of this program by the Senate Special Committee on Aging shows that Section 236 may not be economi- cally feasible for the elderly and, moreover, costs about three times as much to operate than did Section 202. Moreover, FHA Section 236 financing is currently further clouded by social Issues The Department of Housing and Urban Development has recently issued a series of "criteria" which prohibits the FHA from financing 236 housing proj- ects unless the application fits the difficult criteria required for racial, social and economic integration. Such requirements may deny applications for con- struction of housing for moderate and middle income elderly w T here race and other criteria may not even be a relevant consideration. In order to help fill the vast demand for shelter for our elderly citizens, I submit to you the following recommendations as immediate steps for justice for our older American citizens : . 1 A larger segment of the annual housing appropriation must be set aside for the construction of housing units, specifically for low income, elderly resi- dents to qualify for public housing. • 2 Section 202 of the National Housing Act of 1959 should be reactivated and funds appropriated to make it a viable instrument for meeting the demands for housing for low and moderate income elderly citizens. 3. The HUD criteria for Section 236 financing should not be applicable where housing for the elderly is the principal goal of the project. Statement of Robert J. Ahrens, Director, Division for Senior Citizens, Chicago, III. My name is Robert J. Ahrens and I am Director of the Division for Senior Citizens of the City of Chicago's Department of Human Resources. I would like to welcome the commitee to Chicago and congratulate it for directing its atten- tion to the needs for comprehensive services for the elderly. It is my estimation that in today's world the most disadvantaged group in our society is that of the elderly. Yet, oddly enough, rich or poor, black or white, tal- ented or unskilled, men or women, or young today — it is the one minority group that we shall all join. Considering the present status of the nation's elderly, it is not a very happy thought unless, as Maurice Chevalier put it, you "consider the alternative". , The number of people age 65 or over, only 3.9% of our State s population in 1900, is 10.1% today, and the numbers are growing. There are now 20 million Americans age 65 and over. Of these 20 million, 1.1 million live in Illinois, with 600,000 of these senior citizens our neighbors in this city and its suburbs. Only 4% of these 20 million people are institutionalized in our hospitals, nursing homes, homes for the aged and similar facilities. Fully 96% of our elderly are liv- ing in the community. Of these, 8% are homebound and bedfast and another 67. The availability and number of enabling or supportive services which are critical tO the accessibility of all services, such as threshold to threshold trans- portation for those with impaired mobility, neighborhood based information and referral programs, shopping services Cor the homebound, and escort services for the confused or emotionally impaired elderly. 4. The availability of community education programs in aging. 5. The availability of trained staff and of training programs in the field of aging. If you multiply these kinds of specifics by the kinds of problem areas we men- tioned, you get a reasonable picture of what we mean by and what is needed in comprehensive social services for the elderly. I would like to offer for the record of these hearings, our report on The White House Conference on Aging in Cook County, 1970-1971: Recommendations for Policies, Programs and Priorities. It contains the observations I have cited and is, in its way, an outline for the kind of action on comprehensive social services that we feel is needed. How do we achieve these programs? One thing is certain— not alone. The job can only be done by a massive effort of the public and private sector, the elderly and others, working together in ways we have still to invent. Above and beyond specific services, it is clear that we must initiate great new social reforms. Justice Holmes once said that "to live is to function". A society that takes away function, by cutting off activity and income, through compulsory retire- ment on the arbitrary basis of chronological age, is destructive of its own pro- fessed values and eventually of itself. It destroys the present basis of useful contribution to society — the job and work — around which the personal identity and lives of most people are organized. No two people are alike. It is a differential process. And human development and education are both lifelong processes. The time has come to end the univer- sal lock step of %rd of life at school, %rd of life at work and %rd of life in inactivity or retirement. We must reorganize our institutions of education, work and leisure on a basis that is more sensible for all. Education/school, work and leisure should be three streams that flow through all of life, each broadening or contracting from time to time, to fit the needs and life style of the individual as well as the demands of society. In such a world a man might continue to hold a part-time job at the age of 80, if this is his desire ; go back to school at 45 for a new career or delayed degree ; and interrupt his work life much more frequently to enrich it and himself with travel, leisure and education for its own sake. The experiments with the four day week, the Xerox Corporation year sab- batical program for community activity, the new adult degree programs in higher education, are all beginning steps toward the new work mix or flexible life style. It is not so much, I believe, a question of our young people dropping out of school or society today, as it is of offering all our people more and more varied opportunities to plug in. The world can at last be organized to recognize individ- ual differences, and to take the measure of each person according to merit, per- formance and individual worth. Age is but one facet of that measurement. What we ought to share at ages 17 and 70 is not so much a point of view as a sense of purpose. That sense of purpose should flow from a fuller view of the potentials of human development. What shall I do with my life, we ask at 17? What have I accomplished with it, we ask at 70? And also — what more can I do, while time is left to me? These are all questions of development and growth, no matter at what age we ask them. And so I would argue that while we must do much for those who are old today, and create vast new and comprehensive systems to serve them, the long run view of our senior citizens must be that of a vast potential resource for our nation and one that is largely untapped. It is, instead, a resource we have retired. A fellow Illinoisan, the late Adlai Stevenson, may have said about all we can on the subject, when he remarked that : 71-272— 72— pt. 1 28 428 * . . What a man knows at 50 that he did not know at 20 is, for the most part, incommunicable. The knowledge that he has acquired with age is not the knowl- edge of formulas or forms or words, but of people, places, action— a knowledge not gained by words but by touch, sight, sound, victories, failures, sleeplessness, devotion love— the experiences and emotions of this earth and one's self and of other men and perhaps, too, a little faith and a little reverence for the things you cannot see." The White House Conference on Aging in Cook County, 1970-71 Recommendations for Policies, Programs, and Priorities introduction The Division for Senior Citizens of the City of Chicago's Department of Human Resources was designated by the State of Illinois to coordinate the participation of Cook County in the activities preliminary to the Illinois White House Conference on Aging, scheduled for Springfield, Illinois, on July 13 and 14 and the White House Conference on Aging itself, scheduled for Washington, D.C., from November 28 through December 3, 1971. % _,_ ' Preliminary activities included organization of the Older Americans White House Community Forums in the fall of 1970 and the Cook County Community White House Conference on Aging in the spring of 1971 The latter was one of seven regional conferences held in Illinois during April, 1971. The 101 coun- ties outside of Cook were grouped into six regions and each region was allocated 100 delegates for its conference. Cook County, with half of the state's population age 65 and over, was granted 600 delegates and named as a separate region for Xt Delegates To the Cook County Conference were proposed by the Division for Senior Citizens and named by the Governor. In addition, the ^™™£™%* numerous other citizens to observe the proceedings It is understo^od that 200 delegates will be named by the Governor for the July Springfield Conference- 100 from downstate and 100 from Cook County-and that Illinois has been allo- cated 100 delegates for the concluding Washington Conference, who will again b %Te^rpLe h of?hirr^ort is to bring together three statements The first is the ranking of priorities as stated by the elderly of Cook County themselves m the 1970 community forums. The second statement results from an exhaustive su?vev of resources and programs for older people in Cook County , undertaken bv the Division for Senior Citizens, at the express request of the State of Illinofs As a part of that survey, primarily a catalog under various classifica- tions staff of the Division analyzed service gaps and unmet needs by these classifications, and that analysis is reported here. The third and final statement fs composed of the policy recommendations adopted by the delegates to the Cook County Community White House Conference on Aging. Older Americans White House Community Forums, October 1970 It was not feasible to hold one community forum for Cook County on the 20th of September, proposed nationally as the day for these meetings. Instead work- ing through the senior citizen clubs, groups and centers of the city and sur- roLding area-an established pattern for the Division for Senior Citizens-a numbei If community forums were organized and conducted over a longer period Xpresentatives of these centers, groups and clubs were called together by the DMsSnafa meeting in the Council Chambers of City Hall, Chicago, on Sep em- beJ 24 The proposed activity was outlined, thousands of questionnaires for which wLhin. on sought responses were distributed, and kits of materials on how to conduct the forums were also given out. These kits were specially f Prepared J by the Division for Senior Citizens. Staff also monitored a number of the forums. Sen or citizens responded enthusiastically to the opportunity to voice the con- PPrnTaml needs of the elderly, through the 1970 community forum meetings of Sow organization. Between September 24 and November 2, 1970 126 com- munity forums were scheduled by 114 sponsoring groups Of these groups 38 re- turned written statements of priorities to the Division for Senior Citize *is In order of importance, as viewed by the elderly themselves, these priorities are. 429 1. Income. 2. Health Oare, :\. Housing. i. Transportation, 5. Education. 6. Legislation. 7. Employment. 8. Leisure Time Activities. 9. Police Protection. 10. Nutrition. 11. Involuntary Retirement. 12. Consumer Protection. 13. Pre-retirement Counseling. Their interpretations follow. 1. Income. — The need for more income was expressed vividly in a variety of ways by forum participants. Among the many questions they asked at the forums were, (a) why should a widow face reduced benefits when her husband dies? (b) what do you do when taxes on your house keep going up yet your pension and Social Security income stay the same? (c) why can't older people, like the young, have the option of earning more without having to pay back Social Security benefits? The emerging theme of need for more income was expressed by most older peo- ple in this way : "Given the funds to pay for services and care, we could solve most of our needs and problems by ourselves." Alternatively, where increased income did not seem realistic or feasible — or sensible to a generation of older people accustomed to paying their own way — they proposed discounts as a solution. 2. Health care. — What do you do about the many medical expenses not covered by Medicare? Easily accessible comprehensive health care should be available at reasonable cost. A comprehensive plan should include such services as dental, ophthalmic and podiatric care, home health care, medication and transportation when necessary. 3. Housing. — Elderly homeowners worried that rising property taxes may drive them from their communities. Aged who live in apartments stated their need for more low and moderate income housing in more neighborhoods and suburbs. Adequate low and middle income housing should be available in locations near transportation, shopping facilities, churches and leisure time activities. Improved enforcement of building codes was advocated by some. Other senior citizens questioned the value of age-segregated housing. More and improved sheltered- care facilities should be available to meet the needs of elderly persons who do not need nursing care, but who are unable to remain completely independent. 4. Transportation. — Transportation, judged too expensive and inconvenient, evoked a number of recommendations ranging from free passes on public trans- portation and free ambulance service, to an improved unified metropolitan trans- portation system. 5. Education. — Participants recognized the need for continuing education which utilizes and builds on life experiences. Stimulating educational opportunities should be available at low cost for senior citizens of all educational levels. A particular need was experssed for basic adult education in reading, writing and arithmetic, so that senior citizens might understand current issues better, and handle personal business more intelligently. 6. Legislation. — Effective legislation was recognized as a key to elimination of many problem areas discussed at the forums. A call was made for appropriation of all funds authorized for programs benefiting senior citizens. 7. Employment. — Society must be made aware of the capacities and untapped potential of senior citizens to contribute to the nation's economy. All aged barriers to employment should be eliminated. 8. Leisure time activities. — Appropriate use of leisure time can maintain and improve the well-being of elderly persons. Both public and private agencies should increase funding of leisure time programs for senior citizens. 9. Police protection (safety). — Elderly persons are especially vulnerable to purse-snatching, robbery and confidence games. Improved police protection is needed in all neighborhoods to ensure safety on the streets and on public transportation. 10. Nutrition. — Nutritional needs and suggestions included improved home- delivered meals and the serving of low cost or free hot meals at public locations, but largely emphasized reducing the high cost of food. 430 11. Involuntary retirement. — Many senior citizens reject the practice of com- pulsory retirement. Each person should be allowed to contribute to society through his employment as long as he wishes, so long as he maintains his phys- ical and mental health. 12. Consumer protection. — Protection against dishonest, deceptive and fraudu- lent practices must be available through education and legal services. 13. Pre-Retirement counseling. — Many participants recognized their own lack of preparation for retirement and its attendant problems in adjustment. Counsel- ing is recommended for all who are approaching retirement. Unmet Needs and Gaps in Service for Older People in Cook County, February 1971 As part of the documentation required in preparation for the Illinois White House Conference on Aging, the Division for Senior Citizens was asked to develop a comprehensive report on existing community resources for the elderly and to identify unmet needs and service gaps. A listing of these unmet needs and service gaps follows : A. Employment Services exhibit deficiencies related to : 1. Systematic job development for older workers by both public and private employers. 2. Increased availability of specialized job counseling for older workers. 3. Establishment of job re-design and employee re-training programs. 4. Compulsory retirement and age discrimination policies which systemati- cally reduce all employment opportunities for senior citizens. B. Nursing Homes and other institutional settings exhibit deficiencies re- lated to : 1. Concentration in the older areas of Chicago rather than dispersal of facili- ties throughout the community. 2. Enforcement of existing minimum standards. 3. Periodic review and upgrading of standards. 4. Continuing education and training programs for administrators and staff of institutions and enforcement officials. 5. Improved liaison with health care and community resources. 6. Improved payment mechanisms for long term care. C. Hospital and Clinic Facilities exhibit deficiencies related to : 1. Lack of geriatric units in general hospitals. 2. Community based clinics easily accessible and especially geared to the needs of elderly persons. 3. Comprehensive care — including preventive care/screening. 4. Continuity of care. 5. Access to cost-free care (e.g., Cook County Hospital) throughout the city. D. Miscellaneous Medical Services exhibit deficiencies related to : 1. Coordinated comprehensive home health care programs accessible to all resi- dents of the county, subsidized by government when necessary. Such programs should include social services, homemaker/housekeeping services, home delivered meals, escort services, telephone reassurance, specialized transportation and companion-sitters. 2. Systematic geographic coverage and age-comprehensive, non-categorical coverage with respect to the elderly. E. Housing Resources other than Nursing Homes exhibit deficiencies related to : 1. The number of low income public housing units for the elderly. (Hard data is lacking except for the Chicago Housing Authority waiting list of 10,000- 14,000 individuals. For the quarter ending December 31, 1970, the Chicago Hous- ing Authority reported a ratio of ten applicants for every available unit of elderly- designed low-income housing. ) 2. Housing — private or public — designed for elderly persons whose incomes fall just above the line defining "low-income." 3. Moderate income housing, which becomes virtually unavailable to the elderly with their fixed incomes, as market rentals continue to increase. F. Resources to meet Recreational Needs exhibit deficiencies related to : 1. The number of clubs, groups and centers, particularly in those neighborhoods where the elderly are still unserved by them. 2. The availability of leadership training for senior citizens. 431 8. The availability of training Cor both staff and senior citizen Leaders to plan, develop and implement broadened Leisure time activities. •i. The scopo of recreation programs for the homebound. ;"). The nse of the active elderly as volunteers. 6. The availability of specialized transportation systems. G. Resources to Moot Educational Needs exhibit deficiencies related to: 1. The full range of programs formal and informal—Including basic educa- tion, cultural enrichment and political awareness. 2. Programming geared to the specific needs of older people. II. Resources Of Public Libraries exhibit deficiencies related to: 1. Programs specifically designed Cor the interests and needs of older adults. 2. Meeting and Lounge areas for the use of senior citizens. 3. Outreach programs with educational and cultural programming for the whole of the city's elderly, utilizing the branch library facilities as regional edu- cal Lonal centers. 4. Use of the senior citizen as a program resource. I. Social Services and Programs exhibit deficiencies related to : 1. The availability and number of social services, such as casework, counseling and protective services. 2. The availability and number of home-delivered social services for shut-ins, including : Home Health aides Homemaker/Housekeeper aides Home-Delivered meals Companion sitters Chore Boy services Home Maintenance services Friendly Visiting and Assurance services 3. The availability and number of enabling or supportive services which are critical to the accessibility of all services, i.e., Threshold to threshold transportation for those with impaired mobility Neighborhood based Information and Referral Shopping services for the homebound Escort service for the confused or emotionally impaired elderly 4. The availability of community education programs in aging. 5. The availability of trained staff and training programs in the field of aging. The Cook County Community White House Conference on Aging, April 15 and 16, 1971 The Cook County Community White House Conference on Aging was held in Chicago on Thursday, April 15 and Friday, April 16, 1971. The delegates ap- pointed by the Governor participated in one of five conference sections, all held at the Hotel LaSalle, Chicago, from 12 :30 p.m. to 5 :00 p.m. on Thursday, April 15. With one exception, noted below, voting was done only in the section meetings, in accordance with the conference guidelines and instructions set down by Wash- ington. The delegate sections were (1) Education and Retirement Roles, (2) Health, Mental Health and Nutrition, (3) Housing, Environment Transportation, (4) Income, Employment and Retirement and (5) Personal Adjustment-Spiritual Well Being. The policy recommendations adopted by each of the five delegate sections follow. A Plenary Session of the Conference was held on Friday, April 16, from 9 :30 a.m. to 12 Noon, at Hermann Hall, Illinois Institute of Technology, Chicago. Re- ports of the policy recommendations adopted by the five delegate sections w^ere given. The conference concluded with an address on "The Prospects for Living Longer," by Dr. Alexander Comfort, Director of the Medical Research Council Group on Aging, University College, London, England. A resolution adopted in full by Delegates of the four Sections on Education, Health, Income and Personal Adjustment and in principle by Delegates of the Section on Housing, in their meetings on April 15, was presented to the Plenary Session of the Conference, meeting on April 16 in Hermann Hall. This resolution was adopted unanimously by the Conference Delegates. It represents the only resolution on which action was taken by the entire body of delegates. It leads off the policy recommendations which follow. 432 Resolution, Adopted Unanimously by Cook County Community White House Conference on Aging, April 16, 1971, Chicago, III. The Cook County County Community White House Conference on Aging rec- ommends that the Administration on Aging of the U.S. Department of Health, Education and Welfare, accept as its charge, immediate implementation of all policy recommendations emanating from the 1971 White House Conference on Aging through the means provided for it by the policy recommendations which follow. It is recommended that the Congress and the President of the United States give immediate priority to the restructuring of the Administration on Aging and its establishment as an independent, effective advocate agency for the elderly, at cabinet level, and therefore directly related to the executive office of the Presi- dent, with : (1) Responsibility of developing workable minimum standards for representa- tion and inclusion of the elderly in the planning and priorities setting of other federal agencies, including the Department of Health, Education and Welfare, the Department of Housing and Urban Development, the Department of Labor, the Department of Agriculture, the Office of Economic Opportunity and all fed- eral agencies with age comprehensive responsibilities, (2) Powers to review other federal agencies' priorities and budgetary plans to insure that the elderly are represented and served according to their needs and number, (3) Powers to require these federal agencies to meet established minimum standards, (4) Powers to administer such programs as have already been developed or proposed in the Older Americans Act, and to expand them, and (5) Restitution under its own direct control of all titles of the Older Ameri- cans Act, including research and demonstration programs. It is further recommended that concurrent with restructuring of the Adminis- tration on Aging and its establishment at cabinet level as an independent agency, the agency be funded and staffed to permit it to perform all of its basic functions effectively. POLICY RECOMMENDATIONS I. Section on education and retirement roles The Education and Retirement Roles and Activities Section of the Cook County Community White House Conference on Aging has accepted the following pro- posals, based on one fundamental assumption. Although the main concerns of this section are the needs and needs meeting areas of education and retirement roles, there must be adequate income maintenance before these proposals can have any real effect. There must be some method open to all members of this massive voting bloc to remedy their living conditions and esteem in American society. The central hope of this section is that we can act, as concerned citizens of Cook County and the United States, to deal with this basic income problem. We must organize in our own precincts, neighborhoods, wards, townships, county and state to provide the pressure to force the legislatures to upgrade the level of funding for older adults. Specifically, 1. Public expenditures for education for older people should be based upon the percentage of the population which is elderly. 2. Money and manpower devoted to providing educational opportunities should have a higher priority, but the total picture for older people must be upgraded in terms of opportunities, kinds of education, and places where the education is offered. 3. The primary responsibility for educational programs for older people should be centered in and administered by the Administration on Aging (HEW) and equivalent state and local agencies, and channeled through existing agencies, public and private educational and non-educational. 4. Education should be integrated whenever possible, with people of all ages ; further, it should be segregated only on the basis of interest, in the hopes of changing the awareness and sensitivity of society at large. 5. The limited financial resources available must be expanded to provide for both research and innovation of new programs, in addition to expanding existing programs. 6. Education should concentrate on instruction in a more effective use of political processes for a greater collective (group) influence (or power). 433 7. Increased amounts of financial and manpower resources should be given I high priority, for both educational services to those people most, ready, and for education of those who are hidden, relatively unknown and difficult tO reach. However, we need the greatesl funds and manpower tO reach and motivate the isolated elderly. S. Available facilities, manpower and funds can be used for educational pro- grams designed ami offered by educators to the elderly, on the basis of their expressed and presumed needs and Interests. Available resources must, also be developed to be run by the elderly themselves, to insure that those programs do serve the older adult. 9. National, state and local governments and private agencies, in cooperation with retired citizens, should assume the responsibility of creating role opportuni- ties, both paid and volunteer, which would provide the leadership in creating a change in society's attitude toward the elderly. They would stimulate other agencies and organizations in accepting the idea of retired citizens as useful persons in society, leading to the realization that individual citizens of retire- ment age are a great source of human potential for the benefit of the whole Bociety. 10. Priorities must be given to all human needs — physical, emotional and so- cial. The important issue here becomes the phrase, "given limited resources." We must provide for each according to his need, from a base that is far above the minimal level now provided. The intent is to provide for all older adults on all Levels. 11. Society should provide education for life's changing roles, including retire- ment. 12. National, state and local governments and supportive agencies, with family cooperation where possible should assume responsibility to provide the elderly with supportive services in order to maintain their independence. 13. These governments should encourage and promote the direct involvement of older adults in civic affairs and both government and the media must insure the recognition of their outstanding contributions. II. Section on health, mental health and nutrition 1. Health services for the aged should be integrated with services for other age groups, but provisions must be made to meet the special needs of older people for services, facilities and specialized personnel. 2. A continuum of health care services should be available at reasonable cost to all citizens, with financing through mechanisms such as a system of national health insurance, in contrast to a system which relates benefits to financial eligibility. 3. Responsibility for the entire spectrum of health services should be vested in an intermix of the public and private sectors. The leadership should he provided by the private sector in such a way that health services are most effectively available, accessible and acceptable to persons in need of them. This would require finncial participation and standards setting by both the public and private sectors. 4. Valid, relevant and positive education about the processes of aging and the total life cycle should be provided at all levels of schooling. Special efforts must be directed to development of educational programs in human development for professionals and providers of service to the elderly. 5. Available funds should be appropriately apportioned among health care services, research and training of health manpower. LONG-TERM CARE The section on Health. Mental Health and Nutrition expresses its concern about the quality and effectiveness of the present long term institutional care system, particularly with regard to its service to elderly persons. We recommend that the administrators of the Cook County Community White House Conference on Aging appoint a committee to draft an agenda and arrange for a meeting to which all the delegates to this section will be invited, in order to examine current recommendations and proposals of interested agencies, to formu- late recommendations for action and to act as advocates for implementation of recommendations with regard to quality care of the patient with a long term illness. 434 NUTRITION 1. The Federal Government should allocate funds for research on the influence of nutrition on the aging process, and at the same time institute action programs based on previous research, to meet the needs of malnourished aged persons and to prevent malnutrition among those approaching old age. 2. Standards for quality of food and nutrition services provided by institutions and home care agencies should be established by the Federal Government and implemented by state and local governments. 3. Government resources allocated to food should be concentrated solely in the provision of foodstuffs to those in need. Additional funds Should be appropriated for education of all consumers about nutrition, especially the aged and those who serve the consumer in professional and related capacities. Such education should begin in early childhood. 4. Federally assisted housing developments for older people should have available several alternative types of food service which meet the needs of the individual residents as determined by the individuals involved, with federal funding if necessary. These services should also be available to older persons in the community who do not live in such housing developments. 5. The Federal Government should assume the responsibility of making ade- quate food available to every American. 6. There should be considerably improved governmental control of the safety of our national food supply. Furthermore, a central authority should be given the responsibility to develop and promulgate a uniform policy to ensure the safety of our food supply and to serve as an agency to integrate available research data, for dissemination for educational purposes to schools, churches, senior citizen groups and others. III. Section on Housing, Environment and Transportation The Housing, Environment and Transportation Section of the Cook County Community White House Conference on Aging met ad discussed issues crucial to the elderly of Illinois and the United States. It was a well attended conference with vigorous debate. Out of the discussion emanated the following policy recommendations : 1. Some fixed proportion of all government funds, Federal, State and local, al- located to housing and related services should be earmarked for the elderly. 2. Eligibility for low and moderate income housing should be based on social and health needs, with recipients having incomes above an established minimum level, paying for benefits at a sliding scale rate related to their income. 3. The Federal Government should insure that State and local governments produce suitable housing for the elderly on suitable sites, based upon need. 4. Residentially-oriented settings Should be permitted and provided for those elderly who need some assistance in daily living but do not need skilled nursing care. 5. Life-supportive services should be provided when needed, to help older peo- ple remain living independently in their own homes, and more congregate hous- ing should be provided for the elderly, which would include the services needed by residents, and also provide outreach services to the elderly living in (adjacent residential neighborhoods. 6. The Federal, State and/or local governments should provide financial in- centives to make local property tax relief for the elderly homeowner possible, and consideration should also be given to renters. 7. The 1971 White House Conference on Aging should go on record to say that the United States Congress should appropriate sufficient funds to supply ade- quate housing for all elderly who need it. 8. The Federal Government should adopt a policy of increasing services for the elderly, by subsidizing transportation systems, and providing reduced rates for the elderly without restriction. 9. The Federal Government should provide for 'the development of transpor- tation systems and services to meet the particular needs of the elderly. 10. The Federal and State governments should require that transportation be an integral part of any social services program for the elderly supported by Federal and State funds. 11. The Federal Government should vigorously support the development of individualized flexible transportation for the elderly with Federal, State or local financial assistance which would provide increased access to shopping, religious, social, recreational and cultural activities. (:::> 12. The Federal, State and local government! should share In the support and development of programs designed t<> provide for the safety, comfort and con- venience of the elderly as pedestrians, drivers, and users of transportation systems. IV. Section on income. Employment and Retirement In consideration of issues relating to Income, employment and retirement, the |ection on Income, Employment and Retirement adopted the following recom- mendations: 1. That the federal government be required to insure that priority he given to older persons, i.e., all those age 45 and over, In search of employment, including provision for adequate training programs, and that funding he done in relation to the needs of older persons in employment programs. 2. That the federal government adopt as a national policy the right of every older person, i.e., all those age 45 and over, to he provided the opportunity to continue to contrihute his skills through gainful employment, and that the fed- eral government he the ultimate guarantor of this right through appropriate public service employment. 3. That $6,617 he regarded as an adequate annual income for older couples (proportionately for older non-related individuals), with provision for cost of living increases, in order to allow for some psychological sustenance as well as physical sustenance. 4. That the federal government intervene to ensure protected pension plans. Such protection is to be based upon the right of the individual to have income from such plans and shall include adequate safeguarding of funds to ensure that benefits will continue to be paid. 5. That we support and encourage the United States Senate Special Committee on Aging in its study of pension plans and vesting rights. 6. That current pressures to lower the retirement age below 65 be discouraged. 7. That society assume greater responsibility for helping people prepare for retirement years through some form of pre-retirement education. 8. That a guaranteed annual income program be established which shall be administered by the federal government and funded through the general federal revenue. ACCEPTED AS A MINORITY RECOMMENDATION ON THIS ISSUE That a guaranteed annual realistic income program be established which shall be administered by the federal government and funded through the general fed- eral revenue and the contributory Social Security system. 9. That we endorse the recommendation of the Conference Section on Health, Mental Health and Nutrition, which states : "It is recommended that a continuum of health care services be available at reasonable cost to all citizens with financing through mechanisms such as a system of national health insurance in contrast to a system which relates benefits to financial eligibility," with provision that Medicare and Medicaid benefits be expanded to include coverage for drug and medicine expenses, and incorporated into the program, with the further provision that adequate attention be given to contingencies relating to chronic illness and long term care. 10. That the Social Security annual earnings test be eliminated. 11. The chair permitted inclusion in the proceedings of the following recom- mendation submitted by a single individual, namely: That all Federal and state taxes on income received from cashing government "E" bonds by persons over 65 years of age be eliminated. V. Section on Personal Adjustment and Spiritual Well Being The Section on Personal Adjustment and Spiritual Well Being adopted the following policy recommendations : 1. Due to the increasing number of elderly people and the widening gap be- tween needs and resources, more government funds must be made available to meet personal adjustment requirements. 2. Admittedly there are problems peculiar to the aged, yet they need an opportunity to interact with all age groups. The aged must be offered a choice of program activities and participation in meaningful roles in order to accom- plish true personal adjustment. 3. Since many elderly turn to organized religion to meet their basic spiritual, psychological and social needs, religious organizations must be actively involved in meeting all of these needs. 436 4. A Declaration of Human Rights on Aging needs the input of more than religious bodies. It is recommended that the White House Conference on Aging climax its work with the inclusion of such an article. 5. We urge the 1971 White House Conference on Aging to broaden the con- sideration of Personal Adjustment and Spiritual Well Being. The conference workbook is chiefly directed toward the role of organized religions in serving the spiritual well being of the aged, which is only one facet of personal adjustment. There are many other social institutions, agencies and organizations that are equally concerned with, contribute to and serve the personal adjustment needs of the aged. November 8, 1971. Mr. Arthur R. Weed, Consultant on Retirement, Department of Human Resources, Chicago, III. Dear Mr. Weed : This will acknowledge receipt of your letter of November 3 in which you enclosed the additional materials requested at the hearing. I found the hearings quite beneficial and I thank you for your help. Best wishes. Sincerely, John Brademas, Chairman, Select Subcommittee on Education. Department of Human Resources, Chicago, III., Novembers, 1971. Hon. John Brademas, Chairman, Select Subcommittee on Education, U.S. House of Representatives, Washington, B.C. Dear Congressman Brademas : As requested at the November 2 hearing in Chicago, I am enclosing a copy of our July bulletin in Pre-retirement. The eleven points in which you evidence interest are listed starting on Page two with a brief statement on each. Also enclosed are other publications of our Division which may be of interest. I will secure information on the City College extension courses and send it along in a few days. In a separate mailing I am having a copy of a survey which was taken of Re- tirement programs in the Chicago area. I enjoyed the November 2 hearing very much. Sincerely, Arthur R. Weed, Consultant on Retirement. Statement of Arthur R. Weed, President, North Shore Senior Center, Chicaco, III. My name is Arthur R. Weed. Since 1964 I have been consultant on pre-retire- ment preparation for what is now the Division for Senior Citizens of the De- partment* of Human Resources, City of Chicago. I am currently President and temporarily acting director of the North Shore Senior Center. I also am co- chairman of the Commission of Senior Members of my church so I associate with Seniors nearly every dayof the week. Several months ago I was with the leaders of several local groups of senior citizens when the question was raised "What is the chief problem of older per- sons?" Immediately and unanimously the answer — "Inflation". Generally speaking, seniors live on fixed incomes and any deterioration in the value of the dollar means a tightening of the budget. There have been, as everyone knows, increases in Social Security, but this source of income was never intended as the answer to retirement living. Most of those drawing pensions (and they are a relatively small percent of the senior population) are included in plans that were drawn up before such things as "vested interest" and "cost of living increases" were considered. Many of those who thought they were going to receive pensions haven't received them, for reasons which have been well 437 publicized, but the majority of those who do gel a pension check And that it is for the same amount as it was the first month of their retirement and it will remain that way. Retirees can't strike for a 30 percenl Increase in wages, if tin.;- reserves arc in securities, these, too have decreased in value. All of which bears out the Oft repeated statement. "The Longer yon live the more likely you are to he poor." Problem number one as mentioned in several pro-White House conferences is income, complicated by the decrease in buying power of the dollar. A second problem is one that isn't, nearly as ohvious. As Tom Collins, then of the Chicago Daily News, in speaking before a group in Chicago some time ago said : "In this country people do not know how to retire." At a recent American Management Seminar on retirement one of the partici- pants said: "Mr. Weed, isn't the word retirement negative?" In reply I said it it was not only negative hut to many i>eople actually repulsive. These people do not even wish to think about it nor talk about it — yet the average person who retires at age 65 has from 14 to 17 years of living for which they should prepare. The phrase "retirement shock" is now quite well understood and it is pre- ventable. It is necessary, however, to develop a changed attitude toward retire- ment as well as recognition that 80 percent of retirees are still active. They are not senile, doddering weaklings. A third comment deals with those who wish employment in their senior years. Too much stress is put on chronological age. No two people are alike at age 65. Some people never have a new T idea after age 45 wmile others at 80 are capable of doing an acceptable day's work. Whether because of income requirements or just because they need to feel useful, there should be improved opportunities for eliminating the discrimination against the employment of older people. Since your Committee includes Education, may I comment on adult education for older people? Adult courses are available in most communities. Too often these courses are available only in the evening — a time when many seniors for varying reasons, stay home. Some experimentation has been done with day classes. At the North Shore Senior Center we have no difficulty in securing enrollment in day classes in Spanish, French and German with volunteer in- structors. This indicates the interest. Top priority, if advance indications are correct, will probably be given at the White House Conference on Aging to Income, Health and Housing. It is my belief that pre-retirement preparation, employment and education also deserve some real attention. News From the Field of Pre-Retirement Preparation (Editor: Arthur R. Weed, Retirement Consultant; Robert J. Ahrens, Director, Division for Senior Citizens) SOME FACTS ABOUT PROGRAMS IN THE CHICAGO AREA Exactly 39 people attended Workshop #12 on Pre-retirement Preparation held at Carson's on April 14. As promised there were no set speeches but rather an opportunity to exchange ideas and become familiar with what some other organizations are doing. Tom Wilson of the Division for Senior Citizens gave a brief summary of findings of the recent Division survey of retirement programs in Metropolitan Chicago. Here are some facts of interest : Individual counseling is the principal technique employed in pre-retirement programs with primary emphasis on financial questions. Many counseling sessions do not cover anything more than the organization's pension or profit sharing plan. Most contacts with employees are made in the last nine years of employ- ment — too many in the last year only. Of 260 employers reporting, 60 per cent have compulsory retirement with only 14 per cent at an age older than 65. Where retirement is voluntary most em- ployees tend to work beyond age 65. "It is the employer's role (1) to guide the employee in planning his own retirement, (2) to stimulate positive thinking about preparation for retirement, (3) to serve as a resource in disseminating factual information pertinent to suc- cessful retirement, (4) to motivate the employee to plan early for retirement and (5) to aid employees in achieving an overall successful retirement life." Few firms have full or even part-time retirement counselors. Most programs 438 are scheduled on company time. Most employers provide special services for former employees — insurance, counseling and medical resources are most common. The most common reason stated for not offering a pre-retirement program is "too few employees retiring." Most existing programs are administered by the personnel department. A majority of those attending the April meeting expressed interest in a full day seminar on the development of a pre-retirement program including all steps necessary to plan and install it. Such a program is being planned for early fall. Tentatively, another workshop is being planned for summer. CHECK WITH CENTERS BEFORE RETIREMENT There are about 500 Senior Citizen centers, clubs and groups in the Chicago area. The Senior Citizen centers operate full time, five or more days a week. The groups and clubs meet once or twice a month, perhaps to play cards or just talk. If you are approaching retirement, or counseling those who are, we suggest a visit to one or more Senior Citizen centers or groups beforehand. Find out, by visiting several, which ones have the program and the people that will be of interest to you. Then you will be ready to participate as soon as you do retire. A Guide to Services for Senior Citizens in the Chicago Area, issued by the Division for Senior Citizens, will tell you how to locate the groups or centers near you. If you do not have a copy, ask us for it. THESE ARE THE AREAS TO COVER IN PRE-RETIREMENT PLANNING In the first issue of this bulletin on pre-retirement planning, we printed the eleven topics which need to be covered in a complete program. Not everyone who is approaching retirement will be affected by each of the eleven subjects, but several of them are important to each person nearing that great day where there is no need to set the alarm clock. Again, retirement is an individual matter. No one can tell you how to retire but one or more topics need the attention of every pre-retiree. So we are reissuing the eleven points as given in that first issue of January, 1970 : 1. Finance. — Most people approaching retirement think — "Will I be able to live as I am living now?" Most incomes will be cut, sometimes by as much as two- thirds, but there are also offsetting reductions in expenditures. Advance study and information will help in making the financial adjustment. 2. Leisure Tim.e. — The average retiree Will have 200 hours of additional time each month — which will come at the time of day when he has previously always had something to do. 3. Physical Health. — Do you have a check-up at least once a year? 4. Mental Health. — New discoveries are constantly being made in the field of preventive measures against mental illness. 5. Where To Live. — More than 70 per cent of people retiring do so in the com- munity where they have worked. With the exception of Florida, the five states having the highest percentage of population over 65 are in the Midwest. 6. Friends and Family Relationships. — Effective retirement is impossible with- out continuous social participation, daily contacts both in informal friendships and formal associations. 7. Legal Questions— Wills and Estates.— Do you have a Will? Do you under- stand implications of joint tenancy? 8. Work. — Are there opportunities for earning money after retirement? What are they? How do you go about getting part-time work? 9. Volunteering. — One of the most satisfying of all activities is doing something for someone else. Volunteers are needed in hundreds of places and many of the opportunities are interesting and challenging. 10. Travel. — 'See America First or join a tour party to other parts of the world? Some travel is hardly more expensive than staying home. 11. Adult Education. — Night classes are available almost anywhere, and more institutions are realizing the potential of day classes for seniors. Learning new things is always a challenge. 'not where, but how One of the most recent books on retirement (and they come out frequently these days) suggests a different approach on the selection of where to live when you retire. 439 The suggestion is "not where but hew." The quote deserves Interpretation, l.e., pick your living place Cor retirement on the basis of wh.it you are going to do. if you are planning on part-time employment, St. Petersburg (and most, other parts of Florida) already has many senior citizens who. are Looking for part- time jobs, if you plan to tish, move to good Ashing grounds, etc. Adapt your place of residence to your retirement activities. This approach emphasizes again that pre-retirement plannii ••. Is Important, if What you are going to do helps to determine the location of your post-retirement home, 11 is certainly necessary that you have some idea of your program. The great majority of people who retire don't move. Will you live where you do now, in the same neighborhood, or where the action (the kind you plan) is? PROVISIONS FOR RETIREES IMPROVE — BUT GAPS ARE STILL THERE "At the end of 1960, an estimated 146 million persons (employees and depend- ents) had hospital expense coverage, 57 million had life insurance and death benefit protection, 31 million employees had temporary disability protection, and 29 million active workers had private retirement plan coverage through em- ployee-benefit plans. These totals mark the end of a decade during which the mem- bership in plans covering hospital, surgical and medical insurance, life insurance and retirement has grown 40-50 percent. Major medical insurance coverage ex- panded at an even greater pace ; temporary disability insurance grew less rap- idly. During the sixties, total contributions to provide these benefits have more than doubled and benefit payments have about tripled." The paragraph above is quoted from the April Social Security Bulletin. Ob- viously these statistics indicate an improved "tomorrow" for retirees. Yet, ac- cording to the same source, only 48 per cent of the labor force is covered by private pension plans and the per cent of those presently retired, who are cov- vered, is much lower. Hence, the need for further emphasis on the importance of financial aspects of pre-retirement preparation is obvious. Even when financial affairs are not a problem, the many other factors required for successful retire- ment make advance planning necessary. Total outlay for retirement benefits in 1960 called for 1.8 billions with a com- parable figure of 5.9 billions for 1969, according to the same source. Total reserves in private pension plans now stand (end of 1969) at $125 billion and contribu- tions for retirement funds are $3.05 for each $100 of wages. YOU ALWAYS WANTED TO What did you do when you were a "kid" that you haven't done since? This, say some of the people who are studying the psychology of aging, is where you might look for your post-retirement activities. So-called leisure time in retirement offers the opportunity of doing those things which you have always wanted to do but for which you never had the time. DON'T RETIRE TO NOTHING MORE REASONS FOR PREPARING Speaking of retirees. Dr. Irving S. Wright, president, of the American Geri- atrics Society said : "Many of them begin to deteriorate — fall apart— because they are not prepared for retirement and should never have retired." Earlier retirements, particularly forced retirements, are adding to the problem, accord- ing to the doctor quoted in the Chicago Tribune. Dr. Wright questions the wisdom of early retirement to make way for younger workers. Recently many companies have suffered catastrophies because of the faulty judgment of bright young men in key positions. "The careful melding of the experienced judgment of maturity with the energy and new concepts of youth still presents the most solid basis for the national economy." To quote the Tribune article further : "Retirement should he based on biologi- cal age rather than chronological age. Some people at 45 are 'burned out' and are not capable of generating a new idea . . . those over 60 or 65 who are phys- ically and mentally able and willing to work should be encouraged to do so." "With time on their hands, they (retirees) begin paying more attention to normal aches and pains . . . Sitting quietly for hours can also lead to more seri- ous medical ills, Dr. Wright said. "Not only does forced early retirement cause countless personal tragedies, but it also is increasing the heavy non-productive load on society, costing billions of dollars for support from either public or pri- vate welfare or pension funds." 440 MORE INTEREST SHOWN IN PRE-RETIREMENT PROGRAMS Interest in pre-retirement programs continues to grow. New groups of employees approaching retirement have or are meeting with discussion leaders from the Division for Senior Citizens through the Department of Defense Contracts, the Chicago Civil Service Commission, Kemper Insurance Company and Zenith Corporation. Programs in which the Division for Senior Citizens has been involved in prep- aration of meetings or in leading discussions have been started at Hines Veter- ans Hospital, the U.S. Department of Labor and the Tool and Die Institute. Arthur Weed and Thomas Wilson went to Cincinnati for an all day session on pre-retirement planning for 120 Sisters of Notre Dame whose order serves a four-state area. Mr. Weed also discussed retirement planning for 54 Sisters of St. Joseph at LaGrange Park. Preliminary contacts on pre-retirement programs have been made with Mac- Neal Memorial Hospital of Berwyn and the CNA Corporation. Pre-Retirement Planning A new Retirement Planning Program for business, labor, community, civic, religious, and social groups is now ready. It consists of three parts : "ARE YOU PLANNING ON LIVING THE REST OF YOUR LIFE?" A 72-page do-it-yourself planning booklet for all age groups that will start you toward a rewarding retirement. It helps you to plan Finances, Where To Live, Activities, and Health. It is designed for two people to go through together to plan for their retirement years. "THE REST OF YOUR LIFE" A 28-minute, full color, 16 mm. sound film produced by Gilbert Altschul Pro- ductions, Inc. The film serves as a motivating factor, emphasizing the need to plan for retirement. It identifies and examines some of the myths and fears related to retirement, bringing new insights and concepts about retirement and stimulating thinking and planning. A SET OF THREE POSTERS To use while the program is being conducted. One announces the session where the film is to be shown and the booklets distributed. The others are posed at intervals at reminders while the partners are going through the booklets at home. HOW TO USE THE PRE-RETIREMENT PROGRAM The program is designed to stimulate thinking about retirement in all age groups. It is short and simple. It is flexible. You can use the program as a prelude to a formal program already in opera- tion, or you can use it as a complete retirement planning program by itself. It will work in a centralized or de-centralized organization, a single plant or a multi- plant operation, a large or a small organization. Prudential and Jewel Help Employees Plan 1. In the Mid-America Home Office, housed in the Prudential Building in Chicago, the pre-retirement program was inaugurated more than five years ago. The essential outlines of the program were adopted from our corporate offices in Newark, New Jersey. 2. The program is based on group presentations and discussions. Individual counseling is offered only for questions arising from any of our employee benefit plans. 3. First contact is made approximately five years prior to the anticipated date of retirement. 4. For the majority of employees, retirement is compulsory at age 65. 5. All employees are invited to participate in the program, but their participa- tion is entirely voluntary. 6. The following subjects are covered in the program : •Ill (a) Financial Planning A talk with discussion offered i>y ;i member of the Regional Home Office financial staff. {b) Retirement Activities and Psychological Aspects of Retirement a general presentation by a member of Management of the Regional Homo Office's Per- sonnel Division. (c) Social Security — A presentation by a member of Management of the Social Security Administration in Chicago. Arrangements are made through the Social Security director in Chicago. (d) Prudential Benefits — A talk by the member of Management in the Re- gional Home Office directly responsible for Prudential benefit programs. Questions and discussion are encouraged throughout. Informality and warmth are striven for from beginning to end. 7. Numerous passouts and printed materials are used. A partial list follows : Increasing Your Retirement and Other Income, by N. D. Ford. Your Social Security, Social Security Administration. Public Affairs Pamphrlet No. 131, When You Grow Older. Public Affairs Pamphlet No. 182, Getting Ready to Retire. Public Affairs Pamphlet No. 276, Making the Most of Your Years. Wills, Illinois Bar Foundation. Food Guide for Older Folks, U.S. Department of Agriculture. The Harvest Years, The Chicago Public Library. Where to Retire on a Small Income, by N. D. Ford. A plastic binder containing these and other pamphlets and special printed matter developed by Prudential is given to each individual taking part in the program. 8. The pre-retirement program is the responsibility of the Personnel Director, Mid-America Home Office. 9. We have received several compliments on the program from retirees who have taken part and are generally pleased with results to date. We are aware that the current plan is not perfect, however, and it is under almost continuous review for improvement. 10. The Mid-America Prudential Retiree Club was established during 1905 for retirees from this office. The Club operates independently from the company. Various publications of the retirees' choice are mailed to them after retirement. JEWEL STARTS AT AGE 57 On an employee's 57th birthday, the Trustees of JRE sends the employee a letter saying that his Jewel Retirement Estate's Fund is now fully vested for his benefit. Specifically, the letter points out that : 1. Beginning at age 57, the entire amount of an employee's JRE account balance is available whenever he decides to retire from active service with the company. 2. Maximum enjoyment and benefit from his Jewel Retirement Estate can only be realized through good, careful, pre-retirement planning. 3. Even though the employee may not be planning to use his JRE during the next few years, it is not too early to start thinking about this future personal plans. 4. The JRE Trustees and the personnel staff at Melrose are available for help at any time for any preliminary pre-retirement planning which the employee may desire. 5. The Trustees extend every good wish for a continued and successful Jewel career. Within 60 days from the mailing of the Trustees' letter, the appointed Pre- Retirement Planning Counselor writes the employee a personal letter of introduc- tion. His letter refers to the Trustees' letter and offers personal assistance when it may be desired. Included with this letter is a copy of the company's publica- tion on Pre-Retirement Planning. Shortly after the employee's 58th birthday, the counselor writes again offering his services should they be desired. This letter also offers the employee a free annual subscription to "Harvest Years" if he would like to have it. A subscrip- tion application form is enclosed for the employee's use. Upon the employee's 59th birthday, the counselor will send him a third letter. This letter, in most cases, will have to be personally written to acknowledge any previous communications, but in general its purpose is to : 1. Invite the employee to ask questions about his JRE account, amount avail- able, probable pay-out schedule, etc. 442 2. Discuss Social Security benefits and how they fit into retirement planning Complete information on Social Security, as published by the Federal govern ment, is included with this letter. Also included is an application blank for th employee to use should he wish to request from Social Security the amount o his deposits to date. This will not only give him the dollar basis for his benefits but will confirm his Social Security number and account. 3. Invite the employee to contact the counselor at any time for help or in formation. At age 60, the counselor will request the employee to attend an individua conference. The spouse may also attend this conference. It is expected that th employee attend this conference whether on company time or employee time The purpose will be to : 1. Discuss JRE in detail and outline anticipated pay-out schedule. 2. Cover medical, hospital, and life insurance benefits following retirement 3. -Explain in detail what to expect from Social Security benefits. 4. Confer on personal plans after retirement — where to live, hobbies, budge of income and expenditures, supplemental part-time work, etc. 5. Determine a probable retirement date. At age 62, the counselor will request the employee to attend his secon mandatory conference. At this age and upon retirement, the employee may choos to receive 80% of his Social Security benefits available at age 65. Plans reviewe at age 60 will be updated and crystallized. At age 64, the counselor will initiate his third mandatory conference with th employee. Emphasis will be placed on the fact that at age 65 the employee i expected to retire from active service in accordance with the Jewel Retiremer Estates Trust Agreement. All previous plans will be updated and a retiremer date established. At age 65 or sometime between ages 64 and 65, if a retirement date has bee: agreed upon, the counselor will have his final retirement interview with th employee. The counselor will finalize plans for distributing the JRE account an gather all required information for recommendation to the Trustees. He will als handle all details required to convert to Direct Pay Plan for Blue Cross an Blue Shield, if that be the employee's choice. At any time after age 57, the counselor may distribute copies of publication on pre-retirement planning to those employees whom he has contacted. The dii tribution of such material will not only be helpful, but it should assist in estat lishing a sincere and personal rapport between counselor and employee. The counselor's relationship with operating management for those employee contacted should be on a "professional" service basis. Information obtained b the counselor which related to the welfare of the employee should be relaye confidentially to the respective operating men, but every effort should be mad by the counselor to avoid involvement in working relationships and informatio of a personal nature is kept confidential. Preparation for Retirement, Carson Pirie Scott & Company (Several years ago, in December 1958 to be exact, the Commission reprinted description of Carson's pre-retirement program as originally prepared for th Research Council for Economic Security by Martha Douglas. For this report w are printing a summary of the program in much briefer form. Martha Dougla; now retired, also prepared this one, but with the help and approval of Margare Sawyer who succeeded her as Director of Counseling and Employee Activities. When a formal pension plan was adopted at Carson Pirie Scott & Company o February 1, 1952, management realized that retirement as a way of life was new idea to most of the store personnel. The problem at Carson Pirie Scott Company was especially acute. Since there had been no formal pension plai over 400 associates age 65 and over were still working in the organization. Cor sequently, management realized that a program of retirement preparation wa necessary to implement the benefits of the pension plan. A personnel executive with long experience with the company, who was we acquainted with the store personnel, was given the assignment of starting Preparation for Retirement Program. The program is still administered by personnel representative with the title of Director of Counseling. The Preparation for Retirement Program began by the Director of Counselin interviewing all associates age 64 and over, giving them information about th pension plan, social security, and associate benefits that would continue afte 443 retirement. The individual's job performance was reviewed a rating made by two of his supervisors thai showed whether the associate was maintaining bis job standards plus a review Of Ids medical report made by Hie company Medical Director. The individuals plans for retirement family problems, financial situation, outside interests, and Living arrangements were discussed. The associate was assured that the company policy remained the s;ime as long as his health and job performance remained good, retirement at age 86 would not. he compulsory. However, lie was told that earnings after age <">•"> would not in- crease the pension amount; that; the personnel policy that "only the rare indi- vidual may work after age 70" would continue. Assurance was given that the entire conversation between him and the Director of Counseling would be kept in strictest confidence. And that such a conference would be held annually during his birthday month as long as he remained in the store. The associate was urged to discuss retirement plans with his family and to think through the problems of living after retirement. PROGRESSIVELY REDUCE INTERVIEW AGE Iii 1954 the age for the annual interview was lowered to age 63, then to age K in 1956. The interview now becomes a friendly discussion of the plans the individual and his family are making for a meaningful life in retirement. His Job and health ratings are reviewed, and questions answered about retirement benefits. A booklet, "Look Forward to Your Retirement Benefits," describing in detail the privileges that are retained after graduation from work is also given each individual. Realizing the value of group discussions, in 1954 a course, Life in Later Matur- ity, was added to the program. The Director of Counseling attended the two week training session on the course given by the Industrial Relations Center of the University of Chicago. This course, consisting of nine sessions, has been given two or three times a year since 1954. Each session is conducted as a conference, with 20-23 people participating in the course. Topics covered are : The Meaning of Later Maturity, Nutrition and Health in the Later Years, The Physical Side of Aging (led by the company Medical Director), Mental Health in Later Years, Financial Planning, The Meaning of Work, Leisure Time Activities, Family. Friends and Living Arrangements, and Where to Live When You Retire. In addition to discussion, movies and role playing are used to add interest to the course. Before each session, members are given a booklet written by experts in the field to read for the next session. Carson Pirie Scott & Company purchases the sets of booklets from the Industrial Relations Department of the University of Chicago and gives them to participants in the course to keep for future reference. Although participation in the course is voluntary, most associates age 50 and over, including executives, ask to enroll in the sessions. At the completion of the course, a framed diploma, signed by the head of the Industrial Relations Department and the President of Carson Pirie Scott & Company, is awarded each member. These awards are made at the closing session and are often presented by the President or a Vice President of the company. To date over 300 associates who have attended a course are now retirees of the store. The value of the annual individual counseling session and the results of the course, may be evaluated by the following results : Associates today face retirement without fear, with well organized plans for life after work. Most people retire voluntarily — many more taking early retirement than when the program first began. The number of retired associates who comment on the value of the counseling sessions and the course that not only helped them prepare for retirement, but that has assisted them to lead interesting, meaningful lives after graduation from work. To celebrate the retirement occasion, a monthly luncheon is given for the people retiring that month. The closest store friends of each associate are also invited for the luncheon. A member of management, usually the President or Chairman of the Board, presides. He reviews the many accomplishments of each retiree and tells of the future plans of the individual. The luncheon is a "fun party" which retiring associates really enjoy. 71-272— 72— pt. 1 29 444 RETIREES HAVE PLACE FOR CONTACT The office of the Director of Counseling remains the center of contacts for retired associates. To this office they bring their problems, report illnesses, changes of address, or return just to visit. To help with the immediate adjustment to retirement, a subscription to Har- vest Years is sent to retired associates for the first year after they leave the company. Annually the Director of Counseling remembers the birthdays of retired asso- ciates by sending them cards to commemorate the occasion. The extra discount granted to regular associates Spring and Fall is also extended to retirees. The special discount cards for retired associates are issued from this office. To cele- brate the holiday season, retired associates are feted at a Christmas Tea with management represented. After this party a Christmas gift is sent to all re- tirees. In case of the death of a retired associate or his spouse, flowers are sent. Throughout the year the office of the Director of Counseling endeavors to show real interest in the welfare of all retired associates. The management of Carson Pirie Scott & Company believes that the company has a real responsibility to help people plan for productive, interesting lives after long years of work. Experience has shown that associates who have prepared for retirement make successful adjustments. Management believes that the time, effort, and expense of the Preparing for Retirement Program pays real divi- dends — not only in adjusted retired people, but in the morale of active associates who realize that, "Carson's really cares what happens to us." ABOUT REFERENCE AND SOURCE MATERIAL This topic on our question form referred to earlier seemed of least interest, judging from responses. Instead of devoting an issue of this bulletin to the subject, we will try to include some information with each report. Reference and source material is varied in form. There are books, magazines, pamphlets, movies and study courses dealing specifically with retirement, and any number of random pieces in a wide variety of publications. Magazines make as good a start as any so we will list : Harvest Years — is offered to employers for bulk circulation to employees, but individual subscriptions are accepted. Annual subscription $4.50, reduced on orders of more than 500. Address : 681 Market Street, San Francisco, California 94105. Senior Citizen — a monthly (pocket sized) issued by Senior Citizens of America for its members. Individuals may subscribe at a rate of $5 per year. Address: 1424 Sixteenth Street, N.W., Washington, D.C. 20036. Aging— published by U.S. Department of Health, Education & Welfare in- cludes information about Administration on Aging. Subscriptions ($1.00 for 12 issues) should go to Superintendent of Documents, Washington, D.C. Modern Maturity and Dynamic Maturity — each published every other month by the American Association of Retired Persons. Modern Maturity is the mem- bership publication. Dynamic Maturity is primarily for Pre-Retirement and Retirement Planning. Address : 406 East Grand Avenue, Ojai, California 93023. Preparing for Retirement at Abbott Laboratories About 1950 our management conceived a plan for doing "something" for em- ployees about to retire and for retirees. Mr. Freed Faassen who was a member of the Personnel Department received the assignment to head up the program. Fred attended the University of Chicago class for discussion leaders and started the program. For the first several years a number of surveys were conducted on employees' reaction. The results of the surveys were all positive so the program has continued. About five years ago Mr. Faassen retired and I took over the pro- gram. I also attended the University of Chicago classes. Our programs are conducted in group discussions of ten to twenty members. We endeavor to make two groups with hourly people in one group and salaried in another. This is because when we discuss "Financial Planning," "Where To Live When You Retire," and several other topics, we find a difference in interest and need between the two groups. Also, discussion is more forthcoming with "like" members. If any individual desires special counsel I ani available, but most prob- lems are discussed in class. Our Insurance and Benefits Division counsels all 445 Mni>loy program """ are StaSS down oage fifty ] bel^e Retirement Planning should start fifteen years before the •<; "vmrni date to allow for pro,..,- financial planning, [f someone wishes , ittend the program who is not fifty he is Invited. We have compulsory retirement it age sixty-five. I his applies to all employees and directors of the comnanv lassos are held on company time and all participation is voluntary. PLANNING BEFORE REGISTRATION Here s a summary of the information sent each employee in announcing the worses. This is accompanied by a questionnaire, the return of which furnishes wish- information and registers them for the course. •In beginning to talk about planning for retirement, when should we start to flan: Is it when you have your first life insurance policy, your first savings tccount, or planning your career? Formally, you ought to think seriously about t when you reach r>0 years of age. Complexity of life today at 62 or 05 (retire- aent) requires good plans. •'Statistics tell us that a person attaining age 65 today has a life expectancy of * v ; eei \ 14 a ? d 1° - vears for m and more than 15 years for women. This period ., S 1 1 L? be the most interes ting. All of us should preserve our physical, iiental, and financial well-being in order to make all those years count in terms of Measure, contentment, and service. "The older we get, the more planning we have to do. (Life is made up of plans— ome completed— some broken— and others placed in storage until you have time o carry them out.) In our retired career our freedom is almost complete and ►ecause that's the case, we will have more room for planning and carrying out han we ever had before. In previous periods of our lives somebody else always lid some of our planning for us. But when we retire, it's up to us to plan our own .ctions. "Life planning is an art that a lot of us may have neglected. Our lives go along a a set pattern and we take things for granted. The 'Big Six' may help you emember every question you should ask yourself when you have some life plan o make. " 'What' activities fill all my needs? (Careful now !) What do I really want to lo? What difficulties are involved? I 'Where' will I be able to follow this plan? Where will it take me? Where will be happiest? " 'Who' else is involved who might have a different opinion? I 'When' can I go ahead with my plans? How long a program will it be? " 'How' will I go about it? How capable am I of doing it? How well suited am I nancially? '< 'Why' do I want to do it? Why do I want to move to a new location? "Retirement should not be the lazy man's dream of doing nothing. We should tep up, not down. Here is what can be the most productive part of man's life, ne which can allow us to reach goals that we never could have touched in our arly years. That's the way to live longer and like it. "Have you asked yourself : "How does the family feel about my plans? "How about my physical capacity ? "Do I need additional income ? "If I move, what about my friends? "Who is dependent on me? "What is my first step? "From the start, I hope you realize that Training and Education and those f us who will be leaders at these meetings, aren't interested in becoming pro- rammers or planners for you. And we're not trying to snoop into your private ffairs. After all, what you do with your lives is your own business. We all have ifferent ideas, desires, and backgrounds. Nobody is going to try to sell you nything. We're just going to look at some facts of life and explore some ques- ons that all of us are going to face." Here is the program that is being offered for "Planning For Those Years Iiead." 446 General Topics for Discussion are : 1. Looking at Your Needs : How are you going to fill your day — to replace that which you have lost by retiring? 2. The Challenge of Later Maturity: What later maturity is — how it came about. Nutrition and Health: What foods are needed each day and why— how to improve poor food habits. 3. The Physical Side of Aging : Dr. M. J. McAndrew of the Employee Health Department. 4. Mental Health in Later Years : Your responsibility for your mental health. 5. Social Security : "How Social Security Affects Me"— Manager of Waukegan Area Social Security. 6. Financial Planning for Retirement : Planning ahead and developing an in- vestment program. 7. Abbott Retirement Benefits: Mr. Robert Dietmeyer, Manager of Benefit Plans. . J 8. The Meaning of Work : What work means to people— play instead of work. GETTING THE MOST OUT OF LEISURE 9 Increasing Your Retirement Income : Why a retirement career? 10. Family, Friends, and Living Arrangements, and Where to Live When You Retire We use the booklets that are published by the University of Chicago and we give each participating member a complete set of these booklets. The employee does not share in the cost. This year (1965) we have tried something new for all members of the class who have an attendance record of eighty percent or better; we give them a free year's subscription to the magazine "Harvest Years. If they like this magazine after a year we will subscribe for them at fifty percent of the cost We use other pass out material pertaining to Social Security, the Abbott Benefits and other pamphlets. The University of Chicago booklets are passed out one week previous to the following week's assignment. I discuss the booklet in general but basic content of the session is usually highlighted with other in- formation. Our sessions run one and one-half hours per week for ten to twelve I am very enthusisatic about this program. I have had more than one in the group that pooh-poohed the idea of a retirement program, and after three or f oui sessions that same person became very concerned and recognized the importani need of planning for retirement. Statement of John H. Ballard, Executive Director, Welfare Council oi Metropolitan Chicago Mv name is John Ballard, and I am Executive Director of the Welfare Counci of Metropolitan Chicago, a voluntary agency with 245 member agencies, botl governmental and voluntary, which provide the major health and social service: to people in Chicago, suburban Cook, Lake and Du Page Counties. Since 1914 the Council has been a center for community planmng and actioi to strengthen health and social services and advance human welfare. Over the years, significant part of the Council's activities have been devote< to problems of the aged. In 1951 we completed a three-year study of needs an< communitv services for the aged which concluded that the development of com munity -based, preventive and supportive services was essential to extend th productive years of the aged, and enable them to live with dignity and mdepend ence within the community as long as possible. This basic goal has guided all o our planning, research, and advocacy on behalf of the aged since that time. I should like to highlight some of the ways in which the Council has moved t meet the needs of the elderly. 1. NURSING HOME SURVEY In July 1971 the Council issued a research report on the relation of organiza tional characteristics to resources in 214 nursing homes in the Chicago are* Copies of the report and a summary of its findings are attached. ' Recently, national and local media and other sources have exposed shockin conditions in certain nursing homes. Staff of the Council's Information Cente for the Aging regularly visits every nursing home in the Chicago area, and ] 447 well aware of the shortcomings In many facilities. In ;i press conference held March 18, l i>T l we offered a sel of recommendations, which are attached. Our statement again stressed the Importance of In home, community services t<» avoid unnecessary placement in overcrowded Institutions. This emphasis reflects the fact that some 95 per cenl oftheelderlj Live out aide institutions. According to die Council's [nformation Center Tor the A.ging, (tie single, must important problem faced by the aged is having to live without adequate funds. Year by year, the aged remain the one proverty group that continues to grow. Nursing home abuses are directly related to the low priority our Society places upon the needs of the aged. Whether It's nursing home care that Is needed or housing, home health care, supportive or protective services, vocational rehabili- tation or jobs -old people have few or no choices and, in fact, must compete witb each' other for the few resources that the community does provide. This is a direct result of the conflict between the level of care and services which the community considers humane and the community's willingness to meet the necessary long-term cost. 2. INFORMATION CENTER FOR THE AGING Iii 1967, we established an Information Center for the Aged — the largest and most complete referral service for the aging in the Midwest. The fragmenta- tion and scarcity of services, their long waiting lists and complex eligibility requirements, present barriers to the aged that were beyond their energies to penetrate and make such a referral service essential. The Center has as- sembled comprehensive information on health and social services, including nursing homes. It gives the elderly the choice of having a sympathetic coun- selor and advocate at their side as they enter the service system. From 1967 through 1970 it has served approximately 24,500 older people. Through careful followup of its referral placements, the Center has docu- mented the unmet needs of the aging. These have been published in a three-year report to the community which is attached. Many of the most acute needs — for decent housing, employment for the healthy, facilities for the handicapped and persons in failing health — have been incorporated into Council position statements on public policy. These positions have been brought to the attention of public officials, legislators and the com- munity on many occasions through our public affairs program, and copies are attached. Financing of the Center has presented difficult problems. For five years it has been financed on a declining level by funds received under Title III, of the Older Americans Act, to which were added matching funds from the State of Illinois and from voluntary funds obtained locally. Although we have made some progress, sustaining financing for this essential program is not yet assured. The simple fact is that validated demonstrations of new service pro- grams such as the Information Center for the Aged, which are initiated with the aid of short-term federal grants, can rarely generate sufficient added finan- cing from local sources to continue. It is not possible to meet long-range needs of the aged with short-range financing. 3. HOME DELIVERED MEALS In 1962 a Council study found older people living in isolation, suffering nutri- tional deficiency. Through the mobilization of voluntary agencies and volunteers and through funding from the U.S. Public Health Service, the Council operated a success- ful three-year demonstration program of Home Delivered Meals to the chronical- ly ill and aged. After certification and prescription by a physician, hot meals meeting fourteen special dietary standards were delivered daily by trained vol- unteers who injected also a friendly visit into an atmosphere of aloneness. The final report of this project, which is attached, outlines its methods of operation, service standards, and the patterns of cooperation between volun- tary service agencies which were developed. One of the most important results of the project was to show that hospitals could discharge patients significantly earlier when a home-delivered meals serv- ice was available. One of the hospitals found means to continue this program on its own, as have a few of the cooperating agencies. But when overall funding ended after the demonstration period, the project ended, and new funds to make this essential home health service available to the aged on a com- munity-wide scale have not been available. 448 Based upon this experience it is our conviction that meals delivered to the home under medical supervision should be recognized as a legitimate home health service and its costs reimbursed through Medicare, Medicaid and pri- vate health insurance. 4. PROTECTIVE SERVICES TO THE AGED An elderly person whose health becomes seriously impaired often has no alter- native but to give up his or her home and enter an institution— either a costly nursing home or a state mental health facility. In 1969 the Council established a demonstration project in a Chicago com- munity heavily populated with older people, to explore ways in which a com- prehensive system of protective services could be designed and established so as to maintain seriously impaired elderly in the community as long as possible. After four years of making application to federal sources, financing from the National Institutes of Mental Health and the National Center for Health Serv- ices Research and Development was finally granted. Two sources of funds were required in order to meet the needs at a reasonable level. This project has been successful in demonstrating a viable approach to deliver- ing such services. Based on its findings, the Council has developed a model for utilizing the capacities of existing governmental and voluntary agencies to furnish a full range of protective and supportive care. Currently we are seek- ing financing under Title XVI of the Social Security Amendments of 1967 tc implement this model on a broad scale in the Chicago area. We urge this co- ordinated, purchase-of-care approach as preferable to the costly alternative oi establishing a single agency or institution to meet this need. Let me emphasize that the services which are being offered in this compre- hensive system are applicable in varying degrees to all aged— not just the seri- ously impaired. They include : (a) Information, referral and short-term counseling ( & ) Casework counseling and services (c) Full medical, psychiatric, and social evaluation (through the Public Health Hospital) (d) Placement in sheltered care or nursing homes when indicated ( e ) Home health care : Arrangements for physicians house calls Arrangements for Podiatry, Optometry, etc. Nursing Care Homemaker Services Housekeeping services and personal care Home delivered meals (/) Financial management (g) Legal guardianship (h) Other legal services (i) Emergency cash assistance (j) Transportation (Jc) Volunteer services SUMMARY OF RECOMMENDATIONS Based on what we have learned in developing a wide variety of services foi the aging, the Council submits the following points and suggestions for this Com- mittee's consideration. It is hoped they will help the Committee advance the goal of a humane system of services to all elderly. First: Short-term financing to meet long-term needs is not a suitable means of supporting essential services and programs for the aged. The overriding need at this time is for adequate and systematic long-term financing, which is consistent with the aged's long-term needs and problems. Second : The Council endorses the concept of a coordinated, community sys- tem of comprehensive services for the aged which utilize and upgrade the capacities of existing services to the fullest extent. Third : The Council urges that emphasis be given to the development of ade- quate systems of home-based services such as home health and nutritional serv- ices homemakers and other home-health aides, which must be expanded if they are to be included in comprehensive service systems. Fourth : The Council endorses in principle the report of an Advisory Council to the U.S. Senate Special Committee on Aging which was chaired by Dr. Harold Shepard. 441) Agencies or offices should be established at the highest levels of municipal, state and federal administration to serve as advocate Cor the needs of older citizens. Any such agency should be administratively divorced from direct administration of services and grant programs for services. Jt should be provided with sufficient staff so as to permit it systematically bo: 1. monitor and report the progress of operating programs Cor the elderly; 2. engage In Long-term evaluation of the impact of operating programs; and 3. promoting coordination and comprehensiveness among all such programs. Statement of John H. Ballard, Executive Director, Welfare Council of Metropolitan Chicago, At A Press Conference, Thursday, March 18, 1971 The Welfare Council of Metropolitan Chicago, joined by a number of its member agencies that operate voluntary philanthropically supported homes for the aged, iu view of the recetn exposure of abuses in some proprietary nursing homes, is issuing the following statement : Nursing home abuses are directly related to the low priority our society places upon the needs of the aged. Whether it be nursing home care which is needed — or housing, home health care, supportive or protective services, or vocational rehabilitation and jobs — old people have no choices and in fact must compete with each other for those few resources the community does provide. This is the direct result of the conflict between the level of care and services which the community considers humane and the community's willingness to meet the necessary cost. Public aid funding for the elderly in homes for the aged and in nursing homes is not only insufficient to support adequate levels of care, but, through its system of payment, discourages services aimed at restoring the elderly patient to higher levels of health and independence. The State of Illinois program of discharging elderly patients from state mental hospitals aims at restoring them to the community, but since it carries no provision for increasing overtaxed community resources, the practical effect is to encourage the opera tion of substandard nursing home facilities. We support demands for more effective inspection and enforcement for all fa- cilities and call, further, for inspectors to be trained to evaluate not just physical facilities but the quality of care being given. But again it must be understood that setting humane and adequate standards by Government carries with it the obligation by Government to provide appropriate support. Our society's low priority for the aged is starkly apparent when we consider the meager programs and services that are available to old people, whether they live in the community or in institutions. Bear in mind that some 95 percent of the elderly live outside institutions. According to the Council's Information Center for the Aging — which provides skilled counseling and referral to existing services — the single, most important problem they face is having to live without adequate funds. Year by year, the aged remain the single poverty group that continues to grow. While the community may like to think that income and services are sufficient so that people can live out their retirement years in comfort, the fact is that they are not. Only rarely is the Information Center for the Aged able to secure home nursing service for low-income elderly people and thus prevent their having to go to a nursing home. I.C.A. files show case after where waiting lists and eligibil- ity rules barred old people from essential help. Flexible counseling programs that could help the aged cope with their struggle to meet day-to-day needs are scarce and overburdened. New programs that could have added to the community's resources for the aged have had to be dropped after successful demonstration. The community — either through public funds or private donations — has failed to support them. For ex- ample, home health services for the aged are seriously lacking ; yet the Welfare Council's pioneering program of home delivered meals had to end for lack of com- munity support. A current project of the Welfare Council and its member agencies — the Protec- tive Services Project for the Aged, which is being funded for three years by fed- eral grants — shows that many older people in failing mental or physical health can remain independent and would not have to enter nursing homes if they re- ceive a multi-pronged service — health care, including nutritional aid, social serv- ices and legal protection — at the time they need them. Yet, unless we can reverse 450 past experience, this demonstration program, too — which is now serving nearly 200 old people — will end when the initial grant is over. Homes for the aged that are members of the Welfare Council, have a high per- centage of residents whose income comes from public assistance. These voluntary agencies can give what they consider to be good care only by adding substantially from contributions to the rates of payment provided by Public Aid. But resources of private charity in these days of rising costs are unable to fill the gap. Organza- tions sponsoring these homes believe that public assistance should pay for the ac- tual cost of care, just as it must do for every other kind of institutional care — hospital, mental institutions, or correctional facilities. In addition to basic public assistance support, Public Aid has a "point sys- tem" for the support of special nursing services. This system makes additional payments for added services that a patient needs. But there is penalty, rather than reward, for healing and rehabilitating the resident so that he can do more things for himself. As a resident improves and needs fewer of certain kinds of services, the payments decrease — yet a good institution must keep its rehabili- tation staff working with the resident so that he can maintain and continue his progress. Good staff require good supervision and continuous in-service train- ing to upgrade the quality of care. Yet public aid support makes no provision for this aspect of maintaining good programs. In the wake of the expose of nursing home abuses, many aged persons who need residential care and their families are shocked and confused. The need re- mains ; where can they turn ? We take the opportunity to call attention again to the Welfare Council's Information Center for the Aging, which provides skilled counseling and referral to people who must seek nursing home placement or other services. The telephone number is 346-5336. We can help, but the fact re- mains that there is lack of commitment to the aged by the federal, state, and local governments. It is this message we want to get across so that the current wave of concern about care of the aged will help to bring about the essential major changes in public understanding and support for the aged among us. Information Center for the Aging, Third Year Report FOREWORD The Information Center for the Aging is a project of the Welfare Council of Metropolitan Chicago funded under the Older Americans Act through the Illi- nois Council on Aging and by voluntary contributions. In operation since Feb- ruary 1967, this specialized information and referral service deals with prob- lems of persons aged 60 and over who reside in the metropolitan Chicago area. The Third Year Report supplements an earlier document, the Interim Report published in May 1969. The Interim Report provided background information concerning the development of the Center, outlined the objectives, described the research component and began to identify unmet needs essential to serving the aging population more adequately. This Report is based on the Center's experience over three years in serving 18,000 aged clients or others seeking help in their behalf. The Center staff have been encouraged by the development of new resources, as limited as they have been, that aid the elderly, such as the Protective Services project of the Welfare Council and the Chicago Transit Authority reduced fare plan. However, the staff continues to be faced with the lack of comprehensive services for the aging and the need for change in delivery of services to meet the multi-problem situ- ations facing aged clients and their families. Chapter IV of the report, "Unmet Needs : A Non-Quantitative Approach," con- tains case material illustrating some of the problems in obtaining service for the elderly and points up major gaps in service. New approaches are needed, and it is hoped that information contained in this report will stimulate greater atten- tion to the needs of the aged which are no being adequately met in the metropolitan Chicago area either by the voluntary or governmental agencies. The Advisory Committee, under the chairmanship of Jack Weinberg, M.D. (members listed in Appendix A) gave guidance and constructive assistance in directing the approach and operation of the Center during this three-year period. Acknowledgement is also given to Mr. Jemmie L. Turman, Graphics Specialist, at the Welfare Council for preparation of the cover layout. 451 The [nformation Center Cor the A.ging continues to be a vii.il pari of the total referral services offered by the Welfare Council. Now beginning Its fifth year of service, the ('enter has continued to receive financial support under the Older Americans Act through Illinois Council on A.glng, though at a reduced level. Only appropriations from limited Council reserve funds permitted It to continue at the ••normal" level of operations, it is clear that the program has demon- strated its effectiveness and equally clear thai private contributions alone can not sustain the service at a level reasonably commensurate with (he need. Sus- taining support from government and other sources is essential if this "project" is to become a continuing and even expanding service to our growing elderly population. John H. Ballard, Executive Director, Welfare Council of Metropolitan Chicago. Chapter I. — Introduction To have spent the past three years working in an information and referral service for the aging has been an experience indeed. While the nation was rock- lag with problems of pollution, over-population, war, civil rights, and inflation: and a growing number of the youth of the country had taken to the streets, determined "not to talk with anyone over 30,'" the Center was set up to specialize in the problems of aging and, in essence, "not to talk with anyone under 60 !" What part of the experience should be written? For whom should the story be told? To write about the project during its final months is difficult; there has hardly been time to assimilate the happenings of the last three years, much less formulate ideas, reactions, and recommendations. Perhaps the report should be written about how the Information Center for the Aging was a "hurry up" project. From the first day of its being it was "hurry up" and give service, "hurry up" and accumulate resource information and simultaneously "hurry up" and communicate it! More recently it has been "hurry up" and document unmet needs, and now "hurry up" and write a third year report. A third year report ! Words, words, words, when what seems most needed is action! For so many years, so many specialists (including ICA staff 1 ) have been writing so many words about the problems of the aging. Repeating the same chant for more relevant services for the aging would seem now to be superflous. Words become verbiage, unless they stimulate action toward solu- tions. What do you write about to stimulate this action? Who will begin to implement more meaningful services and effect change in attitudes toward the aging? The Center itself might be the subject of the report. By developing the Center, the Welfare Council offered the aging at least one option. The aging client can enter the vast, fragmented network of agencies on his own, or he can enter through the Center, assured that a Center professional will remain the "key helping person" until the appropriate resource can take over. In lieu of a re- source, the professional will help him to refocus and often to reach some solu- tion. This report is based on the Center's experience with 18.000 aged clients who have used the Center. These aging clients, or others in their behalf, were asking for help. The problems ranged from simple questions about Social Security to requests for protective services. The Center staff is aware that the majority of the aging in the area are not in dire distress, but the report cannot be about this group. Aged clients do not call a casework-oriented information and referral center to say they are alive and well and living in Metropolitan Chicago. The Center's overview then must be based on the clients who have come for help. Is the aged client served? The ICA professional staff will tell you that more likely than not he is rarely completely served. He may have entered this great plexus of care-giving agencies, but if his need is financial assistance, for instance, the amount of assistance granted is insufficient to cope with present inflationary costs. He may then necessarily need cheaper housing. He may apply for public housing, but he will immediately encounter a waiting list of several years 1 Welfare Council of Metropolitan Chicago ICA Interim Report, May 1969. 452 duration. He may then try for rent-lease supplementation through the Chicago Housing Authority. Aged clients tell staff, however, that available apartments on the list are not always suitable for the aging. He might also discuss the rent- lease supplementation with his present landlord, and if the landlord agrees and the housing authority approves, he may be able to stay where he is. How rarely this happens ! First of all, the aged client is timid about approach- ing his landlord to whom he must reveal his financial situation. He may also be fearful that the landlord will take a dim view of supplementation from a govern- ment agency, which may demand that forms be filled out, that inspections be made — in general, any regulations which he might consider to be red tape ! To further complicate his situation, if the client accepts rent-lease supplementation, he automatically forfeits his Chicago Housing Authority number and his plac< on the waiting list, as well. Or, what, about the client who wrote to the Center from a nursing home. Hei leading statement was that people who were supposedly helping her bv extending her life, were really extending her death ! Like Socrates, she felt that final "deal may be the greatest of all human blessings !" Response to her cry for help revealed that although she was physically helpless and in need of the physical care being provided, she was the only mentally alert patient in the entire nursing home She was a retired school teacher with a Master's degree in English. Long-term illness had drained her savings; alone in the world, she had had to enter a nursing home and request supplementation through Medicaid. Six months of. al first gentle and eventually not so gentle persuasion on the part of ICA, achieved her transfer to a home not only able to give her physical care, but intellectual stimulation and camaraderie, as well. But she told staff that she had read that society slaughters slowly and extends not life but death. How ? First, anthropologically, with forced retirement at sixty five ; then, sociologically, for when he is no longer vital and viable in the work oriented society, either he begins to withdraw from those who are or they fron him ; then, psychologically, when he no longer feels alive or desires to fight tht system ; then, physiologically and final. ICA staff cannot subscribe to nor refute this theory but they can tell you aboui their experience in attempting to get help for the aging client within the present system. In almost three years of working exclusively with the aging and a biasec sample qualify a professional staff to make a qualitative appraisal of the re sources available, ICA staff would agree that inadequate financial assistance is the most serious problem and that the "hang ups" in the delivery of even this in sufficient assistance could certainly fill a report. The staff believes this paucitj is the underlying cause of many other problems and that income adequacy woulc greatly alleviate many other problems for the aging. A good subject for a report might be phrases that become anathema to th< information and referral worker. The most notorious are : "uncovered case load,' "closed intake," "waiting list" and "custodial care." These "phrases" automati cally jockey the helping person from broker (the go between) to advocate (th< clients representative). On the other hand, new resources might be a good topic for the report. New re sources create joy for an Information and Referral center. New nursing home: and licensed sheltered care facilities have been opened. The Chicago Transi Authority reduced-fare plan for the Senior Citizen went into effect. The Depart ment of Human Resources, Division of Senior Citizen's Nutrition Project wa; begun. The mini-busses (provided through the YMCA and Hull House) hav< greatly aided the aging. The most exciting new resource ICA has experienced is the Welfare Council'! "Protective Service Project for the Aged." These services and others have en hanced the aged person's well-being but much more must be done. Perhaps ICA'i experience in community participation speaking, serving on committees an( panels would serve a report well. It has convinced staff that there is a tremendou: reservoir for positive action, concern, and kindness, for the aging. A dynamic surge of energy and concern for the aging is sweeping througl our churches. The Center has been host to seminarians, nuns, deaconesses, an( clergy who have spent several days accompanying the staff on nursing homt visits and listening to the calls for help that come into the project, and thei have attempted to develop services for the aging within their parishes. Om deaconess began a system of telephone calls among a group of shut-in age( whereby each one receives on telephone call from and makes one telephone cal to an aged person daily. The clergy became convinced while at ICA that visitinj 453 nursing homes In their parishes should be considered a "must." Although some denominations have traditionally made a practice of such visits, it is gratifying to observe that now all denominations are involved. This experience leads to further ••educational'* possibilities or an Information and referral center. [CA's experience in this area has included Supervision of Career students, who test out their Interest in becoming social workers by spending a summer working in a social agency, and of "Specialists in Aging" From the Department of Human Resources, Division of Senior Citizens, who spend several days at [CA as part of their orientation. It is the opinion of staff that if office space were available, it would he advantageous to have all Intake staff from both public and voluntary agencies spend time at the Center, actually answering client calls under supervision of ECA staff. This would give them a vivid look at the total system and might effect a change in attitudes regarding the aged client. Requests have come to ICA from all parts of the United States and from a few foreign countries requesting ICA's '•plan'' for an Information and Referral Service. Perhaps this report should be a "here's bow" to run an Information and Referral service for the aging, replete with the service and research design. A question that Center staff is often asked is "Aren't the aging different?" The answer is that the aged have all the human differences and variations to be found in the general population. They are sometimes tragic, sometimes comic, often touching, at times exasperating, at other times valiant ! The ICA staff has noticed just one thing about the aging that perhaps sets them a bit apart. They still say "Thank you !" The files are filled with letters from the clients expressing their gratitude for the help they received. These letters would make a lovely report. What part of a project's story should be told and for whom should a report be written? A little of all of the story will be told and the report will be written for all the people interested in the aging and willing to do something for them ! Chapter II. -The Grant — The Goals — And the Geographic Area of the Information Center for the Aging The Information Center for the Aging is a new and specialized kind of infor- mation and referral service, designed to deal with the problems of persons aged 60 and over, wdio reside in the Chicago metropolitan area. It developed out of the Welfare Council's long-time experience with a general referral service, Com- munity Referral Service, and a specialized service, the Central Service for the Chronically 111. The Central Service for the Chronically 111, originally sponsored by the Coun- cil as a time-limited project, began operation in 1944, to devote full-time atten- tion to research and planning for better care for the chronically ill, a high pro- portion of wmom are older people. The Service also undertook an information and referral service as a supplementary function. Auspices were transferred in 1944 to the Institute of Medicine of Chicago. Emphasis on research and plan- ning w y ere terminated in 1955, with the referral function preserved as the con- tinuing program. Because of increasing difficulties in financing, the Institute of Medicine de- cided to discontinue the service in late 1965, and the CSCI Board terminated its financial support and its operation of the agency as of the end of 1966. From May 1, 1966 until the end of the year, temporary space and supplementary office services w r ere provided by the Welfare Council. In the meantime, in the general service offered by the Community Referral Service, the number of requests from the aging population for a variety of serv- ices had steadily increased. Because of the generalized nature of its services and the limitation of its resources, CRS has never been able to offer specialized services in any field. It was believed, therefore, that a new T service was essential to fill the gap left by the Central Service for the Chronically 111 and to extend the scope so that the whole range of referral needs of the aging could be more nearly met. A proposal for an Information Center for the Aging, originally called the Information Center for the Aging and Chronically 111. was submitted by the Welfare Council of Metropolitan Chicago and w T as approved for funding by a grant under the Older Americans Act through the Illinois Department of Public Aid. The grant is a Title III grant for a three-year period and is a diminishing federal grant in that the federal share for the first year is 75 percent, the state's 12% percent ; the second year the federal share is 60 percent, the state's 20 per- 454 cent, and the Welfare Council's 20 percent ; the third year the federal share is 50 percent, the state's 25 percent, and the Welfare Council's 25 percent. The amount of the total project budget reflected a modest increase each year. The goals of the project may be classified as follows : (a) Kesource Information — To collect information about all health and welfare resources in the Cook, Du Page, and Lake County areas, which may be brought into play in the interest of aged persons with problems, which includes visiting all licensed nursing homes and homes for the aged in the area ; to maintain a central repository of current information so that it is readily available for direct service to clients as well as to other professionals and to agencies who provide services; to disseminate the information to appropriate agencies for their use in planning for the aging. (fc) Referral — To make referrals to appropriate agencies for specific problems of the aging and/or to accept referrals from professionals and agencies and individuals and their families for counseling and consultation. (c) Counseling — To provide counseling to help individuals and families solve their problems, including locating and matching their needs to the best com- munity resources available. (d) Consultation — To offer professional consultation to physicians, nurses, social workers, and others providing direct services to the aged, and to local community groups and individuals concerned about gaps in services for the aged ; to assist in the development of new services to more nearly meet the needs. (e) Planning and Research — To make data, available to community agencies for planning, resulting from documented unmet needs. To formalize liaison be- tween the project and the Community Participation and Action Division, and the Planning and Research Division of the Welfare Council, to utilize data accumu- lated in the project for planning and community action programs regarding the aged. (/) Resource Accumulation — To visit and to accumulate data on all licensed nursing homes and homes for the aging in the three county area and to compile information on all existing resources for central repository purposes, as well as for individual rolodex files for use in direct services. GEOGRAPHIC AREA The three counties served by Information Center for the Aging — Cook. Lake, and DuPage combined — had a population of 5.736,840 in 1960 and an estimated population of 6,219.900 in July, 1968, an increase of 8.4 percent. 1 These three counties contain the great majority of the population in the six-county Chicago metropolitan area, which in 1968 had an estimated population of 6.815,200. 2 The number of persons aged 65 and over in these counties reached an estimated 546,000 by 1965, which represents a 10.6 percent increase over the 1960 popula- tion, as shown in Table 1. This table also indicates that even though Cook County contained the greatest number of persons aged 65 and over in both 1960 and 1965, the proportional increase of this population in Du Page and Lake Counties was greater than that in Cook County, that is, a percent change of 20.7 in Lake County and 17.2 in Du Page County compared to 10.2 in Cook County for the five year period. As might be expected, about two-thirds of the population aged 65 and over the three-county area is concentrated in the city of Chicago. In 1965 this amounted to an estimated 360,000 which is around 10.4 percent of the population of Chicago, (estimated at about 3.5 million). 3 iUS Bureau of Census : 1960 Census of Population, V.I., Characteristics of the Popula- tion, Part 15 Illinois U.S. Bureau of the Census, Current Population Reports, "Provisional Estimates of the Population of the Largest Standard Metropolitan Statistical Areas. July 1. 1967." Series P-25. No. 432. 2 U.S. Bureau of the Census, op. cit. . 3D T. Bogue and D. P. Dandekar, Population Trends and Prospects for the Chicago- Northwestern Indiana Consolidated Metropolitan Area; 1960-1990, Population Research and Training Center. University of Chicago, March 1962 U.S. Bureau of the Census Current Population Reports, "Summary of Demographic Projections," Series P-25, No. 383, March 14, 196S. 455 IABLI 1. NUMBER AND PERCENT OF PERSONS 65 AND OVER IN COOK, LAKE, AND DUPAQI COUNTII ., I960 1965, INCLUDING PERCENT CHANGE County Total three counties. Cook__. Lake DuPage — I960' Peicent total Number population 1965' Percent total Number population Percent 492,444 8.6 546, 000 8. 9 + 10.6 455,499 8.9 502, 000 9. 3 22, 000 5. 5 22, 000 6. 4 -1 10.2 18,231 5.8 +20. 7 18,714 6.4 +17.6 i U.S. Bureau of the Census, 1960 Census of Population, V. I. Characteristics of the Population, part 15, Illinois, a U S Bureau of the Census, "Estimates of the Population of Counties, July 1, 1366" Cunent Population Reports, Series P-25, No. 407, Oct. 10, 1968. Note: Estimated Population Aged 65 Years and Ove. by County, Illinois: July 1, 1965, Illinois Department of Public Health, D. T. Bogue and D. P. Dandekar, Population Tiends and Prospects for the Chicago-Noithwestetn Indiana Con- solidated Metropolitan Area: 1960-90, Population Research and Training Center, University of Chicago, March 1S62. Chapter III. — Scope and Method : Service and Research Aspects The Information Center for the Aging project was set up with service to the client as its primary goal. The research goal was secondary and the original proposal allowed only 25% of a Research Associate's time. At the recommenda- tion of the Technical Advisory Committee, the Research Associate's time was raised to 40% for the second year and 50% for the third year of the project. During the second year, one clerk-typist salary was used to employ a Junior Statistical Clerk. ICA's purpose is to provide information on and referral to community re- sources, for the most expedient handling of social problems. The task is divided into four parts : information and direction, referral, short-term counseling, and consultation with referral sources and resource agencies. Requests are received from individuals, social agencies, business firms, labor unions, civic organiza- tions, churches, other professionals, hospitals, and business men. These requests — thousands each year — provide an accurate test of felt needs and trends. To the extent that the needs are not effectively met, the inquiries offer information about service gaps. They also give important information about the response of the network of service agencies. ICA is primarily a telephone operation. Although clients do come into the Center and do make requests by letter, telephone contacts have constantly out- numbered office or mail contacts. The hub of the Center has been, therefore, the Center's switchboard. The switchboard operator is consequently very im- portant to the Center. It is vital that this position be filled by a person with intelligence and warmth, and the ability to screen cases so they are appropriately referred to nursing consultants or caseworkers. An added responsibility besets the switchboard operator when on an extremely busy day, the professional staff is not immediately available to the client. In this situation, the responsibility of the operator is broadened either to "holding the client on the line" until the worker is available, or to be sufficiently reassuring in promising that the worker will call the client as soon as she is free to do so. ICA has been extremely fortunate in its final year of operation to have a person of "case aid" potential agreeable to performing the very complex job of "switchboard intake" although the job is understated and underpaid in the Information Center for the Aging project. This, perhaps, seems to belabor a minor point, the ICA experience and other information and referral experience as well proves that a whole cadre of professionals in the background cannot compensate for a technically competent but insensitive person at the switchboard position. Consideration should cer- tainly be given to raising this position to a "case aid" level in ICA and anyone contemplating setting up a professional telephone referral service should ponder this point seriously. The staff consists of the director, the assistant director, two full-time and one part-time caseworkers, and two-full-time nurses, the project secretary, the senior and junior statistical clerks, the switchboard operator, and a volunteer. 456 To handle the inquiries that come into the Center daily, a schedule is set up and strictly adhered to. One nurse and one caseworker are scheduled as "nurse 1" and "caseworker 1" to receive calls. The alternate worker and nurse are scheduled to take overflow calls and to interview clients who come to the Cen- ter. The weekly schedule is attached to the switchboard so that there is no question as to whom calls are to be directed. During their time as "1" on the line, the worker and nurse make no out-going calls. They receive incoming calls knowing that later they will have time to make necessary calls to agencies, do recordings, etc. The only exception results when a crisis case comes in and immediate action is necessary. Then the "1" w r orker notifies the switchboard operator, who immediately gives her an out- going line and notifies the alternate that she now has the "lead" position until the crisis situation is resolved. The two days that part-time casework staff and the three days that part-ime nursing saff are with the Center give full-time staff opportunity to make agency and client calls and to do their recording. This system by no means guarantees appropriate time to staff for all their duties. It is, however, the best method ICA has arrived at to achieve some controls on tremendous pressures. The system has worked for ICA mainly because of the spirit de corps among staff. There is a strong sense of project loyalty and a sincere desire to give the best service possible. This spirit involves inter-disciplines, as well. There are well defined areas that can be equally well handled by caseworker or nurse. If either discipline is heavily barraged, the other immediately takes over in these specific areas. Because of the versatility demanded of the workers receiving calls, an attempt was made to broaden the "broker versus advocate" roles to include the broad spectrum of requests coming in. This greatly aided the learning process for new staff, whose different roles included these : 1. Resource Broker — This is, if course, a crucial role in an information center. For example, Mrs. R., aged 66, called requesting information about where she could get a hearing aid. She lives on her Social Security pension, owns her own home, is not eligible for, nor was she asking for, public assistance. Her limited income and savings did not, however, allow for purchase of this type. She had been examined by her physician and had his written evaluations and recom- mendations regarding the hearing aid. She was referred to the Chicago Hearing Society. 2. Advocate Role — Very often clients have made application to an agency and as far as the client and the Center are concerned, that agency seems appropriate, but service has not been granted. Staff then feel they must reach out in the client's behalf and play an advocate role. They clarify with the agency the reason why the client was rejected and are usually successful in reinstating his application. There are other times when the client is already an active case with an agency but he is an uncovered case load, and although he has tried to get satisfaction from the agency, he has been unsuccessful. The former situation occurs in both public and private agencies where restrictive intake policies at times seem to be used to negate the client's eligibility for help. The latter situation happens most often with public aid offices because of their critical manpower shortages. In many instances, the aging client is not able physically to follow through with the resource information given him. At other times, he is operating without the income or educational background essential to complete all the necessary forms, to secure supporting documents, etc. These demands at times create insurmount- able obstacles and an advocate, again, is almost essential. In some situations the Center provides this service. At other times it asks someone else to help. The "someone else" may be a community representative from an Urban Progress Center, a relative, friend, clergyman, or neighbor. 3. Buffer-role — An information service has been viewed as constituting an in- termediate stage in the client's decisionmaking process, that of providing a buffer service. Clients tend to seek help or advice from a whole hierarchy of con- sultants, starting with their own families and friends and running the gamut to the professional referral system. When consideration is narrowed to an information service for the aged, the notion of a buffer organization takes on more significance. Older persons need to rehearse their cases before an audience. A number of them are denied this op- portunity because they are living alone and their family is not close by. Talking with one of the Center's staff offers the older person an opportunity to test out his speech on a professional, knowing full well that he is not yet ready to take direct action. 457 i. Agency's Agency There are well-informed people In the health and welfare fields dealing with aged people who use the Center for consultation about re- sources in the metropolitan area. They may be volunteers, attorneys qui ministers, physicians, social workers. Probably the majority of these calls :ir« inquiries about resources available In the areas of nursing homes and home he.i II h i\-i re. ."». Holding Company There are limes when (he Center is used to support the client through another agency's waiting list. This happens most often in referrals to family agencies and mental health facilities, after the Center worker has made the referral to the agency or mental health center and the case has been accepted. There may, however, he a waiting period the worker believes the client could Sustain. This demands a supportive relationship, usually allowing the client to call the worker during this period or in some situations offering weekly in -office appointments. This service varies in length: while the average time period is from two weeks to a month, some clients have been on waiting lists for as long as four months. The interview in an information and referral center is a highly focused one. Referrals take many forms, depending on the motivation of the client, the urgency of the problem, and the ability of the existing agencies to cope with it. The process fonges from the simple, that of suggesting a specific agency, to the complex, that of 'standing with" the client until the direct serv.ee agency has entered. The entire procedure, which includes accurate diagnosis of the problem and the frequently difficult process of linking the client to the network, often is viewed simplistic-ally, hut it can be highly complex. If done badly, it is damaging to the client and the care-giving system, and it is expensive as well. It is essential, therefore, that the nucleus staff of an information and referral system be professionally oriented, thereby knowing how to learn enough about the individual to identify needs and to make appropriate referrals. For instance, when someone contacts an information and referral center asking for some good nursing homes, the staff must begin by finding out the needs and ca- pacities of the person to be placed, his medical problems and limitations, his age, his capacity to pay for care, bis preferences, etc. This exploration may reveal many other important facts. He may need supplementary financial assistance to meet the cost of nursing home care, or perhaps he needs only sheltered care, or in some instances, too rare to be sure, he might be able to remain in his own home if various services are available to him there. A frequently heard comment is that an information and referral service can only be as good as the available resources. In part this is true ; however, adding the dimension of a professional staff means that even in the absence of an appro- priate resource, through supportive casework, a reaching out and standing with, sometime re-focusing, real help is given the aging client. There is no substitute for genuine concern, or for the mastery of interviewing and the supportive techniques which come with professional training. Clients often tell the Center that they feel better just talking with someone, or that they have been helped by being given a focus, a place to start. This core professional staff is imperative also in creating a climate in which the para-professional staff, the trainees, and the volunteers can learn and grow in the helping situation. The Center should always allow for an on-going educa- tion process. Without the help of a professional in the Center, the para-professional trainees, and volunteers can also teach the professional about the community, the clients, etc. Sessions of mutual learning and sharing between the professional and para-professional staff are exciting and beneficial to the staff and to the com- munity as well. ICA receives many inquiries about "clearing of cases." It is true that an in- formation and referral service does not have the advantage of clearing cases through files before talking with the inquirer. The number of calls coming into the Center varies from twenty to fifty calls a day. The calls are immediately dis- patched to the worker. Contrary to the intake procedure in most agencies where the case is "cleared" before assignment to the worker, in the Center the clearing is done "after the fact." At the end of the day the worker leaves sufficient identify- ing information on all incoming cases on the junior statistical clerk's desk. The first duty of the junior statistical clerk each day is to clear cases through files. Clearance consists primarily of checking the name of the client through cases previously completed and interfiled alphabetically in the bank of file drawers. In most cases of recurrent or reopened cases, of course, the inquirer asks for a particular worker, but there are times when this is not done and it is not until the following day that the worker is aware that there has been a previous con- tact There are other instances when two initiators may call about an elderly 458 client and if these calls go to two different workers, again it is not until later that this is recognized. The concensus of opinion among ICA staff is that although it is true that it would be convenient to have prior clearance, this would so impede the immediacy of service that it would negate the Center's effectiveness. Inquiries to other information and referral services in the country have revealed that they, too, have not avoided this inconvenience ; that they agree that the immediate avail- ability of the professional to the client greatly outweighs the negative aspects. RESEARCH ASPECTS Referral of clients from one agency to another is a function shared by many health, mental health, and welfare professionals and para-professionals. Be- cause of its importance and the time allotted to it, one might expect to find much research devoted to referral techniques, but these remain relatively unexplored areas of social casework. ICA, research, and service staff, therefore, were faced with attempting to set up goals that would produce the results demanded in the original proposal. The first goal that has been achieved in the Information Center for the Aging is the establishment of a systemized procedure for routine collection, tabulation, and reporting of case and client characteristics (Service Statistics). The second goal, the documentation of unmet needs and deficiencies in service primarily through a routine method of following up all referred and selected di- rected cases — was successfully operationalized ; however, there are certain limitations to this method (to be expanded in Chapter on Follow-up) and docu- mentation of unmet needs still relies heavily on the worker's subjective opinion. The delineation of the perceived role of the worker in the Center was broadened by ICA staff as a teaching tool for new staff members. Documentation of the perceiving role of the workers and its relationship to client's needs and com- munity resources became a third Research Goal during the second year of the project. The results of this attempt remain vague and inconclusive partly because of the worker's difficulty in recording roles in their first year. It is interesting to note that although there was never any hesitancy upon the part of workers to become the client's "advocate" there was hesitancy in recording the advocate role in the beginning. These cases were often erroneously recorded in the "broker- age" or "buffer" columns. It is also interesting that after a year's experience in attempting to match needs to inadequate resources, the workers frustrations became apparent in recording. Not only were they now willing to record the "advocate" role but they began to muddy the Resource Evaluation. Undoubtedly, the Resource Evaluation might much more properly have been called Evaluation of the Referral, as that is exactly what it is. However, because of ICA's de- limitation of "referred" as meaning a formal agreement between ICA and the care-giving agency and "directed" as meaning a suggestion of a resource to a client or initiator, it was decided to use "Resource Evaluation" to indicate that all directed and referred cases were to be evaluated. By May, 1969, the workers were using this column to evaluate the agency's action, not their own referral. To correct this error the code sheets were revised (see below) to allow them some vent to their disenchantment with the system and at the same time to keep the Resource Evaluation intact as designated. RESOURCE EVALUATION 381 ( ) Adequate. 2( ) Qualified adequate. 3( ) Not adequate. 4 ( ) None available. 5( ) Not applicable. IF YOU HAVE ANY DOUBTS ABOUT THE ABILITY OF THE AGENCY referred or directed to in this case to provide the service (s) needed — even if the Resource Evalua- tion is "Adequate" please indicate below : June 1969. In this case, was it necessary for ICA to impose upon an agency not ordinarily responsible for providing the service needed but which agreed to assist to solving the immediate need? Yes No 459 Recording from June, L969 to February, L970 Buds worker error ;ii a minimum and If there is merit to this goal, it should be reevaluated od the basis of this period. The fourth goal of the Center was the establishment of a Central Repository of Information, or resource ale, on community resources for the Aging. This repository lias been compiled on a functional level in ail areas of service, it has been formalized in the areas of nursing homes and homes for the aged. The immediate demand for service imposed on the Center from its iirst day of Operation impeded stall" from collecting data from agencies on an in person basis except in the nursing home area. A complete listing of agencies, or institutions, providing services to the aging hy the appropriate field of service has been compiled. The Social Service Direc- tory has remained the primary source of basic information. Bach worker is responsible for assigned fields of service. This entails up- dating information for the auxiliary tile, a rolodox visible index file, maintained on each worker's desk and in the master tile. The running record resource file (Exhibit 1) was developed to accommodate recording information and circula- tion to all staff. This form provides for recording change in personnel, change of address, addition or deletion of particular services, the opening of a new service or addition to an existing one, etc., as well as opinions and comments from applicants or others about a service. In addition to the material in this report devoted to the research component, suggestions for the continuing improvement of data collection and application, follow-up procedures, etc., are included in a staff report — "Research Recom- mendations" — available upon request. METHOD Service statistics (goal 1 ) For purposes of analysis and presentation, the service statistics are divided into two major classifications, case characteristics and client characteristics. Case characteristics refer to items such as need, initiator, source of referral, disposition of case, intake procedure, urgency, agency role, or those other features which generally describe the dimensions of the "case." Client characteristics refer to the age, sex, marital status, living arrangement, place of residence, income, and possibly religion, race, nationality of the individual served, i.e., the "subject" of the case. For a complete listing of these items, see Figure 1, Figure 2 and Figure 3. Service statistics are recorded on the 5x8 client service or non-client service control card 1 — Exhibits 2 and 3. Not only are the appropriate case items, as listed under the stages of operation providing direct service to the applicant (Intake, Exploration, Resolution— Figure 1) entered on the control card, but also the results of Follow-Up in those cases where his procedure is initiated. The client and non-client control cards are different in format because less information is needed for the latter, e.g., no client characteristics. Important revisions on the client service control card in May, 1968 were the provisions for recording urgency of case (crisis, non-crisis), and agency active. For purposes of easily distinguishing the two different kinds of services, the control cards were also color coded, white and yellow for client, salmon for non- clients. Most case and client information collected on the control cards has been summarized by month as well as year to date from July 1, 1967. Client charac- teristics were recorded by month and year from July 1965 through June 1969. See monthly Report of Service Statistics (Appendix C) . 1 Non-client refers to cases which do not immediately relate to a direct presenting problem (or need) for a particular aging client. Rather, most non-client requests are for information about resources for use by professionals and students outside of any direct application to an individual client, or information or consultation by administrators or pro- fessionals for planning or evaluating community resources for the aging. 71-272— 72— pt. 1- -30 460 s> S3 Is JJ 461 SERVICF: REQUESTS TO ini >N CENTER FOR 'nil-: AGING BY COMMUNITY ARRA OF RESIDENCE IN CHICAGO* ►Based on requests for service for 2, 352 clients whose address was s | g - s it known for the periods January • June, 1968; October. 1968 • March, §§ s; 1969. WCMC 2/70 462 Fif»re 3 SERVICE REQUESTS TO INFORMATION CENTE! FOR THE AGING BY SUBURBAN AREA OF RESIDENCE IN THE CHICAGO AREA* EACH DOT* EQUALS TWO REQUESTS • Based on requests for service for 545 clients whose address was known for the periods January - June, 1968; October, 1968 - March, 1969. 463 in June of L968, the ('ode Sheet closed Case (Exhibit h was Introduced to facilitate the tabulation of data collected on the control card. Largely the result o( a preceding of items as they might appear on the control card. In addition, the codification of these items on the Code Sheet, much as they are listed in Figure 1 was instituted to allow the immediate adaptation of the unit record [control card) to electronic data processing' During the last half of L968, the service statistics were processed by a computer. in addition to the information yielded by the Monthly Report of Service statistics 111 rough hand tabulation, percents by totals, etc., were Included as par of the computer program. The professional expertise available through the data-processing service en- gaged was less than sufficient to achieve maximally effective computerization of the service statistics. This limitation in addition to customary adjustments which arc to he expected with the introduction of the computer system created excessive delays in reporting of Monthly Service Statistics. The senior and junior statistical clerks and a Center volunteer spent days correcting the statistics and bringing them up-to-date. Despite these problems, had the Center purchased computer service from a more satisfactory source, it is the consensus of staff that the service statistics could be successfully computerized and thereby reproduced. On the one hand, the introduction of the Code Sheet seems to have sharpened the workers' awareness of the items to be recorded for tabulation. This is illus- trated by the fact that in March of 1968, prior to the introduction of the Code Sheer, the percent of cases in which more than one need was mentioned, or recorded, according to the Monthly Report of Service Statistics, was 11.7 percent. With the introduction of the Code Sheet in June 1968, tbe proportion of cases with multiple needs rose to 27.2 percent. Project experience indicates that, initially at least, this increase is more likely to be the result of reinforcing the necessity to record secondary needs via the Code Sheet than it is of any immediate increase in the actual number of cases presenting multiple needs. The introduction of the Code Sheet transferred the duty of coding service statistics from the statistical clerk (heavily burdened by the research demands) to the workers. Workers' errors, mainly those of transcription and omission, did occur. However, with time the workers achieved greater accuracy and error has been reduced. Chapter IV. — Unmet Needs : A Non-Quantitative Approach It has now been more than three years since ICA was set up to work ex- clusively with aging clients. The staff have examined the individual needs of the persons served, and have attempted a kind of qualitative appraisal of these needs, and the services available to meet them. These perceptions are essentially sub- jective and do not necessarily have statistical validity. The staff has been constantly aware of the lack of comprehensive services for the aging in the metropolitan area. Parochialism prevails — the aged client goes to one agency for financial assistance, another for medical services, another for case- work counseling, etc. Although the worker in ICA may be assessing the client's needs in toto, when referring him into the service network, she may have to partialize and refer or direct to several agencies and even then may have ques- tions as to how well the total needs may be met. This experience in ICA has con- vinced staff that the traditional patterns for delivering service are not sufficiently comprehensive to cope with the muli-problem situations so often presented by the aged clients and their families. ICA staff is aware of the heavy demands upon the agencies and they are in- deed cause for concern ; however, the staff believes that an information and refer- ral system emphasis must be placed on how well the existing agencies are meeting a community's human needs rather than totally responding to the needs of agen- cies and institutions. It is in that spirit that this chapter is presented ; not to heap further invective on a system that is already laden with criticism. Financial Assistance. — The December 1969 statistics revealed that a cumula- tive count from July 1967 through June 1969 sbowed that 2,458 cases coming into the center were already active with an agency, and that about 88 percent of these cases were active with a public assistance agency. For the most part, these initia- tors were requesting advocacy rather than information about resources. 464 It has been mentioned earlier in this report that the staff believes that the lacl of adequate income for the aged seems to be the cause of many other problems The income deprivation of the aged clients, while statistically significant, ap pears even more appalling in reality. The following are case examples of th< delays in delivery of services : *C4 — ID 11767. — An aged couple called ICA because they had been cut off pub lie assistance and could not understand why. Exploration revealed that this 7^ year old man and 68 year old woman were receiving Social Security totaling $105.00 monthly. They had no other income or equity. The ICA worker requestec the agency review the budget and after eight weeks and many contacts with th< agency, the couple again began receiving OAA supplementations. ICA-ID-114158. — An 84 year old man was referred to ICA by a Society Secu rity office. He had been placed in a nursing home through the public assistant agency after hospitalization for broken ribs. He refused to remain in the nursing home or to be transferred to another. He did apply for supplementary Old Ag< Assistance to his Social Security of $79.00. He had found himself adequate nous ing but needed supplementation badly. ICA exploration revealed that he had beei refused supplementation because the agency instead he had received a lumj sum from Social Security. After ICA got written evidence that no lump sun had even been granted by Social Security and after the ICA worker had con tacted the agency five times and six weeks had passed, supplementation wai finally granted. ICA-ID 212608.— Miss K. first called ICA in April, 1968. Her 81 year old mothei was confused, unable to stay at home alone without danger to self or others. Sh( would turn on the gas, and the neighbors were becoming alarmed: constan; worry about, concern for and care of the mother were jeopardizing Miss K's job Miss K., an epileptic, had always supported herself and her mother. At the tim( of her first contact with ICA she was fearful that her own job was in jeopardy Miss K. had made application for nursing home placement for her mother at s district public aid office in September 1967. At that time, all necessary medicl forms were completed by the attending physician, but the agency advised that tin forms were lost. The forms were again completed by the physician, and at th« time of ICA contact, placement had still not been made. A total of 16 telephoJ conversations with Miss K., one with her employer, eight with an agency super visor, and a letter to that agency culminated in placement of Mrs. K. in a 'nursing home on July 25, 1968. ICA-ID 115650. — Mrs. G., seventy-two year old widow of a surgeon, requested ICA's assistance. She had made application to a district office of public assistance on September 2, 1969 for Medical Aid No Grant. The ICA worker called the agency and was told that a caseworker from that agency would call on Mrs. G, at her home in the immediate future. On November 10, 1969, Mrs. G. again called ICA to report that no one from the agency had visited her. She had called the district office on November 3rd and had talked with a caseworker who assured her that someone would be out to visit her. The ICA worker called the agency and was advised by a supervisor that the worker was ill but that someone from the agency would be in touch with Mrs. G. on November 12, 1969. On November 13, 1969, Mrs. G. again called ICA to tell the worker that she had not heard from the agency worker. At this time ICA contacted the Special Referral Services of the public agencj and requested that office assist ICA in getting the district office to establish or deny Mrs. G.'s eligibility for MANG. ICA later received a call back from the Spe- cial Referral Services worker informing there was no record at the district office of Mrs. G.'s application. ICA insisted an application had been made and supplied the name of the agency worker who took the application. Later another call came informing ICA that the record had been found and that "service was denied" because Mrs. G. received free medical care from colleagues of her deceased hus- band. No home visit had ever been scheduled. The agency was vague as to why tbe client had not been so informed. ICA's information revealed that Mrs. G. had had some free medical care from Dr. G.'s friends. However, her drug costs averaged $10.00 weekly and she had to borrow money to purchase these prescriptions. Her Social Security was $12^00 monthly and her rent $75.00. All savings were diminished. She did own a 1959 automobile that she drove for grocery shopping. She had a chronic heart problem and had recently undergone a mastectomy. Oh the basis of this information. ICA insisted Mrs. G.'s application be reactivated on the basis of her drug costs. Mrs. G. again went to the district office and reapplied. In late November, Mrs. G. called ICA again. No one had visited her and she had had to borrow monev to 465 buy medicine. [CA again contacted the agency and was Informed thai a borne visit would not be made until the application cleared the agency's master flies and that this would probably lake another week. The client was Informed about the delay, [n early December, Mrs. G. again called ICA. Neither she nor the ICA worker could reach the agency by telephone. She agreed to go i<> the agency again. She was informed there that her caseworker bad been drafted for jury duly so that the home visit would not be made for several weeks. Mrs. <;. could no Longer borrow money so she was going without her medication ! At this point a letter was written to the director of the agency asking his assistance in getting Mrs. G. help. In late January 1070 Mrs. G.'s application was approved! The ICA staff experience in helping the aged client to get adequate financial assistance convinces them that the present system has grown into a bungling giant, extremely impersonal, impossible to administer efficiently, and for these reasons often brutalizing the very people it is trying to help. The ICA staff be- lieves that it should not be perpetuated, but instead an adequate guaranteed an- nual income for the aged should go into effect. Adequate cannot be overly st ressed, for if the income is not adequate the situation could be worse instead of better. Careful scrutiny should be exercised to ascertain what problems will still exist for the aging and what services the community must ready itself to offer. Casework Counseling. — In the ICA Interim Report it was stated that in some of the agencies, patterns of avoidance toward the aging client can and have grown into unwritten intake policies, with the result that only minimum service is offered the aging client. In the early days of ICA, the referral worker was often the victim of a "put down" by her professional peer in a family service intake. The referral worker was not only from a "short term" agency/but was also asking for on-going service for an aging client — this seemed to constitute double jeopardy. There has certainly been an improvement in at least the dialogue between the two professionals at the referral point. This improvement did not occur spontaneously, but rather through documented case evidence discussed with the agency involved. The situation has improved but there is room for much more improvement. There still persists in the family agencies the attitude that 'tis nobler to work with the emotional problems of a thirty- year-old than it is to give supportive casework help to the aging client! The following example illustrates how the client gets lost in the process : ICA-ID 112067.— A friend, Miss B., came to the Information Center for the Aging requesting protective services for Mrs. G. who was living in a hotel. Mrs. G. is in her seventies according to Miss B. and she has Parkinson's disease and osteoporosis. She had savings according to the friend, and gets a veteran's pension — Miss B. did not know the amount of either. The friend was leaving the city and was concerned that Mrs. G. could not manage after her departure. The client had been dependent on the friend since her husband's death two years ago. Miss B. described the woman as deteriorating mentally and physi- cally ; she had to be escorted to restaurants in the neighborhood. The friend also told us that Mrs. G. was known to the medical social service department at a hospital and to the Episcopal minister and his lay assistant at her parish. The friend was delaying her own admission to a home for the aged in an attempt to work out a protective plan for Mrs. G. The ICA caseworker agreed to explore the situation further with the medical social service department at the hospital and with the client's minister. The friend agreed to cooperate in any way indicated. The ICA caseworker talked with the medical social worker at the hospital concerned, and was advised the client was no longer active there. The medical social worker verified that the client, was deteriorating mentally ; she said they had to bar her from using the hospital cafeteria because of bizarre behavior : that upon discharge from the hospital, referral was made to a family agency as the attending physician was hopeful that a supportive casework relationship would enable the client to sustain in the community. The case was rejected by the family agency at the time of discharge because "there was no one to bridge the agency in." The ICA worker also called the client's minister who concurred that the client should have protective casework services, that from both emotional and physiolo- gical standpoint she was deteriorating: she had exhibited bizarre frequently when attending any social functions. The ICA caseworker then referred the case back to the family agency for nrotective casework services. She shared with the intake worker the concern expressed by the medical social worker and the minister. She arranged for the 466 friend who had contacted ICA to "bridge" the family agency worker in. The friend agreed to call the agency to make arrangements for a home visit. In August 1968, ICA sent a follow up request to the family agency. The follow- ing response was received from the agency : • A Miss B., a friend of Mrs. G.'s at the hotel, contacted this agency and re- quested assistance for Mrs. G. because she would be permanently leaving the hotel and felt Mrs. G. would have no one to depend upon for companionship and physical assistance. In an interview with Miss B. and Mrs. G. at the hotel on June 27, 1968, our services were "explained and offered to Mrs. G. She showed reluctance to accept our services at this interview and has not been heard from since." TCA's impression was that the referral on this case was a very well formulated one. The request was for protective casework services. ICA supplied the "bridge" requested when the agency had rejected to "bridge" them in. ICA was aware that the patient would not reach out for help, and asked for the agency to reach out to the client It seems that the home visit consisted of explaining agency services. This client was beyond involving herself in any passive approach used by the caseworker that visited ; the ICA worker and other collateral had pointed this out. The follOw-up ignored the hospital's earlier referral, and seem- ingly ICA's exploration. Nursing Homes. — ICA staff are often asked if there is an unusual information gap about community resources. The answer usually is that there is not so great an information gap but there is a service gap ! There is one exception and that is in nursing homes. The community is dependent upon ICA for information about nursing homes. It is the only centralized agency that visits all of the licensed nursing homes in the three-county area and maintains a repository of information about these homes for the purpose of directing those in need to them. The ICA nursing consultants assist people who are looking for nursing homes, to find the ones most likely to meet the needs of the particular patient involved. The ICA staff visit these homes only with the approval of the nursing home management. ICA has been refused admittance to only three homes in the metro- politan area. The nursing consultant visiting the home discusses with the nursing home administrator her opinion of the home, gives him her recommendations regarding upgrading services and if it is a home that ICA does not direct patients to, the administrator is so informed. He is also reassured that confidentiality between ICA and the nursing home will be maintained. If the nursing home upgrades its services, the staff will gladly revisit and re-evaluate. The ICA files on nursing homes are not therefore, public domain. ICA has been criticized for this stance by some community agencies who have requested that they be allowed to review ICA's nursing home files. On the other hand. ICA's greatest praise has come from agencies who use ICA for consultation on place- ment of individual patients in nursing homes. At any rate, a high percentage of requests for information about nursing homes continues to come into the Center. The staff is especially concerned about the requests for homes that will accept the basic care cases from public aid. The proprietary nursing home cannot pos- sibly deliver the quality services for the rates being paid for these services. The ICA has recommended an appropriate increase in the allocation of the health and welfare budget for payment of adequate nursing home care, to be accom- panied by a concurrent increase in standard-setting control of the services pro- vided by the homes in exchange for their increases in funds. There continues to be great need for educational programs to orient nursing home staffs in working with the aged ill. The present situation is that no matter what the standards of the homes, their beds are at a premium. The staff of ICA was pleased to have with them temporarily, Jordan I. Kos- berg. Doctoral Student in the School of Social Service Administration, Univer- sity of Chicago. Mr. Kosberg is studying the differences in nursing homes and the level of services offered for his dissertation, which is entitled The Relation- ship of Organizational Characteristics to Orientations of Nursing Homes. In this study, individual nursing homes will not be identifiable, but rather a profile of existing services will be portrayed. The staff believes this will be a great con- tribution to the community when completed. People calling ICA for information on housing or home health care might state that they did not really get much help. The staff would readily agree. Housing for the aging is most difficult to find. The Chicago Housing Authority's waiting list for Senior Citizen Housing is phenomenal. There would seem to be little improvement in low income housing forthcoming in the immediate future. There 467 are very few private developments in (he area. Retirement hotels Eire tew, and again in both low cost and higher cost facilities there are waiting lists. Home Health Care is practically non existent in the area. II is true that for those Who Can afford it, registered nurses, licensed practical nurses, honieina L«-r companions and sitters can sometimes he secured through the coinnierical regis- tries. For clients una hie to afford these services it is indeed rare that ICA is successful in obtaining them through the social agencies that do provide them. The demand for this type of help far exceeds the supply. Financial Assistance, Casework Counseling, Nursing Homes, Housing and Home Health Care are the areas that need the immediate attention of com- munity planners. Surely knowledge of deficiencies in services, waiting lists, Is a ha sis for developing additional services or re-allocating existing ones ! After more than three years of experience in an information and referral service, the professional staff presents the following recommendations for its future to its Technical Advisory Committee and to its sponsoring agency, the m el fa re Council of Metropolitan Chicago : 1. That the Core staff always remain a well-trained professional staff. If ex- pansion becomes feasible, the use of the para-professional and volunteers, prop- erly selected, trained and supervised should be considered. 2. That follow-up service be continued, extended whenever possible, as a means of measuring the effectiveness of the Center as well as of the delivery of services in the area. 3. That the Center should report periodically its experiences, documenting facts, opinions, criticisms and recommendations and that this report be made available to the agencies. 4. That the Center remain an aggressive advocate for its clients ! The staff would like to reiterate that what has been developed in the Center is but a beginning. Chaptee V. — Statistical Analysis of Case and Client Characteristics SUMMARIES OF FINDINGS AND IMPLICATIONS In a two year period 12,652 cases were served through the Information Center for the aging at the Welfare Council of Metropolitan Chicago. Of these clients served there were certain specific characteristics identified. The clients for whom or by whom services were requested were predominantly between the ages of 70 and 89, as 60.3 percent were in that age bracket, while an- other 20 percent were between 60 and 60, and almost four percent were 90 or over. Twenty-seven (27) percent of the clients were male; 62.5 percent w r ere female, and there were an additional 599 (or 9 percent) couples (counted as one case even though both man and wife) were served. A large percentage (31.8) of the clients were living alone, 17.6 percent with their spouses, 26.7 percent with family or relatives, and 12.7 percent were in nursing homes or other residences. Over 50 percent of the clients' income was from Social Security benefits and savings. These data on income reveal that these clients were living on Social Security and public assistance, (old age assistance) or a combination of both in 49.3 percent of the cases. Need for financial assistance was either the primary or supplementary request in 48.2 percent of the cases. The data on intake revealed that of the 12,852 cases, 89 percent of the requests came by telephone and 49.5 of them came from relatives of the clients. In a special analysis of 2,250 requests for nursing homes, only one ( 1 ) percent of the requests came from the clients. This may be indicative of the reality that the clients were unable to provide for themselves at the time of the requests. Thirty percent of the referrals to the Center came from other public or private agencies. The primary service requested in 47.4 cases was for nursing homes or in- stitutional housing. Another 10 percent requested financial assistance, 8.7 per- cent requested counseling, and 5.7 percent requested homemaker-companions. Over the two year period studied there was a decided change in the requests for housing and counseling. The first year there were twice as many requests for institutional housing as for casework counseling, but in the second year the proportion was reversed. The secondary requests were most frequently for financial assistance. Cases studied from July 1968-June 1969 revealed that 17 percent were clas- sified as "crisis" cases, while 68.7 were determined to be non-crisis and in 14 percent of the cases the urgency level was not determined. 468 Of all the requests received 3.5 percent were classified as "nonclient", how- ever, these calls were received from other professionals and in 41 percent of their calls, they were related to or on behalf of an individual while 58.6 percent of their calls related to community needs and services. Follow-up was studied in terms of those cases who were "referred" (see Ex- hibits number 5, 6, 7 and 8) and those who were ''directed". In 58 percent of the referred cases services were received ; in 31.8 percent of the cases the services requested were not received from the agency to which the client was referred, and in 10 percent of the cases the outcome was unknown. Only 50 percent of the cases received protective services while 67.9 percent of the cases received case- work counseling, and 78.9 percent of those requesting outpatient medical care received it. IMPLICATIONS These data provide specific client information to assist in future planning. There exists a specific need for more information on Nursing Homes, Medicare and public assistance benefits for clients and their families. Certain unavailable services such as homemaker-companion should be studied and recommendations made for program planning and implementation. Trends in requests and services were reflected when there was a casework emphasis and more information on nursing homes and institutions were avail- able to the public. The primary or presenting problem of a client or his family may only be the most critical issue at the moment, with many other problems which might be primary depending on one's orientation, being discovered as one enters the case. These data in conjunction with the Interim Report of the Center, dated May, 1969, a study of nursing homes and the eventual data being derived from the Protective Services for the Aging should provide knowledge upon which to base program planning and implementation. STATISTICAL ANALYSIS OF CASE AND CLIENT CHARACTERISTICS Data collected during the two years described in this report will be divided into two major headings as defined for the collection of case and client statistics. A statistical analysis of the cases served, 12,652 between July 1967 and June 1969, and client characteristics, 6,411 clients between July 1968 and June 1969 will be provided. CASES SERVED Over 12,000 or 12,652 cases were closed by the end of June, 1969, based on the Monthly Report of Service Statistics (see Table 2). Subsequent to June, 1969, an estimated 17,600 to 18,000 cases will have been closed by the end of the initial project grant (February 1970). TABLE 2.- -TOTAL CASES SERVED BY INFORMATION CENTER FOR THE AGING, JULY 1967-JUNE 1969 Status of case Number Percent Total (unduplicated) 12,652 New clients 11,307 Recurrent of reopened 1,345 100.0 89.4 10.6 CHARACTERISTICS OF CLIENTS SERVED Data gathered throughout this project were divided into two major classifica- tions; case characteristics and client characteristics. Case characteristics in- cluded need, initiator, source of referral, disposition of case, intake procedure, urgency, agency role, or those other features which generally describe the di- mensions of the "case." Client characteristics referred to the age, sex, marital status, living arrangement, income, religion, race, nationality of the individual served, i.e., the "subject" of the case. SEX AND AGE OF CLIENTS The proportion of female to male clients served was approximately two and one-third to one, as indicated in Table 3. This table also allows that close to ten percent of the cases closed concerned couples. 469 TABLE 3.-SEX OF CLIENTS BY NUMBER AND PERCENT: CASES CLOSED, JULY 1968 JUNE 1969 Sex Number Percent Total clients 6,411 100.0 Male . \,IM Z7.2 Female . 4,000 62.5 Couple i 599 9.3 65 1.0 Each couple (.man and wife) which applied for service was counted as 1 case. TABLE 4.— AGE OF CLIENTS IN 10-YEAR INTERVALS BY NUMBER AND PERCENT: CASES CLOSED, JULY 1968-JUNE 1969. Age Number Percent Total.. 60 to 69 70 to 79 80 to 89 90 and over.. Unknown Not applicable 6,411 100.0 1,561 24.3 2, 136 33.3 1,731 27.0 250 3.9 729 11.4 4 .1 MARITAL STATUS Over half of the clients were widowed, an additional one-fifth were married, and approximately one-tenth were single. Comparatively few (or only 209) were divorced or separated. ( See Table 5) TABLE 5.— MARITAL STATUS OF CLIENTS BY NUMBER AND PERCENT: CASES CLOSED, JULY 1968-JUNE 1969 Marital status Number Percent Total clients 6,411 100.0 Single 610 9 5 Married 1,329 20.7 Widowed. 3,381 52.7 Divorced 114 1.8 Separated 95 1.5 Unknown 882 13.8 LIVING ARRANGEMENT More clients lived alone (almost one-third) than with spouse, or with family, as shown in Table 6. A relatively small proportion of the clients lived with another relative than someone in the conjugal family or a friend. Nine percent of the clients were in nursing homes at the time service was requested and almost four percent were in other living arrangements such as homes for the aged, sheltered care facilities, or retirement homes. TABLE 6.— LIVING ARRANGEMENT OF CLIENTS BY NUMBER AND PERCENT: CASES CLOSED, JULY 1968-JUNE 1969 Living arrangement Number Percent Total clients Alone. Spouse Family (conjugal).. Other relative Friend Nursing home Other residences.. Unknown 6,411 100.0 2,035 31.8 1,131 17.6 1,463 22.8 251 3.9 176 2.7 575 9.0 235 3.7 545 8.5 470 SOURCES OF INCOME All sources of income, current and potential, mentioned by a client were re- corded. Clients' income from a pension and savings if reported, were recorded by the worker. TABLE 7.— SOURCES CLIENT INCOME BY PERCENT: CASES CLOSED, JULY 1968-JUNE 1969 Source Number Percent All sources Social security Savings (and interest) Pension Public assistance Old-age assistance... Children's support... Property Spouse's earnings Employment Insurance Other Not determined 19,841 106.6 3, 955 42.9 1, 093 11.8 897 9.7 595 6.4 591 6.4 518 5.6 240 2.6 191 2.1 186 2.0 100 1.1 321 3.5 1, 154 12.5 i Total (all sources) exceeds number of cases as clients had more than 1 source of income. Table 7 reveals that the source of income mentioned most frequently was social security. Secondly, savings and interest. Pensions also appeared to be a fairly important source of income. Public assistance was reported by six percent of the clients, of whom the overwhelming majority were receiving old age assistance. Support from children was reported in close to six percent of the cases. Other sources included property, spouse's earnings, and employment. The proportion of requests directed to the Information Center for the Aging which directly or indirectly concern financial assistance were close to 50 percent. (See Table 8) The type of request for which it becomes most problematic to establish the proportion in which financial assistance may be indirectly involved is casework counseling. Financial management or apprehension over dwindling resources may become part of a total "assistance plan" needed by the elderly, when disruptions occur in the living pattern, but may not immediately be a crucial problem. TABLE 8.-ESTIMATED NUMBER, PERCENT REQUESTS INVOLVING FINANCIAL ASSISTANCE: CASES CLOSED, JANUARY 1968-JANUARY 1970 Type of request Number Percen Total cases closed Total cases financial assistance primary or supplemental request- Nursing home (supplementary) Medicare Nonmedicare Financial assistance (primary) Low-income housing (supplementary) Employment (primary) Casework counseling (current or pending) 14,540 ... 7,006 48.2 3,928 27.0 (981) (6.7; (2,947) (20. 3; 1,582 10.9 2 623 4.3 208 1.4 665 4.5 i Estimated: 85 percent of all requests for nonmedicare nursing home include financial assistance as supplemental need 2 Estimated: 85 percent of all requests for noninstitutional housing include stipulation it be "low income." CASE CHARACTERISTICS The case characteristics were grouped according to whether they were more descriptive or evaluative in nature. "Descriptive" referred to those characteristics which usually required a minimum of interpretation or assessment on the pari of the worker. "Evaluative" implied that some degree of assessment of the situation, or interpretation as in the case of agency role, was necessary on the worker's part. 471 Documentation of most case characteristics 1 was begun in July, L967. June, uh»9 was selected as the year to-date Interval Cor presentation or case charac- teristics i" this report. This date concludes i he second I welve month period during which service statistics were routinely tabulated. Tims, comparison of year-to- late statistics liave heen made at two twelve month intervals — Juno, 1908, and June. 1!X>9, in order to determine whether or not there have heen any changes worth noting. Comparison of the two time periods revealed only a few changes which will be noted in text where they have occurred. At the same time, an examination of year-to-date statistics by selected quarterly intervals, particularly luring 1968 and 1969, revealed only a few trends had developed, which are included in context. INTAKE PROCEDURE Cases were usually opened with the Information Center for the Aging through a telephone call, as shown on Table 9. This table also indicates that only about one out of every twenty contacts was made by either office interview or letter. TABLE 9.-INTAKE PROCEDURE: CASES CLOSED, CUMULATIVE TOTAL, JULY 1967-JUNE 1969 Procedure Number Percent All cases. . ... 12,652 100.0 Telephone .. .. . 11 271 89. 1 Office interview . 714 5.6 Letter 667 5.3 INITIATOR A relative of the client made most of the initial contacts with ICA, according to Table 10. This table also indicates that one-fifth of the contacts were made by the client and almost one-tenth by a friend of the client. In regard to social services available in the community, the hospital social service department emerged as the most frequent initiator of cases (6.7 percent), whereas voluntary and public agencies combined accounted for only four percent. TABLE 10.— INITIATOR: CASES CLOSED, CUMULATIVE TOTAL, JULY 1967-JUNE 1969 Initiator of case Number Percent All cases Relative of client Client Friend of client Medical social service,. Agency voluntary Agency public Other professional Business and industry. Other miscellaneous... Unknown 12,587 100.0 6,229 49.5 2,668 21.2 1,262 10.0 848 6.7 292 2.3 221 1.8 267 2.1 119 1.0 538 4.3 143 1.1 There was some indication that the initiator varied with the need or with the type of case presented. For example, in a sample of 2,250 requests for nurs- ing homes in only one percent of these cases was the contact made by the client ; the majority were made by relatives of the clients. Furthermore, information about nursing homes constituted the greatest proportion of all requests for service. SOURCE OF REFERRAL Voluntary and public agencies combined were the source of referral in 30 per- cent of all cases closed. If medical social service was added, then the social agen- cies became the source in close to two-fifths (37.3 percent) of all cases. The next most frequent soure of referral was the telephone directory. The proportion of cases in which previous knowledge was the source increased four percent from, September 1967 to June 1969. Since June, 1968, slight increases occurred in media sources as television, radio, newspaper promotion increased. 1 The characteristics "Urgency", "Agency Role", and "Case Contacts" were added as of July, 1968. In addition, there were addition and deletion items classified under "Initiator" and "Source of Referral". 472 TABLE 11.— SOURCE OF REFERRAL: CASES CLOSED, JULY 1967-JUNE 1969 Source of referral Number Percent All cases Agency voluntary Agency public Red book Previous knowledge Newspaper Medical social service.. Homes for the aged Hospital Nursing home-. Friend Television Radio Government individuals. Nurse Physician Other miscellaneous Unknown 12, 652 100.0 2,184 17.3 1,702 13.4 1,364 10.8 1,063 8.4 871 6.9 847 6.7 521 4.1 574 4.5 536 4.2 444 3.5 260 2.1 241 1.9 137 1.1 122 1.0 141 1.1 699 5.5 946 7.5 EVALUATIVE CHARACTERISTICS SERVICE NEEDED The largest proportion of requests were for nursing homes, 37.1 percent. Of this percentage, slightly less than 10 percent requested Medicare homes, whereas the remaining 27.7 percent did not specify. The second most frequent requests were for financial assistance or institutional housing. The following table also shows that almost nine percent of the requests were for casework counseling, five percent for homemaker-companion (or personal services in the home other than nursing care), and slightly more than four percent requested noninstitutional housing. By July 1969 the proportion of requests for institutional housing had dropped in comparison to the proportion in June 1968 (from 13.5 percent to 10.3 percent), while the proportion of requests for casework counseling had slightly increased (from 4.6 percent in June 1968 to 8.7 percent in July 1969). The proportion of requests for protective service had remained at around two percent. TABLE 12.— PRIMARY SERVICE NEEDED: CASES CLOSED, JULY 1967-JUNE 1969 Primary service needed Number Percent All cases Nursing home.. Financial assistance Institutional housing Casework counseling Homemaker-companion. Noninstitutional housing Skilled nurse in home.. Outpatient medical Protective service Inpaitent mental health. Legal counseling Employment Outpatient mental health Dressing appliance Home delivered meals. . Inpatient medical Social security Recreation Others Unknown 11,956 100.0 4,442 37.1 1,238 10.4 1,233 10.3 1, 040 8.7 636 5.3 527 4.4 317 2.6 337 2.8 268 2.2 153 1.3 206 1.7 175 1.5 114 1.0 127 1.1 188 1.6 104 .9 99 .8 110 .9 586 5.0 56 .5 i All cases total less than 12,652 because 696 nonclient cases were removed. 2 Includes physician to home, visiting nurse (registered), drugs, education, transportation. TABLE 13.— REQUESTS FOR INSTITUTIONAL HOUSING. CASEWORK COUNSELING COMPARED FOR 2 FISCAL PERIODS July 1967-June 1968 July 1968-June 1969 Number Percent Number Percent Cases closed 5,496 6,333 Institutional housing. 731 13.3 427 6. 7 729 11.5 i:;; The comparison of the two fiscal periods revealed :i drop of one-half In the proportion of requests for Institutional housing during the Latter fiscal period. riiis may be attributed to newspaper publicity during the earlier fiscal period vhieh resulted In a large number of written requests for lists of homes for the ked. During four mouths of 1968 (February-May), requests for Institutional Busing varied from tWO to four times greater than normal (usually around 40 tase.S per mouth). The proportional rise of more th:tn one-half in requests for casework counseling vhieh occurred during the second fiscal year may be attributed mainly to the idditions of caseworkers to the staff in the fall of 1968 and more knowledge in he community about the services. The data on "primary needs" revealed that health was .second in importance o nursing home care. Requests for inpatient and outpatient mental health serv- cos. legal counseling, employment, were not requested very often. These data how. however, that the needs of the aging are as broad as those of any other ige group. SECONDARY REQUESTS In June, 1968, the secondary or supplementary service needed was included n the routine recording of service statistics. The secondary request for service eceived most often was financial assistance (41.0 percent of all cases). The iajority of these requests (around 75 percent) occurred in connection with equests for nursing home care. The next most frequently mentioned secondary equests for service were outpatient medical care, nursing home care (almost 11 non-Medicare), and casework counseling, each constituting about 10 percent >f all secondary requests for service in July, 1969. Institutional housing and ion-institutional housing were requested in five percent of all cases closed in rhich a secondary need was mentioned. Homemaker-companion, employment and ecreation were mentioned in two percent of all such cases. In view of the importance of financial assistance as a need among the aged erved by the Information Center for the Aging, not only in relation to its rank s an immediately identifiable primary request, but perhaps even more impor- antly in connection with its identification as a supplementary need, a special abulation was prepared. This tabulation partially estimates the proportion of "enter clients which were or might be eligible for assistance from the Illinois department of Public Aid. See Table 8. CRISIS CASES Routine recording of case urgency w r as begun in July 1968. Over 17 percent of .11 cases closed by June, 1969, were indicated as being of crisis nature, and ubstantially two-thirds (68.7 percent) of noncrisis nature, as shown below. TABLE 14.— URGENCY: CASES CLOSED, JULY 1968-JUNE 1969 Urgency Number Percent Total. risis oncrisis nknown... 6,614 1,132 4,545 937 100.0 17.1 68.7 14.2 The urgency of the case differs according to the presenting need as revealed a Table 14. For example : subsequently one-fourth of the requests for casework ounseling were assessed as being of crisis nature ; and two-fifths of the requests or nursing homes, financial assistance, and outpatient medical care were indi- ated as being of crisis nature. The presenting primary need which had the dghest proportion of crisis cases (89.7 percent), was protective service (Table .5). Requests for institutional housing, homemaker-companion, non-institutional lousing, and legal counseling were seldom of a crisis nature. The small propor- ion of cases indicated as of non-crisis nature in connection with requests for lursing homes may be influenced by the relatively large proportion of cases in vhieh the urgency level was "unknown". By considering need in terms of urgency, some indication of the relative pres- ures which may be placed upon the worker providing information and referral ervices to the aging emerges. Workers anticipated that a majority of requests or protective service would be of crisis nature and knew what was expected of 474 them in terms of knowledge of community resources, time, and effort necessary. Similarly, workers might expect that at least one-fifth of all requests for nursing homes, institutional housing, casework counseling, and outpatient medical serv- ices would be of crisis nature and thus assess their workload accordingly. TABLE 15.- —URGENCY AND SELECTED NEEDS: FOR 3- MONTH PERIOD, 1969 1 Total cases Urgency level Crisis Noncrisis Unknown Need Number Percent Number Percent Number Percent Number P ercen Nursing home ._ 464 151 117 180 102 103 31 30 39 33 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 104 33 8 48 12 13 5 6 35 2 22.4 21.9 6.8 26.7 11.8 12.6 16.1 20.0 89.7 6.1 185 100 109 129 69 79 19 19 3 29 39.9 66.2 93.2 71.7 67.6 76.7 61.3 63.3 7.7 87.8 175 18 3 21 11 7 5 1 2 37.: Financial assistance 11.5 Institutional housing __ Casework counseling Homemaker companion Noninstitutional housing. ._ Skilled nursing home Outpatient medical . 1.1 20. ( io.; 12. ( 16.; 2.( Legal counseling.. 6.: 1 January, February, March 1969, which represented a sample of at least 10 percent of cases closed for each need ai of March 1969. REQUESTS FOR INFORMATION Applicants contacting the Information Center for the Aging were considered as nonclients if the need was not related to a specific client. These requests are generally made by ( 1 ) professionals or students in regard to information about resources for personal assistance or by (2) administrators as well as other pre- fessionals for information or consultation which might be applied to planning or evaluating community resources. By June 1969, 447 or 3.5 percent of all cases closed had been classified as nonspecific. In accord with the types of nonclient requests for service described under (1) and (2) above, workers designated whether that request was related to an individual or community. Of the 447 requests reported by July 1969, 41.4 percent were indicated as individual and 68.6 percent as community. Cases designated as individual included requests about where to get literature for a lecture on aging, where recreation may be available for the aged, and where to donate hearing aids; cases designated as community included requests such as an appraisal of a multipurpose senior adult center at a YMCA, and suggestions for a workshop for senior citizens. TABLE 16.— OUTCOME OF FOLLOWUP OF REFERRED CASES BY LETTER AND TELEPHONE, JULY 1967-JUNE 196! Total Outcome Number Percent Method of contact By letter Number Percent By telephone Number Perce n 688 100.0 485 100.0 203 100. ( 399 58.0 31.8 10.2 251 169 65 51.8 34.8 13.4 147 51 5 12 J ncy 219 25.1 70 2.! All Cases Received service Did not receive service (at agency referred to) Outcome unknown The above table shows that 58 percent of the cases received service, 31.8 per- cent did not receive service from the agency to which they were referred, and in 10 percent of the cases the outcome was unknown. A further analysis of the cases that did not receive service revealed that 37 percent of the clients rejected service, 17.7 percent of the "clients" did not keep their appointments, in 11.5 percent oi the cases the agency did not accept the client, 8.8 percent of the cases died, and the balance included small percentages in several categories such as hospitaliza- tion, unable to reach client, after arrangements were made. In an earlier analysis of why the clients did not receive services, the two major reasons were reversed and 30 percent did not keep their appointments and 17.9 percent rejected service or withdrew. 475 TABLE 17.-RESULTS OF FOLLOWUP OF REFERRED CASES FOR SELECTED NEEDS. JULY 1968-JUNE 1969 Results of followup Total Received service Did not receive service Need Number Percent Number Percent Number Percent Total 270 100.0 187 69.3 83 30. 7 46 100.0 100.0 100.0 100.0 23 91 15 58 50.0 67.9 78.9 81.7 23 50. 134 43 32. 1 19 4 21.1 71 13 18.3 i Includes all cases in which a response to followup was received. TABLE 18.-RESULTS OF COMPETED TELEPHONE FOLLOWUP, DIRECTED CASES, APRIL 1968-JUNE 1969 Cases closed Result Number Percent All cases.. Action taken Care arranged Care not arranged No action taken to arrange care 504 100.0 330 65.5 (232) 46.1 (98) 19.4 174 34.5 TABLE 19.— REASON CARE NOT ARRANGED IN DIRECTED CASES FOLLOWED UP, APRIL 1968-JUNE 1969 Cases closed Reason Number Percent Total Agency could not assist client Resource too expensive Client waiting Did not like resource Ineligible Could not find help Client objected to applicant's help No vacancy Other 98 100.0 25 25.5 14 14.3 14 14.3 12 12.2 8 8.2 7 7.1 6 6.1 3 3.1 9 9.2 The reason mentioned most often for care not having been arranged after action was taken was that the agency could not assist the client. Two different reasons both rank as second in importance as to why care had not been arranged after action was taken, which were resource too expensive, and client waiting to hear from agency. Other reasons included "did not like resource," ineligibility, client objected to applicant's help. TABLE 20.-REASON NO ACTION TAKEN IN DIRECTED CASES FOLLOWED UP, APRIL 1968-JUNE 1969 Cases closed Reason Number Percent Total Deceased Applicant did not use information provided.. Problem no longer present Illness, hospitalization Applicant reluctant to follow advice Applicant keeping information for future use Problem otherwise modified Other 174 100.0 70 40.3 43 24.7 16 9.2 14 8.0 10 5.7 9 5.2 4 2.3 4.6 71-272 O— 72— pt. 1- -31 476 Appendix A ICA Technical Advisory Committee MEMBERSHIP LIST Weinberg, Jack (M.D.), Chairman, Clinical Director, Illinois State Psychiatric Institute, 1601, W. Taylor, Chicago, 111. 60612. Ahrens, Robert, Director, Division for Senior Citizens, Chicago Department of Human Resources, 640 N. LaSalle St., Chicago, 111. 60610. Breckinridge, (Mrs.) Elizabeth, Supervisor, Section on Services for Aging, Illinois Dept. of Public Aid, 209 W. Jackson, Room 602, Chicago, 111. 60606. Garrettson, Jane, Director, Service for the Aged-North, Family Service Bureau, 343 S. Dearborn, Chicago, 111. 60604. Hammerman, Jerome, Route 2, Box 103, Chesterton, Indiana 46304. Jacobson, Alan, Director. Northwest Project Workshop, Jewish Vocational Service and Employment Center, 2626 W. Devon, Chicago, 111. 60645. Kahn, Dr. Robert L., Associate Professor, Dept. of Psychiatry, Albert Merritt Billings Hospital, 950 E. 59th, Chciago, 111. 60637. McEwen, Ernest G. (M.D.), (former President of CSCI), 2681 Sheridan Road, Evanston, 111. 60201. Nelson, Dora, (Consultant, Chicago Commission for Senior Citizens), 5320 Blodgett Ave., Downers Grove, 111. 60515. Petersen, Mrs. William F., 1360 N. Lake Shore Drive, Chicago, Illinois 60610. Potter, Robert M. (M.D.), (Welfare Council Board Member), 122 S. Michigan Ave., Chicago, 111. 60603. Priscilla, Sister M. (Catholic Charities), Villa St. Cyril, 1111 St. John's Ave- nue, Highland Park, 111. 60035. Rubel, Mrs. Frederick, Director, Metropolitan Housing and Planning Council, 53 W. Jackson, Chicago, 111. 60604. Schildcrout, Harry. Nursing Home Administrator, Skokie Valley Manor, Inc. 4600 Simpson Road, Skokie, 111. 60076. Schram, Mrs. Leonard, 11 Lakewood Drive, Glencoe, Illinois 60022, Shanas, Dr. Ethel, University of Illinois at Chicago Circle, College of Liberal Arts & Sciences, Dept. of Sociology, Box 4348, Chicago, Illinois 60680. Simon, W. Paul, Professor of Social Work, Jane Addams Graduate School of Social Work, 601 S. Morgan, 13th FL, Chicago, Illinois 60680. Tobin, Dr. Sheldon, School of Social Service Administration, University of Chicago, 969 East 60th Street, Chicago, 111. 60637. Treynor, Miss Marion, 1360 Lake Shore Drive, Chicago, Illinois 60610. Appendix B Additional Item Listings — Figure 1 INITIATOR OF CASE Unknown Client Friend of Client Landlord Relative of Client Medical Social Service Hospital Nursing Home Sheltered Care Facility Agency Voluntary Mental Health Facility Agency Public Physician Attorney Clergyman Nurse Other Professional Student Employer Business, Industry Club, Civic Group Labor Union 477 SOURCE OK BEFEBBAL Clergyman Attorney < tther Professional Business & Industry Television Radio Newspaper Fact Sheet and Other Publications Red Book Previous Knowledge Club, Civic Group Government Individuals Labor Union CRS Unknown Agency Voluntary Agency Public CCDPA Medical Social Service Hospital Nursing Home Homes for the Aged Rehabilitation Facility Mental Health Facility Sheltered Care Facility Relative Friend Physician Nurse FINAL DISPOSITION (INCLUDING DEFINITIONS) The final disposition is the action, recommendation, or information provided by a worker in closing, or resolving a case. Definitions for several dispositions are given below. Definitions for Referred with Counseling and Directed with Counseling are not given because, generally speaking, a definition of these dis- positions would combine the definition of referred and directed with the ap- propriate element of the definition for counseling. Of the dispositions listed below, Consultation/Non-Client applies only to the Non-C'ient Service Control Card. Information only applies to both this card and the Client Service Control Card. All other dispositions apply to the Client Service Control Cards only (white and yellow) . REFERRED A client is referred when a direct contact is made with an agency usually resulting in an appointment for the client. Also, a referral is made with the understanding that the agency will either make an attempt to accept the client or, if not, evaluate the case with the provision that other services will be made available to the client. DIRECTED A client is directed when he is provided with the name, or names, of agencies to contact, but no direct contact is made with any agency. COUNSELING A client is counseled when he or collateral (Other interested person, or per- sons) receives assistance in identification of the problem, support in accepting the real, or actual, situation, and/or is motivated to accept referral to the appropriate resource. Counseling also includes: (1) continuing contact with the client when an agency referred to has accepted the referral but cannot im- mediately engage the client because of a waiting list; (2) short term case work which handles the presenting problem at ICA without the necessity for referral. CONSULTATION/PROFESSIONAL ICA professional staff is called upon to assist other professionals in handling a client, but no direct contact with or responsibility to the client is involved. (Applies only to Client Service) 478 consultation/client Clients and/or their relatives request resource information for future use, i.e., couple may be planning retirement and may wish to explore existing retire- ment villages, etc. There are no specified presenting problems connected with Ithe request and the client is capable of handling the situation himself but needs resource expertise as a guide. consultation/non-client Other professionals, students, etc. call upon ICA for expertise in community resources, needs, planning, etc., (e.g., potential resources, delivery of services by existing resource) . (Applies only to Non-Client Service. ) INFORMATION ONLY (CXIENT/NON-CLIENT) Requests limited to a question which may be immediately answered without any counseling or any necessity to obtain information other than that which is immediately on hand abouit a resource, i.e., the provision of specific information without any further involvement. Appendix C INFORMATION CENTER FOR THE AGING (MONTHLY REPORT OF SERVICE STATISTICS, JUNE 1969) Item Number Month Accumulative total Total Cases served— total (A+B) (A) Continued from last month (B) Opened during month (status; 301 New 2 Recurrent 3 Reopened (C) Closed during month (D) Continued to next month (A+B-C) I nitiator of cases closed 150 Unknown 151 Client 152 Friend of client... 153 Landlord 1 154 Relative of client 155 Medica social service 156 Hospital 157 Nursing home 158 Sheltered care facility.. 159 Agency voluntary 150 X Mental health facility 161 Agency public 162 Physician 163 Attorney 164 Clergyman 165 Nurse 166 Other professional . 167 Student 168 Employer 169 Business, industry 161 X Club, civic group 161 R Labor union. Source of referral for cases closed 170 Unknown 171 Agency voluntary 172 Agency public 173CCDPA 174 Medical social service 175 Hospital 176 Nursing home 177 Homes for the aged 178 Rehabilitation facilitiy 179 Mental health facility.. 181 Sheltered care facility 544 2 542 468 70 4 Case- Nursing work consultant Total Case- Nursing work consultan 265 2 263 228 33 2 279 12, 698 279 43 12, 655 240 37 2 11,307 1,316 32 5,966 43 5,923 5,264 640 19 6,732 6,732 6,043 676 13 544 265 279 12, 652 5,920 6,732 46 46 544 265 279 12, 652 5,920 6,732 6 2 4 143 48 95 125 96 29 2,668 2,274 394 61 38 23 1,242 687 555 6 2 4 71 52 19 156 90 166 6,229 1,902 4,327 32 8 24 848 194 654 6 2 4 56 17 39 1 1 36 10 26 19 4 15 9 1 8 292 137 155 2 2 47 7 40 6 3 3 221 129 92 65 17 48 52 22 30 4 1 3 73 36 37 5 2 3 87 30 57 18 15 3 267 212 55 26 15 11 2 2 33 25 8 3 1 2 119 59 60 1 1 53 38 15 1 1 5 5 544 265 279 12, 800 6,074 6,726 57 21 36 946 444 502 56 31 25 1,927 1,177 750 65 46 19 1,523 785 738 12 1 11 179 12 167 15 2 13 847 115 732 37 12 25 574 168 406 16 3 13 536 69 . 467 11 6 5 521 407 114 2 2 53 12 41 4 1 3 81 13 68 1 1 21 3 18 479 APPENDIX C INFORMATION CENTER FOR THE AGING (MONTHLY REPORT OF SERVICE STATISTICS, JUNE 1969)-Continued Item Total Number Month Case- Nursing work consultant Accumulative total Total Case- Nursing work consultant 182 Relative 2 2 67 27 40 183 Friend 30 19 11 444 265 179 184 Physician 6 1 5 141 30 111 185 Nurse 2 1 1 122 22 100 186 Clergyman 3 3 65 38 27 187 Attorney 19 10 9 188 Other professional 5 1 4 112 60 52 189 Business and industry 3 1 2 119 42 77 191 Television 4 1 3 260 219 41 192 Radio 6 4 2 241 194 47 193 Newspaper 35 24 11 871 518 353 194 Fact sheet and other publicity 4 2 2 81 54 27 195 Red book 74 34 40 1,364 438 926 196 Previous knowledge 58 22 36 1,063 506 557 197 Club, civic group 5 4 1 61 39 22 198 Government individuals 5 5 137 52 85 199 Labor union 3 2 1 20 12 8 191XCRS(+16) 23 18 5 405 343 62 Service needed— Cases closed (primary) 544 265 279 12,652 5,920 6,732 200 Unknown 2 1 1 56 20 36 201 Inpatient medical 6 3 3 104 51 63 202 Outpatient medical 14 5 9 337 188 154 203 Inpatient mental health 4 3 1 153 118 35 204 Outpatient mental health 4 4 114 91 23 205 Nursing home M.C 35 35 1,129 14 1,115 206 Nursing home Non-M.C 137 7 131 3,313 97 3,216 207 Physician to home 6 6 54 9 45 208 Visiting nurse 5 1 4 50 17 33 221 Education 8 7 1 222 Casework counsel 80 67 13 1,040 937 103 223 Protective service 3 3 268 254 14 224 Legal counseling 16 15 1 206 192 14 225 Other 22 15 7 440 252 188 220X Resource— Nonclient ---- 34 14 19 696 353 343 220R Multiple needs 126 53 73 2,034 962 1,072 Final disposition of cases closed 544 265 279 12,652 57920 67732 261 Referred.... 15) 19~ 546 519 27 262 Referred with counseling - 10 4 6 256 224 32 263 Directed 115 110 5 3,788 2,145 1,643 264 Directed with counseling 212 59 153 3,865 1,153 2,712 265 Counseling 42 10 32 784 387 397 266 Consultation/professional 49 18 31 1,182 287 895 267 Consultation/client 9 2 7 130 55 84 268 Consultation/nonclient 4 4 269 161 108 269 Information/client 39 21 8 873 425 448 260X Information/nonclient 29 14 15 303 160 14J 260R Waiting list _ 9 3 6 9 3 6 Case closed by client 1111111111 271 Withdrew 8 5 3 132 68 64 272 Incomplete 8 3 5 272 14 158 273 Other action ----- 25 13 12 274 No reply to letter... 0_ 21 8 209 9 Agency active on cases closed 544 265 279 12,652 5,920 6,^32 281 Agency active 86 28 58 1,806 657 1,149 282 No agency active" "".".."..". 425 207 218 10,476 4,913 5,563 283 Case to agency active 33 30 3 370 350 20 Urgency-Cases closed 5U 251 260 6,614 3,396 3 ,218 290 Unknown 72~ 3 69 937 87 850 291 Crisis 78 37 41 1,132 497 635 292 Non-Crisis.... 361 211 150 4,545 2,812 1,733 Initial intake-Cases closed 544 265 279 12,652 57920 67732 480 APPENDIX C INFORMATION CENTER FOR THE AGING (MONTHLY REPORT OF SERVICE STATISTICS, JUNE 1969)~Continued Number Month Accumulative total Item Total Case- Nursing work consultant Total Case- work Nursing consultant 311 Telephone 312 Office interview 313 Letter.. Evaluation of resource— Cases closed 381 Adequate 382 Qualified adequate 383 Not adequate 384 None available 385 Not applicable Agency role— Cases closed 391 Resource broker 392 Advocate 393 Buffer 394 Agency's agency 395 Holding company 396 Not applicable Nonclient service— Cases closed 401 Individual 402 Community Service needed— Cases closed (secondary) 231 Inpatient medical 232 Outpatient medical 233 Inpatient mental health 234 Outpatient mental health 235 Nursing home M.C 236 Nursing home Non-M.C 237 Physician to home 238 Visiting nurse 239 Skilled Nursing in Home 240 Homemaker— Companion 241 Meals on wheels 242 Dressing/appliance 243 Drugs 244 Financial assistance 245 Social security 246 Institutional housing 247 Non-institutional housing 248 Employment 249 Recreation 251 Education J 252 Casework counsel 253 Protective service 254 Legal counseling 255 Other 493 39 12 230 33 2 263 6 10 11,271 714 667 348 132 216 25 19 6 69 61 8 69 28 41 11 9 2 22 16 6 4,720 289 705 861 72 211 4,856 517 547 6,415 197 120 544 265 279 12, 652 5,920 6,732 309 154 41 2 12 56 155 81 19 5 19 7,510 2,338 635 294 1,875 2,908 1,030 378 189 1,415 4,602 1,308 257 105 460 122 21 17 75 544 265 279 6,858 3,251 3,337 ,160 2,560 254 35 534 171 360 501 67 5 146 65 33 14 19 447 232 215 13 20 2 12 11 8 185 262 35 197 150 65 139 65 74 2,223 1,103 1,120 2 1 1 26 18 8 4 4 232 114 118 1 1 21 15 6 1 1 22 19 3 24 7 17 17 2 15 248 100 148 3 1 2 15 11 4 1 1 18 7 11 9 4 5 1 1 39 28 11 1 1 18 13 5 5 1 4 1 1 5 2 3 54 11 43 956 210 746 6 3 3 15 12 3 139 112 27 9 9 114 114 1 1 41 38 3 2 2 50 45 5 20 15 5 219 173 46 24 17 7 2 2 34 24 10 4 2 2 72 28 44 GRAND TOTAL, ADDITIONAL CONTACTS, 194 Nursing 1 2 3 4 5 8 13 Casework 12 3 4 (32) Client (telephone) 12 1 (33) Client (office interview) (34) Client (letter) 2 (35) Coll. (telephone) 17 3 (36) Coll. (office interview) (37) Coll. (letter) 1 Total, additional contacts, 82 nursing. n 1 2 2 l (32) Client (telephone) 16 2 2 1 (33) Client (office interview) 10 (34) Client (letter) 3 1 (35) Coll. (telephone) 23 13 3 4 (36) Coll. (office interview) 10 (37) Coll. (letter) 110 Total, additional contacts, 112 casework. 481 INFORMATION CENTER FOR THE AGING (MONTHLY REPORT OF SERVICE STATISTICS, JUNE 1969) Number Client characteristics Total Month Accumulative total Nursing Case- consult- work ants Total Nursing Case- consult- work ants Sex 410 Unknown 411 Male 412 Female 413 Couple - Age --- 420 Unknown 421 <60 to 64) ---- 52 29 422 (65 to 69> 71 34 423 (70 to 74).... - - 80 42 424 (75 to 79> - - 78 39 425 (80 to 84) - 88 37 426 (85 to 89) 51 19 427 (90 and over) 21 8 428 (Not applicable)... - - 0_ Age/couple - 49 38 430 Unknown 14 13 431 (60 to 64) 6 5 432 (65 to 69) 6 5 433 (70 to 74) 4 2 434 (75 to 79) - 4 2 435 (80 to 84) 4 3 436 (85 to 89) 2 437 (90andover) 0_ 438 (Not applicable) 9 8 Marital status 511 251 440 Unknown 82 53 441 Single - 40 20 442 Married 96 43 443 Divorced 4 4 444 Widowed 279 123 445 Separated - 6 6 446 Unmarried couple 4 2 Living arrangement 511 251 450 Unknown 39 22 451 Alone 167 108 452 Spouse 87 42 453 Family 125 52 454 Other relative 17 6 455 Friend. 11 7 456 Nursing Home 55 9 457 Home for the aged 1 458 Sheltered care 2 2 459 Retirement hotel 2 2 450X Other.... 5 \_ Race - 511 25? 460 Unknown 91 80 46i White - 369 152 462 Negro... 51 19 463 Other 729 670 891 1,058 1,078 1,127 604 250 4 594 148 79 86 89 62 59 34 4 1 260 33 6,411 29 20 53 156 2 882 610 1,316 114 3,381 95 13 511 251 260 6,411 3,289 3,122 8 4 63 146 38 4 67 178 11 65 1,747 4,000 599 38 773 2,002 476 27 130 974 324 1,998 49 123 511 251 260 6,411 3,289 3,122 260 6,411 545 2,035 1,131 1,463 251 176 575 22 41 14 158 411 427 554 544 535 486 232 96 4 473 129 72 78 71 44 31 13 3 32 3,289 545 324 633 58 1,651 72 6 271 1,388 582 640 114 102 98 9 19 7 59 260 6,411 3,289 11 217 32 1,187 4,590 626 8 1,020 1,962 302 5 318 243 337 514 543 641 372 154 121 3,122 337 286 683 56 1,730 23 7 3,122 274 647 549 823 137 74 477 13 22 7 99 3,122 167 2,628 324 3 482 INFORMATION CENTER FOR THE AGING (MONTHLY REPORT OF SERVICE STATISTICS, JUNE 1969)-Continued Client characteristics Total Number Month Case- work Nursing consult- ants Accumulative total Total Nursing Case- consult- work ants Religion 511 470 Unknown. 223 471 Protestant 134 472 Catholic 116 473 Jewish 32 474 Other 6 Nationality . 511 481 Polish 19 482 German 18 483 Scandinavian 13 484 Italian 9 485 Slavic 17 486 Other 19 487 Notapplicable 416 Resident 490 Unknown 491 Resident 492 Nonresident Home 530 Unknown 531 Owns 532 Rents 533 Not applicable Income 500 No source known 82 501 O.A.A 43 502 MANG 18 503 Medicare 169 504 DA 4 505 BA 2 506 GA 2 507 Mental health 508 Social security 327 511 Pension 61 512 Insurance 8 513 Annuity. 4 514 Trust fund 1 515 Savings and interest 84 516 Property 16 521 Spouse's earnings. 6 522 Employment 20 523 Children's support 47 524 Benevolent society 525 Other 36 521 R Dollar amount shown 196 251 141 56 42 9 3 251 2 4 2 4 5 6 228 260 82 78 74 23 3 6,411 3,013 1,393 1,407 452 146 260 411 220 234 125 130 172 431 3,289 1,805 672 559 198 55 44 35 49 34 40 107 3,122 1,208 721 848 254 91 3,122 176 199 76 96 132 324 2,119 511 251 260 6,411 3, 289 3,122 82 69 175 7 13 230 17 1,400 4,764 247 1,275 1,885 129 125 405 2,879 24 118 511 251 260 6,411 3,289 3,122 98 51 25 118 57 47 24 75 114 1,431 743 2,228 2,009 754 425 1,443 667 677 49 318 193 785 171 1,342 1,126 544 582 13,425 7,099 6,326 40 42 1,154 641 513 24 19 503 279 224 6 12 202 52 150 63 106 1,869 1,011 858 1 3 55 39 16 2 10 7 3 2 23 23 4 1 3 158 169 3,955 1,973 1,982 28 33 897 423 474 7 1 100 49 51 2 2 21 13 8 1 O 29 16 13 46 38 1,093 510 583 14 2 240 156 84 3 3 191 117 74 19 1 186 179 7 15 32 518 142 376 4 1 3 16 20 263 175 88 97 99 2,108 1,292 816 —— ;*;■ ■■ 00 v£> — .. u 2 b 00 r-> i a >> .u 8 a 4J E 0) u o 0) -a -u h •1J O 3 u ^ o u (0 p 0J o fn eg a*. 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If (2) see other side of (date) card. (Back) 11 C2) and giv bottom. not rece iving service check reas 3on why (01 requested . through 08. in space pro\ ) below e any additional explanation as rided at 01. Client did not make or keep appointment. 02. 03. _ Client Client rejected service or withdrew. Explain below, became ill or hospitalized. 04. 05. 06. m Client _ Agency Agency died. did not accept client. made other arrangements Explain below. for care. Specify kind and why. 07. m Other. Explain below. Form #5 (Rev. 3/69) 491 EXHIBIT 7 (Agency Active) (SAMPLE LETTER) Recently one of our workers contacted your agency in regard to , who is known to be one of your active cases. In order to complete our records, we need to know if this client has received any services in connection with the need for Your cooperation will help us maintain up-to-date and reliable information on community resources so that we can better meet our goal of offering a comprehensive information and referral service to the aging. Please complete the enclosed Follow-Up Card and return it to us in the enclosed stamped, self-addressed envelope at your earliest convenience. Do not hesitate to call us if you have any questions regarding completion of this form. Thank you very much for your cooperation. We assure you that the information you provide will be held strictly confidential. Sincerely , (Miss) Jane F. Connolly Project Director JFC:mm 71-272 O - 72 - pt. 1 492 EXHIBIT 8 (Agency Active) (Front) INFORMA Client Address Agency Person Form _ 1. If (1) TION CENTER FCR THE AGING Follow- Up Card Date "Sent ID > Completing (date contact) (date) OUTCOME OF CONTACT REGARDING NEED FOR Assistance rendered describe assistance below. 2 If (2) No Assistance rendered. see other side of card. (Back) Tf (2) no assistance rendered, please give reason below. 493 Arch i TSOTUBAL Bakkikks in PUBLIC TRANSPORTATION Kacii.ii us The Welfare Council of Metropolitan Chicago takes the position thai : all transportation facilities, Including vehicles, stations and terminals, which arc used by the general public or which arc constructed, remodeled, or operated In whole or In part by public tax revenues should include barrier-free facilities and devices in order that tiny he accessible to and usable by physically handicapped persons. This position is taken for the following reasons : 1. Transportation provides access to the community and its activities. To the extent that this service is unavailable to any group, that group is denied full participation in the community. It is the right of all persons, including the physically handicapped, to be enabled the use of all modes of public trans- portation. 2. Access and accommodation features of present public transportation systems either completely shut out or unreasonably restrict persons with physical handi- caps, thereby preventing these individuals from functioning at their maximum potential in a society that is increasingly mobile. 3. A compilation of national statistics estimates that some 30 million Ameri- cans are physically handicapped in a manner which restricts mobility. 1 This figure does not include persons who are bed-ridden, institutionalized, or under six years of age. It does include conditions which are both chronic (i.e., wmeelchair cases, missing limbs, visual and auditory impairments, pulmonary defects, heart and vascular conditions, arthritis and rheumatism, impairments, necessitating braces) and acute (i.e., fractures, sprains, strains, dislocations, advanced preg- nancy, excessive overweight, aged, and diseases limiting mobility). These handicapping conditions clearly affect a large percentage of the popula- tion, particularly senior citizens whose proportion of the total population is projected to increase 40% by 1090. Translated to this State, these estimates mean that close to two million Illinois citizens are "mobility handicapped," that is, physically handicapped so as to limit their ability to utilize public transportation. 4. The State of Illinois alone (excluding local governments, VA hospitals, prwate p^en-ies) srends more than $290,000,000 per year in aiding, educating and rehabilitating the handicapped, 2 while travel barriers contribute to prevent the majority of those adult individuals from attaining partial or total economic and social independence. A recent study of disabled persons aged 18 to 64 who had been judged employ- able found that only 9% of the general population had 16 or more years of edu- cation compared to 13% of the disabled and, conversely, only 15% of the disabled had less than nine years of schooling compared to 28% of the general population. Despite the disabled being more highly educated, this same study reported that of these employable disabled, only 62% of the least disabled, 34% of the mod- erately disabled, and 21% of the severely disabled were employed. 3 The disproportionate unemployment rate for employable handicapped persons, at least six to ten times greater than that for the general population, is in large part due to their inability to travel to places of employment. 4 Elimination of travel barriers would add valuable workers to the labor force, reduce the cost of dependency, expand the consumer market, as well as create a sense of achieve- ment and dignity in the handicapped individual. 5. Use of barrier-free design features and devices in the construction, remodeling and expansion of public transportation systems would serve to increase potential ridersihip and thereby make available a substantial but pres- ently untapped source of added revenues. For example, a projection of the above-mentioned national figure of 30 million persons who are mobility handi- capped to the populations of the areas served by the Chicago Transit Authority would mean a potential increase of 602,805 5 daily fares, if this system were barrier-free. 1 Appendix I: A Cursory Analysis of the Handicapped Population, Department of Trans- portation, Office of Economics and Svstems Analysis, 1968. 2 Based on related portions of 1971 appropriations for the Illinois Departments of Public Aid. Mental Health, Children and Family Services, Superintendent of Public Instruction, and Division of Vocational Rehabilitation. *The Goal Is: Mobility!, U.S. Department of Health. Education, and Welfare, Social Rehabilitation Service. (Washington, D.C., June, 1969). p. 21. * Travel Barriers: Transnortation Needs of the Handicavped, Abt Associates Inc., (Cam- bridge. Mass., August, 1969), p. 49 : "Thirtv per cent of the handicapped respondents' who were unemp^yed but looking for jobs indicated that transportation was one of the factors in their not being employed. Sixty-seven per cent of the same group claimed they would return to work if transportation were no longer a problem." 5 Rased on 1965 estimated population for Chicago and 34 suburbs, and includes non- duplicated subtotals of 250,800 physically handicapped and 352,000 elderly. 494 Making public transportation usable by physically handicapped persons, therefore, would be economically profitable to the operator as well as to the community as a whole. 6. A recent study by Abt Associates, Inc. of Cambridge, Massachusetts, con- tracted for by the U.S. Department of Transportation, developed an evaluative technique for city officials to use on a cost-benefit basis with a program of grad- ual improvement for barrier-free transportation beginning with items which could be budgeted for immediately and then adding barrier-free devices to their long range plans. Technical feasibility is borne out by this and other studies and is indicated in the following suggestions : A. Subway stations could readily adapt the same type of automatic devices that make it possible to pay fares on a toll road without leaving one's car, to replace the inconvenient turnstyles that subways now use. B. Parking areas could leave several widened spaces enabling people with crutches or wheelchairs to maneuver in and out of cars. C. Mechnical lifts or automatically extending ramps could be installed on D. Highway rest areas and other transportation terminals and stations should consider the use of special devices such as ramps, side doors, lower wash basins, lavatories with special facilities for those persons confined to a wheelchair, and reachable public telephones. E. The use of elevators and ramps in subway and train stations could lessen the problems for wheelchair users and people with leg and back impairments. 7. In recent years the number of handicapped persons who use air transporta- tion, especially for long trips, has increased markedly due to the reduced travel time, but airplanes and airports often present a number of barriers to the handi- capped. The Federal Aviation Administration, lacking regulatory authority, has acted in an advisory capacity by publishing "Airport Terminals and the Physi- cally Handicapped," describing certain features which can be incorporated in designs of building modifications. 8. Personal assistance, rather than structural modifications or the use of mechanical devices, is sometimes a sufficient and appropriate means of making transportation facilities accessible to physically handicapped persons. There are some forms of public transportation which already require the presence of employees, such as taxi drivers or airplane Stewards, and aid needed by handi- capped travelers to enter, locate comfortably and exit from these facilities may often be adequately provided by such personnel. 9. It has been demonstrated that facilities structured to aid the mobility of the handicapped, such as those used at Expo '67 in Montreal, are also easier for all persons to use and are therefore beneficial to the entire populace. At Expo '67, exhibits providing access by both convention stairways and rampis designed to accommodiate wheelchairs resulted in the overwhelming majority of all visitors utilizing the ramps. This somewhat accidental discovery demonstrated a prin- ciple which can be validly applied to transportation facilities, this being that most improvements in the access and accommodation design of public structures to permit use by the physically handicapped will also benefit the able-bodied. Design and Location of Public Housing The Welfare Council Of Metropolitan Chicago Takes The Position That : The number of units in and the location of each public housing dwelling struc- ture and auxiliary service facilities should be planned, designed, and operated to best meet the housing needs, as determined by family size and composition, age, health, and handicapping conditions of the persons who will occupy the dwelling units. This Position Is Taken For The Following Reasons : 1. The pattern of housing use in the general population in a city may be sum- marized as follows : (a) Young married couples before the birth of children select apartments or houses with little regard to availability of and accessibility to play space ; (b) With the addition of children a move is usually made to housing where there is more room, play space, and other services needed by families with young children; and (c) When the children are grown, a third move is usually made to quarters which meet the particular needs of the older couple in terms of health, agility, and similar factors. 8 Ibid., pp. 121-164, B1-B5. 495 in public housing little regard can be given to the need for easily accessible play space for young children when very high rise units .ire the h;isie facility available. The majority of the public housing units are occupied hy young families with several small children. This means that very small children must be bepl inside, a parent must accoin- pany them, or they must on their own go to a play Space which may be as many as 21 floors below. If the parent accompanies them, other household duties must go by the board. For the child to be alone this far away from a parent is not only poor child rearing practice but can be physically dangerous. Day care services and supervised play space is only a partial solution best suited for the 'A to 6 year old group. It is far less suitable for younger children. The need for special toilet facilities at the ground level for small children seems to be clear. Privately operated apartment buildings have locked lobbies and other measures to protect the occupants. The purse snatchings, muggings, hold-ups, and rapes in elevators and corridors in the public housing units show a clear need for such well demonstrated security measures to be instituted in public housing units. 2. In the private housing market, dwelling structures are planned and de- signed to meet the housing needs of the occupants because the person seeking housing makes his selection on the basis of his family need. This "natural" choice in the private housing market has proved the value of all types of structures: — from high rise apartment buildings to single family houses — to meet various housing needs. In public housing the occupant has no choice in his dwelling unit. He is as- signed an apartment. The size of the apartment is dependent upon the number of people in the unit. Some few T units are set aside for people over 65. But, vir- tually all public housing units are in high rise apartment buildings. The special needs of a family based on the ages of the family members are served only by chance, if at all. There are handicapped persons under 65 who may need the special features of units reserved for the aged (those over 65) . 3. To serve these needs many housing forms must be used. As the number of units per structure is reduced to meet these needs and as the auxiliary service facilities and recreation space is included in the plan for such units, more land per unit will be required. Large plots of land in any one area become less and less available. Smaller plots w T ill have to be utilized in various parts of the city. There may be some dis- advantage in administration resulting from dispersal of units. This can be more than offset by locating the units near parks and other services needed by the oc- cupants for whom the building is designed, rather than building them for the housing project. The higher Construction cost per unit resulting from smaller buildings will probably be offset by lower maintenance costs. A housing unit which meets the families' needs will probably contain design features to protect it from special stresses inherent in a given occupancy. It is also to be expected that the tenant will take better care of a home in which he can be more comfortable. Location of public housing units and their design on the site should be such that the occupants will have maximum opportunity to participate in the affairs of the surrounding community. Smaller units will permit the children to go to the public schools already in the neighborhood. Large units or many small units all together usually result in the need for a new school attended only by the children living in the public housing unit. Large numbers of public housing units in a small area also result in stores, recreation spaces, and other services being used primarily by the persons living in the units. This can amount to virtual isolation from the rest of the commu- nity. Smaller units in various parts of the city, located so that public housing occupants share service facilities used by other neighborhood residents of the city would reduce this isolation. Public housing was originally conceived as a method of replacing substandard slum housing with "decent" housing for persons whose income was insufficient for them to rent such housing in the private market. This was to be a temporary occupancy lasting only until the income of the head of the family increased to the point where he could pay for decent housing in the private market. By and large people are no longer "temporary" residents of public housing units. That the concept of permanent residence is accepted for at least one group is indicated by inclusion of units designed for the aging. It is more and more the actual experience for the younger family. 496 If the residents of public housing units will in fact be permanent, the units should be designed and located, and occupancy assigned to assist in the patterns of family growth and community participation most prevalent in our society. In this way the children growing up in public housing units today will be more likely to have the incentive toward educational and job achievement that will enable them to take their places as fuily contributing adults in our City, State, and Nation. Elimination of Abchitectural Barriers to the Handicapped The Welfare Council of Metropolitan Chicago Takes The Position That : All buildings and facilities constructed with Federal, State, or municipal tax funds, all buildings and facilities for use by the general public, and the common usage areas of other buildings with tenants holding themselves out to serve the public should be constructed with, and all remodeling should include, facilities and devices to make them accessible to and usable by physically handicapped persons. This Position Is Taken For The Following Reasons : 1. Approximately one out of seven people in the United States has a perma- nent disability; they represent human resources of immeasurable value and are of great economic significance to the nation. 2. The most common design and construction of buildings and facilities make it very difficult to project the physically handicapped into normal situations of education, employment and recreation. 3. Such reasonable design features as ramps in addition to stairs, swinging doors wide enough for wheelchairs in addition to revolving doors, doorways without raised sills, toilet facilities, drinking fountains, and public telephones at heights accessible to persons in wheelchairs make the buildings usable by the handicapped. Most of these features have been standardized and have been included in such widely recognized documents as the "American Standard Speci- fications for Making Buildings and Facilities Accessible to, and Usable by, the Physically Handicapped." (A117.1-1961). Doors and other fixtures to meet these standards are now regularly manufactured and easily available through- out the country. Use of these features in construction and remodeling imposes no significant economic burden on architects, builders, or owners. 4 Surveys of buildings that are "barrier free" show fewer tripping and falling accidents for the able bodied as well as the handicapped. This results in signifi- cant reductions in workmen's compensation, public liability, fire, and health and accident insurance premiums according to the article "Banning Those Bar- riers" in the Journal of American Insurance for September, 1964. 5 Some states and local building codes or regulations require that such speci- fications be met in government buildings. This has resulted in much more effective use of these buildings. A case in point is the Art Institute of Chicago. The results have been so valuable that similar regulations should govern con- struction of other buildings and facilities intended primarily for public use, m a" All state, county, or municipal buildings, and the surrounding grounds and approaches where people are employed or which are used by the public ; B All schools, colleges, theatres, museums, sports stadia, transportation terminals hotels, motels, restaurants, recreation centers, park buildings and facilities and the surrounding grounds and approaches and other buildings which are for use by the general public ; and ,,..,*- -w^ C The entrance wavs. elevators, corridors, public drinking and toilet facilities, and other common usage areas and facilities of buildings with tenants holding themselves out to serve the public. Public Aid Ceilings The Welfare Council of Metropolitan Chicago Takes The Position That : The amount of public assistance grants should be (based solely on budget standards compatible with health and decency required by the size and composi- tion of the recipient family. This Position Is Taken For The Following Reasons : 1 Fixed maximums or ceilings can lower grants below the amount nec *s- sary for minimum, adequate budget in some families. This is inconsistent witn 497 the stated purpose <»i' the Public Assistance Code and Li beneath the dignity of the State. 2. Grants forced below amounts necessary to meet minimum standards cause nn warranted hardship to individuals and families. ,*i. The deprivation resulting from failure to meet minimum needs of food. Clothing, and like essentials, breeds even greater despair and discouragement, thereby reducing the potential for rehabilitation ami restoration to self-suf- tieieney. 4. Where reemployment or restoration of the adult to employment may not be possible (due to age, disability, need to remain at home to care for children, etc.). the climate of deprivation, discouragement, and desi>air in the house- hold resulting from grants forced below minimum adequate budgets militates Against the motivation of children to prepare themselves for self-sufficiency. This is the cause of many high school droupouts. 5. Although some dollar savings may be achieved in public assistance pro- grams, through fixed maximum ceilings these are more than offset by the re- sulting increases in crime and delinquency, in mental illness, school dropouts, in broken families, and other social ills of immeasurable cost. Special Transportation for the Handicapped The Welfare Council Of Metropolitan Chicago Takes The Position That : Regulatory authority should be established by law to permit private enter- prise and private and public agencies to operate special facilities for the safe and convenient transportation of severally handicapped persons. This Position Is Taken For The Following Reasons : 1. There are inadequate facilities in the Chicago area and in Illinois for transportation of severely handicapped persons. 2. The availability of adequate transportation to such persons is vital both to the individual and the community. 3. The lack of suitable transportation results in the confinement of severely handicapped persons to their homes. Such confinement limits the rehabilitative and recreational services available to them and their opportunity for social relationships. The resulting tendency to withdraw from society encourages a dependency which destroys the initiative to make full use of rehabilitation services. 4. Transportation is needed to carry severely handicapped persons to loca- tions where expert help and facilities are available to provide rehabilitation, training and recreation. Rehabilitation and training afford the means for either partially or completely removing such persons from dependence upon public support. Many could be placed into gainful work where they may achieve a de- gree of financial independence. Such an accomplishment would redound to the public benefit and create a sense of achievement for the persons involved. 5. The safe and comfortable transportation of severely handicapped persons requires speeiaHy equipped and staffed vehicles. Oversized doors, ramps or lifts to allow the passage of wheel chairs, special safety devices to secure wheel chairs, and special safety belts are among the types of special equipment usually needed. Drivers and attendants need special training to handle wheel chairs safely, to lift persons, and to assist people who have braces and other prosthetic devices. 6. Because such specially equipped and staffed vehicles represent a new type of transportation not generally contemplated by existing legislative enact- ments, it is imperative that legislatures, and especially the governing bodies of municipalities, adopt new laws which permit, and regulate the operation of such vehicles. 7. Any license fees and rates set by such legislation should be reasonable in view of the resources of the consumers, the number of persons to be carried by given types of vehicles, and the investment in, and operating costs of. the service. Because the expense for such transportation of severely handicapped persons will frequently be paid by public or private not-for-profit agencies on a contract basis, the legislation should contain an exception from rate require- ments for such situations. 8. In order to protect the public, the operators of such transportation should be required to provide evidence of adequate financial responsibilty. Compliance with appropriate safety standards should be a prerequisite for a license. 498 Guaranteed Annual Income The Welfare Council Of Metropolitan Chicago Takes The Position That : Governmental income maintenance programs should guarantee that no family unit should have an income below the poverty level set by the Federal Govern- ment with allowance rates related to earned income in such a way as to en- courage the participation of employable persons in the work force. This Position Is Taken For The Following Reasons : 1 Present welfare programs have encouraged the development of a welfare structure in which the person served becomes, in effect, a ward of the State subject to the decisions of a governmental department and an involved admin- istrative process. Such programs can be destructive of the incentives of the person being served. He no longer has the power to make all decisions affecting him- self and mav fail to develop or may lose the capacity to guide his own life. This can result in a cycle of dependency in which the person and members! of his family learn to depend upon administrative decisions and external political °2 ^or many who require public assistance, their only disability is an inade- quate income/ Aged persons, mothers who cannot be employed because they must care for voung children at home, and persons with physical disabilities which limit their employment opportunities are among those who may be fully capable of managing their own lives without governmental intervention if an adequate cash income is assured. The coupling of continuing welfare investigations and services to the provision of benefits in these circumstances is demeaning, is wasteful, and may be destructive of the independence which the assistance is lnt 3 n pres t e°nt we!fare programs cover, in general, only those who meet the specific requirements of categorical assistance and general assistance programs The coverage of these programs has little relationship to the extent of poverty m the United States. Many persons are below the poverty level despite consistent or I)e 4°?ncore P \mTnTeLnce programs would permit assistance to be related to poverty rather than to arbitrary categories. The test of coverage would be inade- quacy of income rather than categorical assistance related to specific reasons for th f incomeTa^ntenance programs would assure persons below the poverty level a minimum income and thus permit that person to make his own deaaons as to how his life shall be ordered. While those decisions may not always be judicious, only through such independence of action can the client develop his own capacity, and confidence in his own capacity, to determine his future 6 Present welfare programs generally reduce benefits by whatever the client earn* ^ TM?Ce 'to-one'' reduction in benefits undermines incentives to partici- ^ Incmne'maSance programs would permit greater flexibility ^ developing incentives Allowance rates could be adjusted so as to permit retention of a Scant proportion of earned income to a determined level, and thus encourage the participation of employable persons in the work force. ^^i^ & Income maintenance programs would reduce the ad^i^e^lto ties and expense, and the administrative and political interference in the .live of citizens whose only disability is an inadequate cash income. Such programs would free Social workers to focus supportive social services on those persons who are mentally and physically in need of such services. 9 Adoption of income maintenance programs could be phased over time. ±oi exLple infusion of all aged under a variation of Social Security could be ar rnSediary step in the development of a guaranteed annual income mainte- nance^ systeL. At the same time, it is a specific and worthy immediate goal. Employment Discrimination by Reason of Age The Welfare Council of Metropolitan Chicago Takes the Position That: AbUity to perform a job, not age, schould be the primary criterion for ^adul employment and in the determination of promotion, compensation, and benefit* other than compensation. This Position Is Taken for the Following Reasons : nll ^ nn , nr mmta ; 1. Chronological age is not necessarily a determinant of the physical or menta ability to perform job duties in a given occupation. 499 2. it, is the conviction of the American Medical Association Committee as Aging, and other groups which have studied the matter that denial of work opportunity — whether the work is for pay <>r the pleasure of giving often threatens the health Of the individual concerned, for the physical and mental health of the unemployed older person can be affected hy the loss of status, lack of meaningful activity, fear of becoming dependent, and isolation from com petitive society. Thus, unemployment can produce a chain reaction in the heatlh of such persons. The increase in life expectancy and higher health levels will then he restricted in their henefit to mankind if the opportunity to contribute skills is denied at a specified chronological age. 3. The social structure in the United States is work oriented. Society expects healthy adults to work, and economic gains are awarded primarily for work. The unemployed person, who is capable of working, does not maintain his social or economic position in our society. He loses not only income but social status as well. 4. The report, "Breaking Through the Age Barrier," published by the Bureau of Employment Security, Commonwealth of Pennsylvania, May, 1958, states, in part, "Unless our society can develop methods by which persons can continue to work as long as they are able to work, we shall be faced with an ever-growing number of discontented and unproductive older persons, who will have to be supported by younger persons economically, emotionally and spiritually. "There are also tremendous social costs in denying employment to older workers. There is the cost of supporting such workers. There is the loss in taxes, which would be paid by such workers if they were employed. And, finally, there are the numberless social services which are often required. Approved by the Board of Directors on January 17, 1968. (The approval of this statement does not imply a position for or against compulsory retirement at a given chronological age. ) "It is plain that we cannot continue to lengthen man's life span and at the same time lower the age at which he is allowed to continue as a productive member of society. Sooner or later we will reach the point where the burden of supporting large numbers of older workers who are not fully productive will become too much for our economy to bear. "Therefore, there are at least three compelling reasons why all citizens of good-will should w r ork to break the age barrier to employment. One is economic — we must do it in order to keep our productivity high and our economy pros- perous ; a second is social — everyone in our society must help to bear the cost that arises when an individual is denied the opportunity to support himself and his family ; a third is human — we must do it to keep our society stable." 5. Employers and labor are now T beginning to analyze their policies and attitudes in light of current knowledge of older workers. Studies conducted by the United States Department of Labor, Bureau of Employment Security, on the experience of firms hiring older workers, indicate that these older workers : (1) have the stability that comes with maturity ; (2) waste less time on the job ; (3) have greater reliability and desire to work ; (4) have consistently less absenteeism and greater desire to stay on the job; (5) have a sense of responsibility and loyalty to their job and their employer; (6) generally have steady work habits and a serious attitude toward their job ; (7) usually require less supervision once they are oriented to the job; (8) are less inclined to make trouble ; and (9) are less distracted by outside interests or influences, with fewer domestic trouble, and are capable of greater concentration. 6. With respect to job stability, turnover, and ability to get along with others, on the part of older workers, 84 per cent of the companies surveyed in 1965 by Prentice-Hall indicated less turnover among older workers than younger workers. A University of Illinois survey showed that in terms of ability to get along with associates on the job, employers rated 32 per cent of the older people higher, and 59 per cent about the same as younger workers. 7. Refusal or inability to judge older workers hy the same standards as younger employees denies management the right to make the kind of decisions which would produce the most effective labor force in their company/Discrimination by reason of age should not be used as a substitute for job performance standards, employee performance evaluation, re-assignment, or removal from the job. 500 8. In periods of high employment, the recruitment of qualified replacements is frequently difficult. This situation is intensified where a policy of discrimination by reason of age has been adopted. A change from a restrictive policy to flexible policies based on individual abilities eliminates the ease with which continued employment decisions can be made by management, but this is offset by the in- creasing difficulty to find sufficient competent personnel for certain job categories, such as those requiring high manual skills or managerial and executive com- petence. 9. Opposition to the employment of the older worker, for fear of excessive costs for health and life insurance, disruption of pension plans, and alleged intract- ability of such workers, are matters which are able to be worked out through individualized adjustments in present traditional plans on industrial, occupa- tional, company, or employee bases. 10. A number of authorities have testified that Workmen's Compensation rates do not increase when older workers are kept on. Since occupational death and disability insurance premiums are set on the basis of the hazards involved in a job, rather than on personal characteristics of employees, the ultimate cost is de- termined hy the accident experience of the firm. Accident frequency declines with age, and this offsets the tendency for the period of disability per accident, which may increase with age. These facts lead to the likely conclusion that age has no noticeable influence on Workmen's Compensation rates. 11. In many companies, the health and accident rate is twenty times the Work- men's Compensation rate, so premiums for Group Sickness and Accident coverage are significant. Here, with respect to the older worker, any increase in cost in- curred as a result of the tendency for older workers to recover more slowly from illness and accidents is largely offset by the higher costs of dependent benefits for younger workers, who generally have more dependents. 12. Personnel policies should be applicable to all employees and not only to certain selected occupations or organizational units. Such policies should include provision for physical and mental medical examination of any employee, irre- spective of age, by competent doctors of the employer's selection and at the em- ployer's expense at regular intervals, when in the opinion of the employer, the health, safety, or well J being of the employee or his fellow employees or the main- tenance of performance standards so requires. Based upon such medical findings and recommendations and a review of the employment record, in consultation with the employee involved, the employer is able to determine whether to con- tinue the employment on its existing basis, to propose a reduced workload at reduced pay, or to offer a lateral transfer to suitable duties or separation. Under certain circumstances, an additional medical review may be advisable. 13. Rapidly expanding knowledge of the physical, mental, and psychological aspects of aging, illness, and rehabilitation would tend to indicate that persons heretofore charged off as a loss to gainful employment, can continue to be em- ployed on bases profitably advantageous to the employer, and psychologically and economically satisfying to the worker. Examples may be found in the work of Dr. Paul Dudley White in the rehabilitation and retraining of cardiac patients and in the work being done with physically handicapped youth and adults. According to Miss Mary E. Switzer, Administrator, Social and Rehabilitation Service, United States Department of Health, Education, and Welfare : "Neither age nor anticipated length of reemployment are determining factors in establish- ing eligibility for vocational rehabilitation." Over 25 per cent of those rehabili- tated in 1966 were over 45 years of age. Says Miss Switzer : "The work of older people is essential to the common welfare of every community. For many of our aged, Social Security retirement benefits are not a satisfactory substitute for the opportunity to work. Denial of employment opportunities to older persons is frequently a personal tragedy and is a waste of human resources." The Status of Research in Applied Social Gerontology Gerontological Society Committee on Research and Development Goals in Social Gerontology STATUS REPORT Robert J. Havighurst, Chairman Committee on Human Development University of Chicago Chicago, Illinois (501) 502 Preface In the autumn of 1968, the Administration on Aging provided funds that enabled the Gerontologi- cal Society to establish a Committee on Research and Development Goals in Social Gerontology. The tasks of this Committee were: 1 Survey the existing research in social gerontology which may have a bearing on social policy and practices of social, civic and governmental agencies with respect to the general welfare of people past 50 and especially with respect to people past 65 or 70. 2. Recommend certain areas and problems of research in social gerontology as especially worthy of support by public and private funding agencies. 3 Focus on a small number of areas of research and development within social gerontology which promise to be especially valuable as bases for determining social policy and for guiding the practices of government and private agencies that deal with problems of aging. 4. Define and delineate research problems within these areas. The members of this Committee, its consultants, its staff, and the members of a critical review sub- committee that has provided an independent critique of the first Report are appended below. It is this Report that comprises the body of this special issue of The Gerontologist. Chronology The work of the Committee has proceeded as follows: First, a preliminary meeting of a nucleus o\ the Committee was held in November, 1968, to lay out general procedures. This meeting was fol- lowed by a full meeting held toward the end of February, 1969. At this latter meeting, four broac areas of research were selected for special attention, and an introduction was planned for dealinj with the relation of research in social gerontology to social policy concerning aging. In the summer of 1969, a special Subcommittee was created to: (a) read the Preliminary Repor critically and advise on its revision; and (b) prepare a Supplementary Report on frontiers of research to be attached to the Committee's Final Report. This Subcommittee is composed mainly of peopl either younger in age than the members of the Committee or new to the field of social gerontology It was felt that the criticisms and ideas of these persons would help to correct any over-conservativ "establishment" biases of the members of the main Committee. Contents of the Report The somewhat limited task of the Committee has been to define areas and problems of research ex plicitly aimed to answer questions of social policy about matters that affect the lives of people m the] middle and later years— income, living arrangements, family relations, comfort, and satisfaction. The four areas chosen by the Committee are, from the point of view of the Committee, of majc significance for social policy. These areas constitute a large part of the field of applied socuxl geron tology. They are: 1. Work, Leisure, and Education: Flexible Life Styles 2. Living Arrangements of Older People: Ecology 3. Social Services for Older People 4. The Economics of Aging 503 These areas were also felt to be ones of probably the greatest Interest to the Administration on Aging in connection with its program of support of research in applied social gerontology. It is prol lowever, that one or more other areas will be defined and written up by the Committee during the »ming year. Social factors in physical and mental health, in particular, may be chosen for special ittention. The Committee deliberately avoided areas of basic research (especially in psychology and sociology) >ecause these are not a major concern of the Administration on Aging. These areas have other sources >f support, and the Gerontological Society is working to promote basic research in other ways. The definition of the area of applied social gerontology has purposely been left somewhat vague by he Committee. At the very least, it includes applications of economics, political science, psychology, mthropology and sociology. Also, the chronological age period to which this report has been directed s a broad one, with some recommendations for studies of people in their young and middle adult ears, and others for study of people over 80. The reader will note a certain amount of overlap among and cross-referencing between the chapters. : or instance, the chapters on Social Services and on Living Arrangements both refer to needed re- earch on transportation for older people, and on services that enable old people to maintain indepen- lent dwelling arrangements. The chapters on Economics of Aging and on Work, Leisure, and Educa- ion both refer to needed research on private pension plans as they relate to flexible life styles in the niddle years. B he Tentative Nature of this Report The Committee is calling this report a status report. It deals critically with the present status of esearch in the four areas selected as deserving priority in support for practical or applied research. It oes not go into detail on the nature of the research that ought to be done; neither does it state riorities within the recommended fields. Detailed recommendations will be made during the second hase of the Committee's work. At that time the Committee will survey social factors affecting mental nd physical health, survey the needs for research on aging in minority groups which suffer from eco- lomic disadvantage and discrimination, and, as stated above, possibly add one or two other areas of re- earch to its recommendations. The Committee welcomes comments from readers. 'he Committee on Research anfl Development Goals in Social Gerontology Salter M. Beattie, Dean, School of Social Work, Syracuse University Robert H. Binstock, Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University rnies E. Birren, Gerontology Center, University of Southern California largaret Blenkner, Benjamin Rose Institute, Cleveland Robert N. Butler, MD, 3815 Huntington St., N. W., Washington, D. C. 1. Margaret Clark, Langley Porter Neuropsychiatric Institute, San Francisco lias S. Cohen, Commissioner, Office of Family Services, State Department of Public Welfare, Harris- burg, Pennsylvania Vilma Donahue, Institute for Human Adjustment, University of Michigan larl Eisdorfer, MD, Center for the Study of Aging, Duke University Medical Research Center laurice B. Hamovitch, Dean, School of Social Welfare, University of Southern California tonald P. Kent, Department of Sociology, Pennsylvania State University lanita M. Kreps, Department of Economics, Duke University oss A McFarland, Harvard School of Public Health, Boston ving Rosow, Langley Porter Neuropsychiatric Institute, San Francisco 504 Subcommittee on a Critical Review of the Report Mary L. Wylie, Chairman, Experimental City Project, University of Minnesota Nancy N. Anderson, Director of Health Systems Division, American Rehabilitation Foundation, Min- neapolis James J. Callahan, Director, Office of Planning, Massachusetts Department of Public Health, Boston Richard A. Kalish, Associate Professor of Behavioral Sciences in Public Health, University of California at Los Angeles Allan Pincus, Assistant Professor of Social Work, University of Wisconsin Gerald G. Somers, Chairman, Department of Economics, University of Wisconsin Staff of the Committee Robert J. Havighurst, Chairman, Committee on Human Development, University of Chicago Jacqueline M. Falk, Coordinator, Committee on Human Development, University of Chicago Sandra C. Howell, Coordinator, Gerontological Society, St. Louis Edwin Kaskowitz, Executive Director, Gerontological Society, St. Louis Consultants Louis E. Gelwicks, Gerontology Center, University of Southern California James H. Schulz, Department of Economics, University of New Hampshire (The Committee owes spe- cial thanks to Professor Schulz, who was the principal author of the chapter on income maintenance.) Yung-Ping Chen, Department of Economics, University of California at Los Angeles Elaine Brody, Philadelphia Geriatric Center Thomas Byerts, University of Southern California Dorothy McCamman, Consultant on Economics of Aging, Washington, D. C. Correspondence concerning this Report should be addressed to Professor Havighurst, Judd Hall, Univer- sity of Chicago, Chicago, 111. 60637. Q ^ 505 Introduction Old age in America may represent for many the triumph of technique over purpose. In the last 70 years, changes in medical care, food production and distribution, income distribution, housing patterns, and labor-saving machinery have contributed to longer life for more and more people. The prospect of old age for the vast ma- jority of Americans has come about without much thought given to what old age should be, or might be for most older Americans. If, for most elderly people, old age is a time when energy is low, the circle of family and friends diminished, and income reduced, what is the reasonable ex- pectation for life satisfaction in the retirement years? What is an older person's role once his family-rearing and economically productive years are past? Are these questions for a small number of individuals, or are they relevant for a suffi- ciently large number and large proportion of the elderly to warrant attention as problems of society deserving analysis? There is enough evidence to conclude that for most Americans old age is a time when the arenas of choice become constricted, the environment narrows, and functional decrements press more and more with each passing year. Despite the accumlation of considerable data and some particular inquiries of very high stand- ard concerning the status of the older American, it is clear that the formulation of social policies to assure his well-being does not proceed today from anything but a crude data base. The ele- mentary data, however, may suggest clues to fur- ther inquiry. They prompt speculation about some of the current trends and what they may mean to old and young Americans alike. What are some of the salient facts about old people in America today? 1. There are almost 20 million individuals who have passed their 65th birthday. Half are under 73; more than a million, 85 or over. It is estimated that by the year 2000 there will be in the popula- tion 28.2 million people who are over 65. 1 2. The elderly population is a changing group. While in the course of a year there is a net in- crease of only 300,000, 1.4 million are newcomers to this group. By the year 2000, between 45 and 50 million middle-aged adults will have reached their 65th birthday. 3. The numbers of the very old, that is, those 75 and over, will continue to increase at about twice the rate of the over-65 group as a whole, and at more than twice the rate of the total popula- tion. 4. Widowhood is apparently a normal attribute of a woman's old age. By the year 2000 there may be as many as 9 million aged widows. 5. Women significantly outnumber men in old age. Today there are 134 older women for every 100 older men. By the year 2000 the 65-and-over group will have at least 150 women for every 100 men. 6. Life expectancy at age 65 is presently about 15 years. We can expect this figure to rise signi- ficantly if cancer, stroke, heart disease, and major cardiovascular renal disease are significantly con- trolled or eliminated. If major breakthroughs do occur in these areas, we can anticipate an increase in average life expectancy of 16 years over and above the present 15. In other words, average life expectancy at age 65 might be 31 years. 7. The elderly tend to be economically poorer than the young. In 1966 half of the families headed by persons 65 and over had incomes of less than $3,645, or less than half of the median income attained by younger families of $7,922. Older people living alone were the worst off. The median income for this group of 5 million was $1,443 in 1967. Of the 7 million elderly families, about two out of five had incomes of less than $3,000 a year, while half of these latter had less than $2,000 a year. About 5 million older Ameri- cans, comprising 30% of the 65 group living out- side of an institution, fall below the poverty level. In contrast, about 10% of the elderly families had income of at least $10,000 and less than 1% (a 506 total of 75,000 families) had $25,000 a year or more. 8. While the largest single source of the $45 billion that comprises the income of the elderly is from earnings from employment, this repre- sents a source for only about 20% of aged individ- uals. Regular retirement programs contributed about 40% of total income, with 30% coming from Social Security, 6% from railroad retirement and Civil Service, and 3% from private pension plans. In addition, about 40% came from veter- an's benefits and 5% from public assistance. In other words, almost half (45%) of the total in- come of our aged population comes from retire- ment payments of one sort or another. 9. Private pensions will undoubtedly cover more elderly people as time goes by, but only a small number will be able to rely on this type of in- come. 2 10. While there seems to be some emphasis at the present time on attempting to enlist elderly people in the labor market, the trends seem to run in favor of retirement. One of the major social decisions of the next 20 years will be to deter- mine what proportion of people over 65 should be in the labor force by the year 2000. 11. Educational attainment and adjustment in old age may have a direct relationship. In the near future, the educational attainment of the elderly will rise significantly. About 20% of to- day's older population are foreign bom and re- ceived some or all education in other countries. Changes in the {migration laws since 1920 will undoubtedly reduce this proportion of foreign bom elderly in the population. Similarly, the ef- fective extension of compulsory public education to age 16 will change the picture on educational attainment that currently exists. Fifty percent of today's over-65 group never went beyond elemen- tary school. A million elderly never went to school at all. It is estimated that about one-sixth of the elderly are functionally illiterate. Only 5% are college graduates. 12. Persons over 65 have one chance in seven of requiring short-term hospital care and one in 25 of requiring long-term care in any one year. The chances for long-term care increase with age. While only one in 50 of those between 65 and 72 requires long-term care, one in 15 of those 73 and over requires this care. 1 13. Older people suffer more disabilities than the general population, visit their physicians more often, and, as one might expect, spend more time in the hospital. Yet about five-sixths of the el- derly get along on their own. 14. The political power of the elderly has the potential for significant growth. At the present time they represent about 15% of the eligible voters. In the future they will approximate 25%, even if the improvements in life expectancy as a result of conquering major killers does not come about. 15. Older people will increasingly become more urbanized, like the rest of the population. It is anticipated that between 75 and 85% of the population will eventually live in the metropoli- tan communities of America. There will be in- creasing reliance on automobiles or other systems of transportation, which may produce special problems for those who cannot afford, or, because of physical limitation, cannot manage conven- tional forms of transportation. 4 16. While only 1.3 million, or just under 10%, of the farm population is 65 and over, elderly people form a growing proportion of rural folk because of the relatively faster exodus of younger persons from farm areas. 17. Elderly people will probably form a grow- ing proportion of those living in the central city, not because of convenience, but rather because the central city will become more and more the locus for the poor. The shifts, changes, and trends in medical knowledge, methods of production, transportation, economic management, and other factors will oc- cur at an even more rapid rate than they have in the recent past. The impact of changing knowl- edge and techniques upon society as the aged know it and encounter it has not been carefully con- sidered. The entire area of social policy in the human service and support field has been approached with less precision and reliance on research data than in the physical planning policy field. Despite all of our failures in control of air and water pol- lution, natural resource conservation, housing anc transportation, there has been more systemati< analysis in highway planning, space utilization flood control, outer space exploration, electric power distribution, and port development than ir the human service field. The issues in social gerontology are as comple: as any we can expect to encounter. As Nathar Shock has pointed out, the solution to the com plex problems in gerontology will require the ap plication of research techniques of practicall] every scientific discipline. 507 Effective research must be directed toward ■ specific question. Research is a technical operation and not all questions can be answered in the form asked. Many broad and general questions of great social im- portance must be broken down into simpler and more specific questions before they can be adequately attacked by research methods. ... It is unfortunately true that the greater the social significance of the question the less apt it is to be answerable in terms of tightly designed ex- periments. However, many of these broad important questions can be broken down into a series of more sharply focused questions which can be studied. . . . We are being asked the broad important ques- tions before we have built up much of a backlog of answers to the small specific detailed questions. 8 It is the purpose of this series of papers to pro- vide a summary of some of the important research in social gerontology and to lay out what some of the priority questions are. In other words, if effort, energy, and resources are going to be ex- pended in social gerontological research, to what should we direct our attention first? At this point, one must take special note of the recent volume entitled Aging and Society by Riley and Foner. While it summarizes the results of recent social science research on middle- aged and older people and interprets this knowledge in terms of sociological theory and professional prac- tice, . . . [it] is in no sense a complete compilation. It consists of selected generalizations that are em- pirically based and that meet criteria of theoretical and practical relevance, generality and adequacy of evidence. 6 The authors, in addition to summarizing the re- search in the field, have also attempted to lay out some principal questions for research. The ques- tions tend to be the smaller, more manageable issues subject to investigation rather than the broader type questions which point the direction for social policy. While smaller, more manageable questions are of the utmost importance, the gap between the social science investigators and social policy plan- ners must be bridged by the framing of the broader issues. The primary question then be- comes: Is it possible for us as social gerontologists to determine which areas require our attention for research? Can we describe a system of priorities? Despite the phenomenal burgeoning of reports, studies, investigations, articles, and volumes on social gerontology, and despite improved financing from federal, state, and private foundation sources, the goals for research have yet to be identified. This is not to say that many competent investiga- tors have not identified some of the research questions. They have. There is, however, no re- search policy at any level that represents | of agreement about goal and purpose thai com- pare! with thai which lay behind the effort ex- pended, for example, in achieving a lunar landing. This is not to say that there have been no com- ments about the direction research in social ger- ontology should take. A broad review of research needs in social gerontology has been prepared by Tibbitts. He has defined the goals of social ger- ontology as achieving an understanding of the manner in which time-related biological and psy- chological changes and environmental and cul- tural factors influence the development of per- sonality and behavior of older adults, their roles, status, and collective behavior. He has suggested that the impact of our changing economy and the transition to an automated, cybernetic produc- tion system are major areas for study, even more important than the impact of changing birth rates, migrations, distributions and other popula- tion characteristics. He has raised three basic questions: (a) What is the position of old people in advanced society? (b) What are the roles for old people and can more acceptable roles be found? (c) Can old people respond to efforts to integrate them into a society characterized by rapid advances in knowledge and social and tech- nological change? 7 Related questions include the general one about the impact of large numbers of older people on structured institutions of society. Is the meaning of "work" substantially altered by large numbers of "non-producing" persons? What is the meaning of retirement to the elderly and to the young? Several investigators in social gerontology have raised important questions relative to the value system and its components. How do values change? How are they influenced? To what ex- tent is the condition of the older American today a result of the wishes and ideas of all Americans? Can those national aspirations and values which impinge upon the life situation of the elderly be altered? To what extent do these values affect the self-image of the elderly and hence their be- haviors and expectations? If Shock is correct in saying that we must build up "a backlog of answers to the small specific de- tailed questions," then it would seem that it will be necessary for us to accumulate vast amounts of information about the elderly themselves and about those approaching old age. While the field of public health has long pur- sued an epidemiological approach to information 71-272 O - 72 - pt. 508 acquisition, there has been less attention given in the area of social disorder. In the field of aging the application of epidemiological approaches might be suggested through (c) definition of con- ditions and events affecting individuals; (b) de- velopment of systems for determining prevalence and incidence; and (c) determination of gross characteristics of those affected, such as age, sex, marital status, economic status, and geographical location. There is little information about the combination of problems most likely to occur, or concerning the circumstances under which older people incur social or physical disabilities. Empirical observation has demonstrated that increasing disability and limited energy restricts the natural life space of the elderly. To be sure, architects have taken into account some of the physical problems of the elderly. However, there has been relatively little exploration of the so- cial factors related to health of older people, such as relationships with family, friends, and neigh- bors, social institutions, real life space, protective care and services, and mental disability. Little has been done to further our understanding of the "new" population of moderately and severely re- tarded and severely physically handicapped per- sons who today, for the first time, are surviving into old age. The conditions promoting health and social adjustment have been little explored by social gerontologists. Unless we examine younger groups in our popu- lation as well as the aged, we will have difficulty in developing either preventive or early identifica- tion measures suitable for this problem-prone population. Ethel Shanas, who is one of the few persons who has surveyed large numbers of the elderly, has indicated that research on character- istics and needs of the elderly can have substantial impact on social policy. The absence of data about the characteristics of elderly people has led to an imbalance in research. Concentration has been upon institutional development rather than upon community services. If we are to order the allocation of resources in behalf of elderly people on some logical basis it would appear that it should be done in terms of their real needs and real characteristics.' In a more general vein,, one cannot overlook what all writers concerned with research in aging have pointed out: the need for more longitudinal research. Hopefully, longitudinal studies may be able to give us clues as to the predisposing factors toward success or failure to achieve social adjust- ment and contentment in old age. To be sure, a good deal of research must be directed toward the accumulation of basic informa- tion on the characteristics of the elderly, on the value systems of our society, on the characteristics of younger populations who are to be the elderly of the future, as well as on trends in economic conditions, housing, population, transportation, labor force composition, and education. Nevertheless, social gerontology has a special obligation to contribute material useful for the formation of social policy, particularly when such a large segment of the population is involved. To that end, five steps seem essential. 1. We must articulate with some degree of care objectives for life in old age. Social planning might be taken to mean the effort to plan for the fate of a whole society. However, that fate must be expressed in objective terms. We must be pre- pared to come up with objectives that can be quantified: Income necessary to provide x goods and services; housing of specified quality; health care; effective social centers; and so on. The framing of objectives must encompass both the long and short range. Goals, that is, must be formulated for today's older American, as well as for the older American of the year 2000. The language of objectives must distinguish between activities and the outcomes of activities. The social planners must attain the precision of the social researchers in developing statements of objectives. Without such precision it will not be possible to indicate what the research goals in social gerontology are for society. White House Conferences, in the traditional sense, are not ade- quate for this task, nor are the activities in which health and welfare councils indulge themselves. 2. We must distinguish among those human conditions which are fit objects for change through applied social policy and those which are not. Some elements of human wretchedness can be affected by social action, but not all — particularly if we eschew the conditioning of Huxley's Brave New World. There is legitimate social policy which leaves some problems to the individual to solve. This is particularly true in the society which seeks to meet the twin conditions of pro- viding care yet maintaining independent choice. 3. We must assess the value system in general and the value systems of the very old, the old, the newly retired, and those facing old age. What do each seek for and in their old age and what do they expect? An assessment of the value system will take into account conflicting values and may make easier for us understanding what the trade- 509 offs arc. For example, we have produced an old age and survivors insurance system which is based on a contributory principle. This principle has high value, hut, having been tried, it has been found to produce a model that can condemn the old to poverty, a money-giving system which cm- braces virtually no services. 4. We must assess the state of knowledge rela- tive to life in old age and identify the gaps in. some organized way. What are the key researches yet to be done, and what systematic approach can we suggest for identifying the gaps and the ques- tions that are of importance in the formation of social policy? In this respect, we would call upon the Administration on Aging, or, indeed, the De- partment of Health, Education and Welfare it- self, to give leadership to such examination by financing an effort to identify these gaps. 5. We must establish a method and system for understanding research in line with social policy and the gaps that we have identified. Funding should follow this kind of priority scheme; and federal funding, which, after all, constitutes the major portion of funding in social gerontological research, must follow some kind of well-under- stood system that has meaning to all in the field. It is time for a national idea about aging, a new approach to social policy; indeed, a new so- cial policy itself. Bibliography 1. The facts summarized in the following pages have been taken from: a. Brotman, H. B. Every tenth American. Paper presented at the Slate Conference "I the Iowa Commission on the Aging, Des Moines, October 2, 1968. (multilith) b. Administration on Aging. Memoranda. Usi-ful facts No. 15. National population trends as of July 1, 1966 (analytical tables). Table I, and Use- ful facts No. 16. Year-end statistical round-up. Washington: U. S. Dept, of Health, Education, and Welfare, Jan. 6, 1967. 2. Epstein, L. Income of the aged in 1962: First Find- ings of the 1963 Survey of the Aged, Social Security Bulletin, 27, No. 3, Washington: U. S. Dept. of Health, Education, and Welfare. 3. Rice, D. Health insurance coverage of the aged and their hospital utilization in 1962, findings of the 1963 Survey of the Aged, Social Security Bulletin, 27, No. 7, Washington: U. S. Dept. of Health, Edu- cation, and Welfare. 4. Grier, G. Goals and objectives in aging. Paper presented at the Annual Conference of State Execu- tives on Aging, Washington, April 24, 1964. (multi- lith) 5. Shock, N. Trends in Gerontology, (2nd Ed.). Stan- ford, Calif.: Stanford Univ. Press: 1957, pp. 114-115. 6. Riley, M. W., Foner, A., & associates. Agmg and society, Vol. 1; An inventory of research findings. New York: Russell Sage Foundation, 1968. 7. Tibbitts, C. Middle aged and older people in American society, Pamphlet OA, No. 227. Washing- ton: U. S. Govt. Printing Off., 1965. 8. Viewpoint and interview with Ethel Shanas. Geria- trics, 1966, 21, No. 4, p. 110. 510 Summaries I. Work, Leisure, and Education: Toward the Goal of Creating Flexible Life Styles As American society has become more and more highly industrialized, the adult segment of the life-span has become much more open to changes and to choices. The ideal goal for an in- dividual living in an automated society is to achieve a flexible life style— one that can change to meet new demands and new opportunities. The counterpart goal for society, if it is to act respon- sibly toward its citizenry, must be to help the individual maintain a sense of competence in the face of change by providing him with realistic possibilities for personal growth throughout life. The realization of this last requires social and economic policies that provide adults of all ages with a range of options for work, education, and free-time activities. Such policies, in turn, need a firm basis upon research and the results of pilot programs concerning: (a) the economic system, which provides work and income; (b) the edu- cation system, which provides training, stimula- tion, and a sense of competence for work and free-time activity; and (c) the emerging free-time system, which includes play, contemplation, and voluntary unpaid services. A. The economic system: the labor market and the individual work career. New occupations, new specialties, and new jobs emerge continually. In our highly industrialized economy, only one man in five will remain in the same occupational category for his entire life. The job change in- herent in and, indeed, required by our current economy is, however, seldom orderly and coher- ent. If we ignore both the occupationally highly- stable professionals and the occupationally highly- unstable casual laborers and consider only the majority of workers at the "common man" level, we find that less than a third of them spend half or more of their work lives in positions of employ- ment that can be arranged in an ascending order of prestige and achievement. We need a national policy in support of efforts that will reduce the chaos of the labor market and thereby strengthen the individual's possibilities for achieving strong identity through satisfying work. Such policy needs to be based on research concerning: (a) the characteristics of people who need and desire work but do not have adequate opportunity (such as women, the handicapped, and older workers) as well as those presently considered by industry to be unemployable for emotional or educational rea- sons; (fe) the creation and development of new jobs in the public sector; and (c) experiments with flexible retirement at all occupational levels, which would include development of mid-career change programs, of new careers for mature and older workers, and arrangements to permit con- tinuing partial employment after the usual retire- ment age. Programs now underway in the public sector need to be continued and evaluated on a long-term basis, with results compared across pro- grams and given wide circulation. Many pilot programs now operating in the public sector are likely to be of value in designing programs for the private sector. Along with such research and development, at- tention must be given to measuring the losses that would be borne by employers if they adopted flexible retirement and mid-career change plans. Work aimed toward producing more precise measures of functional age is also urgently needed. Extensive research upon the relationship of age to functional abilities undertaken with civil air- line pilots has shown that ability varies widely among persons of the same age. Such work should be extended to other occupations. Age limitations for employment are both socially and economi- cally wasteful, since chronological age is rarely a reliable index of potential performance. 511 Private pension plans are growing in importance and in popularity among workers, but little is known of the relative advantages and disadvant- ages of the many and various pension schemes. As well as studies of existing data that will relate vesting provisions to labor turnover, we need longitudinal investigations of young people enter- ing the labor market at the present time. How long does it tale beginning workers with varying characteristics and qualifications to settle upon a lifetime job? How important to prospective em- ployees are the pension benefits an employer can offer? Only longitudinal research can provide adequate answers to such questions. B. The education system. Education has tra- ditionally been viewed as an activity appropriate to the first quarter of the life-span. In an economy that requires constant renewal of knowledge, how- ever, we are likely to turn more and more to the concept of life cycle education. Experimental adult education programs should be supported, with emphasis on enrollment of persons over 50, an age at which participation now drops off rap- idly. Studies are needed of the educational ac- tivities of persons in occupations where early retirement is normal (such as the military, law enforcement, and athletics) Special attention should be given to the evaluation of current pre- retirement programs. As knowledge is gained concerning the adult years, efforts must be made to incorporate it into curricula for the training of professional workers. Just as child development was found at the turn of the century to be a necessary area of study for physicians, social workers, and teachers, so now is adult development and aging coming to be viewed as necessary for attaining professional competence in work with adults. Calls are now being heard fear a new service occupation, per- sonal care, that will incorporate the specialties of many occupations in the service of providing pro- tection and maintenance support for our growing population of elderly. Basic knowledge of the "total adult" will be necessary in order to inte- grate the diverse skills from such fields as law, nursing, and occupational therapy into a co- herent course of training. C. 77te emerging free-time system. The propo- sition advanced in this Report is that people in the United States are on the verge of a funda- mental reorganization of the adult life-span that will mean the more even and continuous distribu- tion of education, work, and leisure throughout the course of adult life. Initial changes In this direction in now evident on various fronts. The average man now has time to seek training for a new job. The work week has shortened, the vacation lengthened. As work becomes more flexible, it is possible to create a more flexible life, one that is open to a variety of possible options and developments. The key question is — To what extent can man make good use of his increased free time? It is well to make a distinction between free time and leisure. Free time represents potential opportun- ity; leisure, what develops when people use their free time to get more meaning out of life. In an ideal socioeconomic structure in which the basic material needs of middle-aged and older people are adequately met, it becomes important to set up arrangements in the society to assist people to enjoy true leisure in an active, involved, creative sense. Clues to the nature of such social arrangements might come from the study of how people currently use their vacations, how they combine work and recreation when they are really free to develop their own unique combinations, and how they make the transition from work to play. The Uses of Free Time. — Among the people who have studied the uses people make of their free time, there is agreement that three broad categories will cover the activities of people when they are not working for money or doing the things re- quired for their personal care and family obliga- tions: 1. Study and comtemplation, 2. Play or recreation, 3. Voluntary non-paid service. People who are in a position to organize their adult lives so as to maximize satisfaction will com- bine work with free-time activity in ways most desirable to them; and they will select and com- bine a variety of free-time activities. The social roles of the elderly need to be studied to find out how the social and personal needs of older people can be satisfied through changes in the distribution of effort and time among the various social roles available to them and as time is gained by a decreased need to expend effort in the worker role. Conclusion. — Flexible life styles depend to a considerable degree on the opportunity for free choice and the use of this opportunity by people. Therefore the limitations on free choice should be studied critically. For this reason we have suggested the need for research and experimenta- 512 . tion with the rigidities in the American work, educational and leisure systems, such as automatic and compulsory retirement, lack of vested pension plan, arbitrary age limits on employment in cer- tain occupations, etc. The device of voluntary work for no pay or limited pay has been expanded recently through the development of VISTA, the Peace Corps, and discussion of a National Senior Service Corps. As the principle is developed of the use of public funds to support a wide variety of service activities for needy old people and poor people, opportunities for voluntary service will increase. At the same time, it seems probable that a large number of non-paid or low-paid roles will be created in the field of the performing arts (theater, ballet, or- chestra) under the auspices of the National Foun- dation for the Arts and Humanities. As these choice-enhancing opportunities develop, there should be research on the people who take them. What kinds of people make use of these opportunities, and what values do they obtain? II. Living Arrangements of Older People: Ecology Physical environments may either enhance and complement the quality of life for the aging adult or restrict the opportunities for independence and satisfaction in the later years. Although particular characteristics of communi- ties and dwellings are known and data concern- ing aging adults in the United States are available, relatively little behavior-environment research has ever been conducted relevant to the processes of human aging. It has been our purpose to identify the specific characteristics of living environments which should be of particular concern to applied research in social gerontology. Features of neighborhoods and residences which are the product of physical deterioration, economic neglect, and rapid social change have special im- pact on the function of the aging person. These impacts are visible in known problems of isola- tion, immobility, health accidents and the utiliza- tion of health services, robberies, and attacks, etc. Public policy in the United States has already given considerable social priority to the problems of urban growth and the crises of cities. The Model Cities Programs, designated as remedial demonstrations by local, state and federal govern- ments, appear only tokenistically to include con- cern for the aging adult. Housing programs supported by government pro- vide under 10% of the new construction needed by the elderly, nationally, and probably no more than 2% of needed new housing for the rural aged. Were monies to be made available for a con- siderable greater volume of housing earmarked for the population over 60 years of age, there would be little scientifically sound basis upon which structural, size, spatial or locational deci- sions, with respect to such housing, could be made. Inadequate attention has been paid to the practi- cal alternatives in environmental improvement often more natural to people than age-segregated apartment enclaves, retirement villages, or con- gregate facilities. Standards for rehabilitation and conversion of existing housing and neighborhoods, which are congenial to age heterogeneous popula- tions and multigenerational families, have yet to be specified. Certain applied research directions and meth- odologies with regard to the living arrangements and ecology of older people can now be specified. Methodological Problems 1. Planning of more congenial environments for the aging adult requires refinement of our statisti- cal descriptions of sub-populations within the larger group called "the aged." a. Because of the variability inherent in the process of human aging, age data should probably be made available in 5-year groups for popula- tions over 50 years of age. b. "Head of household" data are inadequate for planning the housing needs of special family groups in the population, e.g., living environments and behavioral patterns of spouses of those over 65, themselves 50-65, need specification. c. Life styles and environmental needs of such special groups as elderly, urban, single black men; or grandparents living with children and grandchildren; need to be explored and specific remedies for problems demonstrated. d The range of "immobilities" (levels of function) of aging groups need to be specified in ecological research. 2. Sources of continuing descriptive data on aging populations are potentially available to re- 513 searchers and planners but have been inadequately tapped and never analyzed for comparability. A central clearing house for data relevant to aging and environments, to which, for example, employ- ers, insurance companies, and the many separate data collecting arms of public agencies would contribute, is now urgently needed. It is certain that such centralization would result in the vis- ualization of unnecessary duplication and of non- comparabilities in descriptive methods. 3. Both neighborhood and residential settings within which aging adults live and move require specification in terms of the known needs and activities of the aged. Variables which appear of most potential value to planning environmental changes are: a. Physical suitability of dwelling units and outdoor spaces; b. Age specific population densities and ratios of older age groups to the total population of the 'area; c. Availability and accessibility of selected commercial and social services inside and outside of an area; d. Characteristics and use patterns of varied transportation modes, public and private, by spe- cific age and social sub-groups within the popula- tion; e. Physical and social barriers to optimum functioning of aging groups which prevail or are developing in an area; f. Economic resources for neighborhood de- velopment and housing, which are available to, are understood by, and utilized by aging in- dividuals and communities. Research Needs 1. Experimental housing units provided for de- fined population groups in a defined range of environmental settings. Such housing should: (a) systematically vary In population density/age, (fa) explore innovative variations in location of com- mon facilities, in safety and functional features, and in person (family) -space relationships. 2. Behavior-setting studies should be supported in a variety of community-size settings. Study of the interaction of adults in old established settings should be supplemented by study of interaction of adults in a variety of experimental settings. 3. Current and future transportation, traffic, and mobility problems of aging groups need fur- ther exploration. Innovative solutions need to be systematically demonstrated. Setting variables and age-function variables need to be carefully con- trolled in such demonstration research. 4. Research on the choices made by people and their decisions with respect to housing and living arrangements should be made with middle-aged as well as with aging people. There is no guaran- tee that the choices and decisions made by the contemporary generation of older people will also be made by the coming generations who will differ from them in education and health status. Furthermore, the changes of housing and living arrangements in metropolitan areas will present the next generations with substantially different problems of choice and decision than the present. III. Social Services for the Aged and Aging: Suggested Research Priorities HPhe majority of aging and aged adults in the •*• United States do not live in institutions. Rather, they remain in their communities and manage without the help of organized social serv- ices. When families and individuals require social intervention because of age-related needs, the cap- ability of communities to respond effectively and efficiently is often deficient. Flexible and alterna- tive programs for providing income maintenance, health services, housing, and work and leisure activities are often either not apparent to the per- sons in need or are not, in fact, available. Because of the varied and changing needs of individuals over the later years of life, social serv- ices need to be comprehensive, to provide services ranging from simple information to immediate direct service during a time of crisis. To achieve this goal it is necessary to clearly identify the elderly who require services, to ascertain their needs and requirements, and to learn how to de- liver services to them most efficiently so that their lives can be permanently changed for the better. Research is particularly needed to clarify the following: (a) the effect of social services on the functional capacity of the individual; (b) the rel- ative values of services offered on the basis of age segregation and those offered in a mixed-age sit- uation; (c) the degree to which older persons may 514 determine which services are best suited to meet their needs; (d) the special requirements of ethnic and economic sub-groups; (e) effects of possible amelioration of the aging process or changes in the social order upon requirements for community services; and (f) a basis for projecting the future service needs of the aged. There is also a great need for the development of a variety of models to demonstrate, explore, and serve as guidelines for the provision of services. These models should focus both upon the provider of services and upon the consumer. In all cases, it is of extreme importance that evaluative re- search be designed into each model tested. The major recommendations regarding research needs reflect a basic lack of information concern- ing the effectiveness of current methods of provid- ing services for the elderly. In particular, we need research on: 1. How to organize and deliver adequate com- prehensive services to the aged. 2. The psychological consequences of how serv- ices are offered and how this affects consumer usage. 3. The range of environmental situations which promote or hinder access to services. 4. Uses of public and private facilities, includ- ing schools and community centers, with demon- stration programs, backed with evaluative research on how these institutions may be used more ef- fectively. 5. Identification of the changes in need that accompany the move from late maturity to ex- treme old age. For this task, longitudinal research will be needed, both with representative samples and with samples from minority groups. 6. Development of a variety of instruments or social indicators to (a) appraise the effectiveness of service; (b) determine disability or functional capacity; and (c) identify individual service re- quirements. 7. The development and evaluation of systems for providing information concerning persons with need and for referring such persons to appropriate services. Such systems must have the function of evaluating the relevance and quality of service ultimately rendered, as well as that of evaluating and classifying needs. 8. Experimentation to determine the relation- ship of housing and other environmental factors to the ability of the elderly to manage on their own. 9. The development of new strategies and pol- icy for gaining personnel to provide services to the elderly. 10. Operational research on methods for or- ganizing medical and health services and deliver- ing care to the elderly. Attention must be given to the problem of ensuring that older people get their just share of such care. IV. Economics of Aging The purpose of this paper is twofold: one, to briefly discuss the nature of the income prob- lem in old age by describing the behavior of earn- ings through worklife, the drop in income at re- tirement, and the subsequent deterioration in in- come position during the retirement period; and two, to identify and discuss a number of import- ant areas where there is a need for greatly ex- panded economic research activity. Incomes of the present aged are significantly lower than those of the younger population. In 1967 the median income for families headed by persons aged 65 or over was $3,928, compared with $8,500 for families with heads aged 14-64. Com- parable medians for persons living alone were $1,480 and $3,655, respectively. Over and above social security benefits and benefits from private pension programs, there is very little income from savings for the older pop- ulation. Furthermore, this income tends to be constant, while the cost of living rises. Older people generally do not share in the extra income created by rising productivity and rising per capita gross national product. The economic status of the future aged is pri- marily dependent on: (a) the earnings-consump- tion pattern during worklife and hence the extent to which private savings are accumulated for the nonworking period; (b) the division of workers' pay packages between current wages and private pension claims; (c) the retirement age decision; and (d) the extent to which the future society is willing to transfer income claims from workers to retirees via the tax-benefit mechanism. In addi- tion to these variables which together explain the dollar amount of retirement income and financial 515 claims, the ageds' economic situations are colored by the forces which determine the purchasing power of their money income and the factors which change the ageds* income status relative to that of the working population (inflation and economic growth). For most families, the income problem in old age grows out of the cessation of earnings of one or more family members and the failure of private savings and/or private and public pensions to re- place a sufficiently large proportion of these earn- ings. For a significant number of retirees, how- ever, very- low incomes were a problem throughout worklife; some form of income maintenance was in order even before they became too old to work. Research into the income maintenance issues as they pertain to the aged requires a focus some- what out of the mainstream of current poverty research devoted to raising low incomes. In the case of the elderly one must be concerned not only with those who have always lived below the poverty line, but also with families whose earnings during worklife provided a comfortable level of living and whose retirement incomes are now meager. While recommendations for some minimum income for all persons may well grow out of the current study focused on problems of poverty-level groups, such proposals are not likely to attend directly to the problem of substantial income loss associated with retirement and the subsequent deterioration in income position dur- ing the nonworking years. Income-maintenance issues as they relate spe- cifically to the elderly require further research into (a) questions of the present and future in- come and wealth levels in old age; (b) the rela- tionship of these levels to pre-retirement income levels, to general budgetary requirements of the elderly, and to the income-needs gap of particular aged groups; (c) the transitional period into re- tirement and the decision-making process involved; and (d) considerations of the adequacy of cur- rent income maintenance institutions and the costs of alternative financing arrangements for these institutions. Major recommendations regarding r< needs concerned with economic aspects of aging are: 1. More detailed tabulations and analyses of existing data and development of new data to more clearly differentiate the economic circum- stances of various aged subgroups. 2. Expansion and updating of simulation pro- jections of the economic circumstances of the fu- ture aged populations. 3. Further research which investigates the im- plications of assets held by the aged (particularly home owners) on their economic well-being. 4. Development of new measures of income adequacy — especially measures which relate re- tirement income to preretirement earnings — and refinement of existing measures. 5. The expansion of longitudinal research to supplement cross-sectional surveys (which tend to hide the changing status of the individual). 6. The gathering of more information regard- ing the population's retirement expectations and other attitudinal questions. 7. Additional econometric studies of the labor force to help understand the motivations for em- ployers' retirement polices. 8. More investigations of labor-management attitudes and practices regarding middle-aged and older workers. 9. Constant study of various proposed changes in the current social security program. 10. Comparative studies of public pension systems in other countries. 11. Estimates of cost and effectiveness of various proposed reforms in the area of aged income maintenance for use in establishing national goals and priorities. 12. Improved estimates of future private pension coverage and benefits. 13. Systematic study of the changes occurring in private pensions — especially benefit levels, vest- ing requirements, and survivor's provisions. 14. Continuing research to evaluate the opera- tion and adequacy of Medicare and Medicaid, along with special attention to alternative ways of financing institutional care for the very old. 516 Chapter I Work, Leisure, and Education: Toward the Goal of Creating Flexible Life Styles The adult portion of the human life cycle is spent within the realms of work, family life, education, and free-time activity. Until recently, free time and education have occupied minor positions within the total life-span compared with work and family life. Indeed, only within the lifetimes of our present population of older people has education come to mean potentially more than training for work, free time more than the interstices between work. Now, with the conditions of a highly productive and prosperous society, the adult segment of the life cycle has become much more "open." There is more variety, and there are more uncertainties. Not only does there exist the possibility that one may spend some time working at an occupation that did not exist at the beginning of the work life, but for the first time, the common man has been presented with the possibility that he may choose (especially toward the beginning and the end of adult life) between education and work, or between work and free time. Compared with the population living in the 19th century, people today not only have the po- tentialities for making more choices; they must make more choices, if they are to respond ade- quately to changing opportunities and changing demands. It is our assumption that the pace of change in American society will increase rather than de- crease over the next few decades and that indus- trial efficiency will rise, thus making production work (that is, work expended to convert raw ma- terials into consumable goods) less necessary to our total economy. Such development will have, and indeed is now having, far-reaching effects upon individuals and their institutions. The identity defined for the young adult by his work and family roles may have to be changed, as old jobs are abandoned and new ones learned. A severe test for many men and women comes after they are 50 years old. Parents then face the task of creating a new form of family life without young children and generally without children in the home. Men often need to change jobs, while women may consider entering the labor market. These people must achieve new identities. There is both challenge and opportunity in es- tablishing new identities— a precious force in hu- man growth. The elderly today are the pioneers of this process. Never before have so many lived to so great an age — or lived so long beyond what society has defined as the limits of working life. The greater material resources and free time provided the current population of adults by our highly industrialized and stable economy will not suffice to solve the emerging problems of the in- dividual without the recognition by and the ac- commodation of society toward their solution. Such efforts must be based upon research: to examine trends in emerging technology and [to] project the change in roles that will be likely to emerge from such changes in technology and in so- cial organization necessary to put it into human service. . . . Essentially we feel that analysis of both changing technology and changing values should be made, treating them as inter-dependent rather than independent variables. . . - 1 The individual's goal in an automated society is the achievement of a flexible life style— one that changes to meet new demands and to take ad- vantage of new opportunities. The goal, for a society responsible to its citi- zens, is to help the individual maintain a sense of personal growth by establishing and maintaining economic and social arrangements to provide pos- sibilities for growth. These arrangements would: 1. Permit the young adult worker to grow with his job through training and eduation. 2. Enable the worker to change jobs or type of work with a minimum amount of loss — and, more- r )17 over, only with km he can adequately estimate and weigh. 3. Allow women to move freely between the roles of home-maker and worker. 4. Enahle the older worker to keep productive employment as long as he wishes to and is able to maintain a reasonable level of efficiency. 5. Permit men and! women to plan for free time and to use it enjoyaibly and creatively. 6. Enable older people to live in material com- fort without the necessity of working for money. The realization of this goal implies the support of social and economic policies which provide a range of choices affecting education, work, and free time. For example, in order to help main- tain flexibility of work and to avoid fixation and obsolescence of the individual, there must be read- ily available information about jobs beyond the local scene and refmed and expanded job place- ment services. Similarly, in order to sustain the basic needs of the Individual while he is getting new training, there must be provisions for finan- cing job change as well as for subsidizing employ- ers, when necessary, $or accepting less than fully- trained workers. Arui, in order to maintain condi- tions supporting psychological health and to enable people to emjoy leisure in good health, there should be provision for flexible retirement — a retirement that is not concentrated toward the end of life, but one tihat runs periodically through the course of adult life. Research Needs A social policy wisth these goals requires re- search and research Institutions to: 1. Provide up-to-darte information on the na- tional economy and tihe regional economies and see that this information becomes available to the individual. 2. Develop new patterns of employment, train- ing, and change in tfiae worker role through ex- perimentation and evaluation of experiments. 3. Study and evaluate patterns of established and emerging uses of free time. Three broad social "systems should be studied in terms of their effects, singly and in unison, upon the individual adult. These are: A. The Economic System, which provides work and income. B. The Education System, which provides train- ing, stimulation, and competence in work and free-time activity. C. The emerging Knee-Time System, which in- cludes play, sti»dy, and voluntary unpaid services. The body of this Section ol the Report li de voted to an exposition <>l the i"' these systems, to a critical analysis "I the M in these systems which h;is contributed to the goal Of flexible life styles, and to proposals for future research. A. The Economic System: Labor Market and Work Careers Occupations, and the skills they demand, con- tinue to change very rapidly, with new occupa- tions, new specialties, and new jobs emerging con- tinually. Based on past experience, we have the conservative estimate that, beginning with his first full-time job held at least 6 months, the average man in the middle income range (that is, the stable working-class or lower middle-class worker) holds 12 different jobs in a 46-year work life. Re- search also indicates that most of these job shifts involve a change in both occupation and industry (by the census definitions of major categories), with the greatest frequency of change occurring in young adulthood. Only one man in five will re- main in the same major occupational category for his entire life. This is a century of emerging new occupations which require a variety of kinds of preparation, and each new occupation is likely to require some special training for its members. For instance, in the health field there are 250 separate names given to health specialties, of which about half are distinctly different jobs. If we define "career" as a succession of jobs re- lated in function and arranged in a hierarchy of prestige, through which persons move in a se- quence they can perceive to be predictable and orderly (as in some established crafts), then less than a third of all "common man" workers (that is, adult male workers who are neither profession- als nor marginal laborers) act out half or more of their work histories in a career. Even when the low status, part-time jobs held by adolescents are excluded, research indicates that most work situations simply do not afford the stable progres- sion over the worklife that workers are coming to expect in an affluent society. 2 There is a good deal of chaos in modern labor markets, chaos that appears to be intrinsic to ur- ban-industrial society. Rapid technological change dilutes old skills, makes others obsolete, and creates demand for new ones; a related de- centralization of industry displaces millions, creat- ing the paradox of depressed areas in prosperous economies; metropolitan deconcentration shifts the clientele of service establishments, sometimes 518 smashing or restructuring careers; recurrent crises such as wars, depressions, and recessions, coupled with the acceleration of fad and fashion in con- sumption, add a note of unpredictability to the whole. There are many familiar variations on the main theme: in industries such as construction, entertainment, the maritime services, and agri- cultural harvesting, the employment relationship is typically casual. In food processing and the needle trades, drastic seasonal curtailments are common. What is new for the 1960's and the 1970's is that expectations for more orderly careers are rising at the same time that the labor force ex- periences continued or intensified job chaos. Manpower Policy Needed Talk about flexible work for the middle aged or aging is misleading unless it is placed in the context of analysis of manpower planning for everyone. The middle-aged or older person who feels dissatisfaction in his work life will not recog- nize the possibilities for favorable change unless he has experienced competence and satisfaction when seeking employment earlier, has access to enough information to make rational decisions concerning job change or further training or a geo- graphical move, and, in addition, has the financial resources for change. Moreover, many of the big reforms needed (e.g., the establishment of com- munity manpower centers) cannot be instituted unless they serve the general public or at least receive very wide public support. What are the special targets of an active man- power policy? Recently there have been increases in structural unemployment, i.e., among certain segments of our population— Negroes, teenagers, women, and the aged. At the same time, there have been continued shortages of professionals in such fields as health, education, and welfare, as well as science and engineering, more severe short- ages of semi-professionals and semi-technical people, and selected shortages in expanding trades (e.g., painting, carpentry, cement masonry, book- binding). The poor— i.e., the aged poor, the de- serted-woman poor, the welfare poor, the Negro poor, the dropout poor— present a series of special problems which require vast programs only hinted at in the skirmish with poverty. Moreover, the considerable amount of frictional unemployment (i.e., of time spent in the limbo of job search) inherent in a disorganized labor market saps the economic and psychological resources of persons who are not, in the usual sense of the term, dis- advantaged; and can lead them to accept employ- ment below their capabilities or desires. An active manpower policy will be designed to cope flexibly with the special needs of both the identifiably disadvantaged and the persons who can be ex- pected, without special training programs, ulti- mately to find work. Research contributory to manpower policy would give priority to studies of (a) untapped sources of manpower, (b) the creation of jobs and careers that serve personal and social needs, and (c) the means whereby persons in differing cir- cumstances seek work. Untapped Sources of Manpower: People Who Want and Need to Work But Do Not Have Adequate Opportunity 1. Old men and the disabled.— -The labor force participation of old men has tended to decrease in every industrialized country since 1890— be- cause of educational and occupational obsoles- cence, because of the decline in "old men's" jobs (such as farmers, tailors, sleeping car porters, and locomotive engineers), because of compulsory re- tirement practices and age discrimination in hir- ing. Automation will intensify this trend. Repeated survey researchers have indicated that the main reason for "voluntary" retirement is ill health; the main reason for remaining at work full time after retirement age, income. We have, how- ever, done very little in depth research on such issues as the length of time persons yearn for work after compulsory retirement or the processes by which older people become adjusted to (or reconciled with) spending the rest of their lives in retirement. What people say, furthermore, is only partly commensurate with what they do. We do not know how many older people who say they wish to work would actively persist in seeking work over an extended period, accept work at a lower salary and prestige level than that to which they have been accustomed, or undertake train- ing for a new job. We also do not know how much additional income it would take to move significant numbers of older persons in differing socioeconomic circumstances from the "seeking work" to the "satisfactorily retired" category. Long-term policy decisions, furthermore, must be made in light of knowledge concerning the amount of work future populations of aged will desire. Work appears in recent years to have lost some of its moral overtones, since adults now evince less guilt over spending time and money on recreation than they did at the turn of the 519 century. This shift in attitude, however, occurred concurrently with the decline in the average work week. It may be that the morally obligatory quali- ties of work only appear to have lessened, as work has come more and more to be viewed as nor- mally occupying only a precisely-defined and restricted number of hours. Should this be the case, then the adverse psychological effects con- nected with the loss of the work role cannot be expected to lessen appreciably in succeeding dec- ades. Careful research is needed upon the mean- ing of work for the current population of young adults and middle-aged people; and develop- mental studies should be carried out to determine if and how attitudes toward work change as the middle-aged move toward the retirement years. Research questions: How well do our public and private disability programs, job retraining programs, and unemployment services and benefits meet the needs of older workers? Evaluation is needed of the Javits-Hartke bill to extend unemployment benefits to eligible older workers. We need, also, to study the early retirement, disability, and unemployment programs now in effect in other industrialized coun- tries. Would the implementation of more liberal benefits than we now have for retirees cool the de- sire of older persons for work? How can employers be persuaded to retain or hire older men who wish and need work? To what ex- tent would inefficiencies requiring outside compensa- tion or subsidation occur when such personnel re- main at work? Case studies of firms that do not have compulsory retirement policies or that do not practice age discrimination in hiring might demon- strate that the presence of older workers does not necessarily result in economic loss. What determines whether the older worker handles aging as a devastating tragedy or as a door-opener? Research on opportunity might discover the lines of work in which employers (a) now seek older work- ers, or (b) can be persuaded to try; and in which older employees are more or less successful than younger ones. 2. Women. — As nations have become indus- trialized, they have experienced a universal rise in women's desires and opportunities for work out- side of agriculture and the home. (Much of the displacement of older men in very recent years in the United States has been due to the increased availability of middle-aged women for clerical, personal service, and professional jobs. Jobs for women have also shown a disproportionately greater growth than jobs for men.) Research questions: How can employers and govern- ment create part-time jobs and flexible schedules to fit women's needs? What is the experience with at- tempts to do this? What is the experience under the recent law barring discrimination by sex? What edu- cational programs can be devised to reorient and retrain and place women returning to work after their children are (a ichool 01 gone? wh.it bai bean thi development In European nations, with i rea t e i nun bers of woman In the profeetionj than li uw la the United States? Job creation, job development. — There is no mystery about how new, useful jobs can be created for those least able to compete in the labor mar- ket: the starving public civilian sector can gen- erate the jobs whenever we decide to invest the necessary money in desperately needed services in health, education, and welfare. The 1966 report of the National Commission on Technology-, Au- tomation, and Economic Progress put it plainly. New programs such as the Neighborhood Youth Corps recognize the anomaly of excessive unemployment in a society confronted with a huge backlog of pub- lic service needs in its parks, its streets, its slums, its countryside, its schools and colleges, its libraries, its hospitals, its rest homes, its public buildings, and throughout the public and nonprofit sectors of the economy. They recognize that employing the unem- ployed is, in an important sense, almost costless. The unemployed consume; they do not produce. To provide them with meaningful jobs increases not only their income but that of society. Much of the work that needs doing calls for only limited skills and minor amounts of training. Some of it is manual in character; some of it is sub-professional. The Commission estimated that 5.3 million jobs can be provided through public service employ- ment in six fields — medical institutions and health services, educational institutions, national beauti- fication, welfare and home care, public protection, and urban renewal and sanitation. 3 Research questions: Some communities have tried such job development. Comparative evaluation of administrative arrangements, types of recruits, train- ing programs, usual job performance — successes and failures — would be instructive. Considerable attention has been given at the na- tional level to manpower planning in the recent years; and we wish in this report to underline the importance to the health of the nation of the pro- posals of the President's Commission on Man- power. The economy of the United States is truly national, but the labor market is as yet a highly uncoordinated conglomerate of local markets. The government employment system has coordinative ties with neither educational institutions nor with other governmental agencies that have the poten- tial for expanding the manpower market, as is true in certain European countries. The efficiency of the public employment system can be estimated by the number of new workers it places and by the amount of help it can give the laid-off worker. Currently, the governmental system places only 520 about 16% of all new workers. 4 A study of job-seeking behavior of laid-off workers in a lo- cality possessing a state employment office noted for its innovativeness and efficiency showed that, although well over 80% had sought jobs there, the state employment office placed only 14% of the male workers and 13% of the female workers. Considerably over half of these workers obtained new jobs through relatives and friends. Of a small group of white-collar women workers (who had also used private agencies), 35% were placed by the private agencies, compared with 24% by the state employment office." A system of job procure- ment which is accidental to this extent does little to enhance rational job mobility.* Research needs: Much more study is needed of the labor market and its regional variations, as well of as the job-seeking efforts of persons of varying socio- economic status within it. The pilot efforts to in- crease mobility, such as grants-in-aid for unemployed persons wishing to locate, should be evaluated. Mid-Career Changes An apparently growing number of persons want career changes when they are in their late 40's or early 50's. Some are retiring from organiza- tions which do not want older employees in great numbers, such as the armed services, police and fire departments, and professional sports. Others want to change because they have lost interest in their present jobs. The majority of these people change employers at this time and look either for training to prepare them for the new job they think they want or directly for a new job. However, middle-level white collar employees of a big organization may prefer to change positions within their own organi- zation. This may be true of people working in a large governmental organization, or in a manufac- turing concern, or in a school system, or in a church organization. These latter people may be quite valuable to their employer, even though they wish to change the nature of their work. To give such people the opportunity to make choices more freely, some large firms have been experi- menting with sabbatical or study leaves, with mid- career clinics and other devices aimed at greater career flexibility. By such means, persons are aided in choosing and assuming occupational positions outside their regular promotion ladder. The choice may be for a less demanding job, one which would represent in retrospect the first steps toward retirement; or for a more demanding job, one more in line with abilities, or one which would permit continuance in the labor force be- yond the customary time of retirement. Experiments with flexibile retirement procedures are desirable at all occupational levels. Part-time work appears to be attractive to many men and women in their 60's and 70's; some prefer full- time work, even at an advanced age. Individuals need to be protected, however, from unrealistic views of their ability, and the public needs to be protected from incompetent workers. The success of efforts toward solving these two problems re- quires the development of measures of efficiency and productivity tailored to fit the needs of specific occupations. (Current work in this direction is summarized below, pp. 26.) Flexible Retirement As pension plans and social security benefits have increased, the statistical trend has been to- ward earlier retirement. In the face of this trend, there has been a stubborn insistence on the part of many people that they do not wish to retire before 65 and would prefer to continue to work after that age. Davidson's study of early retirees from the Lockheed-California Company' indicated that "The more successful a retiree had been in his working career, the less satisfaction he received from the typical retirement activity." Studies of attitudes toward work and retirement on the part of professional men (physicians, law- yers, teachers, engineers) indicate that they gen- erally continue to work beyond the age of 65 if they are free to do so. Mid-career transfers. — Non-competing public service organizations (such as telephone, power, and transportation companies and hospitals) and certain government services (such as the Post Of- fice) are organized regionally or locally but have greatly similar occupational structures within a given field. Systems for providing workers with options for occuptional change within a company, or for transferring to another region, could be cooperatively developed on an experimental basis, with assistance from public funds and with pro- visions for evaluation. Such programs would aid (a) persons displeased with their current occupa- tional niche, either because it does not offei enough opportunity or because it is currently toe difficult; (b) persons who face technological dis- placement; and (c) persons seeking alternate work that will permit them to earn income pas retirement age. Such systems would present certain problems given the differences between concerns in salar and fringe benefits and the tendencies for com panies to bypass older workers. Such losses, how 521 ever, both real and those erroneously anticipated, could be at least partially compensated for. The opportunities such research and development would provide for extending our knowledge con- cerning the capacities of older persons and persons with minimal amounts of formal education would far outweigh the initial costs of such programs. New careers. — As products and methods change, situations are created in which new jobs suitable for mature and older workers might be developed. At present, many organizations seem to reject the "new careers" approach to unemployment because it frequently implies merely breaking down pres- ent occupations into simpler components which can be handled by poorly- trained, marginal per- sonnel. What is needed is systematic development of new positions that are integral with the larger organization and in line with its general goals. Such development is now rare, but could be in- jected into current job development programs by providing monetary incentives to organizations that are willing to take risks in training man- power and in developing new jobs in line with changing conditions. At the present time, small experiments are required, with careful evaluation. A considerable amount of retraining for new careers in middle age is going on in Europe. 3 Great Britain operates government training cen- ters for adults. There are a hundred centers for retraining adults in France. In Sweden, 1% of the adult population is being retrained (at any one time) for a new occupation. It appears that many middle-aged workers apply for jobs requir- ing lesser skill when they are automated out of their old jobs. Counseling and encouragement to seek retraining are needed to help people main- tain their skill level when changing jobs in middle age. Flexible retirement.— -Workers at retirement age who wish to keep on working might be retained by their employers for a stated period, or indefi- nitely, if these employers could have demonstrated to their satisfaction that such arrangements could be made without upsetting regular personnel poli- cies and the expectations of other workers for pro- motion and without economic loss to the firm. Reassurance can come only from carefully con- structed experiments designed to measure costs in loss of efficiency by retained workers. Such ex- periments, in their turn, will depend upon the development of measures for efficiency and pro- ductivity. Employers might well need, in addition to technical assistance for setting up such programs and evaluating them, help in meeting the l fringe benefits and in adjusting managemer.: and union policies so that older workers may tained. Research funds should support develop- ment of various types of programs and should provide evaluation over a period of at least ' Continuing partial employment. — Worker's needs for partial employment can be met by a shortened work week; by increasingly longer va- cations for older workers; by the breaking down of full-time jobs into two or more part-time jobs; or by retaining a retired worker on a substitute or a consulting basis. Some professional and man- agerial workers have continued part-time employ- ment by consultation-service organizations. The government has utilized older workers for brief periods in Project FIND and Medicare Alert. Partial employment requires development in three directions: the establishment of pilot pro- grams and incentives for firms to retain employ- ees past retirement age on a part-time basis; and the development of organizations of older workers to provide needed services for themselves and for others; and the development of part-time service occupations to utilize the skills of older people, such as the experimental "Green Thumb" and "Foster Grandparent" programs. For those pro- grams in the first category, the same difficulties apply as for flexible retirement programs within government and industry. For those in the second category (which are most applicable to profes- sional and managerial persons), economic aid, such as that now tendered through the Small Business Administration, is likely to be needed, as well as some technical assistance. Programs in the third category can be encouraged through re- search and development grants to non-profit ser- vice and welfare organizations. Research needs: Development of such programs within the private, profit-making sector of our econ- omy are still at the initial stages. A descriptive assessment of similarities and differences of current programs within industry, with evaluation of prob- lems and results that have emerged thus far, are currently needed to provide a basis for systematic expansion of such programs. Study of such practical issues as measurement of loss of productivity inher- ent in retaining older workers, extent of disruptions in personnel procedures, pension plan problems, loss of promotion for younger workers, latent costs in shifts of schedules and work roles, and resistance within the private sector to government financing of research and development— all need to be ex- amined. Programs now under way in the public welfare sector need to be continued and evaluated on a long- term, continuing basis. The results need to be com- pared across programs and given wide circulation, 522 comparable to that given the results of social ex- perimentation directed toward the beginning of the life cycle. Much of work in program development now going on in the public welfare sector is likely to be of value in designing programs for the private sector. And finally, experimentation in the development of new careers and flexible retirement is likely to pro- vide basic knowledge concerning adult life in the middle and later years. Basic research, that is, can serve two purposes: enhancing satisfactions and in- comes for older people and producing data for answering such questions as: How can society en- hance personal satisfaction, self-esteem, and physical and mental functioning in later life? What are the characteristics of older people who are amenable to occupational change? What social and ethnic dif- ferences among the old detract from, or add to, life satisfaction? What kind of retirement preparation is needed for persons at various socio-economic levels, and how soon should retirement preparation begin? Studies of Productivity and Efficiency Related to Age As a basis for the operation of a policy of pro- moting career flexibility there is need for much more information about the productivity and ef- ficiency of men and women in various occupa- tions in relation to their age. Some of this kind of research has already been done. For example, the rules for employment of airline pilots past the age of 50 have been substantially reviewed and reconsidered as a result of research. It is desirable to define the concept of functional age as contrasted with chronological age and to de- vise ways of measuring functional age in relation to the requirements for competence in various oc- cupations. Chronological age, as measured in years and months, is not the same as physiological age. There are great individual differences in the physi- cal stamina of older persons, and chronological age is hardly ever a reliable index of functional capac- ities. Some men are old at 50; others at 75. Mental senescence may come prematurely in some; in others continued brilliance of intellect will defy corporal senility. Osier aptly said that "a man is as old as his arteries." In the world of work it would be equally sound to say that a worker is as old as his vision, his motor skill, or his produc- tivity. The important factors to consider in em- ploying older men relate, not to chronological age, but to "functional" age, or ability to perform ef- ficiently the tasks involved in specific jobs. Research on body efficiency has been extended in recent years to include older and older per- sons. The most recent studies of sensory and per- ceptual processes in aging indicate that sharp de- clines in curves representing the level of function- ing occur at much later age ranges than previously believed."' 10 The general picture which now emerges indicates a gradual decline in absolute sensitivity of sensory perception from early matur- ity to the 50's or 60's, followed by more extensive decline in older persons. Some of the characteristic changes vary from one modality to another, how- ever, as well as from person to person; and while the general trends outlined are real, the possibility of compensation is always present. The most obvious implication of these findings is that the useful working life (and not merely life) is being prolonged. If capable, workers should be allowed to work if they so desire, even beyond the usual retirement age. Another impli- cation is that workers between 60 and 75 years of age are not only proving to be capable of work- ing in many occupations; they actually excel 1 younger persons because of their superior judg- ment, experience, and safety of performance. Ad- vances in technology that have taken away much of the physical stress of work tend in many in- stances to place a premium on the abilities that many older workers possess. Studies carried out in England, chiefly on in- dustrial workers, have indicated that older workers require special training methods in order to learn new skills or activities. Older workers are more susceptible than younger ones to making errors when under time pressure, for example, when a succession of complex activities have to be carried out within narrow limits of time."' ,2 Such in- formation aids in evaluating the "physiological age" of a person. More information is needed, however, in order to set up criteria in relation to the basic nature of skill and for prediction of per- formance under stress. Also required are tests of performance which reflect deleterious effects in spite of attempts to overcome them, such as tests which detect increased effort at the task. Recently, techniques have been developed in sensory and per- ceptual research which may be of value in de- veloping measurements of both kinds." One way of adjusting one's performance to off- set poor responses is to sacrifice speed for accuracy (or vice versa). Such trade-offs need not indicate loss of practical capacity. Until recently, there was no way of combining these two measures. With the development of information theory, a non- arbitrary way of combining measures of speed and accuracy into a single "rate-of-information-trans- mission" measure has become availble, and can be used to determine the magnitude of task-induced stress. 523 Recent advances in simulating many industrial operations have made possible more precise meas- urements of skill that offer promise for the study of aging. Two avenues of research have led to tests of increased effort. One has been concerned with spare reserve capacity and with peripheral attention. Such work deals with, for example, the deterioration of performance on the main task as the burden of effort needed for a secondary task is increased. Effects of age are measured in terms of spare capacity to deal with more than one task." The other avenue has dealt with physiolog- ical measures of arousal, tenseness, and such other characteristics, as well as with central nervous system activity." Physiological studies of aging have brought out the nature of the physiological changes that re- late to ability to perform certain types of work. 10 Younger men can set a steady pace for hard work without upsetting the homeostatic mechanisms of the body. Older men have limited ability for sustained physical effort and should therefore be replaced when intense physical activity is required, such as in the lifting of heavy materials. Modern industrial developments, however, have increased possibilities for flexible placement of workers. A study of why truck drivers left their vocation at a comparatively early age revealed dislike or inability to do heavy lifting, coupled with reluctance to drive at night. Mechanical hoists helped solve the first problem; a shift to daytime hours, the second. A large number of men were kept in their vocation by these relatively simple expedients." Studies of civil airline pilots through extensive medical examinations have been particularly re- vealing of the wide differences in ability that are masked when only chronological age is considered. Some airmen are quite old physiologically at age 50; others, quite young at age 60. Extensive opera- tional flight tests have made it possible to take ability as the basic criterion of acceptance, rather than age. 18, " (Attempts to develop quantitative indices from such diverse measures as blood pres- sure, pulse rate, visual acuity, light sensitivity, and immediate memory have not so far been satisfac- tory, but promising steps in this direction have recently been made in industry by Dirken and his associates in the Netherlands. 10 ) An investigation of medical problems in airline pilots surprisingly has shown that the mean age of those forced for medical reasons to retire was 40 years; a third of the cases involved heart and circulatory disorders. These diseases, which we typically think of as belonging to old age, are a primary problem in middle age for men who must maintain peak physical condition. 21 Pilots should be judged on the basis of their ability to perform the complex task of operating high speed, high altitude aircraft and not on the basis of their age. The law which makes retire- ment compulsory for pilots at age 60 is in conflict with this principle; undoubtedly many very able men have been lost to this profession in the prime of their ability. After a study of pilots, Szafran stated that it would be rash to conclude that the capacity of discrimination and choice, when examined within the overlearned repertoire of adult professional life, need necessarily decline with advancing age. ... At least in this profession, age per se could not neces- sarily be equated with decline, nor should it be con- sidered a sufficient reason for retirement. He went on to say that the nature and magnitude of age changes must be understood more clearly before the empirical observa- tions are allowed to become accepted as established facts. Otherwise, all discussion about "loss of capac- ity" in later adulthood is likely to arrive at the puzzling junction of biology and semantics where the terms become too evasive to be meaningful. 22 It is more than likely that this statement is ap- plicable to a wide variety of occupations that commonly observe rigid retirement policies but for which there is no body of research concerning functional aging such as now exists for pilots. Studies of safety in driving motor vehicles indi- cate that deterioration with age known through laboratory research to exist in sensory, mental, and physiological capacities are not practically appar- ent in the form of an increase in motor accidents until after age 65. This empirical evidence pro- vides a good example of the way in which experi- ence, judgment, and compensation for declining abilities can maintain a higher level of perform- ance than might be expected from laboratory tests. The conclusion to be drawn from the above examples is that judgments about who should and who should not work can be made more intelli- gently on the basis of functional ability than on the basis of chronological age. The real question is, When in the aging processes is physiological and psychological deterioration no longer ade- quately compensated for by past experience, and by adaptations made to offset declining capacities? This question implies the need for tests to measure how capable an individual may be in meeting the requirements of his particular job or life situation. Proper placement and job adjustment are prob- lems deserving continuous consideration through- 71-272 O - 72 - pt. 1 - 34 524 out the span of work life. They are particularly important following disability or illness and when the older worker encounters difficulties related to the normal processes of aging. In the final analysis, most of us are unsuited, either physically or psy- chologically, for most jobs. It is difficult, for ex- ample, to find even a few individuals who can pilot planes, tend blast furnaces, or perform heavy construction. All persons are physically handi- capped; yet all persons are at the same time suited for some activities. The great majority ought to have the opportunity for gainful employment. Matching men and jobs.— Required, for persons of any age, are adequate methods for matching their physical and psychological capacities with the physical and psychological requirements of the job." Requirements of the job can be obtained through job analysis. Knowledge of the employee can be acquired by preplacement, placement, and thereafter, by periodic examinations. Both, job and employee, should be described by the same termi- nology for degree, kind, and duration of effort; and the units of measurement used should be suf- ficiently objective to prevent a misunderstanding among all those involved with employee manage- ment, job placement, and the particular job under consideration. When these conditions are ob- tained, operational efficiency and safety are pro- moted because proper placement can then result on jobs which do not exceed physical and mental tolerances of the workers. 24 The proper matching of men and jobs has, furthermore, significant im- plications for enhancing individual satisfaction with work and for maintaining optimal emotional adjustment. Retraining of older workers for new careers. — The view has been commonly held in industry that it is difficult to train older workers for new types of work. In recent years, however, several studies of training have placed greater emphasis on a better understanding of the nature of the changes which take place with age. It has become apparent that in some areas "skill prognosis for age be- comes steadily more and not less favorable." 25 For example, it has long been accepted that learn- ing ability declines steadily from age 30 onward. The more recent studies indicate, however, that middle-aged and older persons can learn as well as younger ones, providing that consideration is given to how the learning techniques of older per- sons differ from those used by the young. 26 Inves- tigators have demonstrated, moreover, that retrain- ing older workers for new jobs can be successfully carried out if training methods are adapted to the learning capacities of older persons. Some of the principles are as follows: 1. Older persons learn more readily if material is presented in ways allowing them to understand the essentials of the task, as by a selective presen- tation of essential areas. 2. Pace of instruction should be slowed to en- able full comprehension, or the pace should be under the trainee's control. 3. Learning by activity yields better results than memorizing instructions for translation into action. 4. It seems essential to relate instructions and task as directly as possible to each other, with op- portunities for ambiguity kept to a minimum. Thus, the learning of errors which can be un- learned only with difficulty is kept at a mini- mum." The part motivation plays in enabling the older person to learn is as yet poorly understood. To what extent can high motivation make up for functional losses? Research on amputee drivers 58 who exhibit a better safety record than intact drivers suggests that desire for work may be the key factor for the elderly in learning a new job. Interviews with the amputee drivers brought out the fact that their hostility toward society for being unfairly treated produced emotional reac- tions so extreme as to constitute a greater safety hazard than their physical infirmity! Undoubt- edly, many older persons are highly motivated to overcome their failing capacities. However, more information is needed in regard to the role of deep-seated emotional feelings in the adjustments of older persons. A study on the functional appraisal of aging individuals was made in 1967-1968 under the sponsorship of the Gerontological Society, with funds from the Rehabilitation Medicine Branch (USPHS Contract No. PH 110-100). The objec- tive of this study was to survey current research, concepts, and knowledge relevant to functional ap- praisal of older individuals and then to prepare "categories of adult function." This study outlined systematic approach to the functional appraisal of the aging individual. Apparently it has not been possible to follow this preliminary work with the development of clinical and non-clinical methods for matching older people to new careers; such work needs to be continued. Research needs: It has been established that older persons can learn new jobs in later life. More re- search, however, is needed upon the ways in which old people learn, upon interferences with learning, and upon motivation for work in the later years. Further work is needed also upon practical procedures 525 needed to keep the individual functioning safely and effectively at work well beyond the modal retirement age. Research should, furthermore, be conducted in fields where prolonged voluntary employment is fre- quently found, and especially in areas where a com- pulsory' retirement age is now customary. Protection of the Public Against Too-Long Postponed Retirement in Certain Occupa- tions While certain people in certain occupations may be forced to retire while they are still competent performers, there are other occupations in which great labor shortages exist. In these occupations, people are permitted and even encouraged to re- main at work beyond age 65. Medicine, the law, and politics are examples of critically necessary occupations in which members can "die with their boots on," and may even continue to practice de- spite disability. These professions have been left to police them- selves with respect to ethical standards, mental health, and the capacity to function. None has done very much to develop devices for protecting the public against practitioners disabled by decline in mental ability or, indeed, from any other cause, although grievances committees of medical societies and similar committees within bar associations function to protect the public in some measure. In the early 195»'s a State Constitutional Amend- ment was suggested which would give the Cali- fornia Supreme Court full power to remove unfit judges at every level, including its own. The Amendment, approved in I960, provided for a nine-member Commission of Judicial Qualifica- tions—composed of five judges, two lawyers, and two laymen — to review complaints of disability and misconduct among the judiciary. The Commis- sion has the power to subpoena medical records and to order medical examinations. By 1965 the Commission had received 344 formal complaints and produced 26 resignations. At the same time the Amendment was passed, retirement benefits at 70 were increased. This two- pronged approach has had a significant effect. Be- tween 1959 and 1965, the number of judges over age 70 in California was reduced from 80 to 6. Such review systems deserve careful study. How applicable would they be to other fields? How successfully do they operate within their present limits? Our entire political leadership must even- tually be subject to appraisal of its physical and mental health. Several striking cases of incom- petence due to disabling conditions in federal of- ficials have already been documented. Private Pension Plans and Flexible Careers Private pension plans have in recent years be- come an important addition to Social Security for many people. Such plans will cover about 60% of workers by 1980, although most plans are not designed to meet income needs, but only to provide supplementary funds. Since most such plans provide that a person loses his right to a company pension if he leaves the company before a stated minimum period (usually 10 to 15 years), the tendency of private pension plans has been to bind people to their jobs. The problems with private pension plans may be summarized as follows: 1. Although now considered deferred wages (rather than a reward for faithful and long service by a benevolent employer), it is by no means clear who owns the contributions. As yet the govern- ment has done very little toward clarifying and regulating in this area. 2. The workers at the bottom of the economic ladder, the part-time workers, and the as-yet-un- committed, lose pension rights because of rapid job turnover. The amount of aggregate loss borne by such workers is at present, however, highly con- troversial. 20 3. Industry-wide or multi-employer plans now cover only about 16% of workers under private pensions; most plans thus tend to bind the worker to a particular employer. Plans also tend to pen- alize workers for moving into new occupations. The extent to which workers actually feel con- strained to remain in their present positions be- cause of loss of pension benefits is, however, an- other controversial question. Development of Private Pension Plans While pension plans have been in existence for half a century or so, their current popularity is a very recent phenomenon. A Bureau of Labor Sta- tistics study of 1964 indicated that only about 2% of current private plans were in existence before 1940. Not until the Welfare and Pension Plans Disclosure Act, which required the reporting of all plans covering 26 persons or more was passed in 1958, did data become available to permit the systematic study of pension coverage. At the pres- ent time we know very little about the effects of such plans on the economy and on individual se- curity, although data are rapidly being processed and evaluated and a number of studies have emerged. 30 Employers justify the expenses of pension plans in terms of their ability to attract high-level, stable 526 employees; however, it is not at all clear that the particulars of the pension plan do indeed have any significant weight in the minds of prospective employees. At present, there is extremely wide variation found between plans within industries, and plan "norms" have failed to emerge, which strongly suggests that companies are not compet- ing for new workers by means of pension plans. 31 The original primary impetus behind worker support of pension plans was to give the older worker an incentive to retire, thereby purchasing better job security for the younger worker. 32 How- ever, this can no longer be the primary explana- tion for the rapid burgeoning of plans, given their popularity among "secure" employees such as teachers and civil servants, as well as the popular- ity of other fringe benefit plans such as contribu- tory group health and life insurnace. It appears that the American worker is presently choosing to extend earnings from coverage of the working life to coverage of life in retirement as well. 33 When workers gained the right to negotiate for pension benefits, the pension came more and more to be viewed by both economists and workers as deferred wages and thus benefits to which the worker has an inherent right. If this view is valid, then all workers who have contributed to such plans have a right to share in their benefits, no matter how long their employment has been. In structure, however, the private pension has retained the form of a reward for long service. Only about one in a thousand grants vesting rights immediately upon employment; very few grant rights before 10 years of employment. A President's Commission for the study of private pension and welfare programs, which re- ported at the beginning of 1965, voiced concern over the possible power of pension plans to impede occupational mobility, as well as over "the possi- bility that such plans in the future will not per- mit a rate of mobility among mature workers sufficient to accommodate a rapid rate of tech- nological change." 34 The Commission recom- mended that vesting be made mandatory but, be- ing also concerned about increasing pension costs and stifling experimentation, recommended only minimum vesting of 50% of accrued benefits after 15 years of service, with full vesting after 20 years with no minimum age requirement. In the past few years, however, and without legally-established standards, the trend has been toward more liberal vesting rights than those pro- posed. By 1967, 63% of all workers covered by pension plans had such rights, with a service re- quirement that was usually 10 years. In half the plans, there was no minimum age requirement; in a little over a quarter, the age was 40 or lower. For employees with gradual vesting rights the time was usually longer to achieve full vesting (15 to 20 or even 30 years), but as the benefits in this case are usually based on the formula at time of retirement rather than that at time of termina- tion, the benefits are likely to be somewhat higher than under deferred full vesting. Members of Congress, especially Congressman Dent and Senators Javits, McClellan, and Yar- borough, have been alerted to the need to protect the workers' interests in pension assets and have proposed bills to establish higher standards and enforcement procedures concerning management of monies, accountability, and disclosure, and to make vesting (after 10 years of service) manda- tory. It must be remembered, however, that private plans have been designed only to supplement regular social security benefits and, for the vast majority of workers, will under current conditions provide for considerably less income than that ex- pected under OASDI. The question of whether or not these plans provide adequate supplemental in- come upon retirement (for both current and future retirees) will be taken up in Chapter IV. Research needs: The evidence we have at present does not enable us to arrive at meaningful estimates of what coverage from private plans will be in the near future, or of what this coverage will mean to the retiree. We urgently need studies of existing data that will treat plans according to coverage categories and that will relate plan participation to labor force turnover data. At the same time, we need longi- tudinal investigations of young people entering the labor market at the present time. How long does il take the beginning worker with a particular socio- economic background and set of qualifications tc settle upon a lifetime job? How important to him are his pension benefit prospects in considering whether or not to take a job or to change jobs? Tc what extent are peripheral workers a dynamic fora in technological change, and to what extent are the) marginal workers trapped at the bottom of the eco- nomic ladder? Perhaps immediate vesting would be of benefi to society. On the other hand, the goals of societ] might be better met by reducing the number o job changes the average worker makes by bring ing more order into the labor market and by estab lishing the right to leaves of absence without los of pension rights for such causes as long illnes and pregnancy. 527 B. Education and Truining In the United States it has been customary to view education as an activity appropriate to the first quarter of the life-span and a high school diploma as the passport either to a steady job or 10 college training. At a time when labor-hungry European industry has been successfully incor- porating illiterate Turkish peasants into its factor- ies, American industry has been coming more and more to insist that its workers attain as a mini- mum the twelfth-grade certificate. Only very re- lently have there been signs that industry is will- ing to accept less educationally qualified workers. With technological change necessitating a con- tinuous updating of skills, learning and training must go on throughout the work life. The adult with an educational handicap should have the facilities to overcome it, and such encouragement that will ensure his use of them. At present, somewhat over one-fifth of the adult population of the United States participates in »me form of adult education, principally for vo- xtional reasons. The adult education system in- cudes night schools that are part of city public lystems, university extension courses, private cor- respondence courses, and small public and private raining programs of a more experimental sort, ruch as: 1. Intra-industry training programs and re- resher courses for workers and executives. 2. Professional association refresher courses for >hysicians and dentists, lawyers, and teachers. 3. Pilot government-supported training pro- grams such as those under the Manpower De- relopment and Training Act. Research needs: At present we have little more than survey research on the adult education system and its users. Further research is needed to leam more about those who avail themselves of educational oppor- tunities in adulthood. Such people are likely to be the prototypes of the flexible labor force of the fu- ture. Experimental adult education programs should be supported with, emphasis on enrollment of people over 50, an age at which participation drops off rapidly according to recent studies of students in adult education courses* Studies of the educational activities of members of early-retiring occupational groups should be made — members of military forces, police and fire depart- ments, and professional athletes. Special attention should be given to experimenta- tion with and evaluation of pre-retirement education. Enough programs of this kind are now being carried out to serve as a basis for conclusions regarding the most effective procedures. Life-cycle Education A kind of education that effectively »ervi citizens of a modern industrialized throughout the stages of adult life might I • education against obsolescence. Such education helps people match their activities at various life stages to their personal and social needs. A number of social scientists have studied the human life cycle and have worked out concepts for thinking about it. Van Gennep, Hall, Buhler, Erikson, Pressey, Benedek, Havighurst, and Neu- garten are representative of those who have de- voted considerable attention to the life cycle. There has been, however, little empirical study of social and psychological changes throughout life, and therefore no comprehensive body of knowledge concerning the life cycle as a whole, its stages, its modes, or concerning the complex interplay of individual life cycles with socio- economic and cultural conditions. With greater knowledge of the characteristics of different periods or stages of the human life cycle and of different interests that develop and wane during these periods, educators might be able to develop more relevant subject matter and techniques than has hitherto been possible, par- ticularly for the educationally handicapped and for the retired. The fit between the interior, or personality configurations at different stages of life and the external, or social, needs is a highly pertinent area of investigation. One cannot con- sider mid-career change or retraining programs without considering also the individual and his so- cial environment. ■Education in its best sense includes both coun- seling and direct supervision, not unlike the su- pervision the young physician receives from an older one. Ideally, career movements in the course of the life cycle should be determined by realistic self-appraisals, aided by collaborative objective appraisals from others. The development of work and personal goals should not be undertaken in solitude, with its accompanying anxiety or un- easiness. Traditionally, the prfmary responsibility of the university has been toward youth, but a number of universities have strengthened their programs in adult education, which in the past were charac- teristically vocational. Proposals were made at the 1961 White House Conference on Aging for senior universities to provide education in the humani- ties and in social studies for older citizens. As the amount of formal education possessed by the aged of this country increases, requests for such 528 courses are likely to increase. There is no reason the facilities of the secondary schools as well as of the universities could not be utilized for the purposes of broadening the scope of adult educa- tion. Many experiments in continuing, or life cycle, or adult, education are now administered by uni- versities throughout the country. Women in mid- dle life who have left their jobs for family re- sponsibilities are now beginning to have the op- portunity, when their children no longer need the major portion of their energy, to enter one or another university program tailored to their spe- cial needs. These programs were pioneered by the Radcliffe and the University of Minnesota plans. They are more than refresher programs; they in- volve a full-scale reappraisal or re-evaluation of goals on the part of the woman, and broadly-con- ceived courses are available to help her re-examine her interests and move to a different field, if she so desires. For example, a woman with a bachelor's degree in biology or psychology would not be required to return to her area of interest, but might choose something quite different. Within professions, the need for continuing edu- cation has intensified as technological knowledge has burgeoned. American medicine has become increasingly responsive to the need for the up- grading of technical knowledge and practice. The American Academy for General Practice requires a certain number of course hours per year for its members. Because membership in this organiza- tion is a valuable asset to the physician for main- taining staff positions in hospitals and for other reasons, there is a continuing professional incen- tive, irrespective of any direct legal penalty, for keeping up in the field. 36 Professional Education Concerning Middle Age and Aging It is fully as important for the people who work professionally with middle-aged and older people to absorb the facts and attitudes of life-cycle edu- cation and knowledge concerning the latter part of the human life-span as it is for middle-aged and older people to maintain the ability and motivations for, and have the opportunities for, continued learning. Physicians, nurses, and social workers need this knowledge as part of their professional education, as do teachers, clergymen, judges, and others who work with adults. Exactly as it became evident at the turn of the century that a knowledge of child development was essential for these professionals, so now is adult development and aging coming to be seen as an area of knowledge necessary for attaining competence in working with adults. We must understand and deal with the "total older person," just as we must understand and deal with the "total child." This concern is presently expressing itself in two ways: in the beginnings of incorporation into pro- fessional curricula of subject matter on develop- mental changes in adulthood and old age; and in the call for a new service occupation, personal care. At present personal care is provided by a host of professionals and semi-professionals: the oc- cupational therapist (or occupational therapy as- sistant), the visiting nurse, the homemaker, the home health aide, the physical therapist, the nurse, the practical nurse. As a consequence there is a fragmentation of duties and tendency toward jurisdictional disputes. The homemaker may re- fuse to change a dressing and a visiting nurse may be reluctant to heat a cup of soup. Such strict demarcation of duties is arbitrary and mean- ingless from the patient's point of view and adds to his burdens. What he requires (particularly if he is elderly) is a personal care worker who is willing to escort him to the physician's office, take him out for entertainment, to the corner drugstore for his prescription, shop, take the social security check down to the bank and, if necessary, perform his business under a power of attorney, change light bulbs as well as dressings, move a paretic arm through passive motion, clean the kitchen, and prepare lunch. No existing professional whc makes home visits can, or is willing to, perform such a wide range of tasks. The personal care occupation here envisioned would not require many years of formal educatior but, if correctly developed, could serve as a step ping stone to an established profession. Such de- velopment has been outlined by the sociologist Frank Riessmah" and has been incorporated intc the Economic Opportunities Act as the New Careers Program. 38 Under this program, the in centives and motivations of the sub-professiona can be mobilized, and a personal care worker wh< developed a special interest in, for example, physi cal therapy or medical technology could get on the-job training in professional skills and slowl; move into teaching or supervisory work with nev personal care workers. The need for such workers is well established The Medicare Act, Title 18, provides for 100 horn visits per year; yet, as of 1967, only one out o 529 very seven. Americans over age 65 with Medicare overage actually lives in a geographic area where ie can receive such visits. There existed in the Jnited States at that time approximately 6,000 lome health workers; approximately 200,000 arc leeded. Older people, in particular, are also in dire leed of protective services to aid them in crisis ituations. Such services have been provided un- ler the Public Welfare Amendments of the 1967 Jocial Security Act, with the federal government jaying for three-quarters of the cost. Protective iervices programs are for aiding the blind, the otally disabled, and persons on old age assistance vith legal, medical, psychiatric, and social ser- vices. This is a major outreach program for help- ng such persons as a 92-year-old about to be jvicted, an older person discovered in a pool of jlood in a shabby, downtown hotel room who re- uses medical aid, a confused, wandering older j>erson in the streets. States have not generally availed themselves of Jiis program; consequently, demonstration projects lave been set up to show the resulting advantages )f such a protective system, both in the economic sense, since persons can thus be maintained out- side of municipal nursing home facilities, and in terms of personal and social gains, that is, the enhancement of life satisfaction for these persons. States might take advantage of the protective ser- vices program if there were a body of trained workers who could make initial contact with per- sons who need such care. Such workers would not need professional backgrounds. The National Personal Care Corps and the Na- tional Protective Service Corps personnel could perform their tasks with only basic human skills and tailored training programs. Both occupations, however, could lead to career advancement .for persons now caught in marginal, dead-end occupa- tions or unemployed, as well as provide crucial services for the disabled and the very old, growing segments of our population. Research needs: Experimental programs for training the educationally- disadvantaged are needed in order to learn how to reach persons with motivation and how to instill motivation in persons at the lowest socioeconomic levels. Such programs would serve also to add to basic knowledge concerning learning capacities and psychological change over the life cycle. The effects of age and of socioeconomic status upon learning are not fully understood, and there is at the present tinne a tendency to over-generalize from the general characteristics of large populations in predicting the success or failure of the individual. Crucially needed are studies of successful products of training programs, in comparison with failures. ('.. The Emerging Free-Time System The American society is now engaged In the of shifting its major goal from that of producing consumable goods from raw materials to that of using time in ways that enhano faction and self-realization. Having achieved the distinction of achieving the highest per capita in- come in the world, we now turn to the more complex task of consuming wisely and balancing work with free time. The decline in the average work week since the beginning of this century is well known. While hours of work have remained long for persons In the professions, still every working American can obtain more leisure time (that is, time outside of monetarily remunerative work) than his grand- father had, if he so wishes. Nobody is forced by iron necessity to work as long as his grandfather did in 1900. The technological revolution which has short- ened hours of work is not over; it is just beginning. Since 1960, the process of cybernation has so in- creased the efficiency of machines that the produc- tivity per man-hour has risen faster than it did during the 1950's. Demand for goods has not risen fast enough to bring about the full use of men or machines, even in a period when war has been diverting a substantial proportion of American production. At present, work, education, and free time are combined in different proportions throughout the adult life span, as shown in Figure 1. All three are now present to an appreciable extent at all times between ages 20 and 65-70. In the past, free time and education comprised much smaller pro- portions of the working life. The trend has thus been, and is continuing to be, toward more equal proportions of work, free time, and education throughout the working life- Leisure 20 80 40 60 AGE Fig.l. The flexible adult life style. Width of band indicates the amount of time and energy devpted to each realm of life. 530 span. The work week has shortened; vacations, lengthened. As work takes a smaller and smaller proportion of the individual's total time and energy, it is possible for him to plan a more flexible life, one that is open to a variety of possi- ble options and developments. Concurrently, at- titudes toward free time have changed. Fewer and fewer people feel guilty about using the time freed from remunerative employment for recrea- tion rather than for more work. While we do not as yet have ethical and institutional supports for the use of free time and thus cannot correctly say that at present we have a free time "system" as we can for the realms of work and education, nevertheless it is very likely that a free time sys- tem, with a leisure ethic, will emerge. The key question is, To what extent can man make good use of his increased free time? It is well to make a distinction between free time and leisure. Free time represents potential opportunity; leisure, what develops when people use their free time to get more satisfaction out of life. American society, in terms of its productive capacity, is presently close to the state where signi- ficant effort can be put to the problem of how to aid persons in achieving more personally-satisfy- ing uses of free time. New societal arrangements, however, cannot be imposed by society upon the individual. Efforts to spread free time more evenly throughout life by such means as mid-career evaluations, sabbaticals, or retraining programs will fail if they do not match desires and motivations. Clues to the nature of such societal arrangements might come from the study of how people of different socio- economic levels currently use their vacations, how they combine work and recreation when they are really free to develop their own unique combina- tions, and how they make the transition from work to play, the latter of which we know very little about. With some possibility on the horizon of arrest- ing and preventing arteriosclerosis (hardening of the arteries and related diseases), there exists the likelihood that increasing numbers of older people may in the future remain vigorous and able to work or play strenuously. The optimal life satis- faction will come with a greater range of choices. The greatest loss of old age at the present time is the loss of opportunity for choice. Current Knowledge of Free Time The expansion of free time in our century has attracted considerable notice, 30 but there are at present extensive gaps in our knowledge concern- ing this new phenomenon. The average decline of the work week, which has been about 2 l / 4 hours per decade since 1900, <0 has been viewed by some economists as an index of the demand for leisure. It is by no means clear, however, that this trend does indeed represent a new demand on the part of workers, or that it will continue in the near future. The decline in hours of work over the past 10 years can be accounted for by the increase in number of part-time work- ers, not by a change in the work week of full- time workers." Furthermore, the long hours of work that were typical at the beginning of in- dustrialization were not necessarily typical before modem times. Medieval records indicate that, among organized craft guilds with control over their working conditions, hours of work were about the same as they are today. 42 When the workers were not able to control their working conditions, however, employers of that era seem to have con- sidered the normal working day as lasting from sunrise to sunset. 43 The present 40-hour standard, therefore, may be close to representing a balance between work and leisure that is "comfortable" for the ordinary, non-professional worker. It does not appear, in any event, that the in- dividual worker has the "economic" view of lei- sure, as a commodity purchased by work, to compensate for a humdrum work life. Rather, satisfaction and dissatisfaction expressed concern- ing work are also reflected in attitudes concerning other spheres of life. 44 Havighurst has stated as a social-psychological principle that there is an equivalence of work and play — the same mean- ings, that is, are found in leisure activity as are found in work (with the exception of income). Moreover, there is little evidence that leisure, at the present time, is considered as a desirable al- ternative to work, even among those who can best afford to stop working. A national survey of per- sons with incomes over $10,000* indicated that only 13% of those with opportunities for extra work specifically mentioned the desire for more leisure as the motive for not working more; on the other hand, only 4% mentioned the need for more income as the main reason for deciding upon the amount of work they actually did; one-half indicated that they were driven by the demands of the job. Those with second jobs tended to be those with relatively higher incomes. For this en- tire sample, hours of work were very high; an average of 52 hours for those below age 40; an average of 40 hours for those over 65 who were still working. One-quarter claimed to be work- 531 ing 60 hours or more. For those who can most afford it, therefore, there appears both to be little free time and little desire for more. Only a very slight amount of systematic study, however, has been given to the uses of free time in this eco- nomic bracket. Considerably more attention has been given to persons at the other end of the economic scale; yet, even, here, the picture is still unclear. These persons now have, on the whole, at least as much, and probably more, free time than persons in pro- fessional and managerial positions; but, when compared with the latter, they are more likely to say they find themselves with time on their hands they don't know what to do with, that they would not know what to do if faced with a period of forced confinement, that they have a great deal of spare time and would not want more." In the survey study of urban blue- and white- collar workers mentioned earlier" less than 2% expressed dissatisfaction with their leisure hours and social activities when asked about them di- rectly; yet over a quarter indicated dissatisfaction with spare-time activities later on in the same interview. Fewer than 15% enjoyed genuinely absorbing, self-expressive hobbies (as judged by the investigators); half stated baldly that they had no special interests. Time not spent working was filled with visits to relatives, puttering with household chores, resting, and watching TV. However, it must be recognized that some routine tasks can be genuinely enjoyed and can bring a sense of accomplishment. Other activities, such as TV, have been viewed by workers themselves as routinized time-filling activity, without pur- pose and without value." Even when work is extremely routine, there do not seem to be great efforts made to get rid of it. When unskilled workers were asked if they would continue working if they inherited enough money to quit, 60% said they would keep on working." The response to this hypothetical question raises doubts as to whether it is only creative work (as is usually thought) that enhances identity. All kinds of work may serve in this function, at least in this transitional period when ethics and esthe- tics concerning the uses of time are in flux. ' Motivations for working and playing are com- plex. Play does not serve the exclusive purpose of providing relief from the job, any more than work is simply for income. Far more research must be done on leisure — to delineate patterns for the future in order to further our understanding con- cerning variations in perceptions of leisure by minority group and by social class. Satisfying leisure, which has its source and de- velopment within the individual, may not be so amenable to social planning as is work; but it is likely that if leisure is better understood, we will be in a better position at least to design acceptable work for those who are retired but who want to remain active. The uses of free time. — Among those who have studied the uses made of free time, there is agree- ment that three broad categories will cover the activities of people when they are not working for money or doing the things required for their per- sonal care and for fulfilling family obligations. These are: 1. Study and contemplation 2. Play or recreation 3. Voluntary non-paid service. People who are in a position to organize their adult lives to their satisfaction will combine work with free-time activity in ways most desirable to them; and they will select and combine a variety of free-time activities. A wide variety of meaningful experiences are to be gained from leisure activities. At present, only a minority of our population have free and full choice in deciding how to allocate their time be- tween work and leisure, and how to spend their free time. Most (but not all) are workers with incomes considerably above average and retired persons who enjoy comfortable incomes and good health. These persons should be sought out and studied, since their patterns of balancing work and recreation may reflect the choices of the ma- jority of the future. The social roles of the elderly of different social class levels need to be studied to find out how the social and personal needs of older people can be satisfied through changes in the distribution of effort and time among the various social roles available to them, and as time is gained by a de- creased need to expend effort in the worker role. In addition, representative samples of persons from middle age through extreme old age should be studied as a means of delineating current ma- jor life styles, and with special reference to the accommodation of free time within a life style. This research should be extended to include other countries at a stage of industrialization compar- able to ours, but where retirement patterns are different. A recent cross-national study of re- tirement 50 ' 51 has shown that the patterns of free- time activities among retired school teachers and retired workers in heavy industry vary from one 532 country to another and from one community set- ting to another. Voluntarism. — The acquisition of a flexible life style depends to a considerable degree upon both the opportunity for free choice and the use of this opportunity. Investigation is now needed of the voluntary work-service system, of the kinds of people who make use of it, of the satisfactions they derive from it, and of the ways in which vol- untary work is related to other free-time activities. The device of voluntary work for no pay or for limited pay has been expanded recently through the development of public programs such as VISTA and the Peace Corps and the proposed Senior Service Corps. Such programs are likely to benefit from research upon similar programs in the private sector. As public programs gain ap- proval, opportunities for voluntary service by old people and poor people will increase. At the same time, it seems possible that a large number of non- paid or low-paid roles could be created in the field of the performing arts (theater, ballet, or- chestra) under the auspices of the National Foundation for the Arts and Humanities. As these choice-enhancing opportunities de- velop, there should be research on the people who take them. What kinds of people make use of these opportunities and what values do they ob- tain? How important is pay for enhancing status? Summary This Report advances the proposition that people in the United States are on the verge of a fundamental re-organization of the adult life-span that will result in a more even distribution of education, work, and free time throughout the course of adult life than is found today. The most valuable citizen for a modern industrial democratic society is one who can learn new tasks and shift occupations as the needs of the society change; and finally, in retirement, continue to live in a manner recognized by both himself and others as useful, satisfying, and dignified. Society, on its part, has the obligation to arm its citizens against the chaos of rapid changes by providing them with the wherewithall to perceive and deal with these changes as opportunities for further growth and development rather than as disasters. This Report thus emphasizes the need for re- search upon the current limitations for choice (a) inherent in the rigidities of current American in- stitutions, such as automatic and compulsory re- tirement, pension plans with delayed vesting rights, and arbitrary age limits upon employment; and (b) that have resulted through the influence of social class upon personality. Investigation is also needed of persons and institutions in the vanguard of change. Summary of research needs: 1. The study of free-time utilization patterns of both sexes and all ages in the work force, as well as the free-time utilization of persons in enforced idleness. 2. The study of values of leisure to various; types of persons, and the planning they do for their utilization of free time. 3. The study of motivations within various career patterns, which make various combinations of work and leisure. 4. The study of personality factors related tc the various life styles and free-time patterns. 5. The study of all the above in various modern societies. Footnotes 1. Cottrell, Fred. Letter to Senator Mondale. In U. S Senate Special Committee on Aging, Subeommitte< on Retirement and the Individual. Retirement ant the Individual. Part I. Washington: U. S. Govt Print. Off., 1967, p. 316. 2. Wilensky, Harold L. Orderly careers and socia participation: the impact of work history on socia integration in the middle mass. Amer. soc. Rev. 1961, 26, 521-530. 3. Bowen, Howard R., & Mangum, Garth L. (Eds.) Automation and economic progress. Englewooi Cliffs, N.J.: Prentice-Hall, 1966, pp. 23-24. 4. Lester, Richard A. Manpower planning in a fre society. Princeton: Princeton University Pres: 1966, pp. 10-22. 5. Sheppard, Harold L., & Belitsky, A. Harvey. Th job hunt: job-seeking behavior of unemploye workers in a local economy. Baltimore: Johns Hop kins Press, 1966, pp. 75, 86, 171, 175. 6. There has long been the realization on the part c professionals concerned with the welfare and ecc nomic problems of the labor force that the govern mental employment system needs strengtheninj The efforts to strengthen it, and the thought be hind such efforts, have been summarized by Sa A. L. Levitan (in Federal manpower policies an programs to combat unemployment. Kalamazoi Michigan: W. E. Upjohn Institute for Employmer Research, February, 1964). These efforts, howeve have been met with a lack of enthusiasm froi private sectors of the economy. Part of the problem arises from the fact thi public policy at times must be at odds with priva policy. While labor turnover can be and frequent! is detrimental to the economy, the long-run effe will be favorable if (1) the employee makes bett use of his native ability on the new job; (2) tot earnings over the working-life span can be ii 533 creased by a change in position; or (3) training for a new position costs less than the amount by which the trainee's salary will be increased in the new position. Neither the individual employer nor the union will share visibly in the long-term ad- vantages. Labor turnover is expensive to an em- ployer and it is to his advantage to keep it at a minimum by binding his employees to him through pension benefits and seniority privileges. It is to the advantage of a union to hold its mem- bership, and bargaining for seniority benefits is one way to reward the stable worker. For the worker himself, the losses of seniority and pension benefits must be weighed against distant and sometimes very risky prospects offered by further training, a shift to another position outside the seniority lad- der he is already upon, or a new job in a new locality. The short-term advantage may lie in his continuing where he is, while, if his over-all earn- ings can be improved or his talents are better utilized in a different occupational category, it is the nation's, as well as his, loss. r. Davidson, Wayne R. Some observations about early retirement in industry. Industrial gerontology, February, 1966, pp. 26-30. L Belbin, Eunice, & Belbin, R. M. New careers in middle age. Proceedings of the 7th International Congress of Gerontology. Vienna: Verlag der Wiener Medizinischen Akademie, 1966, pp. 71-82. ). McFarland, R. A. The sensory and perceptual processes in aging. In K. W. Schaie (Ed.), Theory and methods of research on aging. Morgantown, W. Va: West Virginia University Press, 1968. ). Heron, A. & Chown, S. M. Age and function. Bos- ton: Little, Brown & Co., 1967. [. Welford, A. T. Age changes in the times taken by choice discrimination and the control of movement. Cerontologia, 1961, S, 125-45. I. Welford, A. T. Performance, biological mechanisms and age: a theoretical sketch. In A. T. Welford, & J. E. Birren, (Eds.), Behavior, aging and the ner- vous system. Springfield, 111.: Charles C Thomas, 1965. J. Broadbent, D. E. Perception and communication. London: Pergamon Press, 1958. i. Teichner, W. H. Stress, adaption and the inter- action of behavioral and physiological processes. Unpublished , manuscript, Boston: Guggenheim Center for Aerospace Health and Safety, Harvard School of Public Health, 1966. 5. Wilkinson, R. G. Changes in performance due to environmental factors. Symposium on medical as- pects of stress in the military climate. Washington, D. C: Walter Reed Army Medical Center, 1965, pp. 127-35. 6. Robinson, S. Experimental studies of physical fit- ness in relation to age. Arbeitsphysiologie, 1938, 10, (3), 251-43. 7. McFarland, R. A. & Moseley, A. L Human factors in highway transport safety. Boston: Harvard School of Public Health, 1954. &. McFarland, R. A, Graybiel, A., Liljencrantz, E., & Tuttle, A. D. An analysis of the physiological and psychological charactertistics of two hundred civil air line pilots, f. Aviat. Med., 1939, 10, (4), 160- 210. 19. McFarland, R. A. Human factors in air transporta- tion, occupational health and safety. New York: McGraw-Hill, 1953. 20. Dirken, J. M. Stress and factory work. Mens en Onerneming, 1967, 21, (5), 273-83. 21. McFarland, R. A. Medical fitness for flying in mid- dle-aged pilots. Some problems of aviation and space medicine. Prague: Charles University Press, 1967, pp. 43-53. 22. Szafran, J. Psychophysiological studies of aging in pilots. G. A. Talland, (Ed.), Human aging and behavior, recent advances in research and theory. New York: Academic Press, 1968, pp. 37-74. 23. Hanman, B. The evaluation of physical ability. New England J. Med., 1958, 258, 986-93. 24. McFarland, R. A. & Philbrook, F. R. Job place- ment and adjustment for older workers. Geriatrics, 1958, 13, 802-07. 25. Bartlett, F. C. The bearing of experimental psycho- logy upon human skilled performance. Brit J. industr. Med., 1951, 8, 209. 26. Canestrari, R. E., Jr. Age changes in acquisition. In G. A. Talland (Ed.), Human aging and be- havior, recent advances in research and theory. New York: Academic Press, 1968, pp. 169-88. 27. Belbin, E. Methods of training older workers. Ergonomics, 1958, 1, 207-21. 28. McFarland, R. A., Domey, R. G., Duggar, B. C, Crowley, T. J., & Stoudt, H. W. An evaluation of the ability of amputees to operate highway trans- port equipment. Boston: Harvard School of Public Health, 1968. 29. One expert (Bernstein, Merton C. The argument against early retirement. Industrial Relations, 1965 (3), 4, 29-38.) has estimated that considerably less than half of those now covered will actually re- ceive benefits in old age. Even when only one seg- ment of the working population is considered, i.e., older workers, estimates are poles apart. During the course of a single conference, one speaker claimed that the overwhelming majority of workers aged 55 and over will become eligible for benefits; another claimed that over half the men now work- ing who are aged '55, and over two-thirds of the women, will not qualify for a private pension. Part, but not all, of the disparity was due to the first speaker assuming a service qualification of 10 years;, the second, one of 20 years (Justin, Brother Cor- nelius. The adequacy of industry pensions — some doubts; and Tilove, Robert. The adequacy of pri- vate pension plans — another view. In Thomas G. S. Christensen (Ed.), Proceedings of New York University Eighteenth Annual Conference on labor. Washington: BNA Inc., 1966, 405-20, 421-35.) 30. The first nearly complete picture of pension plans is the previously mentioned study by the U. S. Bureau of Labor Statistits: Labor mobility and private pension plans. This study was summarized in four Monthly Labor Review articles which also appeared in 1964: Characteristics of the private pension structure (July, pp. 774-80); Vesting pro- visions in private pension plans (September, pp. 1014-1021); Early retirement provisions in private pension plans (October, pp. 1165-1170); and Pros- pects of benefit under private pension plans (No- vember, pp. 1283-1286); all in Vol. LXXXVII. At the same time, a nearly comprehensive study was 534 done under the auspices of the National Industrial Conference Board: Corporate retirement policy and practices. Personnel Policy No. 190. New York: NICB, 1964. Later studies are cited passim. 31. Foote, George H. & McLaughlin, David J. The president's stake in pension planning. Harvard Bus. Rev. 1965, 43 (Sept.-Oct.), 91-106. 32. Bers, Melvin K. Equity and strategy in union re- tirement policy. Industrial Relations, 1965, 4, 39- 45. This statement does not imply that the labor unions are ignoring their retired members. Odell gives a description of the UAW program which indicates that this union, at least, is not ignoring its responsibilities toward the retired worker. Odell, Charles E. The case for early retirement. Indus- trial Relations, 1965, 4, (3), 15-28. 33. In The social security and pension fund systems— their place in the American value structure, Walter Williams has ingeniously suggested that the pop- ularity of fringe benefits stems from the desire to reconcile tensions that have developed between the values of equality and achievement within the American value system in recent years. The worker, with more discretionary income than ever before, is under great pressure to consume (and thereby achieve). At the same time, he is con- fronted with the relative poverty of the older gen- eration (which violates the value of equality and cannot be accepted as "failure" within the system). The worker buys fringe benefits to protect him- sel against overconsumption and provide funds for savings and protection. (/. Risk & Insurance, 1964, 31 [3], 341-353.) 34. President's Committee on Corporate Pension Funds and Other Private Retirement and Welfare Pro- grams. Public policy and private programs: a re- port to the President on private employee retire- ment plans. Washington: U. S. Govt. Print. Off., Jan., 1965. [processed.] Pp. viii-ix. 35. Johnstone, J. W. C, & Rivera, Ramon J. Volunteers for learning. Chicago: Aldine, 1965. 36. The President's Commission on Health Manpower has recommended re-licensure to compel physicians to keap current with new knowledge. The newly- established American Board of Family Practice re- quires recertification every six years. 37. Riessman, Frank, & Popper, Hermine. Up from poverty: New career ladders for non-professionals. New York: Harper & Row, 1968. 38. This program has been sponsored in particular by Representative James Scheuer of New York. 39. See especially: Larrabee, Eric, & Myersohn, Rolf (Eds.), Mass leisure. Glencoe, 111.: Free Press, 1958, and de Grazia, Sebastian. Time, work and leisure. New York: Twentieth Cenutry Fund, 1962. 40. Spengler, Joseph J. Some determinants of the man- power prospect, 1966-1985. In Irving H. Siegel (Ed.), Manpower tomorrow: prospects and priori- ties. New York: Kelley, 1967, pp. 57-112. 41. Joseph, Myron L. Hours of work issues. In Bowen, Howard R., & Mangum, Garth L., Automation and economic progress, p. 138. 42. Wilensky, Harold L. Work as a social problem. In Howard S. Becker (Ed.), Special problems: a modern approach. New York: Wiley, 1966, pp. 117-166. 43. See Keith, Thomas. Work and leisure in pre-in- dustrial society. Past & Present, 1964, 29, 50-66. 44. Komhauser, Arthur. Mental health of the Indus- trial worker: a Detroit study. New York: Wiley, 1965, pp. 205-207. See also: Wilensky, Harold L. Life cycle, work situation and participation in formal associations. In R. W. Kleemeier (Ed.), Aging and leisure. New York: Oxford University Press, 1961. 45. Barlow, Robin, Brazer, Harvey E., & Morgan, James N. Economic behavior of the affluent. Washington: Brookings Inst., 1966, pp. 136-138. 46. Johnstone & Rivera, 1965, pp. 263-270. 47. Kornhauser, 1965. 48. Wilensky, Harold L. The impact of change on work and leisure values. In Paul Weinberg (Ed.), Human values and technological change. Proceed- ings of the 17th Annual Conference, Industrial Re- lations Center, McGill University, May 16 and 17 ; 1967, pp. 1-24. Wilensky has emphasized the addictive nature of leisure activities such as TV-watching. A« these effects concentrated within the lower socio- economic levels? 49. Morse, Nancy C, & Weiss, R. W. The functior and meaning of v/ork and the job. Amer. Soc Rev., 1955, 20, 191-198. 50. Havighurst, Robert J., Munnichs, J., Neugarten Bernice L., & Thomae, Hans. Adjustment to retire ment: a cross-national study. New York: Humani ties Press, 1969. 51. Havighurst, Robert J., & DeVries, Augusta. Lif styles and free-time activities of retired men. Hu man Development, 1969, 12, 34-54. 535 Chapter II living Arrangements of Older People: Ecology rHE following statement focuses upon the physical environments which surround the ging and aged American. In addition to selective iscussion of the current status of housing and ving arrangements for the present generation of ged, the paper will comment upon apparent di- ctions of change in American environments as ley may affect the changing needs of the aging dult. Primary attention has been placed upon roblems of identifying the environmental bar- iers and facilitators which may have major im- act on the effectiveness of the aging person to inction optimally in his home, neighborhood, rid community. Finally, areas of promise in ap- lied research will be proposed. nvironment and Public Policy Decisions in the arena of public policy with re- ard to older Americans should be dictated both y the varied needs of the present generation of ged in their existing environments and by the nticipated needs of the generations who will be- [>me older Americans within the coming few ecades. Proposals for applied research and action with ;gard to the living environments of aging tend to ive priority to the current problems of the elderly, ut considerable attention must also be focused n the long-run applicability of this research, emonstration, and action for the next generation f aging adults in terms of the anticipated changes 1 population characteristics. At this particular time in American social his- )ry, some major priority in gerontological re- jarch and demonstration should be given to those ged population groups currently residing within letropolitan areas and their satellite communi- ies. Population and migration trends clearly in- icate that in the future the urban aged (a) will 3i exceed the rural, (b) will contain more mem- ers at higher age levels, and (c) will be likely 3 be home owners in urban fringe areas. 1 As we know, high density central city areas across the country contain both the elderly and the young in heavy concentration (Table 1). Evi- dence indicates that the elderly move less fre- quently than other age groups and that their moves tend to be within the same neighborhood. 2 Elderly home owners have strong resistance to moving ap- parently for both financial and psychological rea- sons. Since younger families tend to move out of declining urban neighborhoods to be replaced by lower income in-migrants, it is frequent that the remaining elderly in central city and fringe neighborhoods are of a different ethnic and cul- tural group than the young adults and children. However, the vulnerability of the older person who is locked into an impoverished and over- crowded environment is special, regardless of the older individual's race or cultural origins. His frailties, physical and social, and his frequent state of isolation, provide particular opportunities for the more vigorous to exploit and threaten him. On the other hand, opportunities for mutual help and neighborliness also present themselves and there is little doubt that such positive adaptive solutions occur, albeit they are rarely reported. The immediate, national relevance of the intergen- erational and intercultural human problems of the cities require the special research focus of social be- havioral scientists. Patterns of both positive and neg- ative interaction between generations in these areas need to be carefully documented in order that na- tural adaptive behaviors and systems of mutual co- operation and support may be maximized in the development of community self-help programs. Status of Current Living Arrangements of the Aged The physical environments within which older people throughout the United States live are con- spicuously different than those of the younger adult in quite specific ways. Key features which distinguish the older Amer- ican's living arrangements and environments are 536 {a) the age and ownership of the dwelling units which he occupies,, {b) the physical condition (state of dilapidation) of owned and rented resi- dences and, associated with this, the problematic availability of personal or public funds for main- tenance and repair, ( one-unit propei Source: 1960 Census of housing. Vol. VII, Housing of Senior Citizens. Ts H, J, K. L, P, & P. 12 (adapted). 537 Hout ng Qua hi / Poor •Good 80 Percentage 6 q Rating of Housing Quality 40 """"---50 ^_^--.32 20 Best 2 4 6 8 Worst Health Index Score ( c L ha ' r or bed con ined) Fig. 2. Condition of dwellings headed by older people 65+, by health index. Source: Beyer, G. H. Economic aspects of housing for the aged. Research Report No. 4. Ithaca, New York: Cornell University, Center for hous- ing and environmental studies, 1961. P. 32. Table graphically interpreted. Table 3. Average Dollar Expenditure for Maintenance, Repairs, and Improvements in 1967 by Age of Head of Household and Region (One Housing Unit, Owner-Occupied Properties) Total North- North U.S. east Central South West All households $216 $275 $215 $172 $211 Male head, wife present 224 277 222 183 224 Head under 45 246 328 249 177 248 45 to 64 228 261 232 217 186 65+ 151 165 138 110 281 All other 175 283 171 115 130 Mot reported 242 23 269 331 356 Table 4. Percentage Distribution'of Expenditures for Jobs of $25 or More for Maintenance, Repairs, and Improvements in 1967 by Age of Head of Household, Structural Purpose of Expenditure, and Object of Expenditure. Age of Male Head, Wife Present All Total Under 45 45 to 64 65+ other Structural purpose Maintenance and repairs 24 20 24 40 31 Improvements 76 80 76 60 69 Additions and alterations 59 69 57 41 51 Major replacements 16 11 20 19 18 Object Payment to contractor or hired worker 73 64 75 79 84 Building materials purchased by owner 27 36 24 21 16 Analysis of expenditures by households for maintenance, repairs, and im- provements shows the usual lower expenditures by older persons, because of income limitation, even though the age of the housing unit would lead to an expectation of higher rather than lower needs. Nevertheless, proportionately, older home owners had to spend substantially more than younger families on maintenance, replacements, and repairs rather than on improvements and on getting an outsider to do the job rather than on "do-it-yourself." Source: Brotman, H. Homeownertkip aspects of the economiet of aging, Fact sheet. July 1969. Administration on Aging. to moving even where the condition <>l il. ent dwelling unit is extremely i*>or Mid ilw physical hazards great, then ;■ personally and socially preferred decision cannot be made, Systematic analyses of neighborhoods and com- munities in terms of the availability of a wide range of living arrangement options to the ag- ing adult have, to our knowledge, never been performed. There is no evidence, for example, that such analyses are an integral component of any Model City proposal. A second set of factors which should determine environmental decisions made by older people can be referred to in terms of the changing needs of the adult through the later periods of his life. .Age Changes and Environment We may best characterize the problems of ag- ing and living arrangements in terms of the inter- action of two sets of changes. The one set of changes is that of the individual, in the course of aging, in whatever environment. What we are dealing with are decreasing capacities to function which reduce the alternative ways in which the individual can manipulate his environment to meet his instrumental and social needs.' In addition to major reductions in cash income, such examples may be given as lessened ability to handle stairs and curbs, reduced visual and auditory acuity, reduction in capacities to carry or lift objects, limiting capacities to maneuver auto- mobiles, along with those personal and social losses attendant to aging which, for other age groups, supply supports (e.g., car pools of workers, availability and close proximity of friends and relatives). Because of reduced mobility, activities and services simply cease to be as accessible as they once were. The second set of conditions that relate to aging and environment are those structural and social changes which take place both within the domi- cile and in the surrounding community. These changes include progressive dilapidation of dwell- ing units, neighborhood disrepair, increasing population density with concomitant pressures on socialization and privacy as well as sanitary ser- vices, high speed freeways and thoroughfares with associated pedestrian and driving hazards, limited accessibilty of needed health and other service agencies, and aggregations, such as shopping cen- ters, which require easy mobility for access. Neighborhoods A more explicitly scientific understanding of the types of neighborhood within which significant 538 proportions of aged reside, from the vantage point of the aging adult, is crucial to the formulation of public and private policy with regard to urban renewal and housing. The implications of neigh- borhood characteristics for major problems which the aging face are now only suggestively stated in terms of (a) increasing isolation, (b) reloca- tion, (c) utilization of health and welfare services, (d) stress. Some evidence exists that "neighborhood" may •be- the- most important single variable in measure- ments of "housing satisfaction" and in the success of planned relocations. 8 We need to identify which components of neighborhood are important to what groups of people. Which aspects of neighborhood change in transitional urban fringe neighborhoods, for example, are critical deter- minants of dissatisfaction to older residents of such areas that stores are empty, or that a par- ticular drugstore is gone? (whether or not the latter has been replaced a short distanct away?) In other words, insofar as dissatisfaction with neighborhood, or loss of the "familiar" by aged residents, creates stress for them which fosters withdrawal and isolation, 9 we can begin to pro- pose to urban planners certain social priorities for rehabilitation of the physical environment, re- placement of critical commercial establishments or public services, and even necessary public rela- tions for the acceptance of redevelopment pro- posals. Area-Wide Planning Metropolitan and area-wide planning, which encompasses the housing needs of the aged-single as well as the younger-multimember family, really requires a complete inventory of the supply of housing suitable for special groups. The ultimate purpose of such an inventory would be to estab- lish priorities for action programs on- a neighbor- hood by neighborhood basis for the total area.; A study group commissioned at the national level could determine the variables to be measured, as well as develop a formula or weighting system by which the relative suitability of a neighborhood for use by the aged could be computed,' as sug- gested by Wilson:' Some possible variables (by neighborhood) might be: (1) the number of physically suitable dwelling units (in terms of levels of disability of potential resident; housekeeping problems; maintenance etc.); (2) num- ber of supportive services available inside or outside the neighborhood; (3) population density of aged, by five year age groups; (4) the proportion of aged groups to total population (index of segregation); (5) direction, frequency and use of intra-city mass transportation (6) proximity of activity and cultural centers etc.; and (7) economic resources within the neighborhood. Criteria for priority which might arise from such measures should emphasize what appear to be positive natural trends in a particular com- munity which are advantageous to aging adults. Programs need to start where they have the most likelihood of accomplishment and where the com- munity would get the most for its money in the way of adapting present housing to the aging and aged. One natural solution for sizable numbers of residences in many older sections of cities has, for years, been the breaking up of large homes into rentable rooms and apartment units. To our knowledge, there are no explicit data on the ex- tent of such activity, the proportions of aged oc- cupying such residences, or the physical character- istics of these accommodations in relation to the needs of aged residents. No guidelines for the systematic reconstruction and rehabilitation of such housing, in terms of the aged or disabled, have been generated which would preserve both thf style of the neighborhood 11 and provide safe and efficient (and low cost?) living units. In this con- nection, local zoning and housing codes and re- strictions appear to limit severely the extent tc which such adaptations of urban environment: can support the needs of current residents. Federal policy and financial incentives are needed t< pilot, systematically, neighborhood rehabihtatioi projects based upon knowledge of those attribute and components of the specific neighborhood whicl are of sustaining importance to both older and in coming residents. Special attention should be givei to older working class neighborhoods of moderat to large homes where the potential for conversion I multiperson dwelling units exists. Standards am guidelines should be developed for such rchabilita tion and conversions which specify alternative schi tions which would meet the changing physical an social needs of aging residents. If we are to provide environments for the el derly adult, within his own community, whic! will continue to support his independence, w must look to ways of defining and describin neighborhoods not with regard to existing gee graphic boundaries but in terms of activity nei works. For example, man-made barriers such i thoroughfares strongly affect the functioning < aging adults by reducing the range of frequer ambulation. Residential Environments The predominant physical component of the e derly person's environment is his housing. Tr 539 general need for research in housing for an aginp; and aged population and suggestions for preferred directions in such research were spelled out by Grier et al., in 1963," by Ashley and McFarland," and many others. Currently there is heightened interest among a select group of architects, plan- ners, and behavioral scientists for systematic ex- ploration of the behavioral effects of both micro- and macro-environmental inputs." Because of the fact that more funding is seemingly available for institutionally connected research than for be- havioral research within urban and community settings, the efforts of these newer multidiscipline groups which are relevant to aging populations ap- pear concentrated in nursing home and formal in- stitutional settings." This is most unfortunate given the national effort to minimize institution- alization for the elderly and, more importantly, the much vaster number of aging adults who reside, albeit often hidden, in the community (Table 5). The most significant shortcoming in housing research is the failure to design and build purely experimental units. In the past 20 years, approximately 30 million new dwelling units have been built in the United States. 16 The number of new dwelling units to be constructed in the coming 20 years is difficult to predict but will most assuredly exceed past figures. Although there are only 20 million people who can be classified as chronologically elderly at this time, 71% of our total population born in the years 1959-1961 can be expected to live past the age of 60 and to spend many years as "elderly" citizens. Over 86% of the white female popula- tion will live past 60 years. Table 5. Living Arrangements for Population Aged 65 and Over, by Sex, United States, 1965 Males, at Ages Females, at Ages 66 75 65 75 and and and and Characteristic over 65-74 over over 65-74 over Number in thousands, as of July 1 7,931 5,153 2,778 10,225 6,333 3,892 Living arrangement— % Live in families 80.3 83.5 74.2 62.9 66.0 58.0 As head of family, wife present 66.9 74.5 52.3 _ _ _ With other head (e.g., 4.4 3.5 6.3 10.7 9.9 12.2 son or son-in-law) Ai wife of head — _ _ 33.3 42.6 18.2 Wit'i other relative 9.0 5.5 15.6 18.9 13.6 27.8 With unrelated individuals in households 15.9 14,1 19.4 32.4 31.4 34.0 As inmates of institutions 3.S 2.3 5.8 4,3 2.1 7.9 Others in group quarters .3 .1 .6 .4 .5 .1 8ouret: Roeow, I. Desoriptive data prepared for the Committee on Research and Development, Gerontological Society, Feb., 1969. There is no public policy which would in any way direct either the public or private sectors of the building industry to attend to the physical and social-psychological needs of users over the life- span. There is no guarantee that mass production of technologically sound and economically effi- cient housing will encompass the known and to- be-known needs of varied population groups, in- cluding the small, aging adult nuclear family; the multigenerational family; the family with a dis- abled member. With regard to aging adults, high concurrence of many experts, nationally and internationally, indicate the following as vitally needed areas of exploration, demonstration and action: 1. Provision, in any given community, of a planned range of residential accommodations which meet the scientifically assessed needs of varied population groups through the later years of the adult life cycle. Such planning should in- clude firm bases upon which location decisions by providers of both commercial and social goods and services may be made. The objectives of such lo- cation decisions and the probable social and eco- nomic consequences of alternative decisions need to be asserted." 2. Systematic studies of xmied residential densi- ties, as density affects clearly defined individual and interpersonal behaviors. Such studies should classify older subjects by past activity and sociali- zation patterns and according to explicit levels of dependency or disability. They should explore the effects of flexible structuring of single family dwelling units, as well as apartment and congre- gate living units, in terms of such outcomes as, for example, (a) the acceptance or rejection of partially deaf elder parents by adult children in relation to the presence or absence of separate but connected living suites; (b) the frequency and quality of use, by varied age groups, of shared facilities and areas in apartment and congregate living complexes (laundries; kitchens; libraries; dining-recreation areas, etc.); 180 ' b (c) the extent and type of interaction, by aging adults in varied density settings, with non-related persons as func- tional substitutes for immediate relatives- and kin who are unavailable. 10 3. Support for demonstrations of technical in- novations in housing that show promise of (a) improving the safety and health of the home en- vironment for aging adults and (b) countering the declining functional capacity that tends to parallel aging. Again, there is now no assurance that mass pro- 71-272 O - 72 - pt. 1 540 duction of technologically sound housing, pro- grams of residential rehabilitation, or even indi- vidually constructed single dwelling units and apartments, will incorporate features that may meet the special health and social needs of older users. Human engineering and ergonomics have been primarily academic disciplines or, when applied, utilized in the narrow context of therapeutic or industrial environments. 20 Two factors relating particularly to the aging adult make demonstrations of innovative interior design and equipment relevant: 1. Fifteen million people require medical care for home accidents and 28 thousand die each year in such accidents. The elderly are particularly prone to such accidents for reasons of reduced sensory acuity and ambulation problems produced by disease or the hazardous conditions of their environment. Accidents among the elderly result in longer, more severe and more costly disability than among the young. 2. The types of chronic diseases which accom- pany the aging process typically permit the in- dividual to remain in his own home and neigh- borhood for the greater part of his years. How- ever, the residual effects of cardiac disease, hy- pertension, arthritic conditions, etc., disallow easy functioning in the usual home environments. A few sufferers from these chronic diseases and disabilities have been fortunate enough to be exposed to the skills of occupational and physical therapists operating out of medical rehabilitation units. 21 In such situations, assistance and funds may be available to lower sink and table heights, reorganize awkward cupboards, widen doors, re- move thresholds, etc. The techniques for evaluating daily activities in the home and of redesigning it from the safety and efficiency point of view are already well de- veloped. What is lacking are the funds and per- sonnel to study further and act upon the problems of housing of the aging adult. A summary of research literature on the topic of noise, light, and ventilation has been made by the Swedish Government Building Research Institute. In this country, intention to fund research to aid in the establishment of Performance Standard Codes for these environmental features has been expressed by the Federal Housing Administration. Inclusion of special considerations with regard to the sensory and health needs of the aging adult should be guaranteed. We need to know, for ex- ample, what are the "noise" variables of which some older people are said to complain? Wha extent of glare or luminosity are least offensive anc most congenial to the living habits of older adult: in connection with varied domestic activities' What are the optimum number and rise height for stairs in terms of energy expenditure for vari ous levels of disability? Economical ways of meet ing standards, when they are established, need t< be demonstrated and evaluated with regard I rehabilitating current housing or planning ne\ construction for the aging. With regard to both structural improvement ii antiquated owned homes and the application c innovative fixtures and materials, a substantia amount of demonstration-research is needed to e> plore feasibile, understandable, and acceptabl modes of financing for aging adults. As of June, 1969, the only funded research c the Department of Housing and Urban Develop ment relative to the aged was one concerned wit usage of home equity as spendable income. 220 Th National Council on Aging prepared a documei for the Community Action Program, Office of Ec< nomic Opportunity, entitled, A Home Mainter once and Repair Program for the Older Poor. this document in use? Where and how are tl recommendations being effectively carried out? 1 what extent will local labor organizations tolera the use of non-union youth and elderly to provk such repair and maintenance services, as recoil mended in the document? What specialized trail ing and information on the particular structur needs of the aged are being included in work training programs in connection with such pre ects? The situation of the more rural aging adi with regard to housing has been given virtually i attention. This sizeable group is at a special di advantage because of the greater scarcity younger family members to assist financially ai physically in rehabilitation and maintenance their housing and because of the peculiarly mc stringent credit terms for financing home ii provement in rural areas. While it is estimated that as much as 90% substandard rural and small town dwellings w have to have Federal assistance for adequate i habilitation, no more than 2% of the combin HUD and Farmers Home Administration effo are being directed to the needs of rural families substandard housing. Mb It is certainly time for a critical analysis of utilization of existing governmental aids to the ho ing and living problems of the aging, together witl thoroughgoing exploration of new approaches. 'J 541 Ntml\ should examine programs at the federal, state and local levels and should include all forms ol assis Unce Including subsidies nnd tax privileges (sec Table II). Of particular concern In this regard are the needs for housing facilities and services I" persons in smaller and middle-sized cities, and the relative availability of programs and their costs to this population. Socio/ interaction.— There is a large body of iterature pointing to the desirability of social in- eraction if an individual is to remain in sound kysical and mental 'health. It therefore appears ritical to investigate what factors within the housing environment contribute to or inhibit so- cial interaction and how these factors vary with culture, socioeconomic status, etc. What types of behavioral settings are most conducive to social interaction? Will a change in the design of the xirk bench increase the quantity and quality of ronversation? It has been found that, in mental lealth facilities, there is more social interaction n private rooms than multi-bed accommoda- :ions. 23 What implications does this have for the »xtended-care facility or acute hospital in which foe health insurance plans continue to promote the semi-private room? High-rise apartments may be so constructed as to inhibit the development of :lose interaction between the occupants. In the urban setting such inhibition of interaction may increase alienation and anomie scores. 14 The physical environment, housing, the dwell- ing unit should not be viewed as an end product capable of providing direct fulfillment of social needs. Nevertheless, it has been proven in many instances that the physical environment if prop- erly designed becomes a catalyst which can aid in fostering personal motivation and social inter- action. We are wasting a major resource if we do not explore in depth how the physical environ- ment can contribute to social interaction. The physical, social, and psychological environ- ments are interrelated and often interdependent. We know, for example, that we tend to feel hotter in a noisy room than in a quiet one. When we are completely absorbed in a task or in very pleasant company, we are much less aware of the physical surroundings than we possibly might be if the situation were otherwise. In rooms where dummy controls for the airconditioning have been pro- vided, there are far less complaints about the temperature than in buildings where these con- trols have not been provided. It has been shown that persons seated at the corner of a cafeteria table diagonally facing each other may have five times as many conversations as those persons di- rectly facing each Other across 1 1 1<- table." There are buildings designed Foi the mentally ill which through severe delnimani/at Ion and generally in- adequate design appear to Intensify psychiatric symptoms." I'\ pel iments in per loi rnai ice ol people in "pleasant" space, as opposed to "unpleasant" space, reveal a marked increase in generation ol Ideas, better performance, in the "pleasant" space." Festinger has emphasized the importance of even minor planning details such as the loca- tion of stairways and mailboxes in the formation of friendships among apartment house residents. He found further that a small change in the di- rection in which a house faced can have consider- able effect upon the social lives of the people residing in the house. In one housing project where the houses were arranged in a U formation to form a court area, those people who lived in homes facing the court had more than twice as many friends within the project as those whose homes faced away from the court and toward the street. 28 We need to refine and apply such re- search in demonstrations with groups of aging adults. Size and social interaction. — In view of the in- crease in housing and other forms of congregate living facilities for the elderly, it would appear most advisable to explore the possible effects of over-concentration and size. In Europe, and par- ticularly in Scandinavia, the number of dwelling units in housing complexes devoted exclusively to the elderly has been limited to approximately 100; in France, to 80 units; West Germany suggests a minimum of 20 units (houses or apartments) to facilitate delivery of services; 29 Sweden virtually abandoned the idea of high-rise enclaves for the elderly almost 15 years ago after many years of experience. This is not to question the proven desirability of peer group relationships but pri- marily to state that the size of the housing de- velopment may well limit the elderly person's ability to remain in the mainstream. The subject of optimum and alternative sizes has been dis- cussed in many circles, but there has been little or no research undertaken to clarify a wide diver- sity of opinion on the subject. No research has been conducted on decision- making processes of aging persons with regard to their living arrangements, e.g., when and why do lower middle-income widows move into sub- sidized apartments in metropolitan areas? When and why do retired workers move into congregate type housing provided by their unions or work associations? Which members do not? It would 542 appear that a growing proportion of aged will un- derstand and plan for expected functional deficits and isolation by moving, in advance, to dwelling units which will be more supportive for the maintenance of their preferred life style. The de- cision-making processes by which retiring couples and individuals elect to move to formal or in- formal congregate living facilities need to be studied now, while it is early in the evolution of such institutional developments. Environmental Sensitivity It would appear that the older person is an ideal subject with whom to test hypotheses involving the theory of person-environment system, 30 Lawton concurs and has stated that in order to maximize the possibility of explaining the conditions of co- variation between the organism and his environ- ment, it is well to choose a sensitive organism (the elderly person)." We do not seem to know in many instances, however, to what degree the sensitivity to items or combination of items in the environ- ment increases or decreases with age and to what extent increased or decreased sensitivity may in- hibit the individual's ability to negotiate his en- vironment. Does the fact that an individual can- not hear as well make him more or less sensitive to noise? It has been shown, in this connection, that the greatest rejection by families of their dis- abled aged is to those with hearing disabilities." To what extent do both kin and neighbor rela- tions contract for major portions of the aged with hearing and communications problems and how can environments counter this process? There are very limited data available concern- ing an individual's relationship to his total sen- sory environment, and what data we do have we lack the experience to apply effectively. There is an established general decline of sen- sory function with age which results in reduced sensory input. 33 Most of the research in this area, however, has been directed loward a single sense or sensory system. We know very little about the interaction of sensory systems. There is no appar- ent direct relationship between changes with age in sensory "thresholds" and their consequences in behavior" and there is not necessarily a direct relationship between the sensitivity of sensory receptors and the adequacy of behavior. In the investigation of a specific spatial be- havioral relationship we have yet to find a means of determining to what degree a person is reacting to presently perceived stimuli, associated past events and objects, future possibilities, or a com' bination of all three. In addition to the above suggestions for study, re search is needed which begins to specify which as pects of changing environments tend to produc anxiety, dissonance and/or withdrawal among olde persons with sensory problems. Use of space.— We know very little about th use of space and particularly how the use a space may vary with age. One thing is certain people do not use space as the architects plan o design it to be used. How people use space i only part of the dilemma. Why they use it is als a vital but unanswered question. Why is on space preferred to another? Studies have shown that often in homes for th aged, the common spaces, the multi-purpose room are not used as much as one might expect, sin< the administration often encourages their us Therefore, the lack of use may be related to tr individual's inability to identify with the space < to find his niche. Some researchers contend thi the ability to acquire a niche in a particular spa< will vary with the ability of the individual identify with the space and the role he shod play in it, and the ability or opportunity to proje one's personality upon it. To project one's pe sonality upon a space one should be able change it. How many people buy a home or ev< rent an apartment without at least changing tl color of the walls? A successful relationship b tween an individual and his physical environme requires a little change in both the individual ai the environment. If the individual must co; stantly adapt his behavior to suit the space, at is unable or not permitted to effect a change the space, the relationship may prove undesirab This may be of particular relevance to resider of high-rise public housing projects. One of the greatest difficulties in an investig tion of the use of space is establishing a val system. Most researchers are acutely aware of tl problem. One thought, however, may be woi mentioning. Use (i.e., the amount of use) many cases may be a very poor criterion of vali The value of a balcony, for example, may be qu high even if the statistics indicate it is ran used. What value can be placed on three minu of fresh air on the balcony after a heated fam argument? A balcony may serve as a sun sha for the room below and a space to cultivate plar The value of a balcony in a tall building w floor to ceiling glass on the exterior wall mi be in the increased use of the inside space imn 543 diately adjacent to the balcony due to a lessening feeling of agoraphobia. Another case in point is the fact that many homes for the aged are reluctant to provide park- ing spaces and/or garages for their residents due to the observation that, as they grow older, the residents used their cars less and less frequently. The psychological value of having the car avail- able, however, even if used only once a month may far outweigh the cost of providing the space to accommodate it. Community laboratories should be established In which behavioral scientists and designers can explore the impact of varying spatial configurations on the interactions of people and on the autonomous be- havior of individuals. Such research would be of particular potential value for multi-generational families in high density areas and might well be- come an integral part of model cities demonstra- tions. Public space as a housing resource.— In a pre- liminary study currently underway in a down- town Los Angeles park with a high density of elderly persons, it has become apparent (although not statistically proven) that many of the elderly subjects utilize this public space as their living room. The question arises to what extent can well-planned public spaces either indoors or out- doors fulfill some of the needs which individual spaces formerly fulfilled. Public spaces either within a housing complex, within a neighbor- hood, or within the urban area in general might well make maximum use of available resources and encourage the elderly individual to stay in the mainstream of life. Unfortunately, in most cities it is now difficult and unpleasant for the younger adult and almost impossible for the elderly person to walk any distance merely be- cause there is no place to sit down for a few mo- ments of rest en route. An investigation of how public space would sup- plement the declining amount and quality of dwelling space would be of great value to all age groups. Housing satisfaction. — A review of the literature and discussions with investigators currently in- volved in the measuring of housing needs and sat- isfaction raises several issues regarding the at- tempts, to date, to measure housing satisfaction. It is of great benefit to future research to find two investigators, involved in perhaps the largest and most current investigation of housing needs and satisfaction, who both describe the limitations of, and in effect criticize their own work to date. 35 We have developed the methods for the mea- surement of life satisfaction 36 but apparently still have considerable difficulty with the m< ment of housing satisfaction. Several factors seem to have contributed to this problem. Satisfaction with housing is quite dependent upon the needs which housing fulfills for the individual. If housing for one person is consid- ered merely as a means of shelter and the roof does not leak he may well be satisfied. It is quite difficult to ascertain the weight of the housing factor in relation to other variables when measuring satisfaction. Indications to date are that there is little distinction between gen- eral life satisfaction and housing satisfaction. The satisfaction or dissatisfaction with health and eco- nomic conditions may be transferred to housing. Low morale may in many instances be so general- ized that we are mistaking projections of poor morale on housing as valid housing complaints. Measures of the potential quality of housing have been handicapped by an over-comparison of the technical standards of the individual's former housing with his new housing when evaluating the pure physical amenities and, on the other hand, a lack of consideration of this contrast when measuring satisfaction. In view of the extreme need of all age groups in some areas simply for safe shelter, the basic minimum requirements have become "desirable" standards to the inhabitant, the planner, architect, and the evaluator. When an individual who has resided for years in a shack in which the paint was peeling, the roof leaked, and the sanitation facilities were almost totally lacking moves to new public housing, he may be easily "satisfied." If one is to measure satisfaction with housing in order to develop criteria for planners and architects to improve the quality of housing, it is of paramount importance that we measure the housing in as much detail and accuracy as we measure the satisfaction. No studies were found to have undertaken this task. We are invariably left with a "satisfied" or "dis- satified" but really do not know with what or why. If we determine, for example, that for subject A in building B and area C, a view is very impor- tant, and subject A is also very satisfied with his view, we still have little information for the plan- ner or architect. In addition we need to know what kind of view is very satisfactory — a view of the ocean, a view of a children's playground, a view of the passing traffic, or a view of the ad- jacent high-rise building. How does the desire for, and availability of a view relate to the indi- vidual's physical mobility and time spent in his home or apartment? Does a view from any room in the apartment fulfill the need? Are we dealing 544 with an actual physical view available from a seated position in the living room or the availabil- ity or feeling that one has a view? Is there a critical proportion of glass area to wall area needed to achieve the feeling that one has a view? Satisfaction or dissatisfaction may give no indi- cation of the influence or effect that housing has upon the individual's behavior, life style, health and well-being, social interaction, etc., and indi- viduals may not know enough about their desired life styles to relate their needs to housing. Fur- thermore, many elderly individuals may be unable to imagine alternatives. This should not deter, however, the investigation of actual or desired life Styles. The planners and architects must become sensitive enough to translate behavior into remedy, if they can obtain the necessary data on which to base decisions. Given the probability, that satisfaction with hous- ing is related to other aspects of life satisfaction rather than the structural characteristics of the resi- dence, studies are needed which correlate specific other need fulfillments for older people with their housing. For example, is the grandmother role en- hanced by the presence of indoor and outdoor spaces at the residence which enable easy visiting (over- night) by grandchildren? To what extent does hous- ing for low income middle aged and aged families require flexible space arrangements to allow for ready inclusion of transient family members (the tem- porarily unemployed, the separated or divorced son or daughter, the migrating members, etc.). Behavior Setting Survey The advantages of the "behavior setting" sur- vey as a method of investigation have been set down by one researcher as follows: 1. The behavior setting survey is far better than asking people what they do, because data have shown people do not attend reliably to their own behavior. 2. The behavior setting survey enables a quan- titative comparison of behaviors, thus enabl- ing a statistical test of the behavioral effects of a particular architectural variable provided other variables are controlled. 3. The behavior setting survey stresses the ob- jective as opposed to the subjective responses to architectural variables, thus eliminating value intrusion in the compiling of data and leaving the setting of values to the interpreter of data. 4. The behavior setting survey provides data on a supra-individual basis that provides infor- mation on how an observed population rather than particular individuals behave. This means that the data will show how nearly all persons behaved generally but nothinj about how any one person behaved in par- ticular." The behavior setting survey as advanced bj Barker 38 might well be utilized to compare be- havior settings of different age groups. Furthei consideration, however, should be given to the ap parent fact that although the behavior setting ap proach includes the physical environment as ar integral part of the setting it measures only th< interaction between the human subjects. An amp. lification of this approach might include an at- tempt to measure the physical environmental as- pects of the setting and the interaction betweer the human subject and the physical environment The designer needs to know the effects of th< room or outer space in which the behavior occurs We must, therefore, "measure" the spatial fea- tures as well as the behavior if the data are t( provide any indicators for the design of spaces. Migration and Mobility There is a distinct paucity of available data con cerning the migration and residential mobility o the elderly population. 30 The State of Florida represents a unique case in which a net migratior of 256,000 raised the percentage of persons 65 an< over from 8.6 to 11.2 between 1950 and 1960 Even here, however, there is little evidence to in dicate why people move, or what percentage o the elderly are in Florida for only the winte months. A factor of more importance is the almos total lack of data on elderly people who woulc like to move but cannot. A survey in Los Angele revealed that approximately 90% of the popula tion 50 years of age and older were dissatisfiet with their present neighborhoods, but only \3J ( of those "dissatisfied" subsequently changed thei residences during a one-year time period. The el derly who cannot carry out mobility plans or de sires may become dissatisfied with a number o different aspects of their life. The knowledge o the dissatisfaction, however, cannot in itself pro vide the possible solutions. The ecological di lemma demands a commitment to understand th reasons for the dissatisfaction if we are to alleviate them (see Tables 6-8). "Mobility" data most pertinent to practical ap plication in social gerontology are in the genera category of what has been referred to as "honv range." "Home range" is defined for these pur poses as an amoeboid pattern formed by a series o behavior settings, oriented about a predominan 545 Table 6. Proportion of Movers and Nonmovers Among Older People 65 and Over, United States, 1960 (Percentage Distribution by Residence in 1955). Moven Hame State, Moved, 1056 Reudeooe st in 1060 All Peraoni Non-move™ ToUl Same County Different County Different State Abroad Not Reported oUl. nil l|«J|- 100.0 40.9 50.2 29.8 8.6 8.9 1.3 1.6 HS9 100.0 70.0 30.0 19.2 4.7 4.5 0.2 1.4 m 100.0 71.0 29.1 18.0 4.5 4.0 0.2 1.5 Ml 100.0 70.9 20.0 19.1 4.7 3.3 0.1 1.8 M4 100.0 68.8 31.1 19.9 5.3 3.4 0.1 2.4 »+ 100.0 64.3 34.7 21.7 6.0 3.4 0.1 3.5 oUIMI 100.0 70.1 30.0 19.3 4.8 4.0 0.2 1.7 Note.— Detail may not add to totals because of rounding. Source: 1960 Ctntu$ of Population, Vol. 1, Part 1, Table 164, P. 367 (adapted). Table 7. Mobility by Married Status, United States, 1955 to 1960 (Percentage in Each Category Who Moved, 1955 to 1960). Total Movers (Age in 1960) Local Movers (Age in 1960) Migrants* (Age in 1960) larital Status 25-34 35-44 45-64 65+ 25-34 35-44 45-64 65+ 25-34 35-44 45-64 65+ Males larried 78.9 52.1 34.2 24.3 44.0 32.4 23.3 16.0 20.3 17.2 9.4 7.4 'idowed 70.4 57.1 43.0 37.4 33.3 33.8 28.3 24.6 18.5 15.6 10.8 10.2 ingle 52.9 42.2 37.1 36.7 22.2 22.0 22.2 22.9 20.7 12.6 9.1 8.2 eparated 78.6 71.4 58.3 49.5 29.9 31.3 31.1 27.7 30.8 25.0 18.0 14.4 •ivorced 73.5 68.0 57.7 48. 3 35.8 38.3 35.8 20.7 27.4 22.4 16.8 14.0 Females larried 70.4 46.4 31.5 22.4 41.2 20.5 21.4 14.8 26.1 15.1 0.0 6.0 idowed 67.3 48.7 39.7 34.7 42.7 33.3 27.2 23.1 20.0 12.4 10.3 9.4 ingle 50.0 39.2 32.5 30.1 26.9 24.1 20.6 18.0 17.4 10.8 8.7 8.1 eparated 72.9 61.0 49.8 42.4 42.8 38.4 31.3 25.6 23.5 17.5 13.5 11.3 Hvorced 73.2 61.4 49.6 40.9 44.7 41.4 34.0 27.1 23.5 16.6 12.8 10.5 •Movers across county lines within the United States Source: 1960 Census of Population, P.C. (2)-2B, Mobility for States & State Economic areas, Table 7, PP. 16-17, (adapted). ocus of activity and connected by significant link- iges. Home range is that series of linkages and ettings traversed and occupied by the individual n his normal activities. It has been suggested hat the size and degree of differentiation within he home range may vary with the biological, ocial, and psychological age of the individual. If ve are to indicate practical means on a priority )asis of increasing the quality, quantity, and differ- ■ntiation within an individual's home range, we leed to investigate the relationships among the oci of activity, the linkages, and the behavior ettings (Table 9). A final consideration regarding mobility is the act that today's younger age groups are far more nobile than their parents and grandparents. As hey become the elderly of tomorrow, a decrease in nobility and the ability to negotiate one's en- vironment in a meaningful way may produce a : ar greater frustration than for those persons cur- "eiuiy 6C and over, who in their youth and mid- dle age were not accustomed to a highly mobile status. Models, derived from community laboratories, are needed to explore (a) the mobility patterns of older Table 8. Proportion of Older People 65 and Over Who Are Unwilling to Move Out of Neighborhood, by Homeownership and Proximity of Most Friends. Less that 20 Years 20 Years or More in Neighborhood in Neighborhood Occupancy Status % % and Proximity No. Unwilling No. Unwilling of Friends Reporting to Move Reporting to Move Owner 861 70 1,935 79 Friends in neighborhood 264 77 1,148 83 Friends not in neighborhood 597 68 787 73 Renter 665 51 484 57 Friends in neighborhood 199 60 286 62 Friends not in neighborhood 466 47 198 49 Source: Langford, M. Community aspects of housing for the aged. Research Report No. 5. Ithaca, N.Y.: Center for Housing and Environmental Studies, Cornell University, 1962. persons as they meet their varied instrumental needs; (b) the particular socialization activities that become an integral part of their movements; and (c) the ex- pansions and contractions of the "home range" of the aging adult which are contingent upon such factors as weather, illness, news reports of robberies, the opening of a new store, the availability of new methods of transportation, etc. 546 Table 9. Facilities Rated Important by- Housing Managers in Selection of Urban Housing-Project Sites for Older People. Rank of Critical Recommended Facility Importance* Dotance b Distance Grocery store 1(57) 2-3 blocks 1 block Bus stop 2(53) 1-2 blocks adjacent to site House of worship 3(46) K-MmUe ^mile Drugstore 4(37) 3 blocks 1 block Clinic or hospital 5(31) tf-Hmile 1 mile Bank 8(25) *■* Hmile Social center 7(14) indeterminate on site if feasible Library 8(9) 1 mife Hmiled News-cigar store 9(9) X-0e Kmile* Restaurant 10(9) K-Xmile no consensus Movie house 11(2) 1 mile lmiled Bar 12(1) indeterminate no importance ■Based on the number of tunes mentioued as "important" in the location of a housing development for the elderly. Frequency of mention is shown in parentheses. Facilities that were mentioned under "other" in the questionaire were shopping (18), recreation (5), cultural (3), "all" (5), and five others (1 each). Ideally, these should be allocated to the frequencies above. b Baaed on the actual distance from a giveo facility in cases where dissatis- faction had been expressed by the residents. "Based on the apparent consensus of the respondents as to the proper distance to each facility, *Many respondents recommended that where possible, some simple form of these should be provided on site. In any event, ordinary commercial facilities should be at the recommended distances. Source: Niebanck, P.L., & Pope, J.B. The elderly in older urban areas. Philadelphia: Institute for Environmental Studies, University of Pennsylvania, 1965. P. 64. Survey of managers of 100 publicly supported or subsidized hous- ing projects built for OP in United States urban areas. Length of time may well influence the con- figuration and differentiation of the "home range." The young adult often spends an hour on the free- way or train commuting between behavior settings. His greater adaptive capacity, his goals, and the rewards make such a lengthy and mandatory trip tolerable. At what point for the elderly person does the time or the energy expenditures in travel be- come so great that he is forced to contract his home range? This is a particularly important question as middle-income aged on the suburban fringe find travel to shopping or cultural centers less feasible. Another question we need to ask is, can we ob- tain a true measure of housing satisfaction among the elderly (and many researchers are now at- tempting to do so) without a careful documenta- tion of the amount of time spent each day and each month within the confines of a room, the house, or a housing complex? The elderly widow may not leave her apartment for days at a time. She may, therefore, have fewer links and less communication with the physical and social world. She engages in fewer behavior settings, and her home range consequently contracts and becomes less differentiated. How can we approach her spatial behavioral relationships with the same variables we would use for a young secretary in a similar apartment who may spend only 20% as much waking time in the spaces? As more time is spent in the same setting, it is presumed that increasing psychological support is derived from familiar objects near at hand. The proximal environment may assume an importance in the aged not often perceived by the mobile young adult. 40 Most of our buildings are designed for peak daytime hour functioning and according to how they will appear during the daytime. Almost any space designed to function well and be esthetically appealing under the conditions of daylight changes drastically when the human activity declines and artificial light is substituted for daylight. In this regard we would do well not to overlook the fact that the vast majority of our investigation time is spent between the hours of nine to five. Mo- bility restrictions imposed on the aging adult by nightime aspects of his environment need specifi- cation. Transportation Because of the probable numbers of "hidden" elderly locked into restricted environments by physical or environmental restraints, we have very little information about the barriers to free move- ment for the aging adult. What information we have must be pulled together to form a composite picture of accessibilities and constraints in mo- bility. Estimates of as low as 3% of persons ovei 65 owning autos come from areas of central city poor." However, national statistics indicate an increase in automobile ownership and later life driving for the coming generations of aged and an increasing proportion of elderly among licensed drivers." The implications of this information for (a) the design of automobile components to compen- sate for probable deficit function of older driven (see accident rates and types of accidents of older drivers' 3 ); (b) design of highways; and (c) tim- ing of signal systems in cities, are enormous. Spatial distribution and transportation. — Al- though general demographic data are available on the spatial distribution of the adult population by state, urban-rural, large city-small city, it is inadequate to provide a true picture of spatial dis- tribution of the type which can be utilized in planning housing, recreational, and health serv- ices or facilitative transportation. The knowledge that in 1960 the proportion of persons 65 and over was about the same in both urban and rural areas tells us very little about the characteristics of the 547 spaces within and between which these populations are mobile. What is the significance with respect to accessibilities to activities and needed services of living on the urban fringe versus, the suburbs? the small city? the outstate (rural) area? As cities expand and towns are annexed, the individual's classification as to location in the inner city, urban fringe, suburban or rural area can be changed without any change in his im- mediate neighborhood. On the other hand his neighborhood may be changed drastically without any change in his classification. The individual living in the inner city in San Francisco is cer- tain to be faced with different mobility problems than the individual living in the center of Man- hattan, but they are an identical statistic. Cities and suburbs are becoming compartment- alized (the medical center and the shopping cen- ter) to such an extent that their economic sur- vival depends upon the two-car family. We need a census of the middle-aged and elderly population which considers their spatial distribution in relation to transportation, employment and serv- ices. To what extent do residential locations and limited transportation modes actually constrict the desired mobility of aging adults? Studies are needed which analyze where and when transportation of various types are used, how subsidization of fares affects utilization, which members of ambulatory aged groups do and do not utilize lower cost serv- ices, and why. Such descriptive, as well as demon- stration, studies are also particularly important with regard to the accessibilities of the more rural aged to activities, commercial and health service areas, and with respect to movement of the urban aged between areas of the metropolis. It is possible to identify a problem group which we might call the "immobile" — those persons who are without access to a private automobile or who lack driving skills, who have physical handicaps which make it impossible for them to operate a car or board a bus or subway, who cannot afford taxi fares regularly for the long distances involved in urban-suburban living, who have had their driver's licenses revoked, etc.* 4 Lack of public support of expanding bus systems or innovative mobile equipment has virtually eliminated inde- pendent movement about the city for these people and made them dependent upon relatives and friends. This is a problem group worthy of con- siderable attention regardless of age. Modern communities have become increasingly designed around the automobile for surface trans- portation, which means that for many in urban centers as well as for those in the more outlying rural areas, mobility is dependent upon use or availability of an automobile. 4 ' In new town de- velopments, and in the emerging Model Cltft Programs of our larger urban centers, high pri- ority needs to be given to concepts of transporting the immobile. Limited experimentation with ipe cially designed vehicles and equipment is being carried out, especially for transporting impaired older persons to day care facilities, in England at Cowley Road Hospital and in Neshaming Manor (Bucks County Home), Pennsylvania. Studies of services to the aging, including those which have examined their abilities to meet such daily living requirements as grocery shopping, get- ting to the bank and post office, point to the fact that, for many elderly, isolation is a function of lack of transportation rather than an inherent withdrawal of the older person from society. With our emphasis on automobiles and ways of more rapidly moving them through our communities, scant attention has been given to ways in which the elderly can move through a community on foot or on specially designed bicycles. One sees, in many cities in Europe, the elderly riding on specially designed three-wheel bicycles to enable them to move about the community. In the United States, little attention has been given to the design of arteries for bicycle and foot traffic assuring mobility and access to resources by the less mobile. By increasing emphasis on one-way, four to six lane city streets, the elderly, particularly those in their late seventies and over, will likely have difficulty in maneuvering the traffic light cycles. The consequence may be seen in a dispro- portionate number of pedestrian deaths and in- juries among the aging. Attention must be given at a national, state, and community level to the transportation needs of the elderly with special research support for developing new approaches and evaluating their outcome. Em- phasis should be placed upon problems of man- vehicle interactions, adaptations of private and pub- lic vehicles and new modes of transporting special population groups (e.g., public mini-bus systems). The Institution as Environment For some 5% to 10% of persons over 65, in- stitutional settings are or will become a significant part of their physical-social surroundings. Although the number of persons who reside in institutional settings (hospitals, old age homes, nursing homes, etc.) is known, at any one time, the extent of movement in and out of institutional settings is not well documented. Illness-enforced movements from community residence to institutional residence and back will become an increasing pattern in the future. We are not now prepared, as a society, to support the 548 technical capacity of the health professions to dis- charge patients, of any age, horn the specialized, costly health institution. Extended care services, home care, half-way houses, and foster homes woven back into the community have not been visualized as planned de-institutionalizing programs. They are inade- quately funded and staffed and not subject to the types of utilization review that would optimize the supportive flow of elderly people toward greater independence or the most economic uses of these resources. While public policy (Medi- care-Medicaid) provides the formulae for deliv- ery of health services to the elderly ill outside of mass, long-term care institutions, actual planning and provision of such services and scientifically sound placement and use principles have not been developed. It is of some urgency that utilization research be mounted, within community laboratories, with regard to optimum location of neighborhood health centers, • halfway houses, home care agencies, nursing homes, etc. Specific research needs to be heavily supported for planning and evaluation of the community end of the progressive patient care model. The factors both in the community and in insti- tutions which foster independence of the elderly ill and their families, need to be studied and this in- formation applied in demonstration of early dis- charge and community support modalities. Such re- search involves demonstration of the impact of struc- tural, spatial and design modifications on the behavior of institutionalized elderly. Continued placement of large institutions for the aged and ill at great geographic distances from home neighborhoods needs to be carefully reappraised and criteria for location of servicing structures need to be developed. New models need to be demonstrated such as subsidized housekeeping motels adjacent to medical center settings which would allow patients recovering or in rehabilitation to dwell, with their families or alone but supervised, in a community-like environment. This is of particular concern for the chronically ill rural aged, who are often out of con- tact with family for months at a time. 46 Retirement Communities and New Town Developments Although a number of researchers in social gerontology have been particularly interested in the potential attractiveness of separate communi- ties for retired persons, there appears to be high selectivity of those who choose these as a pre- ferred later life style. Two types of research might, however, be very fruitfully conducted in such environments. 1. As Table 10 shows, the vast majority of new communities developed to 1968 have not been designated for particular age groups. It is not known to what extent, however, the middle aged and retired are buying into these areas and theii differential reasons compared with retired person; who consciously select age-homogeneous scenes Studies of the middle aged in "new towns" woul< also be of some predictive value in future plan ning of facilities (e.g., transportation) and serv ices in or near such areas. 2. Some of the new communities are specificall; identified, by their developers, as providing op portunities for experimentation. What is the na ture of such experimental components and cai they be encouraged to include features (as pre viously described) of particular relevance to th needs of the aging adult?* Conclusion The distinguished sociologist, Robert Merton, i 1948, spelled out in his publication, The Socu Psychology of Housing, what were then and ai still the political hazards of research in housing. The individual investigator, the organization, < the university department involved in housing I search must be prepared to defend research i housing against divergent self interests. Merton clearly saw that housing research particularly vulnerable to "institutional crossfire Housing is a social institution undergoing rel tively rapid change. And, as in any institution sphere subject to marked change, the field of hoi ing is rich in conflict and controversy. The type housing to be built, the amount to be built, how is built, for whom and by whom it is built— these are matters involving great conflicts of intere and sentiments rooted in economy, society, and c ture. Some of the central issues have been join* public housing versus housing privately financed part or whole; ownership versus rental; the fn standing housing versus multiple dwellings; rac segregation versus nondiscriminatory neighborhoc —around each of these pairs of alternatives I ranged large and important groups, more concerr with satisfying their interests than with having search establish the sociological, economic, and p chological consequences of alternative policies. Housing administrators, policy makers, devel< ers, financiers, architects, and others have distil tive problems regarding housing which dema systematic inquiry. Rarely are the requireme of one group met with full awareness of the * Westinghouse Electric Corporation's "Coral Sprin; Florida, site is to serve as an "Urban Laboratory" test products for the construction market. Near lando, Florida, EPCOT (Experimental Prototype O munity of Tomorrow), a project of Walt Disney 1 ductions, Inc., will be used to introduce, test, and d onstrate new ideas and technologies. 549 Table 10. New Community Developments, March, 1968. 1 ■■ Homing Units Ni-m t'liimmimlir.s 1 oeatiolw \rrr-, I'rcijr-rtrd IIoumiik I'mtn I'r.ijr.lcil l'o|,llli.lloll ll.-nt.-il or S.,1,1 iiona: LUohfield I'»rk Maricopa Coiintv 13,000 22.000 78,000 150 Lake HftTMU Oitj Mohave County 18,000 — 50.000 (MM) Tin-son Crtt-n Valley I'un.i County 10,000 — 25,000 MM Sun City' County 14,000 — 75,000 kansas: Mnumelle Pulaski County 5,300 — 00,000 lifornm: ■ Dorado Hills Sacramento County 9,800 20,000 75,000 400 Foster CS*J San Mateo County 2,700 11,000 35,000 9,000 Rossmoor Leisure World 1 •* Contra Costa County 2,100 10,000 20,000 _ Valencia Los Angeles County 4.300 — 30,000 360 Diamond Bar Los Angeles County 8,000 20,000 75,000 2,500 Porter Ranch Los Angeles County 4,100 12,000 43,000 _ Mountain Park Los Angeles County 7,150 — 60,000 _ Crumnier Ranch Los Angeles and Ventura Counties 6,300 — 50,000 _ Westlske Village Los Angeles and Ventura Counties 11,500 — 100,000 _ Conejo Village Ventura County 11,000 — 87,000 _ Irvine Ranch Orange County 33,000 8 88,000 — 300,000 1,000 Rossmoor Leisure World 1 Orange County 2.465 18,000 30,000 6.000 Laguna Niguel Orange County 7,100 — 90,000 _ Mission Viejo Orange County 11,000 ' 53,000 ~ 50,000 - San Carlos 5 San Diego County 5,000 9,000 35,000 2,000 Rancho Bernardo San Diego County 5,400 11,000 33,000 _ University City* San Diego County 13,000 — — 3,000 California City Kern County 101,120 — 600,000 _ Rancho California Riverside County 87,000 — 400,000 _ lorado: Montbello' Denver 7,000 — _ _ Colorado City Pueblo County 5,000 — 30,000 _ Pikes Peak Park 1 El Paso County 4,300 — 30,000 _ North Glen Adams County 2,528 — 20,000 6,100 [aware: Mill Creek irida: Miami Lakes North of Wilmington 1,300 5,000 13,000 - Dade County 3,000 6,000 25,000 Canaveral Princeton Brevard County 2,500 — 43,000 _ Port Charlotte 1 Charlotte County 92,700 — 100,000 6,000 Palm Beach Lakes Palm Beach County 7,000 25,000 70,000 _ Lehigh Acres Lee County 60,000 — 80,000 6,000 Deltona 1 Volusia County 15,000 41,000 75,000 100 Corsl Springs Broward County 10,400 — 60,000 _ Spring Hill Hernando County 17,000 — 50,000 100 orgia: Chapell Hill Atlanta 1,100 2,900 12,000 - Elk Grove Cook County 3,000 10,000 35,000 _ Oak Brook Du Page County 3,600 — 25,000 _ ntucky : Oxmoor West of Louisville 1,000 — 15,000 _ nisiana: New Orleans East East of New Orleans 32,000 — 100,000 930 iryland: Columbia Howard County 14,100 29,000 110,000 300 Joppatowne Harford County 1,300 3,000 10,000 1,600 Northampton Prince George's County 2,200 8,000 25,000 _ nnesota: Jonathan Hennepin County 2,200 — 50,000 _ issachusetts: New Seabury 1 Barnstable County 3,000 3,750 16,000 100 w Mexico: Paradise Hills West of Albuquerque 8,500 — 60,000 __ w York: Sterling Forest Orange County 20,500 — _ _ sgon: Somerset West West of Portland 6,600 12,000 40,000 - Clear Lake City South of Houston 15,000 40,000 150,000 Horizon City El Paso County 65,000 — 100,000 _ ginia: Reston Fairfax County 6,750 24,885 75,000 1,000 —Information not available. 'Primarily a retirement community. •Partialy or wholly annexed to an adjacent municipality. •Total Source: House and Home, Feb., 1964, p. 125, as modified by information from: E.P. Eichler & M. Kaplan, The Community Builders (Berkeley and Los Angeles: iversity of California Press, 1967), Appendix I, p. 185; unpublished survey conducted by Jeanne M. Davis, Economic Research Service, U.S. Department of ; and unpublished information from the Land and Facilities Development Administration, U.S. Department of Housing and Urban Development. 550 terrelationships between those requirements and the demands of other disciplines or the problems faced by others; rather they are seen as competing. Few have given appropriate attention to the prob- lems faced by both the immediate and subsequent users (see Federal Programs, Table 11). Merton was aware of the political pressures placed upon the researcher to produce "immedi- ate" findings, lest he be charged with fiddling with statistics and experimental designs while housing decisions must be made for a waiting pop- ulation. This pressure of "urgency" often leads lo Table 11. Federal Programs of Possible Assistance for New Community Housing and Public Facilities, 1967 Selected for Relevance to Aging aiMJniitering Kind of Assistance Loan Technical Program 1 Agency Eligible Recipient Loans Guarantees Grants Assistance Description HUD Cities (less than 50.000); — — X X Grants for comprehensive urban grants: Urban counties; State, regional, development planning programs planning assistance and metropolitan planning agencies Housing assistance: Rent supplements HUD Individuals and families — eligible for low-rent pabfic housing; housing owners who provide housing financed under section 221 (d) (3) - X Rent supplement payments to help make certain privately owned housing available to low-income individuals and families Low-income housing: demonstration HUD Public bodies or agencies, — nonprofit groups - X Grants to demonstrate new or improved means of providing housing for low-income families, including construction design, land acquisition, land use, and financing Home association residential sabdi vision HUD Private residential — developers - x X Technical assistance and planning assistance in establishing a "planned unit development" ■ Experimental boosing program Rental housing for low or moderate income families (see; 221 (d) (3)) Basic home owner- ship l HUD Private developers HUD Private nonprofit co- operative, limited dividend, public sponsors HUD Residential property buyers Cooperative housing HUD Rental housing for the elderly Urban ssass trans- portation grants. Neighborhood facili Nonprofit cooperative ownership housing cooperation or trust Nonprofit or profifc- motirated sponsors HUD State, interstate, regional, or local public bodies HUD Pubfi* bodies or agencies provide an alternative to municipa ownership of scow, or all, public facilities Mortgage insurance to back existing FHA experimental housing progra to insure homeowner or renter from loss due to building materials or construction defects Based on below-market interest rates to permit low rentals Mortgage financing for single family homes Mortgage insurance on long-term loans to finance projects owned and operated nonprofit by cooperative corporations Mortgage insurance for new projects designed for occupancy of the elderly (62 years or older) or the handicapped Grants (% of cost) to test and demonstrate new ideas and methods for improving mass transportation systems and servio Grants to establish multipurpose neighborhood centers for health, recreational, and social services. Grants cover M of development cost — % of cost in redevelopment areas under sec. 401, Public Work and Economic Act, 1965 iPrograms inludedwUte useful in Che physical development of a new community. Several, however, require amendment to be fully effective. 551 failure to put a tentative hypothesis to adequate test, resulting in replication of environmental errors. Individuals, over the course of their life cycle, live in environments which are age heterogenous. That a preponderance of adults, in old age, will prefer or accept highly age homogenous en- vironments is an absurdity. For those who do feel more comfortable and secure in housing and communities designed particularly for the elderly, such facilities should be made available. More relevant to the needs and probable pref- erences of most aging adults, particularly of the coming generations, are neighborhoods and dwell- ings which minimize barriers to mobility and ac- cess to friends, relatives, activities, and services and which will facilitate their functioning in accordance with their changing capacities and interests. Identification of these barriers to continued in- dependent function and exploration of structural changes in environments which will facilitate and enhance life in the later years should be empha- sized in research, demonstration, and action pro- grams. References 1. Advisory Commission on intergovernmental rela- tions. Urban and rural America: policies for future growth. Washington, D.C., 1968. Pp. 19-22; 54-61. 2. United States Census, 1960 Census of population. Vol. I, Part 1. P. XVI. 3. United States Senate, Special Committee on Aging. Hearings: The usefulness of the model cities pro- gram to the elderly. Washington, D.C., U. S. Govt. Print. Office, 1968. 4. Riley, M. W., & Fcner, A. Aging and society. Vol. I: An inventory of research findings. New York: Russell Sage Foundation, 1968. 5. Grieu, G. W. Housing the aging: research needs. Washington, D.C.: Brookings Institution, 1963. 6. Beyer, G. H. Economic aspects of housing for the aged. Research Report No. 4, Ithaca, N.Y.: Center for Housing and Environmental Studies, Cornell University, 1961. P. 29. 7. Lawton, M. P. Ecology and aging. Paper presented at the research symposium: Explorations in spatial- behavior relationships as related to older people. Institute of Gerontology, University of Michigan, Ann Arbor, 1968. 8. Carp, F. M. Housing a minority-group elderly. Gerontologist, 1969, 9, 20-24. . 9. Rosow, I. Social integration of the aged. New York: Free Press, 1967. 10. Wilson, R. L. Urban planning considerations in housing and related facilities. In G. W. Grieu (Ed.), Housing the aging: research needs. Washington, D.C.: Brookings Institution, 1963. 11. Jacobs, J. The death and life of great American cities. New York: Random House, 1962. 12. Grieu, G. W. Housing the aging: research needs. Washington, D.C.: Brookings I 1%3. 13. Ashley, E. E., & McFarland, M. C. The need for research toward meeting the housing needs of the elderly. In C. Tibbitts & W. Donahue (Eds.), Social and psychological aspects of aging. New York: Columbia University Press, 1962. Pp. 303- 326. 14. See Man-Environmental Systems, J. Archea & A. H. Esser (Eds.), July, 1969. A new journal of ex- change between architecture-planning and social- behavioral scientists. Also, Milieu, a publication of the Environment Research Foundation, Topeka, Kansas. Among the centers for such research which have developed are: Cornell University, University of Michigan, Pennsylvania State College, City Uni- versity of New York, University of Southern Califor- nia, and the University of North Carolina. 15. Such research is by no means unimportant since it potentially provides evidence for environmental features which are stimulating and reactivating forces to more disabled and psychically disad- vantaged and is, thus, suggestive of needed stimuli in the community environments of aging. See, for example, Dejong, A. J. An outline of the environ- mental language of the older person. Philadelphia, Philadelphia Geriatric Center, 1967. (mimeo.) 16. United States Department of Commerce, Bureau of the Census. New housing units started — number and construction cost. Statistical Abstract of the United States. Washington, D.C.: U. S. Govt. Print. Office, 1945-1968. 17. Holton, W. E., Kramer, B. M., New, P. & Marzot, G. Locational decisions: objectives and conse- quences. Tufts University, School of Medicine, Boston. (Explores non-rational elements in the location decisions with regard to mental health centers.) Paper presented at the First Annual En- vironmental Design Research Association Confer- ence, Chapel Hill, N. Car., June, 1969. 18a. International Standing Committee for Social Hous- ing, Federation for Housing and Planning. Study about housing the elderly. Paris, 1968. 18b. Schooler, K. K. The relationship between social interaction and morale of the elderly as a function of environmental characteristics. Gerontologist, 1969, 9, 25-29. (Factor analytic attempt to correlat- ing environmental components and social-affective components.) 19. Rosow, I. Social integration of the aged. New York: Free Press, 1967. 20. See, particularly, the journal Ergonomics. 21. The Institute for Physical Medicine and Rehabili- tation. Planning kitchens for handicapped home- makers, New York. Also, National Commission on Architectural Barriers. Design for all Americans. Washington, D.C.: U.S. Govt. Print. Office, 1967. 22a. McGuire, M. C. Department of Housing and Ur- ban Development. Personal communication, June 1969. Also, McGuire, M. C. The status of housing for the elderly. Gerontologist, 1969, 9, 10-14, and her Utilization of research data. Pp. 37-38. 22b. St. Louis Post-Dispatch. Blighted homes of rural poor at last begin to get attention. Thursday, June 19, 1969. P. 5-D. (Report of conference sponsored by the Rural Housing Alliance, a non-profit or- ganization funded by Ford Foundation and O.E.O.) 552 23. Lawton, M. P. Social and structural aspects of prosthetic environments for older people. Philadel- phia: Philadelphia Geriatric Center, (mimeo.) 24. Kriesberg, L. Neighborhood setting and the isola- tion of public housing tenants. In P. Meadows & E. H. Mizruchi (Eds.), Urbanism, urbanization, and change: compartive perspectives. Reading, Mass.: Addison-Wesley Publishing Co., 1969. Pp. 276-290. 25. Sommer, R. Personal space. Englewood Cliffs, N.J., 1969. 26. Osmond, H. Some psychiatric aspects of design. In L. B. Holland, (Ed.), Who designs America? Garden City, N.Y.: Anchor Books, Doubleday & Co., 1966. Pp. 281-318. 27. Maslow, A. PL, & Mintz, N. L. Effects of esthetic surroundings. Journal of Psychology, 1956, 4, 247- 254. 28. Festinger, L., & Kelley, H. H. Social pressures in informal groups: a study of human factors in hous- ing. New York: Harper Bros., 1950. 29. International Standing Committee for Social Hous- ing, Federation for Housing and Planning. Study about housing the elderly. Paris, 1968. 30. Pastalan, L. A. Spatial behavior of older people: A research proposal. Mimeographed. Ann Arbor: In- stitute of Gerontology, University of Michigan. 31. Lawton, M. P. Social and structural aspects of prosthetic environments for older people. Philadel- phia: Philadelphia Geriatric Center. 32. Elconin, A. F, Egeberg, R. O., & Dunn, O. J. An organized hospital based home care program. American Journal of Public Health, 1964, 54, 1106-1117. 33. Weiss, A. D. The role and importance of sensory functions in aging. In Proceedings of seminars, 1961-1965. Duke University Council on Gerontol- oly, Durham, N. Car.: Duke University Press, 1965. 34. Birren, J. E. The psychology of aging. Englewood Cliffs, N.J.: Prentice-Hall, 1964. Pp. 104-108. 35. Peterson, J. A., & Larson, A. Personal communica- tions to LouLs Gelwicks and Maurice Hamovitch, June, 1969. 36. Neugarten, B., Havighurst, R. J., & Tobin, S. S. The measurement of life satisfaction. Journal of Gerontology, 1961, 16, 134-143. 37. Bechtel, R. B. Communication with Eric Pawley A.IA, with regard to ecological evaluation of th utility of central dining versus separate kitchen fa cilities in low cost, high-risa housing for the elderlj May, 1969. 38. Barker, R. G. Ecological psychology: concepts an, methods for studying the environment of humai behavior. Palo Alto, Calif.: Stanford Universit Press, 1968. 39. Bultena, G. L., & Wood, V.: The American retire ment community: bane or blessing. Journal < Geronto/ogy, 1969, 24, 209-217. A study which e> plores the differential characteristics of inter-stal migrants and non-migrant elderly to retiremer communities. 40. Birren, J. E. The aged in cities. Paper prepare for the Center for Community Planning, Unite States Department of Health, Education, and We fare, Dec, 1967. 41. Hearings, United States Senate, Special Committ* on Aging. Usefulness of the Model Cities Prograi to the elderly, Part 3, Ogden, Utah, October 2 1968. Washington, D.C.: U. S. Govt. Print. Offic 1969. P. 291. 42. McFarland, R. A., Tune, G. S., & Welford, A. ' On the driving of automobiles by older peopl Journal of Gerontology, 1964, 19, 190-197. 43. Riley, M. W., & Foner, A. Aging and society. Vc I: An inventory of research findings. 1968, Ne York: Russell Sage Foundation. Pp. 252-254. A thors note that older drivers tend to have ace dents characterized by improper turning, starths and stopping rather than by speeding. 44. Wilson, R. L. In G. W. Grier (Ed.), Housing I aging; research needs. Washington, D.C.: Brookin Institution, 1963. P. 266. 45. High Speed Ground Transportation Journal, Fel 1969 issue. Series of articles relating urban trail portation trends to human mobility and activi systems. 46. Meier, R. L. Personal communication, Mar., 19€ (University of California, Berkeley). Also Meier, Science and economic development. New Yoi John Wiley & Sons, 1965. 553 Chapter III Social Services for the Aged and Aging: Suggested Research Priorities Introduction A discussion of research priorities in the area of social services for the aging and aged must take place within the framework of several per- spectives; (a) the majority of the elderly and their families function without, the help of social services; (b) the majority of elderly (approxi- mately 95% of 20 million) in the United States live outside of institutional settings; (c) the needs of the elderly and their families, which cannot be categorized due to the vast range of differences among the aged at any particular cat- egorical age, cannot be met through the more traditional social institutions. Thus, we need to specify those within the broad age span of 45 and over (those functionally "aged" by labor force definitions), those 65-75 (the "young" aged) those 75-85 (the "middle" aged), and those 85 and over (the "mature" aged), and (d) the set- ting of priorities as to social services, their or- ganization and delivery is not practicable or possible on the national level due to the variabil- ity of resources — fiscal, manpower, and program — among the states and within communities. The above should not suggest that the elderly and their families do not need social services. Rather, it is to suggest that the focus of service interven- tion must be on the elderly within the context of the family and with recognition of the variety of life styles subsumed under the broad defini- tion of "the family and the elderly." By social services is meant the organized ef- forts by individuals through special knowledge and skill to ameliorate or erradicate an unaccept- able social condition or to meet an expressed social need within a community. Such services are sanctioned by the community and may be supported by tax monies, voluntary contributions, or through proprietory auspices. The services are usually related to meeting the physiological, psy- chological, or social needs of the individual, his family, or social group. When speaking of the social service needs of the aging and aged, it is important to distinguish those needs which may be related to individuals because of their life styles and those which are due to the processes of aging and occur to the majority of elderly re- gardless of ethnic minority group or social class differences. There is a paucity of research which clearly definies needs according to this distinc- tion. What follows is an attempt to identify research questions which should permit generalizations as to how social services should be provided, for what sub-groupings within the elderly popula- tion, and under what conditions. It is not pos- sible to develop specificity regarding services, their organizational forms and mechanisms for delivery, without first developing a research orien- tation and design which permits linkages among specific studies and investigations. Out of such an approach, knowledge as to the changing needs of an aging population which itself is constantly changing, should emerge and the appropriate roles of social services in meeting such needs should evolve. Perspectives on Research and Social Services To date, no community in the United States has developed a comprehensive network of serv- ices for the aging and the aged nor a full range of service alternatives to meet the varied and changing needs of the population subsumed under the category "aging and aged." 1 To date, the emphasis on social welfare and health care de- livery systems has been on fitting the individual 554 requirements of the older persons to the system rather than designing the system out of the spe- cial requirements of the aging population. Re- search around optimal approaches to the organi- zation and delivery of sen-ices to the aging is minimal. 3 Further, the limited personnel compe- tent to carry out research in applied service set- tings cannot respond to the dimensions of knowl- edge required to build applied social gerontology. To date, the majority of federal and state funded programs which. pass under the guise of demon- strations or experiments to identify service needs and approaches to meet such needs are mainly descriptive. Little in the way of knowledge bear- ing upon reformulation policy has resulted from such "experiments." We particularly cannot now distinguish the characteristics of the populations being served from those not being served; specify criteria to define the hows, whats, whys, and whens of services; or, evaluate whether or not the services effect positive change in the health and well-being of elderly persons served and that of their families. 3 The basic research issues, there- fore, are: Who are the elderly persons who require serv- ices; what needs do they have; what services do they require; how should these services he deliv- ered and by what kinds of people; and, do such services, when provided, effect positive changes in the lives of older people? A further perspective to this paper is that there are several over-all dimensions of services for the aging and aged which must be considered in re- gard to research priorities. These can be posed as questions which should be considered in the majority of research designs in order to assure generalizations for action in meeting the needs of the elderly. Further, there is need to develop criteria of effect for the questions which follow. They include: 1. What is the effect of choice, through the availability of options among different services, on the functional capacity of elderly persons? This question is associated with the fact that in the majority of our communities there are few alternatives to service provision for the elderly in such areas as shelter, i.e.. independent living arrangements, congregate care facilities, institu- tional care, etc.; medical and health care, i.e., services in the home, in the neighborhood, hos- pitals, extended care facilities, etc.; occupational and leisure time pursuits, etc. At the same time, the concepts of independence and self-determina- tion in our society are predicated on the notion of choice. Limited investigation suggests the sig- nificance of this concept to social functioning. 4 There is also evidence that the exercise of choice is related to subsequent favorable adjustment on the part of the older person. 4 2. Over what range of circumstances should age-segregation be the modal approach for the provision of community services for the aging and in what range of contexts should age-integration be the modal pattern? To date, there has been dialogue and, again, limited research, as to the desirability as well as the effects of age segrega- tion in such areas as housing," health programs, and urban design patterns as well as residential and institutional care programs. Issues of infor- mation transfer, communications with other gen- erations, and the effects on family intergenera- tional associations are but imperfectly understood. 3. To what degree can or should older persons take primary leadership and responsibility for services best suited to their changing needs? There has been much dialogue as to the reservoir of social contributions dormant within the ap- proximately 20 million older persons in our na- tion. What should be their role in meeting the needs of their own age group as well as those of the broader society? A number of views have been expressed on these issues including: Elderly persons with sufficient income do not want to work; elderly persons without income cannot af- ford to volunteer their services as it "costs money to volunteer"; previous "life styles" are a more basic determinant of willingness and capacity tc serve. There is great socioeconomic variability among older persons, which defines, differentially the potential contribution of elderly persons as well as the role of services in their lives. 4. What are the special requirements for ethn'u sub-groups in the aging population, such as th( Negro, Mexican- American, or the Orthodox Jew] Limited research in aging points to the great vari ability among the elderly. 7, *■ * Research and pro vision of services must identify the special re quirements of sub-groups within the aging pop ulation. To date most efforts in serving th elderly have been based upon the mistaken con cept that they are essentially alike rather thai that this group represents a wide range of dif ferences. 5. What effects will projected changes in th characteristics of the aging over the next severe decades have on their requirements for commun 555 y services* and ways they are provided? This lould include appraisals on income projections f the elderly for the future, including inflation- 7 trends, consumption needs, etc.; the changing laracteristics of those within the 45-100 age •oup, i.e., those who will face adjustments prior i retirement (the aging), the relative sex ratio, ie distribution, and educational level within ich decade; family intergenerational relationship langes; and, projected changes in health status various points in time in the aging continuum. 6. What is the basis for projecting, quantita- vely and qualitatively, the service needs of the >ed? Measures of needs, at best, are difficult to rtermine. However, if planning for service pro- sion for the aged and the design of specific rvices for sub-groupings of the older population to take place, guidelines as to ratio of need per DOO elderly must be established. Methodologies r the development of such measures of estimate ust be developed. 10 he Development of Models of Social irvice Organization and Delivery Systems The above represent necessary but not sufficient mensions to be considered in developing appro- iate priorities for services to the aging. There a need for models to serve as guidelines for nsideration of service provision which would hance the functional capacities of older per- ns. Models should be constructed along a number lines, with the expectation that the best fea- res of several can be combined after testing and lidation. Such models could be built around number of variables and approaches, such as: e provider of service; the consumer of service; e non-needy consumer and the welfare con- mer; the preventive-public health model, etc. It is important that evaluative research design built into the construction of such models. As ited by Dr. Maurice Hamovitch, One of the major problems in social work research in particular and some policy research generally is its global nature. We tend too much to attempt to evaluate a big broad program in vague unsim- plified terms such as "improvement," "adjustment," 'satisfaction." I believe that we must first state explicitly the goals to be achieved in measurable terms and then proceed to evaluate the degree to which these specific goals are achieved. In addition research tends to fail to assess the spe- cific contributions of individual variables— such as services. What specific services and how? Arc they interrelated? Further, we fail to differentiate the impact of specific services on variables among spe- cific groups and individuals in different circum- stances. What follows is an outline which may suggest approaches to planning for service to the aging as well as a specific range of services which should be available to an aging population, i.e., 45 years and over. A Suggested Outline for the Planning and Provision of Community Services to the Aging* I. The Concepts and Goals of Planning A. Planning and service delivery systems for the aging must be: 1. Comprehensive as aging embraces a variety of different individuals and in- cludes a large segment of the life-span 2. Flexible as the needs of older persons continue to change 3. Dynamic to allow for the movement of persons between the levels of services which may be offered. B. In the planning and provision of service for the aging, the basic concern is the indi- vidual and his ability to function. We need to identify the appropriate ways to intervene to assure optimum functioning. This implies: 1. Finding those situations amenable to levels of evaluation and assessment of the individual and his family condi- tions. 2. Identifying levels of services based upon evaluated need. C. Clarification of planning goals is depend- ent upon the specific relationship of such goals to the condition or need of the older person and/or his family and for which services are to be developed and provided. 1. Specific service activities must be 'Note: The use of the term "community services" used throughout this paper includes the full range services along the continuum from services into the me, those available in the open community, and >se available in congregate care facilities. * This outline is predicated upon the conditions or situations found among a number of the aging in communities throughout the United States. Such con- ditions may be identified in measurable and behavioral terms. They require alternative forms of social in- tervention. The levels of service are organized ac- cording to the frequency of occurrence of situations in the lives of older persons as they age; however, no level is exclusive to any single age-range grouping. 71-272 O - 72 - pt. 1 - 36 556 identified as they relate to the achieve- ment of such goals. 2. Specific levels of services for the aging as related to specific goals of planning: a. Basic services b. Preventive services c. Adjustment and integrated services d. Supportive services e. Congregate and shelter care services f. Protective services IL Levels of Services for the Aging A. Basic services level A primary goal of any community plan of services to the aging must be the identi- fication of what is considered to be the basic service needs which may be required by all age groups including the aged. 1. Specific services might include: Com- munity health services, environmental sanitation, family and individual counseling, financial assistance, group services, in-patient medical care, out- patient medical care, mental health services, housing, recreation, social treatment (group) services. B. Preventive Services Level 1. Specific goal: To prevent, on a popula- tion or individual basis, the break- down of the capacity of the older per- son to function, physiologically, psy- chologically, or socially, through de- tection of need and through social in- tervention prior to old age or prior to a crisis in old age. 2. Specific conditions to which the above goals relate are: a. Environmental hazards and deteri- oration b. Early symptoms of ill-health and disease c. Personal and/or family dysfunction (chronic or crisis) d. Limited income cr financial security 3. Specific services would include: a. Environmental re-design and haz- ard control b. Multi-phasic social and health screening c. Intermittent counseling d. Periodic health check-ups e. Job re-training (including volun- tary community participation and leisure guidance) C. Adjustment and integrative services level 1. Specific goals: The development of ways of permitting the older person to: a. Participate in the life of the com- munity b. Retain and utilize his capacities and potentials in a way that is socially approved and recognized c. Adjust to new social roles in the family and in the broader com- munity. 2. Specific conditions to which the goals are related are: a. Retirement b. Income reduction c. Loss of work- role (45-65 age group) d. Increased physical limitation (in- cluding sensory losses) e. Mental limitations f. Inter-personal losses 3. Specific services would include: a. Old age assistance b. Recreation services for the aging c. Retirement preparation d. Senior activity center programs e. Specialized casework and group- ■ work service to the older person and/or his family D. Supportive services level Specific goal: to aid the older person to remain in his familiar habitat or to retain his usual living arrangement when this is no longer possible through his own efforts. 1. Specific conditions to which this goal is related: a. Aged or handicapped persons liv- ing alone who may be bedfast or housebound with a physical dis- ability b. Inability to normally manage the , home c. Isolation from others due to age, physical disability, illness, and in- creasing deprivation of friends and relatives 2. Specific service would include: a. Escort services b. Friendly visiting c. Homemaker-housekeeper service d. Home meal service e. Organized home care 557 f. Motor service (transportation) g. Organized volunteer telephone checks Congregate and shelter care level 1. Specific goals: To protect the older per- son from hazards of living in the open community, or from his inability to cope with independent or family living situations due to physical and/ or mental infirmity. 2. Specific conditions to which the goal is related: The difficulty and at times inability of older persons to maintain a com- pletely independent living arrange- ment, or inability to meet or satisfy basic needs for self-maintenance, care, or protection. 3. Specific services would include: a. Day care for older persons b. Homes for the aged c. Housing for the elderly with vary- ing auxiliary services. d. In-patient long-term care and treat- ment e. Substitute family care f. Temporary in-patient emergency or family vacation care Protective services level 1. Specific goals: To protect the civil rights and personal welfare of older persons from the neglect and/or ex- ploitation by relatives, friends, the aged individual himself, and the com- munity. 2. Specific conditions to which this goal is directed Inability of older persons with limited mental functioning due to mental de- terioration, emotional disturbance, or extreme infirmity to manage their own affairs in such areas as providing for personal and physical needs, planning and decision making, and handling of finances. 3. Specific service would be basically a coordinated and focused organization of legal, medical, and social services. Knowledge About Social Services to Aging People From the above highly tentative model of a community range of services to aging people, we must recognize that it is not possible to separate social services from the broad range of needs such as housing, food and nutrition, financial assist- ance, etc. In fact, one of the more basic charac- teristics of problems facing older persons and their consequent need for intervention is the in- terdependence of life situations. Income, or the lack thereof, often determines the quality and characteristics of housing and living arrangements which in turn may be related to other expendi- tures such as food and health care. These, in turn, may be related to nutritional deficiencies, chronic disabilities, if not illnesses, etc. Because, therefore, of the tremendous variability within the aging population, already alluded to, it is es- sential that there not only be a wide range of service alternatives, but these be viewed as net- works of services which can respond in concert to the interdependent requirements of this segment of the population. We know very little about how to organize and deliver concerted, coordinated and a comprehen- sive range of services for the aging. Most com- munities and agencies have approached such serv- ives on a piecemeal basis. Again, it is suggested, that there needs to be support for the development of models for service delivery systems to the aging with built-in research components to evaluate out- come and to provide in a sense "feedback loops" to redefine goals and/or redefine methods for achieving stated goals and restructure services based on such evaluations. Support for the design and evaluation of such models is lacking. Re- search in the design and effectiveness of such models is imperative. These designs must be able to assess the relative impact of the specific serv- ices, keeping in mind individual variables such as age, sex, ethnicity, socioeconomic status, life styles, etc., otherwise there is danger of global measures without meaning. Related to the above is the basic question as to how services to the aged can become an integral component of comprehensive planning and serv- ice delivery programs such as Comprehensive Health Planning, Regional Medical Programs, Comprehensive Mental Health Centers, Mental Retardation Programs and Model Cities. Again, in considering services from the standpoint of enhancing the satisfaction of older persons who live in the community, almost no research, to my knowledge, has been done in this area. The question of the acceptability of social services points to the issue of the need for research to de- termine the social psychological consequences of how services are offered. Much of our present re- 558 search is provider-oriented, not consumer-oriented. Services tend to be organized around the conven- ience of the provider rather than the requirements of the consumer. The above is related to a broader question, that of accessibility of services. It is increasingly evi- dent with highway construction, urban design and redesign, that physical planning of a city or com- munity determines to a large extent whether or not people have access to services within the area in which they live. This is the broad area of the environmental di- mensions of urban life and whether or not consid- eration has been given to the functional needs of the aging segment of the population, including ac- cess to a full range of health, welfare, educational and leisure time services. Research must be car- ried out, and high priority should be giuen, to identify the range of environmental situations which promote the function of older persons in- cluding access to services as well as those which negate such functions and access. With the in- reasing emphasis, an building new towns and model cities, high priority should be given to the design of environments, including services for the aging with research built in to determine the con- sequences of such planned environments from the viewpoint of the aging. Here the role of compact geographical areas, organized somewhat along traditional neighborhood lines and encompassing institutional arrangements which support the needs of the aging must be considered. Another large question which begs investigation in regard to an aging population is the use of existing public facilities for the aging, their possi- bilities and limitations. A specific example is the concept of the public school which traditionally has an 8 a.m. to 5 pjm. orientation of education for young people, wMi some exceptions for adult education in the evening. However, with aging, rapid social change and technological obsoles- cence, an argument can be made for the concept of lifetime learning, whether or not such learning is related to occupational goals. Further, it can be argued on a cost efficiency basis that to use schools for the entire population on an S a.m. to midnight basis, with such services as food provision, formal coursework, avocationai interests, and a wide range of activities could be offered to support the multi- generation family, including older members, and its needs for keeping abreast of changing informa- tion and technology as well as to pursue creative interests. What is argued here is the need to develop demonstrations or experiments in the use of existing and new public facilities and to deU mine their feasibility from an economic viewpov from the standpoint of accessibility of servic and the concept of human resource conservati and development. Again, through federal fur ing, including research support, such progra could be tested. Perhaps most basic to the entire question service provision is the need to begin to deve longitudinal studies, particularly of the 60 c over age groups, to determine parameters of n and changing definitions of need within sufcpoj lations of the aging. In a sense, this points to epidemiological framework for the study of ag persons and their vulnerabilities, in order to propriately design services. The entire quest of effectiveness of services raises further quesl as to criteria for measures of effectiveness, as \ as the issue of the reversibility of an unacceptj condition." This, in turn, is related to the qi tion of whether we are dealing with disabilitj functional capacity. It is not possible to de appropriate service goals, particularly those deal with the concept of rehabilitation an( prevention, without developing instruments criteria for the functional appraisal of aging dividuals. This has been attempted, through work of a committee of the Gerontological Soc on a preliminary basis." If professional respc bility for social service delivery is that of ma ing services to individual requirements of aging person, little has been done because we 1 not developed appropriate instruments for as ing individual service requirements. It is sugg< ■ that 1 there is need for expanded federal suppo develop further the criteria and instrument', functional assessment as a first step in bettei lating the needs of the aging to community vices as well as for designing those services ti do not presently exist. In the area of instituti care such an approach is particularly releva we are to develop a full range of out-of-hos alternatives in the extended care, congregate and home for the aged areas of need. Related to the above is the development c formation and referral services for the aging chronically ill. On the premise that inform about the availability of services is basic t< use of such services, the Public Health Servic supported a number of demonstrations of Infc tion and Referral Services. However, wheth not the need presented for service is indee "real" need, whether persons receiving the mation are able to act on it, and whethe 550 needed service was provided once the referral has taken place, are questions that have received scant attention. Information and referral services must fiavv as an integral component, a way of evalual ing and classifying needs (see discussion on func- tional assessments above) and a means for evalu- ating the characteristics and quality of services provuled to the aging. Only then can individual service requirements and community resources be matched. Evaluation must also be made as to out- come, that is, whether or not the service was rele- vant to the needs of the older person. Further, information must be made available to the com- munity as to the existence and use of an informa- tion and referral service. Again, evaluation as to the use of this service is essential. Such a service then becomes critical to community planning for the aging and, if appropriately staffed with re- search trained personnel, could lead to the de- velopment of predicative instruments relating to service requirements of the aging." The work of Walkey, Mangum, Sherman, Dodds, and Wilner on retirement housing in Cali- fornia 14 and the present work of Hamovitch on retirement communities in Southern California suggests the limited extent of our knowledge as to the interrelationship of housing and living ar- rangements with community identification, par- ticipation, and satisfactions on the part of older persons. A critical question, at the initial level, is whether specialized housing for the elderly should be designed to offer a full range of living alterna- tives from the inner city to the suburban and rural areas. The growing but limited literature on family relationships and the aging suggest the importance of the elderly, particularly the older widowed woman, living near adult children but not in the same household. Much of our specially designed housing for the elderly is based on the concept of concentration of the aging population in high-rise apartments, retirement villages, etc. The relationship of social services to various degrees of concentration of numbers of elderly has not, to my knowledge, been studied. 15 Does housing which contains services attract less competent people? Further, the design of housing and its location must be considered from an ecological viewpoint, that is the interac- tions and web of familial and social institutional relationships, including service provision. Experi- ments must be developed to determine the rela- tionship of varieties of housing and ecological relationships to the ability of the elderly to man- age their service needs and to the extent that such service requirements must be provided by othcrt ll scivuc programs can be provided In the vicinity of specialized housing and such services be pro- vided for all age groups, we must determine how the aging may participate in the provision of ser- vice, not only to themselves, but to others in the population, especially the very young as well as to their own age group. The operation of multi- service intergenerational agencies which include preschool day care and specialized services to the aging, as educational and research laboratories for learning should be supported. Within such set- tings meaningful roles for elderly, in relating to the needs of the young, can be tested. This has been attempted to a limited degree by the Foster Grandparents Program sponsored by the Office of Economic Opportunity and the Adminis- tration on Aging. It can be argued that many older persons, after making adaptations to a rapidly changing world from six to seven decades, have much to teach the young as to mechanisms for adjustment and adaptation. Further, in communities which are lacking in a variety of human service resources the aging represent an untapped supply of capacity and talent. A recent document prepared for the White House suggests the development of an "American Community Service Force" which gives high priority to the development, on a local level, of organizations to provide a structure for the use of our "wasted Americans" in a variety of human service tasks. Should such an approach be de- veloped, research must be an integral part. Such research must evaluate and document new ap- proaches to manpower development and utiliza- tion, particularly the role of the lesser than pro- fessionally trained, in order that we may more effectively develop team concepts of professionals, para-professionals, and volunteers. As one reviews the increasing service needs in our society, particularly the increase in numbers of the very young and the very old, and the pres- ent shortages in such areas as nursing, social work, and medicine, we must recognize the need to de- velop at a national level over-all strategies for the development and utilization of manpower for ser- vices to the elderly. In social work, for instance, it has been estimated that there is a current short- age of approximately 100,000 professionally trained social workers. 18 In spite of the rapid in- crease of new professional schools of social work, the gap between available manpower and service needs is ever increasing. Professional schools are beginning to reexamine the role of baccalaureate 560 education as this relates to graduate preparation as one means of addressing itself to increasing the supply of needed manpower. It is suggested here that there is a need to develop broad new ap- proaches of manpower development and utiliza- tion, particularly as applied to those in their middle years who have become technologically displaced and who could be prepared for various levels of manpower in a full continuum from direct service provision to the more complex su- pervisory, administrative, and planning responsi- bilities. Many of the traditional tasks, which are carried out by professionals, can be well handled by those of lesser skills and training. In fact, the rapid expansion of two-year community colleges suggest the availability of training resources in a number of communities throughout the nation. There is a need to develop special demonstrations ■ and experiments in manpower utilization. To date, we have little in the way of criteria as to how best to structure delivery systems to assure the appropriate preparation and use of such individuals. There are, however, a number of be- ginning programs within educational institutions, including commimity colleges, and among service agencies directed to a more rational approach to manpower development and utilization. Support should be given to bring together those approaches which are attempting to utilize the talents and skills of older persons. Related to this is the need to design models of manpower organization for human services delivery, working in concert with a variety of educational and professional associa- tions and service agencies. To date, we have not defined and developed the levels of manpower and their skills in the broad areas of institutional care for the aging, day activity centers, and the full range of other health and welfare services pointed to earlier in this working paper. There is need to develop national policy on manpower and ways to use our rich hwnan resources, especially those of the aging and aged, which are largely un- tapped in today's society. Research support to evaluate the uses and effectiveness of new ap- proaches to manpower needs at all levels, that is from the volunteer through the full continuum of cud, associate, and professional, should be de- veloped. Of special importance in the development of manpower resources in services to the aged is the much held view In the professions that negative attitudes toward the aged in general affect the re- cruitment and training of personnel. To my knowledge, research on the prevalence of such at- titudes or on methods of modifying them among the public or personnel is lacking. The increase in senior centers has been rapid. It is estimated that since the publication in 1962 of Jean Maxwell's book on senior centers," the number has grown from a few hundred to three thousand or more. At the same time, there has been growing concern for the need to define the role and functions encompassed under the term "senior center." While this type of program ap- pears to be moving into a multi-service concept, there are conflicts as to what constitutes such a center. To date, no working definition has in- cluded vital areas of service such as food and nutrition and the role of the elderly in the opera- tion of the center. There are single purposa and multi-purpose centers with apparently different functions and concepts. There is need for a defini- tion appropriate to the role of senior centers in the 1970's. Operational research should he supported to determine the range of services and structures subsumed under senior centers, including evalua- tion of optimal approaches to their organization and the characteristics of persons served." Such study should examine the role of the elderly them- selves in the development, planning, and opera- tion of senior centers. Another emerging questior which needs study is the relationship of the senioi center to other community programs for the aging including its potential role for coordinating com- munity services. Finally, the relationship of cen ters to educational institutions, particularly in th area of training and preparing various levels o manpower in services for the aging must be con sidered. In the area of public welfare, although th< numbers of elderly receiving financial assistano are declining with increases in social security pay ments, a most critical issue is that, for the mos part, the elderly are viewed as a group for "mini mal income maintenance" with little attentioi being given by the public sector to their broa< social needs. With titles XVIII and XIX of the Social Se curity Act, some beginnings have been made ii the area of public policy in meeting the medica and health care needs of the aging. It is importan to identify some critical limitations of these pro grams as they affect the welfare of the population they are designed to serve: 1. The mandated requirement that older persons wh require long-term care must first be hospitalize as a condition for transfer to extended care facili ties. This means a misutilization of hospital bed and, all too often, an inappropriate approach t 561 the social psycholo^" »1 requirements ol the elderly at times of crises or in regard to their being moved from one environment to another. Their is need to encourage, through subsidization if necessary, out-resident care. 2. The broader policy issue of the adequacy of health care services for the aging, particularly in regard to quality and the lack of a more rational ap- proach to health care services systems. 3. The intcr-relationship between mental health and physical health. Care for the mentally impaired and the physically impaired aged must be better interrelated and coordinated as a matter of public policy and of service delivery for the aging. 4. The inequities between States in the provisions and administrative approaches to Title XIX. The need for uniform standards which approach the provision of care from the standpoint of quality and comprehensiveness is essential. Support re- quirements, in many States, are pauperizing adult children of the aged. 5. In the majority of States, Medicare has not helped those elderly who require long-term care. In several of our States, there is strong emphasis being placed on discharging the elderly from state mental institutions and to require that care be provided in the community rather than in State hospitals for those elderly needing psychiatric treatment. This has led to an emphasis on the place of treatment rather than on the characteris- tics of services to be provided. Certainly these two factors cannot be separated. However, all too of- ten, placement has been to small nursing home type institutions which are inadequately prepared to deal with the needs of this type patient. In some States, social policy is to make premium pay- ments for the bedfast and less for those who are ambulatory. This negates the concepts of rehabili- tation and prevention and opens up a Pandora's box of issues in relation to medical and health care of the aging. It is my judgment that public health has given low priority to the aging through its traditional emphasis on prevention. Prevention all too often is translated to mean early services to those in childhood and early adulthood. Yet, the role of multi-phasic screening, physical and social, for those in their middle-years to permit early detection of symptoms is equally important. Such services are almost lacking in communities throughout the nation. To date, the emphasis on health care delivery systems and mechanisms for payment has been on fitting the individual requirements of the older person to the system rather than designing the system out of the special requirements of the aging population. The system has grown without plan or design and with little commitment to develop- ing the appropriate range of alternatives lor the elderly segment ol ill.- population. The above points to the need to build into ad- ministrative structures for public policy develop ment ways in which resources can be btttK de fined and organized to assure responsible provision to the aging. Misuse of payment mechanisms to assure reallocation of federal funds to states and their subdivisions has become part of the issue, particularly around Title XIX. What is suggested is the need for operational research around the organization and delivery of medical and health care to the aging, with particular em- phasis on the effects of mechanisms for payment. In addition, more attention must be given to the inter-governmental relations between federal, state, and localities in other broad areas as well as around Title XIX. Although the viewpoint is negative in regard to the aging, the recent article by Eveline M. Burns, Health Services for All: Is Health Insurance the Answer? 13 suggests the im- portance of clarifying the relationship of pay- ment mechanisms to the availability and character of health services. The policy issue is not whether local and state governments can afford through taxation to support the medical care needs of the aging; rather the larger question is whether ap- proximately 10% of our population, those 65 and over, should not have access to their proportionate share of the Gross National Product. Strategies to assure that the aging receive ade- quate service delivery systems are predicated on basic policy determination. This is the arena wherein manpower issues and fiscal issues must be determined. To date, the American society has placed great emphasis on federal support for facili- ties, particularly health care facilities, but little attention has been given to manpower resource development or fiscal policy to assure the responsi- ble provision of services. Research, perhaps along the lines of the suggested social indicators, must be applied to the broad questions of fiscal and manpower resource development and allocation. If any priority were to be given at the national level to the adequate development of health and welfare services to the aging, they must be based upon this concept. There must be a more rational approach through adequate measures for the al- location of the Gross National Product to the various segments of the population, including the elderly. Concensus must be achieved at a policy level as to those conditions among the aging and aged which are unacceptable and the goals for their 562 amelioration or education. It is only then that we can begin to develop measures oE the adequacy of the tasks undertaken and the appropriate allo- cation of resources to achieve such goals. Com- munities can only respond in random and erratic ways if there exists no policy at the national level to shape the directions of resource development and allocation at all levels of society, particularly at the local level where services must be provided to the aging and the aged. Research must be un- dertaken that links services with outcome. Policy cannot be predicated on assumptions as to the role or outcome of services which are not validated. In testimony presented before the United States Senate Special Committee on Aging, Beattie has suggested the need for Regional Multi-disciplinary Centers for Training, Service and Research in Aging.* The traditional schism between research and application must be bridged. If those of us responsible for educational programs to prepare persons for services to the aging are to move ahead, we must have support for the develop- ment of such institutes. There has been an increase and appropriate emphasis on the funding of basic bio-medical and behavioral research in aging. It is now important that we begin to make a massive effort of preparing persons to apply the findings of such research, where appropriate, to the broad areas of service. Closing the gap between research findings and the utilization of such findings is essential. . . . Basic to any educational effort for developing ser- vice is the related need to prepare persons for evalu- ative research; that is, to develop measures as to the outcome of services— their effectiveness and their efficiency. 21 ' Footnotes 1. Breckinridge, Elizabeth, et al. Community service for older people, The Chicago Plan. Chicago: Wil- cox & Follett, 1952 (the only comprehensive ap- proach undertaken nearly 20 years ago). 2. Morris, Robert, and Binstock, Robert. Feasible planning for social change. New York: Columbia University Press, 1966. 3. Blenkner, Margaret, Jahn, Julius, & Wasser, Edna. Serving the aging. New York: Community Service Society of New York, 1964. 4. Report of the Commission on Local Authority and Allied Personal Social Services (c m n d 3703). London: Her Majesty's Stationery Office, 1968. 5. Lawton, M. Powell, & Yaffe, Silvia. Mortality, mor- •The newly developing regional muit concern themselves with the and children. [ welfare research centers as well as with families bidity and voluntary change of residence by old people. Paper presented at the annual meeting the American Psychological Association, Washin ton, Sept. 15, 1967. 6. Rosow, Irving. Social integration of the aged. N< York: Free Press, 1967. 7, 8, 9. See work of Walter Beattie, Jr., M. Cla; and J. Jackson. 10. Shanas, Ethel, et al. Old people in three industr societies. New York: Atherton Press, 1968. S especially pp. 106-107 for a discussion of the f persons served by selected service areas. The f: of persons being underserved is apparent. Rat of need to population are lacking. 11. Cohen, Elias S., & Kraft, Alfred C. The restorat potential of elderly long-term residents of mea hospitals. Gerontologist, 1968, 4, 264-268. 12. Gerontological Society. Final report, Contract P PH 110-100, Functional appraisal of aging indiv uals, June 30, 1968. S. C. Howell (Ed.). 13. Beattie, Walter M., Jr., & Bullock, Jean. Evaluat: services and personnel in facilities for the agi In Leeds, Morton, 8c Shore, Herbert (Eds.), Get trie institutional management. New York: G. Putnam's Sons, 1964. 14. Wilner, Daniel M. et al. Demographic characte tics of residents of planned retirement housing si Gerontologist, 1968, 8, 164-169, Sherman, Susan et al. Psychological effects of retirement housi Gerontologist, 1968, 8, 170-175. 15. Lawton, M. Powell. Supportive services in the c text of the housing environment. Gerontoloi 1969, 9, 15-19. Lawton notes: "Medical serv are desired by a majority of older people" and I decision to include services in the housing situat may affect the characteristics of the populal which applies," p. 15. 16. U. S. Dept. of Health, Education, and Welf Closing the gap . . . in social work manpoi Washington: U. S. Government Printing Of Nov., 1968. 17. Maxwell, Jean. Centers for older people. P York: National Council on the Aging, 1962. 18. Anderson, Nancy N. Senior centers: Informa, from a national survey. Minneapolis: Institute Interdisciplinary Studies, American Rehabilita Foundation, June, 1969. Of 1,242 centers wl responded to a mailed questionnaire, the gre« problem identified was the failure to identify re< expected through services offered by centers, g for participation, or measures of goal achievem 19. Burns, Evaline M. Medical care: The current si and prospects for the future. American Journa Public Health, 1969, 59, 9-18. 20. Beattie, Walter M., Jr. Perspectives on the chi ing characteristics and needs for service for aging population. Testimony presented before U. S. Senate Special Committee on Aging, De 1967. 563 hapter IV Economics of Aging Introduction ''he purpose of this paper is twofold: one, to - briefly discuss the nature of the income prob- m in old age by describing the behavior of earn- gs through worklife, the drop in income at tirement, and the subsequent deterioration in come position during the retirement period; and o, to identify and discuss a number of important oblem areas where there is a need for expanded onomic research activity. The paper focuses on factors involved in the namics of family income change in the last ree decades of life. In directing attention to the oad patterns and influences on income in later e, research can indicate the probable levels of come of the future aged as well as those who e now old. Only by anticipating the shape and iture of the long-run problem can appropriate licy measures be devised. . Aged Income Maintenance : A Part of the fetime Income Allocation Problem The general status of aged persons in the United ates today, the problems they face, and the is- es which call for immediate Congressional at- ition have been discussed in a recent Task »rce paper prepared for the U. S. Senate Special >mmittee on Aging and need not be repeated re. 1 However, some of the research needs dis- ssed below are also mentioned in the Task >rce paper and supported there by available ta. Incomes of the present aged are significantly iver than those of the younger population. ible 12A shows that in 1967 the median for milies headed by persons aged 65 and over was ,928—46% of the $8,504 median for families ith heads aged 14-64; comparable media for un- lated individuals were $1,480 and $3,655, the eds' income being about 41% of the younger dividuals' income. These 1967 proportions were ur and seven percentage points below the respec- re percentages in 1962. Many aged persons are poor. Table 12B shows the percentage of aged families who were poor in 1966, using the Social Security index of poverty. 5 The tabulation separates the aged by race and area of residence and shows the high concentra- tions of aged poor among rural, nonfarm whites and nonwhites, and among the nonwhite popula- tion in general. The level of funds available in old age can be viewed as determined in large part by the outcome of two general considerations: (a) the allocation of income throughout a person's life- time and (b) the choice between work (earnings) and leisure. The next two sections discuss these two aspects. A. Lifetime Allocation of Income Traditional economic theory has focused on the allocation of lifetime income between consump- tion and saving. The relevant discussions appear in the literature in two places. First, in capital and distribution theory there are the writings of Bohm Bowerk, Fisher, Schumpeter, and — in more recent times — the discussions by Malinvaud and Koopmans. Second, in the post-Keynesian con- troversy over the significance and shape of the consumption function, we have the classical ar- ticle by Modigliani and Brumberg, Friedman's A Theory of the Consumption Function, and Ack- ley's excellent synthesis work appearing in his popular macro text. The basis of the new theories (principally those of Modigliani, Brumberg and Friedman) is the recogni- tion that, if an individual plans rationally to maxi- mize his utility over his lifetime, his consumption in any given year will depend, not on his income in that year, but on the resources of which he disposes during his lifetime. 3 Thus, in anticipation of retirement and con- sequent end of work-related income, economic theory generally hypothesizes that the individual or family saves, in part, in order to provide funds during the retirement period. The family saves enough to maintain spending at its previous level, 564 a higher level, or a lower level— depending on its time preference. The record of actual saving in the United States shows that very few families have saved enough to provide large amounts of retirement income. Table I2A- Trend in Median Money Income of Families and Unrelated Individuals, 1960-1967. taB. Unrelated Individuals Heads 65+ 65+ Heads % % 14-64 of 14-64 of Period Amount Asmunt 14-64 Amount Amount 14-64 1060 $5,905 $2,897 49.1 32.571 $1,053 41.0 1961 6.099 3.026 49.6 2,589 1,106 42.7 1062 6,336 3.204 50.6 2,644 1,248 47.2 1063 6,644 3.352 50.4 2.881 1,277 44.3 1064 6,981 3.S76 48.4 3,094 1,297 41.9 1065 T.413 3.514 47.4 3.344 1,378 41.2 1066 7,922 3.645 46.0 3.443 1,443 41.9 1067 8.504 3.928 46.2 3,655 1,480 40.5 Source: Data from Bureau of the Census. Prepared by Herman Brotman, Administration on Aging. Social and Rehabilitation Service, Department of Health, Education, aiid WeKare, January, 1969. Table 12B. Percentage of Aged* Families Who Are Poor2, by Race and Area of Residence, 1966 Race Area of Residence Central City Fringe Urban Rural Nonfarm Farm All White 15% 18 21 33 15 20 Nonwhite 35 •3 * 68 * 50 'Age 65 or over »As measure by the Social Security Poverty Index •Sample size too small Source: Calculated from data published in Carolyn Jackson and Terri Velten, "Residence, Race, and Age of Poor Families in 1966," Social Security BvBttin, XXXII (June, 1989), 3-11. Table 13, Average Annual Money Income After Taxes, by Age and Occupation, 1960-61 Self- Age employed Clerical Skilled skilled Un- skilled Under 25 $4,528 $4,990 23 to 34 7,645 7,240 35 to 44 9,466 9. 159 45 to 54 9,429 10.722 (to 64 8,100 9.156 $4,459 5,704 6,675 6,804 5.851 $4,676 $4,602 $3,246 5,993 5,351 4,495 6,993 6,042 4,882 7,232 6,136 4,521 6,730 5,760 4,180 Source: Bureau of Labor Statistics, "Consumer Expenditures and Income, •upplement 2, part A to Report 237-238, pp. 30-34. Table 14. Average Annual Expenditures by Age and Occupation, 1960-61 Self- Profes- Semi- Un- -' A«e employed sioKal Clerical Skilled skilled skilled Under 25 $5,912 $5,OS8 $4,526 $4,814 $4,544 $3,469 25 to 34 6,905 6.941 5,632 6.144 5,367 4,599 35 to 44 8,701 8.795 6,668 6,733 5,947 5,051 45 to 54 8,694 9.1)33 6.815 6,945 5,971 4.540 SSto64 7,639 8.281 5,672 6,251 5,629 4,064 Souree: Bureau of Labor Statistics Report No. 237-238, pp. 30-34 Whether this result has been mostly by design or due to neglect is not known. Most people agree that they should save substantial proportions of their incomes for retirement; most people fail to do so. The private method thus has the advantage of allowing a family to do its own life- time budgeting and saving for old age; it has also the disadvantage of allowing it to do neither. In- deed, the widespread reliance on public and private pensions rests on the premise that many people make no voluntary systematic provisions for retirement in- come. 4 Looking at available empirical data gives some insight into practices of various age groups. The "1963 Survey of the Aged" found, for example, that 29% of aged married couples had a total net worth of less than $5,000. For non-married men and women the percentage was much higher; over half of the single persons had less than $5,000 net worth. Looking at net worth less home equity, the survey found 54% of married couples and 69% of single aged persons with net worth less than $5,000. 5 Looking at cross-sectional data, one can ex- amine the variations in income and expenditures with age for various occupational classes. Th< variation in income level with age of family heac appears to be roughly the same in each of th« major occupational groups (Table 13). Relativelj low incomes accrue to the youngest group (agec 24 and under); the average for the aged 21 through 34 group is much higher. In most occu pations, incomes are higher still for the familie headed by 35-44 year-olds, and in all cases thej are lower for the pre-retirement decade, aged 5! through 64 (Table 13). The data in Table 13 are often used as a bast for the conclusion that incomes generally peak h the late forties or early fifties and decline durin; the remainder of worklife, with a sharp drop at th time of retirement. Such cross-sectional date however, have serious shortcomings in evaluatin the relationship between income and age; the; focus on cohorts of persons of different ages at • point in time in an attempt to picture the be havior of individuals over a lifetime.' Although total expenditures at different ages c the family head are admittedly constrained by in comes, age-related differences in income are nc always paralleled by differences in consumptioi Table 13 in combination with Table 14 shows th relation between average income and expenditui by age of family head for the six occupation* groups. In all occupations, average annual incoir exceeds average annual expenditures for at lea: 565 one of the age groups and conversely expenditures are greater than income for at least one other Age group. It is evident that in 1960-1961 most of the age groups in the professional and self- employed categories received income which was greater than consumption expenditures. The skilled and semi-skilled showed slight saving for groups aged 35 and over. Clerical workers barely matched income and expenditures except for the last decade of worklife, and the unskilled showed a deficit for practically all age groups. Here again cross-sectional data are subject to a shortcoming; they do not shed any light on the probable income-expenditure pattern of today's labor force entrant as he moves through his work- life and into retirement. Instead, one must make some assumptions regarding the earnings of to- day's labor force participant during worklife and combine these projected earnings with his family's probable expenditure patterns. When the effect on worklife income of both economic growth and job experience are taken into account, the behavior of annual earnings is quite different from that 1,000 ? 14,000 § 10,000 Income: by age by projected worklife Expenditures: by oge 29 59 39 49 AGE (YEARS) Fig. 3. Income and expenditures by occupation and age for 1960-1961 and projected worklife income for male clerical workers. Source: Kreps, J. M., & Pursell, D. E. Lifetime earnings and income in old age. Table 15. Estimated Average Annual Incomes Through Worklife, with Economic Growth Component Included for Workers Aged 25 and Under in 1960-61 Self- Profes- Semi- Un- Age employed sional Clerical Skilled skilled skilled Under 25 t 4,528 $ 4,990 $ 4,459 $ 4,676 $ 4,602 $ 3,246 25 to 34 10,149 9,681 7,785 8,111 7,179 5,918 35 to 44 17,582 17,845 12,388 12,874 10,722 8,899 45 to 54 23,591 23,316 15,385 17,106 13,956 11,031 65 to 64 32,946 26,322 17,994 22,487 17,489 13,780 Source: Income data for workers under 25 taken from "Survey of Consumer Income and Expenditures," BLS Report 237-238, tables 15a-15e. Incomes for 25-34 and succeeding cohorts from Kreps and Pursell, "Lifetime Earnings and Income in Old Age," Income Amtrance in Old Age, Part II, Joint Economic Committee, 90th Congress, 1967, pp. 260-279. shown by the cross-sectional data alone. Whereas the data showing the income of all age groups at a point in time indicate that the 55-64 aged family heads have lower family incomes than the previous cohort, projections of incomes which in- clude an allowance for economic growth indicate that there is likely to be a continued rise until the end of worklife.' The contrast between the income-expenditure pattern at different ages in 1960-1961 and the behavior of income through worklife for the male clerical worker who was 24 or under in 1960 is shown in Figure 3 (the projec- tions for which are based on Table 15) . The volume of savings available for retirement would obviously be quite large if, given these projected increases in income, consumption at the various ages observed the pattern indicated by the cross-sectional data. But family living standards can be expected to rise and absorb much of the increase in income. Perhaps the most reasonable assumption is to suppose that the consumption increase will be proportional to the rise in income. Goldsmith found, for example, that the personal rate of saving "failed to show a marked upward or downward trend during the past half a cen- tury." 8 Modigliani and Brumberg have hypothesized a constant-saving ratio. 9 They argue that households wish to maintain a certain level of saving to pro- vide for emergencies, retirement, etc. Thus a 10% rise in income would be matched by a 10% rise in expenditures. 10 Should consumer expenditures continue to absorb the 1960-1961 proportions of income, significant volumes of savings would be available for retirement among only two of the six occupational groups considered here: the self- employed and the professionals. Of course future savings behavior could change and be such as to improve significantly the asset position of families going into retirement. While continued study of savings behavior and its effects on the economic circumstances of the aged should be undertaken, it is probable that only limited reliance can be placed on personal savings as a means of cushioning the retirement income drop. This is because of generally high propensities to consume and the fact that for most families the accumulation of asset claims takes place primarily in the form of home equity— claims which are often difficult to convert to cash for various eco- nomic and psychological reasons. 11 The length of the retirement period must also be considered in evaluating the extent to which assets can be expected to provide a supplement to 566 aged income. If retirement occurs at age 62 rather than 65, making it necessary to spread one's equity over three additional years (almost one- fourth the male's present life expectancy at age 65), it will be some time before assets increase .enough to offset the longer retirement span. B. The Drop in Income at the Time of Retirement The retirement period of life is associated (as indicated by the data in Table 12) with a sharp drop in income. This is in large part a result of the lifetime income allocation decision (discussed in the previous section) and the work-leisure choice confronting the individual. Lowell Galla- way has summarized the latter aspect as follows: Very simply, the "retirement" decision may be thought of as the "choice" an individual makes when he elects a certain combination of work and income during his retirement years, given his preferences for leisure vis-a-vis income and the various constraints imposed upon him in the decision-making process. Quite obviously, what we have here called the "re- tirement" decision is a peculiarly complex choice situation, for it must, perforce, encompass a variety of considerations. The physical health of the worker, his subjective appreciation of the physical difficulties of continuing work, his psychological attitudes to- wards work and retirement, the attitudes of the cul- ture in which he lives towards work and retirement, the availability of work opportunities, the degree of re- muneration for available work opportunities, and the availability of nonwork types of retirement income all influence an individual's derision as to what ex- tent he should modify his past pattern of work acti- vities. Presumably, an individual who has reached a chronological stage of life at which retirement is a meaningful alternative will consider all of these factors and then elect a course of action which is in some sense "optimal" for him. . . . The longer the retirement period of leisure, the larger must be the income reallocation from claims built up during the previous work periods and/or the sharper the drop in retirement income relative to prior years. The age at which partial or full retirement takes place, therefore, has im- portant implications for the nature of the old age income maintenance problem facing the individ- ual and the society. The rapidly accumulating body of data which indicate a long-run trend to- ward earlier average retirement age among male workers in the United States, consequently, has stimulated great interest among persons concerned with the aged income maintenance problem. C. Deterioration in Income Position dur- ing Retirement Once the aged person has retired, there is another important economic consideration which arises. Ida Merriam has pointed this out as fol- lows: For the income-maintenance programs ... the difficult question posed by technological change and rising national income is not that of determining the benefit amounts of different individuals at theoime they retire, but rather that of reaching a consensus as to what happens to their benefits over the subsequent 10, 15, or 20 years." When an economy is growing, a gradual wor- sening of the aged's income relative to that dl the wage earner occurs under any income-main- tenance scheme which does not relate the pension to productivity increases. The higher the annual rate of growth and hence the more rapidly earn- ings are rising, the faster the decline in fixed in- comes relative to earnings. If real earnings an rising by 2% per year, for example, and a work© retires on a pension which provides him with 60*$ of current average earnings, his pension will bi 45% of average earnings at the end of 10 year: and only 33% at the end of 20 years." This relative decline occurs even if prices art stable. Tying retirement benefits to the cost o living therefore provides no offset to the growth produced gap between earnings and pensions The two effects— inflation in prices and increase in the incomes of the active population — mus be kept in mind, if income maintenance arrange ments are to provide the aged with pensions tha are in any way comparable to incomes in genera! III. Directions for Research As summarized above, the economic status < the future aged is primarily dependent on: on< the earnings-consumption pattern during wori life and hence the extent to which private s&\ ings are accumulated for the nonworking perio< two, the division of workers' pay packages b< tween current wages and private pension claim three, the retirement age decision; and four, tf: extent to which the future society is willing 1 transfer income claims from workers to retirei via the tax-benefit mechanism. In addition these variables which together explain the dolli amount of retirement income and financii claims, the aged's economic situations are colon by the forces which determine the .purchasir power of their money income and the facte which change their income status relative to th of the working population (inflation and ec nomic growth). For most families, the income problem in o age grows out of the cessation of earnings of oi or more family members and the failure of pi 567 te savings and/or private and public pensions replace a sufficiently large proportion of these rnings. For a significant number of retirees, irever, very low incomes were a problem roughout worklife; some form of income main- lance was in order even before they became too i to work. Research into the income maintenance issues they pertain to the aged requires a focus some- lat out of the mainstream of current poverty :earch devoted to raising low incomes. In the >e of the elderly, one must be concerned not ly with those who have always lived below ; poverty line, but also with families whose •nings during worklife provided a comfortable 'el of living and whose retirement incomes are w meager. While recommendations for some nimum income for all persons may well grow t of the current study focus on problems of irerty-level groups, such proposals are not likely attend directly to the problem of substantial x>me loss associated with retirement and the jsequent deterioration in income position dur- ; the nonworking years. [ncome-maintenance issues as they relate spe- ically to the elderly require further research o (a) questions of the present and future in- ne and wealth levels in old age; (b) the rela- nship of these levels to pre-retirement income els, to general budgetary requirements of the lerly, and to the income-needs gap of particu- aged groups; (c) the transitional period into irement and the decision-making process in- Ived; and (d) considerations of the adequacy current income maintenance institutions and ! costs of alternative financing arrangements for se institutions. The Economic Status of the Aged: come It was the historic "1963 Survey of the Aged" the Social Security Administration's Office of search and Statistics which finally collected ficiently detailed data to document the rela- ely low economic status of the aged popula- ti in 1962. " This survey provided extensive in- mation on aged income, assets, work expen- se, health needs and insurance coverage, living angements, and expenditures on food and hous- ;. The survey tabulations did not break down st of the income and asset data by work tus, however. Because of the existing evidence wing dramatic differences in the income situa- n of the retired and the non-retired aged, there is great need for more tabulations and analy$et which make such a distinct ion. The "1968 special survey of the Kged" collected data similar to that of the 1963 survey and will permit a detailed comparison of the aged popu- lations in the two years. In addition, there will be an attempt "to identify the relative impact of changes in economic conditions, in social se- curity program provisions, and in the age dis- tribution of those 65 and over on changes in the economic status of the aged between 1962 and 1967."" Data from this more recent survey are not yet available, but initial findings should ap- pear toward the end of this year. Survey studies of the present aged population, however, are not sufficient. Given the significant changes in public and private pension systems oc- curring in the United States, the general post- war prosperity, and a continued rise in earning levels, it is important to study the probable im- pact these factors will have on future generations of aged persons. Initial efforts using computer simulation methods have provided, for example, some guide to the probable pension incomes (un- adjusted for rising prices) of the aged in 1980. . . . while the existing pension system can be ex- pected by 1980 to have produced a sizable shift up- ward in the distribution of pension income for aged persons, there would still be a large proportion of aged units in 1980 with "very low" pension incomes. About 50 percent of aged couples could expect to receive total pension incomes of less than $3,000, and slightly over 86 percent of the unmarried aged could expect to receive less than $2,000. In addition, using various measures of income "adequacy," it was found that little or no improvement in the ade- quacy of aged income (from pensions and assets) can be expected relative to the rising incomes of the rest of the U.S. population. These conclusions are especially true for unmarried individuals as a result of the current poor pension protection provided widowed individuals by both public and private pen- sion systems." The simulation methodology offers great flexi- bility for projecting various aspects of the aged's status.* As additional data become available, initial simulation projections should be updated and the development of additional types of simu- lations investigations should be undertaken. These should include simulations to evaluate develop- ments occurring in the private pension system and to evaluate suggested reforms of both the private and public pension systems. The current Social Security Advisory Committee •Professor Thomas Naylor has described simulation as "a nu- merical technique for conducting experiments in a digital computer, which involves certain types of mathematical or logical models that describe the behavior of a system (or some component thereof) over extended periods of time." 568 on Research Development has recommended ad- ditional simulation research in the pension area, and the Office of Research and Statistics has re- cently incorporated exploratory activities in their new work plan- Concerning private pensions, at a recent sym- posium on private pensions sponsored by the American Enterprise Institute interest was shown in developing a private pension simulation model to help policymakers evaluate the many proposals for laws developing and regulating private pen- B. The Economic Status of the Aged: Assets Initial efforts to evaluate the economic situa- tion of the aged and other poverty groups focused primarily on the income of these groups. More recently, however, efforts have been made to im- prove estimates of poverty among various groups by explicitly taking into account the wealth of various individuals. Weisbrod and Hansen have proposed that the economic position of a consumer unit be meas- ured by the sum of (a) its current annual in- come and (b) the annual lifetime annuity value of its current net worth." Their calculations us- ing net worth, and similar calculations by Janet Murray using assets only, give some indication of the importance which this variable could play in providing income during retirement. 20 Research in this area should continue, and Murray's esti- mates of the prorated ixilue of assets should be updated using the net worth concept. Because of the importance of home equity in the asset holdings of aged persons with relatively low incomes, Murray found that there would be a relatively small shift in potential income (ac- tual plus prorated assets) if home equity were excluded; when home equity was included, how- ever, a significant shift in the potential income distribution took place. Given the high incidence of home ownership among aged persons, the con- sequent large amount of "locked- in" assets, and the apparent reluctance of many old people to leave "their" homes— there is clearly a need for further research investigating the economic im- plications of aged home ownership. Two initial areas of inquiry seem promising. First, there should be additional investigations of the feasibility of various alternative ways of con- verting this ass2t into cash to met economic needs in retirement. Yung-Ping Chen has pro- posed an actuarial mortgage plan which merits additional study. 51 The principal problem with such an actuarial mortgage arises from the dif- ficulty of equitably handling increases or de- creases in the value of the property due to infla- tion, market conditions, owner neglect, etc. Chen is currently conducting a pilot study designed to test the willingness of elderly homeowners to ex- change their home equities for cash incomes through the purchase of "housing-annuities." A second related area concerns residential prop- erty taxes. The current economic plight of many aged families, the large number of poor aged who own homes, and rapidly rising property tax rates have combined to cause a number of states to grant or consider granting property tax con- cessions to their elderly residents. While such concessions are a relatively costly and often an inequitable method of helping the aged poor, the political popularity of such proposals seems to be increasing. Consequently, it would be highly de- sirable to have comprehensive studies made of the various tax relief programs already operating in various states. Some initial work in this area has been done by Chen and Margaret Greenfield." In addition, the savings behavior of those fami- lies approaching retirement and those in retire- ment should be studied over time, building on th< previous work of Fisher and Goldstein. 23 We need to know whether people are saving more for theii retirement years than did previous generations. C. The Economic Status of the Aged: Adequacy Evaluation Particular attention also needs to be given t< the question of the adequacy of resources (espe daily income) in old age. Building on the infor mation and earlier analysis by Lenore A. Epstein a new look at our economic goals for the age< would now be timely." It is important to kee] in mind not only the minimum level of incorn we are willing to tolerate— a minimum whicl would presumably be applicable to persons of al a g es — but also the extent of temporal reallocatioi of income we wish to achieve through taxatior Having accepted the concept that the current gen eration of workers supports via taxes the curren retirees, in return for a similar transfer fror future workers to future retirees, we nevertheles have no consensus on the question of the level c that support. There are a number of different approaches t adequacy evaluation which should be further dt veloped. The four approaches which appear mo; promising (a) absolute measures of poverty, (J) relative measures of income inadequacy, (c 569 measurement of income adequacy throughout an individual's retirement, and (d) attitude survey work regarding income adequacy. CI. Absolute Poverty Measures The most popular method of evaluating the economic status of the aged (and other groups) is to look at the aged population at a given mo- ment in time and compare their actual incomes to some standard level. The most widely used measures for aged families are the Social Security Administration's '"poverty" and "low income" in- dexes and the Bureau of Labor Statistics' "Budget for a Retired Couple." These indexes have been useful for setting levels of income below which income inadequacy is indicated. But the levels established by these indexes are somewhat arbi- trary — being based in the case of the Social Se- curity index on an emergency food budget (in 1966 providing for a 75c a day expenditure per person in an average four-person family) and the mumption that these food costs constitute one- third of total required living expenditures. In the case of the BLS budget the designated level is above any minimal level and seeks to provide .omething called a "modest but adequate" living standard. Study of the budgetary needs of old people should of course continue. There is a need to x>ntinue work on size equivalencies and experi- nentation with budgets which indicate regional vnd other family differences. Serious considera- :ion should be given, for example, to development )f a special budget for single persons living alone —given the current concern for this particular rroup of the aged. One purpose of directing further inquiry into hese hypothetical budgets is to draw attention to he fact that a decade or so hence, even under iberal assumptions as to the growth of pension ncomes, the proportion of aged couples and in- Uviduals with incomes that are adequate by hese budget standards may not be high. In order o show this, the budgets must of course be pro- ected to the future date and adjusted for antici- >ated cost-of-living changes and for any change n what constitutes "adequacy," given present rends regarding the improvements in living tandards in general. 12. Relative Measures of Income Adequacy in letirement Derek Bok has succinctly summarized the major imitations of absolute budget standards as fol- ows: . . . Experience in other COUZItrlw htl revealed how difficult ii is to detei ■ nditurei thai are appropriate for any group of people, M it is not enough simply to establish n llngle retire ment budget. Separate determinations would have to be made for each of many income classes reach- ing retirement age, since a budget suitable for a day laborer would hardly seem adequate to a highly paid technician. Furthermore, the standard budget is probably too static a conception for the hand. While it may be possible to define the mini- mum living expenses which should be guaranteed here and now to the poorest of the aged, it is much more difficult to determine what standard of living will be considered adequate many years hence when present generations of workers begin to retire. Yet under our contributory system this question is im- portant. We must concern ourselves with future benefit levels if employees are to have an adequate notion of the pensions they can count on in retire- ment and if they are to make contributions bear- ing some reasonable relation to the benefits they will eventually receive. In view of these problems, any effort to establish an adequate social security policy should aim at defining the proportion of prior wages which each worker can count on receiving when he retires. 25 At the present time we do not know what hap- pens to the living standard of families when the major wage earners retire. There is an immediate need for research to evaluate the adequacy of the income of the currently retiring aged by compar- ing potential or actual living standards before and after retirement. There are also no estimates available of the ac- tual earnings replacement levels of pensions (pub- lic and private) being received by those currently retiring. Projections have been made for 1980, but there is a need for also evaluating the current aged population's pension income adequacy by this standard. 26 The Social Security Administration may report some of this information from their "Survey of New Beneficiaries of Retirement Age." This sur- vey will provide (among other things) limited national data on pre-retirement earnings and re- tirement pensions through monthly mail ques- tionnaires which are now in progress. Better in- formation on this question will also be available when the Social Security Administration's "Re- tirement History Study" produces results. This is a longitudinal study of a survey population of persons 58-63 years of age in 1969 which will continue for 10 years. In addition to developing measures of earnings replacement or living standard changes, addi- tional work is needed in developing policy guide- lines in this area. What are the economic impli- cations of (a) providing most aged with pensions 570 which would enable them to enjoy a standard of living similar to their middle working years, or (b) a standard based on the years immediately prior to retirement, or (c) a standard related to the living standard of the current working popu- lation." In addition, determination of the appropriate ratio of pension to pre-retirement earnings must take into account the following changes associated with a given level of living: 1. The net worth position of aged units. Z Elimination in retirement of expenditures associated with employment — transportation, work tools, clothes, fringe benefit payroll deductions, and so forth. 3. Rising illness incidence due to age and the offset resulting from coverage of some medi- cal expenditures under Medicare and related health programs. 4. Declining aged tax liabilities. 5. Elimination of household expenses associ- ated with child rearing (for education, hous- ing, etc.). Possible declining physical activity and as- sociated expenditures, or rising recreational expenditures due to increased leisure time. 6. C3. Adequacy over the Retirement Period Most surveys of aged economic status have paid little attention to the fact that, just as economic resources, needs, and expenditures vary over a person's entire life cycle, there are also changing conditions over the retirement period which af- fect the adequacy of any given amount of finan- cial resources available to the older person. Major considerations which must be taken into account are (a) the effects of inflation on fixed pensions and dollar assets, (b) the rising standard of living of the working population and hence a rising affluence surrounding the retired, (c) declining mobility and activity resulting from physical and/ or psychological changes, (d) exhaustion of liquid assets, and, finally, (e) the fact of becoming very old, which means a heavy cost for institutional care. There is a need for more longitudinal survey research to supplement the cross-sectional surveys which tend to hide the changing status of the in- dividual. We need to develop a better generalized picture of the changing economic needs over the retirement period and the responsiveness of eco- nomic resources to meet these needs. Extension of the Social Security Administration's "Retire- ment History Study" beyond the 10-year period presently planned would permit this type analysis. 2 ' In addition, cross-sectional survey data shoi be analyzed to develop more information ah special groups within the heterogeneous aged p< ulation. Some aged groups which would seem demand special tabulations and analysis are ( those who were poor and disabled before beco ing old, (b) minority groups, (c) widows and \ married women, (d) the very old, and (c) very sick. Certain aged groups, we know, currently h very low incomes: those among the aged who not covered by OASDI, or who have such ] benefits that they receive welfare payments supplement their incomes; widows; beneficia whose earnings qualified them for very low be fits, but who never apply for OAA payments who are ineligible for these payments for reai other than income.) But what of the man retires at age 62 in 1980, with benefits at or i the maximum, except for the actuarial reduc accompanying early retirement? How man) these men will have a private pension? Do I own assets of any significance, when pror over their longer retirement period? What is income position of the disabled aged person must live in a nursing home for the last ten j of his life? If we separate out the retirees ha significant private pensions claims, what are incomes of the remaining elderly? What is gap between their budgetary needs and theii comes? Since income-maintenance schemes are like consider first those among the aged whose r are greatest, identifying the characteristics o) poorest in the group is critical. An examp! this type of research is the study of the wi of UAW workers who died before retireno There is an important need for this type of vey work applied to a broader population bas C4. Attitudinal Information While there is a need for experts in the of aging to develop quasi-scientific measur economic adequacy, there is still an impt role to be played by gathering research infi tion on the attitudes of the elderly. This is atively neglected area of aging research, alt! there have been a number of important con tions made over the years. For example, I section studies during the 1930's and showed majority opinion behind the devel programs for old-age pensions and social ance." M Shanas and later the Michigan S 571 Research Center reported on opinions regarding public versus family responsibility for aged In come maintenance and the desirability of aged parents living with their children (or vice versa). " It is important to know what an the expecta- tions of various age groups regarding tlie levels and sources of economic support during retire- ment. There is fragmentary evidence to indicate that large numbers of persons lack knowledge about the nature and size of the retirement bene- fits they can expect and about their economic needs in retirement." Also, two other recent sur- veys by Katona et al. and Shanas et al. have produced interesting data on the low proportion of retired and non-retired who feel their living standards have fallen (will fall) in retirement.' 3 More of this type of research is needed to supple- ment the other types of adequacy evaluation. In addition to continuing and expanding the type of survey work cited above, it would be use- ful also to branch off into other areas, such as the one suggested by the following statement by Harold Sheppard: You really don't know what you are going to think when you are 65. That is why I change my mind as I go through time ... I think in this context the ideas or concepts of rising expectations are very im- portant, very pertinent to making intelligent specula- tions about the degree of acceptance, (of) this part of the population or that part of the population, in the future. With higher educational achievement . . . and health consciousness and the effective acceptance of a democratic ideology of equality, I doubt very strongly that the aged in the year 2000 will passively tolerate conditions resulting from the stereotypes and attitudes toward the aged that the young today them- selves entertain toward the aged. . . , 34 We should seek to document whether such changes are in fact taking place. D. The Transition to Retirement* It would be misleading to look at the retire- ment decision as a process which occurs shortly before a worker leaves the labor force. Retire- ment is a complex decision-making process which involves numerous personal and societal circum- stances and decisions. The process can and often does begin long before the actual day of work Force exit. There is an important need to understand the various important influences on the retirement de- cision in order to develop income maintenance yolicy and evaluate the institutional mechanisms involved. We need to know (a) when various l^ C1 ) apter .- X (Work> Edueati( ?n. and Leisure) discusses the transi- ion to retirement at greater length. individuals are retiring, (b) why they retire when thru dn, and (c) the influences or control' by societal norms and various institutions (busi- nesses, labor unions, pension plans, etc ) In the past there have been at least three use ful ways of gaining insight into these questions. First, there have been econometric studies such as Brennan, Taft, and Schupack's construction of behavioral models to investigate the demand for and supply of labor by age. 35 The excellent study by Brennan and his colleagues was limited by the usual data problems but points the way to a promising method of inquiry, as data improve and econometric techniques develop. This area of aged research should be pushed forward as rapidly as possible. The second technique is that of cross-sectional and longitudinal surveys of workers. Streib and Thompson's longitudinal study of retirement, in- vestigating worker attitudes toward work and leisure and the health of persons retiring, has been one of the major contributions of this type. 36 The current research under way under the direc- tion of Lenore Epstein Bixby in the Social Se- curity's Division of Retirement and Survivors Studies also offers promise in this area. The "Re- tirement History Study," the "Survey of New Beneficiaries of Retirement Age," and a 5-year longitudinal survey of labor market experience of men aged 45-59 beginning in 1966 (sponsored by the Department of Labor) are all specially designed to provide information regarding the re- tirement process and the "early" retirement phe- nomenon. Social Security's Office of Research and Statistics has a number of other studies which are designed to investigate particular aspects of these ques- tions. With all the new data relevant to retire- ment that are becoming available (mentioned in the above paragraph and from other sources), it would certainly be desirable to have a major effort made toward developing ways of securing the confidentiality of individual survey records so that the basic data tapes could be made avail- able to government agencies other than the U. S. Census Bureau and to qualified university re- searchers. Nothing would probably be more help- ful to research in aging than to find a way to break the data processing bottleneck created by the confidentiality question. More data should be made available, while at the same time protect- ing the personal privacy of individual reporting units. A third area of inquiry involves investigations 71-272 O - 72 pt.l - ,72 of labor-management attitudes and practices re- garding middle-aged and aged workers. The De- partment of Labor's study of aged discrimination is perhaps the most well known study of this type. 11 There have been, however, many others including the Cornell University study of "re- tirement age" policies and practices of various employers, with Slavik and McConnell reporting on compulsory retirement practices and Theron Fields investigating company-initiated early re- tirement; the National Industrial Conference Board's study, Corporate Retirement Policy and Practices; and the National Institute of Industrial Gerontology's essays on the Employment of the Middle-Aged Worker. 3 ' Given the very large amount of job discrimin- ation by age reported by the Department of Labor, additional research should seek to determine whether this situation is getting worse or better. In addition, research should be undertaken to pro- vide information which would better explain why so much of this discrimination is occurring. An investigation of age-related productivity patterns, for example, would be an important contribution. E. Evaluating the Operation of Public and Private Institutional Mechanisms Over the years there has been increased reli- ance upon public and private group mechanisms to assist in the job of family and individual eco- nomic security and income maintenance, a job which was in earlier times largely a family func- tion. A major area of research in aging should therefore concentrate on evaluating these develop- ing institutions and the proposals made to modify them. The next section discusses the U. S. social security system. This is followed by a discussion of private pensions, and a concluding section that briefly surveys certain institutional aspects of aged health and medical needs. El. Social Security There are two features of the social security system which especially affect aged people— re- tirement pensions and Medicare. This section will look at the pension area, and a later section will deal with Medicare. In evaluating research needs in the social se- curity area we are fortunate to have available the recent Social Security Administration report by The 1967 Advisory Committee en Research De- velopment.". This distinguished group of univer- sity researchers surveyed social security research needs and urged major emphasis in the following areas: 1. Evaluation of the adequacy of the existing OASDHI program. 2. Research on the effects of income-mainten- ance and health insurance programs on the economy and on human behavior. 3. Studies of the interrelationship among the various public systems and between public and private schemes of income maintenance and health care. 4. Analysis of the comparative social efficiencies of the present social security system and a|- ternative approaches. 39 There is no need to repeat the elaboration in the report by the Advisory Council on these varl ous issues. A few points of emphasis and £ddi tions, however, are presented below. An excellent study by members of the $rook ings Institution recently made a number of tecom mendations for substantial reform of the socia security system.''" These recommendations shoul receive careful study, and further analysis shoul be undertaken to investigate their economic impli cations and to consider problems of implexnenta tion. In particular, we would identify for irtfimedi ate study their recommendations (a) to co\mbin the earnings credits of both husband and w\ife i: computing benefits, (b) to base benefits an a: earnings history which avoids the depression c benefits due to past years of inflation and ecc nomic growth, and (c) to change the wiqjto benefit calculation. Regarding the experiences of other country in the aged income maintenance area, there hav been numerous calls for research but relativel . little activity in this area. As early as 1963, Mai garet Gordon wrote that a promising method of inquiry that has been almo totally neglected is comparative analysis of the in pact of various types of welfare programs, includir old-age insurance programs, on the economy i various countries. 41 And the Social Security Advisory Committee c Research Development has commented as follow A good deal of light could be shed on the issu involved through analysis of the rather wide varie of relationships among income-maintenance syster that have been developed in other industrial cou tries. There, income-cenditioned pensions and pa ments not related to income, such as universal ol age pensions and family allowances, exist in varyii combinations with social insurance and public ass tance systems. Since children in poor families repi sent a substantial proportion of the low-incor population, more study of benefits available to ch dren in this country as compared with other countr would be desirable." 573 In addition, we have seen developed and Im- plemented recently in various industrialized coun- tries a number of highly innovative todal security systems. These new systems were in large part motivated by dissatisfaction with existing pro- grams of old age income maintenance in each ?ountry and represented attempts to overcome many of the then existing problems. Public pen- sion developments in Austria, West Germany, Sweden, and Canada, for example, have been watched witb increasing interest. Given the continuing interest in the United states in evaluating and improving our own sys- :em, knowledge about the experiences that other countries have had with different systems is a /ital and necessary part of the information re- juired to formulate public policy in this area; nost of the changes, for example, proposed for the J. S. system (e.g., a "double decker," automatic jension adjustment, and general revenue financ- ng) have already been implemented abroad. Unfortunately, collection of this important in- ormation is often difficult because of geographic ind political barriers. And once collected, the nformation is difficult to evaluate because of the veil-known problems of cross-national data corn- prisons. Nevertheless it is important to continue md expand research in this area. There have been a few articles and books in inglish on the social security systems of West Germany, Sweden, and Canada. In general, these tudies have concentrated on describing the laws gliding past and present social security systems ind in highlighting the major historical develop- ments and issues surrounding these evolving sys- ems. There is little in the literature, however, to ndicate how these new systems are working: the xtent to which they are meeting objectives, their ffects on private pension systems, and satisfaction f dissatisfaction with them. Important exceptions to this lack of study of oreign systems are the works of Gordon, Kreps, Uron, and Rimlinger." Gordon studied 18 indus- rial countries and found a significant correlation •etween the date of establishment of an old-age tension program for a sizable segment of the lopulation and the level of average benefits mea- ured as a percentage of national per capita in- ome. Kreps makes international comparisons of abor force activity and variations in leisure-time atterns. Aaron also studied industrialized coun- ties and found age of programs a major factor etermining the size and adequacy of social se- urity outlays. And Rimlinger has been working on a comparative analysis of the historical de- velopment dl the social security svslems in ( ier- many, Russia. France, Greal Britain, and the I imicd States." Two developments in foreign systems which are deserving of special attention are (a) attempts at providing pension benefits which would permit retired families to maintain a standard of living in old age which was similar to that achieved during the working period and (b) automatic pension adjustments reflecting price and produc- tivity changes. A number of European countries have had such adjustments in their system for over a decade and increasing numbers are consid- ering adoption of similar proposals. The recent British "White Paper" on social security reform, for example, proposed a "dynamic" pension, earned by the individual's ' contributions on his earnings over working life but with his record in each year revalued according to subsequent changes in earnings levels generally, up to the time he reaches pension age . . . Further regular adjustments will then be made to the pension during the years of retirement . . . 4S New information and an analysis of a number of innovative foreign pension schemes would aid public policy-makers in this country in evaluating and improving the U. S. system. E2. Costs and Financing of Various Income Main- tenance Alternatives The background theme to all income-mainte- nance proposals is the recurrent note of costs. But whereas the cost of income transfers to men of working age is always complicated by the ques- tion of work incentives — and the threat that a guarantee of income will reduce work effort and thereby carry an extra cost in terms of foregone output — the work incentive issue is not as im- portant a consideration in the case of retirees.* Society is probably not interested (based on his- torical evidence) in enticing the aged 65-and-over population back into the labor force; quite the contrary appears true. Thus the cost of transfer schemes is primarily that of providing benefits (or other income supplements); the constraints on the size of these benefits are the size of the aggre- gate income and the competing claims of other age groups. In recent years numerous estimates have been made of the dollar cost of guaranteeing incomes *Work incentive is more of a factor, for example, if we do not reward part-time workers. If we recognize at least three stages (regular worker, semi-retired, fully retired), then we can see that society may want to encourage part-time work. Also, there is the consideration that if work is not rewarded, more people will re- tire, thereby raising the costs of aged support for the working population. 574 of different levels to all families below the speci- fied minima. The costs are usually cited in aggre- gate dollar amounts — $12 billion to raise all fami- lies to a minimum of $3,000 and single persons to $1,500 for a year, for example These aggregates are usually net figures, meaning they have taken into account the "savings" from other welfare pro- grams in existence. But they do not usually specify whether the estimated cost covers a possi- ble reduction in output due to removal of work incentive or an increased output arising from the increased spending. Careful estimates of the costs do attempt to consider the incentive question, al- though research on the issue is meager. Any dollar estimate of the cost of lifting the elderly's incomes to a specified level can be con- verted into costs in. terms of the payroll tax rate required or the necessary increase in the tax base. Obviously, there is the alternative arrangement under which a part of the cost is paid out of general revenues. Robert J. Meyers, Chief Actuary of the Social Security Administration, has been the traditional source of estimates of the dollar costs of a given level of benefits and the level cost in payroll taxes. The basis for some of these estimates, (data, assumptions, etc.) is not always noted, however — making it difficult to evaluate their validity. The seroices of economists outside the Social Se- curity Administration might he employed to de- velop alternative cost estimates. In this regard, the recent discussion of social security cost esti- mates by Pechman et al. are to be welcomed." One major area where cost estimates would be most valuable is that of evaluating different gen- eral income maintenance schemes and assessing the appropriate role of social security benefits in such a broad-scale system. The merits of various schemes for maintaining income are currently un- der scrutiny, both in scholarly journals and the popular press. Proponents of the negative income tax have been particularly vocal in the few years since the launching of the anti-poverty program, with important proposals being made by Profes- sors James Tobin, Robert Lampman, and Earl Rolph. 1 " Family allowances, proposed by Daniel Moynihan, and the gauranteed employment thesis, urged by Leon Keyserling, have also received wide public attention. In none of these proposals is the income of the aged singled out for special attention, since the objective (in all cases except the Keyserling one) is to achieve a minimum money income for all families, the specific amount guaranteed depending on family size. The arguments for minimum income payments do not negate, however, the function of the Social Security benefit, which is the replacement of some portion of the annual earnings received during worklife. Minimum payments proposals do not deal with the basic question of what proportion of wages we are replacing (or want to replace) in retirement via the tax-benefit arrangement, or in more general terms, how much smoothing of "the humps and valleys" of lifetime income we wish to achieve. Further research into these is- sues is in order. In recent years there has been increased atten- tion given to dual types of systems— a basic in- come transfer to take care of poverty cases (young and old) and, in addition, a strictly earnings- related retirement pension. 48 Costs of such schemes are in need of investigation. £3. Private Pensions* Perhaps the major problem facing a researcher in the area of private pensions is the large number of individual or group plans and the greater varia- tion in their provisions. For example, the number of corporate plans qualified by the Internal Reve- nue Service at the end of 1967 was estimated tc be more than 150,000 (58% pension plans and 42% profit-sharing plans)." A basic research need is the improvement of estimates of what private pension coverage will be in the future. How does one generalize the characteristics d so many plans? Past efforts have concentratec on plans covering large numbers of workers oi have divided plans into special groups — collectiv< bargaining plans, multi-employer plans, state ant local government plans, etc. 50 Information e a better picture of the "current status" o private pension plans. It is necessary to supple ment this information with sample surveys t gather information not filed in the regular re ports. Closely related to developing information re garding the characteristics of private pensioi plans is the need to develop trend informatio: •The discussion of private pensions in the chapter is Iimi'jd ' their role as an income maintenance device. See Chapter I .or more general discussion. 575 which would highlight changes taking place in the private pension field. BLS has done some trend research in connection with their 100 se- lected plans under collective bargaining." Also, the periodic Bankers Trust surveys of plans they administer have furnished some trend informa- tion. There is a priority need, however, for a sys- tematic study of the changes occurring in private pensions. A basic research need is the improve- ment of estimates of what private pension cover- age will be in the future. Another question of particular importance concerns trends in the levels of benefits for both non-retired and retired work- ers. In order to evaluate the future contribution which private pensions will make to the level of retirement benefits, it is not sufficient to analyze plans in a particular year. It is much more im- portant to study the dynamics of these plans to see where they appear to be going. Another important research area in need of priority attention is private pension vesting pro- visions. The adequacy of retirement benefits for persons covered by private pensions depends in part on whether the person will actually receive the pension rights being accumulated. Most pri- vate pensions do not immediately and fully vest pension credits; certain service and/or age re- quirements are specified. Thus, the number of workers who can accumulate private pension claims which, together with social security, will provide them adequate pension income in retire- ment depends basically on benefit levels and trends, vesting requirements and trends, and labor mobility characteristics and trends. We need to know, for example, the extent to which the young worker and the peripheral worker (a category which includes both the casual untrained laborer and the person who cannot or will not work full time because of illness or family responsibility) lose benefits because of vesting requirements. Hugh Folk has presented theoretical arguments suggesting that pensions reduce labor mobility and that employers tend to exploit workers who leave employment before gaining vested pension rights." He also discusses the available statistics which, while not entirely convincing, indicate that labor mobility may have decreased consider- ably since World War II. Continued research in this area is needed. Finally, just as there is a need to study the feasibility and relative advantages of various types of automatic or semi-automatic adjustment mech- anisms to increase social security benefits over time — there is a similar need in the private pen- sion area. Certain private pensions are in part variable annuity plans (adjusting pension hiv«li with changes in the value of plan-held equities), and a few have price level adjustments built in. The experience of these plans should he studied and the feasibility of extending them to a greater number of plans should be investigated. F. Health and Medical Problems The Senate Committee Task Force on the Eco- nomics of Aging pointed out the following facts:" 1. The prices of medical services have risen faster than the prices of other consumer goods and services. 2. With advancing age, older people have more physical disability that results in higher medical care costs. 3. At the oldest ages, the need is especially great for the types of health care not covered by Medicare, notably long-term nursing home care and drugs. 4. Because Medicare requires that individuals meet half of the cost of Part B premium payments (as well as deductables and co- insurance), the inflation of medical prices constantly adds to the problem of low in- come aged persons. The Task Force paper continues: These facts resulted in a problem that is basic to the economic security of the elderly population: despite the important protection now provided by Medicare, increasing numbers of older people may have to pay ever larger amounts of out-of-pocket to get the medical care they need. More may have to resort to the uncertain and uneven protection pro- vided by State Welfare programs (Medicaid). 64 There is, consequently, a great need for continu- ing research to evaluate the operation and ade- quacy of Medicare and Medicaid. One important area which is not receiving suffi- cient research attention is the economics of provid- ing institutional care, especially for the very old. As the age of the older person increases, the probability rises that he or she will need special housing, special services to maintain adequate living standards, and special personal care. Often these needs are associated with the declining phy- sical and mental well-being of the individual. Some major economic problems are arising here. First, we currently have very few guidelines to help in determining the desirable mix of public and private enterprise in providing the institu- tional housing and special care. 576 Second, our methods of developing and divert- ing manpower needs into areas where the mar- ket price system functions imperfectly are primi- tive. The job of developing programs and salary scales which will attract competent manpower into the areas of service for the aged is an enor- mous one. Third, no matter who provides these new needs in housing and special care, the costs will be large. How will they be financed? We have not begun seriously to face the question of how best to provide the funds (which means a shift in the allocation of the nation's resources) to this area. Alternative financing methods should be investi- gated. Footnotes 1. U. S. Senate Special Committee on Aging, Eco- nomics of Aging: Toward a Full Share in Abun- dance, 91st Congress, 1st session (Washington: Government Printing Office, 1969). 2. "In 1966 the Agriculture Department economy food plan, which is the core of the poverty index, pro- vided for total food expenditures of only 75 cents a day per person (in an average four-person family). The index adds only twice this amount to cover all family living items other than food . . ." Mollie Orshansky, "The Shape of Poverty in 1966." Sociaf Security Bulletin XXXI (March, 1968), S. 3. M. J. Farrell, "The New Theories of the Consump- tion Function," Economic journal LXIX (Decem- ber, 19S9), 678-96. 4. Juanita Kreps, Lifetime Allocation of Work and Income; forthcoming: Duke University Press. 5. Lenore A. Epstein and Janet Murray, The Aged Population of the United States, Research Report No. 19 (Washington: Government Printing Office, 1967), Table 4.1. 6. For an extensive discussion of these problems with regard to data on the aged see U. S. Joint Economic Committee, The Distribution of Personal Income, 88th Congress, 2nd session (Washington: U. S. Government Printing Office, 1964), p. 16 and M. W. Riley and Anne Foner, Aging and Society, Vol. I: An inventory of research fundings (New York: Russell S*ge Foundation, 1968), pp. 7-11. 7. Juanita M. Kreps and Donald E. Pursell, "Life- time Earnings and Income in Old Age," in U. S. Jt Economic Committee, Old Age Income As- surance, Part IE (Washington: Government Print- ing Office, 1968), pp. 264-67. 8. Raymond W. Goldsmith, A Study of Saving in the United States, Vol. I, National Bureau of Economic Research (Princeton: Princeton University Press, 1955), p. 7. 9. Franco Modigliani and Richard Brumberg, "Utility Analysis and the Consumption Function: An Inter- pretation of Crass-Sectional Data," in Kenneth K. Kurihara, Post Keynesian Economics (New Bruns- wick, N. J.: Rutgers University Press, 1954), p. 430. 10. Ibid., p. 419. 11. See James H. Schulz, "Some Economics of Aged Home Ownership," The Gerontologist (March 1967), 73-74 and 80. 12. Lowell E. Gallaway, "The Retirement Decision An Exploratory Essay," Research Report No. S Social Security Administration (Washington Government Printing Office, 1965), pp. 1-2. 13. Ida C. Merriam, "Implications of Technologies Change for Income," in Juanita M. Kreps, Tech nology, Manpower, and Retirement Policy, (Cleve land: World Publishing Co., 1966), p. 171. 14. See Juanita M. Kreps and John O. Blackburn's testi mony in U. S. Senate Special Committee on Agin| Long- Range Program and Research Needs in Agin and Related Fields, pt. I (Washington D.C Government Printing Office, 1967), p. 60. 15. The survey results originally appeared in a serie of articles in the Social Security Bulletin but ai now complied in Lenore A. Epstein and Janet r Murray, The Aged Population of the United Slate the 1963 Social Security Survey of the Aged, R< search Report No. 19, Social Security Administn tion (Washington: Government Printing Offio 1967). 16. Office of Research and Statistics, Work Plan Fisct Years 1969-1970, Social Security Administrate (Washington: n.p.). 17. James H. Schulz, The Economic Status of the Ri tired Aged in 1980: Simulation Projections, Ri search Report No. 24, Social Security Administn tion (Washington: Government Printing Offic 1968), p. 54. 18. The American Enterprise Institute for Public Poli< Research, Proceedings of a symposium on "Priva Pensions and the Public Interest," (forthcoming 19. Burton A. Weisbrod and W. Lee Hansen, "A Income-Net Worth Approach to Measuring Eo nomic Welfare," The American Economic Revie\ LVIII (December, 1968), pp. 1313-29. 20. L. Epstein and Murray, op. cit., pp. 69-77. 21. Yung-Ping Chen, "Potential Income from Horn ownership: An Actuarial Mortgage Plan," U. Joint Economic Committee, Income Assurance Old Age, Part II (Washington: Government Priii ing Office, 1967), pp. 303-11. 22. Yung-Ping Chen, "Property Tax Concessions to tl Aged," Richard W. Lindholm (ed.), Proper Taxation: USA (Madison: University of Wisco: sin Press, 1967), pp. 225-235; Margaret Greenfiel Property Tax Exemptions for Senior Citizens (Be keley: Institute of Governmental Studies, 1966). 23. Janet A. Fisher, "Income, Spending, and Savii Patterns of Consumer Units in Different A Groups," Studies in Income and Wealth, Vol. (New York: National Bureau of Economic B search, 1952); Sidney Goldstein, "Changing I come and Consumption Patterns of the Aged, 195 1960," Journal of Gerontology, XX (1965), 453-< 24. Lenore A. Epstein, Income Security Standards Old Age, Research Report No. 3, Social Securi Administration (Washington: n.p., undated). 25. Derek C. Bok, "Emerging Issues in Social Legisl tion: Social Security," Harvard Law Review, LX> (February, 1967), pp. 717-764. 26. James H. Schulz, "Aged Retirement Income Ac quacy: Simulation Projections of Pension-Ear ings Ratios," U. S. Jt. Economic Committee, J 577 come Assurance in Old Age, Part II (Wuhington: Government Printing Office, 1967), pp. 245-259. 27. See the discussion In Bok, op cit., pp. 753-757. 28. The study is scheduled to study a sample of people ■fad 58-63 in 1969 for at least 10 years. 29. E. L. Loren and T. C. Barker, Survivors Benefit! (Detroit: Michigan Health and Social Research In- stitute, 1968). 30. Matilda W. Riley and Anne Foner, Aging and Society, Vol. I, An inventory of research fundings, (New York: Russell Sage Foundation, 1968), p. 106. The studies referred to were in Hadley Can- tril, ed., Public Opinion 1935-1946 (Princeton, New Jersey: Princeton University Press, 1951). 31. Ethel Shanas, The Health of Older People: A So- cial Survey (Cambridge: Harvard University Press, 1962); James Morgan et al., Income and Welfare in the United States (New York: McGraw-Hill, 1962). 32. See, for example, George Katona, Private Pensions and Individual Saving, Monograph No. 40 (Ann Arbor: University of Michigan Survey Research Center, 1965), Chapter 4. 33. George Katona and James N. Morgan, "Retire- ment in Prospect and Restrospect," in U. S. Joint Economic Committee, Old Age Income Assurance, Part II (Washington: Government Printing Office, 1967), pp. 232-244: Ethel Shanas, et al., Old People in Three Industrial Societies (New York: Atherton Press, 1968), p. 419. See, also, G. Katona, Private Pensions , Op. cit., Chapter 3. 34. U. S. Senate Special Committee on Aging, Hear- ings on Long-Range Program and Research Needs in Aging and Related Fields, Part I (Washington, Government Printing Office, 1968), p. 106. 35. Michael J. Brennan, Philip Taft and Mark B. Schupack, The Economics of Age (New York: Nor- ton, 1967). $6. Gordon Streib, "Longitudinal Study of Retirement," Final Report to the Social Security Administration (Washington, D.C., n. p., 1965). 17. U. S. Department of Labor, The Older American Worker — Age Discrimination in Employment (Washington: n. p., June, 1965). S8. Fred Slavick, Compulsory and Flexible Retirement in the American Economy (Ithaca: Cornell Uni- versity, 1966); Theron J. Fields, "Company-Initi- ated Early Retirement as a Means of Work Force Control" (Unpublished Ph.D. dissertation, Cornell University, 1963); Harland Fox and Miriam Ker- pen, Corporate Retirement Policy and Practices, Personnel Policy Study No. 190 (New York: Na- tional Industrial Conference Board, 1964); The National Council on the Aging, Employment of the Middle-Aged Worker (New York: n. p., 1969). 19. U. S. Social Security Administration, The Re- search Program of the Social Security Administra- tion, Report of the 1967 SSA Advisory Committee on Research Development (Washington: Govern- ment Printing Office, 1968), p. 8. 10. Joseph A. Pechman, Social Security — Perspectives for Reform (Washington, D.C.: The Brookings Institution, 1968), Chapter 9. 41. Margaret S. Gordon. Tht Economic* <>f Wtlfart Policies (New York: ( .'< .lumlii.i I Juiversil J 1963), pp. 75-76. 42. i 1 S. Social Security Administration op tit., pp. 20-21. 43. Margaret S. Gordon, "Income Security Programs and the Propensity to Retire," in Hie hard i I. Wil- liams, et al., eds., Processes of Aging, Vol. 2 (New York: Atherton Press, 1963), pp. 436-58; Juanita M. Kreps, Lifetime Allocation of Work and Leisure, U. S. Social Security Administration, Re- search Report No. 22 (Washington: Government Printing Office, 1968); Henry Aaron, "Social Se- curity: International Comparisons," in Otto Eck- stein (ed.) Studies in the Economics of Income Maintenance (Washington: Brookings Institution, 1967), pp. 13-48; Gaston V. Rimlinger, "Social Change and Social Security in Germany," The Journal of Human Resources, III (Winter, 1968), 409-21. 44. Also, Ethel Shanas, et al., Old People in Three In- dustrial Societies (New York: Atherton Press, 1968) demonstrates through its findings the value and potentialities of a carefully executed study using comparative analysis. 45. "British White Paper on Social Security Reform," Reprinted in Social Security Bulletin, XXXII (May, 1969), 3-15. 46. Pechman, op. cit., Chapter 7. 47. James Tobin, "It Can be Done: Conquering Poverty in the U. S. by 1976," New Republic, 156, No. 22 (June 3, 1967), 14-18; also Tobin, et al., "Is a Negative Income Tax Practical?" Yale Law Journal (November, 1967); Robert J. Lampman, "Negative Rates Income Taxation," paper pre- pared for the Office of Economic Opportunity (Au- gust, 1965); Earl R. Rolph, Statement before the U. S. Joint Economic Committee, Income Main- tenance Programs (Hearings, Vol. 1), 90th Con- gress, 2nd session (Washington: Government Printing Office, 1968), pp. 104-108. 48. See Margaret S. Gordon, "The Case for Earnings- Related Social Security Benefits Restated," in Jt. Economic Committee, Old Age Income Assurance, Part II (Washington: Government Printing Office, 1967), pp. 327-39; Pechman et al., op. cit., Chap- ter 9. 49. W. W. Kolodrubetz, "Employee-Benefit Plans, 1950- 67," Social Security Bulletin, XXXII (April, 1969), p. 4. 50. See, for example, U. S. Bureau of Labor Statistics, "Digest of 100 Selected Pension Plans Under Col- lective Bargaining, Spring, 1968," BLS Bulletin 1597 (Washington: Government Printing Office, 1969). 51. Ibid. 52. Hugh Folk, "Private Pensions and Labor Mobility," University of Illinois Bulletin, Vol. 64, No. 76 (February 9, 1968). 53. U. S. Senate Special Committee on Aging, Eco- nomics of Aging: Toward a Full Share in Abun- dance, 91st Congress, 1st session (Washington: Government Printing Office, 1969), pp. 22-23. 54. Ibid. 578 Supplementary Report A Policy-Oriented Research Approach in Aging In mid-july, 1969, the staff of the Committee on Research and Development Goals in Social Gerontology (CORAD) asked the chairman of this subcommittee to supplement CORAD's work for the Administration on Aging by bringing to- gether a group of persons relatively new to the field of social gerontology. The subcommittee was given two tasks: to comment critically on the CORAD report, and to suggest areas of important research not identified in the report. Both charges were to be conducted within the framework of the overall objective of the contract with the Ad- ministration on Aging, i.e., (1) to identify "prom- ising leads for research in social gerontology" which (2) have the "greatest promise of providing guides for social policy and practice with respect to aging in the near future." The subcommittee also accepted responsibility for the completion of a supplemental written report by October 1, 1969. Method of Operation Each member of the subcommittee received the various draft sections of the CORAD Report be- tween August 18 and August 25. The group held its only meeting on the morning of August 27, at which time it coordinated the individual "critiques" for discussion with CORAD on the afternoon of that day. The contents of the Supple- mentary Report, therefore, represent the convic- tions of the subcommittee as it turned to its second charge— to identify important research areas which will assist in policy formulation and practice in the near future which are not highlighted in the CORAD Report. Every report suffers from shortages of time and from the restrictions placed upon it by the hectic schedules of its authors. Ours is no exception. Our schedule speaks for itself. So does our lack of op- portunity for meeting together. This report was completed rapidly, but not carelessly; it is basi- cally written and coordinated by a single author, but every co-author contributed and criticized; its proposals could probe more deeply, but the ideas are not shallow; its planning was accomplished hurriedly, but this planning was based upon a great deal of prior thought and consideration. In accepting the charge to make recommenda- tions which can provide a harvest in the "near future" for policy and practice, the subcommittee concluded its Supplementary Report must move beyond a description of the "state-of-the-arts" in social gerontology — it must be more than a pas- tiche of gerontological concerns. Consequently, its report reflects the conviction that only by mak- ing a start at elaborating and applying a set of criteria to selection of potentially fruitful research investigations at this point in time could the sub- committee discharge its responsibilities. The em- phasis merits much more consideration than avail- able time permitted. Nonetheless, we have staked out that ground for further exploration, perhaps possessed of the infinite wisdom of fools. Report Contents The remainder of the Supplementary Report is divided into five sections: I. Perspective of Supplementary Report II. The Problem of Criteria Proposed Priority Investigations and Experiments Considerations for Administering a Pol- icy-Oriented Research Program Postscript for Researchers in the Field ol Aging IV. I. Perspective of Supplementary Report The CORAD Report stands as proof that then remain a host of questions in the minds of re searchers in the field of aging. The variety of is sues, policy questions, and research areas th CORAD report encompasses represents a mile stone in assessing work to be done. Identificatioi of such questions is an important step in our con tinuing effort to expand the knowledge base of 579 gerontological discipline. M or e ov er , many of the answers will improve the nation's capacity to ef- fect significant advances in the lot of our aged citizens. But how is the policy-maker to come to grips with the variety and diversity? He has asked for guidance in selecting those investigations and ex- periments with a high probability of pay-off when the results are applied to his areas of concern — systematic policy expression and translation to program. The Supplementary Report attempts to respond to the policy-maker's request, and is, therefore, only secondarily addressed to the aca- demician. Rather than add to the priority areas identified by CORAD which are embodied in its chapter titles, the Supplementary Report focuses in its entirely on policy-oriented issues requiring objec- tive information, and analysis. The variables identified are those of interest to the administrator, planner, and politician — persons in a position to smooth the rocky road from research to utiliza- tion. At the heart of a policy-oriented research as considered in the Supplementary Report, therefore, are those questions of concern to individuals who influence policy which can be developed and tested. Areas to be explored include administrative questions regarding funding arrangements, appro- priate organizational sponsorship of programs, strategies for implementation, measuring program costs and benefits, and substantive questions on the value systems of a society and its sub-groups for the provision of basic amenities for the aged. The perspective of this Supplementary Report stems from the subcommittee's convictions that policy-oriented research has the potential to be transferred relatively quickly to policies and pro- grams which are sympathetic to the needs and interests of the aged. Our priority recommenda- tion, therefore, calls for greater emphasis in the Administration on Aging on policy research. II. The Problem of Criteria Listed in this section is a set of criteria de- veloped by the subcommittee for use by the ad- ministrator, planner, and politician in identifying and stimulating policy-oriented research projects. Application of the criteria in selecting research projects or in requesting research proposals is only the first step in narrowing the field of policy re- search possibilities. For example, more projects than can be initiated may meet all of the criteria, or some may only partially meet the criteria and yet have wider applicability or greater I than other projects which Incorporate all criteria. A discussion of priority issues is initiated in Sec- tion IV of the Supplementary Report. Certainly the selection of priorities among criteria provides fertile ground for additional study. Although such a project is not presented in the succeeding section, the subcommittee recom- mends that the further development of a frame- work of appropriate criteria for selecting policy questions for research be given a top priority. Woven through all the criteria listed below is a core question, "Does the proposed research have potential utility and applicability?" Thus, is it directed to the priority needs and interests of the aged as these are identified by the policy-maker or programmer? Does the proposed project con- tain a research design which assures application? Criteria The criteria have been roughly grouped into two categories: those directly related to the concerns of policy-makers and programmers; those related to research design and strategy to support applica- tion of results. The proposed research: 1. Explores variables of interest to policy-ma- kers and programmers: e.g., yearly review of items brought before a senate subcommittee, reports from the field, a yearly content analysis of a sample; information from groups representing the elderly. 2. Anticipates results which can be translated to policy formulation at the national level. 3. Considers future populations of aged and a changing society: e.g., shows evidence of viewing society as dynamic; specifically incorporates fu- turistic type data. 4. Requires no further investigation for utiliza- tion of results: e.g., variables, cast in an opera- tional framework, have a high degree of identifi- ability, accessibility, manipulability, and potency. 5. Utilizes a methodology which gives a reason- ably solid basis for policy action. 6. Proposes to use data which are accessible and which meet criterion 7. 7. Can develop and test solutions within a two- year time span. Again, it should be stressed that application of these criteria will not necessarily identify projects that will contribute to a developing academic discipline. Moreover, their application is only a first step in the selection process for policy re- 580 search. The allocation of some resources for long- term policy questions would undoubtedly require modification in the criteria. III. Proposed Priority Investigations and Experi- ments This section describes a number of investiga- tions and experiments which incorporate the above criteria. Obviously application of the criteria by others or use of the criteria at another time might well have produced a very different set of project descriptions. The projects are presented here, not as the priorities among all policy research possi- bilities. Rather, they are offered as a sample of policy research endeavors which might well be undertaken in the future. In the final analysis, the value stances of the subcommittee dictated the specific selections after considering many more which met the criteria. For example, all the projects described here have the potential to produce knowledge for policy and program positions which will extend the alterna- tive choices now available to older adults. Each project in one way or another supports both CORAD and subcommittee aspirations for policies which promote opportunities for diversity and flexibility in the life styles of the aged. In this connection, none of the projects envisions policy formulation as dependent on a demonstration of societal contributions by the aged before other choices can be extended. Again, despite the na- tion's limited resources, the subcommittee is not enchanted with projects seeking to identify and es- tablish minima, for fear that minimum becomes the sole choice for older adults with their various needs and interests. The projects described in the remainder of this section seek information for guidance in establish- ing policies to meet the needs of older adults. The first two are primarily concerned with identifying future needs, the next seven with experimentation to meet current needs, and the remainder with isolating variables affecting program implementa- tion and effectiveness. The order in which they appear does not imply a priority-ranking. Some are more developed than others. The pri- mary objective is to provide sufficient data so that a "request for proposal" can be outlined. How- ever, in each instance the project description in- cludes in sequential order: 1. The policy/program implication or issue 2. The research questions 3. Data and methodology 4. Collateral significance Projections of Employment and Income Needs of the Aged 1. Policy/ program implication. — Significant changes are occurring in the demand for labor as a result of technological and other economic change. Demand, rooted in the potential productivity of the worker, is changed under the impact of technology in ways which are differentiated by the age of the worker. It can reasonably be hypothesized that changes in demand re- sulting from new technology will have a more severe impact on older workers than on younger workers. In the projections of future income needs, it is important to arrive at some conclusions with regard to the differ- ential impact of technological change on the employ- ment, productivity, and income of the aged. 2. Research questions. — Research in this area has traditionally been confronted with serious data prob- lems. Although it is generally accepted that a worker's productivity declines in the latter years of his working life and that his income may remain at levels above his marginal productivity in these latter years, the un- availability of data has precluded precise quantification. And yet, the gap between productivity and income in the final years of working life may not be much greater than the gap between (zero) productivity and income after a worker's retirement. 3. Data and methodology. — It is proposed in this re- search that investigations of the productivity of older workers in a variety of occupational circumstances be extended to include their productivity and income at various stages in their immediate pre-retirement period. 4. Significance. — This research, when closely corre- lated with income, would answer some persistent ques- tions concerning the "costs" of various income main- tenance schemes for older workers after retirement compared with income received from work. Planning for Tomorrow's Needs 1. Policy /program implications. — Policies and pro- grams are established as a result of political factors, plus the way experts define the situation. Programs based on present definitions rapidly become obsolete, yet persist because of the personal and institutional vested interests developed. There is abundant evidence that present definitions are inadequate. The old stable divisions of education-work, labor-business, private- public, etc., are not reliable predictors of group or in- stitutional behavior. New roles and mutual problems have produced unique coalitions. Does the aged /young (non-aged) dichotomy have any meaning in the future? 2. Research questions. — Is the aged non-aged dichotomy a valid and useful distinction in planning for human needs in light of what we can reasonably predict to be the impact of technology on society? 3. Data and methodology. — A systematic analysis of the variables which support the present dichotomy and an attempt to predict their future status is currently being conducted, although on a broader basis, by the Harvard-MIT Project on Technology and Society. Their work may well lend itself to a peripheral pro- ject to produce a "think piece" for planners and policy makers in the field of aging. 4. Signi/icance.— Exploration of these questions would help prevent the institutionalization of present 581 itmoded programs. The project would offer a frame- ork for change, plus criteria against which to measure ■escnt proposals. echnological Aids and Potentials in Programs r the Aged 1. Policy/ program implications. — Health policy is oving in the direction of encouraging comprehensive irsonal family health care utilizing physicians plus icillary personnel. The potential of technology for nbulatory and home-care programs has been largely nored. How can technology be utilized to make physi- lly and socially handicapped individuals more inde- sndent? For example, what is the potential of auto- ated stove/ refrigerator combinations which will pro- ice hot meals twice per day for a week, television lkage to adult education and community events, de- xs to eliminate housework so the older person can ly in his home, new types of prosthetics, automated ieel chairs and devices for getting in and out of bed, :? 2. Research questions. — What technological aids are/ 11 be available to increase the independence of so- illy and physically dependent people? What might the social consequences of such developments? 3. Data and methodology. — The proposal envisions ni-structured interviews with technologists in business d industry, universities, and defense "think tanks." the same time a literature review should be con- cted. Social analysis of the interview data by a ted group of behaviorists — sociologists, psychologists, d anthropologists — would be in order. The study aid well lead to a conference reporting on the re- Its of the interviews and social analysis. Whenever ssible, devices should be evaluated for both technical ^abilities and social impact 4. Significance. — See comments under "Policy/pro- im implications'" above. mserving Human Resources for Programs 1. Policy/ program implications. — The scarcity of hu- in resources suggests the desirability of exploring the >vision of a variety of services (appropriate to Ad- nistration on Aging sponsorship) using technological ources. One sudh unexplored resource is the tele- one. I Research questions. — Can funds be provided to ure every older adult a phone which hooks up with /ariety of services: reassurance, information and re- ral, legal counsel, daily "I-am-all-right" calls, etc? e project calls for development and demonstration of h a program at first in several communities, eventu- f nationally. I. Data and methodology. — Development and nonstration involve: (1) a survey of telephone npanies to determine how many older persons do not /e telephones; (2) a study of the desires of older >ple to have telephones; (3) the development of elec- nic hook-ups so that a single number would be an- sred and the call electronically switched to the sded service; (4) the evaluation of service use; (5) study of the desirability of using young people to ivide reassurance. L Significance. — The study would test the feasibility of mounting a massive attack on common problems ot aging without infringing on individual dignity. Cost-Benefit Analysis of Alternative Procedures For Providing Income to the Aged 1. Policy/ program implications. — There are a num- ber of alternative procedures for providing income for the aged. These include traditional welfare payments, the newer approaches of a negative income tax or guaranteed minimum income, and income from work. Even though policies concerning the aged should not be controlled by consideration of economic efficiency, public policy must be concerned with the most eco- nomically effective means of achieving a given socially desirable goal. Cost-benefit analysis has been widely adopted as a means of evaluating the effectiveness of government expenditures. 2. Research questions. — There has been a growing interest in experimental projects designed to test the effectiveness of alternative social policies. One of these experiments, dealing with income payments to welfare recipients, has received a great deal of publicity. Given the scarcity of resources for improving the income status of the aged, research investigators in this field should direct their attention to experimental research projects, which utilize cost-benefit analysis in evaluating alterna- tive income-maintenance procedures for the aged. 3. Data and methodology. — An experimental project could either utilize existing payment schemes and trace their effect through follow-up evaluations; or, if re- sources would permit, alternative income-maintenance methods for the aged could be established as part of the experimental design. The costs and benefits in terms of income, employment, social-psychological well- being, of welfare transfer payments, training-employ- ment stipends, and negative income tax payments could be determined on the basis of this research inves- tigation. 4. Significance. — It is apparent that the present ad- ministration will place considerable stress on cost- effectiveness of public expenditures in the welfare field. Emphasis will also be given to employment for the employable. Research in social gerontology should be used to further these policy objectives. Prototype Low-Cost Dwelling Unit 1. Policy/ program implications. — Needed is a hous- ing policy which will promote a wider range of hous- ing choices for the aged than now exists. Policy issues are raised by the assumptions that housing options are increased by: (a) achieving low-cost quality dwelling units through: relaxation of restrictive union practices and antiquated building codes and ordinances; use of readily available and tested materials suit- able for on-site fabrication by the unskilled. (b) incorporating features in the dwelling unit which are functionally related to the needs of the aged. (c) diverting some of the design talent which is now disproportionately engaged on the multi-family and die institutional dwelling unit to the single family unit. 2. Research questions. — What are desirable housing features which meet the needs of people throughout the 582 life-span? What are the relationships between costs and these features? 3. Data and methodology.— Possible candidates to undertake design construction, and evaluation on an experimental basis are major construction firms or labor unions with "know-how" in the building indus- try and access to the opinions of current and retired employees. The initial task would be collection of data for design of a unit appropriate for the retired couple or the single head of household. Aged needs, including spatial requirements, site preferences, and items for equipping the unit, would be solicited from four groups, each group consisting of representative socioeconomic levels: (a) married and single employees approaching retirement; (b) recently retired employees or their spouses; (c) employees who have been in retirement for several years, or their spouses; (d) retired employees recently returned from a hospital or institution. Once the unit has been designed, constructed, and furnished, representatives from the four groups will occupy it on an experimental basis for evaluation of site and unit satisfactions and suggested modifications. 4. Significance.— The experiment, although directed to the single family dwelling unit, may well point to improvements in mobile homes, multi-family and in- stitutional dwellings, rehabilitation of existing aged residents and a desirable community setting. It may also suggest desirable modifications in current home- building practices. Identifying New Roles for the Elderly from Exist- ing Programs 1. Policy /program implications.— Do social services provide meaningful new roles for the elderly which correspond to their interests and desires? 2. Research questions.— What behavioral changes oc- cur in participants in Senior Center programs (foster grandparents, green thumb, and others could be in- cluded) which indicate new roles for the elderly? 3. Data and methodology— After identifying possible behavioral changes, survey existing measures that could be used. Sample participants in selected pro- grams and apply measures. 4. Significance. — In addition to evaluating the im- pact and value of such programs, the study might il- luminate appropriate objectives for existing services. Perceived Meaning of Leisure as a Function of Age Cohort, Ethnicity, and Social Class 1. Policy /program implications. — One possible short- coming of many present programs for the aged is that they aim too much at involving a broad base of per- sons, without considering the needs of various popula- tion sub-groups. There is little doubt that social and educational programs for older persons are utilized by only a small portion of eligible participants. Even when income, knowledge, transportation, and health problems are taken into account, it is obvious that many persons do not take part because they are just not motivated. Undoubtedly a substantial portion of these non-participants are adequately serviced through agencies that do not appear in our compilations; others simply find no need to attend. Most social gerontolo- gists, however, assume that many older persons would gain considerable satisfaction in participation if they found programs and opportunities that were appealing. 2. Research questions. — How many older persons par- ticipate in social and educational programs (a) not only just those specifically for their age groups, but also (b) those available for the entire community? (In so doing, we need to be aware that many older persons participate in numerous community programs, so that the same people appear in many of our "counts" on several occasions, thus giving us a false sense of ac- complishment). How do the various groups feel about the use of leisure? (e.g., does leisure imply loafing or productivity? Does it induce feelings of guilt or recog- nition of self-actualization? Do respondents feel en- titled to leisure at this point in their lives or do they feel they must continue to "earn" leisure time (often by methods now unavailable to them). Where do different subgroups go for social and educational ser- vices? (e.g., will they leave "their turf"? Is a church or community center considered a comfortable place? Should persons try to encourage settings where leisure hours are always being spent? How do the feelings of these people permit them to utilize the facilities that the middle class and middle aged might attempt to impose upon them? How can their present uses of leisure be more effectively utilized (this includes both the physical space and the social involvements?) 3. Data and methodology— -To get data on the num- ber of elderly utilizing current programs, a painstaking community survey, perhaps based upon a community sample, which uses door-to-door interviewing tech- niques is suggested. The survey would focus on sub- group differences, i.e., how program involvements vary with increasing age, and as a function of sex, social class, ethnicity, family status, etc. The participant-ob- server method, perhaps combining some of the newei thoughts of ethnomethodology or grounded theory with structured interviews and with depth interviews would be appropriate for determining attitudes toward leisurt and utilization patterns. And initial venture in a com- munity with heavy concentration of Eastern Europear Jews, Italian or Irish Catholics, Scandanavians, or son* comparable groups is suggested. 4. Significance— By determining with accuracy thosi persons being serviced, those persons not being ser viced, and the motivations of each group, it may bi possible to break through present resistance to partici pation in the social and educational offerings ahead; widely publicized as available. The study would als» yield valuable information on population subgroup and the anthropology of their own communities. Values of Life as Held by Various Age Cohorts 1. Policy /program implications. — Considerable ma terial has been published suggesting that the valu placed upon the life of an older person by the com munity is less than the value held for younger person These feelings are held not only by the middle age and young, but are accepted by the old themselve Our country is now watching leaders in the black an brown communities attempt to instill into communit members a pride in being who they are as a membe of an ethnic group. Perhaps pride in oneself as member of an age group is as important to an indivic ual's life satisfaction as pride in one's ethnic grou affiliation. If this is the case, then we need to considi programs for older persons which stimulate this prid 583 2. Research questions. — What are the values regard- ing aging and being old that are held by successive age cohorts and how do these values affect life satisfaction and social participation? 3. Data and methodology. — Research methodologies would include surveys, structured interviews, and un- itmctured depth interviews seeking information on im- portant age-related changes producing a devaluation of •elf, the variation in changes as a function of age, life experiences, ethnic identification, place of birth, and the values of the respondent which make "meaningfulness" to society personally important. . 4. Signi/jcance. — If we can leam more about those roles and capacities that change with age which make older persons see themselves (and others see them) as less adequate and less worthy persons, we can give more effective thought to planning programs to counteract these feelings. And we might break away from the cliche that ours is a youth-centered society, a cliche which has been used for many years to explain the social problems of the elderly. Measuring Effectiveness and Quality of Services in Nursing Homes and other Congregate Care Facili- ties for the Aged 1. Policy /program implications.— -The proliferation of congregate care facilities for the aged in recent years, •long with a growing concern with the quality of care and effectiveness of services provided in such facilities, has led to the development of governmental standards and licensing requirements. However, quality of ser- vices is often defined in terms of "input" criteria. (For example, number and qualifications of the staff, amount of time alloted to recreational activities, etc.) "Output" criteria (the effects of the services or programs on the residents, e.g., has capacity for self-care been raised? has confusion and disorientation been diminished?) are largely ignored. Thus, it is not known if standards do in fact assure that the institution has a beneficial effect on the residents. Once established, "input" type criteria tend to be perpetuated — they are simple to use and they frequently serve the self-interests of the profes- sional and semiprofessional groups involved in provid- ing services. 2. Research questions. — If input criteria for evaluat- ing and licensing facilities for the aging continue to be used, it is important to answer the question: To what extent and in what ways are input measures of quality of care and effectiveness of services related to output measures (the actual results obtained)? 3. Data and methodology.— There are several valid and easily applied measures of individual functioning in such areas as capacity to carry out activities of daily living, mental status and orientation, and sociali- zation ability. From the numerous demonstration proj- ects which have utilized such measures it is now possi- ble to begin determining the probability of raising the level of individual functioning in selected areas for a given group of elderly residents (those who share cer- tain characteristics such as age, sex, physical disability, baseline level of functioning, etc.) Further studies could be constructed to refine the probability statistics. With this knowledge the actual level of functioning of the residents after a period of time in an institution could be compared with their potential level of func- tioning. The difference between the two would serve as an indicator of the effectiveness of the institution's program and services. A comparison of effective and in- effective institutions would help determine the validity of currently used input criteria for evaluation and licensing of such facilities. 4. Sfgm'/icancc. — If a policy of setting standards on the basis of output criteria was adopted, this would encourage flexibility and experimentation in staffing patterns and programs for maximizing effectiveness. Too often rigid adherence to rules and regulations be- comes an end in itself. Such a policy could also help make professional accountability more of a reality. This approach to standard setting Is not limited to institutional settings, but can be extended to a variety of community programs and services. Developing Outpatient Mental Health Services for the Aging 1. Policy/ program implications. — There is a large gap between our knowledge of how to improve the lives of our elderly population and our ability to put this knowledge into effect. A costly demonstration project may establish the desirability of a certain program or service, but the availability of this knowledge does not assure that communities which lack such a service will establish one. To increase the utilization of available knowledge, we need to know more about factors pro- moting and hindering the development of agency and community programs and techniques to overcome resis- tance to change. One important area where knowledge is not being put to use (except a small group of dedi- cated practitioners) is that of community mental health services for the aging. Community mental health cen- ters (and similar agencies) are generally reluctant to serve elderly clients, despite a growing literature which suggests such clients can be helped. 2. Research questions. — What factors determine whether a community mental health center will initiate and maintain services for elderly clients? The factors to be studied include characteristics of the agency, the community in which the agency is located, and the re- lationship of the agency to the community. 3. Data and methodology. — The study would be di- vided into two parts. The first would be descriptive study comparing the factors which differentiate those agencies serving elderly clients from those which do not. Drawing on these results, the" second part would be an experimental study comparing a number of differ- ent approaches for implementing services for elderly clients in community mental health centers, (e.g., hir- ing a staff person specifically concerned with aging, encouraging physicians to make referrals to the center, etc.). 4. Significance. — Though persons 65 and over com- prise only about 10% of the population of the country, they occupy a disproportionate number of beds in men- tal hospitals. There is good reason to believe that ade- quate community mental health services could not only help prevent many hospitalizations, but help facilitate early release by providing after care. Thus, if ways could be found to initiate agency services for the elderly this could have a substantial impact in reducing the number of institutionalizations. Further, such research might well give clues as to how to get other com- munity agencies involved in serving the elderly. 584 Generalized vs. Specialized Programs 1. Policy /program implications— Advocates exist for both the generalized and specialized approaches to de- livering services to particular target groups. In the areas of health services, for example, one approach to helping the aged would be to improve the functioning of the entire medical care system. The alternative ap- proach would be to develop specialized mechanisms within the system to help the elderly (e.g., more home visits to homebound elderly). Some of the proposed alternatives, however, may be dysfunctional to the over- all systems (e.g., home visiting reduces the efficiency of manpower.) 2. Research questions.— What patterns of general/ special programs produce equality of service to all participants regardless of special categories? 3. Data and methodology— The project envisions the implementation of demonstration projects utilizing four or five models of general/special programming and analyzing these for service outcomes on participants. The project could be augmented by survey data prob- ing where elderly do go and would prefer to go for services for a variety of settings. 4. Significance.— The project will identify variables associated with successful and unsuccessful outcomes. Fusing National Goals and Local Interests in Poli- cies and Programs for the Aged 1. Policy /program implications.— -How can national goals and local interests related to programs for the aged be made more compatible? 2. Research questions— What relationships exist be- tween whether the program is nationally or locally sponsored and functions of organizations serving the older person? What are the consequences of different patterns for services to older people? 3. Data and methodology— -Much information can be gleaned from a review of literature. A cross sectional survey of a sample of programs for the elderly by spon- ' sor and function for the purpose of developing a typo- logy of patterns and differential consequences would be conducted. Comparisons would be drawn with OEO, mental health, or other social welfare programs by sponsorship and function. 4. Significance.— The study should point to an ideal pattern for local-federal partnerships, or at least im- proved patterns. It should also identify variables as- sociated with successful and unsuccessful outcomes. Family and Friends as Providers of Services to the Aging 1. Policy /program implications.— Many services and programs for the aging consider the elderly individual as the unit of service and neglect consideration of the pattern of help which may be provided by his network of family and friends. Sociological research in the past few years has shown that the three-generation family remains a viable social unit in our society. We do not know what effects current programs and services geared to the individual aged have in strengthening or weaken- ing these networks. Nor do we know the kind of help best provided by formal agencies and the kind best provided by the informal networks. 2. Research questions— What kinds of help (both material, e.g., money, housekeeping, etc., and non-ma- terial, e.g., emotional support) are provided the elderly through their network of family and friends? What kinds of services do elderly prefer to receive through these networks as opposed to formal agencies? How can the help-giving potential of the informal networks be increased? What effect does the current pattern of community services and programs have on these networks? 3. Data and methodology.— By interviewing a sample of elderly and members from their network of family and friends, comparisons between those elderly pri- marily receiving help from formal agencies vs. informal networks regarding utilization of help (including type), attitudes, and satisfactions can be made. Kinds of help, attitudes toward giving, and satisfaction variables would also be compared for the informal networks related to the two categories of elderly. 4. Potential significance.— Many elderly are reluctant to use services of formal agencies because it requires a self-identifiction as old or needy and admission of un- willingness or inability of friends and relatives to help. If policies directed at strengthening the person's net- work of informally-derived assistance in certain areas are implemented, many more aged might utilize such help. As an example, instead of establishing a home- maker service an agency might pay or otherwise en- courage neighbors to do these chores. The Relationship of Funding Source to Program Characteristics 1. Policy /program implications. — There is a continu- ing controversy surrounding the relationship of tax sup plied vs. private sector funding to the planning, imple mentation, and conduct of programs. Questions an raised in regard to responsiveness, quality, and fled bility. By systematically examining programs will similar goals but with different funding sources, thi project seeks to provide information for the develop ment of a financial policy which will improve th effectiveness of publicly-funded programs for the aged 2. Research questions.— -How do issues arise relate to the program budget and accounting system? What J the range of decisions possible within existing economic social, and political constraints? What are the out comes of decision on the program? 3. Data and methodology— To provide a basis fo making comparisons, it will be necessary to searc out a program for the aged, financed with largely pri vate funds, which is about to be implemented. A sim: lar program would then be implemented on a demor stration basis with a public funding arrangement whic incorporates current financial policies. The demonstrs tion program should be set in a city of approximate! the same size with a similar age population pyramii The total budget for the demonstration program woul be equivalent to that of the privately funded progran Among the program characteristics which may we be related to financing potentials and constraints ai the following (the relationship of each to fundir policies would be identified): major- obstacles encoui tered; modifications in originally stated program goal characteristics of program staff; explicit and implic procedures for measuring program impact and progres number of aged persons participating in the prograr their socio-economic characteristics, and the mann 585 n which they became involved; administrative and ervice cost ratios; characteristics and reasons for the ■©gram involvement «f individuals outside the or- pnization and other organizations; attitudes toward he program of aged participants and non-participants loquainted with the program, staff, and other organi- sations. A second stage study could focus on variables Jentified in stage one and compare the effects of fund- ng source in a much larger sample of programs. 4. Sigm/icartce. — Akhough the study seeks informa- ion for use in formulating public sector financial policy, be study should be of value to the private funder as veil. 'mpacts of Gerantologists on Policies and Pro- prams 1. Policy/ program implications. — The perspective or ife views of geronaologists and others who work with he elderly influence their behavior which has conse- [uences for the croacomes of policy deliberation and ■©gram. 2. Research questims.— What are the perspectives of jerontologists and can they be meaningfully classified? Vhat effect might these perspectives have on behavior elative to policy and social action? 3. Data and methodology. — A first step in the project irould be the development of scales along such dimen- ions as tough-tender, politically sophisticated-unsophis- icated, normativer-empirical, clitists-non-elitists; control if environment-conarolled by environment. The scales irould then be appJUed to compare gerontologists along hese and other dimensions with businessmen, Chil- Iren's Bureau constatuency, etc. 4. Significance. — -The project may well point the way o training and recruitment needs for the field of aging is well as provide objective tools to broaden our per- pectives. Manpower Concerns in Social Gerontology 1. Policy I program, implications. — Recruitment, selec- ion, training, and placement of persons who work with he elderly is a serious problem. 2. Research questions. — How did present workers of til ages and educational levels enter the field, why lid others leave the field? 3. Data and methodology. — A commercial motivation ©search organization, working in concert with the jeronto logical Society, for example, would devise depth nterviews around tahe area of recruitment to the field. Hie interviews would use projective techniques. The tudy would seek data on the public image oT those vho work with ofeier people, their personality charac- teristics, changes that occur after experience in the ield, and reasons for leaving. As the study of recruit- Itent progresses, se&ction and training insights may be wealed. 4. Significance. — Ef manpower problems are not at east partially sorted, programs will not go forward iffectively. The proposed study should open the way br a more realistic appraisal of our strengths and weaknesses as a vocational area, and suggest methods br communicating our strengths more effectively. IV. Considerations in Administering a Policy- Oriented Research Procram There are few precedents on which to base rec- ommendations for administration of a policy- oriented research program. Observers of research and public policy affirm the importance of a close relationship between those who produce findings and those who implement. The infrequency of such close ties may not be difficult to understand if one looks at the reference groups of each. Re- searchers are oriented to the acclaim and criticism of other researchers, who, in the behavioral and social sciences, place high value on basic research. The project officer (the responsible official in the sponsoring federal agency) is often removed from agency policy-making and planning processes; in fact, as a former researcher in the academic set- ting he tends to look to the researcher, not the policy-maker. Three major principles seem to capture existing knowledge regarding administration of a policy- oriented research program. 1. Close and continuing ties between agency decision-makers and research administration in formulating and shaping relevant research under- takings The establishment of communication linkages between the sponsoring agency and the research grant operation involves more than procedures for proposal and report routing. The principle de- mands the personal involvement of agency lead- ership in formulation of research objectives and design, and in technical leadership of research projects. President Hoover gave his commission on the utilization of research in government com- plete freedom. Franklin D. Roosevelt, in con- trast, refused to divorce himself from the issues discussed by his commission on executive reor- ganization but did promise to abide by its rec- ommendations. He did. The Hoover commission report was filed. Stronger problem formulation and project management activities by the sponsor- ing agency and policy-makers enhance the policy- making potential of research endeavors. 2. Agency investment in implementing research results The agency sponsoring research must specific- ally budget the manpower and financial resources necessary to disseminate, explain, and demonstrate findings. In the usual case, the contract contains a "restriction of information" clause. The budget 586 permits reproduction of a few reports for the sponsor's use. Needed are incentives and encour- agement for the researcher to disseminate his re- sults. Needed too, is reduction of the numerous restrictions on printing and distributing reports. Time and money must be allocated to follow- through a project and not diverted to new projects. Policies to encourage and finance the dissemina- tion of results would undoubtedly promote utiliza- tion. 3. Coordinated management of a program of interrelated research projects directed toward ex- ploring several facets of a policy issue Most research projects focus on a problem that is too narrow to provide sufficient data for im- portant executive decisions. For example, policies usually encompass more than that which can be drawn from a study of the relationship between two variables (however well measured) in a sam- ple of three nursing homes. A larger sample need not be either the only or the most important im- provement. A cluster of interrelated projects should be designed so as to provide an empirical contribution to each facet of the decision. In re- gard to administration, the agency must assume responsibility to assist in formulating a suggested "program" of related "projects" and importantly, to arrange for coordination of the individual projects, e.g., by at least getting the project di- rectors to meet together. Admittedly questions are easier to raise than answer. However, information on the following would provide assistance in implementing the major administrative principles. (a) What new bureaucratic arrangements will assure the relevance of research sponsored under Title IV to other Administration on Aging pro- grams, notably Titles III and V, and to agency planning and legislative activities? (b) Can the Gerontological Society and the several presidential or departmental advisory councils be enlisted to assist the Administration on Aging in mapping out proposal requests and research programs that could shed light on policy concerns? Many sponsoring agencies find it dif- ficult to devote staff time to detailed proposal development. They also have difficulty attracting qualified researchers to conduct contract, directed research. Involvement of such outside resources could partially alleviate both problems. (c) Would a publication program disseminating results serve as a recruitment device for attracting more researchers to the field who have the requis- ite collaborative skills? In an earlier section of the Supplementary Re- port, mention was made of the need for guidelines in selecting a policy research program. The cri- teria outlined in Section II were presented as a be- ginning set of guidelines. Two issues are raised here, resolution of which would permit a more discriminate use of the criteria. The first issue relates to relationships among proposals and the second issue to priority content areas of a policy- oriented research program. The first considers whether a series of related research projects will be more relevant to policy formulation than a series of unrelated projects which taken together perhaps probe more areas of interest. The sub-committee recommends as a further priority a policy-research program which incorporates the concept of "staged" research. A staged research program would consist of a series of projects, each project resulting in usable find- ings, the next project adding to the last and at the same time, producing worth while findings of its own, etc. As an example, a first project might describe participants in a program and their needs; another, a description of services of- fered and how they correspond with need; and third could demonstrate a new programmatic ap- proach to meeting unmet client needs. Or a staged research program might be organized around potency for generalizability. One in the series would be descriptive, another demographic or epidemiological, and a third experimental. However a staged research program is organized, two distinct advantages can be identified at this time: first, the administrative principles suggested in the preceding paragraphs — linkages, investment, and program management — could be more easily applied were projects interrelated; second, final results could be translated with confidence to policy and programs for the aged on a national scale. The second issue considers the identification of a priority content area for policy-making research for the Administration on Aging. The projects identified for this report with the suggested cri- teria tend to focus on the delivery of services to enhance the welfare of the older American. The Administration on Aging might wish to relate this emphasis to its Congressional mandate and its unique resources. An important consideration here is the unique advantage of the Administra- tion on Aging when its resources are compared with funds available for research support in, for example, the National Institute of Child Health and Human Development. The Administration might also wish to place high priority on how best 587 deliver services and leave research on the specific rvices to the agency whose mission has that nction: housing services to Housing and Urban evelopment, health services to Public Health irvice, income maintenance to Social Security Iministration, employment to Labor, etc. The Administration on Aging might then spon- r policy research concerned with: 1. The current and future needs of the aged >pulation (and its subpopulations) and who ould be entitled to services. 2. The process of intake to services through formation and referral centers or their equiva- nt. 3. The assessment of available services in such manner that the results can be transmitted to ie President. 4. The nature of services to enhance opportuni- »s for social and psychological integration and ipportive services to protect those who cannot manage their own affairs (these services do not seem to be the mission of another functional agency). V. Postscript for Researchers in the Field of Acing The recommended research projects each gave some attention to methodology. We would be re- miss at this point if we did not mention an "in- novation" methodology which appears nowhere in the project descriptions. The methodology is described in the Preface to the CORAD report- solicitation of supplementary efforts from a group of relative newcomers to the field of aging. The Supplementary Report is offered in the hopes that this methodology as well as the issues raised by the report will stimulate critical com- ment from other members of the Gerontological Society. Such comment should assist CORAD as it embarks upon the next phase of its work. 71-272 O - 72 - pt. 1 - 38 588 Ronald Weismehl, Director, Council for Jewish Elderly, Jewish Federation of Metropolitan Chicago Before proceeding with my statement, let me introduce myself. I am Ronald Weismehl, Director of Council for Jewish Elderly, of the Jewish Federation of Metropolitan Chicago. The Council for Jewish Elderly is a new organization which has been formed to plan, implement, and maintain a comprehensive and coordinated program of service for the Jewish elderly of Metropolitan Chicago. Prior to being appointed Director of this new organization, I was the Execu- tive Secretary of Gerontological Council of the Jewish Federation of Metropoli- tan Chicago. The Gerontological Council was composed of lay and professional representatives from ten affiliate agencies of the Jewish Federation and the Board of Directors of the Federation. The Gerontological Council examined the problems and the needs of the aged, evaluated the effectiveness of the present system of providing service to the elderly, studied programs that were being initiated in other communities, and sought new and innovative ideas related to providing the best possible service and care to the aged. The Council Plan published in the Spring of 1970, and entitled, A Jewish Community Plan for the Elderly, is currently being implemented by the Council for Jewish Elderly. The Jewish Federation has for many years provided a broad spectrum of services to the aged. These services have been made available through Federa- tion's affiliate agencies: Jewish Family and Community Service, Jewish Com- munity Centers, Jewish Vocational Service, Drexel Home for Aged, Park View Home for Aged, Jewish Home for Aged, Michael Reese Hospital and Medical Center, Mount Sinai Hospital, and the Schwab Rehabilitation Hospital. Ap- proximately four years ago, the Jewish Federation decided to reexamine its program of service to the elderly. At that time it was determined that the special needs of the elderly and the changing characteristics of our elderly population warranted a reexamination of our service program and a search for a new policy on aging. The planning study developed by the Gerontological Council not only involved all agencies of the Jewish Federation, but it also stimulated a new commitment on the part of our committee toward develop- ing an overall community plan. In our agencies, like so many other community service agencies, the needs of the elderly were being met in a piecemeal fashion. Each agency served a par- ticular category of older person (i.e. the ambulatory, the chronically ill, the elderly in crisis, etc. ) , and each developed what was termed an internal policy on service to the aged. This situation was described in the Gerontological Coun- cil Report : "There is a general agreement that the present system of providing service and care for the aged can be conceptualized at the straight line leading from the home environment through a referral system of independent and largely uncoordinated agencies directly to the nursing home or home for the aged." As we noted in our study, many changes were taking place within the elderly community and the community service model that we were utilizing was not responding to these changes. On a very practical level we observed that those agencies that served the elderly through programs that provided service for all age groups, were con- tinually faced with the dilemma of making choices between whom to serve, how much service should be given to a particular group, or a particular category of need. In the area of long-term care services, the Jewish Federation found it- self in the position of carrying a greater financial burden for the delivery oi care in the Federation's three Homes for Aged. In 1966, prior to Medicare and Medicaid, the Jewish Federation appropriated $845,975, to meet the deficit of the three Federation Homes for Aged. In 1971, the Jewish Federation has approved an allocation in excess of $1,800,000, to meet the deficit for Homes for Aged witt no real change in standards of service. The Gerontological Council observed that the communities were allocating large sums for a type of service that served a limited number of people and served them in what was considered an inappro priate setting. To quote from the Gerontological Council Report : "Institutions which are confined to traditional form, must accommodate everj level of care within their four walls and, as a result, the individual becomes sub ordinate to the setting. To be sure, the home for aged does not lack in compas sion and interest but, bound by its form of delivery, it becomes rigid and unabl* to respond to the problems of aging and social change." 589 How then should we provide comprehensive social service to the elderly? In Dur plan we concluded that we must be a coordinated program, providing a net- work of resources for the older person and his family. The Gerontological Coun- cil concluded that the overriding objectives of tins coordinated program must be to maintain the individual as an Independent functioning person by making use 9f whatever resources and strength the older person and his family possess. This calls for the rejection of those policies and institutions which tend to reinforce the weaknesses of the older person and thus hastens his deteriorat ion. The main thrust of our new program is flexibility and availability of choice. Sfche aged person must be considered a member of the community who because i>f certain problems which develop with age will from time to time, need assist- ance in one form or another to support him and his life within the community. The new services system will be composed of eight inter-locking components, at the peak of which is a central coordinating and planning organization, the Council for Jewish Elderly, which will serve as the governing organization for ill services for the elderly. The service system's seven program units will be : (1) Area Service Centers, (2) Employment Program, (3) Area Transportation Service, (4) Housing, (5) Evaluation- Service Center, (6) Community Health Center, and (7) Education and Training Program. The Evaluation-Service Center is the pivot service unit for the system. Through this regionally based unit, the older person and his family will be able to par- ticipate in planning and making choices which best strengthen the dignity of the older person and his family. Through the Area Service Center, the elderly will be provided with a wide spectrum of services including emergency assistance, home-maker and shopping services, telephone reassurance, transportation services, home-meal services, em- ployment counselling (and employment opportunities on the staff of the Center itself) , health screening and in-home health services. In the area of Housing a variety of different types is envisioned to meet the varied needs of elderly individuals. It is planned to provide, at rents which older people can afford, leased apart- ments in privately owned buildings ; specially designed apartment buildings for the elderly and Group Living housing. The latter will be made up of two "house- holds : to a unit— a "household" consisting of approximately 12 individuals with enough household help and, when needed, personal aides to fulfill the needs of the residents without undermining their strengths and independence. Additional housing of a more specialized kind will be provided by the health service arm of the program. This would include a short-term crisis program and rehabilitation, aimed at moving the older person back into the community rather than institutionalizing him. The program also provides, of course, for long-term, in-patient care within a nursing facility for those who clearly are unable to care for themselves, even with assistance, in their own homes or the other forms of special housing to be pro- vided. In our planning we have concluded that a totally conceived program must be put into effect as a unit to maximize the goals of both services and economy. To the degree that it is not done, the community will fail to deliver the best and most economic service. The basic premise underlying all of our recommendations is that we must go where the older person is located, give just the amount of service he truly needs to reinforce his strength, and give this needed service in the setting in which is most efficiently delivered. In doing this we have no intention of discarding valuable service concepts as developed by existing community agencies. In fact, many of these service designs will be reorganized and introduced into the new system, allowing us to move forward from our present level of service to a new and better level of community service. We have no intention of duplicating the services provided by our com- munity agencies. Rather, we are asking these agencies to provide us with those skills and staff services that they have developed over the years, but have asked that these skills and staff services be delivered within the context of the new pro- gram and under a policy mutually developed by the agencies through the Geron- tological Council. 590 There are many gaps in the service resources currently available in our con munity and the general community. Therefore, we shall be introducing such ne^ services as transportation services, housing, a crisis intervention program, home help services, and nutritional programs. The plan that I have described to you today, cannot be attained merely b superimposing new service functions on existing community organizations. If on accepts the principles that I have laid down in my presentation today, one mus also accept the fact that we must reexamine the forms of administration that eJ ist within our community agencies. Where forms of administration are fruitfi and productive they should be retained, but no restriction should be placed o forming new relationships with other community organizations if such relatioi ships will result in the advancement of the principles stated above. In othe words, one cannot achieve a comprehensive and coordinated program of servic for the elderly merely by adding some new objectives to an existing organizatio or by developing a few more services. We have the technology to deliver many kinds of services to the elderly. Hot ever, we must not confuse technology with policy. The major issue before us today relates to the development of a policy on agin, A policy that allows us to open up our communities, their institutions and the: resources to the elderly so as to enable our older Americans to live in these con munities as independent and productive citizens. Outreach : Bringing Services to the Elderly introduction The Elderly . . . Lost in the Shuffle In this affluent, opportunity-rich country, one growing segment of the popul tion has been dealt a losing hand. America's elderly have somehow been lost the shuffle of minority groups struggling for equal rights and a decent standai of living. The reasons for this are numerous and complex, but the result is si gularly poignant — the crying needs of many aging Americans, whose producti' years have gone to making their country great, are not being met. Aggravate the situation and presaging grave problems for the future is the fact that fl number of elderly is increasing at nearly twice the rate of the general pop lation. 1 Needed . . . A New Approach Although public and private concern about the plight of the aged has accele ated in recent years, constructive remedial action has been slow in coming. Leg: lation lags. Social services remain fragmented, and social workers persist assigning the elderly a low priority. Many senior centers cater to the "well" age serving those fortunate few able to attend center functions and often failing look beyond their walls to the ill, impoverished, and isolated — the so-called "i visible elderly." We have reached a point where the rhetoric of concern and piec meal action are no longer acceptable. Critically needed is a new approach- realistic approach, geared to the multiple problems of aging and to deliven: tangible, essential services NOW to all aging Americans in need of help, wherev they may be. An Early Start in Chicago In the mid-1960' s, Hull House of Chicago began exploring ways to reach out the community elderly. This role was altogether appropriate for Hull Hou with its settlement house tradition and long history of active involvement wi the problems of local neighborhood residents, young and old. A small-scale 01 reach program was initiated in the Uptown area of Chicago's north side whe census figures and personal observation indicated an extremely high concenti tion of elderly people. Many of the aged there were ill, malnourished, alone, a: barely able to make ends meet. Many were utterly confused by the myriad puh and private welfare agencies confronting them or were completely unaware th sources of help existed. It was these people that Hull House particularly want to reach and serve, by placing the highest priority on outreach into the comm nity and on rehabilitation through services and activities provided by neighbc hood senior centers. i McCarthy. Colman, "Politics and Helping the Aging," The Washington Post, July 2 1971, editorial page. 591 The tremendous and Immediate human needs revealed by this pilot program In fptown, ami the equally serious plight of the elderly in the adjoining neigh- Orhood of Lakeview, prompted Hull House social planners to begin searching If ways to expand outreach services. This search was ended With the aocept- nce by the Illinois Stale Council on Aging of 8 proposal for a demonstration roject in outreach to the elderly, submitted under provision* Of the Older jnerlcons Act. With the authorization of government funds in Murdi 1997, the ake view- Uptown Senior Citizens Project officially came into being. Bxperl- lenting with new but basically simple techniques and concepts- — mast imjxor- mtly the use of neighborhood workers — the Project staff succeeded in imple- lenting a system for effective delivery of individualized services to the aged I a neighborhood level. Readily usable written material on how to set up and sustain a program of Utreach to senior citizens is, at this point, a scarce commodity. In the following ages, members of the Lakeview-Uptown Project staff have outlined some of heir methods and experiences in the hope that these may be of use to others Igaged in the important work of helping aging Americans. THE SENIOR CENTER AND EFFECTIVE SERVICE DELIVERY . Central Resource for the Elderly The priorities of the Lakeview-Uptown Senior Citizens Project have been clear pom its inception : to reach out to the invisible neighborhood elderly and to rovide them with services to meet their needs. In approaching these objectives, lull House planners recognized that the needs of the aged are frequently multi- le, desperate, and immediate. They envisioned the establishment of a central eighborhood resource equipped to sort out the innumerable social service agen- ies that the elderly individual encounters, to act as his broker and advocate, ) interpret his needs, and to provide or arrange for the appropriate .service as uickly as possible. The multi-purpose neighborhood senior center seemed niquely suited to this task. In March 1967, two such senior centers were established, one in Lakeview nd another in Uptown. These centers provided a congenial place where older eople could casually drop in, gather to socialize, engage in recreational activity, r just get away from dreary home environments. But they were service-oriented acilities as well — bases of operation for neighborhood outreach workers and or a small professionally-trained back-up staff. L Model for Effective Service Delivery As these centers began serving the community and gaining experience, it ecame clear that a workable system for maximizing the delivery of available ervices to the elderly could be achieved on the neighborhood level. The successful unctioning of this system depended on coordination of three essential types of ervices — those of neighborhood/outreach workers, center professional personnel, nd related community agencies. By combining its own sendees and those of ther vital programs and organizatoins into an integrated whole, the center could ope wdth the multi-problem situations presented by the aging person and not nly provide him with services to meet current needs but also help him formu ate an overall plan for future years. Neighborhood Worker Services. — The senior center was the axis of the service lelivery system. From the center, neighborhood workers moved out into the ommunity, finding isolated elderly, forming friendships, regularly helping the ged with personal tasks, and referring to the center professionals those prob- ems requiring their attention. The neighborhood workers became the center's ink with the people of the community, informing local residents about center activities and services, and feeding back information about the neighborhood nto the center. Perhaps most important, they provided the tangible supportive ervices as well as the personal interest and concern which helped make it possi- ble for many homebound elderly to continue living independently. Center Professional Services. — Backing up the neighborhood workers were n-center personnel from a variety of professional disciplines — a social worker, a wblic health nurse, and a recreation worker. These staff members contributed lot only substantive knowledge and direct .services in their respective fields, but ilso know-how in dealing with the many related community organizations and urograms. They provided the center's link with outside resources from which iged clients might need assistance. A basic social casework procedure was the irofessionals' rule of thumb : establish contact with the client, develop an 592 assessment/diagnosis to identify the problem, and formulate a service interven- tion plan. A strong effort was made to maintain flexibility so that the client s needs would not be lost sight of in a rigid, institutionalized plan of action. Related Outside Resources.— A broad spectrum of outside resources was tapped by the Project's professional workers for the benefit of their elderly clients. The advocacy skills of the workers were regularly used in dealing with such agencies as the Chicago Housing Authority, local Social Security offices, and the Cool County Department of Public Aid. Ongoing relationships with nursing homes hospitals, and clinics were maintained. Perhaps most interesting and productive however was the use of two other Hull House-sponsored programs, specifically designed— like outreach— to provide tangible supportive services for disabled homebound elderly. The first program, Home Delivered Meals, 2 supplied an essen tial service for physically handicapped older people who might not otherwise have gotten the proper food or perhaps might not have eaten at all. The second the "Get Together Bus," 3 met another vital need by providing special, free trans portation for the aged. The bus was regularly used to distribute Home Deliverec Meals and also to transport elderly people to clinics, shopping, and occasionally on pleasure outings. The Lakeview-Uptown Project successfully coordinated it outreach effort with the Meals and Bus services, thereby enhancing the effect of all three programs. Consequently, it has been possible to provide an integratec and quite comprehensive service which has allowed many elderly people to r€ main in their own homes and to avoid a dreaded alternative— institutionalize 1 The successful functioning of the service delivery system is best illustrate through a case example such as that which follows : Mrs. H., a frightened, insecure elderly woman, was discovered by a neigh borhood worker who was canvassing a dilapidated building in search of olde people who might need help. Mrs. H. was living alone and had complete! lost track of her family. After several visits with the worker, Mrs. H. bega: coming to the Uptown Senior Center for recreational activities. At first sh seemed somewhat retarded, but as staff members became better acquainte with her, they realized that she had severe visual and hearing diflicultie! Mrs. H. was examined and treated at a clinic, where she was taken by neighborhood worker. Subsequently, she was admitted to a hospital for cats ract surgery, and was fitted with a pair of special glasses. A hearing ai was also secured for her. At about the same time, the Project staff provide another important service by relocating her to better housing. Although he vision and hearing were still impaired, Mrs. H. became more independen resumed her sewing, and began talking about going back to work. It was a if she had gained a new lease on life because someone cared. Eventually, t the urging of the Project social worker, Mrs. H. decided return to school she had dropped out many years earlier at age ten. She entered adult classe at the Urban Progress Center and, in six months of hard work, graduate from the eighth grade. Project staff members— "her family"— attended tt graduation and helped Mrs. H. celebrate the happy occasion. Mrs H. is planning to continue her education and has enrolled in hig school classes. She has literally blossomed and has become an accomplish^ hostess, frequentlv entertaining staff and center members in her home. SI is still not ready to handle the strains and frustrations of a job, but wit social worker guidance and support, Mrs. H. may someday achieve this goi or at least find an acceptable substitute. The Storefront Center Over the years, the Lakeview-Uptown Project has had experience with vai ous tvpes of center facilities— facilities within a community center, in a churc in a 'storefront, and within a senior citizen housing project. Staff and elder alike agree that by far the most successful has been the storefront center locate on a busy street— "where the action is!" The advantages of a storefront a: many : it 'is easily accessible to older people who may be in wheelchairs or hai 2 Originally a demonstration project, funded in part by the U.S. Public Health ' Servi and the Department of Health. Education and Welfare ; when the government grai terminated on July 31, 1968, Hull House continued the service with private funds 3 A government-funded demonstration project administered by Hull House Associatu "^^'^^"L'nfF.X^Senior Centers of Metropolitan Chicago, in testimony Chicago on November 2, 1971. before the Select Subcommittee on Education, Committee < Education and Labor, House of Representatives, U.S. Congress. 593 difficulty navigating steps; its large, street-level window is Inviting to elderly passers-by; and center participants are able to watch the busy street activity from a secure vantage point but in close enough proximity to feel a pari of the community life. The storefront is also beneficial to the out reach effort. This aspect was brought out by a neighborhod worker, who noted — The center members loved the storefront, and it was alee tor the neighbor- hood workers too. I felt very comfortable approaching i>oople on the street just outside the center, telling them about, our activities and services and then inviting them in. Hut DOW that the storefront center is no longer there, I wouldn't think of just going up to a strange person on the street like that ! The visible, accessible base of operation afforded by the storefront gave neighborhood workers the confidence and assurance to spread word about the center to local residents, although they were complete strangers, and to actively promote their involvement. The storefront center in Lakeview eventually had to be closed because of inadequate funds. If the needed financial support could be found, the Project staff would strongly favor its restoration. Senior Center Staff Facilities are important but people are more so. One of the key factors in the Lakeview-Uptown Project's successful effort has been the cooperative, team ap- proach taken by all staff members. From the outset, center personnel, profes- sional and non-professional alike, joined forces as equals working toward common goals, exhibiting a mutual respect for each individual's contribution to the effort. This situation generated a free and creative exchange of ideas which lias greatly facilitated outreach and the delivery of services. The moral support the workers gained from each other was also invaluable. All these factors contributed to the congenial atmosphere within the senior centers themselves. The Lakeview-Uptown staff has not been able to do everything the Project's planners suggested in their original proposal. Their priority has been on indi- vidual services and in-center activities have accordingly played a subordinate role. The Project might have been strengthened if funds had permitted an ex- pansion of staff, particularly the employment of a trained group worker who could have stimulated and developed more group activities for center members — a vital aspect of rehabilitation for many older people. THE ROLE OF THE NEIGHBORHOOD WORKER The Neighborhood Worker . . . "Someone Who Cares" By far the most interesting, successful and innovative aspect of the Lakeview- Uptown Project has been the use of neighborhood workers. The tangible results produced by these workers, ordinary people with little or no formal training, have astonished Hull House professionals and generated a whole new approach to the field of aging by that agency and its affiliate, Senior Centers of Metropolitan Chicago. The secret of the workers' success seems to lie in the nature and sim- plicity of the job they perform, a job which utilizes the natural neighborly im- pulses of sympathetic people to react as a friend to someone alone or in need of help. Particularly exciting has been the capacity of the neighborhood workers to fill a vacuum left by generations of professional social workers who have defaulted on service to the elderly. Social workers have traditionally treated the aging like a stepchild. 6 For a variety of reasons, they have been unwilling or unable to reach out to or meet the needs of elderly people, increasingly isolated from so- ciety by ill health, by loss of friends and loved ones, and by a youth-oriented culture which dismisses them as worthless. The effects of such isolation, so common among elderly people, are extremely severe. The isolated retreat from reality and become withdrawn. They neglect themselves, often eating little or nothing and becoming personally unkemipt. They neglect their homes and live in disorder. They lose all sense of time and direction. These people, lonely and in need, remain unreached by social agencies. Neighborhood workers have been able to fill this gap in services. In a sense, they function as an extension of the caseworker, but their role goes much further. Their unique contribution is in becoming almost a substitute family for aging people who often are homebound and utterly alone in the world. The genuine concern, moral support, and personal friendship which they offer add an entirely new dimension to the traditional social worker-client relationship. 5 Connollv, Jane F., Information Center for the Aging: Third Year Report. Welfare Coun- cil of Metropolitan Chicago, Central Services Division, May 1970, p. 31. 594 As neighborhood workers make regular visits to the homes of elderly communit residents, they personally concern themselves with the weilbeing of their client and perform a variety of essential tasks which help the older people meet th normal — but at their age arduous — demands of daily living. These visits gh the aging a new stability and direction, a chance to break out of isolation, base from which to begin relating to the outside world again. Acceptance of he! and friendship by the aged often comes slowly ; older people are frequently war of strangers or too proud to accept assistance, and they have been conditione by society to expect rejection. But, as meaningful, trusting relationships & velop, the elderly begin sharing their concerns and requesting help, reassuranc and advice. For example, A neighborhood worker making visits in a large apartment house rappc on Miss S.'s door. Although there was no reply, there was movement with! The worker identified himself and asked if he could help her in any wa: Still there was no reply, so he went away, saying he would return anotln time. He came back at least once a week, making his presence known I identifying himself. At first, Miss S. only spoke to him through a clost door ; eventually she gained enough confidence to admit him to the apai ment. Miss S. was neatly dressed and attractive although frightened ar suspicious, almost a recluse. The kind of behavior shown toward the worki was typical of her behavior toward her neighbors. Miss S. said she wi alone, ill, and worried about what would become of her. As the week visits progressed, a feeling of trust and faith was established. At this point, neighborhood workers can try to dispel the loneliness and i security about the future which haunt so many aging people. At the same tii they can regularly provide tangible supportive services. The crucial role of neighborhood workers in this Project cannot be ovc emphasized. Their mission of giving the isolated, despairing elderly a new lea on life is the essence of outreach. Recruitment of Neighborhood Workers Outreach work with the aging requires a sensitivity to human problems, sympathetic ear, an ability to communicate concern, a capacity to accept peoj with all their faults, and an ability to maintain perspective. Compassionate pe pie in all walks of life possess these characteristics. In Lakeview and Uptow a housewife, a factory worker, a teacher, a small businessman, a skilled machi operator, and a domestic all became successful neighborhood workers. The people had in common an inner strength which enabled them to cope with lif< experiences and command their own lives. All had had positive experiences wi neighborly people. All had a desire to be of service, particularly to the less f( tunate, and a genuine liking for elderly people. Finally, all were in good heah This last characteristic has proved essential for outreach work because the dai routine is quite demanding, both physically and emotionally; it involves r only much walking and stair climbing, but also frequent exposure to discoun ing situations and serious problems. The Lakeview-Uptown Project has had notable success in recruting and util ing older people from the local communities as neighborhood workers. As eldei adults themselves, these individuals shared with their clients a peer-group stat which helped establish rapport. As neighborhood residents, they were famili with local shops, community organizations, housing problems, and so on. A as people with little or no professional training they were able to deal as equi and as friends with those they were trying to serve. No one source provided all of this Project's neighborhood workers. Some ha been referred to Hull House by community residents and employment agenci< others have responded to newspaper advertisements; still others have be recruited from senior center memberships. All candidates have been persona interviewed and selected by the Project Director. Four part-time neighborhood workers were authorized by the grant for t Lakeview-Uptown Project, but Hull House participation in the U.S. Departmc of Labor's Senior Aide Program has enabled the staff to increase its neighb hood worker component to six people. In addition, the number of workers I periodically been sweUed by VISTA and other volunteers. Elderly neighborhc workers and Senior Aides generally work about 15 to 20 hours per week a carry an average weekly case load of twelve clients. Preparation of Workers for the Job The process of preparing a new neighborhood worker for the job is a higil informal and individualized one. The elderly workers in Lakeview and Upta 595 ive brought to the Job different backgrounds, personalities, and capabilitiei ;)oii which to build. They have generally been people with Insight, a friendly inner, and an ability to competently manage daily affairs. But the] have often ten somewhat hesitant to take on now social roios in the retirement years. Self- (nfldence has been carefully Instilled and reinforced through a personal relation- dp with the Project Director and ongoing informal consultation with the re- iBurance from other staff members. Through this process, the neighborhood orkers have developed a definite recognition that their special expertise in Hiiniunicating with and serving the people of the community is a unique and isential feature of the outreach effort, that their contribution is as vital as tat of the professional worker. Prepa ration for the job has, in fact, been more an emotional orientation on a le-to-one basis than a formal training procedure. Basic information has been wvided gradually so as not to overwhelm the new worker. Little by little, he or le learns the important aspects of public aid and acquires needed information >out agencies such as the local housing authority from professional staff embers. For the most part, problem situations are dealt with as they arise. r hen feasible, a new worker is given an opportunity to accompany a more ex- jrienced colleague on home visits, a kind of on-the-job training. Soon after, ie newcomer is ready to strike out alone, but always with the knowledge and ssurance that the professional staff is there to help and provide support — that iere will always be someone to come to. One of the most interesting aspects of this whole process is that the learning [perience has been reciprocal. The professional workers have learned at least as uch from the neighborhood workers as the latter have learned from the pro- ssionals. he Basic Duties of a Neighborhood Worker Finding the Elderly. — The duties and responsibilities of the neighborhood orker cover a broad range of basic tasks and human services, all of which are aportant. In the initial stages of this Project, the immediate necessity was for orkers to begin locating the elderly who were out there somewhere and in *ed of help. This search was carried out in a variety of ways, including direct ►ntact with older people in the streets, stores, libraries, laundromats, and irsing homes of the neighborhoods. Door-to-door canvasses were conducted, and olated elderly were discovered as neighborhood workers talked with landladies, jartment and rooming house managers, tenants and neighbors. Information x>ut the Project's services was given to the public media, to local shops, and > community organizations and churches. The Project's connection with Hull ouse, long recognized as an agency genuinely dedicated to helping people, nought a positive response from the community. As news of the outreach effort >read, other social welfare agencies began making referrals to the Project aff. The job of finding the invisible elderly was a difficult one which entailed tremendous amount of aggressive spade work, and it is still going on. Workers mtinue to find isolated older adults, desperately in need of help but unreached I and even unaware of existing services. Actual cases, related in the words of neighborhood workers themselves, pro- de the most vivid descriptions of how the invisible elderly have been located lid their needs identified : I saw Mrs. H. on the street carrying a heavy shopping bag. Introducing myself as Mrs. A. from Hull House Uptown Center, I offered to help her and walked her to her apartment on the second floor of an ugly, poorly kept building. The stairs were dirty with worn carpeting; the hall was unlit, and the railing pulled out from the wall. Mrs. H.'s two-room apartment was clean but dark, being lit only by single bulbs on the ceiling. Mrs. H. invited me in. She is a pretty woman, 83 years old, who has been a widow for ten years. She walks with a cane. She thanked me for helping her, saying she often feels dizzy on the street, especially when she has to manage both her cane and a shopping bag. She seemed anxious to have a friend and someone to call on her. I told her if she would like, I would be able to stop by next Tuesday morning and we could talk about it then. Providing Tangible Services. — Finding an older person and identifying his pedis are of little significance unless services can be provided to meet those needs. gain, at this ooint, the neighborhood workers play a crucial role. They perform >me of the most important services themselves. Through "friendly visits" they >mmunicate their concern for the person and establish themselves as friends — 596 "someone who cares." On this basis they are able to offer companionship and moral support, and to ask if there are tangible services they can perform such as shopping for groceries, cashing social security checks, writing letters and filling out applications for assistance, picking up medication, taking someone to a clinic — generally doing anything that needs to be done. For instance, One of the neighborhood workers in the Lakeview area is able, through friendly visiting and related services, to help a partially blind woman, Mrs, M., remain in the apartment in which she has lived for twenty years. Th€ worker's services include weekly shopping, reading and writing letters. The most interesting service, however, is the worker's assistance in organizing Mrs. M.'s pantry. Since Mrs. M. can recognize bright colors, a code has beer worked out so that contents of canned goods can be identified. Canned fruits for example, have a red label, and are placed in .certain positions on the shelves. This enables Mrs. M. to plan a balanced diet. Concern about the whole person is a vital aspect of outreach, and neighborhood workers are visible symbols of this concern, needed particularly by the lonely isolated aging. To these people, especially the physically disabled, the outreacl services are often the determining factor in avoiding nursing home confinement Telephone Reassurance.— Another service handled by the neighborhood work ers themselves involves weekly telephone reassurance calls to incapacitated old sters. During one particularly bad winter when many of the Project's elderlj clients and senior center members were ill or did not venture out because of th< severe weather, the telephone service was expanded. Neighborhood worken spearheaded the program, but seniors were also encouraged to regularly cal each other. In this way, the staff was able to dispel some of the loneliness result ing from the seniors' confinement indoors andl to discover if they were getting thi things they needed. The program worked out quite well and continues for lonely homebound elderly people with limited social contact who appreciate occasiona telephone conversations with a friend. Information and Referral.— The needs of many older adults, however, are no so easily met. Their problems are all too often multiple and desperate, most fre quently concerning health and finances. Also common are housing difficulties inaccessibility of suitable transportation, and exploitation by local merchant and landlords. The low-income elderly are usually unaware of existing commi nity resources which can help alleviate their problems. Here again, the neighboi hood worker plays a vital role, making sure that the aged person knows wha services are available and how to obtain benefits. If a case needs the attentio of a health or social worker, it is the worker's responsibility to refer it to tn center's professional staff. The Neighborhood Worker and the Professional Worker Health, recreational and social services have been an integral part of th Lakeview-Uptown Project and its senior centers from the beginning. Althoug the professionally-trained staff has at times been shorthanded, it has continue to provide services not available elsewhere in the community and to supply coi stant support for the neighborhood workers. Close cooperation between the latte and the professionals has been essential for the success of the outreach pr< gram With experience, the neighborhood workers have gained an understands of what kinds of problems they themselves should handle and what should in mediately be referred to their professional colleagues. Informal conferences o individual cases are held frequently so that neighborhood workers have continui guidance in handling their client's difficulties. The professionals provide the e: pertise in identifying particular health and welfare problems which can t remedied, while the neighborhood workers supply vital information about tt community and a unique insight into short and long-term needs of the indiyidui elderly with whom they are personally in touch. Working together, freely e: changing ideas, the staff members devise a comprehensive plan for each client The Neighborhood Worker as Enabler and Advocate.— In utilizing profession! back-up services in specific cases, neighborhood workers act as a bridge betwee the professional worker or community agency and the client. They may refer case to a Project staff member or ask the professional to accompany them on visit to a particular older person's home. The workers may provide moral .wM port for clients by escorting them to the center for counselling or to a referrc agency such as the local housing authority. They may even play the advocate ro for clients in their dealings with landlords, nursing home licensing authority 597 he Department of Public Aid and so on. If the staff arranges for medical treat- lent or admission to an extended care facility, the neighborhood workers and he professionals follow up the case, visiting the convalescent and working to- ether to see that the client- s needs are being met. When a client can no longer live independently and nursing home or .sheltered arc placement is the only solution, contact is still maintained through visits, n he home or care facility is still in the neighborhood, the patient is called for and aken to center activities, thus keeping a link with the outside world. Every ef- ort is made to help him feel that he still has a friend 1 and that he is not a for- otten member of society. The case below, related in the words of the neighborhood worker involved, lustrates well the working relationship between the professional and the neigh- orhood worker: It was a cold day with near zero temperatures and 40 mile-an-hour winds. I was on my way to visit a client when I saw a frail elderly woman waiting to cross the street. A strong gust of wind suddenly knocked her down and her head struck the curb. I went to her assistance and found that her head was bleeding. Several other people had gathered so I asked one of them to stay with the woman while I went into a store to call my supervisor. She advised me to call the police ambulance and to accompany the woman, who was very shaken, to the hospital. I did) this and stayed with the woman dur- ing emergency treatment and the taking of x-rays. I again called my super- visor and she suggested that I ask the patient if she had a relative or friend whom she would like notified. I then phoned the 80-year-old sister with whom the patient lives (she herself being 84) and I waited until the sister arrived. Before leaving, I again called my supervisor to bring her up to date on the case. I now visit the two sisters in their home, doing shopping and other errands for them. Because of their advanced age, they may eventually need addi- tional services which I will be able to provide. he Outreach Goal . . . Rehabilitation and/or Maintenance In all outreach cases, the objective is to rehabilitate the aging person or at »ast to enable him to maintain an independent status as long as possible. For lany homebound, disabled people, avoidance of institutionalization is the ulti- late goal and outreach services are a solution, with arrangements for neigh- orhood worker services, home delivered meals, and special transportation to linics via the "Get Together Bus." If these aging people can simply remain in be community in their own homes, their highest hopes will have been realized. Vhen this is no longer possible, the best available institutional care is arranged. For other older people, the goal may be the regaining of a sense of security irough the maximizing of financial resources. In a few cases, this may culminate i part-time employment, but, more frequently, the security will be achieved trough application for public assistance, social security, or pension benefits to rtrich the client is entitled. For still other elderly adults, rehabilitation may be primarily an emotional nd a social experience. It may begin with the slow development of a trusting elationship with a neighborhood worker, progress to the regaining of self- onfidence, and eventually to active participation in center or perhaps even ommunity activities. A poignant example of this last type of rehabilitation and the central role layed by the neighborhood worker is revealed in the following account : In January 1968, a neighborhood worker found Miss S. during a canvass of a community rooming house. Miss S. is single and 65 years old. She has no use of her right arm and wears a brace on her right leg as a result of a paralytic stroke. She lives on the third floor and has little communication with the outside world since she cannot afford a phone and the buzzer sys- tem of the house phone does not work. Miss S. was very lonely and asked the neighborhood worker, a man, for a "female visitor." This was arranged and after several visits, Miss S. came to the center to discuss some of her prob- lems with the social worker. She stayed to visit with the members pres- ent. We have helped her file applications for public housing for the elderly and for food stamps. Miss S. has since joined the cards and games activity group, and she was recently observed making a collage with her left hand in an arts and crafts session. Outreach Work is Therapeutic In a very special way, some of the neighborhood workers themselves may b the Project's best example of successful rehabilitation through outreach. B; participating in the program, elderly workers have broadened their social cor tacts and fulfilled their personal need to continue helping others. Their salarie also have given them an increased sense of independence. These therapeutt benefits are illustrated in the case of a widower, 66 years old, who joined th staff in March 1969. He noted, I like this job. Before I began working, I kept to myself so much I wa forgetting how to talk. This job is good for me because it makes me get ou and meet people. Now I'm learning how to converse again. In his capacity as neighborhood worker, this man was exposed to conditior he never knew existed among the very poor. He developed not only a sensitivit to the problems of others, but also an earnest desire to help alleviate them. . man of action, he succeeded in getting an entire apartment building cleanej painted and fumigated, thereby improving the living conditions of many elder] residents. Problems Neighborhood Workers May Encounter Exploitation.- In the course of their daily rounds, neighborhood workers ei counter a number of difficulties. Their relationships with elderly clients do m always develop harmoniously. Occasionally, older people who are physically ab, to care for their own needs to take advantage of a worker's willingness to hel] making unreasonable demands or treating the worker like a servant. Worke: must be prepared for potential difficulties of this kind and are cautioned again letting themselves be exploited. Allowing such situations to continue is unfa to workers and does not serve the purpose of outreach— to rehabilitate tl elderly and help them help themselves. The professional can be very supportive in this situation. He can clarify mar issues such as why the visit is being made, what tasks should or should not 1 done by the worker, how much time can be spent with the client, and so on. Th provides the worker with a frame of reference and also lets the clients kno what he can expect. , ' . ^ Overinvolvement.— Another danger for neighborhood workers lies in ove involvement. Particularly at first, a worker may become too deeply and pe sonallv entangled in an older person's problems. Loss of prospective and objectivi often follows, hampering the worker's effectiveness and preventing the ldentinc tion of specific needs which can be met. Overwhelming Situations.— In still other instances, workers may becon overwhelmed by the sheer number and extent of the problems they find ; tin may feel at a loss as to how to proceed. In such cases, they must realize that the professional colleagues, who are trained to deal with complex situations, ct shoulder the burden of finding solutions. In addition, the professionals must ma the neighborhood workers aware of the fact that not all problems can 1 solved ; this is sometimes a very difficult idea to accept. The value of alwa; having a professional worker available to talk over such situations as thi arise is clear. Regularly scheduled staff meetings and individual conferences a also useful in putting ail of these problems into perspective. A Day with a Neighborhood Worker A glance at the typical day of a neighborhood worker may be useful at tli point. Our worker— we will call here Mrs. C.— begins the morning by telephonn the people she regularly sees on that day to make sure that they want her drop by as usual. This reminds her elderly friends about the visit, in ca they may have absent-mindedly forgotten, and gives the worker a chance to off to do errands on the way. Mrs. C. also calls and schedules an afternoon appon ment with an elderly woman whom a local grocer has noticed in his store and wl he is sure, is nearly blind and in need of help. The grocer knows of Mrs. C. a: her work because she often shops in his store for her elderly clients. Mrs. C.'s first visit is with Miss M. who is 85 years old and confined to a whe chair. Mrs. C. stops en route to buy a few supplies for her at the drugstore. Mi M. cheerfuliv welcomes our worker and they chat for a while. Mrs. 0. inqmi about how the home-delivered m^als are working out and is assured that t arrangement is very satisfactory. Then Mrs. 0. takes Miss M. for their accustom short outing. 599 Next, on 1km- schedule is a "friendly visit" with Mrs. B., ;i 65-year-old widow ho, because of a aearl condition, gets onl very Little and simply Likes to fe Mrs. 0. come so thai she can chal with a friend, serve her coffee, and dross > for an occasion. On this particular day. Mrs. s. has no errands she needs to ■re done; as always, Bhe comments on how much Bhe Looks forward to the sits. Sho tolls Mrs. 0., "Yon'iv (lie only ono I can always count on." Mrs. 0. next ops in briefly to check on Mr. R., who is bedridden, and his elderly wife who ires for him. She brings them a few needed groceries and asks if there is iy thing Mr. R. needs to make him more comfortable. During the visit, Mrs. R. entions an elderly neighbor who needs help in finding less expensive housing, rs. C. agrees to call the man and offer help. After lunch at the senior center, Mrs. 0. walks to the home of Miss L., the [>man referred to her hy the grocer. She finds that Miss L. is existing in near olation in a tiny third floor walk-up apartment, located in a shahhy, neglected lilding. Miss L. seems quite confused and disoriented; she cannot rememher hen she last had a visitor. After talking with Miss L. a few minutes and dis- issing her physical and financial trouhles, Mrs. C. learns that Miss L., who 70 years old, thinks she has cataracts in both eyes. She has difficulty doing r en the simplest chores because of her poor vision ; but she has no money to •nsult a doctor. Mrs. C. promises to have the staff health worker see about an :amination for Miss L. at the eye clinic. The woman also is unaware that she eligible for Old Age Assistance, and our neighborhood worker offers to help ir apply for these benefits. As Mrs. C. is about to leave, the woman thanks her ofusely and politely asks her to please come again, "just to visit." Mrs. C. as- res her she will come next week and asks if she can run any errands or do ly shopping for Miss L. today. Mrs. C. also resolves that during the second visit. e will offer to help clean up the apartment a little ; Miss L. cannot see to clean operly and is especially distressed about the condition of the kitchen. Mrs. C. spent the next half hour visiting residents of a nearby nursing home ; me are people she has seen before and some are new acquaintances. They all press appreciation for her visit and for the magazines she has brought, and they ik her to come again. Several mention a desire to attend functions at the senior nter if the "Get Together Bus" can pick them up. Mrs. C. spent the next half hour visiting residents of a nearby nursing home ; ty's experiences and talks briefly with the health and social workers about iss L. whose medical and financial problems need professional attention, len she calls the man whom Mrs. R. had mentioned was in need of housing ; rs. C. makes an appointment to see him the following day. itreach Work Is Creative The Project staff and Hull House have learned a great deal from the neighbor- ed worker program. First, they have become convinced of the employability older people and have joined the growing ranks of those demanding that job portunities be made available to the many elderly who want to continue using eir skills and talents in paid or volunteer capacities after retirement. America nnot afford to let this rich resource remain untapped ! Second, neighborhood workers have produced important changes within Hull ouse itself. In 1968, Senior Centers of Metropolitan Chicago (SCMC), an or- nization exclusively serving the elderly, entered into an affiliation with Hull [)use. The Lakeview-Uptown Project became part of SCMC. gaining an ad- >cate and enhanced status within Hull House. Although SCMC support was an iportant factor in the Project's success, a more interesting development has en the part that neighborhood workers have played in affecting SCMC. The f)rkers' impressive efforts have strongly influenced the thinking of the Board Directors of SCMC which is now fully committed to the outreach approach r all Hull House senior citizens' programs in Chicago. CONCLUSION : AN ALTERNATIVE TO INSTITUTIONALIZATION The staff of the Lakeview-Uptown Senior Citizens Project considers the suc- ssful development of the role of the neighborhood worker its most creative id useful contribution to the field of qging. With advancing years, many people gin to harbor fears that they will eventually be "put away" when they n no longer care for their own needs. This is a particularly strong fear among ose Americans with meager financial resources and few family ties. Most sople want, above all else, to live out their lives independently in their own 600 homes and communities. Outreach through neighborhood workers can make this hope a reality for many by providing an alternative to institutionalization. The value' of and need for such an alternative are increasingly evident Nursing home care is frequently unavailable or exorbitantly expensive. Evei worse, patients in many care facilities are exploited and brutalized by staf members. Neighborhood worker and related outreach services provide a strik ing contrast. They are inexpensive, individualized, and humane. They facilitati independent living. They provide social contact— a link with the rest of society- instead of limiting the world of the elderly person to the often stifling halls o a nursing home and the company of other sick and aged people. In another veir outreach also is a vehicle enabling more fortunate older people, those who be come neighborhood workers themselves, to develop new social roles afte reti rement With life expectancy increasing and the elderly population growing rapidlj the development of new ways to meet the needs of the aging is absolutel; essential. Outreach to the elderly through neighborhood workers is an ide whose time has come. Its simplicity makes it a technique adaptable to almos any kind of community, even one with very limited resources. Although th Lakeviow-Uptown Project has primarily utilized paid workers and older adults outreach work can be carried out just as successfully by volunteers and youn people under the proper professional supervision. No age or economic group has monopoly on friendliness or the capacity to help people in trouble. The relatively small amount of money required to initiate and sustain tni sort of operation is, indeed, a wise investment. It is an investment which wl begin to indicate its worth almost immediately and will continue to provic. dividends for many years to come. Congress of the United States, House of Representatives, Washington, B.C., July 15, 1911. Hon. John Brademas, Chairman, Select Subcommittee on Education, House Education and Labor Committee. Dear John : You will please find herewith 29 letters I have received in respons to a mailing I sent to delegates to the White House Conference on Aging 1 inform them of the nutrition bill for the elderly, H.R. 5017. Several state deleg tions have indicated they are urging consideration of this legislation at tr conference to be held in Washington in November. 1 You would favor me very much by inserting these letters into the file c the nutrition program. Kindest regards, and Believe me, Always sincerely, CLiuDE Peppek, Member of Congress. Enclosures. Commonwealth of Virginia, Office of the Governor, Division of State Planning and Community Affairs, Richmond, Va., April 15, 1971. Hon. Claude Pepper, Member of Congress, Washington, D.C. Dear Congressman Pepper : Thank you for your recent letter and copy of tl bill proposing a Nutrition Program for the Elderly. Our State Committee w: be meeting during the first week in June and your bill will be presented to the for consideration. . . . . .. You may be interested to learn that we have been gaining experiences in tfl area of service for older people, through projects funded under the Older Amei cans Act. We presently have two Meals-on-Wheels programs in operation. (J Richmond project is in its fourth year and funding has been taken over by t] community. Our Roanoke project is in its second year, and we believe it w be accepted for community funding at the end of its third year. Both projec 601 live made excellent progress and are providing this much needed service to he elderly in their communities. Two additional projects of this type are planned and will probably begin operations during this quarter. One will serve Portsmouth and the other an idjacent tri-county area. Both will be based on an existing Food Service facility Eerated by an O.E.O. project. During lik>9, our Program staff developed an application for a more compre- lensive project to serve the older citizens in the Model Cities area of Norfolk. his project would have utilized existing school lunch facilities, and would have tffered cafeteria service as well as home delivered meals. Unfortunately, it was lever funded. Experience gained in these projects should be most helpful in planning and idministering a program such as you propose. Sincerely, Charles H. Graves, Director. International Brotherhood of Painters and Allied Traders, Washington, D.C., March 26, 1971. Ion. Claude Pepper, U.S. House of Representatives, Washington, D.C. Dear Congressman Pepper : Thank you for sending a copy of H.R. 5017 which rou recently re-introduced in the 92nd Congress. I have given this material to our Director of Legislation, John J. Pecoraro, vho is a member of the Task Force and, incidentally, is assigned to the Commit- «e on Nutrition. You may be certain that he will do all that he can to assure favorable con- sideration of this legislation in his task force discussions and will keep you nformed as to progress. With our sincere wish for early enactment of this most worthy legislation. Sincerely, S. Frank Raftery, General President. Department of Social and Health Services, Olympia, Wash., April 14, 1971. Ion. Claude Pepper, Congress of the United States, louse of Representatives, Washington, D.C. Dear Mr. Pepper: The State White House Conference Task Force on Health ind Nutrition has met frequently during the past six months. The members have istened carefully to the voices of older citizens in over thirty area meetings. Nutrition has been a high priority item. The proposals that have evolved encom- pass measures for improving the nutritional status of older persons but have not specified a particular program to meet these needs. The proposals are now under- going a final revision for presentation to the State White House Conference on May 3. The actions taken there will designate those proposals that will be sub- nitted as this state's recommendations for a national policy on aging. Although the proposed program under H.R. 5017 may not be mentioned specific- illy in our proposals, I am quite sure it will be among proposals received from ;he 55 other states and territories participating in the Conference. Sincerely, Sidney E. Smith, Secretary. State of Oregon, Office of the Governor, Salem, Oreg., April 2, 1971. 3on. Claude Pepper, louse of Representatives, Washington, D.C. Dear Representative Pepper: Thank you for your letter of March 22, 1971 •eferring to your bill, H.R. 5017 — "A Nutrition Program for the Elderly," which rou have reintroduced in the 92nd session of the Congress as an amendment to fhe Older Americans Act of 1965 creating Title VII. 602 Here in Oregon the nutritional needs of the elderly have been of concern fr< the very outset of our state-wide White House Conference activity. We noted tt nutritional needs came into discussions of health, housing, income and transpori tion during our 92 Community Forums held during September, 1970. Current Task Force hearings are taking place here in Salem during April on a m( formally structured basis with testimony from professionals and some senio These hearings are designed not only for policy formulations and recommen< tions feeding into the State White House Conference on May 10 but also for t benefit of our Legislators now in session. I am certain, Representative Pepper, that we will find specific coverage of 1 nutritional needs of the elderly coming out of our State White House Conferen scheduled for May 10, 1971 here in Salem. Thank you again for writing to me and sharing your concern relative to t basic need of older Americans. Sincerely, Robert G. Davis, Executive Assistant to the Governor Public Welfare Board of North Dakota, Aging Services, Bismarck, N. Dak., April 23, 1971 Hon. Claude Pepper, Representative in Congress, Washington, D.C. Dear Mr. Pepper : Your communication regarding H.R. 5017 has been refer to Miss Joan Tracy, Nutritionist for the North Dakota State Health Departm* Miss Tracy who is Chairman of the Task Force on Nutrition, will incli information about this Nutrition Program for the Elderly in her report to delegates to the North Dakota Conference on Aging May 6-7. You may be interested to know that we have in Mandan, North Dakota a mc program that provides a balanced noon meal five days a week in a Senior Ceil that is attached to a low-income housing development. Surplus foods are us The meal costs 50 cents. From six to eight meals are delivered to homebound < sters. We consider this to be a successful effort. A hospital based home delivered meals project in Grand Forks seems, at 1 point, to be too costly and will probably be discontinued. No surplus foods being used in this program. The cost per meal is $1.25 to the recipient. We will follow with interest the progress of your bill. Sincerely yours, Leslie O Ovre, Executive Director State of New York, Executive Department, Office for the Aging, Albany, N.Y., March 29, 197. Hon. Claude Pepper, Member of Congress, House of Representatives, Washington, D.C. Dear Congressman Pepper : Thank you for your letter of March 22, in wt you enclosed "A Nutrition Program for the Elderly," H.R. 5017, which you h reintroduced in the 92nd session of the Congress. I am pleased to learn that 117 of your colleagues in the House of Represei tives have joined in the sponsorship of the above legislation and that Sens Edward M. Kennedy has introduced a companion bill in the Senate, S. 1163, v 18 cosponsors. My I assure you that I will do everything possible to include discussions nutrition in the task forces which are meeting in New York State prior to 1971 White House Conference on Aging, and I will be happy to inform yoi any poMcies or recommendations that are developed in the ten regional meeti which are projected pertaining to nutrition. Thanking you for your interest and with kind greetings, I remain Sincerely, _, . Marcelle G. Levy, Dxrecto 603 State of Nebraska, Advisory Committee on af the neighborhood health centers, community centers, lum-hes, and schools as a silo for inoal functions and the sorvioe of nut rilionally jfiequate low cost meals for the aging should ho further encouraged. Restaurants, n some communil les, might also serve as the center. The Importance of sociability nd psychological effect of meal time cannot ho over emphasized. DIRECT SERVICES Future health care Legislation should stipulate diet counseling services by ietitians, and public health nutritionists as an eligible service for third party ay merits. In the meantime with the extension of home care services into the omo, the dietitian can contribute substantially to the education in nutrition, [>od purchasing and preparation of the health aides or homemaker aides who urnish direct services to the home bound elderly. SERVICES AND VOLUNTEERS Because of limitations that come with the aging processes, multiples of assist- nces are needed by the elderly. There generally is no money for such services, so icreased use of volunteers has been the answer in some cases. This is not a satis- ictory answer to the needs of the aging. Since our main interest is food for the ging we pose the questions : What can be done to provide for the home bound Iderly — the individual who is not able to leave his home because of physical mitations and is thus cut off from the outside world? What can be offered to the ?asonably well elderly person who has no 1 transportation? Stores are not always ?adily accessible and if they are, can the elderly walk that far, not considering etting the groceries back to his room, apartment, or home? A free food delivery (rvice would be a tremendous contribution to thousands of elderly persons who ish to retain some independence. Special taxi or bus schedules and special store ours to permit elderly to do their own shopping also would be of assistance. More volunteer groups might assist the elderly. Students from community col- ges could be encouraged to organize services to provide for delivery of food to le homes of the elderly. Church groups, senior citizen groups, men and women's srvice clubs, other organizations and voluntary agencies might also help to over- )me the difficulties of getting food into the homes of the aging and give assist- ive in preparation. The same groups might visit with the elderly since psycho- >gical and social needs are important and contribute to a sense of well being. ADDITIONAL IDEAS I should like to share several ideas from individuals who are convinced that le elderly helping the elderly has great merit. We know of "telephone chains" 'here members call other members regularly. If there are emergencies, or help ; needed, someone knows. Bringing two or more persons together at mealtime furnishes an environmental tmosphere conducive to good eating and helps morale whether it be in a home, partment, hospital, or extended care facility. Extension of foster homes and boarding homes for the elderly might also be icouraged and subsidized, if needed. A program "Aid to Dependent Elderly" light be established. The additional funds would assist substantially in providing ?rvices to the elderly which are important to health. In addition to encouraging and making home delivered meals more readily mailable, the Association would encourage further extension of meal preparation mters designed for group feeding where the elderly might go. In the planning f facilities for housing for the aging, we would encourage the planners to con- fer the advantages of certain food and dining arrangements. Because of the thousands of Association members who serve as consultants and art time dietitians in nursing and retirement homes and in institutions and hos- itals providing long term care to the aging, we would recommend continual sur- ging and evaluation of the food service and feeding practices as to their nutri- onal adequacy. CONCLUSIONS In conclusion I would reiterate the Association's position that nutrition care be component of all health care and that it should be available to the elderly on a mtinuing and coordinated bases. It is recognized that improvements in nutri- 606 tion have direct effects on the level of health and the resulting need for health services. The Association would further encourage providing adequate funding for pre- ventive, as well as curative nutritional care services. Until such time as the nation is geared to deliver comprehensive health care, there is a need to support nutri- tion services in existing and new specialized programs and services to the elderly. In support of these comments I have attached supporting papers. These are : Policy Statement of The American Dietetic Association "Promoting Optimal Nutritional Health of the Population in the United States JADA Vol. 55, No. 5, Nov. 1969. The American Dietetic Association Position Paper on Nutrition and Aging JADA, Vol. 57, No. 5, Nov. 1970. Nutrition for Older Americans — Jeanette Pelcovits. JADA, Vol. 58, No. 1, Jan. 1971. Physiologic Aspects of Aging— Nathan W. Shock, M.D. JADA, Vol. 56, No. 6, June 1970. The American* Dietetic Association, Chicago, III., March SI, 1971. Hon. Claude Pepper, House of Representatives, Congress of the United States, Washington, D.C. Dear Mr. Pepper : Thank you for your recent letter and for the enclosure of th< bill concerning the nutrition program for the elderly. I have reviewed it witl The task force which I will work on does not meet until May. I will he glac to let you know the reactions of the task force at that time. As an individual, I can assure you that I am very much interested in nutntioi programs for the elderly, and so I appreciate your concern. Sincerely, . „, _ Marjorie M. Donnelly, (Mrs.) Marjorie M. Donnelly, R.D., President. State of Illinois, Department op Public Aid, Springfield, III., April 1, 1971. Hon. Claude Pepper, Member of Congress, Congress of the United States, Home of Bepresentatwa Washington, D.C- Dear Congressman Pepper : The Section on Aging of the Department of Put lie Aid has been requested by Director Swank to acknowledge and thank you fo your letter of March 22, 1971, regarding H.R. 5017. In only a few instances, covering a relatively small number of elderly pei sons who need "meals on wheels" or other arrangements for providing goo nutrition has it been possible to provide this service in Illinois. In some few cast this has been done with the help of Title III or Title IV funds (Older Americar Act) and in fewer cases by action of purely local groups. We agree that in the absence of a strong Federal program and ample Feden funds to provide this service, it will be a long time, if ever, before the nutritions needs of senior citizens can be met. ■_.; \_ i This is a matter which has concerned our planners for the White House Coi ference in November. . .^ . , We will certainly see to it that all concerned shall be informed of the mtei and content of H.R. 5017. We hope the question it raises may be included in tt program of the White House Conference. Thank you for your continuing concern for the welfare of older people. Sincerely, .< _ __ _ Henry L. McCarthy, Special Assistant, Office of the Director. 807 State op Connecticut, Department <>n A.oing, Hartford, Conn., March 30, 1971. Congressman Claude Pester, House of Representatives, Washington, D.C. Dear Congressman Pepper : I was delighted to receive your letter of March 22 uith enclosure of U.K. f>017 "A Nutrition Program for the Elderly". I know of lour Interest in the provision of food for our elderly. It is a tremendously im- portant program and I recollect your previous letter to me dated July 30, 1970 regarding H.R. 17763, to establish a new Title VII under the Older Americans let. I will refer your letter and enclosure to our Technical Committee on Nutrition for the White House Conference on Aging. Thank you so much for thinking of us. Sincerely yours, Sholom Bloom. State Commission on Aging, Atlanta, Ga., May 7, 1971. Jon. Claude Pepper, If ember of Congress, Jo use of Representatives, Washington, D.C. Dear Congressman Pepper : I have read HR 5017 which proposes a Nutrition J rogram for the Elderly and find it most commendable. I have forwarded it to he Task Force on Nutrition of the Georgia White House Conference on Aging is per your suggestion. The food program under the Departments of Agriculture intertwined with Welfare leave much to be desired in the service delivery area. It is a great ravesty on our American system that such imaginative, humane and thought- ully prepared legislation fails to meet expectations when it finally appears ►n the local scene. It is believed that a U.S. Department of Elderly Affairs to serve as a rallying ►oint for older people, to provide them with care services and the opportunity o improve their own well-being would be a great improvement. Many thanks for sending this to me. Sincerely, Harold B. Parker, Executive Director. Enclosure. [From the Congressional Record] House of Representatives NUTRITION PROGRAM FOR THE ELDERLY Mr. Pepper. Mr. Speaker, H.R. 5017 of the 92d Congress is the bill H.R. 17763, D provide a nutrition program for the elderly, which I reintroduced on Thurs- ay, February 25, 1971, with the support of 111 of my colleagues, both Democrats nd Republicans. I urge your consideration for the acute need for a national ohcy aimed at providing the elderly with low-cost, nutritionally sound meals >rved in strategically located centers such as community centers, senior citizens enters, schools, and Other public or private nonprofit institutions suited to such se. The program directs itself to the promotion of both the physical and iental_ health of the elderly through provisions of balanced meals, education l nutrition, as well as opportunity for social contact to end the isolation of old ge and the encouragement of greater physical and mental activities. I wish to remind my colleagues that on May 28 of last year I honored Senior ltizens Month with the introduction of H.R. 17763. This bill received recognition iroughout the country by all those familiar with the problems of our senior tizens as providing a sound approach to the needs of the elderly. 608 The legislation utilizes Federal, State, and local funds on a matching basi together with surplus commodity programs for the provision of at least one he meal per day at a reasonably low price to the participant. Typical of the enthusiastic response to the introduction of this bill is th statement of the Honorable William R. Hutton, executive director, Nations Council of Senior Citizens, during hearings on the bill, to the Select Subcon mittee on Education of the Committee on Education and Labor, Mr. Huttoi testifying on behalf of the 2.500,000 members of the Council said : "The National Council membership welcomes this legislation and urges i\ early enactment. We trust that the administration will support H.R. 17763 whic is designed to carry out a major recommendation of the Panel on Aging of tt White House Conference on Food, Nutrition and Health held in Washingto last December "The very first recommendation of the Panel on Aging of the White Hous Conference on Nutrition calls for legislation contemplated under H.R. 17763. I commend the report of these hearings to the attention of my colleagues ar call particular attention to the testimony of the Honorable John B. Marti Commissioner, Administration on Aging, the Administration's spokesman. Tl Administration admitted the need for better nutrition among the elderly ar supported the purposes of the bill. However, the Administration put fori the notion that it is time to cease categorical grant programs. Even though t] elderly would suffer, they must wait until a nutrition program could be pr vided for in a total social services scheme that, at some future time, may be a cepted and implemented at the Federal level. Moreover, the entire program mu then be accepted and implemented, in whole or in part, in the 50 States and to- i*T*n ^1* 1"f*rritoriGS I question wliat would have been the fate of social security had this legisl tion been left up to the States? Would experience lead us today to abandon o- national social security system and make the benefits dependent upon the a tion of the individual States? How long can the elderly wait while the admin: tration ponders broad concepts of total social service legislation proposing take care of health and welfare needs from the cradle to the grave? My bill won make it possible to stretch the social security dollar in the purchase of nutntio hot meals and I believe we need this legislation on a national scale to suppleme our national social security benefits. Furthermore many of mv constituents in Dade County, Fla., would, I kno be handicapped by the vast social and all-encompassing social services approac I am sincerely convinced this group of citizens in Miami, New York, Los Angel Chicago, and the elderly in other urban and rural areas across the Nation woi not be able to cope with the obstacle race that would be created in such a co plex HEW structure simply to be able to participate in a hot meal program or a day in a social setting with their friends. The administration spokesman also proposed there may be a need tor m< testing I submit the categorical grant concept provides for continuous evaii tion and improvement of the nutrition program and with the knowledge and < perience already available from the research and development grants under Older Americans Act. I question the necessity for delay of enactment ; of i bill for the sake of further research. You must feed the person first and tl worry about other needs. -™™ I support the ideal of continuing to integrate people's needs and to impr< Federal assistance programs thereby enabling all Americans to share in- wealth of our country. I am aware too that man's inclination to identify w his peers brings forth in today's technological society important legislat challenges for all my colleagues who care about human beings— the young, poor, the uneducated, the sick, and the elderly. There are basic needs particularly unique among the elderly and these ne are immediate and urgent. These needs cannot be sacrificed while Congress the administration debates methods of administration and funding of Fede State or local levels. To sacrifice the needs of the Nation's over 20 million eld€ while' indulging in intellectual challenges of political science is unconsciona and I urge the support of my colleagues to provide for early enactment of 1 legislation in this session of the Congress. *«..,.,*. m ^„v. Mr. Speaker, I include in this statement the text of this legislation which stirred such great interest throughout the country. A bill to amend the Older Americans Act of 1965 to provide grants to Sta for the establishment, maintenance, operation, and expansion of low-cost n 609 programs, nutrition training and education programs, opportunity for .social BOntactS, and for other purposes. lie it enacted by th< Semite and House of Representatives of the United States ■>f imerioa in Congress assembled, Section 1. Title VII of the older Americans Act of 1966 is redesignated as ■tie VIII and sections 701 through 706 of that Act are respectively redesignated is seel ions 801 through 805. Sec. 2. Section 102(1) of the Older Americans Act of 19G5 is amended by leleting the semicolon and inserting a comma and inserting immediately there- ifter the words "except for the purposes of title VII where the term 'Secretary' lhall mean the Secretary of Agriculture." Sec. 3. The Older Americans Act of 1965 is amended by inserting the following ie\v title immediately after title VI thereof : '•TITLE VII— NUTRITION PROGRAM FOR THE ELDERLY "FINDINGS and purpose "Sec. 701. (a) The Congress finds that the research and development grants, ;itle IV. Older Americans Act, nutrition program has demonstrated the effective- less of and the need for permanent nationwide programs to provide the nutri- ional and social needs of millions of persons aged sixty-five or older who are inable to overcome the complex and intertwining problems of inadequate diets. Many of the elderly persons do not eat adequately because they cannot afford to io so, while others, who are economically better off, do not eat well because they ack the skills to select and prepare nourishing and well-balanced meals, have imited mobility which may impair their capacity to shop and cook for them- selves, and have feelings of rejection and loneliness which obliterate the incentive lecessary to prepare and eat a meal alone. These and other physiological, psy- chological, social, and economic changes that occur with aging result in a pattern )f living, which causes malnutrition and further physical and mental deterior- ition. "(b) In addition to the food stamp program, commodity distribution systems ind old-age income benefits, there is an acute need for a national policy aimed it providing the elderly with low cost, nutritionally sound meals served in stra- ;egically located centers such as community centers, senior citizen centers, schools, ind other public or private nonprofit institutions suited to such use and through )ther means toward this purpose. Besides promoting better health among the )lder segment of our population through improved nutrition, such a program, mplemented through the use of a variety of community resources, would be a neans of promoting greater opportunity for social contact ending the isolation )f old age, increasing participants' knowledge of nutrition and health in general, md promoting positive mental health and independence through the encourage- nent of greater physical and mental activities. ADMINISTRATION "Sec. 702. (a) In order to effectively carry out the purposes of this title, the Secretary shall — "(1) create a new division within the Food and Nutrition Service of the Department of Agriculture, under the Assistant Secretary for Marketing and jonsumer Services, for the administration of the program. "(2) make full utilization of the existing services within the Department Deluding but not limited to the Federal Extension Service under the Director of Science and Education ; and "(3) consult with the Administration on Aging, Department of Health, Edu- cation, and Welfare. "(b) In carrying out the provisions of this title, the Secretary is authorized ;o request the technical assistance and cooperation of the Department of Labor, ;he Ofiice of Economic Opportunity, the Department of Housing and Urban Development, the Department of Transportation, and such other departments and igencies of the Federal Government as may be appropriate. "(c) The Secretary is authorized to use, with their consent, the service equip- nent, personnel, and facilities of Federal and other agencies with or without reimbursement, and on a similar basis to cooperate with other public and private igencies and instrumentalities in the use of services, equipment, personnel, and iacilities. 610 "(d) In carrying out the purposes of this title, the Secretary is authorized to provide consultative services and technical assistance to any public or privato nonprofit institution or organization, agency, or political subdivision of a State to provide short-term training and technical instruction ; and to collect, prepare publish, and disseminate special education or informational material®, includin; reports of the projects for which funds are provided under this title. "allotment of funds "Sec. 708. (a) (1) From the sum appropriated for a fiscal year under sectio 706 (A) the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgi: Islands, and the Trust Territory of the Pacific Islands, shall each be allotte an amount equal to one-fourth of 1 per centum of such sum and (B) each othe State shall be allotted an amount equal to one-half of 1 per centum of such sun "(2) From the remainder of the sum so appropriated for a fiscal year eac State shall be allotted an additional amount which bears the same ratio to sue remainder as the population aged sixty-five or over in such State bears to th population aged sixty-five or over in all the States, as determined by the Secretar on the basis of the most recent satisfactory data available to him. "(3) A State's allotment for a fiscal year under this title shall be equal to th sum of the amount allotted to it under paragraphs (1) and (2) . "(b) The amount of any State's allotment under subsection (a) for any fiscf year which the Secretary determines will not be required for that year shall t available for reallotment, from time to time and on such dates during such yea as the Secretary may fix, to other States in proportion to the original allotmenl to such States under subsection (a) for that year, but with such proportional amount for any of such other States being reduced to the extent it exceeds tl sum the Secretary estimates such State needs and will be able to use for sue year; and the total of such reductions shall .be similarly reallotted among tr States whose proportionate amounts were not so reduced. Such reallottmem shall be made on the basis of the State plan so approved, after taking into coi sideration the population aged sixty-five or over. Any amount reallotted to State under this subsection during a year shall be deemed part of its allotmei under subsection (a) for that year. "(c) The allotment of any State under subsection (a) for any fiscal year sha be available for grants to pay up to 90 per centum of the cost of projects in sue State described in section 705 and approved by such State in accordance wil its State plan approved under section 705. Such allotment to any State in ar fiscal year shall be made upon the condition that the Federal allotment will 1 matched during each fiscal year by 10 per centum, or more, as the case may b from funds within the State. "(d) If, in any State, the State agency is not permitted by law to disbun the funds paid to it under this title in the State, or is not permitted by law match Federal funds made available for use by such public or private nonpros institution or organization, agency, or political subdivision of a State, the Se retary shall withhold the allotment of funds to such State referred to in su section (a). The Secretary shall disburse the funds so withheld directly to ai public or private nonprofit institution or organization, agency, or political su division of such State in accordance with the provisions of this title, includii the requirement that any such payment or payments shall be matched in tl proportion specified in subsection (c) for such State, by funds from sourc within the State. "PAYMENTS to states "Sec. 704. (a) Funds allotted to any State pursuant to section 703 during fiscal year shall be available for payment to such State for disbursement 1 the State agency in accordance with such agreements not inconsistent with tl provisions of this title as may be entered into by the Secretary and such Sta agency, for the purposes of carrying out the provisions of this title, during su fiscal year in supplying — "(1) agriculture commodities and other foods for consumption by perso: aged sixtv-five or over, and "(2) nonfood assistance in furtherance of the programs authorized und this title. "(b) The Secretary shall certify to the Secretary of the Treasury from til to time the amounts to be paid to any State under this section and the time times such amounts are to be paid ; and the Secretary of the Treasury shall pi to the State at the time or times fixed by the Secretary the amounts so certifie 61] "Sec. 705. (a) Any State which desires i<> receive allotments under ( his title mail submit to the Secretary for approval a stale plan tor purposes of this title vhich — •'(l) establishes or designated a single State agency as the sole agency for administering or supervising the administration of the plan, which agency shall >e the agency primarily responsible for coordination of state programs and ictivities related to the purposes of this title; "(2) sets forth such policies and procedure's as will provide satisfactory assur- ince that allotments paid to the State under the provisions of this title will be expended — ••(A) to make grants in cash or in kind to any public or private nonprofit in- stitution or organization, agency, or political subdivision of a State (hereinafter •eferred to 'recipient of a grant or contract') — " ( i ) to carry out the program as described in section 700. "(ii) to provide up to 90 per centum of the costs of the purchase and prepara- ion of the food ; delivery of the meals ; and such other reasonable expenses as nay be incurred in providing nutrition services to persons aged sixty-five or >ver. Recipients of grants of contracts may charge participating individuals for neals furnished but such charge shall not exceed a per meal limit to be estab- ished by each State agency, taking into consideration the income ranges of ligible individuals in local communities and other sources of income of the ecipients of a grant or a contract. "(iii) to provide up to 90 per centum of the costs of such supporting services as nay be absolutely necessary such as the costs of social services and local public ransportation to and from the residences of participating individuals to the ixtent such costs are not provided by grants for these services from the Admin- stration on Aging. Department of Transportation, Office of Economic Opportu- lity. or other Federal agency. "(B) to provide for the proper and efficient administration of the State plan: Provided, That the amount expended for such administration and planning shall tot exceed a sum which shall be agreed upon between the Secretary and the State agency— "(i) in making report, in such form and containing such information, as the secretary may require to carry out this function under this title, including eports of the objective measurements required by section 706, and keeping such ecords and for affording such access thereto as the Secretary may find neces- ary to assure the correctness and verification of such reports and proper dis- lursement of Federal fund under this title, and "(ii) in providing satisfactory assurance that such fiscal control and fund iccounting procedures will be adopted as may be necessary to assure proper dis- iursement of, and accounting for, Federal funds paid under this title to the 5tate, including any such funds paid by the State to the recipient of a grant or ontract. "(3) provides such methods of administration (including methods relating to he establishment and maintenance of personnel standards on a merit basis, xcept that the Secretary shall exercise no authority with respect to the selec- ion, tenure of office, and compensation of any individual employed in accordance rith such methods) as are necessary for the proper and efficient operation of he plan. "(b) The Secretary shall approve any State plan which he determines meets the equirements and purposes of this section. "(c) Whenever the Secretary, after reasonable notice and opportunity for earing to such State agency, finds (1) that the State plan has been so changed hat it no longer complies with the provisions of this title, or (2) that in the ad- ainistration of the plan there is a failure to comply substantially with any such ■rovision or with any requirements set forth in the application of a recipient f a grant or contract approved pursuant to such plan, the Secretary shall notify uch State agency that further payments will not be made to the State under he provisions of this title (or in his discretion, that further payments to the Itate will be limited to programs or projects under the State plan, or portions hereof, not affected by the failure, or that the State agency shall not make fur- her payments under this part to specified local agencies affected by the failure) intil he is satisfied that there is no longer any such failure to comply. Until he 9 so satisfied, the Secretary shall make no further payments to the State under his title, or shall limit payments to recipients of grants or contracts under, or 612 parts of, the State plan not affected by the failure or payments to the State agency under this part shall be limited to recipients of grants or contracts not affected by the failure, as the case may be. "(d)(1) If any State is dissatisfied with the Secretary's final action with respect to the approval of its State plan submitted under subsection (c), , such State may, within sixty days after notice of such action, file with the United States court of appeals for the circuit in which such State is located a petition for review of that action. A copy of the petition shall be forthwith transmitted by the clerk of the court to the Secretary. The Secretary thereupon shall file ie the court the record of the proceeding on which he based his action, as provided in section 2112 of title 28, United States Ode, J "(2) The findings of fact by the Secretary, if supported by substantial evidence, shall be conclusive ; but the court, for good cause shown, may remand the case to the Secretary to take further evidence, and the Secretary may there upon make new or modified findings of fact and may modify his previous action and shall certify to the court the record of the further proceedings. Such ne\* or modified findings of fact shall likewise be conclusive if supported by substan tial evidence. "(3) The court shall have jurisdiction to affirm the action of the Secretary o] to set it aside, in whole or in part. The judgment of the court shall be subjee to review by the Supreme Court of the United States upon certiorari or certifica tion as provided in section 1254 of title 28, United States Code. "nutrition and othee program requirements "Sec 706. Funds allotted to any State during any fiscal year pursuant to sec tion 703 shall be disbursed by the State agency to recipients of grants or contract w"h o ft srrcp "(1) to establish a program (hereinafter referred to as a 'nutrition program' which, five or more days per week, provides at least one hot meal per day an* any additional meals, hot or cold, each of which assures a minimum of one-thin of the daily recommended dietary allowances as established by the Food an Nutrition Board of the National Academy of Sciences-National Research Council "(2) to provide such nutrition program for individuals aged sixty-five or ove ( hereinafter referred to as 'eligible individual s' ) ; ..*.**: "(3) to furnish a site for such nutrition program in as close proximity to th majority of eligibile individuals' residences as feasible, and, preferably withi walking distance ; ... „„■] "(4) to utilize methods of administration including outreach which will assui that the maximum number of eligible individuals may have an opportunity t participate in such nutrition program ; "(5) to provide a setting conducive to expanding the nutritional program t include recreational activities, informational, health and welfare counseling an referral services * "(6) to include such training as may be necessary to enable the personnel t carry out the provisions of this title ; "(7) to establish and administer the nutritional program with the advice ( persons competent in the field of service in which the nutrition program is ben provided, and of persons who are knowledgeable with regard to the needs < 8 "(8) ^provide an opportunity to evaluate the effectiveness, feasibility ar cost of each particular type of such program ; and "(9) to give preference to persons aged sixty-five or over for any staft pos tions, full- or part-time, for which such persons qualify. "surplus commodities "Sec 707. Each recipient of a grant or contract shall, insofar as practicabj utilize in its nutrition program commodities designated from time to time by U Secretary as being in abundance, either nationally or in the local area, or coi modities donated by the Secretary. Commodities purchased under the authori of section 32 of the act of August 24, 1935 (49 Stat. 774), as amended, may 1 donated bv the Secretary to the recipient of a grant or contract, in accordant with the needs as determined by the recipient of a grant or contract, for utiliz tion" in the nutritional program under this title. The Secretary is authorized prescribe terms and conditions respecting the use of commodities donated und such section 32, as will maximize the nutritional and financial contributions such donated commodities in such public or private nonprofit institutions organizations, agencies, or political subdivisions of a State. 613 "appropriations authorized "Sec. 708. (a) The Secretary may utilize the programs authorized under this it lo in carrying out the provisions of clause (-) of section 82 of the Act approved tagust 24, L935, as amended (40 Stat. 771, 7 D.S.C. 614c). "(b) In addition to any other funds which may be available, there arc author* Rd to l>e appropriated such sums as may be necessary to carry out the purposes if this title. "PROGRAM expenditures "Sec. 701). Of the sums appropriated for any fiscal year pursuant to the au- korization contained in section 708 of this title, not to exceed $50,000,000 shall B made available for the iiscal year ending June 30, 1972, not to exceed $100,- 00,000 for the fiscal year ending June 30, 1973, not to exceed $150,000,000 for he fiscal year ending June 30, 1974, for grants-in-aid pursuant to the provisions f this title, less — "(1) not to exceed 3% per centum thereof which per centum is hereby made vailable to the Secretary for his administrative expenses under this title ; "(2) direct expenditures by the Secretary for agricultural commodities and ther foods to be distributed among the States and such public or private non- profit institutions or organizations, agencies, or political subdivisions of a State, >articipating in the nutriton program under ths title. "relationship to other laws "Sec. 710. No part of the cost of any program under this title may be treated as acome or benefits to any eligible individual for the purpose of any other program r provisions of State or Federal law. "miscellaneous "Sec. 711. None of the provisions of this title shall be construed to prevent a ecipient of a grant or a contract from entering into an agreement with a profit- laking organization to carry out the provisions and purposes of this title." Sponsors of H.R. 5017 James Abourezk (S. Dak.), Bella S. Abzug (N.Y.), Joseph P. Addabbo (N.Y.), rlenn M. Anderson (Calif.), William R. Anderson (Tenn.), Frank Annunzio 111.), Thomas L. Ashley (Ohio) ; Herman Badillo (N.Y.), William A. Barrett Pa.), Nick Begich (Alaska), Jonathan B. Bingham (N.Y.), John Brademas Ind.), Frank J. Brasco (N.Y.), J. Herbert Burke (Fla.), James A. Burke Mass.), James A. Byrne (Pa.), Shirley Chisholm (N.Y.), Frank M. Clark Pa.), William Clay (Mo.), George W. Collins (111.), James C. Corman (Calif.), L Lawrence Coughlin (Pa.), W. C. (Dan) Daniel (Va.), Dominick V. Daniels N.J.), John H. Dent (Pa.), John D. Dingell (Mich.), Harold D. Donohue Mass.), John G. Dow (N.Y.), John Dowdy (Tex.), Robert F. Drinan (Mass.), 'haddeus J. Dulski (N.Y.), Bob Eckhardt (Tex.), Don Edwards (Calif.), oshua Eilberg (Pa.), Marvin L. Esch (Mich.), Dante B. Fascell (Fla.), Dan- ?1 J. Flood (Pa.), William D. Ford (Mich.), Donald M. Fraser (Minn.), ames G. Fulton (Pa.), Cornelius E. Gallagher (N.J.), Edward A. Garmatz fed.), Joseph M. Gaydos (Pa.), Robert N. Giaimo (Conn.), Henry B. Gonzalez Tex.), Gilbert Gude (Md.), Seymour Halpern (N.Y.), James M. Hanley (N.Y.), ulia Butler Hansen (Wash.), Orval Hansen (Idaho), Michael Harrington Mass.), William H. Harsha (Ohio), William D. Hathaway (Maine), Augus- ts F. Hawkins (Calif.), Ken Hechler (W. Va.), Henry Helstoski (N.J.), loyd V. Hicks (Wash.), Louise Day Hicks (Mass.), Frank Horton (N.Y.), ames J. Howard (N.J.), Albert W. Johnson (Pa.), Harold T. Johnson (Calif.), ames Kee (W. Va.), Edward I. Koch (N.Y.), Dan Kuykendall (Tenn.), Peter N. [yros (Maine), Arthur A. Link (N. Dak.), Paul N. McCloskey, Jr. (Calif.), park M. Matsunaga (Hawaii), Lloyd Meeds (Wash.), Ralph H. Metcalfe (111.), .bner Mikva (111.), George P. Miller (Calif.), Joseph G. Minish (N.J.), Patsy T. [ink (Hawaii), Parren J. Mitchell (Md.), William S. Moorhead (Pa.), F. Brad- 3rd Morse (Mass.), John M. Murphy (N.Y.), Morgan F. Murphy (111.), iucien N. Nedzi (Mich.), Robert N. C. Nix (Pa.), David R. Obey (Wis.), ames G. O'Hara (Mich.), Thomas M. Pelly (Wash.), Carl D. Perkins (Ky.), Bertram L. Podell (N.Y.), David Pryor (Ark.), Roman G. Pucinski (111.), 'nomas M. Rees (Calif.), Ogden R. Reid (N.Y.), Donald W. Riegle, Jr. (Mich.), eter W. Rodino, Jr. (N.J.), Robert A. Roe (N.J.), Benjamin S. Rosenthal 614 (NY.), Edward R. Roybal (Calif.), William F. Ryan (N.Y.), Fernand J. St Germain (R.I.), Paul S. Sarbanes (Md.), James H. Scheuer (N.Y.), Fred Schwengel (Iowa), Keith G. Sebelius (Kans.), Robert H. Steele (Conn.), Louis Stokes (Ohio), James W. Symington (Mo.), Fletcher Thompson (Ga.), Frank Thompson, Jr. (N.J.), Charles Thone (Nebr.), Robert O. Tiernan (R.I.), Guy Vander Jagt (Mich.), Charles A. Vanik (Ohio), Joseph P. Vigorito (Pa.), Charles H. Wilson (Calif.), Lester L. Wolff (N.Y.), Jim Wright (Tex.), Gus Yatron (Pa.), Phillip Burton (Calif.). Office on Aging, Little Rock , Ark., May 10, 1971. Hon. Claude Pepper, 11th District of Florida, Washington, D.C. Deab Mr. Pepper : I am replying to your letter of March 22, 1971, addressed to Mrs. Mildred B. Williams, as Governor Dale Bumpers appionted me to replace Mrs. Williams on March 15th. The nutrition task force met May 5th to compile the results from our five regional community conferences into a policy proposal. Enclosed are the result- ing proposals which will be submitted to the Governor's White House Confer- ence on Aging, May 20th. Best wishes to you in your efforts concerning a nutrition program for the elderly. Sincerely yours, -. J. R. Jones, Director. Enclosure. ARKANSAS 1971 White House Conference on Aging TASK FORCE DRAFT POLICY PROPOSALS FOR USE OF STATE CONFERENCE PARTICIPANTS (subject matter area) Draft Policy Proposals in the area of : NUTRITION Issue 1: Should the Federal Government allocate substantial funds for re search on the influence of nutrition on the aging process and on the disease: of old age? Or, should such monies be concentrated on action programs t< rehabilitate the malnourished aged and to prevent malnutrition among thosi approaching old age? Draft Policy Proposals : ""The Fe^dera^fGoVe7nmenTshould allocate % of the funds available for researcl on the influences of nutrition on the aging process, and diseases of old age ; am y 3 to rehabilitative action programs. 1971 White House Conference on Aging TASK FORCE DRAFT POLICY PROPOSALS FOR USE OF STATE CONFERENCE PARTICIPANT Draft Policy Proposals in the area of— Nutrition— (subject matter area) Issue 2: Inasmuch as food and nutrition services are vital components of tots health services, should the Federal Government move more forcefully to establis higher standards for the food services provided by institutions and home cai agencies? Or, can the interests of the consumer be better served by demanding higher level of performance of State government enforcement agencies whe] the primary responsibility for such regulations now lies? Draft Policy Proposals : "" The~sTa~ndardsT^ Federal Government" with responsibilit for enforcement at the state level. 015 1971 White House Conference on Agino task force draft tolicy proposals for use of state conference participants Draft Policy Proposals In the area of — Nutrition — (subject matter area) Issue 3: Should governmental resources allocated to nutrition be concentrated solely in the provision of foodstuffs to those in need? Or, should a substantial proportion of such resources be devoted to education of all consumers, especially ;he aged, about nutrition and to the education of those who serve the consumer in professional and related capacities? Draft Policy Proposals : A substantial proportion of governmental resources should be devoted to educa- tion of all consumers, especially the aged about nutrition ; and to the education )f those who serve the consumer in professional and related capacities. 1971 White House Conference on Aging pask force draft policy proposals for use of state conference participants Draft Policy Proposals in the area of — Nutrition — (subject matter area) Issue 4: Should Federal Government policy for all Federally assisted housing de- relopments for older people require meal services for group feeding of residents ind for persons living nearby? Or, should the policy be to encourage provision of services and facilities for feeding within each household in the project (individual eeding) and for encouraging community agencies to provide for persons living n their own homes outside the development? Draft Policy Proposals : Federal Government policy for all Federally assisted !Tou^siriYa^velop^enfs~for •lder people should require meal services for group feeding of residents and for tersons living nearby. 1971 White House Conference on Aging TASK' FORCE DRAFT PROPOSALS FOR USE OF STATE CONFERENCE PARTICIPANTS Draft Policy Proposals in the area of — Nutrition (subject matter area) Issue 5: Should the Federal Government assume the responsibility of making dequate nutrition available to every American? Or, should this responsibility be eft to the individual, his family, and/or to the private sector voluntary groups nd State and municipal agencies? If left to other than the individual or his amily, should the fulfillment of the obligation be based on the provision of monev icome or the provision of food, facilities, and services ? Draft Policy Proposal : The Federal Government should assTme~the7elipVn^ ndser 01 } ava able t0 every American through the provision of food, facilities 616 1971 White House Conference on Aging TASK FORCE DRAFT POLICY PROPOSALS FOR USE OF STATE CONFERENCE PARTICIPANT* Draft Policy Proposals in the area of— Nutrition— (subject matter area) Issue 6: Should there be considerably more governmental control of the safet: and wholesomeness of our national food supply? Or, should this be chiefly i matter of private and voluntary responsibility, with government controls lef about at its present level or reduced? Draft Policy Proposals : ~'^^~^^^moT^^Tmi^iBl control on the safety and wholesomenes of the food supply. Utah White House Conference Planning Committee, Inc., Salt Lake City, Utah, April 13, 1911. Hon. Claude Pepper, House of Representatives, Washington, D.C. Dear Representative Pepper : Thank you for your letter dated March 22 197. informing us of your interest in the Nutritional Program for the Elderl; ■pr"p> fca-j n Utah 'did not have a specific task force for White House Conference on Agin dealing with nutritional problems of the elderly. However, we do have a cod mittee preparing a special report on this problem. Although it is our opinio that we would support HR5017, we cannot give any firm recommendations ( commitments until we receive information compiled by our special committe Sincerely, ■ ■ n , „ Melvin A. White, Ph. D., Director, Utah Division of Aging. Association of Schools of Public Health, Inc., Pittsburgh, Pa., April 29, 1971. Hon. Claude Pepper, Member of Congress, Washington, D.C. Dear Mr Pepper : Dr. Raymond Seltser of The Johns Hopkins School of H giene and Public Health has forwarded to me your letter of March 22, 1971, i I have just succeeded to the office of President of the Association of Schools Public Health. In this letter you provided us with a reprint from the Congrc sional Record enitled "Nutrition Program for the Elderly,'' which referred HR 5017 which you have re-introduced to the 92nd Congress. You further asked be informed as to what action we were taking in this regard. The Association of Schools of Public Health is made up of the 18 such accredit schools in the United States, as well as two in Canada. Within each of them will found programs or departments with primary interest in nutrition and geronfc ogy I believe we can be most effective if I place this material in the hands of the most closely associated with the objectives of the Bill. Consequently, I have dup cated the material you sent me and forwarded it to the deans of each of the schoc of public health with the request that they take appropriate action wihm thi ° W pi2ise a be assured of our deep appreciation for the concerns you have express and the action you are taking in this matter so important to the public health. Sincerely, herschel E. Griffin, M.D. President (517 Commonwealth of PENNSYLVANIA Department ok Public Welfare, Hanisburg, Pa., April 5, 1011. Son. Claude Pepper, Member of Congress, Washington, D.C. Dear Sir: Your letter of March 22, 1971, addressed to Mr. Stanley Miller, has >een referred to ine for reply. As State Coordinataor of the White House Conference proceedings, I heartily endorse H.R. 5017. I shall present this for consideration at the Governor's White House Confer- ence. Thank you for your consideration of the elderly of this nation. Your serv- ce in their behalf has been greatly appreciated by the elderly in Pennsylvania. Sincerely yours, Herman M. Melitzer, Director, Bureau of Community Consultation on Aging. Mississippi Council on Aging, Jackson, Miss., April 1, 1971. Congressman Claude Pepper, Washington, D.C. Dear Congressman : Thank you very much for your letter of March 22 enclos- ng a speech made by you on the subject, "Nutrition Program for the Elderly", rhis speech is certainly timely and I hope will be very effective in bringing about i recognition on the part of Congress to the desperate needs of many senior citizens in this country. In my opinion, this is vital legislation. The Mississippi Council on Aging has been in recent weeks engaged in con- lucting community conferences over the State of Mississippi. In these confer- ences there has been discussions on nine needs areas and nutrition is one of the rital subjects under discussion. We very greatly appreciation your dedication to this all-important matter. Sincerely yours, E. D. Kenna, Executive Director. Herman Gardens Inter-Agency Council, Detroit, Mich., April 15, 1971. Representative Claude Pepper, U.S. House of Representatives, Washington, D.C. Dear Mr. Pepper : The Herman Gardens Inter- Agency Council at its meeting >f April 14, 1971 discussed the bill you have recently submitted to amend the 31der Americans Act to provide a food and nutrition program for elderly persons. The members of the Council took affirmative action to wholeheartedly endorse ;he bill and urge its immediate passage. They are particularly supportive of this egislation because of the desperate need for a program of this kind in our low ncome areas and housing projects in the City of Detroit. In light of the recent cutbacks in AoA funds, we are fearful that the needs of 31der Americans are not being considered as a priority by the Administration. Sincerely, Einar Oftedahl, President. The Johns Hopkins Medical Institutions, Office of Health Care Programs, Baltimore, Md., May 18, 1971. Son. Claude Pepper, Congress of the United States, louse of Representatives, Washington, D.C. Dear Congressman Pepper : Your letter of March 22, 1971 was referred to me jy Dr. E. N. Jackson of the National Dental Association. I wish to inform you :he Task Force #12 Nutrition of the White House Conference on Aging met on Vlay 13 and May 14, 1971, and took under serious consideration the recommenda- ions outlined in the bill 5017. 618 The results of our deliberations are the six policy proposals dealing with the issues presented for consideration. (Enclosed are copies of the proposals for your information.) The proposals are those of the Task Force #12 and have not been adopted by the National Dental Association. Sincerely, Harvey Webb, Jr., DDS, MPH, Chairman, Task Force #12 Nutrition, White House Conference on Aging, Representing the National Dental Association. Enclosures. 1971 White House Conference on Aging ACTION PROPOSAL National Organization Task Force — Nutrition — #12 (Task Force number) In view of the lack of central direction in the multiplicity of current nutritioi programs, it is recommended that the President's Scientific Advisory Council se up a panel to study ways and means for utilizing our total resources for achieving effective programs in human nutrition. We believe that Nutrition problems of tin aging are of sufficient importance to justify bringing to the attention of tin President's Scientific Advisory Council. 1971 White House Conference on Aging policy recommendation report sheet National Organization Task Force — Nutrition — #12 (Task Force number) Issue 1: Should the Federal Government allocate substantial funds for researd on the influence of nutrition on the aging process and on the diseases of old age Or should such monies be concentrated on action programs to rehabilitate the mal nourished aged and to prevent malnutrition among those approaching old age Policy Proposal : Since we recognize that the aging process begins at concep tion, the problems of nutrition are concerned with the entire life cycle. There i a need for continued basic and developmental scientific research in the relatio: of nutrition to the aging process. However, we propose that national policy en phasize the direct support of action programs based on current knowledge Alternative Policy Proposal (s) : 1971 White House Conference on Aging policy recommendation report sheet National Organization Task Force— Nutrition— #12 (Task Force number) Issue 2: Inasmuch as food and nutrition services are vital components of tot* health services, should the Federal Government move more forcefully to estal lish higher standards for the food services provided by institutions and hoir care agencies? Or can the interests of the consumer be better served by deman< ing a higher level of performance of State government enforcement agenci( where the primary responsibility for such regulation now lies? Policy Proposal : As a component of the total national health program to il sure quality food and nutrition services the Federal Government must establis standards for food services in institutions and home care agencies. Implement! tion, enforcement and monitoring of the federal standards are a responsibilil of government at all levels. Alternative Policy Proposal (s) : big r.»7i White House Conference oh Aging POLK v kmi'om \ii\n.\Tio.\ BEPOBT SHEET National Organization Task Force NUTRITION — #12 (Task Force Dumber) Issue 3: Should governmental resources allocated to nutrition be concentrated solely in the provision of foodstuffs to those in need? Or should a substantial pro- )ortion of such resources be devoted to education of all consumers, especially ;he aged, about nutrition and to the education of those who serve tbe consumer n professional and related capacities? Policy Proposal : Adequate food for the total population of the United States mould be the immediate concern of the Federal Government. To complement this he Federal Government should support a nutrition education program directed ;oward persons of all ages particularly older adults. Alternative Policy Proposal (s) : 1971 White House Conference on Aging policy recommendation report sheet National Organization Task Force — Nutrition — #12 (Task Force number) Issue 4: Should Federal Government policy for all Federally assisted housing levelopments for older people require meal services for group feeding of resi- lents and for persons living nearby? Or should the policy be to encourage pro- vision of services and facilities for feeding within each household in the project individual feeding) and for encouraging community agencies to provide for )ersons living in their own homes outside the development? Policy Proposal: We believe that the Federal Government should recognize he importance of freedom of choice in the life styles pertaining to housing, lealth, and food facilities for older adults. The Federal Government should stablish guidelines based on federal food service standards and provide for heir implementation. Financial support must continue to meet the meal service leeds of older adults through a variety of existing and new projects in local lommunities. Alternative Policy Proposal (s) : 1971 White House Conference on Aging policy recommendation report sheet National Organization Task Force — Nutrition — #12 (Task Force number) Issue 5: Should the Federal Government assume the responsibility of making idequate nutrition available to every American? Or should this responsibility be eft to the individual, his family, and/or to the private sector voluntary groups md State and municipal agencies? If left to other than the individual or his fam- ly, should the fulfillment of the obligation be based on the provision of money ncome or the provision of food, facilities, and services? Policy Proposal : The Federal Government is responsible for making it pos- sible for every person in the United States to obtain income, meal services, tech- ucal and personal assistance as needed for an adequate diet. Alternative Policy Proposal (s) : 71-272— 72— pt. l- 40 620 1971 White House Conference on Aging policy recommendation report sheet National Organization Task Force— Nutrition— #12 (Task Force number) Issue 6: Should there be considerably more governmental control of the safetj and wholesomeness of our national food supply? Or should this be chiefly a mat ter of private and voluntary responsibility, with government controls left abou at its present level or reduced? Policv Proposal : It is the responsibility of the Federal Government to estab lish such standards as are necessary to insure the safety and wholesomeness o our national food supply. To implement this requires continuing program deve] opment and necessary funding. State requirements that meet i <^™tetexa standards must be established, implemented and momtored with federal supporl Alternative Policy Proposal (s) : 1971 White House Conference on Aging policy recommendation report sheet National Organization Task Force— Nutrition— #12 (Task Force number) Issue 7: Should there be considerably more governmental control of the safet and wholesomeness of our national food supply? Or should this be chiefly matter of private and voluntary responsibility, with government controls lei about at its present level or reduced? . ,««v^J Policy Proposal: In view of the lack of central direction m the multiplied of current nutrition programs, it is recommended that the President's Scientif Advisory Council set up a panel to study ways and means for utilizing out r tola resources for achieving effective programs in human nutrition. We believe th< the nutrition problems of the aging are of sufficient importance to justify brmgin to the attention of the President's Scientific Advisory Council. Alternative Policy Proposal ( s ) : Altrusa International, Inc., Chicago, Ill„ April 15, 1971. Hon. Claude Pepper, House of Representatives, Washington, D.C. _„ _ A1 _ Dear Mr Pepper : Thank you for your March 22 letter concerning H.R. 5017, Nutrition Program for the Elderly. Being a dietitian, as well as an officer j Altrusa International, Inc., I am doubly interested in the contents of the bi Unfortunately, the change in dates of the Regional meeting will prevent n participating in the May Workshop to be held in Arlington Heights. I hope have someone represent me but as yet this has not been settled. I certainly will be happy to give you any information I receive concernu the decisions of the task force and will look forward to perhaps meeting you i the White House Conference in Washington this fall. I appreciate your sending me the copy of the Congressional Record concernu H R. 5017 and will do everything I can to support the bill. Sincerely yours, ^ } ^^ J# Bqyle President-Elect. 621 University OF Hawaii, School of Public Health, May U h 1971. Hon. Claude Pepper, Member of Congress, Washington, B.C. Dear Mr. Pepper: Dr. Herschel GriHin, President of the Association of Schools of Puhlic Health, sent me a copy of H.R. 5017. "Nutrition Program for the Bl- derly." I invited the comments of our faculty involved in nutrition and gerontol- ogy programs in Hawaii and the U.S. Pacific Territories and have summarized our suggestions. We endorse your resolution enthusiastically, with a few recommendations. In our State and the Pacific areas, the effective use of USDA commodities is often limited. Except for public schools serving defined numbers of children and youth, storage and refrigeration facilities are not readily available. For this reason, Hawaii has never participated in the USDA commodities' distribution programs for families. Also, our elderly population represents various ethnic groups who often prefer their familiar native foods to U.S. items acceptable to the younger generations. Thus, we would suggest that H.R. 5017 include provision for a cash allowance in place of the USDA commodities for meal service programs for the elderly. This provision w T ould probably be less costly to the Federal government due to the elimination of transportation costs and of food waste caused by infestation or inadequate refrigeration. Also, the state and territorial agencies could then utilize their allocated funds to develop meaningful programs for meeting the elderly's psychological and social needs, as well as improving their nutritional and health status. We commend you and the Congress for proposing this worthwhile resolution and will be pleased to work with the Hawaii State Commission on Aging and other agencies of the Federal, State, and Territorial governments in promoting its passage and hopefully its implementation. Sincerely, Edward O'Rourke, M.D., Bean. Government of the District of Columbia, Department of Human Resources, Washington, D.C., March 31, 1971. Hon. Claude Pepper, Congress of the United States, House of Representatives, Washington, D.C. Dear Congressman Pepper : You may be sure that the nutritional needs of the elderly are of paramount concern to me and others in the District of Colum- bia who have experience with needs, and findings of demonstration programs now underway. The District of Columbia report to the White House Conference on Nutrition and Human Needs gave bountiful support for the legislation introduced by you and Senator Kennedy and the co-sponsors in both houses of the Congress. You may be sure that the District of Columbia White House Conference on Aging will give ample attention to this issue and I anticipate that additional support will be evident in our report to be completed subsequent to the May 26, 1971 Conference we are now planning. Thank you for calling this matter to my attention. Respectfully yours, Winifred G. Thompson, (Miss) Winifred G. Thompson, Director. 622 Tennessee Commission on Aging, Nashville, Tenn., April 15. 1971. Hon. Claude Pepper, House of Representatives, Cannon House Office Building, Washington, D.C. Dear Mr. Pepper : Thank you so much for sending me copies of the "Nutritior Program for the Elderly," H.R. 5017. Your prompt attention to my reauest is very much appreciated. Sincerely yours, Patty Ree Buchanan, ACSW., Executive Director. American Diabetes, Association, Inc., New York, N.Y., March 26, 1971. Hon. Claude Pepper, 11th District, Florida, Congress of the United States, House of Representatives Washington, D.C. Dear Mr. Pepper: This is to acknowledge your letter of March 22 regarding "A Nutritional Program for the Elderly" addressed to Mr. Connelly. Mr. Connelly is presently out of town attending to organizational matters an< is expected back sometime next week. Your letter, of course, will be brought to his attention upon his return fc the office. Sincerely yours, Norma Rosato, (Mrs.) Norma Rosato, Secretary to Mr. Connelly. National Association of Extension Home Economists, Rockford, III, April 15, 1971. Hon. Claude Pepper, U.S. House of Representataives, Washington, D.C. Dear Sir : Your recent letter addressed to Mrs. Carolyn Yuknus, Past Preso dent of the National Association of Extension Home Economists has been re ferred to me. I shall not be attending the White House Conference on Aging, but I wil forward a copy of your letter to our task force representatives. Thank you for your letter. Sincerely, Alfretta E. Dickinson, (Miss) Alfretta E. Dickinson, President, N.A.EJI.E. Federation of the Americas, Inc., Philadelphia, Pa., April 1, 1970. Hon. Claude Pepper, House of Representatives, Washington, D.C. My Dear Congressman : Thank you very much for the materials on the Ni trition Program for the Elderly, H.R. 5017. I have referred the materials to ou SFA representative, Mrs. Virginia Timmons, of the Soroptimist Club of Wasl ington, D.C. who attended the first session on February 9 and will continue a our official representative. We are very much interested in the latest legislative efforts and wish yo continued success. Sincerely yours, Valerie F. Levitan, Executive Director. 623 Department of Employment \m> Social Sebvioeb, Commission on Agino, Baltimore, Md., June 25, I'.ni. Hon. Ci vude Pepper, mpngress of the i nited states. House of Representatives, Washington, D.C. Dear Congress^ \n Peppeb: in accordance with your request I am sending you I copy of the recommendations of the Task Force on Nutrition made at our State Conference in Baltimore on June 3rd. Very truly yours, Harry F. Walker, Executive Director. Enclosure. 1971 White House Conference on Aging policy recommendation report sheet State White House Conference held in Baltimore, Maryland (city and state) Policy Recommendation in the Area of : Nutrition (subject matter area) (sub-section) Issue 1: Should the Federal Government allocate substantial funds for research on the influence of nutrition on the aging process and on the diseases of old age? Or, should such monies be concentrated on action programs to rehabilitate the malnourished aged and to prevent malnutrition among those approaching old age? Policy Proposal: The Federal Government has the major responsibility for funding research on the influence of nutrition on the aging process and on dis- eases of old age. W T ith health expenditures mounting, it is obvious that emphasis must be shifted from purely curative to prevention and rehabilitation. Concurrently, the Federal Government, in cooperation with state and local sub- divisions, should allocate adequate funding for action programs to rehabilitate the malnourished elderly and to maintain good nutrition to prevent malnutrition Ln those approaching old age. The Federal Government should support the intent of H.R. 5017, introduced by Congressman Pepper, Florida, with 111 additional sponsors, including four Mary- land Congressmen, to implement a nutrition program for the elderly to provide low-cost, nutritionally sound meals in strategically located centers such as com- munity centers, senior citizen centers, existing schools, churches, and other pub- lic and/or non-profit institutions as well as systems for home-delivered meals. H.R. 5017 would be strengthened if it were administered by the agency that is responsible for other services to the elderly. As written, there would be duplica- tion of staff in the Department of Agriculture as a food program for the elderly would be initiated. In the event that categorical grants are eliminated at the Federal level, we propose that this type of bill, with adequate funding to meet Maryland needs, be introduced in the 1972 session of the Maryland Legislature. ■ I TO AMEND THE OLDER AMERICANS ACT OF 1965 SATURDAY, NOVEMBER 20, 1971 House of Representatives, Select Subcommittee on Education of the Committee on Education and Labor, Herbert Lehman College Hall, Bronx, N.Y. The subcommittee met at 10 a.m., pursuant to call in Gillet Hall, Herbert Lehman College, Hon. John Brademas (chairman) presiding. Members present : Representatives Brademas, Scheuer, Reid, Hansen and Peyser. Staff present: Jack Duncan, counsel; Christine Orth, staff; and Charles Radcliffe, minority counsel for education. ( Mr. Brademas. The Select Subcommittee on Education of the Committee on Education and Labor of the House o)f Representatives will come to order. At the outset the chair wants to express his appreciation, as well as the appreciation of all of the members of our subcommittee to those who have come today to take part in this hearing which is one of a series of hearings conducted by the subcommittee on the subject of how best to meet the needs of the older citizens of our society. We are particularly pleased today to be in the congressional district represented by one of the ablest Members of the House, Con- gressman James Scheuer, who has a particular interest in these prob- lems and who has, during his years in Congress, shown himself, in the view of the Chair, to be one of the most imaginative and hard-working legislators in the Nation's Capital. Mr. Scheuer. Mr. Chairman, may I interrupt ? Mr. Brademas. Yes. Mr. Scheuer. If this hearing were taking place in any other con- gressional district I would be constrained to interrupt you and deny all of those things. But since it is in the 22d district of the Bronx I can only express my regret that you didn't say them more fervently. Mr. Brademas. I thank my colleague. The Chair w^ould like to make the general observation for the benefit of our guests at the hearing today that the Committee on Education and Labor is very fortunate to have so many able members from the State of New York. The distinguished ranking minority member of this subcommittee, Congressman Ogden Reid has long played a very important role in a wide variety of major legislative issues. And wq are glad to have a new member of our committee, Congressman Peyser, also of the State of New York, with us here today, who has already made important contributions to the work of the committee, and as well, to have Congressman Orval Hansen from the State of Idaho who, though a long (625) 628 way from New York, has shown himself to be very sensitive to the needs of the urban areas of our land. The Chair might also take this occasion to say that a former member of the staff of this subcommittee, now a member of the staff of 'Ella, Grasso of Connecticut, Miss Arlene Horowitz is here today and she is a constituent of Mr. Scheuer's and a native of this congressional dis- trict, so we are glad to have her as well. The term "generation gap" has been used a great deal in the United States, but rather than dwelling on the popular subject of the gap between the young and their parents, the Chair wants to suggest that we might focus on the gap between older Americans and the rest of our society. I refer to the fastest growing segment of the population of our country which now numbers in the 20 millions. Our older citizens are a valuable and deserving human resource who often go untapped, but even beyond their being a valuable resource to the country, they are human beings who deserve a rich and meaningful life. This subcommittee has jurisdiction over the Older Americans Act which was passed by Congress in 1965, as well as over a variety of othei measures that affect the lives of older citizens, and it is for this reason that we find ourselves here in New York today. We have been in Chi- cago and Boston, and will be elsewhere in the country to reestablish our priorities for older citizens. In a few days the White House Conference on Problems of the Agin£ called by President Nixon will convene in Washington and will hope- fully help focus the attention of all of the people of our country on the need to reestablish our priorities for older citizens. The Chair is very glad to see that a major focus of the White House conference is on action, not simply on passing resolutions. And it seems to me that the time has come for the Federal Government, both th< administration and Congress, both the Democrats and Eepublicans to commit ourselves to action. Some of the kinds of problems that we hope to hear our witnessei discuss today are adequate income for older persons, job opportunities adequate health care, housing, recreation, community service oppor tunities, low-cost transportation. We have with us some distinguished witnesses and we look forware to hearing from the first one who has, on many other occasions, testi fied before this subcommittee. We are glad to welcome Mr. Jule Sugar man, the director of Human Eesources Administration in New York Mr. Sugarman, we look forward to hearing from you. STATEMENT 0E JULE M. SUGARMAN, ADMINISTRATOR, HUMA1 RESOURCES ADMINISTRATION, NEW YORK CITY Mr. Stjgarman. Mr. Chairman and members of the committee I guess I represent this generation gap since I customarily testif before you on matters of child development and here I am today oi senior citizens. I have submitted for the record official testimony and rather thai read that I thought I just might highlight for you some of the prob lems here in New York City, some of the general problems that I se in terms of legislation. 627 I think the situation to New York City is probably representative of what you are going to see and hear in many oilier purls of the country, with the exception that we probably have a much higher concentration of older citizens than do other sections of the country. We have, for example, with about 5 percent of the total popu- lation in the country, about 12 percent of the senior citizens in the country. This is due to the fact that a very substantial number of older people, people who grew up here in New York live their lives here in New York and have simply stayed on, concentrated in a num- ber of sections of the city, particularly on the West Side, parts of Brooklyn, parts of the Bronx and represent a very significant part of the population here. Actually nearly a million people in the city of New York are 65 bears of age and older, and they have all of the problems which the chairman enumerated in the conditions of housing, the problems of health care, the problems of transportation, the problems of food, the problems of simple social contact and avoidance of isolation. In a way, I suppose, that is the most significant problem with which we are trying to deal here in the city : The problem of the isolation of the poor, the isolation of the old, situations where they have no con- tacts, where their families are not here, where their friends have either died or moved into other areas and they stand alone except for the help of a good many voluntary organizations and except for the help the city can give them. Now the city has basically two offices which try to deal with this problem. One is an office which is a part of the mayor's office, headed by Alice Brophy, which is a coordinating arm funded through the Older Americans Act and which has had, I think, some very signal success particularly in the stimulation of additional housing. The other is the services which are provided by the Human Resources Administration and particularly by the Department of Social Serv- ices where we have a very extensive, and I think, a very innovative program of senior citizen centers, some 68 centers scattered through- out the city and rather well distributed, verv heavily used but not reaching anywhere near the total population 'that they should. Those centers serve some 600,000 lunches a year. They offer a variety of educational programs, recreational programs and some employ- ment opportunities. We also have a number of special services such as the telephone reassurance service which has proved to be most useful in terms of simply maintaining a contact between one older person and another older person. # The way in which that works is that the assigned individual, who m this case is a volunteer, calls the other person at least once a day and simply checks to see how they are doing. We have had at least two instances where that resulted in discovering that someone was critically ill and getting medical help to them in time. But I think, just as important for many people, this initial contact has led to involving the person that was being contacted in other kinds of activities or bringing them out into the senior citizen centers, of starting some form of friendship which stands people in very good stead. I am sorry that this committee is here today rather than next week because if you were here next week I would be pleased to tell you about 628 a very extensive program which the mayor plans to announce on Tuesday to further expand ouc programs for senior citizens. Unfortunately the timing is just a little bit off on that but I can tell you about the basis of this because I think it says a great deal about the work of this committee and the legislative framework m which it now operates. .,«'-.» The parallels with title IV of the Social Security Act are so dramatic here I am sort of struck by them since we talked about that question so many times in the child development field. But basically there is a title of the Social Security Act called title XVI which says that the Federal Government will provide assistance to States and through States to cities for the provision of services to the aged who are either on welfare or who were formerly on welfare or would potentially be on welfare. Like title IV, this is a program that is funded with an open-ended appropriation with 75 percent Federal money and it really offers the basis for doing a great many things in the way of social services. The problem is that that statute has been on the books since 1967 and with few exceptions has hardly been implemented at all. Mean- while, the city of New York, out of its own tax levy funds has been spending about $3i/ 2 million in support of just exactly the kinds of services that would qualify under this act, or at least almost all of them would qualify. So what we are about to do is to propose that those tunds now qualify for Federal and State matching, and the effect of that will be to multiply our available funding by a factor of 8. And so, instead of $31/2 million we will have something closer to $28 million available for senior citizen programs. Now that same option, of course, is available throughout the coun- try to any State and city that wants to take advantage of it, and as I have indicated to you, it is a very comprehensive kind of program. The Federal regulations on this are quite broad. They permit al sorts of things related to senior citizen centers, all sorts of outreacl services, all sorts of protective services for adults, all sorts of services in connection with the provision of food. It does not deal, however, with actual health care nor does it dea with housing per se, nor does it deal with income maintenance. It deals only indirectly with jobs in the sense that many of the jobs in the pro vision of senior citizen services can and, in fact, should be done on 1 paid basis or a voluntary basis by senior citizens themselves. We do that in New York and manv of the senior citizen centers which operate here do employ other senior citizens to actually providi the services. In our new expansion program we plan to continue tha effort and greatly enlarge their participation. That still leaves a lo of senior citizens with very serious financial problems. I don't want to understate in any way the nature of that problei) but at least there are opportunities here. Now what does that sa; about an Older Americans Act? Well it says to us there is not onl room for but a necessity for a permanent Older Americans Act whicl o-oes beyond the research and demonstration phase. S One of the real tragedies with this and other similar acts is tha people do get good things going and then 3 years later they ar 629 stration project is over. There are no funds usioning to over because the demon available to continue. That kind oC thing is terribly disheartening and disi people who really worked very hard to get these things Started. W< think the time has come for permanent, funding for these soils of filings. We think it is time that there be an agency that is clearly and permanently recognized as a vocal and effective spokesman for the |dult senior citizens of I his land. I wish 1 could be as optimistic as the chairman seems to be about the action phases of the White House Conference on the Aging but I must say that our experiences with other conferences haven't led us to have any great conviction that that will happen. Mr. Bradtcmas. If the Chair can interrupt, the Chair was not ex- pressing optimism rather than hope. There is a considerable difference. Mr. Sugarman. We think there should be an act. In the prepared testimony we have enumerated some of the principles we think are important here. I will very briefly state those. One is that the agency should have a comprehensive responsibility for programs for senior citizens. That does not mean that all pro- grams that affect all old people should be in the same agency because 1 think that is literally impossible. Those programs are spread through Transportation, HEW, Labor, and all over the place and I see no way in which they could be combined. But it does mean this agency should have the right to investigate, to study, to recommend policies that may affect senior citizens in any agency of the Federal Government. Secondly, we believe that the flow of funds should be to both State and local governments. There should be an opportunity for very heavy consumer participation and decisions about programs affecting senior citizens. It has been interesting to me to observe the growth and the desire of senior citizens to be effective in making these decisions in the last 5 years. I can recall that in the early days of OEO when programs like foster grandparents program and the FIND program were begin- ning, it was just a group of professionals sitting around and deciding this would be a good program for senior citizens. It is not true anymore. At least here in the city of New York and other parts of the country that I have been in, you see very active and vigorous groups of senior citizens who want to be right in on the decisionmaking themselves and who are increasingly well organized bo do that. I think it is a very healthy development and one that ought to be encouraged by this legislation. I would argue that these programs that we are talking about really ought to be under one act, that it ought to be the Older Americans Act, particularly the types of programs under title XVI. But I cannot conscientiously argue for that unless somehow we can have the assured kind of financing that is available through title XVI. That, of course, involves the jurisdictions of two different commit- tees ; yours and the Ways and Means Committee and the corresponding committees in the Senate, and I recognize the difficulties that are involved. But until there is that kind of guarantee I think one has to remain in support of title XVI as a continuing piece of legislation because of 630 its very generous financing provisions. We also, of course, want to see strong evaluation and accountability as a part of any senior citizen program. I think that is important for all Federal programs. It ought to be honored not only by the letter of the law but by actual practice as well. I think, Mr. Chairman, that that is the essence oi what I have to say and I would be pleased to respond to any questions Mr. Brademas. Thank you, Mr. Sugarman. Because of the shortage of time this morning the Chair is going to ask that we follow the 5 -minute rule. Mr. Reid has to go to another meeting so the Chaii recognizes Mr. Reid first. Mr. Reid. I would like to say, Mr. Chairman, how happy I am to b( in Congressman Scheuers district and equally to be here with Con gressmen Peyser and Hansen today. I would like also to mention thai we are delighted to have a new counsel with us on the subcommittee ai regards the^area of the aging, Charlie Radcliffe, who has done a greai deal toward the work on the Education and Labor Committee. I would also like to thank Jule Sugarman for his work, both at thi national level and here in New York City where his ideas have beei creative and effective. I would like to make one comment and just as! two brief questions in the time remaining. I note in the early figures that have just been released by HEW based on the census, that 100 years ago, in 1870, out of a total popu lation of almost 40 million, only about 4.6 million or a little over 1< percent were aged 45 to 64. Now 100 years later in 1970, we have a population five times as large a middle-age population nine times as large and an older population a] unprecedented 17 times as large as it was 100 years ago. I would like to ask two things. One, if you would be kind enoug to talk briefly about the formula that you mentioned on page i wherein you say, "My conception of the ideal arrangement is direc funding from Washington to the locality, utilizing the States to serv smaller areas where local programs would be difficult to organize. Would you care to comment on the application of your statement t the other end of the generations, namely, the Early Childhood Deve opment Act. Second, what kind of funds are you talking about to do national program, not relying just on title XVI of social securit but permanent funding to go beyond the research and demonstrate which you mentioned ? Mr. Sugarman. Mr. Reid, on the first question one is torn betwee the desire to have as much local decisionmaking as possible as close t the people who are involved and the practicalities of administratioi As you know, during the course of the debates on the child develor ment bill I personally testified in favor of a cutoff point of $100,00 as being the reasonable level. This, of course, was not related to ih aging but rather to child development. The principles that I had in mind there were the administrate capacity of the Federal Government to supervise programs which think is necessarily relatively limited, and the fact that those pre grams require a sufficiently large base of operation to really have comprehensive program. If you have a program which only can potentially serve 100 childre you aren't going to do things for 'handicapped children. You aren going to do things for children with specialized needs. You are n( 63] joing (o have a career progression system for the staff and nil of the lungs that go intoatruly effective program. I think the considerations in the senior citizen programs are aot Bssimilar and while I have not made it a specific analysis of where the jbtofT would be, I suspect, at least on the administrative supervision lection it would bo very similar. At the same time, I would want to argue vigorously that if a Slate is tdm mistering the program for other areas that there must be strong ocal policy committees which can have a real impact on what the State loes for senior citizen programs, and that nobody should sit in Albany fed tell the people of Poughkeepsie and the people of Schenectady to lo exactly the same thing because those are not necessarily the right kings for both places. On your second question of the total dollar need, I am afraid I can't feswer you. I have never really made a study of this. We have a defin- able need. What we find is, every time you open a senior citizens' center you find , lot more problems you haven't been dealing with that nobody knew ,bout because they weren't visible. So it is an elastic kind of thing. Mr. Reid. May I ask a question, just in relation to the cities? You aid there are about a million senior citizens. How many of those are r ou reaching on some kind of daily or weekly basis ? Mr. Sugarman. Probably less than 10 percent. Mr. E-eid. Thank you very much, Mr. Chairman, and I thank my olleague from this congressional district for letting me proceed Lrst. Mr. Brademas. The Chair recognizes Mr. Scheuer. Mr. Scheuer. As the host Member of Congress, may I thank the Chairman for scheduling this meeting in the Bronx and'thank my col- iagues for coming. I particularly wish to welcome Charlie Eadcliffe to the work of be Subcommittee on the Aging. He is an old and valued friend of urs and we know he is going to make a notable contribution to he work of the subcommittee. Mr. Sugarman, you mentioned in your testimony and in your pre- ared testimony as well, that there should be more funding, there tiould be more independent funding, there should be more flexibility, tare should be more opportunity for citizens input, and in general, iss administrative hassle all around in getting the funds and desig- ating relevant programs without Federal interference. Can you give us some examples of specific changes in the legisla- ion that you would suggest to achieve these purposes ? Mr. Sugarman. I think the basic problem with the Older Amer- ;ans Act at the moment is that it is largely oriented to a research and emonstration program rather than to ongoing funding, so that what ssentially is necessary is to provide not only expanded funding but time unlimited type of funding so that when people get good pro- rams going and everybody knows they are good programs that they an keep on going rather than having them terminated. Mr. Scheuer. Then your testimony also mentioned that you advo- ite that we establish advisory boards that should be composed of fc least 50 percent elderly. In the last number of years we have had anous Federal programs that have involved various kinds of com- 632 munity involvement, community decisionmaking, community partici- pation, community power in general, and this has been true of the poverty program, the model cities program, the child development program sponsored by Congressman Brademas and Congress woman Patsy Mink. This is another type of citizen involvement in the design and de- livery of services. Can you tell us how the various types of citizen in- volvement, going all the way from advice and input to total control of the program, is worked, in your opinion, in the various experimental program that you have had and what degree and quality of input would you recommend in the future as getting sufficient input so the programs are relevant and geting sufficient community support because they had something to do with designing the program and perhaps avoiding some of the confusion and conflict that has been produced where there is total community control % Mr. Sugarman. I think one has to say that the pattern of experience varies from very, very good to terrible in situations in which communi- ties have really rallied around together, worked toward common ob- jectives and really have given everyone a sense of involvement and had excellent results. The situations in which the struggle for who was in charge have consumed so much time that nothing ever happened, or, in some cases, rather bad things happened. I don't know really how to generalize that or give you a statistical feel for what proportion were good and what proportion were bad. Mr. Scheuer. Can you tell us what elements are present? If the total net result is good, what elements seem to be present, and when the process appears to be counterproductive ? Mr. Sugarman. I think the fundamental thing that has to be present is something which nobody can legislate and that is respect for one another. Where the public officials and professionals and consumers, whoever they may be, have that kind of respect for one another then I think things go very well. Where there is a great deal of suspicion, mistrust or outright dislike for one another then you probably are going to have trouble. No^\ there are things, I think, which can be done legislatively and ad- ministratively which increase the possibility that people will be abk to work together. One of those is to try to have a really fair system of selecting people and one which is clearly perceived as a fair system by everybody in- volved; a system which is not subject to manipulation by a few in dividuals or organizations, and, I think, a system which calls foi continuing changes in leadership. I was distressed, for example, to see the effort in the economic op portunity bill — and I don't know how this has come out in con ference — to lengthen the maximum term of office from 3 years t< 6 years. I think that was a mistake because it perpetuates leadership which, it seems to me, ought to change. If you are truly trying to involve a great many different people J think it is important that there be control in the combined efforts o: the total group. I have always argued, and I recognize that many o: my colleagues differ with me on this, but I have always felt that th< notion of participation was not basically a question of control bu 633 rather a question of trying !<> get all of the elements that were affected by decisions involved in those decisions, and I include the three basic categories of public ollicials, private citizens who are consuming the service, and professional organizations. I recognize that sometimes, when you don't have a clear decider, a clear authority who can unilaterally make a decision, you get to the point where no decision is made. But I consider that preferable to saying the public official has the unilateral right to make a decision or the consumer has a unilateral right to make a decision. I think if people understand that, that they must reach consensus in order for anything to happen, then it isn't very long before you begin to get consensus. I don't know that any particular proportion can be said to be the right proportion. I generally argue that the closer you get to where the program ac- tually is the closer you should get to majority or at least 50 percent consumers. But I have seen very effective parent participation in Head- start programs when there was only one-third parent representation. I think then finally, it is important — this is something the Congress can and should do something about, and that is to give people some- thing to work with, and that is money. It is a terrible drain and a terrible stress on any policymaking body, on any kind of participation if there is nothing to work with because people simply end up fighting about little tid-bits and all of them know that they can't possibly succeed and that really drains the energies of the organization. So I think, until there really is a flow of public funding to make these programs happen, you are going to have a lot of tensions. It can't be abated. Mr. Scheuer. Last spring when Congressman Gus Hawkins of California chaired an oversight committee on the poverty program we had testimony that while there may not have been conscious discrimination there was, in effect, as a result of a whole combination of circumstances, discrimination against the elderly Jewish poor in the administration poverty program. That was due to a variety of circumstances that were alleged. You may remember at that time when I asked for an investigation by the GAO, the General Accounting Office, an investigation by the Poverty Administration, the OEO, and by your office, I think it is fair to say that all three investigations ended up by saying that while there might have been some overstatement, while some of the facts alleged may not have been true, in substance, there was a great deal to the charges in that there was a problem there that ought to be dealt with ; namely that elderly Jewish in poverty in this town were not being given the opportunity to participate on an equal basis in the benefits of the poverty program. In the 4 or 5 months that have passed since that, can you tell us any action you have taken or an action you have taken in cooperation with the interested Federal or State agencies, the OEO and the like to remedy the situation? Mr. Sugarman. Let me, if I may, Mr. Scheuer, supplement your remarks about those investigations because I think there is one very important fact that was found by all of the groups and that was that the Economic Opportunity Act as it was administered in general, ignored the needs of older citizens, partially because the program 634 which got started in 1965 and 1966 were much more heavily concen- trated on things like youth employment and Headstart, legal services and so forth. Of course, in those days everybody believed there was going to be a war on poverty and the funds were going to come along and we would take care of senior citizens. There were, of course, some things like Foster Grandparents and Meals on Wheels and other things which had beginnings, but they were almost like the Older Americans Act; they were demonstration programs and not ongoing programs. So what happened here in the city is not typical of what happened throughout the country and that is that senior citizens just didn't get any real attention under the Economic Opportunity Act. In terms of what has happened since the investigations, there has been discussion, particularly with the leadership in the Jewish com- munity. The Jewish Agency for Services to the Aged submitted to the city a rather substantial proposal for the creation of senior citizen centers and satellite programs. After some discussions, we modified that a little bit m terms of the total size but submitted it to the State for approval under Title XVI We have a communication from the State, which I must say is a littfl ambiguous, but in essence, seems to say that they will approve this proposal. We haven't announced that yet because we are not absolutely sur< what the State is saying in their letter. One of the things they may b< saying is it is okav if the city wants to provide all the money — the cit] or private agencies want to provide 25 percent, but we are not terribb interested in providing any State money for it. That may be a pos sibility, that some of the Jewish federations will be able to providi matching money, or that the city will use some of its own money t< provide it if we can't get the State moved. That will be a rather significant effort, and I think, represents th< beginning of some redress. We also will, of course, be accepting appli cations — under the program I talked about earlier in my testimony- from all sorts of senior citizen agencies and Jewish agencies. I think that will also make some improvement. I must say, howevex that I see no way to rearrange the existing level of poverty funds to d< much more to overcome the alleged discrimination because there jus isn't any money to rearrange. The problem is one of contraction rathe than expansion of services. And I think those services that are in existence are clearly going t people that need the services, that are legally eligible for them and see nothing to be gained by taking it away from one person and givin* it to another. Mr. Scheuer. In terms of some of the impediments to the participa tion by elderly people, remember there were allegations of threats o exclusion from local elections and so forth in the poverty boards. Ha anything been done to eliminate that problem ? Mr. Sugarman. Yes. At the conclusion of the last Community Boar elections I had a special study made by our Office of Keview and the drew up a set of recommendations. I have now assigned Mr. Farre Jones, who is the new First Deputy Administrator of the Human Hi sources Administration to work with the Community Developmer Agency and the Council Against Poverty to draw up a set of guideline 635 for the next elections which we I hink will minimize i hat problem, and Isotodeal with the very thorny issue of elections on Saturday which, is you recall, was a serious problem last time. air. Scheuer. Thank you very much. Mr. Brademas. Mr. ougarman, just following one of Mr. Scheuer's hiestions, I noted in your testimony you say the scope of the Federal pthorization under Title X\'I of Social Security is limited only by the piwillingness of Stale and local governments to approve programs for vhieh they would have to contribute 25 percent. What can you tell us with respect to the contributions made by the ■bate Government of New York and of the State governments gen- ially, first, and second, about contributions paid by local government? Mr. Sugarman. As I indicated earlier, the State of New York has fever really taken advantage of title XVI until we began to force the ssue around the city's own involvement in programs. The State, of purse, does provide services for senior citizens in a variety of pro- grams, but here again the pattern is one of contraction and given the ooming $700 million budget defect in New York State, potentially a 111 ion or more in the next fiscal year, I think all of us are very con- en ied that once again senior citizen programs, what few there are, lay really bear the brunt of that. The city, historically, has put more money into these senior citizen enters, specifically far more than the State of New York. As I recall Irrectly, the State puts about $300,000 to roughly $3-and-a-half mil- ion of city money. The city is in a desperate financial situation, too, id our capacity to expand the basic city contribution is pretty linimal, if at all. But the city is determined to protect the investment it already has. Vhat we are simply hoping to do is trying to multiply it by extracting tie Federal dollars for which we are eligible. Air. Brademas. I hear what you are saying. I understand from what lie chairman of the Appropriations Committee said the other day, we lay have a $35 billion to $40 billion deficit in the Federal budget this ear, which is a very sobering fact to have to contend with. Mr. Sugarman, you made the point, I think, that you see the Admin- feration on Aging as playing a leadership and advocacy role as well as esearch and demonstration and also perhaps they are going to have ertain programs that might not get enough attention under title XVI, £ I understood your point correctly. Among several bills that are under consideration in this subcommit- ee are two I would ask you to make a comment on before yielding to ther members. One on which we have alreadv had extensive hearings, 3 a bill introduced by Congressman Pepper of Florida, H.E. 5017, that rould provide Federal support through a new title of the Older Amer- 3ans Act to make available nutrition programs for the elderly. You mentioned nutrition in your opening informal remarks as one of be problems of older persons. Can you give us any comment on that problem so far as it affects older people in the city'of New York, and rhat your attitude would be toward this kind of proposal ? Mr. Sugarman. I think the problem with nutrition has several facets r> it. One is simply having enough income to buy an adequate amount f f ood. Second is the problem of cooking of food and the interrelation- tnp between living alone and being lonely and losing interest in pre- 71-272— 72— pt. 1 41 636 paring food so that you often find isolated people eating less and less and certainly eating improper diets. . Then there is the problem of those who are so handicapped or ill that thev can't or don't have the capacity to prepare their own food. The solution to that then, it seems to me, lies in several different sys- tems. , , ,, ... I mentioned the 600,000 meals that we serve at the senior citizen centers I think those have a dual benefit. They do, in fact, provide about one-third or one-half of the nutritional requirements for the day, but they also get people in contact with one another. I believe that is terribly important. Some sorts of congregate feeding arrangements, I think, are very useful from a dual point of view. On the other hand, I think there are people who are not able to come out or who are maybe unwilling to come out for whom you have to provide thmo-s like homemakers who can go in and prepare a meal for them. I don't know that it has to be a full homemaker service all the time. It may simply be a high school girl who comes by for an hour a day and fixes supper. I think that is a very useful kind of thing to do or it may be the preparation of food centrally and the dispatching of it on a Meals on Wheels kind of basis. All of those things ought to be possible. What we really need is a funding authorization that has sufficient flexibility to deal with the situation in the way that is best for each of the individuals. Mr Brademas. I just have one other quick question I would ask you to give a brief answer to. I am sure you could talk about it at great length This subcommittee has given very strong support to President Nixon's proposal to establish a National Institute of Education to carrj on research and development in that field. m We have before us another bill that would support geriatric research on the aging process. What would your reaction be to a rather broadei concept perhaps analogous to the National Institute of Education let us say, a National Institute of Aging that would carry on research and development in all aspects of the problems of the elderly, in- cluding not only geriatric research, medically defined, but the whole range of social problems in the problems of the elderly ? Mr Stjgarman. I think the substantive need is clearly there. Con gressman Keid illustrated some of the figures about the proportion* of the population that are elderly and we expect, of course, that those proportions will continue to grow. J I am not familiar with the intricacies of who does what kind o. research in the aging process. I know that NIH has some mvolvemen in that and I can't comment on the specific organization. Mr. Brademas. Mr. Hansen. Mr Hansen. Thank you, Mr. Chairman. Let me first also ae knowledge my pleasure at being in the district of our very valued col league in this committee, Jim Scheuer, who has previously extend* to us an invitation to visit his district. This would appear to be ai opportune time to extend to him an invitation— that is, to renew im invitation to visit my district in Idaho— I assure him that Sun Valle : in the spring is a delightful place to be— and to acknowledge public!: how much we are indebted to the very strong leadership he ha contributed to this committee's work. 637 I would also say whal a great pleasure it is <<> have Jule Sugarman lack as one of our expert witnesses and one who, I believe, has eon Iributed as much as anyone who has appeared before (his subcom- mittee iu a wide range of areas where this subcommittee has been Ibtempting to meet human needs. Obviously the members of this subcommittee have a very high ■Bgard 1'or you and are pleased that you would lake the time to be with us again this morning. 1 would acknowledge, also, the last time we were here in this city, through your efforts we were able to get a rood look at a number of the programs within your administration. Let me raise a question and pursue somewhat the question touched )n by others, including our chairman, and that is the efforts of the Ity under title XVI of the Social Security Act, wherein I believe you stated that the city is contributing about $3.5 million and that is about the sum total of all that is being contributed to the program. [s that substantially correct ? Mr. Sugarman. That is correct. We are not actually operating under title XVI yet, but what we are proposing to do is to begin operating under that and that would then, in turn, attract State and Federal money, which should take us up to something in the neigh- borhood of $28 million. Mr. Hansen. But you are doing the kind of things that would be lone if title XVI were really implemented. Mr. Sugarman. That is right. Mr. Hansen. Would you explain how you get this $3.5 million to the $28 million? Mr. Sugarman. The process is that the State files with the Federal Government what is called a State plan, and that State plan says that we intend to provide these kinds of services to these kinds of older persons. The Federal Government checks that plan for consistency with their regulations and approves it. Once they approve the plan, there is no limitation on the quantity of services that can be provided, and if the notion of having a Senior Citizen Center has been approved, you can have one or a 100 or a 1,000 in the way the system works. Now, the Federal Government simply says, send us a bill for 75 percent of what you have spent. So this year, if we spend only $3 million, we would get $2,250,000 from the Federal Government. If we spend $30 million, we would get $27.5 million from the Federal jrovernment. Mr. Scheuer. Twenty-two and a half million dollars. Mr. Sugarman. Twenty-two and a half million dollars, correct. Mr. Hansen. What part would be the State's contribution? Mr. Sugarman. Normally, the State and city share equally in the 25 percent but the State, in a number of instances, has reneged on that and the city has put up the full 25 percent. There is also the possi- bility that provide funds can be donated to the city or to the State for purposes of the matching share. Mr. Hansen. So the private organizations, church groups, and so forth, could make a part of that and generate some matching Federal funds. Mr. Sugarman. Yes ; but with some important restrictions. The donor organization cannot receive money back as a contractor to carry out 638 the program. The way we are talking about it, for example, in this city is the Greater New York Fund, which is our United Givers Fund, may give a lump sum of money saying that they would like to have services in particular areas of the city of a certain kind. Then we will contract with the appropriate organizations to carry out those services, but not with United Fund itself. Mr. Hansen. I understand that Congress has never appropriated funds for title XVI. Is that correct ? Mr. Sugarman. I think that is not correct. I think that there are funds available for title XVI. They are part of the general public assistance appropriations for social services. They are not specifically earmarked as such. Mr. Hansen. So the need is for appropriations that are specifically earmarked for these kinds of programs ? Mr. Sugarman. I don't think so. I think we have a general appro- priation, the title of which escapes me, but it is something like train- ing, administration and social services and those funds are available for any purpose authorized in the title XVI of the Social Security Act. It may be that if States and cities take greater advantage of this, the amount of the appropriation will have to be increased but the ex- isting appropriations, so far as I know, would be available right no^ for anybody who wanted to spend them. That is one of the appropriations that traditionally has a supple- mental later in the year as you find out more about what is actually being spent. Mr. Hansen. I am a little unclear on why, if it is available, the citj of Xew York has not been able to take advantage of it with the amounts available here. Mr. Sugarman. The basic reason here is that the State of Ne^ York has been unwilling to move or simply hasn't moved. And sim- ply because this a direct Federal-State program, those cities that woulc like to do something just don't come up. We can't get around then and do it even if we brought our own money. Mr. Hansen. So the major obstacle in this case is the State govern- ment? Mr. Sugarman. That is correct. Mr. Hansen. One further question with reference to the upcoming White House Conference on Aging, mention of which has been made Of course, I think there are various attitudes with respect to the con ference and I would be the first to acknowledge that many past con f erences, if they can be used as a guide, do not give reasons for un restrained optimism. I think we could also agree that one of the surest ways to mak< certain that the conference is not a failure is to not have a conferenc< at all, then there could be nothing against which performance woulc be measured. My optimism about the conference, I think, stems partly from th< leadership of Dr. Flemming, who impresses me greatly in his appear ances before this subcommittee, and also the structuring of the con ference as a 3-year process rather than a single event. The 3-year process involves a good deal of preliminary work a the State and local level and f ollowup work at the State and local leve 639 so (hat, hopefully, in the course of the conference, the role and respon- Ibihty ol all of those who have some concern with the aging can he Eentified, including that of localities, State governments, cities the Congress, and Federal agencies. . Lot mo ask: What has happened, to your knowledge, in forms of the Ity^New York and the State of New York as far as preparations for fee \\ hite House Conference and its local conferences? what do vou mow about plans for followup action on the part of the city and the state to make certain that the recommendations at least have a good pance of being implemented ? Mr. Sugarman. I have not been personally directly involved with he preparations here. This has been handled by Alice Brophy who leads the mayor's oflice on aging. I am aware, however, of a verv deep lissatisf action with the composition of the New York delegation, the Sew 1 ork State delegation, in the sense that the city is grossly under- •epresented m terms of the proportion of that delegation, both in terms »f some of the really excellent leadership— I see some of them in this oom. There just aren't enough of those people. Just in terms of the numbers of elderly people we have in this city here is jnst no fairness to the composition. There has been a number >f meetings in preparation at the State level. I am afraid I can't tell on what the f ollowthrough plans are. ^' Ha . nsen - T m ight say that one of the most startling things you aid here m your initial testimony was that, if I recall the figures, New r ork City has 12 percent of the aginof population of the country, mereas it has only 5 percent of the total population. It would seem to me that that dramaticallv illustrates the problem ■at confronts the city of New York just in this area alone. Thank vou ery much. Mr. Brademas. Mr. Peyser? Mr. Peyser. Thank you, Mr. Chairman. I want to particularly thank ou for arranging this opportunity this morning and to Congressman cheuer for letting us be in his district. It is a great pleasure and also avmg Mr. Sugarman as our first witness. I am the newest member, I guess, of this group and I would like to )rt of take a little different slant to the questioning rather than to be liking about what the administration, either in Washington or the fete, is doincr in directing this a little more to people involvement. I would like to speak to the question Mr. Hansen raised on this reparation or planning for the Conference on the Aging. I know that l the Westchester and Eockland areas, which I represent, there has sen very extensive planning for this particular program that is com- ig up in Washington. I personally attended some of the meetings and have spoken at some f the luncheons involved where the people have gathered together for av sessions to carefully lay out their plans, their programs. I simplv hope that the city delegations have been— particularly l New York City— following this kind of procedure and I am sure lev have. Coming to the problem of the aginsr, the figure of 1 million peo- le in New York City that qualify under the definition of aged, and 3u indicated that less than 10 percent of them are reached through hatever programs may be, I am wondering what kind of programs 640 are instituted in New York that are really getting involved witr P6 In other words, not where we are dealing with professional socia workers or situations like this. I think this telephone idea is an ex cellent one, but are there any programs that are getting people in al walks of life involved with the senior citizens, who can stop m an( visit perhaps during the daytime and make calls. .*,«■, I am sure many of you read the article 2 weeks ago in the bunda; New York Times. It was a very touching story of this elderly womai who died. It gave a little of her background. From one organization- I don't remember the name of that particular organization— a gentle man came out and talked with this elderly woman a day or two betor she died, but she responded and smiled and laughed a little and it wa the first laughter that had been in her life in years. This type of thing, it seems to me— the 30b is getting people or in all walks of city life to get involved, to make a call to see some body because so much of this is loneliness. Eating alone, as you spot of, is a real problem. I wonder what is being done in this area. Whj is the motivation that the city, let us say, is giving to people to d ' Mr Sugaeman. I think the initiative in this area has come muc more heavily from the voluntary organizations than it has from tl city. The church groups, the settlement houses and senior citizen o ganizations have done a number of things. m Again, it is a problem of dimensions, that their efforts are reac ing a very small fraction of the people they should. I believe that tJ city ought to display more initiative in this respect, and this I mu say is true not only with respect to problems of the senior citizens, b with respect to a whole lot of things in the city. Whether it is the operation of our parks or recreation areas, or tJ operation of our Headstart programs, the operation of our nospita there are tremendous opportunities for human beings to be helpful 0I The mayor has discussed this question at his cabinet meetings bi as vet, nobody has really developed a concrete plan to make it ha pen. There are sporadic things. For example, there is a group call the Friends of the Parks which does a great deal of valuable work conjunction with the Parks, Eecreation and Cultural Affairs Adim S Headstart prop-rams have large numbers of volunteers both amo: senior citizens and also among young people who like to work in the programs but I think there really is room for a much more massi effort, using public funds essentially to provide the logistics for it, arrange f o? somebody to recruit the people and to assign them a things like that. , . . There is also a need often for things like transportation money a lunch money. Many older people who would l*e very much to voli teer simply don't have the dollars to get there, but that is a pretty lc cost operation compared to hiring a social worker. We certainly, seems to me, should be doing more of that. t Mr Peyser. I happen to feel very strongly in this area becaus. think this is one of the real problems. Up in my own area where have these problems but not nearly to the extent, of course, as the . , The program officially began in 1965 with the signing of the Old* Americans Act, and at that point many of the State organizations c ao-ing began to be established. In New York our office on the agin was created in 1961, so we had somewhat of a jump in terms of gettm into running programs. We were not the first State to submit a State plan and, as a matt< of fact, it was well over a year before the programs actually bega here in New York, the first 20 projects having begun in January < The plan was slow in coming for the simple reason that we ie that it required a great deal of time and thought to prepare for tl flow of money that could be available to local communities. Now our plan in New York took some variations that do not exi in other States. The principal one of these is that we decided "to pi our money where our mouth was," and here again I think there is parallel that was lost in the creation of the Administration on Agin As a unit that reported directly to the Governor and was responsib for letting him know what the needs of older people were, we ask( the Governor and the State legislature to very dramatically demo: strate the kind of interest they had in older people. What this meant was that our State decided i(, would financially participate along with the Federal Government in every title Ml pro- tram that was going to be approved in New York. And I am happy to say i ! ;;i( that kind of commitment still exists. I am sure we are the only Slate iu this Nation that financially par- t icipates in each and every title III program we approve paying one- half of the non-Federal share in hard dollars. Iu our 5 years of oper- ating programs, this has meant the release of over $1.2 million in State money. Now the release of that money has meant something else as well — and that is that many local agencies that otherwise might not have been able to apply have been able to come to us for local programs. And I might point out that the local share in New York is a cash contribution. It is not "in kind" as it is in some other States. The title III program has funded 44 projects in New York. At first, one might not think this very astounding in terms of 5 years of opera- tion — and I know some States may have a larger number of projects, but again, there was a variation in New York. We had more older people in our State and we had a higher level of professionalism in terms of the people who worked for them, and so, our budgets for local programs were considerably higher than for other States. The range was from $2,700 for a local program in Poughkeepsie to a $395,000 program in New York City. So when the Areawide Model program came into existence under the Administration on Aging, we were not too flabbergasted by it, be- cause, in fact, we felt that we had been running similar type opera- tions already — the only difference being that we called them title III projects. Now Congressman Brademas and Congressman Reid have been inti- mately involved in the Older Americans Act, particularly the 1969 amendments thereto. I think that they probably share the same sur- prise and sorrow to see what happens to good legislation that is poorly administered. The Administration on Aging has lost their research and demon- stration programs. They have been conveniently shuffled off into another area. The Administration on Aging itself is now buried under the Social and Rehabilitation Service. The continuing Foster Grandparents program and the new Retired Senior Volunteer program that came into existence have been marched out of the Administration on Aging into another superagency called Action. Now I don't know how Action is going to approach serving older people in New York State. We are talking about 2 million people 65 years of age and over. We are talking about a million of these who live right here in New York City alone. ^At the moment, $5 million is available for RSVP programs. Just lightly over $12 million is available for Foster Grandparents pro- grams. If we left them to their own devices. I wonder what the new Action agency would feel was its responsibility to 10 percent of its clientele group, namely, New York State's older population. But rather than wait for them to make the decision, I think we are going to go to them and tell them what we think the slicing of the cake oueople in the city. We need more of them. They need more help as veil with the very frustrating problems of trying to deal with the con- tracts that come along both legislatively and in certain curtailments n programs. If there is one thing I want to stress it is the fact that there is evi- lence for the need of a clear-cut advocate for the elderly. We have een in New York City and New York State a diminution of programs I the whole area of housing, in the area of nutrition programs, and vq are on tenterhooks with regard to a very important prgoram which >ur office administers directly and that is the Eeduced Fare program. We have some 700,000 old people, residents of New York City, who ire participants in that program. Briefly, this allows them to travel >n our public transportation systems, subways and buses, at the mo- nent at half fare. When I said we were concerned with regard to the continuation of hat program, as we have known it as a half-fare program, we are •eferring to the threat of an increase in the transit fares, and we are lopeful that we can retain this very vital program which enables older >eople to get out into the community so they can get to friends and •elatives, to clinics and other places of need. The city of New York, you might be interested, pays to the Metro- )olitan Transportation Authority the sum of $15 million a year for hat program, so it is no small figure that is involved. I could go on to talk about the things we have done through our esearch department. We are soon to have a fairly massive study •eport out based on interviews with 1,500 elderly in the poverty areas )f the city. Interestingly enough, there are fewer older people in these poverty ireas than in other parts of the city. We have recognized this. This s a fact that we will be attending to from here on in. As I said before, we are not bound now to stay in and close to the lew model city areas, although we will continue our work there. I ;hink there is clear evidence that the elderly have to have an advocate 646 that is clearly identified because I think the communication to then is that we as a nation care when there is evidence of something thai is tangible by way of a Federal agency. Again, there have been all kinds of suggestions as to its placemen organizationally. We would certainly go along with upgrading th< location of the Administration on Aging, even to the Cabinet level. I think it is an important enough area to warrant even that. Cer tainly we would like to see its position restored rather than as hai happened over the years, its various parts being eroded. I think I would like to end here and maybe the questions would b< more fruitful. Mr. Brademas. Thank you. Mr. Shroder, would you summarize you: statements for us? STATEMENT OF JERRY SHRODER, EXECUTIVE SECRETARY, CITI ZENS COMMITTEE ON AGING, COMMUNITY COUNCIL OE GREATEI NEW YORK Mr. Shroder. A few personal notes first, Mr. Chairman. I would lik to support my colleagues' welcome to all of you to New York and par ticularly in my case, sir, to you as the chairman, having been one o your constituents in Indiana for a year, and having visited with yor as a matter of fact, in your parents' home one Saturday morning 11 years ago. Some of the things that have happened to me in the interim were a a result of that interview. Mr. Brademas. Thank you very much. Mr. Shroder. Also, with respect to the way in which I am listed d the program this morning, there is a minor error which should be cor rected. My affiliation should be listed as the "Citizens' Committee oi Aging," not the "City Committee on Aging." I make that distinctioi because we want to be certain it is understood we are not an agency o city government. I addressed my prepared remarks to the Older Americans Act an< its continuation in two basic areas. One, the operation of the grant pro gram and the other the possible future structure of an aging agenc; at the Federal level, specifically with regard to the enactment of th law in 1965. Anyone who has been in the field of the aging for any length o time had great hopes at that point that we were really going to have I major Federal entity in the field of aging in spite of the fact that th initial appropriations were very small. I think we have all been sadly disappointed and disillusioned in th years since. I won't repeat what my predecessors have said, other tha: to emphasize the fact that there has been considerable disappointmen among many of us in the field during that time. This extends to a number of areas, not the least of which is the ap parent breaking up of the Administration on Aging, which has alread; been mentioned. In this connection, much of that which I have to sa; derives from my previous experience with the State office for the agin, with which Mr." O'Malley is associated. I was there during the enactment of the Older Americans Act anc in fact, was the staff person responsible for the administration of tha program in the first year of its operation in New York State. 647 This leads me to offer several other observations about bow that |eveloped. In the first instance, wq had hopes that the funding formula s originally established in the act- which provided Federal funds on declining income basis over a 3-year period — might possibly be snored, or that there might be subsequent amendments fco the law rhich would modify that formula. Our basis for hoping that this might happen related to the Economic )pportunity Act which had been enacted just the year before and Much, if you will recall, provided 90-percent Federal funding and then eclining Federal participation for the next several years. Because of community pressures, you will also recall that that OEO ormula was never implemented. That is, the high Federal dollar ratio ontinued in the funding of the poverty program from the beginning, s I understand it, until the present. We who had some responsibilities for the administration of the )lder Americans Act were not so fortunate. That is, the declining in- ome proposition in the original 1965 statute was, in fact, carried out. t leveled off at 50 percent and the States and localities were respon- ible for supporting the remainder of the cost of the project. So a principal point I would like to make is that in view of what has appened to our capacity to produce funds in the voluntary sector at le local level, the notion of the seed money concept, which assume >cal capacity to pick up costs when Federal and State funds are with- rawn is, I think, virtually a thing of the past. I hope that this will be taken into consideration in future enact- lents. To my mind, this is terribly important and I say it with some jar and trepidation because I am not certain we should be totally de- endent on Federal dollars. The realities of the situation are that this 5 what is happening to us. In the same vein, the initial language of the Older American Act de- reed that projects would be funded for a limit of 3 years. A subsequent mendment a few years later added additional years to that provision. My same position would pertain here ; namely that the concept of the emonstration just isn't viable anymore in terms of our ability to ob- lin funds at the local level. One of the real hazards for anyone apply - ig for a project today in which Federal funding is involved in the al- lost certain knowledge that if it is funded on this basis, at some point own the line the applicant will have to come up with local funding. [i most cases, this is very difficult to do beyond, let us say, a 25- to 50- ercent local contribution. In terms of the future of an agency in the Federal Government deal- lg with problems of older people, I am now convinced that the struc- ire and the housing of the agency is not as important as the commit- lent and the leadership. Therefore, in view of the fact that the locus of aging leadership iems to be transferring from HEW to the White House which I prob- bly would not have suggested or recommended, it is possible to create a itisfactory structure there, provided the commitment and leadership i present. This is the primary consideration. If the President and his domestic staff are going to give this a high riority, then let's try it there. If not, let's put it someplace where it can et that kind of leadership. 648 One more comment directly to you gentlemen, and that is, we have al] been tremendously impressed in the field in the last 10 years with the work done by the Senate Special Committee on the Aging There have been resolutions before you with respect to the establishment oi 8 Select Committee on the Aging in your chamber. I understand there are political reasons why that has not beer adopted by your body. I am not sure it would be in order for me to sug- gest that any resolution currently before you should be adopted bui I would suggest that the cause of older people would be much furthei advanced in your Chamber if there were some committee which hac full-time responsibilitv in this area in much the same way as tin Special Committee on Aging has had m the Senate. I don't know where it should be lodged and I don't know politicall; where the leadership should fall but I believe the 435 Members of you Chamber would have a much sharper focus on problems of older peopl than they perhaps do now if such a body were created. Inank you. Mr. Brademas. Thank you very much, Mr. Shroder, for your open ins; comments. It also is good to see you again after all these yean As I listen to the excellent statements of all three of you gentleme I come to the conclusion that there are certain themes that run throug all of your statements. One is that a good deal more Federal mvesl ment is needed in terms of money. . . : 4u;il The second, that a good deal more is required in terms of visibilit at the higher levels of responsibility in the executive branch so tar g programs that affect the aging are concerned. And to make a more general comment, that a good deal more con mitment is required on the part of the Federal Government. I don wish to be particularly partisan here this morning, although I am pe. fectly prepared to be so, but I would just observe Mr. Shroder b moving the responsibility from, let's say, HEW to the White Houi will realty not solve the problem unless there is action that match I^doesn't really solve the problem to send the resolutions over to tl White House. So that, I think, is a large part of the problem. Let n ask a couple of more specific questions. Mr O'Malley, you made a very telling point about the role oi hta leadership being played in New York so far as the title Illprogram concerned. What can you tell us about the point to which Mr. Suga man addressed himself; namely, title XVI of the Social Security A program so far as New York State is concerned? What kind of mon do you put in and if you don't put in very much, why not? " Mr O'Malley. This is not one of the programs in our onice. btj turally, it is in the State department of social services. The State pi has been submitted by that department, and when it is put into opei tion, it will be administered by the department of social services opposed to our own office. m Permit me to put something in perspective. When Mr. bugarm mentioned the figure of $300,000 in State aid, he was referring to t prooram called the Recreation Council for the Elderly which v established in New York in 1956. That program provides State aid localities to pay for the operation of senior citizen clubs and cente At this pointin time I believe there is an allocation of about $80U,l of this is earmarked for New York City, and, as Mr. Sugarman m 649 cated, the city even exceeds their loea] matching (<> (lie point where they are committing some $3.5 million to senior citizen clubs and centers. This now title XVI program can stretch those funds even further. However, it is a question of how much the Slate and the city arc prepared to match in order to cam the 75-percent Federal funding and I wouldn't presume to judge what the decision will he by either the State or the city. Mr. Brademas. I just raised the question because it does seem to me that without having gone into it in any great depth, and 1 do hope our subcommittee, in whatever Stales we visit, will raise this question with State officials of both parties. What are you doing in order to help solve some of these problems by investing some State funds in order to take advantage of the title XVI program? Mr. O'Malley. I do not know the exact figures. Mr. Bbademas. Could you get them ? Mr. O'Malley. Yes ; I could. Mr. Brademas. If you could tell us what New York State is doing in the way of trying to take advantage of the title XVI Social Security program in State funds and OEO. Mr. O'Malley. I will. (The information follows:) State op New York, Department op Social Services, Albany, N.Y., December 13, 1971. Hon. John Brademas, Chairman, Select Subcommittee on Education, Committee on Education and Labor, U.S. House of Representatives, Washington, D.C. Dear Congressman : Mr. James J. O'Malley, Acting Director of the New York State Office for the Aging, has asked us to supply you with information on the amount that New York State is currently spending for services under title XVI programs. That information is contained in the following tables : [In millions of dollars] Federal fiscal year- 1972 1973 Gross expenditures _ . $44.0 Federal share """" 33*0 State share I" I™ .""""" 5^5 Local share. ll""ll"lllll'. 5. 5 $55.0 41.3 6.9 6.8 These expenditures are for programs such as homemakers, housekeepers, senior services centers and direct local administrative costs for services to the AABD group. We have recently clearance from HEW for the implementation of an expanded Senior Citizens Center program and this accounts for a large portion of the esti- mated increase for the next fiscal year. If you need additional information or if you have any questions concerning this data, please let us know. Sincerely, Barry L. Van Lare, Executive Deputy Commissioner. Mr. Brademas. I have many more questions, but as I say, I am going to move along. Mr. Hansen. Mr. Hansen. I would like to make an observation in response to some points raised in the course of the testimony. Some apprehension has 650 been expressed and disappointment expressed over changes involving Administration on Aging. I think those expressions stopped short of making final judgment. I think perhaps it is appropriate. I think Mr. Sugarman made the observation in the course of his com- ments that problems relating- to the aging cut across all departments; Transportation, HEW, Agriculture. They also cut across somewhat the jurisdictions of a great many committees of the Congress, which might suggest at least the possibility that there would be less direct responsibility in Congress if a committee with purely oversight func- tions were created. At least this is one of the potential disadvantages of the organiza- tion of a special committee without legislative jurisdiction and one of the advantages of retaining responsibility in the Ways and Means Committee and Government Operations and this subcommittee and others that have legislative authority, the power to translate some of these recommendations into action. What this is leading up to is my comment with respect to the organi- zation. The final test I think is yet to come but I think the initial action follows some of the changes that many have interpreted as the weak- ening of the Administration on Aging, which suggest that there has been no lessening of the commitment. The research and development functions were transferred into a laro-er framework within which related problems can also be dealt with and one can reinforce the other. The funding for this program has, in fact, been increased. Now I am not prepared to say whether they should finally rest m one administrative framework or the other. I think the test is going to be m the performance and that test is yet to come, although the initial signs are somewhat encouraging. _ OTm The same is true with the Foster Grandparents and the RbA^F pro- grams. The funding has actually been increased. When this came to Congress I had real reservations but the fact is Congress gave its blessing to that reorganization plan when it voted to reject a resolu- tion which would exercise a congressional veto. Ao-ain, the purpose there is to involve other resources so that one kin(f of volunteer program can reinforce the other because the prob- lems are not peculiar in many respects to the aging. Ao-ain the funding in each case was increased. In the case ot the RSVP from just a beginning, admittedly $500,000, it was increased to $5 million. In the Foster Grandparents program, the appropria- tion was increased from $500,000 to $12,750,000. m '.- Maybe this won't be the place it ought to rest, m the final analysis. Maybe out of the White House Conference there will be recommenda- tions. - . . . _ . , , . , Mr O'Malley. Mr. Hansen, I wonder if I might pick up on a point. You were talking about the transfer of volunteer programs to the Action agency. I know Congressman Brademas would be inter- ested in what happens to his legislation when it gets administratively strangled, as we think it is. . . The new Action agency has turned to the State units on aging and asked them to handle the receipt of letters of intent and applications, to review them and to send them on to Washington where final deci- sions on funding will be made. 651 Now that is a nice procedure in terms of the new Action agency, but je who have to administer State programs, with wvy small staff, lat cover many areas find i( difficult to justify the use, of our stafi d do the work of another agency particularly a Federa] agency. Vhat we have, in fact, is the responsibility without the authority. We can make recommendations on programs, but they don't have d be accepted — the funding mechanism would be directly from Washington to a local community. I am now in discussions with the bople in Action as to exactly what the legislative intent was and pat t heir operating procedures are. The law reads that a State agency or a public or nonprofit group In apply for RSVP programs. The Action agency also admits that luch of the development of their program has depended upon what re did here in New York in the last 2 years with our serve-in-New fork State volunteer programs. I know Mr. Rittenberg and Jean Carey are going to talk about le Serve program. In Staten Island there are 650 volunteers working l that one location. In 38 communities around the State there are nother 750 volunteers. We have demonstrated what can happen and T e have shared this with Action. We are now suggesting that, as a State unit, we think we know ■Lat we are doing. We would like to be able to make an application nder the provisions of the law, and yet, we are told that the Office f Management and Budget has other ways of viewing this ; namely, lat a State agency would not be a particularly good sponsor for an lSVP program. They would much rather see local agencies funded irectly from Washington. Now this removes what we think is a responsibility in our State to versee the development of programs providing volunteer opportuni- ies and it is administratively being taken away. Mr. Hansen. How did you handle it before ? Mr. O 'Mallet. There were no programs funded. Before the transfer f the Serve project it was paid for under the title III program. Mr. Hansen. You are arguing partly my case, which has been lost l so many other decisions, on the relative role of States and local gov- rnment. Without pretending to know the difficulties that you face, I wouldn't lose this opportunity to make a strong pitch for a meaning- iil role for a State government to the extent the States can demon- brate their capacity and willingness to perform. I won't pursue this, Mr. Chairman. We could spend the rest of the lorning. Mr. Warrack. Mr. Hansen, I wonder if I could make one point. r ou were speaking on the matter of commitment which Mr. Shroder aised earlier. I think for many older Americans one of the signs of ommitment would be a clearly identified agency located in a place hat would be a communication to them that someone is watching what 5 happening. Whether they have legislative power directly or not, think it would serve as a focal point certainly. For me at any rate, I would not like to lose this point of there eing this focal point that older people can clearly recognize, and o it doesn't get lost in the shuffle among the many comniittees that .o have legislative authority. Mr. Brademas. I might just observe before calling on Mr. Scheuer, b was, I think, last March that our subcommittee learned that the 71-272— 72— pt. 1- -42 652 plan of the administration to cut back the budget of OEO in respec to several programs to which Mr. Hansen referred, and we callec hearings of this subcommittee and raised cain about it. Both majority and minority members of the subcommittee com plained very deeply about it and I am glad to see there was a respons and the Secretary restored the funds and even provided some more Mr. Warrack. This is a good example, of course, of another, agenc; having a bearing on the services to the elderly. I'm referring to th cutback in the legal services program of OEO. We are finding, on th local level here, an increasing need for legal services of all kinds fo older people, not the least of which is around the whole area o housing and rental cost problems. Mr. Brademas. Mr. Scheuer. Mr. Scheuer. Mr. Warrack, the time is running out so I would lik to be very brief and just ask one or two questions. I understand you office is doing a research document on the needs of the elderly in th inner city. Mr. Warrack. That is correct. To describe what the elderly peopJ in the inner city need. Mr. Scheuer. Can you tell me what the status of this study is ? Mr. Warrack. I would have liked to have been able to bring tli final report along. It is not as yet ready. We are expecting it will I momentarily. Mr. Scheuer. How long a report will it be ? Mr. Warrack. I can't tell you the number of pages, but to give yo some idea, as I mentioned before, there were 1,500 older people wh were interviewed and each of those interviews entailed asking some £ questions. Mr. Scheuer. Would you be good enough when you get that repoi to send a copy of it to the committee and if it is too long to include * this point, perhaps your list of recommendations could be included ? Could you summarize roughly what your conclusions will be ? Mr. Warrack. I can't really because the study was so broad-rangin It covered all aspects of housing, isolation and loneliness to nutritio: economics and so on. Mr. Scheuer. What are your conclusions? What do our elder] need that they aren't getting now ? Mr. Warrack. I think the answers to those questions have certain! been touched upon by the many comments so far. ^ Mr. Scheuer. Have you produced any insights in this research r port that would add to what we heard today ? Mr. Warrack. I hope we will. The status of the study at the m ment is that the data is all processed and is being analyzed, and insigh are being teased out of this data now. It is, as a matter of fact, almo done and when the report is ready we will make sure to get it to you. can't be more precise than that at the moment. Mr. Brademas. Mr. Peyser. Mr. Peyser. Thank you, Mr. Chairman. Mr. O'Malley, I think, : your statement you mentioned the fact that New York City is makir 50 percent in real contributions — that is dollars I take it rather th* in-kind. Mr. O'Malley. Yes, in terms of our Title III programs. Mr. Peyser. In other words, does that mean New York City is pu 653 ting par dollars in this thing rather than being able to get people working Tor an in-kind type of thing? Mr. O'Mallet. We contract for Title III programs in New York State. This is required constitutionally when the Stale government provides funds to a private, nonprofit organization, [f we tools the Federal funds and worked only with public agencies we could provide a grant program — give them the money in advance and le1 them account for it later. But since we were working with many private, nonprofit groups, the constitution required that we have a contract reimbursement pro- gram. The services must have been rendered before payment can be made. We decided that since the program asks that local sponsors continue operation after 3 years — this is the way it was originally written — the only way we could sincerely convince ourselves that this might happen is to ask for those hard dollars right at the begin- ning and gear the local program up for w T hen they would have the total budget at the end of 3 years. When I say hard dollars, we would consider the time of a staff person who was employed by the agency as a cash contribution. In other words, the local agency was actually putting out dollars for that person's time. We would not allow such things as the "in kind" value of furniture and equipment which was purchased earlier to be used as a local share. There is no dollar expenditure for our program involved here. Mr. Peyser. What about people's time ? What discourages me a little is if this concept is, in effect, saying to the city — and the city is cer- tainly hard-pressed for any of its dollars anyway — put up your money instead of putting up people or volunteering people who are going to do the services, frankly I w^ould much rather see the people there who are doing the job than to see the city pay out the money to get people to do the job. Mr. O'Malley. I don't think they are mutually exclusive and it has not happened that way in our program. Quite honestly, we were caught in a dilemma. How do you face the dual responsibility of meeting this continuation afterwards, and yet, as you say, providing the easiest way for a local sponsor to meet his share of the project costs. I think when New York State put in money to pay for half of the local contribution, this eased the burden on localities. And so, I don't think the local "cash" contribution was so severe in this case. What it also had the good effect of doing was limiting "pie-in-the sky" type proposals — when you really had to sit down and find out what you could afford to run. I think we got more realistic projects in New York as a consequence of it. Mr. Peyser. If I may, Mr. Shroder, you had indicated, I believe, that money on a voluntary solicitation basis — I believe this is what you are speaking of — has not been forthcoming. Is this correct, that you no longer could see how voluntary money could be used or could be ob- tained and that is why you must get the Federal contribution ? Mr. Shroder. Let me elaborate on this a bit. The program, as it now stands in New York State, is such that at the end of the first 3-year contract most programs are terminated from any further Federal and State financing, so that by year 3 in the project contracts, you have a 50-25-25 funding formula. 654 In most instances, beginning on January 1 or whatever the anni- versary date is of year 4, the project must go virtually 100 per- cent local. In other words, that means going from 25 to 100 percent. My concern is that many of these projects have demonstrated them- selves to be quite successful and to be meaningful in the community but have not been able to bridge that gap between 25 percent at the end of year 3 to 100 percent at the beginning of year 4. Mr. Peyser. I guess my concern is that this is a time while money is difficult, many organizations are voluntary organizations, are rais- ing more money than they ever raised before, even with the money as tight as it is and the economic situation and I am concerned that something as important as this doesn't seem to be able to get this kind of support on a voluntary basis, if that is what you are saying. Then I think maybe we ought to be working and redirecting our efforts on how do we get the voluntary aid. I am not trying to get the Government off the hook but I think the commitment has got to be here on both ends of this line. Mr. O'Malley. I think you are going to see the opposite though,. Mr. Peyser. The United Way has very strongly suggested to their loyal constituents how they can become vendors under the title XVI program. I think this kind of directive speaks directly opposite to what you are saying. Mr. Peyser. My feeling is, I want to get those people's money and people themselves into the programs far more than they are in it today. I become unhappy if the concept is only looking to Washington for more money. I agree with the need for more money but I hate to shut off this other sector which I think is vital. Mr. Shroder. I think one universal statement would apply both to the public and voluntary sectors today. It is very difficult to get any new money to expand anything beyond the level of the status quo so that an agency which has, let us say, contributed 25 percent of the cost of a project will do well to continue with 25 percent of the cost of the project. But what is extremely difficult is to double or treble or quadruple that figure to try to maintain the operating level of the total program. Mr. Warrack. I think there are two other points here too. When you speak of the ability of the voluntary agency to raise funds, funds can be raised more easily for certain kinds of causes. I am not so sure that raising money for the elderly is as appealing as for little cripple children. Mr. Peyser. That is exactly the thrust of what I am taking. I think there is a great deal to be sold and told about the problems of the aged to make it appealing. Mr. Warrack. Also on that point, and also in relation to what Mr. Shroder was saying too, if you have a well-working agency with an effective staff that is providing direct service to the elderly you can't expect them, at the same time, to put in the kinds of know-how and energies to organize an adequate fund-raising effort. That requires staff time and energies too. Maybe that can be dealt with with some special programs. Mr. Peyser. Thank you, Mr. Chairman. Mr. Brademas. Gentlemen, thank you very much indeed. Your testi- mony has been most helpful. The Chair wants to observe we now have three panels with several persons each on them to appear so we are simply going to have to im- 655 pose time Limitations, which is fche way the I louse of Representatives often operates. Because there are 435 of us we arc often compelled i<> speak for only a couple of minutes at a time. So what, we are going to do is devote 20 minutes to each of < be I hive panels. That will brine;- us just, a Little overtime in any event. Would the members of the first panel please come forward. We shall include the text of your prepared statements in our hear- ings if each of you will be kind enough to limit himself or herself to just 2 minutes to summarize the major points you would like to make, then the four of us here would have a chance to put some ques- tions to you. (The documents referred to follow.) Prepared Statement by Miss Mary Cannata, Project Director of the Meai.s- On-Wheels Program, Stanley M. Isaacs Neighborhood Center Mr. Chairman and members of the committee: I am Mary Cannata, Project Director for the Meals-On-Wheels program at the Stanley M. Isaacs Center, New York City. I would like to thank you for this opportunity to give testimony relating to the nutritional problems of a specific segment of our population, namely the frail homebound elderly. For the past five years, the Meals-On-Wheels program, Project No. 46, has been funded under Title III of the Older Americans Act, through the New York State Office of the Aging. The primary purpose of this project is to supply a hot noonday meal and a supper, daily, seven days a week, to the incapacitated elderly, who are unable to shop or cook for themselves. We hope through this service to reduce the incidence of hunger and malnutrition so often found among the aged isolated ill — especially those without relatives or friends or the finan- cial resources to hire a housekeeper or to have meals delivered from a commer- cial establishment. A second purpose is to improve the nutritional status of the infirm in order to postpone or prevent institutionalization in a home for the aged, nursing home or some other extended care facility. The current cost is $10,000 a year. Fear and anxiety of leaving one's home to enter a communal living arrangement is often such a traumatic experience for the elderly that within a month's time, a large number die. A third purpose of the program is to reduce the length of hospitalization time for those who have no one to assist them upon discharge. In addition to the preceding, we have attempted to provide auxiliary com- prehensive care by information and referral service in the areas of health, hous- ing, financial and familial problems. Thus far we have served 375 persons in Yorkville and East Harlem a total of 57,410 meals. The majority of these recipients live in dilapidated walk-up tene- ments. It might be appropriate at this time to consider the costs involved to the public, if the Older American Act is terminated, and this particular project abandoned. The daily cost of care in a New York City operated hospital is approximately $105.00 daily or $38,325 for a year. The cost for a patient receiv- ing only custodial care in a nursing home is $27.00 daily or $10,000 yearly. When we compare these amounts with the $1,000 yearly cost per our forty recipients, one can readily calculate the enormous additional revenue required from the taxpayer. Private citizens as well as public and private agencies have expressed con- siderable interest in this home delivered meal program. We have received nu- merous requests for service or information on the procedure required for the establishment of similar projects. The need is overwhelming and unmet throughout this city, state and nation. The support from the New York State Office for the Aging, without which we could not run the Meals-On-Wheels Program, has enabled us to care for a small fraction of requests for assistance. We can no longer ignore the pitiful plight of this group who cannot leave their homes to make their needs known. 656 Testimony by Mrs. Robert J. Chapman, Board Member, Stanley M. Isaacs Neighborhood Center, Inc. Mr. Chairman and members of the committee : My name is Ann Chapman. I am a Board member of Stanley M. Issacs Neighborhood Center and was its first President, helping to plan and establish a Meals-on-Wheels program financed largely under Title III of the Older Americans Act. That was some five years ago when Isaacs Center was itself new. I want to thank you for letting me testify, but in addition I will thank you ahead of time for listening to me, because many of us have the distinct impression that there are some very hard-of-hearing people in Washington. I am here to demonstrate against the idea of a demonstration project being cut off from future funding once it has proved itself— 'and any Title III project, as I understand it, fits that category. The sponsoring agency for a project provides an increasing percentage of the money each year, starting at 12y 2 % the first year. Then, when time, effort and the taxpayers' money has produced a viable service (in this case Meals-on-Wheels to the elderly homebound), what happens? The theory, I presume, is that the community will be so enthusiastic it will pick up the tab. Let's face it. For even the most well-established agency that is asking a lot. There are requests to pick up the pieces of a great many problems, and the elderly, especially the elderly homebound, are not apt to (be the squeaky hinges who get the attention. They don't have the strength to make much noise, and they can't picket because they are behind the closed doors of their apartments. Is that any less reason for us to provide only lip service and not concrete service, such as food in their mouths? By lip service I am referring to the public and private officials who have ap- peared from the city level to the national level to appraise the Meals-on-Wheels service— and to praise it. Naturally we are proud of Meals-on-Wheels and want to show how it operates. Nevertheless, when our worry over financing is greeted with "Great program," "Much needed service", we have reached the somewhat desperate point of wanting to say, "Put your money where your mouth is". Great sympathy is professed for the plight of the elderly— when it is election time or when reporters are around it is particularly conspicuous. Last week I made a field trip to a children's center having nothing to do with Isaacs Center. As I left, the parting shot from the rather militant Director was "Don't come .back without money." He was sick of the bureaucracy down- town and I represented the central office. I thought to myself, "I don't blame him a. bit, That's just the way we've begun to feel about Meals-on-Wheels". What we ask of you as legislators is that you put the money in the right place. Into demonstration programs? Yes, but when the program turns out to be a good one— be it Meals-on-Wheels or any other that has proved itself— dpnt let it be discontinued. When the shakedown cruise has been made, don't sink the ship unless the ship is full of leaks. This ship is sinking from lack of funds be- cause it has been bombed by unsound legislation and voting. I say this as the spokesman for a private agency which will have raised by the end of our fiscal year as much money for Meals-on-Wheels as has been received from the public sector— if we raise it. To be specific I am speaking of $84,000 received from New York State Office for the Aging and $90,000 raised by Isaacs Center over a five year period. Obviously we believe in the service, but financing cannot continue in such a hand-to-mouth manner. I would like to think that sensible legislation and intelligent voting by Con- gress is the answer. In the case of Title III, wouldn't it be more logical to keep what is going alive, and even to expand it if it is feasible? Instead the cancer of bureaucracy is spreading— each agency, public or private, wanting to do its own tbing iust so it will eet a piece of the turf, even if it means starting anew. I close with gratitude to New York State Office for the Aging for having enough confidence in the Meals-on-Wheels service at Isaacs Center to give it a badly needed transfusion. But I also close with bitterness, not just because Meals-on- Wheels is under-financed, as are the indigent elderly the program serves, bu1 because Title III programs which have demonstrated their effectiveness are destined for the scrap heap if you legislators do not take notice. Statement by Mrs. Elizabeth Stecher Trebony I am the Director of Project FIND and FIND Aid for the Aged, Inc., a senioi citizens program on the Lower West Side of Manhattan m New York City ('>;>/ I started as a demonstration program in July L967, funded by the Office of fcmomic Opportunity tbrougn the National Council <>n the Aging. par program was continued with local OEO funds after demonstration funds me discontinued in October L968. The need for the service aspect of our pro- am was evident: when we started in L967 there were no service agencies ciusiveiy working with the aged, who constitute 23% of the total population, 27,000 persons over the age of ('»•">, Living in a 240-square-block area, 34th t<» th Streets, Sixth Avenue to the Hudson River. Based on 10%-sainple survey ■ducted by FIND 1!)(>7 68, the median income Is $1,500 annually. Ours lias been an unusual program in that we persistently reach out Into the minunity to bring services to senior citizens; anything that affects the aged in e 240-block area we consider to be our responsibility. We are responsive to all ents from supporting senior citizens being evicted because of building demoli- >n to launching a door-to-door information campaign about the availability Federal Food Stamps. During the 4 1 / 4 years of work in the community, our staff has serviced almost )00 seniors. Today we have a network of senior citizen clubs in donated space four church basements and one settlement house. Our club membership mbers close to 1,000. We have recently opened a free Coffee House for senior citizens, jointly spon- red by Project FIND, the Port of New York Authority, the New York City fice for the Aging, and the Travelers Aid Society of New York. It is a coopera- te effort to answer a serious problem evidenced in every urban area : senior izens congregating in public places because they have no place else to go. le FIND Coffee House is funded privately by the Port of New York Authority, e Federation of Protestant Welfare Agencies, the New York Foundation, and lividual contributions. Within three months of operation 650 seniors have come members and daily attendance has reached 125 persons. Four local urehes, one Catholic and three Protestant, have joined together and formed lunteer groups to open the Coffee House every Sunday afternoon. We started FIND with a staff of 35 senior citizen aides, working part-time, and caseworkers. Our program was cut to 7 senior citizen aides and 3 full-time iff — the Director, one Caseworker, an Assistant Caseworker — when demon- ration funds were discontinued in '68 and we became funded by New York ty's umbrella organization for OEO funds, the Community development ;ency with a $50,000 annual budget. Our work consists of service to the homebound — escort service to doctors, spitals and clinics ; emergency homemaker and home visiting program — case- >rk and referral ; advocacy intervention and organizing senior citizens into mmunity action groups; as well as staffing five senior citizen clubs. Because of cuts in our OEO grants — our staff has received no salary raises in e past four years — transportation costs for escort service excluded and meet- g supplies discontinued, we have raised a small amount of private funds r transportation and service to the homebound. As well, local church and ten- t groups support a free soup-and-sandwich lunch program at our five clubs, e serve free lunches to close to 500 senior citizens every week. 1 welcome this opportunity of highlighting important problems which will rectly affect senior citizens, particularly in the year ahead. Many of us in e field of the aging believe that in the ensuing year senior citizens will be sing a greater crisis in living conditions in New York City than faced in the st ten years. The crisis is caused largely by actions taken this year by the New York State "gislature. Yet, we in New York City have little chance of gaining sympathy 3m the State Legislature. The needs of the aged and disabled in New York City em to sound on deaf ears in the New York State Administration and the State gislature. When facing our State Legislators in New York City with those issues vitally ecting their constituents, they advise that older people must bring their use to up-State Legislators because City Assemblymen and Senators lack the imber of votes to have an impact on the power of the up-State votes. Yet, the use of the aged poor in New York State is overwhelmingly a City cause. Two-thirds of all the State's aged population, or 1.3 million who are 65 years d older, live in the downstate area — New York City, Nassau, Suffolk, West- ester, and adjoining counties to W T estchester. Almost one-half (48%) of the ate's aged reside in New York City — 943,000 over age 65, according to the 70 census. 658 A significant impact through Senior Power on up- State Legislators seems wist ful thinking, because the weight of the senior citizen population, even if senior joined together in their demands, is singularly a small minority in up-Stat counties. By contrast, in the 240 block, small community on the West Side of Mai hattan where we have our FIND program, there are more seior citizens crowde into 4 and 5 flight walk-up tenements and 3rd rate hotels. 27,000 in less tha a 4 sq. mile area, than in three and four counties taken together up-State. Examples of the regressive legislation which promises to make life unbeaj able in the coming year for our senior citizens in New York City are cuts i the State Medicaid program, the removal of vacant New York City apartment from Rent Control, and a State Law which prohibits our City Council froi extending senior citizen rent increase exemptions in January 1972, one of si bills included in the vacancy de-control package supported by Governor Rock feller. In addition, we in the New York City area have been warned that Feden provisions for new senior citizen service programs may be rejected by the Ne 1 York State Legislature. Under Title XVI of the Social Security Act, the Federi Government is offering to put up 75% of the cost of service programs, with tt State 12y 2 % and the City 12%%. The New York State Legislature reported] may not put up a significant amount as the State's 12y 2 % share to make the Fe» eral 75% share of new funds worthwhile in the state. Again, the area to suffer most greviously for such disregard for the aged the State of New York, will be the down-State area. No amount of clamor fro New York City, apparently, will move the up-State Legislators to realize tl enormous needs of the aged poor in the down-State area for such programs. The cuts in Medicaid passed by the State Legislature last June are being he up presently by a lawsuit. But, it is now rumored and City machinery is no being readied to put the cuts into effect in January 1972. These cuts direct affect the aged and disabled. As you know, if an elderly person has Medica but is not receiving Welfare, after January 1972 he will no longer get coveraj through Medicaid for prescription medicines, appliances like hearing aid crutches, eyeglasses, wheelchairs, and home health aides — the very servic which help to keep elderly people living independently in the community, out institutions. Some 200,000 senior citizens in New York City have Medicaid, yet less tm 60.000 are Welfare clients ; the majority of elderly people are too proud to acce Welfare. These 200,000 elderly New Yorkers will have those services, the on services for which they relied on Medicaid, discontinued; hospital and doct bills are covered by Medicare. If Medicare for all senior citizens is not extended to cover what is called pi ventive medical care, like prescription medicines, e.g. eyedrops for glaucom medication for heart disease or diabetes and medical appliances, like hearing ai and eyeglasses, which can upgrade the general physical condition of an ag person, at least Medicaid broad enough to include these needs should be co tinued for the aged poor. The restoration of Medicaid benefits to the aged ai disabled as it appears now will not pass at the next session of the New Yo State Legislature, however, unless pressure is brought from all areas of co: muuity life and all parts of the State, or Federal controls are mandated to t State Legislature to give due recognition to the needs of the aged and disabl poor. . . Vacancv de-control of Rent Controller apartments in New York City is just a other action which heightens the already horrifying housing crisis in New Yo Citv, to affect the aged more cruelly than any other age group. Landlords in N< York Citv, and most particularly in Manhattan, are harassing aged people that apartments can be freed from Rent Control and rents can be appreciat raised. Obviously, the philosophy at work is that it is simple to harass an old worn or man and, because of fraility, he or she may not react quickly enough to avc eviction. The tragic effects of vacancy de-control on senior citizens — 70% whom are renters in New York City— are compounded by rising rents in re dential hotels, one of the few housing resources for the aged in Manhattan, adequate stock of senior citizens residences, and an insufficient number of a( quate nursing homes. At the some time, there are nowhere near enough new or renovated housi: prospects for the aged in the City to be other than a drop in the bucket towa the need for accommodations for elderly persons being displaced, either becau 659 of luxury development. Institutional expansion, <>r the all-out effort to drive older people out of (heir Long-term occupancy of Rent Controlled apartments. in other words, there Is absolutely no place Cor elderly people to move to today in New York City if they lose the small hotel rooms or Rent Controlled apartments which they now have it is vitally important that for (ho sake of the aged poor and middle Income sonior citizens in New York City the freeze on rents lie continued ;it the Federal level. Let the housing situation for the aged in New York City he cited :is n ■rational emergency with no worsening of conditions allowed, until steps can be taken to provide new or renovated housing for the aged living in the City today. If the freeze is not continued, some 29,000 low-income senior citizens in New York City will get a 22% increase in rent as of January 1072. This will occur because the State has prohibited the City from continuing Rent [ncrease Exemptions granted the Fall of 1970 and the Spring of 1971. It is not so simple to say that those who cannot afford a rent increase will just have to take Welfare : this would demoralize the majority such that it amounts in real terms to signing their death warrants. One practical solution w r ould be Federal or State rent subsidies to be granted directly to older low-income people, regardless of where they live : Rent Con- trolled apartments, hotels, adult residences, non-controlled housing units. But the prognosis for this seems dim. Rent subsidies in the past have been restricted to new apartment dwellings, mainly to allow for establishing an economically mixed tenant community which otherwise would be totally middle and upper income. What's called for is some imaginative programming instituted through the Bousing and Urban Development Administration. Here we are in New York City with an old present housing stock which does not meet standards set for being granted funds for renovation. Everyone it seems has his vision set for 50 or 100 years in the future. If in idvance it cannot be surely proved that a building will provide sound housing, with all of the improvements deemed necessary for the health of older people, which will still be serving as sound housing some 50 to 100 years from now, Federal funds cannot be put into the renovation. Yet, all the while, the majority [>f older people are living under sub-standard housing conditions in our City with none of the safety or comfort devices deemed absolutely necessary. Somehow it must be possible to exercise imagination in renovating present housing — new housing takes from 2 to 10 years — just to meet minimum condi- tions, raising sub-standard conditions. For example, on the Westside the hous- ing presently occupied by a great number of senior citizens are Old Law r tene- ments, with toilets in the halls and bathtubs in the kitchen. These are four and five flight walk-up tenements. Another large housing stock are old brownstone and limestone family houses which have been converted to small apartments or single room occupancy Iw T ellings. One idea would be to acquire the brownstones through non-profit community housing corporations and convert them into old-fashioned boarding houses, which abounded at the turn of the century, with communal dining rooms and the personal ministrations of a friendly landlady. But financing for renovation of the brownstones seems bogged down because it is not financially feasible nor physically possible to install elevators. In effect, Federal guidelines for feasible programs for the aged dictate that it is not lealthy for older people to climb stairs ! Isn't it amazing to note that countless mousands of elderly people climb 3 and 4 and 5 flights of stairs everyday, and someone observed that maybe it's for doing that that their hearts are as healthy is they are. It is only chronic heart patients who absolutely should not climb stairs. I am not advocating intentionally asking an elderly person to test his mdurance by climbing stairs, because it is possible to install simple seat elevators )n staircases for the upper levels, but this short-range (that is 25 or 30 year) ipproach is apparently not feasible according to HUD. Thus, because of the mass problems that our mass society presents in New fork City, we in the field of the aging must beg for compassion for the cause of :he elderly poor, and if not openly criticized for our aggressiveness, or what ap- pears to be over-reaction to the mass problem, we are more simply ignored as •ebels by the State Administration and up-State Legislators. Our emergency problems require some emergency measures. I make the follow T - ng recommendations : 660 Extend Federal control of rents in New York City, and establish a specia emergency office in HUD for developing a massive new and renovated housinj program for the aged in New York City. Bv-pass New York State with the offer for funds under Title XVI of the Socia Security Act by offering 75% funding to New York City for services to the age<3 either with the City paying 25% or the City 12y 3 % and private agencies 12% 9 to bring these new funds into New York State. Extend Medicare to include preventive medical care : prescription medicines medical appliances, eyeglasses and hearing aids ; home health aids — or, mandat that the State include such services to the aged, disabled, and blind through th State Medicaid program. Set up a watch-dog Committee of the Administration on Aging to insure tha a fair share (2/3rds) of all Federal funds coming into New York State i allocated for programming in the Downstate area. And demand that senior servic programs be given mandated priority at the Federal level for those program fund presently allocated by the Office of Economic Opportunity. Thank you for this opportunity of giving testimony. [The New York Times, Oct. 15, 1971] Bus Tekminal Habitues Get Own Coffeehouse (By Paul L. Montgomery) Mrs. Bertha Moore is 80 years old and lives alone in $35-a-month room o Tenth Avenue. About the only pastime she used to be able to afford was a tri to the Port Authority Bus Terminal waiting room to watch the world go by. "When I started over there, the cops would come and chase us out," she r< called yestedary. "They would come and look and look at you. I don't like thei looks. Here, you come and nobody looks." Mrs. Moore was one of 150 guests yesterday at the formal opening of th FIND Coffee House ait 425 West 43d Street, a place where elderly habitues < the terminal can come and enjoy one another's company. The opening was the culmination of two years of work by the New Yor City Office for the Aging, the Port of New York Authority, the Travelers Ai Society of New York and Project FIND, a program for the elderly begun by tl Office of Economic Opportunity. FIRST OF ITS KIND "This is the first project of its kind in the country," said Mrs. Elizabet Stecher Trebony, the executive director of FIND (an acronym for Friendlee Isolated, Needy, Disabled). "We've already had inquiries from all over the wor] about it." Mrs. Trebony formed a committee two years ago to study the elderly habitm of terminal. The other key members were Mrs. Stella B. Allen of the city Offi< for the Aging, Marvin Weiss, who was then manager of the terminal, and tl late Herbert Rummel of Travelers Aid. . One of the first tasks was to check on the habits of the terminal sitters. Th was accomplished bv Mrs. Mary Z. Butler, who is 67, and Mrs. Stella G-. Trebon Mrs. Trebony's mother-in-law, who is 72. They set up a table in the terinin waiting room and began gathering data on 84 regulars and 189 sporadic visitor They met some resistance at first, but after a time the habitues began to tal usually prefacing their remarks with something like, "Don't tell anyone, but do sit* here a lot." The median age of the sitters was 69, the average incon $1,500 a year. About 70 per cent of the regulars sat alone; 25 per cent can from outside Manhattan. $35,000 CONTRIBUTED In the meantime, Mrs. Trebony's committee was gathering money and suppo for the planned coffeehouse. The Port Authority, the Federation of Protesta Welfare Agencies and the New York Foundation made contributions totalu $35,000, and there were also individual donations. Last year, a place was found. The Port Authority provided workmen to « much of the renovation. Since June, about 400 elderly people have joined t. project and each weekday from 11 A.M. to 5 P.M. they fill its spruce quarte 661 on the ground floor of two adjacenl brownstonejH to chat, sip coffee, play card*, or read. An arts and Crafts program is offered and so is a referral service lor I hose who have problems they waul to discuss. There is no charge for membership. The average age of the members is to, and the average income, $1,660 a year. Mrs. Trehon.v says that Hie coffeehouse can operate on a budget of $35,000 a year, which is about one-third (he average cost of a city-sponsored senior citizens center. "This is the closest thing to home they've got," said Mrs. Allen. "It's really like an extended family situation. You can talk about things here you couldn't talk about in a more structured place." "I like it very much," said Mrs. Moore. "1 was here the first time it was open and I saw it was nice. They talked to me so nice, I said to myself, these are the friends I should know." [Chelsea Clinton News, June 3, 1971] Health, Foon and Rent : Three Crises for the Elderly (By Elizabeth S. Trebony) Project FIND's Fourth Annual Conference, "Senior Citizens Report to Con- gress," on May 21st came at a time this year which could be described as the most serious crisis for the elderly people trying to live in this city. The West Side's three Congressional Representatives. Bella Abzug, Edward Koch, and William F. Ryan, gave up most of their day for the event, which was co-sponsored by the East Harlem Committee on Aging, Inc. First the Congress- men came to St. Paul the Apostle Church for the morning session on the West Side and then they travelled to East Harlem for the afternoon. Jack Ossofsky, Deputy Director of the National Council on the Aging, was moderator both on the West Side and the East Side. More than 1,000 senior citizens attended. Frustration was the keynote of the day, expressed both by the Congressmen and all of the seniors who spoke out. The idea of the meeting was, as Jack Ossofsky put it, "to bring together the people of the community, the ordinary citizen of our town with their Representatives in Congress who make the legislative decisions." The Congressmen all stressed the importance of Senior Power and exerting pressure. Many seniors wanted to know how much Senior Power was necessary beyond what they had shown and were showing that day in the pouring rain by being there and speaking their minds. One lady in East Harlem said, "Do you expect older people to go to Washington or Albany, when most can't afford carfare to City Hall?" The meetings were planned months ago before many of the recent events occurred which can spell real crisis to the aged in the year ahead. Here are some of the current issues : The State Legislature has passed a bill cutting Medicaid, which appears to be directed straight at older people, because those payments being cut are the only things elderly people rely on Medicaid for : dental care, eyeglasses, prescription medicines, appliances for the handicapped, home health aides for the sick. Federal Food Stamps are slated to cost more next September. Now the minimum an eligible person pays is $9 for stamps with which he can buy $14 worth of food. Stamps are to cost more after September. Mayor Lindsay is cutting the budget and threatens to discontinue the New York City Office for the Aging, the only agent through which elderly people have a voice in City government. Governor Rockefeller has pushed through his proposal to discontinue rent con- trol in vacant City apartments. Elderly people are already harassed because of rent increase exemptions, which are slated to be revoked in January 1972 ; the Governor's proposal will mean that older people will be surely pushed out of their apartments by landlords employing one technicality or another. Medicare is being whittled away year after year such that, while it never covered preventive care that Medicaid presently picks up (eyeglasses, etc.), it is becoming inadequate for proper hospital coverage — last year the cost was increased and this year — in May, Senior Citizens Month — the duration of full hos- pital care has been cut from 60 to 30 days a year. As Stella Allen, director of the West Side Office for the Aging, guest speaker at the West Side meeting, said, "Cut, cut, cut . . . increase, increase, increase. 662 Higher rents in hotels and apartments, higher prices ; increase everything that il takes to live a dignified, comfortable and adequate life." Jack Ossofsky and everyone of the Congressmen deplored the "upside-dowr priorities in this country." Congressman Koch called for the end of the war William Fitts Ryan condemned legislators for "putting ahead of human beings the military, SST, and other irrelevancies ;" Congresswoman Abzug called for "* National Bill of Rights for elderly citizens, who are entitled to decent Socia Security, decent medical care, decent housing, regardless of their ability to pay.' In his summary statement, "A Mandate to Congress," Jack Ossofsky said "Obviously your message to our Congressmen in New York is that you requir< action very fast ; less talk and more action. This is the message that came througl to me as I review the discussions on the West Side and on the East Side today." He summed up those needs expressed in both communities as adequate Socia Security, total health care without the need for additional payments, new am better housing at levels they can afford to pay, with a moratorium on rem increases in hotels and present rent controlled apartments, and finally, mor< vigorous effort on the part of the police to make the streets and homes safe fo] elderly people. In addition to getting the undivided attention of all of our Congressmen fo: this event, the conference this year had several unique features. Present wer< invited delegations from every senior club and center on the West Side, frqn Hudson Guild-Fulton Senior Center on 19th Street to Goddard-Riverside Senio: Center on 93rd Street, a number of which made donations toward the cost o: free lunch for close to 600 on the West Side. The day ended with a volunteer guest artist from a professional dance group organized* by Eleanore Kingsley, who was elected last September a director o: the Community Corporation of the Lower West Side . The dancers, directed by the world famous choreographer-balletmaster R Antic, were from the Pan American Ballet Company: Eleanore Kingsley, Joi Von Erb, and Constanza Piccirillo. Also performing was Miss Indra Nila, wh< presented dances of South India. One elderly lady said after the hour's entertainment, "I forgot there wa; such beauty left in the world." With all the bad news, I guess we all had. [Reprint, Chelsea Clinton News, Mar. 11, 1971] Project FIND : Seeking Out the Isolated (By Jerome D. Bona) "Hello. Mary," George McDermott called out to Mary Greene. "She's a rea old timer," George explained. "We all come here from the neighborhood and t< the other FIND clubs, to pass the time of day with each other, And the peopl< from Project FIND help us with our problems. Anything that comes up, yoi name it. they try to help us. They have a Newsletter which this time tells abou senior benefits we ought to know about," In spite of gale winds, snow and ice this bitter cold March day, some thirt; seniors had braved the foul weather, and had gingerly made their way dow] the steps for the weekly Thursday meeting of the FIND Club held at the Sacre< Heart Church on West 51st Street, Elizabeth Stecher Trebony, Director o FIND, sat in one corner, answering special problems, which one-at-a-tinn seniors were raising in response to their Newsletter. Mrs. Trebony said FIND was currently working with city-wide groups i] the field of the aging to convince older people that they should take advantag of the federal food stamp program and city rent increase exemptions. "They are adverse to welfare and are against taking charity. But they hav a right to programs like food stamps and rent increase exemptions, as past am current contributing members of our society," she said. "And seniors mus be encouragpd to overcome the stigma these programs seem to have." Project FIND has develoned into a wholly responsive program, adapting it self to whatever causes senior citizens seem to be facing as time goes by. Thi present under-utilization in the city by seniors of food stamps and rent increas< exemptions are just two current examples. Another example is the crisis FINI 663 met head on in helping hundreds of seniors when they were being evicted from hotels in the Times Square aron t \\ <» yen rs ago. Marie Peterson says she's known about Project FIND Cor a little over a year. piargarel Lehrfeld came to me Crom FIND because a neighbor told ber about fee of my problems, which I'm glad to forgel now because it was worked out tor lie," she said. "I'm 71 years old now," says Mario. "Unlike the hoy who Leaves home, I'm that ■rl who ran away from homo to join the cirrus. I only weighed about 90 pounds then." said Marie, who looks as If she couldn't weigh nuieh more than thai. fcday. "I did aerial work on the trapeze, the rings, and the ladders. They liked ne because I was Light, l guess. "In the 1920's, I rode the elephants bare back, you know, with the Downie pothers Circus all up and down the East Coast. They used to have to singe the lephant's hair for me, otherwise it was like bristles," she explained. Two others, almost as tiny as Marie, are the Greene sisters, Margaret and Vlary, both in their 70's. They told about how the West Side was "peaceful" in he old days. "It was most neighborly. Nobody was beaten up just walking lown the street. Nowadays it's hard to know which people to trust. Project FIND lelps a lot. "We've always lived on the West Side," says Mary Greene. "And in just two louses all our lives. About three or four years ago, we had to move from 42nd Street to Ninth Avenue when the Port Authority expanded the Lincoln tunnel." "We were lucky," said Margaret Greene. "We were recommended by an old riend, and were able to get our apartment in a four-family house, and there has nly been the one vacancy there in many years." Mrs. Trebony emphasizes that housing for the elderly is the worst problem n both Clinton and Lincoln Square, where FIND's staff members, who now lumber 10, seven of them senior citizens, have accomplished an impressive ecord in servicing the very high number of elderly residents. Project FIND is an "out-reach" organization. That is, it makes definite moves seek out isolated senior citizens, mobilizes resources, and reacts to all issues rhich affect the elderly community. Since it was started three and one-half ears ago, FIND has been able to service about 15% of the senior citizen popula- ion in the areas. That is well over 5,000 of the 36,000 over-age-60 residents. Originally one of 12 Federal projects in the nation, New York City's FIND is tie only one still in existence; the others didn't have the power to gain local mdmg after their neighborhood surveying had been completed. FIND is now funded by the Community Corporation of the Lower West Side ith War on Poverty (Office of Economic Opportunity) funds from the Com- tunity Development Agency of the City's Human Resources Administration. Rabbi Gerald A. Goldman, then with the Stephen Wise Free Synagogue, on 7est 68th Street, was the first chairman of Project FIND's advisory committee, le has now been followed by Rev. Kevin Sheehan, C.S.P., of St. Paul the Apostle ihurch, just south of Lincoln Center. Mrs. Trebony is quick to stress that the problems of senior citizens are nowhere ear being met. Many live in the 55 or so low-and-middle rent hotels between 34th ad 74th Streets. "The majority of these hotels are falling into deterioration," tie points out, "as landlords take their profits, simply waiting for their property alues to increase as the hotels and walk-up apartment buildings give way to igh rate commercial buildings, institutional development, and luxury apartment )wers. "We need housing for the elderly desperately," Mrs. Trebony emphasizes. "But ie transition of the West Side makes the acquisition of property prohibitive ccept for luxury development and institutional expansion. "If the elderly and other longtime residents of the West Side are to be pro- ved," Mrs. Trebony maintains, "if the area is to be kept a mixed community :hmcally, religiously, and financially, more land has got to be acquired by the &, just as it has been from 50th to 56th Streets, where the Clinton Housing ssociation is now sponsoring the construction of some 3,000 mixed income fusing units." In keeping with its style of responding to current needs, Project FIND, through s recently founded non-profit corporation, FIND Aid for the Aged, Inc., is also orking on the acquisition of brownstones, apartment buildings, and hotels to irn them into old-fashioned boarding houses, licensed under state law' as isidences for the elderly. "If we can do this," says Mrs. Trebony, "people evicted om SRO s (single room occupancy buildings) and run-down hotels would have place to go. But here again financing is an almost insurmountable problem." 664 Frances McLaughlin agrees about the relevance of Project FIND -became I West Sider nine years ago when the building I lived m on East 73rd Stieet wal renovated," Frances explained. "I had to move out. I was alone down here and didn't know anybody. Then I heard about Project FIND when I went to Slow stoppers one night at Hartley House. For three years now Project FIND has given me a lot of pleasure. I never need be lonesome. I always have a place to go. -You know I'm 87 vears old." says Frances: "Elizabeth just helped me out of a scrape with my landlord. And I've been on TV twice to talk up for senior citizexj and Project FIND. Now that we have four FIND clubs, we have some place to g °c e iub r s y a d r| y an important activity for FIND staff. In addition to giving seniors a Place to go and a free lunch, the clubs are the focal point of the seniors com- inunitv action activities, which, next to direct service to seniors in their homes, is the heart of FIND'S efforts on behalf of the elderly community. j There are club meetings every day in donated quarters : Tuesdays at St. Luke Lutheran Church, 308 West 46th Street; Thursdays at Sacred Heart Romar Catholic Church, 457 West 51st Street; Mondays, Wednesdays and Fridays ai St Stephen's Episcopal Church, 120 West 69th Street; and Tuesdays and Thurs days at Lincoln Square Neighborhood Center, 218 West 64th Street. With the numerous churches involved, it's an ecumenical project ; it s relevant it's filling a vital need for the neighborhood's older citizens, this Project I IND. [Reprint — Newsday ] Soon To Be Forgotten? By Penelope McMullan Only seven elderly women are left of Project FIND in New York. But thei search for abandoned old people in West Side tenements and hotels, and thei attempts to help them, is still one of the few well-coordinated community effort to help the aged in the country. «-nvrxm« Proiect FIND survives, unknown and unthanked, the only one of 12 FI^Ds the Office of Economic Opportunity funded around the country four years ago t «*tndv the old Its an acronym— for friendless, isolated, needy, disabled. ^f's me Betty," says Margaret Drain, 73, staring expectantly at a chippe grav door ofa third-floor walkup. Clutched to her chest, is a bag filled wit milk, Marlboros and soup. She waits. MaWflrpt TYiqrP h< The grav door gives way to an acrid odor of cat and Margaret marcm through Tin her Accustomed way and sets down what Elizabeth Z , 69, ha ^ttTi? Project FIND area-from 34th to 74th Streets, Eighth Avenue to tl Hudson RlvS-there are 36,000 people over 60. Most, like Betty Z ,J Sonron an income of around $1,500, their total Social Security phw saving "DecavW' is too good a word for the buildings or hotels they live in, but mo oftlSS ■money goef for rent. Their landlords wish they would die or leave ; rei control will end in these buildings the day the tenants go. "There's no mail," Margaret Drain says importantly, her laige Diue ey Hip last one thev had to break down her door to get to her. "There neyeT is [any mail]" she replies, and sits down at her kitchen tahl TTer amrtment is ugly-exposed pipes, dirty walls, grimy windows that bio ^ht \nd arnWst the flutter, such things as a dusty man's cap perched on a na BrttyZ doesn't know where it came from-one of the infrequent vis, from hersons maybe. u ^ ^ the money ^ afK™ being usffuh SooTsbe leaves to take an 88-yearold woman to SniVrhin thrust forward, she seems to march down the streets. The ob iectives of an 12 projects set up by the OfBce of Economic Opportun in^7 were the same : they were to hire senior citizens who needed the mon< n'avTbee'n^arch'out thei? peers, and then mobilise their communities. OI h Trrd7dn'tTaplerSev a enS "iS down^eaving only a joint repo "The I Golden Years-A Tarnished Myth," behind. As it turned out, local agent. 665 money KIM) Stella \s just lid n't really help them ; their communities didn'1 really care, and then i be an out. New fork's agencies and Wesl Side community were no better, but thli roup survived in spile of them. "The aged in New v<»rk have do priority,' Ben, bead of the West side Office <>f the Aging:, says frankly. "Then ■^mentation and do planning." The city's aged population, 948,212 (12 ji ent ) the only segment In the city thai is Increasing is way down on the riority list. In Project FIND, tor example, when the distribution of I he OBO unds thai support it changed hands from the National Council on Aging to New irk City, the budgel fell from $99,000 to its present $50,000. What happened with this one group was that it was not only well -organized ut quickly involved the senior citizens. (Almost the day their doors opened at IKK) Broadway, one of the hotel owners decided to close, and sent eviction notices o more than 250 people who had no place to go and no money for moving. ) "We are advocates," Margaret Lehrfeld, 75, says carefully. She's been a FIND rorker from the beginning, and has learned the government jargon. Belieing a ifetime spent on West 24th Street, she refers to "pockets of poverty," "ad- ocacy," and her job — "therapy for me." But the workers never had a chance to be just "finders." Issues like the hotel miction made them advocates immediately. And when they won a promise from tie hotel owner to pay $25,000 to his tenants, they took heart, and prepared ever to lose again. "They got personally involved," Elizabeth Stecher Trebony, FIND's director 11 four years, says. "In the first months we had two clubs opened up, by the ext May two more." This space, donated by four churches in the area, was the italyst they all needed : a place to meet for recreation and a place to organize )r their rights. Meanwhile the aides continued what Stella Allen calls the "day-to-day serv- es," the little odd jobs like escorting and shopping the aged who have no imilies to do for them. And, they knew how to get Medicare, Medicaid, or food tamps for the people they found needed help, and how to convince them that iking welfare wasn't the end of the world. "They don't know their rights," Mrs. Lehrfeld says. "They don't have radios rid televisions, most of them, and they don't see the papers." FIND has to be careful not to offend. "Most people say they'd rather die than ) on welfare," Mrs. Lehrfeld says, for these are people that come from a time hen poverty meant laziness. "These are proud people," Mrs. Trebony says. Outside volunteers haven't worked out for that reason. At one point/ some omen from the Ea: ;': Side planned to do a "telephone reassurance service," tele- tioning shut-ins once a day. "They were going to do it, but then they said they didn't want to use their real imes," Mrs. Trebony says, her eyes darkening at the memory. "They were Eraid the old people would start calling them back. But you can't take a digni- ed old person and say, 'Hello, this is Miss S.' " In one club, for example, Tereasa O'C sits alone, waiting patiently for le free lunch. Painfully, she answers a few questions about herself, but her jes beg off. When the food comes she swiftly eats as much as she can get, iffening slightly when she sees her hunger has been noticed. Mrs. Trebony is protective and dedicated. She fell into this work as a volun- er, and gets an ironic satisfaction from using techniques of the business world she formerly was an editor at McGraw-Hill) to push for old people instead of •ofits. Last year, for example, FIND wrote a report on the "sitters" — about 200 old iople who journey from all over the city, and even New Jersey, to the Port uthority Bus Terminal, where they sit in the waiting rooms from morning until ight. There are so many that sometimes there's no place for the travelers to sit. "It's quite a phenomenon," says one FIND staffer. "They do it in Grand Cen- al, too, and if they had the money, you can bet they'd be out at the airports." Mrs. Trebony's study led to press coverage of "the sitters," and then to money ■om two foundations and the Port Authority itself for a free "coffee shop," to be m by FIND, at 425 W. 43rd St. FIND will try to get "the sitters" to go there stead. It will be for others, too ; Mrs. Lehrfeld tells Richard K about it when she sits him in his tiny one-room apartment at W. 45th St. To save electricity, J wasn't using his fan, but he turned it on when she came, and pulled out a Iding beach chair for her to sit on. 666 He said lie would go to the coffee shop. "It's so monotonous," he told her, "I o-o from this chair here to that chair over there and back again." His apartment is barely furnished ; the "chair here" is one by the front window (most hav€ chairs by their windows), and the "chair there" is next to a small kitchen table Add a bed, nightable and a sewing machine (so he can repair his own clothes) K is an example of how budget cutbacks and funding affect the elderly 01 the West Side His apartment is under rent-control, which a Rockefeller-sponsorec state bill now abolishes— once the tenant leaves "voluntarily." Even if a semoi tenant doesn't leave, there will be an automatic 22 per cent increase in January Joseph Giamo, K 's landlord, simply refuses to make repairs ; a broken sink no cold water, and two rat holes that should be plugged up. If it gets worse, maybi the 8S-vear-old man would leave, "voluntarily." The state also cut back on Medicaid services— payments for eyeglasses, hearms aids and prescription medicines. So K , who pays $60 a month out of an $82-a month Social Security check, will simply not get those things, even though he l deaf and going blind. , But Mrs Lehrfeld tells him she will take him to an eye doctor she s found "He's a human being," she says, proud of her discovery, "you know, beyon< medicine " She also spotted a sign in a Woolworth's that seniors can get thei shoes resoled at half price ; K 's shoes will make that visit. And then there' the television Mrs. Lehrfeld convinced a woman who had three to part with om K watches the little red portable often. Gh. 11 is all he can reach on it, bu "Beat the Clock" is better than nothing. Still, FIND'S future is not secure. A FIND Fund tries to raise money fror private sources, but that's not all they worry about. "The lack of priority starts at the federal level," Mrs. Trebony says, an works its way down to the state and city. Right now we're facing the worst yea of all as I see it. The cuts in state aid, and now, federal food stamps will cut cos more.' The cuts seem to be directed against the aged, and nobody seems to realiz that these are people who just don't have time to wait." Statement by Feed Yaeger, Executive Director, Bronx Foundation for Senior Citizens in the Bronx, N.Y. Mv name is Fred Yaeger, I am the Executive Director of the Bronx Foundatio for Senior Citizens in the Bronx, New York. The Bronx Foundation is one < eleven agencies, across the nation in a sub-contract with the National Council c Aging, participating in the Senior Community Service Demonstration Project Through the National Council, we receive funds from the U.S. Dept. of L,abo to employ older persons, 55 years of age and over, whose incomes are at or belo the poverty line. Our older people are employed in meaningful and needed cor munity service work. One of the most important goals of our program is to sir plement the inadequate incomes of older persons and to demonstrate ways ar means in which the talents and skills of our older adults can be utilized to he; others help themselves. ... . -j At our two storefront "Human Service Centers", we provide a setting in whic older persons can either drop in or telephone to speak to our trained Senior Oitizc caseworkers, who are skilled in understanding the problems of old persons, ai experienced in providing direct services in the areas of welfare, medicaid, meti care, social security, housing, food stamps and health problems. Although we a: primarily an agency for Senior Citizens we don't turn anyone, young or old, aw* from our doors. We help troubled teenagers, young families and unwed mothei The number one need facing elderly citizens in New York City, is tor an aa quate income. The extent and depth of the poverty of old age is one ot ti best kept secrets of this society. Thirteen per cent of the city's population a proximately one million New Yorkers are 65 and older, living m the five borough And their proportion is steadily increasing. Their median income is appros marelv $1 523 per year. The major source of that income is from Social feecunt Gentlemen, Social Security benefits must be raised to alleviate gross pover among this minority group in this nation. In fact, I urge your committee To™ further in the direction of the expansion of Social Security or some for of guaranteed income for the elderly, to the point where needed income is pi vided, through the establishment of a system of built-in benefits, adequate I decent living. 667 The elderly citizen in New York City requires massive :inorough. Receni regressive state legislation eliminating rent Introl, hits the elderly severely, causing suffering beyond comprehension. All of us here are well aware of dramatic increases in the cost of all the basic ecessities for survival. Our elderly suffer, as no other, every time bread and lilk. costs a penny more. Rising costs of medical care are second only to food nosing ^insurmountable problems for all on fixed incomes. In New York, medical care offered through Medicaid is not only failing hut < dying. We need now a National Health Insurance policy for all Americans. t is time that we all faced the fact that our Nation's once heralded social poli- ies are turning into mechanisms for driving elderly persons deeper and deeper lto the abyss of poverty. It is obvious to many of us here that this present administration and the past dministrations have failed to reach the heart of this nation's graves! current [)cial problem, the poverty of our elderly. Gentlemen, from my observation as Director of a Neighborhood Multi Service rogram, there are far too many demonstration and pilot programs federally mded, which have been proven to be effective and invaluable, time and time gain, only to be dropped by the wayside and never implemented on any massive ?ale. What is immediately needed to help alleviate the plight of our elderly is perma- ent implementations of existing Federal programs, the Senior Community ervice Project, Meals on Wheels, Friendly Visiting, Homemaking Services, rograms like Project Find, on a massive scale in every neighborhood, through- Lit the nation that has a concentration of the elderly poor. Only a commitment of this kind by Congress, can begin to meet the needs C our elderly. A Society that can afford to send a spaceship to the moon and spend billions a an unnecessary war, certainly can find the manpower and resources to provide >r the needs for our elderly, rich and poor alike. rATEMENTS OF MARY CANNATA, PROJECT DIRECTOR, MEALS-ON- WHEELS PROGRAM, STANLEY M. ISAACS CENTER; ANN CHAP- MAN, BOARD MEMBER, STANLEY M. ISAACS NEIGHBORHOOD CENTER; ELIZABETH STECHER TREBONY, DIRECTOR, PROJECT FIND; FRED YAEGER, EXECUTIVE DIRECTOR, BRONX FOUNDA- TION FOR SENIOR CITIZENS, NEW YORK CITY Miss Cannata. I am Mary Cannata from the Stanley Isaacs Neigh- orhood Center and I am the project director for the Meals-On- Wheels rogram. This is a program that supplies the elderly homeboimd per- >n with two meals a day, 7 days a week. In order to be eligible for the program a person must be incapaci- ited. This is the group that has so often been ignored by people mply because they cannot get out and make their needs known. We feel that we have been instrumental in keeping people from sing institutionalized, be it a hospital, nursing home or some other ^tended care facility. Briefly, to state the figures as a comparison of hat it would cost the taxpayer if a person can remain at home with ur support by a meal program and if they were to be in an institution, le difference is quite astounding. Our program costs approximately $1,000 a year per person to keep lem in their own home and in their own surroundings. If the same erson were to be placed in a nursing home, the cost would then be L0,00O a year. 71-272— 72— pt. 1- -43 668 I am discussing a nursing home providing only custodial care Should the same person be in a home requiring nursing care or in i hospital, the cost then goes to $38,000, so we are talking of $1,000 versus These people have no one to speak for them. We are their only con tact in many instances. We continued this program for 4 years Noy we are in our fifth year. There is no doubt in my mind that it tin program were to be discontinued these people simply would eitne starve to death or be placed in a home. Mr. Brademas. Thank you. Mrs Chapman. I am Ann Chapman, a board member of btanle; Isaacs Neighborhod Center and I was its first president, helping | establish the Meals-On-Wheels program. You have my two or thre pages of testimony. . . I am not on anvbody's payroll and I typed this last night at mid night because and I just feel very, very, strongly about some of th problems that have come up today. Mr. Peyser, you asked about th voluntary agency and people getting together and moneys being raisec I think this particular program is a good example. It is funded unde title III of the Older Americans Act, through the New York fctat Office for the Aging. We have been granted this year $6,000. I he firs year it was around, let's say $26,000 from the New York State Offic for the Aging. It is very, very difficult to raise ongoing moneys to any program. . I have visited foundations who have said we are in the business c seed money to prove the efficacy of a program so that the Federal Go\ ernment will pick up the tab. Don't come to us about expanding c continuing a program that is already being paid for with taxpayer monev. . . T ~ •-. At "this particular point in the private sector ot Isaac Center it \* raise the necessary money for the fifth year of the Meals-On-Whee program, we will have been able to locate $90,000 as opposed to $83,0C coming from the New York State Office for the Aging, over a 5-yes period. . . We are extremely grateful that they had enough faith m this servic to continue it for a fourth year and now for a fifth year, dropping f roi $9,000 down to $6,000 in the fifth year. I think perhaps there is one point that needs to be made. Mr. Scheue our children were in second and third together. Back to the elder! You were asking Mr. Warrack about some insights gleaned from tl Office for the Aging's research project. I frankly question any mo research and asking people all these questions when we know whi the problems are. Let's get food in their mouths. Let's provide some sort, of concre service. If the elderly is home-bound, let's keep them from being horn bound as long as possible and out out the questionnaires and cut o the conversation. You asked me to speak for 2 minutes so I will cut out now. Mr. Scheuer. That is your insight and I think it is a damned go< one, We know the elderly are undernourished. We know they are lone and abandoned and physically in the four walls of their apartmer We know they need some kind of rent supplement help. We know th< need transportation. We know that voluntary action "ain't" going do it. That is a cop out. It has been a cop out in the past. G139 When }>eople talk about voluntary action it is a cop out and it i Itellectual dishonesty of the first water in my opinion. I couldn't gree with you more We know what they need and Congress and the American people ought to get out and do the job in putting resources n the skeletons of (heir pretensions. Mis. Trebony. 1 am Elizabeth Stecher Trebony, the director of project FIND and FIND for the Aged. We started as a demonstra- ion program through OEO. 1 might point out that Project FIND was mentioned in the 1967 war on poverty bill 240 times. The funds were never implemented Tor its continuation. All of the programs that started when we did in L967 were discontinued because bey couldn't gain local support. We did, through local Community Lction funds. I should point out that in OEO there is no priority for programs for he aged. I don't know that this has been mentioned at all. Mr. Scheuer. The problem is as Jule Sugarman said, there is a riority for kids, and the kids need the resources and I don't think ny of us want to take money away from the kids. But the fact that here is that congressionally stated priority has meant that the elderly .are gotten the short end of the stick. When they investigated the charges of discrimination against el- lerly poor who were Jewish they found out, yes, there were examples f discrimination against Jewish elderly poor, but the real discrimina- ion was against elderly poor of all kinds, not only Irish, Italian, Jew- sh — the whites, but the black and Puerto Rican elderly poor were pcriminated against. Mrs. Trebony. So are other white elderly poor — the Irish, Italian n the west side, the lower east side and in east Harlem. Mr. Scheuer. There is a large group of elderly Italians in my dis- rict in the Tremont section of the Bronx who are out in left field as ar as the Poverty program is concerned. Mrs. Trebony.' But it is not only Federal mandate as far as the pri- rity is concerned. It exists at the city level as well and I would like o point out that the Council Against Poverty has a list of 26 priori - ies for this city and the aged and senior citizen programs are 26 on the ist as an acceptable program — not recommended, not mandated — for ity programing. So I would like to demand that this priority either be changed at he Federal level and also at the city level. But the couple of points I rould like to make today that nobody seems to have talked about at 11 is the crisis we are going to be facing in the next year in services o the aged. These are vital services. Medicaid is being cut. It has been already ►assed by the State Legislature and it is now said to become effective anuary 1972. This is eyeglasses, hearing aids, medical appliances, description drugs, home health aids; the very services which help to eep elderly people out of institutions are going to be taken away from hem. It affects 200,000 aged poor in New York City alone. What service gencies at the community level are going to do to bring services in he future is almost an impossibility. Mr. Scheuer. What you are suggesting is instead of our spending 1,000 here we are going to be spending $10,000 to $40,000 a year when hey are finally forced into institutionalization. 670 Mrs. Trebont. I am certainly suggesting that service programs must be mandated at the Federal level or through OEO for more monej? and its fair share of funds through the Office of Economic Oppor- tune tv for service programs. Then, also, that the Federal Government mandate that the State spend money for the aged through Medicaid This can be done. The other big point is our housing crisis. We have no place foi people to go. They are being evicted from all of the tenements, anc particularly in Manhattan, the third-rate hotels are being demolishes for luxury* housing and there is nowhere for anyone to move to. I think* what we need is some innovative programing through HUD We have an old housing stock in New York that doesn't fit the require ments for getting money for renovation and it takes 2 to 10 years t< get new housing. I think this is another major area that just makes the whole notioi of service programs absurd when people have nowhere to live am will not have proper medical care. Mr. Brademas. Thank you. Mr. Yaeger. I am going to compromise. I am going to read m; statement fast. My name is Fred Yaeger. I am the executive directo of the Bronx Foundation for Senior Citizens in the Bronx, New York The Bronx Foundation is one of 11 agencies across the Nation in | subcontract with the National Council on Aging, participating in th Senior Community Service Demonstration project. Through the National Council we receive funds from the U.S. De partment of Labor to employ older persons 55 years of age and ove whose incomes are at or below the poverty line. Our older people ar employed in meaningful and needed community service work. One of the most important goals of our program is to supplemen the inadequate incomes of older persons and to demonstrate ways am means in which the talents and skills of our older adults can be utilize' to help others help themselves. At our two storefront "Human Service Centers," we provide a sel ting in which older persons can either drop in or telephone to spea to our trained senior citizen caseworkers who are skilled in undei standing the problems of older persons, and experienced in providin direct services in the areas of welfare, medicaid, medicare, sock securitv, housing, food stamps, and health problems. Although we are primarily an agency for senior citizens we don turn anyone, young or old, away from our doors. We help trouble teenagers, young families, and unwed mothers. The No. 1 need facin elderly citizens in New York City is for an adequate income. The* extent and depth of the poverty of old age is one of the bes kept secrets of this society. Thirteen percent of the city's populatioi approximately 1 million New Yorkers, are 65 and older, living in tl five boroughs. t a , . . And their proportion is steadily increasing. Their median incon is approximately $1,523 per year. The major source of that income social security. Gentlemen, social security benefits must be raised i alleviate gross poverty among this minority group in this Natio] In fact, I urge your committee to move further in the direction c the expansion of Social Security or some form of guaranteed incon for the elderly to the point where needed income is provided throug 67] pie establishment of a system of built in benefits, adequate for decenl Iving. The elderly cit izen in New York ( Jity requires massive and extensive Federal programing and massive appropriations in housing, mil pit ion and medical care to meet Ids need. For the first lime in decades, i lents of New York City are facing a monumental housing shortage winch is causing rents to skyrocket in every borough. Recent regressive State legislation eliminating rent control hits the iderly severely causing suffering beyond comprehension. All of us lere are well aware of dramatic increases in the cost, of all (lie basic necessities for survival. Our elderly suffer as no other every time bread and milk- costs a penny more. Rising costs of medical care are second only to food in bosing insurmountable problems for all on fixed incomes. Mr. Brademas. Mr. Yeager, you can read it all, but von will not ■low us to question. Mr. Yaeger. Let me just make one other comment. In the Older Americans Act the agencies that are primarily getting the funds from the State office are the more established agencies in the city of New York and I think there should be some kind of a mandate in the act itself to have a certain proportion of grassroots type of agency to have that type of opportunity to get moneys from the State. At this time there is absolutely nothing like that. There should be programs to meet the needs of minority groups in the city; the black Iderly, the Puerto Bican elderly and the Jewish aging in New York City. Mr. Brademas. Thank you. We have already run well over our time, [ am afraid, but I will forego my questions and let Mr. Scheuer have i question. Mr. Scheuer. I just wanted to make a brief statement, I have recently introduced a bill that will provide rent supplement payment ;o the elderly poor making less than $4,000 a year. These rent supplement payments would have a maximum of $100 a nonth additional to what they are paying now. That, in fact, would rive them a passport to find housing in neighborhoods congenial to ;hem. I think it is better than public housing at a fraction of the cost, [ think that we are seeing the problems with getting more public lousing built outside of hard-core center city locations and what is lappening in Queens now. I think rent supplement payments to the poor would give them their rations as to the kind of community in which they want to live. Mrs. Trebony. What chance has it got? Mr. Scheuer. I think the Congress and the American people are ping to have to face up to their obligations to help our elderly people ive in civilized comfort, convenience, and dignity. Mrs. Trebony. Also, the major point was how do you Mr. Scheuer. The purpose of hearings like this are" not only to get rour views and your wisdom and your insight but also to bring a kind f public support that we are going to need across this country to do ight by our elderly citizens. Mrs. Trebony. How can we get massive funds to come into this city o renovate and bring substandard conditions up for the aging ? 672 Mr. Brademas. If my colleague will yield. That is a political que* tion. Mr. Hansen. Mr. Hansen. I will waive my questions. Mr. Brademas. Mr. Peyser. Mr. Peyser. I thought all the testimony this morning is certaml of great interest, I think what the four of you just had to say was moi to The point of what we are here to talk about and I want to thank yoi Mr. Brademas. I would add to what Mr. Peyser has just said. Yo have given very eloquent statements and Ave are very grateful to yc for having taken the time to prepare them and come. We will see to that you all get copies. Indeed, all of the witnesses will receive copu of the print hearings when they become available. Thank you all vei much. Our next panel is Mr. Warach, Mr. O'Niel and Mr. Eittenberg. STATEMENTS OE BERNARD WARACH, JEWISH ASSOCIATION FO SERVICES FOR THE AGED; JEAN WALLACE CAREY, COMMUNIT SERVICE SOCIETY; AND CASPAR W. RITTENBERG, COMMUNIT SERVICE SOCIETY Mr. Warach. My name is Bernard Warach. I am the executive d rector of the Federation of Jewish Philanthropies' newest soci agency, the Jewish Association for Services for the Aged. The organization was created 3 years ago to provide social servic for the elderly in New York City and Nassau County, to create housn for the elderly, health related facilities, nursing homes and other nisi tutional care units required by older people. What happens to the elderly, 20 million of them m the country, o million of them in the city, affects the life of every younger f ami] The elderly and their families are a growing and concerned cons tuency in the United States. We must respond to their needs. Ul mately the elderly will vote in their own behalf. In our day-to-day work at our eight social service offices througho greater New York, we are confronted with the consequences of legis tion which is built and piled on year after year, which has creat masses of red tape in Medicare, Medicaid, Social Service Regulatio and so forth, which make it almost impossible for the elderly perse to get the help they need to solve their difficult problems. Some sun] solutions for services for the aged must be found. We support extension of the Older Americans Act. JASA has be granted an important title III grant for service m the Rockaways the New York State Office on Aging. We believe that while demonst] tions have been constructive it is time to get providing f unds for need services To that end, the title XVI program, offers immediately promise. 1 want to thank Congressman Scheuer and other members of this co mittee for having called the attention of New York and of the Nat] to the problem of the poor elderly and the Jewish elderly of t city. They have been a silent, lonely group of people. JASA hope to secure the support of Government authorities for community service proposals to be funded under the title XVI p gram. It would mark an historic step forward in care of the ag ' Mr. Brademas. Thank you very much, Mr. Warach. (17:^ Could you give us your name, please \ Mrs. Carey. 1 think I would be remiss if I did not acknowledge Hie voice of Congressman Reid joining with you Congressman Brademas in introducing the RSVP legislation. We have had a State ■rani and a Federal grant. Mr. Rittenberg, on my left, is the chairman of the SERVE sub- committee and for (he record we would like to highlight the accom Kishments under those two programs. Mr. Rittenberg. Mr. Rittenberg. Gentlemen, highlighting the accomplishments of BERVE on Staten Island, which is the original SERVE Project, I iould like to emphasize that it was supported, in part, by a title IV trant and also SERVE, in New York Stale, which is now operating under a title III grant from the New York State Office on Aging. I would like to comment on the fine cooperation we have had from Mr. O'Malley and the New York State Office on Aging in this pro- gram. Incidentally, the Community Service Society on its own is con- Inuing the SERVE Program on Staten Island, the Federal funding having runout. It was launched in 1967 as a 3-year research and development proj- ect to determine whether group methods would be feasible in retaining rider men and women as volunteers. The results are impressive. Today 3ver 600 older men and women 60 to 93 years of age are active in SERVE at least once a week in 24 different social and health and education agencies. They contribute their time and talent without any stipend what- soever. Transportation is provided, which, of course, has developed into the most important factor in conducting such a program, and 3ometimes lunch. It requires two full-time coordinators who are responsible for the entire program. Now regarding SERVE in New York State, this is a consultation Drogram funded under a title III grant for a 3-year period to see whether the lessons that were learned on Staten Island will work m other communities. It was started in October 1969. SERVE in New York State has some r50 volunteers giving weekly service in 38 pilot SERVE Programs n 19 counties in New York State. It should be noted that SERVE fvas the model for Federal legislation which established the Retired Senior Volunteer Program which we know as RSVP. Last summer RSVP initiated its first 11 older volunteer programs n that many States and considerable expansion is planned for the joining year. As was commented on earlier, the $5 million allocation of funds should be helpful in this direction. In conclusion, out of our own experience and review of other re- )orts, we believe that there is a continued need for strong Federal programing for the aged and for the extension of the Older Ameri- cans Act. Today the situation is grave for the older Americans who continue >o need a courageous advocate within the administration. Where that idvocate should be located in the Federal scheme will surely be de- rnted in the weeks to come in the White House Conference on Aging md elsewhere. Whatever the outcome, the need for a strong voice and action by Congress is clear. We believe that the current dismal picture can be 674 corrected but it will take a mass pooling of effort by the public and private sectors. Please be assured of our help and call us, if you will, whenever we can be of service. Thank you. Mr. Brademas. Thank you, Mr. Rittenberg. Mr. Scheuer. Mr. Scheuer. I just want to thank the witnesses for their very excellent thoughtful testimony. Mr. Brademas. Mr. Hansen. Mr. Hansen. Let me raise one question for a comment. Perhaps others in the later panel may also want to address themselves to it. II hasn't really been discussed in the course of the hearing yet this morning but it has come out fairly clearly in other hearings and, 1 would say, particularly in the series of Senior Citizen Seminars thai I conduct in my district each year. Mr. Yaeger did make the point and I think this is implied and re- inforced by other testimony that the No. 1 problem facing the elderlj is lack of adequate income. I think it goes without saying that s( many of the other problems are traceable directly to the inadequate income. If you had income then you could acquire better housing, you coulc have a better diet, you could have better transportation, better medi cal care and so forth. Of course, one of the reasons for inadequate income is the level of social security benefits. I might observe, however, that I met with some retired teachers ii my own State a few days ago who didn't come under social security They retired before this happened and they are worse off than any body could possibly be in terms of any source of help. But among the remedies that have been suggested in many of th< meetings that I have been involved in, it goes beyond changes ii social security and addresses itself to some of the artificial barriers wi have erected to employment opportunities that will provide jobs an( source of income for older people. We just closed those doors. Are there comments you may have oi how you see we may move toward enlarging opportunities for olde people to help themselves, those that have the desire and capability and a great many of them do, to reinforce income and provide for i better life. Mrs. Carey. Perhaps I can answer. There was a study made as i part of the original SERVE program. We were interested in the ques tion of employment versus volunteering and there is need for hot] programs. The people who volunteered said it was great for many of them ti give for once in their entire lives. This does not rule out for indi viduals the need for part-time employment. It should not be a demand ing job. They tended, however, to say that they weren't that craz; about working, if you will, if they had enough money. But the point here is, you need to explore a lot of ways to augmen income. I happen to think social security is the root to go to provid a basic income. Mr. Hansen. The point that was made dealing with the problem and needs of aging is that need to be needed. They have accumulate! skills of great value and experience and wisdom and insights that the; can impart to the rest of the country. 675 It is genuinely an asset and a resource of enormous value t hat we are literally wasting. A.nex?ample where I think we can reclaim that value is iii the step we took in the subcommittee in developing legislal ion for young children. The point was made in the testimony and we strongly agreed with it, that there is a great affinity between older people and young children. There should he a definite place in early childhood programs for older people. The contribution thai each can make to each other is enormous. This is the kind of creative idea, it seems to me, that we are not coming up with frequently enough to take advantage of those who really have something to contribute and want to and ought to be paid and can, therefore, laugment their earnings. Mr. Warach. There has been a variety of programs which might increase employment opportunities. The lifting of the maximum ceil- ing would be helpful to older adults. But one factor Ave should be aware of when we are talking about older people; one-third of the pity's elderly and 'around the country are over 75 years of age. You have got an enormous spate of elderly people. : Even if you doubled e very elderly person's income — and it is a direc- tion we ought to move in — you are not going to meet the crisis problem of the medical and all-other-cost care of as many as eight percent of the elderly people not now in a medical institution. It is that critical thing that affects and colors all of their life. Sec- ond I think is the very real problem of just personal security in all of the big cities. That is, even given income and access to income, we have got several hundreds of thousands of elderly people who live in chang- ing neighborhoods where they simply can't use money they have to buy the services they need. Mr. Eittenberg. I could just add one sentence. I think very often where there is a will there is a way. I think the availability of employ- ment is much greater but the acceptance of it is much lower. Mr. Brademas. Mr. Eittenberg, you put your finger, with that old phrase, on the problem — where there is a will there is a way. Part of our problem is, there doesn't seem to be enough will. Mr. Peyser. Mr. Peyser. I just thank the witnesses for their testimony. a Mr. Brademas. I want to thank you all very much for taking the time to be with us. Our next panel is composed of Mr. LoMolino, Mr. Dimond, and Mr. Newbursrher. STATEMENTS OF LAWRENCE LoMOLINO, AMERICAN ASSOCIATION OF RETIRED PERSONS; GEORGE DIMOND, PRESIDENT, WILLIAM HODSON SENIOR CENTER; AND WALTER NEWBURGHER, CON- GRESS OF SENIOR CITIZENS Mr. jNewburgher. I am Walter Newburgher, president of the Con- gress of Senior Citizens of Greater New York and a national vice president of the National Council of Senior Citizens in Washington. I have no prepared statement with me, but I notice, if my eyesight doesn't fail me, that you have this in your hand, and I would appre- ciate it, Mr. Chairman, if you would accept that as my written statement. 676 Mr. Rrademas. Yes, Mr. Newburgher. The statement to which you refer is the document prepared by the National Council of Senior Citizens in connection with the forthcoming White House Confer- ence on Aging and is entitled "A Platform for the Seventies for All Older Americans." Without objection, this statement would be in- cluded in the record if you like, sir. (The document referred to follows :) White House Conference on Aging a platform for the seventies for all older americans To the Delegates : The 3,400 delegates to the 1971 White House Conference on Aging will participate in almost 100 meetings scheduled by sub-sections of the 14 Sections that make up the Conference. They will be called upon to deal- with a wide range of topics. - The endorsers of this presentation believe it will be helpful to all partici- pants in the Conference to have available a handy guide outlining goals for all Conference sections followed by a position taken on each of the issues posed in Conference Workbooks. . Over the decade since the first White House Conference on Aging, the endorsers believe a foundation has been built for formulation of a sound public policy in the field of aging— and this is outlined in the statement of guiding principles which have been set forth in this special publication. We hope these principles will be supported by all who wish this Conference to be meaningful in terms of action for and on behalf of the elderly— and not just an exercise in rhetoric. . j Although the issues as stated in the Conference Work Books are not included here, the materials for each Conference Section follow closely the order in which these issues are listed in the Work Books. The recommendations in this special publication are significantly addressed to the problems and needs of all older persons. However, we want to underline the importance of and necessity for programs geared to special and unique needs of minoritv groups— blacks, Indians and the Spanish-speaking. Racial discrimination, unemployment and/or low paying jobs and educational deficiencies have condemned substantial numbers of minority elderly to low levels of income and inadequate health provisions. Too often, these minority groups of the elderly have not had the resources or capacity to stand up foi their rights, nor have governmental agencies and senior citizens organizations adequately served as advocates for them. ,„„./'* , * Jm We can and must demand that government fulfill its advocacy role for this group of the poorest of the elderly poor and we seek the fullest involvement ol the disadvantaged in all action-geared senior citizens organizations. GUIDING PRINCIPLES The Foundation for Sound PuUic Policy On Aging 1 A nation as wealthy as ours can afford to do more for its older peopl without decreasing its efforts for the younger population. This is not a matter of "either/or." Gains for the elderly should not be a the sacrifice of young people. We must avoid the misleading cost/benefit type o analysis that usually leads to the conclusion that the benefit to the public is les with public programs to help the elderly than with programs to help other seg ments of the population. -u-Ji 2 Where the needs of the elderly are essentially universal, the responsibility for financing and for assuring adequate administration and delivery of sud programs belongs to the Federal Government. Income maintenance and protection against rising health care costs, for exan pie, are basic needs of all older people, with little or no regional significance lU-sponsibilitv is thus properly lodged at the Federal level. 3 An adequate and equitable contributory social insurance system is based o tripartite financing— employee and employer payroll taxes and Federal geners Appropriate use of general revenues is a more equitable way of sharing th tax burden that now bears heavily on workers through regressive payroll taxes. (>77 EThe argument which seeks to suj fe funds to pay pari of the cost of unitize as "welfare" the use of general reve- i social insurance program is false becau e is a right to the bene like welfare programs the social Security beneficiary I s without undergoing a means test. 4. Government has the duty and the responsibility t<> serve as a strong advo- te for the beneficiaries of the programs it provides. In a representative democracy, government at all levels is the servant of the Iple. For Older people, with their special problems of income loss and health, verninent must he the guarantor that older people have a fair share of our na- m's income. 5. While adequate income is the first priority for elderly people, a program appropriate services is also essential and necessary. Even in the unlikely event that all older people had adequate income, there mid remain the problem of the availability of services. Adequate income does t solve the transportation needs of older people Living in areas that lack trans- lation services. It does not provide an answer to the nutritional and social eds of an older person living- alone. Nor is more income the answer to the Dhlems of the infirm elderly who are forced into institutions simply because r society lacks the services that would make it possible for them to live inde- udently. 3. Voluntary non-profit agencies and organizations — membership organizations seniors and direct service agencies — are essential components of a well bai- led and adequate system of programs and services for seniors. However, such agencies should remain free to act as constructive critics of hlic programs of services and benefits to seniors. 7. Appropriate identification of programs and funds for the aged is necessary. to the maximum extent possible, older people desire and should participate equal terms in programs for the total population. But there will always re- lin areas requiring that older people he singled out for the special consideration it takes account of their greater needs (for example, the extra heavy burden health care, especially for long-term illness, or their lesser ability to* compete th younger people in the job market) . I The Time to Act is now. We can no longer postpone action in the hope that the problems associated th old age are transitional problems that will solve themselves, given sufficient le. The evidence is all too clear that without positive and immediate action ? situation of people already old will deteriorate still further. Moreover, w T e now know T that future generations will face many of the same plems facing today's elderly when they in turn reach old age. The nation >uld therefore immediately embark on the course of action that will meet the ads of today's older population and at the same time provide assurance to )se still young of a brighter future in old age. INCOME 5oal : Every American should have enough income to live on in comfort and :nity and to participate fully in the life of the community. As an immediate p toward this goal, the Federal Government must provide a guarantee that one need live in poverty. Standard of adequacy. — Achievement of this goal for the elderly requires a ndard no lower than the Bureau of Labor Statistics moderate level — a level ich is adequate to maintain health and enables an individual to he self-suffi- nt. (In 1969, it would have cost elderly couples living in cities at least $4,192 maintain this modest but adequate standard.) The standard must be peri- cally updated (not just repriced to take account of purchasing power) to pre that older people share in the nation's rising standard of living and there i better balance between pre-retirement and post-retirement income. Providing a floor above the poverty level. — Society's responsibility for assur- : that no one need live in poverty should be implemented through a Federally meed and administered system of assistance to supplement Social Security lefiis and any other sources of income. dus Federal guarantee, financed through general revenues, should apply to » young as well as the old, differing only in how the guarantee is administered. r the aged, blind and disabled — for whom employment is not means of escape m poverty — appropriate use should be made of the Social Security system to ;ermine eligibility and pay assistance in a manner that respects the dignity of > individual. 67S States that have already recognized their responsibility for doing more for theh needy than merely to lift them from poverty should continue this effort witl Federal help. Social Security benefits. — The level of Social Security benefits should b< raised substantially. For the short run, a meaningful increase is necessary t< give proper recognition to past coverage under the contributory system. For tin long run, a meaningful increase is necessary in order that benefits bear a mon reasonable relationship to pre-retirement earnings. The level of earnings taxed and credited for benefits must be raised to reduci the regressivity of the tax and to permit replacement of more of the earnings o workers with higher wages. Thereafter, adjustments — whether automatic or through Congressional action- should ensure that Social Security benefits keep pace with rising standards o living (not just rising prices) . Federal sharing in Social Security costs. — As is the case in other industrializes countries, general revenues should help support the costs of this nation's socia insurance program, thus reducing the heavy burden of regressive payroll taxe on today's workers. There is no validity in the argument that general revenu sharing in social insurance costs causes the program to take on characteristics o a welfare program. The Social Security beneficiary is and should be entitled 1 benefits without a means test. We believe that the contribution from general revenue should be predetei mined ,by formula specified by law and that a reasonable share over the Ion run is one-third— approximately the cost resulting from paying benefits t workers already old when first covered, many of whom would otherwise hav been dependent on public assistance. Social Security retirement test. — We recognize that the retirement test whic: results in a loss of Social Security benefits for those who earn more than th designated amount sometimes serves as a barrier to the employment of worker past retirement age. But we also recognize that the test conserves funds for payment to beneficiarie who are unable to supplement low retirement incomes with earnings. Elimina tion would place unfair higher tax burdens on younger workers for the pui pose of paying full retirement benefits to the comparative few who continu to work at full earnings. We therefore recommend that the basic principles of the test be retained, nc eliminated. We also recommend that the test be reexamined periodically fo purposes of liberalization (such as raising the dollar limit and perhaps lowerin the age at which the test is no longer applicable) as well as for purposes of seel ing various methods of offsetting penalties under the test. Financing of health costs. — The nation will continue to fall short of a reasoi able goal of income security so long as heavy and unpredictable health cost threaten fixed incomes. We believe that our elderly population's best hope of adequate protectio against health costs is through enactment at the earliest possible date of national health insurance system for the total population, with the governmei assuming responsibility for improving the organization and delivery of compr hensive services as well as for the financing mechanism. Until enactment of national health insurance legislation, we urge improv ments in Medicare and Medicaid to extend protection and to reverse the trer toward heavier copayments and deductibles (out-of-pocket payments require of the beneficiary). Medicare — and the proposed national health insurance program — should 1 financed through payroll taxes and general revenues, not through premiums an other heavy out-of-pocket costs paid by retirees living on fixed incomes. We also urge special attention to the need for long-term home care arrang ments as an alternative to unnecessary institutional care. Property tax relief. — In many parts of the country, the local property tax c the older person's home takes such a large share of limited income as to threatc continued ownership. Because this is a problem not likely to be solved locally, we urge the develop ment of a Federal program to reimburse States that extend relief to low-incon householders — whether owners or renters — who are overburdened by properl taxes. Private pensions and Federal responsibility. — Under present trends, only minority of the retirees of the future will have private pensions and other i: 679 bine which, in combination with Social Security benefits, Is sufficient to main En a reasonable standard of living. We recommend early Federal legislation to improve the protection of private ension plans through appropriate vesting, provision for survivors' benefits, ^insurance or other methods of guaranteeing pension funds, and to assure fldu- iarv responsibility. To make possible pension protection for employees Of small linns as well us )r individual Investors, we recommend thai the government exercise vigorous jadership in the development of a national portable pension system as .-i com- anion to the Social Security system. Goal : High quality, comprehensive health servces should be available to every merican as a matter of right regardless of age, income, race or religion Need for special consideration.— The delivery of health services for the elderly mst be fully integrated with care for the general population in order to assure Itimum treatment of the elderly person's acute illnesses. Health services for those with chronic physical and mental impairments— igardless of chronological age— must be adjusted to the medical and social Eseds of the individual and may require specialized personnel and facilities In the planning, coordination and financing of health services, special consider- twn should be directed to the aged because of the framework in which their Inesses occur— for example, inadequate income, forced retirement, poor housing ck of mobility and social isolation. Coordinated care as an integral part of the total system.— A system of com- •ehensive, coordinated personal health services for both the short-term and ng-term care of the ill, infirm or disabled aged should be developed as an inte- •al part of the nation's health care system. The comprehensive and coordinated >rvices should include the full range of preventive, maintenance and rehabilita- ve services needed to promote health and reduce expensive institutionalization Goal is national health security. We support the proposal for National Health fcurity as the method of reorganizing the present chaotic health care system to a system with national standards and public accountability for delivery and lality as well as for efficiency and economy of services. Immediate improvements in Medicare and Medicaid.— Until the nation has 'hieved health security for all Americans, the protection afforded by Medicare id Medicaid should be strengthened— not weakened as is contemplated in gislation now before the Congress. To the extent possible, the principles of cost control and public accountability at are basic to a national health security program should be incorporated into edicare and Medicaid. Co-payments and deductibles should be eliminated and nefits expanded to include the full range of services need for optimum health Medicare should be financed through contributions from earnings and through 'deral general revenues— not through even higher premiums paid bv the aged t of low incomes. Federal responsibility for Medicaid should be extended to sure adequate and equal health services regardless of the State of residence Long-term care.— The nation must move ahead immediately to meet the long- mi needs of chronically ill persons, including the aged, under a policy that the onsorship and operation of services and facilities in this area shall be primarily rough non-profit private and governmental agencies. We urge special attention to the development of personal care programs in lucmg the need for institutionalization, thus conserving health care dollars Our public policy must be to keep the older person functioning to his maximum ysical and mental capacity within the community — not separated from it in institution. When it becomes necessary for medical reasons, the care then pro- led— whether for a few days or a longer period— must be in a facilitv capable of cwidmg comprehensive medical and social services and geared to a rehabili- :ion philosophy— the concept of a geriatric hospital with a wide-open admission hey. Responsibility.— Responsibility for the entire spectrum of health services for s aged belongs in the public sector at the Federal level. Maximum implements - n of the planning process, delivery of services and evaluation should remain State and local levels. in educational program.— A national continuing educational program fo*- the leral public should be initiated for the joint purpose of promoting a more 680 positive attitude among younger people about old age and health and informini them about specific health issues that affect individuals regardless of chronc logical age (rather than setting aging apart in a way which stigmatizes th elderly ) . Specilization in geriatric problems. — While the development of specializatio in geriatric problems is desirable, all appropriate health professionals should b given adequate education on the physical and mental health problems of th elderly. This should be part of the education of health workers at all levels o training and on a continuing basis. Allocation of funds. — In view of the critical need to provide more direct service to the physically and mentally ill elderly, much more funding must be put int these services. At the same time, additional funds must be provided to financ more basic and applied research and to develop increased health manpower an facilities. employment/retirement Goal : Functional ability, not chronological age, should be the test of emplo; ability. On reaching "normal" retirement age, individuals should have a choh of continuing to work as long as they are able or retiring on adequate incon with opportunities to pursue meaningful activity. Reversing the trend toward early involuntary retirement. — Achievement < this goal requires that we reverse the trend toward involuntary retirement c permanently reduced income. To lower the normal retirement age merely coi pounds the problem, making it increasingly dimcult for older workers to contim in gainful employment as well as being costly to the economy. The solution li< instead in an action program to end discrimination based on chronological aj and to provide more job opportunities for middle-aged and older workers. Extended unemployment benefits. — The duration of unemployment benefi should be extended for older workers so that workers faced with long-ter unemployment do not become so discouraged that drop out of the labor mark< Categorical manpower programs. — All experience indicates that it is insufficie: merely to promulgate policies for improved employment opportunities for old workers. Adequate funds must be earmarked for special placement, training ai job assistance programs for the elderly. Limits upon employer's action. — Basic to any effort is an active education program among employers, workers, and the general public. Also basic is stri enforcement of existing anti-discriminatory legislation accompanied by a remov of the upper age limit of 65 in current legislation. We also favor requirements f listing of job vacancies, scrutinizing of dismissal from employment and ear warning systems that may be necessary to eliminate age-employment problei even if such requirements impose limits upon the employer's actions. Public service employment. — We need much more than the actions impli in the phase, "government as the employer of last resort." We believe that t government should actively promote — not just underpin — the development public srevices not generally available but which are so urgently needed by t nation and so appropriate for the employment of older persons (including pa time employment after retirement). The Emergency Employment Act of a and similar legislation should be amended to prohibit discrimination on t basis of age. Social Security retirement test. — See statement on this issue under discussi relating to Income Section (page 2) . A nationwide program of community service. — Even if we were to attain c goal of adequate retirement income, many elderly people would want the p chological satisfaction of continuing activity. For them, broader opportunit for volunteer services are needed. Others, especially widows with little or no e ployment experience to help them compete in the regular labor market, need source of income while waiting to be eligible for old-age benefits. Special empL ment programs are essential if their talents are to be used and if they — a those with inadequate retirement income — are to have an alternative to depei ency on welfare or relatives. We therefore recommend immediate enactment of a nationwide Commun Service program — modeled on such outstanding demonstrations as Senior AID and Green Thumb — to provide part-time paid community service employm< for the low-income elderly, administered through the Labor Department a« special employment program for the elderly. [Senior AIDES is a community service employment program operated by National Council of Senior Citizens for the U.S. Labor Department. It is 68] demonstration program providing community service Jobs for 1,160 men and women age 56 Or over willi low ineomes in L'O eommnnil ies ;icrnss Hie imtion. AIDES in Senior AIDED, means Alert, industrious, Dedicated, EJnergel Ic Service. I A similar program is operated l>.v the National Council on the Aging lor Hie Labor I department [Green Thumb provides jobs for the low income elderly in heant ilieal ion and improvement of the environment on public property Including highways. This program is operated by the National Farmers' Union for the Labor Department. I Reduction of "normal" retirement age. — Pressures to reduce the so-ealled nor- mal retirement age of 05 — whether for workers generally or in special eircuw stances — should be strongly resisted as part of a national policy to make ehrono logical age immaterial to employability. Institutionalizing a given age as normal for retirement makes it harder for workers close to that age to get jobs. A lower retirement age would be costly to the economy in terms of the burden of supporting the nonproductive segment of the population and in terms of dissatisfaction among the displaced elderly with a life of inactivity. Workers forced to retire prematurely. — To help workers forced to retire before the "normal" retirement age because of health problems or job displacment caused by technological change (or jobs requiring early retirement), we recommend new national policies accompanied by publicly and privately supported programs in existing agencies that have responsibility for dealing with these problems. Specifically, the Labor Department should administer a continuously funded program especially designed to maintain economic security during the transitional period while the unemployed worker is being retrained and educated for reem- ployment or while resources are being mobilized for a meaningful retirement. The Social Security system should be liberalized to provide dsiability payments for workers forced into retirement by disability not severe enough to meet present definitions. Private pensions and Federal responsibility. — Under present trends, only a minority of the retirees of the future will have private pensions and other in- come which, in combination with Social Security benefits, is sufficient to maintain an adequate standard of living. We recommend early Federal legislation to improve protection of all private pension plans through appropriate vesting, provision for survivors' benefits, reinsurance or other methods of guaranteeing pension funds and for assuring fiduciary responsibility. To make possible pension protection for employees of small firms as well as for individual investors, we recommend that the Federal Government exercise vigorous leadership in the development of a national portable pension system as a companion to the Social Security system. Pre-retirement education. — Society should resume greater responsibility for helping people (the spouse as well as the worker) to prepare for the retirement years. We believe that organized pre-retirement educational programs should be made available on a voluntary basis through local industrial and educational channels, with Federal assistance in the development of program materials. HOUSING Goal : In keeping with the inherent dignity of the individual, older people are entitled to suitable housing — individually selected, designed and located with reference to special needs and available at a cost which older people can afford. Federal, State and local funds should be earmarked to provide adequate hous- ing for the elderly. Guiding Principle No. 7 (see page 2) calls for "an appro- priate identification of programs and funds for the aging . . ." The needs of the elderly for housing have been submerged by the Depart- ment of Housing and Urban Development in a program of meeting the hous- ing needs of the low income group generally to the serious neglect of the mil- lions of elderly who are poor or close to the poverty level. Thus, while there is a need for over 3 million units less than 40.000 units a year are heing constructed. Legislative authorization for a program provid- ing at least 120,000 housing units per year is essential and must be obtained. Eligibility for housing. — Housing designed to meet the special requirements of the elderly should be available to all elderly who need such housing at a cost proportionate to the individual's income. Housing charges or rentals should 6S2 not exceed 20% of the person's income, with further consideration given to the costs of special services due to poor health or other handicaps. Importance of Federal leadership and funding. — Vigorous Federal leadership and adequate funding are essential to the provision of adequate housing for the elderly. Accordingly, there should be established the position of Assistant Secretary for Housing for the Elderly in the Department of Housing and Ur- ban Development with statutory authority to initiate, review and implement housing programs for the elderly. Housing funds now impounded by the Adniiistration should be released and the highly effective Section 202 of the Housing Act, with its special guidelines related to space, design, construction and particularly favorable financing, re- stored. Consideration must also be given to the rehabilitation of housing units in- habited by older people which are being ruined by deterioration and decay, up- ward revision of eligibility for low-income and moderate-income housing, and the provision of professional security protection for elderly citizens in housing projects. Maintaining the option of independent living. — Given the option, the great majority of older people would choose independent living to even the most benign type of custodial care. This argues for a range of services — social, health, rehabilitative, recreational,, nutritional, protective and counseling — that would enable the older person to live in his own home or with his children or grandchildren or with a small group of other older persons or in a residential facility. We maintain that too many nursing homes are not living arrangements but custodial facilities to which an elderly person is committed until death. U.S. public policy must be to keep the older person functioning to his maxi- mum physical and mental capacity in the community — not separated from it in an institution. When it becomes necessary for medical reasons, the care of the elderly — whether for a few days or for a longer period — must be in a facility capable of providing comprehensive medical and social services and geared to a rehabiltation philosophy. We believe there should be essential supportive services for the elderly or- ganized, administered and delivered on a community-wide basis and made avail- able to all elderly living in the community. This, we argue, is the most humane and economical housing policy for the elderly. Relief from property taxes. — We support property tax exemption for home- steads because steadily rising property taxes have increasingly adverse effects on elderly persons living on low fixed incomes. As a parallel proposal, we support also a homestead tax rent refund which would provide relief for elderly renters. We also maintain that the time has come to view the cost of education, which takes up half to two-thirds of the local property tax, as the obligation of hoth the Federal and State governments. The recent finding of the Cali- fornia Supreme Court that the local property tax for schools is unconstitutional since it discriminates against the poorer communities adds a powerful argument for the re-examination of how universal education for all children should be financed. Because securing State and local action is a slow process and the financing of education controversial, consideration should be given to the development of a Federal program to reimburse the States that extend relief to low-income householders — whether owners or renters — who are over-burdened by property taxes. TRANSPORTATION Goal : Transportation services in every community should be sufficient to enable older people to have access to the basic services of their community and to sup- port their needs and their right to participate in social life. Federal action. — Transportation problems in general and those of the elderly in particular are so critical that vigorous action by the Federal Government is required. Only by massive Federal aid and the concentration of that aid into selected transportation problem areas will the elderly and the general public be assured adequate transportation services. This means: A substantial portion of revenues from Federal gas, oil and motor taxes be earmarked for improvement of mass transit services. Action be taken by the Interstate Commerce Commission and the Civil Aero- 683 nautirs Board, either by regulation or through new Legislation where required to provide Cor reduced fares for elderly riders on planes, buses and trains bederal action is essential to guarantee the right of older motorists to buj car besisof 06 : ' san urgenl tieed f, "' ;l i ,,0,lil,i,i "" against denials solely on the Federal legislation should be enacted setting up a national system of no fault fer Insurance thai would provide tor paymenl of most accidenl claims without the expense oi egal action and would make available a greater share of the car insurance premium dollar to pay claims. Integrated services.- Separate transportation systems should nol be devised solely for the elderly. The most fruitful approach for resolving the mobility problems of the elderly is through a more effective transportation system for Be oi all aps. The elderly do require certain specialized transportation services mi in the long n.u such services should operate within more generalized net- works. Specialized transportation efforts for the elderly can and should provide foapetus for improved transportation services for (he general population Program requirements for transportation.— Achievement of improved' trans- brtation services for the elderly would he enhanced if the problem remains the fesponsibihty of all units of government-Federal, State and local, it, is appro- priate, however, tor the Federal and State governments to provide leadership hv requiring, for example, that transportation he an integral part of any socia 1 se vl fe^uX^ * BUt tbeSG ^"^ Sh ° Uld meSh WUh Simihlr activS [inMviduaUzea I transportation.— The Federal Government should act vigorously >n behalf ot individualized transportation for the elderlv for such activities as |opping and religious worship. At the same time, it must he recognized that federal action is not enough. A successful program will require the energies ocal government and volunteer community groups. A variety of mechanisms are ■equired such as low cost car insurance, volunteer driver programs and demand ictivated services In short, there should be a wide spectrum of services which can By be achieved by a mix of Federal, local and private efforts Safety and convenience.— A more active role by the Federal Government in the Itting of standards is required in the areas of safety and convenience for the elderly as pedestrians, drivers and users of transportation systems State and ocal efforts in these areas are frequently fragmented, uncoordinated and in- consistent. Adoption of legislation now pending in Congress which would make it l Federal offense to deny an elderly motorist car insurance solely on the basis >f age is an example of an appropriate Federal standard. The diverse needs >t older people in these areas will require the traditional involvement of State ind local governments, which are best equipped to handle the day-to-dav detai s >t such programs. y ueid.ii*> Nutrition Goal: The nutritional well-being of the nation's elderly should be improved Eerl 8ame therG should be P r °S rams to help meet social needs of the Research and services.— Both research and services are important and financial import for both should be increased. However, increased funding for one area iould not be at the expense of funding in another area. Programs must be base ►n the best information and research currently available. The victims of mal- nutrition among the aged have made their contribution to society Societv must ee that no aged person's nutritional needs are neglected * ' Higher standards.— State and local governments have had ample opportunitv o raise standards for institutional food services but generally have not done so federal action is essential to raise standards and the most' effective approach irald be to require institutions and home care agencies to meet higher standards is a condition for receiving funds under Federal programs Educational programs.— There is a need for governmental sponsorship of tutritional education programs designed for the elderly. These programs should nvolve the mass media, voluntary and public agencies, national communitv organizations, and the training of professional and semi-professional workers in lutntion and gerontology. The cost of this educational effort should not be at the ■xpense ot the nutritional needs of the elderly. It would be a cruel hoax to oro- ide nutritional education but at the same time deny the elderlv utilization of his knowledge through a lack of income or the lack of services or programs to fleet their needs. * & 71-272— 72— pt. 1- 44 684 Group meals vs. home-delivered meals. — Experience demonstrates that a meal service program is more effective when meals are provided in a group setting which encourages social interaction and facilitates the involvement of other services which directly relate to adequate nutrition. The objective should be not only to provide food but to meet social needs as well. However, such programs, to the extent possible, should include home-delivered meals, nutritional education and appropriate auxiliary services for shut-ins. Federal responsibility— -'The responsibility of the Federal Government to pro- mote adequate nutrition was documented by the 1969 White House Conference on Food, Nutrition and Health. A major emphasis should be to raise the inadequate incomes which now pre- vent so many older Americans from eating nutritious meals. But inadequate income is only one of several causes of malnutrition among the elderly. Programs should be devised which not only provide proper nutrition but at the same time combat the social isolation and other problems faced by so many elderly. Safety and quality of food supply. — All levels of government must act vigor- ously to protect older persons who, because of low income and greater incidence of poor health, are very often victims of price gouging on food items. Congress should provide the redirection and funding to make government more responsive to the needs of the consumer. There must be a rededication by Federal protection agencies, including the U.S. Department of Justice, the Federal Trade Commission and the Food and Drug Administration, to consumer needs with' special emphasis on the safety and quality of the nation's food supply. RETIREMENT ROLES AND ACTIVITIES Goal : The retirement years shounld be satisfying years — a time to deepen and widen relationships with friends and relatives — a time to be of service to others — years filled with a sense of usefulness and worth — a time of recogni- tion of the individual's contribution to society. For the retirement years to be meaningful and satisfying, older people must be assured adequate income, housing and health care. Governmental responsibility to provide opportunities for gainful employment and also volunteer employment programs. — Age or compulsory retirement (the latter described by many older people as being fired rather than retired) should not mark the watershed between a useful and contributory role in the community and a life of inactivity. The average older person wants to continue to work at socially useful tasks, be part of the larger community and have a meaningful choice as to how he shall spend his later years. The Federal Government has a responsibility to provide community service programs which not only provide income for the low income elderly but alsc afford them the opportunity to make a further contribution to society. Elderly persons can and do derive great personal satisfaction from being oi service to others — through churches, unions, community social welfare organiza- tions, senior citizens centers and programs to help the needy — but these volun teers very often need to be compensated for out-of-pocket expenses as is provided for under the new Federal program. Retired Senior Volunteer Program (RSVP) No means test for services programs. — Except for programs clearly designee to provide income supplementation, eligibility for service programs — protective homemaker, etc. — for the elderly should be based on the need for the service anc not on the person's income. Historically, programs for the poor have become "poor" programs. As a nation, we possess the resources not only to eliminate poverty among th< elderly but to provide them with a level of income that would permit them t< live in comfort and dignity and to participate fully in the life of the community As Guiding Principle No. 5 (see page 2) indicates, "while adequate income is { first priority, a program of appropriate services is also essential and necessary.' Preparation for retirement. — Public support is needed to prepare the aged foi the inevitable changes that occur along the life-span so that their quality o life may be enriched and their effectiveness as contributors to society enhanced Supportive services for the elderly and their families. — The maintenance o strong familial ties is of great importance to both the elderly and their families This provides older people with a significant sense of dignity and security. O equal importance, this familial relationship can and does enhance and strengthei family ties and family life. 68; To strengthen the older person's sense of Independence and prevent bis or her fear of becoming a heavy burden and source of concern to (lie family, supportive services protective bomemaker, nutritional— should be available to meet critical emergencies and to supplement the family's obligation to the elderly. For the unattached individual or (he older person whose family Is widely scattered or unresponsive, an outreach service functioning in fl substitute family role — backed up by a wide range of supportive services is essential. How a senior citizens organiagtion am affect public attitudes toward the el- derly. — Organiaztions Of, by, and for seniors, democratically governed and dedi- cated to promoting the welfare of older persons, can and do make important contributions to the general welfare. Such organizations make possible : Satisfying and significant roles for older people in managing the affairs of the organization and in conducting service programs Cor the elderly. Action programs designed to secure legislation benefiting not only the el- derly but their children and grandchildren, such as extension and improvement in Old Age, Survivors and Disability Insurance and a national health security program designed to provide comprehensive health services for persons of all ages. Such organizations promote responsible citizenship by supporting progressive candidates and issues. They share with other groups a common concern for the nation's welfare. EDUCATION Goal : Older people should have the right to participate in educational activi- ties that will enrich their lives and enhance their contribution as citizens. This guarantee must be accompanied by adequate services to ensure a dignified and secure old age ; otherwise most educational efforts, no matter how well formu- lated, are certain to prove futile. Education as a right. — Every American, including the elderly, should have the right to the finest possible educational opportunities and that right should be based on the concept of the individual worth of every human being. This concept should not be subject to modification by cost/benefit considerations based on age. National commitment. — There should be a national commitment to educate the elderly and this commitment should be reflected in increased public expen- ditures and efforts to include education as an integral part of all programs designed for the aged. A national policy to implement this commitment should include : High priority for funding and staffing educational activities that will better enable older people to cope with urgent problems related to health, income, housing, employment and other necessities related to daily living. Public support for programs to prepare the elderly for retirement during pre- retirement years so that the quality of their life in later years w r ill be greatly improved and their effectiveness as participating citizens enhanced. Responsibility and leadership. — Responsibility for initiating, supporting, con- ducting and coordinating programs in education for older people should be vested in the established educational system and should include : Involvement of State educational agencies, universities, community colleges, local school districts, as well as specialized agencies, private and voluntary institutions, organizations and groups serving older people. An overall leadership role for the U.S. Office of Education and Establishment within that agency of a Unit of Education for Aging, headed by an Assistant Commissioner of Education, and a National Center for Life Long Learning. Increased effectiveness and status for the Administration on Aging in securing educational and other needs for the elderly by making it an independent agency or by transferring it to the Executive Office of the President. Flexible education. — Education is a life-long process and the educational sys- tem should offer all groups in the population — youth, adults and retirees — equal opportunities to participate based on their needs and interests. The system should be flexible enough to see that the education of older persons, when necessary, can be conducted apart from the education of persons of other ages. A variety of educational activities should be available ranging from voca- tionally-oriented to culture- and leisure-oriented programs in order to provide maximum opportunity for the elderly to gain all they can from their learning experience and at the same time enable them to contribute from their experience and wisdom to other age groups in the population. 686 Research versus program needs. — There should be increased funding for re- search and for innovation of improved educational opportunities not provided by the traditional educational system and for expansion of existing programs of demonstrated effectiveness. Maximum progress in expanding and improving educational services for the elderly can be best achieved through a balanced deployment of resources in support of both these objectives. _ Political education. — National educational policy should stress the importance of the political process as a means of improving the well-being of older people and should educate them to make more effective use of their collective influence in achieving that objective. An integral part of this effort should be educational programs which will enable older persons to participate more effectively as individuals in the political process. Special programs. — Special outreach programs should be developed to en- courage older persons to participate in educational services. Included in such programs should be special efforts to involve older persons difficult to reach by reason of social, economic, health, or racial characteristics. Criteria for educational services. — It is imperative that the needs for older persons, and not institutional needs, be the basis for provision of educational services to older persons and that this be the basis for determining educational priorities. In order to achieve this objective, there should be full participation of the elderly at every level of policy formulation and implementation. SPIRITUAL WELL-BEING Goal : The individual's religious beliefs can be a sustaining force throughout his lifetime. The later years with their changes in physical strength and health and the losses of relatives and friends place demands on the inner resources of mind and spirit of the older person for which the supportive services of a re- ligious ministry are often essential. Relationship of government and religious bodies in providing for the welfare of the elderly. — There are various and complementary roles in the development and protection of the individual's spiritual well-being appropriate to govern- ment, religious organizations, community, family and friends. Each must assume a responsibility and recognize their limitations. Government can assist chiefly in providing the underpinning of economic se- curity so essential to peace of mind and assuring the conditions of a free society essential to the fulfillment of the spirit. The community can provide the environment necessary to a healthy life, while church, family and friends can be supportive of the individual's efforts to meet and master the problems of advancing years. Older persons have special religious needs.— The needs of older people, while often reflecting the needs of the whole society, are of such special nature that it is appropriate there be special programs designed to meet their needs with par- ticular effort devoted to involving the isolated older person without family ties. Religious organizations should serve both spiritual and temporal needs. — Re- ligious organizations need not restrict themselves solely to the spiritual sphere but can rightfully be concerned with both the spiritual and temporal concerns of the elderly based on the concept of serving the whole man who is composed of body and soul. Religious organizations can rightfully be concerned about the various social needs which relate to the elderly such as housing, nutrition, mental and physical health care, and other needs. The various religious bodies can effectively serve as advocates together with the elderly in order to effect an improvement in the lives of senior citizens. Religious organizations should approach the needs of the elderly ecumen- ically. — Religious denominations often maintain a ministry on the aging. These ministries should work together across denominational lines developing a joint commitment to the spiritual and temporal needs of the elderly. In fulfilling the temporal needs, an ecumenical spirit should prevail that would assign to that church body with the resources and the desire to act the responsi- bility for designing and providing facilities and programs for the elderly re- gardless of race or religion. PLANNING Goal : Government at all levels should establish a leadership-planning mecha- nism with sufficient power and funds to assure that the needs of older people ;ir*' met either through adequate programs for the total population or through special programs for the elderly. 687 Planning al the Federal level, in order to achieve the cloul essentia] to Implement coordinated planning as well as advocacy, we recommend thai there be established, within the Office of the President, an Independent agency for the aging under the direction of a Presidential Assistant on Aging, We use the word "Aging" advisedly (rather than "Aged" or "Older Americans") because aging is of concern to the total population, not just t<> those having reached u certain chronological age. The proposed White House agency should have the authority, funding, and shifting needed to formulate and administer policy, to coordinate and monitor programs of those Federal departments having a direct concern In matters re- lating to aging, and to significantly affect the budgeting process of the (federal government. The agency should have whatever funds are needed to finance innovative aging programs of appropriate Federal departments or agencies — when deemed neces- sary by the Presidential Assistant on Aging— on a demonstration basis until their value has been proved and they can he delegated to existing agencies. The independent agency would be served by an Advisory Council that is ade- quately representative of older people. Federal departments or agencies especially concerned with programs for the aging should he required to establish a position of Assistant Secretary on Aging i or its equivalent) for the purpose of developing and maintaining operating programs on aging and for assuring appropriate emphasis on aging within the department or agency. Through a Federal Council on Aging, directed by the Assistant to the Presi- dent on Aging, the Assistant Secretaries on Aging would recommend inter- departmental policy and program innovations. Planning at the State and local levels. The leadership-planning mechanism at State and local levels should — to the extent possible — parallel the mechanism at the Federal level. The White House-level office should have both the resources and prestige necessary to encourage the development of such parallel units. Relationship of government levels. We believe that it is essential to establish a meaningful relationship between the planning activities in aging of all levels of government — just as it is essential to coordinate planning at any one level. Federal grats for State and local planning efforts should be accompanied by reasonable requirements for joint planning. Primary objective of planning. The planning mechanism should have the authority and respect necessary to make existing programs and services re- sponsive to the concerns of older persons and more effective in meeting their needs. One of its major responsibilities is to identify areas w T here a separate program or earmarked funding of general programs is essential in order to assure that the needs of older people will be met — initiating and administering such pro- grams if necessary until they can be safely delegated to existing agencies. Participation of the aging in planning. The elderly must be significantly in- volved in planning, in cooperation with professional personnel who combine a knowledge of the needs of older people with expertise in program development and implementation. Middle-aged and younger people should also have a voice not only as future consumers but because their financial and moral support is necessary to the success of the plans. FACILITIES, PROGRAMS, SERVICES Goal : A wide and adequate range of facilities and services appropriately de- signed to meet the needs of older people through consultation with older people must be developed and financed. The emphasis in the management and operation of these services and facilities must be on the maximum feasible participation of older people. Maintaining independent living. — Our resources, public and private, must be ■directed toward maximizing the likelihood that older persons — even when en- feebled — can continue to live in housing arrangements of their own choice. Given the option, the great majority of older persons would favor independent living to even the most benign type of custodial care. This argues for a range of services — social, health, rehabilitation, recreational, nutritional, protective and counseling — that would enable the older person to live in his own home, or with his children or grandchildren or with a small group of other older persons, or reside in a residential facility. Unfortunately, too many nursing homes are not living arrangements but cus- todial facilities to which an elderly person is committed until death. 688 Our public policy must be to keep the older person functioning at his or her maximum physical and mental capacity in the community — not separated from it in an institution. When it becomes necessary for medical reasons, the care then provided — whether for a few days or a longer period— must be in a facility capable of furnishing comprehensive medical and social services and geared to a rehabilitation philosophy— the concept of a geriatric hospital with an open admission policy. Wo believe essential supportive services for the elderly should be organized, administered and delivered on a community -wide basis. This, we argue, is not only the most economical way to provide these services but has the particular advantage of keeping the resident of a housing project, for example, related to the community. Sponsorship and operation of services and facilities should be primarily by non-profit private and governmental agencies. — The great majority of the elderly cannot pay for the essential services and so must receive them free or be par- tially subsidized. Many of these services— recreational, protective, homemaker, nutritional and others — have significant preventive aspects and so like public health programs ought to be universally available. As Guiding Principle No. 5 (see page 2) notes, even an adequate level of income does not assure that a needed service will be available. Only governmental or non-profit private agencies can assure the availability and accessibility of essential services most efficiently and economically. Governmental agencies should have the major responsibility for the planning, financing and coordination of services and facilities for the aging. — As indicated in Guiding Principle No. 6 (see page 2), voluntary non-profit agencies and organizations are an essential component in any well balanced program of serv- ices for the elderly, but the development of a universal system of services requires the resources of government. These resources plus the rule making, standard-setting and inspectional powers needed argue for a governmental agency carrying the primary responsi- bility for the planning and coordination of facilities and services for the aging. Role of older people in the management and operation of facilities and serv- ices. — Programs for the elderly should be designed and operated with significant participation of older people in policy and management. The fullest consideration should also be given to employing older people as staff. There are many older people with professional and technical competence for whom such employment can represent a second career. Moreover, the con- cern we profess for retirement roles and activities implies an obligation to design staff positions that can utilize older people. Separate vs. integrated facilities, programs and services for the aging.— As Guilding Principle No. 7 (see page 2) indicates, older people to the maximum extent possible desire to participate on equal terms in programs for the total population. But older people often have special needs that demand programs uniquely designed for them. If these can be arranged by a recreation department or a housing agency, this would be preferred by many older people to setting up a facility, for example, to be utilized exclusively by older people. The' responsibility of government for consumer protection. — Although there are a variety of governmental agencies charged with consumer protection — pub- lic utility commissions, the Federal Trade Commission, the Food and Drug Ad- ministration — these have largely become captives of the industries they are supposed to regulate. To protect the consumer, legislation is needed to enable consumers to sue in the Federal courts on behalf of themselves and others similarly situated (class action litigation) for damages and court costs where manufacturers or mer- chants are found guilty of defrauding the public. Congress should also enact consumer product safety legislation, a consumer fraud prevention act, a fair warranty disclosure act and a consumer product test law. ■ To make consumer protection more effective, an independent Federal Con- sumers Council should be established. Legal sendees for the elderly. — Elderly persons need to have easily available legal services at no or low cost for the protection not only of their rights and property but also to assure them full access to their legally entitled benefits- Social Security, housing assistance, health services and protection against arbitrary governmental action. hS'.l Elimination of age discrimination. Increasingly, age is becoming ;i Icej fac tor in denial of employment, eligibility r<>r ;> borne mortgage and denial of auto mobile insurance except al an exorbitant cost. These practices call for a vigorous enforcement of the age discrimination in Employment law accompanied by a removal of the upper age limll of <;•"> in cur- font legislation to prevent the growing practice of early "retirement." Then- is argent need for a Legislative requirement that insurance companies insure at ;i reasonable COSl older drivers with valid drivers permits. TRAINING Goal : To make sure essential services for the elderly are sufficiently and effec- tively provided and delivered, adequate manpower to render these services is essential. Emphasis should he placed on the problems and needs of the elderly in training programs for service personnel. — The curriculum for the education of service per- sonnel — particularly physicians, nurses, social workers, rehabilitation personnel, recreation staff, and adult education teachers — should provide as an integral pari of the educational process information on the special problems and needs of older people and. where appropriate, clinical experience. Consultation and in-service training in service agencies. — Agency services for the general public, including older people, should provide consultation and Biservice training directed toward assisting staff members to understand and serve the special needs of the elderly. Development of leadership personnel. — Schools of Education, Medicine. Nurs- ing. Social Work and graduate departments in Psychology, Sociology and other disciplines related to human service should he stimulated and assisted financially to recruit promising students who are interested in hecoming experts on the aging within their respective disciplines. . Such specialists are essential to sensitizing their basic disciplnes to the prob- lems and needs of older people. A highly flexible approach to recruitment. — Demands for staff in the service programs for o»de-r people should be met in a highly flexible manner and should seek young people planning a lifetime career, middle-aged persons seeking a career change and older persons for whom such employment would constitute their unique contribution to helping their fellow 7 seniors. RESEARCH AND DEMONSTRATION Goal : A comprehensive program of research into the causes of aging in humans and matters affecting the quality of life of older people should be developed includ- ing effective means for rapid and practical application of new knowledge by legis- lators, administrators and professionals. Research priorities. — The resources devoted to research on aging are meager. For every dollar paid for nursing home care less than y 2 cent is invested in seek- ing to determine now T to prevent chronic disabilities and mental deterioration that force institutionalization of a great many elderly. More intensive research into the causes of aging in humans by maximizing the ability of the elderly for self-care and independent living would bring incalculable benefits in human terms and would save billions of dollars in the process. Research and evaluation versus facilities and services. — There is dire need for increased expenditures both for research and evaluation and for facilities and services. One should not be at the expense of the other. It is not a question of "either/or" but efforts in both areas should complement each other so maximum results are achieved at minimum cost. Federal coordination. — Research in the area of aging in humans is not receiving sufficient financial support or making significant progress. It receives modest funding from a variety of sources but the total is inadequate. A major need in aging research is a clearer delineation of what should be done and ho w best to do if. A unified research effort in the area of aging under the leadership of the Fed- eral Government, is the most feasible approach toward this objective, and estab- lishment of a National Institute on Gerontology is the most likely way to accom- plish it. Specialized versus multidiscinlinary research. — Specialized research projects are important and must be continued and expanded. But there is an increasing 690 need for research on broader approaches that will provide valuable information for determining social policy. Establishment of multi-disciplinary centers would help close the gap between specialized research knowledge and the use of that knowledge. Basic and applied research. — High priority must be given basic research efforts such as those directed toward an understanding of the biological aging process, geared to an attack on chronic diseases of middle and old age. But at the same time, there is a need for increased support for research that concentrates on im- proving the quality of life in later years. The goal should be a balanced growth in both the length and quality of life. GOVERNMENT AND NON-GOVERNMENT ORGANIZATION Goal : Government should implement its basic responsibility for assuring that the later years shall be secure, dignified and satisfying. As Guiding Principle No. 4 (see page 2) indicates, "government has the duty and the responsibility to serve as an advocate for the beneficiaries of the pro- grams it provides." By policy, Government should administer its programs for the elderly in ways that will encourage and support the independence of the individual, supplement and strengthen family relationships, and utilize the resources of churches, pri- vate non-profit organizations and local government. The public, including the elderly, have the right to look upon their government as truly of, by, and for the people — a "we" institution, not a "they" institution. To perform an advocacy function effectively, government must provide strong leadership. — To provide strong leadership in advocating and promoting programs for the elderly, there must be established at the Federal level an Office on the Aging Within the Executive Office of the President — charged with oversight over all Federal activities related to aging and capable of raising the emphasis on aging in the Departments of Health, Education, and Welfare, Housing and Urban Development, Labor, Transportation, Agriculture, and the Office of Economic Opportunity (anti-poverty agency). At the State level, equivalent independent bodies should be established with authority to oversee all activities related to aging. Such bodies should receive Federal support and be authorized to create regional offices and, where appro- priate, city or county commissions on aging. The membership of such commissions should include older people's organizations. Where regional commissions or city or county commissions exist or are estab- lished, these commissions should possess authority to coordinate programs for the aging and be entitled to financing from the State Office on Aging. Further to strengthen Congressional coordination and surveillance of programs for the elderly, a House Special Committee on the Aging similar to the Senate Special Committee on Aging should be established. Provision of services and facilities as a matter Of right. — The right to a floor oi income — above the poverty level — and the right to Social Security benefits which have been earned can no longer be argued. The right to health services for the elderly within the limits of Medicare has become fully accepted. The right tc comprehensive health services for all Citizens seems likely to become public policy at an early date. A wide range of services for the elderly — recreational, homemaker, day care, nutritional and protective — is essential to the well-being of older people. Because these services are preventative or ameliorative — preventing the need for much more expensive Institutional care — they should be viewed as analogous to public health services and offered on a universal basis with the sole eligibility require- ment the need for the service. Services for the elderly offered by private non-profit organizations are ar essential part of the range of services that should be available. — Non-profit agen- cies and organizations — membership organizations and direct service agencies- are essential components of a well balanced and adequate system of programs and services for seniors. The mutual help activities of a senior citizens membership organization — pro- grams provided by churches, unions, fraternal organizations and non-profit serv- ice agencies — are not only important supplements to basic governmental programs but provide for a degree of individualization and personal contact not always practical or possible under government programs. Private organizations also are freer to innovate and experiment with programs than are government agencies. 69 Goverzunenl should stimulate and encourage citizen organizations to undertake programs for bhe elderly and provide Limited financing Cor such programs. The voluntary organization, however, should not become so dependenl on government funds that It is Inhibited in acting :is ;i constructive critic of governmental pro grams and as an advocate for seniors. Mr. Newburgher. Thank you very much, Mr. Chairman. Mr. Scheuer. I want to lake this opporl unity (<> welcome M r. New- burgher. He and I have worked together for years in l Iw field of (lie aging and I know of no representative of senior citizens across the country who has more youthful vitality, who has more qualities of dynamic leadership than Walter Newburgher and if is a great, great pleasure, Walter, to have you with us today. Mr. Newburgher. Thank you, Mr. Scheuer. r would like to make a few statements first before I really get into the meat of the thing. The Congress of Senior Citizens here in New York has a membership of over 200,000 members so we have been talking all morning about a fraction of the population. That is a pretty good fraction, the same as the National Council with its 8 million members. I am awful sorry that Commissioner Sugar- man isn't here yet. Mr. Scheuer. He lias testified. Mr. Newburgher. I know it. I v^ould like to break a lance with him. He introduced himself as the representative of the generation gap. What generation gap? I don't believe in a generation gap. It lias been wished on us and the fact perhaps that generation and gap start with the same letter of the alphabet — it was invented by somebody who was very great on alliteration. Mr. Hansen. I think, in fairness to Mr. Sugarman, his reference to it was calling attention to the interest that he has had with this com- mittee in early childhood programs and in programs for the aging in which he has demonstrated an interest. Mr. Newburgher. I assure yon it would have been a friendly combat with him. Mr. Brademas. Mr. NVwburgher, I must tell yon that your time is about running out. Mr. Newburgher. I haven't started yet. Mr. Brademas. I am going to have to give you one more minute and yield to your colleagues. Mr. Newburgher. Then I have to drop most of it. I will be a dele- gate for the White House Conference from the State and I want to assure you that we have a wonderful program going down there. When we came up to Albany the program wasn't to my liking but it is going out of Albany as perfect as any statement can come out of Albany. My main thrust here that I w T ant to make is this : You are well- meaning friends of ours, all of you, but if you are going to come up after the White House Conference with law^s on the books that con- tain even a slight hint of a means test you will fail in your intent to do something for these old people because they will not use it. The old people will not swear to a poverty oath because they feel this is undignified. They deserve better than that. They are the gen- eration that went through the depression, put this country back in shape again at low wages, paid to the social security fund in heavy dollars and are now getting paid back in phony dollars and it is about time that you made up your mind that such programs will not be utilized here. 692 In the city of New York we have 1 million retired senior citizens over the age of 65 ; 500,000, according to the statistics would be eli- gible for welfare and less than 50,000 have accepted the concept of welfare in the first place. We have gotten a rent exception for them here. Hardly anybody signed up for it. You have given us food stamps. The older people don't want to walk out of a supermarket with their next door neighbor m back of them handing out food stamps. Anything that smacks of charity these people will not accept. They do not want to hold their hand out for a handout. Iney teel that they have earned the right to have adequate social security bene- fits. As Mr. Hansen said, they have inadequate income, yes. Give them adequate income but don't embarrass them by means tests, by poverty oaths and make them hold their hand out for charity. They do not accept charity. They do not want charity. They simply will not participate in any program of that kind. I would have liked to sav more, Mr. Chairman. Mr. Brademas. You have been very eloquent, Mr. Newburgner. Mr. Newburgher. I wanted to talk about the AOA. Mr. Brademas. We may get back to it after we have heard the other two gentlemen. Mr. LoMolino. My name is Larry LoMolino. Mr. Scheuer. I would like to welcome Mr. LoMolino. He is a rep- resentative of the American Association of Ketired Persons and he is a very distinguished citizen leader in the Bronx. We are very privi- leged to have you here, Larry. Mr. LoMolino. Thank you. I have representation in the American Association only as far as I am on the legislative committee of a chap- ter in our neighborhood but I am very active in the legislation of the American Association. I don't want to say that I am representing the American Associa- tion in its entirety. I think our association is going to represent itself at the White House Conference and I ask and request that you gentle- men and your colleagues give assistance over there in Washington in this White House Conference. I represent senior citizens is what I like to say, in that 90 percent ot the 1 million in New York City does not know what is going on. I don't say we need a committee here. We don't need a committee, as Congressman Scheuer mentioned before, as to what is wrong and what is needed for our aged. I think all you gentlemen are well aware of that and therefore 1 don't want to go into much repetition of what has been taking place here this morning because I am just getting my feet wet m this thing. I see now there is lots of water and I better learn how to swim. But to you, Congressman Hansen, I would say this: although we have our senior citizen who is supposed to have the education and the experience and the knowledge of all their years, they still do need an education to come out forward and help themselves also. And then to Congressman Scheuer who says the public has to be interested in our younger group. Today they don't realize that they are ever going to get old but they are going to get old someday and they are going to need the assistance that we are asking for today. So we, as senior citizens, in my opinion, are the pioneers to see that 693 Congress and you gentlemen behind us give us the j<>l>s that we need. Thank you so very much Tor having me here today. Mr. Brademas. Thank you, Mr. LoMolino for ;i very line statement. Mi-. Dimond. Mr. Dimond, My name is George Dimond. I am president <>l* the William Elodson ('enter which is one of the oldest centers in the United States. This center is well organized. It has a membership of over '2,000 people. Despite the Tact that we have many activities in the center a lot of people don't come down for the simple reason that the center is located on 169th Street and Webster Avenue. There isn't a week that passes by that we don't hear of a member being mugged or robbed, man}' of them two and three times. It is getting worse rather than better. The members live in fear that they will be next to be mugged. Instead of the police or anybody doing anything to protect them — we had a letterbox on the corner there and the letterbox was broken into a few times. Instead of putting someone there to watch the letter- box and to catch the people who were breaking into it they took away the letterbox. That was the simplest way of settling the argument. So now they don't have to worry about the letterbox being robbed. They just took it away. There is another thing. The people that live in the housing are compelled to live there, the elderly people. As Mr. Newburgher said, they are proud. They don't want to go on relief. They don't make too much money and they have to live there because the rent is not too high. If there is a lot of mugging going on there I don't see why, in a city project like that, they can't build a separate house there for the senior citizens that they shouldn't live among all these people that mug them and rob them. They should have some kind of protection. They don't get any pro- tection from the law. At least they should build a house for senior citizens alone and should have that house with a lock on the door downstairs and some kind of protection for the older people, not that they should have to be afraid for their life, afraid to walk out of their apartment. We have, down at the center, plenty of activities and everything and the people would come down if they weren't afraid. I think we ought to do something to protect the older people. That is very im- portant. I guess that is about all I have to say. Mr. Brademas. Thank you very much, Mr. Dimond, for another very compelling statement. Mr. Scheuer, this is our final group of panelists in your district. Perhaps you would like to begin the questioning. Mr. Scheuer. Let me yield at this time, Mr. Chairman. I think their remarks were cogent, short, sweet, and to the point. I think they gave us a very clear picture. We don't need a lot more research and experi- mentation. We just have to get on with it; put in our bucks where our great speeches are. Mr. LoMolino. The only thing, gentlemen, I would like to say is our present bomb explosion in Alaska, which was an experiment in order to find out what would be needed in defense of our country and whether or not it would be appropriate, took only 24 hours to get the 694 Supreme Court to convene to make the decision on whether or not this bomb would be effective in case we were invaded. Yet, the aged are invaded today and you can't get any sort of legis- lation brought together immediately to make a decision on what to do for the aged. Here you can get the Supreme Court together within 24 hours. I say get rid of the redtape. Mr. Scheuer. Well said. Mr. Brademas. We are now experiencing a similar kind Mr. LoMolino. I am not against the bomb. Don't misunderstand me. Mr. Newburgher. What this gentleman says — we who are about to die salute you. Mr. Scheuer. Most of us are against the bomb. Mr. Brademas. Mr. Hansen. Mr. Hansen. I might say I was there. I won't go into the issues. It was rather interesting. I would make one observation and I have one short question. In all of the hearings that we have held on this subject we have heard some very excellent witnesses, many who were specialists in the field and administered programs. I think it is correct to say and I am sure my colleagues would not disagree with me when I say there have been none better than the senior citizens themselves. Whatever handicaps they may suffer from, lack of communication is not one of them. They have been able to communicate effectively and eloquently and right to the heart of the issue. Our experience here this morning rein- forces that conviction. Let me just ask one question on a matter that Mr. LoMolino touched on that we talked about in our Chicago hear- ings at some greater length. You referred to the need for education so that older people can more effectively utilize their skills in a productive way. What would you suggest might be done in the way of providing educational oppor- tunities, not only just for the purpose of enrichment of the individual but for the purpose of gaining the kinds of skills that may be market- able and may be a means of helping to reinforce income ? Mr. Dimond. May I have a word ? In our center we have an English class, we have a Spanish class, and we are trying to educate the people as much as we can there. Mr. LoMolino. I say educate them in the sense of what is going on in our legislative division of our country so they can appreciate what they are asking for too. As to educational programs, there are so many right now, Congressman Hansen. This is my first experience being before a committee and I believe in a little more time I will be able to answer questions a little better than I do. Mr. Hansen. I think you have performed very excellently. Mr. Brademas. Mr. Peyser. Mr. Peyser. I would just briefly like to speak to one issueand that is the issue I mentioned before and you brought up, sir, which is the problem of safety on the streets. I think there are very few things that get me angrier quicker than the attacks and muggings on aged people in this city. It seems to me this problem has got to be directed to the city itself and I hope that your organizations are speaking as loud and clear in (i«)5 the city hall here bo demand the kind of protection I think you are entitled to in this city as you are righl here this morning. I just hope you are mating this expression. I would certainly do Anything in my own area of power to hark it up. 1 say that il is of vii;il importance because it just shouldn't be happening the w;i\ il is today. Mr, Dimond. A lot of them there claim they gel mugged, they know the people and they are afraid to talk because if (hey do lock them up the next day they arc out on the street again, or a couple of weeks later they are out on the st reet and t hey are a I' raid of t heir li IV. So they are afraid to even talk. They know that there ace people in their own house that break in and 'rob them and they can't say anything- Mr. IV.Ysr.K. Thank you. Mr. Brademas. The Chair noted we have had a request to testify from Mr. Leith. Mr. Leith, we will give you the same 2 minutes. STATEMENT OF PAUL LEITH Mr. Leith. Some of you said that if you go down from the State officials down to the senior citizens we seem to be getting closer to what you want, but you haven't got down to the people in the neigh- borhoods, the senior citizens. They are not here. Efforts were made to get them here. They don't come because they don t feel that anything you are doing in Washington reallv affects them, that you are not listening to their needs and their demands. That is what is happening today. Your 5 percent in the House, social increase, is a measly thing. It may go up a couple of dollars but that is not the real issue. It is not meeting the needs of older people. We are getting less when we retire. U e are way behind those who are working. Their standards increase, ours do not and vou don't address vour- self to that question. I feel that Congressman Scheuer should call a hearing in this district and find out what are the unmet needs of the older people here and that is what your whole committee should be do- ing also in that connection. Second, the White House Conference on Aging : Everybody thinks it has been wonderful so far. What has happened ? The year 1970 was to get the older people to express themselves, the voice of the older American. In May, when the senior citizens meeting was supposed to talk about it practically none of them discussed the question. When the forum line m September of 1970, the senior citizens were supposed to talk .111 we got were speeches from the stage and a couple of people at the fc-d were allowed to get up— senior citizens— and talk for a few ninutes. Fifteen minutes were given to the older people. The needs of the )lder people are being neglected, the voice is not heard and unless pat is changed you are not going to accomplish much. The priority, that older people are way down on the bottom yet is not being solved. It is a serious problem and it ought to get reaf serious attention. Mr. Brademas. Thank you very much, Mr. Leith, for a very elo- quent statement. I think I ought to make clear that it is precisely be- 096 cause the members of this committee share the sentiment you have ex- pressed that we are here in New York city today . It is precisely because members of this subcommittee are deeply concerned about the failure of our National Government to make an adequate commitment to meeting the needs of older people that we are holding these oversight hearings in las many cities of the United States as possible. It is precisely because we think the White House Conference ought to emerge with action and not speeches or resolutions we are moving around the country inviting the views of people like yourself, people like your other senior citizen colleagues, people Who work in the vine- yard of the problems of the elderly that we are here. So I say only, to you sir, I couldn't agree with what you had to say more and I am one member of this subcommittee and I think all of the members of this subcommittee, on both sides of the aisle, share the con- cern that you have expressed and I hope very much that you will keep a sharp eye on that White House Conference on Aging that begins m a few days with a view toward seeing what action emerges from it. I have been very reserved as chairman of this subcommittee in what I have had to say about the policies of this administration, but that is because I am hopeful that we will see some action emerge from the White House Conference, action along the lines of what has been promised this subcommittee by Dr. Flemming, the distinguished Chair- man of the White House Conference on Aging. So I think, Mr. Leith, your statement ought to be regarded by all ot the members of this subcommittee, and indeed, of Congress as a chal- leno-e. We are very grateful to you for what you said. We are very grateful, gentlemen, for all of you and indeed to everyone who has testified and to Congressmen Scheuer for his help m having arranged these hearings. We are adjourned. (Whereupon, at 1 p.m. the hearing adjourned.) (The following material was submitted for the record :) Testimony of Jule M. Sugarman, Administrator, Human Resources Administration, New York City Mr Chairman and Members of the Committee, thank you for the opportunity to testify before your Committee. My purpose in being here today is to discuss with you the provision of social services to the elderly in New lork City. The need for these services is extraordinarily great in New York City where over 1 000 000 senior citizens reside. ' The goal towards which we must aim is the efficient delivery of a comprehen- sive range of services to all the elderly who need and would benefit therefrom. These services should be delivered, we believe, on a coordinated basis using as a base senior citizens' centers and multiservice centers. The Older Americans Act of 1965, which is under consideration today, has elo- quently stated the objectives which must be met by any legislation you write. It is well to keep in mind the most salient points : 1. an adequate income ; 2. the best possible mental and physical health ; 3. suitable housing ; 4. pursuit of meaningful activity ; 5. free exercise of individual initiative in planning and managing then own lives ; and 6. adequate and suitable transportation. 697 Given those objectives, a (-ireful analysis will reveal that 1 1 1 « - Older Americans Act has made a good beginning, but only m beginning. l say this primarily because of the Limitations on programs and funds in the act. in New York City, several programs are under way whose hush- nature Is either research or demonstration. This Ls an Important function, bul after five years we have some answers and our need is now to deliver services bo ;i wider constituency. What Ls now needed is a permanent authorization with adequate funds. To achieve this, the Legislation authorizing both the services and the fund- ing should encompass all persons above the age of ^ and authorize (hose kinds of services which would assist the aged in achieving the goals of enchancing their functioning in the community and remaining in or returning to their homes. I would now like to discuss some of the principles which ought to he Included in such legislation. Any new Legislation must he comprehensive; that is most important. It must also provide for tiie administration of the service programs at the local level. My conception of the ideal arrangement is direct funding from Washington to the locality, utilizing the States to serve smaller areas where local programs would he difficult to organize. This will avoid an extra layer of bureaucracy and permit closer relation to the needs and desires of senior citizens. The new legislation should permanently establish a national agency for older Americans primarily engaged in policy setting, program planning and advocacy of the needs of the elderly as set out in the declaration of objectives. Virtually all major Federal agencies have and will continue to need special staff con- cerned with the problems of the aged. I see no practical way in which all of these can be merged in a single Federal Office. Instead this Act should make clear the responsibility of this agency to provide leadership to other Federal staffs and to stimulate their creative efforts. It must also be remembered that many of the needs for income and services are already met — at least in part — through existing organizations and funding. There should be continued author- ization available to the agency for o'der Americans for direct funding of research and demonstration programs as well as seed money to enable communities to test out program ideas prior to seeking full funding under the Older Americans or other Acts. Certain types of services, not otherwise available, might be funded through this Act. but as explained below there is already substantial authority and funding available for such services. Examples of the areas of interest vital to the elderly in which the agency should be concerned, are adequate incomes (including all aspects of pensions, Social Security and minimum incomes) ; transportation (new systems, cost, ac- cessibility, design) ; health (national health plans, availability of care) and housing ( special facilities, a certain percentage of housing devoted to the elderly, and fedral subsidies). Research and recommendations on these and similar sub- jects, coming from a recognized advocate, could form a basis for future legisla- tive action at the State and local level. The Federal agency should create an advisory board and mandate that local administrations do likewise. An indispensable component of these advisory boards is consumer input. It should be mandatory that at least one-half of the membership of each board consist of the elderly who are dirct recipients of the services. This participation is essential to program success, since it is well known that the elderly are fiercely independent and proud. Furthermore, it is the wisest course to draw upon their many years of knowledge and experience ; to ignore it would be an indefensible w y aste. The service programs, included in the new legislation must take account of those currently authorized under Title XVI of the Social Security Act and the Federal Regulations implementing that Title. In point of fact, Congress has authorized an extensive service program for the elderly, limited essentially only by the income of the service recipient. This has been done by authorizing 75% Federal reimbursement for services to all public assistance recipients and those who have received or potentially will receive public assistance. Under Title XVI, this includes anyone who within five years is likely to become a recipient of Old Age Assistance. Other criteria include residence within a specific geographic area. Virtually every type of service except residential care could be provided to low-income persons under that Act. Its major limitations are that it is not available for seniors with higher incomes — and there are many who need services and it cannot be used to fund necessary construction. It has a very major ad- vantage in that Federal funds are open ended — available in whatever amounts may be necessary to match State and local spending. 698 As a long range goal, we believe that all social services legislation for the aged — programs and funding — might be under the Older Americans Act. This would be consistent both with the intent of H.R. 1 which places the financial assistance programs in the Social Security Administration and with current Federal and State legislative requirements, which have mandated a separation of income maintenance and services. But, and that "but" must be emphasized, funding for these service programs would have to continue on a 75% Federal matching basis with an open-end authorization. Although it would be preferable for all service funding to be consolidated in the Older American Act, I do not believe this is likely in the near future. The reality for us then is to urge that any bill approved by this Committee include at least the following : 1. Eligibility for services for all at age 55 and for all those not eligible under Title XVI. 2. The same range of services as are authorized under Title XVI. 3. 75% Federal participation. It is most essential that service delivery be able to be coordinated and that there be authority for joint funding of programs, under Title XVI, this and other Acts. Since, as I said earlier, we intend to use senior citizens centers, and multi- service centers as the focal point of our delivery system, and potential must exist for users to be programmatically integrated. Otherwise, you will sacrifice optimum effectiveness as well as efficiency. I am sure that it can be no one's intention to serve the elderly poor and the near-poor separate from their more fortunate friends and neighbors. The reason that we are recommending a minimum eligibility age of 55 is essentially because social service programs have always reached the elderly too late. And that is really not intended as a pun. Although we cannot prevent aging, we can inhibit the growth of the attendant emotional problems. Ap- propriate services and programs begun at the onset of the aging process — about age 55 — should lead to a healthier outlook and easier adjustment. It is a well documented statistic that most of the nation's elderly are poor ; and in New York City, even more of the elderly than the nationwide average are poor. There are more than one million people over the age of 65 in New York City today. That is 12% of our population and five percent of the aged in the entire United States. And while our overall population has remained rela- tively stable, the percentage of those 65 and over has increased by 16% over the past ten years. The growing need for additional services to the elderly is obvious. In authorizing programs then, it is important to keep in mind the necessity for compatibility with Title XVI. Our reading of the Federal Regulations leads us to believe that practically any service program benefiting the elderly is reim- bursable. The scope of the Federal authorization is limited only by the unwilling- ness of State and local governments to approve new programs for which they would have to contribute 25%. It is clear that a large percentage of the elderly can be served under Title XVI and, given present reimbursement rates, that would be our choice. The omnibus bill however, must provide for other elderly — those whose income exceeds the Title XVI eligibility levels. Such persons also require services, especially in the area of protection of person and property. In regard to my final point about Federal financial participation, I must re- emphasize that no State or City alone has the resources to provide the necessary services to its aged. The Federal government has recognized this, as exempli- fied by its 75% financial participation in Title XVI programs. The model should be emulated. Even if, as contemplated in the Older Americans Act, a dollar maximum is authorized, within that authorization Federal participation should be at 75%. One reason this is so important is to insure integration of services under the Older Americans Act and Title XVI of the Social Security Act. It would wreak havoc on our programs if we were forced to cut back services because of our inability to raise the funds required as a result of any lower Federal effort. In addition, unnecessary administrative effort would be entailed in determin- ing who was eligible for servives under which program. This is exactly the dilem- ma we want to avoid. As you well know, most of the elderly fiercely guard their privacy and resent unnecessary intrusions into their financial status. Many go without rather than submit to a means test. I am sure we can all agree that that is exactly the opposite of our intentions. It should be understood that even though enough dollars are not currently avail- able, the bright ray of hope is that if and when they are, legislation already 699 exists in Title XVI which authorizes their expenditure, four efforts mus1 n n legislation which builds upon the Older Americans Act, expanding 11 Hlggested. In that way, services will he available to nil (he elderly based on tll( n feed, not on their income. pESTIMONY OK AXICE M. BROPY, DlBEOTOB, OFPICE FOB Till': AGING, OFFICE OF THB Mayor, City ok New York, Presented by James T. Wabback, Dibectob of Field Operations The New York City Office for the Aging originated under the Older Americans let in UHks and has come increasingly to act as advocate and spokesman at the flghest levels of government for New York City's one million elderly who are '»' , of all the elderly in America. The need for advocacy for these older New Yorkers is vividly defined by the tct that while about a quarter of the elderly nationally live below the po ine, one half of the elderly in New York City live on less than $3,000. and one liird live on less than $2,000. The City Office for the Aging assesses the needs of the elderly for housing, lealth care, income maintenance, recreational programs and transportation. It s charged with developing programs to meet these needs. Coordinating both mblic and voluntary programs and initiating new systems for delivery of serv- ces, we exist to insure that the interests of aging will receive proper attention- hat they wall not be the silent and invisible of our society. We now have the first runs of our massive three year study, commissioned and inanced by the Administration on Aging, HEW, on the Elderly in the Inner City Ihich has immediate application for all those aging who live throughout urban Imerica. The study is unique in that is is drawn from the point of view of the Iderly as they see themselves rather than from the view of agencies. These self- >erceptions may or may not agree with seemingly objective facts but they un- ioubtedly determine to a large degree patterns of service utilization. That the elderly see themselves on the whole more encouragingly than do igencies in the position of appraising their needs is rather gallant testimony to heir pride and spirit. We consider it our obligation to creatively furnish "the neans to insure that the population of the inner city increasingly made up of the Iderly, is not obliged to survive on internal optimism and external isolation. The City Office for the Aging implemented the Reduced Fare Program for the dderly which has resulted in the enrollment for the half-fare of three-fourths )f the more than 800,000 eligible persons. Because of the Office for the Aging's nitiative in realizing the Reduced Fare Program, the City now levies taxes of .15,000,000 to make the Reduced Fare available. The difference in the available >ocket money to an older New Yorker, whose means are severely limited and vho is totally reliant on public transportation for mobility, affects every area )f his life. It means that small extra amenity that makes his life a little less ■onstricted, a newspaper, a small gift to a grandchild or an occasional movie. We have recently concluded a Transportation Study indicating that 93% of the eligible older persons carry the Reduced Fare Card and use it whenever possible. )ver 50% of the program's participants are able to get around more now, and $7% actually plan their day around the reduced fare hours. Most of the elderly >e)ieve that by instituting the Reduced Fare Program, the City has recognized hem as individuals who are valuable and merit special consideration. One im- >ortant factor in the acceptance of the program is that the elderly do not see t as a form of charity. Most elderly in the study wanted to remain active and n touch with society. The study pointed out that the elderly represent an im- portant polictical force in the community reporting a remarkable 75% voting n the last local election. They maintain friendships and contacts with society hrough available communications systems and the mass media with 67% read- ng at least one newspaper daily. The Reduced Fare Program for senior citizens las pioneered for the elderly in public transportation and provided informative, •ften surprising data in other major areas of concern. Another Office for the Aging research document has served the needs of the Iderly in New York in an instrumental fashion that would not have been )ossible except for the existence of this office as advocate. Anticipating the re- vision of rent control, which would most certainly have crucial concerns to the Iderly on fixed and limited budgets in a housing environment dominated bj 71-272— 72— pt. 1- -45 700 rental rather than ownership, the Office for the Aging's Research Department prepared a study entitled "The Elderly in the Rental Market." This study focused the attention of the legislature on the well-documented need for special con- sideration of the elderly. The legislature then responded to this initiative on our part with the Senior Citizen Rent Increase Exemption Program. The need for advocacy continues as further negotiations for regulation in the near future are once again underway at the beginning of the new year. Renewing and sustaining efforts such as the Rent Increase Exemption Pro- gram for Senior Citizens have increasingly become ongoing concerns of our Office. Additionally, we have among our projects funded under Title IV of the Older Americans Act of 1965 "Dial-A-Ride" — an alternate method of transporta- tion for elderly and handicapped persons unable to use existing transportation. In order to evaluate the impact of introducing the Dial-A-Ride System and to ascertain its applicability to other parts of the country, the Office for the Aging Research Department is directing its efforts toward evaluating the system and its impact on people and institutions. We feel that in the success of our programs to date, the original intentions of the Older Americans Act "to provide assistance in the development of new or improved programs to help older persons through grants for community planning and services and for training through research, development or training project grants . . ." have been translated into significant first steps and that the direc- tions explored and accomplished in research and demonstration have been fruit- ful and contain real future promise for greater gains. We would, however, strongly affirm that the advocacy network so far estab- lished by the Older Americans Act would be better and more efficiently served I. The Administration on the Aging was relocated at the federal level within the Executive Office of the President. So positioned, the Administration on the Aging would be charged with overseeing all federal activities related to aging ir the Departments of HEW, HUD, Labor, Transportation, Agriculture, and the Office of Economic Opportunity. At present, as the Administration on Aging was subordinated to the Social & Rehabilitative Service within Health, Education & Welfare, it is not appropriately placed to function most effectively in an ad vocacy role nor to provide strong leadership in stimulating programs for the elderly. We also emphatically feel that the best interests of the elderly require the establishment of a House Special Committee on the Aging similar to the Senat( Special Committee on Aging. Without a House Special Committee on Aging the House of Representatives is without a counterpart committee to carry or serious studies in the area of aging continually being undertaken by th< Senate Special Committee on Aging. The Senate Committee has an impressiv« ten-year history of providing factual information as well as publishing a seriei of powerful studies that document the hard facts about the needs of the elderly Until and unless such a House Committee exists, the mechanism for strengthen ing Congressional coordination and surveillance of programs for the elderl: cannot fully function. While we believe it is essential to extend this act. we believe that the federa government must go beyond funding research and demonstration programs. W< have proven the need for transportation, large-scale nutrition programs, out reach home health services, etc., but we must acknowledge that counties an< municipalities are in a budget crisis. They will be cutting back on humai services rather than expanding them. Therefore, the Older American Act must include large appropriations t< subsidize operating cost of local services. The City of New York must receiv help with its $15,000,000 half-fare program. We need money to set up am maintain hundreds of nutrition programs for the elderly. In many fields, w do not need demonstration programs to create new demands for services, bu federal monies to support existing programs. We are deeply concerned that the Administration on Aging has failed to utiliz the full resources authorized by Congress. In the past year, Congress authorize! $60,000,000 for the elderly, while the Administration utilized only $39,000.00( The proclamations of concern for the elderly emanating from the White Hous and the lack of willingness for some time to fully utilize the monies Congres appropriated moves us to call on the Nixon Administration to match its rhetori for the elderly to its action priorities. 701 statement of Caspab W. Rittenberg, Member, Committee on Aging 01 the Community Service Society of New York i am Caspar \Y. Rittenberg, a member of the Committee on A.ging of the Com mmit.v Service Society of New York .-md chairman of t he SERV E Sulx ommil tei lore about SERVE Later, i am pleased to express our views, here in the Bronx, mi the operation of the older Americans Act, as we have In Washington. We ippreciate the leadership of the House Selecl Suibcommittee on Education In psped to Legislation t<> benefit the nation's older men and women. The Community Service Society of New York is a voluntary, nonprofit, non- sectarian agency dedicated since 1NIN to the Strengthening of family life and he betterment of community life. The Committee on Aging within the ess De- partment of Public Affairs is a citizens' committee concerned especially with the pell J being Of the elderly. The Committee consists of a broad cross section of jusy men and women who, for more than ten years and with the help of a highly competent professional staff, are working to improve the lot of the 20 million elderly persons in the United States. The basic needs of older Americans are well known — their need for adequate ncome, for comprehensive health services, for a variety of housing arrange- ments, for outlets and opportunities to use their time and talents in way® that are satisfying and constructive. Some of these needs are met through special service systems ; others, presum- ably, through general service systems, but here all too often the elderly are un- equal competitors with younger age groups for scarce dollars and scarce services. Awareness of the low priority accorded the aged, with the notable exception of ;he Social Security Administration, led to the enactment of the Older Americans ict in 1965. The Administration on Aging, and later, state offices on aging, came nto being "to assist our older people to secure equal opportunity to the full and ! ree enjoyment of (specified) objectives." We applauded these developments. We are on record in support of the original )lder Americans Act and amendments to strengthen it. We have urged — and tlong with others have been forced to urge — that appropriations be made at the evel of authorizations — which were modest enough. A case in point is the ituation for fiscal 1972. The authorization was $105 million which, given a 65-and-over population of 20 nillion, works out to a meager $5 per person. The original 1972 budget was 529.5 million or $2.5 million less tlnan the budget for fiscal 1971. This was first nereased to $39.5 million and then by heroic efforts inside and outside the Con- gress to $44.75 million. We take small comfort from the fact that the final appropriation for programs mder the Older Americans Act this year is the largest since its enactment in 1965. When the Administration on Aging was established, it was hailed as a lational agency that would be a courageous advocate, calling Federal attention :o the needs and capabilities of older Americans, a channel for funding a variety )f programs on state and local levels. We view with dismay the downgrading ind gradual dismantling of the Administration on Aging. Instead of the inde- pendent agency directly responsible to the Secretary of the Department of Health, Education, and Welfare, AoA became a unit within the Social and Rehabilitation Service in 1967. AoA staff has been shifted over or assigned dual responsibilities vithin SRS. Most recently, the popular Foster Grandparents Program and the lardly launched Retired Senior Volunteer Program have been moved out to AoA ;o become part of a mix in a new umbrella agency for all Federal voluntary iction programs called ACTION. The overall situation is not reassuring. We speak out of direct experience about the good that has come out of Titles [II and IV of the Older Americans Act as administered by AoA and the potential mder Part A of Title VI for a nationwide RSVP Program. For the record, we highlight the accomplishments of SERVE on Staten Island, vhich was supported in part by a Title IV grant, and also of SERVE-in-New fork-State which is now operating under a Title HI grant from the New York State Office for the Aging. Incidentally, the Community Service Society is ontinuing the SERVE program on Staten Island at the present time. SERVE on Staten Island was launched in 1967 as a three-year "research and levelopment" project to find out whether group methods would be effective in ecruiting, placing, training and retaining older men and women as volunteers. The results are impressive. Today over 600 older men and women, 60 to 93 702 years in age, are active, giving service at least once a week in 24 social, health, "and educational agencies. They have set a record of giving valuable, reliable service over long periods of time. They contribute their time and talent without any stipend whatsoever. Transportation is provided and sometimes lunch. Two full-time paid co-ordinators are responsible for the programs. SERVE-in-New- York-State is a consultation program funded under a Title III grant for a three-year period to see whether the lessons learned from the Staten Island demonstration "work" in other communities. It started in October, 1969. Accomplishments of SERVE-in-New- York-State are encouraging. Some 750 volunteers are now giving weekly service in 38 pilot SERVE programs in 19 counties in New York State. Interest in the SERVE concept and requests for information go far beyond our State boundaries. We always emphasize that funds are needed to provide staff supervision and continuing transportation, if communities are to initiate successful SERVE-type programs. In addition, SERVE was the model for federal legislation which established the Retired Senior Volunteer Program (RSVP). Last summer RSVP initiated its first 11 older volunteer programs in that many states and considerable expansion is planned for the coming year. Out of our own experience and review of other reports, we conclude that there is continued need for a strong Federal program for the aging and for extension of the Older Americans Act. Today's situation is grave for 20 million older Amer- icans who continue to need a courageous advocate within the Administration Where that advocate should be located in the Federal scheme will surely be debated in the months to come at the Whie House Conference on Aging and else where. Whatever the outcome, the need for a strong voice and action by the Con gress is clear. So, too, is the need for watchdog efforts by the Congress to be certain that its intentions are not watered down. We believe that the currem dismal picture can be corrected — but it will take a masive pooling of effort bj the public and the private sectors. Be assured of our help. Statement of Jerry A. Shroder, Executive Secretary, Citizens' Committei on Aging of the Community Council of Greater New York I am Jerry A. Shroder, Executive Secretary of the Citizens' Committee oi Aging of the* Community Council of Greater New York. I also serve as Directo: of Information Services for the Council. During the early period of the Olde: Americans Act, I was associated with the New York State Office for the Aging In my final year in that agency, I was the staff person with principal responsi bility for administration of the Older Americans Act in New York State durinj its first year of operation. Part of my comments draw on that experience. Thu I am speaking today for myself rather than for my agency. Implementation of the Older Americans Act For those of us who had been in the field of the aging for any length of time the enactment of the Older Americans Act of 1965 was a milestone. This was th culmination of a series of efforts over a number of years to legislate a Federa Grant Program dealing exclusively with the problems of older people. Its enact ment into law took place during the same months in which both "Medicare" an< "Medicaid" were enacted. This suggests that the Older Americans Act may ow its very existence to the impact of the "Medicare" dialogue which took place for i number of months prior to the passage of the Social Security Amendments o 1965. While the initial amounts appropriated for the operation of the Adminis tration on Aging and the Federal Grant Program under the Older Americans Ac were small, those of us in the field were nonetheless delighted that a beginnin had been made. It was our hope that subsequent appropriations would be i: greater amounts and that, in fact, we really had our "foot in the door." Further, while it may not have been admitted properly at the time, I thin! some of us secretly harbored the notion that the funding formula established J the bill with its declining Federal participation would be ignored as a resul of community pressures. Our reason for thinking that this might happen stemme from experience with the Economic Opportunity Act which had passed the Cor gress a year earlier. You will recall that the EOA contained provisions fo declining Federal participation, beginning with 90% and dropping to lower fij ures for subsequent years. You will also recall that a substantial hue and cr; 703 wax raised from the Community Action Programs, with the resull thai the Federal government Pound it necessary to maintain a higher rate of Federal Participation in the Economic Opportunity Program than was originally planned. As I understand it. the original progressively declining Federal Income format was never implemented. in the ease of the Older Americans Ad, however, the funding formula sped- led hy law was enforced, as written. This proved to be a key problem in the years which followed as many speakers today will undoubtedly point out Further, when it was initially indicated that projects funded under Title HI [that Title given to the States to administer) were to he limited to three (3) lears of Federal financing, some of us harbored hopes that this too might be extended. As yon have heard already, New York State look the position not to fund most projects beyond their initial three (3) year contract. 1 believe they were correct in assuming this position, despite the tact that my own agency Differed as a result. Inasmuch as the States were totally dependent on the whim [ >r Congress for the funding- of Title III and insofar as appropriations hills were frequently not passed until well into the Federal fiscal year under consideration, logical State administration of Title III was difficult if not impossible. There- fore, an obvious suggestion for the future of the Older Americans Act and probably for all Federal Grant Programs should be to make commitments for periods beyond the current Federal fiscal year, in order to bring about a more manageable administration of the programs. An obvious additional observation is that the day in which Federal Grant Programs, designed for "demonstration" or "seed money" purposes, can be successful in stimulating local funding, is largely behind us. Certainly the large number of Title III projects that have had to curtail or terminate their success- ful services in the community will bear unhappy witness to this. From my cur- rent view of the voluntary sector, it is absolutely alarming to have to admit that we have become so completely dependent on public funds, which in more and more instances, means Federal funds. Nonetheless, if we are to meet the needs of older people, we must have greater commitment of resources from the Federal level. I would plea, therefore, for an enlarged and enhanced Older Americans Act, minus the fiction that local sources of funding can spring up to take over that which Federal and State revenues have been largely responsible for starting. Administration an Aging At the time the Older Americans Act was passed, we hoped that the Administra- tion on Aging created by the Act would be the beginning of a major program unit within the Department of Health, Education, and. Welfare. Again the appropria- tion was small, as was the staff. The fact that the word "Administration" had been used to identify the unit encouraged us to think that a major entity was in the making. Some of us analogized it to the Social Security Administration when assessing its potential within the Department. While I am unsophisti- cated about things in Washington, I naively clunge to the belief that the Ad- ministration on Aging could become a major leadership agency within the Depart- ment. To this day, I am convinced that this might have taken place had it not been for the reorganization of the Department and the subsequent creation of the Social and Rehabilitation Service, under which the Administration on Aging was subsequently subsumed. This began the process of taking us down a road we had traveled before. That is, we saw the beginning of the diminution of the im- portance of the Administration on Aging from that day forward, much as we had seen once before following a period of having a staff on Aging in the Office of the Secretary. It is difficult to fathom the intentions of the Federal administration. However, one w T oulcl have to observe that the dismantling of the Administration on Aging is currently well under way. While I personally believed that the major respon- sibility for programing in the field of aging belonged in HEW. I would settle for housing this leadership in the White House, provided that it was really given top-notch support by the President and hjs staff. What this boils down to is an observation that structure alone will not deter- mine the effectiveness of a program. The decisive factors are really commitment and leadership. If those characteristics are present, the job will probably get done. A suggestion has been made that there should be an Assistant Secretary for Aging Affairs in each Department of the Federal government having programs for older people. Again, this would only be meaningful to the extent that the given departments are interested in executing the program effectively. I refer you, 704 for example, to the amendment of the Economic Opportunity Act a few years ago in which an Assistant Director of that agency was legislated into existence in order to supervise their programs for older people. I am not certain whether that statutory provision is still in the Economic Opportunity Act. I am certain that nothing significant came of it because there was no real interest within that agency to implement Congressional intent. Therefore, I would be inclined to argue that an agency with outstanding leader- ship, a commitment to enhance the welfare of our nation's older population and direct access to the Secretary, housed within HEW, might still be the best ve- hicle for advocacy on behalf of the elderly within the Federal structure. I would like to see the Assistant Secretary concept attempted in other departments such as Housing and Urban Development, Labor, Agriculture, Office of Eco- nomic Opportunity, etc., but with the full realization that this may never achieve its goals. Membership of these Departments in a Cabinet-Level Committee on Aging with White House stimulus, may be in order. However, our experience in years past with the former Federal Council on the Aging should alert us as to the potentials for non-action that such a Committee can reflect. Federal-State Relationships During my tenure on the staff of the New York State Office for the Aging, I pre- pared the initial draft of the State Plan for administration of the Older Americans Act in New York State. The experience of watching Federal-State relationships in action in terms of getting that Plan approved was a revelation to me. Long after the questions of our program design had been settled and agreed upon, our Plan was held up for reasons of an administrative difference between the two levels of government. In fact, the negotiations were completely out of the hands of the as I recall it, was whether the State Civil Service system met the standards of the Federal Merit System. The State Civil Service staff insisted that our standards, in most instances, were even higher than the Federal standards. The fact that they weren't identical on one or two points delayed our accessibility to the Fed- eral program for months. (The record will show that we were one of the latter urban States to have our Plan approved in Washington.) Thus, I would plead for more flexibility for the States in the administration of Federal Grant Programs. I hope that other speakers will address themselves to this point, as well. House Committee In this connection, I have been tremendously impressed over a number of years with the superb fact-gathering job done by the Senate Special Committee on Aging. The hearings they have held and the publications they have developed have been an inspiration to all of us in the field. While I don't believe we need additional materials from the House of Representatives, I would think that the existence of some analogous Committee within the House would advance the cause of older people considerably. This would happen, because I am certain it wou'd provide a much sharper focus on the problems of older people for members of the House than is possible now. I understand that there are political questions involved in the creation of such a Committee and it would be presumptive of me to suggest how this should be resolved. I do urge on each of you who have been good enough to give youi precious time to this hearing to devise ways in which more attention can be given to problems of older people in your Chamber. Thank you very much for the opportunity to appear before you today. Community Service Society, New York, N.Y., December 2, 1971. Hon. John Brademas, Chairman, Select Subcommittee on Education, Committee on Education ana Labor, U.S. House of Representatives, Washington, B.C. Dear Congressman Brademas : This is responsive to the question of Congress- man Hansen at the hearing in the Bronx on November 20 about employment oi the elderly. . ,J We have long been on record as to the importance of utilizing the time and tar ents of older men and women in ways that are socially constructive and personalis satisfying. For some this comes about through employment ; for others, througl volunteer service. d&tt&ttftfe 705 Back in L964 -long before SERVE, the volunteer program on Stater [sland, was Launched we undertook a held survey of 260 older persona <>n Manhattan's Lower Kast Side. Aim was to ascertain their Interest in employment and rolun- |Ber activities. Findings Indicated a "semi-retired" manpower pool of 27% of the study population aged •'►<> 71 years L3.596 Interested in volunteering, 7..v,; Inter- pted in working, 6% interested in <■///«(■/■ volunteering o/- working. Elelatively few were making concerted, individual efforts to become "engaged" to tins end. We observed the ugly reality that there were few opportunities for either gainful employment or volunteer service for older persons, in respect to employment, we recommended that efforts by management, labor and government be directed to re-ordering and dignifying a wide variety of service jobs and to developing part* time and Intermittent jobs. As to volunteer service, we urged welfare and health agencies, political groups, trade unions, and service and trade organizations to develop conviction about the role and place of older-age volunteers, work out job specifications, provide orientation and supervision of workers and cover expenses incident to volunteering. As you know, we focussed on volunteer service in the SERVE demonstration. And we were pleased to see that the results justified the set-up of an RSVP pro- gram that you co-sponsored with Congressman Reid. This does not blind us to the obvious fact that, for the foreseeable future, inadequate income is the #1 prob- lem for the majority of older Americans. Employment, at least for the "younger- old", is one way of improving their economic situation. Liberalizing the retire- ment test under social security would benefit many persons aged 65 to 72 years. In our own review of H.R. 1 we have supported raising the allowable annual earn- ings limit to $2,000 or $2,200. More importantly, we have proposed that a work- able alternative and a variable formula be developed to avoid the unfortunate effects of a uniform retirement test on total income of beneficiaries at different benefit levels. Further, we have recommended the replacement of the monthly retirement test with a quarterly retirement test. In respect to the uniform retirement test, we have observed : The effect of a uniform test is the forfeiture of cash benefits by the beneficiary of smaller monthly benefits at a significantly lower level of total income than the beneficiary of benefits in the middle and upper benefit range. For example, under the current retirement test, a $100 a month ($1200 a year) beneficiary forfeits all cash benefits when his total earnings are $3500. The bene- ficiary of $200 a month ($2400 a year) does not lose all cash benefits until an earnings level approaching $5000 is reached and a $300 a month ($3600 a year) beneficiary would lose his entire social security payments only when he has earned close to $6000. The figures can also be viewed in percentage terms. Under current legislation a $100 a month beneficiary with annual earnings of $3000 forfeits 60% of his benefits; a $200 a month beneficiary with the same earnings loses 30% of his benefits and a $300 a month beneficiary also earning $3000 has an offset of only 20% against his benefits. At an earnings level of $3500 the $100 a month bene- ficiary has lost 100% of cash benefits, the $200 a month beneficiary only 50.8% and the $300 a month recipient only 33.8%. H.R. 1 liberalizes the retirement test, but retains the differential percentage loss. Under H.R. 1 a $100 a month beneficiary loses 41.6% of benefits with earn- ings of $3000 ; a $200 a month recipient with the same earnings loses 20.8% and a $300 a month recipient loses 13.8% of benefits. The income tax does not remove the inequity brought about by the uniform test. Since social security cash benefits are not taxed, each beneficiary with, for example $3000 of earned income and using the tax tables, will have the same tax liability. The social security beneficiary at the upper level of cash benefits will not pay any more in tax dollars than the social security beneficiary at the lowest end. We hope that the Select Subcommittee on Education will consider the value of a flexible retirement test related to the amount of social security benefits. We believe this to be a pracical way to join the issue of low income. Employ- ment is not a total answer, but it is a partial answer and could be made a better answer than it currently is, in our judgment. Sincerely, Earl Wallace Carey, (Mrs.) Jean Wallace Carey, Staff Associate for Aging. 706 Community Service Society of New York, Department of Public Affairs, Committee on Aging MEMORANDUM Re : Retirement test under the Social Security Act. To : Members of the Committee on Aging. From : Gladys Ellenbogen, Ph. D. Date: August 6, 1971. The purpose of this short report concerning the retirement test is to focus on some of the significant issues. H.R. 1 retains the earnings retirement test, which has been part of social security legislation since its original passage, but increases from $1,680 to $2,000 the amount a beneficiary may annually earn without forfeiting any part of his benefit. Additionally, the proposed legislation liberalizes the forfeiture provision by subtracting from the monthly cash benefit only $1 of each $2 earned over the $2,000. At no point does the elderly employee have every dollar of earnings offset against his cash benefit. Raising the earnings test is an incentive to the lower paid 65 or over worker, while not affecting the highly paid older employee or salaried individual. H.R. 1 contains an additional incentive to work by providing a 1% annual increment in benefits for each year between ages 65 and 72 a worker does not receive benefits because of employment. A worker continuing employment until 72 will receive benefits 7% higher than the worker who received benefits starting at age 65. Several fundamental issues are raised by the earnings test : 1. Should there by any retirement test? 2. If the retirement test is to be retained, is $2,000 an appropriate figure? 3. Are there inequities in principle in the retirement test? There is a threefold rationale for a retirement test : ( a ) Social security benefits are a replacement for earned income. (b) An insurance program is designed to protect the insured against loss fron a specified risk. The risk here insured against is loss of earnings in old age. Foi the older person with substantial earnings the risk has not materialized. Fo] the older person with limited earnings, e.g., $2,000, the risk has partially material ized. Social insurance benefits for the low, elderly earner are payments for th< occurrence of part of the contingency. (c) Removal of the retirement test would sharply increase the program's out flow of funds. Replacement of these monies would come about through an in crease in employer-employee contributions, already scheduled to rise to finance the higher benefits under H.R. 1. Elimination of the retirement test is costly. On a cost J benefit basis elimina tion of the retirement test may be undesirable. Estimated at $3 billion the firs year and at a higher figure in subsequent years, employers and employees woulc each have to make an additional contribution of 0.35% of covered earnings t< finance the benefits. 1 An estimate of slightly more than one million persons or S per cent of retiree beneficiaries would be helped by the removal of the test. 2 The figure of one mil lion persons may be a serious undercount because of the difficulty of estimatinj the number of persons who, without the retirement test, would go on working This is especially significant because workers are affected by the decrease o: loss in their dependents' benefits when the earnings of the primary beneficiar: limit his cash benefit payments. No one really knows how many persons are care fully calculating their potential benefit loss and ceasing to work just short o the cut-off notch. If the retirement test is removed more persons 65 and over will receive bene fits. To pay benefits to more persons more contributions to the system are needed Contribution rates may have to rise more than estimated. With respect to the second issue : Should $2,000 be the total amount of earn ings annually waived in calculation of benefits? H.R. 1 provides, although no effective until 1974, that the retirement earnings test will automatically increas- when the Consumer Price Index benefit adjustment takes place, and the increas< will be "according to the rise in average covered wages." i- npnorts of the 1971 Advisory Council on Social Security, p. 37. 2 Ibid. timfaiemmisx M >; Wwh^Vfttilfr i 707 Although future Inflation protection Is provided for, the question may be stated this way: is $2,000 the proper base to which an Inflation adjustment mould ho made? The average retired couple's henelit will he, under the pro- posed Legislation, $2,808. With additional income of $2,000 the retired couple's annual earnings will ho just slightly over the t969 Intermediate budget lor a retired couple in the New York area. The $2,000 earnings tv*l is Slightly less than half the median annual earnings )f workers in L969 subject to FIOA tax. In L950 the retirement test, was just; below one-third of the median earnings and in 1964 was 60 per cenl of median Earnings. With respect to inequities in the program : in reality there are two retirement tests: an annual one and a monthly one. On an annual basis earnings over $1,680 currently are used as offsets against cash benefits. However there is also i monthly test. Regardless of total yearly earnings, benefits are paid for any month in which less than $140 was earned. (Under the proposed legislation this figure rises to $1G0.60.) So that a worker earning, for example, $10,000 in one month as a consultant, may still collect benefits for the next eleven months with not forfeiture except for the one month during which he had the $10 000 of earnings. ' It would surely appear that this is one inequity in the program. Another equity issue is that the $2,000 is a uniform amount. Perhaps it should be related to the social security cash benefit so that the lower the monthly benefit the higher the allowable earnings. Statement on H.R. 1, 1971 Social Security Amendments, Submitted to the Senate Finance Committee by the Special Committee on H.R. 1, Represent- ing the Committee on Aging, Committee on Family and Child Welfare, Committee on Health, in the Department of Public Affairs, November 1 1971 The 1971 amendments to the Social Security Act passed by the House of Representatives contain the most far-reaching changes in the 'nation's income maintenance system to be considered by the Congress at any one time since 1935 when the Act was enacted. The Congress is to be congratulated on under- taking so major a legislative overhaul as that embodied in H.R. 1. This is a massive piece of legislation making significant changes in a wide range of social policies. We consider some desirable, some undesirable. Therefore, we do not find it useful at this stage to adopt a position for or against the Bill as a whole. Instead, we are commenting on the Bill by reference to its main objectives. Our concern is for the consequences of the proposed changes on the social and physical well-being of the citizens in our own community and throughout the nation. As a voluntary, nonsectarian social welfare agency, the Community Service Society since its founding in 1848 has been dedicated to strengthening family life and to the betterment of community life. Its Department of Public Affairs, through its citizen committees and staff, is that arm of the Society svhich engages in social and legislative action aimed at the improvement of community conditions, services and facilities. Our analysis and comments on the Bill are the product of joint study by representatives of our Committees on Aging, Family and Child Welfare/ and Health. These committees are concerned with the implementation of the Social Security Act and the related federal, state and local measures authorizing publicly funded and administered income support, health and social service programs. They have developed expertness in their respective fields. They have spoken over the years, both in support and in criticism of legislation and admin- strative actions affecting these programs. Our statement is presented in tw r o parts. Part I discuses the main objectives of the Bill and how the major provisions would, in fact, implement these objec- tives. In Part II we present a more detailed analysis, by titles and sections of the provisions discussed broadly in the first part of the statement and a few provisions of a more technical nature which are omitted from comment in Part I. PART I ANALYSIS OF H.R. 1 OBJECTIVES AND IMPLEMENTING PROVISIONS H.R. 1 appears to be directed to three main objectives. These are (1) im- provement of the nation's income security programs, (2) reduction of the numbers dependent on public assistance, and (3) improvement in the administra- 708 I lion of those health programs with which the federal government is financially involved, namely, Medicare and Medicaid, and to a lesser extent, Maternal and Child Health Services. We also offer comments on the provisions of the Bill that affect the social services and public accountability. A. Improvement of the income security programs The nation currently applies two different principles in its income security policies : provision of social insurance benefits as a right to insured persons in the event of inability to earn because of old age, retirement, permanent dis- ability, death of a breadwinner and unemployment, and a system of assistance payments on the basis of demonstrated need in the individual case to those not covered by social insurance or whose insurance payments are inadequate for their needs. The assistance system in turn is in two parts : a group of federally aided programs for needy aged, blind and disabled and for families with dependent children and a wholly state or state/local program for all other needy people. H.R. 1 deals with both insurance and assistance. 1. Amendments to the federal old-age, survivors and disability insurance pro- gram.— This is probably the most satisfactory part of the Bill. We welcome those amendments in Title I of H.R. 1 which increase the role of social insurance in providing income security by improving the level of benefits and liberalizing eligi- bility. In particular, we strongly support the 5% increase in benefit levels across the board. We are especially pleased that the Bill provides for automatic in- creases in the benefit levels with increases in the cost of living, as this will pro- tect beneficiaries from erosion of the purchasing power of benefits as prices rise. The proposed increase in widows' and widowers' benefits from 82y 2 % to 100% of the deceased spouse's benefit is also a move in the right direction. We believe, however, that the proposed increases in the minimum benefits are too meagre and that an increase to $100 an individual and $150 a couple would be desirable. As our detailed comments in Part II indicate, we are in general in favor of other amendments such as those that would improve the benefit levels of per- sons long covered by the program or postponing retirement beyond age 65. We are glad to see some liberalization of the retirement test though we sug- gest exploration of the possibility of a variable formula permitting retention of larger dollar earnings by beneficiaries at the lower level benefit levels. We recognize that the liberalizations of the program will increase its costs and we are concerned about the increasingly heavy burden of the regressive wage and payroll taxes, especially on low income receivers. While we note with satis- faction the increase in the level of taxable earnings (both immediately and in the future by tying the level to increases in the general level of covered earn- ings), because this will involve tapping ever higher incomes and thus somewhat reducing regressivity, we would hope that the Congress would explore other sources of funds. In that connection our own studies indicate that the investment policies of the Fund Trustees have resulted in interest yields considerably less than could have been legally obtained and we suggest adding to the Trustees two representatives of the public to assure that investment policies would not so strongly reflect the fiscal interests of the federal government. 2. Assistance for the needy aged, permanently disabled and Mind. — The changes which Title III would bring about represent a major step forward. We strongly favor the creation of a federally financed and administered program which would introduce a long-needed federally determined floor of assistance and uniform eligibility conditions for the nation as a whole. This is indeed a major advance. We also support the use of the Social Security Administration as the agency to administer the program, as proposed by the Ways and Means Committee. This agency has an outstanding reputation for administering social security in a man- ner which emphasizes the rights of beneficiaries, respects their dignity and at the same time protects the interests of the insurance funds. In the hands of such an Administration there is good reason to expect the kind of non-discretionary and objective determination of both eligibility and payments amounts to which the long-period dependency of the aged, the blind and the permanently disabled so obviously lends itself. \ . We note, however, that the proposed level of the federal minimum is con- siderably below even the poverty level for aged individuals and slightly below this for aged couples. Although the Bill provides for a staged increase by 1975, it is to be expected that prices also will rise during this interval but the Bill docs not require that the dollar minimum shall be automatically adjusted to in- creases in the cost of living. 7(H) Given the relatively low level of the federal minimum and the fact that II la Iwer than many states are now paying, 11 is regrettable thai the Bill does nol fequlre the states to supplement the federal payments up to al least their cur- fent Level. While Section 509 puts considerable pressure on the states (on pain I losing federal reimbursement under Titles IN', V, XVI and xix of the Social fecurity Act) to supplement up to the amounts recipients would have received f June 1 1 > T l together with the bonus value of food stamps which were provided r available, a state could avoid this pressure by passage of state legislation peeitieallv prohibiting it from supplementing the federal minimum. Given the iresent tendency of the states to lower their standards and CUt welfare expendi- ures it seems Likely that many will take advantage Of this leeway. We urge mendment to require the states to supplement at least up to their previous Kyment levels (including the cash value of the food stamps bonus) and federal participation in the costs of such supplementation. Furthermore, although as we stated above, eligibility conditions are uniform feographically, it is unfortunate that the Bill would perpetuate the differential roatment of the aged as compared with the blind and disabled who would be fermitted more liberal disregards of earnings. We see no justification for this recrimination against the aged. 3. The Family Assistance Plan {FAP).— Title IV of the Bill replaces the xisting Aid to Families with Dependent Children (AFDC) program with a Lew assistance program for families with children, the main feature of which 3 provision of a federally financed and administered assistance payment with ationally uniform eligibility requirements. Adoption of this principle is a major tep forward and one we have long urged. Our satsfaction is, however, greatly iminished by the way the Bill implements this policy. First, the federal minimum is far too low, and fails to reflect geographical lifferences in costs of living. The sum of $2400 for a family of four is well below ven the meager 1970 poverty line ($3968), and for larger families the payment s even more inadequate due to the setting of a maximum of $3600 to total pay- tients however large the family. The standard is even below the current as- istance standards of about half the states and makes no provision for auto- natic adjustments in the dollar amount of the minimum with increases in the ost of living. We believe that the minimum guarantee should be substantially ncreased and that if, for financial reasons, it is initially set below the poverty s?vel the Bill should provide for a staged increase toward a more satisfactory iving standard as national income rises. Second, given the low level of the federal minimum and its shortfall as com- pared with what many of the states are even now paying, it is unfortunate that he Bill does not mandate state supplementation up to at least current payment evels. For reasons we have already given, we do not believe that Section 509 s an adequate substitute for such a requirement. Third, while we regard food stamps as an inferior substitute for an adequate ash payment and thus welcome the incorporation of the bonus value of food tamps in the basic federal cash payment, we believe it unfortunate, so long ls the federal minimum falls so far short of even the current poverty standard nd so long as state supplementation is so problematic, that recipients of FAP vould not be permitted to buy or use food stamps. Another new feature of FAP is the coverage of the working poor. The check o initiative and the inequity of denying assistance to those whose efforts at elf-support yield them an income below assistance standards has long been tpparent. While we welcome rectification of this injustice we also recognize that implementation of earnings raises some difficult economic issues and in any case vill greatly increase the numbers of FAP recipients. We would hope that, for he longer run, the Congress will continue to explore other ways of dealing with he problem of full-time earnings that are insufficient for family needs. In any case, families other than those with working mothers are assured sup- )lementation only up to the level of the federal guarantee, for the supplementary »rograms of the states are permitted to exclude families with both parents ►resent and not incapacitated, regardless of whether the male parent is eni- )loyed or unemployed. The two assistance programs introduced by H.R. 1 do indeed mark a major ;tep forward by introducing the important principle of a federal minimum stand- ird, federally administered. But taken together and considered in the light of :urrent needs in our public assistance programs and policies, they have serious shortcomings over and above those to which we have drawn attention when con- sidering them individually. 10 First, neither one provides assistance for single or childless adults under age 65 or for those who are not disabled. In addition, families headed by a full-time college or university student are excluded. Quite apart from hardship to the families involved this last provision seems clearly inconsistent with the emphasis placed in Title IV on training as an aid to employability. Second, the combined programs perpetuate the shocking discrimination in our assistance policies against families with children. As the Bill now stands, the federal minimum for a family of four is no more than the mimimum for couples who are aged, blind or totally disabled, while for larger families the discrepancy is even more pronounced. And while we recognize that in the past, improvement in social provision for the needy has taken the form #f gradual removal of one category after another from the total group in order to grant them more liberal treatment, we are concerned that the application of the policy in practice has! tended to isolate what may be called a "discarded population" whose character- istics do not invoke popular sympathy, and on whom public resentment about the rising costs of public assistance can be concentrated. Thus the Committee onj Ways and Means makes it clear that the Secretary of Health, Education and Wel-^ fare (HEW) is expected to provide a much more stringent administration of eligibility conditions for the FAP families than for the H.R. 1 Title III adult 1 categories : for the latter a declaration system for applications would not be ruled \ out as it wolud be for the FAP population, nor would the verification and other procedures be so rigorous. Third, both Titles would permit the states to establish duration of residence requirements as a condition of eligibility for state supplementary payments. Such a provision is not only socially undesirable but is also unconstitutional and we urge its removal. Fourth, the burden of assistance costs on the states and localities is heavy and growing and is one of the reasons why reform is needed. The proposed "hold harmless" provisions (whereby the states are guaranteed that their expenditures on cash assistance payments will not exceed their total outlays for categorical cash assistance in calendar 1971) together with federal assumption of costs of| administration of state supplementation (where a state agrees to federal admin- istration) fall far short of giving the states the fiscal relief they need. Further- more, the financial provisions of the Bill give least relative aid to those states which have been most adequately meeting need in the past or have been caring for relatively large numbers of assistance recipients. We believe that nothing short of federal assumption of the costs of assistance (including needed supple- mentation above the low federal minimum) will meet the problem. B. Reduction of the numbers dependent on assistance It is obvious from many of the provisions of H.R. 1 and from the Report of the Committee on Ways and Means that a major objective of the drafters of the Bill has been a reduction in the numbers of assistance recipients. The Bill proposes to achieve this result in two ways: (1) by moving as many of the re- cipients as possible into self-support and (2) by tightening eligibility require- ments and their administration. 1. The Work Program. — Substitution of "Workfare" for "Welfare" is held by the Administration to be the heart of "welfare reform." We support the objec- tive of the Opportunities for Families program (OFF), namely, encouraging and facilitating self -support. Nor do we question the propriety of requiring those who are clearly capable of self-support to accept appropriate training or suitable available work. But we have serious questions about the way these policies are! applied in H.R. 1. We wish to make it clear that there are some features of OFF with which we are in agreement. The proposal to disregard some fraction of earnings in determining whether a family is entitled to FAP payments will correct the', present deterrent to earning whereby in most states earnings serve only to reduce the assistance payment. But we suggest that a disregard higher than the proposed $720 per year plus one-third of additional earnings would provide a more effective incentive to earn. Similarly, while we are glad to see that^ working mothers may deduct from their countable income for FAP purposes any charges they pay for child care services, we believe that the $2000 limit on this deduction (which covers also any irregular and student earnings) is too low in, view of current costs per child of day care and similar child care services. We are pleased too that the Bill recognizes one major weakness of current training programs, namely, the lack of available jobs for those whose training is completed, by providing for the creation of temporary public service jobs. 711 towever, the number of positions possible under the appropriation envisaged Is ^significant In relation to the current number of unemployed ,i<»i> seekers wboae lumbers will be swelled by the newly trained OFF employables. A vastly greater pork creation program will be necessary If the employment objectives <>r H.R. l re t<> be attained. We also welcome the centralizing of responsibility for operation, administra- ton and financing of work and training programs In the federal Department of tabor, in the 4 past, diffused or shared responsibility for administration and the jequirement of state financial contributions have severely Limited the effective- ness of work and training programs. Om - objections to the off proposals relate mainly to two questions: (a) to vheni should the pressure to accept, work or training be applied and under what afeguards and (h) what kinds of jobs are people required to accept ? a. To whom should pressure i<> accept work or training he applied and under what safeguards? The Hill specifies that all persons age 1(5 or over except those Incapacitated or Rf advanced age, or caring for a sick household member or for a child under hree. or regularly attending school if under age 2,2 shall be required to register or, and accept if offered, work or training. We strongly question the social desirability of imposing this requirement on mothers of young children who, we >eiieve, should have the right to decide whether it is in the best interests of their hildren that they should work. It is a further weakness of the proposal that lo account is taken of the numbers of children in a family. We also hud it par- icularly ironical that a woman with a husband in the home who is registered s not required herself to register, whereas the mother with no man to help share he burden of housekeeping and child care is required to do so. The Report of the Ways and Means Committee implies that a mother will be -equired to accept work or training only if suitable alternative child care ar- angements are available to her. But no such explicit safeguard is written into ;he Bill and this should be rectified. At present day care and other organized irrangements for substitute care of children of working mothers are shockingly inadequate even for mothers who are currently working, let alone for the in- n-eased numbers of women workers that are expected to result from the OFF irogram. The Bill does provide HEW with funds for an expansion of day care services and additional resources would be available if other child care proposals currently before the Congress should be enacted. But it is questionable how far ?ven these funds will go in filling the gap. It is presumably in recognition of this shortage that the Secretary of Labor who is given the responsibility of purchas- ing such care for OFF families, is authorized to the extent he cannot utilize the 'acilities developed by HEW, to purchase or contract for child care services 'from whatever sources may be available" including public or private agencies 'or other persons." The Report of the House Ways and Means Committee makes t clear that this includes private profit-making enterprises. We fear that this )pen-ended authority may lend itself to serious abuse. For although the Secretary )f HEW is required to promulgate standards assuring the quality of child care services (with the concurrence of the Secretary of Labor), no guiding principles ire laid down in the Bill. We believe that if society assumes the responsibility >f pressuring mothers to work it must also accept the responsibility of defining standards of substitute child care. b. What kind of jobs are people to be required to accept? It is of the utmost importance that the OFF program not be used as a weapon to force people to accept substandard jobs, or those who are in conflict with cur- rent national policies. We note that the Bill defines as unacceptable positions vacant as a result of a strike, lockout or other labor dispute and those where, is a condition of being employed, workers must join a company union or join or refrain from joining any bona fide labor organization. But, while the Bill specifies that wages, hours and working conditions of acceptable jobs must not be con- trary to or less than those prescribed by applicable federal, state or local law, we regret that for the jobs available in private employment that are not covered by minimum wage laws, the wage level is permitted to be only 75% of the already few federal minimum. Furthermore, although individuals may refuse to par- ticipate in work or training programs "where good cause exists for failure to participate," "good cause" is not defined. There should be reference to the suit- ability of the job or training for the particular registrant and reasonable stand- ards defining suitability such as are prescribed for public service employment. 712 ■ 2. Tightening eligibility requirements and their administration. — The second prong of the effort to reduce the numbers on assistance involves a tightening of eligibility and administration. Reference has already been made to the exclusion from eligibilitv of families headed by a full-time college or university student. The numbers of eligible persons will also be reduced by the requirement that drug abusers and alcoholics must be undergoing treatment at an approved institution; by the counting as a resource, income received in the preceding nine months even though in the current quarter a family has no or inadequate income : and bv including in resources, the income of a step-parent even though he has no legai liability for the support of his wife's children. We find these last two provisions especially objectionable. Even more important in keeping down the numbers of recipients are the directives given in the Bill and elaborated in the Report of the House Ways and Means Committee for stringent administration. There is to be no declaration system for applications ; statements by applicants are to be rigorously checked : recipients must immediately report changes in circumstances and make quar- terly reports on income, in both cases under pain of severe penalties and at the end' of two vears must reapply for benefits. W T e are "strict constructionists" in the sense that we do not believe in lax administration or the admission to bene- fits of those not legally eligible. But we fear that the great emphasis placed in the Bill and by the House Committee on stringent administration will lead to harassment of applicants and recipients and may even discourage some needy persons from applying. C. Improvements in administration of health programs The main thrust of the health amendments in Title II is clearly to improve the operating effectiveness of Medicare, Medicaid and the Maternal and Child Health Services. With most of the specific proposals for containing the costs of health programs bv limiting the charges of providers, introducing incentives for economical operation, improving administration by encouragement of the use of mechanized equipment, improving the delivery system and the like we have no quarrel, although we recognize that time alone will tell whether the specific changes will achieve their intended result. We suspect that for many years tc come the Congress will be grappling with the problem of assuring an efficient and economical operation of our health services while at the same time protect- ing quality. , But Title II also contains some substantive changes in the programs and some of the cost-oriented amendments are likely to have adverse repercussions on the nature of the Medicare and Medicaid programs. , 1 Medicare.— We strongly support the extension of Medicare to disabled social security beneficiaries although we would hope that it would prove possible tc reduce* the two-year waiting period. We also urge inclusion of the early retirees a group whose age and income levels make medical expenditures especially heavy and onerous. • We are pleased that some modest additional reimbursable medical expendi tures have been added but greatly regret the non-inclusion of the much more important out-of-hospital prescription drugs among the reimbursable benefits and strongly urge their inclusion. As our more detailed comments in the follow ing section make clear, we also welcome a number of other amendments whicl make it easier for certain categories of people to secure supplementary medica insurance or entry to hospital. We believe that removal of current barriers t( the use of Health Maintenance Organizations by Medicare beneficiaries is i step in the right direction. We hope, however, that the amendment removing the requirement for provision of social services in Extended Care Facilities wil be eliminated. The patients in such institutions are likely to be persons foi whom social services are of special significance. 2. Medicaid.— -The substantive changes proposed for Medicaid are numeroui and serious. While there are a few desirable liberalizations such as the optiona provision of service in an Intermediate Care Facility and, on a qualified basis of care in institutions for the mentally retarded, inclusion of some provision! aiming at improvement of the quality of medical care for Medicaid recipient! and encouragements for the delivery of care through Health Maintenance Orga nizations (all of which are discussed later in more detail), most of the change! are of a restrictive character. -v,.* We are strongly opposed to the changes which would (a) restrict eligibility (b) impose charges on recipients and (c) narrow the scope of covered services 713 (a) Assistance recipients with total incomes in excess of the Btate'a medically Indigent eligibility standard (usually L33.3% of the current payment to A.FDC families) will be required to draw down (he excess !<> pay medical bills before they become eligibile for Medicaid. Quite apart from the hardship involved, this provision undermines efforts In other parts of the Bill to encourage earning by permitting recipients to retain some fraction Of their earnings. We alSO urge elimination o\' the provision whereby states are not required to make .Medicaid available to persons or families newly eligible for assistance under I he income maintenance sections of H.R. 1. By definition these are low income people whose assistance payments will be too low to leave any leeway for meeting the Costs Of medical care. (b) We strongly oppose the imposition of charges on Medicaid recipients. Even the "nominal" charges for non-mandatory services which the Bill would permit states to levy on cash assistance recipients are objectionable, for the payments they receive, even with state supplementation, will be barely, or not at, all, adequate for meeting recurrent basic needs and will leave no leeway for medical bills. It must not be forgotten that the non-mandatory benefits include such costly items as drugs, dental care and the like. For similar reasons we oppose both the proposal to require the states to impose on the medically needy a premium fee graduated by income and the permission granted them to impose deductibles and co-payment requirements. Given the low income eligibility level for Medicaid in most of the states, eligible medically needy families will have no resources to cover the premium, while the co-payment and deductibles will deter many who should seek medical care from doing so. We are not impressed by the argument that such charges are necessary as a protection against overuse of health services. All evidence suggests that not overuse but underuse of health services is characteristic of the poor and in any case the main determination of the volume of service to be received by a patient lies in the hands of the phy- sician, not the patient. (c) The scope of medical benefits available under Medicaid is unfortunately narrowed by H.R. 1. The states would be permitted to reduce the range of non- mandated services without being subject to the maintenance of fianancial effort requirements currently in force. Given the financial pressures under which many states now operate, the consequence is likely to be a reduction of the benefits now available to the level of those mandated. The scope of medical benefits is also likely to be restricted by the proposed reductions in federal aid for certain types of institutional care after service has been received for specified periods. We recognize that the intent of these amendments is to discourage unnecessary hospital or institutional occupancy and to encourage movement of patients to less expensive forms of care when medically indicated. But given the acute shortage of nursing homes and other alternative facilities for care we fear that the main result of these proposals will be to deny needed institutional care to many poor people, or if states are unwilling to do this, to add to the financial burdens of already hard-pressed states which, will have to provide this care without federal aid. We take particular exception to the proposed elimination of the requirement that states have in effect a comprehensive Medicaid program by 1977. The fate of the Medicaid program since 1965 has been a succession of reductions in benefits and coverage instead of the progressive expansion envisaged in the original legislation. This amendment is the final blow to the promise of an adequate program of health care for the poor and medically indigent. D. Amendments to the social services Several sections of H.R. 1 directly affect the social services and their financing and administration. We welcome the new specific provision for appropriations for foster care and adoption. We are gratified that this additional federal aid for foster care wall not be limited, as are the cash benefits under the family pro- grams, to cases in which a judicial determination has been made, but will be available in respect of any child "for whom a public agency has responsibility." We are especially pleased that the adoption provisions include payments to allow for the additional costs resulting from adoption of physically or mentally handi- capped children who are hard to place. We welcome, too, the provisions which aim to extend the availability of family planning services to the poor and the near-poor. Society has no right to criticize the extent of out-of-wedlock births and the large families of those receiving public support so long as it withholds from them the knowledge and the means of more responsible family planning. 714 But we deplore the imposition of ceilings on appropriations for all except the child care and family planning services. Hitherto social services rendered to the federally-aided assistance categories have been subsumed under the Titles deal- ing with these groups and as such have been financed on an open-ended basis. We urge a return to the principle of open-ended financing and would addition- ally like to see removal of the closed-end grants now applicable to the Child Welfare Services under Titl IV B of the Social Security Act. All these social services are almost everywhere inadequate in relation to the need for them and the imposition of ceilings will only further check their expansion. It is true: that, commendably, the Bill provides that part of the appropriation for services to assistance recipients is to be set aside for states whose development of social services falls below the national average per recipient but the sum envisaged is small ($50 million) and the real problem is that the national average is itself too low. It is evident, too, from the Report of the Ways and Means Committee, that the detailed spelling out of services for assistance recipients is intended as a restrictive device and we w r ould prefer a more general definition such as is used in Title IV B or in the original Titles IV A and XVI of the Social Security Act. We are troubled too by the provision that would permit the Secretary of HEW to remove the statewideness requirement. Unless the conditions of such abroga- tion are narrowly defined (e.g., for the purpose of experiment or demonstration) and time-limited, elimination of the statewideness requirement can lead to dis- criminatory treatment of populations in certain areas. We welcome the proposed separation of the administration of cash payments and of services. But we fear that the differing financial arrangements applying to the social services ( according to whether they are rendered under one Titie or Section or another) will foster a fragmentation of what should properly be a unified service system and will greatly add to the administrative burdens of the states. Because we have always stressed the importance of simplified administration we look with apprehension to the vast responsibilities given to the Secretary of Labor in connection with the provision of a wide range of social services for the OFF families. The interposition of a second federal agency administer- ing social services will greatly complicate and confuse administration at the local level and foster divided responsibility. In addition, the freedom given to the Secretary of Labor who has hitherto had no involvement in the adminis- tration, operation or supervision of social services to select his local adminis- trative agencies, including profit-making agencies, we believe, is fraught with danger and may threaten established policies. E. Public accountability The Bill provides in numerous sections for the Secretary of Labor or HEW alone or in conjunction to adopt regulations that will establish standards, as for child care, or prescribe requirements, as for filing applications, or institute criteria, as for determining a disabled person's ability to engage in activity. It is clear that the rules and regulations to be adopted to implement the vari- ous Titles will be of critical importance, frequently of greater significance in their impact on the recipient than the language of the sections being imple- mented. Nevertheless, there is no provision for public hearings prior to their adoption. We submit that the opportunity for an exchange of views and thorough public analysis of issues which is exercised in committee hearings and floor debate prior to Congressional action on proposed legislation is equally essential in the administrative system. The Bill should include a requirement that rules and regulations which are not purely ministerial and which substan- tially affect the right of recipients to benefits and services be adopted only after publication of the proposed rules and regulations and adequate public notice and opportunity for public hearing. Another instance of failure to provide for public accountability is the absence of a participatory role for recipients in responding to the policies and regula- tions of the programs which directly affect their lives in such vital matters as their subsistence level, training, employment, child care and medical or other services. Even the provision establishing local committees to evaluate the effec- tiveness of manpower and training programs specifies as members representa- tives of labor, business, the general public and units of local government, thereby representing everyone except the persons most affected, the families registered for the OFF program. We recommend that the Bill provide for the appointment of local advisory committees in each state to evaluate the effectiveness of the 715 programs and services offered under each Title and thai the committees Include in their membership representatives of those Intended to benefit from the pro visions of each Title. PART II ANALYSIS OF SELECTED PROVISIONS I \'>y Title and Section) Title I. Provisions relating lo Old Age, Survivors and Disability Insurance. Provisions relating t<> Medicare, Medicaid, and Maternal child Health. A. Provisions relating lo Medicare. P. Provisions relating to Medicaid. Assistance for the aged, blind and disabled. Family programs. Miscellaneous : Now social services provisions. ii. Ill IV V Title I— Provisions Reiating to Old-Age, Subvivobs and Disability Insurance (Amending Title II of the Social Security Act) Sec. 101. Increase in cash benefits of 5%.— Provides an across-the-board in- crease of 5% in social security cash benefits effective June 1972. We support the proposed 5% increase in cash benefits effective ar. tiie earliest possible date, January 1972 if this be feasible. Additionally we recommend a $100 monthly minimum for an individual and $150 for a couple, thus raising benefits for the low level regular and the social age-72 beneficiary. We recommend that general revenues be applied to pay the additional cost of this proposed minimum. There are good reasons to increase the minimum. The proposed minimum monthly benefits are $74 for the retired individual and $111 for a couple, or, put in annual terms, $888 and $1,332 respectively. For the special age-72 beneficiary the monthly payment would be $50.80 for a single person and $76.20 for a couple or $609.60 and $914.40 per year, respectively. How well these payments cover minimum living needs may be judged by com- parison with two standards: 1 (a) the lower budget level in the Spring of 1970 for persons and couples 65 and over for urban United States and (b) the 1970 poverty level for nonfarm persons and couples 65 and over — both adjusted upward by a 5% annual inflation factor, compounded through 1972. The cash benefits for the retired worker at the minimum level would be close to $1,200 less than the estimated 1972 nonfarm poverty level of $2,052 and over $800 below the lowest budget of $1,714 for an aged individual living in an urban area of the U.S. at the same time. Special benefits to age-72 individuals would be even further below the poverty and budget levels. A couple aged 65 and over with the minimum social security cash benefit would be more than $1,200 loiver than the 1972 poverty level of $2,589 for a retired couple and nearly $1,800 less than the lowest budget of $3,122 for an urban 65-and-over two-member family. Couples receiving special age-72 benefits fall even further below the standards. The proposal to raise minimum monthly cash benefits to $100 for an individual and $150 for a couple will narrow but not close the gap between benefits and low budget or poverty levels. The recommendation that general revenues be tapped for this increase is finan- cially justifiable because, in lieu of a higher cash benefit minimum, old age assist- ance which is financed out of general revenue would likely be used as a supple- ment. Administrative costs would be cut down, too, with beneficiaries receiving- checks under one, rather than two programs* each with its own criteria for eligibility. Sec. 102. Automatic increase in benefits, contribution, and benefit base, and earnings test. — Provides an automatic, once-a-year increase in cash benefits, pro- vided that the Consumer Price Index has increased by at least 3% and the legis- lation increasing benefits had neither been enacted nor become effective in the preceding year. 1 The two standards differ significantly. The Spring 1970 lower budget level is $1555 for single persons; $2832 for couples (respectively $1714 and $3122 for 1972 using 5% as the inflation factor compounded through 1972.) The 1970 poverty level is $1861 for single persons and $2348 for couples (respectively $2052 and $2589 as updated.) 71-272— 72— pt. 1- -46 716 Provides a parallel automatic increase in the contribution and benefit base, according to the rise in average covered wages, if wage levels had gone up suffi- ciently. Also provides a comparable automatic increase in the exempt amount under the retirement test. We support automatic cost of living adjustments to cash benefits, recognizing that this does not improve the economic status of older persons but merely serves to avoid further deterioration. We believe that such an adjustment should be linked to an increase in minimum benefits, as before discussed. We note with approval that the Congress may take interim action before the Jan- uary 1974 effective date of this provision as well as subsequent action to in- crease general benefits. Increasing the wage base subject to FICA tax by the same percentage that benefits are raised will assist in the program's financing. Furthermore, auto- matically raising the retirement test with the rise in average taxable wages at the same time the CPI adjustment takes place in an advantage in the pro- posed legislation. Sec. 103 — Special minimum cash benefit for persons with a substantial em- ployment record. — Provides a special minimum for persons who worked 15 years or more under social security, such minimum to be computed at $5 times the number of years of covered employment up to a top limit of 30 years or $150. ,. . We approve this provision. However, we question the non-application of a price rise adjustment to this benefit. Sec. 104 and Sec. 113— Survivors 1 benefits.— Provides in Sec. 104 an increase in cash benefits to widows and widowers from the current 82.5% of the de- ceased spouse's benefit to 100% of the amount the deceased spouse would re- ceive if living. Survivors' benefits applied for before age 65 would be actuarially reduced. Provides in Sec. 113 payment of reduced benefits to widowers at age 60 as is now done for widows at age 60. We support the increase in cash benefits to dependent widows and widowers. We, however, favor a no-penalty provision for the widow or widower of an early retiree, and recommend that the widow or widower receive 100 percent of the benefit the retired worker would have received at age 65. We favor the option given to 60 year old widowers to receive decreased sur- vivor benefits, an option already given to widows. Sec 105 and Sec. 142— Financing.— Provides in Sec. 105 an increase in the annual taxable earnings base from $7,800 to $10,200 effective January 1972. Provides in Sec. 142 new schedules of tax rates for OASDI and Medicare for the self-employed and for employees and employers. For the latter, the com- bined rate would increase from the current 10.4% to 10.8% in 1972, to 12.4% in 1975 and to 14.8% in 1977. nnn We approve the rise in the taxable earnings base to $10,200 effective in Jan- uary 1972. This tends to decrease the regressivity of the tax. We withhold approval of the proposed changes in the tax rates. We believe that tax rates should be reexamined subsequent to a change in the investment policy of the Trust Funds. • A We strongly recommend that the interest rate pattern of the Trust iunds be altered with the objective of raising the interest income. The need for liquid- ity and safety of Fund monies is acknowledged, but the income of the Funds (notably the Old-Age and Survivors Trust Fund and the Disability Insurance Trust Fund which together totaled $40.3 billion as of April 1971) could be sub- stantially raised within legal investment limits. m J Setting the investment policy of the Funds, within the framework legislated by the Congress, is a three-man Board of Trustees. Managing Trustee is the Secretary of the Treasury ; others are the Secretaries of Labor and of Health, Education and Welfare. Official records 2 indicate that investment practice has favored the government to a significant degree through what is tantamount to loans at low interest rates. For fiscal 1971, the overall interest rate was less than 4.8% for the Trusl Funds. 2 Portfolio of OASDI Trust Funds, Congressional Record, June 23 1971 p. H5813 Interest rates on government securities 1965-1971, Federal Reserve Bulletin, June 1971 pp. A33, A34. As of April 30, l'.'Tl 11 is significant (lint 42.9% or sit.:; billion of the OASD1 Trust Funds was Invested al 4.7595 or lower interest rates; 29.4% al 8 or less; i.",.i<; at 2.75% or Less. These Investments were accumulated over a period of time. However, the l!»7l> rate on :'. :> yenr U.S. Government Securities was i:M r /c ; in L969 it was 8.85%. In fact, in every year beginning with !!»<;»! steadily upward and beginning with L966 never fell below 4.66%, reaching b high of 6.99% in June L970. Most of the OASD] Trust Funds are invested in special issues $27 billion out of $40.3 billion or (u Child Health A. PROVISIONS KKLATINO TO MEDIC ABE (Amending Tide XVI 1 1 of the Social Security Act) Sec. 201 — Eligibility for coverage extended to disability beneficiaries. Extends eligibility Cor hospital Insurance and supplementary medical Insurance to a social security disability beneficiary two years after entitlement to disability benefits. Coverage extended to disabled workers entitled to social security or railroad retirement benefits, disabled widows and disabled dependent widowers between ages 50-65, and persons aged 18 and older receiving benefits because of disable- ment prior to age 22. Effective July 1, 1972. We favor this proposed liberalization of eligibility. Sec. 202 — Extension of hospital insurance benefits to uninsured individuals. — Extends eligibility for enrollment for hospital insurance on a monthly premium basis to a person who has attained age 65, is either a resident citizen or a lawfully admitted resident alien, and is not otherwise qualified for coverage. Initial monthly premium of $31 to rise as hospital costs rise. We support the principle of enrollment on a monthly premium basis of persons otherwise ineligible for hospital insurance coverage. However, we question the utility of this proposal because of the size of the premium covering the full cost of protection. Additionally, we urge that Medicare coverage be phased in for the early retiree, that is, the beneficiary between the ages of 62 and 65. A person taking early retire- ment — for whatever reason — not only receives actuarially reduced social security cash benefits but may very well have no health insurance protection. At least three reasons account for the lack of health insurance coverage for the early retiree. Many persons claiming benefits at age 62 have been out of work for several months and, therefore, have no employer-financed coverage. Intensifying the un- employment problems is the major reason for the unemployment : illness. In its Survey of New Beneficiaries, published in 1971, the Social Security Administra- tion found that "Health is the most important reason described by over half the group, whether they stopped working at age 62 or more than three years earlier." So, large numbers of those taking early retirement are unemployed and in poor health and have been both unemployed and in poor health for some time. Even those employed just prior to early retirement are unlikely to be covered by the extension of their health insurance into retirement. Finally, many early retirees, with their small cash benefits, are unable to pay for private health insurance coverage. We recognize the benefits of health care coverage for early retirees. We recog- nize, too, that costs are a factor. Therefore, we suggest phased-in coverage. Sec. 203 — Setting supplementary medical insurance premium. — Directs the Sec- retary of HEW 3 to determine a premium as of December of each year estimated to be necessary so that the aggregate premiums for the 12-month period begin- ning July 1 in the succeeding year will equal one-half of the total benefits and administrative costs of the supplementary medical insurance program. However, the premium generally would increase only if monthly social security cash bene- fits had increased since the last increase in the premium and would rise by no more than the percent increase in such benefits across the board. We support the reasonableness of the proposed basis for increasing the supple- mentary medical insurance premium charges. We particularly favor the provision that, beginning with fiscal 1973, no increased premium may be charged unless there has been an increase in social security cash benefits, either as the result of the enactment of legislation raising the benefit level or as a result of the auto- matic cost of living benefit rise. Sec. 204 — Deductible. — Increases the annual deductible for supplementary medical insurance (Part B) from $50 to $60. We regret the apparent need to increase the deductible for Part B of Title XVIII, but we do not oppose this change. However, we believe this should be accompanied by a change in present law with respect to the deductible for hos- pital insurance (Part A of Title XVIII). This now is $60 for each benefit period and is scheduled to go to $68 January 1, 1972 reflecting the increase in hospital costs. Since a patient may be admitted to and discharged from a hospital several times a year, he could be required to pay the deductible five times, totaling $300 In subsequent sections, HEW is substituted for Secretary of HEW. '20 a year as of now and $340 as of January 1, 1972. The payment of even two or three deductibles a year causes financial hardship to many. We, therefore, recom- mend the benefit period in respect to the deductible for Part A be defined as one year, which is the period used for computation of the deductible under Part B. -Sec. 205 — Benefits and coinsurance. — Increases from 60 to 120 days the life- time reserve under which the beneficiary pays one-half of the deductible for hos- pital inpatient care. Shortens from 60 to 30 days the period in a spell of illness when coninsurance is not imposed for hopspital inpatient care. Benefits, that is to say the coverage of specified services for a specified dura- tion or a specified volume under Parts A and B, are largely unchanged 4 in H.R. 1 except as they are affected by changes in provisions in respect to coinsurance or deductibles. We view the increase in the lifetime reserve for hospital inpatient care as a highly desirable liberalizing feature of the Bill. This may well be a trade off, compensating in part for the shortening from 60 to 30 days the period in a spell of illness when coinsurance is not imposed for hospital inpatient care. We rather regret this tightening measure, but we recognize that vast numbers will still be covered since the average hospital stay of Medicare patients is only 12.8 days and 91% of the discharges from hospitals — other than psychiatric or tuberculosis — represent stays of fewer than 30 days. There is, however, a serious omission from the benefits. The cost of out-of- hospital prescription drugs is a serious financial burden to the elderly and the federal social insurance program provides a feasible and efficient mechanism to alleviate the problem. We urge the inclusion of such a program under Part A of Medicare. 5 We recommend a $1 co-payment per prescription or refill by the beneficiary, with payment of the balance to be made by the Social Security Administration to the vendor. At the same time we suggest that HEW undertake further study of a just and effective method of utilization control. Sec. 206 — Automatic enrollment in supplementary medical insurance. — Pro- vides automatic enrollment under Part B for individuals entitled to hospital insurance benefits. We favor this proposal but suggest that the new social security beneficiary be informed of the reason for a deduction from his monthly cash benefit check. An insertion, for several months running, in the envelope with his check would appear a satisfactory way of informing the retired worker of the fact and cost of his coverage, and of his option to withdraw from part B coverage. Discussed below are certain specifics directed to Medicare cost controls that affect large numbers of persons or embody broad principles — Section 221-^, 226, 228, 234, and 236. Sec. 221 — Limitation on federal participation for capital expenditures. — Au- thorizes withholding or reducing reimbursement amounts to providers of service under Medicare (Title XVIII and also Titles V and XIX) for defined costs related to certain capital expenditures that are inconsistent with state or local health facility planning. For this purpose, capital expenditures are defined as expenditures for plant and equipment in excess of $100,000 ; which change bed capacity ; or substantially change services. We strongly endorse the provision that capital expenditures as here defined would be reimbursed only when such outlays are consistent with state or local plans. Mushroom expansion without regard to overall needs is wasteful. Sec. 222 — Plan for prospective reimbursement ; experiments and demonstra- tion projects to develop incentives for economy. — Authorizes HEW to develop and engage in experiments and demonstration projects designed to determine the advantages and disadvantages of various alternative methods of prospective re- imbursement to hospitals, extended care facilities and other providers of services under Title XVIII (applicable also to Title V and XIX). Clearly, the present system of provider reimbursement on the basis of reason- able costs" carries little incentive for efficiency. We support the authorization for HEW to develop ways of testing the efficacy of the alternative whereby rates are set in advance of the period to which they are applicable. We inject a word of caution about the possibility of lowering the quality of care and some escalation in costs. Advance rate setting may result in losses to providers when costs rise There are modest ch anjres in respect to physical and other therapy services (Sec. 2jl), covers of supplies related to colostomies (Sec. 252), coverage of ptosis oars (Sec 253), hospitalisation for a noncovered dental procedure (Sec. 256). prosthetic lenses furnished by ° P « AvailaMe onrequest is a detailed fact sheet and outline of a proposed program. '21 above those anticipated; the temptation to cul corners and reduce service Is a real threat. Contrarywise, prospective rates can be escalated to avoid an an favorable spread between the actual and estimated costs, In respect to experiments with various rciinhiirseiiieiii method ed tO increase efficiency and economy : We support this provision and particularly wel- come its Linkage to community wide peer, medical and utilization review mecha- nisms designed to assure that health services meet professional standards and that medically necessary services are given In the most appropriate and eco- nomical setting. There Is no provision for adoption into practice of effective experiments — an oversight that should be corrected. Sec. 223 — Limitations on coverage of costs. — Provides authority to set cost limits for certain classes of providers in various service areas on a prospective rather than a retrospective basis. Requires public notice to beneficiaries of Charges beyond reimbursable limits. We support, the requirement that providers be informed in advance of the ap- proved, reimbursable limits and that beneficiaries be advised of the nature and amount of extra charges. We would add to this a requirement for disclosure by the financial intermediary to both public bodies and the consumer of reimbursable costs in the locality for standardized services and procedures. In our view, this additional measure of public accountability is important. Sec. 224 — Limits on prevailing charge levels. — Limits increases in physicians' charges through June 1972 for fee scales up to the 75th percentile of prevailing charges ; after fiscal 1973 provides that physicians' fees may be increased only to the extent justified by economic changes ; provides that charges deemed reasonable for medical supplies, equipment and services may not exceed the lowest level at which such items, comparable in quality, are widely available in a given community. We recognize the need for setting limits on prevailing charge levels and con- cur as to the need for continuing study and attention to this thorny question. We note that the Bill authorizes HEW to develop "appropriate economic index data" as a basis for adjusting fees, but that the House Ways and Means Com- mittee is fairly specific in its report on the items to be considered for such an index computation. We urge that such study be both sophisticated and objective as a means of providing a fee structure that is fair, defensible and supportable. Sec. 226— Payments to health maintenance organizations. — Adds a new section to Title XVIII providing for payments to health maintenance organizations. We support the encouragement given to the development of health maintenance organizations as one acceptable, alternative mechanism through which patients eligible for Medicare could elect to have all covered care, except emergency service, provided. Sec. .228 — Advance approval of extended care and home health services. — Provides authorization to establish periods of time for which a patient is pre- sumed eligible for extended care and home health services on certification by the patient's physician. We are in agreement with this provision. The establishment of specific post- hospital time periods during which there is presumptive need for such services should encourage transfer to less costly types of care and should decrease the number of cases in which benefits are retroactively denied. Sec. 234 — Institutional planning. — Requires that participating health facilities have a written plan reflecting an operating and capital expenditures budget. We welcome the inclusion of this requirement which is clearly tied to other Sections, e.g., Sec. 221 and Sec. 222. Sec. 236 — Prohibition against reassignment of claims. — Prohibits Part B Medicare payments being made to anyone other than a patient, his physician or other person providing the service (with limited exceptions) . We support this provision which seeks to close a loophole in the existing law and control undesirable collection practices that have resulted in inflated claims and escalated costs and beclouded the determination of reasonable limits. Sec. 265 — Deletes requirement for social service in extended care facilities. — Prohibits HEW from requiring an extended care facility to furnish medical social services. We are not persuaded by the arguments put forward in the report of the House Ways and Means Committee to support this Section which would nullify the HEW regulation requiring the furnishing of medical social services as a condi- tion of participation for extended care facilities under Medicare. We urge the 722 removal of this Section from the Bill and review of the regulations by HEW to determine their fairness in the light of experience to date. Sec. 269 — Requirements for nursing home administrators. — Permits states to provide a permanent waiver from any licensure requirements for persons who served as nursing home administrators for the three-year period preceding the year the state established a licensure program. We urge the deletion of this Section which would appear to permit adminis- trators who could not meet licensure requirements to return to or remain in prac- tice. We believe that the device of licensure upgrades service by upgrading ad- ministration. The public interest should be protected rather than private, vested interests which would seem to profit by this proposed permanent waiver. B. PROVISIONS RELATING TO MEDICAID (Amending Title XIX of the Social Security Act) Sec. 207(a)(1) — Incentives for states to emphasize comprehensive health care. — 1. Increase in federal reimbursement: Provides that states in contract with Health Maintenance Organizations (HMOs) 6 or other comprehensive health care facilities would receive 25% increase (up to 95%) in federal reimbursement per- centage under the Medicaid program. We strongly favor prepayment over the fee-for-service method of financing health care. We support the intent of encouraging new patterns for the delivery of health care and believe that the quality of health service can be significantly improved under a program providing comprehensive coverage. We do not believe that there are sufficient safeguards in H.R. 1 to assure that improved patient care will necessarily result. We think that the Bill should stipulate that HMOs, or other comprehensive health organizations, that are formed in keeping with the Bill's provisions, must be under public or private non-profit auspices. 2. Decrease in federal reimbursement : Provides that the federal medical assist- ance percentage would be decreased by one-third after the first 60 days of care, in any fiscal year, in a general or tuberculosis hospital or a skilled nursing home, ^nless the state establishes that it has an effective utilization review program. For inpatient care in a mental hospital, federal reimbursement would be de- creased by one-third after 90 days except that it may be extended for 30 days if the state can show that the patient will benefit therapeutically from such care. No federal reimbursement would be provided after 365 days care in a mental hospital. We believe every effort should be made to use less costly facilities than hos- pitals when such care is appropriate and adequate to an individual patient's needs. We think, however, that some of the assumptions about need for hospital- ization and length of stay on which the reductions are based do not give full weight to the fact that Medicaid covers persons under 65 as well as over 65 and that not all patients irrespective of age and condition require treatment of only short duration in "acute" hospitals. Moreover, the lack of facilities to provide different levels of care poses a major problem, especially for those who may need something less than full hospital care but who do need institutional care until well enough to be cared for at home. We are concerned that as a result of these amendments-, appropriate and adequate health services may be denied those persons who are most vulnerable. 3. Computing reasonable reimbursement between skilled nursing homes and intermediate care facilities (ICFs) : Authorizes HEW to compute a reasonable cost differential reimbursement between skilled nursing homes and ICFs. The apparent purpose of this amendment is to assure that care in an ICF results in decreased costs to the Medicaid program. We support the measure as being administratively sound. Sec. 208(a) — Cost-sharing. — Permits states to impose a nominal cost-sharing charge on cash assistance receipts for non-mandatory services under the Medic- aid program. Requires states to impose on those not receiving cash assistance an enrollment fee premium or similar charge related to income, and permits co-payment provisions not related to income. An HMO is an organization that, offers to an enrolled population, a comprehensive system of health service, including preventive, ambulatory, hospital and related care on a capitation reimbursement basis. '23 in addition to our h:isi<- objections to the Imposition of charj ■ on Medicaid (recipients as stated In Pari l. we believe the coal i of admlnistei pro- posals would be prohibitive and thai patient services would be unnecessarily delayed In i be course of establishing eligibility for care. Sec, 209 {(■) and (4>) — Determination of payments. Sec. 209(c) denies Medic- kid coverage to those in reeeipl of cash assistance whose Incomen are In i of the medical assistance level established by the state. Sec. W9(d) permits slates to deny Medicaid coverage to those persons who would be newly eligible for cash assistance under the Income maintenance sections of U.K. 1. [f ;i phooses bo provide Medicaid il would be required thai recipients' Incomes nor be in excess o\' t he state's medical assistance level. We strongly object to both these proposals. Currently, states thai have n Medicaid program are required to provide care under .Medicaid for all recipients pf cash assistance. We believe these amendments strike at the basic purpose for which the Medicaid program was first enacted, thai is, to assure a program of health care for persons in financial need. Sec. 209(d) is ominous since It gives tacit approval to states to deny health care to needy families and at the same time releases the federal government from any responsibility for reimbursement to the states which so act, for health care payments for their needy families. Sec. 221(a) — Limitation on federal participation for capital expenditures. — Prohibits use of funds appropriated under the Social Security Act to support unnecessary capital expenditures; provides that reimbursement under such titles would support state health planning activities. We are in full support of this provision. It takes into account that state and local health planning agencies have primary responsibility for determining the need for health facilities for given geographic areas and provides that capital expenditures under Title XIX of the Social Security Act would be related to the priorities established by the health planning agencies. Sec. 222(a)(1) — Plan for prospective reimbursement. — Authorizes HEW to develop and engage in experiments and demonstration projects designed to deter- mine the advantages and disadvantages of various alternative methods of prospective reimbursement to hospitals, extended care facilities, and other pro- viders of service under Title XIX in order to stimulate more efficient health care and thereby reduce costs, without adversely affecting the quality of services. We favor this proposal in the belief that more effective patient care, more effi- cient use of health personnel and a decrease in medical costs could result from this kind of experimentation. There is no provision, however, that those experi- ments found effective might be authorized to be continued ; we believe this over- sight in H.R. 1 should be corrected. Sec. 231 — Deductions in care and services. — Permits states to reduce the scope and extent of health services which are optional under Medicaid. Currently, states may not reduce the level of their expenditures for their Medic- aid program in successive years. We object to this amendment because it would permit the states that choose to do so, to deny or diminish the availability of vital health services which are denned, under the Medicaid statute, as optional. We believe the optional services are necessary components of adequate health care and should not be withdrawn. Sec. 235(a) — Payments to states for claims processing and information retrieval systems. — Makes federal matching under this provision available to states for developing and instituting mechanized claims systems at 90% and 75% for operation of such systems. We support this proposal because it should encourage rapid development of mechanized collection and retrieval systems to the end that the Medicaid reim- bursement and related operations would be more efficiently administered. Sec. 236(d) — Prohibition against reassignment of claims. — Prohibits Medicaid payments to anyone other than the patient, his physician or other service pro- vider unless the provider is required as a condition of employment to turn over his fees to his employers. We fully support this provision which would outlaw the use of fee collection agents by providers of services under Medicaid. Sec. 239 (a) and (b) — Use of state health agency. — Sec. 239(a) requires states to provide that the state health agency, or other appropriate state medical agency, have responsibility for establishing and maintaining health standards for insti- tutions in which Medicaid recipients may receive care or services. Section 239 ( b ) requires that the state health agency or other appropriate state medical agency, be given responsibility for establishing a plan for the review by professional 724 health personnel of the quality and appropriateness of care and services fur- nished to Medicaid recipients. We fully support both of these amendments. The first should assure at least basic standards for the quality of care provided to Medicaid recipients. The sec- ond provision sensiblv makes use of an existing mechanism to provide a service for the Medicaid program ; the quality of care under Medicaid should be improved bv this provision. * Sec 240— Relationship between medicaid and comprehensive health care pro- grams— Provides that states may enter into contracts with organizations that agree to provide care and services in excess of those offered under the state plan at no increase in costs. . . We question this proposal in the absence of an acceptable minimum standard throughout a state. However, we see as desirable, experimentation that likely would emphasize preventive care and early treatment in order to contain costs, and on this basis support the proposal. Sec 254(a) (1) and (a) (2)— Inclusion of care in intermediate care facility.— Sec 254(a)(1) provides, an optional service, care in an Intermediate Care Facility (ICF) as an additional benefit under Medicaid. Sec. 254(a) (2) provides that services in a public institution for mentally retarded persons would qualify for Medicaid coverage, if the primary purpose is to provide health or rehabilita- tion services, and if the patient is receiving active care. Currently federal reimbursement for care in an ICF is not available under the Medicaid program. Each of these provisions, in our view, would be desirable additional elective benefits for Medicaid recipients. Sec 255(a)— Coverage prior to application.— Requires states to provide cover- age for care and services furnished in or after the third month prior to applica- tion for Medicaid. . , n Under present law, a state may at its own option, cover the cost of health care provided to an otherwise qualified recipient for the three months prior to his application for Medicaid. We favor this amendment as being both sound and desirable. Title III — Assistance for the Aged, Blind and Disabled (New Title XX of the Social Security Act) Sec 2002 and Sec. 2003— Administration.— Sec. 2002 provides that eligible aged, blind and disabled individuals shall be paid benefits by HEW. Sec. 2003 provides that HEW make arrangements to carry out the assigned functions, including arrangements for determination of blindness and disability similar to those in effect in determining eligibility for social security disability benefits. Although the Bill does not so specify the report of the Ways and Means Com- mittee recommends that responsibility for administering the program of cash benefits to the needy aged, blind and disabled shall be assigned to the Social Security Administration (SSA). We welcome this recommendation. Persons receiving benefits under this program for the most part comprise a relatively stable group, similar to the OASDI beneficiaries. We believe that the SSA s long experience in administration of payment programs would enable it to administer this new program efficiently and humanely. Services to the needy aged, blind and disabled would continue to be provided through federal-state financing and be administered by the states. Those m need of services would have contact with the local social services unit of the state administration. In our view, the administration both of the cash payments and services for this group of persons should be simplified and flexible because they are limited in ability to respond to complicated procedures by the very nature of their eligibility. ; ,J Sec 2011(b)— Gash assistance; amount of benefits.— Prescribes the amounts payable in 1973 1974 and 1975 to individuals, with or without an eligible spouse, whose non-excluded resources are not more than $1500. The Bill does not require that the couple be living together. A „ M ~ ^ . , The Bill provides cash assistance in the amount of $lo60 for a single person and $2349 for a couple. These amounts are increased to $1800 and $2400 respec- tively by 1975 and are to remain at that level thereafter. The level of assistance projected in the Bill is inadequate as evidenced by the fact that the poverty level as determined by the 1970 Census is $1861 for an aged individual and $2348 for an aged couple ; due to the inflationary factor this level had increased approxi- 725 mutely 5% by \\n\ and unquestionably will be even higher by L975. The Bill siiouiti be amended (<> provide a level of assistance adequate to meel basic nerd. Sec. 2018(b)(8), See. 2016 and Title \. See. 509—E(DOlU8ion8 from income; optional stale supplementations state supplementary payments during transU tional period. — See. 2012(b)(8) provides for exclusions from income: $86 ot earnings plus one-half Of the balance for the blind and disabled and $60 of earnings plus one-third of the balance for the aged. See. 2016 permits states to supplement the federal payment. See. 509 of Title \ requires the slates to make supplementary payments to maintain their payment level of .June 1 ( .>71 plus the bonus value of food stamps unless they modify that. Level by affirmative Legislative action to the contrary prior to July 1972. Eligibility conditions for assistance would be uniform nationally. However, blind and disabled persons would receive more liberal income deductions than the aged and therefore the amount of assistance granted the different groups would not be uniform. The difference in disregards among the three categories should be corrected. Further inequities would result from the optional provision for state supplementation. We believe that needy persons should receive an adequate level of assistance to meet need. Therefore, the states should be required to supplement the federal payment at least to the current payment levels. Sec. 2031(a) (2) — Protective payments. — Authorizes payments for the benefit to a person other than the individual or his spouse (including an appropriate public or private agency) if HEW deems it appropriate. Assistance payments may be made to a third party (including an appropriate public or private agency) who is interested in or concerned with the welfare of the recipient, if HEW deems this to be appropriate. While it is believed that this leeway may be in the best interest of an aged, blind or disabled recipient, the regulations and procedures governing determination of appropriateness should safeguard against excessive use of this provision. The conditions under which these payments would be ordered should be included in the Bill. Sec. 2011(c) and Sec. 2031(e) — Application process — period for determination of benefits; application and furnishing of information. — Sec. 2011(c) provides that eligibility for and the amount of benefits shall be determined for each quarter of a calendar year and shall be redetermined at such time or times as may be provided by HEW. Sec. 2031(e) directs HEW to prescribe requirements for filing applications, sus- pending or terminating assistance, furnishing data and reporting changes in circumstances and specifies the penalties for noncompliance by the applicant or recipient. In our judgment the current annual redetermination is preferable to a quarterly review of eligibility and should be retained, especially in view of the relatively stable circumstances of this group of recipients. We favor the simple declarative form for determining eligibility over extensive investigations and recommend that the Bill provide for its use. We further recommend that the Bill allow for flexible application of the requirements for reporting changes in circumstances with due consideration for the hardship which rigid application of penalties would impose on the very old and seriously disabled. Title IV — The Family Programs (New Title XXI of the Social Security Act) Sec. 2111, 2112, 2114 — Operation of manpower programs; employable mothers; child, care and other supportive services. — 1. Operation of manpower programs : Sec. 2114 requires the Secretary of Labor to develop an employability plan describing the manpower services, training and employment needed to enable each individual to become self-supporting and se- cure and retain employment and opportunities for advancement. Several of the employment provisions must be changed to make them truly effective in helping persons achieve self-support. There must be a sufficient num- ber of jobs, paying adequate wages and meeting acceptable working conditions. It is not realistic to mandate employment but fail to provide satisfactory train- ing programs and sufficient work opportunities. The Bill creates public service jobs paying at least the federal minimum wage, to supplement other employment opportunities but these are few in number and temporary. Federal reimbursement will not extend for more than three years of an individual's employment in a public service employment program. After 726 that period a person must either be hired by the agency or terminated. Perma- nent public service jobs should be created to the extent needed to meet mandated employment requirements. The Bill requires that wages for the public service jobs shall be at least at the federal minimum but permits wages in private employment, which a needy person could be required to take, at 75% of the federal minimum. The Bill should require that all mandated employment shall be at least at the federal minimum wage level ; that conditions of work shall be of acceptable standard ; and that the job a person is required to take shall be suitable to the person, with suitabil- ity defined with respect to such maters as a person's prior training and experi- ence and the distance of work from his home. 2. Employable mothers ; child care and other supportive services : Sec. 2111 includes as an individual who shall be considered available for em- ployment, a mother of a child three years old or, until July 1, 1974, six years old. Sec. 2112 provides that the Secretary of Labor shall make provision for the furnishing of child care services, in such cases and for so long as he deems ap- propriate for the individuals registered for employment or training who need such services to participate in the program through such public or private facil- ities as may be available or appropriate. After 1974, mothers of children over three years would be required to accept employment or training (unless there is a husband in the home who is regis- tered) whether or not suitable child care services are available. Considerable hardship to children could be caused if despite the authorization to the Secre- tary of Labor to make provision for such services suitable child care is not available. Furthermore, the requirement that a mother of young children shall be considered available for employment removes from her the right to determine if it is in the best interest of her child for her to work or remain at home ; that decision should be based on the needs of a particular family, including the availability of suitable care for the children. Sec. 2134 — -Child care standards ; development of facilities. — Directs the Secre- tary of HEW to establish standards assuring quality of child care services with the concurrence of the Secretary of Labor ; to prescribe schedules to determine the extent to which families must pay the costs ; and to coordinate child care services under Title XXI of the Social Security Act with other child care and social service programs. Authorization of funds for child care services is provided but in an insufficient amount to meet the need and should be increased. HEW would be required to set standards of care. Setting and overseeing standards of care is particularly im- portant since the Bill permits contracts for day care with profit-making as well : as with public and nonprofit agencies. Adequate day care, not now defined, should be defined in the Bill and the standards set should be in line with these defini- tions. This is essential if mothers of young children are to be compelled to accept work or training. Sec. 2152(a) and (b) and Sec. 2152(d) — Cash assistance: eligibility for and' amount of benefits ; period for determination of benefits. — 1. Eligibility for and amount of benefits : Sec. 2152(a) and (b) prescribe bene- fits for eligible families at the rate of $800 per year for each of the first two members, plus $400 for each of the next three, plus $300 for each of the next two members, plus $200 for the next member, to a maximum of $3600. reduced by non- excludable income ; no benefit is payable of under $10 per month. Resources mayl not exceed $1500. The nationwide minimum standard of payment for needy families with chil- dren would not be adequate. The payment levels — for example, $2400 annually for a family of four persons — is less than even the poverty level of $3968 for a family of four determined by the 1970 Census. And since no family could receive more than $3600 regardless of the number of family members, large families would be even further below this poverty line. Therefore, substantial increases in payment levels must be made if persons are to have an adequate level of exist- ence — particularly since this Bill would freeze the federal payment at this level for the five years' duration of the Bill. 2. Period for determination of benefits: Sec. 2152(d) provides that payment of benefits shall be made on the basis of HEW's estimate of the family's income for the current quarter after taking into account income from the three preceding quarters and modifications for changes of circumstances. The federal payment should be computed according to a family's current need. H.R. 1, however, provides that the portion of a family's income during the nine ..-'< aonths preceding application Cor the FAP payment In exi • ienl level [Including excludable Income) would be deducted from benefits otherwi «• due n the time of application, in the case of such excess Income, a famil: would not bceive even the Inadequate federal payment. This provision should be chan )niy aeed al the time of application should determine eligibility md amount ot laymenl ; it should qo1 be assumed thai persons have saved money fn m b prior period. See. 2158(1) Work incentives; income disregard. — Enumerates the Items to >e excluded in determining the Income of a family such us a student's earnings; rregular Income limited to $30 a quarter If earned or $60 a quarter If unearned ; fcarned income used to pay the cost of child care as prescribed by HEW; $720 ►lus one-third of the remainder of earned income. The total exclusions of the h-xt three cannot exceed $2000 for a family of four, up to maximum of $3000. To encourage persons to work, the Bill provides that some income from earn- bgs be retained and disregarded in computing eligibility for benefits. Ou1 of jarned income. $7:20 per year plus one-third of the excess earned would he ex- •luded. Thus, payment to four-person families in which \Uorv is a working nemher would be made only if the allowable income is $4140 or less. Although mild care costs are deductible, the total of these costs, irregular earnings and student earnings could not exceed $2000. Work expenses such as transportation and taxes are not excluded in determin- ng a family's income. Therefore, if these costs are higher than the retained income, a working family could find itself with less money at its disposal than t no member were employed. To provide a true work incentive, the Bill must Dermit retention of a larger share of earnings. Furthermore, the ceiling on in- come exclusions should be removed, particularly since these include the cost of mild care services. If, for example, the cost of day care absorbed the total illowance for excluded income, a school child working irregularly would not be Dermitted to retain any of his earnings. Sec. 2155 and 2156(b) (2) — Exclusions from coverage; meaning of family and >Jiihl; exclusions from state supplementation. — 1. Meaning of family and child: Sec. 2155 defines those who qualify as family nembers and, therefore, are eligible for benefits under the family programs, as wo or more related persons living together in the United States, at least one of ,vhoin is a citizen or alien lawfully admitted for permanent residence, and with it least one child dependent on one of the others. It expressly excludes families leaded by full-time college students. By definition, federal payments would not be made to needy single adults or mildless couples who are not aged, blind or disabled nor to needy families leaded by a full-time college student. Persons in these groups would be without iccess to public assistance except in those states which made provision for their lid without benefit of federal reimbursement. A basic level of financial assistance mould be made for all needy persons and the Bill amended to include these ex- cluded groups in the federal system of income maintenance. 2. Exclusions from state supplementation: Sec. 2156(b)(2) permits states to ieny benefits to families with both parents present and neither parent incapaci- :ated, regardless of whether the father is employed or unemployed. There are exclusions within the groups eligible to receive FAP or OFF pay- bents which we believe should be removed. States are permitted to exclude from supplementation of FAP or OFF payments, families in which both parents are present and neither is incapacitated regardless of whether the male parent is employed or unemployed. It should be required that the states include all needy families in their supplementary programs. Sec. 2155(d) — Forced responsibility of step-parent ; income and resources of ion-contributing individual. — Excludes income and resources not available to )ther family members if it is derived from a family member other than a parent ir a spouse of a parent. The income and resources of a parent's spouse living with the family would be ncluded in determining the family's eligibility for benefits even though the spouse does not have legal responsibility for the children and may have his own children elsewhere to support. This can result in needy children being denied issistance and thus penalized because of a parent's marriage. This provision mould be changed so that the spouse's resources would not be included on be- lalf of those persons in the family for whom he does not have legal responsibility. Sec. 2156 and Title V. Sec. 509 — TJniformity in amounts of assistance; optional Hate supplementation; state supplementary payments during transitional peri- id. — Sec. 2156 permits the states to make cash payments to supplement the 728 federal payments and requires that the supplementary program respect the federal earnings disregard provisions. The states are not required to include families with a male parent present in their supplementary program. Sec. 905 requires the states to make supplementary payments to maintain their payment level of June 1971 plus the bonus value of food stamps unless they modify that level by affirmative legislative action to the contrary prior to July 1972. We are in full support of the provision for uniformity in the amount of federal payments based on uniform conditions for determining eligibility. The level of payments, however, is inadequate. Moreover, since supplementation is optional with the states and they are permitted to exclude certain groups from their supplementation program, if any, there would be inequalities in the amount of assistance among needy families with children in the various states. All persons should have a right to an adequate level of assistance which should not leave them in poverty. We believe the states should be required to supplement the inadequate federal payment at least to their current payment levels. Sec. 2171(a)(2)(A) and Title V. Sec. 529— Indirect payments; vendor pay- ments. — 1. Indirect payment of benefits: Sec. 2171(a) (2) (A) permits payments to any person other than a family member (including an appropriate public or private agency) if HEW finds that the family member to whom benefits are payable has such inability to manage funds that making payment to him will be contrary to the welfare of the children in the family. Payments may be made to non-family members if it is found that the payments are not being used in the best interests of the family. The Bill should state the criteria for finding the family incapable of managing its own affairs and the conditions under which such third party payments may be ordered. 2. Vendor payments under the AFDC program : Sec. 529 of Title V effective immediately upon enactment authorizes the states to provide for non-recurring special needs which cost $50 or more by payment directly to the person furnishing the item. This provision immediately applicable to the current AFDC program, permits states to pay the provider directly for goods or services costing $50 or more. This method of payment is contrary to the premise that needy families have a right to manage their own affairs, including making purchases and handling money, in the absence of proof that they are unable to do so. Sec. 2171(c) — Hearings and review. — Requires notice and opportunity for hearings for anyone who disagrees with a determination with respect to eligibil- ity for or amount of payments, if requested within thirty days. Final determina- tion by HEW after a hearing would be subject to judicial review, except that HEW's findings as to facts shall be conclusive. The Bill fails to specify certain fundamental standards for the conduct of hearings when a recipient challenges administrative decisions, such as adequate notice of the reasons for the initial determination. In providing that findings of fact are not subject to judicial review, the Bill does not add the necessary protection against arbitrary findings— that they must be supported by a clear preponderance of the evidence. Furthermore, the Bill should require that a re- cipient shall receive benefits pending the final decision. Sec. 2152(e) and Sec. 1271(c)— Application and hiennial reappUcatton process. — Sec. 2152(c) prohibits benefits being paid a family for more than twenty four consecutive months except on the basis of a new application filed and processed as though it were the family's initial application for benefits. Sec. 2171(e) directs HEW to establish requirements for filing applications, suspension or termination of benefits, furnishing data and reporting changes in circumstances necessary to determine eligibility. Each family shall be required to submit a report within thirty days after the end of the quarter to determine eligibility for benefits payable for that quarter or be subject to penalty. The Bill should prescribe a simplified method for determining eligibility for benefits both in the initial application and the biennial reapplication process. The Bill requires families to make quarterly reports of income and expenses within thirty days, under automatic penalty. It requires a family to file a new application to be treated as if it were an initial application despite the accumu- lated data of twenty-four consecutive months. We believe that the emphasis in the Bill on investigation, furnishing evidentiary materials and frequent routine reporting to substantiate eligibility for benefits, is costly and unnecessary in most cases and would impose needless hardships on families. Flexibility in the application and reapplication process should be permitted while at the same 7L >( .) time assuring thai benefits are paid only to eligible persons. We recommend provision he made Cor the use of the simple declarative statement where appro priate, a method now In use In many stales. Sec. 2102, 2151, 2156, etc. Administration; multifile sections, This Bill would necessitate a complicated administration requiring continuing contacl among several federal, stale and local agencies. Locally, there would need to be :i tre mendous increase in the state and local offices for providing cash assistance, services and employment. The FAP program and the payments to OFF recipients would ho administered by HEW. other agencies would be involved to provide Information to establish Eligibility. If requested, mow would administer a state's supplementary pro- gram and Medicaid eligibility. As an Inducement, the state would pay HEW the amount of the supplemental payments and he relieved of responsibility for the administrative costs. The OFF program of training, work and employment would he administered by the Department of Labor including such supportive services as day care. This can he done by direct federal administration or through contacts with state and local agencies. Nearly all recipients would be required to have contact with many agencies. Among the local offices with which a head of a needy family may have to deal could be that of HEW administering payments and of the Department of Labor, and possibly with a day care center or some other office rendering a service. Since the states would continue to administer the social service programs under the present federal-state matching arrangements the recipient requiring service would need to have contact also with local social service units of state adminis- tration. It. is to be hoped that procedures will be devised to minimize and co- ordinate the multiplicity of agency contacts necessitated by this Bill. Title V — Miscellaneous, 7 New Social Services Provisions (Amending Titles IV and XI of the Social Security Act) Sec. 511 — Definition of services. — Sec. 511(a) lists twelve services for individuals in a family receiving assistance to needy families with children, which the state plan may include in its service program. These are : family planning including medical services, child care, serv- ices to unmarried girls who are pregnant or have children, protective services, homemaker services, nutrition services, educational services, emergency services in connection with a crisis or urgent need, services to assist in training of employ- ment, assistance in locating housing, services to abusers of drugs or alcohol, information and referral services. Sec. 511(0) lists eight services for aged, blind or disabled persons receiving assistance under Title XX or other needy aged, blind or disabled persons which state plan may include in its service program. These are : protective services, homemaker services, nutrition services, assistance in locating housing, emergency services in connection with a crisis or urgent need, services to assist individuals to engage in training or employment, services to abusers of drugs or alcohol, in- formation and referral services. States should be encouraged to develop those service programs which would best meet their local needs. Specifying in the Bill the services to be offered limits the variety and scope of the states' programs. We prefer the broad statement of the purposes for which services are to be provided now in the law to an enumera« tion of specific services. However, if the states are to be limited to the services enumerated in the Bill, that list should be enlarged to include all the services that may be required to achieve the purposes of the Act. Sec. 512. — Authorization and allotment of appropriations for services. — Au- thorizes an appropriation of a maximum of 800 million for payment to states for training of personnel, for services to the aged, blind and disabled and for services for any individual receiving assistance to needy families with children. Although the program of matchng grants to states for services to needy families and needy aged, blind and disabled persons w r ould be continued, the Bill makes an important and, we believe, undesirable change. For the first time, a limit 7 For discussion of Sec. 509 — State supplementary payments during transition period, see pp. 47 and 54. For discussion of Sec. 529 — Payment under AFDC program for nonrecurring special needs, see page 55. 730 would be placed on the amount of money to be appropriated for services (except family planning and child care services which would be funded differently) to these groups of eligible persons. Under current law, there is a ceiling on appro- priations for child welfare services to non-recipients of cash assistance but appropriations for services otherwise are open-ended. The Federal Government matches what the states spend. We urge that the Bill be amended to restore open-ended appropriations, thereby encouraging, not discouraging, the states to develop the preventive, supportive and rehabilitative sendees which are needed. Furthermore, the financial plight of so many states and the lack of sufficient services is reason for giving consider- ation to the possibility of federal assumption of the cost of services. Sec. 513.— Adoption and foster care services under child ivelfare services program. — Authorizes $150 million for the year ending June 1972 rising to $200 million for the year ending June 30, 1976 for payments for foster care including medical care not available under any other state plan) for a child for whom a public agency has responsibility and for payments to a person adopting a handi- capped child. Payments may be made to any agency, institution or person if the care meets standards prescribed by HEW. The large numbers of children who are in need of foster care make it particu- larly necessary for their protection that the Bill define the standards of care required with respect to quality of care, health and safety. Because of the difficulty in finding good foster care for children, we commend the inclusion of funds for the cost of locating such resources. Payments to a person adopting a physically or mentally handicapped child (based on financial ability to meet the medical and other remedial needs of the child) should expedite placement of hard-to-place children, especially those requiring costly medical care. With respect to both the foster care and adoption programs, we believe the Bill should provide an open-ended not a close-ended appropriation. Sec. 522 — Statewideness not required for services. — Permits HEW to make exceptions to the requirement that the plan for social services should be in effect in all political .-jurisdictions of the state. (Amends Titles I, IV, X, XIV, XVI.) Although grants to states would continue to be based on an accepted state plan, the plan no longer would have to be enforced throughout the state. We consider this an unfortunate change in the law. It could result in unevenness within a state depending on the locality of the regular, continuing services offered and unevenness in their delivery. Testimony by James J. O'Malley, Acting Director, New York State Office for the Aging I am James O'Malley, Acting Director of the New York State Office for the Aging, an independent, statutorially-created agency in the Executive Department of New York State government. I would like to thank your Select Subcommittee for bringing these hearings to New York State and providing me, and the other speakers whom you will hear from today, with the opportunity to express our views on the Administration on Aging and its programs. If you will pardon a rather clumsy cross sex analogy, I feel somewhat like the maiden tied to the railroad tracks — either the mortgage will be paid or the roar- ing locomotive will put an end to the problem. In our situation today, the roaring locomotive is emblazoned with the date "June 30, 1972" — the expiration date of. the present legislation for the Administration on Aging. On July 14. 1965, when the Older Americans Act of 1965 was signed into law, older people in this country— and we in the field of aging, in particular — felt encouragement and gratification. Despite dissatisfaction from some quarters that the new bill did not go far enough, there were equally strong feelings that at least we had begun. Surely tins cautious initial commitment could be seen as a reason- able start upon which all of us could build and expand — Parkinson's Law would work in the field of aging as well as anywhere else and we would now be off and running. Perhaps "off and running" is too correct a phrase, for some critics felt that everyone was "off and running," but they weren't as sure they could tell where everyone was running to. State Plans were quickly submitted and as quickly approved, for we were all bound and determined to get into this thing as fast as we could. It wasn't until iome Ave years later thai any of us were truly Involved In m Bodal Indicators study Which would tell US, first hand, just e\;ie||y wli.il the most pressing Deeds if our Older Citizens really were. However, things didn't work quite s«> quickly In New York State, for we felt there was an obligation to work out a reasoned approach to what we were doing In order that we might more effectively meet the needs, as we then saw them, oi our nearly 1 million older Citizens a tenth of the nation's older population. Though we had had an Office for the Aging since 1961, the now windfall, if I ma\ use the word, which would allow us to begin planning, demonstration, service and training programs which we as a state agency determined to he of value, was something we wanted to think about before we took the hall and ran. Having been with the office since 1961 and engaged in the "planning, coordinat- ing, Stimulating and cooperating" functions — without the resources to truly in- fluence major decisions in the field — I knew that the availability of dollars would significantly enrich our ability to discharge these previously tenuous responsibilties. And so, the New State Plan for the community programs section of the new Act was not approved until August of 1966 — a fact that did not disturb us in the sense that the meager first-year federal funds ($285,000 for the entire State) would he coupled with the second-year allotment and would still be available to us. And I would like to thank one of your panelists here today, Mr. Jerry Shroder, Executive Secretary of the Citizens' Committee on Aging at the Community Council of Greater New York, who was then with our Office and helped to write this original State Plan. In April of 1965 — just prior to the enactment of the Older Americans Act — our Office became a statutorially-created unit in the Executive Department of State government. In August of 1966, we had an approved State Plan for the Title III program. And in January, 1967, we began our first 20 local programs in New York. We were on the map and we, too, were now off and running. But there were some significant differences in the way we approached our new existence here in New York State. The most important of these — and I think there may be a parallel in what may be wrong at the federal level — is that we, as a State, put our money where our mouth was. Our Office had been created as an independent agency at a top level in State government. We reported directly to the Governor and it was our responsibility to keep him informed of the needs and concerns of older people and of the agencies which worked with and for them. In this instance, we advised that the federal dollars would go farther and more agencies could apply for local programs if our State was willing to commit its own resources to help with this program. I am pleased to say that the Governor and the Legislature concurred in this and decided that New York State would meet up to one-half of the non-federal share in the cost of every Title III project which our Office approved. To this day, I believe we are the only State in the nation which makes this type of commitment to all of its local Title III programs. To put this into hard dollars, it has meant that New York allocated over $1.2 million dollars of hard cash, not in-kind contributions, to getting better programs ind services for her older citizens. Had we been a section within a bureau, within a division of a gargantuan lepartment — rather than an independent agency reporting directly to the Gov- ernor — I am not certain that this unique proviso would have come into being. rhe prototype, I am afraid, was lost in the creation of the federal Administration m Aging. Another variation we applied in New York was that, early on, we began to establish priorities for the types of programs which we felt should be created tvith these funds. We knew that the field of aging needed a good many more "warm bodies" in every section of the State if we were ever going to be able to influence the creation >f new programs and services for the aging. We had seen too much of the deference tvhich was paid to the problems of the aging by both large and small agencies — and far too much of the neglect when it came down to slicing up dollars for pro- grams and services. If it took the squeaky wheel to make sure that someone paid attention to this or that particular need, then we would see to it that there would be a proliferation rf squeaky wheels sounding off for the aging. 71-272— 72— pt. 1- -47 732 But we also tried to see that these squeaky wheels — and I hope my fellow workers will pardon the phrase — were placed in the highest positions of authority in agencies which would be able to continue to squeak even after we could not provide funding to them. The priority was set — a network of agencies which would be set up to speak out for older people. The network of older people speaking out in their own be- half would follow shortly thereafter — and I am pleased to say that we have seer proof that both of these networks have finally begun to nourish. And I am happj to say that many of the people who will testify here today were instrumental in bringing these two networks about for it was they who administered so manj of the successful Title projects which we have had in New York State. Now during all of this process, we recognized full well that we could nevei attempt to meet all of the needs of our State's older population with the funds we had at our disposal, but our goal was a more realistic one in that we wantec to see that there were people strategically placed in as many communities as pos sible who could begin a process which would eventually mean that older agencies would be prevailed upon to give of their time, money, personnel and facilities ti help the aging. . Now at the same time, we were also setting priorities through a process o: elimination. We did not feel that it was our responsibility to pick up programs which were rightfully the responsibility of other departments and agencies with far more resources than we would ever have. And Where we knew of sucl situations, we turned our attention to helping local applicants to apply to them A particular case in point is in the area of recreation for the aging, specifically support for the operation of senior citizens' clubs and centers— an area whicl is clearly outlined in the original Older Americans Act. Since 1956, New York State had had a separately supported Recreation Pro gram for the Elderly and in 1967, the State was spending some $600,000 to sue port such local programs. Consequently, the priority for funding such program was not high on our list— not from a lack of need, but rather, in order to cc operate with other agencies and not duplicate their programs. It seemed a logica and necessary planning endeavor. I raise the point because I am afraid there are too many of our States runnin senior citizens' centers under the Older Americans Act and, thereby, limiting it potential to demonstrate how we may serve the aging in a variety of ways. Though I do not presume to judge legislative intent, I suspect that the Olde Americans Act was written to do more than this — else, I am sure that th Congress would have called the program the National Senior Centers Act an not the Older Americans Act. And yet, if this type of program has evolved a something which meets a pressing need in the nation, then it may not ha.\ been a total loss in the sense that such a separate and distinct senior centei act might still be developed. Again, a prototype might exist in New York State. For some 16 years we ha\ supported the operations of senior clubs and centers and in 1970, Governc Rockfeller signed a Senior Centers Construction bill which authorizes $£ million in low-cost mortgage loans for such centers. We would be pleased 1 share this with the federal government — provided, of course, that it, too, do( not get buried in some bureaucratic hierarchy. But even if this were to be done, we must not lose sight of the other respons bilities we have under the Older Americans Act. I would like to go into details on all of the 44 projects we have funded sin< 1987, but time will not allow me this pleasure, and anyway, you will be hea ing from many of these project directors today and I know they will speak eve more proudly of their accomplishments than I ever could. For the record, ho\ ever, I will enclose a resume of our 26 existing programs. I might add, that < the 18 other projects which we are no longer supporting, all but two are still operation and have now graduated from students to alumni in terms of tl Older Americans Act Program. During the almost 5 years of Title III operations in New York State, we ha> funded aging programs worth $6,541,335— a figure, I am sure, that is the large in the country. Of this amount, just over $4 million is federal money, $1.2 mi lion is State money, and $1.2 represents local resources — cash contributions, might add, and not "in-kind" resources. In case you are curious why there have been only 44 projects, I might poii out, that, by necessity, we are obliged to support large budgets because of tl size of our older population in any given area and the level of professionalis: '33 which is required In our State. To give you an Idea of the range of programs, however, the smallest one-year budgel was $2,787 and the largest Ls $895,402. This ■atter budget, by the way, is Larger than any of the Areawide Model Project budgets which have been proposed Cor thai program and was one of the re; pre were not flabbergasted v. hen the Areawide Model Program came Into being, for in truth, we had been conducting such programs It's just that we called them Title HI projects. Now the $6.5 million figure which I jnst spoke of may look good when i bared to other State Offices Cor the Aging, but In terms of the needs of 2 million older New Yorkers over live years, they only represent n commitment of about 50c per person— hardly a worthy testimony to federal, state and local concern for the needs of older people. But 1 WOUld Like to torn to some other aspects of the Older Americans Ac!, ind the Administration on Aging. Without going into all of the gorey details — for the wreakage is plain for all to see — «the 19(57 and 1969 Amendments to the Act have had the effect, of emasculat- ing what we all thought might have been the beginning of a partial salvation in the field. You, the members of the Committee, and particularly Congressman Brademas who was so instrumental in bringing about these Amendments, are more keenly ■ware of how good legislation can be destroyed with bad administration. The moving pieces of the kaleidoscope that is now the Administration on Aging give off a dull patina where vibrant colors should be seen. The Administration on Aging — our once-thought-of focal point on aging in the federal government — holds sway in the Social and Rehabilitation Service many layers down from even the top hierarchy of the gargantuan Department of Health, Education, and Welfare. Research and Demonstration have been all 3ut pulled out as separate entities and on July 1st — what could have been very risible programs for a government agency that sorely needed visibility — the Foster Grandparents Program and the Retired Senior Volunteer Program — were narched out to join another superagency, ACTION. To disrobe a man in public is shame enough, but to take out his vital organs n the name of corrective surgery cannot even be classed as euthanasia. The skeleton that is left will probably need more than the plastic surgery of ;he Areawide Model Projects Program to make it, in any way, resemble its lormer self. There are nenv 14 Areawide Model Programs in the country and I am pleased :o say that one of the newest of these ha,s been awarded to our Office for a urogram in the Syracuse and Onondaga County area. I am hopeful that the >rogram and its hoped-for budget of $350,000 will help to bring new services o a bard core of older isolated and impoverished people in that region, but low 7 many Areawide Models wall it take to meet the needs of 2 million elderly n New 7 York State. For that matter, how many v 7 ould we need right here n New York City to serve our nearly 1 million elderly — 5% of this nation's total tlder population. If the program is designed to combat isolation, loneliness md poverty, then I think w r e may have to ask for the entire national budget of 55.2 million right here in New 7 York. During 1970, there were 95,000 older people i month receiving Old Age Assistance here in New York State. And their average nonthly payment was only $99. And you can be sure that with the attitude older )eople have about taking "welfare," that these represent only the surface of the ceberg. If only a quarter of our State's older population lives below the poverty evel — and that's a conservative estimate — then how 7 are we going to help the 105,000 older people who might have been eligible, but declined to apply for )ld Age Assistance? And in another area, if they w 7 ere left to their own devises, how much of the ;5 million for the Retired Senior Volunteer Program and the $12 million for the roster Grandparents Program w r ould the new 7 ACTION agency feel should come o New 7 York State ? Before we w 7 ait for their decision, we will make it our business to let them mow how 7 much responsibility they should have for a tenth of their clientele. It is a difficult position to be in to have to bite the hand that feeds you, so to speak, but I know from many conversations I have had with people in the Administration on Aging that they, too, are aware of the shortcomings which *xist in the present set up. And they are anxious to see changes made w r hich will 'eflect a new 7 emphasis on developing programs and services to help our nation's )lder people — regardless of the design or structure this may take. 734 i It is not within my wisdom to recommend all of the changes whicn need to be made or how the Administration on Aging should be changed. There are several very selective committees and Task Forces working on this very question and I know their recommendations — as well as the suggestions which your own committee will make — will reflect the consensus of all of us who are concerned about improving the lives of older people. And for our part, we stand ready to help vou in this quest in any way we are able. A week from tomorrow, I and about 300 other New Yorkers will be going to Washington to continue this discussion at the 1971 White House Conference on Aging. If we can achieve the overall goal of the Conference — the creation of a new National Policy on Aging — then I think we will have come a long way in meeting the need for a new national commitment to older people which is now so painfully lacking. And when we are there, there will be a very gnawing pressure constantly reminding us that many of the people for whom we are planning will not be around to see the results of our work. Three of our own delegates to this con- ference have passed away in the few short months since their appointments. If there is any group in this nation which can rightfully say "We want change, and we want it now !" it is our Older Americans. Our job will be to see that they get it. Thank you. New York State Executive Department — Office for the Aging TITLE III. PROJECTS IN EXISTENCE OCTOBER 1, 1971 IN NEW YORK STATE Project number and sponsor No. 40 — 5th year: Tri-County Council for the Aging, Inc., Town Hall — Court St.; Elizabethtown, N.Y. 12932. No. 46— 5th year; Stanley M. Isaacs Neighborhood Center, 415 East 93d St, New York, N.Y. 10028. No. 62 — 3d year; Senior Citizens of Western Orleans, Inc. ; Medina, N.Y. 14103. No. 69 — 4th year ; Council of Community Services of Chemung County, Inc., Room 316 — Federation Bldg., Elmira, N.Y. 14901. No. 71 — 3d year ; Tompkins County Sen- ior Citizens' Council, Inc., 147 East State St., Ithaca, N.Y. 14850. No. 74 — 4th year : New York City Office for the Aging, Office of Administra- tion, Office of the Mayor of the City of New York, 250 Broadway, New York, N.Y. 10007. Brief description Tri-County Senior Citizen Voluntary Self-Help Program — establish three county advisory committee on aging and develop community self-help units on a voluntary basis to meet the needs of the area's elderly. Prepared Meals Delivered to Home- bound Elderly living outside the cen- ter, utilizing elderly and youth corps volunteers. Provides a centrally located and staffed facility in Medina to serve the sen- ior citizens of the Towns of Ridge- way, Shelby, and Yates, as well as the Villages of Medina and Lyonville. Provides a central structure to coordi- nate programs and services for the aging in Chemung County. A staff evaluates the current needs of the elderly and develops programs and services to meet these needs in the areas of housing, health, education, employment, retirement planning, rec- reation, volunteer services, and re- storative services. The project is designed to expand and refine the programs and services of the present Council by providing a more vital role for older persons in planning, establishing and imple- menting self-government methods for older persons and by rendering com- munity service and other special self- help projects. A central City agency to relate present public, private, and voluntary pro- grams and services for the aging to the actual needs of the aging and to unify and coordinate existing pro- grams. ^ew York State Executive Department Office for the a<;i\<; Continued TTLE III. PROJECTS IN EXI8TAN0E OOTOBEB 1, ll>7 1 [N NEW yokk BTATE COn. Project number and sponsor — Oon. S T o. SI — 3d year; Health Association of Niagara Oounty, inc., 708 Pine Ave, Niagara Falls, N.Y. 14301. lo. 84 — 3d year; Community Service Society of New York, 105 East 22d St., New York, N.Y. ?o. 86 — 3d year; Catholic Charities of the Diocese of Albany, Inc., 37 1st St., Troy, N.Y. 12180. to. 87 — 3d year; Good Shepherd Fair- view Homes, Inc., 80 Fairview Ave., Binghamton, N.Y. 13904. lo. 88 — 3d year; Syracuse University, School of Social Work, 926 South Crouse St., Syracuse, N.Y. 13210. lo. 89 — 2d year ; Putnam County Board of Supervisors, Putnam County Office Bldg., Carmel, N.Y. 10512. o. 90 — 3d year; Broome County De- partment of Health, 68 Water St., Binghamton, N.Y. 13901. o. 101— 2d year ; Office of the County Executive, County of Erie, 45 Church St., Buffalo, N.Y. 14202. Brief description < Jont Lnued The project will locus attention on the needs of Hie County's elderly lliein- seives in establishing a self-governing "Council OH Aging" to assess and solve local needs. This project, will provide technical guidance and assistance to local agen- cies throughout the state In develop- ing local, voluntary service programs for men and women GO years of age and over. The project is designed to coordinate and develop programs and services for the aging in Rensselaer County with an emphasis on information and referral, short - term counseling, friendly visiting, creation and expan- sion of senior clubs and centers and the development of employment op- portunity programs. The project will extend the services of a neighborhood based nursing home- adult home-health related facility complex into the immediate commu- nity in the East side of Binghamton. The project will identify areas where special training is needed for persons in the field of aging in New York State, and to meet these needs, will develop a series of workshops, insti- tutes and seminars to provide con- tinuing and advanced training in these areas. The project is designed to provide a central government agency in the County to be responsible for the plan- ning, coordination and stimulation of more and better programs and serv- ices for the aging. This project is designed to assist the individual older person to remain an active and independent member of the community by providing neces- sary services directly in the local community. Such services may in- clude information and referral, short- term counseling, nursing and health- related services, and assistance with, transportation. This project creates the Erie County Office for the Aging which seeks to expand the capacity of the County to respond as effectively and efficiently as possible to the special needs of its elderly citizens by coordinating and expanding existing public and private resources in Erie County. An impor- tant component of this project is a centralized screening and referral service utilizing a multi-disciplinary team of physicians, social workers, 736 New York State Executive Department — Office for the Aging — Continued TITLE III. PROJECTS IN EXISTANCE OCTOBER Project number and sponsor — Con. No. 102— 2d year; County Executive, County of Westchester, County Office Bldg., White Plains, N.Y. 10601. No. 104— 1st year ; The Monroe County Council on Aging, Inc., 31 Main St. E., Rochester, N.Y. 14614. No. 105 — 1st year; Action for Older Persons, Inc., Rooms 1104-05 Press Bldg., 19 Chenango St., Binghamton, N.Y. 13901. No. 106 — 1st year; State Communities Aid Association, 105 East 22d St., New York, N.Y. 10010. No. 107 — 1st year: Syracuse Housing Authority, 516 Burt St., Syracuse, N.Y. 13202. , 19 71 IN NEW YORK STATE COn. Brief description — Continued public workers, public health nurses, and psychiatrists to facilitate the placement of elderly patients in the most appropriate facility or services on the basis of matching needs and resources. This project created a Westchester County Office for the Aging which is designed to provide full-time staff and sustain professional leadership to foster the development of coordi- nation of resources for the aging in Westchester County. The project es- tablished an office under the County Executive which will focus upon the health and welfare of the aging and be responsible for the development, promotion and coordination of county programs related to the social needs of the elderly. This project will provide for the devel- opment of a planning, coordination and social action program for the older population of Rochester and Monroe County. Initial emphasis will be given to the development of pro- grams to meet the needs of older peo- ple in the areas of housing, protective services, transportation and prepara- tion for retirement. This project will develop a regional planning program in the Counties of Broome, Chenango. Delaware. Otsego, Tioga and Tompkins. The organiza- tion will work with all public and pri- vate agencies for the expansion of existing programs and services as well as the development of new serv- ices in both urban and rural areas of the six counties they will serve. Design and implement a statewide edu- cational training program to counter- act senility in older people. Training programs will be offered to the staff of institutions caring for older peo- ple, as well as to selected homemaker and home-health aid agencies, for the purpose of helping these people to de- velop remotivation programs for old- er persons with mild senility prob- lems. Provides social, health and counseling services to the older tenants in the six housing projects which this agency manages, one of which is the oldest in the country. The project will use as a model the unique program which was developed at the Toomey-Abbott Towers in cooperation with Syracuse University. 7:*7 Nkw York State Executive Department Office for the Aging Continued TITLE III. PROJECTS IN Project number and sponsor — Con. No. 108 — 1st year; Jewish Association for Services for the Aged, 222 Park Ave. South. New York, N.V. L0003. No. 109 — 1st year ; New York City Com- munity College, Division of Continu- ing Education, 300 Jay St., Brooklyn, N.Y. 11201. No. 110— 1st year; Lenox Hill Neigh- borhood Association, Inc., 331 East 70th St., New York, N.Y. 10021. No. Ill — 1st year; Young Men's and Young Women's Hebrew Association of Washington Heights and Inwood, 54 Nagle Ave., New York, N.Y. 10040. No. 112 — 1st year ; Schoharie County Community Action Program, Box 28, 22 East Main St., Richmondville, N.Y. 12149. EXISTANCK— OCTOBER I, 1971 IN NEW YORK STATE coll. Brief description ( lontinued Implement community planning, coor- dination and service program em- phasising protective services lor Hie elderly in Hie Kockaway section of Queens County, an area of New York City which includes a Large number of older people who, because of phys- ical distance alone in many cases, are virtually cut off from services. The program, which will operate out of a community service center, will pro- vide information, referral and coun- seling services and will also work to- ward the development of senior citi- zen associations and volunteer pro- grams utilizing the talents of older people. Emphasis will he given to the involvement of the elderly in the plan- ning and delivery of the programs which will he developed. The City University of New York has planned and will implement a unique educational program for the aging in cooperation with the seven commu- nity colleges in New York City. The program will be under the Division of Continuing Education and Extension Services of the New York City Com- munity College and will involve staff and faculty of the College, graduate students and the elderly themselves. Through a multi-disciplinary ap- proach, special institutes will be de- veloped which will provide an on- going learning process geared to their demonstrated needs and interests. Provides a conimunity-based program of services to the 28,000 older people residing in an area of Manhattan from Third Avenue to the East River and from 59th to 89th Streets. The project will focus on locating the elderly and providing services to them, wdth a special emphasis on health-related needs. This program will involve the elderly in the iden- tification and solution of needs. Received an award for a community- based planning, information-referral and counseling program for some 35,000 older persons living in the area of Manhattan above 155th Street. Under the guidance of pro- fessional staff, the program will in- volve all known neighborhood re- sources and utilize the elderly them- selves in the planning and delivery of needed services. A unique home maintenance and repair program for and by older people. This rural-based program wdll attempt to serve the 4,000 older persons in the county, many of whom live in homes which they can no longer adequately maintain, and on incomes far below any accepted poverty level. 73S New York State Executive Department — Office for the Aging — Continued TITLE III. PROJECTS IN EXISTANCE — OCTOBER 1, 1971 IN NEW YORK STATE COn. Project number and sponsor — Con. No. 113 — 1st year ; Nassau County Office for the Aging, 33 Willis Ave., Mine- ola, N.Y. 11501. No. 114 — 1st year; Syracuse Univer- sity, School of Social Work, 926 South Crouse St., Syracuse, N.Y. 13210. Brief description — Continued This project will permit the develop- ment of community programs for the nearly 112,000 older citizens of Nas- sau County. The unusual nature of the program will come in the com- bined advocacy role of older people working with younger people on be- half of the aging through the estab- lishment of local demonstration pro- grams. The project will include out- reach efforts to locate older persons in need and information-referral and counseling for specific problems, as well as the development of new pro- grams and services to meet unmet needs. The principle obligation will be the es- tablishment of a Syracuse City- Onondaga County Metropolitan Com- mission on Aging. The proposed com- mission will represent a coalition of public and private agencies in the City of Syracuse and the County of Onondaga for the purpose of planning and coordinating environmental and personal services and programs to meet the needs of the aging. SERVE : Older Volunteers in Community Service: — A New Role and a New Resource A Research and Demonstration Project Conducted by the Committee on Aging, Department of Public Affairs Community Service Society of New York (Janet S. Sainer, Mary L. Zander) GENESIS OF SERVE During the twentieth century, the aged have assumed a new significance in our society. Dramatic growth in numbers has been accompanied by an equally dramatic increase in the life span. Projections for the future indicate that this trend will continue. With such a growth in the older population comes an increase in the number and complexity of the problems which face them : insufficient income, multiply- ing health problems, inadequate housing, limited mobility, and lack of employ- ment opportunities. These physical and material problems are, in turn, intensified by the less tangi- ble but nonetheless well-documented problems which come with retirement: loss of familiar roles, diminishing social contacts, increased isolation, and long hours of enforced leisure. During the retirement years, older persons must make a series of adjustments that affect their way of living, their status as persons in the community, and their self-esteem. Family ties are weakened as children grow up and leave home and as marital partners and siblings die. With job- and family responsibilities at an end, it is the rare aged person who can carve a place for himself which he, his peers and younger persons alike regard with respect. No longer the bread-winner or the acknowledged head of the family, the average elderly individual has lost the role that he understands and the community respects; it is difficult for him to maintain his former self-image, and the community offers him little help in doing so. How may retirement years be used constructively? The Committee on Aging, established in 1961 in the Department of Public Affairs of the Community Service Society of New York, is a citizens' committee 739 charged with study and action aimed nt the broad Improvement of those com- munity conditions, services anjS programs related to the aging, in pursuing the several avenues Involved In this charge, the Committee noted that concern for the growing population Of elderly persons is SO focused on service 1'or them that it tends to exclude the potential of service by them. Comparatively little atten- tion is paid to the basic worry of many older persons themselves: How can they still be useful? Many retired individuals find no answer to this question and therefore become increasingly isolated with each passing year, especially if they live on small incomes which further limit opportunities for new experiences. In an effort to determine how the retirement years could be used most, con- structively, the Committee in h)(\2 authorized a research study of some 250 older persons living in the Lower East Side of Manhattan to assess their capacity for and interest, in either gainful or volunteer employment The study found that 25 per cent o\' the men and women aged 00 to 74 years had some such interest/ but would require help and support in order to make use of their interest and abilities. The study further pointed out that to open up either employment or volunteer opportunities for the majority of today's older adults is no small or easy task. Unemployment is fast becoming a chronic condition in the United States with 25.000 workers losing their jobs each week to automation and with the labor force growing twice as fast as the number of jobs. It was noted that volunteer service is most commonly engaged in by members of the middle and upper socio- economic groups, and there are few openings for, and only modest experiments In, utilizing unskilled and inexperienced volunteers. Existing volunteer' opportunities for older persons As a social agency, CSS thought it could most appropriately and constructively direct its attention to how the older persons might develop new roles and use his skills, energies and lifetime experience in volunteer service to his community. Therefore, as a next step, the CSS Commitee on Aging in 1965 decided to review current programs and projects specifically concerned with volunteer opportuni- ties for older persons. Although older volunteers were working in many agencies and programs, as a rule these elderly persons had done so for many years and, having grown old on the job, had long been accepted in this role by the community and by them- selves. A survey 2 conducted by CSS staff disclosed only a limited number of attempts — some 16 programs in different parts of the United States — that spe- cifically aimed to provide opportunities for older adults to continue as active members of society by contributing their services to community improvement. On the whole these efforts represented small beginnings rather than full-fledged community programs. Many were experimental and short-lived. Nevertheless, the experience of three in particular provided invaluable information which enabled CSS to begin to think about the possibility of conducting a demonstra- tion project. One of the early pioneers in this field was the National Council of Jewish Women, which had developed volunteer service programs by the aged in a num- ber of communities across the nation. The prototype was a volunteer bureau in Philadelphia known as HELPMATE. 'There a large number of individual job opportunities were uncovered, but recruitment of older volunteers presented a problem. Good Companion Volunteers of the Henry Street Settlement on the Lower East Side of Manhattan conducted a demonstration project to recruit, train and super- vise older volunteers in a low-income neighborhood so that they could provide a variety of out-of-hospital individualized services for other elderly residents in their immediate neighborhood. They gave service to individuals referred by nearby hospitals, clinics and public housing managers as well as to their own club members. Weekly meetings of the volunteers were held to receive visiting assignments for the week to come, to review problems and to gain further in- sight in relation to their responsibilities. Most significant were the findings and recommendations of the Brandeis Uni- versity study 3 based upon a three-year research and demonstration project 1 Aaron Rosenblatt, "Older People on the Lower East Side : Their Interest in Employ- ment and Volunteer Activities and Their General Characteristics" (New York : Community Service Society, 1964). 2 "Volunteer Opportunities for Older Adults : A Survey of Current Programs and Proj- ects" (New York : Community Service Society, 1965). 3 Robert Morris, Canaille Lambert, Jr.. and Mildred Guberman," New Roles for the Elderly," Papers on Social Welfare, No. 10, Brandeis University (Massachusetts: 1964). 740 conducted in Newton, Massachusetts, in 1961-64 under a grant from the U.S. Public Health Service. Its aim had been to determine the nature and extent of the volunteer potential among older persons and the opportunities available to them for service in meeting the health-related needs of other older persons. Its major conclusions were that both manpower potential and agency opportunities were severelv limited. This may have been due, at least in part, to the fact "that the demonstration community, largely a middle-to-upper-middle-class residential area, is somewhat atypical" 4 and that time was insufficient to develop the re- cruitment phase after the completion of the survey. In any event, interviews with older persons indicated that although manpower possibilities were evident, they needed to be fostered and specifically encouraged. It was also found that most agencies had little experience in using older volunteers, available job open- ings were likely to be routine and unattractive to the potential recruit and there was little desire to create new and challenging job opportunities. Despite these limitations the project staff commented, "A more insightful evaluation would lead to the conclusion that there is much more involved here that is worthy of further study than first appeared, that much has been learned upon which fur- ther work can be built, and that perhaps, if structure and method were modified, different results would be obtained." 5 m Literature in the field of aging indicated two different points of view about the value of continued active involvement by older persons as well as the form this involvement should take. A widely discussed theory of disengagement tended to accept the withdrawal of the elderly as a normal process over time. The activity theory stressed that continued social involvement was essential in meet- ing problems posed by a longer life span, the increasing pressure for early re- tirement, the diminution of family responsibility, and the consequent loss of familiar role and enforced leisure. 7 . After extensive study of the ways in which older persons used their time, Robert Havighurst at the University of Chicago concluded that continued social participation and other activities are important to successful aging. In addition, he noted that for most persons several important satisfactions are the same m paid work and in free time activities. Both offer "opportunities for pleasure, to be creative, to be with friends, to have self-respect, to make time pass, to he of service to others, and to give prestige and popularity." 8 Implications for a new project The broad overview of existing programs and literature in the field, with both its positive and its negative aspects, presented a challenge to try to find new ways to make life in the retirement years more productive and more fulfill- ing Therefore, the decision was made by the Committee on Aging in May 1965 to see if it would be possible to develop a demonstration project using older volunteers in community service in one area of New York City in order to answer such questions as: . What type of activities and responsibilities might older adults he given that would have real meaning for them and be useful to their community and the agency they would serve? . . 1 What kinds of community agencies and organizations would use the services of volunteers most effectively? . Do older adults really want to be volunteers in community service activities | How can they be motivated in this direction? How can those who will benefit from volunteer service be recruited and re- tained? What techniques should be used? How should such programs he struc- tured ? What sort of volunteer workers will older persons be? What kinds of assign- ments will interest them most? Will they be reliable and responsible? ^Camille Lambert Jr Mildred Guberman and Robert Morris "Reopening Doors to Community pSicipation for Older People : How Realistic?" Social Service Review, volume 38 (1964).* No. l.p. 43. l%lhifcn^kf^awimlA 4 Umvj, "Growing Old : The Process «f Disengagement" (New York : Basic Books. Inc.. 1961) : Elaine Cumming "Further Thoughts on the Theory of Disengagement," International Social Science Journal, XV (1963). No. 3, p. <™7. 'Ethel Shanas, Peter Townsend. Dorothy Wedderburn. Henning Fms, Poul Milh0i and Jan Stehouwer, "Older People in Three Industrial Societies" (New York : Atherton Press, 19 s Robert J. Havighurst, "The Nature and Values of Meaningful Free Time Activity "in Robert W. Kleemeier (ed.), Aging and Leisure (New York : Oxford University Press. 1961). p. 317. 741 I i \Di \<;s OF THE SERVE PROJ1 01 The goal of SERVE* Initially and throughout the demonstration project, was 'io create a useful and satisfying role for the older adult as n volunteer pro- riding needed and helpful service In community agencies" and to achieve this aimarily by the use of group methods. Twenty-seven community agencies received service from 642 volunteers, sub- stantially more than the 400 projected at the outset. SERVE has continued uninterrupted under ess auspices since the expiration of the demonstration period and Is si ill growing on Staten island where it began. Concurrently, It Is spreading to other Localities in New York Slate, and has been used as a prototype for the recently enacted federal RSVP program of volunteer service >y older adults. SERVE has demonstrated that volunteerism represents one important ap- proach to meeting: some of the common problems of aging-. The SERVE program has also proven to he of great value to the placement agencies and to the community. The final chapters of this report present general findings growing out of SERVE experience ; specific guidelines for recruitment, placement, training, and retention; and a series of broad recommendations for implementation. Implicit ire suggestions for the development of SERVE-type programs in other localities. Findings The SERVE project clearly shows that older persons are willing and ahle to volunteer on a regular basis if agency needs are real and apparent, if appro- priate volunteer assignments are available, if transportation is provided, and f staff leadership is present on an ongoing basis. Qualified full-time staff is essential for the development and continued con- duct of a community-wide SERVE program. The staff complement need not be arge, nor need staff members be professionally trained, but their maturity, sound judgment, sense of community interrelationships as well as their w r armth md concern for the older persons are indispensable. What is important is a qualified, full-time, flexible staff working as a team that can respond quickly ind decisively to the changing needs of the program. SERVE on Staten Island :?ould not have developed at all nor would it have expanded to the extent it lid without the competence and continuous presence of SERVE staff. SERVE experience has demonstrated that non-traditional volunteers of low socioeconomic status w T ho have never volunteered before can be recruited and -etained in a volunteer program by older persons. These individuals have proven ;o be reliable, responsible and enthusiastic volunteers with as high or higher i rate of retention as their middle class counterparts. This group represents i hitherto untapped manpower resource for volunteer service in communities icross the nation. Persons well past the age of retirement — in their seventies — not only vol- mteered to serve but had excellent attendance and a high retention rate. The •esearch data documented that it was the oldest SERVE volunteers who under- ;ook the largest number of assignments and contributed the greatest number of lours of service. The youngest — 55 to 64 years — had the lowest retention rate. 3ence, special efforts should be made to reach the older age group and involve hem in volunteer service. Most of the SERVE volunteers functioned consistently and well despite health lifficulties or limitations, thus challenging the sterotype that the elderly are not lesirable as volunteers because of health problems which generally accompany )ld age. They functioned well even though health difficulties were the main rea- son given by those who dropped out of the program. Volunteer service as understood in the SERVE program on Staten Island re- ierred to volunteers who were willing to give regular, year-round, weekly or bi- veekly service to an agency or program in the community. Experience under- scored that this concept was both appropriate and necessary if a new and sig- lificant role was to be created for the older volunteer. The major reasons for volunteering and for remaining in the program as itated by the volunteers were their need for social contacts and their need to ind a useful and satisfying instrumental role. The meeting of these needs was a significant factor in retention. The group approach to every aspect of the SERVE program — recruitment, )lacement, training and retention — proved to be productive for volunteers, 742 placement agencies and the total SERVE program. The presence of a group provided the volunteers with peer support in the work setting and with the social contact and opportunities for friendship which so many older persons need. This structure also made it possible to attract and retain the unaffiliated, iso- lated individual who had particular need for these supports. In addition, the group approach was effiicent and time-saving, permitting the agencies to con- centrate supervision on one day of the week and allowing a small SERVE staff complement to develop programs in many agencies. Although the primary emphasis of the project was to meet the needs and in- terests of older persons, important benefits accrued to the placement agencies through the strengthening and expansion of their programs and in their improved image in the community. The volunteers in the SERVE program were regular and dependable in their attendance, committed and loyal to the agency, proud of their accomplishments, and enthusiastic in their interpretation of the agency to others. Contrary to general belief and practice, SERVE findings show that recruitment should not be the first step in the development of a volunteer program. The se- quence found to be productive in the SERVE program on Staten Island was selection of the placement agency and development of assignments followed by recruitment and ongoing in-service training. SERVE demonstrated that the expectation of rapid recruitment of large numbers of older volunteers was unrealistic. A program of volunteer service requires step-by-step development over a period of time and grows out of a personal rather than a mass appeal. A primary reason for the successful recruitment and retention of older volunteers in the SERVE program — particularly those of lower socioeconomic status — was the development of assignments appropriate to their background, experience and life-style. It was found that there were not as many assignment opportunities readily available for all those who might wish to serve as is generally assumed. This is true for volunteers of all age groups but it applies particularly to older volun- teers. As a result, SERVE staff worked continuously with agencies to uncover new ways in which volunteers could be used productively. The SERVE volunteer group showed a higher proportion of role lacks or losses than did the general population in this age group on Staten Island. Yet, contrary to expectations, their morale and satisfaction were better than those of a group of non-volunteers. The difference is attributed to participation in the program. Public recognition from the broader community proved to be important to all volunteers and particularly to those from lower socioeconomic levels. For many of the volunteers this kind of community recognition and status was a form of remuneration for it represented to them the value that society placed upon the services they had rendered. The SERVE program underscored that the provision of a bus, car or taxi for group transportation was essential in a volunteer program by older persons because of the inaccessibility of many agencies, the time and difficulty in reach- ing other agencies, the lack of convenient transportation, and the diminishing strengths of older persons. These problems usually cannot be solved by simple reimbursement of carfare. SERVE developed a new and clearly defined role and image of the older person as a community service volunteer. The assumption of this role both incrpased the self-esteem of the volunteer and brought recognition and respect from the broader community. GUIDELINES ON RECRUITMENT, PLACEMENT, TRAINING AND RETENTION The project proposal submitted to the Administration on Aging in August 1966 stated that one of its major objectives was to develop and define techniques of recruitment, placement, training and retention. Specific guidelines on each of these component parts of the SERVE project have evolved out of experience during the three-year demonstration period. These are presented in the belief that they will be useful to other communities Interested in creating volunteer service programs by older persons. Recruitment guidelines Direct recruitment should be preceded by an assurance of community recep- tivity, the selection of a placement agency and the development of a variety of jpeciflc assignmenl opportunities within thai agency, a well .1 tin 1 benl of a relationship with the network of Individuals and groups thai baa Kocesfi bo and Influence upon the older person. Recruitment must be based upon reaching-out techniques, and a willingness bo go out to the neighborhoods where older persons live and meet. Older pei are not likely to toko the Initiative and come to a central office to apply for the ppportunlty to serve. Recruitment is most effective when conducted by direct person-to-person contact with the potential volunteer. The use of mass media and community- tvide publicity campaigns though conducive to creating and substaining com- munity understanding of the SERVE program seldom bring about Immediate lirect recruitment of an individual older volunteer. Recruitment of older persons is more productive when it is related to one selected agency and to the choice of visible assignments within thai agency, rather than to volunteerism in general. Recruitment efforts should be focused on attempts to form a group of SERVE volunteers rather than to recruit and place single individuals. The opportunity to participate as a volunteer with others is encouraging to the older person who uvomes more confident and interested when he sees that a group— large or small— will serve at one time and that he will be a welcome part of it Opportunity should be afforded to the potential volunteer to see an agency and its needs before he is asked to make a commitment to volunteer. The most effec- ive approach to the establishment of new SERVE groups has been the use of' a ;enes of recruitment techniques, culminating in the "Tour-and-See" visit of the igency or institution. The entire process of direct recruitment should move quickly so that the nterest and enthusiasm of the prospective volunteers are captured at their leight and not given an opportunity to dissipate. Recruitment activities must be ongoing and continuous in order to establish lew groups, to expand already existing groups, and to maintain a high level of >articipation. The enthusiasm, interest and experience of the volunteers, once strong SERVE' groups have been formed, can be utilized effectively as recruiting agents. Placement guidelines In selecting a placement agency appropriate for a SERVE-type program the ollowing are important criteria : There must be some appreciation of the value and potential of a volunteer wogram by older persons before the placement agency undertakes a SERVE urogram. Support from three levels of staff is necessary ; the administration the ^lunteer director or staff assigned this responsibility, and line staff with whom he volunteers will be working. An agency staff member should be assigned to carry responsibility for the °£ 5™™ an ? 27 e ^ a11 su P ervisi °n of the program, and to work cooperativelv rith SERVE staff. Such staff should be available with some regularity lor mentation and in-service training of the volunteers in the work setting and at he weekly group meetings. There should be the readiness and ability to use the services of a number of •egularly assigned persons on one selected day of the week Volunteers should never displace staff members. This policy mav require inter- pretation to agency staff prior to the arrival of the volunteers and, if necessarv enforcement by interpretation to volunteers. Two factors— the potential volunteer's needs and the agency's needs— must be ept in constant balance. Individual opportunities should be developed which i 1 F®P re i entin S re£a tasks and reflecting agency needs also fit the interest nd skills of available volunteers. In agencies where the major need is for one-to-one relationships between volun- eers and patients or residents, there should be a willingness to offer assignments aitially which will facilitate exposure to the agency and permit volunteers to ome into contact with patients informally rather than confined to a direct one-to- ne assignment. An assessment should be made of the availability of a meeting room in which fie volunteers can hold group sessions and have lunch, if they are at work at that An agency should encourage expansion of its SERVE program either by absorb- ng more volunteers on the specific day originally selected or by adding another roup on a second day of each week. I 744 Training guidelines One and the same training program cannot and should not be applied to all SERVE programs. Although a number of essential factors should always be in- cluded, each training program should be adapted to the needs of the placement agency, the kind of assignments available, the size of the volunteer group, the interests and characteristics of its members, and the time commitment of the di- rector of volunteers. Volunteers should start on their jobs as soon as possible, with training to follow rather than precede placement. General orientation should be provided to all volunteers prior to placement, but formal pre-service training should be given only in those situations in which detailed information about the assignment is necessary in order to get started on the job. Training should be on the job and continuous, and related initially to a specific job assignment within a specific agency. As each SERVE program progresses, training should be broadened beyond the specific job assignment to include in- formation about the total agency and discussion of issues of significance to older persons, the agency, and the community. On-the-job supervision and guidance by the unit supervisor (line staff) are essential in order to foster the interests and skills of the volunteer, to pro- vide him with the necessary information about his job assignment,' and to motivate his continued participation. The group approach to training is particularly well suited to the older per- son, and is also of benefit to the placement agency because it is an efficient use of supervisory time. Training should be the joint responsibility of the volunteer director of the placement agency and SERVE staff. The provision of lunch is an added feature which is important to the volun- teer if he works beyond the lunch hour. It is of social as well as nutritional value to older persons and provides a sense of fellowship. An intensive Training Institute for the SERVE volunteers in several agencies not onl ystrengthens in-service training within the single agency setting but also broadens the knowledge and understanding of the volunteers. The Institute, which in many ways substitutes for the pre-training required by many volunteer pro- grams, should take place at a time when the older person has already been active and is, therefore, more interested in and responsive to absorbing addi« tional information. Rent ent ion guidelines Retention activities are essential and should be seen as an ongoing permeating the entire program. An important retention factor is the group approach which provides indi< vidual volunteers with an opportunity for the social interchange and mutual sup- port that most older persons want and need — particularly the more isolated and those of lower socioeconomic status. Assignments which are obviously needed and useful and expectation of regu- lar attendance are of key importance in stimulating the continued interest and enthusiasm of the volunteers. Group transportation on a regular ongoing basis is essential. It is the actual provision of transportation rather than reimbursement for carfare which makes it possible for older persons to go to their respective agencies week in and week out. The attitude of SERVE and agency staff in making the volunteer feel wel come and wanted and in viewing him as a person as well as a giver of serv ice is an important aspect of retention. Recognition by staff and community officials of the individual volunteer anc the total SERVE program serves to raise the volunteer in his own self-esteem and in the eyes of his family, friends and neighbors. This, in turn, helps to de velop the sense of satisfaction and pride which forms the basis of successful retention. Identification of the older volunteer with the total SERVE program as well as with his specific placement agency should be encouraged. The SERVE Training Institute fosters this identification in a most effective fashion. The opportunity that SERVE offers for broad and multiple identifications represents anothei stimulus toward continued participation in the program. process i;> BROAD RECOMMENDATIONS FOB NATIONWIDE UTILIZATION OF OLDEB \ou S C] SERVE has demonstrated that through giving volunteer service to the com- munity the older person gains now satisfaction, dignity and self-esteem while helping to meet previously unfilled community needs. The success of the demon stration project on Staten [sland has Led to Its continuance there, to the spread Of the SERVE idea to other communities in New York State, :ind to the introduc- tion of the federal legislation establishing the Retired Senior Volunteer Program (RSVP). in the two preceding chapters recommendations are given as to the methods and principles which have proved to he useful and productive in the actual con- duct of volunteer programs by older persons on a local community level. The broad recommendations which follow outline those national, state, and local efforts which should be undertaken to stimulate the establishment of SERVE-tvpe volunteer service programs in all states and localities. Based on SERVE's experience, the Committee on Aging of the Community Service Society of New York strongly recommends that high priority be placed on enabling older persons throughout the nation to give volunteer service to their communities, and that both the public and the voluntary sectors marshal their efforts and resources to achieve this aim. Specifically, it is recommended that : The White House Conference on Aging, to be held in Washington, D.C., in November 1971, should recognize and adopt as a national policy the respon- sibility of society to provide older Americans with a wide choice of retirement roles, including the opportunity to serve their communities as volunteers, and should ensure the implementation of this policy in the years ahead. The Administration on Aging, through its research and demonstration projects, its training programs, its information and public relations activities, and its relationshp with state offices on aging, should continue to encourage widespread puhlic understanding of the contribution which older persons can make to theif communities. In addition, national organizations and agencies whose primary interest is in the field of aging, including those whose membership is composed solelv of older persons, should use their prestige and influence to press for the adequate funding of older volunteer programs. These organizations, along with other national groups and service clubs interested in citizen participation, should adopt volunteer service programs by older persons as part of their national emphasis and effort. Future appropriations for the Retired Senior Volunteer Program (RSVP) should be increased to ensure that sufficient funds will be available for the thousands of communities across the nation which are interested in and would benefit from the service that can be given by older volunteers. As one of the federal volunteer programs in the new ACTION agency recently created by the President, RSVP focuses exclusively on the older citizen. It is essential that the special identity of RSVP be maintained and strengthened so that the elderly will not be subordinated to other age groups, and their experience and abilities will receive the recognition they deserve. The National Center for Voluntary Action, whose principal mission is to stimulate voluntary endeavors throughout the nation, should emphasize the role of older volunteers in community service and the valuable contribution their efforts w T onld represent. Through a national education and information program, conferences and training seminars, and the provision of staff guidance and assistance, it should urge local voluntary action centers and volunteer bureaus to undertake older volunteer programs. Greater efforts should be made on every level — national, state, and local — to create a host of new volunteer opportunities for persons of all ages, both in agencies which traditionally have not used volunteers at all and in those which traditionally have not used volunteers at all and in those which have not taken sufficient advantage of this vast manpower resource. Such efforts will inevitably result in the expansion of opportunities for older volunteers. Federal and state agencies should provide for the continued funding of demon- stration projects which have proved their value. It is unrealistic to expect complete community takeover within a short-term demonstration period. Time is required to engender the necessary community commitment. Moreover, a taper- ing off period following the years of a demonstration grant is necessary to enable communities to marshal their financial resources on a more gradual basis. Even then, it is unlikely that any single community agency can undertake total 746 fiscal responsibility, so that supplementary public funding on a long-term basis should be provided. State offices for aging and state departments responsible for programs and services for the older population should recognize the importance of volunteer service programs and should supply the necessary staff leadership to stimulate these on the local level. Consultation and guidance similar to that provided by the SERVE-in-New-York-State project should be made available on a permanent basis through expanded staff in state offices for the aging. Sponsorship for a SERVE-type program must be undertaken at the local level and responsibility for the conduct of such a program should be carried by a local agency with community-wide relations. Appropriate sponsors might in- clude a city or county office for the aging, a council of social agencies, a local recreation department, a family service agency, a community mental health center, a model cities program, a council of older adult clubs, a volunteer bureau, a local center for voluntary action, a Junior League, a local chapter of a national service club or other suitable community organizations. In order to be effective, a local SERVE program should be structured as a sepa- rate unit of the sponsoring agency maintaining its own identity. Paid staff lead- ership is essential, as is provision for the transportation of volunteers and basic operational expenses. In those localities which are not ready or able to develop a community-wide SERVE-type program, individual placement agencies or individual older adult groups could utilize the SERVE principles and guidelines in order to develop and conduct an older volunteer program in a single agency. Although the basic SERVE goal is to establish a multi-faceted older volunteer program for the total community, the guidelines that have been developed can be adapted to fit the needs of small programs in single agencies. Senior centers should incorporate group volunteer programs conducted in out- side community agencies as an integral part of their regular weekly activities. Staff should be provided to stimulate and supervise this kind of group activity just as it is provided for other programs of the senior center. A SERVE-type program of service to others would enrich the activities of the one-day-a-week club as well as the five-day-a-week center. In conclusion, the need to create satisfying, useful, status-bringing social roles for the aged seems more urgent today than ever because of the rapid social changes which conspire unwittingly to cut off the older person from the world he knew. A productive role for the elderly has been established by SERVE through a group approach to volunteer service which places primary emphasis on the needs and interests of older persons as individuals. This kind of program gives the older person the status and recognition that are so often lacking in the later years and creates a new image Of the aging in the community. It provides an out- let for those who need it most, particularly those who do not have the money, background or social skills to create, without assistance, new roles for them- selves to replace the ones they can no longer fulfill. The time has come to place greater emphasis on service by older persons — service which adds meaning not only to their own lives but to the lives of those they seek to help. Our hope is that the SERVE program will encourage commu- nities throughout the nation to open their doors to new and exciting volunteer opportunities for older persons everywhere. TO AMEND THE OLDER AMERICANS ACT OF 196.1 MONDAY, NOVEMBER 22, 1971 House of Representatives, Select Subcommittee on Education of th e Committee on Education and Labor, Boston, Mass. The subcommittee met at 1 :30 p.m., pursuant to call, in the Gardner Auditorium, State House Building, Hon. John Brademas (chairman of the subcommittee) presiding. Present : Representatives Brademas, Hansen, Peyser, and Hicks. Staff members present: Jack Duncan, counsel, Charles Radcliffe, minority counsel for education and Christine Orth, staff. Mr. Brademas. The Select Subcommittee on Education of the Sub- committee on Education and Labor of the House of Representatives will come to order for the purpose of continuing hearings on the sub- ject of how best to meet the needs of the older people of our country. The Chair wants to observe how very pleased members of the subcom- mittee are to be in the great city of Boston. We are particularly pleased to be in Boston today because one of the able members of this committee is the young lady from Massachusetts, Mrs. Hicks. We find it a real pleasure, Mrs. Hicks, to be in your part of Mas- sachusetts and to listen to your fellow citizens give us their views on the problems of the aged. The White House Conference on Aging called by President Nixon will begin in Washington next week. The Chair hopes that the purpose of that White House Conference will be sim- ilar to the purpose of the hearings which this subcommittee had been conducting to listen to the views of men and women who want to draw the attention of the Government, both the Legislative and Executive Branches, that they are concerned about the role of older citizens. I am confident that the members on both sides of the aisle in our sub- committee are in agreement that the time is right to reestablish our priorities for older Americans. Rhetoric is not enough. We must ac- tively work to meet the needs of this sector of our society who have been too long neglected. The older persons in American life are the fastest growing segment of our national population, now numbering in the twenty millions. Our senior citizens are a valuable human resource which is too little tapped, but still more important they are human beings who deserve a meaningful life. Legislative work in this subcommittee, which has jurisdiction over the Older Americans Act of 1965 and acts of legislation relating to problems of the elderly, has been beneficial in enabling a number of older citizens to benefit from activities to which otherwise they might (747) 71-272— 72— pt. 1 48 748 not have been exposed. Yet we have a long way to go to be sure that the older persons in our country have the kind of opportunities to which they are entitled. We are going to hear a number of witnesses here today, including the distinguished Governor of the State of Massachusetts. Our first witness today is the Chairman of the Committee on Social Welfare of the Senate of Massachusetts Senator Jack Backman. We will be pleased to hear you, sir, and look forward to your testimony. STATEMENT OF STATE SENATOR JACK H. BACKMAN, CHAIRMAN OP JOINT LEGISLATIVE SOCIAL WELFARE COMMITTEE, MASSACHU- SETTS LEGISLATURE Mr. Backman. Mr. Chairman, thank you. If I may say, Congresswoman Hicks, welcome back to Boston. I am glad you are here on this very important subject. Mr. Chairman, I am pleased that the committee has come to Boston today to hold hearings in regard to the need for increased social services for the elderly. The Commonwealth of Massachusetts has over 600,000 citizens over age 65, more than 11 percent of the population, and I might say that in my own town of Brookline ,a suburban town of 50,000 adjacent to Boston, over 19 percent of the citizens living there are over age 65. This is more than any other city in the Commonwealth and as much as the State of Florida, or California, which is sometimes known as the haven for the elderly. As Chairman of the Joint Legislative Committee on Social Welfare and as a former Commissioner of the Brookline Housing Authority, I have worked closely with the elderly population of the Common- wealth as well as with the senior citizens of Brookline. We can paint a dreary picture of the life of the elderly. The elderly population of Brookline, the State of Massachusetts and perhaps all 50 States are in great part without adequate housing, food, medical attention or income, and I might say from my personal experience, living literally in fear of what tomorrow will bring to them. My own town of Brookline is an upper-middle-class suburban community and is recognized as having one of the best housing pro- grams in the State. Yet, how sad that record really is. Although Brookline has 300 beautiful housing units for perhaps 5,000 eligible applicants, I might point out that right at the present time there are over 350 applications of citizens waiting to get into the Brook- line Housing Authority. We have vacancies, perhaps 20 to 30 a year, and you do not have to be a mathematical whiz to realize that for the average person over age 65, if he were to wait his turn it might take 10 to 15 years before he could get into the Brookline Housing Authority, which of course as I said is considered as having one of the better programs in the State, and what is it like in some of the other cities ? There is no Food Stamp program in Brookline or in Boston for that matter. As you know, nationally it is being cut down. However, here there is no program to cut down. Mr. Peyser. Excuse me one moment. There is no Food Stamp pro- gram ? I am curious at this point to have an explanation as to why. '49 Mr. Bradbmas. Senator, would you Like to respond to Mr. Peyser's question) Mr. Backman. I would say for the last year there have been meet ings of citizens in Boston and Brookline to try to get the Department of Public Welfare to initiate Food Stamp programs and we have not had any satisfactory answer to dale. ^\V get one answer that we have a Food' Surplus program and arc not eligible for a Food Stamp pro- gram. I believe you know that under present Federal statutes both arc possible and J might say that the Food Surplus program is very poorly run throughout the city of Boston and the whole metropolitan area, of which 1 am familiar. It is unfortunate, first of all, that elderly people will come and not be able to get the articles that are supposed to be available. They will come one day and another day and another day and more times than not the full quota of the food surplus is not there. I am sorry I do not have an answer. I would like an answer. Mr. Peyser. Thank you. Mr. Backman. The problems of the elderly are manifold. When you talk about increased social services and the need for medical and other services for elderly, I would like to point out some shocking correspondence that our social welfare committee received just this year from the Massachusetts Department of Mental Health with re- gard to unfortunate senior citizens who are in many cases literally prisoners in State mental hospitals. It was stated to me by the Depart- ment, I have the correspondence, that in our overcrowded mental hos- pitals there were 4,900 elderly persons of which number over 20 per- cent could and should be discharged from the hospitals. However, they have no place to go. -tit. I also have dismaying data from our Department of Public Health of a similar nature in regard to our nursing homes. Earlier this year the department sent me a memorandum in regard to our Massachusetts private nursing homes, in which they stated that 15 percent of the elderly within the nursing homes did not require institutionalization at all ; 25 percent could have been cared for in rest homes without nursing care, and 23 percent needed only limited nursing care. A total of only 47 percent, as they stated in this memorandum to me, actually needed the special services of nursing homes. However, these people had no place to go. To typify the terrible dilemma of our elderly I can take you to two large restaurants in Brookline at any time, Hayes Bickford and the Waldorf. From 8 o'clock in the morning until 12 o'clock midnight you will see them occupied steadily by elderly persons from Brookline, guarding a single cup of tea or coffee with perhaps an order of toast for hours at a time, sitting alone in the midst of a crowd, sitting in a restaurant in our affluent society without being able to afford a meal. If you go there when you leave here I am sure you will see the same people I saw this morning and that you can see tomorrow or any day. Here in Massachusetts we have recently gone through a govern- ment reorganization and have instituted a secretariat for elder affairs. This year our legislature mandated that new programs of social serv- ice be provided for the elderly including meals, nutritional services, legal services, housekeeping services, group activities and counselling. 750 However, this goal cannot be implemented without money from our State government and I will say that there was no tremendous budget put forth to put these services into being, and at the present time we do not see the funds coming forth from the Federal Government to put these social services into action. However, these social services might help the elderly persons stay healthy, to stay independent, and to stay out of institutions in many cases. There have been many studies made in the State and Nation analyzing the condition of the disadvantaged, the poor in our society, with great emphasis on the elderly. We can elaborate on the problems of the elderly, their loneliness, their helplessness. These are problems of the elderly perhaps more than any other group of poor. However, we must no longer overlook the most important approach to the prob- lem of the poor regardless of social services. Our failings can be summed up very simply. We have avoided the central problem that lies at the root of all prob- lems of the poor, an adequate income. According to the 1970 U.S. Bureau of Labor Statistics, the low minimum budget for a single person was $1,943, and for a couple, $3,540. Over 45 percent of all our elderly population falls below these levels. Although there may be need for special social services for the elderly as I pointed out earlier, the primary need is for a minimum adequate income for the elderly. It is time now to stop dealing in a patronizing manner toward our poor, offering them social workers as a substitute for cash. Together with Prof. David Gil of the Heller School for Advanced Social Studies at Brandeis University and other economists and edu- cators, we are filing in Massachusetts this week a minimum amiual in- come bill for Massachusetts residents, utilizing the Federal system of 50 percent reimbursement of benefits. We are not sure that if Massachusetts were to adopt such legislation that we could still get the 50-percent reimbursement. We ask that you lend your efforts to make certain that if any State might entertain a minimum annual income program that it be entitled to the same con- sideration with regard to reimbursement as those that are still labor- ing under the outmoded welfare system. We are recommending a minimum income of $2,000 for a single per- son and $3,500 for a two-member family, which combination constitutes 90 percent of the elderly families, a minimum income for a family of four of $5,000 today and in 2 years $6,500. I would like to say to you in all sincerity, there is one quick way to erase poverty and that is to make transfers of income to those who do not have it. There is really nothing in our western heritage that says that 45 percent of our elderly must be poor. This is certainly not within our traditions. Although it does not appear likely that the elderly will re- volt or rebel or become violent, perhaps through the avenue of helping the elderly we may yet legislate a change in the built-in structure of in- equity in our society. For who is to say that the elderly population of our country, our own fathers and mothers, ourselves in a few years shall as a class literally starve to death. 51 Therefore, l hose of you who think in the dired ion of social for the elderly, I would hope that you would reorient your thinking. U will be helpful to legislate increased social services. However, first and foremost, legislate a minimum adequate income Tor the elderly. Let the senior citizens have the self -dignity to buy their own food and services. Give them the means to do it. We have the vehicle, [t will soon be before the Massachusetts Legis- lature. 1 know that Congress is now considering a most inadequate structure that was proposed by our President 01 $2,500 a year for a family of four. Our own Governor has recommended that it be raised to $3,000 for a family of four. Such a program would be a sham and a farce and no heller- 1 ban the present welfare system as far as the northern industrial cities of our Nation. Here in Massachusetts we now pay a family of four in our welfare system over $3,800 a year. What an unusual thing to say we are going to reform our welfare system and then have the maximum $2,400 a year or $3,000 or $3,500 in 5 years. We urge your support in bringing forth Federal legislation that would help Massachusetts become a huge model for the Nation. Let us proceed to test in one State, perhaps Massachusetts, a minimum ade- quate annual income as a viable and sensible way to erase poverty. If we test it out in Massachusetts, perhaps our Nation will decide that the way to solve the increased services for the poor, and especially the elderly, is to give the income. We can go on from there. Mr. Brademas. Thank you very much, Senator Backman, for a most effective statement. How many people are there in the Boston area that are 65 and over ? Do you have any idea ? Mr. Backman. I would say 11 percent of the population of Boston, and Boston has about 600,000 — there are about 66,000 elderly persons in Boston. Mr. Brademas. Has any survey been made in recent days of the needs of the elderly in the Boston area ? Mr. Backman. I have in my office a study made of the poor in Boston by the model cities program, and it is certainly a revelation as to the kinds of hardships they must undergo. That was not specifically done for the elderly, but for the poor in general. It is quite a bulky report, It might be 2 inches in thickness, and I recommend it to your commmittee. Mr. Brademas. The reason I asked that question is simply as a mat- ter of information to determine whether or not, inasmuch as this is one of the great metropolitan areas of the country, and systematic effort has been made to assess the problems that are particularly faced by older persons, and I take it from your answer that the needs of the elderly poor have been looked at as part of the model cities study. Is that correct? Mr. Backman. I would say so. There are also many other studies. You will find plenty of reading material every month on the plight of the elderly. The fact of the matter is, nothing seems to take place. My office is full of bulletins from 50 different kinds of community orga- nizations, pointing out their plight, and every year we have 100 to 150 bills before our committee. Nothing very much happens. Mr. Brademas. I hear what you are saying, Senator, and this is some- thing for you to judge, not for me. But the answer I get is : "No ; in the city of Boston, Mass., no study has as yet been made in a systematic 752 way for the needs of the elderly." If I am wrong, you must tell me ; but there is no overall study, am I correct ? I do not say that it ought to be the responsibility of the Common- wealth of Massachusetts. Is there a city agency or a municipal agency in Boston, or a metropolitan agency that is an agency of local or county government, that is charged with tending to the needs of the elderly ? _ Mr. Backman. No; not a city agency. In Massachusetts, all public welfare is under the State. Mr. Brademas. Wait a minute, I did not say public welfare. I just said "an agency," like, say, the Administration on the Aging which is part of the Department of Health, Education, and Welfare at the Fed- eral level, whose mission is to look into the problems of older persons. Is there a similar municipal agency in Boston? Mr. Backman. I do not know one that is functioning. Mrs. Hicks. If I may, Mr. Chairman ? Mr. Brademas. I defer to the gentlelady from Boston on that. Mrs. Hicks? Mrs. Hicks. I know when I was a member of the Boston City Council in 1970, we established a commission for aid for the senior citizens, and they have been handling the problems of senior citizens in Boston since that time. Mr. Brademas. I thank the gentlelady. Let me turn then to another related point that you made in your statement, Senator Backman. When you observed that the Common- wealth has just established a new Secretariat for Elder Affairs, is that what it is called ? Mr. Backman. Yes. Mr. Brademas. How much money has been provided either as a budget request by the Governor or appropriated by the legislature for programs to be administered by this secretariat as distinguished from the cost of simply administering the office ? Mr. Backman. My guess is that as of the moment, unless there are funds that would go over to it from another agency now in being, aside from the administration of the office itself, there are little or no funds. Mr. Brademas. So it is not an agency that actually administers programs, is that what you are saying ? Mr. Backman. The State reorganization took place just this year, and the Governor just appointed the director of the secretariat, or swore him in, today, so that it has not been a functioning body until this very day, and I do not believe they have done anything as yet. Mr. Brademas. We will ask the Governor who the new director of that secretariat is when he arrives. I would just make one other ob- servation. I noted your statement that adequate income in your view is the central problem of the elderly, and I can only say that from the hearings we have had so far, this is a theme that has been reiterated in other parts of the United States. I noted last Friday in Cleveland, Governor Gilligan issued a plea for a minimum income for the elderly not unlike the proposal you have given us this morning. My final question : Are there any Older American Act programs in the Boston area of which you are aware ? Mr. Backman. Yes. There is a Society for the Elderly in Boston. There is one in Cambridge. 753 Mr. Brademas. You did not understand my question. Does Boston receive any Federal funds under the Older Americans Act of L96i amended? Mr. Backman. I believe thai our State docs, and I believe we now have a program where we are employing older Americans. This is something fairly new, in the last 6 months, and we are now employing older Americans in various social work capacities. However, thai pro gram is still new, and it has made no impact as yet. Mr. Brademas. Thank yon very much, Senator. r J ne Chair will now turn for questions from my distinguished colleague from Massachu- setts, Mrs. Hicks, who I know has a very deep interest in the subject, of these hearings; and Ave are pleased, as I said earlier, to be here today. Mrs. Hicks. Thank you, Mr. Chairman. Senator, I noted that you feel that the prime importance for well- being of our senior citizens is to increase the amount of money for them, either on the welfare program or under the social security, which we have been trying to do without too much success. I am also concerned about this fact, and I realize this is a prime concern, the increase of the funds ; and as I say we have been trying to do it in many ways, increasing the actual amount of money they would have in their hand, and then also filing of bills that would lower the cost to them for transportation and other social services. I am also very concerned about this factor of the loneliness of the elderly, and I realize that actually money is not going to be able to solve all of that problem for them. I wonder, could you tell me how many drop-in centers we have for senior citizens here in Massachu- setts? Mr. Backman. No; I cannot. I can only speak for Brookline, and in Brookline we have at least two, and they are both in housing for the elderly and were put together by the Brookline Housing Authority with the aid of private citizens. Each of the new housing authorities have been built with facilities not only for those people living there but for people in the community, and I might say the wealthy as well as the poor. I am talking about my Mission Hill area of Boston. I know of none in the Brighton- Allston area of Boston. I know of nothing that is really worthwhile. There is something in the basement of one of the housing authorities. I would not consider it to be, at least, a drop-in center ; so in the total city of Boston, say 40,000 or so, I know there is certainly a great need. Mrs. Hicks. I feel there is a great need for this type of center to be established in many parts of the city. I know there are some, but there are not enough. I feel this would be one step forward in the problem, in the loneliness problem, that I feel all of us have, but which is even more prevalent in the senior citizens who have lost their helpmate. Also I am concerned about the nutrition program for the elderly and I know that I introduced a bill in Congress asking; for the so-called Meals-on-Wheels. When I was on the school committee we tried to initiate a program giving hot meals to senior citizens down in the cafeteria of certain local schools but it did not work out too well because it was not well equipped and in the winter weather and incle- ment weather they were unable to go out in order to get the meals. I was wondering what you think about this so-called Meals-on-Wheels if 754 It could be brought to a particular center, and particularly if it could be worked out in the housing projects and have them gather for a meal ? Mr. Backman. I think that would be fine as a stopgap, but in your new legislation I would hope it would be written in that no new hous- ing for the elderly be built without kitchen facilities so that there could be meals offered to people resident in the community, and inci- dently, in Brookline we have two minor programs where one hot meal is provided once a week to some of the elderly. It is certainly not ade- quate, just something. Mrs. Hicks. I agree I would like to see Massachusetts be the pioneer and have the pilot program started and I hope we will be able to. I think your recommendations that in all new projects we would have this type of facility as well as recreational facilities for our senior citizenry, should be invoked. Thank you, Senator. Mr. Brademas. If the gentleman from Idaho would yield for one moment, I have one last thought you might be interested in, Senator Backman. This subcommittee has conducted hearings in the last Congress on this, and a bill was introduced known as nutritional programs for the elderly which would seek to provide on a much more systematic und sustained basis the kind of nutritional program I believe you were indicating you thought was wise. Mr. Backman. If I could just add one comment. Having served on the planned housing authority for 5 years and having seen their present program in operation, it would seem quite exciting if housing authorities were built so that people living in nearby communities could get hot meals, recreation, and perhaps medical services at the housing authority, and I feel that there are people of all levels of life that need this sort of service. This is aside from the primary need of more cash in their pocket. And perhaps the housing authorities are a good place to focus these new services. Mr. Brademas. Thank you, Senator. Mr. Hansen ? Mr. Hansen. Thank you, Mr. Chairman. I thank you also, Senator, for your statement and I am particularly interested in your reference to your background and efforts to provide adequate housing to the elderly, especially in Brookline. I expect you would agree with me that in addition to adequate housing it is im- portant that the older people have a freedom of choice in housing and that in many cases they are forced by economic circumstances to seek public housing accommodations or even institutional care when they would prefer to remain in their own homes. Would you agree with that premise ? Mr. Backman. I would, and I would like to say — you asked for a summary of my statement. I had something in there and I thought it was getting too long, but directly relating to your question I know of situations in Brookline that are a little different. A little different focus from your question. I know people in Brookline and Boston who are living in substand- ard housing, in illegal housing, housing that should not be opened to any accommodations, and they are living there out of choice. They are living there because they do not want to complain against their , oo landlords, even though there is rent control, even though (lure are Federal controls, because they know if they complain :m1 Yun have impressed l>\ I Mr. Brademas. Thank von very much, Mr. Liederman given us a most constructive statement. I am especiall} the insight you bring to this difficult problem involving the ddc have a couple of quest ions to be put to you. I know in your statement that you say (lie State of Massachu this year will commit an additional $150 million to new housing for the elderly. Could you explain? That is a great deal of money Tor one State to commit. As a matter of fact, (lie Federa] Government docs not. do that much Tor the whole country. I am wondering if you can tell us what kind of program that is, and what, the phrase means "the State will commit an additional $150 million Tor new housing for the elderly" '? Mr. Liederman. I think about 2 years ago, actually it goes a little further back — I do not want to go into the history, but there has been an awareness in Massachusetts that the State has a responsibility for elderly housing. This really has not been the case in this country, but in Massachusetts we have taken steps we consider an important move forward. We have developed two or three major programs. One is a program called the Massachusetts Housing Finance Agency. There are two other models like it, in New York State and one in New Jersey. We have given the Massachusetts Housing Financing the capacity to sell bonds of $2 billion which will provide 40,000 units of housing for both senior citizens and families, 25 percent of which will be subsidized so there will be more housing for the low-income families in the next 2 or 3 years in Massachusetts. The second major program we have is our State aid to public hous- ing program. This gives to the local housing authority the option of either taking the State subsidy or Federal subsidy. They can now take a State subsidy and they can use permanent financing through bonds, or if they use financing through temporary notes they can get up to 6 percent which will cover what we call full debt service. It will pay for the interest, plus the amortization costs which really has the effect of allowing the rentals that are paid by the tenants to be used so that the operation of the project does not have to go back into the rents to pay off the interest. This money is raised through the sale of bonds. We allow our housing authorities and the Massachusetts Housing Finance Agency the power and the capacity to float bonds on the open market to build this up. Mr. Brademas. That is my only question because I want to see that we move along today. But as my colleagues well know, I am one who is often very critical of the shortcomings of the Government in meet- ing the wide variety of problems of the very young and the very old. I am both astonished and gratified to see this degree of leadership at the State level and hope other States will go and do likewise. Mrs. Hicks? Mrs. Hicks. Thank you, Mr. Chairman. Mr. Liederman, I do feel that the housing needs of the elderly is a very serious problem in Massachusetts and we do have to do something right away, but I was interested in that finance agency you speak of that we have on the State level. I was wondering if in any way through this finance agency the elderly would be able to obtain loans to repair their property, because this seemed to be a tremendous problem ? 762 Mr. Liederman. Well, that is an interesting area, Mrs. Hicks. Just -this morning we had a meeting of 10 people who tried to figure out how we could do that at the State level. The problem, as you know, of the 312 program which is a 3-percent loan program for homeowners to rehabilitate their property, is available only to those homeowners who live in code enforcement areas. If you do not live in a code enforcement area, if you do not live in an urban renewal area, if you just live in a plain rural community that does not have any of those programs, you are not eligible for that 312 program, and that is something that is wrong with the 312 program. What we are exploring is exactly what you are asking for, how we can develop a program on the State level to deal with that specific problem of giving the homeowner some rehabilitation money at low interest cost. We do not have it yet. Mrs. Hicks. I will be the most interested to see the outcome because I know many people who need that type of loan that are not in code enforcement areas. Thank you. Mr. Brademas. Mr. Hansen ? Mr. Hansen. Mr. Chairman, I would also congratulate the State of Massachusetts for what has been effective leadership in this matter of housing needs for the elderly. The Federal Government cannot boast as good a record in terms of the total resources made available. I would note that including the Federal elderly housing an increase to something over $400 million from 1969 when there was under $300 million. This is an encouraging increase and moving in the right di- rection, but it still cannot match the efforts that Massachusetts has made. I think much of this Federal effort has reflected the shift from section 236 housing for the elderly which in many respects brings housing more readily within the need and reach of the people. Mr. Liederman. The only problem with the 236 is that you are not giving us any money. The 236 program is a great program and the 202 is a good program, but we are not getting the money. As a matter of fact we have a statutory requirement that the Massa- chusetts Housing Finance Agency, which has this million dollar ca- pacity, has to provide 25 -percent subsidy. We specifically^ did that be- cause we did not want it to become a middle- or luxury-income hous- ing program and the only way we can do that is with your subsidy. We must have that 236. We need assistance, but we are looking for $80 to $90 million in 236 money for this State and they are talking about $3 or $4 million for the State. That is incredible. It is almost like the administration is turning its back on the cities and urban areas in this country. We need to change that. Mr. Hansen. Obviously demands are greater across the country for these resources, but it is still a fact that the Federal appropria- tions for these programs are making the shift as part of it has gone from less than $300 million to over $400 million. We obviously need to go up a great deal more but would you agree that the 236 represents a better approach for meeting the elderly housing needs than the 202 ? Mr. Liederman. Yes, and in conjunction with other programs it will be a very effective program. r 63 Mr. 1 »i;adi:.m \s. Mr. Peyser \ Mj-. Peyser. I think your testimony is very interesting and I ani delighted :is 1 said earlier about the activity that Massachusetts is showing in this area. I would like in clarify iliis for :i moment. Is il a. housing authority bonding arrangement 3 Mr. Liederman. Yes. Under the loca] housing authority run by the Department of Community Allah's which is our State agency. Mr. Peyser. And in your statement you indicate Ilia! 10,000 units are presently in the process of being built under this program? Mr. Liederman. Yes. Mr. Peyser. I think you are really stepping forward and I am de lighted to see your State moving in this way. .Mr. Beademas. I want to ask one more question while we are wait- ing for the Governor, a question I denied myself earlier. What about 202 programs in this State? Is Massachusetts — I might explain that 202 is a program of direct loans and low common interest rates to nonprofit associations and church groups for construction of housing for the elderly. lias Massachusetts received such money? Mr. Liederman. I think we have but I think, as Mr. Hansen pointed out, what we are doing is shifting over to 236. We had a church group in our own community that just put up a 125-unit middle-income elder- ly housing and it started out as a 202 and ended up as a 280 because of the advantages in the 230 program. So again, we are going to go to whatever program has the most subsidy with the end result of the best rents. Then senior citizens on fixed incomes, even if they are on a pension and receiving $350 or $400 a month which is not often the case, or it would be rather unusual, they cannot afford much more than $100. So if you build this middle-income nonprofit housing you come up with rents of $150, $160 a month, and there is no way they can handle them. That is why we are going to the 236. Mr. Brad-emas. Just one other question. If you can give us any gen- eralization with your own observances and experience, what about the nursing home picture in the State of Massachusetts? Do you have enough of them? I do not want you to make a ha If -hour speech — just briefly. Mr. Liedeemax. We ought to save that for another time. I think we have a lot of beds in nursing homes. Again, the problem is, are the beds available for medicaid patients? That gets to be a problem. We have the beds available where the people can be handled under their insurance programs, be it private or the medicare-medicaid programs. Some nursing homes always set aside X number of beds for certain kinds of patients, so that gets to be a problem. We also are in the process of taking a hard look at our rate-setting commission which has a great deal to do with the rates set by nursing homes and how that gets handled, and frankly it is a very complex bag and. one that I am in the process of doing a lot of homework in. That is about it. Mr. Brademas. Thank you very much. From my observations you have been about as constructive a witness as Ave have had on this whole problem of housing for the elderly and w T e are very grateful to you for 71-272— 72— pt. 1- 49 764 The Chair would like to express the thanks of the subcommittee to Robert Morris, the director, and Francis G. Caro, his associate, of the Levinson Gerontological Policy Institute at Brandeis University for the splendid assistance they have given us in arranging these hearings in Boston today. In addition, the Chair would like to ask unanimous consent that a statement prepared by Mr. Morris and his associate, Francis Caro. for inclusion in these hearings be inserted at the appropriate point in the hearings. We are very pleased indeed to welcome our next witness, the distin- guished Governor of the Commonwealth of Massachusetts. The Chair just observed that he has just come from an overseas meeting at Har- vard and the Governor responded that he has a sign on his desk that says, "Don't throw me out. I didn't go to Harvard." He went to MIT. but it is never too late to be saved. The Chair wants to say how very pleased we are with the hospitality which you and your associates have given to the members of our sub- committee, and we are very pleased to be in this great Commonwealth and this great city. We look forward to hearing what you have to say. Governor Sargent. STATEMENT OF HON. FRANCIS W. SARGENT, GOVERNOR, COMMON- WEALTH OF MASSACHUSETTS Governor Sargent. We are very delighted and honored to have you and the members of your committee here and I might say that I was in your State and I said nothing ill of you. I heard many very favor- able comments and I said I looked forward to meeting you today. ] particularly want to say to our distinguished Congresswoman, Louise Day Hicks, I am pleased that you were able to be here today. Maybe if I had been counting the ballots it would have helped a little. Mr. Chairman, members of the committee, again I say welcome and Mr. Chairman I say this afternoon that this Nation has seen a grow- ing trend to place our elderly and handicapped away in institutions and nursing homes. During the past 20 years, both here in Massachu- setts and throughout the Nation, we have utilized nursing homes and institutions as a way to treat many citizens, mostly elderly, who could not physically care for themselves. Right now over 900 nursing homes are operating in this State; 32,000 of our citizens call these places home. This service, ranging from limited to the most extensive nursing and medical care, is the most costly way to treat these citizens. Here I am speaking of financial costs riot to mention the costs in isolation and loneliness when one is separated from his other home or com- munity. Yet a survey done by our State department of public health last year showed that no less than 12 percent and possibly as many as 20 percent of the people in our nursing homes, approximately 5,000 peo- ple, had no medical need to be there. They were there because they had no other place to go, no other accessible and supportive care to permit them to remain in their own homes. However, in recent years, in increasing numbers, people in the field of aging and in the medical profession have been calling for alterna- tives to institutional care. WTiile this is still a relatively new area of re i ■oirivss in concern, wo m Massachusetts have already made some i>i developing t hese alternal Lve care programs. In Fall River, under the direction of Dr, David Greer, an innova bive program for the elderly and handicapped allows a person to live in his own apartmenl and make his own decisions as to his needs and how to meet them. He has done (his by designing a modern hou development with a built-in medical and social services to meet the total needs of the individual. In Boston a citizens' group known as (he Roxbury Council of Elders has developed a unique program of social services designed specifically to allow the elderly to live independently as Long as possible. This program provides mobile meals, homemaking services, individual counseling, group activities, and so forth. At the executive*, level of government, we have begun to move as well. I have taken three major steps. First, 1 have, officially sworn in Mr. Jack Leff who is sitting here with me, as secretary of the executive office of elder affairs and Mr. Frank Manning as assistant secretary. Mr. Manning, I might say, is going to be chairman of the group that will be going to the White House Conference representing Massachu- setts. This will give us the greatest, possible visibility and vitality in our efforts to solve the needs and problems of the elderly in this Com- monwealth. Secondly, I have officially transferred the former office of services for older Americans to the new executive office of elder affairs, thus providing that office with the staff resources necessary to plan and implement a total State program. And finally, I have signed an execu- tive order directing Secretary Leff to plan, develop, and implement a statewide program of home care services for the elderly and handi- capped living in the Commonwealth. It is my firm belief that a program of home care services for the elderly is vital to the well-being of our elder citizens. We in Massa- chusetts have made a commitment to make this type of program a reality but unless the Federal Government matches our commitment, and the commitments of other State and local governments, home care for the elderly will be a dream whose time will never come. I ask you to give us two things. First, lend us the talents and re- sources that now exist on the Federal level and second, and even more important than the first, give us your financial assistance. Without this aid. all of the programs we develop, all of the plans we make, will fail. At this time. I would like to introduce our secretary of elderly af- fairs, Mr. Jack Leff, who I just today swore into office, and I believe he is on the payroll, Mr. Chairman/ 1 am very pleased to introduce to you, Mr. Chairman and members of your committee, Mr. Jack Leff, our new secretary of elder affairs, who has been intimately involved in planning and" developing home care services for the elderly, not only in the Boston area but throughout Massachusetts. I am very pleased and proud to present him to you and I want to thank you and the members of your committee very much for coming. If you have any general questions I will be happy to try to answer them. Mr. Brademas. Thank you very much, Governor Sargent, and con- gratulations to you and Mr. Leff on your new and very challenging assignment. 766 I wonder, Governor, if you could elaborate a little on the proposed role of the new Executive Office of Elder Affairs. I note that you indi- cate that you transferred the former Office of Service for Older Ameri- cans in this new Executive Office. Could you give us an idea of the kinds of programs that would be involved and would you here indi- cate what would represent a total State program for the elderly ? And some ball park idea of what kind of money we are talking about in terms of programs ? I have already congratulated other public officials in Massachusetts here today for indications that your State is rather unusual and tak- ing more seriously its responsibilities toward its elderly than most, but are we talking about the establishment of an office only, or are we also talking about giving Mr. Leff some serious money to spend ? Governor Sargent. In the first place Ave are transferring those serv- ices that have been designed particularly for the elderly to him, so they move right on to him and become his staff and his assistants. Mr. Bradevc as. How much money does that mean ? Governor Sargent. The dollar figure I really could not comment on, but that is only the beginning. The other thing I have done, I have em- phasized to all of the new members of our Cabinet, and they are all new because of the Avhole reorganization of State Government that is going into effect, that he is an equal member of the 10-man Cabinet and that all of the Cabinet members must work with him, cooperate with him. For example, in the area of transportation it will be necessary for him to work on a weekly and perhaps daily basis to develop programs that make sense with the Secretary of Transportation in our State. Certainly the Secretary of Human Eesources who is responsible for the fields of public health, mental health, many aspects of the needs of human beings. He will have to be working almost hourly with him. The question of essential funding I cannot really answer. All I can say is that we are immediately handing over to him any services that logically can be placed in his agency to start with, and I am certain that as he com- mences to solidify this new agency, which is brand new, it has never been really tried in any State before, he will have many programs that he will be recommending. I just hope that we will be able to provide the revenue to take care of the needs that he will be serving. Mr. Brademas. I appreciate that explanation, Governor, and as I said, my question I do not put in any critical way because I believe you are to be greatly commended for establishing this greater visibil- ity, but I would be less than candid if I did not offer a warning that I hope your proposed new Executive Office will not find itself in the same straits as the Administration on Aging in the Department of Health, Education, and Welfare which was established through the strong Bipartisan support in Congress in 1965 precisely for the pur- pose of providing high visibility and attention to the elderly at the Federal level. We still have the Administration but we have seen it lose funds and lose responsibility and be constantly downgraded, and I must tell you, speaking as a Democrat, that part of that process be- gan under the Johnson administration so I am just as critical — I won't say just as critical — because the Nixon administration is not any worse than the Johnson administration in this respect, but I am critical of both and I only express the hope, Governor, that you finish out your 767 for Mr. Leff to spend, hat observal ion. splended LntentionB with some serious money I hope Mr. Leff will not mind my having made Mr. Leff. 1 certainly appreciate it, sir. Governor Sargent. I don't see any tears coming to his »•. Mr. Leff. Let me point out, 1 think there is a difference here !><• tween Stair and Federal level and 1, too, have been critical of (Ik- Ad ministration on Aging and yon arc right about the Democrats and Hie Republicans on this. First of all, I think the difference is at the State level the Department of Elder Affairs has equal rank in (lie high visi- bility in State government whereas the Administration of Aging has never had this rank, being under the Department of Health, Educa- tion, and Welfare, which as we know is a very difficult administrative department. I think this is where the difference is. II is much easier to hide the Administration for the Aging than it will he to hide the Office of Elder Affairs. Mr. Brademas. I do not want to monopolize the questions because I know my colleagues have questions, but I do not want to let the oppor- tunity pass since you spoke of your Cabinet. I want to congratulate you on having named a former constituent of mine from Indiana, Tom Atkins, to your Cabinet. Do you have a question, Mrs. Hicks ? Governor Sargent. Could I interrupt for a moment. This is the rudest thing in the world to do, but I would just like to say with relation to your comment, Mr. Chairman, that you are criticizing both the Democratic and Republican administrations. I am a Republf- can elected to a Democratic State so I am on the same side of the street with you, but in my view I would hope that the administration and the Congress can place much greater emphasis financially and other- wise in the affairs of the elderly and I would hope and I am sure this White House Conference will be acrimonious at times, but there will be some of the feelings of this administration and others will perhaps be brought forth at that meeting and I w^ould expect great results w 7 ould be forthcoming. Sitting as Governor of the State I must say that the problems of allocation of funds and priorities are more critical than most people imagine in terms of funding today. We have not sat back and said, "Somebody has to pay for this." We unfortunately have had to fight for very substantial tax programs to pay for some of these programs. Mr. Brademas. I appreciate those observations, Governor. Mrs. Hicks? Mrs. Hicks. Thank you. I would like to commend Governor Sargent for feeling that the elderly should have top priority in the Common- wealth and you have done* this by placing it in the Executive Office of Elderly Affairs in your Cabinet. I think that is a step forward in rec- ognizing the elderly to be of prime importance in the Commonwealth and in trying to do something about their problems. I know that you talked about the Roxbury Council of Elders. I know this Council and the wonderful work they are doing. Do you know if they are funded through the model cities program ? Governor Sargent. Jack Leff here with me I am sure can answer that better than I possibly can. This is one of the reasons I selected him. 768 ■ Mrs. Hicks. I want to commend yon because that program is work- ing very well and I surely wish it could be duplicated many times in the Commonwealth because of the tremendous work they are doing, so I will wait until you speak and direct the question to you. Thank you very much. Mr. Brademas. Mr. Hansen ? Mr. Hansen. Thank you, Mr. Chairman. Let me also express my appreciation for your being here. I w^ant to add my congratulations to those of the chairman for the initiative that has been taken in Massachusetts and through y our own leadership in effecting the kind of reorganization you believe will provide visi- bility and resources to the needs of the elderly. I think it is proper to point out in reference to comments made by the chairman that the appropriation for the Administration of Aging cannot be reduced even though some of the programs have been moved into another organization or structure. The total appropriations are still there. In fact if you add to the amount of the current year fiscal appropriations that which was allocated for the research and develop- ment activities and had been transferred you have a very substantial increase, and also the categories of the trust funds and discretionary funds have been significantly increased. Now I am not going to say we have gone nearly far enough in any of these categories, but the purpose of the reorganization was to effect the transfer of the Foster Grandparents program and the RSVP program of the Administration on Aging and to strengthen those programs by combining them with other volunteer type programs with the hope of getting better results. Whether or not this will be a success has yet to be determined. The Congress, in any event, did give its blessings to that reorgani- zation plan. What I am trying to say — it is not as much the structure through which the service is so delivered, although that is important. I think that has great impact on Iioav much mileage you get out of the dollars available. But a great deal of the effectiveness depends on the total dollars available rather than the channel through which funds move to the States. I think any fair judgment of the efforts made by the administration, by the Congress, which is not controlled by the same party as the administration, but the cities ought to take into account all the programs and all of the efforts that are being made. Thank you. Mr. Brademas. Mr. Peyser? Mr. Peyser. Thank you, Mr. Chairman. Governor, I am delighted to be here in Massachusetts in spite of the weather. In New York it is sunny and beautiful, but up here it is cold. It was sunny and beautiful when I left New York yesterday. In any event, I guess I continually w T ork under a little inferiority complex here with Chairman Brademas plugging Boston or Cam- bridge, his school, I forget the name of the school — M.I.T. is it? I went to a little upstate New York school, Colgate, and I just want to put a plug in for the State of New York. I am delighted to hear some of the programs that have taken place and particularly you have spoken now of raising it in effect to the Cabinet level, this job of dealing with the problems of the elderly. I would like to speak in one area and ask you whether this comes w under the province of tlie m-w Cabinet member or uol the problem of safety in the streets here, particularly in your urban areas in the city of Boston and perhaps oil km- areas in the Stale in relation to the elderly. Are (here any State provisions or plans or programs thai concern tins particular problem? It is a problem ( hat lias come on! in many other areas where eldnl \ people in particular have been subject to brutal attacks and I fee] i here should be Something done. I wonder it' your State has any pro grams or plans in that area '. Governor Sargent. Thank you for the quest ion, ( Jongressman. I am sorry we did not. arrange better weather. L forgot that you were coming? 1 did not make the necessary changes. Next time you come I will try to have it done. Mr. Peyser. I accept that. Governor Sargent. The weather here is generally sunny and it ranges from TO to 80 all yea r. Seriously, I think the matter that you June mentioned is one of tlie most appalling problems for anybody of any age, but particularly the senior citizens. I have had occasion to visit a number of the housing projects for the elderly in our State regarding this problem, but wher- ever I went I heard the same concern and the concern was that "We don't even dare go outside of our little apartment and go down and visit our friends in the nearby apartment at night,-' and this is true in many parts of our State, in many cities in our State. Last } T ear we provided some limited funds to assist with additional police. It was not sufficient. We did what we could. Essentially, of course, it must be the local city or town problem. The State can assist and must assist, but we have been very limited as to what we can handle and I think it is as serious as any problem facing the elderly today. Mr. Peyser. Thank you. One other thought I would like to bring out because inasmuch as the responsibility of these programs lie with the Federal Government in providing adequate funds, and incidentally I do believe you are going to see a far greater liberalization in moneys that are flowing into these programs, I think the area I do not like to see overlooked is the area of the so-called volunteer forces that can be marshaled within any State. , I think if there is a way of giving high visibility to the projects where elderly people can be served by voluntary organizations I think there is a great satisfaction in helping the elderly, the senior citizens, and working with them. If volunteer programs can be promoted in any way I would certainly think it would be a tremendous step forward and I hope you might be in a position to do that. Governor Sargent. I hope we can and I think we can. We must have volunteer programs. Those we have are i^ery excellent in some areas and inadequate in others. It seems to me that today in these troubled times throughout American volunteers should be encouraged and I think a great many people want to get involved and they do not know just exactly what they can do and what they cannot do. They need a little guidance. This is one of the things I hope particularly that we can accomplish by such imaginative leaders as our new Secretary Let!'. Mr. Peyser. Thank you, Governor. 770 Mr. Brademas. Thank you, Governor Sargent, Mr. Lett', we are very grateful to each of you for having come today and giving us the benefit of your views. Governor Sargent. Mr. Chairman, you can now ask Mr. Left' any detailed questions that I might have been unable to answer. I think you will find he is very able. Air. Brademas. Thank you, Governor. Air. Left, just let me put one question to you. What about the im- pact of Older Americans Act programs in the State of Massachusetts ? Mr. Leff. That is one of the first things I am going to have to find out, Congressman. I have Donald Strong here with me. Don has been director of the Office of Services for Older Americans up until 11 :30 this morning, so if there are any detailed questions I will turn to him. Oh, they tell me he is not here at the moment. I think in that area a program that has made some impact was a homemaking program, for example, a title 3 program. It started off as one and it is now T running with third party payments to the welfare department keeping about 200 people out of institutions. One of the problems with title 3 funding is, there is never any other funding so if you do get a good program we have to rely on the cities and towns and local communities and private moneys to pick them up. Consequently agency directors are also involved in raising money and too little time is directed to providing services. I think they should provide us with some sort of scale so we can measure a program by their standards so we can tap into some perma- nent money. I think it is tragic that people like myself when I was working for a private agency had to compete against a lot of other people, private volunteer agencies, for the same dollar. I told Senator Kennedy and Mr. Brooke's special committee on aging that I learned my competition playing basketball, and we are not in a basketball game here. People's lives were depending on it. And here we had various people and agencies competing for the same dollar as everyone else. I think this is tragic. We have to come up with some kind of permanent funding to insure it. Mr. Brademas. I agree with you. Mrs. Hicks. First of all, Mr. Leff, I am so pleased that your first testimony as Secretary would be before this committee so concerned about the affairs of the senior citizens. I look forward to working with you with regard to the funding for your programs for our older people here in Massachusetts and particularly Boston. But in the testimony about the present, Senator Backman talked about the fact that Massachusetts did not have a food stamp program and I was wondering if you would comment on this ? Mr. Leff. I think I can. This is part of a problem that is created by the Federal Government. The Federal Government gives alternatives between the surplus food program and the food stamp program and then asks people to make up their minds which they should choose. The option is, I believe, to lean more to the food surplus program than the food stamp, which I would favor myself. Mrs. Hicks. Then I asked you a question about the Koxbury Council of Elders. I was wondering if that came under the model cities pro- gram in the funding ? 771 Mr. Left. Yes, it does. The council of elders is responsible for pro- viding all of the services for the elderly within (lie model cities area. Mrs. Hicks. Do you have other councils within Unit model cities area, other than just this Roxbury council ? Mr. Left. Other groups of elderly within Roxbury that have affilia- tions with the council. Mrs. Hicks. Doing the same types of programs that the Roxbury council is doing? Mr. Leff. No, there are very few programs around that I know of that are providing a broad base support of service. I certainly hope to draw from my experience with the Council of Elders and do what you suggest and duplicate these programs because there just aren't any. Not intentionally, but most of them just do not have the resources that the model cities provides, and even then model cities is not providing is much percentagewise as they should. You are talking about 230,000,- some-odd budget versus 7y 2 million overall budget. Mrs. Hicks. In your new office will you be attempting to create any drop-in centers for the senior citizens? Mr. Leff. We certainly believe that drop-in centers could be the vehicle through which the other services we are talking about are spun 3fT. We have done this successfully in Roxbury and we hope w^e will be successful in the next one. Mrs. Hicks. I am very much interested in that program, so I am inxious to see it. I want to congratulate you and thank you very much. Mr. Brademas. Mr. Leff, we are grateful to you for having come to oe with us today. We wish you well in your new responsibilities and :iope you will let the members of the subcommittee know if we can be lelpf ul to you. Mr. Leff. I sure will. Mr. Brademas. The subcommittee will next hear from two witnesses is a panel, Mrs. William Dwight and Dr. James Cummins. Will they }lease come forward and each make a statement and then we will put mestions to both of them ? STATEMENTS OF MRS. WILLIAM DWIGHT AND DR. JAMES F. CUMMINS Mrs. Dwight. Ladies and gentlemen, I am pleased to bring you greetings from Congressman Conte. I am not a technocrat, I am not a lociologist. I am terrified of microphones and I have never written 50 copies of anything I have ever said before. I can't believe it. But I do lome to you today to tell you what the city of Holvoke is doing about ts elderly. I have no need to go into the background on the needs of the elderly >ecause certainly everybody here knows them. I would like to tell you vhat our city of Holyoke, an industrial city of 50,000 people, has done. ^s of October our board of aldermen has created a geriatric authority. rhe Massachusetts Legislature passed a bill allowing the city to take his step. This has an autonomous bonding authority which will be con- rolled independently. This authority is an independent city agency. Let me describe to you our city for just a minute.. It is 50,000 people >ut it is down 4,000. We have an influx of probablv 5,000 new citizens primarily Puerto Rican or black. This means we have lost some 8,000 71-272 — 72 — pt. 1 50 772 to 9,000 of our older — I don't mean older — former citizens and this has left in our inner cit}^ a population that includes 20 percent elderly. These people live in the old neighborhoods where they used to be held by ethnic ties and they are held now by low rent. They live in dilapidated housing and they are indeed the city's problem. After 2 years of discussion and I must say some arm twisting, we got to the point of creating this authority. The authority will manage a skilled 134-bed nursing home which is now successfully in operation. We hope to include in this home sheltered living. This would be a cot- tage community which people could live in together with their spouses, although one may be too ill for care in the outside community. It would allow older couples to remain together with their sense of privacy and dignity and yet receive the needed care. We would also provide day and possibly night care for people who are still able to remain with their families but need our sociai and medi- cal services. We also see a need for intermediate care for people who need medical and physical and social supervision but in no way need skilled nursing care which is a very expensive commodity. We are trying to change the emphasis of the medical facility to a social facility but the needs are so all-entwined in the elderly and we feel you must attack both of these problems at the same time. We are also trying to ease many people out of the nursing facility as long as possible. This is for a social reason but also for financial reasons. Most of the elderly are poor and most of them will be ill before they die. Our question is how human a facility can we make for them. We plan to have trained specialists in this and this will be an outlook in both social and medical fields. They will be under the direct supervi- sion of our medical and social staff and allow more people to stay in their homes. We would like to see an expansion of the city funded drop-in centers which are working now, to be expanded to have shel- tered workshops, health and social referral systems, and actually clinics. We would like to become and will become the central clearinghouse for all public and private agencies, profit and nonprofit. We feel that if people have a central clearinghouse the needs would be more direct- ly met. There are many groups who would respond if they could be made aware of the individual and other needs. If our sheltered living concept is a success we would hope to expand it into various inroads, perhaps attached to our public housing for the elderly and model cities. We would encourage the private, nonprofit sector to undertake this. My own personal feeling on housing for the elderly which is so en- twined with health and social problems, economics, is to perhaps ap- proach it in the Massachusetts Housing Finance Agency manner which was discussed earlier by Representative Liederman, where people in mixed income groups, and so that they are not segregated by age, can live together. I think it is a slower way to the answer of the prob- lem of housing for the elderly, but I think it is a more humane way and I would certainly hope that we can attack these problems together with intelligence, coordination, and planning. I think coordination and planning have definitely been lacking. Thank you. :;:; Mr. Brademas. Thank .you very much for your comments, Mrs. Dwight. \\V will now hear from 1 )r. ( !ummins. J)r. Cummins. Mr. Chairman, members of the subcommittee, Ladies and gentlemen. Mr. Chairman, thank yon for the opportunity to ad- dress this committee. May 1 introduce myself to yon. I am Dr. James F. Cummins and my interest in the problems concerned with aging stem back L5 years when I beaded up a project in the held of biometry in the aging of the normal healthy octogenarian males. We had to find out what made them so healthy and vigorous at the age of 80. I spent a great deal of time trying to lind out about an elusive item called successful aging. Second, I have been concerned with extensive investigation into the social factors which concern themselves with both medicine and en- vironment with relation to age. Third, as a practicing internist in a small rural community, seeing many older patients or people on a daily basis. These interests have given me a perhaps wider association with the older individuals' per- sonalities, pathologies, both internal and external environments, and I feel I am cogent to speak of some of the problems that relate them- selves to social pathology and to medical pathology that I see in the practice of medicine concerning the older person. I w T ould like to make four points before this committee. One, there must be prompt recognition by those agencies which concern themselves with the administration of funds for the aged in these particular situations. One of the most successful, if not the most successful, program for handling some of the problems of the aging- come in maintaining third-generation families where grandmother and grandfather are integral parts of the family situation. This third- generation family seems to be very unpopular in the current youth- oriented society. However, the advantages of this type relationship far outweigh the disadvantages. It also surprises me, in the clinical practice of medicine, the number of families who really care for their parents in a most beneficial and satisfactory manner. The individual needs, medical, social, financial, and situational, are met to a far greater degree in this kind of situation than in any other. As long as the older generation can remain by themselves, I prefer this. But the next step should be a family unit which cares. To date most of our social legislation shamefully neglects any provision to help out the younger family in aiding granny's care. I would strongly recommend that such families have access to one or two provisions. One, that the older citizens be allowed an additional stipend to pay her way in the son or daughter's house and/or two, moneys should be made available for the financing of an additional room or small apartment to care for these individuals in the confines of a family situation. I have watched people build these apartments out of their own pockets for these individuals. I should like to illustrate this above point with one of the most classic examples I have ever seen. In our community, I have taken 3are of a family — both grandparents were alive — both older women. Dne was a bilateral amputee diabetic at the age of 78 and the other ls an 86-year-old gal who is still living in the three-generation family. I have watched the son-in-law build an additional bedroom with :oilet facilities and adapt them to the amputee's needs. Her shower 774 was built wide enough to accommodate her wheelchair so that she could roll in and take her own shower. The shower head was fixed with a flexible showerhead so that granny could bathe herself. Her toilet was designed to accommodate an individual who had no feet. Ramps were built into this place, both to the outside and the rest of the house so that a wheelchair could be manipulated around. This is the finest example that I have seen of a family taking their own resources to accommodate an elderly person. I can see no reason why society should penalize this family. Two, in my previous biometric studies, I have been horrified at an arbitrary, capricious dateline which defines old age as 65 in males and 62 in females. I have seen older people at 50 and younger people at 80 than their chronological age would indicate. I would make a real plea that laws related to the older person be made extremely flexible and that one may move from box to box in both forward and retrograde progress. I have looked at age as main- tenance of a psychological status, a medical status, or a social status. With three subdivisions of age, such as medically, socially, and psy- chologically, normal medical, psychological, and socially incompetent and a great netherland in between. This then gives us in essence nine compartment boxes without walls, recognizing that any individual may move laterally, forward, or downward in these boxes. The requirements for people at 65 are ob- viously different than the requirements at 75, 85, or 95. For example, there are a number of appreciative but dissatisfied older citizens in this country who are upset by the ramifications, com- plexities, and nonsense in the medicare law. It is frighteningly hard to try to explain the limitations, additions, and restrictions to an 85- year-old man. Centralized guidelines to the administration of pro- grams to the aged are fine, but keep them as guidelines. Three, in the town of Wrentham, thanks to our fine citizens, the board of selectmen and to the interested professionals, we have a group of older persons' dwellings known as Garden Lane Apartments. For urban communities these kinds of units solve many of our problems for the care of older people. However, the success is not predicated on the building no matter how well it is designed. The factors that make for success are seldom realized. These factors are — one, by the nature of their locations fam- ily units are close by and visiting grandma, attention to groceries, church, being invited into homes of the younger family. Two, if these villages are located close to centers of commerce then much of the independence of the citizen is maintained so they can walk to shopping centers for groceries and daily needs. The church group is not far away and is accessible for them, social dialog with old friends, old granges, and old associates can be maintained. If some planning goes into the construction of these units, the peo- ple can then get out most of the year. These units also are successful because at least locally we have a superb nursing service and these two interested nurses are Mrs. Fowler and Mrs. Robinson who keep a watchful but distant eye on the han- dling of the individuals under their care. The personalities of these two ladies is such that doctors are kept alert as to changing situations in the health of their patients, families t t •) are gently reminded to be of more assistance and kindness is extended to those individuals essentially bereft of family. Unless low income old-age housing units such as these actively require, and unless these factors are considered, they are essentially doomed to becoming pris- ons. The older person does need someone who will not restrict his free- dom but who will watch after him from a distance. Most older people are not particularly gregarious and have diffi- culty in establishing similar relationships with members so that they tend to remain boxed in the compartment to which they have been shoved. Mr. Brademas. Doctor, I wonder if I may interrupt, and ask if you could just summarize the statement, which you have submitted. Some members of the committee have planes to catch and Ave have other wit- nesses to hear, and we do want to have a chance to question you and hear the others. Dr. Cummins. I can stop immediately. Mr. Brademas. All right, sir. Thank you very much. Mrs. D wight, first let me thank you very much for your greetings from Congressman Conte. I remind you he is one of the ablest and most respected Members of the House of Representatives. I do hope you will take my greetings back to him. I just have one question to put to you. With whom in your work in Hoi yoke have you found it most effective, that is to say, what kinds of groups of people do you find most productive in terms of advancing programs for the elderly — or can you respond to that kind of question ? Mrs. D wight. As I say, it has been a 2-year struggle when I thought no one would respond. Certainly our council for the aging which was originally a Federal grant, a 2-year pilot project, and picked up by the city has been most successful — limited in scope because of limited funding, but I think this coordination planning will help. I must say that the private nonprofit sector has been nonexistent and this is really a difficult situation to deal with in the city. Mr. Brademas. I must say I am very impressed by the evidence you give of an optimistic nature about what can be done to make life better for older persons, and do you think that as a physician that one can, in effect, make generalizations in the kind of experience you have had, in other words, that would be replicable in similar situations? Dr. Cummins. Why not ? If we can do it in a small, underprivileged, deprived, depressed area, why can't other people? Mr. Brademas. I would only hope that the kind of testimony you have given and the kind of studies you have made reference to would become more widely available. My only other question to you, Have you published the study to which you made reference in your testi- mony ? Dr. Cummins. Those studies were done here locally on Court Street by the Veterans' Administration. Those are the property of the Vet- erans' Administration. I might add that the Veterans' Administration probably has the greatest experience with male health problems of any single unit in the United States. Mr. Brademas. Well, if you would be kind enough to give us the cita- tions, maybe they could be obtained. Dr. Cummins. They are the property of the Veterans' Administra- tion. 776 Mr. Brademas. I think the Veterans' Administration is the property of the United States, so I think we would like to have a look at those. Mrs. Hicks. I have no questions. I would just like to commend both Mrs. Dwight and Dr. Cummins for the testimony they have given. It will be of great value to bring back to Congress before the full Com- mittee on Education. Mrs. Dwight, Maurice Donahue has commended you on many occa- sions for the work you have done, and I am delighted with it, and that the geriatrics department was finally created in Holyoke. Thank you. Mr. Hansen. Also I have no questions, but I would add my com- ment to the chairman's statement acknowledging a very high regard, and my own very close personal friend there, the esteemed Mr. Conte, who I might say also many years ago spent some time in the State of Idaho. I would only underscore without raising a question, the point by Dr. Cummins. This is the first time it has come out in these hearings, and I think it should not be lost sight of. That is the need to take an- other long hard look at our arbitrary mandatory retirement rules, for example, and other practices and prejudices that have effectively ex- cluded talents and energies, manpower, of enormous value to society, from the opportunity to participate, thereby depriving society of benefit of what they may contribute and depriving the individuals themselves of the sense of being needed. It is also a terribly important role to people, and this seems to be in terms of Federal policy and State policy, employer regulations, a whole range of various practices ought to be looked at. Dr. Cummins. I agree. I would like to just say that approximately a year ago, there was an old man in this town who was emotionally dead, but he lived long enough to see his successor named. He willed to live through this installation of the archbishop of Boston. Cardinal Cushing died within a month after he installed the current archbishop, but literally, this man was an old man, a sick man, but by driving himself hard — everyone who saw the installation, witnessed it on television, knew this man was dying. Everyone cheered this man. It is a classic example of what one at 75 can do. Mr. Hansen. And we thank you very much. Mr. Brademas. Mrs. Dwight and Dr. Cummins, we are very grateful to you. Thank you very much. Our next three witnesses will be heard in panel, also. Mr. David Steadwell, Miss Fannie Allen, and Mrs. Ruth Bean. I understand David Steadwell is not present, but his statement will be inserted into the record. Mrs. Jeffires. Mrs. Bean, the executive director of the Women's Educational and Industrial Union, was unable to be here. I am Mrs. Virginia Jeffires, director of social services. STATEMENT OF MISS FANNIE L. ALLEN, DIRECTOR, SERVICES FOR OLDER ADULTS, UNITED SOUTH END SETTLEMENTS, ACCOM- PANIED BY MRS. VIRGINIA JEFFIRES Mr. Brademas. We are looking at the clock. We would be very grateful, and I know my colleagues would, if you would allow us simply to insert your statements in the record, and perhaps you could give us a brief summary at this time. 777 Miss Allen. That is exactly what 1 intended to do, I am Fannie Allen, United South End Settlements, a private agency in the South End of Boston. There are two points 1 wanted to make. One was the need for borne help service — some call it personal home care or homemaker service and I am very happy to know that the Governor signed the hill today for home care service. This was one of our recommendat ions, for a cen- tral resource to be established in the State, where all older people, could turn for help regardless of income, because previously most of them could not get this service within the welfare system. Another illustration of comprehensive service was the demonstra- tion project at a public housing development over a period of 3 years, wherein private agencies within the communities, health and social agencies, got together with the Boston Housing Authority and planned for social services to be provided for the residents at the time they moved into the development. This has been going on for 3 years. It is now being studied by the research department of the United Commu- nity Services. So far, they have found it to be very valuable in provid- ing the health services, social services, and the preventative services for older people. In my written testimony, I refer to the numbers, the history, of the project and some of the services provided. Mr. Brademas. Thank you, Miss Allen. Glad to have you with us, Mrs. Jeffires. Mrs. Jeffires. Thank you, and I will be brief. Most of the agencies here are new. I represent a 94-year-old pioneer in meeting the current needs of the community. The problems of the older people, especially their need and desire to live independently, has long been of concern to the union. Be- cause of this, our social service department has developed the fol- lowing programs: Housing referrals, training and placement of homemakers, training and placement of home health aides, com- panions unlimited volunteer program. In our housing, we give individual consideration to the elderly per- son and the handicapped person who wishes to live independently. We have on our staff a home finder whose exclusive job it is to develop and investigate all kinds of living arrangements from the very simple to the more complex. In 1970, over 2,000 satisfactory living arrange- ments were found by our department. We do not charge for this service. For those who were unable to live independently, we have refer- rals to rest homes, retirement homes, nursing homes; and as you may now know, we are the agency that prepares the Nursing Home Guide and Rest Home Guide in Massachusetts: We have just finished the fourth edition, in connection with the department of health. We learned early from our work in housing that many elderly and handicapped need the assistance of a responsible person if they are to continue living in their own homes, and now for 41 years, the Women's Educational and Industrial Union has been supplying home- makers. Within the last few years, the last 8 years or so, the demand has become so increased that we now have developed our own train- ing course and training program and placement for both homemakers and home health aides. 778 You may be interested to know that 85 percent of our homemakers are themselves elderly people who otherwise would depend on social security as their only source of income. Thus, our system meets a two- fold need, the elderly and handicapped person is made independent in their own homes, and giving employment to those wishing to re- main resourceful and independent in the community. Through its involvement in the above programs and referring, Mrs. Hicks, to your statement about the lonely isolated people, we soon become aware of the dreadful isolation and loneliness of many of our clients. Such simple daily needs as food shopping, transporta- tion, escort services to medical appointments, recreation, and pick- up and delivery of Government surplus foods soon become appar- ent. After months of research and consultation with the other major agencies in the city to determine how great the need was for these services we developed the volunteer program called companions unlimited. This program, now in its fourth year, has 124 active, trained vol- unteers representing a cross section of the community. They come from diverse social, educational, and economic backgrounds and all ages from students to 80 years old. Their function is to be a friend and we need friends to carry out many of the necessary services. The knowledge that these volunteers are unpaid makes them truly a friend in the minds of our clients. Mr. Brademas. I wonder if you would mind my interrupting. I see you are reading from your prepared statement which we all have. Perhaps you will let us just put questions to you ? Mrs. Jeffires. Fine. Would you do that ? Mr. Brademas. What strikes me about the testimony of both you, Mrs. Jeffires, and you, Miss Allen, is that they represent the kinds of programs that can be made available through private, nonprofit orga- nizations. I am struck also by what I take to be a sensitivity of those who operate these programs to the need to get into the homes of older persons and that seems to be a lesson that those of us who deal with Federal programs touching the lives of the elderly ought to take into account. Mrs. Jeffires. You might like to know, Mr. Chairman, that we have 124 volunteers. We service over 800 clients. This is just the fourth year. This year we have made 6,000 individual visits. Mr. Brademas. The only question I would put to Miss Allen is, as I look at the last line of your statement you recommend strongly that funds be made available on whatever governmental level to support comprehensive social service programs. So I take it you are saying that if the programs were to be made available through the Federal Gov- ernment, which is our area of responsibility, that United South End Settlement would in your view be one of the instrumentalities which would administer such programs on the local level ? Miss Allen. Exactly. Mr. Brademas. Mrs. Hicks ? Mrs. Hicks. I would just like to ask about this program, Companions Unlimited, Does that also include that program they have regarding the telephones, where any hour of the day or night you can call ? Mrs. Jeffires. No, Mrs. Hicks, that is not it. We do some telephon- ing, yes, but most of our people say, "I want to see your face. I don't want to just hear a voice." 779 Mrs. Hicks. I see. Thank you very much. I certainly want to com- mend both of you on your fine work in the programs, particularly the South End House. I remember when I was going to college I took up cooking at this house. When 1 was there I don't know that I did very well, but 1 was one of those volunteers in this Women's Educational and Industrial Union. There was another name for it, wasn't there? < h lias that always been the name? Mrs. Jeffires, It has always been Women's Educational and Indus- trial Union. May I make one point, Mr. Chairman, speaking of homemakers and the need to have them. We have many many people who are just above the welfare level who want to live independently, who do not want to accept charity. If there could be moneys for a sliding scale so they would pay just so much this would be prevented. It would allow them to have the very needed services which they do not have now. Mr. Hansen. May I ask a question ? Mr. Brademas. Just a moment, ladies. Don't leave our friend from Idaho in the lurch. Mr. Hansen. Let me thank you both for a very fine statement and ask you for your reaction to an idea that might channel more Federal resources to strengthen and support the kinds of efforts you have described. In 1968 an amendment to the Vocational Educational Act, the funds that go to homemaking and home economics programs, a third of those funds were earmarked for consumer-oriented or related services which involves students going into the homes and providing assistance. What would you think of further amendment to that act which ear- marked an additional one-third for similar services to the elderly, as a means of applying this knowledge in a practical way and assisting the elderly ? Would you endorse such an idea ? Mrs. Jeffires. I think that would be splendid. Mr. Hansen. Would you agree, Miss Allen % Miss Allen. Yes. I think we could work something out with the idea. It is very hard to find the workers and the helpers to provide the service and this would be one valuable resource. Mrs. Jeffires. Recruiting, as I say, is the most difficult thing we have in any of our programs. Mr. Hansen. Having gotten your endorsement I will commend it to my chairman and perhaps we can initiate something. Thank you very much. Mr. Brademas. Mr. Peyser? Mr. Peyser. I will be very brief. Just one thing really. Working in this area of volunteers, I want to congratulate you on this effort which seems to be so productive and in many ways so much more meaningful than governmental agencies. With the exception of money which is involved, you have people involved, you have people doing the job and I congratulate you. Thank you very much. Mr. Brademas. Thank you very much for having come. The Chair would like to ask unanimous consent to insert into the record a state- ment submitted just now by Mr. John A. Collins of Cambridge, Mass. Our next witness is Dr. James Callahan, assistant commissioner, department of public welfare. 780 STATEMENT OF JAMES J. CALLAHAN, JR., PH. D., ASSISTANT COM- MISSIONER FOR MEDICAL ASSISTANCE, MASSACHUSETTS DE- PARTMENT OF PUBLIC WELFARE Mr. Bradem as. We are pleased to have you, sir. Dr. Callahan. My name is James J. Callahan, Jr., assistant com- missioner for medical assistance, department of public welfare. I am pleased to have the opportunity to be here. Massachusetts has a large medicaid program, the third largest in the Nation— 57 percentof the funds spent are for persons 65 years of age and over. m The department's medical assistance advisory council devoted much time to an analysis of this and they concluded that frequently medical solutions are used to solve essentially nonmedical problems and this can be seen particularly in the areas of nursing home care, and others have testified to this. In my testimony I mentioned a project that the Department became involved in with the Levinson Gerontological Policy Institute at Brandeis University. I would just like to focus on one matter, namely in terms of framing legislation regarding social services to the elderly that consideration be given to amending title 19 of the Social Security Act to provide social services to those persons who, without the pro- vision of such services, would have been institutionalized. Specifically, the amendment should provide 90 percent Federal matching up to i0 percent of the amount spent on nursing home services by a State for social services and related items for persons who would have been institutionalized. I think this mechanism of diverting some of the ongoing funding for nursing homes into the area of social services will be verv beneficial. During the testimony an idea occurred to me — when title 19 was first enacted it provided a special program to pay for the care of persons over 65 who were in State mental institutions. Massachusetts picked that program up and in the intervening years the number of persons 65 or over in our mental hospitals has decreased from about 6,200 to now somewhat less than 3,000 and Ave see an ultimate hard core level, so to speak, of about 1,500 recipients so that it may make sense to try to copv this type of funding program for social sendees. If you have any questions, I would be glad to answer them. Mr. Brademas. I point out. Dr. Callahan, that though there is no reason for you to be aware of this, this committee technically does not have jurisdiction over the medicaid program. We are very grateful incleedto you for your suggestion that points to the possibility of amending title 19. 1 hope very much that you will allow us to perhaps be in correspondence with you and give the Board still more specific suggestions for us to consider in this whole field, especially as it relates, in my view, to the standards of the nursing home services, so I very much appreciate this suggestion. I just have one^ question to put to you. What about the problems of substandard nursing homes in Massachusetts? Is this a problem? Can you give us any generalization about it ? Dr. Callahan. I think in general the nursing homes in Massachu- setts are of good quality. The department of public health has a good staff. Recently they have enacted a levels of care, which provides for 7sl four levels of care, We are now in the process of reclassification there, There are some problems at some homes, but I am not sure it is a gen- era] problem. Mr. Brademas. Yon addressed yourself to title L9. What about title 16 of the Social Securities Ad, which is a subject on which we look testimony in New 7 York City on Saturday? I low much money has the, State of Massachusetts requested under your title L6 program? Dr. Callahan. I am noi familiar with that — how title L6 works. Mr. Brademas. Mrs. Hicks? Mrs. Hicks. Thank you, Mr. Chairman. Dr. Callahan, is there any requirement under the statutes for get- ting a license for a nursing home that you have a recreational direc- tor or someone that would come in to give some type of recreation to the patients of a nursing home ? Dr. Callahan. I do not believe it is a requirement for a license, although under the new rules and regulations adopted by the depart- ment of public health it requires the classification by levels of care. They have put this requirement into the regulations — so much time of activities directors depending on the size of the home, so that is in the new rules and regulations. Mrs. Hicks. Thank you. I want to commend you for your recom- mendations that the amendment should provide 90 percent Federal funding and 10 percent otherwise. This is a step we should be trying to achieve. Mr. Brademas. Mr. Hansen ? Mr. Hansen. I have no questions. Mr. Brademas. Mr. Peyser ? Mr. Peyser. I have no questions. Mr. Brademas. Thank you very much, Dr. Callahan. You responded to my question on title 16 that you were not familiar with it. You might take a look at title 16. You might find some gold in those hills for the kinds of programs with which you are concerned. Mr.'. Coard, would you like to come up and give us a brief sum- mary of your statement, all of which will be included in the record ? We are very pleased to have you here, sir. STATEMENT OF ROBERT M. COARD, EXECUTIVE DIRECTOR, ACTION FOR BOSTON COMMUNITY DEVELOPMENT, INC. Mr. Coard. I want to say thank you to our Congresswoman, Mrs. Hicks, for making this hearing possible and for the work she had done for the elderly in Boston before. It is very encouraging. Just briefly to summarize, Mr. Chairman, ABCD is the official anti- poverty agency for the city of Boston and as such is the administrative agency of neighborhood groups with two programs for the elderly. One is the Foster Grandparents program. The other is working with the Welfare Department and helping in the distribution of the Sur- plus Food program in the city of Boston. I am glad to have an opportunity to speak to the members of Con- gress in regard to these two concerns. In the Foster Grandparents program we strenuously fought against a drastic 30 percent cut and it was rescinded. This attempt to cut back on a program which was very badly needed by the elderly, for the income supplement as well 782 as the emotional and psychological assistance, is something I have urged Congress not do. The other aspect of the Foster Grandparents program which was upsetting was the shifting of the volunteer aides and this seems to be a part of the trend of cutting back the Office of Aging or Office of Elderly on the Federal level and this concerns us a great deal here. I feel the Federal Government should have an Executive Office for the Aging rather than have it buried in departments and subdepart- ments and sub-sub-departments and scattered all over the place. In the Federal Government there should be an Executive Office for the Aged established as soon as possible. The other thing is the food program. We have set up a distribution program in the neighborhoods in Boston, the Surplus Food program, with the Welfare Department and we were able to get some funds under the Emergency Medical Assistance program which is being- eliminated at the end of this year and we have been making attempts to get the Governor and the Welfare Department to carry on this pro- gram of distribution centers particularly for the elderly and for other citizens who need this service. The elderly as well as other citizens are going to indeed suffer when these distribution centers are eliminated at the end of the year because the present ones were for demonstration purposes only. We hope Con- gress will consider making this kind of distribution for the elderly, a permanent kind of assistance. Apparently this State does not have money for that. The Federal Government could do this. The other aspects I would like to summarize briefly are that I feel there are five basic strategies that should be employed in dealing effec- tively with the elderly. One is an income strategy, having a minimum level of income so the elderly can live in dignity and with pride. The income should not be given with any strings. The second thing which has been neglected at all times is the job creation strategy for the elderly. Usually instead of encouraging the elderly to do jobs like Foster Grandparents, which allow them to con- tribute to the younger person in the community, they are penalized any time they try to get a job. I think all efforts of penalizing for their earning money should be eliminated. The other aspect is the services strategy. In this area we have had a lot of testimony in terms of the services that the elderly can have. We need improvement to make them even better, and fully avail- able. We also need not to collectivize. They should be as individualized as possible, including the elderly person who lives at home and private living and sometimes collective and so forth. The fourth aspect is housing which is usually very inadequate, for the more specialized perhaps even more than public housing and with all the political roadblocks removed. The fifth and last aspect is the area of adequacy to which I made reference before. At the Federal level there should be this adequacy, such as an agency out of the Executive Office like at our State level where Governor Sargent has included the Elderly Affairs Office on his Cabinet We have offices like the Frank Manning group and the Council of the Elderly which are very beneficial. Thank you very much for the opportunity to appear before you. Mr. Brademas. Thank you very much, Mr. Coard. I have tions to put to VOU. I can only tell you that. I have just read your Bt ment and heard your summary, and perhaps I agree with your criti- cisms with reference to united funding and the problem of hiring high visibility at the Federal level. I think it is an excellent statement. I thank you for having testified. Mrs. Hicks f Mrs. Hicks. Just one question I want to ask. Have you worked with the Commission to establish at the city level needs for the elderly ? Mr. CoARD. Yes; we have. As a matter of fact the Commissioner sits on the ABCD Hoard of Directors. We have a very good working rela- tionship with the Commission. Mrs. Hicks. I want to thank you for the recommendations you have made, and some of the recommendations we are now working on. There are some bills before the House and I know the Congressmen have filed bills also, so what we really need is your support in trying to get some of these things through. Thank you very much for testifying. Mr. Hansen. I nave a question and just one comment. I would ask leave to place in the record some figures that are relative to this mat- ter. I think it is fair to say that the pressures brought to bear by this subcommittee were helpful in some changes which resulted in the in- crease for all levels of funding in many of these programs. But I think, in order to put them in perspective, I want to put the exact figures into the record at this point. Mr. Brademas. If there is no objection permission will be given. The Chair wants to invite all those in the Boston area and the Commonwealth of Massachusetts who may wish to submit statements for our hearings to feel free to do so, either directly to our committee or through Mrs. Hicks. The Chair wants to thank all the witnesses from the Boston area and the State of Massachusetts and all of our guests. We are very grateful for your hospitality and grateful to Mrs. Hicks and her kindness in helping us to arrange these hearings. We are adjourned at 4 :10. (Whereupon, at 4:10 p.m. the subcommittee was adjourned.) (The following material was submitted for the record :) Testimony of Women's Educational and Industrial Union, Boston, Mass. subject : "problems of the elderly" In its 94 years of social service the Women's Educational and Industrial Union has been a pioneer in providing programs to meet the current needs of the community. The problems of the elderly, especially their need and desire to continue to live independently within the community has been one of the major concerns of the Union. In dealing with this problem the Social Service Department of the WEIU has developed the following supportive services: housing referrals; training and placing Homemakers; training and placing Home Health Aides; and Compan- ions Unlimited volunteer program. 784 HOUSING For each person wishing to live independently individual consideration and personal investigation of each accommodation on its housing list account for the Social Service Department's record of successful referrals. The department has a "homefinder" who works exclusively at developing and investigating all kinds of living arrangements from furnished rooms with or without cooking facilities, to boarding homes, apartments, foster homes, and independent living quarters for the blind and other handicapped. In 1970 over 2,000 satisfactory living arrangements were found. No fee is charged. For those who are unable to live independently, referrals are available to retirement homes, nursing homes, and rest homes. In 1971 our Social Service Department, in cooperation with the Massachu- setts Department of Public Health, published the fourth edition of the Guide to Nursing and Rest Homes in Massachusetts, now entitled "Levels of Long Term Care Facilities in Massachusetts." We learned early from our work in housing that many elderly and handi- capped need the assistance of a responsible person if they are to continue living in their own homes, and so, for forty-one years, the Union has supplied this assistance through its Home Employment Service. With the increasing need of the elderly for this service we have developed our own training program for Homemakers and Home Health Aides. Indeed, 85% of our Homemakers are themselves elderly individuals who otherwise would depend on Social Security as their only source of income. Thus, our system meets a two-fold need ; assist- ance for the elderly and handicapped in the home, and employment for those wishing to remain self-supporting and useful members of the community. Through its involvement in the above programs the Social Service Depart- ment of the Union soon became aware of the dreadful isolation and loneliness of many of its clients. Such simple daily needs as food shopping, transportation, escort service to medical appointments, recreation, and pick-up and delivery of Government Surplus foods became apparent. After months of research and consultation with the other major agencies in the city to determine how great the need was for these services we developed the volunteer program called Companies Unlimited. This program, now in its fourth year, has 124 active, trained, volunteers representing a cross section of the community. They come from diverse social, educational and economic back- grounds and are of all ages from students to retirees. Their function is to be a friend and in being a friend, carry out many of these necessary services. The knowledge that these volunteers are unpaid makes them more truly a friend in the minds of our clients. Referrals of our now more that 800 clients are made through social service agencies, hospitals, and the VNA. The staff makes an initial visit to each referral, assesses the needs and explains the program. In addition, the staff recruits, assigns, and coordinates the volunteers. One of the essentials of the program is the sensitivity of the staff to the needs of both volunteer and client. Very important to Companions Unlimited is a Volkswagen Bus (donated) which provides much needed mobility and extends our services to many more clients, particularly in areas that are inaccessible to our older volunteers for rea- sons of personal safety. To service the clients in these areas we use our VW with a male student driver to food shop, to transport to medical appointments, and to provide much needed recreation by group rides. This, in brief, is what one private non-profit Boston agency has been doing to help solve the problems of the elderly. Because of our experience in actively creat- ing and sustaining the above programs we feel the following recommendations are valid : Recommendation 1 : We feel there should be Federal or State monies available to fund programs which are proving their value and to allow these ongoing pro- grams to expand and extend their services. For example, one area that should definitely be expanded is transportation to medical appointments. Mr. Chairman and members of the committee, we appreciate that you are as aware as we that there is a large group of elderly of limited income who badly need these services but cannot afford them. In wishing to live independently they are being deprived of necessary medical and health services which in many cases can mean premature institutionalization and an added burden to the tax payer. Recommendation 2: We feel that monies should be provided for Homemaker Service to those elderly who are on limited income, i.e., Social Security and pen- sions, but who do not qualify for Public Assistance. Based on a sliding scale to fit the individual income this supplement would be paid to the agencies providing the Homemaker Service. 785 Statement of Robert m. Coabd, Executive Director, Aotioh fob Bo ( \>\i MUK ITi 1 Ma 1:1 OPMENT, 1 NO. AJBCD la t ho official anti-poverty agency tor the cltj of Boston. Our total funding on an annual basis comes to approximately $22 million, made up pri- marily of manpower pro-rams, Including the CEP program, Bead Starl pro- grams, 2 Neighborhood Health Centers al Columbia Point and Roxbury, Drug au; , and Famllj Planning programs, youth programs, and Neighborhood .\iuiii- Purpose Centers In all of Boston's low-income areas. This network attempts to servo the needs of all of Boston's poor, Including the elderly. Nearly 90% of ABCD's funding is earmarked exclusively for certain specific groups in the poverty population, such as pre-schoolers in Head Start, teenagers in the NYC program, mothers in the family planning grant, and unemployed persons with an emphasis on veterans and male Loads or households. Indicating the lack of emphasis (as far as the elderly are concerned) in anti-poverty programs is the faci that only $225,000 of our total ,$22 million hudget is earmarked by Wash- ington for the elderly in the Foster-Grandparent program, and as recent as three months ago, Frank Manning and other elderly-concerned persons joined with me protesting a drastic federal cut of 30% of those funds. A BOD, of course, attempts to serve as many elderly as possible through its multi-purpose centers and by interpreting as broadly as possible the existing ear- marked programs which we operate in the areas of health, manpower, drug addiction, family planning, youth services, and Head Start. It is a disgrace that since the elderly form such a significant portion of the poor, the national ad- ministration has not seen fit to earmark more than this minimal amount (which they are constantly cutting) for the specialized needs of the elderly poor in Boston. It is time for this incredible imbalance in provision of services to the poor be redressed. Other groups of poor in our society have demanded attention and funding and, as a result, some legislation has been enacted. Few demands have been made by the elders, so little action has been taken. In Massachusetts new attention has recently been afforded the elderly with the creation of the Secre- tariat of Elderly Affairs. However, it is clear that this action is the result of outspoken, well-publicized demands from various elderly groups. Masses of elderly citizens were bussed to Suffolk Downs and in a rally there, demanded participation and services in this state. Must we wait through our APACs, some recreation, health services, outreach and information referral are pro- vided. Thousands of elders need to be offered assistance in nutrition, health care, and a variety of social services, but there is not adequate funding available to provide these essential services. The services that we are able to provide are far from inadequate to meet the needs of Boston's elderly poor. Too often when federal monies are considered for the elderly, emphasis is placed on providing only recreational and social facilities. There are so many other needs that must he met. It is not enough to merely provide the elderly with social services. Funds are needed for training programs, to train elders them- selves and enable greatly-needed services to other elders. We must begin to consider job-development possibilities for able-bodied elders. Also, there is great need for outreach money to provide our elder citizens with information on what services are available. Housing is another problem of the elders which could be greatly alleviated with some adequate resources. These are only a few areas in which we would like to begin to serve the elderly of Boston. Recently, ABOD called together a Boston Task Force on the elderly to evaluate services currently available in Boston and to determine new ways in which better programs could be initiated. Countless good ideas, filled with enthusiasm and dedication have come out of that group. But we are still faced with the crucial queston : What shall we do with these new, innovative sugges- tions? Where shall we go to find funding? For years, we have been told that there is just no money in the budget of OEO, HEW, or the Department of Labor to fund elderly programs. When there is an announcement of funds available, it is always too small to support a pilot proect, let alone a significant program for the elderly citizens of Boston. Re- cently, our regional OEO office held a conference on the Elderly at which it was said that there was $200,000 available for OEO Region I for elderly programs. $200,000 for the entire New England Region ! Even if that money were really available — and we have since been told that the whole thing was a misunder- standing and that no such money exists — it would hardly be enough even to 7S6 begin adequate service provision for the city of Boston, let alone for the whole region. The need for adequate service programs is great. In addition, there are several other areas in which meaningful legislation could provide for needed changes in the life style of elders. Let me mention just a few. 1. The Social Security Act desperately needs to be revised to take into account the vastly-increased cost of living since its enactment. An increase of 25% in benefits would not be out of line. The elimination of the limitation on earnings of those over 65 who wish to work and are able to do so would greatly improve the financial situation of many elders, as well as enable many useful, productive citizens to resume their rightful place in society. 2. New legislation could provide for fare reductions for senior citizens on in- terstate transportation, especially on airlines and railroads. 3. The states need federal aid to help them enable elders to keep their homes and not be forced to move into sub-standard buildings and low-income housing projects. Such assistance could include tax abatements, home aid services, and low-interest loans for home repairs and maintenance. 4. The Administration on Aging needs to be strengthened and organized as a separate federal department with additional responsibility for administering Social Security, Medicare and Old Age Assistance. 5. We need a good, national health plan for the elderly which is not limited to insurance coverage, but which will provide for delivery of health services and preventive medical services. Attention to a number of these specific problems which so seriously affect the daily lives of our elders could help improve the overall quality of their existence by merely adding to their income. The provision of social services could then be more meaningful and effective. If the quality of life for this im- portant but neglected segment of our society is ever going to be improved, Con- gress will have to pass a comprehensive services legislation with ample provi- sion for the implementation of new services either through existing federal de- partments or by the creation of new office especially for elderly affairs, as well as redress some of the imbalance which exists in current legislation. We must, however, begin to take the problems of the elderly seriously and be willing to take some drastic steps to alleviate them. The fact that you are here today, giving us the opportunity to advise on new legislation, is evidence of your concern. We need meaningful federal legislation so that we on the local level can begin to serve more adequately the needs of the elderly population. We pledge our support and assistance to you and eagerly await your action. Testimony of James J. Callahan, Jr., Ph. D., Assistant Commissioner for Medical Assistance, Massachusetts Department of Public Welfare My name is James J. Callahan, Jr., Assistant Commissioner for Medical As- sistance of the Massachusetts Department of Public Welfare. I am pleased to have the opportunity to appear before this Committee on the subject of Compre- hensive Social Services for the Aging. My responsibilities include that of administering the Commonwealth's Title XIX Medicaid program. It is from this perspective, namely, as an administrator of a large health program, that I will direct my remarks. I am not an expert on Comprehensive Social Services but I do know that health services and social services are necessarily related when it comes to serving our elderly citizens. The Massachusetts Medicaid program is the third largest in the nation when measured by expenditures. For the fiscal year ending June 30, 1971 over .$300 million was spent under the program. It is also one of the most comprehensive when measured by the services available. The Medicaid program is a significant resource to the elderly of the State. It fills in the gaps of Title XVIII Medicare by paying the deductibles and co- insurance amounts for those elderly persons unable to do so. It provides an array of medical services not covered by Medicare ; long term skilled nursing care, dental services, prescribed drugs and preventive health measures. During the last fiscal year, of the total $304 million spent by Medicaid, $171 million or 57% was for persons 65 years of age and over. Medicaid, therefore, is a major resource to the elderly of the Commonwealth and thp elderly are a major con- cern of the program. 787 Last year the Department's Medical Assistance Advisor) Council devoted much of its energj to the question of Medicaid services t<> the elderlj part leu larly as they related to QUrsing homes. The Council concluded : "Medical problems of the elderly and/or use of medical services by the elderly are frequently related to or actually caused by QOD medical situations. Medical solutions to essentially non-medical problems are expensive to society and may be contrary to the needs of the elderly. This situation is exemplified situations where nursing homes have been \ism\ as a solution to the housing or social needs of the elderly." The committee concluded further that sound social policy would dictate the provision of non-medical services and facilities for those elderly persons whose needs are essentially non-medical. Commenting on this point, Dr. Ralph Berry, Chairman of the Advisory Council noted "It should he obvious that as this funda- mental policy decision is postponed the real cost will he relief ted in the status of the elderly but there will he a money cost to the State in the form of higher and higher expenditures under Title XIX. I would imagine that over time both inflation and a natural "learning phenomenon" would tend to increase the num- ber of elderly who sought to substitute medical care for other things by seek- ing medical solutions to essentially non-medical problems." It seems to me that the underlying reality of the Council's recommendation is the fact that if a social problem exists solutions will be found for that prob- lem. The solution may hide the problem, may be detremental to the person involved, or may be inefficient and costly, but a solution will be provided. Problems just won't "go away". It is imperative, then, that we design solutions to problems that meet needs in an efficient manner. Over the past months, the Department and the Levenson Gerontological Pol- icy Institute at Brandeis University have been working on a proposal related to alternatives to institutional care for the elderly and disabled. A community has been selected as a pilot area and we are now seeking administrative funds to get the project off the ground. I believe other witnesses will give some of the details of this project. Previously, I mentioned that my perspective was that of an administrator of a health program. This project, at least initially, will reflect that perspective since the target group will be patients being discharged from hospitals or newly admitted to nursing homes. Both of these groups are a high priority be- cause the evidence seems to show that any extensive period of institutional- ization results in erosion of the patient's ties with the commnuity. The project also is intended to provide some answers to the administrative question of how do you begin to move an existing program (i.e. Medicaid) to provide essential and appropriate services not seen as being within its scope. Medicaid can spend u pto $600 per month for a nursing home patient, but can- not spend anything for non-medical services which might help that patient at home. I would like to recommend that when the committee is framing legislation regarding social services to the elderly it consider amending Title XIX of the Social Security Act to provide social services to those persons who, with- out the provisions of such services, would have been institutionalized. Specifi- cally, the amendment should provide 90% Federal matching up to 10% of the amount spent on nursing home services by a State for social services and re- lated items for persons who would have been institutionalized. This amendment would provide the flexibility needed to move the Medicaid program into providing non-medical solutions to non-medical problems. This flexibility is a necessity because it appears that no matter what National Health Insurance plan is enacted, long term institutional care will remain with the States and probably through Title XIX. We must act early so that our elderly citizens won't be forced to accept an inappropriate solution to their problems because acceptable alternatives were lacking. Statement of Fannie L. Allen, Director, Services for Older Adults, United South End Settlements, Boston, Mass. My name is Fannie L. Allen, Director of Services for Older Adults at the United South End Settlements. I am happy to testify in support of the need of a battery of necessary social services in order to sustain older persons in their homes, and enable them to continue to live in the community as long as possible. For many years there has been recognition by social workers and workers in 71-272—72 — pt. 1 51 788 other helping professions, of the need for a more cooperative and disciplined social service delivery system. Services to older people are fragmented, limited or in many instances non- existent. Services such as health, legal, protective, recreation, transportation and and others are talked about as being needed, but are rarely available. This fragmentation of the delivery system has forced the older persons to adjust to severe limitations of service rather than the services adapting its roles to the changing needs of older people. In regard to health care, there are many older people who would prefer to remain at home rather than in many instances forced into nursing home care. The provision of supportive services such as are provided by neighborhood aides, home-makers or of Home Helpers, Home Health Aides and companions serves to keep manv older persons in their homes. The USES has a long history of service to older people. Several years ago a re-assessment of its Day Center program was made. It was found that numbers of elderly in the community most in need of service were not being reached. Id order to find the most effective program to reach this group, an intensive survey was conducted. It was discovered that many older people living in small apart- ments, rooming houses and public housing seldom came in contact with the variety of available community services. This isolated group was a victim of the framgmented social service system. The result of this earlier study revealed a need for reaching out and respond- ing to the specific needs of those less mobile older persons in need of more inten- sive supportive services. Although need for the Day Center program at USES persisted, greater emphasis was placed on developing an out reach program which would respond to the critical concerns of the isolated older persons. Prob- lems such as shopping, housing, meal preparation, income, housekeeping and health care ranked high. m The first step in developing an out reach program was to design a program and secure funds for a Home Help Service. The components in the design in- cluded training, employment opportunities, contractual arrangements with public and private agencies, and re-deployment of USES staff. A grant was requested and received from Trust funds. The second step involved recruiting, and train- ing neighborhood persons to act as Home Helpers which included the older persons themselves. Staff time was restructured in order to identify older per- sons in greatest need of the new service and to interpret to the community its purposes and objectives. Once under way, contractual arrangements with the Department of Public Welfare were made on a cooperative basis to provide Home Help Service to older persons under their care. This arrangement reflected the lack of Home Helpers in both the public and private sector. This program is only a begin- ning and points up the need for the establishment of a Central Home Help Service Division available to all older persons in the community regardless of Since the inception of the Home Help Service in 1965, the USES has been able to divert from institutional care on the average of 40 older persons a year. (These numbers could have been doubled with additional Home Helpers.) For example, it was found that twelve (12) older persons served by the USES Home Help Service were given 750 hours of service over a period of 5 months by 4 Home Helpers costing $1650.00. This is equivalent to approximately a three (3) months stay for one individual in a nursing home. In order to provide an adequate supply of Home Helpers to meet the personal needs of older persons, much of the funds used for institutional living could be shifted to cover cost of training and employing personnel to provide these neees- Q arv services Home Help is a personalized service and USES realized there must be a bridge between this kind of service and a more comprehensive service plan. The agency initiated with the Boston Housing Authority its role with the community in a new service approach which should be done at the same time as the physical planning for olderly housing. As a result several community social and health agencies met over a period of two years and made plans to provide compre- hensive health and social services for the potential residents of this housing complex The program has proven effective in getting services to the residents when and at the time needed. Over 140 persons have lived in the housing develop- ment since it opened. During this time only three (3) have been transferred to Nursing Homes and two to mental institutions. It is also significant that when residents have to be hospitalized their length of stay in the hospital is less 789 threatening because they feel assured <>f supportive and follow up services once they return to their homes. This program of service La being evaluated by the Research Department of United Community Services, and Its findings will be available Por dlsl ribul Lon by i be flrsl of ( be year. Tnough definite findings bave not been released, there Is a strong Indication that this design of comprehensive bealth and social services can be adapted to serve older persons In both public and private housing In the community at large. The I'SKS believes In the value of community-based supportive services of which there are others not mentioned In this testimony. Such programs are preventative in nature and in the Long run reduce the need for costly programs of rehabilitation and institutional care. Documentation of the need, value and cost factors In support of these sup- portive services can be found in studies and findings made by the following agencies and institutions: Hebrew Rehabilitation Center, Social Gerontological Research. Mass. Department of Public Health, Division of Medical Oare. Visiting Nurses Association of Boston. Mass. Department of Mental Health, Geriatric Service. '•Alternatives to Nursing Home Care," Levinson Gerontological Policy Institute. USE^ strongly recommends that funds be made available on the federal, state and local level to develop, implement and systematize a comprehensive social service program to meet the current as well as changing needs of the aging population. Holyoke, Mass., November 22, 1971. Hon. John Brademas : I need not take any of your time today to discuss the many faceted problems of our elderly. They have been over studied, analized and talked about. As one old man said to me when I took out my pencil to write down his answers. "I'm just an old computer card, but no one's spindled me yet." We are all aware of the economic strain under which they exist. Our cost of living has far outstripped their incomes. Their medical needs are compounded by the lack of home care, the unavail- ability of doctors, and their own physical deterioration. The elderly are forced to remain in old neighborhoods which have completely changed in the past few years. They are isolated from familiar life styles, which has created in them fear and alienation. Or they have been concentrated into large subsidised buildings filled with others or their age group, making more unmet social problems. All these factors have contributed to the isolation of our elder from the main stream of our society along with the breakdown of the traditional family unity. The needs grow, but the solutions continue to evade us. Who is responsible for the elderly? Obviously their families cannot cope. Is it the government, federal, state or local? The private profit or non-profit sector? I think all are because the problems reach into all sectors. The result is chaos and infectual solutions. The older person does not know where to seek help for his very human needs. I would like to take some time today to tell you of a rather unique approach the city of Holyoke is about to take. First, let me describe Holyoke. It is an industrial city of 50,000, which was built as a planned city 98 years ago. It all went up at the same time and it's all falling down at the same time. The primary ethnic makeup is French- Canadian, Irish and Polish. We have seen a decline of 4,000 since the last cen- sus, but we have also had an in-migration of about 4,500 new citizens composed of around 3,000 Puerto Ricans and 1,500 blacks. This means that some 8,000 former inhabitants have moved elsewhere, mostly to the suburbs. Close to 20% of those who remain are elderly. They dwell primarily in the old tenements of the inner city, formely because of ethnic ties, now because of low rents. These buildings are for the most part five stories high, without elevators, and in sub-standard condition. The need to achieve, to produce, has been the driving force in these people's lives. Many of them left their homelands to compete for a new chance in this country. They have raised their children in an economic and educational en- vironment that they themselves did not experience. They are not the idle rich. '90 They are the cast-aside poor with skills and knowledge that are no longer sought. We are the first society that has not called upon the aged to give advice, and don't think they don't know it. We ignore the fact that the skills which they have accumulated through a lifetime are still of value. I mean social and manual skills. In a time when many of our young people are looking toward manual expression to offset our impersonal, mechanical society, we have forgotten our weavers, printers, cobblers, soupmakers, nurses, breadmakers, etc. Who will put it all together? Well, we hope the city of Holyoke will. The city felt (after two years of discussion) that comprehensive planning and coordination was necessary to pull it off. Therefore, last month. October 1971. the Board of Aldermen passed an order creating a geriatric authority. Last February the Massachusetts Legislature passed a bill allowing the city to take this step. This authority is an independ- ent city agency, financially autonomous, with bonding ability. Its primary pur- pose is to address members, representing the legal or financial world, the medical profession, and the social and/or geriatric field were appointed by the mayor. Three members representing the same disciplines were appointed by the Board of Aldermen. The seventh member shall be elected tonight by that group. The authority will manage a 134-bed, skilled nursing home which is now suc- cessfully in operation. It will coordinate all the geriatric programs in the city to eliminate overlapping and bring greater efficiency. It will explore the expan- sion of the nursing home for a more varied use of its services. We hope to expand the Home to include sheltered living. This would be a cottage community where spouses could remain together even though one mem- ber of the household requires more medical or social care than could be provided in the community at large. It would allow older couples to retain their sense of privacy and dignity and their familiar belongings, and yet receive needed care. There will be a day care, and possibly a night care, center for those who are still able to remain with their families at home, but require our social and medical services. We also see an intermediate level of care for those whose physical and social needs require greater time or supervision, and yet are in no need of skilled nursing care. As you can see, we are trying to change the emphasis from medical care to social care. Both needs are most often so intertwined that they must be treated simultaneously, but we strongly feel that the facility must adapt to the needs of the client, not the client adapt to the climate of the facility. We are also try- ing to keep as many people out of the nursing home environment for as long as possible. This is primarily for social, or human reasons, but it is also for economic reasons. Most of the elderly are poor and most of them will be sick. Most of them will end their days in a medical facility. How human will that facility be? We plan to train paraprofessionals at the complex. These men and women would become social and health outreach workers throughout the city. They would be under the supervision of the social and medical staffs of the authority, providing guidance and care directly to the client in his home. We would like to see the expansion of the city-funded Council of the Aging programs. Their drop-in centers can become sheltered workshops, informational and referral services and social and health clinics. The Council has been doing a good job with limited funding, but we feel it can be bolstered and expanded with coordination with other agencies. We would like to become the central clearing house for all public and private agencies dealing with the problems of the elderly. There are many groups who would respond if they were made aware of the individual or the larger needs. If the sheltered living concept is successful, we would like to expand it to other areas of the city, Model Cities for example. We would encourage the private, non-profit sector to undertake this challenge. Personally, I would like to see a concentrated effort to include the elderly in new mixed income housing developments (MHFA types) so that they may main- tain contact with varying age groups and still have good, new housing. Mixed income housing is a slower but more human answer to "housing for the elderly," I think. Health, housing, and social needs are so basically interwoven that to attack them separately seems to me to be a futile task. Hopefully, this new Geriatric 791 Authority of Holyoke can deal with all the problems of 10,000 <>r Its citizens with planning, coordination, and Intelligence. [f wo consider life, liberty, and the pursuit <>f happiness basic rights, then we can ii<> nothing less than make it a reality Cor those who created our past, and formed our present. Maicia B. I >W Kill I. Cambridge, m I have been Led to believe that this committee came here seeking information and to explore what needs to he done to help the elderly to remain In their homes in the event they become incapacitated to the extent they need minimum care for a short period of time, or a longer period. To le factual, the answer is trained Home Maker-Home Health ('are Aides. This type of care can he costly, the low average cost per hour for this type of care is $2.50 per hour. At this rate for an eight (8) hour day the cost would he $20 — for a seven day week of care, $140. As the Home Maker aides hecome more experienced, their hourly rate goes up to $3.00 per hour, or $168 for a seven day week. This has happened in some communities that provide this type of service. Every week on Sunday, the Boston newspapers have an insert advertising Health Insurance such as this one, which was inserted in yesterday's paper. Let's look at an article, that was released by the State Auditor, of an audit of the welfare office in the City of Cambridge. If this committee, through its hearings, finds an answer other than a full National Health Insurance Program to finance this type of care, they will be known as wizards, and to my knowledge there are very few wizards in Wash- ington. This, as I see it, is an Else-Or question. I don't hear any Else's, but do hear, -Or a full National Comprehensive Health Insurance Program. John A. Collins. Allston-Brighton Area Planning Action Council, Inc., Allston, Mass. The attached statement is submitted by Edith Stein, Coordinator of Elderly Programs in Allston-Brighton and is based on intensive contact and involve- ment with elderly in this area over a period of years. Much more could be added to the statement, but there are other elderly ad- vocates wiio will surely deal with the needs that have been omitted from my rather brief statement. I would be most interested in receiving from this committee a communica- tion regarding reactions to my proposals. Edith Stein, Coordinator of Elder Programs. Presented herewith are some of the problems that are facing the elders in the Allston-Brighton area of Boston, Massachusetts. What this statement shall do is to identify the problem and then suggest the solution both in terms of services and in terms of organized approaches to changes in environment. 1. Housing. — This is the major problem that is facing all section of our population, but it is particularly aggravated for the elderly who are forced to live on fixed incomes. Solution : Begin immediate construction of small housing units made of pre- fabricated parts that can be ready for occupancy within 4-5 months. Construct all units on small lots within greater communities so that elderly will not be socially isolated and with elderly on building committees wiio have had ex- perience visiting and observing construction needs. 2. Employment. — Implementation of legislation which will invalidate all exist- ing employment regulations which make it near to impossible for all persons over 65 years of age to continue gainful employment. (Review of unemployment compensation regulations and workmen's compensation laws.) Solution : All regulations forcing retirement because of age to be completely invalidated on the basis of discrimination. The immediate implementation of gradual retirement plans to be worked out with unions, employees committees in the labor committee with a view to continuing employment possibilities for each individual as long as possible. (Sociological investigations have shown 792 that the need of individuals for a functional relationship to society's function is of prime importance in the maintenance of physical and mental health.) 3. Fragmentation of Services. — In our community it has become more and more obvious that even where services are available many never reach those who need it most. Getting to the source of the service, getting to know where housing may be available, getting to know your welfare rights are all too frequently beyond those who are most deprived of education and social connections. Solution : Every major section of our urban centers to have a Senior Center where all life-giving services and functions may be housed and available under one roof— a structure that is central to every means of transportation in the area and which is staffed by people from the universities, colleges, churches and anti-poverty personnel — working together for this major purpose. Anything less is tokenism ! Andover, Mass., November 22, 1911. Hon. John Brademas, House of Representatives. Subject : Enabling the Retired Elderly to Keep their Homes. At least in Massachusetts, the chief expense which forces retired people to sell their homes is the property tax. This often amounts to one-quarter of total income. The property tax is a regressive tax, as some minimum quality of shelter is needed even for those with the lowest incomes, and too much more than this minimum is often regarded as ostentation and is avoided by those with high in- comes. Thus, the range of tax paid in a given community tends to be narrower than the range of income. An amelioration would be to seek another source of revenue to pay for public schools, which, incidentally, would make it possible to provide greater uniformity in quality of education. If the burden of education were taken off the property tax in Massachusetts, that tax could be reduced by more than one-half. A less desirable amelioration would be to institute a system of rebates to those who, through no fault of their own, find it difficult to pay the entire tax. This cate- gory should include not only the retired elderly, but also the incapacitated. Since shelter should not, according to experts in budget making, take more than 25% of income, it would be reasonable to assume that the property tax, the largest element in the cost of shelter, should not exceed 15% of income. It is therefore suggested that the elderly retired and the less elderly incapacitated persons be entitled to- rebates on their property taxes, such as to reduce the burden of the tax on each individual household to no more than 15% of the aggregate income, including social security, of all members of that household. The questions immediately arise as to how to pay for these rebates, and what the distribution of burden should be as among the various layers of government. One possible answer to the first question is to tax more heavily than is now done the unearned increment of real estate value. This suggests a transaction tax, of say 10 or 15%, on the profit obtained by the grantor on the sale of real estate. Real estate appreciates in value because of inflation, because of the increase in pop- ulation, because of migration of population, because of road and other improve- ments made by government, and because of improvements made by the owner himself. The cost of the last mentioned would, of course, be deductible from the profit obtained on sale. The other reasons for value appreciation have more to do with society and the economy in general than with the owner, and society in gen- eral should be entitled to a large share of the profit. Certain categories of real estate transactions should be exempt from the tax. If the grantor were a government agency, it would have to be exempt. And build- ers who buy land, develop it, and then sell should also be exempt, as that is their regular business, and they are fully subject to income tax on their business profits. Details with respect to gift or inheritance of real estate would have to be ironed out under the principle that the person benefited should be liable for any unearned increment eventually obtained by him in sale to an outsider. Whether or not an unearned increment tax is adopted, the fact remains that those who have had to retire from the world of business and live on a relatively fixed income need help in holding onto their homes in the face of a regressive property tax that increases year after year in burden. Raniel Pingree. 13 Statement bi Massachusetts House Speaker David M. Bartucs (D-Hoi Mr. Chairman and distinguished members of your Subcommittee's hearing con- cerning Comprehensive Social Services for the Aging : 11 Is my pleasure to pre enl the following material to you for your consideration. The material attached includes : 1. A compendium of Legislation for I lie elderly in lt)71 passed by the Massa- chusetts House of Representatives, those lulls enacted Into law during the 1973 session and laws assisting elders passed during the 1069 1!>70 General Courl of the Commonwealth. 2. Selected material gathered by a special subcommittee on Elder Affairs, chaired by myself, Representative Mary E. Fantasia (D-Somerville) and Repre- sentative David S. Liederman (D-Malden). I present this material to you, including the summaries of Massachusetts laws already enacted because I believe this Commonwealth has responsible social services for elder citizens high in its agenda. Massachusetts has taken major legislative steps forward for our elder citi- zens by providing home care services, hot lunch programs, whole estate abate- ments up to $45,000, increased grant allowances for transportation and leisure time, half-fare on the Massachusetts Bay Transit System and by establishing a cabinet office for Elder Affairs not recommended by the Governor of this Commonwealth. The General Court has taken these steps because it believes elderly citizens have served their society well and in their latter years should not be denied the necessities of life because their pension plans are destroyed by galloping inflation and a cultural fear of growing old which is resulting in the growing isolation of America's elderly. During the 1970 session former Senate President Maurice A. Donahue and I co-sponsored the law creating the cabinet office of Elder Affairs. With the assistance of Mr. Frank Manning then President of the Massachusetts Legislative Council for Older Americans we drafted the following declaration of policy by the General Court which serves as the guiding principles for the Secretary of Elder Affairs : "In keeping with the traditional American concept of the inherent dignity of the individual in our democratic society, the older people of our commonwealth are entitled to and it is the duty and responsibility of the government of the commonwealth and its political subdivisions to assist our older people to secure equal opportunity to the full and free enjoyment of the following objectives : 1. An adequate income in retirement in accordance with the American stand- ard of living. 2. The best possible physical and mental health which science can make avail- able and without regard to economic status. 3. Suitable housing, independently selected, designed and located with refer- ence to special needs and available at costs which older citizens can afford. 4. Full and restorative services for those who require institutional care. 5. Opportunity for employment with no discriminatory personnel practices because of age. 6. Retirement in health, honor, dignity after years of contribution to the economy. 7. Pursuit of meaningful activity within the widest range of civic, cultural and recreational opportunities. 8. Efficient community services which provide social assistance in a coordi- nated manner and which are readily available when needed. 9. Immediate benefit from proven research knowledge which can sustain and improve health and happiness. 10. Freedom, independence and the free exercise of individual initiative plan- ning and managing their own lives. 11. Meaningful assistance through grants to local councils on aging estab- lished under section eight B of chapter forty of the General Laws to encourage their development of programs to meet the problems of the aging. 12. To assist in carrying out the purposes set forth above, adequate establish- ment and funding of programs as a senior citizen service corps, nutrition and nutrition education, foster care services, and legal advocacy for the elderly. I believe this statement expresses that we in the Massachusetts General Court embrace and encourage Massachusetts elders as we together work out the pro- grams necessary to implement "Senior power." 794 Congressman Brademas, I know this is your goal. I commend you and the mem- bers of the Select Subcommittee on Education for your concern and support of the elderly of this country. The Commonwealth op Massachusetts, House of Representatives, State House, Boston. Enclosures. Elderly Legislation, 1971 passed by house H. 6321 : Increased state elderly housing bond authorization from $260 million to $410 million and assumed full debt servicing. The state will now pay for all projects up to $460 million dollars and will pay all the interest and mortgage payments to local authorities for elderly housing. H. 5441 now H. 6412 : Requires the Secretary of Elder Affairs to plan, develop and supervise the administration of programs providing social services for elderly and handicapped persons. The term "social services" includes but is not limited to meals, nutritional services, legal services, housekeeping services, group activity programs and individual counseling services. H. 6424: Increases the whole estate which an elderly person may have to qualify for real estate tax exemption from $30,000 to $40,000 dollars and if mar- ried the combined total estate from $35,000 to $45,000 dollars. H. 80 : Increased the stipend received by those participating in the Service Corps from $80.00 to $100.00 dollars per-month. NEW LAWS Ch. 698 of the Acts of 1971 : Establishes the Leisure Time Activities Allowance at $34.50 a month and the Transportation Allowance to anyone not in a nursing home or institution at $12.50 a month. Also, a sum of $15.00 monthly shall be paid to individuals receiving aid to the blind. Ch. 860 Acts of 1971 : Provides for the protection of consumers against care- less and erroneous billings. Ch. 131 Acts of 1971 : Requires that a mechanical device be maintained at a check-out counter or retail counter in order that customer may see the total of his purchase. Ch. 397 Acts of 1971 : Provides that the Director of Standards establish rules and regulations relative to heating oils to protect the consumer against any adulteration in this important commodity. ELDERLY LEGISLATION, 1969-1970 Ch. 703 Acts (1969) This act provides that the school committee of any city or town or any private school designated by the Department of Community Affairs may extend the school lunch period to serve lunches to needy elderly persons. The conditions and restrictions involved are : ( 1 ) The charge to such persons for each lunch shall not exceed fifty cents. (2) The lunches served shall meet the nutritional standards established by the Department of Education. Ch. 6 Resolves (1969) Under this resolve the Board of Education is authorized and directed to in- vestigate the feasibility of setting up a continuing program of education for the elderly throughout the state. Ch. 800 Acts (1969) This law provides program of medical care and assistance for certain older residents of the Commonwealth. The benefits will be available to all persons who are eligible for financial assistance under the provisions of this act and chapters 118 and 118A and 118D. Ch. 51 ^ Acts (1969) The Massachusetts Bay Transit Authority was directed by this act to charge half -fa re rates for persons who are sixty-five years of age and over and reside within the MBTA territory. 795 Oh. 16 Resolves (1970) The Department of Community AiTairs is directed by this resolve l<> conduct :i study relative to making the food distribution program of the federal government available to the elderly citizens of the Commonwealth. Ch. 15 Acts (1970) This act provides that the Department of Community Affairs shall encourage the formation of regional clubs or councils for the aging, commonly railed Golden Age Clubs, to serve the senior citizens in towns which do not, have such a club or council. Ch, 862 Acts (1970) The Executive Office of Elder Affairs was established by this act. The law was tiled by Senaate President Maurice A. Donahue and House Speaker David M. Bartley. The new department will include the services now run by the Aging Bureau of the Department of Community Affairs. These provisions will become effective on April 30, 1971. Ch. lJf Acts (1970) This act provides that a Senior Citizens Day will be observed annually on the first Sunday in October. Ch. 169 Acts (1970) The leisure time activities allowance under the Old Age and Disability laws was increased from $14.50 to $26.50 per month for approximately seventy-five thousand citizens throughout the state by this act. The reason for this increase was to offset the bite by the state on a federally mandated fifteen percent Social Security benefit increase. The actual result is a net increase in benefits for many thousands of older citizens. Ch. 359 Acts (1970) By this act the guarantee of the Commonwealth to Housing Authorities con- trolling elderly housing projects is increased from tw 7 o-hundred and ten million to two-hundred and sixty million dollars. Ch. 456 Acts (1970) An abatement of $4,000 on the assesed value of the home of an elderly person seventy years of age and over or three-hundred and fifty dollars in cash is pro- vided for by this act. The larger of these two figures is the one which will be chosen for the recipient. An estimated twenty-eight million dollars in taxes will be eliminated for the elderly by this act. Stipulations include : Property ownership : occupation for ten years in Massachusetts — $6,000 single or $7,000 married income limit in the year preceding abatement — whole estate, real and personal total not more than $30,000 single or $35,000 married. Notes on Hearing of Elder Affairs, November 10. 1971 Nutrition. — Steve Cohen/Staff of Kevin H. White, Mayor or Boston : The Speaker asked Mr. Cohen to explain again how the Dept. of Agriculture packaged the various food products (in quantities) for the elderly. Some of the people expressed their opinions of the large food orders such as 4 lbs. of butter, large cans of peas, 4 or 5 lbs. of rice and flour which is extremely too much for two people to use up in a week. They went on to explain that you are given 4 and 5 lbs. of canned meat such as turkey, chicken, chopped meat, etc. which is entirely too much for one or two people to consume without wasting food. They explained that so much of the food that is canned or packaged in such large quantities is wasted and thrown out. Food Stamps— Steve Cohen/Staff of Kevin H. White, Mayor of Boston : The issuance of food stamps seemed to be the solution to the problem for so many because it allows them to buy for their special diets and smaller food quantities, allows for a wider selection of food products and eliminates waste. Although we seem to have a State Welfare Department Agency, each town gives out a different amount of food to the people. The commodities differ accord- ing to the town or city dispensing them. The federal government only gives out food stamps once a month. Recently, the food stamps have been just about abolished. They have cut the food stamps allowed each person. Yet, the cost of food in the grocery stores continues to steadily rise. Consequently, the stamps are not serving much of purpose for the elderly. The majority of the people in 796 attendance seemed to be in favor of bringing the food stamps back into exist- ence. They are requesting legislation along these lines. The Speaker commented that a good administration will cure this problem rather than legislation. He also inserted that many states have not bothered to apply for the Federal assistance that could be had to help wieir people. Health . — Mrs. Ruth Robinson, Massachusetts Legislative Council of Older Americans : Suicides among the people over 65 are higher than the regular death (suicides) rate. The Boston City Hospital Clinic needs financial assistance to meet the medical needs of the elderly. Representative Fantasia suggested the mobile clinics for the disabled elders, if the elders are unable to come for med- ical services then bring the services to them. Mrs. Ellena Clark spoke on Medicaid and Medicare. She suggested combining the two programs as one to save time and money. She said that the elders are penalized if they work and make a certain amount of money. Medicaid or Medi- care steps in to say they will cut their benefits right away. She asking to be permitted to work, if able to, but not have their funds cut because they want to show some independence. Crime and the Elderly. — Oliver Rifle Council of Elders Incorporated of Bos- ton : Mr. Rifle testified before the U.S. Senate Committee in Washington regard- ing the need for Security Legislation for the elders. He said so many robberies are committed because of the lack of security for protection of property and possessions. The elders are taken advantage of when walking the streets espe- cially the older women. Who are knocked down, assaulted and hurt because the robbers seems to feel he has advantage over them. He feels some kind of security should be set-up for elderly housing to ward off would-be house breakers. Shermon Sass. — Social Services United Community Service of Boston : The elderly should be permitted to live as independently of any assistance as possible. They should be allowed to live in their own homes, apartments with a little supervision or assistance from the outside. Many people in nursing homes should be at home according to a recent survey of nursing home patients. With available support from the Federal Government and the State. Money spent to keep people in nursing homes should be reallocated to enable them to continue living more or less in the manner in which they have been accustomed rather than shut them out. Remarks of James Breagy, Associate Director, Citizens Housing and Plan- ning Association and Chairman, Housing, Task Force, Governor's Commis- sion on the Elderly Over the past nine months the Housing Task Force of the Governor's Com- mission on the Elderly has participated in a number of community conferences with elderly people in different parts of the Commonwealth and last July it made public its report and recommendations on the housing needs of the elderly in Massachusetts. What the Task Force reported and what it recommended should not be any- thing new to anyone who is concerned about housing needs in this state. Oniy two years ago a Legislative Subcommittee headed by Rep. David Liederman of Maiden undertook an intensive study of public housing and found that more than 14,000 elderly couples and individuals were on public housing waiting lists. That Subcommittee found that the average waiting time was eight years since there are so few units available and because the turnover rate is so low. The Task Force found approximately the same situation. Without going into all the figures, it is clear that out of some 300,000 households in the state in which the individual or household head is 65 years of age or older, 60,000 are in deficient units and 45,000 are paying too much of their fixed incomes for rent. So we must produce housing faster than we are doing it now, and rent sub- sidies must be provided by the Federal and State governments that will help elderly people to afford decent shelter. Just yesterday the two Houses of this Legislature concurred on a housing package which includes a considerable in- crease in bond authorization for elderly housing construction and takes the limit of funds to be appropriated in the future of our State Rental Assistance program. But it is clear that the State must take a stronger role than it has thus far if the elderly across Massachusetts are to be adequately housed in the foresee- able future. Right now out of 351 cities and towns in Massachusetts, there are 181 communities that have built or are in the process of building housing under the state elderiy program. Another 27 have built or are building through the Federal elderly programs. So there are about L40 communities In the Btate which have not built and are not In the process <>r building any housing for the elderly. While many elderly who have lived In single family homes for manj years do not consider themselves clients for subsidized housing, we must nevertheless in- crease elderly housing opportunities Tor those who desire them even in suburban and relatively rural communities. Most elderly who came to the Community ,- ""- ference ol' the Task Force were homeowners primarily concerned with lav relief. But many others would like to gel out from under heavy laves and all the work that comes with maintaining a house. One of the real tragedies in this situation are elderly people who have lived in a community all their lives or most, of their lives, and hud that when they retire they can no Longer afford to slay there. It should be the responsibility of local communities to provide adequate local housing opportunities for these people rather than have them seek housing in another town. The state should assume a strong posture in assuring that they do so. Thus the primary state recommendation of the Task Force was that a State instrumentality have the power to build elderly housing in communities which refuse to do it on their own. The elderly in the State are dependent on local initiative to do this. It is encouraging to note that since the passage of the anti- snob zoning law in 1969, that the number of local housing authorities has in- creased from 161 to approximately 210. So many towns are now beginning to face up to this responsibility. But it is questionable wiiether local housing authorities will act with deliberate speed given the needed local approvals to acquire and use land for construction. The Task Force feels that an existing State Agency or a newly-created one should set goals for regions and localities to meet their elderly housing needs and have the necessary powers to move in and do the job if it comes to that. We feel that this is a policy that the new Secretaries for Elderly Affairs and Communities and Development can develop together. The Task Force also feels that the State should do all that it can to encourage the use of Turnkey or any other methods of housing production that will serve to reduce the time it takes to build housing for the elderly. In this legislative ses- sion two bills would have helped considerably in production — the statewide per- formance building code and the systems method of housing construction. It ap- pears now that both will not be passed this year. Last year we gave local com- munities permission to join together and form regional housing authorities. This can be a very helpful approach in suburban and rural areas and we hope the Department of Community Affairs will do all it can to bring these new arrange- ments about. That was the major thrust of the Task Force — stronger state power. The other recommendations are fairly familiar to people w r ho have worked with the legis- lative housing packages last year and in this session. They seek, seed money for non-profits, tax incentives for communities to build housing. The recommenda- tions are weighed heavily on the side of low-income elderly renters rather than elderly homeowners. We felt that this is where the more serious problems lie. Nevertheless, the Task Force did address the question of tax relief to allow elderly homeowners to live in their homes without carrying heavy financial bur- dens. Again, this does nothing about the housing shortage in Massachusetts. The Task Force recommended a decrease in property taxes through abatements as well as a decrease on state income taxes for edlerly renters. It also suggested the State investigate the feasibility of compensating elderly people with a housing allow- ance according to their income with the Federal government ultimately taking responsibility for it in a few years. The Task Force urges the Legislature to address itself to these questions in the next session keeping in mind that elderly housing problems must be seen within the larger context of the housing problems of all low and moderate-income people and the overall housing shortage facing the Commonwealth. Statement of the City of Boston Before Special Hearing on Problems of the Elderly, November 10, 1971, Presented by Steven P. Cohen, Mayor's Staff With the cooperation of the Ford Motor Company, United States Department of Agriculture, and Massachusetts Department of Public Welfare, the City of Boston is running a pilot program to deliver surplus food allotments to some elder- 798 ly, blind or disabled people. Two small vans are used to transport food allotments from distribution centers to recipients who are unable to pick up the food themselves. A very substantial number of elderly persons simply cannot handle the heavy, bulky packages of surplus food they are offered. Unless it is delivered to their homes, they have no way of taking advantage of the food program. Distribution centers are not located close enough for convenient food pick-up. The answer does not seem to be a distribution center on every street corner, but rather a service that brings food to people who cannot get it for themselves. Boston's program operates in the South End and Allston-Brighton. The pro- gram has been kept small, serving some two hundred fifty households each month, because the City is running it as a pilot demonstration project. The City should not be in the food delivery business. Delivery of surplus food is a logical constituent part of the Commonwealth's overall food assistance program. If the Commonwealth intends to run a program that provides benefits to all eligible needy people, particularly senior citizens, delivery is a necessary component. For many of the older recipients of food deliveries, the delivery itself provides a link with the outside world from which so many senior citizens feel isolated. Surplus food is not a panacea for the nutrition problems of older people. Many of the commodities offered cannot be used by people who must restrict their intake of fats or salt. The food is often packaged illogically : cheese is provided to distribution centers in five-pound blocks even though it is alloted to recipients in tw T o-pound increments. Some canned goods contain too large a portion to be used at one time by a person living alone. Even so, surplus food is a form of aid available now to supplement the food sup- ply of low income persons. It is the rightful job of the Commonwealth to make this assistance available to all needy eligible persons, particularly through delivery to homebound elderly recipients. Testimony of Robert Morris, Director, and Associate Sandra Howell, Levinson Gerontological Policy Institute, The Florence Heller Graduate School for Advanced Studies in Social Welfare, Brandeis University, Waltham, Massachusetts SUMMARY Comprehensive services for the aged, blind and disabled are a seriously ne- glected dimension of the current debate about health services financing and income maintenance. Both Medicare and Medicaid have important deficiencies in their approach to financing care for the severely disabled. Other federal programs pro- vide only token financing for services. Present proposals for national health in- surance, further, are conspicuous in their failure to deal with long-term care. Several principles and objectives for federal legislative action to address the personal care aspect of long-term care are submitted for consideration of the Committee. In addition, legislative strategies that would stimulate the develop- ment of comprehensive, relatively inexpensive helping services that would address the personal care needs of the severely disabled living in the community are outlined. As an initial measure, it is recommended that: (1) a study of the service requirements of the chronically ill, such as that called for in the Kennedy- Griffiths Bill, be authorized and undertaken immediately; and (2) legislative authorization be provided the Social Security Administration to use some por- tion of Medicare and Social Security trust funds for experimentation in alter- native ways of delivering comprehensive services. INTRODUCTION An important and seriously neglected dimension in the present debate about the financing of services for the aged, especially health services, is that of long- term care of the chronically ill. The intent of this statement is to outline the scope of the problem and the limitations of present federal programs in ad- dressing it, to examine current legislative proposals for their implications for the long-term care problem, and to suggest some principles and possible strate- gies for federal legislation concerning the organization and financing of long- term care. 799 THE SCOPE OF ["HE LONG-TERM CASE PROBLEM Approximate^ sis million adults presently suffer from chronic dJ • i such an extent thai thej are unable to carry oul their major activity, an verely restricted In their mobility, and are highly limited In their abilil care for themselves. A small majoritj of these persons are over 66 years of age, but nearly as many are aged L8 c.i years, only a minority perhaps 20 25 per cent are presently eared for in aursing homes or in other Long-term care Institu- tions. These estimates of the prevalence of severe disability would be consider- ably larger if they included those whose disabilities were solely attributable to meiual illness or mental retardation. Care of the severely disabled Ls already B considerable COSt to the public. In 1970, for example, public expenditures for aursing home care amounted to nearly $1.8 billion. Long-term care, further, is a problem which can be expected to grow In magni- tude. Population projections for the next decade indicate that substantial growth can be expected in the very old population. It is in this age group that severe disabiliu conditions for which care is required are most likely to occur. Possible breakthrough in the treatment of cancer, stroke, and heart disease would only add to the problem. By sustaining the lives of persons suffering from chronic diseases, these advances in medical care would prolong the period in winch the disabled were dependent on others for care. LIMITATIONS OF MEDICARE AND MEDICAID Consistent with its legislative intent to address only acute illness and its immediate consequences, Medicare provides only a limited basis for financing long-term care. Most important for the chronically ill is Medicare coverage of the costs of 100 days of nursing home care following hospitalization for treat- ment of an acute illness. Less use has been made of Medicare's provision of payment for a limited number of units of home health care. Because of the imple- mentation of administrative measures to exclude chronically ill persons whose primary need is for custodial care, Medicare is presently playing a declining role in financing long-term care. Medicare's bias in favor of institutional care of the chronically ill is note- worthy. When care is provided in a nursing home, Medicare is a source of payment not only for direct medical services but also for social costs of room, board, laundry, and other personal services. When the chronically ill person seeks care outside an institution, Medicare finances only more narrowly de- fined medical services. The costs of social services which may be required to maintain the disabled person outside of an institution are not covered. In a number of states, Medicaid has assumed a major role in financing long- term care in nursing homes and intermediary care facilities. In Massachusetts, for example, Medicaid presently finances care in licensed nursing homes for approximately 20,000 persons at an annual cost to the public of $100 million. A number of serious limitations are apparent in Medicaid as a vehicle for financing long-term care. Some states, of course, choose not to use Medicaid to finance long-term care or do so at such a low reimbursement rate that care of adequate quality cannot be purchased. Because Medicaid is limited to the poor and near- poor, chronically ill persons must suffer the indignity of depleting their personal resources before they become eligible for Medicaid benefits. Medicaid patients are often placed in facilities offering more sophisticated care than required at excessive costs to the public. At the same time, the program has lacked adminis- trative controls required to assure adequate quality of care. Further, Medicaid is also biased in favor of institutional care. At present, it is much easier to use the program to finance care in an institution than to finance equivalent services at comparable or lower costs outside an institution. Medicaid often confronts families of the disabled with a cruel dilemma. Families of the disabled can either make enormous sacrifices to provide care in their own homes or they can "aban- don" the disabled person in calling upon the public to finance care in an institution. LIMITATIONS OF OTHER FEDERAL PROGRAMS Other relevant federal programs are concentrated in the Social and Rehabili- tation Service Administration of HEW, including Old Age Assistance and the special grants of the Administration on Aging. An additional federal resource is the Office of Economic Opportunity. The categorical program of Old Age Assist- ance is primarily devoted to providing a minimal subsistence for older persons 800 lacking other sources of income. The efforts to stimulate programs of social serv- ices through public assistance have in the past been under-funded, and these limited funds have almost uniformly been directed towards supplementary health and casework services for children and families with small children. Sporadic efforts through Public Assistance to address service needs of older recipients have ended up in facilitating transfer of these recipients into nursing homes where there is any limitation in their ability to care for themselves. The Administration on Aging has had available to it marginal sums to ad- dress the whole spectrum of needs of the elderly. These sums have neither been sufficient, given the size of the elderly population, nor has the concentration of these limited resources been within the effective control of the Administration. A significant part of the Administration's funds are allocated by state units, each of which determines its own priority, and few of which have been directed pri- marily at the development of comprehensive services. Where Administration funds have been used for this purpose, the funds have been inadequate for im- pact, with the result that under-funded state programs for the aging have sought to persuade voluntary agencies and other state agencies to deliver necessary services, each in the context of their separate authorities. The result has been that funds of such other organizations have not been diverted to the needs of the elderly, and effective coordination of partial and incomplete services has not been sufficient to overcome the service deficiencies which exist in every commu- nity. The insubstantiality of the present AoA program as regards comprehensive services is seen in the level of services funded — not more than $1.00 per year per older person is available through AoA sources. The Office of Economic Opportunity suffers from the same limitations as the AoA — insufficient funding and insufficient authority. One of its creative and sig- nificant programs, Foster Grandparents, cannot satisfactorily answer the need for comprehensive services for reasons which are inherent in any voluntary programs, although the Foster Grandparents program does introduce a way of increasing the quasi-voluntary contribution of the elderly within a more compre- hensive package. In like fashion, the OEO funds to support activities of com- munity action groups has improved the level of citizen understanding about the needs of the elderly in many communities, but has not provided either the means nor the framework for delivery of tangible and meaningful services to the elderly requiring such services. The Department of Housing and Urban Development is by legislative sanction concerned with the provision of physical facilities and, except for the Model Cities Program, has little authority to develop and support direct services. The Model Cities Program has in a few places had an impact on local services delivery comparable to that of OEO. The Department of Labor has recently been drawn into the development of special training for some of the elderly, but their mission is primarily concerned with the return of some elderly to the labor force, and does not concern itself with the developemnt of nor the organization of comprehensive services. LEGISLATIVE PROPOSALS Of the current legislative proposals for national health insurance, the Kennedy- Griffiths Bill comes closest to addressing the long-term care issue. It would finance care in skilled nursing homes and extended care facilities for up to 120 days for the entire population without deductibles and without prior hospitaliza- tion. The authors of the bill recognize their failure to address the problems of those whose chronic conditions primarily require less sophisticated care. They call for a two-year study to formulate a legislative proposal for organizing and financing the social services needed by the chronically ill. The bill would leave Medicaid, at least temporarily, as the primary vehicle for public financing of long-term care. The Administration bill, the National Health Insurance Partnership Act, would have little or no effect on long-term care. The bill does not concern itself with the over-65 population in which chronic disease problems are concentrated. Fur- ther, its coverage would be primarily for the treatment of acute illness and would offer only limited protection against costs of extended care. Other bills for financing health care need not be reviewed here because they do not pretend to address the long-term care issue. In general, they would leave public responsibility for financing long-term care with Medicare and Medicaid. Of considerable importance for long-term care are the provisions of H.R. 1,' which would federalize public assistance for the aged, blind, and disabled and SOI extend Medicare coverage bo bhe disabled. What is qoI clear La whether re pon l« bdlity for financing Long-term care beyond Medicare for the Beverely disabled Indigent would remain with the slates or would be assumed by the federal government Primary discussion about, services, in the context of H.R. I, has been Limited to a more efficient use of the public assistance funds currently Identified .1 di- rected towards social services. These sums have been used primarily for s ■ ■ ***