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PUBLIC
HEALTH

“STATES

A Report of

Progress «Concerns Goals

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UNIVERSITY OF

 

WHITE HOUSE CONFERENCE ON AGING
Washington, D.C.
January 1961

 
White House Conference on Aging

The Hon. ARTHUR S. FLEMMING «ooo Secretary,
U.S. Department of Health, Education, and Welfare

The Hon. BERTHA S. ADKINS __ ooo Under Secretary,
U.S. Department of Health, Education, and Welfare

The Hon. RoperTr W. KEAN vce mm mmm Chairman,
National Advisory Committee, White House Conference on Aging

Planning Committee Chairmen

of the
National Advisory Committee

Joun E. AnpersoN, Ph. D. Haroin B. Jones, Ph. D.
Josep P. ANDERSON LroNnarp W. Larson, M.D.
Epwarp W. Bussp, M.D. Roserr H. MacRAR
Brevarp CRIHFIELD Joun B. MARTIN
George E. Davis, Ph. D. Warter C. NELSON
Winma Donanug, Ph. D. Josep PRENDERGAST, LL.D.
Right Rev. Msgr. R. J. Garra- Howaro A. Rusk, M.D.

GHER DwieHT S. SARGENT
Harry G. HasgeLL, JT. CuArLES I. SCHOTTLAND
G. WarrieLp Hoses Rabbi Marc H. TANENBAUM
Viora HyMmEs Wirniam J. ViLeauvme, D.D.

MarGarer A. IRELAND
Jaymes Warr, M.D., Special Assistant
on Aging to the Secretary
Ropert H. GRANT, Director,
Special Staff on Aging

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AGING IN THE STATES

A REPORT OF
PROGRESS + CONCERNS + GOALS

 

 

 
The views in this report do not necessarily represent the official
position of the Federal Government.
Published January 1961

 

For sale by the Superintendent of Documents, U.S. Government Printing Office
Washington 25, D.C. — Price 60 cents

a
PUBLIC

MEALTH

Contents Lisaany
Chapter Page
I. The Conference Across the Nation____________________ 1
II. Aging in an Industrial Civilization____________________ 15
III. The Fifties: A Decade of Exploration. ________________ 51
IV. 1960: Year of Inventory. ____________________________ 85
V. New Goals and Directions ___________ etree mmm merge 119
VI. Age With a Future. _________________________________ 161

233

1X

 
Foreword

Aging in the States: A Report of Progress » Concerns * Goals
is a summary of the emerging needs of our older population and the
necessary blueprints for action as seen in the States.

We are deeply grateful to the National Advisory Committee which
was established to assist in planning and conducting the White House
Conference and to the Governors and their citizen planning com-
mittees who have participated in Conference preparations and con-
tributed so greatly for the enrichment of the added years.

Ue Ad

ArrHUR S. FLEMMING,
Secretary,
U.S. Department of Health, Education, and Welfare.

 
COMMITTEE ON PUBLICATIONS AND STUDIES
OF THE
NATIONAL ADVISORY COMMITTEE

JOSEPH P. ANDERSON, Chairman

EDWARD BoORTZ, M.D.
VioLA HYMES

GRACE SCHELL

KARL SCHLOTTERBECK
GRACE STEVENSON
LUCILLE WILKINS
Preface

The White House Conference on Aging represents a 2-year coop-
erative effort on the part of government, organizations, and citizens.
In accordance with the law passed by the Congress in the fall of
1958, and upon invitation of the Secretary of Health, Education, and
Welfare, the Governors of 53 States and territories established citizen
committees to study the need of older people, inventory the resources
serving them, and recommend suitable goals for action designed to
create a climate for health and satisfying later years. The 50 States
and 3 territories focused on these objectives through intensive fact-
finding, scores of county and regional meetings, and statewide con-
ferences in searching committee deliberations. Their efforts resulted
in comprehensive analyses of needs and far-reaching plans for action.
These contributions have been summarized in this report to give a
picture of aging across the Nation.

This summary report was prepared under the aegis of the Commit-
tee on Publications and Studies of which Mr. Joseph P. Anderson is
Chairman. The Committee on Publications and Studies is a subcom-
mittee of the National Advisory Committee.

The report was compiled by Mr. Clark Tibbitts, Chief, Program
Planning, Special Staff on Aging; Mrs. Katharine D. Pringle; Mr.
Taft Feiman; Dr. William T. Van Orman; and Miss Amelia Wahl
with the able assistance of the Technical Directors and Regional
Representatives for the White House Conference.

The National Advisory Committee for the White House Confer-
ence on Aging expresses its gratitude to the local, State, and terri-
torial committees and to all the citizens who contributed to this report.
Without their interest, participation and contribution, this report
and the White House Conference would not have been possible.

Roeerr W. Kran, Chairman,
National Advisory Committee for the
1961 White House Conference on Aging.

 
Chapter I

THE CONFERENCE ACROSS THE NATION

During the past 2 years, 1959 and 1960, Americans had the oppor-
tunity to demonstrate the flexibility, ingenuity, and enthusiastic vigor
characteristic of the democratic process in meeting social challenge
and solving national problems.

The problem was to develop a blueprint, an action program to meet
the needs of the older population. The challenge was plainly visible
as year by year in the past score of years the total population of those
over 65 rapidly accelerated until today there are some 16 million
elderly persons in the United States, with a prospect of more than 20
million by 1970. The need for a coordinated, well-balanced national
program had become increasingly apparent with each surge of popu-
lation.

“There has been a great deal of talk about aging and what we need
now is action”, stated Representative John E. Fogarty of Rhode
Island on January 8, 1958, when he introduced the bill which became
the White House Conference on Aging Act about 8 months later.

Congressman Fogarty’s remarks outlined the objectives for such a
conference. He felt strongly that the time had come to provide
“leadership or direction to the problems of aging commensurate with
the urgency of the situation.” Such a conference would serve to em-
phasize the problems of aging and their importance, and it would also
serve to stimulate the interest and the participation of the people
throughout the country * * * specialists as well as those who had a
personal, vital interest in aging. The product, he hoped, would be an
imaginative, practical program for the Nation’s elderly citizens.

The act, which Congress hoped would generate activity at all levels,
invited each State to collect facts about its older population, inventory
its present resources and facilities, locate and identify through analy-
sis of the facts where services to the elderly were adequate and where
there were gaps. In addition to its factual reports, each State was to
develop recommendations for new approaches and programs and these
were to provide a basis for discussion and consideration at the White
House Conference. Federal grants were made available to the States
to assist them in organizing their activities as part of the Federal
policy to work jointly with States and their citizens toward a common
goal.

 
THE TECHNIQUES OF ORGANIZATION

The manifold individual and societal aspects of aging, the breadth
and depth of the required stocktaking effort at community, county,
and State levels, indubitably required employment of sound organiza-
tional principles and techniques which in themselves were crucial to
the success of the problem-solving task.

Although the patterns for participation were broadly staged within
the backdrop of the Conference Act and the covenant of principles
implied in Congressman Fogarty’s remarks, the variations within the
pattern were as uneven and different as the pieces of a mosaic, as
widely different as the topography of the Nation itself. The ingred-
jents in each piece of the organizational mosaic were the same, yet
each piece had its own unique shape and form, which with its con-
tiguous pieces contributed to the unity of the whole—a plan for action.

The First Ingredient—State Commissions

What were these ingredients, these basic elements of organization ?
Each of the States established an interdisciplinary council committee
or commission on aging and included broad representation from the
public. These commissions, ranging in size from less than a dozen per-
sons to several hundred, generally were assigned the responsibility
for a State’s preparation for the White House Conference. In about
20 of the States, commissions on aging had been established prior to
the call for the Conference. Minnesota, Illinois, Michigan, Cali-
fornia, Indiana, North Carolina, Oregon, Massachusetts, Connecticut,
New York, and Kentucky are a few of the States where ongoing
organizations in aging were centered at the State level.

Where continuing organizational machinery already existed, the
States had a distinct advantage in being able to assign a knowledge-
able and experienced cadre of professional and lay citizen experts
to develop the State’s activities for the White House Conference.
Or, as was true in some of the States, such as Rhode Island, these
cadres were named to assist and advise the citizen commissions desig-
nated by the Governors to assume that responsibility. Or as in
Connecticut, advisory committees were designated as resources and
working groups through which established commissions on aging
could carry out the preparations for the national meeting.

On most of these commissions, whether permanent or those set up
specifically to carry out the State’s mission for the White Ilouse
Conference, could be found citizens from every walk of life—a broad
spectrum of American life—citizens of different vocations and oc-
cupations, citizens representing the geographic regions in which they
lived, or representing the voluntary agency in which they served or
the interests of the professions which they practiced. In all States,
emphasis was placed on obtaining as broad representation as possible.
In Wyoming, as one example, any citizen, interested in working on
the studies of aging, was invited to be a member of the Governor’s
Committee.

The Second Ingredient—Subcommittees

Most of the States employed the specialized subject-matter sub-
committee or workgroup approach in getting, developing, and inter-
preting the facts about the various aspects of aging in their States.
Usually, the subcommittees evolved from the roster of the advisory
committee itself, as was the case in Massachusetts, where the 14 sub-
committees conducted the workshops from which the recommenda-
tions to the State conference were developed. There was no fixed
number of subcommittees each State used nor was the role assigned
to them exactly the same. The special subcommittees often were en-
hanced by professional consultants. In Connecticut, for example,
the seven subcommittees developed situation papers which provided
background information and suggested recommendations for the con-
sideration of the State conference participants. In other cases the
subcommittees reviewed the work of other groups and formulated
the State’s recommendations.

In Arizona, the 96 members of the Governor’s Committee on Aging
were assigned to subcommittees and a 27-member advisory committee.
The subcommittees conducted two regional institutes to obtain the
facts and the opinions at local levels. Later, the subcommittees and
the advisory group constituted the State conference and developed its
recommendations. Other subject-matter subcommittees in other
States conducted local hearings in pursuing their studies.

The Third Ingredient—Interdepartmental Resources

There was hardly a State that did not tap the reservoir of knowl-
edge, professional and technical know-how, and information already
available in its own departments of State government. The usual
technique was to designate an interdepartmental committee as an ad-
visory group to assist the citizen-based commissions on aging.

In Pennsylvania, for example, the Secretary of the Department of
Public Welfare served in a dual role of chairman for both the Gov-
ernor’s Committee on Aging and the Departmental Resources Com-
mittee set up to assist it. Commissioners of New York State depart-
ments with responsibilities in the field of aging were named to its
interdepartmental committee. In Wisconsin, the interdepartmental
committee was assigned the major role in organizing the State’s
activities for the White House Conference.

 
The Fourth Ingredient—Steering Committees

Some of the States found it administratively practical to coordinate
the commission subcommittees through a specially selected steering
committee, usually made up of persons from the committee or commis-
sion. Rhode Island and Utah used such an organizational device
which coordinated the work of planning groups with those carrying
on studies and hearings. In New York, the steering committees
operated at the regional level.

Regional Committees

Hundreds of local, county, and regional meetings were stimulated
into action by the preparations for the White House Conference.

At least 85 of the States were known to have held regional confer-
ences. Regional organizations were established in some and in others,
the State commissions or subcommittees developed regional activity
under their own aegis.

Nine special study committees appointed by the Virginia Commit-
tee for the White House Conference on Aging centered their fact-and-
opinion-gathering mission at six regional meetings, and the Florida
approach was similar. The Indiana Commission on Aging, estab-
lished in 1955, used its six regions for program and organizational
purposes. Regional committees were named by the new Michigan
Commission on Aging for the State’s 11 regions, and the regional
conferees reviewed the recommendations that flowed upward from the
county meetings. The mayors and county judges in Tennessee were
asked by their Governor to appoint 5 to 10 delegates, representing a
cross-section of local groups, to seven regional committees.

The regional technique was used broadly in most of the States,
with but rare exception in the Midwestern and Rocky Mountain
States. Montana’s experience in this area of organization is note-
worthy. The initial State committee enlarged and expanded itself
after it experienced difficulties in getting together for meetings be-
cause of climate, distances, and terrain. It then organized county
subcommittees and assigned the factfinding mission to them. Forty
of the State’s 56 counties were thus brought into direct activity and
to assure continuity of interest the committee held six regional confer-
ences to weigh the facts and opinions produced by these organizations.
In Colorado, six district meetings were held and the districts then
sent delegates to the State conference.

On the Pacific coast, Washington, where 74 individuals from the
State’s geographic regions were named to the Governor’s council, a
regional conference committee was also established, which with
cooperating local and community groups set up four regional
meetings.
County-Community Meetings

As important as the regional conferences were in obtaining a cross-
section of public opinion, the needs of the elderly citizen and his opin-
ions were perhaps best obtained at the grassroots level—from the
tewns, cities, and counties. At least 677 of these meetings were held
but it is known too that there were considerably more—no one had
enumerated them or those who participated. At least 26 States used
one or more types of direct grassroots approach.

Some of the States generated activity in aging at all three levels—
State, regional or district, and county or community. Illinois is a
good example of this. In this State at least 98 counties set up organ-
izations and were represented at 6 regional conferences as well as the
State conference. Maryland followed a period of intensive local ac-
tivity, holding seven local conferences and five regional, in which
thousands of persons participated.

The regional meetings were unnecessary because of the small area
of some States or perhaps because some had already developed strong
county-state organizational relationships. Pennsylvania focused its
activity at the county level. It possessed a large complex of local
organizations, official and voluntary, already engaged in services and
programs for the elderly. This organizational readiness permitted the
State to hold a preliminary statewide meeting to plan the activities
for the State’s counties. The Governor appointed chairmen for the
60 county committees that were organized for White House Confer-
ence activity. Pennsylvania provided several interlocking devices to
strengthen State-county ties in this work. Not only was the chair-
man of the Governor’s committee head of the departmental resources
committee, but each member of the latter was an ex officio vice chair-
man on the Governor’s committee. County chairmen also were named
to the Governor’s committee and, in turn, members of the statewide
committee or subject-matter subcommittees were automatically con-
sidered members of the committees of the counties in which they
resided. More than 9,000 persons attended the county conferences in
this State.

Texas, despite its vast size, also centered its attention at the grass-
roots. Here, as in Tennessee, the county judge played a key organiz-
ing role. In Tennessee, this role was to select the delegates from the
communities for the regional meetings. In Texas, the county judges
saw to it that county committees were formed, established, and went
to work. More than 100 county committee meetings were held by the
220 county committees established in this way. Many of the counties
combined their meetings. More than 200 of the counties completed
the survey work requested by the Texas Advisory Committee.

Instead of county judges, the State of Oklahoma called on its

 
mayors and supervisory county officials to establish the local councils
on aging. In all, 31 mayor's committees and 77 rural committees on
aging were organized, and the facts and opinions they developed were
reviewed at five regional conferences prior to the State meeting. In
New Mexico, 29 of the State’s 33 counties produced county commit-
tees, and 3 of the remaining 4 asked for guidance in establishing such
committees after the Governor's conference was held. White House
Conference activity in Louisiana was marked by sessions of 70 mayor’s
committees, most of them existing or about to be formed because in
1958 the Touisiana legislature permitted the parishes and municipal-
ities to establish advisory committees on aging.

All of South Carolina's 46 counties organized committees on aging.
These groups sponsored the local meetings and supplied the man-
power needed by the State committee for its statewide survey. To ac-
quaint these volunteers with the survey form and its uses, 9 regional
meetings were held. Georgia's 83 county committtees on aging par-
ticipated by collecting facts and submitting extensive factfinding re-
ports and opinions on each major area of interest to the Governor's
Commission on Aging. In Alabama, 43 county committees held meet-
ings and developed facts and sought opinions.

Among the most intensive local campaigns were those launched in
Ohio and North Carolina. In the latter, 100 county coordinating
committees on aging supplied the data requested and required by the
eight subject-matter State subcommittees. More than 70 county work-
shops were held, and some county committees held them jointly with
others. The Governor's Coordinating Committee on Aging and mem-
bers of its subcommittees served as resource persons, speakers, modera-
tors at these workshop sessions. Representatives from civic, fraternal,
church and social service groups, and interested citizens, professional
and lay, including many elderly persons, spoke out at these work-
shop meetings. Leaders of the county conferences represented them at
the Governor’s conference. In Ohio, the State Commission on Aging
appointed a county representative for each of the 88 counties. Asa
result 60 county meetings were held.

On the other side of the country, activity was highlighted by the
participation of more than 10,000 citizens in California. Most of these
were active in town or county committees on aging and in the studies
that they independently initiated at the request of the Governor.

The town, county meetings were productive in the way that those
who planned the White ITouse Conference had hoped. They had
brought the problems of aging into the farms and ranches of Amer-
ica, into the streets and homes and clubs and organizations of villages,
towns and the great cities. They came to these meetings, some with
technical and professional knowledge, others with just a “strong feel-
ing” that something must be done about the Nation’s elderly. They

6
discussed the complexities of rising medical living costs and the impact
of inflation, the need for new designs of architecture, educational
programs and recreational services, and preretirement policies.
Sometimes, the language they spoke was not that of the technician
or the professional, but, as in the case of one Wyoming lady, it
poignantly made her point so that it developed into a recommenda-
tion. Yes, she explained, she liked and missed very much going to
church on Sunday. Her neighbors discussed this with a local service
organization and transportation to and from church was offered, but,
alas, she said, it was not to much avail for when she got there she
discovered she couldn’t negotiate the “blasted steps.”

Every State had available to it the same ingredients of organiza-
tion—the advisory councils or commissions representing as broadly as
possible the population of the State, the statewide subcommittees or
subject-matter subcommittees, the regional organizations, the county
committees, the town councils, the steering committees, and the inter-
departmental resources groups. Yet no State mixed these ingredients
in exactly the same way. The role of each ingredient in the State
organization varied not only in the responsibility assigned to it but in
function as well. But this mosaic of organization accomplished what
it was supposed to do. It took stock of resources and needs and
analyzed its inventories and opinions, it produced volumes of dis-
cussion material which will be the base for discussion at the national
meeting, and it provided a base so that progress against the challenge
of the problems confronting the Nation’s senior citizens can be
measured.

THE FORCES FOR FACTFINDING

Less eloquent but more important was the army of manpower that
emerged from these local and regional meetings, manpower that
learned how to interview, complete survey forms, do the footwork and
clerical work and all the other routines needed to get at the facts,
sample the opinions, tabulate and code, and complete the State surveys
so that wise and efficient program planning to close the gaps and de-
velop new programs could begin.

The State Surveys, Local Studies

In State after State, those who conducted the surveys drew heavily
upon data obtained from many State agencies conducting programs
for older people, from community organizations and local operating
agencies, or colleges and universities. Each State was free to go
about surveying conditions and needs in its own way just as it was in
setting up its organizations. Although many relied heavily on a
“Guide for State Surveys on Aging” prepared especially to assist them

7

 
by the Staff for the White House Conference on Aging of the U.S.
Department of Health, Education, and Welfare, many States de-
veloped their own manuals or guides for use by their county or local
committees.

In Maine, a private research firm conducted the detailed survey of
the aging in that State. In New Hampshire, the representatives from
more than 200 voluntary organizations submitted written suggestions
and statements on unmet needs at four statewide meetings held spe-
cifically for conducting this informal type of survey. This tech-
nique was also extended to the State’s 10 county committees. In
neighboring Vermont, the Vermont Medical Society undertook a sur-
vey of elderly patients seen by the State’s physicians during a given
month, the AFL-CIO sent out to its member unions a questionnaire
dealing with employment and retirement, and a survey of retirement
and employment practices was made by the Associated Industries of
Vermont. Thus, in three adjoining States, the approach to factfind-
ing was different, yet each method yielded important facts and in-
formation.

In addition to up-dating a previous-statewide survey, Rhode Ts-
land in cooperation with several organizations, conducted several spe-
cial research studies. Brown University was concerned with dis-
placement and relocation problems of 150 elderly roomers affected by
the construction of a freeway. Dental and oral health needs were sub-
mitted to a random sample study conducted by the State’s medical
society. The Providence District Nursing Association studied the
nutritional needs of selected homebound patients over 65. A house-
to-house canvass, utilizing the questionnaire and interview technique,
was made of the entire population over 65 in Jamestown, and Brown
University undertook special economic studies concerning employment
and retirement practices.

Two field surveys were conducted in Wisconsin. One, a survey of
“living patterns” embraced the study of persons over 65 in 16 rural
Wisconsin towns and was made by one of the State’s subject-matter
committees with the aid of the branches of the American Association
of University Women, clergymen of various communities, and one
local business and professional women’s club. Emphasis was placed
on personal interviews with the elderly themselves. The second field
survey went into the problem of public library services to the aging.
Questionnaires were distributed to all Wisconsin libraries by a com-
mittee of the Wisconsin Library Association.

Tllinois used its 101 county departments of public aid and their
respective welfare services committees to conduct a statewide in-
ventory of the needs of older residents, existing services and desirable
improvements in programs for the aging. Organizations and founda-
tions throughout the State produced information about their activi-

8
ties with older people and gave their suggestions and recommendations
regarding inadequacies in services and facilities. In Nebraska, the
State’s physicians conducted a survey of elderly patients.

The colleges and universities of the States west of the Mississippi,
were the nucleus for many of their surveys and studies. Approxi-
mately 1,700 persons over 65 were interviewed by volunteer inter-
viewers in Minnesota to find out the conditions of the population in
health, income, housing, employment and adjustment to retirement,
and free-time activities. The sociology departments of the University
of Minnesota analyzed the data, interpreted the findings and wrote
the report. The Minnesota AAUW conducted the interviews and
most of the coding work was performed by members of the retired
teachers association.

The University of Missouri conducted the survey of 1,700 elderly
citizens in that State and analyzed and interpreted the data. The
North Dakota Agricultural College performed the same role for its
survey of 1,000 senior citizens. The sociology department of the
University of South Dakota conducted the statewide survey in that
State. In Iowa, the survey was carried out in 13 urban and rural
counties in which 1,400 Iowans over 60 were interviewed. The Towa
State University statistical department performed the sampling and
the Institute of Gerontology of the State University of Iowa analyzed
and interpreted the findings. In Kansas, a survey entitled “Our
Senior Citizens,” was the work of the University of Wichita.

The targets of studies and surveys ranged from the problems of
relocation caused by urban redevelopment to the complexities of the
problems caused by inflation on fixed retirement incomes. In nearly
all cases, response to the seekers for information was enthusiastic and
informative.

DESIGNS FOR DECISION

The climax for the pre-Conference activity in all the States was
the State or the Governor’s conference. Usually these required one
day for discussion in subject-matter committees or workshops and
another day for plenary sessions. Several States found it convenient
to hold more than one meeting, New Hampshire recording 6 and
Arizona and New Jersey held 4 each which could be classified as
State conferences. In all, there were 77 statewide meetings and more
than 30,000 participants, with Ohio and California each drawing more
than 2,000 persons to this final meeting.

Conference participants usually found that their hard campaigns
for facts had paid dividends in the way of illuminating reports and
studies. They could, in most cases, join the subcommittee or work-
shop groups dealing with subject matters in which they had special
interest. In some conferences they were part of the process of evoly-

577791—60—2 9
ing the recommendations which the State would send forward for
consideration at the Washington meeting. In some others their de-
cision was not always final, approval or rejecting being reserved for
special executive committees. In still others the conferees assembled
to consider draft recommendations over which a subject-matter sub-
committee had labored. Where conference participants voted, the
results of the voting often were included in the State’s report.

Not always was the matter of decision a simple enumeration of aye
and nay votes. More often it was a complex process of consideration
and reconsideration.

At New York’s regional conferences there were some 2,000 par-
ticipants representing the State’s geographic areas. Copies of the
more than 400 recommendations developed at the regional sessions
were sent to each member of the State’s committee of 100 for the
White House Conference on Aging with the request that he vote for
the recommendations he favored. After minimizing duplication, 236
recommendations remained. A complete report on the results of the
individual balloting was forwarded to each member. The members
were also advised that they would have the chance at the final meeting
of the State committee to act on the recommendations that had been
approved by the individual voting, along with those recommenda-
tions that had failed by one vote to receive a majority. At the final
meeting, 113 regional recommendations were adopted and 5 sub-
mitted by the committee itself were also approved.

In Missouri, the Governor's committee had conducted its work
through 19 subject-matter task forces, each acting independently and
evolving its own recommendations after consideration of those coming
up from the communities at regional conferences and those from the
workshops at the State conference. Iawaii’s recommendations orig-
inated in a preliminary State conference and then were sent out for
discussion and comment to 50 government and voluntary organiza-
tions, after which each preliminary recommendation was referred to
one of five small subcommittees for further study. An editorial com-
mittee then prepared the final report. Wyoming's recommendations
incorporate the recommendations approved by two groups; the first
included those developed at workgroup meetings at the State con-
ference and the remainder came from the study and evaluation efforts
of the nine State study committees.

Whether the decision process was complex and unique, or left for
an advisory committee or a State executive committee to exercise, the
reports give ample evidence that recommendations and suggestions
made by regional or community committees on aging were seriously
considered and were frequently approved by the State groups having
the responsibility for decision.

10
PARTICIPATION AND AWARENESS

At least 103,000 citizens—officials, committee members, represent-
atives of agencies and organizations, the public (including many of
the elderly themselves), consultants and professional workers—took
an active part in the pre-Conference activities in the States.

This estimate is conservative, for the State reports shows that many
thousands of persons participated in local and county meetings where
attendance was not recorded.

If a count had been made, or even estimated, of all those who took
part in local council or local organizational planning meetings, in the
programs and seminars given to members of community organiza-
tions and societies, many more thousands would be added to the
figures.

And there is no estimate of the legions of volunteer workers who
contributed so substantially to the factfinding missions by conducting
the interviews on surveys, the time-consuming task of getting
opinions from the elderly or from institutions or from industries and
agencies. And the other volunteers who arranged programs and
who served in local action programs must also run the count up into
more thousands. At least a minimum of 100,000 more persons can
thus be estimated to have participated actively in the pre-Conference
activity.

If the tabulations on participation were to include those who re-
plied to newspaper polls, answered the telephone in response to in-
quiries, or invited interviewers into their households to develop the
factfinding inquiries, the figures probably would reach another three
or four hundred thousand.

If the participation figures were converted into interest figures, the
results might indeed be impressive. In addition to the formal meet-
ings, the States used TV, radio, newspapers, magazines, special in-
terest seminars, and programs in their effort to stimulate participa-
tion and interest in the problems of senior citizens. These efforts
were often statewide in effect and coverage, and sometimes they pin-
pointed their attention with very good results to local areas where
efforts seemed to be lagging. Unfortunately, without a scientific sam-
ple any estimate at this “interest” figure would be sheer guesswork.
But it is evident from all the foregoing that the incredible American
process of meeting its problems had gone to work in its usual unusual
manner and had produced results which exceeded the most optimistic
expectations.

TOMORROW'S SIGNS

The activities of the States and the White House Conference are
a means, not an end. Almost every State report confirms this. Op-
timistic though they may be in face of the great challenges, there is

11
almost universal agreement that the White House Conference on
Aging is not expected to be the panacean be-all and end-all to the
problem of aging. But, in general, all hope that the hard effort of
the past year will amount to a real beginning.

“The White House Conference on Aging gave new impetus for
action in the State,” Michigan’s Report on Recommendations states.
“Activity leading to the Conference has stimulated the growth of
local organizations. More community committees have been created
and a large number of county and regional organizations have come
into existence. * * * It remains to be seen whether these conference
committees will develop into active, permanent organizations.”

The road ahead in Virginia is implicit in this statement taken from
its report: “Virginia is not a State where its people, regardless of
age are allowed to go hungry, homeless, without medical care, or,
* # to Jive their last few years in poverty, discomfort and without
the necessities of life. * * * The activity for the White House Confer-
ence, nevertheless, did reveal defects and omissions.”

In Ohio, where a large number of well-developed community wel-
fare planning councils have been established in its large cities and
metropolitan areas, there is the feeling that implementation of the
recommendations made at the White House Conference and its own
State conference “will be assured through the use of this existing
community planning machinery.” But, says Ohio, “the real problem
is the matter of future planning and implementation in those areas
of the State where there is no established ongoing community plan-
ning organization. The expressed need (almost a plaintive cry) for
consultation, guidance, help and direction was practically universal
from those attending this workshop from the unorganized areas of
the Sale * # *2»

“These recommendations, which reflect the composite views of our
people,” says the Wisconsin report, will not only serve the purposes
of the White House Conference, but will be of even greater value,
perhaps to Wisconsin’s government, voluntary organizations, com-
munity institutions and groups, and individuals in identifying and
solving the State’s problems of the aging and the aged.”

In a preface to its report entitled “Some Admissions and Conces-
sions,” New Mexico explained that local participation “brought home
the point that there are too many unchartered areas filled with too
many forgotten people 65 years of age and over, and that the need
to do something about the aging can and must be met.”

“The point is that as a result of all this conference activity during
the past year, the entire State is being organized on the local level,”
Maryland announced in its report. “This is a new development and
augurs well for a systematic, broad-based, future program for aging
in Maryland. The counties will be ready to receive the blueprint

12
the Governor’s conference will draft, and, adding their own specifica-
tions, will be able to build constructively from the ground up in each
local area.”

What was true in Maryland was true in most of the other States.
Solid starts had been made in many places across the land, some in
areas where they had not known for sure that problems in aging
existed as was the case in Montana.

Thus, from one report to the next, there is tangible evidence that
the objective of stimulating the public of America to act on the
challenging problems of the aging had been achieved. Some local
action programs were initiated and from an organizational viewpoint
there was much progress. The Illinois report states, “Arduous though
it was in a State as large and complex as Illinois to carry through
the procedures * * * the unprecedented enthusiasm that gradually
captured volunteers and staff engaged in the process was itself con-
vincing evidence that these preparations for the White House Con-
ference on Aging were meeting with a real need within the State.
Beyond this, a third of 101 counties have already had followup meet-
ings on this subject and all of the six regions have indicated their
desire for continuing conferences”.

In California, many local committees were formed for the WHCA
and many of these will continue as permanent organizations. The
same is true in Washington, Oregon, Alaska, and Delaware among
others. Many State commissions have become permanent and of-
ficial, such as the one in Hawaii, while in some States, such as Ken-
tucky and Nevada, the recommendations request permanent status
for their commissions on aging.

And, finally, in some, the plan for followup after the White House
Conference on Aging was included. One such State was Tennessee
which called for its interdepartmental committee on aging to become
a permanent organization staffed by the program coordination sec-
tion of the State’s executive department and also requested that the
36 delegates to the White House Conference be named as the State
followup committee on aging to replace the planning committee which
carried on the pre-Conference activities and ceased to function after
the reports were drawn.

13
Chapter II

AGING IN AN INDUSTRIAL CIVILIZATION

Today man is living in an affluent society which has
come in an era of technological and scientific develop-
ments. Because of these achievements people live longer
and have healthier minds and bodies; as a result, a large
segment of our population find themselves classified as
senior citizens * * *. The daily routine involved in earn-
ing a living, paying for educations, purchasing a home,

aying taxes, and other responsibilities attached to life
ne retirement have ceased. With retirement comes
abundant leisure time posing new and entirely different
problems.

It is fitting that this broad assessment of aging as an achievement
of modern society should come from Midwest’s Iowa, one of the top-
ranking States in the proportion of older people in its population.

Old age there has always been, but, historically, for only a privileged
few. Long life has been universally sought and from time immemo-
rial. Only in recent years, however, and only in highly developed
civilizations has it become an expectation of the many. Today—along
with peace and understanding among men; education for all in keep-
ing with their desires and capacities; recapture of the values of family
life; higher levels of wellness with freedom from physical and emo-
tional handicaps; and preservation of individual freedom—attain-
ment of longer life and satisfying later years has become one of the
great goals of American society.

Every advance—every new set of goals creates problems of achieve-
ment and problems of dislocation, too. Most of the problems of aging
are seen by the States as outgrowths of the extension of life and of
increasing numbers of older people. Underlying their reports, how-
ever, is the growing recognition, which comes to the surface in the
Iowa report and in others, that this is not. the whole story. Most of
the reports reflect, in one way or another, the spreading awareness of
the parallel explosion in science and technology with its mushroom-
ing effect on our total civilization. Increasingly, the opportunities and
problems of aging are being understood as products of the interrelated
population, technological and social changes which have given rise to
similar problems and challenges in childhood and adolescent develop-
ment, work satisfaction in a mass-production economy, and the wise
and meaningful use of growing increments of free time.

There is widening realization, revealed in most of the States’ re-

15

 
ports, that many of the responsibilities formerly allotted to older peo-
ple are not relevant in a mechanized economic system and a fast-
changing society in which much of the emphasis is on breaking rather
than preserving tradition. Throughout the reports, however, runs the
fear that with our work-centered, materialistic, future-oriented cul-
ture we may be breaking too many traditions—that we may not be
affording the right of individuality and a place for those middle-aged
and older people who have made their principal contributions.

There is recognition, too—frequently voiced by the States, that
we have created an economy of abundance. But there is also con-
siderable doubt of its reality—Ilack of assurance that the national
income and product will increase rapidly enough to meet the needs
of the burgeoning younger population and of older people as well.
The urgent desire to recommend increased expenditures for the older
population, evident in every State report, is tempered by awareness
of the need for rising expenditures for assistance to underdeveloped
countries, national defense, education and cultural opportunities, pro-
motion of physical and mental health, urban renewal and redevelop-
ment, and highways.

The States are well aware that the opportunities and problems of
aging cover the entire range of human experience. Hence, as their
reports abundantly reveal, they are concerned with a vast array of
problems and questions. Some of the most frequently expressed are
the following: What is adequate income for the retirement years?
How is it best provided? Ilow many older workers are needed in our
automation economy? How can skills be maintained in the face of
-apidly changing technologies ?

When so many older people are well and vigorous, why must so
many more suffer from long-term illness and disability? How can
we transmit to people the emerging knowledge of health and pre-
vention of sickness? And how can we provide the motivation for
using it? How can older people keep their minds alert and avoid
becoming has-beens in an era of breathtaking social change?

What new roles will society assign its older people for their lengthen-
ing retirement years? What services can they provide to their com-
munities with their growing quantities of energy, time, and experi-
ence? Which among the variety of leisure-time pursuits will yield
stimulus and satisfaction ?

What new family relationships and concepts of responsibility will
free all generations from their feelings of guilt? What kinds of liv-
ing arrangements best meet the requirements and preferences of the
aging whose families have shrunk? Of the aged whose energies have
declined and who may need assistance? Tow will the housing be pro-
vided? What services are needed and where will they come from ?

These and numberless other questions arose when the States probed

 

16
into the circumstances and needs of their older citizens. Underlying
these relatively specific problems, the States found a number of broader
and more general ones.

One that bothers the States a good deal is how to obtain general
acceptance of later maturity and old age as natural, integral parts of
the life cycle. Now that long life is an expectation of nearly all of
us, how do we build it into our system of knowledge so that those of
all ages will make adequate allowance and preparation for it? What
must we do to insure that the position and rights of the older people
ahead of us will be acknowledged ?

It is pointed out repeatedly in the State reports that the later stages
of life have special characteristics of their own; that later life is not
a unitary period; that the real turning point in later maturity comes
in middle age—a transition period between young adulthood, with its
fresh goals, ambitions, and later maturity, when a number of changes
and events occur in rapid succession. Following this comes old age
with psychological and physical dependency and the need for care
and protection. The States recognize that, while these later life
stages or modalities do exist, there are enormous variations in the
characteristics and capacities among people within and between them.
Can these variations be explained? The States want to know. Can
they be measured and taken into account in developing expectations,
programs, and policies? And how can we avoid the pitfalls of reckon-
ing age in chronological time—and the injustices this works upon
many ?

While the States recognize differences from one stage of life to
another, they sometimes wonder whether, basically, the differences are
great enough to warrant specialization in aging, building a specialized
body of knowledge, specialized training for those whose work is with
older people and the problems of old age. And, often, they wonder
if it is wise to provide separate facilities and services in such areas
as health, housing, and recreation. They wonder, whether in doing
80, we may not be running counter to the wishes of older people
themselves, and perhaps setting them off into a group apart.

Below the layer of immediate requirements and wants, older people,
say the States, are like all people; alike in their basic needs for
physical and emotional security; for companionship and belonging ;
for independence and recognition ; and for stimulation and new expe-
rience. While the needs persist, their manifestations, and certainly
methods of satisfying them, vary from one phase of life to another.
The problem is not so much in recognizing the needs, according to the
States, but how to achieve balance in meeting them so that good per-
sonal and social adjustment is maintained.

A common concern, among all the States, revolves around who
should provide the whole range of services it is widely agreed are
required by members of the older population group. Most of the

17
States urge that the family should be the first line of defense and
assistance when problems arise and when long-time care is required.
Several observe with regret that there appears to be a decline in the
willingness of adult children to shoulder the responsibility believed
tobe theirs. All States are fully aware of the need for community and
public intervention, though they seem reluctant to multiply services
and are fearful of the effects on the self-reliance of those who are
served.

The reports of the States leave no question but that thousands of
Americans have become aware of the older population. The analysis
that follows shows that they are seeing it and the whole complex
process of living longer—of aging—in larger perspective.

THE AGING INDIVIDUAL

The central concern of the White House Conference on Aging is
with the aging individual himself. Although many problems are
created for the family of the older person, for the community, and
for society as a whole, the principal focus in all of the State reports
is on the place and well-being of the rising numbers of their citizens
living into the extended periods of life.

No fact has become more clearly recognized during the past decade
than that aging is a complex of complex processes. The aging in-
dividual is at once a psycho-physical organism in a continuous process
of change and a person responding intellectually, emotionally, and
behaviorally to these internal processes and to external changes in
circumstances, including the attitudes and expectations society ex-
presses toward him. Some of the changes in later life, it is noted,
occur independently but many are closely interrelated and profoundly
affect one another.

Biological Aging

Aging within the physical organism is now commonly regarded as
a natural process of progressive changes in body structure and func-
tion. Some of the changes which have been observed and measured
occur in cellular composition and capacity for growth; in tissue strue-
ture and function; in glandular, respiratory, and cardiac output; in
basal metabolism; in the speed, strength, and endurance of the neuro-
muscular system; in the capacity to maintain balance in the function
of organ systems. Parallel to these changes and often closely asso-
ciated with them is the increasing likelihood of long-term disease and
disability arising from cumulated insults to the organism.

The results of the multiplicity of factors in biological aging are
seen in decline in strength and energy reserve ; reduced ability to with-
stand stress; slowing down in various types of performance; increased
susceptibility to disease and slower recovery; infirmities; and changes

18
in physical appearance. Most of the changes in the biological sphere
represent losses. Yet research over the past decade has shown, as
some of the States point out, that the processes of aging and degenera-
tive disease can be retarded within limits, through proper nutrition
and good health practices. Or, they can be hastened through ex-
posure to radiation, neglect of symptoms of illness, and failure to
maintain a sound body and mind.

Psychological Changes

The growing body of research, being conducted in an increasing
number of centers, also reveals concurrent changes in the intellective
system and in mental performance. Most easily measured are changes
in sensory and perceptual capacities. Losses in visual, auditory, and
feeling sensations reduce the amount of information that can be
taken in. There appear to be additional losses in the number of
stimuli that can be absorbed and stored, in the speed with which they
can be accepted, and in the capacity to integrate new information with
old and to organize responses.

Underlying changes such as these produce noticeable effects on learn-
ing and memorizing; on the time required for various types of per-
formance ; on problem-solving ability and creativity ; on flexibility and
rigidity in new situations; and on capacity for adjustment. Not all
changes are downward, however. Experience and wisdom are cumu-
lative, as the States point out, and give older persons the advantage in
some situations. Skills and knowledge acquired and improved over
long periods may increase in value provided they do not become out-
moded by new circumstances or processes. Intellectual performance
has been shown to remain high among the educated and among those
who continue to use their capacities. For some the period of peak
performance comes in the later stages of life.

Normally, most psychological changes are gradual and are not
likely to become seriously handicapping unless some disease process
intervenes. Or, as a number of the States suggest, motivation is lost
through deprivation of positive incentives and social expectations.

Sociological Aging

In addition to these internal, age-related changes, there are others
which occur in the circumstances or in the position of the individual
as a member of the family, community, or society. It is these that are
most widely noted in the reports from the States and which are dis-
cussed more fully in following sections. They include retirement
from work, reduced income, reduced or completed parental roles,
separation from friends and associates, loss of husband or wife, and a
very considerable increase in the amount of uncommitted time. Con-
comitant with these are the attitudes, images, and expectations society

19

 
develops and expresses toward older people. Most of these circum-
stances occur among younger people, too, but their incidence rises with
age and they are common to most older persons. Some of them have
positive as well as negative values but all require conscious adjust-
ment on the part of the individual.

Behavioral Changes and Adjustments

A fourth area of concern lies with the responses and adaptations
aging poeple make to the changes noted above. Their responses fall
into two categories. First are the individual's own inner attitudes and
reactions: the concepts he develops of himself as he ages and whether
based on acceptance or denial of the facts; his efforts to retain organ-
ization and balance as changes occur; or his loss of motivation and
interest not infrequently resulting in neuroses and, sometimes, psy-
chotic states.

The second category comprises the responses he expresses in ex-
ternal behavior. ITe may look upon the added years and retirement as
opportunity to expand his life space; to find substitutes for parental
and work roles; to intensify his activities or develop new interests. Or,
he may reject the new opportunities afforded; narrow his range of
interests, and gradually withdraw into himself. Much of the con-
cern of the States turns on the question of how to promote and facili-
tate positive responses and to enable older people to enjoy the poten-
tial rewards of longer living.

Stages in the Later Life Cycle

Although the States in general focused on the older population,
their reports reveal awareness that some problems, such as employ-
ment and maintenance of health, may become acute much earlier.
The real turning point in maturity, marking the onset of aging, prob-
ably occurs between the fifth and sixth decades of life. The reports
tacitly if not pointedly recognize value in considering later life in
three broad stages: middle age, later maturity, and old age.

Young adulthood may be characterized as the period in which
growth in the size and functional capacity of the organism are com-
pleted, when the basic psychological capacities are at the peak of
development, when the individual is setting his goals for adult life,
forming his family, launching his career, and establishing himself
in the community. The ensuing years are spent largely in family
and work activities, with the majority of leisure time devoted to main-
tenance of the home and family-oriented social activities.

Middle Age

A number of changes take place during the fifth decade which ap-
pear to mark the beginning of a new stage of life. Most people be-

20
come aware of declining energy and feel the need to seek satisfaction
in mental pursuits. Many seem to feel they have achieved the goals
set earlier in life or at least that they are reaching a plateau in their
careers.

Children become increasingly independent and most of them have
left by the time parents have reached age 50 or 55. Women who are
not in the work force and who do not return to it may find they have
a good deal of time on their hands but no clearly defined expectations
as to how they shall use it. There is increasing evidence that this
period of life may give rise to a considerable amount of restlessness
with a need to develop new goals and patterns of living.

Later Maturity

Middle age shades into later maturity when the losses experienced
begin to exceed the gains. Further declines in sensory acuity, the
onset of a long-term health condition and infirmity may limit activity.
Retirement comes to most workers and with it reduction of income.
Long associations may be broken through death of spouse and friends.
By the late sixties the majority of women have become widows.

On the positive side, complete freedom from work gives the indi-
vidual greater opportunity for choice of action than he has known at
any earlier stage of life. The majority do retain health and psycho-
logical capacities and are able to draw on a lifetime of experience in
developing new interests, friendships, and meaningful roles.

Old Age

The final period of life is old age, though it does not come to all.
Increasingly, old age is being said to have arrived when general
decline or debilitating disease have resulted in extreme frailty, dis-
ablement, or invalidism ; when mental processes have slowed down and
the majority of time is spent in self-contemplation, retrospection, and
search for the meaning of life. Mobility becomes greatly restricted
and there may be almost total withdrawal and abandonment of inde-
pendent living. Little is yet known about the positive aspects of old
age. The reports from the States show clearly that it is usually a
problem period with a good deal of loneliness, boredom, and mental
pathology.

Résumé

In summary, the aging individual, toward whom the White House
Conference is largely directed, is seen by the States as a total organism
and person living through relatively new and definable stages of a
longer life cycle. The later years call for a succession of adjustment
to internal and external changes which must be regarded as parts of
a whole. Physical and physiological changes are facts in themselves
but the time of their onset and the rate at which they proceed are

21
subject somewhat to environmental determinants. They are also sig-
nificant factors in fixing particular events such as retirement and in
conditioning later life styles. So, too, social expectations may influ-
ence motivation, which may, in turn, be reflected in an older individ-
ual’s effort to learn.

The sections which follow undertake to describe and synthesize the
reported efforts of the States to identify and bring into focus the major
problems of aging. Prominent in all of their reports is recognition
that the individual aging today is confronted not only with changes
that take place within himself but also with a rapidly changing
society.

THE MAJOR FACTORS IN AGING

The phenomena and problems of aging reported by the States grow
out of a host of complex changes, factors, and forces associated with
an advancing civilization. Primary among them are the increases in
the number and proportion of people living into later maturity and
old age and the emerging technological economy which profoundly
affects the position and circumstances of those who live into the later
years. In both respects, change has been and continues to be faster
than at any previous time in man’s long history.

The Biological Revolution

More People; More Older People

“If we gaze into the future to the year 2000 we are seeing only the
time distance that we have traveled since the end of World War 17,
says the North Carolina report. It then goes on to cite a forecast of
a total United States population of 312 million, “an increase of 69
percent over these four decades * * * the population above 65 years
will increase to about 32 million and this would represent an increase
of about 90 percent. By 2000, the population above 70 years of age
will be nearly 23 million, and this age group would have increased by
120 percent”.

Of its own population, New York reports that “In 1950, there were
1,270,000 * * * residents 65 years of age and over; today * * * 1,
600,000; by 1970 * * * 2,150,000; and by 1980, around 2,800,000”.
And Puerto Rico says that, “While the total population is expected
to increase by only 5.5 percent (by 1975), the number of those 65 years
of age and older will have increased by about 77 percent to approxi-
mately 240,000”.

No facet of aging has become more widely recognized than the bur-
geoning increase in the numbers of older people over the past 60 years.
It has been noted again and again and again, during the past decade,
in hundreds of speeches, studies and surveys, and in every factual re-
port from the States. And properly so, for the population 65 and over

20
doubled between 1900 and 1930, almost doubled again between 1930
and 1950, and will have doubled once more by 1980. Every State has
noted the increase and every State has experienced it to a greater or
lesser degree.

Nor has the increase been in numbers alone. State after State points
out, too, that older people are accounting for higher proportions of
their populations, and this has been true for the country as a whole.
From about 2.5 percent during the height of the agricultural era
(around 1850), to from 4 to 5 percent during the transition period,
the population aged 65 and over has risen to almost 9 percent in today’s
highly mechanized economy.

From Where Have They Come?

The rapid rise in the older population has been, in major part, a
concomitant of the biological revolution which catapulted the size
of the total population of the country from 23 million in 1850, to 75
million in 1900, to 180 million today, and to the more than 300 mil-
lion projected for the year 2000.

The country was settled largely by young adults in the child-bearing
ages who found a whole continent rich and ready for development,
who greatly expanded the production and distribution of food, who
created a fast-moving economy hungry for workers, and who learned
how to lead healthier lives by revolutionizing the sanitary environ-
ment and the control of infectious diseases. The case is well stated in
the North Carolina report—

A large number of people above 65 years of age com-
prising a sizable proportion of the total population in
any society is, relatively, something new under the sun.
Countries or societies containing a “high” percentage of
older persons are quite few even in these modern times,
and * * * a high proportion of older people is possible
only in a society which may be characterized as having
an economy of abundance. This concept of abundance is
made up of a host of elements: adequate and stable
food supply; widely distributed medical services and
hospital facilities; a rational approach to sanitation by
individuals and communities—these elements and more
but the twin foundation stones are research and
education.

Towa has undertaken to assess factors in the natural increase in the
population and in the development of an age structure characteristic
of industrialized societies as well. First, to paraphrase the Iowa re-
port, mortality rates fall, increasing the proportion of children who
grow up and survive into the older ages. (Under 1900 rates, 48 per-
cent of the children born would reach 60; by 1950 the proportion had
climbed to 76 percent.) Then there is a drop, though not as sharp,
in the fertility rate. While the population continues to increase, the

23
age distribution changes so that there are smaller proportions of chil-
dren and youth and larger proportions in the upper ages. Thus, in
this year of our inventory, while both fertility and mortality rates
are well below what they were at the beginning of the century, the
number of births exceeds the number of deaths by 4.3 million to 1.7
million and the population grows at the rate of about 2.6 million a
year. And with it, those 65 and over increased by around 370,000
each year. This natural population increase, according to the Bu-
reaw of the Census, accounted for nearly 50 percent of the rise in the
number of older people during the first half of the century.

The second major factor has been immigration. Between 1880 and
1910 (when today’s middle-aged and older population was being
born), 18 million persons immigrated to the United States in search
of freedom and better living conditions and in response to the man-
power needs of America’s expanding economy. The majority came
as children or young adults who have now grown old. The number
of foreign-born 65 and over today is 2.7 million and is particularly
high in New York, New Jersey, Massachusetts, Rhode Island, and
Connecticut.

Immigration slowed down during World War I and has been
restricted by law ever since. Immigrants now number only about
265,000 a year but their predecessors accounted for approximately 20
percent of the increase in the older population between 1900 and 1950.

The third major factor in the increase of the older population has
been the extension of life through improvements in public health,
nutrition, prevention of disease and methods of treating and restoring
the sick. Thus, Alaska—49th State, reports “Tuberculosis deaths
which were numbered among the native population in the hundreds
in the early 1940’s had dropped to 223 in 1950 and still more phenome-
nally to 24 in 1959”. And Missouri’s report is typical of many when
it notes “the remarkable advances made in medical science which have
lengthened the span of life by about 25 years since the turn of the
century * * *

The total effect for the country has been an increase in average
life expectancy from about 40 years in 1850, to 49 years in 1900, and to
almost 70 years today, in deed to 73 years for women. Thus far, most
of the increasing expectation of life has resulted from the reduction
of mortality among infants and children but considerable improve-
ment is being shown for young and middle-aged adults. Nine years
have been added since 1900 to those entering adulthood (at age 20)
and 5 years to the lives of those who reach 40. Remaining life ex-
pectancy at upper ages has changed very little but current progress
in research on the chronic diseases gives promise for the future.
Improvements in life expectancy accounted for about a third of the
increase in the older population from 1900 to 1950.

24
In sum, then, the fertility rate remains relatively high; the mortal-
ity rate continues to fall gradually over the entire age range; and,
while there is no longer large-scale immigration, the total population
continues to increase rapidly and to carry a rising number of older
people along with it.

Will Old Age Dependency Become Burdensome?

Will the rising number of older people increase the burden of their
support? One of the principal concerns expressed by the States is
that of the potential threat of continuing increases in the numbers of
children and retired persons to the ability of those in the productive
years to support them.

While the relative numbers of children and older people are certain
to increase, the threat may be more apparent than real. What is
often overlooked, as noted by some of the States, is that children grow
up and become producers themselves.

A common way of measuring the extent of the responsibility of
those in the working ages is to calculate the ratio of the sum of the
number of persons under age 20 and the number 65 and over to the
number of persons of 20 through 64. When this is done, a marked de-
cline is revealed from 94 dependents per 100 persons 20-64 in 1900
to 74 per 100 in 1950. Much of this decline resulted from the short-
range drop in the number of births during the great depression of
the 1930’s. However, the rapid, postwar rise in the number of births
and its sustained high level, together with the continued increase in
the older population, has returned the dependency ratio to about 89
per 100 at the present time. Long-range forecasts involving fertility
and mortality rates are hazardous. Yet, population experts predict
that, as the demographic effects of the depression recede and as the
children of the 40’s and 50’s move into adulthood, the dependency
ratio may be expected to level off at somewhere between 75 and 85.

Variations Among the States

The number of older people ranges from fewer than 50,000 in
Alaska, Delaware, Hawaii, New Mexico, Vermont, the Virgin Islands,
and Wyoming to more than a million in California, New York, and
Pennsylvania. In general, large older populations are associated
with large total populations. There are, nevertheless, major vari-
ations among the States in the proportions of older people in their
populations. Six States—Arizona, Nevada, New Mexico, North Car-
olina, South Carolina, and Utah—have fewer than 7 percent, but 12
States have 10 percent or more older people in their populations.
These are: Arkansas, Florida, Iowa, Maine, Massachusetts, Minne-
sota, Missouri, Nebraska, New Hampshire, Oklahoma, Rhode Island,
and Vermont.

577791—60——38 25
A variety of factors account for these differences, not all of them
easy to measure. It may be said that, in general, long in-migration of
young adults who eventually reach the older years produces higher
ratios of older persons as in Connecticut, Massachusetts, New Jersey,
New York, and Rhode Island. The 12 States with the highest propor-
tions, noted above, were settled by in-migrants but have been charac-
terized more recently by out-migration of young people largely as a
consequence of declining opportunities in farming and other tradi-
tional industries. South Dakota’s analysis of the problem typifies
the situation in these States:

The emerging interest in the present and long-run con-
sequences of an aging population is justified by data on
the changing age structure in South Dakota. In the
first quarter of the century the conditions in the State
were favorable for growth. This early population gain
was based mainly on the incoming flow of migrants, pre-
dominantly in the young adult ages. In the years of eco-
nomic depression during the 1930s the balance of migra-
tion shifted and the State lost young adults * * *,
In the subsequent census years the total exhibited some
recovery, but the increase has come at a rather slow
pace * * * The many persons who settled in the State
in the early part of the century, and who were responsible
for the more rapid rate of growth at that time, have now
reached advanced years. When the growth of the State’s
older population 1s compared with the pattern for the
Nation as a whole the decade 1930 to 1940 marks a turn-
ing point, for during this period the proportion of South
Dakota's population in the older ages began to exceed the
national figure.

Low ratios of older persons in State populations are found, usually,
in States which have had both high fertility and relatively high
mortality rates characteristic of the Southeast and Southwest. But
now in these States the trend toward higher proportions is apparent.
Thus Alabama reports—

This is a relatively new situation for Alabama. Forty
years ago, the average aged Alabamian was much
yom than is the average aged person of today. Past

ich birth rates have swelled the population; medical
science has greatly prolonged lives; and many young peo-
ple, particularly young Negroes, have left the farms for
better job opportunities out of State. The result has been
an unbalanced and growing proportion of older persons
in the State * * *. The outlook appears reasonably
clear * * * If survival trends and migration rates of
the period 1950-57 continue, the State can probably
foresee another increase of more than 20 percent in the
number of older people bringing the total to about
300,000 by 1970.

26
States with equable climates are popularly supposed to be attracting
large numbers of older persons. It is true that Arizona, California,
the Carolinas, Florida, Hawaii, New Mexico, and Texas have had
larger rates of increase than the Nation as a whole and most of these
are expecting continued increases above the rate for the country. But,
except for Florida, these are not the States with high proportions of
older people. Generally speaking, these States have attracted people
over the whole range of ages, older people among them.

In these, as in other States anticipating larger than average in-
creases over the next decade—such as Delaware, District of Columbia,
Maryland, Michigan, Nevada, New Jersey, New York, and Utah—the
dependency ratio promises to remain in approximate balance. The
major concerns over continued imbalances are found in the upper New
England States and in the primarily agricultural States in the
Missouri-Mississippi Valleys.

The Technological Explosion

Paralleling the unprecedented increase in the length of life and in
the number of older people has been an even more explosive increase
in the mass of scientific knowledge and in the machines, energies, and
technologies flowing from it. These, together with a sharp increase
in work-life expectancy and a marked increase in participation of
women in the work force, have brought “within a single generation”,
according to the Missouri report, “dramatic changes in our social,
economic, and political life * * * and in the physical environment in
which these changes have taken place.” It is true that the changes
have profound effects on the lives of everyone, as seen in the reports
from all of the States, but their impact has been greatest on middle-
aged and older people.

Scientific Knowledge and Technology

One of the most dramatic measures of the increase in scientific
knowledge and technology is found, as Virginia says, in the “expansion
of capital facilities and the substitution of mechanical and electrical
energy for human and animal energy.” In quantitative terms, as
national studies show, there has been a 12-fold increase since 1850 in
the amount of productive energy available per person in the popula-
tion, with 99 percent of the 750 million horsepower hours produced
today coming from inanimate sources and only 1 percent from human
and animal muscles as against 65 percent a century ago.

Until around 1890 or 1900, the thirst for more goods and services
meant that the new machines and energies were used primarily for in-
creasing the output, hence, the level of living, with relatively little
attention given to other possible benefits. Since 1900, the horsepower
hours of energy have risen from 1,075 per person to more than 5,000

27
and the results have been overwhelming. Output per worker has in-
creased sixfold and the total output of goods and services has in-
creased more than twice as fast as the population, resulting in a two-
fold increase in the level of living. Length of the workweek has
declined from 55 or 60 hours to 37 and retirement is becoming an
expectation of all workers.

While output per worker has been increasing so, too, has the average
length of working life. To quote the Kansas report—

“Advances in medical science, improvement in work-
ing conditions, which includes reduction in the number
of hours worked daily and weekly, along with wide-
spread use of labor-saving machinery and safety prac-
tices current in industry, have contributed to an ever-
lengthening (work) life expectancy for the Nation’s
workers.”

Due to longer life expectancy, a cohort of 100,000 males born and
living under today’s conditions will contribute an average of more
than 40 years to the work force compared to just over 30 years for a
similar group born in 1900 and living and working under the condi-
tions that prevailed during the early part of the century.

Equally striking has been the increased work force participation of
women, as noted in the reports of Vermont, Mississippi, and other
States. Release from confining household duties has enabled three
times the proportion of women to work outside the home as were able
to do so in 1900. The increase has been greatest among those who
have completed their parental responsibilities—50 percent of the
group 45-54 now being in the labor force.

Some Consequences of Technological Development

Fewer Older Workers Needed —Few of the State reports discuss
the technological explosion in these multifaceted terms, but all are well
aware, as Michigan notes, that “acceleration of the trend toward auto-
mation of production processes with consequent mergers, reorganiza-
tions, decentralization and relocation of plants continuously reduces
job opportunities for middle-aged and older workers.” West Virginia
reports, in similar vein, that “today, the same amount of coal is being
produced but with 71,000 fewer miners than in 1948”; that “additional
miners are being released from their jobs almost every week”; and
that “most * * * will never return to work since automation is mov-
ing steadily ahead.”

Most States comment on the well-known decline in work force
participation with age. Nationally, the relationship between upper
adult age and attachment to the labor force is shown in these figures—

28
Percent of men and women currently in the work force at ages—

 

 

Sex 45-49 | 50-54 | 65-59 | 60-64 | 65-69 | 70-74 | 75-79 | 80-84 | 85and

over
Men..cocnans 97 95 91 82 47 37 24 14 5
Women______ 51 48 42 32 18 7 4 2 1

 

 

 

 

 

 

 

 

 

 

It is clear to the States, from these declining percentages and from
the increasing productivity noted above, that our modern high-energy
economy is well able to maintain its growing productive output while
it frees large proportions of its older people from work responsibili-
ties. But the States still have to reconcile the fact with reduced
employment opportunities for their older workers. Historically, it
has been estimated that about 98 percent of the men 65 and over were
in the work force in 1850 and that the proportion was 65 percent in
1900 compared to about 35 percent in 1960.

Science and technology have made still greater impacts on agri-
culture and on employment in the rural States. “The Rockefeller
Report on the U.S. Economy” shows that “As recently as 1910, 35
percent of our people lived on the land. Today, only 13 percent
live on farms, and each year a million more people leave the farms.
A minority, comprising 2.1 million farms, now produce 91 percent
of the output of food and fiber and could produce more, while the
majority, comprising 2.7 million farms, produce only 9 percent.” In
consequence, Arkansas reports that “there are not enough jobs to
meet the need, and that this is especially true in the smaller towns
and rural areas.” North Dakota says that it “is a surplus labor
State” by reason of its agricultural economy. Wisconsin reports
high rates of unemployment in the farm counties. Hawaii reports
changes in its labor force composition as it makes the transition from
agricultural to a commercial and service economy.

Retirement.—The correlative of the figures on declining employ-
ment provides a measure of the increase in retirement. Whether as
long-sought goal or as necessity, retirement has become a common
expectation, a characteristic of the way of life in America, as in
other highly developed societies. Its multiple effects upon older
people are discussed later on.

Household Tasks Reduced.—A similar revolution has occurred in
the demands made by household work, less widely noted, however,
because there are some tasks to be done as long as a home is main-
tained. Schools, factories and offices, community centers, churches
and synagogues, clinics and hospitals have long since taken over the
functions of formal education, most of the preparation of food, manu-
facture of clothing, a great deal of the recreation, religious leadership

29
and care of the sick which formerly provided lifetime occupations
for all household members. Appliances, electricity, and modern home
design have made what remains of housework easier and faster.
Women whose children are grown are freed, by and large, for work
outside of the home or for increased participation in social and com-
munity activities. Few are needed, the States point out, in the homes
of their children.

Completion of Parental Roles.—Still another consequence arising
out of the vast matrix of population and technological change, and
frequently noted in the State reports, is the earlier completion of
parental responsibilities and extension of the postparental family
period. Changes in the ages at which the major events in family life
occur are shown in the following figures—

Median age at which events occur for

 

 

 

Men ‘Women
1960 1890 1960 1890
First marriage... eevee eee ee 23 26 20 22
Birth of last ehild______________________ 29 36 26 32
Marriage of last ehild - ._ ______________ 50 59 47 55
Donth of SPONSE. wwe smn mame mmm 64 57 61 53

 

 

 

 

 

In 1900, the average marriage partnership had been broken by
death 2 years before the marriage of the last child. Today, earlier
family formation, fewer children, and rising longevity give the aver-
age couple an unprecedented expectancy of 14 years of freedom from
the immediate concerns of parenthood. The increase with age is
shown in the following data—

Percentage of couples without children under 18 at ages—

 

 

45-54 52
55-64 81
65 and over 97

 

Aging—Product of Our Times

Aging in American life, in the light of long-range social objectives
and as broadly interpreted by the States, is seen as a major achieve-
ment of our modern, scientific civilization. With all of the problems
it produces, it represents, nevertheless, realization of man’s millenial
desire to extend the years of his life. And, increasingly, with the
spiraling output of factories, farms, and offices, it represents freedom
in the later years from the hitherto lifelong tasks of making a living

80
and bringing up children. The Vermont report describes the change
in the following paragraphs—

The adult years of man divide into two main areas, the
first of which is “family” and the other of “leisure.” Ac-
cordingly, the principal characteristic of our older citi-
zens is that they are well along in the “leisure area” with
its almost limitless potentials both for them and to
society.

In the earlier mature years of the “family area,” the
average man learns a job, establishes a home and raises a
family and for two or more decades is happily engaged in
on-the-job learning and providing for himself and others.
These are the years of challenge, of struggle, the hard-
working time of life; and his responsibilities, economic
and social, weigh heavily upon him. He is motivated by
the demands of bringing up a family aright.

In time, his children leave him and in the nature of
things they repeat the same performance. On the aver-
age, the family now is reduced to a man and spouse.

They are now in the “area of leisure.” Life to each has
been a state of preparation and as individuals, each is
now at the fullness of his being. Obligations generally
have been lifted and the element of free time for the
first time enters into their changed mode of living.

Longer life together with “the increased free time which today’s

older citizen enjoys,” says the Minnesota report, “is a privilege of this
culture, these times, of our industrial society.”

SOCIAL CHANGE AND THE AGING PERSON

The changes in the environment of aging and older people extend
far beyond those already noted. Indeed, the entire social order is in
a seemingly permanent state of change and flux. All of the State
reports reflect awareness that patterns of community life and struc-
ture are being reordered; that values of work and leisure are being
turned upside down; that cherished concepts of individual self-re-
liance and family responsibility are having to be modified in the light
of the increasing complexity of our social system. These, too, have
profound effects on older people and complicate enormously the task
of the States as they seek to find ways of achieving the benefits of
longer life and of solving the problems it is creating.

Employment and Economic Security

One of the broad problem areas confronting the older individual
and the community, in its efforts to deal with his problems, arises out of
changes in the conditions of work and in sources of economic security
in the later years.

81
Changing Conditions of Employment

Today's economy of mass production is increasingly dependent
upon large aggregations of workers, a steady flow of newly trained
personnel with a growing variety of specialized skills, complex and
formalized managerial systems, and keen awareness of costs and compe-
tition. The impact of these requirements on workers and on older
workers in particular has been one of the most profound of all those
reported by the States.

The past two or three generations of workers have experienced a
very nearly complete shift, as the New York report states in its
opening paragraphs, from the status of self-employment on a small
farm or in a cottage-industry to that of employee in an organization
in which formalized personnel policies and practices greatly restrict
his range of decision and movement. Most workers, the States point
out, are no longer free to reduce their workloads to a comfortable
level when energy declines or to transfer to occupations compatible
with their changing capacities. While more workers survive to re-
tirement, as noted in the Kansas report, retirement is likely to come
earlier and to be based, according to the States, on a fixed chronological
age which fails to recognize individual differences and personal pref-
erences. And even greater concern is expressed by virtually all of
the States over the widely alleged discrimination experienced by the
older worker forced to look for a new job in competition with younger,
more vigorous, freshly trained workers.

The overall result has been the creation of an “older worker prob-
lem,” which most of the States recognize is not an easy one to solve.
The changing interests and capacities of the individual are involved,
together with his financial status and prospects and the kind of work
he does. Management is involved through considerations of efliciency,
economy, and half a dozen other factors. Organized labor is con-
cerned because of its responsibility for the welfare of its members, old
and young alike. Finally, the total society is concerned because em-
ployment is closely related to the volume of goods and services pro-
duced, the financial costs of retirement, and the individual and social
health of the older population. Although a majority of the States
report efforts to deal with the problem and though most of them made
recommendations for further action, they are also inclined to agree
with Idaho that “further studies (are needed) * * * to help answer
the questions whether biological or chronological age should be con-
sidered * * *” and with Illinois which feels the need of “further re-
search * * * directed toward further clarification of controversial
issues.”

Income Security
The increasing number of older people, the spreading practice of
retirement, and the changing status of the worker created a compelling

L214

[229]
need to find new sources of income for the later years and the length-
ening period of retirement. Traditional sources of income—continu-
ance in gainful employment to the end of life, income from ownership
of property and tools of production, reliance on relatives or on chari-
ity—are no longer available to the great majority of older people.

Invention for a New Age—In this situation, one set of changes has
begotten another; the United States, like other industrialized societies,
has had to invent new methods of providing income to cover the re-
tirement years. The old-age, survivors, and disability insurance pro-
gram, now almost universal in worker coverage, was set up during
the great depression and has been improved a number of times. Retire-
ment pension systems of private industry and public employers have
spread and grown rapidly over the past 20 years. Pensions to vet-
erans have become more common as veterans become older and reach
qualifying ages. Personal savings are relatively common among older
people though relatively small. Publicly provided old-age grants and
subventions undertake to meet the needs of those not adequately pro-
vided for in other ways. Progress is being made but the States are
dissatisfied with the extent of it, as is reported in subsequent chapters.

Health Costs.—While there is consensus among the States’ reports
that overall expenditure needs decline with age, most of the States
point out that precisely the opposite is true of costs of maintaining
health and of meeting the increased needs for medical care. The
extent to which these costs should be met by individuals, through
direct payments by their families or government, through voluntary
insurance, or through extension of the OASDI program is one of the
major issues of the day and was prominently discussed in almost
every State.

Inflation—A further aspect of the income maintenance problem,
also discussed in a good majority of the States, has been the continuing
inflationary trend and its depreciative effect on the purchasing power
of retiree dollars. Expressions of the States’ concern are noted in a
later chapter.

The Changing Community

Size, location, and complexity of the community and the nature of
community life are also significant factors in the environment of older
people. Problems and satisfactions that derive from characteristics
and trends in community settings are described in the reports of most
of the States.

Urbanization and the City Environment

Two-thirds of the United States’ population live in urban areas and
more than 50 percent in the great metropolitan aggregations. Today,
nearly 8 million or one-half the 65-and-over population live in cities
of 25,000 or in metropolitan areas. Urban living is, thus, well estab-

33
lished; particularly so in New England, the North Atlantic States,
the industrial areas of the Midwest, and in the coastal areas of Florida,
Texas, and the Pacific. Other States, however, still report as Alabama
does, that “Industry has been growing rapidly, resulting in a marked
increase in the urbanization of many communities.”

While the city provides opportunity for younger adults, it is com-
monly thought to have disadvantages when the later states of life
are reached. Social, as well as geographic, distances seem to be greater
in cities than in towns; life tends to be anonymous and new friend-
ships are often difficult to form. Living costs are generally higher
than in small towns and villages; although part-time jobs are avail-
able for some, there is relatively little opportunity to supplement
income with vegetable plantings. Transportation to health and shop-
ping centers may be relatively expensive.

On the other hand, larger population centers, the States point out,
are able to support greater varieties and numbers of services, wider
opportunities for choice of living arrangements, and easier access
to recreational and cultural opportunities.

Currently, a new phase of urbanization is having its impact on
older people and on the central cities in which many of them reside.
The mushrooming of satellite suburbs has been particularly attractive
to younger people in the family formation stage with incomes gen-
erally high or rising. The problem is well stated in the Rhode Island
report, which notes also the situation of older persons who may be
scattered about within the new suburbs:

The emptying out of the more mobile elements of pop-
ulation from metropolitan centers has left behind resid-
ual groups with high concentrations of older persons
and this fact has been acknowledged in recommendations
regarding housing in this report.

At the same time, the social isolation, less dramatically
evident, but probably at least equal in degree, for many
who live in suburbia, demands attention, not only from
social planners but from agencies responsible for de-
velopment, of land-use patterns, routing of highways,
establishment of zoning codes, and from other responsible
community leaders.

There are, of course, old suburban areas which, in themselves, have
high concentrations of older people and which may now or in time
provide favorable environments for them.

The large programs of urban renewal, redevelopment, and highway
building are producing still another problem for older people. Thou-
sands of them, stranded by low income and property ownership, are
being dispossessed, often with little provision made to assist them in
finding new places to live, and often compelling them to move into
new neighborhoods where they are strange and unknown.

34
Farm and Village Life

Traditionally, life on the farm or in the rural village has been re-
garded as providing the most nearly ideal circumstances for older
people. The Missouri report notes that, “The attraction of rural
living for older persons results in part from the availability of cheap
housing, space for a garden, closeness to neighbors, and freedom from
noise, tension, and hurry often associated with city life.”

While these conditions were no doubt fairly common a century ago,
some of them are disappearing, and a number of States point out that
rural life is no longer as idyllic as it has been made to sound. Several
of the reports note that older people are often left on farms they can
no longer manage; that 1960s industrialized farm and kitchen provide
little work for the older generation; and that social isolation may be
as severe as in the cities. The situation, in extreme form, may well
be found in Alaska which notes that—

* * ¥ from * * * go few people scattered over such a
tremendously large area, one could make significant in-
ferences regarding the psychological feelings of isola-
tion experienced by aging persons, particularly single
or widowed individuals living in the less settled areas.
Moreover, implicit * * * are connotations regarding
adequate health and recreation programs for aged people.

Village life, too, may be more difficult, in some ways for older peo-
ple than life in the city. Houses tend to be older and frequently
without such amenities as running water, central heating, and inside
toilets. Similarly, as Wyoming reports: “Most of the communities
and counties are of small population and hence cannot hope to sup-
port the services, institutions, or programs for the aged which might
be found in more densely populated areas.”

The Virgin Islands report notes that the desertion of villages by
young people and young adults creates problems similar to those on
the farms.

‘While few older workers have been observed to leave
the Islands, emigration of younger workers, especially in
the early part of the decade, created certain difficulties
for the aging group. Many older persons were left to
themselves without companionship of younger relatives
and in some cases without financial support. Even when
these relatives sent financial support, many older persons
felt a need for guidance and assistance in handling their
financial and social problems, thus increasing the demand
for service from the various government agencies.

The urban trend of young people aggravates the problem of pro-
viding services for children and old people alike, because it increases

35

 
the ratio of these groups to those in the middle, more vigorous and
productive stages of life. Ohio notes—
Young people have been leaving, going to cities where
there are greater job opportunities. As a result, higher
percentages of older people remain. In these counties
percentages of those 65 and over range from 12 to 16
percent.

And Illinois says—

Urbanization and industrialization of many rural and
semirural communities have vitalized some sections but
left others drained of young people and without sufficient
wage earners to support adequate public services. Tech-
nological changes have created additional problems for
older workers.

The net effect of the various factors and forces which have been
operating over the past 50 to 75 years and more is that it is the villages
and small towns that have (in 1950) the highest proportions of their
populations in the upper ages, 8.6 percent, compared with 8.1 percent
for urban areas and 7.6 for rural farm territory. The total number
and proportion of middle-aged and older persons is greatest, of course,
in urban places.

Living Arrangements and Housing

The rising number of middle-aged and older people is reflected in
the number of couples and persons concerned with maintaining suit-
able living arrangements and in the number of dwelling units required
to meet their needs. Approximately 30 million household units are
headed by persons 45 years of age or more and these represent about 55
percent of all United States households. Slightly more than 9 million
of the 30 million are headed by persons 65 and over and include three-
fourths of the older population.

Most middle-aged and older couples and individuals continue to live
in their own households but the number having to seek other arrange-
ments rises with age. A gross measure of the shift in living arrange-
ments with age is shown in the following table:

Living arrangements of the population 45 and over, by age, in 1950

 

 

 

Arrangement 45-64 65-74 75 and over
Total. _ a 100. 0 100. 0 100. 0
I Housaholds. . «mcmemmmss ss semen wanes 96. 1 95. 3 92.1
Own Households. _ ooo 84. 6 74.7 56. 4
Not Own Households_ _________________ 11.5 20. 6 36.7
In Quasi-households______________________ 3.9 4.7 7.9
Institutions. cee cmmen sence cm mmm 1.3 2.1 5.3

 

 

 

 
The proportion of older persons in households other than their own
and in quasi-household arrangements is three times as high among
those 75 and over as it is in the middle-aged group.

Abandonment of independent living arrangements may be brought
on by reduction or cessation of income, by severe infirmity or illness,
and the need for companionship after the husband or wife has gone.
In its chapter on housing, the Missouri report speaks of « * * *
feebleness, loneliness, lack of motivation and a physical and mental
inability to function at an earlier level of efficiency * * *” and then
adds that “* * * it (housing) is part of the economic problem of
one whose income is, at best, stationary in a time when living costs
are rising.” The numbers of older people with below-standard in-
comes, with restricted mobility, and the widowed are reported else-
where in this volume. Each of these factors has a bearing on the
housing needs of the older population.

The most common arrangement among older people no longer liv-
ing by themselves is sharing a home with adult children. At the pres-
ent time, approximately 5 million persons 65 and over either have
adult children living with them—>56 percent of the total—or live in
households maintained by their children—49 percent of those who
share. Thirty-eight percent of all older women live in shared house-
holds in contrast with about 28 percent of the older men.

The problems faced by older people and by their children are aggra-
vated by longer life expectancy from middle age onward and by the
increasing numbers living into the advanced ages in which dependency
rates from all causes are the highest. Urban living conditions and the
mobility of the younger generations are contributing factors, as sev-
eral of the States report.

Other solutions to special housing needs of older people are being
found in the increasing capacity of homes for the aged, retirement
villages, grouped low-cost housing hotels, and residence clubs for the
retired. Reports from the States concerning progress, current, prob-
lems and needs and recommended solutions appear in the chapters that
follow.

Health and Age

Health is a central factor in every aspect of the older
erson’s life. It cuts across every social and economic
ine. It affects every proposal for improving the lot of

older people in family life, employment, recreation, and
participation in community affairs.—Surgeon General
Leroy IE. Burney.

Prolongation of life and increasing numbers of people in the later
stages of life aggravate problems of health and disease for both the
members of the older population and the community. Maintenance
of health and vigor becomes more difficult for the individual the

37

 
longer he lives. Losses resulting from the aging process become more
severe as do the consequences of longer exposure to environmental
hazards and disease processes.

While the New Hampshire report states that “ITealth needs of the
elderly do not differ materially from those in the population of all age
groups,” it goes on to say—

The emphasis on certain phases of health services does
differ somewhat, however. This is due to the proneness
of aging persons to accumulate degenerative changes; the
inability to rapid tissue repair; more susceptibility to
the development of chronic disease, including cancer and
tuberculosis; development of insidious nutritional and
metabolic disturbances; progressive cardio-vascular
disease, including increased incidence of cerebro-vascular

accidents (strokes) and the increasing need for help in
caring for self.

The Volume of Illness

Though there is no adequate measure of the change in the volume of
long-term illness, the increases noted by all of the States can be in-
ferred from the following data, reported by the National Health Sur-
vey, which show the increases in the older population over the past
generation, and the prevalence of chronic disease among those not
in institutions:

 

 

 

Population in thousands Percent with one or
Age more chronic condi-
tions
1930 1960

BB cm sme msm sii wi i Se SE 13, 096 20, 846 56. 5
BEB. co. oom im mmm mm sm mmm 8,477 “15, 610 64. 4
rn i rt Are Tt lain 4, 760 10, 260 74. 2
75andover________________________ 1, 945 5,519 83.3

 

 

 

 

Much of the significance of chronic disease derives from the extent
to which its limits the activity and mobility of the individual and re-
quires the services and assistance of others in providing treatment
and care. The numbers of middle-aged and older persons who re-
ported such limitations in 1959 are as follows—

 

Number with one

Age or more chronic Number with lim- Number limited

conditions, in itation of activity in mobility
thousands

 

I —— 11, 199 2, 520 437
55-64 ___ 9,610 3,181 866
65-74 7, 197 3, 458 1, 143
75andover_________________ 4, 141 2,743 1,515

 

 

 

 

38
These figures are for persons living in the community. To them
should be added over 500,000 middle-aged and a similar number of
older persons living in institutions.

Although the numbers of older people without chronic illness or
without limitation are gratifyingly large, the numbers with one or
more long-term conditions and with limited activity or mobility pre-
sent serious problems to themselves and to others. These facts are
widely recognized by the States. Mississippi projected the national
ratios to its own population of older persons and reports about 25,000
of those 65 and over unable to carry on major activities and 8,000 con-
fined to their homes. Similarly, Indiana estimates that it has 59,000
older persons limited in activity, with 18,000 confined to the house.

Chronic Conditions Most Prevalent in the Later Years
The nature of the chronic conditions prevalent among middle-aged

and older people covers a wide range. Principal among the physical
conditions are—

 

 

 

Age—
Condition

45-64 65 and over

Thousands Thousands
Heart conditions. _ _ eee 1, 863 2, 183
High blood pressure____ eee 2,317 1, 894
DADE ec ce wae rim rn Ensen eR area 670 593
PCDI OBIT. cc ri 959 327
Arthritis and rheumatism cc ccc acme 5, 122 3, 898
Heras csr cremate se ss Sr SS 857 801
Asthma—hay fever. _ eee 2,094 786
CHIronie DIONCRILIS.. « cow wow pin wii i on ves 502 277
Visual impairments _ _ __ ooo. 839 1,514
Deafness and other hearing impairments__...__________ 1, 750 2, 520
Paralysis of major extremities and/or trunk. ___________ 285 328

 

 

 

Although cancer does not appear in this list, it is the second-ranking
cause of death among those 45 through 74 years of age.

Older persons suffer acute illness, too; relatively common com-
plaints being influenza, colds and sore throats, tonsilitis, diarrhea and
enteritis, and accidents. Incidence of short-term illness is not greater
among older people than among younger persons, but the length of
disablement is greater.

Susceptibility to mental illness also rises sharply with age, and its
wide prevalence among the older population is one of the major prob-
lems reported by the States. The causes seem to lie within three
broad areas: organic breakdown and impairment of tissues and cells;
psychological losses, such as failing sensory equipment and declining
capacity for adaptation and integration; and environmental stresses,

89
such as loss of spouse and meaningful social role. With regard to
the third factor, a New York report says, following a city-wide study
of the prevalence of mental illness, that the area having the highest
admission rate also had, on the average, “the highest proportion of
widowed and divorced, multiple dwelling structures, tenant occu-
pancy, one-person households, and persons seeking or unable to
work”—all more common among older people than among any others.

More Older Women Than Men

Another situation arising out of population and cultural changes
is the rising preponderance of women and widows in the older popu-
lation. Due to longer life expectancy, the number of women 65 years
of age and over exceeds the number of men by a ratio of 100 to 82.
A handful of States, including North Dakota and Wyoming, have
more older men than women, but Rhode Island reports a ratio of 100
older men to but 73 older women.

Women marry 3 years earlier than men, on the average, and when
older men become widowed they continue to marry women younger
than themselves. As a result of these three factors combined, today’s
older population contains about 4.8 million widows as against only
1.5 million widowers. The proportion of widowed women rises from
about 10 percent in early middle age to more than 83 percent at age
85 and over. These differences have major significance, as noted by
the States, with reference to a number of problems such as mainte-
nance of income, housing, family relationships, and utilization of
time.

Attitudes and Values

These older men and women are quite literally displaced
persons, without homes or friends of their own.—Vir-
ginia

Many of the State reports share Virginia’s concern over the nega-
tive values our culture attaches to old age; over the attitudes society
expresses toward older people; and over their loss of position in the
family and in the community. Implicit, and frequently explicit, in
their discussions is the recognition that social attitudes, the roles we
assign, and the expectations we have for them are powerful factors
in determining how older persons regard themselves, the extent to
which they are motivated to maintain their health and seek satisfying
retirement activities and the degree of their adjustment or maladjust-
ment.

Preindustrial, low-energy societies, living close to the margin of
subsistence, necessarily attach the highest values to activities related
to survival of the group. Thus, the principal roles assigned to adults

40
in all such societies have been those of bearing and nurturing children
and contributing to the support of themselves and the community
through the production of food and other commodities and the per-
formance of services essential to community welfare. Moreover, these
have been lifelong activities in societies in which average life expect-
ancy was 25 or 30 years and in which few survived beyond age 50.

The effects of longer life and the development of a high-energy
economy on the social roles of older people have been noted earlier.
The role of parent is removed or greatly diminished when the children
leave home, and little significance attaches to the role of grandparent.
Most of the roles assigned to older people in preliterate societies do
not appear in highly developed cultures, and we have created few new
positive positions for them. Thus, the number of older people has
increased rapidly while the number of attractive roles open to them
has declined, leaving large numbers without assigned status positions
and with little opportunity to achieve them through their own efforts.

Far too many of our older citizens, according to the State reports,
are relegated to the sidelines, unneeded, their experience and energies
wasted, lonely. The Colorado report goes so far as to say that—

The essential problem of old age is the potential loss
of those very interpersonal relationships and life roles
which have defined the individual as a meaningful mem-
ber of society.

And Nevada’s report shows concern thatthe same problem applies
to those who are not yet old but who are approaching old age—

This group is not so old that it avoids the companion-
ship of younger folks, but they are approaching, or have
entered, the area of the “also ran”, but have not yet
found any consolation in their position. They have been
relegated to a place of retirement when they still have
much to offer. They find that the ranks of those who are
younger have been closed and they are unable to move
into a place of usefulness.

West Virginia defines the problem in terms of “public apathy * * *,
The attitude seems to be: Well, they have lived their lives, why worry
about them”. The Kansas report agrees that there is “* * * lack of
a feeling of identification. In the church, as in other community
affairs, it appears that many of our senior citizens have been shunted
to the sidelines”.

Some States ascribe the neglect to persistence of materialistic values
and a production-centered culture which have so far failed to recog-
nize that our affluence and abundance provide a place for other values.

Many of the aging’s present-day concerns are due to
the culture of our times—a culture that recognizes only

accomplishment, vigor and material gain. Such a cul-
ture is not likely to be too concerned with the elderly

577791—60—4 41
whose accomplishments are largely behind them, whose
vigor has diminished and who have reached the conclu-
sion that material gain is too elusive and relative to be
important when compared to other considerations such
as inner peace, relationships with one's fellow men and
one’s relationship to his God.—Missouri

And Alabama states—

The problem is aggravated by the fact that our present
materialistic society tends to relegate the older, retired
individual to a secondary role.

Whatever may be the factors involved, the potential effect of atti-
tudes on older people themselves is illustrated by an older woman in
a small, midwest community. Busy with a variety of activities and
friends she observes, nevertheless, that

 

We are a queer tribe, we people who live at the end of
life. Still alive, yet not of life as we have always lived
it. No matter how much we try to be as the younger
croup, we are decidedly a separate part of society, wait-
Ing to write “finis”. We are always only on the fringe,
never in the real stream of life * * * waiting, waiting,
always waiting.

Stereotypes

The position of older people is jeopardized further, according to
the State reports, by our tendency to develop stereotypes of groups
which become foci of social concern. Aging first came into the gen-
eral public awareness during the Great Depression when large num-
bers of older people were unemployed and without income, when
their families could no longer take care of them, and when their
rapidly growing numbers resulted in chronic illness coming to be
regarded as the Nation’s No. 1 health problem.

It was perhaps inevitable that such traits as lack of employment,
dependency, long-term illness, and infirmity should have given rise
to unfavorable images with which all of those in the later stages of
life could be easily and carelessly associated. The more or less tacit
adoption of age 65 as the conventional retirement age and the practice
of tying pension eligibility to it were almost certainly contributing
factors.

Youth and Future Orientation

Another factor underlying our attitudes toward older people and the
depreciation of their status positions appears to be that, in the lan-
euage of the Montana report, “we have placed a premium on youth
and a penalty on age,” or, as the Texas report says, “The accent on
youth is a total note in our culture.”

The American culture is a culture dedicated to change. The reports
from the States are in agreement that our whole orientation is toward

42
the future. New discoveries and new methods are sought continu-
ously. New goals are set before the old ones have been achieved. The
present becomes the past almost before we can make its acquaintance.
The old, who must unlearn what they already know before they can
learn the new, often have great difficulty maintaining the pace.

In a culture of this kind, the greatest value is placed upon youth
because youth has the greatest future before it. It is the young, in
the main, who are seen to be in pursuit of new ideas; the old, it is
said, are more likely to cling to the past which they helped to create
and to defend it. The North Carolina report analyzes the problem
in the following words—

* * * the social status of the older citizens is very
different in a society characterized by rapid change as
compared with a society characterized by tradition, i.e.,
relatively unchanging generation following generation.
In a traditional society, the older citizen has high pres-
tige and is accorded high esteem. His accumulated
knowledge and folk wisdom are sought by all members,
and this accumulation is thought to be necessary for the
sheer continuation of the community.

In a rapidly changing society, the accent or value is
placed on youth because, in one respect, adjustments are
quicker and easier. Accumulated knowledge and wis-
dom have little place in the new society. The net effect,
then, is a lowered status for older people in the changing
society.

Colorado is in essential agreement—

The problem aspect of the aging process is a socially
created one. Such attributes as physical beauty, stamina,
alert reaction time, and pace of production are empha-
sized, while the greater wisdom, judgment, and perspec-
tive that can attend old age often remain in the shadow.
These qualities of experience and mellowing do not bring
enough reward in our value system to allow the aged in-
dividual to retain his self-esteem.

While the reports of the States reflect a good deal of discourage-
ment over the declining status of the retired and of the old, they
do not regard the matter as hopeless. Attitudes are man-made, they
say, and most would agree with North Carolina’s evaluation that—

An abundant economy affords the opportunity of
reaching the position of older citizens; but developing
necessary and satisfying roles for the older population is
a great challenge mn our rapidly changing American
soclety.

The Gift of Free Time

Free time is the most abundant commodity society has vouchsafed
to its older citizens. It may well be that, in the words of the New

43
York report, “The major problem of the aged is what to do with
the years of life expectancy after retirement.” Today, at age 60,
the average male worker has a remaining life expectancy of 16 years
with 42 percent of it to be spent in retirement, compared with 14
more years in 1900 and only 20 percent in retirement. While he is
still at work, he has more free time than he spends on the job. And
when he leaves the job at age 65, the average retiree is presented with
an additional 30,000 hours to use as he chooses.

The sources of these gifts of free time were discussed earlier in this
chapter. Work, formerly a means to survival and an end in itself,
is now coming to be regarded as the means to higher levels of living,
to the preservation of freedom, and to achievement of still greater
increments of free time. It is free time—leisure, that is now be-
coming an end in its own right—particularly for those in the extended
periods of life. The case is set forth in the Vermont report—

No nation in the world has the amount of leisure time
that we in America are experiencing today. We are told
by competent authorities that this is just the beginning.
Technological progress has already produced automation
and promises to all but do away with our present system
of labor. Even today machines are capable of solving
mathematical problems in a few minutes that would take
the most brilliant mind weeks of effort. The 40-hour
week may soon be a thing of the past resulting in less
work and more leisure time. Leisure, only yesterday a
Utopian dream, is today a dramatic reality.

Most of us take this abundant leisure for granted and
few stop to realize that it is a part of our American heri-
tage. Our forefathers bequeathed to us this freedom
from work which they themselves were denied. They
struggled and slaved, endured hardships and peril just
in order to live, yet they passed on to their children, their
grandchildren and to the present generation this inheri-
tance that is ours today. That is why we must cherish
this precious gift from those who made America great.
Just as an inheritance of vast wealth can be a blessing
or a curse, so leisure can enrich or lay waste our lives.
The future of our civilization may well depend upon the
use of leisure time. This is the challenge of leisure. It
is real, imminent and must be met not only by the nations
of the world but by the State, the community and the
individual as well.

Retirement and free time are relatively new, as several of the States
have reported. Three-fourths of today’s older people are outside of
the work force. Most of the women among them have household
duties which occupy greater or lesser amounts of their time. In
large measure, however, today’s 13 million unemployed older people
represent the first full retirement generation, one of the principal
products of the 20th Century's technological economy. Grown up in

44
a work-centered society, relatively few people have learned how to
develop new patterns of living for their work-free later years. By
and large, the States would agree with Connecticut that—

* * * most elderly folks have more time than they
know what to do with. They have too little to do, too
many hours of loneliness and drab leisure and nowhere to

go.
and with Michigan when it makes the point that—

Had people made more adequate preparation for the
increased years of life, many of the difficulties facing
older people today would not exist, or at least would be
less critical.

The phenomenon is new to society, too, and it is only during the
past decade that more than a handful of communities have given
serious thought to developing new and meaningful roles for those
who have completed the responsibilities of earlier adulthood.

Social Institutions and Social Responsibility

A final concern, noted earlier and deeply reflected in the reports of
the States, arises over the question of the proper allocation of responsi-
bility for helping the older individual adjust to the aging process and
to his changing circumstances and for creating an environment in
which he can realize the opportunities afforded through longer life.
Most of the States would probably agree with Nevada’s statement
that, “While the individual has a responsibility for planning his own
future he may not be able to do this without help from the family and
the community in making the necessary resources available to him.”
Nevertheless, in their efforts to arrive at balanced solutions older in-
dividuals, their families, and those involved in community and social
planning—all appear to be caught in the conflict of values and ideol-
ogies arising in the transition from a social order built on concepts of
individual and family responsibility to one in which increased reliance
is placed on organizations, agencies, and government.

American Individualism

Older people of today were born in a culture which placed one of
its greatest emphases on individual initiative and self-reliance. Per-
sonal responsibility, independence of decision and action, and self-
sufficiency were highly regarded as strong character traits. Success
was for the ambitious and the energetic; failure was the result of lack
of willpower, improvidence, and laziness. Open competition of ideas,
interests, and rugged individuals, it was argued, made for a better
society.

45
When the West was opened and when opportunities spread in manu-
facturing and commerce, more and more individuals responded to
these values and sought success outside of the family industry and in
occupations different or removed from those of their fathers. They
soon discovered, too, that the individual could rise more rapidly alone
than he could if he undertook to carry an extended kinship group
with him.

Yet, while this ideology was in its greatest ascendance, the same
forces that nurtured it were creating, in the language of the Missouri
report, “* * * a complexity of modern life (in which) the interde-
pendence of individuals is recognized and the inability of the indi-
vidual to achieve of and by himself life-long and complete self-suffi-
ciency is normal.” Thus, the older person today is no longer able to
fend for himself as many were able to do in simpler individualized
societies and economies and when their numbers were few. The point
of view expressed in the Missouri report is a relatively new one, how-
ever, and a basic conflict of values may appear when the older indi-
vidual is forced to seek help from the family or from society. Ilis
concept of himself as a person may be threatened or destroyed when
he realizes he is no longer capable of meeting the expectations of the
society in which he grew up.

The Kinship System

One of the most widespread beliefs, underlying current approaches
to solution of the problems of aging, is that in preindustrial societies
the extended family or kinship group provided occupation and haven
for the old. Turther, that today’s mobile, conjugal family of husband
and wife, with or without children, developed in response to an indus-
trialized-urban economy and finds no place for the elderly. Research
on the question is recent and meager, and gives rise to conflicting con-
clusions. It appears to be true that some older persons exercising
prerogatives inlierent in possession of property and scarce knowledge,
were able to retain authority and security for themselves in earlier
societies. Nevertheless, others, and perhaps the majority, were forced
to look to the beneficences of feudal landlords, charity, or the State
when they could no longer go it alone. Though it had its origin in
antiquity, the responsibility expected of adult children for support,
care, and protection of their aged parents is, according to a recent
report of the Social Security Administration, largely a development
of our 19th and 20th Century value system.

Against this background, longer life, retirement, declining capaci-
ties and health create serious problems for the older person. And, as
the reports of the States point out, the rapidly rising number of such
persons creates equally acute problems for adult children who are also

46
expected to provide well for their own children and for their own
later years.

The current dilemma of the adults in the middle is recognized in
Hawaii’s report when it states “that it is difficult for family members
to take care of the needs of their older members”. The South Dakota
report observes, too, that, “Although family ties are of great impor-
tance to the older person, these are often difficult to maintain under
contemporary conditions”. The report from neighboring North Da-
kota says that “the capacity of adult children to provide for all the
needs of aged parents is sometimes limited by family income”.

Conflicting values appear again when the report from one State
noting that—

There * * * appears to be a general moral decay pres-
ent in many American families, the effects of which will
permit children to allow their parents to become second
class citizens and dependent upon taxpayer charity for
their livelihood.

is contrasted with that of another which says that—

The majority of the older people felt that children
should not be asked to make extreme sacrifices to give
support to parents if they were eligible for financial aid
from an agency set up to deal with such problems.

The Rise of Organizations

At one of the Illinois regional conferences on aging, one of the
conferees got up and said, “I've heard, ‘The church should do some-
thing; society should do something; the State should do something.’
I have not heard ‘I am the church; I am the State; I should do some-
thing. We are the government; we should do something.” ”

The gradual accumulation of knowledge and the evolution of com-
merce and industry gave rise to man’s early and continuing creation
of organizations and agencies to provide services for him. The modern
burst of scientific and technical knowledge, along with changing cul-
tural patterns, has resulted in an enormous increase in specialization of
economic and societal activities and functions, and in the organizations
through which they are carried on. Man’s needs are now met through
a vast and complex system of corporations and factories; health, wel-
fare, recreation, and educational agencies; associations, societies, and
religious groups; and a wide array of private and government services.

The reports from the States reflect emerging awareness, over the
past decade, that older people, too, must look increasingly to com-
munity groups and to agencies of society for assistance in satisfying
their needs. Thus says Montana in its report—

The Montana Committee on the Problems of the Aging
realizes fully that the time when the complete respon-

47

 
sibility for an aging person rested with himself, his
family, and his community was irrevocably put behind
us by the great depression and the resultant change in
social concepts. Among these changing concepts has
been the delegation of an inereasing amount of power and
regulation to the Federal authority.

Ohio, too, speaks in its White House Conference report of “changing
patterns of life (which) have shifted more of the responsibility of
finding solutions to the community at large.” Texas conferees urgently
submit that the—
#5 % hasie right of the individual, regardless of his

age, should then arouse each community, city, county or

other local form of government to accept its responsi-

bility for the overall attention that is required for this

segment of our population. All of the family and com-

munity assets that represent useful and purposeful liv-

ing for the aged should be employed. These include in-

stitutions such as the churches, social clubs, fraternal

organizations, homemaking clubs, garden clubs, ete.

These are powerful forces for daily living and the

sense of belonging to one’s community life * *

Responsibility in Transition

While the reports from all of the States agree on the need for com-
munity action, some of them reflect the oft-spoken fear of prolifera-
tion of facilities and services and, particularly, of the deeper involve-
ment of government. Thus, the Illinois report states that, “The
individual and his family have primary responsibility for personal
adjustment. After them, in order, come voluntary and then public
services.” Speaking in the same vein, Oklahoma’s report reads, “Re-
sponsibility * * * rests first with the individual, secondly with the
family, and thirdly with the community.”

Much of the reluctance to extended organizational and govern-
mental services appears, from the State reports, to stem from alarm
over the costs involved. But some of it comes, too, from concern
over loss of individuality and personal dignity, which may occur as
Texas avers, when “government” intervenes and “must reduce its
caseload to numbered file cards in a steel cabinet.”

The issue raised by the States in their concern for the welfare of
their older citizens is one of long-standing. It is well set forth in the
following wholly pertinent lines from a recent report of the National
Planning Association:

For Americans, conflicting views about the objectives
of the economic system became a major issue of national
policy in the early years of the Republic. To Thomas
Jefferson, the ultimate values of society were “Life, Lib-
erty and the pursuit of Iappiness.” These, he believed,

48
could best be ensured by an economy of independent
family farms and small workshops. His opponent, Alex-
ander Hamilton, had a vision of American national
greatness made possible by the power and wealth of a
growing population and an expanding industrial system.
In the past century and a half, Americans have been
fortunate in achieving national power and wealth be-
yond even Hamilton’s imagination without sacrificing
the Jeffersonian values of individual independence and
rR nang.

owever passionately the realization of these ideals
was sought, their embodiment in social institutions has
not been rigid and doctrinaire, but flexible and practical.
Throughout the Nation’s history, there have been recur-
ring waves of reform. But in all of these, there has been
a working compromise between Jeffersonian and Hamil-
tonian objectives, which reflected the possibilities and
limitations of the times. An agrarian economy of small
farms was the relevant embodiment of the Jeffersonian
ideal of individual independence in the late eighteenth
and early nineteenth centuries. But in the mid-twentieth
century, only an ineffectual nostalgia would seek in-
dividual independence through reversion to a predomi-
nantly agrarian society * * * The question is: Can the
American society succeed in combining the benefits of
large-scale organization in the economy and in govern-
ment with the greatest possible freedom of individual
choice and the fullest possible realization of the poten-
tialities of the individual ?

LOOKING FORWARD

The States have taken a hard look, as their reports clearly show.
There is ample recognition in their studies, their reports, and their
recommendations that American society has achieved a new stage in
demographic and cultural development. The 1950’s have been years
of exploration and discovery, as the succeeding chapter will show—
1960, a year of inventory. The recommendations reported in chapter
V give clear evidence that we have entered on a decade of action.
That we are committed to new patterns of life for the years we have
added, from which we would not turn back if we could.

49
Chapter III

THE FIFTIES: A DECADE OF EXPLORATION

“There has been a burst of activity” in the field of aging in the past
2 or 3 years, the South Carolina report tells us. While the activity
has been stimulated in part by the 1961 White House Conference, it
is based on 7 or 8 years of exploration—of surveys and studies, pilot
projects, and some action programs. It is true that the projects and
programs are scattered and spotty. We are only beginning, as re-
ports from the States point out, to learn what we need to do for our
older citizens.

The States report some concrete achievements: Generally higher in-
comes for more older people through social insurance; the growth of
private pension plans and voluntary health insurance; a decrease in
dependency, but larger old-age assistance grants and medical care
programs for those in need; programs for early detection and pre-
vention of chronic disease and disability; special placement services,
vocational training and rehabilitation for older workers; a variety
of housing and leisure-time projects; much—though not yet enough—
research. Above all, they reflect, in the words of the Iowa report, “a
serious and conscientious concern with the problems of older people.”

The growing awareness of these problems is the measure of prog-
ress. The State reports reveal new approaches to dealing with
some of them, a greater flexibility. Researchers and workers in the
field seem to have heeded the warning of the director of the New
Jersey’s Division of Aging against “hardening of the attitudes.”
Most important is their recognition, as the Massachusetts report says,
“that older persons are as different from one another as are younger
persons, and that the solution that is ideal for one may be totally un-
satisfactory for another.” There is no single answer, no one kind of
housing or adult education or leisure activity—nor, perhaps, one right
age for retirement.

From surveys and studies, State and local agencies and organiza-
tions have learned, for example, that most older people want to live
independently as long as possible. The awareness of this desire for
privacy and self-sufficiency by Americans grown used to their own
ways with the years is basic to plans for housing, social services and
health services. Surveys have revealed differences in preferences.
Many older people do not want to be segregated with their own age
group in activities or living arrangements; but neither do all of them
want to be integrated with younger people. Many older people in

51
good health would rather not retire at a fixed age of 65; indeed some
are better workers at 68 or 70 than their fellows who are chronolog-
ically a decade younger. Among those who do retire, voluntarily or
otherwise, there is “a very wide range of temperaments, attitudes and
interests,” observes the Connecticut report. Some embark on new
careers or find satisfaction in community service. Others may not
want to be prodded into active participation in community affairs or
social life or recreation. They may be happy to “just loaf.”

A MORE POSITIVE CONCEPT OF RETIREMENT

Although we Americans talk a great deal about the delights of
retirement, we have tended to resist it, especially when we are on the
verge of retiring. As a people we set great store by work; it is the
source of status and self-respect as well as of income—“the cornerstone
of * * * life”, the Ohio report calls it. We are likely to view leisure
with suspicion, to enjoy it with a sense of guilt, as synonymous with
laziness if not with sin, and to extend that view to retirement. Un-
willing to consider retirement until forced to it by company policy or
ill health, many have found themselves suddenly facing long empty
hours, stretching ahead into long empty days and years.

Recently we have begun to question some of our long-held assump-
tions about retirement. We have begun to wonder whether it is
necessarily “a necessary evil,” and whether we should in fact post-
pone it as long as possible. A representative group of older citizens
at the Towa State Conference on Aging called for “a more positive
* * % concept of retirement * * * a more constructive view of the
enjoyment of leisure in youth and the employment and enjoyment of
retirement in old age.”

Wisconsin reports “some evidence that there has been a sharp rise
in * * * acceptance of retirement by the older worker during the last
decade. In the late 1940’s, fewer than 10 percent of the retired re-
garded themselves as having retired willingly. Ten years later 60
percent of the older male workers in companies with pension programs
were looking forward to retirement.” An overwhelming majority
(three out of four) of retired Ilansans questioned in a recent survey
said they would not consider going back to work. Their attitude
toward retirement, the Wisconsin report suggests, “seems to be most
directly related to their estimate of whether they can afford to retire,
and the increasing financial base being built under retirement seems to
be bringing about a redefinition of its meaning.”

It has dawned on us, however, that successful retirement requires
much more than an adequate financial base. “Retirement is a profes-
sion in itself”, as a retired professional man in Connecticut put it.
“Like marriage, it is not to be entered into lightly, but soberly, with
due consideration of the opportunities and problems involved.” Rec-

52
ognition of the importance of preparing for this new profession has
been one of the great forward steps of the decade. Business, industry,
universities, and labor unions have begun to organize preretirement
counseling programs—programs ranging anywhere from one to two
counseling sessions to a 5-year course.

The University of Chicago’s pioneer preretirement service is nation-
ally known. Recently an Illinois survey discovered 143 preretirement
programs offered by employers, churches, community organizations,
and universities in Chicago alone, and 22 such programs down-State,
most of them sponsored by industry. A college in Connecticut offers
weekly or monthly workshops for the retiring employees of 29 busi-
ness and industrial firms. The New Jersey Department of Civil
Service provides both group meetings and individual counseling inter-
views for State employees on the verge of retirement. Massachusetts
reports that a number of large employers in the State have preretire-
ment counseling or education. Some of these programs deal with
problems of health, housing, employment, and leisure-time activities
as well as finances. Their theme is that the worker can retire not
merely from work, but to a new life of activity, community service, or
self-enrichment.

There is, moreover, a growing sentiment in favor of flexible and
gradual rather than mandatory and sudden retirement. In Massa-
chusetts, for instance, “a number of employers * * * have moved in
the direction of more flexible retirement policy,” although there has
been no wholesale change as yet. North Carolina reports “a shift in
management thinking about retirement,” a tacit admission that, in
spite of the greater ease of administration, “compulsory retirement at
65 is wasteful in many ways.” Retired people who were questioned
in such States as Minnesota, Illinois, and Kentucky indicated that they
would have liked to “taper off.” Farmers and other self-employed
people often do precisely that. Noting that some firms now arrange a
gradual retirement for individual employees, the North Carolina com-
mittee foresees that many large companies will eventually institute
gradual retirement programs.

A FLOOR UNDER RETIREMENT

All the State reports testify to the generally improving income posi-
tion of older people in the past decade. In the Nation as a whole,
in 1958, 96 percent of all men and 73 percent of all women over 65 had
some money income. Ten years earlier the proportions were 89 per-
cent and 49 percent. Meanwhile, the proportion of older people with
no income or with less than $1,000 a year dropped from 74 percent to
57 percent, while the proportion with $3,000 or more rose from 6.5 per-
cent to 12.3 percent. In 1949 one out of every five Americans over 65
had no income at all; by 1957 this figure had dropped to one in 20.

53
Progress in Social Insurance and Private Pensions

The most important element in this improvement has been the ex-
tension of social insurance to more beneficiaries and the increase in the
size of benefits. It is an impressive fact that between 1948 and 1958
the number of our older citizens increased by 3.6 million, while the
number of social insurance beneficiaries increased by more than 8 mil-
lion. At the end of 1960, 70 percent of all Americans aged 65 or over
received some income from social insurance or related programs—a
total of nearly 11 million beneficiaries.

Most State reports note that the Federal old-age, survivors and dis-
ability insurance program is now the principal source of income for
older people. In Pennsylvania, “the availability of OASDI is the
greatest single factor affecting the retirement income of older per-
sons.” In Nevada, “OASDI is by far the greatest single means of in-
come maintenance for the aging.” In Florida, “benefits under the
OASDI program constitute by far the most frequent source for per-
sons aged 65 and over.” In Wisconsin, “the most frequent source of
income for the aged is social insurance. Three-fourths of the aged
persons in Wisconsin now, including survivors and dependents, get
income from this source.”

The size of OASDI benefits has also risen during the decade,
tending to offset the impact of inflation. In December 1950 the mini-
mum monthly benefit for all States was $20, the maximum $68.50. By
December 1959 the minimum was $33, the maximum $119, both be-
cause of amendments to the Social Security Act and because of higher
wage scales, on which contributions and benefits are based. Workers
retiring in December 1950, provided they were eligible under 1939
terms of the Act, received an average benefit of $49.50 (worth $58.10
in 1959 dollars). Monthly benefits paid to workers retiring in Decem-
ber 1959 averaged $82.

Meanwhile other public retirement programs were also expanded.
The number of aged beneficiaries under railroad and Government
retirement programs doubled between 1948 and 1958. The number of
men receiving veterans’ compensation or pensions more than tripled,
as many veterans of World War I reached 65. In 1950 social security
coverage was extended to Federal, State, and local employees without
staff retirement protection ; later amendments extended it to State and
local employees under retirement systems. By January 1960 almost
three out of five State and local government workers were covered
by social security, and 70 percent of them also by staff retirement plans.
In 1951 railroad workers, already under railroad retirement system,
were brought under social security.

The great expansion of private pension plans in the course of the
decade also contributed to the improved position of older people. It

54
is estimated that in 1948 fewer than 400,000 persons were receiving
private pensions; relatively few of them were also OASDI benefi-
ciaries. Ten years later some 1,250,000 people were receiving pensions
from private industry; at least a million of them were also OASDI
beneficiaries.

A few private and a few public pension schemes have been adjusted
to cost of living changes. OASDI benefits have been increased peri-
odically by congressional amendment, of course. A few State systems
have provided for automatic adjustments: Wisconsin’s incorporates
the variable annuity principle; in Tennessee the benefits paid to re-
tired State circuit court judges reflect any salary increases voted by
the general assembly to judges currently serving on the bench.

There are indications that the experience of contributing to public
or private pension plans has encouraged other forms of saving. A
survey of OASDI beneficiaries in 1957 showed that three out of four
beneficiary couples, and three out of five single beneficiaries or
widows, had some liquid assets. The median amount of these assets
was $2,980 for couples, $2,600 for widows, and $1,950 for single retired
workers. One in ten of the aged beneficiaries had as much as $10,000
in liquid assets. In addition, roughly two-thirds of nonfarm OASDI
beneficiary couples owned their own homes in 1957, as did nearly half
the widows and a third of the single beneficiaries, with 83 percent of
the homes free of mortgage.

Another sign of improvement is the decrease in dependency re-
ported by the States. Even the low-income, largely agricultural
States have seen some improvement as amendments to the Social
Security Act have extended coverage to new categories of workers.
In the country as a whole, in 1950, 206 out of every 1,000 people 65 and
over received OASDI benefits; 224 in every 1,000 received old-age
assistance. The agricultural States, with their farmworkers in-
eligible for social security benefits, felt the limitations of coverage
more than other States. Some States had as many as 5 OAA re-
cipients for every OASDI beneficiary. In North and South Carolina,
Mississippi, Tennessee, Alabama, and Georgia, nearly 4 out of 10
persons over 65 were receiving OAA in 1950, while fewer than 1 in 10
drew OASDI benefits. In industrial Massachusetts, Rhode Island,
Connecticut, New York, New Jersey, and Pennsylvania, more than
1 in 5 received OASDI benefits, about 1 in 10 received public assist-
ance. By 1959, however, North Carolina could report over three times
as many aged OASDI beneficiaries as OAA recipients. Even in
Louisiana, which has the lowest proportion of OASDI beneficiaries
of any State, there is evidence of a reduction in dependency : although
Louisiana has 45,483 more old people than in 1950, it has only 4,613
more OAA recipients.

13
Rising Public Assistance Support

As OASDI has assumed more of the load of old-age income main-
tenance, the States have been able to raise the level of their public
assistance support. They have redefined their standards of basic
essentials to include needs earlier regarded as special, and they have
liberalized eligibility requirements. The average OAA payment went
up from $43.95 in December 1950 to $63.86 in December 1959. Pro-
visions for relatives’ responsibility have been eased in many States,
and some States—although mostly before 1950—have relaxed or
eliminated their residence requirements. Moreover, in the past 10
years many States have been providing welfare services to their
OAS recipients, partly in response to a 1956 amendment to the Social
Security Act, to help them to greater self-sufficiency.

Perhaps most important, almost all State public assistance pro-
grams have been broadened to meet the cost of certain medical serv-
ices. As a result of 1956 and 1958 amendments to the Social Security
Act, providing for Federal sharing in State expenditures for this
purpose, 42 States cover the cost of nursing home care to OAA re-
cipients through “vendor payments.” Many States pay for hospitali-
zation and other items. A later amendment to the act both increased
the Federal grants for medical care for OAA recipients and made
Federal funds available for medical services for older people who,
though not OAA recipients, have not enough resources to pay the
high cost of medical services. Colorado has its own old-age pension-
medical plan, instituted in 1958. Administered by Colorado Blue
Cross and Blue Shield, and patterned on their minimum schedule, the
Mountain State’s medical care plan for its 58,000 old-age pensioners
makes vendor payments for nursing home, hospital and surgical care,
limited payments for medical treatment in home, nursing home, or
physician’s office. Colorado has met its share of the cost of this medi-
cal plan, as it does the basic old-age pension payments, out of State
excise taxes.

 

Other Benefits

While provision for medical care of the indigent and the medically
indigent has been improved in the past decade, there are also some-
what fewer medically indigent older persons, thanks to the spread of
voluntary health insurance. The extent of coverage by private pre-
payment plans is not precisely known. But surveys indicate that the
proportion of persons over 65 carrying some degree of health insur-
ance increased from 26 percent in 1952 to 43 percent in 1958. An
estimate by the health insurance association suggests that by 1960,
almost half of all older Americans had some health insurance.

The economic position of older people has been improved in the
last 10 years in other ways—by special tax exemptions (chiefly Fed-

56
eral) : not only the double exemption, already in effect in 1950, but
also the retirement income credit and the liberalization of the medical
expense deduction. The States are showing increasing interest in
reducing older homeowners’ taxes through “homestead” provisions.

HOPE FOR THE OLDER WORKER
Defining the Problem

A significant development of the 1950’s was the realization that
compulsory retirement policies were shortening the effective work
span of many able and still healthy workers, with adverse effects on
the economy, society, and the individual. At the same time it was
realized that competent workers well under 65 were having trouble
finding jobs. The definition of the “older worker” became “a person
who is encountering or may encounter, difficulty in getting a job prin-
cipally because of his age.” That age might be as young as 35, al-
though more typically for men it was 45. From this realization
stemmed widespread factfinding, experimentation, and specialized
placement services.

Stimulated by the 1950 National Conference on Aging, several State
legislatures gave attention to older workers’ problems as jobseekers
and jobholders. Between 1948 and 1958 the hearings and reports of
the New York Joint Legislative Committee on Problems of the
Aging, considered various proposals for improving employment op-
portunities—from antiage discrimination laws to job reengineering
and reemployment of older people in less demanding work. Institutes
of gerontology, established at such universities as Connecticut,
Florida, Iowa, and Michigan concentrated much of their research on
employment. Temple University in Philadelphia held three confer-
ences on “The Problems of Making a Living While Growing Old.”

At the beginning of the decade, little was known about hiring prac-
tices in relation to age. But now the facts, the necessary basis for
doing something, were accumulating. In 1950 and again in 1956
State employment agencies made studies in key cities across the
Nation, investigating the extent of age discrimination in hiring by
occupation, industry, and size of establishment, and the duration of
unemployment in different age groups. Studies by the University of
Wisconsin and the University of California confirmed the findings.

In California, for example, it was found that in 1959 workers over
45 represented 35 percent of the labor force but 41 percent of the
unemployed. These older workers faced problems: Strong compe-
tition from younger jobseekers, especially in such “growth industries”
as aireraft, electronics, metals, and automotive assembly; less educa-
tion than younger workers; greater likelihood of physical handicaps;
less good chance of being hired by large firms or by firms with estab-
lished pension plans; likelihood of a longer period of unemployment.

577791—60——b5 57
On the other hand, workers over 45 often had higher occupational
qualifications than younger workers, were likely to be more depend-
able and less inclined to change jobs. Meanwhile the U.S. Depart-
ment of Labor was studying the output of workers between 40 and 65
and the cost of pension and fringe benefits. Its findings showed that
older workers’ production usually equalled that of the younger
workers, was sometimes better and often more consistent; that the
cost differential in pension and benefits was insignificant and was
offset by the older workers’ experience and stability.

New Services for Older Workers

Armed with ammunition to counter employers’ arguments, State
“older worker specialists” were appointed, with the aid of Federal
funds, and local specialists were placed in the major city offices of all
State employment services. Counseling and placement services for
workers in or beyond their mid-forties had been started in New York
and a few other States as early as 1950. Dut their growth was slow
until 1956, when the older worker specialists launched a large-scale
training program for employment agency personnel and provided
them with detailed operating manuals.

The new special services include individual and group counseling
of older workers and an educational campaign aimed at employers.
Jobseekers are helped in making vocational choices, in adjusting to
new vocations, in overcoming handicaps or defeatist attitudes. Pros-
pective employers are approached directly and often successfully.
In Louisiana, for instance, the State employment service has dis-
covered that many companies with a maximum age stipulation for
a particular job will relax this restriction when LSES staff makes a
person contact on behalf of a worker with the required skills. Simi-
larly, the Virginia Employment Commission reports that its local
offices, dealing on an individual basis, have been able to persuade some
employers—especially smaller ones—to raise upper age limits from
45 to 50, 55, or even in a few cases to 60. The employers’ willingness
has been due partly to shortages of younger factory workers, ship-
yard mechanics, secretaries, bookkeepers, or nurses aides, but also to
the greater reliability of older workers. The result of the older
worker specialist program, between 1958 and 1960, has been a nation-
wide increase of 20 percent in the annual placement of workers over
45.

The proportion of workers over 65 who are placed is smaller than
of those under 65, but the number of applicants is also, inevitably,
much smaller. For example, in 1959 the Virginia Employment Com-
mission received more than 16,000 applications from jobseekers be-
tween 45 and 64, fewer than 1,300 from applicants aged 65 or over.
It placed approximately 72 percent of the applicants under 65, 43 per-

58
cent of those over 65. Vocational rehabilitation or retraining has
assisted even 70-year-olds to reenter the working world. Arkansas
reports that many of the trainees in its older worker training program
have been over 70.

Many State employment services have added special techniques of
their own to the general program. Florida and California have
emphasized group counseling to sharpen job-hunting skills. The
Missouri State Employment Service cooperated with Saint Louis
University in a series of “man-marketing clinics” to bring older work-
ers and employers together. In Baltimore, the Maryland State Em-
ployment Service joined with management, labor, and community
groups in organizing an “Earning Opportunity Forum” for mature
workers—a precedent followed by almost 40 cities around the country.
In 1959 the Michigan State Employment Service began a 2-year
demonstration project in Lansing, where, with the support of com-
munity agencies, it will concentrate on placing qualified older workers
and will try to create an atmosphere receptive to hiring for ability
rather than age.

A number of States—notably Arkansas, California, Pennsylvania,
and New York—have felt that vocational training or retraining is
the key to placing older workers. Arkansas training program, be-
gun as a pilot project in Hot Springs and expanded throughout the
State, has trained more than 1,500 workers over 45 in trades and crafts
or for such occupations as industrial selling, retailing, practical nurs-
ing and home care. A good 90 percent of the trainees have been
placed. In 1953 the Hazleton School District in Pennsylvania started
a community training project which demonstrated effectively that
older coal miners could be taught to operate sewing machines.
Worcester, Mass., has stitcher training and clerical retaining projects.
Several States (Massachusetts, Michigan, California, and the District
of Columbia) have amended their unemployment compensation laws
to encourage the training of unemployed older workers in new skills.

Besides expanding counseling, placement, and rehabilitation serv-
ices for older workers, nine States and Puerto Rico passed legislation
during the 1950’s to prohibit discrimination on account of age in
hiring or discharging. Louisiana and Colorado already had laws
forbidding employers to discharge for reasons of age alone. It is
difficult to measure the effect of these laws, especially as most of them
have been passed quite recently. In practice, the emphasis has been
on mediation, conciliation, regulation of advertising (as in Connecti-
cut), and educational campaigns.

Public information campaigns have been used extensively to sup-
port the State employment services’ effort for older workers. Both
State and local employment offices have distributed pamphlets, issued
news releases, put on television programs—such as Arkansas’ weekly

89
show “Can You Use Me?’—to create a climate of acceptance of the
older worker. State and local employment office staff members have
made innumerable speeches to community groups and businessmen’s
clubs. Various organizations, both national and local, have helped
with “jobs after 40” campaigns and awards to employers with out-
standing records of hiring older workers. State commissions on
aging have publicized the employment of the older worker through
“Senior Citizens’ Month.” In a number of cities committees repre-
sentative of many interests have been formed—for example in New
York State the Rochester Committee for Widening Employment Op-
portunities for Older Workers, and in Seattle, Wash., the Mayor's
Committee on Employment of the Older Worker.

Many older people have found full- or part-time employment
through self-help organizations rather than through public services.
In the past decade there has been a considerable development of this
kind of self-help; the Forty-Plus Clubs, in such cities as New York,
Boston, and Denver, which find appropriate jobs for unemployed
executives and professional people over 40, and Senior Achievement,
Ine., of Chicago, which creates jobs for able retired persons, are only
two examples. Oregon reports another type of self-help organization
in its Senior Craftsmen of Oregon, Inc., a nonprofit cooperative which
encourages and guides older people with craft skills, sells its mem-
bers’ products and provides them with a welcome supplement to small
incomes. There has also been an expansion of “sheltered workshops”
like those of the Goodwill Industries, which help to rehabilitate and
offer employment to people too handicapped by age or disability to
compete in the normal job market.

 

NEW CONCEPTS OF REHABILITATION

“Rehabilitation is uniquely important to older people,” the Mis-
souri report suggests. Because of the higher incidence of chronic
disease among them, more older people are disabled by it than younger
persons. A disabled older person has usually lost his job as a result
of the accident or illness which caused his disability ; he is handicapped
both by the disability itself and by his status as an older unemployed
worker. To older retired people, the mere functions of daily living
are exceptionally important. Life is difficult, and may even be vege-
tative, for those unable to perform those routine daily functions;
moreover the social cost of caring for them is high.

There are in the United States some 5 million middle-aged and older
persons who have been disabled for more than 3 months, in some cases
for years, by chronic illness. Probably a million and a half of these
people can be restored to active, working life, including perhaps
115,000 of those over 65. The remaining 3.5 million may never be

60
able to go back to work, but they can be rehabilitated by modern meth-
ods to the point of taking care of themselves, even to independent
living. They need not be doomed to drag out their days helplessly,
confined to bed or wheelchair, dependent on the care of others. Since
1950 new concepts and new techniques of rehabilitation have been
evolved, holding out hope for the disabled.

Vocational Rehabilitation Reaches the Older Person

The more substantial advances have been made in rehabilitation
for work, thanks to a nationwide Federal-State program. The Fed-
eral Office of Vocational Rehabilitation has shared with the States
the support of 40 significant research and demonstration projects
stressing rehabilitation of older people. The Department of Labor
and the Office of Education have provided consulting services and
assistance to the States in job training and retraining. In 1960 an
estimated 28,300 disabled persons, 45 and over, were restored to em-
ployment—a small fraction of those who could be rehabilitated, yet
twice as many as in 1950.

A dozen or more States have placed special emphasis on vocational
rehabilitation of disabled older people, as have Puerto Rico and the
Virgin Islands. Their efforts have proved, in the words of the Okla-
homa report, that “vocational rehabilitation is a wise investment,
which pays large dividends in actual financial returns, as well as in
humanitarian gains.” Between 1957 and 1959 the Oklahoma Agency
of Vocational Rehabilitation restored 876 persons over 45 to gainful
employment. About 125 of these disabled people were 60 or older;
10 were septuagenarians. Some were blind and deaf; others were
amputees, crippled by arthritis or strokes, ruptured, handicapped by
heart disease or the scars of mental illness. When they were accepted
for rehabilitation, three out of four were unemployed ; one out of four
was dependent on relatives; one in five was on relief. Of those em-
ployed, many were in unsafe or unsuitable work, earning less than
$25 a week. Their combined weekly earnings totaled $5,300. After
rehabilitation, 657 of the 876 found jobs, with combined weekly earn-
ings of $25,700. The remaining 219 were also earning, on farms, in
homemaking, or in their own small businesses.

Once rehabilitated, many disabled older people have entered or
reentered occupations in which there are serious shortages of compe-
tent personnel, such as teaching, nursing, social work, the ministry,
and research. Vocational rehabilitation of people in the upper age
brackets has been attracting particular interest. In an impressive
New York City pilot project, now being copied in other States, some
250 persons over 60—one of them over 80—were retrained and placed
in competitive employment.

61
Rehabilitation for Independent Living: The New Approach

There is as yet no nationwide program of rehabilitation for “inde-
pendent living” for older people too severely disabled to be restored
to work. A few larger communities, a few States have begun inde-
pendent living programs. A number of hospitals—such as Baltimore
City Hospital, Highland View Hospital near Cleveland, and Fairmont
Hospital in Alameda County, Calif., have comprehensive rehabilita-
tion services for older people; so have some progressive homes for the
aged like the Mary Manning Walsh Home and the Home for the Aged
and Infirm Hebrews in New York City. Demonstration projects have
produced remarkable results in putting bedridden or wheelchair pa-
tients on their feet, through the use of new drugs, diet, physical ther-
apy and retraining in the use of impaired faculties. The geriatrics
rehabilitation program of the Cook County, 11l.; Public Aid Depart-
ment, in less than 3 years, returned 93 out of 112 hospitalized aged
public assistance recipients to community living. New Jersey sub-
mits encouraging statistics from an Iissex County Hospital experi-
ment. In a group of public assistance recipients, 134 were bed fast on
admission, only 13 were bed fast on discharge; only 16 were ambulatory
on admission, 121 were ambulatory on discharge. It was then pos-
sible to place them in the community for an average cost of $104 a
month, instead of the custodial care figure of $300 a month per patient.
But more than saving money for New Jersey taxpayers, the experi-
ment rescued well over 100 aged New Jersey citizens from bare exist-
ence and restored them to some measure of activity.

These are only scattered experiments, but they have proved the
value of the new approach to chronic illness. The new approach dis-
cards the old practice of consigning the old and sick to live out their
days in backrooms, hospital wards, or nursing homes. Rather than
passive custodial care, it stresses positive activity and hope for the
future. To be effective, it requires “teams” of specialists, an appro-
priate combination of medical, surgical, psychiatric, vocational, or
educational services for each individual. To help create such teams,
the Office of Vocational Rehabilitation has been supporting special in-
stitutes in geriatric rehabilitation for nurses, occupational therapists,
physical therapists, social workers. Geriatric rehabilitation institutes
in California, Oregon, Arizona, Texas, Mississippi, and West Virginia
have brought community agencies for cooperative attack on problems
of service to disabled older people. A beginning has been made in
developing community resources to put the new concepts of the 1950’s
into practice in the 1960's. A speaker at the Maryland Conference on
Aging summed up the principle on which the new concept of rehabili-
tation is based in these words:

“i * * no Maryland citizen is so unimportant that he must sit with

62
vacant eyes and idle hands when he is capable of being employed, nor
so unimportant that he must live out his lifespan in a ‘marginal’
home.”

HEALTH IN THE LATER YEARS

The increased emphasis on rehabilitation and training in self-care
is only one facet of the progress in health and medical care programs
for older people since 1950. Especially in the past 8 or 4 years there
has been a considerable expansion of State programs for early detec-
tion of chronic diseases and prevention of disability resulting from
disease. In many States comprehensive medical care programs for
old-age assistance recipients have helped to improve the health status
of older people in the bottom income brackets. In a few States coor-
dinated home care programs make it possible for patients with long-
term illnesses to remain in their own homes. Many States report
expansion and improvement of hospital and nursing home facilities.
There is a growing awareness of the special mental health needs of
older people. Most important of all, in some States there is evidence
of an increasing emphasis on positive health, beyond the mere pre-
vention of illness.

Early Detection and Treatment

Thirty-six States now have programs for the early detection and
prevention of chronic disease and disability, nine more States than in
1956. Fifteen States, Puerto Rico, the Virgin Islands and the District
of Columbia have multiple screening programs, combining detection
tests for diabetes and glaucoma with tests for other diseases—heart
disease, hypertension, cancer, tuberculosis, and venereal disease.
Twenty-odd additional States screen for diabetes, and some also for
glaucoma. The expansion of diabetes screening has been furthered
by the Federal Public Health Service’s program guide and by the
loan to local health departments of its 28 fast, large-volume, blood-
testing “clinitrons”. North Carolina has developed its own small
hand-operated blood-testing devices, 30 of which circulate to local
and county health departments with small budgets and sparse
populations.

Several States report programs to prevent or lessen disability re-
sulting from disease. The Public Health Service booklets, “Strike
Back at Stroke,” and, more recently, “Strike Back at Arthritis,” have
inspired a number of community projects. A project in Multnomah
County, Oreg., to take only one example, has successfully demonstrated
what can be done to prevent the physical and psychological damage
which so often follows a stroke. Through intensive physical and
occupational therapy, victims of severe strokes have been helped to
avoid contractures and atrophies, to develop muscle groups, to walk

63
as soon as possible and to take care of themselves. In Kansas City,
Mo., the Arthritis and Rheumatism Foundation has just opened a
center which will concentrate on mitigating the crippling effects of
arthritis.

The movement to return older persons suffering from chronic ill-
nesses to their homes, if possible, and as soon as possible, is one of
the major trends of the 1950’s. Many restorative measures can be
carried on in the home, when trained therapists and nurses are avail-
able. Visiting nurse associations such as that of Milwaukee have
physical therapists as well as professional nurses on their staffs and
include rehabilitation in their established pattern of care. The Wis-
consin report points out that the advent of the Salk vaccine freed
much of the therapists’ time, formerly devoted to polio cases, for
“work with victims of heart attacks, strokes, arthritis, Parkinson's
disease, fractures, and amputations.

More and Better Facilities

One of the most challenging problems of health care
for the aged is that of insuring that patients at various
stages of their illness are being cared for in the most ap-
propriate institution or community facility. or ex-
ample, a recent study of a Boston general hospital
showed that almost 40 percent of those patients who were
in the hospital for more than 30 days stayed for non-
medical reasons. That is, they needed nursing care and
certain social care that could have been given in nursing
homes and possibly elsewhere. Many patients in gen-
eral hospitals could be in chronic disease hospitals.
Many of those in chronic disease hospitals could be in
nursing homes, and a fair number of the patients in
nursing homes could be in old-age homes, in foster homes
or in their own homes if certain supportive community
services were available. * * *

During the 1950's some progress has been made toward supplying
more of the appropriate facilities and services suggested in this quo-
tation from the Massachusetts report. There has been a considerable
expansion of chronic disease hospital and nursing home facilities, and
some improvement in the quality of facilities and care. A number of
States report development in home care programs, foster home place-
ment, and other community services.

Federal grants-in-aid to the States under the Hill-Burton program
have helped to provide 13,000 new chronic disease hospital beds and
7,300 beds in nonprofit nursing homes. Skilled nursing homes are
assuming an increasingly important role in medical care of older
patients. Construction of new homes has been encouraged since 1950
both by Federal and State aid and by the success of a new, more
luxurious, profitmaking type, catering to high-income patients. In

64
States like New York, New Jersey, Iowa, and Wisconsin, the number
of nursing home beds has doubled since 1950. Minnesota has author-
ized counties and municipalities to issue bonds and levy taxes for the
building, improvement, and expansion of nursing homes. In 1959
North Dakota created a $1,000,000 revolving fund for loans to non-
profit corporations for this purpose.

The “skilled nursing homes” account for approximately 180,000
of the 400,000 or more nursing home beds in the United States. An-
other 80,000 beds are in personal care homes which provide some
skilled nursing. Somewhat over half of all the Nation’s nursing
homes are licensed by State health or welfare departments. In the
past 10 years many States have stepped up their inspection activity
and consultation services for these facilities. Many States have
tightened nursing home standards, and the higher standards have
stimulated much of the new construction. Three years ago the Mis-
souri Legislature, for example, enacted new standards after a con-
flagration killing 72 persons occurred in a nursing home which not
only met, but exceeded, the existing standards. “Not a single home
in the State came up to the new standards,” the president of the
Missouri Association of Licensed Nursing Homes observed.

New construction allows for facilities and new programs which
characterized few older nursing homes. A nursing home in North
Dakota plans to add a complete physiotherapy department “to enable
us to take patients from hospitals almost a month earlier than we
could before.” Some of the larger, progressive homes offer a more
or less complete range of services and activities, including social and
psychological services, occupational therapy, adult education courses,
and various kinds of recreation—so that, as Vermont’s Commissioner
of Health has said, patients will “have something to live for and not
just be made comfortable while waiting to die.” Many States, with
the help of the Federal Public Health Service, have been organizing
nursing-home aide training programs to raise the level of care in
the homes. In 1958 Oklahoma, for instance, conducted a pilot project
to train 184 nursing aides in 71 nursing homes, representing 16 per-
cent of the licensed nursing homes in the State.

Comprehensive home medical care programs are the development
which seems to have “the greatest potential for taking some of the
pressure off hospitals and nursing homes,” as the Massachusetts re-
port says, and for keeping older patients in home surroundings at
much less cost than in hospitals. A home care program includes
medical, nursing, rehabilitative and social services. It may be based
on a hospital or organized by a group of community agencies. The
home care service of the Jewish Hospital in St. Louis, Mo., is a good
example. Its patients go to the hospital outpatient service for a first
thorough checkup. Thereafter they are visited regularly at home by

65
the physician, nurse, dentist, nutritionist, social worker, and health
educator who make up their home care team. There are two such pro-
grams in Connecticut, four in Massachusetts. One county in North
Carolina and a group of 5 counties in Kentucky have proved that it
is possible to provide organized home care to chronically ill patients
in rural areas. Altogether, perhaps 30 communities in 12 States and
the District of Columbia now have one or more organized home care
programs.
Home Care and Home Placement

Many communities have developed nonmedical services to help older
people remain in or return to their own homes. The most widespread
of these are homemaker services, which have been organized by vol-
untary agencies in over 100 communities in 32 States. In New Jersey,
a pioneer in this form of social service, homemakers are available to
about two-thirds of the population. They are mature women, trained
to work with families in which there is a crisis. Their best known
function, perhaps, is to hold a family together by managing the house-
hold and caring for the children when the mother is ill or absent.
But homemakers also assist families with aged relatives, or frail older
people living alone, by doing light housekeeping, marketing, and pre-
paring meals. Another very useful adjunct to home care, which has
appeared in a few urban communities (notably Columbus, Ohio and
Rochester, N.Y.) is “meals on wheels,” a service of nutritionally sound
hot meals prepared in a central kitchen and delivered once a day to
homebound oldsters.

A few communities in a few States have begun to try foster home
placement for older people who do not need nursing home or hospital
care but cannot live by themselves. Foster home placement has been
used successfully for some years in California and North Carolina for
senile patients who no longer need treatment in mental institutions.
More recently Missouri State ITospital has released some 200 aged
patients to carefully selected and supervised foster homes, and the
District of Columbia is trying a similar experiment with aged former
patients at St. Iilizabeths Hospital.

In many States there is a growing trend toward moving older pa-
tients out of mental institutions, generally into nursing homes. Alas-
ka has established a special nursing home for senile patients, as well as
for mental defectives, who do not require continued psychiatric treat-
ment. One of the chief objectives of the Pennsylvania Department
of Public Welfare’s Mental ITealth Center in Philadelphia is to place
patients who do not need hospitalization in outpatient clinics, or in
foster, nursing, or convalescent homes. Several State mental institu-
tions, however, have added special geriatric units to their mental hos-
pitals. Massachusetts now has such geriatric services in three of its
State institutions, with a total of 1,500 beds. “The admission rate

66
for patients over 65 is almost three times as great as that * * * in the
younger age groups,’ according to the Massachusetts report. “It
has been estimated that between one-third and one-half of these older
patients are just as ‘treatable’ as are younger patients admitted to
mental institutions.”

Promotion of Positive Health

“Health is * * * a state of complete physical, mental, and social well-
being and not merely the absence of disease,” the Vermont Report
quotes from the charter of the World Health Organization. This pos-
itive concept of health inspired the “Well Oldster Clinic” of Toledo,
Ohio, which has been copied in other cities and States. Organized by
local health departments with the cooperation of the local medical
society, and patterned on well-child conferences, the clinics’ aim is to
prevent illness by regular examinations of older people who consider
themselves well, and by group health education. Seeing positive
health as involving the total adjustment of the older person, the
Pennsylvania Departments of Welfare and Public Health have carried
this principle a step further. Their adult health and recreation cen-
ter in Philadelphia includes recreation and personal and vocational
counseling along with physical and mental health diagnosis and
evaluation and referral to appropriate community resources.

Two essential but often neglected factors in total health are dental
health and nutrition. The two are closely related, since lack of teeth
or a neglected mouth infection can result in inadequate nutrition and
a drain on the physical resources of older persons. The States report
a growing awareness of the importance of geriatric dentistry. A few
large hospitals have organized geriatric dental services. The Phila-
delphia County Dental Society has started a pioneer dental care pro-
gram for homebound patients. At least one State dental society (Con-
necticut’s) has a committee on dentistry for the chronically ill and
aged, which disseminates information to the members and cooperates
with the State medical society’s committee on aging. Recently the
committee held a seminar on dental care for the aged which included a
2-hour televised demonstration of bedside dental care witnessed by
dentists from all over Connecticut and from five other New England
States.

RESEARCH IN AGING

Before a ripe and vigorous old age becomes a reality for everyone,
we will need to know much more than we now know about what makes
for positive health, as well as what causes the illnesses of the later
years, and more about such things as how older people learn, how
they adjust to change, what they want. Research is of crucial im-
portance to solving many problems. The 1950’s saw a considerable

67
expansion of research in aging, both in the medical and biological
sciences and in the social sciences and psychology.

More than a score of States have developed very active research pro-
grams in the medical and biological aspects of aging. Missouri, Indi-
ana, and Maryland are examples of States reporting a broad range of
research activity in universities, hospitals, and organizations. New
and imaginative approaches in four other States are of particular
interest.

In the last 8 years, four major interdisciplinary research centers
in aging have been established with support from the National Insti-
tutes of Health: At Duke University Medical School in North Caro-
lina, Yeshiva University’s Albert Einstein School of Medicine in New
York, Western Reserve University in Ohio, and the University of
Miami in Florida. These four centers bring together sociologists,
psychologists, biochemists, biologists, physiologists, specialists in in-
ternal medicine, surgeons, and other scientists to collaborate on re-
search problems, cutting across traditional barriers. At Duke Uni-
versity, research is concentrated on aging in a rural community. At
the Albert ISinstein School, a parallel interdisciplinary project is
focused on metabolic alterations with age in a highly urbanized set-
ting. The centers serve their respective regions as resources for the
latest information on aging, furnish consultants, and are attracting
young investigators to this new research field.

During the decade institutes of gerontology were established at a
number of State universities—including those of Connecticut, lowa,
Michigan, and Florida—to carry on research in the psychological and
social aspects of old age. Gerontological societies have been organized
in several States. Major research projects are underway in various
parts of the country. In Kansas City, Mo., the University of Chicago
is exploring personal and social adjustment in middle age. In New
York a Cornell University team is making a 5-year longitudinal study
of retirement. The University of California’s Institute of Industrial
Relations has done several studies, on income and politics of older
people and on company pension and retirement policies. In San
Francisco, the Langley Porter Clinic is studying mental illness in
aging persons.

Massachusetts reports more than specific research studies going on
or completed, many of them at the Age Center of New England. This
unusual nonprofit institution, supported by Federal grants and foun-
dation funds, was established 5 years ago “to provide a place for inde-
pendent people to find recreation, companionship, and a chance to
work out their individual problems while contributing their knowl-
edge and skills” to basic research. More than 500 apparently healthy
men and women over 50 years have joined the center voluntarily,
paying $4 dues, and have taken part in its studies in return for coun-

68
seling. This type of older person, as the Massachusetts report points
out, is rarely seen in hospitals or clinics or by social agencies and has
seldom, if ever, been studied before.

AGE AND EDUCATION

Progress toward solving economic, social, and health problems of
older persons has been retarded in many communities by public atti-
tudes about aging and old age. This can have a serious effect on the
progress of the community as a whole. It has been demonstrated that
where older people’s problems are not recognized and met, they may
form a discontented and disruptive minority. Informal studies of
voting behavior in California, for example, have indicated that areas
with a high percentage of older people have a consistent record of
“no” votes on community improvement issues.

Education About Aging

Such findings underline the need for public education about aging.
Stimulated by the voting behavior surveys, several major California
cities have developed educational programs to create a more positive
image of older people. Not only have these programs resulted in a
better public understanding of problems of aging; they have also
encouraged many younger people to begin preparing for their own
later years. In another State, New Mexico, where Future Home-
makers of America have launched a statewide program of aging,
young people and older people have been brought together in a common
search for ways to mobilize community resources. In Indiana, the
State chamber of commerce has undertaken to educate business and
industrial management personnel concerning the needs of older people
with the aim of stimulating business leaders to organize resources in
their own communities.

Education for Older People

Education in relation to aging has three aspects: Education about
aging—including retirement counseling as well as public information
programs; education for older people; and education by older people.
Besides the preretirement programs offered by universities, labor
unions, and industry, which are discussed in an earlier section of
this chapter, there has been a considerable growth of education about
aging aimed at older people already retired. Courses dealing with
health, nutrition, family life, economics, and other problems of old
age are presented by universities, public schools, community councils,
libraries, and senior citizen clubs. Thirty-two national organiza-
tions have educational programs about aging. A number of com-

69
munities have compiled directories for their older citizens, listing
available resources from old-age homes and health and welfare serv-
ices to specialized employment agencies and adult education programs.
cxamples are the San Irancisco Chronicle’s giveway booklet
“Opportunities for San Francisco’s Older People,” and “Adventures
in Living,” prepared by the New Haven Junior Chamber of Commerce
for the New Haven Council of Social Agencies.

Education for older adults is something new in the past decade, or
almost so. By it is meant not so much education about problems of
aging, but general education to stretch intellectual sinews, enrich the
mind and expand its horizons, or vocational education to prepare for
anew career. Many State reports reflect the recognition that learning
is a lifelong process; that no one is too old to learn, although the old-
ster may learn differently from the youngster.

There is still considerable controversy over whether separate pro-
grams should be set up for older adults. Some adult education ex-
perts argue that separate programs would isolate them and that
special efforts should be made to attract older people to existing pro-
grams. After a survey, the California State Director of Adult Iidu-
cation concluded that in cultural and leisure-time activity subjects,
older people preferred classes designed for all age groups, but that
courses in health, insurance, and investments, vocational retraining,
and “the art of aging” should be designed specifically for the older
group.

In 1957, 18 States reported special adult education classes for older
persons in a total of 161 communities. Over half of these were in New
York State. Since education for older people is an integral part of
adult education, those States which have the most extensive adult
education programs have shown the strongest leadership in this field.
Among them, besides New York and California, are Michigan, Ohio,
New Jersey, and Florida. The Los Angeles and Baltimore school
systems and New York State have full-time persons assigned to edu-
cation for older adults, and New York makes State aid available to
school districts for older adult education.

Currently about 1 in 30 people over 65 attends formal adult educa-
tion classes, whether these are offered by universities, communities
and junior colleges, public schools, employers, unions, clubs, or other
agencies. Their major interests, according to a California survey, are
crafts, homemaking, fine arts, Americanization (citizenship and Eng-
lish for the foreign born), business education, current events, civic
education, “language arts” (English or foreign language), and voca-
tional education—in that order. Nearly 1,000 senior citizens’ clubs
and centers throughout the country offer informal classes in the arts,
hobbies, music, world affairs, and homemaking.

70
Older People in Educational and Social Services

The possibilities for education by older people only just began to
be tapped during the 1950’s. In 1957-58, 41 percent of the colleges
and universities were hiring retired professors over 65 years of age,
and many others had changed their employment practices to allow the
retention of their older teachers. But many older people retired from
other professions are going into second careers as teachers. In 1959,
over 240 colleges and universities were employing retired armed serv-
ice officers. Retired engineers and scientists, older women who have
finished their jobs as mothers, are going into teaching. Some institu-
tions are providing retraining in teaching for older people, and many
groups—such as the American Council on Education, the American
Association of University Professors, the National Manpower Com-
mission—are helping to place retired people.

Many other older people are contributing to education as school
board members or as volunteers. The Director of Adult Education
at Santa Barbara, Calif., has an advisory committee of distinguished
men and women, all over 65, who survey adult education needs, pro-
pose new courses, and approve the total program. Still other retired
citizens have volunteered their services to work with preschool chil-
dren or exceptional children, in summer schools or in special com-
munity research projects.

Community service—whether in education or in other fields—offers
the most challenging opportunity for the use of older people’s free
time. Individual older people have always contributed their experi-
ence and talents on their own initiative, but only very recently has
there been any organized effort to use their potential. Recognition
that willing and able people must be used is the main forward step
of the 1950’s. Here and there in the State reports to the White House
Conference are evidences of organized effort. Indiana, for instance,
reports that a few of its business organizations discuss with their
retiring employees the opportunities for using their new leisure in
the service of the community. In Ohio the Cleveland Volunteer
Bureau recruits and trains retired people for community service, as
do chapters of the American National Red Cross in a number of
States.

CREATIVE LEISURE

The Church of the Latter-day Saints organized free-time activities
for its older members as early as 1875, according to a Utah report.
But it was not until after World War II that communities in many
parts of the country became aware of this major social need. The
National Conference on Aging in 1950 helped to stimulate a nation-
wide movement.

71
Clubs and Centers for Seniors

The most frequent and popular leisure-time activity so far is the
“golden age club” or “senior citizens club,” which has sprung up in
practically all States under the sponsorship of both public and volun-
tary agencies, sometimes of churches. “Substantial numbers” of these
clubs are reported by industrial States like Massachusetts, New York,
New Jersey, Pennsylvania, Ohio, and Illinois. Connecticut has more
than 60. Several predominantly rural States—Vermont and New
Hampshire, North and South Carolina, Georgia and Alabama, Texas,
and Idaho—have seen a considerable growth of the clubs. Inevitably
they have flourished in States with large retired populations: Cali-
fornia, Arizona, Colorado, and Florida. The District of Columbia
has 40 such clubs.

The senior citizens clubs are chiefly social and recreational. The
best of them, however, offer a wide range of activities, from indoor
and outdoor games and hobbies to handerafts, fine arts, discussion
groups, lectures, and sightseeing trips. In the larger communities
there is an increasing trend to adult education programs in the clubs.

Since the clubs usually meeet only once a week, some communi-
ties—often on the initiative of labor unions—have established “drop-
in” centers or “day centers” to fill the empty hours of other days.
The centers may offer no more than companionship, television, or a
bridge game; a few have a full program, including counseling and
vocational training, under the direction of an experienced leader. The
recently established Senior Citizen Community Center in Anderson,
Ind., plans to have classes for retirees in hobbies and languages, and
classes for young people, taught by retirees, in fishing, crafts, and
homemaking. The Sorrento-Sullivan Recreation Center at Hancock
County, Maine, includes the area’s older citizens in a variety of com-
munity activities, as well as offering programs for their special needs—
among other things, a library, meal facilities, and crafts. One of the
best known senior centers in the country is Little ITouse of Menlo
Park, Calif., with its broad and varied program of activities and the
opportunities offered its older members for community service.

Recreation in Environmental Settings

As awareness of recreational needs spreads, housing projects for
older people are being designed with their own recreation facilities,
or located near community facilities. California, Washington, Mich-
igan, Texas, and Ohio report provisions for recreation in “retirement
villages” and hotels with older residents. Even more important, in
the past decade there has been considerable progress in providing rec-
reation for ill or handicapped older persons, whether at home or in
nursing homes. New York City is conducting a pilot project in rec-

72
reation for the homebound. Connecticut, New Jersey, and Pennsyl-
vania are among the States reporting pilot projects to demonstrate
free-time programs in small institutions. The many nursing homes
of Colorado Springs—with 4,000 beds among them—offer a broad
range of activities for their patients. In California a recreation pro-
gram is a licensing requirement for nursing homes. Wisconsin
reports remarkable success in two institutional projects: At the
Veterans Administration domiciliary at Wood, nearly 300 severely
disabled older men were given work assignments in sheltered work-
shops, plus a program of diversified recreation in line with their in-
terests; in the Milwaukee County Asylum, physically and mentally
disabled patients between 70 and 90 have been taught new skills and
given new interests through work therapy balanced by parties, picnics,
movies, games with music and singing, crafts, and cooking classes.

Many healthy older people who take no part in club or center
programs make use of regular facilities provided by Federal, State,
and local governments—particularly of parks, museums, and libraries.
And increasingly, attention is being given to their needs and con-
venience. Ohio for example, reports that parking lots are being lo-
cated as near as possible to other facilities; many State park nature
trails are on level ground; that ease of access, sanitary and first-aid
facilities, inclines and elevations, steps and grades are taken into ac-
count in planning new park and forest areas. Free fishing licenses
are granted to all recipients of old-age assistance in Ohio and some
other States. Five parks in Phoenix, Ariz., reserve several hours a
week for exclusive use of shuffleboard and horseshoe courts by older
citizens. Other Arizona towns, especially Tucson, offer concerts and
other special programs for oldsters.

Library Services for Older Adults

A number of States report that librarians, at least in the larger
communities, are increasingly conscious of their responsibility to
serve older people. Several New Jersey public libraries have special
services for shut-ins, assisted by volunteers from the Junior League
(Englewood), the Red Cross (Trenton), the National Council of
Jewish Women (Teaneck), or—in Ridgewood—Dby a single dedicated
woman library trustee who operates a “shuttle service to shut-ins”
herself. A few public libraries in New Jersey and other States own
ceiling projectors which are loaned to patients unable to hold books.

Some larger public libraries (for instance in Indiana) make up
booklets with titles of special interest to older people; or provide
lectures, discussion groups, and reading clubs. A number of State
libraries have mail services specifically for older people who cannot
get to the library, as well as braille books and talking books for the
blind. Some Michigan local libraries operate a bookmobile service to

577791—60——8 73
patients in institutions, providing a wide choice of materials. And the
Michigan State Library, noting oldsters’ fascination with geneal-
ogy—to which any librarian can testify—is encouraging older people
to gather or write the history of their families or their communities
as a contribution to State records.

THE CONTRIBUTION OF RELIGIOUS GROUPS

Spiritual Guidance

A focus on older people is relatively new in organized religion.
Many congregations have always included their older members in all
appropriate activities, as a matter of course; many pastors have long
made a point of visitation to the elderly. There is nothing new in this
nor, for instance, in providing facilities for the deaf in churches and
synagogues which can afford them. But since the State reports to the
White House Conference suggest that many churches are not particu-
larly aware of older people's needs, this report of a church in Galves-
ton County, Tex.—though not unique—is worth quoting as an ex-
ample of thoughtful attention to its senior members.

The Galveston County church “ministers to its aged through a regu-
lar radio broadcast * * * [which includes] a special taped message
to the aged and shut-in.” It also provides “free bus service for those
who do not have transportation * * * and a program of social
activity and religious study for those in the sunset years. * * *
[There is] a special extension department whose trained visitors carry
literature and other helps into the homes of those who cannot * * *
regularly attend the worship services. * * *7

Idaho reports that the Mormon Church in that State has “a well
defined program of welfare” for its oldster members. “The aging
and the aged are contacted once a month, as is every family, by a
representative of the bishop to determine any needs. The practice of
the church for many years has been for each member in a family to
fast two meals on the first Sunday of each month. What would have
been the cost of the food is contributed for the care of the church
needy. Out of the fast-offering fund and storehouse and welfare
funds, the bishop is able to take care of every living need, such as
housing, food, clothing, utilities, doctors, hospitals, medical needs,
special training for jobs, ete.”

Joncern with problems of aging has been growing in religious
organizations on both national and local levels in the past decade.
One State report comments: “National and regional [religious
groups] conferences on aging are becoming more frequent. Articles
in church papers and * * * books and pamphlets [issued] through
national church channels are appearing more often. * * * Courses
are showing up in leadership schools and in pastors’ seminars.”

4
National religious bodies have established departments on aging
which make suggestions to local churches. In 1955 a first nonsec-
tarian church conference on aging was held, with the emphasis on
pastoral counseling.

Services for Older Parishoners

On the State and local levels some religious organizations are
studying the needs of their older parishioners or holding institutes
on aging for their ministers. The Indiana State Commission on
Aging has a committee on religious institutions and organizations
with three subdivisions—housing, counseling, and recreation—which
attempts to inform and guide local churches and synagogues; the com-
mittee has organized workshops for ministers and laymen and will
sponsor a statewide conference in the fall of 1961. Some States re-
port specific church-sponsored community programs for older people,
especially in the form of senior citizens’ clubs and centers. In the
District of Columbia, for instance, the Episcopal churches have a
group worker assigned to organize social clubs. In San Francisco
the Council of Churches sponsors two senior centers. In some States
(Minnesota and Idaho among them) churches have organized sum-
mer camping for older people.

The religious groups’ chief concrete expression of concern, how-
ever, has been in the form of housing projects, “retirement villages,”
and homes for the aged. Church homes for the old are a time-hon-
ored tradition, expanded in the 1950’s. Housing developments are a
recent, phenomenon, built and operated by many sects, with more
planned for the 1960’s. Willamette Manor near Portland, Oreg., a
cooperative developed by Oregon Methodist Home, Inc., has been the
model for several similar projects. Baptist Village, a 563-acre de-
velopment in Georgia; the 40-acre Presbyterian Village in the sub-
urbs of Detroit; another Presbyterian development, for retired minis-
ters, in the outstkirts of Philadelphia, are only a few examples. In
many cases they offer a choice of accommodation—residential hotel-
type, apartments, small houses or cottages—along with central recrea-
tional facilities, medical care and meals if desired, sometimes covered
by an all-inclusive monthly fee.

Meanwhile there has been notable progress in the standards, attrac-
tiveness, and programs of church-sponsored homes for the aged. The
religious groups have pioneered in many ways. Increasingly, their in-
stitutions offer care in depth—recreation, rehabilitation, counseling.
The Jewish Home in Dallas, for example, provides a pleasant environ-
ment and activities for healthy older adults, rehabilitation for disabled
ones, skilled nursing care in long-term and terminal illness. The Mary
Manning Walsh Home in New York City, operated by the Carmelite
Order, has a full program including medical and nursing services,

75
social and psychological services, speech and hearing therapy, resident
counseling services for the blind, occupational therapy, adult educa-
tion, recreation, a house paper. Many of its services are available to
older people living in the neighborhood.

HOUSING FOR OLDER PEOPLE

Progress over the past decade in meeting the housing needs of older
people is hard to measure. A crude measure is the net increase in
the nationwide housing supply—from 46 million available dwelling
units in 1950 to 59 million in 1960. This increase of 13 million units—
about 4 million more than were needed to meet the needs of new house-
holders—suggests that the population as a whole had more choice in
selecting a place to live. Presumably this was also true of older people.
However, it is diflicult to pin down accurately the adequacy of avail-
able housing for older people, because 1960 census data were not avail-
able when the States compiled their reports. A few States—Arizona,
Ohio, Florida, Connecticut, Massachusetts, and New York in partie-
ular—reported considerable activity in construction for the elderly.
A number of States reported low-rent or moderate-rent public housing
built or planned. The specially designed building for the elderly in
Cleveland Housing Authority’s Cedar Apartments Development, built
in the early 1950’, is recognized as a pioneering achievement in low-
rent housing. Massachusetts has been a leader in the low-income hous-
ing field. The first government-sponsored housing for the elderly in
Hawaii is being built in Honolulu by the ITawaii Housing Authority
(96 out of 156 units in a federally aided low-rent housing project,
scheduled for completion in December 1960). Hartford is one of the
several Connecticut towns to have State-assisted low-rental projects
built or underway.

There was more progress in housing for group living—a national
increase of 72 percent as compared with the 24 percent increase in the
old-age population. Most of this was in the form of private, non-
profit homes for the aged—in which religious groups accounted for
approximately two-thirds of the total increase—or of commercial con-
ralescent, rest, or nursing home. Many States referred to an upgrad-
ing of standards, describing a generally encouraging picture as com-
pared with 1950.

In noninstitutional group housing, California, Texas, New York,
Ohio, and Florida reported that old hotels were being used increas-
ingly as residences for older people. In Ohio two hotel chains, operat-
ing in 8 towns, cater to older residents and include recreation and
counseling in their fairly moderate rates. Only Florida—perhaps be-
cause of the concentration of outmoded hotels in Miami Beach—men-
tioned retirement hotels as a major factor in housing for the elderly.
The State reports scarcely refer to rooming and boarding houses,

 

76
which seem to have declined with the increase in suitable housekeeping
quarters. But North Carolina and Washington State, as well as
some individual communities like Cleveland and Los Angeles, note
that specialized boarding homes providing foster care are beginning
to play an important part in the housing of older people unable to live
alone.

Many State reports reflect the growing awareness of the need for
building safety features into housing for older people, and, most
important, for locating it conveniently near shops, parks, libraries,
recreation centers, health services, churches, and transportation.
There is an increasing sensitiveness to the different tastes and desires
of older people, to their emotional ties to the neighborhoods in which
they have spent most of their lives. Tt isa heartening sign of progress
that many State and community housing agencies are studying their
tastes, desires, and needs before planning new construction.

SOCIAL SERVICES FOR OLDER PEOPLE

Social services for the aging have assumed greater importance in
the past decade because of what most State reports suggest is a chang-
ing pattern of family relationships. Ten years ago the National Con-
ference on Aging surveyed the older person’s family relationships
mainly in terms of housing and living arrangements. Since then the
mobility of American families has tended to separate parents and their
children to an even greater extent than in the past—or so the States
report, as in this passage from Illinois:

“The shifting of much of the responsibility for the care of older
people from the family to the community has been inevitable in a
highly mobile mass society, but the resultant gains to the individual
and the family have been marked weakening of age-old family rela-
tionships. * * *»

Social Services in Times of Crisis

The result has been a greater need for the support of social agencies
in times of crisis. In general, the States see the role of the social
services as one of the strengthening family relationships—through
counseling of both parents and children; through helping to achieve
the best and most realistic living arrangements for both older and
younger family members; through special aids, such as homemaker
services, to prevent premature institutionalization. They see this role
also, and significantly, as one of helping to keep enfeebled, unattached
aged persons in the community with as much independence as possible,
through protective care and guidance in their affairs, if need be, and
perhaps through semiprotected living arrangements. They see it as
the very essential one of maintaining and improving the morale of

(ut
homebound patients, especially those in nursing homes and hospitals,
by helping to solve the nonmedical problems which may compound an
illness.

The Development of Social Services

During the 1950s there was progress in providing these services,
to a greater or lesser extent, in many States. As of 1959, 21 States
could report social services for older people in the areas of casework
and counseling, living arrangements, guardianship and protective
services, rehabilitation, health and medical care, and organized special
resources such as homemaker services, meals-on-wheels and foster-
home placement. (Some of these have already been discussed in con-
nection with health and medical care). In most sections of the country
social agencies consider information and referral an integral part of
their services. Casework services are available ordinarily as part of
a general community service for all ages whether by family service
agencies, mental health clinics, the Red Cross or other voluntary or-
ganizations, or by public welfare departments. A few large cities
and a few family service or public welfare agencies have organized
centers or departments specifically for the aged. Among them are the
United Charities of Chicago, the Catholic Charities of Detroit, the
Catholic Charities Bureau, The Family Service Association, and the
Jewish Family and Children’s Services of Boston, the Community
Service Society of New York, the Jewish Community Services of Long
Island, and the New York City and Chicago public welfare depart-
ments.

Usually the social services of public welfare agencies are available
only to public assistance clients. But the fact that they are available
is one of the advances of the 1950's. A major recommendation of the
1950 National Conference on Aging called on public, as well as private,
agencies to develop social services as an integral part of their aid to
older people. The recommendation was heeded in 1956 amendments
to the Social Security Act which directed the States “as far as prac-
ticable under the conditions of each State” to provide services aimed
at helping old-age assistance clients achieve self-care. Congress made
Federal funds available to the States on a matching basis for this
purpose. All but three of the 50 States have applied for the matching
grants for some type of social service.

A major issue of the 1950’s in connection with old-age assistance
programs has been that of filial responsibility for financial assistance.
Thirty-four States and the District of Columbia now have laws re-
quiring adult children to contribute money to needy parents who re-
ceive aid under the Federal-State old-age assistance program. There
has been and is, considerable controversy over this legislation and its
effects, but the controversy is not reflected in most of the State
reports.

8
PROFESSIONAL PERSONNEL

The fields of geriatrics and gerontology have expanded so rapidly
in the past 10 years that professional training has not caught up
with them. More attention has been given to facilities, services, and
programs than to personnel. As programs have been set up, profes-
sionals from many fields have been drawn into them—“sometimes
much to their own surprise,” as one State report puts it—without
specific training. And indeed there has been little time to define
what the nature of that specific training should be.

Moreover, there is still a controversy over whether professional
personnel should be trained as specialists in aging. A number of the
State committees for the White House Conference felt that “speciali-
zation” in aging would result in undesirable segregation of older
people. For all these reasons the States do not report extensive de-
velopments in training programs. This summary of the situation
from the Alabama report would apply equally well to other States:
“Findings of the subcommittee on * * * professional personnel were
both encouraging and discouraging * * * encouraging in that inter-
est in the subject is widespread * * * [and that] interest is gaining
momentum as related to * * * training for workers with the aging.”

The States do, however, report growing attention to geriatric as-
pects of medicine, nursing, rehabilitation, public health, mental health,
social work, and vocational counseling and to a lesser extent in recrea-
tion and adult education. Much of this training is in the form of
parts of university or professional school courses, rather than full
courses programs. Problems of aging and care of older people are
integrated into instruction in anatomy, internal medicine, bedside
nursing, social work, or nutrition. A few institutions offer more ex-
tended treatment. In the past few years both of Nebraska’s medical
schools have organized teaching programs in rehabilitation. The
University of Kentucky has an undergraduate major in geriatric
social work. At the graduate level the University of North Carolina
School of Public Health lists five continuing courses in geriatrics and
gerontology and is planning a gerontology major.

There is an increasing amount of short-term training, in the form
of institutes for physicians (Texas, Nebraska—the latter especially in
rehabilitation), mental health personnel (Brigham Young University
in Utah, the Community Council of Greater New York). Texas re-
ports seminars on nutrition for health officers and nursing home oper-
ators. South Carolina mentions short courses of psychiatric training
for nurses, doctors, medical students, and nursing home operators,
given in its State hospitals. Library training conferences in Georgia
have stressed what the librarian can do for older people.

Partly as an outgrowth of the older worker specialist program, voca-
tional counselors in many larger communities have received special

79
training in older adult counseling. The Veterans Administration
9
public rehabilitation agencies, and employment agencies have estab-
lished outservice training programs at colleges and universities to sup-
plement inservice training programs. As a demonstration, the Wis-
consin State Board of ITealth and several Brown County agencies have
been conducting a detailed and impressive program of training in re-
habilitation techniques in a number of hospitals and nursing homes.
i g
Finally, as was noted in the section on research, a significant start has
been made in training investioators in the medical, biological, psycho-
5 = 9 > 9
logical. and social aspects of aging in institutes of gerontology in half
5 9 = ™
a dozen States and four new regional research centers.

STATE AND LOCAL COMMUNITY ORGANIZATION

The key to serious progress in the field of aging, as workers in the
States would agree, is planning and coordination of programs and
services at both State and community levels. As the Massachusetts
report explains:

Tt is because the problems of aging cut across so many
areas, involve so many different professions, so many
organizations and agencies, that there is such a great need
for overall coordination. The problems of aging can be
viewed on the basis of the neighborhood, the community,
the region, or the State. The complexity of the problems
of the aged and complex structure of services and activi-
ties that are required to cope with these problems make
it essential that a single agency keep a constant over-
view of the whole situation.

Organization at the State Level

Before 1950 only three States had such a single agency: Massachu-
setts, Connecticut, and New York. The National Conference on
Aging stimulated the organization of commissions on aging, or similar
devices, in a dozen more States. Others were established before or
after the 1956 Federal-State Conference on Aging, conducted by the
Federal Council on Aging and the Council of State Governments.
While some of these commissions of the 1950’s proved short-lived, 20
were in existence in 1959, just before Federal grants under the
Fogarty Act sparked the formation of State committees for the White
House Conference on Aging.

Various patterns of organization have characterized the State bodies
on aging. The most common type is an interdepartmental committee,
as in Kansas, Wisconsin, and Wyoming. Louisiana’s and Washing-
ton’s are public advisory commissions. Minnesota, New Jersey, and
Rhode Island have created special assistants to the Governor or a
special unit in the executive office. Some, like Michigan's recently

80
established commission, are the result of years of study and experi-
mentation.

In most cases the functions and responsibilities of the State com-
missions have consisted mainly of surveys, recommendations to the
Governor or legislature, review of existing programs, advice on policy.
Many have been handicapped by shortages of funds and staff. One
of the best supported of these agencies has been the New Jersey Divi-
sion of Aging, which coordinates all State programs affecting older
people. The division includes an 11-member advisory commission,
representing citizens and interested State departments, a citizens’
council which assists in organizing local community councils, and a
staff of 6 professionals and 5 clerical personnel. With a $100,000 a
year budget, the division has been able to publish a monthly news-
letter, carry on a campaign of public information, and actively pro-
mote community organization.

Probably the State commissions’ most valuable contribution has
been in the form of guidance to local communities. The Massachu-
setts Council for the Aging, a nine-member advisory board with a
two-man professional staff, has helped 47 communities develop their
own local councils. Since 1956 the Louisiana Commission on Aging,
another nine-member advisory body, has aided in the creation of 50
municipal or parish councils which have been studying local needs,
facilities, and services. The Statewide Committee on Community
Organization of the Indiana Commission on Aging, operating through
six regional committees, has helped organize county committees on
aging in 21 of the State’s 92 counties.

Community Planning and Coordination

In the past 10 years, there has been considerable development of
local community organization, whether in the form of councils under
municipal auspices or county councils established under State law, or
in the form of committees on aging within health and welfare councils.
Most of this development has been in towns and metropolitan areas,
little of it in rural areas. However, Towa reports some form of or-
ganization for the aging in 96 of its 99 counties, many of them rural.
Committees have recently been set up in five rural counties in Min-
nesota, with the aid of a State community organizer, in a successful
demonstration project. While State bodies on aging have assisted
local organization in some States, in others local groups have looked
to universities or independent agencies for leadership. In Michigan,
where municipal councils on aging exist in 14 larger cities, a State
commission was not formed until 1960, but the University of Michi-
gan’s Division of Gerontology and the legislative advisory council
have played important parts in assisting local committees.

Committees on aging within health and welfare councils are the

81
more frequent type of local organization. These local committees
vary in the kind and degree of their activity. Some have been formed
to make a specific study and have been dissolved on completing their
assignment. But a number which have achieved permanence grew
out of more limited projects. The Senior Citizens Committee of
Peoria, Ill, a part of the community council, stemmed from an in-
stitute on needs of the aging, which in turn was inspired by the process
of developing a home care plan.

A primary function of the health and welfare council committees
is coordination of the member agencies’ services for older people.
But this function in itself may lead to cooperative projects, such as
the establishment of a central senior center, providing activities,
counseling, and referral services. Los Angeles County, Calif.; Port-
land, Oreg.; Dayton, Ohio; Richmond, Va.; and Philadelphia are
among the communities which have senior centers under the auspices
of their health and welfare council committees on aging.

One of the most important activities of local community organiza-
tion so far has been to study the needs of older people, either in gen-
eral or in specific terms of health or housing. Such studies are basic
to planning, and some have already produced concrete results. For
example, Cleveland’s Highland View Hospital for the chronically ill
was inspired by a study project of the Committee on Older Persons of
the Cleveland Welfare Federation. Paterson, N.J., conducted one of
the first research projects of its kind in the country in 1958, taking
a scientific sampling of the living arrangements, health, and economic
condtions of its older citizens, and establishing an accurate count of
those over 65—all facts which had not been available before. Chatta-
nooga, Tenn., New Orleans, Tucson, Arizona, Kansas City, and
Wichita are only a few of the communities where surveys have been
conducted since.

THE ROLE OF NATIONAL VOLUNTARY ORGANIZATIONS
IN THE STATES AND COMMUNITIES

Many of the surveys and studies have been sparked, carried on or
greatly assisted by, local branches of national voluntary organizations.
To take just one, the Paterson, N.J., survey was proposed by a repre-
sentative citizens committee on service to elderly persons, which was
cosponsored by the Paterson section of the National Council of Jewish
Women and the Paterson YM-YWHA. The survey itself was spon-
sored by the YWCA, and 150 volunteers were mobilized from every
service club, civie, religious, and professional group in Paterson to do
the actual legwork and doorbell ringing. Branches of the American
Association of University Women have cooperated in a number of
surveys—for example, Bar Harbor, Maine ; Midland City, Mich. ; and

 

82
Tucson, as well as Paterson—helping to develop questionnaires and
to tabulate, evaluate and interpret the results.

Many national organizations have a long history of concern and
programs for the aging. Their publications have served as an im-
portant medium of interpretation and leadership. They have played
a significant part by joining with others in discussions and explora-
tion of goals and methods. Most of their projects have been carried
out at the local level, with the parent organization making suggestions
and proposals and stimulating its local affiliates to action through
newsletters and outline guides. Kiwanis International, for instance,
has provided its clubs with a five-page mimeographed bulletin, listing
70 ways in which they can assist senior citizens, “from * * * cookies
to * * * housing, and Kiwanis clubs have done both.”

National organizations’ local affiliates have taken a leading part in
a great variety of programs for older people. Chapters of the Na-
tional Council of Jewish Women have sponsored some 200 “golden
age” clubs. The Arkansas Federation of Business and Professional
Women’s Clubs sponsors that State’s older worker training program
for up-dating the skills of job applicants over 45. A number of
women’s service clubs work in the States and locally to overcome dis-
crimination against older women in employment, notably the Altrusa
Clubs in Phoenix and Tucson, Ariz. The YWCA has cooperated
with the New York State Employment Service on clinics for mature
women wanting to go back to work. The Fraternal Order of Eagles
has “jobs after 40” committees in all States and 1,600 communities;
their active support of antiage discrimination laws has already borne
fruit in six States.

Perhaps the most important contribution of the national voluntary
organizations has been in the carrying out of pilot projects, and
among the most energetic pioneers have been several labor unions.
The Dayton, Ohio, senior citizens’ center is the end product of an
informal committee originally organized in 1946 at the instigation
of District 65 of the Retail, Wholesale, and Department Store Work-
ers Union, AFL-CIO. District 65 has evolved well-rounded programs
for its own retired members, including a pension plan, complete
health insurance, adult education, social and recreational activities.
Another national labor organization whose locals have stimulated
programs in the community at large is the United Automobile
Workers Union, which has pioneered in opening drop-in centers in
some 50 towns and cities across the Nation. UAW’s Local 155 has
established a counseling and activity center in New York City which
welcomes all retired men and women.

Philanthropic foundations have also become interested in support-
ing pilot projects for the aging. The division on aging of the Health
and Welfare Council of Metropolitan St. Louis has received a Ford

83
Foundation grant to study the role of the churches in the lives of
older people and to demonstrate how religious groups can work with
other community agencies in meeting their needs. Another Ford
Foundation grant has recently been made to the United Community
Fund of San Francisco for a pilot project in coordination of local
services for the aging—a project which had already won the support
of the San Francisco Junior League.

FEDERAL PROGRAMS AND THE STATES

Few of the State factual reports to the White House Conference on
Aging devote a separate section to Federal programs. Yet all the
reports contain evidence that the improved economic situation of the
States’ older citizens is due in large part to Federal and Federal-
State programs: old-age, survivors’ and disability insurance; railroad
retirement ; civil service retirement; old-age assistance. The older
worker specialist program; hospital and nursing home construction
under the Hill-Burton Act; rehabilitation projects aided by the Office
of Vocational Rehabilitation, the Veterans Administration, or the
Public Health Service; housing projects for the elderly assisted by
Federal housing programs—all these have been furthered by Federal
funds and the advice of Federal agencies. Grants of the National
Institutes of ITealth and the Office of Education to many State institu-
tions support basic research which promises longer and better years.
The Department of Health, Education, and Welfare’s Special Stat
on Aging has pioneered for a decade in serving as a national clear-
inghouse for information; providing consultation service to States,
organizations, and communities; developing and publishing bibli-
ographies, factbooks, program guides, and a monthly news bulletin,
Aging. With an expanded staff, including a Representative for
Aging in each Regional Office, it has had primary responsibility for
providing staff service for the White Iouse Conference on Aging.

It seems obvious that without the partnership, and often the initia-
tive, of the Federal Government in local and State effort, the States
could not report so much achievement during this decade of
exploration.

84
Chapter IV

1960: A YEAR OF INVENTORY

During the past year the States have been taking inventory of con-
ditions for their older citizens. The process, as the Maine Committee
has observed, “has a double value.”

First, it may reveal to many citizens that much has
been done * * * Maine has not forgotten its aged.
There have been many praiseworthy efforts * * * at
both local and State levels, but * * * the total effort has
not been publicly realized.

Second, it will reveal that there is still a lot to be done.

THE PROBLEM OF RETIREMENT INCOME

The States have found many unmet needs, many unsolved prob-
lems. The first of these is the problem of support for the declining
years. Utah calls it “the major problem of our aging population”;
Texas and Wyoming refer to it as “paramount.” South Carolina
underlines the broad implications in this paragraph :

The housing and health of older people depend di-
rectly upon the adequacy of income and the availability
of resources. Income also has a direct bearing on the
maintenance of the family and community relationships
and on the extent to which older persons continue to en-
gage in meaningful activity. With insufficient financial
resources older persons are seriously limited in the man-
agement of their own affairs, in making their own choices
and decisions, and in maintaining their self-respect.

Low Levels of Income

In spite of the general improvement in their economic situation
since 1950, “many older persons have inadequate income, even after
making allowances for tax advantages, nonmoney income and less-
ened needs for * * * goods and services,” as the Colorado report
observes. Many States report that half their citizens over 65 have
incomes too low even to meet their basic needs. A considerable num-
ber of aged Ohioans “lack funds to purchase necessities, minimum
medical care, and satisfying participation in social and community
life.” A study of Kansans over 65 showed that their financial posi-
tion is all too frequently precarious, and “the extent to which older
Kansans are without money incomes suitable for mere existence or are

85
susbsisting on marginal incomes” is probably even greater than sug-
gested in the study. To state it more explicitly: according to the
most recent Bureau of Labor Statistics figures, a minimum budget for
an elderly suburban couple owning their house is $1,900 a year; for an
older city couple, it is $2,641 to $3,366, depending on the city. Yet
almost 60 percent of Americans over 65 have yearly incomes of less
than $1,000 or no money income at all. New York studies have indi-
cated that “3 percent of aged men and 29 percent of aged women are
entirely without money income.”

The problem of income maintenance is most acute in the low-income
rural States, especially those of the South. Until recently, when social
security was extended to regularly employed farmers and farm
workers, these States were under a handicap which continues to affect
their already retired citizens. Moreover, during the years when their
citizens now over 65 were productive workers, the per capita incorne
of the Southern States was exceptionally low. Take Louisiana:

* kk ip 1929, when the person who is now 65 was 34,
[the State’s per capita income] was $415 a year. In 1933
it was $222; in 1939, $354; and in 1941, when he had
reached age 46, it was $434.
His inability to accumulate savings * * * hardly
needs underscoring here—
nor does the low base on which his OASDI benefits were calculated, if
he was eligible for them. Mississippi summarizes: “* * * the average
income of all Mississippians is about 50 percent of the national aver-
age. Mississippi's older people are a low income group in a low income
State.”

Inevitably, inflation has affected the incomes of older people, al-
though amendments to the Social Security Act and adjustments in
other public and a few private pension programs have helped to meet
rising prices. New Mexico reports that “the impact of inflation upon
the living standards of senior citizens seems to have been quite se-
vere * * * Despite some increases in pension and assistance benefits,
the majority of [our] counties report that living standards for older
persons have fallen during the past few years.” In Hawaii “sky-
rocketing land values, spiraling taxes, and the high cost of building
make home ownership * * * difficult * * * for the older citizen unless
he * * * acquired a home some years ago * * * In Nevada, an un-
usually high cost of living works special hardship on older people
dependent on fixed retirement incomes. This is even more true of
Alaska:

A retired individual trying to live on what is usually a
reduced income is faced with a critical problem in provid-
ing himself with mere subsistence. The cost of living is

Dighar than the U.S. average by 22 percent in Ketchikan
and by 75 percent in Nome. The tendency is for the

86
senior residents to move to lower cost living areas and
to other States where their social security or other income
will buy more. This not only deprives them of contact
with their families, friends, and familiar pursuits, but
robs [Alaska] of valuable experience they can contribute.

As was noted in the previous chapter, old-age, survivors’, and dis-
ability insurance is now the major source of income of most peo-
ple over 65. But OASDI benefits alone, although they are larger
than a decade ago, do not constitute an adequate income. And a
third of our older people are still not covered by social security. As
the Tennessee report points out :

Individuals and couples * * * with the lowest income
are at the same time least protected by this social in-
surance. Even for those who do have this coverage
present-day benefits provide little more than a third o
past earnings for anyone who had earned $300 or more a
month. It is only those whose past earnings were at a
much lower level who receive an income which approxi-
mates their earlier earnings.
* * * Average monthly payments of approximately
$74 are * * * too low to enable persons without additional
income to maintain even a substandard of living.
The Louisiana report notes than many OASDI beneficiaries receive
less than that average; at the end of 1959, about three-tenths of re-
tired workers received under $45 a month and more than a third of
the aged widows and widowers received less than $40. Widows and
elderly spinsters, as Tennessee again observes, have the most serious
income problem of all and make up the largest single group of older
people.

With still existing inadequacies in the Social Security program, de-
pendence on old-age assistance remains heavy in some States, whether
to supplement or to substitute for other sources of income. In the
Nation as a whole, about 1 in 6 persons over 65 receives old-age as-
sistance, but in the lower income States as many as 2 out of 5 older
people are OAA recipients. In June 1959 (the latest date for which
exact figures are available), more than a quarter of the caseload de-
pended on OAA to supplement OASDI benefits.

Here again, the States report that OAA grants, while more liberal
than in 1950, are still too low. Maximum monthly cash payments
range from $107 in Colorado down to $33 in Mississippi. “There is
almost nationwide agreement that old-age assistance grants in most
of the States are entirely inadequate for minimum needs,” the Utah
report says. In Maine, the “OAA program * * * provides essen-
tially a subsistence level * * * and in all probability does not cover
all who need aid.” In Maryland “* * * at least half, and perhaps
all, [of the OAA recipients] must live below a socially acceptable
minimum level * * *” The Mississippi report admits frankly that

87
“public assistance payments are based more on availability of money
than on needs of older people.”

Some of the State reports assume, as does Utah’s, that “as more of
our aging and retired workers, their surviving spouses and their
dependents [are] covered by OASDI and other retirement plans, the
problem [of economic security] will lessen.” But others, foreseeing
ever increasing numbers of older people, are less hopeful. Tennessee
predicts that more and more Americans, when they retire, will have
living elder relatives to support, and concludes on this discouraged
note:

#% % jt may be expected in the near future that science
may find prevention and cure for the most common causes
of death—heart ailments, cancer and strokes. When
such scientific advancement is accomplished, our present
problems will be compounded beyond belief.

The High Cost of Illness

Meanwhile, the States agree, the cost of medical care for heart
ailments, cancer, strokes and other chronic illnesses is the most difli-
cult financial problem for the older person to meet or prepare for. 1t
hits older people harder than younger people, because they become
more prone to chronic illness just when their incomes are reduced.
Massachusetts cites “several reasons why the medical care ex-
penditures of elderly persons have been singled out for special
attention:

In contrast to other expenses * * * these are generally
difficult to anticipate and predict. And their impact 1s
not uniform on all elderly persons. While there are,
of course, differences among [them] in the expenditure
for such items as food or clothing, the range of variation
is far less than that for medical expenses. For a not
insignificant number of older people medical expenses can
be very high and of very long duration.

The need for medical care may come without warning—the heart
attack or the stroke in the night, the cancer discovered in a routire
check-up and requiring an immediate operation. Such illnesses
“require more visits by doctors, a greater need for institutional care,
and at least twice as many days in hospitals” compared with the ill-
nesses of most younger people, as a Connecticut report points out.
And the same report goes on to emphasize that the impact of inflation
has been greater in this area of the economy than any other: “The
problem of increasing need for medical attention [by older people]
is compounded by the rising costs of medical care. While total living
costs since 1947-49 have risen about 35 percent, the cost of medical
care has risen about 50 percent. and hospital costs alone, about 100
percent.”

88
“Many more older people could sustain themselves without aid,
except for high costs of medical care and drugs,” the Ohio report
suggests. A serious illness can exhaust an older person’s savings; and
considerable numbers of older people are without savings. A study
of 400 older people in Memphis, for example, showed that 25 percent
“had no way of meeting emergencies, or would have to go into debt.”
Of the older Negroes, only 3 percent had savings to use or property to
sell.

While it is estimated that 49 percent of older Americans now carry
some form of health insurance, this leaves 51 percent who do not, or
who cannot afford to. (A survey cited by the Wisconsin report found
that the cost of health insurance held by older people averaged $4.62
a month.) Moreover, most health insurance policies pay only a pro-
portion of medical costs. A 1957 survey of OASI beneficiaries in-
dicated that insurance payments covered about two-thirds of the
hospital’s charges and one-fifth of the physicians’ and surgeons’
charges to insured persons. Another study, by the National Opinion
Research Center in 1958, also cited in the Wisconsin report, found
fewer than 1 in 200 retired persons fully protected against medical
expense. “Even considering the improvement * * * that has taken
place since * * * it is apparent that insurance coverage for the medi-
cal costs of the aged is not very extensive.”

It is a matter of concern to the States that many older people who
need medical care do not seek it because of the expense. The District
of Columbia reports that “the proportion of older persons who state
they need health care, but cannot afford it, rises steadily as incomes
drop * * * [there are indications] that the lack of income has pre-
cluded older persons from obtaining adequate health services.” Ken-
tucky reiterates that “many older persons are receiving inadequate
medical care,” adding, “Health insurance policies are usually inade-
quate to meet the needs, particularly for long-term illness.” And
South Carolina mentions as “a great concern * * * the frequently
reported cancellation of medical care policies following a prolonged
illness * * *»

Wasted Potential

The States recognize that the problem of financing medical care is
complex; their various alternative proposals are summarized in the
next chapter. The general problem of income maintenance, however,
they see chiefly in terms of providing employment for older people
as long as they want to and are able to work. The main assignment
of the West Virginia Subcommittee on Income Maintenance, for ex-
ample, was “to try to find means of increasing employment for those
wishing to work after the age of 65.” This solution, as the State
reports make clear, will require drastic changes in present hiring and
retirement practices.

577791—60——7 89
EMPLOYMENT

In their discussion of employment, most of the States differentiate
between the problem of the worker over 65 and that of the worker
between 35, 40 or 45 and 65. Some States are more preoccupied with
one problem than with the other. Vermont, New Hampshire, and
Maine, which have, except for Iowa, the largest percentage of people
over 65, naturally emphasize the older group, but other States are
almost equally concerned with it.

The problem of the over-65 worker is a dual one. Many have “A
real need * * * to find employment * * * to supplement their meager
income,” the South Carolina report emphasizes. Employment may
also be a psychological necessity—Dboth “the key source of income” and
“a means for supplying purposeful activity,” in the words of the
Alabama report. But, as Tennessee points out, “there has been a
marked decline in employment of the over-65 population throughout
the country.” The extent of resistance to employing over-65 workers
is indicated by a New Jersey study of men who had exhausted their
unemployment insurance. Of the 25 percent who were 65 or older,
only 1 in 20 had found full-time jobs 4 months after exhausting their
benefits.

There are several reasons for this decline: population shifts from
rural-agricultural to urban-industrialized areas; the shift from se f-
employment to company employment; the depression-years tendency
to make way for younger workers with family responsibilities; the
disproportionate increase in the number of older people; the ple-
nomenal rise in output per worker; employer attitudes toward older
workers; the $1,200 limitation on earnings of OASDI beneficiaries
between 65 and 72. Dut the States tend to put much of the blame on
mandatory retirement policies.

 

Effects of Retirement

The State reports view retirement chiefly in negative terms. “The
day of retirement,” says the Wyoming report, “often serves to signify
the unimportant and nonproductive role in which the employee is
about to be cast.” The States are concerned with the adverse effects of
compulsory retirement on 3 counts: economic and psychological loss
to the worker, and loss to the national economy. Maryland sum-
marizes: “* * * for the great majority of the State’s workers, retire-
ment * * * means complete detachment from a job and simultaneous
cessation of all wage income.” Ohio complains that “years of useful
service * * * gkill, talent, leadership, wisdom and experience are lost”
through arbitrary classification of people as aged at 65. And Georgia
comments: “As a nation we give lip service to the respect and venera-
tion * * * due the older person, but often we do not accord him the

90
right * * * to be self-reliant and to fulfill his human potential * * *
This cheats society at large out of his potential contribution and
denies him * * * his full stature as a human being * * *.”

State after State agrees with South Carolina that “employment
practices have failed to accommodate themselves to profound changes
in longevity and technology * * *.” The reports are practically unani-
mous in calling for flexible retirement, but many are pessimistic about
the implications of current trends to business consolidation, noting
that larger organizations lean toward mandatory retirement policies.
North Carolina and Florida see the need to overcome a present ob-
stacle—namely, the lack of suitable “criteria for measuring the aging
process” and of adequate “administrative procedures to implement
flexible retirement.”

“No One Over 40 Need Apply”

To many States the problem of the middle-aged worker, 45 to 65,
seems more acute than that of his senior. Caught in a “no-man’s land,
between the maximum hiring age and the minimum retirement age,”
as the Ohio report says, too old for employment and too young for
retirement benefits, he still has a family to support. He also has,
Oklahoma points out, “other expenses that older persons do not or-
dinarily have,” such as payments to make on his house. And the total
number of middle-aged workers in the labor force is much larger
than those over 65.

“The older worker does not have a higher rate of unemployment than
the younger worker,” the Delaware report says in a typical comment.
“But when he is laid off, it is much more difficult for him to secure
other employment.” The States mention as principal factors in lay-
offs technological change, such as the mechanization of coal mining
in West Virginia and Pennsylvania, and labor force shifts resulting
from the movement of major industries (for example, New England
textiles) to other parts of the country. New machinery has made old
skills obsolete. When a plant closes, older workers, with their roots
deep in the community, find it difficult to move to other areas. “Some-
times whole communities feel the impact of unemployment when a
major firm closes down or leaves the area,” Wisconsin reports.

The closing of the Electric Auto-Lite Company plant
in La Crosse about a year ago * * * affected some 1,300
people. Most of them had worked for Auto-Lite for
many years * * * More than 50 percent of the people
laid off were over 45 * * *; 18 percent * * * were 55 or
older.

[Only] 18 percent of all the men workers under
45 * * * gre still seeking other work * * * more than
43 percent of those over 45 are still looking for a job.

“There is no work in La Crosse,” [one of these men
commented]. “Forty-four * * * is too old.”

91
At least 26 State reports mention restrictive hiring policies as a
serious block to employment of over-45 workers. State employment
office statistics show widespread discrimination not only against older
workers but against the middle-aged. “* * * For other purposes, 65
has commonly separated the older from the younger. For employ-
ment, however, 40 and often 35 for women are the dividing lines,”
according to the Ohio report.

The majority of the States report that between 30 and 50 percent
of job orders listed with the public employment service had age re-
strictions. In Maryland, “80 percent of all organizations which list
openings with the Department [of Employment Security] include age
ceilings in job specifications.” Oklahoma adds that “8 percent of all
such job openings [are] restricted * * * to persons below the age
of 85.” The restrictions are not always on paper. Louisiana notes
that firms with no avowed restrictive policy “give preference to
younger workers”; and the Hawaii State Employment Service has
observed that “many employers do not specify age restrictions on their
job orders, but they will disqualify applicants at the interview be-
cause of age.”

The workers hardest hit by these restrictions seem to be those in the
professional, managerial, clerical, sales, skilled and semi-skilled cate-
gories. Most States confirm Kansas’ experience that “restrictions
vary with the occupation or industry” and that “labor market condi-
tions likewise affect the acceptance of the older worker by the em-
ployer.” Nebraska reports that “in some instances 35 is considered too
old for a woman clerical worker, whereas a machinist at 65 can find
ready employment.”

Age restrictions are partly, if not largely, based on uninformed
prejudice. In general, the States report employers believe that the
older worker costs more from a pension and group insurance stand-
point, and is less productive, less adaptable, less adjustable to new
policies and work programs than the younger worker. Some States
point out that the very policies which protect the older worker on the
job—such as seniority and promotion from within—militate against
him when he is looking for a job.

Employer attitudes are not the only problem, however. The older
worker’s own inflexibility or defeatism may be at fault. “A large
number of older applicants refuse work if it doesn’t fit their own
special requirements,” Kansas reports, and Kentucky adds: “* * *
They believe society is against them. They give up hope and do not
make constructive and concentrated efforts * * * They tend to * * *
assume that it is ‘normal’ for them to be unwanted, unproductive and
a burden to themselves and their community * * *7
Special Assistance Required

To overcome these obstacles to the employment of older workers,
the States feel the need for legislation to minimize or eliminate re-
strictive hiring practices, and, on the Federal level, for a reexamina-
tion of the impact of the social security program on the labor market
status of beneficiaries. Utah and other States stress the need for
“positive” legislation which would coordinate “resources to provide
essential services to all older workers.” Connecticut notes, too, the
need for much more factual information “to pinpoint the problem of
employment for the aging.” A greatly expanded educational cam-
paign is needed at all levels, as the Florida report describes it, “to
bring about changes in traditional attitudes toward employment and
employability of older workers.”

Training and retraining programs for older workers are basic.
There are far too few programs to help workers with obsolete skills
develop new ones and adjust to changed conditions. More direct
guidance for older workers is needed, and more special placement
assistance. Chiefly, the need is for more funds. As a report on the
Philadelphia Pilot Project states:

We know how to find jobs for older workers. The big

problem is getting the resources to do it. It requires

more than 4 times as much time to place an older worker

[as] to place the average jobseeker in a public employ-

ment office (161% hours as opposed to approximately 4

hours).
The Virginia and Michigan reports confirm the need for more staff-
time and money to place older workers: “The principal problem in our
[Michigan] program is adequate financing * * * Additional budget
should be provided * * * It is an accepted fact * * * that it costs
considerably more to place or service an older worker * * *?

The fact is, as Utah says, that “only a bare start” has been made
in marshaling resources to solve the problem of the older worker.
New Hampshire speaks for its sister States in concluding that there
must be a joint effort “by national, State and local agencies, as well
as employers, unions and all other groups interested in the most
efficient use of our manpower potential * * *»

The Need for Retirement Readiness

New Hampshire, again, is one of many States pointing up the
urgent need for counseling services “to cope with emotional and phys-
ical adjustment problems affecting [the older worker]. But at least
as great as the need for counseling of older job-seekers, the States
agree, is the need for programs to prepare them for ultimate
retirement.

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Retirement, as the Washington State Report puts it, “is a normal
phase of living.” Yet “studies available to date [in Connecticut |
seem to indicate that too many men and women just ‘coast’ into retire-
ment with none of the anticipation and preparation they gave to
previous periods of their lives.” The findings of a recent Iowa survey
of retired men, for example, reveal “that retirement was not in itself
a desirable state to most of [them], although it was accepted by those
whose health no longer permitted them to work. The minority who
found it most appealing were those with adequate post-retirement
income, who had cultivated outside interests before stopping work.”

A really effective preretirement program, as Massachusetts suggests,
would encourage workers to plan ahead for both the income and the
interests. Such a program would include counseling on financial needs
and preparation; health needs in the later years; cultivation of new
interests and new social contacts; positive attitudes toward old age
and retirement.

Many States report, as does Nebraska, that “a beginning” has been
made in preretirement programs. Many large firms and a number of
labor unions now provide preretirement counseling, but these pro-
grams are usually not available to employees of small firms or workers
who are not union members. Some “preretirement programs” consist
only of one or two brief chats with the personnel manager shortly
before the last day with the company. Much more needs be done,
whether by industry or by communities, not only to educate the indi-
vidual worker in the years before retirement, but also to educate the
general public to the need for economic preparation and psychological
preparation during the working years.

Multiple Handicap: Age and Disability

“The increase in the numbers of older disabled workers during the
past decade has presented new problems” to society in caring for them
and to employers in employing them, the Utah Report observes. All
the States recognize that only a small number of the older disabled
people who could be rehabilitated are being served, and that there is a
great shortage of employment opportunities for them. Tennessee
summarizes the situation :

At present the aging suffer disproportionately from
chronic illness and disability. They are economically less
able to bear the costs of prolonged medical care. The
care they receive is often custodial rather than rehabilita-
tive. Thus thousands of older citizens * * * become de-
pendent on others for their support and for meeting the
normal demands of daily living.

With * * * modern rehabilitation services many could
live independent lives. Many could return to work;

94
others could become less dependent on relatives and
friends. For those freed from constant attendance or de-
pendence, institutional and welfare costs could often be
decreased.

The States list a number of hindrances to realizing this objective:
inadequate rehabilitation facilities, shortages of personnel and funds;
the conservative attitude of the medical profession; lack of training
programs; public attitudes. In a typical reference, Nevada reports
that “while a Physiotherapy Department is operating in most county
hospitals, it is inadequate to care for all who need this therapy and
training, and is too costly to the tax structure * * * In Michigan
“some rehabilitation centers have been developed * * *, but most cities
and rural areas are almost totally lacking effective facilities for physi-
cal restoration.” Utah, Montana, Texas and North Carolina are
among the States emphasizing the scarcity of rehabilitation services
and the need for them in smaller hospitals.

Largely urban Massachusetts sees as vital needs placement services
for handicapped workers, services to rehabilitate severely disabled
older people for independent living, and “community-wide educational
efforts aimed at altering the current negative attitude toward chronic
illness and disability.” At present the Massachusetts Rehabilitation
Commission has neither sufficient funds nor specialized staff to foster
these programs.

Vocational rehabilitation of middle-aged and older disabled workers
is hampered by shortages of funds, facilities and job openings. The
Michigan report sets forth the problem clearly in these pargraphs:

The State [ Vocational Rehabilitation] policy provides
for consideration of all disabled prsons who might bene-
fit from rehabilitation services, who are of employable
age. There is no maximum age limit * * * However,
the agency from a practical standpoint must exercise some
selection when funds are not adequate to cover the mini-
mal needs of the program * * * When a counselor is
faced with a need to offer a cost service to two persons—
one in his early 20s and the other over 60—and he has
enough money 1n his budget to serve only one individual,
he naturally restores the first to employability and post-
pones service to the second.

* * * jt takes longer to train an older person [in] a
new skill * * * a longer work adjustment period adds
to the cost of equipping [him] for employment * * *,

Furthermore, the agency would be remiss if it were to
ignore the framework of labor demands within which it
must operate. Industry does not readily accept the older
applicant who has no history of employment with the
firm when it has a choice of employing an equally capable
younger man * * *,

ob
Oklahoma, however, counters this practical viewpoint with a chal-
lenging statement and question:

In vocational rehabilitation we have too often assigned
higher priorities to younger persons * * *. Such eri-
teria must be modified if we are to make significant
strides in the rehabilitation of older persons. It it only
when we accept responsibility for services to all disabled
persons, regardless of age or extent of disability, that
we will begin to meet the rehabilitation needs of the dis-
abled older person.

There may be as much potential in a 75-year-old hemi-
plegic as in a 20-year-old rheumatic fever victim. Is 10
years of employment for one rehabilitant more important
than one year for another? The young rehabilitant may
die tomorrow. If so, were we wrong in providing serv-
ices to him?

The limited education and limited work experience of many older
disabled workers present additional problems in rehabilitation and
placement, as Alabama and Hawaii, among others, point out. ITawaii
notes that “training facilities as they exist today are generally geared
to meet the technical demands of industry and the younger persen
with good language facility and preparatory education.” Still an-
other problem is the disabled worker’s own sense of defeat. Many feel
“that their disabilities are too handicapping,” Hawaii reports. “This
feeling seems to be based on the longstanding nature of disabilities
and the pain and discomfort experienced * * *. As a result, the offer
of * * * vocational rehabilitation services is often refused. Com-
prehensive services as soon as possible after onset of a disability ave
vital to prevent physical and psychological deterioration.”

Little is being done as yet in vocational rehabilitation for the over-
65 disabled worker; Michigan, for example, reports that only 1.5 per-
cent of those rehabilitated for employment in 1958 were over 65,
although this age group made up 7.3 percent of the State’s population.
Oklahoma mentions only 1 organized rehabilitation program in the
State open to the worker in the upper age brackets—the speech ard
hearing clinic of the University of Oklahoma. Virginia reports that
there are all too few sheltered workshops for rehabilitated disabled
workers (those of the Goodwill Industries are apparently the only ones
in the State).

And finally, although its great potentialities have been demonstrated
in pilot projects, rehabilitation of severely disabled older people for
independent living is, West Virginia states, “by far not a reality.”
As Texas comments: “There is a general lack of communication to
doctors and the public on what rehabilitation is and what it can
accomplish.”

96
HEALTH CONCERNS

The impressive advances in medical science in the past decade have
kept many more older people alive but not necessarily well. Some
States report that well over half their citizens over 65 suffer from a
chronic disease with more or less disabling effects. Much more
research is needed into causes and means of cure or prevention. Mean-
while, despite recent progress, the State reports make it abundantly
clear that for lack of funds, facilities and personnel we are not apply-
ing all we now know to the prevention of disease; neither are we pro-
viding adequate care for many of our older citizens who are ill. The
most important shortages reported by the States are in nursing homes,
chronic hospital beds, home care services, mental health services and
facilities, dental care, early detection and prevention programs, health
education.

Nursing Homes: The Big Problem Area

The general shortage of nursing homes is mentioned by more States
than any other single problem of elderly sick people. Even more,
however, the States are concerned about the poor quality of many
existing nursing homes. Although standards have been improved in
the last 10 years, approximately half the nation’s nursing homes are
still unlicensed establishments where, often, care is quite inadequate.
In a typical statement, Mississippi lists low minimum standards, oper-
ators untrained in administration, inadequate medical care or super-
vision (sometimes none), no regular supervision of food service, lack
of recreation as some of the shortcomings. Oklahoma mentions that
77 percent of its “nursing homes” are without skilled nursing care.
Even wealthier Massachusetts reports “many gaps in services” pro-
vided to patients in its nursing homes. They “often do not have ade-
quate medical care or recreational, occupational and physical therapy
programs, and the broad range of rehabilitation services usually is
not available * * *7”

The problem is partly economic. Good care costs money, which
many older patients are lacking. Many of them are public assistance
recipients; the States report universally that Old-Age Assistance pay-
ments to nursing homes are “quite low”. Florida, for example, de-
scribes its nursing homes as “predominantly custodial institutions,
giving the main minimum care * * *” and adds: “Accepting [the
figure of] at least $150 a month to provide reasonable care in an
acceptable environment, then more than half the patients cannot be
provided suitable care for economic reasons. * * *” In Missouri,
where nursing homes have raised their charges to meet higher stand-
ards required by recent legislation, low-income families have been
transferring elderly relatives to less expensive, unsupervised board-

97
ing homes where safety provisions, nursing care, adequate nutrition
and sanitation are not required.

It is not only a question of money, however, as the Massachusetts
Report points out: “* * * raising the [Old-Age Assistance] pay-
ments * * * alone would not guarantee any improvement. * * *
Almost all nursing homes are * * * independent profitmaking enter-
prises, and very few have formal ties to hospitals or other institutions.
The homes are thus isolated from the major medical care institutions
in the community and also from the broad range of professional
services that their patients so badly need.” Making the same poinr,
the Utah Report adds that “doctors have not demonstrated enough
concern as to the kind of care their patients receive in nursing homes,”
nor has the community as a whole taken much interest.

The shortage of nursing homes with skilled nursing and other es-
sential services is directly related to the shortage of chronic disease
hospital facilities reported by several States. Louisiana says that not
more than 35 percent of the need is being met; Texas that “there is
great need” for more chronic disease units; Maryland that its general
hospitals have no geriatric clinic, ward, or department. North Caro-
lina, however, suggests—as do other State reports—that the problem is
not, one of a shortage of chronic disease beds in hospitals so much as
an over-utilization of these beds because of the shortage of other fa-
cilities. In Massachusetts “a recent study of a Boston general hos-
pital showed that almost 40 percent of those patients who were in
the hospital for more than 30 days stayed for nonmedical reasons.
That is, they needed nursing care and certain social care that could
have been given in nursing homes * * *” if space had been available
in suitable nursing homes.

Several States referred to “progressive patient care” hospital pro-
grams as a possible solution to the problem of overntilization of gen-
eral hospitals. A progressive care program includes four types of
units—intensive care, intermediate care, long-term care and self-care——
providing varying degrees of nursing and medical supervision within
the hospital itself—and home care, an extension of hospital services
into the home. Few communities have such a program. The Colo-
rado committee, which favors its use, reports that it was tried at
Memorial Hospital in Denver and “dropped, at least temporarily,”
apparently because neither the community nor the medical profession
had been persuaded of its value.

 

 

The Shortage of Home Care Services

The Massachusetts Report observes that “a fair number of the
patients in nursing homes could be in * * * foster homes or their
own homes if certain supportive community services were available.”
Many of the State reports mention the shortage, or sometimes total

98
lack, of such home care services as visiting nurse associations, com-
prehensive home care programs, homemaker services and meals-on-
wheels. A beginning has been made toward providing these services,
but most communities are still unserved.

Virginia, for example, reports only one comprehensive home care
program (in Richmond), home nursing in only 7 cities and 3 counties,
no homemaker service. In Missouri, “only the larger cities have vis-
iting nurse services, and these in most cases are inadequate to the
need * * *. There is only one [comprehensive] home care service
actually in operation in the State (that of the Jewish Hospital in St.
Louis) * * * and this * * * in a very limited area within a large
city * * *” Mountain and rural regions indicate a particularly
urgent need for this service. Michigan reports that although over
half its population lives in areas served by the State’s 16 home nurs-
ing services, “the rest, including most rural families, are deprived of
the kind of service which can often help older people keep going in
their own homes * * * At the present rate of development, it looks
as though the elderly farmer with a stroke who needs some nursing
help at home is going to have a long wait * * *”

“Many older citizens must be admitted to hospitals or nursing
homes simply because there is no one in their own home who can do
the simple services that they require. A homemaker program solves
this problem * * *” but homemaker services in the main are avail-
able only in large cities, and some States report none at all. In
others—Ohio for example—homemaker service is available chiefly to
public assistance clients. “Meals on wheels” are still in the pilot
project state, organized in only a few communities. At present, Illi-
nois summarizes: “It is because of the lack of bedside nursing care,
homemaker service and such useful programs as portable food service
that a number of persons arrive inside the walls of an institution
instead of living * * * longer at home.”

“The Most Neglected * * * Health Problem”

At least a third of the State reports mention the mental health
problems of older people as a major concern—in terms of need both
for more and better services and facilities and for broad preventive
measures. Puerto Rico calls mental health “the most neglected aspect
of the health problem of the aged” and reports that “altogether there
are not nearly enough facilities for the care of the mentally ill * * *7
Utah says that “the needs of the elderly are sparsely met throughout
the State.” Missouri admits that “our planning and programing to
deal with * * * mental illnesses of elderly people has been grossly
inadequate.”

“Grossly inadequate” is Nevada’s description of its mental health
facilities, and Illinois uses the same words. Specifically, the Illinois

99
Report mentions the need for more psychiatric beds in general hos-
pitals outside of Chicago, for outpatient services (“which are almost
non-existent throughout the State”), for more training psychiatrists
(a need “probably more acute than in any other field of health serv-
ice”) and for social services to supplement psychiatric and psycho-
logical services. The shortage or lack of outpatient services is
mentioned repeatedly, along with its basic cause, a shortage of psy-
chiatric workers. Arizona comments that “many cases would require
less hospital time if patients had been able to get local therapy at
outpatient clinics; some would have avoided hospitalization
entirely * * *7

Several State reports emphasize the need for prevention of mental
illness. Montana mentions especially the need for “additional men-
tal health counseling services, such as might be available in psy-
chiatric clinics.” The report stresses education about the aging
process, the encouragement of older persons to maintain or increase
their social contacts and to participate in meaningful activity as im-
portant to mental health. As the Missouri report puts it, “Good
mental health is much more than the absence of mental illness * * *
there is a need to consider programs aimed toward more effective and
happier social and emotional adjustment with aging * * *

“ * * the Most Prevalent of All Illnesses”

Dental disease is ‘the most prevalent of all illnesses,” according
to surveys cited in the Missouri Report. It increases with age, and
its presence has a serious effect on total health. The North Carolina
Report gives figures which are confirmed by other States: “50 percent
of the people 65 years and over have lost all their teeth. The dental
needs of the remaining 50 percent * * * very great and * * * likely
to increase.” A Public Health survey of 1,200 elderly patients in
Nebraska nursing homes found that 53.7 percent of the residents
needed dental services ranging from extractions and provision of
both upper and lower dentures to periodontal treatment and denture
repair or adjustments.

But there is a grave shortage of dental care in the United States,
outside of large cities. Colorado reports “an especially acute need
for more dentists in most of the [north-central] counties * * * a defi-
ciency apparently general throughout the State.” In Illinois: “There
is almost a total lack of dental services for the senior citizen, except
for the care given by dentists in their private offices or emergency
treatment in the hospital. * * *” Four Tennessee counties reported
no dentists; 55 counties have one dentist per 2,500 or more. Only 31
of North Carolina’s 161 hospitals have dental facilities and not all 31
have dental staffs. “The majority of dental services rendered [the

100
older| age group are done in the private offices of the State’s 1,316
dentists. However, 8 counties do not have a practicing dentist, and
the overall dentist-population ratio is one dentist to 3,900 people.”
Vermont states that “there is no provision for dental care in present
old-age assistance programs. Older recipients who need dentures
must do without unless they can be provided in some other way.
Without properly fitted dentures, other problems arise—mouth infec-
tion, improper chewing of food with resultant complications. * * *”

The Need for Health Education

Untreated dental disease is largely responsible for malnutrition
which, according to the Missouri Report, “a high percentage of older
persons suffer.” A Texas study of health problems of the aged also
showed malnutrition to be one of the most common ailments. Faulty
nutrition, in turn responsible for other medical disorders, is an area
in which the States see health education as especially urgent. A
number of States mention health education as a major need, pointing
to the “lack of awareness of the importance of periodic health
appraisals” (District of Columbia) and the “failure to * * * seek
available health services.” Alaska feels the need of health education
for all age groups, so that both younger and older people will under-
stand the problems of aging. Montana suggests that health education
“should begin at the lowest school levels, since the health of older
persons is often affected by health habits of early life.” But the
urgently needed health education programs are practically non-
existent so far in many States, for lack of trained health educators.
Noting that 47 counties have expressed a wish for health education
programs, Illinois reports that even “the Chicago Board of Health
has no qualified health educators for over 31% million people when a
minimum of one per 75,000 is considered standard. * * * The
Cook County Department of Public Health has only one trained
public health educator for about 1,225,300 people in suburban Cook
County. * * *»

Prevention of disease and disabling conditions is stressed by a num-
ber of States—prevention through proper diet, exercise and good
mental health, and also through regular checkups and screening pro-
grams to spot disease early when, as Michigan observes, “there is the
best chance to correct the condition, to postpone disability or to use
rehabilitation measures.” Screening programs have been established
in many States in the past decade, but a great expansion is needed of
public testing for such conditions as diabetes, glaucoma, heart condi-
tions, cervical cancer. “Too much disease is discovered too late,”
the Michigan Report states.

101
Public Health Facilities Wanted

The lack of public health units, clinics and centers, and of profes-
sional personnel to staff them—especially in rural areas—has been a
major factor in retarding the expansion of screening programs. They
are equally needed to provide outpatient care for older people. New
IHampshire, Tennessee, and Montana are among the States mentioning
the need of public health facilities in sparsely settled counties. Texas
reports that “approximately 25 percent” of its population is “without
the services and facilities of a public health unit.”

More public health facilities are needed ; also more coordination and
planning between public and private agencies concerned with the
health of older people, and a communitywide determination of their
medical needs. The Montana Report shrewdly observes that there
needs to be “much closer cooperation and understanding between the
State legislature and the various agencies and groups concerned with
health care.” The greatest need of all, as the California Report em-
phasizes, “is for increased funds to stimulate better methods of apply-
ing modern health knowledge for the benefit of the aged.”

RESEARCH

“What our old age will be tomorrow depends upon how well we do
our research homework,” says the New York report. All of the State
reports reflect an awareness that much more knowledge about all areas
of aging is needed before many of the problems of older people can
be solved. In the medical and biological fields they emphasize the
need for further research into metabolic changes and the degenerative
processes accompanying physiological aging; nutrition; psychoso-
matic illness; means of assessing the restoration potential of disabled
persons; dental problems. They are concerned about the timelag
between the discovery of new techniques and the application of these
techniques. They note that most of the past studies in aging are cross-
sectional and urge support of valuable but expensive and time-
consuming longitudinal studies. They stress the need for funds, for
the establishment of committees on aging in all medical schools, the
need for geriatric research hospitals; the need for coordination of
research programs.

“In the field of biological research there is very little being done in
Delaware at this time * * * according to its report. Maryland
says, “We need to identify and describe quantitatively age changes in
the performance of various organ systems” and goes on to specify need
for knowledge of “cellular function, tissue culture studies, investiga-
tions of enzyme systems * * * problems of growth, differentiation,
and repair.” New York believes there is not sufficient “research in
geriatrics to control, and hopefully eliminate, diseases that now
cripple and kill the aged.”

102
Delaware feels the lack of knowledge on intellectual faculties (lon-
gitudinal studies) ; changes in perception in aging; age changes in
motor behavior (on which retooling might be based to make jobs avail-
able to older workers) ; and personality changes. Massachusetts, too,
feels too little is known of “alterations in basic intellectual, psycholog-
ical, and other bodily functions with increasing age * * * or the
impact of changes on the actual performance and daily behavior of the
older person.”

A number of States—Alaska, Connecticut, the District of Columbia,
Florida, Missouri, Rhode Island, South Carolina, and Tennessee among
them—express concern over the lack of basic knowledge of what kind
of education older people want, their motivations, most effective teach-
ing resources and media, existing and needed resources, and public
attitudes toward aging and how to improve them. They feel the need
of demonstration projects, especially of methods of serving the aged
in sparsely settled areas and at home. Oregon feels the need for
“research on the subject of older workers * * * ag to their wish in
regard to compulsory retirement at age 65” and “* * * concerning the
influence of adequate pensions on voluntary retirement.”

Arizona feels the need for “added emphasis (or research) in this
important field of study” in universities; for “grants for faculty and
graduate students”; and “for a standing (statewide) committee on
research.” Indiana would like “to have established a registry where-
by information on research * * * could be obtained” and “to aid com-
munications between persons involved in research * * *” North
Carolina notes the need for “basic multi-disciplinary and interdisci-
plinary as well as disciplinary research” and for stronger support from
public and private sources. Maryland notes that “we need avenues of
communication” among scientists. Mississippi sees need for “closing
the wide gap * * * between current health knowledge and its appli-
cation.”

“MORE TIME THAN THEY KNOW WHAT TO DO WITH”

The three great problems of the later years are money, health, and
time. Many older people are poorly provided with the first two; of
the last they are likely to have all too much. Recreation and educa-
tion, both in their broadest sense, are seen as ways to fill the empty
hours with pleasure and purpose. Kentucky describes the objectives
of recreation for older people as “* * * mental growth, development
of latent potential * * * creative opportunity * * * participation
in church and community * * * to be of service to others.” The
description could apply equally well to education.

Many older people have resources of their own, sharing their leisure
with family and friends and the community at large, but “the vast
majority,” the Missouri Report suggests, “need and would benefit

103
from organized free-time programming.” These are the people “who
have worked hard all their lives and have never learned to play or have
forgotten how,” the single and the widowed, the newcomers without
family or friends, the tiny apartment- or single room-dwellers, with
neither space nor income for social life.

In many States a good beginning has been made at organizing recre-
ation programs for older citizens. Yet all States except Florida report
that recreation is still a major unmet need. “Too few persons in older
age groups are being reached through organized recreation,” according
to the Ohio Report—and this in a State where more than 2 score public
and private agencies in many communities offer a wide variety of
recreational activities for older people. Missouri estimates that “only
2 percent of the [State’s] 470,000 adults 65 and over are members of
organized free-time activities—a low figure indeed.” States like
Kentucky, Oklahoma, New Mexico, and Utah report very few
programs.

Iiven the “golden age” or “senior citizens’ ” clubs—the most exten-
sive leisure-time activity for older people—are in many cases too few
in number and too limited in their offerings, sometimes providing no
more than social contacts and games. New Jersey comments that the
clubs “fall short of filling the need for a sustained and constructive
leisure-time program.” Their geographical coverage is often poor;
by no means all are within easy reach of their potential members.
Lack of transportation is an important reason for the underuse of
many recreational facilities.

And a serious concern to many States is the shortage of recreational
programs for older patients in hospitals, nursing homes, and homes
for the aged, as well as for the homebound. Although newer and
more progressive institutions recognize recreation as essential, the sur-
face of this need seems hardly to have been scratched.

Most. States report that the idea of organized recreation for older
people is generally accepted, a few—Oklahoma and Texas, for in-
stance—blame the scarcity of programs on lack of public interest.
The Washington State and New Mexico Reports, among others, reflect
a feeling that some public and private agencies are still unconvinced
of the value of recreation programs for older people. There is, many
reports emphasize, a lack of leadership and planning at the State
level; a failure to consult with older people and include them in the
process of setting up programs. There is a lack of basic knowledge
of what they want in recreation; too great a tendency to segregate
them. Itmay well be that many share the feeling of the oldster whom
the Illinois Report quotes as saying: “I don’t want to sit around with
a bunch of other old men.”

 

104
THE GAPS IN EDUCATION

Although the 1950s have witnessed some growth of education for
aging people, the great expansion has occurred in relatively few
communities and in less than half the States. This statement
applies to all kinds of education for older people, whether it is
pre- and post-retirement counseling, vocational education and retrain-
ing for new occupations, or adult education for intelligent citizenship
and enrichment and enjoyment of life.

The States recognize that the problems of retirement are often so
complex as to require individual or group counseling to help plan ef-
fectively for it. The earlier preparation begins, the more effective it
will be; but it is evident that many, and perhaps most, older people are
reluctant to start thinking about retirement until it stares them in
the face. For this reason an even more urgent need than preretire-
ment counseling is counseling for retired people who had made no
advance plans.

The States generally agree that every community should have an
old-age counseling service. It is just as generally agreed that there
are all too few such services at present. Maryland’s report is repre-
sentative of many: “Counseling services are needed throughout the
State * * *” No Georgia county “reported classes in retirement
preparation or problems of aging.” Tiven in Illinois, where the Uni-
versity of Chicago pioneered in designing preretirement counseling
programs, its courses and those of other Illinois institutions “have not
been widely used.” The Michigan Employment Service makes this
interesting comment :

We feel we have many older applicants in our active
files who would not be there if they had the proper pre-
retirement counseling some years before pension retire-
ment * * *_ Retired people are sometimes looking for
jobs because they are bored with nothing to do and get
very dissatisfied with themselves, sitting around the
house * * * We feel there is a great need for retire-
ment counseling * * * (1) to prepare the worker for re-
tirement and (2) to stay active after retirement * * *,

Vocational training programs for older people who genuinely need
or want employment are very scattered, and for the most part poorly
organized. Those who need vocational training and jobs most are
usually those with the least financial resources, for whom even bus
fare may be a problem. Often they do not know about the exist-
ence of vocational retraining classes. In Georgia, for example,
“o# EF * those over 65 make up only a small fraction of the adult mem-
bership of vocational classes. * * *7” Tn Illinois, “* * * relatively
few older people * * * are included in vocational programs. * * *?
Only a few large cities, such as Denver and Los Angeles, have centers

105
577791—60——8
which supply information on occupational training and job opportu-
nities. But many States report a lack of appropriate training pro-
grams. Liven in Arkansas, where a noteworthy pilot training
program for older workers has been expanded to several sections of
the State, “many counties expressed the need for * * * some form of
adult educational program which would include counseling and train-
ing for older workers.”

A broad program of adult education, with a variety of offerings,
seemed to most of the States to be the most urgent educational need,
however. Despite some progress in the last ten years, they report that
educational opportunities for older adults are still very spotty. Only
a small number of adult classes are planned specifically for older
people—partly because there is considerable disagreement as to
whether they should, or want to, be segregated from other age groups;
partly because many colleges and universities and public school ad-
ministrations feel they must devote all their energies to meeting the
needs of their rapidly increasing regular student enrollments. Ohio,
for example, reports that “although 24 colleges and universities * * *
have an adult education program, only 13 have persons 60 years or
older enrolled in classes of any type: * * * of the total enrollment of
less than 1,000 in this age group, 730 are enrolled in [the University
of Cincinnati], 110 in [Miami University] and the remaining 135
scattered in the other 11 colleges. * * *” In all of Wisconsin's 9 State
colleges, only some 200 adults over 45 take courses; the 18 private
colleges have a handful of students between 45 and 64, only one over
65, so far as those replying to a questionnaire were aware.

Apart from the great need which most State reports mention of
older-adult education for enrichment, hobbies, citizenship, health, and
so forth, Missouri and Louisiana raise an even more cogent argument
for special attention: there are an estimated 8,500,000 people aged 25
and over, who have had less than 5 years of schooling, some 2,250,000
who have had no schooling at all. School systems, they suggest, are
making no attempt to reach out to these illiterates or near-illiterates,
of whatever age.

Still another area of concern to most States is that “self-improve-
ment” programs are even scarcer in hospitals, nursing homes and rest
homes than is recreation. A considerable number of libraries offer
special services to the aged in some States, especially in larger cities;
but in many areas there is neither special service nor equipment for
older adults. Mississippi notes that librarians still disagree as to
whether older people should have special service or be considered part
of the general public. In any case, most libraries have neither the
funds, nor the staff, nor the materials to provide special service to
older people.

106
The State reports attribute the slow progress of educational pro-
grams for older adults to several factors. First is a lack of planning
and clear focus at both State and local levels. While most States have
begun to develop such a focal point in a commission on aging, there
has been so far no organized planning for education of the aging out-
side of a few States like New York and a few cities like Baltimore.
There has been very little effort, as California notes, to involve older
people in planning. Two-thirds of the States reported that State and
local adult education personnel give scant attention to planning for
older adults; most of them have been heavily oriented toward youth
and the young adult.

A second factor is lack of coordination of the programs of agencies
and organizations at community, State and national levels. With-
out coordination, some services are duplicated, others never come into
being. Lack of leadership at either national or State level is a third
factor. In most cases, the initiative in education of older people has
been taken at the community level, if at all, without technical assist-
ance from State or national organizations or government agencies.
While a few State departments of education, such as those of Cali-
fornia, Florida and New York, have provided staff services to assist
communities, most State education departments are too short handed
to spare staff for older-adult programs. “Our most serious problem,”
as one Oregon community leader wrote, “is not the State leadership
but the complete lack of it.”

Finally, a very important factor is lack of funds. Many States and
localities are not supporting their existing public education programs
adequately. Some appropriations have been severely cut. Non-voca-
tional programs appealing to older adults who want some recreation
along with education have been eliminated as “frills.” In many States
and localities an inadequate tax structure does not even cope with the
boom in school-age children, much less allow for launching new pro-
grams. In the main the public is still unaware of and unsympathetic
with the free-time problem of older people. Education for them seems
a marginal, not an essential, activity. As the Georgia Report says,
“Although * * * information about aging is increasing, the knowl-
edge is not reaching the general public; it can have no real significance
until it does. The general public creates the social climate which
shapes the way in which people grow older.”

THE NOT-SO-ACTIVE RELIGIOUS LIFE

The relatively small participation of older people in church life
concerned many of the State committees reporting to the White House
Conference. Their comments suggest that one reason is the tendency
of churches and synagogues to move to the suburbs, following the

107
young families who are their main support and leaving large numbers
of older people stranded in the inner city. This is less true, of course,
of smaller towns, where the elderly person who has been an active
church member all his life is not forgotten, the problem here is the
older person who was not an active church member in his younger
years, and whom the church cannot, or does not try to, reach.

A second important reason is the orientation of many clergymen to-
ward the younger group. “The emphasis is almost completely centerec
on the young family and adolescent age group,” a Texas clergyman
writes; and another adds: “Society as a whole has moved away from
the aging, and the churches have not yet bridged the gap. The ‘old
folks” have been left behind by a fast-moving community * * *.7

There are other reasons, however. A study of older people in Long
Beach, Calif., which showed that 52 percent of those over 65 attended
church services less often than 10 years earlier, found the most fre-
quent explanations to be declining health, transportation problems,
lowered income, and loss of interest.

Specialized programs to attract older people “have depended almost
entirely upon the initiative of the local organizations,” Kansas re-
ports. Many excellent suggestions are available from the National
Council of Churches and the national offices of individual denomina-
tions, but these “often are not fully implemented locally,” as the Nort].
Carolina Report observes. Some churches have “a program of signifi-
cance,” according to the Texas Report, “but the number of such
churches in relation to the total * * * is extremely small.”

Church leaders, both clergy and laymen, are increasingly interested
in the needs of older people, the State reports suggest, but their aware-
ness of special needs is very recent. Indeed, there is considerable dif-
ference of opinion among ministers and among older people themselves
as to whether there should be special programs for them. Many
churches lack skilled and trained leadership to meet the needs of
older people, and many do not know what the specific needs are. Some
of them—counseling, spiritual preparation for old age and death,
visitation by ministers and lay members, recreational programs, trans-
portation for infirm members or those without cars—are being met by
many churches. But evidently, more churches should be doing much
more. Rural churches, with their limited resources, are sometimes
particularly at fault. A questionnaire submitted to churches in one
Ohio county “yielded a ‘picture of general inattention to their [older
members’] needs except for occasional ministerial visits.”

Yet another unmet need is indicated by the Missouri Report in its
eriticism that “far more emphasis seems to be placed [by the churches]
on serving the older person than on the potential and obligation of
the older person to serve others.” Arizona proposes many areas in
which older church members may serve, according to their interests

108
and capacities: as consultants on committees, vocational counselors,
teachers, group leaders, librarians, visitors. Older State-of-Mainers
have let it be known that they want their church to “provide chal-
lenges * * * not simply to console them by ‘holding their hands.’ ”
“The situation of the older person in modern society presents a
tremendous opportunity for organized religion,” the California Re-
port concludes its section on this topic. “Yet organized religion has
been very slow in realizing this opportunity. It has been beguiled
into thinking that it can fulfill its mission to the aged by providing
shelter alone. It must be the role of the church to lead society into a
greater acceptance of the aged and recognition of their inherent
value, and to develop programs that will further their spiritual
growth and enable them to share fully in the life of the church.”

HOUSING NEEDS

With the results of the 1960 census still a year or two away, the
States really do not know whether or not there is enough suitable
housing for older people. Trying to find out, the State committees
discovered that the housing industry itself has operated over the
years on little more than second guessing; it has concentrated its efforts
on observed areas of need until it effected a surplus or near-surplus,
and then moved on to another area of observed need.

The States seem to think that there should be more of everything—
more houses, more apartments, more hotel rooms, more accommoda-
tions in institutional facilities, but they are not sure how many more.
“Lack of community information as to housing problems * * *
needs * * * budgets * * * patterns of living, varieties of communal
and independent housing required,” notes Minnesota, makes it difficult
to determine specific housing requirements. The first need, in other
words, is for accurate statistics. North Carolina suggests that answers
are needed to such questions as: “What are the specific problems [of
old people] in such areas as safety, accessibility to public transporta-
tion, shopping facilities, etc. ?”

A related need is for dissemination of information—perhaps from
a State housing or planning office, or from a subcommittee on housing
of the State commission on aging—to guide planners and builders
of housing.

Even without specific data, the States recognize certain problems
affecting housing for older people. Dislocation by urban renewal or
interstate highway projects has, as Rhode Island puts it, “a propor-
tionately greater impact upon older persons, whose attachments to
neighborhoods and familiar patterns are of long duration.” Zoning
restrictions often prevent “multiple housing, nursing homes, congre-
gate living developments and smaller homes for older people [from

109
being built where they should be—that is,] close to business or shop-
ping centers, to accommodate to the restricted mobility of most older
people.” Or such restrictions may prohibit building small houses in
residential areas, and may make it necessary to use commercial sites,
“adding to the expense and detracting from the aesthetic appeal,” as
the Michigan Report says.

Above all, the volume of “inadequate and substandard housing for
our aged” was appalling to many committees. Over and over, the
State reports emphasize the need for housing code enforcement in
general, and for specific additional requirements in the case of housing
designed for older people. Of the deteriorating housing in which
many older people live, the Missouri Report has this perceptive com.
ment :

Even though it can be said that young people live
under circumstances that are just as distressing, it should
be recognized that [they] are at least hopeful that such
conditions are temporary and that they can dream of im-
proving their conditions in the future. * * * the elderly
can often only dream of the past and look forward to in-
creasing decay, more inconvenience, and a more distress-
ing environment [where, with] increasing leisure time
[and] physical disability * * * they must * * * spend
more and more time in one room or one house. * * *

The needs on which most States seem to agree are first, an increas-
ing supply of new houses and apartments for older people—with
some States favoring more home ownership and others an emphasis on
multiunit, flexible, rental housing; second, a larger supply of hotels,
residence clubs and other congregate facilities, but even more impor-
tant, an upgrading of standards since many existing facilities of this
type are substandard; third, a larger supply of boarding and foster
homes (which North Carolina and Washington State committees pre-
fer to institutions for many older people) ; fourth, and most urgent,
suitable housing for older people with low incomes. A sampling of
comments from the State reports indicates how urgent a problem they
find that of suitable low-rent housing:

First priority must be given to the aged living in slums.
* ok % (Puerto Rico).

There is [in Massachusetts] an immediate need for
8,000 to 10,000 housing units for older persons in the low
income group.

A ’59 report [for New Jersey] showed that more than
7,000 people over 65 [had] applied for low-rent housing;
less than half of them [had] been accommodated.

* * ¥ there are virtually no suitable homes [in Ohio]
for the elderly to buy or rent, at prices they can afford.

The incomes of approximately one-third of the aged

in California are insufficient to provide adequate housing
without assistance.

110
Most States also feel the need for more housing for older people
with moderate incomes, once the needs of the low-income aged have
been met.

THE NEED FOR SOCIAL SERVICES

Most States share the impression that family relationships have
changed for the worse, with tragic implications for the older members.
Nowhere is the consciousness of change more poignant than in regions
of hispanic culture like New Mexico or Puerto Rico, where the patri-
arch was traditionally venerated. The Puerto Rico Report says,
“Our senior citizens have witnessed many radical changes within the
last 30 years * * * [and] must adjust to a series of events that puzzle
and bewilder everyone.” But the conviction is widespread that the
typical New England, Southern or Midwestern family of half a cen-
tury ago consisted of 3 or 4 generations under one roof, making up “a
family constellation in which there was an understood relationship, a
certain division of function, an accepted hierarchy of status,” as the
Ohio Report describes it, and in which younger members accepted
responsibility for ailing elders. Equally widespread is Maine's regret
“that there has been such a weakening of family ties in the last
few decades that the family is unwilling to tend the disabled or elderly
member of the groups * * * West Virginia refers, as do other
States, to the increasing “distance separating children and parents.”

This general impression of older parents living far apart from
indifferent adult children is not supported by the facts (including
findings of State committees). Various studies have shown that,
nationwide, a higher proportion of aging parents are sharing house-
holds with their children than ever before. They also show that this
is by no means an ideal situation for any of the generations involved.
Comments in the State reports themselves point to some of the diffi-
culties. Ohio quotes a representative housewife as saying: “Jack’s
mother is living with us. She needs rest and quiet. How can I keep
the children from being noisy? They are normal healthy children.”
New Mexico refers to family “tension” and to lack of room and privacy
for older members.

Survey after survey of older people’s opinions, cited by the State
reports, has made it clear that they would rather live alone, although
near family and friends. “The 3-generation household exists where
financial necessity requires it,” Arizona reports. “Of 157 persons in-
terviewed at an all-day hearing in Tucson, only one expressed a prefer-
ence for living with married children * * * 12 had tried it and had
made other arrangements * * *” Maine notes of its rural natives
that “only when too sick to stick it out alone will an oldster agree
to moving in with the children.” But this very insistence on inde-
pendence may be a source of anxiety to the children, most of whom

111
are obviously not unconcerned, but who have problems of their own.
Ohio, again, quotes this typical comment :

My parents are a real worry. They live alone but are
too old to do their own housework. Our home is too
small for them to move in. We can’t afford to hire any-
one to stay with them * * *,

Whether they move in with their children or stay in their own
homes, the State reports agree that community services may be essen-
tial to achieve and maintain a livable situation. As the Wyoming
Report putsit:

Aged persons generally are more vulnerable to a
variety of problems and often less able to overcome them
without help because of reduced income, declining phys-
ical vigor and loss or reduction of personal ties. * * *
the need of older persons for appropriate and effective
social services is somewhat like a family’s need for * * *
the fire department. Not only does the existence of the
service help prevent problems from occurring or becom-
ing severe; but, when the problem strikes, the need is
urgent.

But it is evident from the State reports that in many places social
services are not equipped to do this job adequately. Illinois reports:
“In no area of social service are the needs of older people being ade-
quately met * * * either qualitatively or quantitatively. * * *
Stressed in local, regional and State discussions was the need to expand,
improve or establish * * *: information and referral services; case-
work and counseling; home services of all kinds; protective services;
home finding and placement; activities and centers. * * *” Tn Rhode
Island “there are over 500 health, welfare, and recreational agencies
* 2% * many of which service older people either directly or indirectly.
# # * [But] many have been long-established, * * * need replace-
ment or modernization of plant, and have restricted income. * * *”

Welfare services ave lacking especially in small communities which
have not the means to support them. As West Virginia points out:
“x x the smaller community will not have a community chest * * *
a family service organization * * * a senior citizen club and many
other types of welfare services usually found in larger places * * *?
and their absence is most acutely felt in that State’s depressed coal-
mining areas.

In addition to homemaker services and other social services in con-
nection with medical care, discussed earlier, friendly visiting programs
and protective services, the States see especially urgent need for larger
public assistance grants to older recipients; at the same time “major
emphasis should be given to services * * * to decrease and prevent
dependency.” There is need for a great expansion of individual
counseling or casework services. Massachusetts, noting that casework

112
is “probably the core social work service that should be offered older
persons,” stresses that counseling must be extended to their families.
Although Boston has at least 8 major family agencies with special
divisions for the aging, their services “are probably not too well known
in the community. * * *” Publicity for these services is an urgent
need. And as Illinois points out, they “should not only be publicized ;
they should be accessible. Here, transportation is a major problem
* % * nonexistent or too expensive.”

Information and referral services are essential, as Oklahoma empha-
sizes, to prevent older people from “being sent several different places
before locating the agency” which can help them. Yet in Oklahoma
and in many other States “this service is not available on a State-wide
basis or even on a community basis. * * *” To develop this necessary
central service, as to make progress in other areas, coordination among
public and private agencies is badly needed. Maine’s comment can
be applied to all the States:

A great variety of State and city, public and private
agencies * * * organizations and groups are carrying on
some type of social service designed to include the old-
age group. IHowever, there seems to be little coordination
among all these efforts, with the notable exceptions of
[two] areas. * * *

* # * These groups have a common purpose * * * yet
[they are] haphazard. * * * The most obvious imbal-
ance 1s between urban and rural areas, the rural areas
being in many instances markedly underserviced. Inter-
views with the aged reveal that many of them do not even
know what assistance is available for the asking. There
is less casework, less * * * information on needs * * *
less medical help and free-time programs. * * * This
is unfortunate [since] the rural areas have a greater
percentage of old people than urban ones. * * *

A basic factor which makes many social services in-
effective in the area of aging is the scarcity of factual
information [as to] who the aged are, how many there
are, how and where they live, and what they need. * * *
Before a community sets out to “do good” for the older
citizens, it should discover the pertinent facts about [its]
old people, especially what the “good” is which they
themselves want done.

THE SHORTAGE OF PERSONNEL

“The major factor determining the quality of service to the aged,”
says the Tennessee Report, is professional personnel. “If professional
staff is poorly trained or unavailable, the other related factors are
of little value.” The States report shortages of personnel in practi-
cally every area of work with older people—notably shortages of
physicians, dentists, nurses, all kinds of rehabilitation personnel, social

113
workers, vocational counselors and placement workers, librarians, nu-
tritionists, recreation leaders, retirement counselors.

But the reports tend to stress the shortage of trained personnel in
many areas for all age groups. Some State committees definitely
oppose specialization in aging on the ground that it would “produce
the undesirable effect of segregating older persons from the popula-
tion as a whole,” as North Carolina says. The only areas where the
North Carolina committee feels the need of specialized personnel are
employment, dentistry, religious activities and, to a limited degree,
social work,

“The major need is for strengthening the existing services,” ac-
cording to this report, “since the total population needs are the same
as those for older people.” In health and medical care, for example,
the North Carolina committee feels that “although there are certain
problems peculiar to the aging, the need for a geriatrician is pre-
mature. In the area of home care, programs for older persons should
be a part of the overall program. * * * Only those [social] services
which require specialized knowledge and skills in meeting the needs
of older people should be selected out in terms of special personnel.”
The educational needs of older people can be better met if “this
work * * * is developed as a part of * * * a larger program of gen-
eral adult education * * * older persons should be a part of the
total [recreation] program.”

The still continuing generalist vs. specialist controversy helps to
explain the dearth of specialized training programs. So does the
newness of the field, and the uncertainty as to what specialized train-
ing should consist of. As the California Report observes, “one of the
crucial problems related to the role and training of personnel has to
do with the lack of job descriptions.”

The basic need is clearly for recruitment of young people for all
the health, welfare, education and related fields, and for expansion of
all training programs. In many States—especially in the South and
the Great Plains and Rocky Mountain areas—training facilities are
lacking. There is, for example, no dental school in all the Rocky
Mountain area; and the Oklahoma Report suggests that it is futile
to train dentists for geriatric work until there are enough to take
care of the unfilled teeth in children. This statement from the South
Dakota Report is representative of the situation in the more sparsely
populated States:

* % * there are few facilities offering professional
training in * * * services for, or care of, older people.
Nurses’ training is a possible exception. * * * How-
ever * * * public health nurses are found in less than
one-third of the counties.

114
Training in medicine is limited to one school with only
a 2-year program. No * * * institution of higher edu-
cation has a graduate school ot social work.

By and large, specially trained persons must be re-
cruited from the outside, and the level of salaries is such
as to present difficulties. * * *

In States which are much better supplied with training facilities
there is often a lack of professional interest. Texas reports that the
majority of graduates of its medical schools have received “very
limited experience” in rehabilitation medicine, and quotes a hospital
administrator as saying that “specialty training in geriatrics is neither
available nor contemplated in his area” because the approach should
be rather through preventive measures to regard the aging process.
University courses in human development, the Missouri Report notes,
usually give only “slight emphasis” to aging. Only a few institutions
and organizations offer professional training for the field.

The Missouri committee blames a lack of interest in the State as a
whole. “There will,” it predicts, “be only limited progress in pro-
fessional training and development until [there is] both community
and State-wide interest. * * *”

A lack of energy and imagination is also manifest in solving the
shortage of personnel for work with older people. For one thing,
North Carolina notes, the “extensive opportunities * * * for the ef-
fective use of volunteers” have been “as yet little realized.” And
there is, as the California Report points out, “a great untapped reser-
voir of competent and effective manpower within the older group
itself. Many retired individuals are both able and willing to work
with others of the same or greater age. * * * However, these com-
petent older people usually require additional specialized training to
work effectively with [their peers]. It is largely a job of coordina-
tion. * kk)

STATE AND COMMUNITY

The need for programs for older people “is just beginning to pe
realized” at the community level, South Carolina reports, looking
hopefully ahead to the 1960’s. One of the territorial committees dis-
covered that most of its local communities had not yet even realized
the need. Nearly two-thirds of the municipalities replying to a
questionnaire insisted that their older citizens had no problems. But,
the territorial committee wrote, “those same municipalities reported a
total of 29,304 persons over 65 * * * who are recipients of public
welfare benefits, with an average monthly allowance of $8.21 per
person. Most of the municipalities also reported older people begging
on the streets.”

The Utah committee found a “near void of programs for the aging.”
County after county reported “no program for the aging presently

115
functioning * * #7; “none of the agencies had any organized com-
mittee or plan. * * #7 These are extreme cases, perhaps. In many
States, some excellent programs for older people have been started
in the past 10 years. Dut all the States recognize that “much more
needs to be done.” They could all echo Utal’s conclusion that “only
a token of [the State's] potential organizational strength and re-
sources is being used to develop programs for the aging. * * *7

The State reports give three main, and closely related reasons:
lack of coordination and planning at the community level; lack of
leadership at the State level; lack of funds at both levels.

Service clubs, women’s clubs, religious and civic organizations, as
well as public and private welfare agencies, have focused attention
en general or specific problems of older people, but there have been
few coordinated, unified, community-wide programs. Work at the
community level, says Kentucky, is “spotty, overlapping * * *. The
same report comes from Arizona, from rural States like Mississippi
and West Virginia, from States with huge metropolitan areas like New
York and California. “* * * we have many organizations concerned
with aging and the aged,” is a California comment. “In a very real
sense the most crucial issue is how to organize the organizations * * *.”

Part of the trouble lies with the organizations themselves. They
are often affiliates of national bodies with special interests. The na-
tional voluntary organizations have made valuable contributions to-
ward solving problems of older people. But their activity at the
State and local level has suffered from a segmented approach, from
a tendency to divert activity into certain channels, and from inex-
perience in cooperating with other local groups in joint community
planning.

A major weakness, however, is that most communities are flounder-
ing, without State leadership. Most, if not all, of the States agree
that many problems of older people can best be met at the local level.
But their communities feel strongly the need of guidance in setting
up and strengthening their local organizations and activities. Even
in Ohio, for example, where an unusual number of large cities have
well developed community welfare councils with subcommittees on
aging, there are many communities without an overall planning body.
“The expressed need (almost a plaintive ery) for consultation, * * *
help and direction is practically universal * * * from these unorgan-
ized areas * * *7

Only «a score or so of the States have permanent State Commissions
on Aging. With adequate funds and staff, a continuously functioning
central agency can assist immeasurably the organization and coordina-
tion of local committees. Iven with limited funds, State units like
those of Louisiana and Massachusetts have been able to promote some
degree of community organization; Minnesota has recently demon-

116
strated what a single qualified staff person can do. But if the State
Commission must operate with little or no funds, the problem is far
from solved. The Massachusetts committee, after surveying the ac-
tivity and organization of all local councils on aging and community
welfare councils, reported to the White House Conference that “there
was a total lack of planning for older people * * * on the local level.
Isolated examples occur, but coverage for the State as a whole is
totally inadequate * * *. The weakness has been the failure to pro-
vide funds [for] sufficient professional staff to carry out the function
of the State Council.” The Florida Council on Aging, though in
existence since 1955, has “neither adequate funds nor staff * * * to
encourage the establishment of local services or to furnish materials
and assistance to local communities * * *.”

Funds seem also to be the crying need of community welfare coun-
cils on aging. Although roughly one-fourth of the councils of social
agencies in the country have divisions or committees on aging, this
does not necessarily mean that these units have funds and staff to
carry on an effective operation. This passage in the Michigan Report
is illustrative—and challenging :

Most of the committees in Michigan, like the aged
themselves, have very limited means. Only 5 of 14 com-
mittees * * * have paid staff members. Three groups
had a budget of $10,000 or over in 1958; 2 other groups
received between $2,500 and $3,500 per year, and the rest
operated on nominal sums.

* % % a continuing source of financial support [is a]
prerequisite to survival and effective operation. To date,
significant support has come from only 3 sources:
Junior League organizations, Kellogg Foundation and
community chests. Junior League and foundation
grants have proved most valuable in getting new pro-
grams under way, but they are not intended to provide
permanent support. The community chest * * * canbe
expected to maintain a continuing interest, once it has
accepted responsibility. * * * [But] the demand for
chest programs is so great that these organizations are
understandably reluctant to make large-scale commit-
ments for aging. Convincing chest boards of the im-
portance of * * * programs on aging will remain a
major task of the local commmittees. * * *

The lack of expressed demand for services by older people them-
selves makes this task difficult, as the Michigan Report goes on to
suggest. “In part, this is because the elderly do not know what is—
or could be—available to them. The great majority of older people
do not join organizations that lobby for the aged. However, it would
be erroneous to conclude * * * that they do not have serious unmet
needs. * * *7 State after State reiterates the need for involving
older citizens in community organization, for calling on their experi-

117
ence and for finding out directly from them what they need and want.

“One of the most common complaints of the older person,” the
Michigan Report says, “is that ‘no one listens to me or cares what I
think.” Public indifference to the problems of older citizens, West
Virginia comments, is a major block to community organization on
their behalf. The first step, apparently, still needs to be taken—in the
words of the Florida Report, to “focus public interest and concern on
[their] potential and needs * * * so that senior citizens may become
an integrated segment of community life.”

118
Chapter V

NEW GOALS AND DIRECTIONS

The overall concept of the White House Conference on Aging in-
vited the States to develop facts and recommendations over the entire
range of subject-matter areas out of which the Conference is struc-
tured. All 53 States and territories did develop recommendations
and most of them have one, several, or many within each of the 20
subject areas. They—more than 6,000 in all—grew out of at least a
full year of factfinding and study. Many are based on a decade or
more of exploration and experiment. Taken together, these recom-
mendations form a broad and detailed basis for action. New direc-
tions were sought and discovered for achieving new and clearly de-
fined goals.

The process by which recommendations were developed tends to
follow a general pattern. Most were initiated in local, county, or
regional committees or meetings. They were then submitted, along
with recommendations formulated by study groups of the State com-
mittee, to the delegates of the State conference for further discussion
and, often, for final approval. In some cases, post-Conference review
and final approval was given by the State commission on aging or by
a White House Conference Committee.

The pattern of recommendations which emerge from the State re-
ports reveals many similarities from State to State. This chapter
attempts to summarize the principal recommendations, proposals, and
suggestions on which there was widespread agreement, as well as
some of special interest on which there was disagreement or which
were mentioned by only one or a few States.

Certain recommendations which made recurring appearance in the
States’ reports apply to all or most areas of concern. All or nearly
all of the States call for:

* Clearer identification and acceptance of the later stages of
life, together with the development of positive images and
potentials of those who are in them.

* Retirement incomes that permit dignified participation in
family and community life, with assurance of being able to
meet the costs of medical care.

* Improved health status for all older people, through increased
knowledge, widespread preventive services, and dynamic
restorative programs.

119
* More effective long-range State and community organization
and planning, with permanent State and community com-
mittees on aging.

¢ Better coordination of efforts of Federal, State, and local
levels, as well as among the levels of government.

e Acceptance of increasing responsibility by public agencies
for expanded and additional programs and facilities, and
greater involvement of voluntary organizations, too.

* Additional and better trained professional and nonprofes-
sional personnel.

e [xpanded research programs in all individual and societal
aspects of aging.

* New and enlarged ways of financing additional programs,
facilities, and services in all relevant fields.

e Opportunities for employment of those who desire it and
who are qualified and able.

* Greater emphasis on the opportunities and on positive ap-
proaches to solutions of the problems of aging, and mean-
mgtul involvement of older citizens as contributory mem-
bers of society.

SOCIAL AND ECONOMIC ASPECTS OF AGING

The economics of aging, and particularly the maintenance of ade-
quate income for older persons, is viewed by many as the core con-
sideration in meeting the problems of the later years. Whether this
is an accurate assay or not, State meetings have given major emphasis
to income maintenance. Within this subject, the timing of State con-
ferences and the political debates which were taking place, resulted
in a focus on meeting the medical care costs of aged persons. The
recommendations produced by the States reflect this sharpening of
the issues. At the same time these recommendations demonstrate an
awareness that any one issue or factor cannot be dealt with in isola-
tion; that continued employment is a considerable factor in income
levels of older people; that the proportions of the older population
taken together with proposed benefits can significantly affect the total
economy, and particularly inflationary pressures; that the whole popu-
lation is affected by any substantial measures to ameliorate condi-
tions of the older segment; that health affects housing, and housing
health; that employment is a factor in health and vice versa. Thus,
the interrelatedness of many factors became most apparent in the
grouping of subjects dealing with the social and economic aspects of

aging.

Our Aged Population’s Share in Expanding Productivity: How Much
and Through What Methods?

Recommendations are made on the collection and analysis of popu-
lation data. on the respective roles and responsibilities of governmental

120
programs and private provisions, especially in the area of income
security, and in financing of OASDI.

* More data by age, States said, should be available for use by
States in analyzing the socio-economic and health status of
their populations and in formulating constructive policies
and programs.

» State governments should undertake population counts each
10 years at midpoint between the Federal decennial censuses.

e Economic provisions and social services, both public and pri-
vate, for the aged, should be continuously reexamined in the
light of population trends and changes in our expanding
economy.

* Individuals should be encouraged at an early age to make
private provisions for their later years. Self-reliance in old
age should be emphasized.

When governmental assistance is necessary, most States conclude,
such assistance should be administered at the local or State level rather
than by Federal Government. Nine States emphasized the basic re-
sponsibility of the individual and his family for meeting needs of old
age. Three recommend that better understanding of the role of
OASDI be achieved through information and discussion.

With respect to the financing of OASDI, the diversity of the recom-
mendations did not permit generalization. Typical proposals in-
clude that OASDI funds should be invested in self-liquidating housing
projects for older persons, thus helping beneficiaries to stabilize living
costs.

» Tax rates or tax base should be increased to pay the cost of
added benefits so that the system would remain on a finan-
cially sound basis.

OASDI: Benefit Levels, Coverage, and Eligibility Requirements

Twenty States recommend that the level of benefits under OASDI
should be brought in line with the cost of living and be adjusted
wherever necessary.

¢ Minimum benefits should be raised and benefits for workers
who continue to work after retirement age should be in-
creased to reflect their continued employment.

On coverage and eligibility requirements, no generalization is pos-
sible other than the coverage of the system be strengthened. KEx-
amples are:

* Better coverage for persons whose income is for the most
part unearned, through taxation of personal income from
sources other than employment.

* Consideration of a lower eligibility age and a reappraisal of
age 65 in the light of increased longevity.

The Retirement Test Under OASDI

About 40 States recommend that retirement test under OASDI
should be liberalized to permit greater supplementation of benefits

577791—60——9 121
with earnings, but only a few States recommend outright elimination
of earnings as a retirement test. Among the recommendations for
modification were the following :
* Raise the exempt amount to $1,800 and withhold $1 of bene-
fits for each $2 in excess earnings.
* Raise the exempt amount to $2,000, to $2,400, to $1,800 or
one-half the amount on which the benefit is based.

* Allow employment income equivalent to 2,000 hours at the
prevailing federal minimum wage without loss of benefits.

Public Assistance for the Aging

In general, the recommendations in this area are that old-age assist-
ance programs should be strengthened through adequate appropri-
ations to provide payments at levels that meet the needs of recipients,
and under less restrictive eligibility conditions.

All but a handful of States make recommendations aimed at im-
provements in their old-age assistance programs, recommending
that:

* Payments in line with the cost of basic needs and the ceiling
be raised to take account of special needs; e.g., costs of main-
taining health and care outside the home.

* Modification or complete elimination of residence require-
ments.

° Relative responsibility laws be liberalized.

e Old-age assistance recipients be permitted some earnings
without loss of payments.

One form of liberalization urged, relates to the value of a home or
other assets a recipient can have.

A few States specifically approve administrative funds for use in
the provision of services or demonstration projects, recognizing the
value of such expenditures in ultimately reducing dependency. Sev-
eral States request that:

e The Federal act be amended to provide matching funds for
recipients in mental and tuberculosis hospitals.

Financing of Medical Costs

Widespread concern about the problems of medical care costs of the
aged and how they should be financed is evidenced by recommenda-
tions on this subject from all States. Almost all States deal with the
general approach to be taken in financing medical care. The weight
of opinion favor voluntary health insurance and individual respon-
sibility, with governmental programs limited to persons who qualify
as needy or medically indigent.

More study and exploration is needed. Six others endorse the prin-
ciple of some provision for comprehensive medical care or recommend
the development of programs, without specifying the method of financ-

122
ing such provisions. Of the remaining 34 States, 9 express the prin-
ciple of individual and family responsibility, with involvement of
government—and particularly the Federal Government—only as a
last resort. Many of these accompany their statements of philosophy
with specific recommendations for improving voluntary health insur-
ance and public assistance programs for medical care for the needy
and medically indigent.

In 11 other States there are recommendations that health insurance
be extended and improved and/or that there be improvements in
public assistance medical care based on need, including use of the new
program of medical aid for the aged.

In total then, of the States with specific recommendations on meth-
ods of financing, 20 recommended methods other than use of the social
security system.

Ten recommend that medical care for the aged be financed through
the social security program with benefits provided as a matter of right,
including one State which recommends that individuals have the
option between this method and private provisions. Three of the ten

recommend that:

e Programs of medical assistance for old-age assistance re-
cipients and for the medically indigent should be improved
and extended through Federal grants made available under
recent legislation, and through increased State appropria-
tions.

e Special attention should be given to inclusion of health serv-
ices that make it possible for individuals to receive care out-
side of institutions.

e Payments on behalf of welfare recipients in nursing homes
should be raised.

Nearly 40 States make some recommendation relating to the financing
of medical care through public assistance, suggesting that:

e The financing of services place emphasis on rehabilitation
care, on services that reduce institutionalization or on dental
care.

* Increased rates of payment in behalf of welfare recipients in
nursing homes.

* Revision in the basis of payment to hospitals or other institu-
tions.

In the area of voluntary health insurance, it is generally recom-
mended that:

e Noncancellable health insurance, providing medical benefits
tailored to the needs of the aged, should be made available
at premium rates older people can afford.

* Group insurance which individuals have through their em-
ployment or as members of pension or retirement system
should be continued after retirement.

* Insurance should be noncancellable (except for nonpayment
of premiums).

* Group insurance should continue after retirement.

123
« Insurance protection should be extended to one or more health
benefits not usually insured at present, such as diagnostic and
outpatient service, nursing home care, drugs, dental and eye
care, mental or emotional disorders, and long-term illness.

Private Pensions and Individually Provided Retirement Income and
Resources

The important contributions of private pension plans and their
frequent limitations are recognized in recommendations that:
o Private pension plans should be extended and encouraged
to provide increased protection through vesting provisions.
» To improve the income position of the aged, adjustments are
needed in tax legislation.
e More consumer education and protection is urged.

Nine States forward recommendations on private pension plans,
which include:

» Coverage of private pensions be extended.

e Protection be strengthened through provisions for vesting and
portability, and that employees be fully informed of their
rights under these plans.

» Tax incentives or other encouragement be given to individuals
to accumulate their own retirement funds.

Twenty-two States recommend that tax legislation be revised, or at
least studied, with a view toward easing the impact on older people, or
on taxpayers contributing to the support of an aged person. Tax
revision proposals frequently relate to:

* Real property tax benefit in the form of a homestead exemp-
tion for persons over 65 with low income.

Measuring Resources and Income Needs of Aged Persons

The lack of comprehensive, accurate, and recent data obviously
became apparent in the deliberations of the States resulting in state-
ments that :

* More information is needed for assessing the income position
of the aged population.

¢ Basic standard budgets should be developed and kept current.

e There should be a cost of living index geared to the buying
needs and habits of retired persons.

* The Bureau of Labor Statistics should develop budgets for
retired couples and single individuals “on modest but ade-
quate subsistence,” or some other level,

» Study of the impact of various methods of meeting medical
costs on the family.

o Study of the influence of adequate pensions on voluntary
retirement.

Earnings and Other Sources of Income in an Inflationary Period
One method of protection against inflation that is frequently sug-
gested for retired persons is through participation in employment.

124
The retirement test under OASDI is therefore relevant and States
recommend that the retirement test under OASDI be liberalized to
permit greater supplementation of benefits with earnings during an
inflationary period. Whereas 40 States forward recommendations
that the retirement test be liberalized or eliminated, or that consider-
ation be given to such change, only a few States recommend outright
elimination. Some of the recommendations for modification were in
terms of a specific dollar amount. Others suggest that the test be
made more realistic or more practical in its application, in view of
inflationary trends. As examples:

* The retirement test be made flexible, varying with the cost of
living.
° Old-age assistance standards, eligibility requirements and
Joye, should keep pace with the rising costs of living.
* Consideration should be given to increasing other pension
income to meet higher living costs.
* The effect taxes have on the fixed incomes of the aged should
be studied and necessary adjustments made.
Recommendations relating to study of tax legislation include the
possibility of increasing the retirement income exemption to help offset

the erosion of purchasing power due to inflation.

Mandatory and Flexible Retirement

States are overwhelmingly in favor of formal and informal pro-
grams to encourage a more flexible retirement system in both private
industry and government agencies at all levels. Underlying this rec-
ommendation is the concept that as we progress in the social and physi-
cal sciences (enabling persons to lead longer, more healthy and more
productive lives) it becomes all the more necessary for retirement
decisions to be made on an individual basis. However, the economic
and psychological needs of the individual, though of prime impor-
tance, is not the sole consideration of the States. They interpret pro-
jections of population and other data, as indicating that in 20 years,
two-thirds of our population will probably be supported by the one-
third who are working unless present retirement practices are changed.
States recommend :

* Educational types of programs to emphasize the advantages
of a retirement system based on physical, mental, and work
abilities rather than solely on chronological age and to en-
courage employers to reexamine their present retirement poli-
cies in light of present knowledge.

* State and/or Federal laws be modified so as to achieve more
flexibility in their own retirement systems, to set an example
for other employers.

* “Gradual retirement” or “phased retirement” should be given
serious consideration by both public and private organiza-
tions.

125
Implicit in this type of retirement is the concept of decrease in re-
sponsibility and workload (with or without a corresponding decrease
in earnings) as a substitute for compulsory retirement or dismissal.

One State recommends that :

e An increment in social security benefits for each year of de-
forred retirement should be given to those over 65 who con-
tinue employment and retire at a later date.

Retirement Policies and Pension Plans as Related to Workers Mobility

The States generally recommend that retirement policies and pen-
sion plans be liberalized. The underlying reason for this recommen-
dation is the belief that such liberalization would help to prolong the
employment life of middle-aged and older workers and would encour-
age the reduction of age restrictions in hiring policies of employers.
Major recommendations favor:

o Portability of pension rights broadened to include those work-
ers who change jobs to other industries.

e Establishment of vested pension rights where nonexistent in
current company pension policies.

Efficiency of Older Workers and Adjustment to Aging

The major emphasis under this category is the adjustment of the
individual older worker to his work and to the inevitable period of re-
tirement. The largest number of recommendations deal with direct
employment and rehabilitation services to older workers and the de-
sirability of preretirement counseling, specifically:

o The development and expansion of public and private coun-
seling, placement and rehabilitation services to assist the older
worker with his vocational and related problems.

Such development and expansion in many cases would necessitate
budgetary increases, enlarged facilities, and training of qualified staff.
Twenty-two States recognize the need for:

e Formal and informal programs or preparation for retirement
to “educate workers for successful retirement.”

e Preretirement counseling services should be provided by in-
dustry, labor unions, State or community groups, or in some
-ases, jointly by these groups.

Implicit in these recommendations is the recognition of the indi-
vidual’s responsibility for making his own retirement plans as early in
his working life as possible.

The recommendations also reflect a need for continuing efforts to
collect factual information relating to the problems of employment
and employability of the aging and to determine specific job oppor-
{unities for older persons. Nine States recommend :

e Programs of part-time work should be developed by Govern-
ment and private industry.

126
Industrial Change and the Older Worker

Automation, mechanization, and other technological advances, inter-
state shifts of companies and industries, organizational mergers, and
similar developments directly affect workers of all ages. Older work-
ers—being generally less mobile than younger workers—often having
less education and sometimes possessing skills that are no longer in
demand, are particularly affected by major industrial changes. The
major recommendation is:

* Expansion of existing training programs for those workers
having to renew old skills or who are seeking to develop new
skills and abilities in order to meet the skill requirements of a
changing industrial scene.

For the most part, such training and retraining is recognized as the
responsibility of not only business and industry, but of labor organiza-
tions and community vocational and educational agencies as well.

Adequate skills must be accompanied by sufficient job opportuni-
ties. This need is reflected in the recommendations of at least seven
States. Stimulation of economic and business growth within the
State through various means (in most cases unidentified) is the basic
recommendation for achieving the goal of increased job opportuni-
ties for workers both young and old.

HEALTH AND MEDICAL CARE

Many individuals and communities are intimately concerned with
complicated tasks of achieving optimum health and satisfactory medi-
cal care for older persons. This involves constant evaluation to de-
termine how well existing facilities and resources are meeting re-
quirements and which of these need strengthening, what new ones are

needed, what personnel are required, and, finally, how these programs
shall be financed.

INSTITUTIONAL HEALTH AND MEDICAL CARE

About 5 percent of the 65 and over are institutionalized. The
older patient spends about twice as much time in a short-term care
hospital as do younger persons. At any one time most of the institu-
tionalized aged are in long-term care facilities such as a nursing home,
psychiatric hospital, veterans facility, chronic disease hospital, or a
chronic disease section of a general hospital.

Facilities

Many State recommendations call for an increase in facilities to care
for the aged. Most of these are for chronic disease facilities such as
nursing and convalescent homes, mental hospitals and facilities for the

127
care of less severely disturbed patients. Several suggest that hos-
pitals should establish wings or units for the care of the chronically ill.

The necessity of community planning for such facilities is urged and
the States express concern over restrictions in zoning that are bottle-
necks in developing nursing homes.

Financing, Construction, and Equipment

The States suggest a variety of recommendations relating to the fi-
nancing of construction and equipment. The recommendations ex-
press a general need for:

e Increased allocation of funds for nursing home construction

under the Hill-Burton program.

A realignment of the apportionment of these funds in a man-

ner that will make the Federal share larger than it is at

present.

Readjusting FITA mortgage insurance rates to cover as high

as 90 percent of the construction and site costs for nursing

homes.

Federal funds be made available for remodeling and modern-

izing existing facilities.

e A more active program should be undertaken to acquaint the
public with the various kinds of Federal assistance presently
available to those contemplating the construction of nursing
homes.

Costs of Care

There was general agreement on the need for:

* Realistic payments for care rendered welfare patients in all
facilities.

o Welfare payments to be made as vendor payments and based
on cost per patient day.

Development of a standardized accounting system to be used
by nursing homes and allied facilities.

(lost data to be reported to a central source in each State.

A number of States recommend that encouragement be given to pri-
vate insurance groups to expand and broaden their coverage of aged
individuals and to include such services as outpatient care. It is also
recommended that State and Federal agencies establish a program that
cares for the medically indigent person who is not totally “indigent.”

Standards of Care

The States are concerned about the standards of care for older peo-
ple. Their recommendations reaffirm their belief that:

o There should be better, more realistic, and more workable
standards.

» Substandard homes should be eliminated.

Financial, educational, and other incentives should be used
to raise sttandards of care.

128
* Better, more comprehensive, and more physicians supervision
is needed.

* Administrators and personnel of the homes should meet mini-
mum qualification and training standards.

* Progressive patient care and a continuum of specialized serv-
ices are needed.

*Adequate patient records should be maintained in relation
to physical examinations, case histories, and patient progress.

Licensure

Many States make recommendations that:

* All facilities for the care of older people should be licensed
and regulated by a single agency.
Several States feel that more funds and staff are needed for both

licensure and educational programs and that there should be more ef-
fective regulation of boarding homes and foster homes.
The recommendations also indicate a need for:

* More uniform interpretation of laws and regulations for not
placing welfare patients in unlicensed facilities.

* Better classification of facilities.

* The creation of a nursing home advisory council to the licen-
sure agency.

Administration and Classification

In addition to the need for better definitions and classification of
facilities, some States feel that nursing homes should provide a
variety of services for individuals living in the community. Rela-
tionships between hospitals and nursing homes should be strengthened.

Rehabilitation and Progressive Patient Care

To improve and expand progressive patient care and rehabilitative
services the States recommend :

* More rehabilitation services for nursing home patients.

* More physical therapists, rehabilitation centers and facilities.

* Physical therapy services in more general hospitals.

* Improved rehabilitation services in nursing homes.

* Increased cooperation among hospitals, nursing homes, and
community agencies and facilities in helping patients return
home.

Training and Utilization of Personnel

Training grants, licensing laws and recruitment of personnel are
included in a variety of recommendations made in relation to train-
ing which is indicative of the increased emphasis States are giving
this area of concern. One State felt training should take precedence
over the building of facilities. Others felt inservice training pro-
grams should be developed for institutional personnel.

129
Dental Care

Several States make recommendations for dental care of patients
in institutions. These include:

Installation of dental facilities.

Portable dental equipment.

Strengthening dental staff.

Preentrance oral examinations.

Dental care on a routine basis.

Development of methods of payment for dental services.
Dental health education for patients and staff.

Nutrition

Concern for nutrition in institutions is expressed by several States.
Their recommendations stress the need for nutrition education of
patients, staff, families, and community agencies. One State recom-
mends that Congress allot sufficient funds to study the best method of
communicating nutrition information to older people.

Public Information

Several States indicate there is a need for better public informa-
tion on health care problems of the aging. They feel the public needs
a greater appreciation for and understanding of the role of nursing
homes and related facilities for the care of the aged, as well as the
need for the family to recognize and assume greater responsibility
for their care,

HEALTH AND MEDICAL CARE AT HOME

Most of the States in reviewing potential programs for the com-
munities report the need for the development of services to be pro-
vided to the chronically ill and older individual in his own home.
Many States recommend a more formalized home care program in
which they visualize a comprehensive medical care plan using a team
approach of physician, visiting nurse, social service worker, occupa-
tional therapist, physical therapist, vocational therapist, and psy-
chiatrist under the supervision of the attending physician.

The financing of home care was of concern to several States. They
recommend :

 Tlome care services as well as hospital services be included in
the usual prepayment health insurance plans.

Other States are concerned about educational programs. They
recommend that:

 Iducational courses in home nursing be developed to enable
families to take care of the sick and injured who need
nursing and bedside care.

130
° Home nursing clinics be established to conduct training
programs.
* Rehabilitation procedures should be included in home nursing
courses.
Nursing Services

Many States recommend specifically that nursing care in the home
should be expanded in various ways. Several recommend home nurs-
ing as a single service; however, other States see it operating in con-
junction with other services such as homemaker and home care
programs. Recommendations are that:

* The local health departments should play a vital role in the

rovision of home nursing services.

* Inactive nurses should establish a visiting nurse society to
provide home care for the aged with members serving on a
part-time basis.

* Practical nurses should be utilized in home care and their
training organized.

* Visiting nurse services should be expanded considerably for
rural and outlying areas.

Homemaker and Social Services

The establishment of homemaker services for the chronically ill and
older individual is recommended by many States. They feel it should
be part of community program services. One State recommends that :

* The sponsorship should be assumed by local groups and social
agencies.
In discussing the personnel needs of a homemaker program several
States recommend that : -~

* Emphasis be placed on thelutilization of nonprofessional or
even volunteer workers who could be trained.

* Senior citizens should be encouraged to participate in home-
maker programs, thereby not only providing personnel for
the programs but giving the homemaker herself a therapeutic
situation.

* All homemakers who render services below the technical level
should be given training including sound nutritional infor-
mation.

* Homemaker services should be on a paid basis.

HEALTH MAINTENANCE

In the early years of this century health supervision, medical care,
and sanitary measures were directed toward the young. Hence, the
major decreases in death rates have been in the younger age groups.
The present emphasis on health maintenance programs for adults, and
especially those over 45, is a relatively new development.

131
Education

Most States recommend broad aspects of educational programs
related to health of the aging. The important goals visualized are:

e An informed citizenry and legislature to achieve understand-
ing of present and future needs in the field of aging and to
obtain support for sound and useful programs.

+ Positive education directed toward the public to prepare in-
dividuals in responsibilities for their own health.

« Education of the older citizen, both well and ill, to adopt and
maintain desirable health practices.

« Tducation of families concerning their role in the care of ill
aged.

+ Preparation of medical and allied groups who work with the
aged.

The methods proposed for the attainment of the goals of a broad
health education program include wider use of the mass media, col-
laboration with all agencies carrying on educational programs related
to health of the aging, and intensifying health education in problems
of chronic illness and aging in schools, colleges, and adult education
programs. An active in-service educational program for all personnel
who work with the aged is also deemed necessary.

Prevention and Early Detection

Many States make recommendations that preventive health pro-
grams be provided, expanded, and strengthened by existing social and
health agencies, both voluntary and public, at the State and local level
for the aging and aged.

Early detection of disease and disability by means of various types
of screening programs is recommended by several States. They sug-
gest that:

« Planning be done cooperatively at the community level for
the establishment and operation of such programs.

+ Screening programs include instruction in nutrition and per-
sonal health care.

+ Screening programs serve as an aid to the private physician.

Medical Care

The medical care aspects of health maintenance are considered by
many States. They recommend that:

« Outpatient services be expanded to provide geriatric services,
including screening, comprehensive diagnostic evaluation,
and treatment services.

+ Counseling services be made available to older people who
anticipate or who have medical problems to assist them in
making total plans to meet the problem.

132
e State and local agencies and organizations establish a con-
tinual and concerted program of nutrition education for the
aging and the aged.

Several States point out the need for podiatry services for the aged.

MENTAL HEALTH

There is a common concern among the States about the mental
health problems of older persons and over the implications of senility
and mental illness for the person himself, his family, and the com-
munity. Solutions to these problems are believed to lie in increasing
and improving the total range of services with considerable emphasis
being placed upon the development of care facilities in the com-
munity where the patient lives. Specifically recommended are:

* Development or extension of community mental health
programs.

e Provision of geriatric units or services.

e Provision of mental health clinics.

* Provision of evaluation and after-care services.

e Provision of community facilities for care.

ORGANIZATION OF COMMUNITY HEALTH AND MEDICAL
CARE SERVICES

Planning and Implementation

States feel there is need for long range community planning and
more coordination of health and medical services. Several States
recommend :

e Continuous evaluation of existing services in relation to needs.

* Long range planning for necessary improvements and
additions.

e Continuing coordination of activities both in the planning
of new services and in the operation of health departments.

e Organization of voluntary planning bodies or other appro-
priate means.

Other States stress the need for greater utilization of existing fa-
cilities and services through the establishment of a central agency, or
a State unit of the Joint Council on Health Care for the Aged.

Training and Research

Many of the States urge the need for more and better trained per-
sonnel. Subjects for research include:

e Medical care and rehabilitation.
¢ Administration of services.

133
e The adequacy of existing medical facilities, including hos-
pitals, nursing homes and the need, if any, for additional
facilities.

e The feasibility of developing local or regional home care pro-
grams, nutritional and recreational services, and the coor-
dination of such programs with existing services and
facilities.

e Objective evaluation or study of all existing resources, both
public and private, to determine how effectively such re-
sources, if fully utilized, could meet the medical problems of
aging.

o Assessment and reassessment of State responsibility for
defraying costs of community services required by aged as-
sistance recipients.

Expansion and Coordination

Many States make explicit recommendation for expansion of serv-
ices to meet specific problems. These include such things as veterans’
services, programs or services to alcoholics, and accident prevention.
They also indicate a need for expansion of local health department
services. Several recommend the development of a centralized re-
ferral system between agencies working with the aged.

Financing Services

In planning new and expanded services the inevitable question of
sources of support must be answered. Many States specifically men-
tion the need for an increase in local, State, and Federal moneys for
services to the aged.

REHABILITATION

The States feel that if modern rehabilitation services are widely
provided, many of the disabled aged could once again learn to live in
independence and with greater dignity and that many could return to
gainful employment.

Vocational Rehabilitation

Many States recommend that :

e Vocational rehabilitation services be improved and expanded
so that older disabled people may maintain or regain their
ability to work and secure suitable employment.

The professional stafl's of rehabilitation agencies be enlarged.
Additional public funds be appropriated.

Prompt referrals be made for rehabilitation of older disabled
people.

Special counseling services and refresher training courses be
established.

134
Several States propose that age be considered a disability which
would qualify an applicant for vocational rehabilitation services.

Rehabilitation in the Practice of Medicine

Many States urge the incorporation of rehabilitation principles into
all medical and health care and into curricula for training professional
personnel. Specifically recommended are:

* The establishment of rehabilitation services in all general
hospitals.

* The development of outpatient rehabilitation clinics.

* Nursing home programs be designed towards progressive
self-care and self-sufficiency of the patients to enable them to
return to their own homes.

Rehabilitation Services Within Institutions

It is quite apparent the States believe rehabilitation services should
be emphasized in the community to keep older people out of costly
medical facilities and other institutions. When older persons are
institutionalized in homes for the aged, geriatric hospitals, and long-
stay facilities, the States, without exception, recommend that all such
institutions include and stress restorative and rehabilitative services
that will enable older disabled people to live as independently as
possible.

Organization of Community Services to Meet the Needs of the Disabled

In planning community services for the disabled many States pro-
pose:

* Better coordination of existing services.

« Establishment of information centers for advising those in
need of rehabilitation, physicians, and other pr ofessional peo-
ple of the rehabilitation resources within the community.

* Extension of library services to include special services for
the aging who are handicapped.

* The friendly visiting programs of churches, synagogues, and
local groups include rehabilitation.

* Adult education programs be planned with older people in
mind, and allowances made for various types of disability.

* Churches and synagogues plan their building and remodeling
programs in light of the physical capacities and needs of
older adults.

* Builders and developers consult with rehabilitation experts
so that housing is designed to meet the needs of the aged
disabled.

The necessity of developing multiple screening programs for early
detection of those conditions for which rehabilitation may be required,
and early rehabilitation evaluations by teams of experts in any illness

135
that may lead to deformity or physical disability is emphasized. Many
States recommend that:

o Additional rehabilitation centers be developed which will pro-
vide a wide range of rehabilitation services to meet the needs
of elderly who are disabled.

e Workshops and the services provided by workshops be estab-
lished or expanded.

e Special services be provided for the aging who are emotion-
ally and mentally ill.

e Provisions be made for increasing rehabilitation services for
the aged and the chronically ill in their own homes.

e Mobile teams be established for teaching families the rehabili-
tation procedures that can be carried out in the home.

e Legislation be enacted establishing a nationwide, State-Fed-
eral rehabilitation program for independent living.

FAMILY LIFE AND SOCIAL SERVICES

The family is often a resource for assisting older persons in adapt-
ing and adjusting to the process of aging. Changes in our modern
life have created difficulties, however, for older persons and their
families, as they seek to maintain and strengthen bonds between the
old, the middle-aged, and the young of today’s extended family.

The social services are a flexibly organized system of activities
and institutions to enable individuals to attain satisfying standards
of life and health while at the same time helping them develop their
full potentialities for personal and social relationships.

The fact that all States make recommendations relative to the roles
of the family and the social services in meeting the needs of older
people is indicative of the significance and the level of concern the
States attach to these resources.

Role of the Older Person in the Family

The States express their concern in several ways:

e By reaflirming the values of the family as a basic unit in our
society.

* By suggesting ways in which, through family life education
and supportive social services, family ties, particularly be-
tween children and older family members, could be strength-
ened.

¢ By reaffirming a basic belief that families should be encour-
aged to care for their older members.

Rights of Older Persons

The States in considering the rights of older persons recommend :

* The natural rights of the aged to life, liberty, mobility,
happiness, individuality, and health should be recognized
and promoted.

* The right of older persons to obtain social services and in-
dependence in their choice of these services.

136
* The factors which assure aging with dignity, independent
decision making, successful retirement, continued independ-
ence consistent with capacity, and meaningful social roles, be
aided and abetted by appropriate services and financial aid
from private voluntary agencies and from public social
agencies.

Status in the Community

The States feel older people should be given public recognition and
prestige. This should spring from a capacity, inherent in the pro-
grams and institutions of our communities, to create a climate of
opinion which recognizes the personal dignity and worth of the in-
dividual. The basic community forces should be encouraged and
stimulated to continue and to expand their role as fundamental atti-
tude-developing instrumentalities in the community.

Personal and Family Counseling Services

Almost all States recommend that social services, in the form of
personal and family counseling through casework services, be made
available to older persons. Specific suggestions were:

e Services as a support to help the older person continue to live
independently and to strengthen family life.

* Additional funds should be made available to State depart-
ments of public welfare to reduce existing caseloads, establish
and expand casework services, and train staff providing these
services.

* Make casework services available to older people in every
community, regardless of their income.

* Agencies and organizations, public and private, should im-
prove the adequacy and availability of their counseling serv-
ices to older people.

Protective Services

Many States recommend providing adequate protective services for
older people, unable to manage their affairs in whole or in part. The
form this service should take ranges from that of providing legal aid
and social protection to protecting the mentally incompetent older
person.

Information and Referral Services

It is stressed by many States that informational and referral services
should be established to help older persons identify and use the re-
sources of the community to meet their individual needs.

577791—60——10 137
Homemaker Service

Almost all States identify the need for homemaker services as a
major factor in enabling a greater number of older persons to remain
in their own home. They recommend that:

e Local communities through voluntary and public agencies
provide homemaker services.

« Demonstration projects be undertaken.

o Methods of financing be explored and facilities for training
homemakers be developed.

Meals on Wheels

Many States recommend the establishment of “meals on wheels”
programs in local communities as one means of helping older persons
remain in their own homes.

Transportation Services

Recognition is given by many States that older people need trans-
portation service if they are to take full advantage of the community
resources. The contributions which voluntary organizations and
service groups can make are emphasized in the recommendations.

Friendly Visiting

Friendly visiting services provided by voluntary and service organ-
izations, including churches, youth groups and senior citizen clubs, are
recommended by most States.

Foster Home Care

Many States recommend that more consideration be given to the
development of foster home care for those individuals who no longer
are able to live in their own home and who do not require the spe-
cialized care offered by institutions but need the support of a sub-
stitute family setting. Adequate standards are needed and demon-
stration projects should be developed.

Social Services in Institutions and Other Facilities

Social services should be made available to older people in in-
stitutions. Such services should include:

e Counseling with the aged.

Interpreting their illness.

Reducing their length of stay.

Txplaining their financial responsibilities.

Assisting in securing relief and working out suitable living
arrangements once the need for care closes.

138
Activity Centers

The establishment of activity centers is recommended by many
States. Public and voluntary groups should provide opportunities
for older people to participate in community activities through the
utilization of such centers. Several States recommend multiple service
centers which would provide social services, educational programs,
recreation activities, medical services, and counseling and referral
services for employment.

Joint Planning and Action

Recommendations concerning community planning and the utiliza-
tion and training of professional personnel appear elsewhere.

HOUSING

Today, the majority of older people live independently in their
own homes. A quarter or more of them, particularly in the very late
years of life, share houses with their children, or take up residence
in a group setting. Residence clubs, retirement hotels, grouped hous-
ing, and villages are finding increased favor. A few migrate to
warmer climates or move to another place to live with a friend.

The State recommendations reflect concern for finding adequate
answers to the complex question, “What objectives must housing ful-
fill for independent living in the later years and how may these objec-
tives be attained ?”

Housing in Relation to Community Planning

Throughout the States’ recommendations there is acknowledgement
of some special housing needs in old age, needs which are not now
being met. Most States feel broad as well as specific action is neces-
sary if the supply of housing is to be brought up to a level commen-
surate with both need and demand. They recommend :

° Federal, State and local community action to increase the
general supply of housing available to old people.

A number of other States in identifying specific courses of action
recommend that :

* The overall problem of housing for older people be given
particular consideration in all urban renewal and redevel-
opment proj ects.

* Local planning and zoning agencies take particular cogni-
zance of the needs of older individuals and families by
adoption of ordinances which permit the construction of
housing of a suitable size and type.

139
e TTousing be distributed throughout the community in such a
way that individuals in old age might retain contacts with
younger relatives and friends, and remain a part of the total
community—active, participating citizens.

e Iousing centers be established to provide information and
counsel to the public and to stimulate action.

e Broader dissemination of housing information be given to

the public at local, State, and National levels.

. and research be undertaken on the housing situations
of older people.

New Houses and Apartments

Most States imply that the production of individual houses should
be increased in the immediate future. The specific recommendations
which are made relate primarily to the quality of the house, the
neighborhood, and to the manipulations related to sale and purchase.

The recommendations pertaining to the design of individual apart-
ments express the concern for the physical and psychological needs of
older residents. In addition to repeated emphasis upon safety and
ease of accomplishment of routines of living the States recommend

that:
o Specific effort, go toward providing housing at rentals which
older people can afford to pay.

Hotels, Residence Clubs, and Congregate Facilities

As is true of housing in general, most States feel there is a need for
increasing the supply of all types of quasi-household accommoda-
tions—hotels, residence clubs, boarding and foster homes, retirement
homes, and homes for the aged.

In considering environmental design and the new concepts of in-
stitutional endeavor some States recommend :

e More coordination between the broad resources of the com-
munity and the institutional programs, services and facilities.

e Institutional locations where maximum use could be made of
existing community resources.

e Inclusion of social and recreational activities in program
and physical plant.

Other States in referring to existing Federal programs of mortgage
insurance and loans, recommend expansion of those programs, simpli-
fication of procedures, and various modifications to ease the burden
of financing.

A number recommend that the sponsorship of institutional and
other quasi-household accommodations be provided by :

Religious, fraternal, and labor groups.
Private foundations and individuals.
+ City, county, or local public groups.

Increased attention to the enforcement of standards of facilities

and care in institutions is recommended by many States.

140
Housing Individuals of Inadequate Income

Almost every State recommends action to provide housing for indi-
viduals of inadequate income. Such action is advocated through di-
rect programs such as that of the Public Housing Administration, or
through the search for new techniques for solving the problem.

In relation to current programs the States recommend that :

* The public housing program, a major resource in the com-
munity, be continued and improved.

* Nonprofit groups with religious, fraternal, labor, and civic
sponsorship be encouraged to continue efforts in behalf of the
low income aged, under both the mortgage insurance and
direct loan program.

Living Independently—Needed Services and Facilities

To enable older people to reside longer in their own homes the
States repeatedly recommend the provision of such services and facili-
ties as adequate transportation; recreational opportunities; com-
mercial shopping centers; homemaker service; meals-on-wheels; day
care centers; visiting nurse services; rehabilitative, vocational, social
and counseling services; medical facilities; weekly health clinics and
churches, most of which are dealt with in other sections.

EDUCATION

The State recommendations give clear recognition to the need for
education for enrichment of the lives of older people and for improve-
ment of community services for them.

Increasing Knowledge and Understanding of Aging and the Aged

Progress toward the solution of many of the economic, social, and
health problems of older persons in many communities is caught on
the hidden sandbars of our attitudes about “those old folks” and our
expectations of “old age.”

Educational agencies and organizations can help create a new image
of aging. Almost all States recommend :

e Iducational programs for all age groups should be offered
to develop concepts that would lead to positive attitudes
toward elderly people.

* Resource centers should be developed by Federal and State
agencies and by universities to disseminate information and
provide consultative services to communities conducting such
educational programs.

The increased knowledge about aging is of small significance unless
it is disseminated to the general public, who make the public and
private policies concerning aging, and who create the social climate

141
which affects the way people grow older. To facilitate the dissemi-
nation many States recommend :

e Coordination and cooperation among agencies and groups
carrying on education about challenges and problems of
aging—in order to avoid duplication of efforts and to estab-
lish better means of communication.

e Coordinated efforts should be made to develop community
resources for education about the aging and for preretire-
ment education and counseling.

Several States recommend :

The placement of courses about aging in all levels of edu-
cation,

e The research on education about aging be disseminated
through mass media.

Education for Older People

While education for older people may not be as dramatic as a new
housing project or a senior citizen center, or as easily measured as
the number of older people treated in a hospital or given welfare
assistance, it is essential in helping older people to cope with the tasks
which confront them in the later years. The need is evident to almost
all States as they recommend :

o Community adult education programs for older people be
encouraged, promoted, and developed by local educational
agencies, by State departments of education, by universities
and colleges, and by the federal Government.

 Gireater financial support be provided from State, local, and
Federal funds.

The employment of the older worker will continue to be limited
until occupational retraining and other services are made available
to them. The States recommend:

e Vocational education and reeducation for older people be
developed and expanded so that the older worker may be
assisted in gaining employment, through expanded counsel-
ing and placement services, vocational training, and rehabili-
tative programs.

Retirement provides some special opportunities and gives rise to
some problems, too. To assist individuals in planning for and mak-
ing the transition from employment to leisure many States recom-
mend :

e (lasses and group discussions in preretirement counseling
and retirement counseling for the aging and the aged be

organized in public and private educational institutions, in
Federal and State agencies, and in industry.

Public library service in relation to education for older people is
geared to a wide range of users and carried out in a variety of ways.

142
Special library services are recommended by many States for older
people and for those working with them.

Facilities are important factors in establishing educational pro-
grams for the aging. Many States recommend the use of facilities in
churches, clubs, local schools, union halls, and other locations which
might be made available for classes and discussion groups.

Education and Community Services by Older People

More and more, older people have the time to contribute a variety
of services to society. These contributions can help provide the man-
power which can make a difference between what exists today and an
enriched way of life for tomorrow. They recommend :

» There be an exploration of practical approaches through
National, State and community organizations for emtnying,
developing and utilizing talents and abilities of older people
for educational and community service programs, including
the development of fellowships for talented older people who
want to make a contribution to society through a variety of
creative efforts.

Older people should be used as resource people, counselors,
consultants, and lecturers on matters of concern to the aging
either on a voluntary or paid basis.

ROLE AND TRAINING OF PROFESSIONAL PERSONNEL

The problem of the role and training of professional personnel in
aging is a relatively new one. Until recently the concern of both scien-
tists and professional practitioners was limited very largely to indi-
viduals in the first three decades of life. The achievement of a sig-
nificant increase in life expectancy has added new and relatively unin-
vestigated periods of life during which profound changes take place.

Role and Utilization of Personnel

The States are concerned with the numbers and kinds of profes-
sional and ancillary personnel required to provide the broad range of
services needed by middle-aged and older people. In resolving the
question of current, and probable roles of each discipline in working
with the aging and aged, they indicate their awareness of the need for
many new programs of training for professional personnel. It is
implicit in the recommendations of all States that :

e Aging affects all aspects of people’s lives and often creates
problems and special needs which can be met effectively only
with the assistance of professionally trained personnel.

* There is a need for skilled services in health and rehabilita-
tion, welfare and social work, recreation, education and li-
brary work, religion, employment counseling, community
organization, and environmental planning.

143
The conflict in thinking on the roles of the specialist and generalist
in working with older people is evident in recommendations which
urge that:

+ Professional personnel working with older people be equipped

with knowledge of the processes of aging and of the special
characteristics of aging and aged persons.

One State recommends:
The training of generalists to administer programs for older
persons.
Another believes that:

Specialists are not required but that older persons should be
served by personnel generically trained in their fields.

Some States recommend that measures be taken to create a wider
public and institutional recognition of the special needs of older people
and that professionally trained personnel should assist them, particu-
larly in the nursing home field.

Professional Standards

All of the recommendations quite apparently flow from the con-
victions of the States of the need to raise existing levels of qualifica-
tions for personnel working with older people and to require specific
training in various aspects of aging. Many States specifically recom-
mend :

 Iistablishing standards for personnel of nursing homes and
other institutions.

» Requiring agencies to include especially qualified personnel
on their staffs.

Formal Education and Training

Educational institutions at all levels were called upon by most
States to incorporate material on aging in their general educational
programs and to provide specific professional training for individuals
preparing to work in professional and quasi-professional occupations
in all fields of aging.

Twenty-three professions or occupations were mentioned one or
more times in recommendations calling for formal training. Most of
the recommendations in which levels are mentioned urge that train-
ing be given in professional and graduate schools.

Informal Training

Most States recommend informal training opportunities in the
form of inservice programs, conferences, institutes, workshops, and
correspondence courses be made available. The recommendations
specify the use of professional schools, colleges, university extension
services, and secondary schools for informal training. Several States

144
also urge operating agencies to conduct inservice training programs
for their own staff members.

Recruitment

Normally the professions are recruited from among the young; but
the young, generally, find many concerns and interests closer to them-
selves, and are reluctant to bypass these in order to look after those
who “have no future.” They are at once sympathetic toward, and
intolerant of, those whose lifespan has run too far beyond their
own. Many States are cognizant of the recruitment problem which
has resulted in a shortage of personnel for providing services to
older people and recommend :

e Hstablishment of active recruitment programs, particularly
among people at the stage of making career choices.

* Recruitment efforts begin at the secondary school level.

Some States recommend :

* Well qualified professional persons from the aging group
should be recruited within the special State departments or
university to work with the aging group. The aging group
should constitute a “pool” of specialized professional per-
sons whose services and contribution should be utilized in
this field.

Training Funds, Scholarships, Etc.

Answers to the problem of lack of funds for research, for training,
and for salaries of those who might seek training and employment if
the rewards were greater, are widely sought. One-half of the States
made recommendations that funds be made available to support train-
ing programs and facilities in the basic sciences and professional fields
concerned with aging. A variety of sources are recommended :

e Foundation Spin be sought to provide assistance for work-
shops to train helpers, and to stimulate inquiries as to the
needs of the aging.

* Both government and voluntary agencies should take ad-
vantage of community, State, and Federal funds to provide
inservice and fieldwork training. Additionally, scholarships
should be established with Federal, State, local, and com-
munity funds for the purpose of training personnel in social
service work and in related fields with older people.

* Federal stipends should be made available for the graduate
and postgraduate training of professional workers.

e The State and Federal Governments should make more funds
available for the purposes of adding teaching staff, conduct-
ing research, financing training, and carrying out pilot proj-
ects related to the general field of gerontology. Specifically,
direct Federal institutional grants and traineeships should
be increased to better finance research and provide scholar-
ship aid for the expansion of training in the professions

145
and disciplines significant to research and improve services
for the aging. Appropriations should be made for the gen-
eral purpose of developing all pertinent fields related to
aging rather than being narrowly directive and prejudging
as to what avenues of research and training should be
emphasized.

Training Facilities

Several States recommend the establishment or expansion of exist-
ine facilities within universities to enable them to improve both train-
ing opportunities and services. A number recommend the organiza-
tion of institutes of gerontology or similar coordinating units to give
the necessary leadership in providing training opportunities, research,
and consultative and technical assistance.

FREE-TIME ACTIVITIES: RECREATION, VOLUNTARY SERVICES,
CITIZENSHIP PARTICIPATION

The States recognize the importance of a broad range of free-time
activities for older persons. These activities should include recreation
in its broadest sense, service to others and participation in all appro-
priate community projects and services.

Activity Programs

Most States emphasize the need for greatly extended programs and
recommend :

e A broad range of activities sponsored by public agencies,
civic organizations, service clubs, churches, women’s groups,
voluntary welfare organizations, educational institutions,
libraries, hospitals, nursing homes, homes for the aged, and
other institutions with older residents.

Programs should include day centers, clubs, social activities,
outings, travel, camping, hbrary service, informal educa-
tional programs, volunteer service by older people to their
contemporaries and other age groups, and active participa-
tion in community affairs and central counseling, referral
and information services.

e Free-time activities should be made available to the ill and
handicapped, whether institutionalized or homebound.

Facilities

Activity programs require facilities. To meet this need most States
recommend :
e The free use of existing public and private facilities by the
aging as well as other groups.
e Facilities for the exclusive use of older people and the con-
struction of new facilities where necessary, including special
areas and facilities for day centers, camping, and crafts.

146
* Public housing and other institutions for the aging should
provide space for free-time activities.
Several State reports recommend that State and local parks and
recreation areas should provide proper facilities and overnight ac-
commodations for older people.

Financing

Implicit in the recommendations of all the States in free-time activ-
ity programs is the recognition that public and private funds must be
made available for these purposes.

Several States recommend financing by local government agencies,
while several others recommend that State financial aid be made
available to local communities for general recreation services.

Several States recommend Federal aid, one that it be on a matching
basis.

Organization

Most States recognize the need for effective organization and recom-
mend that proper provisions should be made for cooperative plan-
ning, coordination of programs, and other services. Many also rec-
ommend close coordination and overall planning at the local level,
coordination at the State level, and State services to local communi-
ties.

Several States recommend that statewide services for rural areas
be provided by agricultural colleges and State extension services.

Leadership

Many States feel adequately trained professional leadership sup-
plemented by carefully selected, trained, and supervised volunteers
is essential if full program coverage and quality are to be achieved.
They recommend :

e Basic qualifications should be set for working with the aging.

e Special courses should be included in college and university
recreation curricula.

e Special inservice training institutes and workshops should be
conducted for both professional and volunteer workers.

* Volunteers should be recruited from the older adults as well
as from other age groups.

* Older people should also be recruited for volunteer service to
other community programs and projects.

Research

Many States feel there is a need for special studies and research at
all levels to determine the needs and interests of older people, evalu-
ate programs, determine standards, quality of leadership, extent of
use of existing facilities and services, and the needs of older adults in
rural areas.

147
Preretirement Preparation

Many State recommendations stress preparation in earlier years for
the use of leisure through the development of interests, skills, and
habits in recreation and service activities by schools, recreation agen-
cles, and community organizations.

Public Information and Education Programs

The States suggest that programs of public information should be
developed to stimulate community action, recruit volunteers, develop
interest in participation by older persons, make free-time facilities
known to older people, and stimulate older people to take responsi-
bility for organizing and conducting activities.

Miscellaneous

Attention is directed by many States to the problem of older people
in financing their own free-time activities. They recommend:

e Special rates be granted to older people at concerts, lectures,
and museums.

* Also, that special rates be given for fishing and hunting li-
censes and other entertainment activities.

* Motor pools should be organized for transportation of older
adults and special rates be granted on public carriers.

RELIGION

“Religion has to do with the meaning of life—all life,” says one
State. In the words of another—“religion which gives meaning to
the whole of life offers indispensable aid in meeting and solving the
problems of aging such as loneliness, lack of purpose in life, feeling
of no longer being needed * * * (or) wanted.”

 

Role of Religion in the Life of the Older Person

The meaning of life is found essentially in a relationship to God.
Although religion and God’s relationship has meaning to all age
groups, advancing years may bring with them greater openness to the
meaning and message of religion. The States recognize that much
emphasis has been placed upon youth fellowship ; perhaps, little realiz-
ing that older persons are in need of the assurance of God’s love. The
States embody the principle that religious groups in each community
individually and collectively should study ways of meeting the fol-
lowing religious and spiritual needs of older persons:

e The need for assurance of God’s continuing love.

e The need to be certain that life is protected by the Providence
of God.

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* The need for relief from heightened emotions growing out
of life’s problems, such as illness or the process of death itself.

* The need for relief from the loneliness brought on by the
circumstances of advancing years.

* The need for a perspective of life which embraces both time

and eternity.

* The need for continuing spiritual growth through new
experiences.

* The need for a satisfying status in life maintained by an
acceptance by one’s peers and by younger persons.

e The need to be aware of and accepting of the physical, mental
and emotional changes that come about with advancing years.

Another State brings out the following :

e A sense of the “wholeness of life” should be cultivated and
emphasized throughout congregational life to the point that
the spiritual graces of the religious personality are evidenced
even at the end of human existence.

While another recommends:

* To religious groups—that their programs with older age
groups be based on the same re of careful study, as, for
example, youth programs have been ; the object of such being
to bring about an understanding of the needs and potential-
ities of those in this period of life and of the relevance of
religion to these needs and potentialities.

Role of the Older Person in the Congregation

While the States are fully aware that society must provide its share
to those older persons who have contributed so much, they also rec-
ognize that older persons as well have a role to play in the congrega-
tion and recommend :

* Creation of opportunities by church leaders for older persons
to be of service within the church, especially to one another.
* Help the older age residents gain a feeling of acceptance by
incorporating them into church activities through the exist-
ing church organization.
One State recommends that the White House Conference urge the
real possibility of using the accumulated wisdom and experience of
our older citizens in visitations to other countries of the world for the
purpose of person to person exchange of ideas to establish understand-
ing, friendship and peace, a similar project to the “SS Hope.”

Role of the Church in Affecting Attitudes

The role of the church in affecting attitudes is twofold; i.e., atti-
tudes as to the acceptance of the older person in the home and family,
in the church and community ; and, attitudes as to the older person’s

149
acceptance of himself as a part of the family, the church, and the
community. States recommend:

« That religious leaders accept their responsibility for adopting,
building up, and maintaining attitudes of acceptance toward
aging and the aged on the part of older people themselves
and of people in other age groups and their interdependence.
Education as to the significance attached to each period of
life should begin with the very young and continue through
life, emphasizing the expectation of continued growth in
thinking, devotion and general concern for others.

« Religious leaders should help to dispel current negative atti-
tudes toward old age and elderly persons by their own favor-
able and respectful attitudes toward older members of their
churches.

« That mutuality of respect and acceptance of young by the old
and old by the young be encouraged.

« That since religious belief is vital to a philosophy of life for
so many persons, and since religious organizations are such
important instruments of adult education, these organiza-
tions should be responsible for helping young and middle-
aged adults to develop the competencies, relationships, and
attitudes necessary for creative living in old age.

Thus, the States feel that religion has an important role in the life
of the older person and older persons themselves must shoulder some
responsibility. In a sacred Hebrew writing it is said, “There is an
old age without the glory of long life; there is long life without the

ornament of age, perfect is that old age which hath both.”

RESEARCH IN GERONTOLOGY: MEDICAL AND BIOLOGICAL

The aim of medical and biological research is to understand, and
reduce or prevent changes associated with aging and to eliminate
diseases which reduce the person’s power to think, feel, perceive, and
respond. The objective, of course, is to enable the individual to meet
his needs more effectively and fulfill a meaningfull role in society.

Biological Research

The States’ concern over the manner and force with which the bio-
logical sciences may assist in the resolution of socially significant
problems is manifested in recommendations which call for research
in such areas as:

e The effects of heredity, nutrition, stress, and fatigue on the
rascular and skeletal system during the process of aging.
* The needs of the aged, the aging process, and the implications
of population aging.
The nutritional requirements of older individuals.
* The events preceding onset of illness in older persons.
The cell and its relationship to the overall aging process.

150
Medical and Dental Research

The States are also concerned about the broad aspects of medical
and dental research. A Midwestern State feels that since remedial
processes are based upon the results of research, research directed
toward the prevention of diseases associated with old age, and the
reduction of disability therefrom, should be encouraged. This per-
haps reflects the general feeling of the States making recommenda-
tions on research. Other recommendations call for specific programs
such as:

* Research into economic and quality aspects of health care for
the aged is urgently needed, as a basis for planning the sub-
stantial expansion of services in the years ahead.

* Research be further promoted in the areas of physical degen-
eration and psychosomatic illness.

* Studies to determine more exactly the needs and costs to be
expected in an adequate dental program for the aging.

* Studies on the relationship of aging to emphysema.

Coordinated Approaches

The States recognize that the medical problems of the aged cannot
be solved satisfactorily on an individual disease or individual organ-
system basis alone, valuable as continuing research in these topical
fields may be. A Southern State recommends that :

* Basic-multi-disciplinary and interdisciplinary, as well as dis-
ciplinary, research on the social, economic, psychological and
biological aspects of the process of aging * * * be more
actively encouraged and strongly supported by appropriate
agencies, both and private.

Research Programing

A variety of recommendations are made in relation to the program-
ing aspects of research. They call for increased participation and
support at all levels of government and the involvement of institutions
and organizations in the total effort. A Southwestern State recom-
mends that :

* Private agencies, the States, and Federal Government through
their appropriate agencies support and assist basic science
research studies in the fields of biophysics, biochemisty,
genetics and physiology, leading to the control of the rate
of growth and decline of living systems.

* These private and public agencies support and assist applied
research studies toward better understanding of the social,
economic, recreational, medical, housing, and personal prob-
lems of our aging population, and that special attention be
given to research relating to the mental health of older
persons.

151
Research Training

The States recognize that research requires specialized training
for personnel in the aging field and recommend :

« Since there is a critical shortage of trained personnel in the
disciplines involved in aging research, we recommend the
establishment of scholarships and post-doctoral fellowships
in aging, and the setting up of a suitable program of lecture,
laboratory and demonstration instruction in aging research at
the graduate level by the appropriate State or Federal educa-
tional reseach agencies.

RESEARCH IN GERONTOLOGY: SOCIAL SCIENCES AND
PSYCHOLOGICAL

The increase in the length of life and in the number of older persons
in our society create personal and social problems of great moment.
The States feel that to meet these problems and to provide a rational
basis for understanding, for program planning, and for evaluation of
programs, substantial programs of basic and applied research must be
developed in the psychological and social sciences.

Changes and Modification of Behavior and Personality

The States recommend that further research is needed :

On the individual differences and the common characteristics
in the behavior, personality, and motivational changes that
accompany the aging process.

e On the skills, abilities, and personality components of older
seople and the reciprocal interaction with the aging process.

. oa the performance level of older workers

« On the learning ability and motivation of older people.

Personality and Social Adjustment

Several States make generalized recommendations which express
the need for further research in the broad field of personal and social
adjustment with age. Research is needed on the total individual, both
social and physical, and on the role assigned the older individual by
his culture, his community, and his family.

Retirement and Meaningful Activities

An area of increasing concern from the practical point of view, both
for the individual and for social policy, centers in the question of
“compulsory” retirement and the proportion of persons who, because
of retirement, move out of the labor force and have free time available
for their own pursuits. The States recommend research in this area
on:

e The role of education in preretirement programs.

152
* The effect of preretirement planning on postretirement ad-
justment.

* An alternate to compulsory retirement at a fixed retirement

e.

. Mothods of providing “productive” activities.

* Special problems arising from cultural differences or more
rural populations.

* The development of “recreational” or “leisure time” activities.

Income and Support of Older People

In the area of employment, the recommendations deal with research
on the older worker's performance, productivity, and injury risk, as
well as on employers’ attitudes in the hiring or retention of older
workers.

Several States make recommendations for research in the area of
“economics” of the later years of life and in the source and size of in-
come. They recommend studies on :

* Income in relation to housing needs.
* Income in relation to voluntary retirement.
* The responsibility of children to support aged parents.

Settings in Which Older People Live

The States recommend additional research on the various economic,
physical, psychological, and social factors which are interrelated with
the housing and living arrangements of older people. Areas for spe-
cial study suggested by the States are:

* Problems in rural or isolated areas.

* Problems in the inner city.

* Problems in public housing projects.

* Living arrangements for transition through successive de-
grees of dependence.

* Living arrangements for avoiding placement in institutions.

* The effect of three-generation living arrangements on family
relationships.

Several States make recommendations for intensive study of the social
and psychological effects of institutional living.

Support and Organization for Research

A wide variety of recommendations are made by the States in
assigning responsibility for support and organization of new and
expanded research programs. It is evident that State and Federal
agencies are expected to share a major responsibility as sources of
financial support. Colleges and universities are seen as the logical
research centers.

577791—60——11 153
LOCAL COMMUNITY ORGANIZATION

The States express their faith in the availability of leadership and
skills in every American conmunity for planning and organizing
effective programs for their older people. While the States recognize
that certain problems can be dealt with only on a State or national
level, they feel many of the problems must be resolved through
creative planning and action by the local community.

Establishment of County and/or Community Committees

Forty-one States recommend the establishment of county or com-
munity committees on aging. Other recommendations are:

« That these committees have close association with the State
connuission on aging.

e That county committees should be appointed by the county
courts, county judge or the mayor.

e That county welfare officers assume responsibility for ap-
pointments of committees on aging.

o That in smaller rural areas, joint councils on aging of two or
more counties be organized.

« That adjoining towns might combine to form area councils on
aging where this is necessary.

» That community councils on aging should be affiliated with
councils of social agencies wherever such agencies exist.

That county committees on aging should apply for member-
ship in local community welfare conneils,

Coordination and Function

Most States are anxious to avoid fragmentary planning and see each
segment of the total problem in relation to a comprehensive program.
They believe that the local committee on aging should be the coordi-
nating and planning body for all services to older people. They
recommend that the broad functions of this committee should include:

e Creating an awareness of problems of aging.

Consultation with local groups on needs and resources.

Development and promotion of programs.

Development and dissemination of educational materials.

Encouragement of older persons’ contributions.

Planning for the future as well as the present.

Familiarizing itself with developments in other communities

on county, State, national and international programs.

+ Serving as a liaison with the local community governing body
and with the State commission on aging.

e Promoting broad community education on concern for the
aging through conferences and institutes.

e Recommending support or opposition to legislative or budg-
etary action after thorough study and deliberation.

A number of States give considerable emphasis to research and sur-
veys as a broad function of local committee on aging.

154
Composition

Several States gave attention to identifying the factors likely to
give a committee its greatest effectiveness. They recommend broad
representation of citizen groups, lay and professional leaders and older
citizens themselves, and that the committee should be of sufficient, size
to ensure adequate representation from major community interests.

Financing

Local committees are generally concerned about two aspects of
financing; namely, financing of the committee itself and its various
planning operations, and financing of direct service programs and
facilities. Methods of financing include F ederal, State, and private
funds. One State recommends that the State legislature appropriate
funds to county welfare boards for employment of staff to specialize
in local community organization.

STATE ORGANIZATION

The White House Conference on Aging Act states “* * * the pri-
mary responsibility for meeting the challenge and problems of aging
is that of States and communities * * *.» However, the services and
provisions which States now malke for older persons are substantially
those available to the population as a whole and antedate public aware-
ness of the increase in the number and proportion of older people in
our population.

Forty-four States favor the creation of a permanent committee on
aging established through legislative action to provide statewide
leadership in programs for older people. Only a few States make
recommendations which stress that the responsibility be placed in op-
erating departments such as the State Departments of Health or Wel-
fare.

Functions of State Units on Aging

A majority of the States specify the following three areas with re-
gard to functions of a State Committee on Aging :

* The State unit should stimulate, guide, and provide technical
assistance to the localities in the organization of community
councils or units of aging, and in the local planning and
conduct of services, activities, and projects.

* The State unit should gather and disseminate information
about research and action programs and provide a clearing-
house for current plans and ongoing activities.

* State units should coordinate plans, policies, activities, and
services of varied agencies which serve or should serve older
persons.

155
One State recommends that the State unit initiate and stimulate other
organizations to carry on needed research, while another State expands
the above functions by recommending that the State commission on
aging should also assume responsibility for:

* Making requests to suitable agencies for aid and assistance
in solving particular problems in training and research.

« Developing and establishing urgently needed minimum stand-
ards of qualifications for personnel administering or working
in institutions and agencies caring for the aged, with atten-
tion directed toward degree requirements where appropriate,
and toward civil service recognition of increased proficiency
due to extra training.

e Organizing of an interinstitutional committee of colleges
and universities in the State to develop policies regarding
professional and semiprofessional education in the field of
aging.

Structure and Financing of Statewide Unit of Aging

Of the States making recommendations in relation to the location
of a commission within the government structure, most of them feel
the commission on aging and its staff should be established in the Gov-
ernor’s office, independent of any existing State department.

Different types of organization patterns are suggested. The two
recommended most frequently by the States are:

e A State commission with wide citizen participation, represent-
ative of all major interests and agencies in the State, includ-
ing voluntary, public, and private groups working with the
aged.

e An interdepartmental committee on aging consisting of the
heads of State agencies concerned with the problem.

Many States make specific recommendations on the staff and budget
of the commission. They feel there should be an executive director
of a separate central stafl on aging in the State government which
would be responsible for the overall program planning and coordina-
tion of functions affecting older people. It is felt that a budget of
$35,000 to $50,000 should be appropriated for the unit on aging.
Seven States recommend that Federal grants be made to State com-
missions for financing their operations, developing pilot projects, and
for other purposes.

Relationships With Other Agencies and Organizations

The types of relationships a State committee on aging is able to
establish with other agencies and organizations will, to a large degree,

156
determine its ultimate effectiveness. Relationshps with other agen-
cies and organizations as recommended by many of the States are:

* State commission should recognize the joint responsibility of
public and private agencies and should encourage private or-
ganizations to conduct pilot programs and research studies
since such organizations are freer to experiment with unor-
thodox ideas and activities. Generally, encouragement
should be given to voluntary organizations in the conduct of
their regular programs and in supplementing those of public
agencies.

* Leadership should be provided to all organizations and vol-
untary service groups to undertake projects in the interest
of aging within the framework of organized community re-
sources.

* Close cooperation should be established between the State
commission and universities.

NATIONAL VOLUNTARY ORGANIZATIONS

The importance of national voluntary groups in the social scene
today needs to be reiterated and emphasized. Singly, they make an
impact on a single problem; together, they constitute a formidable
group with a sometimes startling impact on American culture.

The recommendations of the States with respect to the responsibili-
ties and functions of national organizations recognize that such or-
ganizations have continuing programs; but, expansion and change
to keep abreast of new developments are necessary.

New Ventures Through Service

Opportunities for services to older people are many and varied.
In general the States recognize that even though organizations al-
ready have programs on aging many possibilities for expansion exist.
Several recommend :

* Voluntary organizations should establish programs on aging
where none exist.

* Voluntary organizations should cooperate and coordinate
their programs with other interested agencies, sponsoring
home care and nursing homes, friendly visiting and recrea-
tional services.

Several States note the importance of involving older persons in
new and ongoing services and recommend :

* Voluntary organizations should recognize that resources for
participation in services performed include the aging them-
selves and every effort should be made to keep them active
if already participating; if not, they should be invited to
participate.

157
New Programs for Action

Action programs to be effective must be implemented at both the
State and national levels. There are, of course, a variety of approaches
which can be used. One State recommends that national organiza-
tions based in the State coordinate and continue their cooperative
efforts with the official State or legislative organizations on aging.
Several other States recommend:

« The establishment of a national voluntary service organiza-
tion concerned with all phases of life of the senior citizen,
emphasis on the “people to people” approach to aging prob-
lems, and assumption of responsibility for programs for the
aging until taken over by governmental units.

New Image of the Aging

The creation of a new and positive image of aging is a task towards
which many organizations and agencies direct much of their effort.
In furtherance of this objective several States recommend :

« Research and demonstration projects to correct the miscon-
ceptions which project the age barrier into hiring practices.

eo A better understanding of aging by our leaders.

s A better public understanding of the aging and their problems.

To assist in the creation of a new image of aging the States rec-
ommend :

+ National organizations, such as the National Advertising
Council, should promote and develop programs utilizing the
mass media which will create a more attractive image of the
older person than is now projected.

FEDERAL ORGANIZATIONS AND PROGRAMS

In announcing the formation of a Federal Council on Aging on
March 21, 1956, and in setting forth in broad terms the major chal-
lenges in the field, President Eisenhower clearly indicated it was not
his intention that the Federal Government should assume primary
responsibility for meeting them. Instead it was his purpose to co-
ordinate and strengthen the Governments present efforts and to
bring these to bear more effectively on measures initiated by State
and local agencies, private groups, and older persons themselves.
While the States’ recommendations support this principle, they also
urge more activity at the Federal level.

Organization, Coordination, and General Services

Many States transmit recommendations with implications for
action in this area. Specific recommendations include:
* Establishment of an Office or Bureau of Aging.

158
* Making Federal grants available for post-White House
Conference on Aging activity.

Congressional review of conference recommendations.

* Expansion of data collecting about the older population and
issuance of special tabulations and publications.

Proposed Federal Action in Specific Areas

A number of States make recommendations about action within
the Federal Government for its own employees. These suggest elim-
ination of age requirements in Government employment and develop-
ment of preretirement preparation programs within the Government
agencies.

Many additional recommendations directed to the Federal Govern-
ment urge such matters as improvement in the Social Security pro-
gram, utilization of surplus food for older people, expansion of hous-
ing programs, support of training and research, and creation of a
Department of Recreation. These are reported more fully in the
appropriate sections.

159
Chapter VI
AGE WITH A FUTURE

The State reports and recommendations, out of which this sum-
mary volume has grown, provide exactly what the White House
Conference on Aging Act designed they should provide—a compre-
hensive inventory of needs and an action blueprint for the future.
Well over 100,000 people, by actual count, have been the surveyors
and architects. They have worked diligently in groups, teams, and
in conferences all over the nation, and they have been encouraged
and assisted by thousands of others working in and through their
own agencies, committees, and organizations.

Their response to the call of the Conference and the results and
reports of their work give overwhelming evidence that neither they
nor older people themselves are satisfied with the lives led by the older
generation today. They are fully determined to give in the future
and in the near future, too, meaning and vitality to the promise in-
herent in longer life.

What kind of life is it they see for the older people of tomorrow ?
What changes in the climate and environment of aging may we ex-
pect if the States and communities, and the Nation, too, show the same
zeal for action they have shown in measuring the dimensions of the
needs and problems and in developing their recommendations ? ‘What,
in short, do we see if we look ahead 10 or 20 years into the future?

First of all, according to current estimates, we see a population of
26 million Americans 65 years of age and over, more if mortality rates
in the older ages fall, as they may. Average life expectancy by the
1980s will have reached at least 70 years for men and 75 for women,
and there will be almost 2 million persons 85 years of age and beyond.
The middle-aged transition period—45 through 64—will account for
45 million persons of whom 1.8 million will reach the age of retirement
each year.

Looking into the future, beyond mere numbers, Connecticut notes
that—

* * * The aged of 1980 may be very different from the aged of
today. Most of today’s oldsters were born and received their
early training in the 19th century. Those of two decades hence
will be products of the 20th century with different values and
probably different social characters.
And, Connecticut might have added, the pioneering of today’s genera-
tion of older people is establishing new patterns and precedents which
will be of inordinate value to those of the oncoming generations.

161
HIGHER LEVELS OF WELLNESS

One of the assurances readily derived from the reports of the States
is that the later years will be not only longer but more healthy and
vigorous too. Older people grown up in the 20th century, with longer
exposure to the concepts of positive health, will have developed better
habits of nutrition, exercise, and activity and more compelling aware-
ness of need for periodic checkups to discover latent, insidious con-
ditions.

Twenty years hence, if the recommendations of the States are real-
ized, research will have yielded much greater knowledge of the proc-
esses of aging and of chronic diseases. All manner of personnel,
professionally trained within their fields but with specialized knowl-
edge of aging, will be providing services through a vast network of
health education programs; “well-adult clinics”; geriatric diagnostic
centers which take the total person and his circumstances into account;
and treatment facilities which embody the miraculous restorative tech-
niques being evolved in the pilot programs of today. Most of the
suffering and early death from heart and circulatory diseases and
from cancer will have been prevented, and few will experience the
agonizing pains of arthritis and rheumatism. Purely custodial care
in vegetative environments will have given way, if the States attain
their objectives, in favor of rehabilitative services attached to commu-
nity hospitals, active home-care and home-service programs, and health
maintenance activities in centers of congregate living.

INCOMES FOR LIVING

Most older people in the 1980s, if the aspirations of the States are
realized, will enjoy incomes geared to the levels of their needs and
styles of life. Real progress has been made in the past decade in the
States and in the Nation in understanding the budgetary needs of
older people and in devising measures for the provision of retirement
incomes. States that have given serious thought to the matter are well
aware that the total national income will probably have nearly doubled
by 1980 and that average per capita income will have increased almost
asmuch. They point out that, as incomes have risen in the past, work-
ers have willingly set aside larger percentages of their wages and
salaries in public and private insurance and pension systems, in order
to build up adequate income credits for the retirement years; and that
they will continue to do so. And they add that personal savings, pri-
vate annuities and homeownership, probably more widespread now
and perhaps greater in value than ever before, will have become still
greater.

Escalator provisions in insurance and pension programs may be well
established, enabling retired people to share automatically in rising

162
productivity and national income. Special attention will have been
given to the financial circumstances of the rapidly increasing number
of widows. Burdens of support imposed on many younger families
today will have been removed in order that they may provide for their
own retirement years. Comprehensive insurance against the hazards
of long-term illness and mental decline will have been long established.

WORK AND RETIREMENT—1980

One of the greatest changes to be noted by the 80’, if one may fore-
cast from testimony of the States, will be in the attitude toward re-
tirement. Several of the States point out that in our economy of
increasing energy, automation and abundance, retirement, earned after
a specified period in the work force and determined by the total vol-
ume of goods and services required, will be an accepted and common
expectation of all who desire it. Most will have had systematic prep-
aration for retirement, and many will taper off their work careers
through gradual retirement arrangements.

Continuance in paid employment will be optional for those with
essential skills and with the ability to carry on. Opportunities may
Increase as we recognize our growing financial capacity to enhance
our own well-being and to accept our responsibilities to the citizens
of underdeveloped countries.

The rapid change in the occupational requirements of a technological
economy will have been fully recognized if we follow the lead of the
States. Vocational retraining programs will have become widely
available for all whose skills become obsolete, as well as for the grow-
ing number of middle-aged women returning to paid employment
after their children have grown. Part-time work opportunities will
be far more numerous for retirees who wish to keep a hand in and for
mature women whose household duties or other interests prevent
their working full time.

LEISURE REVALUATED

By the 1980s the very concept of “retirement” will have changed
its meaning from that of withdrawal to transition or shift to any one
or more of a variety of self-satisfying activities chosen by the indi-
vidual entirely on his own initiative—though often with the aid of
avocational counseling services widely available in adult schools, ac-
tivity centers, and community information services.

Older people in the 1980s will be engaged in a variety of leisure
pursuits already widely noted in the reports from the States. Edu-
cation will be lifelong as colleges and schools come to recognize the
desires of older people to pursue intellectual interests and keep abreast
of the times. Hundreds of thousands will be engaged in various

163
forms of self-expression in the fine arts and arterafts. Activity cen-
ters, especially designed for the use of older people, together with
neighborhood social and recreational facilities, will afford ample op-
portunity for developing new associates and friends in retirement.
Many thousand of middle-aged and older people will be giving volun-
tary service to their communities, serving on advisory boards, and
participating in the affairs of political parties. Reading, contempla-
tion, and relaxation will engage the time of many, as will travel and
attendance at concerts, galleries, and museums.

Much of this, it is realized by the States, is dependent upon in-
creased recognition of the later stages of life as integral parts of the
life cycle and of the significance and value of leisure. The ferment,
however, is already well at work. It is significant that at least two
of the States quoted from philosopher Irwin Edman that “The best
test of the quality of civilization is the quality of its leisure. Not what
the citizens of commonwealth do when they are obliged to do some-
thing by necessity, but what they do when they can do something by
choice, is the criteria of a people’s life.”

A number of States urge the need for a conscious and rational
change in the value system to recognize the new place of leisure in our
lives. The host to a Kansas conference on aging indicated that the
shift may already be underway when he said—

* * * Our values are in the process of change * * *. It
seems likely that we will gradually be able to accept
leisure more gracefully and with less guilt. We may
come to acknowledge that one of the fruits of our “affluent
society”, one in which we can take pride, is that we can
afford the luxury of leisure. This includes the luxury of
retirement, an early release from the burdens and re-
sponsibilities of work * * *. With such a change of
values, we may be able to let the retired person enjoy his
leisure as he pleases. Let those who want to keep busy
find satisfying ways of expressing this need, but also
accept the possibility that there are those, who, in fact,
want nothing more than the opportunity to sit down.

The recommendations on Education and on Free Time look toward
the creation of facilities, opportunities and habits of life which clearly
reflect the new attitudes toward leisure.

A NEW SUBCULTURE

Twenty years hence, or perhaps within a decade, general recogni-
tion of the nature and potentialities of the later stages of life and
increased awareness by older people of their community of interests in
the population, will have led them to develop a subculture of their

164
own. Several of the States have already noted the tendency of older
people to seek out their peers and often to create their own organiza-
tions for sharing experiences.

Members of the subculture may be expected to place increasingly
higher values on leisure and freedom of movement, to show greater
concern for protecting the purchasing power of retirement incomes, to
seek expansion of facilities and services through which their particu-
lar needs can be met, and to show an increasing desire to serve as their
own interpreters of their needs and styles of life.

Positive life styles in later maturity and old age will be widely
recognized. A variety of images of successful aging will have re-
placed today’s stereotypes associated with dependency, deterioration,
and complete withdrawal.

INDEPENDENCE IN LIVING

Following the patterns being firmly established by the present
generation, most older people of the 80’s will have achieved full inde-
pendence from their adult children. Current cultural conflicts over
intergenerational responsibilities will have been resolved, freeing both
adult children and their older parents from feelings of guilt. New
models of intergenerational relationships will have developed, based
on mutual recognition and respect.

Independence in living arrangements achieved during middle age
will continue to be highly prized. If the recommendations of the
States are carried out and present trends continue, older people who
desire it will find an ample supply of housing designed to meet their
special needs, with particular attention given to provision for privacy
and independence, controlled lighting and climate, safety and con-
venience. Some retirement housing will be interspersed within the
community, some will be grouped within familiar neighborhoods and
in villages, some will be congregate—to suit the variety of needs and
preferences. Grouped and congregate housing will include built-in
recreation, lounge, dining, information, referral, and outpatient clinic
facilities for residents and for older persons in surrounding neighbor-
hoods.

Housing for older persons following today’s emerging patterns,
will be located with ready access to shopping centers, synagogues and
churches, libraries, medical centers, adult schools, and community
centers all of which will have specialized services for older people
as they do now for members of other generations. Many colleges and
universities will have encouraged the development of retirement com-
munities, as some have already done, in order that retired people may
take advantage of their educational and cultural programs.

165
OLDER PEOPLE WITH RESPONSIBILITIES TOO

While the constitutional guarantees of older people “for freedom,
independence, and equality of opportunity” will have been fully
recognized, partially to paraphrase a goal set in the Minnesota report,
society will also have established clear-cut expectations for them. It
will have become generally recognized that middle-aged and older
people have primary responsibility for maintaining their own health
and well-being; for planning their affairs and acquiring the knowl-
edge and skills that will enable them to move easily through the later
stages of the life cycle; for continuing as informed and alert partici-
pants in the civic and political life of the community ; for helping to
improve their communities through a variety of voluntary services;
for granting their adult children freedom of self-determination but
for sharing their own experience when it is sought ; and for retaining
their own independence of action and decisionmaking as long as they
are able to do so.

MECHANICS OF ACHIEVEMENT

These, in summary, represent the aspirations and expectations of
the States and of older people themselves as revealed in the studies
and researches of the past decade and in the surveys and analyses
conducted during the year of inventory.

Impatience to move forward is readily apparent. It is clear that
no State or community is content merely to file a report and to shift
responsibility to higher levels of action. Indeed, there is clear indi-
cation that, in the eyes of the States, responsiblity is the concern of
every citizen, and that scores of citizens in their communities and
hundreds and thousands across the Nation, along with professionally
trained personnel, will have to be organized into effective planning
and action groups at all levels of the social structure.

1f the judgment and recommendations of the States prevail, every
community in the land will have its own broadly representative coun-
cil or committee on aging, usually set up under public auspices and
responsible for planning, stimulating, coordinating, and evaluating
programs and facilities for its oncoming generations of aging, older,
and aged citizens.

And, if they carry forward their recommendations, each State will
have a planning council or commission responsible to its chief execu-
tive for coordinating the work of administrative agencies in aging,
developing policies for statewide action, providing guidance and con-
sultation to agencies, communities, and organizations, sponsoring pilot
projects and programs, and keeping all citizens generally informed of
emerging needs and progress. Several States have already taken
action or have plans underway to give permanence to the committees
established to carry on their White House Conference activities.

166
Most of the States report that they will look to the Federal Govern-
ment for continuing leadership in research, in dissemination of new
information and knowledge, in helping to develop new approaches
and policies, and in assisting in the development of standards for
facilities and performance.

How new and expanded programs are to be financed is also a mat-
ter of general concern. Some States apparently feel well able to call
upon their own legislatures for larger appropriations, though all look
to continuance of Federal subventions for present programs in hous-
ing, health, welfare, rehabilitation, research, and professional train-
ing. Several recommend increased expenditures in these fields, and
some urge that Federal assistance be extended in support of State and
community planning and coordinating activities and of programs in
education, leisure time and cultural pursuits.

Throughout all of the reports, runs strongly the concept of shared
responsibility —sharing by community planners and older people, by
public and private agencies and among all levels of government, and
all levels of voluntary organizations. The following statement from
the Idaho report seems to speak for all of the States—

We learned long ago in dealing with our problems to
pool our wits and our talents and resources with those of
other individuals having similar problems and so to
strengthen ourselves through association. In so doing,
our individual well-being became the common well-being
of ourselves and our associates. When our association
succeeded, we all succeeded; when it failed, then we all
failed.
In our present highly organized and interdependent so-
ciety, we recognize that problems common to large num-
rs of our people impose common responsibilities upon
all of us. This because we know that the well-being of
the nation is secured by the well-being of the individuals
who comprise it.

All 53 reports from the States agree with the Act creating the Con-
ference that the time for action is now. The blueprints they have
developed for the decade and for the years ahead bear little re-
semblance to the current scene. If we build according to their specifi-
cations, we shall be creating an edifice in which all may look forward
to age with a future.

167
Technical Directors for the White House Conference on Aging

Herman Brotman Cyrus Maxwell, M.D.

James Burr Eunice Minton

Clyde Gleason, Ph.D. Stanley Mohler, M.D.
Joseph LaRoceca Louis Ravin

Charles G. Lavin Warren Roudebush

Dorothy McCamman Esther Stamats

George Mann, Ph. D. Clark Tibbitts, Sc.D. (Hon.)

Robert 8. Waldrop, Ph. D.

Regional Representatives, Department of Health, Education, and Welfare

REgion Lome comm osm som ro ee ee semen stm James C. Hunt

Region IIe mem meen Stanley Fioresi

Region 111 omen H. Burton Aycock

Region IV _ em Virginia Smyth

Region Vem Verna Due

BEGIN VX oie mimes iiarasimimmms mim ms ms oe meres a Amelia Wahl

Region VIL... coi aminom mio mis mt meme se mt mt Clarence M. Lambright

Region VILL... cme mom stom msm mets sm William T. Van Orman, Ph. D.
Region IX ____ Donald T. Sutcliffe

STATE PLANNING OFFICIALS

for the
WHITE HOUSE CONFERENCE ON AGING
Alabama—Alvin T. Prestwood Nevada—Fred L. White
Alaska—Paul L. Winsor New Hampshire—Margaret L.
Arizona—Grace J. Schell Arnold
Arkansas—Gus Blass IT New Jersey—Eone Harger
California—Albert M. G. Russell New Mexico—Murray A. Hintz
Colorado—Hon. Robert L. Knous New York—Marcelle G. Levy
Connecticut—Donald P. Kent, Ph. D. North Carolina—Ellen Winston,
Delaware—C. J. Prickett, M.D. Ph.D.
District of Columbia—Jack Kleh, North Dakota—Jack R. Smutz
M.D. Ohio—Vernon R. Burt
Florida—Harry P. Cain Oklahoma—George I. Cross, Ph. D.
Georgia—John T. Maudlin, M.D. Oregon—Wesley G. Nicholson, D.D.
Hawaii—Margaret S. Faye Pennsylvania—Ruth Grigg Horting
Idaho—A. E. Montgomery Puerto Rico—Guillermo Arbona,
Illinois—Peter W. Cahill M.D.
Indiana—George E. Davis, Ph. D. Rhode Island—Roberta B. Brown
Iowa—Jim O. Henry South Carolina—Martha T. Fitz
Kansas—Z. Arthur Nevins gerald
Kentucky—Jo M. Ferguson South Dakota—Fred J. Nichol
Louisiana—Madge S. Kennedy Tennessee—Edward J. Boling
Maine—Robert C. Russ Texas—Hon. Crawford C. Martin
Maryland—Hon. Margaret C. Utah—Delbert L. Stapley
Schweinhaut Vermont—John Wackerman
Massachusetts—Joseph Alves Virginia—John E. Raine
Michigan—James E. Brophy Virgin Islands—Macon M. Berryman
Minnesota—Arnold M. Rose, Ph. D. Washington—Margaret Whyte
Mississippi—Travis McCharen West Virginia—F. Duane Hill
Missouri—Emil E. Brill Wisconsin—S. Janice Kee
Montana—Ralph C. Knoblock Wyoming—James ~~ W. Sampson,
Nebraska—J. D. McCarthy, M.D. M.D.

168
NATIONAL ADVISORY COMMITTEE

for the

WHITE HOUSE CONFERENCE ON AGING

John E. Anderson, Ph. D. *Marion Eberly

Joseph P. Anderson Bayard L. England

Ethel Percy Andrus, Ph. D. A. T. Everett

Guillermo Arbona, M.D. Charles F. Feike

Margaret Long Arnold, LL.D. Donald E. Flieder, D.D.S.
Sarah Pratt Atwood Walter Foody

Florence L. Baltz Rt. Rev. Msgr. Raymond J. Gal-
Grace C. Bamonte lagher

Mary Bannister Oliver Kelleam Garretson, Ph. D.
John H. Barclay Chloe Gifford

Hazel K. Barger Lillian Moller Gilbreth, Ph. D.
Bernard Barnes Orville Francis Grahame, J.D.
Clark W. Blackburn Warren P. Griffiths
Charles E. Bloedorn Alfred M. Gruenther

Robert Blue George P. Hansen
*Ernest J. Bohn Robert W. Hansen

Roy W. Bornn, Ph. D. J. Floyd Harrison

Edward Bortz, M.D. Harry G. Haskell, Jr.
Rosamonde R. Boyd, Ph. D. Harold Hillenbrand, D.D.S.
Margaret C. M. Brock G. Warfield Hobbs

John Brophy Maggie Bell Hodges
Theresa S. Brungardt Richard G. Hughes

W. D. Bryant, Ph. D. Viola Hymes
*Joseph C. Buckley Margaret A. Ireland

Sylvia Bushnell Hardin B. Jones, Ph. D.
Edward William Busse, M.D. Marjorie M. Jones

Thomas H. Carroll II, D.C.S. William Boyd Jones
Vincent P. Carroll, D.O. Walter U. Kennedy, M.D.
William T. Coleman, Jr. Donald P. Kent, Ph. D.

J. Douglas Colman Fred R. Knautz

Ralph E. Conwell Gladys Ellsworth Knowles
Harry Finch Corbin, LL.D. William B. Kountz, M.D.
Theodore D. Cornman Louis Kuplan

Barbara Coughlan Arthur Larson

Brevard Crihfield Leonard W. Larson, M.D.
Edwin L. Crosby, M.D. Eugene Lipitz
*Nelson H. Cruikshank Anna C. Lomas

Grace B. Daniels Robert H. MacRae

George E. Davis, Ph. D. Travis McCharen

Robert J. DeCamp Benjamin Mosby McKelway
Mother M. Bernadette de Lourdes John B. Martin

Thomas C. Desmond Geneva Mathiasen

Hayden H. Donahue, M.D. *Berwyn F. Mattison, M.D.
Wilma Donahue, Ph. D. Karl P. Meister, D.D.

Edna Baston Donald Garson Meyer

*Loula Friend Dunn Carl T. Mitnick

Jane P. Earles Woodrow W. Morris, Ph. D.

 

*Member of the Coordinating Committee.

12 169

577791—60

 
Mary C. Mulvey

Walter C. Nelson
Herschel Newsom
*[dwin Niehaus

James Franklin Oates, Jr.
Charles E. Odell

William F. O'Donnell
John Thomas O'Rourke
Florence Ozbirn

IH. Bruce Palmer

Georgia S. B. Patterson
Elisabeth Cogswell Phillips
Mary Pickford

Harry N. Pollock
Clarence 1. Pontius, LL.D.

Thelma Elizabeth Porter, Ph. D.

Joseph Prendergast, LL.D.
*William Andrew Regan
Louis Regenstein, Jr.
Holland Luley Robb
Minnette B. Roberts
Josephine Roche

Nat S. Rogers

Thelma T. Rogers
Howard A. Rusk, M.D.
William P. Sailer
Dwight S. Sargent

 

*Member of the Coordinating Committee.

170

Grace J. Schell

Karl T. Schlotterbeck
Charles I. Schottland
Louise Schwarz

Louis Benson Seltzer
Louise Shadduck

Charles B. Shattuck

Jecil G. Sheps, M.D.
Morris Sider

V. J. Skutt

Norman R. Sloan, M.D.
Belle S. Spafford

Wilson D. Steen

Michael A. Stepovich
Grace T. Stevenson

Ella Phillips Steward, Ph. D.
Donald H. Stubbs, M.D.
Frederick C. Swartz, M.D.
Richard F. Taitano
Rabbi Mare II. Tanenbaum
Margaret S. Taylor
Edward A. Turville
William J. Villaume, D.D.
Ralph B. Wick, O.D.
Lucile B. Wilkins

Lvle Campbell Wilson

T. J. Woofter, Ph. D.

U.S. GOVERNMENT PRINTING OFFICE: 1960
C028898334
 

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