Mr. SEGURA. The AAA nutrition program at the Westside Community Center. I am quite sure you are aware where it is. This is one of the places that we have.

Most of our people that are in those pictures come to receive the aid they have in food and in care. At the same time they are transported, as you can see. In the status of their life, they find it difficult to be transported. This is federally funded.

Senator DOMENICI. Do you have enough of that type of transportation to do what the requirements of that center would dictate?

SHORTAGE OF FUNDS

Mr. SEGURA. No, sir. No, sir. Right now, we find one of the worse problems we have is transportation. However, we cannot accommodate all of these folks that need to be helped. The next thing is, we find we are short on funds, and we cannot feed as many as we would like to. The center is quite a distance from place to place. We find a lot of these older folks cannot be helped because it is impossible with the staff that we have.

Senator DOMENICI. I have two remaining questions. On the same series of photographs, your van shows a very elderly woman who obviously uses a wheelchair. It shows her getting out of your van, and being placed in the wheelchair and then I assume the wheelchair would be taken into the center where the food is being distributed.

Mr. SEGURA. Right.

Senator DOMENICI. Do you often have that type of person in the region?

Mr. SEGURA. Yes. In fact, today we have one of the elderly men that could not come for that reason, could not be mobilized. I don't know, but maybe you can ask Mrs. Costa if that young lady is here. Senator DOMENICI. Maria, you made these photographs?

Mrs. COSTA. Yes.

Senator DOMENICI. Do you work there full time?

Mrs. COSTA. I am a volunteer.

Senator DOMENICI. You are a volunteer?

Mrs. COSTA. Yes, I am a volunteer with the metropolitan nutrition project, and we have only recently acquired this bus-which was acquired for us for the nutrition program. I tried simply to give you a picture of the kinds of people we are trying to reach.

There are many, many more we are not able to reach. First the bus operates only 4 hours a day. It belongs to some others. The pictures are simply a way to tell you that this is one way to meet the needs. Senator DOMENICI. Before we leave this, I would ask that these photographs be made a part of the record,1 and that they be identified by the conversation that we have just had with Maria Costa and our first witness of the day.

MEALS ON WHEELS

One last question. Are you familiar with the meals-on-wheels program?

1 Retained in committee files.

Mrs. COSTA. Yes. I was acquainted with it for about a year or so before we ever started in South Valley. I think it is coming to a close, which I regret to hear. I would like to see it go farther if possible.

Senator DOMENICI. Would you say, based on your observations at this point, Mr. Segura, that many of the people you have helped with transportation, could more easily be helped with the program if the meals were taken to their homes, rather than try to transport them to a place to feed them?

Mr. SEGURA. Yes. Some of the older people cannot be moved because of the medical denials. Some are veterans, and some have medical problems. These are people that could be reached, if outreach could be possibly extended and if our buses could be made more available, they could go out and find these people that really need the services. But we have been serving the people in between, the ambulant ones. Senator DOMENICI. One last request. Could you ask your community center-within the 30-day limit-to give us whatever detailed facts they have about the number of people that need transportation to centers for either nutrition, or health delivery services, and the capacity you now have to deliver them?

Mr. SEGURA. I would be very glad to.

Senator DOMENICI. Would you have that sent to us as per the instructions on the green list. I assume it would be a rather objective analysis.

Mr. SEGURA. I would be glad to do it.

Senator DOMENICI. Let's go to the next witness, Mrs. Selma Clever, community relations aide.

STATEMENT OF SELMA CLEVER, COMMUNITY RELATIONS AIDE, ALBUQUERQUE, N. MEX.

Mrs. CLEVER. Mr. Chairman. I would like to talk about how the meals program got started with the Office on Aging. When we were organizing to work with the senior citizens, we did not want to do anything that would be against the rules of the senior citizens. At our first meeting, we set up an advisory committee. At this meeting there were about 200 people participating. We talked with them about what they would like to do, and it was decided that we would go to a Santa Fe meal site.

On the way back, on the bus, they asked our supervisor if we could have the same thing in Albuquerque. She said. "This is your program, and whatever you would like to have, that is what you will have."

We started our meal program in the summer of 1970, a 21-day pilot program. At this time, I do not have the figures, but we served quite a few meals. Before the school term, we contracted out the APS for two meal sites-one at John Marshall Elementary School, one at Albuquerque High.

MEAL PROGRAM STIMULATES ELDERLY

We served those meals at the school until April 30 of this year. There has been a lot of people that were helped. At first, some of our

senior citizens did not want to go to the meal sites because they were poorly dressed. They did not have dentures and many other things that kept them from wanting to come to the meal site. We finally talked and persuaded them to go. At the end of the program, they all hated to see the program go out, but we were glad that the metro area agency could continue the meals in our model cities area.

I would just like to tell you about one senior citizen; she is dead now, but she was in her 80's. At first she did not want to come to the meal site. After she started coming, she could hardly wait until the time to serve the meal the next day.

At first she did not comb her hair. She put a bandana over her hat, and she would wear a large fur coat. I have the picture, but I left it in the car. I would like everybody in the audience to see how she was helped by the meals at the school site. Later on, she started to put makeup on her face, cleaning herself up, and even came to our office where we had ceramics and different activities for the senior citizens. She made some potholders and put little bells on them which we cherish until this day.

I would like to tell you about two other people that are in the audience today. One is 84, the other is 83; will you both please stand? Mr. Corteriz and Mrs. Blair. Thank you, you may be seated. At first, they did not care about getting out of their houses, and going out, but after they got started-if all of you know the Spanish dance group-they are the best dancers in their group. It is not only those two, but I could point out several in the audience today that have been helped by the meals.

We have the home meals, which we are now serving 40 homebound people. Up until April 30, we were serving 50. Due to the lack of funds, we had to cut those 50 down to 40; however, some of our people that work with the senior citizens had to be laid off, our home visitors were laid off; there are just a few of us in our office. Seven in our office, to do the work that 22 were doing.

We are not doing everything in our office that we know needs. to be done, but we are doing our best. I was so happy to see that the metro AAA is going to get going in the area, because we know that not only in the model cities area, but Albuquerque, as a whole, senior citizens need help. I can tell you about another experience I had in the community with senior citizens. I have a client now that gets out of her house about once or twice every 2 or 3 months, and she is in bad shape. Her housing is not what it should be.

Back in the fall of 1972 or 1973, I do not remember the date exactly, she did not have water in the house. She did not have a way to cook. She did not have water for anything, even for the bathroom.

HEALTH DEPARTMENT INDIFFERENT

I see ladies in the room today that have carried her to her house. I called the health department, and they did not do anything about it. I read in the paper a few days ago where the department representative said, "Well, nobody informed us about it." We constantly stayed on the health department about many of our senior citizens, and it seemed like it was not too much done about it. If you are in an environment

where there is an odor in the house, and other things like that, you do not have an appetite to eat.

How can you eat in such an environment? I am asking the health department to be more considerate for our senior citizens.

Senator DOMENICI. Mrs. Clever, I am going to have to ask you that if you have any other specifics, would you put them in writing, because we are running behind, and we need to get on. However, I want to ask you several questions. You mentioned APS. I just wanted to clarify that. That is the Albuquerque public schools?

Mrs. CLEVER. Yes.

Senator DOMENICI. What you have done is taken a school site that has facilitates to cook and dispense food, and contracted with them. That becomes the meal site for your program?

Mrs. CLEVER. That is right.

Senator DOMENICI. One last question. The AAA that you are speaking of, as I understand it, is the agency that is brought into being under the Older Americans Act?

Mrs. CLEVER. Right.

Senator DOMENICI. One further question. You are telling us we could use more meals on wheels, rather than less. Is that correct?

Mrs. CLEVER. Right.

Senator DOMENICI. Would you have your agency submit to us for our records the facts you have about the number of senior citizens in your area who you cannot serve, but could use meals on wheels. Submit it in writing, so we will have that specific set of facts in the record.1

Mrs. CLEVER. I certainly will.

Senator DOMENICI. Thank you very much. Our next witness is Mrs. Cora Cooper of Albuquerque.

STATEMENT OF CORA COOPER, ALBUQUERQUE, N. MEX.

Mrs. COOPER. Mr. Chairman, I realize time is short for you, and I was going to speak informally, but that sometimes takes a little longer. It would be quicker if you would permit me to read the couple of pages I have. I would first make it clear that I am a home health aide, nursing the terminally ill in their own home, and it is from this viewpoint that I will be speaking. I want to reflect the attitudes, the comments, and the reflections of such people in their homes. To me, this is a unique way of looking at old age, from these people who are in a terminal state.

My observations have been arrived at after 15 years of tending elderly patients in their own homes. I do this work because few people choose it. But I have found a new dimension of service and appreciation in this type of personal nursing. Whereas the institutional nurse must be objective, businesslike and always with the goal of getting a patient up and about, the terminal nurse has a different role: Providing family and patient a buffer against the trauma of final separation; to relieve family from certain necessary chores of nursing care; to reinforce their courage and cheerfulness during a long stage.

1 See appendix 2, item 6. p. 1150.

If terminal illness sounds more appropriate a subject for professionals to discuss, that is unfortunate. The last span of life is the most private and poignant time. Staying at home means surrounded by familiar and loved possessions, all members of the circle close by, cherished memories-one's own bed and blanket. There is no other right and natural way to go.

Hospitals should be for the young and hopeful, the emergencies, for repair and correction-for the getting well. It is less than human to dump wasted bodies into Lysol ghettos, concrete cubicles of steel, plaster, and plastic that serve only to portend what is coming. Strange hands with threatening instruments that poke, pump, squeeze, and shock. Tubes up the nose, needles in the veins, and ankles bound with straps.

AMERICANS FEAR AGING

Yet, most people are dismayed at the idea of nursing the terminally ill. Americans have a horror of aging and dying. It's ghoulish, they think, to deal with death. Is this a hangover from the middle ages, like sex? Does a puritan ethic condition us to shy away from dealing with it? So, we abdicate the last labor of love, relegating it to total strangers. Custom for nearly a century has decreed we go to the hospital to die. Therefore, families are not prepared to cope with this last episode.

But consider living at home in the final time. In all my cases home was insisted upon by the patient and in every case with the doctor's approval. In such a setting there is time for meditation and reflection. What are their thoughts in retrospect? What concerns them most about their aging? Though they came from diverse stations and occupations, their thoughts focus in on a few concepts common to them all: A sense of not being appreciated in their mature years; regret at not having close enough ties with grandchildren and not being with the young as much as they would like; a feeling of failure to pass on whatever unique wisdom that nearly three-quarters of a century has endowed them with; and finally, the innate rightness that when their time arrives, it should come swiftly.

They express these thoughts over and over in many ways. Such as "The children were too far away; they didn't have the time and I didn't have the money to visit them." Or, "I didn't get to know my grandchildren very well, nor they to know me."

Again, "They lived in Spokane, I never got to visit them there." "Nobody listens to me."

They weren't speaking of their complaints, but that none listens to their advice. An 84-year-old said softly as he gazed out his bedroom window to a peach tree in full blossom: "I planted it years ago; isn't it beautiful?" an that must have been the vision he took, for a few hours later he was gone peacefully. To have something beautiful, then go.

I submit that the lessons from knowing their final introspections are clear:

(1) That the problems of aging are not primarily medical ones. (2) That Americans don't know how to die. We don't know how to diminish ourselves gradually and gracefully.

(3) That the tragedy of aging is set off early-allowing children to mock and taunt the old. As a most generous people who pamper