mosphere of belonging, developing and enjoying the life ahead for many who can no longer live a proper life in the outside community. It is believed imperative to keep the resident/patients occupied as well as develop in them feelings of well-being and usefulness. The difference in a facility with full blown activities and therapeutic programs and one that does not have such programs can be likened to the differences between human beings in the average ways of life and derelicts in a weed filled vegetable garden.

It is needless to go into a long narrative in this regard but it is believed the development of a feeling of activity and usefulness together with a good preventive medicine program provides a feeling of well-being and happiness which in turn leads toward increased longevity-a longevity with a purpose instead of a rocking chair with an hour glass.

In an endeavor to share experiences, there is narrated herein some of the programs in practice at the North Carolina Jewish Home that have helped put more "Life into the Years" of those residing at that Home-a Combination Home (ECF and Home for the Aging).

To the uninitiated these programs should prove innovative to the initiated they may prove to be "old hat"; nevertheless, they have proved successful in practice at a facility where it is believed a happy atmosphere exists and there is minimum of "turnover" as related to other facilities according to national statistical information relating to inpatient care in long term care facilities. (The present average age at the North Carolina Jewish Home is 83+ years. The average patient has 4 to 6 chronic ailments.)

GROUP THERAPY

There are four major types of group therapy used at the Home: Reality Orientation, Remotivation, Resocialization and Advanced Group Therapy. Under these headings there are sub-types such as music therapy, work therapy and other motivating and maintenance therapeutic projects.

Reality Orientation.-Reality Orientation is a technique used for the most regressed and brain damaged residents. A worker meets every day with a group of four or five residents. With the help of a Reality Orientation Board consisting of the name of the Home, the date, the weather, next meal, etc. The residents relearn information they have forgotten. Many residents who have not spoken for many months begin to speak again through this technique. The technique is based upon the theory that there is some usable portion of the brain intact even in a severely brain damaged person. There is continuity and follow-up throughout the day with other staff members who try to develop and maintain contact with the resident.

Results: The Home has had excellent results with this technique. Almost all residents involved have improved to some extent. Many have shown vast improvement.

Remotivation.-Remotivation is used for confused residents who are not regressed to the point of needing Reality Orientation. This type of group therapy aims at people who are vegetative-not taking part in programs, and therefore becoming more confused and isolated.

In a remotivation session six to eight residents listen to a story or some music. Afterwards, they are asked about the stimuli. Sometimes a subject will prove interesting to a given resident and he will begin to speak about it.

Results: There has been increased interest in other programs through this type of group therapy. The purpose of the Therapy is to remotivate residents to participate in programs and therefore become more interested in their surroundings and life in general.

Resocialization.-After a resident completes a course in remotivation he can move into a resocialization group. The purpose of this type of group therapy is to increase socialization with the other residents. Although a person might become motivated to participate, he still might be isolated from the others and not communicate with anyone. The weekly service project at the Home serves as a resocialization project. This project consists of making bandages for the Cancer Society and Leprosarium, making lap robes and toys for other charitable sources. During the session the residents must ask each other for materials to work with; thus conversations are stimulated. The staff remains in the background during these group meetings.

The Residents' Club is also a form of resocialization. The president of the club is a resident and he presides at the meeting. He tries to stimulate discussions

concerning the Home. Each member contributes a token dues at each monthly meeting. The money is used for special occasion gifts or it is given to charities from time to time. The Residents' Club is also a sounding board for any problems that arise among the residents. They occasionally meet with other peer groups from the community and from other Homes.

Results: The residents become aware of the needs and problems of others. They become more open-minded, find people who share the same problems; hence, solve some of their own problems. Most important, they become productive members of the Home and general community, interested in programs and most important-others.

The Social Hour.-Every day from 4:30 to 5:30 p.m. a social hour takes place near the dining area. A resident bartender serves sherry and other wines to those residents who wish a before dinner drink.

There is a 2-fold purpose for this activity. 1. The residents are able to get together and talk about the day's events. 2. The wine is medically approved as a "tonic" to increase circulation and stimulate the appetite.

The Cocktail Party.-A cocktail party is given for the residents about every 5 to 6 weeks. The reason for the party, from a therapeutic point of view, is that the party atmosphere encourages socialization.

The residents choose from an assortment of mixed drinks and hors d'oeuvres. They listen to music or sing songs and sometimes dance. Many times a community group provides entertainment during this event thus creating a "night club" atmosphere.

The cocktail party is in keeping with the philosophy of the Home. The residents are not infantilized. They are encouraged to do as much as they can in a way in which they are accustomed in earlier life. Most of the residents enjoyed cocktail parties and other social events prior to entering the Home. There is little reason for these activities to stop on admission. This is an activity the majority of the occupants look forward to the social event of the season where most voluntarily dress and primp for the occasion.

Advanced Group Therapy.-The advanced group is for those residents who have minimum confusion and demand a more stimulating type of activity. The group is called the Current Events Club. Each week a different member of the group brings a topic for discussion. The topics range from politics to art with heated discussions developing from time to time among those in attendance.

Result: The residents keep abreast of what's happening in the world. They keep their minds alert through debates. During the week they read more, listen to more radio, etc., in order to prepare for the club meeting; thus developing a chain of events or activities that stimulate their life throughout the week.

Occupational Therapy. Since the Home employs a Registered Occupational Therapist and an Occupational Therapy Assistant, the occupational therapy program is quite comprehensive. Each resident is involved in some type of occupational therapy or craftwork. Even the most regressed are worked with on a one-to-one basis. If necessary, projects for the latter are developed on the "floor". The occupational therapy room serves as a therapeutic environment for those who need special therapy and a social and work environment for those who need minimum supervision.

The crafts made in the shop have won many awards at Fairs and Craft Shows in the area, providing stimuli for more and better products. The residents also participate in the receipt from sales of any of their products. This above is proof of usefulness, an incentive to keep active.

EDUCATIONAL AND RECREATIONAL THERAPY

Besides the regular program of games, there are two games played that would be considered innovative: Questions and Answers and Concentration. Questions and Answers is a mind building game. It is a team game geared toward the more adequate resident. The team member chooses a question from a board which has different categories with four questions in each category. The categories range from current events to art and music. If he feels he can answer a difficult question, he can pick the 20 point one. If he feels he can only answer an easy one, he can pick the 5 point one. The team with the most points wins. Results: The game sparks competition between teams. The individual people must really put their "thinking caps" on for some of the questions. Everyone benefits because if no one knows the answer-the group worker provides the answer and everyone learns something new. The game is stimulating and educational.

Concentration can be played with moderately confused residents. As a person ages, the remote memory often stays intact but recent memory is often impaired. Concentration helps stimulate the recent memory. It is played very much like the T.V. game of the same name.

Because this game is played for tokens, the player tries harder to remember and match the cards on the board. The recent memory can become stimulated and active through "game or play therapy".

News Letter.-The "Home News" is published bi-monthly by the residents. They have several meetings concerning the paper, deciding which events should be included. The residents who are able to write, submit articles. Others can dictate their thoughts to someone who can write.

The newsletter is therefore a reflection of the resident's views. It is not a professional paper written by the staff.

WORK PROJECTS

Wherever possible, the residents are involved in the workings of the Home in such activities as mail delivery, garden tending, bird feeding, visitor tours, receptionists for special events, hobby shop and gift shop sales, etc. An appropriate "salary" is provided for certain routine services.

There have also been "farming" projects under supervision and with the help of staff. The "fruits" of the residents' labor have proved most rewarding on the sideboard and in the dining halls. The satisfaction of seeing one's own produce being used productively is an additional reward.

SPECIAL OUTINGS

There are many special outings during the year. They include Fairs, Theater Parties, Shopping Trips, tours of various manufacturing plants and other points of interest.

Since the Home has developed a van which can transport wheelchair residents, almost everyone can be included in these outings.

We emphasize that the programs listed above are only a small sample of many projects that are ongoing at the North Carolina Jewish Home. The deterrent to activity programs is the lack of imagination, lack of perseverance, lack of initiative and lack of follow through by the professional worker. It must be pointed out that well indoctrinated volunteers and sub-professional staff can do a tremendous job in this area of activity provided there is good supervision and continuity of programming. We must always remember a good patient care plan includes, with TLC, a means to "Activate and not Vegetate".

LUTHERAN SOCIAL SERVICES OF NORTHERN CALIFORNIA,

San Francisco, December 22, 1971. DEAR SENATOR Moss: In response to your request for information on innovative programs of care and services provided for the aged by long term care facilities, I submit the following:

A. AT ROHLFFS MEMORIAL MANOR

A housing facility for the aged, who are capable of independent living, is lo cated in Napa, California and provides 100 apartments for 112 residents. The garden apartments are ground level and each have a patio area and front entrance and adjacent parking spaces. A central office, recreation area, library facility is within easy walking distance.

(1) Regular bus service for shopping, church attendance and recreational activities is provided.

(2) A monthly afternoon gathering “Birthday Party” is held in the recreation room for all the residents. Coffee and cake are served; games and a program are enjoyed.

A monthly potluck dinner open to all residents is held. Favorite dishes are prepared and shared with fellow residents.

(3) Weekly religious services are conducted for the residents in the recreation room. A social hour is held after the services.

They also have an afternoon quarterly newcomers gathering to introduce new residents with coffee and cake.

(4) The women residents have a sewing club that meets weekly in the recreation room. An annual boutique allows display and sale of the items so carefully made.

(5) An annual Christmas Party is held-a gala event.

(6) A newly formed Men's Group meets weekly to discuss common concerns of "the minority" (only 18 men residents out of 112). A woodworking shop and an indoor shuffle board are current requests of this group. Some lively pool games have been held since these men became acquainted and found others with a similar interest. Perhaps a pool tournament can be planned!

(7) Social work service is available to each resident. A total resident visitation was conducted by the social work staff to acquaint residents with social services and how they may be obtained. This was also a case finding program and ongoing service has been given to some residents by social workers as a result of this visitation.

(8) Social workers interview each applicant for residence. Information from the application form and the interview is used to complete an evaluation form which determines the applicant's position on the waiting list through a points system. This assures equitable handling of each application.

(9) A telephone reassurance program for residents has been initiated. Since there were more volunteers recruited to make phone calls to residents, the service is now being offered to the larger community.

(10) A Meals on Wheels demonstration dinner was served to the residents to introduce them to the program and determine whether or not there is interest sufficient to support a program. It was learned that the residents prefer to cook their own meals, so this program will not be initiated.

(11) A series of health care lectures is being presented to acquaint the residents with available health care facilities in the community and how these facilities can be used to greatest advantage in order to achieve an independent living status as soon as possible after a major illness or hospitalization. The Medicare and Medicaid programs are also being discussed.

(12) Social work staff is available as ombudsmen on behalf of residents who have difficulty with Social Security, Old Age Security or similar bureaucratic systems.

B. IN SAN FRANCISCO-MISSION AREA

Social workers provide direct and indirect services to aged in San Francisco, with an emphasis on the Mission District of the city. This area has a high concentration of aged with 1,690 persons receiving Old Age Security.

1. Services are given to help in housing needs-relocating to another apartment, a residential care home or a nursing home depending on need.

2. Every effort is made to help aged remain in their own homes through enlisting homemaker services, home health aides, visiting nursing services, Meals on Wheels, friendly visitor services and any other service available to help maintain or restore independence.

3. Many aged live in old poorly equipped hotels where rents are less expensive but facilities are poor. A reaching out program to find the aged in these hotels and to explore, with them, the needs they may have has been initiated. Small group meetings of these residents have been requested by them.

4. A drop-in center, where comfortable furniture, a coffee pot and opportunity for companionship with other "Oldsters and youngsters", is one plan in the discussion period. The center would be staffed by volunteers, most of them aged themselves and a staff person to be available to the more seriously troubled. It is anticipated that problems ranging from Social Security questions to deep psychological difficulties may be reached through a center of this type.

5. Direct financial aid, food and clothing, is available when no other resource can be used. For example, payments for medicines not covered by Medicare or Medicaid; or help with rent can be given in emergency situations.

6. Help with obtaining legal services is given.

7. Whenever possible, our staff cooperates with and provides information for class action suits on behalf of the aged. Recently, the visible labeling and dating of dairy products by supermarket chains was effected through such a suit.

We hope that the above data will be of assistance to you in preparation of your report to Congress. If additional information is needed, please feel free to contact us.

Sincerely,

(Mrs.) RUTH SAMIEE, ACSW, Director of Social Services.

HEBREW HOME OF GREATER WASHINGTON,

Rockville, Md., December 23, 1971.

DEAR SENATOR Moss: Thank you for your interest in nursing home problems. You have requested descriptions of positive nursing home programs. The Hebrew Home of Greater Washington is proud of its many innovative approaches and is happy to share its experiences with you and your Subcommittee on Long-Term Care of the U.S. Senate Special Committee on Aging.

1. GROUP THERAPY FOR KEY STAFF

Dr. Jack Baruch of N.I.M.H. has been conducting weekly group therapy sessions with key staff with the goals of facilitating communication and understanding among staff members, and increasing understanding of residents' needs. Staff members have been able to see themselves as part of a group or team rather than a nurse, a physical therapist, a kitchen manager, etc., resulting in better agreement among key staff on goals and philosophy. Dr. Baruch is writing a paper on this experience and will send it to you when it is completed.

2. WEEKLY GROUP THERAPY MEETINGS LED BY NURSING STAFF WITH RESIDENTS AND UNIT STAFF

Supervising nurses on each 33-bed unit have been trained by Dr. Baruch to be group therapists. They have led weekly group sessions with residents and staff of their unit. Interpersonal problems, complaints, misunderstandings, feelings are discussed openly. Such topics as fear of death, sex drives in the elderly, problems of group living, are explored. Residents have used these meetings to suggest new programs in the Home such as holding monthly hot dog and beer parties and purchasing game equipment. Children of residents are invited to join the group once a month.

3. THE RESIDENTS COUNCIL

Each 33-bed wing of the Hebrew Home has selected two residents as representatives to the Residents Council which has a social worker as staff advisor. At their bi-weekly meetings, Residents ask their representatives to bring up problems of food service, housekeeping problems, etc., and they suggest better, more economical ways of managing the Home. As much as possible, resident recommendations are implemented. Morale in the Home has improved notice. ably since the inception of the Resident Council.

4. FAMILY MEETINGS

Families are invited to several meetings a year at which specific programs of the Home are discussed, and families are given the opportunity to ask questions of the staff and to make suggestions for better care. These meetings have benefited family members by relieving their guilt, giving them a feeling of being involved in their parent's care, and informing them of ways in which they can help in their relatives' care. They have benefited the staff by giving staff more insight into the feelings of family members. Many suggestions coming out of these meetings have been worthwhile.

5. CLOTHING SHOPS

A ladies' dress shop and a men's clothing shop have been set up in the Home, stocked with clean, good used clothing donated by people in the community. Residents enjoy the opportunity of making purchases (the highest price for any article is $1.00) and even the most mentally deteriorated residents have been found to be interested in making selections of color, material, etc. This program is a therapeutic tool and has also had the result of residents taking more pride in their appearance. Residents assist as salespeople, stock clerks, etc., and those who had worked in clothing shops in their earlier lives have been particularly interested in continuing in their careers.

6. ICE CREAM PARLOR

Residents and volunteers manage an ice cream parlor which is open every afternoon in the Home. Residents can treat their guests, and can enjoy the con