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to develop among retired persons the skills needed to meet our publicservice shortages. Most of the jobs filled through this program would be part time.

The proposal would make $5 million in Federal grants available each year for 3 years to public agencies and nonprofit community organizations for training and placement services. The Secretary of Health, Education, and Welfare would be authorized to conduct manpower surveys in the fields of health, education, and welfare to determine the kind and extent of community-service employment opportunities available in local areas.

This program could begin to provide the basis not only for helping the aging to find satisfying and useful jobs but also for reevaluating our adult education programs and determining what subjects and activities would be most profitable to senior citizens. Also, it could show us what employment and education directions we ought to be moving in, to minimize job competition between younger and older workers.

OFFICE OF THE AGING

The subcommittee feels that the time is overdue for establishing an effective agency for the aging, to deal systematically with their needs and help assure them dignity and independence. The problems of aging are great enough in scope and urgent enough in priority to require a high level agency created by the Congress to serve as our eloquent spokesman for America's senior citizens.

Senators McNamara, Clark, Randolph, and eight colleagues introduced a bill proposing the establishment of such an office, to be headed by a new Assistant Secretary of Health, Education, and Welfare for the Aging. The bill was sent to the Committee on Finance. Creation of this Office would not provide an automatic solution to the problems of aging, nor would it be a substitute for action, but it would permit these problems to be attacked as a whole, rather than in bits and pieces, as is true now. A permanent agency would provide the Federal leadership and support necessary to encourage and stimulate action at the State and community level. What would the U.S. Office of the Aging do?

It would serve as a Federal clearinghouse for information for the the public and private groups which concern themselves with the problems of the elderly.

It would promote research and demonstration projects, such as senior centers, counseling programs, and studies of what social, recreational, and training programs and facilities are needed in the field.

It would make possible the coordination of the many separate programs for the elderly now being carried on by such independent agencies as the Veterans' Administration and the Housing and Home Finance Agency.

It would provide a clearinghouse through which each of the States could use and assess the information acquired by the other 49 States. It would provide technical assistance and organize conferences for the stimulation and guidance of States, localities, and organizations working in the field.

It would administer grants to public and nonprofit groups to establish and evaluate demonstration programs of various kinds to enlarge

the civic contributions of our senior citizens and to enhance their

personal growth.

It would identify the unmet needs in the field and formulate plans for dealing with them.

The bill proposing establishment of the U.S. Office of the Aging provides for a system of grants which would help each State prepare an analysis of existing services for the elderly, a survey of current needs, and a listing of proposed projects. Grants for demonstration projects would be available on the same formula as Hill-Burton hospital construction grants and additional grants would go to public and other nonprofit institutions for research and training programs.

This bill also includes a declaration of objectives for senior Americans, which summarizes what the subcommittee believes our national policy should be to insure a life of dignity and purpose for the elderly: 1. An adequate income in retirement in accordance with the American standard of living.

2. The best possible physical and mental health which medical science can make available and without regard to economic status.

3. Suitable housing, independently selected, designed, and located with reference to special needs and available at costs which older citizens can afford.

4. Full restorative services for those who require institutional

care.

5. Opportunity for employment with no discriminatory personnel practices because of age.

6. Retirement in health, honor, dignity after years of contribution to the economy.

7. Pursuit of meaningful activity within the widest range of civic, cultural, and recreational opportunities.

8. Efficient community services which provide social assistance in a coordinated manner and which are readily available when needed.

9. Immediate benefit from proven research knowledge which can sustain and improve health and happiness.

10. Freedom, independence, and the free exercise of individual initiative in planning and managing their own lives.

COMMITTEE REPORTS

Among the subcommittee's publications in 1960 are two we would particularly emphasize: "The Aged in Mental Hospitals" and "The Condition of American Nursing Homes."

The first points out the disturbing rate at which the proportion of older persons in mental hospitals has been increasing. About one out of every three beds in public mental hospitals is occupied today by a person 65 or older. Since 1939, while the ratio of persons hospitalized for mental illness in each age group under 65 has decreased progressively, the ratio for persons 65 and over has increased by almost 40 percent. These proportions will go on increasing, according to present projections.

Perhaps as many as half of these patients require only brief hospitalization, but the lack of facilities for their rehabilitation makes it impossible to release them. The greatest need is for "in-between"

ACTION FOR THE AGED AND AGING

17

facilities for those patients able to leave the hospital and return to their families, who are struggling with the problem of how to provide proper home care. Mental hygiene clinics could reduce the hospitalization rate for the elderly and increase the rate of turnover in hospitals; yet only a tiny percentage of released, elderly patients go to such clinics. Here is a clear need, both for expansion of clinic services and for understanding by the clinics of the role they could play in helping older patients to make the transition from hospital to home.

The field of mental health has made progress in recent years, but requires a substantial financial boost to take advantage of new and proven knowledge. The subcommittee believes that the problems of patients in mental hospitals, particularly as they affect the aged and aging, can only be attacked effectively today with a program of Federal grants for the operation of new mental hospital and community mental health services-preventive and rehabilitation. Outside of education, mental health is the only major function of State government without substantial support by Federal grants. A problem which affects personally 1 out of every 10 Americans and which requires such heavy construction and operating investment in our times can only be met adequately through cooperative Federal, State, and local sharing of the financial burden. No level of government can escape its obligation for solving the problems of mental illness; the Federal Government should lend its support to an effective preventive, treatment, and rehabilitative effort in this area of such importance to the aged and aging.

"The Condition of American Nursing Homes" highlights the dim state of many of these institutions. The States report that half of our 300,000 nursing-home beds do not meet acceptable standards under the Hill-Burton Hospital Construction Act. We are short about 125,000 of these beds.

We are not only short of the necessary nursing personnel but of auxiliary personnel of all kinds trained to understand the needs of elderly patients. An astonishing number of these homes do not have medical care. (Only a third of the homes have a registered or licensed practical nurse.)

Worst of all, the majority of nursing homes provide no means of rehabilitation and restorative services. For lack of these services, people who do not need to be helpless become so. Total disability often results not from the patient's initial illness, but from sheer vegetation.

There are many good nursing homes in the United States. They are cheerful, clean, safe, and properly staffed and equipped. Unfortunately, they are in the minority and most of them are extremely expensive. The other minority of institutions which are dismal, unhealthy and hazardous should be eliminated; while the majority of nursing homes, which fall between these two extremes, should be improved. The problem is largely financial, as we pointed out:

It is inherently impossible for even the most altruistic nursing home proprietors to provide registered nursing service, routine medical care, rehabilitative and recreational activity and still make even a small profit.

Like so many institutions in the field of the aging, nursing homes are largely the victims of cultural lag: they are today's "old folks' homes" from which far too many people never return.

It is the subcommittee's hope that every State will at once launch a vigorous program of raising and enforcing its nursing-home standards. We also favor development of Federal minimum standards which could serve the States as models.

We favor a program of Federal financial assistance to nursing homes which will meet these minimum standards for medical and restorative services.

WHERE DO WE GO FROM HERE?

Long life has been one of the glorious dreams of mankind since Methusaleh's time. Now we have it-and what are we doing with it? Instead of boasting of our miraculous progress, we shudder and think of aging only as obsolescence and uselessness.

The programs outlined in this report require thought, planning, action, and money. They require the development of new skills and the expansion and refinement of old ones. They require a new set of attitudes.

Our Nation has throughout its history put the accent on youth: that was natural to a growing, young country with enormous resources awaiting exploration and cultivation.

We

In this century, we have been forced to a sudden maturity. have become the leaders of the free world without having asked for the job. We are still not fully prepared for it, and in part this is true because our attitudes give us not only the virtues but also the drawbacks of youth. The lack of self-assurance, of perspective and wisdom which we have sometimes displayed on the world scene, reflect a national culture in which these qualities do not yet predominate.

In the subcommittee's view, it is not too much to suggest that there is a subtle interplay between our attitudes toward aging and toward world leadership. Meeting the problems, which both challenges pose, requires staying powers which we have just begun to develop.

That we must develop them, if we are to prevent chaos, is selfevident. That we can is also self-evident to anyone who has faith in our remarkably flexible and productive economic system and in our dynamic way of life. In the past we have met and even profited from incredible challenges when history has flung down the gauntlet. We have shown what imagination, industry, and ingenuity can accomplish when war and depression have been upon us.

It is perhaps harder to mobilize ourselves to meet the needs of the elderly than to deal with war or depression, because the challenge is not so dramatic. But mobilize we must, to assure ourselves and our parents of a decent and fruitful retirement. Let us bend some of the ingenuity which has devised so many marvelous machineselectronic brains, jet aircraft, weather satellites-to the greater task of making the retirement life worth living.

America's senior citizens want and need society's recognition that they are people like the rest of us, with problems which differ from ours only in degrees, not in kind. Adequate income and housing, the best possible physical and mental health, full restorative services for those who require institutional care, the opportunity of employment with no discrimination because of age, the pursuit of meaningful activity, efficient community services when needed, immediate bene

fits from proven research knowledge, and freedom, independence, and the free exercise of individual initiative-this is what our senior citizens want and deserve. Doesn't it parallel closely what all Americans have come to expect out of life?

We have the abundance to realize these aims. What we must do is to channel that abundance properly. The subcommittee believes that the legislation introduced under its aegis in 1960 provides a basis for directing our efforts toward realistically meeting the needs of the elderly. It feels the time has come to establish a Special Committee of the Senate on Aging to meet the problems of the elderly at the level they deserve. Such a step will evidence the recognition by the Senate of the magnitude and importance of the problems of 16 million senior Americans; it will affirm clearly that our national concern is sustained rather than expedient. It will give tangible evidence that concrete action will follow surveys, studies, reports, and recommendations.

We look forward to a vigorous 1961 in which as much of the subcommittee's recommendations as possible will be brought to legislative fruition.

The text of the bills introduced in 1960 and recommended for legislative passage in 1961 follow:

RETIRED PERSONS MEDICAL INSURANCE ACT

A BILL To provide for the payment of hospital and other health services furnished to aged retired individuals, and to provide for a continuing study of the health needs of such individuals.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "Retired Persons Medical Insurance Act".

TITLE I-AMENDMENTS TO TITLE II OF THE SOCIAL SECURITY ACT

SEC. 101. (a) Title II of the Social Security Act is amended by adding after section 225 the following new section:

SEC. 226. (a) Title II of the Social Security Act is amended by adding after section 225 the following new section:

"MEDICAL INSURANCE BENEFITS

"SEC. 226. (a) (1) Every individual who—

"(A) has attained retirement age (as defined in section 216(a)),

"B) is retired (as defined in paragraph (3)),

(C) is, or would upon filing application be, entitled to monthly benefits under section 202,

shall be eligible to receive medical insurance benefits. Payment of such benefits shall be made in accordance with the provisions of this section, but only if application is filed for such payment in such form and in such manner and by such person as the Secretary may by regulation prescribe. The provisions of clauses (B) and (C) shall not apply to any person (i) who is the husband or wife of an individual eligible to receive medical insurance benefits and (ii) who was receiving more than one-half of his or her support from such individual for one year provided such year began no earlier than the calendar year preceding the year such person attained retirement age.

"(2) Medical insurance benefits shall be the payments made under this section for hospital services, nursing home services, home health services, diagnostic outpatient services, and very expensive drugs (as defined in subsection (c)) furnished in the United States.

"(3) For purposes of paragraph (1)—

"(A) Except as may be provided in subparagraph (B), an individual shall be retired with respect to the period for which he files for payment of medical insurance benefits if—

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