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status of the Nation's growing population of senior citizens. recommendations should be based not only on systematic examinɛ of interrelated factors; the actions and programs they envisage sh also be flexible without being erratic. The problems they attemp tackle cannot be viewed as if they were merely a repetition of old "normal" phenomena which we have always had with us. If th is any underlying theme in the work and deliberations of the s committee, it is that we are faced with a new set of social and e nomic conditions in which an unprecedented number of older citize increasingly find themselves.

It is in this spirit that the subcommittee presents the followin recommendations which give first priority to passage of medica insurance for the aged through social security, includes new legislativ proposals for 1961, and concludes with recommendations for enactment of specific bills introduced for action in 1960.

A FIRST PRIORITY

I. Financing the provision of health services

Without question, the primary problem of our increasing population of retired older citizens remains the question of meeting the costs of basic health care at a time when their income is low, potential or actual illness or disability at its peak, and the relative cost of health services, enormous. The following chapters on health status and on the income of the aged population demonstrate this clearly.

1. As a first priority for 1961, the subcommittee recommends that legislation be enacted to provide for the financing of a balanced program of health services, including hospitalization, outpatient laboratory diagnosis, skilled nursing home care, home health services and, within actuarially feasible limits, part of the costs of expensive medicines, for all retired elderly persons, under a separate insurance fund to be collected and administered by the Social Security Administration. As part of the same legislative proposal, the subcommittee includes as eligible for health benefits, not only those retired senior citizens covered by the OASI system, but those who were never able to achieve such coverage. The cost of including the group outside of the OASI system will be covered by appropriation from general revenues. The net cost to the Federal Government will be relatively small since most of the funds will be offset by present Federal expenditures for medical care under old age assistance, medical assistance for the aged and other programs.

The extension of the social insurance principle embodied in the social security program (OASDI) to finance such a health care program is firmly believed by the subcommittee to be the logical solution to this No. 1 problem of retired elderly men and women. It is the most efficient and economical solution; it is aimed at preventing and reducing dependency in old age; it will be uniform in application; it will ultimately protect nearly all retired older citizens; the recommended benefits are based on the desire to prevent illness and to restore truly adequate health levels, as much as possible.

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NEW RECOMMENDATIONS FOR ACTION IN 1961

In the second year of its activities, the subcommittee considered additional areas dealing with the improvement of the lives of aged Americans, present and future. It makes the following additional recommendations:

II. National Institute of Gerontology

The findings of research, both basic and applied, hold the brightest promise for the future well-being and usefulness of older persons. The spectacular success of medical and biological research in overcoming polio, in attacking tuberculosis, diphtheria, smallpox, and pneumonia, hold similar promise for preventing or ameliorating the diseases of old age. Research in the social sciences can pave the way for sustaining the vibrant, productive contributions of older persons, rather than relegating them to passive dependency.

The crucial thing is that progress in the modern world depends in large part on science and the scientific method.

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The several sciences have actual and potential contributions to make in the slowly, but definitely emerging fields of geriatrics and gerontology. But they need a large-scale stimulation to coordinate, expand, and hasten the specific application of research methods in these fields and to make known the results of such inquiries. The shortcomings that now exist in funds, personnel, and in the nature of most grants for age-related research, call for a major improvement if we hope to avoid a hit-or-miss, wasteful approach to the problems of an aging population. What is needed is a program of long-term research projects adequately financed and directed, on a coordinated basis.

2. The subcommittee recommends the establishment of a National Institute of Gerontology with a staff of competent scientists from the biological, physical, and social sciences. It further urges legislative support for an improved program of well-financed research and training at the Institute, and through grants, at other research organizations, especially universities, for the systematic development of interdisciplinary research programs in geriatrics and gerontology. III. Multipurpose senior citizens centers

Good health and adequate income are the first two important goals of aged men and women in our country. But even with these goals partially achieved, there is still the problem of the use of retirement time. It is easy to assert that an aged person's family should serve as the circle of his social relationships and activities. But many older persons have no such families for this purpose; other aged find that their adult children cannot completely fulfill this purpose and a need exists for useful activities beyond the family circle; and finally, many

G. H. Mead, "Movements of Thought in the Nineteenth Century," University of Chicago, 1936, p.

older persons prefer to include in their activities others of their same generation-in such groups age is not a stigma or a barrier to full recognition as an individual. Above all, older, retired persons need a place where they can continue contributing to their fellow men through important voluntary service in their home communities. Unfortunately, at the present time, the opportunities for such participation and for such voluntary activities are lacking, despite the notable exceptions in various parts of the country-examples of which are described in chapter VI.

3. The subcommittee recommends that the Federal Government join with States, localities, and nonprofit organizations to stimulate and help finance senior citizens centers with qualified staffs and with programs of education, recruiting, and training for community service, counseling, and other activities in keeping with the needs of older citizens.

IV. Mental health and aging

One of the end-products of the current low status and relatively deprived position of so many aged persons in our society is the high rate of mental disorders in the upper age groups, disorders that are not always associated with physical changes in the organism. This situation has led to disproportionately high rates of admissions into mental hospitals among the aged. One out of every three persons admitted to a mental hospital today is 60 years of age or over. While the proportion of patients under 65 in mental hospitals has decreased in the past 20 years, the proportion over 65 has increased by 40 percent.

The tragic element of this trend is that we have much of the knowledge through proven research to either prevent hospitalization in the first place or to discharge early approximately half of the admissions. To do so, however, requires a heavy investment in trained personnel to undertake early diagnosis and treatment right in the community and to give intensive treatment in hospitals. It also requires available facilities as alternatives to mental institutions such as day and night hospitals, clinics and social services so that a person can be helped right in his own home. In this manner we can make the investment pay by restoring huge numbers either to productive activity or to more independent living. The subcommittee believes that an effective attack on mental illness should be met by a cooperative Federal-State-local sharing of the financial burden.

This conclusion is also the major recommendation of the monumental report of the Joint Commission on Mental Illness and Health, Inc., which was established by the Congress and given $1.5 milllon to undertake a 3-year comprehensive study of mental illness and mental health. Over 30 organizations, including the American Medical Association and the American Psychiatric Association, participated in this historic study which recommended that the Federal Government join the States in a financial breakthrough of such proportions as to be commensurate with the size and quality of the problem.

4. The subcommittee recommends a program of Federal grants to the States, utilizing the well-accepted Hill-Burton formula, to provide necessary community mental health facilities for prevention or early treatment of mental health problems of older persons in their home

communities; for the intensive treatment of the aged mentally ill in mental hospitals; and for more rapid communication and application of research knowledge.

V. A special committee on aging for the U.S. Senate

During the past 2 years the subcommittee has collected basic data and published reports on the problems of aging and on its emergence as a concern of national importance. It has compiled information depicting factually conditions in such areas as employment, income, health, housing, and education. It has recommended legislation in a number of areas, as indicated in this report, and has focused public attention on the needs of the aged through hearings in Washington and across the country.

It has established a clearinghouse for the views, grievances, and recommendations of senior citizens. The voluminous correspondence received from older persons all over the Nation, describing individual problems, and seeking answers to needs attests to its role in partially filling a national vacuum.

But what has been accomplished to date primarily delineates the magnitude and nature of the problems of America's senior citizens— problems which will increase in size and complexity tomorrow. A next step is required: an examination in depth of specific problems from a coordinated overall view.

One important lesson we have learned is that the problems of older persons cannot be contained within a narrow subject-matter compass. They cut across the gamut of executive and legislative responsibility. Several Senate committees have jurisdiction over parts of the problem but none looks at it as a totality.

The subcommittee's work should now be undertaken by a larger agency of the Senate, separate and distinct from any standing committee, having full investigative but no legislative power, and composed of a greater number of Senators representing every section of the country.

By elevating the study of aging to the status of a Senate special committee, we will demonstrate to the Nation both the importance we attach to our 16 million aging fellow citizens and the determination we share to develop policy and programs commensurate with the need and the opportunity.

5. The subcommittee recommends the creation of a Special Committee on Aging, to make complete studies of all matters pertaining to the status of older persons, to serve as a nonlegislative committee for the purpose of providing relevant information to the Senate's standing committees, and to make recommendations leading to productive, independent lives for the Nation's senior citizens.

BILLS READY FOR ACTION

In 1960, the subcommittee introduced a program of basic legislation based on its previous studies. We urge that these bills be enacted in 1961. (The texts of these bills are carried at the end of ch. I.) VI. Employment opportunities

Age discrimination. The past decade has been characterized by a series of economic and employment crises which have worsened the chances of jobseekers defined as "too old to work, but too young

to retire," typically those between the ages of 40 and 64. Whether the cause be prejudice and discrimination, or "skill obsolescence, the remedy cannot wait for "long-run" economic processes to take effect, if indeed such processes actually are operating at all.

At the very least, the Federal Government should assume a major responsibility in those spheres where it can act directly.

6. The subcommittee recommends enactment of legislation requiring contractors and subcontractors of the U.S. Government to review their personnel policies and eliminate all forms of employment discrimination based on age. As part of the same recommendation, the subcommittee would include a program of regional labor-management conferences on older workers' performances and abilities and surveys of compliance with the purpose of the bill.

A Senior Citizens Training Program.-Since the filing of its 1960 Report, the subcommittee has been even more impressed than previously with the fact that while many retired persons over the age of 65 seek worthwhile part-time employment without success, there are critical shortages in the fields of health and other community service activities-activities that could, with proper recruitment and training, be manned by such retired citizens.

7. Therefore, the subcommittee recommends that, in cooperation with private and local governmental units, the Departments of Labor and of Health, Education, and Welfare, establish a senior citizens service training program, for the purpose of recruiting and training willing and able older persons to serve in specified community activities, the personnel for which are otherwise in short supply.

VII. Protecting income

Increasing OASDI Benefits.-Aging, or rather its typical concomitant, retirement, means economic deprivation for most Americans. The incomes of retired, elderly heads of families in our country are, on the average, less than half of the average (median) income for all American families; the case of 3.6 million unrelated individuals is much worse. Even when family size is taken into consideration, the income status of millions of aged still must be recognized as below any decent level required for adequate housing, proper nutrition, medical care, and all other ordinary items in a standard of living deemed proper in the second half of this century. More than half of our retired elderly urban-dwelling couples are attempting to survive on incomes uncomfortably below the costs of a minimum budget for such couples.

Private pensions currently are enjoyed by only a small minority of retired senior citizens, and their role in providing a floor of protection for the majority of retirees in the foreseeable future has definite limits. The average social security benefit-the main source of retirees' income-is around $74 per month, while the average monthly payment to recipients of old-age assistance is $69. Among aged men and women who receive social security benefits well below the $74 average, the vast majority have few, if any, additional sources of money income.

8. The subcommittee recommends a substantial increase in old age benefits under social security for all aged beneficiaries, and particularly a raise in the minimum benefit from $33 to at least $50 per month. As part of the same recommendation, the subcommittee urges that Congress in 1961 remedy the dilution of the original

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