and to stay out of bed as long as possible; barring acute or terminal illness, we believe that the bed is the worst possible place for the person. Inasmuch as we try to provide the best normal life for our residents, we find it very difficult to do so very frequently, and as is too often the case, with nonprofit organizations, our sources of money available to us handicaps us in our efforts to provide wide-range programs of care. This is aggravated by the fact that the general and even more so the official approach to the elderly person is predicated upon overspecialized concepts, particularly those of health and welfare. There are entirely too many well-intentioned people who regard the older person as an ill person, or as one who will eventually become ill. As a result, all their efforts and planning are centered around building hospitals and nursing homes rather than on how to prevent the older person from becoming bedridden, and too early in his later years.

This is a defeatist attitude which can only be devastating and shattering to the morale and behavior of the elderly and encourage them to think in terms of ill health. True, the older person may have illness, his physical capacities do wane, but this, too, does not make of him a chronic health problem. Yet, so much of our State and Federal Government action in the field of aging is influenced by this ill health and disease concept.

It has yet to be proven that old age is a disease; nevertheless, we have placed the medical profession in the dominating position in considering the needs and problems of the elderly. The latter does need such attention, but why should it not be on the positive side? Why should not the emphasis be placed upon well older people, on prevention, I might say on restorative and rehabilitation concepts, or at least upon the slowing down of physical and mental deterioration?

Perhaps we need to take a leaf from out of the child-health programs. We could have senior citizens' clinics, and I might say this is done in a number of the homes for the elderly, much in the same order as well-baby clinics.

Another undesirable approach to old age is that the problems of aging are welfare problems. This is not so. While the elderly are by far economically disadvantaged, they still resent the idea they are indigents. They resent the implication that they have attained this unhappy status because of their own shortcomings.

Most older people have an ardent desire to retain the independence with which they have lived through their younger years. Why should they be treated as indigents or as casework problems? This fragmented approach to aging has created special problems for the nonprofit homes for the aged.

Recently, as a result of the ill health and welfare concepts of the medical assistance to the aged program, under the Kerr-Mills Act, in many States this program has become one of hospitalization and nursing home care rather than a general approach to medical care. As a result, many nonprofit homes for the aged are finding it necessary to convert a major part of their organizations to nursing home care in order to become eligible to receive State and Federal money through the medical assistance to the aged program, for this money helps them to operate without a deficit.

To provide older people with normal living arrangements, it is necessary to think of them as we would think of all people, regardless

of age, because all of us without regard to birthdays have the same basic needs. Thus, we, who are working with the normal elderly person, find it necessary to be concerned not only with housing, food, and medical care, but also spiritual needs, recreation, education, selfdevelopment, creative outlets, and opportunities for our residents to be of use to others. We could not exist for long without this kind of thinking and motivation in our nonprofit homes.

We believe that the same principles apply to older persons who are living outside of these homes and living independently. It becomes evident that the current overspecialized approach to the needs of the elderly is erroneous as well as harmful to them, and to our society as a whole; therefore, we would recommend that there be established in the Federal Government a commission on the aged and the aging which approaches the problems on a well-considered and firmly designed, integrated and coordinated interdepartmental basis. Only through such a device will it get away from dominance of the field by any one department and away from the narrow approaches such as the illness, disease concept, and the welfare indigent concept.

us.

Normal life is not categorized in this way, nor should it be for the aged. We are of the opinion that such a well-integrated approach will help us do a better job for and with the people who come to live with Its impact upon our society as a whole will also be beneficial, because this attitude will encourage continued independence and activity of the elderly. It will give greater emphasis to the prevention of dementia and ill health, and will minimize the need for hospitals and nursing homes and welfare programs.

Mr. O'HARA. I want to thank you for your suggestions. I am in accord with the essence of your statement, that is, that we should be more concerned with preventing acute problems confronting the aged group. We should consider the problems before they become serious, instead of attempting to care for them after they have arisen. I hope that one of the features of any bill this committee might approve would be to stimulate more interest and activity with regard to these objectives rather than merely strengthening existing programs. Mr. Giaimo, do you have any questions?

Mr. GIAIMO. I have no questions, but I do want to thank you for your testimony, because I think that the type of testimony such as given us has been needed and is needed for the record, namely, the fact that the sociological aspects of the problem, the importance of not causing this great body of people to feel that they are left out of things, I think this is the heart of this whole matter.

us.

Mr. O'HARA. Thank you very much.

Mr. PRYOR. Thank you.

Mr. O'HARA. We appreciate your taking the time to appear before

Mr. Kuplan or Mr. Jenkins?

STATEMENT OF LOUIS KUPLAN, CONSULTANT TO THE ASSOCIATION OF NORTHERN CALIFORNIA HOMES FOR THE AGED

Mr. KUPLAN. Congressman O'Hara, I-my name is Kuplan, Louis Kuplan. While I am here as a representative, or I might say consultant to the Association of Northern California Homes for the Aged, I have had vast experience in the field of aging and gerontology.

I am currently president of the International Association of Gerontology. I am a member of the faculty of the University of San Francisco, giving courses in gerontology. I am a past president of the American Gerontological Association, so forth and so on. I have also spent many years helping establish and develop California Citizens' Advisory Committee on Aging, and I was executive director of that until 2 years ago, when I resigned to go into the work of prevention, and, Congressman O'Hara, I would like to offer a few points in the field of aging as a consultant.

I think the problem presented by Mr. Pryor which he faced among the nonprofit homes for the aging epitomizes the problem faced by our entire society in regard to the problems of the aging in their later years.

Personally, I resent very much having to talk in the terms of problems of the aging, because I don't think they are giving perfect satisfaction to the problem. Our problem is the way society looks at the aging, the entire problem, and its antiquated notions in regard to what constitutes an older person, an older person's capabilities and potentialities. And, as Mr. Pryor indicated, the institutions are guided by a fragmented approach to the problems of the people who are living in these implications, and the only way we are going to overcome this is through a well-coordinated, integrated, planned program, both at the Federal and State levels.

While I would agree that the present special staff on aging in the Department of Health, Education, and Welfare has done an extremely fine job over the years, and I have worked very closely through these years, they are still rather handicapped in the fact they are related to one agency, to one department.

My own experience of 20 years in government service for every level of government has indicated to me, as you well know the facts, that there is such a thing as bureaucratic competition, each department wants to be the top, especially in a new field, each department wants a budget, they want a staff, they want all the honors, and unless there is some way of forcing them to work together, despite any informal arrangement, there is going to be quite a bit of sniping, and I assure you I speak from personal experience in this field.

Therefore, I think that it is extremely important that there be at the Federal level an independent agency separate from any department, because just as soon as you put it in one department, all the other departments are going to say, well, look, well, there's the Health, Education, and Welfare, this doesn't concern us too much, we might give them a little bit, but the problem is theirs, or if you put it in the Department of Labor, it begins all over again, only turned around. They will say, well, that's the Department of Labor, so on and so forth, ad nauseam. So it is essential that there be an independent agency with authority, with staff, with budget, to be able to coordinate and bring together all of these people.

Now, for instance, wherever we look at the problem of gerontology or old age, no one can draw a sharp line and say, here is where health begins or ends, this is where economics pick up, or this is where education picks up. Let's take a quick look at some of the problems that have to be included in the problems of aging, and they are akin to many of our governmental agencies. Of course, there is physical and mental

health, welfare and social security programs, housing, education, employment, income, maintenance, recreation, spiritual guidance, institutional care, nutrition, and I believe the matter of research and training, and I believe that any effective committee should also have on it representatives of the fiscal arm of the government agency involved, or the branch of government, and I even believe that certain legislative members should be represented on such committees to be able to discuss back and forth.

I think one of the most salutary developments in California was the fact our Citizens' Advisory Committee had on it representatives of both houses of the State legislature. It was a matter of them not only educating the citizens of our government, but this was also an eyeopener to the members of the legislature as to what the problems were, and they became stanch promoters in getting the program pushed.

So I believe that every branch of government must work together in any of our programs if we are going to be effective. As it stands today as I see this on an international as well as a national basis, the emphasis is mainly on ill health and disease and on welfare.

I insist that aging is not a welfare problem alone. Aging is not a health problem alone, but they are all related, because who can say, who can come and say, this is where health stops and this is where welfare picks up?

In relation to the economic ends, the economic aspects of old age are absolutely related to health, to housing, to education, all of these other things that we feel make a normal life for the older person, and they must be well considered.

I would very much like to support the statement made by Dr. Gordon and seconded by Mr. Ash that we think in terms of the aging and not the aged. I recall that the first time we had a conference on aging in California, back in 1951, we called in a group of citizens to discuss the problem for that time, and do you know what they argued about most was whether there should be a conference on aging or on the aged, because there was a desire to limit this thing right off the bat. But, fortunately, the eyes of the people who started the idea of aging won out, because aging is a relative problem. You might say, well, it was indicated by Dr. Gordon and by Mr. Ash as far as employment is concerned, a man of 40 may be superantiquated. We know that many larger offices will not hire any new girls over 28 years of age. When it comes to physical capacity, aging is something else again, and you might discuss it back and forth, when does this girl or boy become superantiquated. So all of it is a highly relevant thing, and I do think we have to keep this thing on an equitable basis, not only for an effective program, but in planning.

I am a very firm believer in work, preventive work, in the field of aging, where research, scientific, social, or economic-unfortunately, today we live with outmoded notions that old age is an evil thing, that a person 65 is ancient, degenerative. There is nothing much I can do about it. These things don't hold true. Scientists tell us today no one has a right to think of himself as being too old physiologically, before he is 75. But, on the other hand, we read in the newspapers where youngsters 17 or 18 years of age are about to die of senility, so here again we can't draw any sharp lines of demarcation, but we do have to help our people prepare for old age, because retire

ment in the later years is a new phenomenon of our society. Automation, technology, all of this is going to bring, in my opinion, earlier years of retirement, longer retirement, and at an earlier age, and unless our people can prepare for this retirement, we are going to have increasing social problems, more so than are already in existence. Now, in the field of education. In most cases our educational programs in high schools and colleges, we all have these which serve as courses for life adjustment. At the end, at the point where the individual enters the labor market and gets married. It is for them now a life of adjustment. It includes preparation for retirement. All of us are going to have a certain number of years in retirement, and we have notions how to live in retirement. Are we going to go into a home or are we going to live independently, spending our life with our children, and so forth? If we are going to encourage people to plan economically for retirement in old age, then we should begin helping them, encouraging them to make plans when they are at the height of their economic earning power, not wait until they are 50 or 60 years and tell them they are going to have to find some way of life insurance, social security or personal income. And this goes down the line to a good many, a number of things, and a matter of health, which was mentioned earlier, the need for preventive health measures.

So I say, let's have a simple program, well defined, integrated, which also thinks in terms of the entire human being, not just a fractionated part of it, and which will not be limited so far as the aged are concerned.

Now, one other thing I would like to add here, and that is the need for a central agency in central government which is extremely important. While I am a very strong believer in the fact that the basic job must be done in the local communities, these communities do need help financially, morally, and in every other way. They do need the example of a well-organized governmental agency which will stimulate them, encourage them, and give them status in doing their work.

And one final word on the matter of whether this should be under one department or another. I realize in my experience many arguments between different departments, each one giving reasons why this should be in my department and not in yours, and at the White House Conference on Aging in Washington, in some of the sections I participated, there were pretty violent discussions along these lines. One eastern gentleman, a gentleman from the east coast, was very violent in a statement that only a public welfare department has the right to tell all the people what to do or to plan for them. Well, he was just as vehemently opposed by representatives from the public health point of view.

So you see if we are realistic about this, the facts of life, let's say, bureaucratic government as such, that if the power is given to one agency, it is going to be rather harmful to the overall program.

This again winds up my final work, this epitomizes what happens to the home of the aged. We are being forced, because of uncertain approach, to turn our homes for the aging into homes for well older people rather than nursing homes for which we have funds to operate, and I say this cannot be, in this country we cannot build enough hospital beds and enough nursing homes to meet the needs. We feel we need a more positive, constructive approach.