(9) Finally, as to the need for a commission, most of those present probably favor an independent, high-level commission of the type proposed in H.R. 10014. However, I believe that they also hope that failure to agree upon organizational structure would not preclude the establishment of at least a minimum program at this time. Certainly they would prefer having a central office to deal with and certainly they fear that as long as the program is centered in the Department of Health, Education, and Welfare that it might take on the complexion of a gigantic welfare operation.

However, it must also be recognized that this desire for an independent commission is not the unanimous wish of State executives. All support the objectives for a commission set forth in H.R. 10014, and most recognize the failure of previous programs, such as the Federal Council on Aging, in not reaching these objectives. However, many felt that the final governmental structure to be established will be complex, that it is more important to proceed rapidly with at least a minimum program rather than to delay hoping for perfection. In view of this it is my recommendation to the subcommittee that it first explore the possibility of strengthening the alternate bill that has been drawn up by the legislative counsel by giving more explicit duties to the staff of the President's Council established therein and by making it more independent. It is also recommended that the Special Staff on Aging (Office on Aging in the alternate bill) in the Department of Health, Education, and Welfare be further strengthened and that an Assistant Secretary as head of this office be considered. Discussions have been held with the legislative counsel and alternate proposals are now being studied along these lines.

If this cannot be achieved in the short time available, then I would suggest that consideration be given to the approval of H.R. 11752 with the following additions:

(1) Provide for a separate appropriation for training programs that is identified as such.

(2) Add to H.R. 11752 the provisions for State planning grants as stated in H.R. 10014 with the following changes:

(a) Administration to be by the Department of Health, Education, and Welfare instead of by the Commission.

(b) That in addition to the planning provisions that some additional money be made available, under the same title, for planning, establishing, and expanding programs that would encourage the development of more senior citizen centers, for the development of noninstitutionalized oriented health and maintenance of health programs, and for expanding employment opportunities for the aged.

Certainly this type of legislation would not be all that is to be desired, but it would to some degree put an emphasis on action rather than on further study, further conferences, and further delay.

In the event that either H.R. 11752 or H.R. 10014 are approved, with or without amendments, but without the Joint Committee on Aging which has been proposed in the alternate bill, then I would recommend that the subcommittee do whatever it can to secure adoption of House Resolution 33, introduced by Congressman Jeffrey Cohelan, of California, which calls for a Select Committee on Aging within the House of Representatives.

Mr. TED ELLSWORTH,

NORTH KINGSTON, R.I., April 17, 1962.

Special Consultant, Subcommittee on Aging,
Old House Office Building, Washington, D.C.

DEAR MR. ELLSWORTH: I want this letter taken in the form of a testimony before the Subcommittee on Aging and added to your files.

I would like to state that the King-Anderson bill is the best of the those that have been presented which offer medical care for the aged, and it is backed by the administration. But it does not go far enough to be of value to any large proportion of the aging. In its present form, approximately 1 percent would be able to use the health care benefits. The reason for this is that the deductible amount in the bill is so large that about 80 percent of the aging would have no way of raising the funds.

For instance, they want a deductible of $10 a day for the first 9 days. That alone is $90. The first step for these people is to go to a doctor before they can be admitted to a hospital. His office call alone ranges anywhere from $5

to $10. Undoubtedly, they have to make a second trip to the doctor's office for diagnosis. In addition, there is a $20 deductible clause for the clinic diagnosis. It should not take anyone very long to figure out that it would cost about $135 before they could even get a recommendation to be admitted to the hospital. The health and welfare committee survey shows that at least 60 percent of the aging receive pensions ranging from $40 to $74 a month, which is inadequate to take care of their immediate living expenses such as food and housing. The young in the family have to supply the difference, and in most cases they are in the low-income group themselves. Therefore, they would be unable to put up any such money for the entrance to the hospital.

I have been inquiring and going to various club meetings and hearings, talking with numerous people in organizations, and they agree with me on this. I would say that the largest portion of the aged are chronically ill and need a doctor's consultation and advice. If the doctor's visits and service would be paid for by the bill, these people could get the care they need.

I suggest that the Subcommittee on Aging submit an amendment to the KingAnderson bill to strike out all deductibles and to write in that doctors' office fees and services be included. I have talked to leaders in organized labor, and they tell me that they are willing to bet that this kind of amendment is needed by the people; and the present bill is of little value without such an amendment.

I know that you will find that all of the aging groups in the country will also back this type of amendment. I also believe that the President of the United States would back this type of an amendment to the bill. At least I am going to write and ask him for his support.

I would appreciate your advising me what could be done or will be done along this line.

Very truly yours,

Hon. CLEVELAND M. BAILEY,

JOHN F. KINDER.

BALTIMORE, Md., April 19, 1962.

Chairman, Subcommittee on Education and Labor,
Washington, D.C.:

The Baltimore City Commission on Problems of the Aged supports H.R. 10014, the creation of the U.S. Commission on Aged. We wish to stress the urgent need for a strong Federal coordinating agency and the importance of a comprehensive grant program for projects related to problems of aging for the Commission.

STANLEY Z. MAZER, Executive Secretary.

STATEMENT BY ALVIN T. PRESTWOOD, COMMISSIONER, ALABAMA STATE DEPARTMENT OF PENSIONS AND SECURITY

I am Alvin T. Prestwood, commissioner of the State Department of Pensions and Security in Alabama (the State's public welfare agency) and chairman of Alabama's followup subcommittee on carrying out the recommendations of the 1961 White House Conference on Aging. I work closely with Hon. John Patterson, Governor of Alabama, who has offered to our State constructive leadership in the area of planning for senior citizens. Governor Patterson is chairman of the State board of pensions and security and both he and I were members of Alabama's official delegation to the 1961 White House Conference on Aging. In 1960 and again in 1961 Governor Patterson personally called conferences in Alabama to deal with the subject of aging.

I wish to present some of my thinking in regard to some of the proposed legislation now before the Congress which has to do with the planning for senior citizens. My comments, of necessity, will be general and not directed to any single proposal. Of primary interest to me, however, is coordination at the Federal level of efforts in behalf of the aging. I recognize that bills have been introduced that would establish new agencies or separate commissions on aging, while other measures would set up divisions within existing agencies. I cannot be explicit for many reasons and I feel that the subject is so important that more time should be given to a study not only of the proposals but of what needs to be done before decisions can be reached as to methods.

When I participated in the White House Conference in 1961 I was a member of the group considering Federal organizations and programs. I asked for assignment to this section because of my tremendous concern over the need for

coordination of activities for the aging at the Federal level. The deliberations of the committee presented widely divergent points of view. Most States do feel a need for more direct guidance from the Federal Government. At the same time, there are differences as to whether such guidance should come from an overall independent planning or coordinating body or commission, or should flow through the U.S. Department of Health, Education, and Welfare. There are real and understandable questions as to how the coordinating body should function and how it should be accepted by the States. This is one of the reasons it appears to me that action on this matter should be deliberate and should be based on full knowledge of needs as well as of mechanisms that might be adapted to meet them.

In Alabama there is a legally constituted State committee on aging. This body, however, has no funds for a permanent staff and serves purely in an advisory capacity. Under its direction Alabama has a subcommittee, of which, as I have indicated, I am chairman, geared to follow up on recommendations of the White House Conference. Of particular concern to me is a fuller development of public awareness of the effects of aging on society, and of organization of local committees to study local needs and resources.

Thus, as I see it, there is need for a coordinating body within each State and for a coordinating body at the national level. I do not feel in a position to take a firm stand on how such bodies should be organized and set up. I would point out, however, that no coordinating body should interfere with operational programs. Though such bodies might offer useful guidance in development of special demonstration projects or research, I would not consider it their role to come between cooperative programs performed by more than one agency, public and/or private, whether these be two agencies within a State, or a State-level agency and a Federal or national agency.

I have indicated that I am interested in the whole broad field of aging and in full coordination of programs in the field. I do not want to go into further detail on all of the different aspects of aging and all of the different areas where resources should be developed. I should like to cite two needs that are of primary importance to me as administrator of the public welfare program in Alabama.

It is probably obvious that I am going to point to the importance of income maintenance of older people and to the necessity for their being able to have their health needs met. Everyone knows that a "living" is essential for every human being. He must have the means in our present society to purchase the necessities of life-food, clothing, shelter, etc. He must also have an opportunity to receive medical care which is essential if he is to live out his three score years and ten. In Alabama we view with pride the fact that our average old age pensions (old age assistance) have risen in the past 4 years from $38 to more than $63. We are making payments today on the basis of 100 percent of unmet budgeted need up to a maximum money payment of $75. We know that our standards could be more liberal and that this is actually a minimum level. At the same time, Alabama has made more progress during this period than any other State. Our rate of growth is about five times that of the average old age assistance payment in the Nation. Along with this progress we have made gains in other fields, but we recognize, for example, that more public low rent housing geared to the needs of the aging is needed and will make living conditions more suitable for persons dependent on old age pensions.

Thus, I see the need of coordination at the State level in the same way that I believe that other States, like us, see the need for Federal coordination. It would be helpful to look to Washington for facts about what programs are in operation and for an understanding of the approaches needed to get help at the State and local level. At present there is a veritable kaleidoscope of Federal agencies with programs that affect seniors citizens. Many of these programs and services overlap and frequently two or more have similar purposes. The Department of Health, Education, and Welfare, for example, has specific responsibilities for the social security program (insurance and assistance) and for many other services. Since the needs of the aging are basically the needs of all adults, however, they cut across activities of such Federal agencies as the Department of Labor, the Veterans' Administration, the Department of Agriculture, Housing and Home Finance, to mention but a few. How is a State to know where to go for what service?

Perhaps the most useful service a Federal level coordinating body could offer the States would be that of disseminating information on what the various pro

grams are and how they operate. Obviously, needs are more clearly determined by State and local groups. Oftentimes, however, resources are least where need is greatest. It is easy to know how to get Federal aid when a particular county, city or State is declared to be a disaster area, but it may prove confusing and channels may seem indirect in securing other aid that is there for the asking. Also, local groups may need assistance in seeing some of the broader perspectives of aging. For instance, some needs are obvious to us all. Others are clear only to those who have made a study of the subject of aging.

We are also proud in Alabama of our new medical services for the aging. We have offered care in a licensed nursing home for many years to persons on old-age penison rolls who needed it. Now it is possible to make higher allowances and payments that are more realistic in terms of rates charged. A contributing factor to this progress has been the Kerr-Mills legislation of 1960. Also, under Kerr-Mills, we have developed a program of hospitalization for old-age pensioners as well as limited office visits to physicians following hospitalization. The hospitalization covers only acute illness or major injury and is limited to 15 days to a fiscal year. The physicians' services are also limited as to the amount per visit and the total expenditure.

A third medical program for the aged under Kerr-Mills is Alabama's new medical assistance for the aged. This includes hospitalization on a similar basis to the program for pensioners except there is a deductible item of up to $50 on each period of hospitalization unless it is a direct transfer. Physicians' services are included in MAA and are the same as for pensioners.

I should like to point out that we in Alabama believe that Kerr-Mills legislation is vital, too, in developing medical care programs and we would favor its continuance. In addition, and along with it, we would like to see enacted a program of financing medical care for the aged through social security. We do not see any reason for considering that these programs cannot exist side by side.

Alabama is a case in point. At the end of the 1961 calendar year there were an estimated 265,000 Alabamians in the 65-and-over age bracket. About 153,000 of these were social security beneficiaries. About 100,000 were receiving oldage pensions. There was an overlapping of about 25,000 who received both pensions (assistance) and social security. Thus, only 37,000 Alabamians were not included in either program though some of these undoubtedly would have been eligible for social security if they had chosen to retire.

As I see it, social security medical care would benefit the 153,000, some of the 37,000 and would take from those eligible for old-age pension medical care the 25,000 who are included in the social security beneficiaries. The result would be a reduction to 75,000 of the potential medical care load of pensioners and would also sharply reduce the number potentially eligible for MAA, which now has a rather strict income limit in Alabama. The results would mean that benefits under the Kerr-Mills program could be more adequate and eligibility requirements more liberal.

In brief, while I am fully aware that the total needs of the aged are the same as the total needs of all people, I think that adequately meeting the income and health problems will enable aged persons more nearly to meet their other needs. It is for this reason that we in Alabama place our first emphasis here.

In conclusion, I want to see coordinated efforts at the Federal and State levels and greater public awareness that aging begins at birth and will at some point influence the lives of every American.

TESTIMONY BY W. P. KENNEDY, PRESIDENT, BROTHERHOOD OF RAILROAD

TRAINMEN

I address myself to the proposed legislation to deal directly and comprehensively, yet practically, with the many problems of aging and the aged which are properly the province of government.

In doing so, I want to commend all those who have so selflessly and ably labored to bring this tremendously important complex of problems before the American people and put it in focus for legislation to be enacted now. In this connection, my two good friends, Senator Pat McNamara and Congressman John Fogarty, authors of identical bills S. 2779 and H.R. 10014, are to be singled out for special mention and commendation because they have made such searching studies of these problems and come forward with such vigorous reports and proposals.

THE FACTS

I do not believe our elder citizens should be set apart from the rest of society either in our thinking or our public actions, for they are not made into something alien by reason of having reached age 65 or gone beyond that figure. Yet in this rough and ready industrial and urban social life we are now forced to live, age does become a major factor causing drastic changes that the individual in his private capacity cannot cope with successfully.

Our economy has become impersonal. Most people work for wages and most of them face a compulsory age retirement. Much of industry has raised an age barrier to employment as well. So that the older person is caught in a vise where retirement may be forced upon him whether he is economically and emotionally prepared to meet its obligations or not.

The very size of the problem forces public recognition of it. In 1900 we had less than 4 million persons 65 years or older; today we have 16 million, and this number will double to 32 million in the next life working span of 40 years. By the turn of the next century 1 out of every 10 persons will be over 65.

At the turn of this century a retiring person of 65 could expect to live on less than 3 years; today his average expectancy is 8 years. But the number reaching real old age, say 75 years or older, will triple by the end of the century. While there will be many among them needing health care and nursing attention, by and large these older people will be in reasonably good health and vigor. And among them women will outnumber men for each age group.

Only a handful of these older people are gainfully employed. Unless we change our present working practices substantially, proportionately fewer will have jobs in the future.

Despite the growing number who have some form of private pensions or retirement funds, over half of all retired persons are living on incomes of less than $1,000 a year. About the same proportion have assets of that amount, too. Yet they are potentially a major market for consumer goods as the University of Michigan income studies showed recently. For of all consumer units living in poverty or deprivation a sixth were households whose heads were aged 65 or older.

Such are the bare essential facts of the situation which caused the 1961 White House Conference on Aging to summarize that—

As people pass through their 60's, roles will change. Responsibilities of each person as worker, parent, or spouse will lessen, but those of citizen, friend, church or club member, and user of leisure time may be expanded if he has the desire and capacity and if society expects this to happen and provides opportunities.

A COORDINATED APPROACH

We in the labor movement, and my fellow members in the Brotherhood of Railroad Trainmen, are on record against creating any human scrap heap of older people. We emphatically endorse the conclusion of the President's Conference. We urge that machinery be established which will allow the transition from active working life to retirement status to go ahead without harmful consequences. For these older people are our fathers, mothers, near relatives, friends and ourselves in a few short years.

We are convinced that the White House Conference was right, and that Senator McNamara and Congressman Fogarty are on the right track when they offer legislation to set up a Federal Commission dealing with the many problems of aging in one place under sympathetic and understanding auspices. We believe the argument advanced in favor of this centralized approach has much of merit in it. For the presently widespread responsibility for health, education, recreation, employment, occupational training and retraining, community service, leisure time activities, home ownership, family adjustment, income, and social security and other such endeavors makes impossible any coordinated or thorough attention being given them by any existing agency of the Government. There is a developing science of gerontology, a developing body of professional knowledge, a developing trained leadership in this important area which need to be gathered together in one place in order to achieve greatest good for the people who as they become older are the participants in these endeavors.

WHAT CAN BE DONE?

It may be premature to offer at this stage any comprehensive program which the Federal Commission should follow. But at the same time the facts de