help formulate policy, and while I think the U.S. Council should have its own staff, an office of aging could also be of assistance. I believe that such a council would have the desired effect of stimulating and coordinating action on the part of the various Federal departments, and would insure the vigorous development of the program responsibilities of the Department of Health, Education, and Welfare.

Because I know that you are intrinsically interested in the problems of adult education, I am taking the liberty of sending you the enclosed memorandum which I prepared at the request of Mr. Everett Soop, director of extension, University of Michigan. He in turn had requested its preparation in response to a questionaire from Ed Keller. Thus a copy may already have reached you. If courses of the type described in the mimeo are not within the purview of the Bailey General Extension Act, I would like to see a provision included in H.R. 10014. This along with a provision for emergency training of instructional staff in aging are, I believe, imperative.

Sincerely,

Hon. CLEVELAND M. BAILEY,

Chairman, General Subcommittee on Education,

WILMA DONAHUE.

SAGINAW COUNTY HOSPITAL,
Saginaw, Mich., April 12, 1962.

U.S. House of Representatives, Washington, D.C.

DEAR CONGRESSMAN BAILEY: This will acknowledge your letter of April 3 inviting me to discuss in Detroit on April 16 the need and desirability of a rehabilitation program for the older population.

I am grateful for your kind invitation. Regretfully I have a commitment which I cannot change and I will therefore not be able to be present. However,

I take the liberty of commenting on several items dealing with the subject of rehabilitation of the aged.

I am pleased that Congress gives serious consideration to the problem and perusal of several bills submitted to Congress is indicative of serious thought which is given to the problem by the U.S. Congress.

From the study of the descriptive charts received I hope that the responsibility for the service to the aged will be made part of the Department of Health, Education, and Welfare for the reason that the major problems of the aged are in the areas of health, education, and welfare.

By having a Division of Aging as a part of the Health, Education, and Welfare Department it will offer more direct effective channels of service than an independent U.S. Commission on Aging. Incidentally it would have to depend in all its major functions on the Health, Education, and Welfare Department. As to the special needs of the aged in the field of rehabilitation, I would like to mention first that many present-day problems of the aged are a direct result of neglect by the aged of public health needs during childhood and adult life. Thus the long-range aspects of public health needs of the aged are in intensive and aggressive public health community programs with the child and young adults. I therefore hope that your committee will consider the importance of primary prevention as a factor in reducing the number of disabilities later in life.

The secondary prevention program, as you well know, deals with restorative aspects of disabilities through a dynamic and aggressive rehabilitation program. Our experience is similar to many others that a good program of rehabilitation is tremendously productive in restoring a great many people to the status of total health or at least self-care. This presupposes that the quality of rehabilitation service must be of the highest type in institutions. In my opinion it should be offered in institutions capable to provide such service as carried out in a professionally guided rehabilitation program.

Since the majority of aged people are getting benefits of Government assistance, it appears logical to me that Government owned and operated hospitals such as accredited county hospitals should be encouraged to provide an acceptable program. Regretfully the general hospitals could not be used extensively as a rehabilitation center for indigents because of the excessive costs of such a service.

I sincerely hope that the U.S. Congress will find it possible not only to provide the funds for such a service but to establish standards on the basis of which funds could be provided for rehabilitation programs.

87006-62-pt. 1—35

Since it would be next to impossible to construct enough hospital beds to take care of all of the needs of the aged, both present and future, I am of the opinion that some intermediate programs should be developed similar to the existing "half way house" and "day care center" programs, etc.

I recommend that consideration be given to a day care rehabilitation program whereby the patients, after having achieved maximum benefits in the rehabili tation center could be discharged home or to a nursing home and transported regularly to rehabilitation center to continue their rehabilitation program. This day care rehabilitation program of necessity would be expensive, but much less expensive than a hospitalization program. Both of these would complement each other to a very great degree.

The third phase of the rehabilitation program is home care which calls for participation of the health departments, public health nurses, physical therapists, occupational therapists, social workers, and other paramedical groups to make regular visits to the homes of the patients. To me, this home care program is extremely important as a third phase of the rehabilitation program where the need for hospitalization or day care patient program is no longer imperative and the patient graduates, so to speak, into the home care program. This, in summary, is the rehabilitation program in Saginaw County where respectable strides have already been made.

If one is permitted to dream, I hope that in the future there might be a possibility and advantages of building small apartments for the aged in close proximity to the rehabilitation center. These apartments will offer privacy to the patients and closeness to the rehabilitation center. The regular service by the the health department, and availability of the rehabilitation and recreation program from the rehabilitation center, will be of great help to many ex-patients. My final suggestion is regarding personnel problems. We cannot hope to achieve marked benefits from rehabilitation efforts unless we have competent rehabilitation workers. I hope the professional schools, which develop rehabilitation workers, will continue to expand. I do, however, feel that not all rehabilitation workers must have degrees and 4, 5, or 6 years of schooling. It is too time consuming and will be prohibitively expensive. We should develop some technical schools for physical therapy technicians which will provide a cadre of skilled technical personnel who would work under the supervision of physicians or registered physical therapists. These technicians could do a tremendous job toward making the rehabilitation program not only a goal but a reality.

I respectfully submit the above suggestions and hope you will find them worthwhile.

Thank you again for inviting me.
Very sincerely yours,

V. K. VOLK, M.D., Dr. P.H.,
Medical Superintendent.

STATEMENT OF CONGRESSMAN JOHN E. FOGARTY AT CONFERENCE OF STATE EXECUTIVES FOR AGING, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, WASHINGTON, D.C., APRIL 11, 1962

Mr. Chairman, distinguished guests, ladies, and gentlemen, I am very glad to have an opportunity to meet with you today and to take part in this Conference that has been called to stimulate action and cooperation with officials of State organizations in the field of aging.

Before accepting this invitation to speak, I inquired whether I would be welcome in view of some of my recent statements regarding the Department's program in aging and my strong views favoring an independent U.S. Commission on Aging. I was assured this meeting would attempt to air controversial issues and clarify ways to achieve action.

I commend the courage of the staff and fully endorse the purpose of the meeting.

It has been encouraging to me to find out how many people read the "Hearings on Appropriations." As you can surmise there has been an impressive response running the full gamut of, "you were too severe" or "congratulations on your forthright statement of the facts."

Anyone who is familiar with my congressional record should understand my obsession for practical action and my irritation with vague generalities and

empty words. Having done everything within reason to encourage and support a positive program in aging, my patience has worn a little thin.

I did not introduce the bill for a White House Conference on Aging as a political gesture as some of its critics now choose to remark, but rather as a sincere desire to convene the most knowledgeable people in the field to give serious thought and consideration to the vast uncoordinated research and information and to submit a workplan for action within a reasonable time following the meeting.

As you may recall, the three basic ideas I continued to voice in supporting the legislation were: (1) that the Conference be planned and directed on a bipartisan or nonpartisan basis, (2) that older persons be given the opportunity to speak for themselves, and (3) that government at all levels and organizations, public and private, should come to know the area of responsibility for which each is best qualified and proceed on a coordinated basis.

In the many meetings preceding the White House Conference, I severely criticized those groups and individuals who attempted to divert or pervert the plans and goals of the Conference.

My concern for the aged has never been based on an opportunistic approach to a special interest group. It has been firmly developed over the years on deep awareness of their problems and a firm belief in the need to restore the Nation's elderly to their rightful place as first class citizens with full recognition of their rights, feelings and obligations.

Serving as I do as chairman of the House Subcommittee on Appropriations, I know that the solutions to the problems of the aging at the Federal level are the concern and responsibility of many departments and agencies and not contained within the jurisdiction of any one. In recognition of this fact, I announced my intention to sponsor a bill creating a Federal Commission on Aging at the opening session of the White House Conference on Aging and went directly to the floor of the House and introduced such a bill. I believed then, and time has supported my view, that such a commission would be needed to give meaning and support to the recommendations that would come from the White House Conference, if the meeting were to become something more than just another meeting on aging.

As some of you may know, the scheduled hearings on my bill were postponed last year at my request, to allow the new administration and its chosen leaders in aging to proceed with their plans without undue pressure or conflict of interest.

To further assist the efforts of the staff on aging, I encouraged and supported a request for supplemental funds for expanding staff and developing materials so necessary to achieve even a minimum action program at the Federal level.

There are reasons why the purposes of the supplemental appropriations were not achieved and I do not want to imply that it was due to a breakdown in staff responsibility. I believe they are well qualified and able public servants, and are dedicated in their work. Rather, I am further convinced that the organizational structure is at fault and serves to defeat their aims.

As you know, Senator McNamara had introduced a bill calling for an Office of Aging within the Department of Health, Education, and Welfare which he strongly endorsed at the White House Conference. Since then his Special Committee on Aging has conducted 34 or more hearings throughout the country. Based on firsthand knowledge and information furnished by professionals as well as older persons themselves, the Senator also recognized the need for a more dynamic role for the Federal Government in setting an example and giving leadership to the States and government at all levels.

With these thoughts in mind, Senator McNamara and I introduced identical bills, S. 2779 and H.R. 10014 on January 31, 1962, calling for the establishment of an independent U.S. Commission on Aging with authority and funds to meet the goals of a Nation interested, grateful and faithful to its senior citizens.

We recognized that a commission might not coincide with the administration's aim to reduce the number of such independent bodies, but we felt so deeply the urgency for positive action that the Senator and I sent a joint letter to the President outlining the need for vigorous action at the Federal level to give visibility to the Government's sincere desire to move courageously into the broad field of aging with a balanced program that gives equal recognition to all of the vital programs throughout the entire Government without restricting it to any one department or agency where it becomes a miscellaneous function that does not rate the distinction of a separate line item in the total budget.

87006-62-pt. 1-36

I shall not attempt to go into the details of the bill for a U.S. CommissionIt may be helpful if I call to your attention as State officials to several of the features that have direct bearing on your programs and the function for which you have responsibility.

Title IV of the bill on planning grants would appropriate $2,090,000 for grants to States "for establishing and inititaing the operation of a State agency to, or improving the operation of an existing State agency to, and for assisting such agency to

(1) plan new or improved programs to carry out the purposes of the act; (2) assist communities in planning and developing such programs;

(3) improve the coordination of programs and other activities to carry out the purposes; and

(4) conduct studies to assist in planning and improvement of such programs. Title V covering project grants would authorize to be appropriated for each of the next 4 fiscal years the sum of $10 million for grants to States for projects for

(1) community planning and coordination of programs for carrying out the purposes of this act;

(2) demonstrations of programs or activities which are particularly valuable in carrying out such purposes;

(3) training of special personnel (including volunteers) needed to carry out such programs and activities; and

(4) establishment of new or expansion of existing programs to carry out such purposes, including establishment of new or expansion of existing centers providing recreational and other leisure time activities and informational, counseling, and referral services for older persons and assisting such persons in providing volunteer community or civic services.

Times does not permit going into the many other ramifications of the bill that were purposely designed to answer the needs of States and their programs. It does take full advantage of the talent and experience that the States have identified and gives assistance and support in such a way that it will stimulate and encourage further effort without the threat of domination or control. I have brought copies of the bill for you to study, consider, and yes, support.

I am sure that when you read the bill in its full context you will realize that the purpose of a commission transcends personalities and is not a reflection on the efforts of these who are doing their best under unrealistic, organizational barriers.

The U.S. Commission in no way detracts from the importance or significance of the Department's programs concerned with aging. Anyone knowledgeable in the field of aging must be aware of the tremendous task of coordinating and relating the farflung programs of HEW.

The broad implications for aging in the Public Health Service and the Institutes of Health, the social security program, Food and Drug Administration, vocational rehabilitation, and the many aspects of the Office of Education and the special staff on aging require the full-time attention of all staff available. You must also recognize the need for the Department of Labor with its vital role in employment and training to be fully recognized in a Federal program in aging, together with all of the needs of the elderly represented in the responsibility of the Housing and Home Finance Agency. The far-reaching activities of the Department of Agriculture, Veterans' Administration, and other agencies of the Federal Government deserve to be represented as equal partners in meetings to determine national policies and goals for our senior adults.

I would like to call your attention to the President's message of March 29 which recommended a reorganization in the field of science and technology. This calls for the establishment of an Office of Science and Technology in the Executive Office.

Of special interest is the supporting language contained in a study submitted to the Committee on Government Operations in the Senate by its Subcommittee on National Policy Machinery.

"The range of agency technical activities is immense ***. No one person in the Government, nor any one committee of directors, can have detailed knowledge across the whole spectrum of science. The departmental experts in each field, together with their agency heads, must bear the main planning burden on programs related to their departmental missions.

"At the same time, a President can be greatly helped by having his own abovethe-department science advisers. They can give him counsel 'in the round'—from

a Government-wide, rather than departmental, perspective. They can assist him in cross-agency coordination. They can alert him to promising developments lying outside of obvious agency missions and having no departmental home. They can call to his attention programs of high national priority, but low agency priority. They can help him in checking on agency performance." This is precisely the point Senator McNamara and I made in our first letter to the President and again in a joint letter we sent to him yesterday endorsing the same reasons for establishing an independent commission on aging.

This concept of a commission is one that States have been encouraged to establish to meet their needs and overcome difficulties in interdepartmental relationships that exist much as they do at the Federal level.

There is more I could say, but I feel certain you must be aware of my conviction that the establishment of the U.S. Commission is the most promising hope we have of meeting the challenge that we have shadowboxed too long. It will bring into reality those overdue promises we have continued to make to our citizens over the years.

I pledge you my support in moving forward in an area where we share common interests and goals and must coordinate all of our efforts if we are to achieve and maintain the leadership that is America.

DYNAMIC PROGRAMING FOR THE AGED PROBLEMS AND METHODS IN PROGRAM PLANNING AND COORDINATION

(By Elva D. Walker, chairman, Governor's Citizens Council on Aging,

Minnesota)

(Prepared for Conference of State Executives for Aging, April 9-12, 1962, Special Staff on Aging, Department of Health, Education, and Welfare)

PROGRAM PLANNING AND COORDINATION

Implicit in effective programing and coordination are recognition of certain basic factors:

1. Program planning to be effective must recognize, catalog, and plan to meet the needs (primal).

2. It must aim to equate, orient, and initiate resources to allow for varying needs.

3. It must seek and it must visualize new dimensions and scopes for problems in order to meet the complexities of modern life.

4. It must recognize the role of modern science and technology in terms of future needs from both the negative as well as the positive aspects.

5. It must identify potentials for change, give cognizance to the fact that long-range planning will and can put day-to-day problems into proper perspective.

6. It must recognize that the development of a master plan is vital for the provision of continuity and direction.

7. It must recognize the fact that planning bodies must win the support and confidence of their affiliates (involved citizenry).

In other words, effective, dynamic program planning is a vigorous creative art which has in it the components of a highly specialized science.

"Given all of these things," someone asked, "If you could have your choice, how would you do it? If you could start from scratch, where would you begin?" "Well," I smiled, "I'd-" I'd what?

Well, I guess I'd think awhile.

There is a need, there are people, there are programs, there are resources, there is involvement, there is commitment, there is decisionmaking, there is implementation, there is coordination, there are goals. All of these underscore a dynamic program.

How would I do all this? I'd start from the premise:

The broader the people involvement, the greater the potential for progress. But the involvement must be interested, openminded, resourceful, imaginative, Prescribed along with the "people involvement" must be a willingness to look for alternative solutions and the ability to weigh projected results in terms of ultimate goals.

Then: What are the techniques for developing a creative, dynamic program? What elements are basic to a program which seeks to establish and resolve the