better chance to avoid the pitfalls of longterm bed confinement. This is vitally important not only to the patient, but to the community that has to foot the bill. The 1959 annual report of the Laguna Honda Home for Aged in San Francisco, poignantly shows the cost differential in inpatient care: Hospital inpatient $8.50 per day; semiambulatory $6.12 per day; ambulatory $3.58 per day. There are approximately 15 million people presently over 65 and by 1975 this number will reach 21 million. The percentage of older people coming to podiatry offices approaches 50 percent of patient volume. In one of the largest foot clinics in the country affiliated with one of our schools, the number of patients visits by individuals over 65 constitutes almost two-thirds of all patient vistis. One home and hospital for the aged in a recent year had 164 residents and permanent hospital patients. Of these, 147 had consultation in the chiropody department. The department with the next largest number of consultations was eye, ear, nose, and throat, with 79. Here in Florida, we have men inhospital outpatient clinics, and nursing home clinics, performing the functions mentioned above. However, not all the patients who require care get it because of the lack of funds. Many are not close enough to large hospitals to avail themselves of the clinic facilities. Many over 65 do not fall into the category of hospital or nursing home patients, and cannot get treatment without signing a pauper's oath, because their fixed incomes will not permit any but the most disastrous emergency care. We have run a preliminary survey in conjunction with the White House Conference. This reveals the area of greatest need footwise, and where the greatest emphasis on research should lay. But here too, finances limit the extent of the survey. With appropriate funds we could pursue these areas of need and find answers to many of the problems for the aged here in Florida. I would like to thank you for this opportunity of appearing before you. I hope I have pointed out where our present programs are not meeting the needs, and where we as podiatrists can help keep our senior citizens on healthy feet, and contribute to objective No. 3 of H.R. 10014. If you have any questions I will be happy to answer them to the best of my ability, and if I don't have the answers immediately available I will get them for you. FLORIDA DEVELOPMENT COMMISSION, Hon. CLEVELAND M. BAILEY, Chairman, General Subcommittee on Education, House of Representatives, Washington, D.C. DEAR CONGRESSMAN BAILEY: This is in response to your invitation request of April 18 to set forth my views on legislation now pending in Congress to establish a Federal Commission on Aging. As manager of the retirement department of the Florida Development Commission, it has been my privilege to have been closely associated with all public and private groups in Florida concerned with the problems of older people since November 1955. I served as staff director for the Citizen's Advisory Committee on the Aged, which prepared Florida's State report for the White House Conference on Aging titled, "Florida Presents an Action Program on Aging." I have been one of the trustees of the Florida Council on Aging, a statewide nonprofit organization, for the past 5 years. I was a delegate to the White House Conference and have attended all Washington meetings of State officials on aging beginning in 1956. My testimony on the subject of aging before the McNamara committee in Miami, December 2, 1959, and again before the Smathers committee, November 8, 1961, in Sarasota, is a matter of record, and reference thereto is hereby made. Senate bill 2779 and House bill 10014 are designed to implement the policy statement of the White House Conference. I endorse and strongly favor these bills. Sincerely, J. M. BUCK, Manager, Retirement Department. Hon. ADAM C. POWELL, THE ALHAMBRA, A CALIFORNIA LUTHERAN HOME, Chairman, Committee on Education and Labor, DEAR MR. POWELL: I was requested to attend a field hearing on the matter of the aged and the aging held recently in San Diego, Calif. I was to represent the Southern California Association of Homes for the Aging. Because of an unavoidable conflict, I was not able to attend and therefore felt that a brief comment to you might be in order. There are just a couple of comments about the existing and future legislation dealing with the aging that I would like to make and bring to your attention. Basically, I feel that the current program of housing under section 231 of the Federal Housing Act is a great help in solving the housing problem. The most glaring failure of this particular section, however, is that it prohibits the inclusion of adequate infirmary or nursing care facilities. I, myself, am involved at the present time in the construction of a "life care" facility under the program and I am faced with a problem of providing separate nursing facilities since the same were not allowed adequately under the program as it now stands. Therefore, my feeling is that those who designed this law were not familiar with the need for having housing for the aging and infirmary facilities in the same program. This leads me to my second suggestion about future legislation. As I understand it, it is now possible to get 90 percent financing for nursing care facilities. Because I am convinced that this is a greater need than housing itself, I would like to feel that future legislation would be even more encouraging to the sponsors who can provide nursing care or convalescent care facilities. A program offering 100 percent financing similar to section 231 would seem to be quite helpful in this regard. I could go into each of these comments at greater length but I believe that you and your committee would be able to interpret from what I have said the stories behind the concerns that I have mentioned. If any consideration can be given to these suggestions I would be most grateful. If any further information would be desired I would be happy to comment further. Thank you for your concern in this challenging matter. Sincerely yours, Rev. JOHN R. STEINHAUS. AMERICAN PUBLIC WELFARE ASSOCIATION, Congressman CLEVELAND M. BAILEY. DEAR CONGRESSMAN BAILEY: In behalf of the American Public Welfare Association, we are submitting for the record of your committee a statement relating to several bills now before your subcommittee which provides various proposals for increased Federal aid to the aged. We wish to register our wholehearted support for the objectives of this proposed legislation and for provisions in the bills which provide grants to the States for the purpose of establishing and strengthening programs and activities on behalf of the aging over the Nation. We wish, however, to raise several questions relating to the organizational structure and methods suggested in some of the proposals. The American Public Welfare Association is the national membership organization representing the field of public welfare. Public welfare agencies supervised or administered at the State level, with their offices in the more than 3,000 counties over the Nation, have as a part of their day-to-day responsibility the provision of financial assistance, medical care, and whatever other help and counsel possible to aged persons. The public welfare field is thus vitally interested in any Federal legislation which will affect aged persons. Each year the association, through action of its board of directors, representing all parts of the Nation, adopts official policy positions on issues of current significance to the public welfare field. These are expressed in the Federal Legislative Objectives, the 1962 issue of which is attached. We have checked 87006-62-pt. 1—38 several items which we believe have special significance to the needs of the aging. We would call your special attention to items No. 10 and No. 25: 10. Specific provision should be made for Federal financial assistance to States to stimulate and support services and facilities to promote the health and welfare of aged persons irrespective of their financial mood. 25. The Federal responsibilities relating to financial assistance and welfare services should be closely interrelated at an effective operating level. These statements have pertinence to bills before your committee. No. 10 indicates our support of the objectives and the proposed grants to States for the aging. No. 25 is the basis for our questions regarding some suggested administrative methods. We should like to expand on these questions. There are, at the present time, on both Federal and State Government levels, a number of operating units which have broad responsibilities for the aged as part of their total function. We believe a review of present on-going State units for aging will indicate that some of the most effective are those attached to an existing departmental unit within the State government. This approach can provide visibility to a program, offer a centralized service of information, establish and use a wide range of citizen advisory committees, provide for close interdepartmental functioning, make productive use of existing staff skills, and often can accomplish these functions more economically. It seems evident that it is possible for an operating unit in government to serve a coordinating function either through administrative directive or legislative action, and provided adequate funds are available for the function. We question, therefore, the advisability of establishing a separate agency for the coordination and administration of services to the aging. On the other hand, if a separate coordinating unit should be established, we would question whether this unit should be given operating functions. We raise this question since several proposals before you provide that the grants to States be administered by what is essentially a coordinating body. We wonder whether such an approach would not run the risks of administrative confusion, unnecessary duplication, and undue complexity and cost. The association heartily commends your committee for its thoughtful and informative deliberations on the many proposals before you. It is through such efforts as those of your committee, and the proposed health insurance under social security, which we strongly endorse, that the needs of the senior members of our Nation will be more fully met. We will appreciate your including in the record this letter and the attachment JAY L. RONEY, AMERICAN PUBLIC WELFARE ASSOCIATION, FEDERAL LEGISLATIVE OBJECTIVES, 1962 (Prepared by Committee on Public Welfare Policy, approved by the board of directors, November 27, 1961) The American Public Welfare Association believes that the States and their political subdivisions have the primary responsibility for developing and administering effective public welfare services in the United States. The Federal Government has the obligation to develop nationwide goals and guides for program content and to use its constitutional taxing power to equalize the financing of public welfare so that public welfare services may be available on an equitable basis throughout the country. The States, their political subdivisions, and the Federal Government, in cooperation, must provide the leadership and the professional and technical personnel to carry out these obligations. The association's legislative objectives are based on these premises and on the recognition of the important role of public welfare in preserving and strengthening family life, encouraging self-responsibility, and assuring humanitarian concern for all individuals and families. To accomplish these purposes the association believes in the following basic principles: (a) A democracy has the special obligation to assure to all persons in the Nation full and equitable opportunity for family life, healthful living, and maximum utilization of their potentialities. (b) Contributory social insurance is a preferable governmental method of protecting individuals and their families against loss of income due to unemployment, sickness, disability, death of the family breadwinner, and retirement in old age; and against health costs of OASDI beneficiaries. (c) Public welfare programs should be family centered and should provide effective services to all who require them including financial assistance and preventive, protective, and rehabilitative services, and these services should be available to all persons without regard to residence, settlement, citizenship requirements, or circumstances of birth. (d) The benefits of modern medical science should be available to all; and to the extent that individuals cannot secure them for themselves governmental or other social measures should assure their availability. These general principles are amplified in other policy statements approved by the board of directors of the association. The committee on public welfare policy of the association has reviewed all of these statements in the light of current needs and has developed specific legislative objectives for 1962. While the following list does not include all of the association's policy positions, it presents in condensed form those immediate and longer range legislative objectives which are most likely to be of current significance in improving public welfare services. Scope of program PUBLIC WELFARE PROGRAMS 1. The comprehensive nature of public welfare responsibility should be recognized through Federal grants-in-aid which will enable the States to provide not only financial assistance, including medical care, and other services for the aged, the blind, the disabled, and dependent children, but also general assistance and services for all other needy persons. 2. Federal financial aid should be available to assist States in carrying out public welfare responsibility for preventive, protective and rehabilitative services to all who require them, irrespective of financial need. The Federal Government should participate financially in State and local projects which would encourage, extends or establish programs for self-support, self-care or the rehabilitation of persons receiving or likely to need public assistance. To carry out these objectives State and local public welfare services should be strengthened by provision for reduced and specialized caseloads, homemakers and other specialized personnel. 3. The Federal Government should participate financially only in those assistance and other welfare programs which are available to all persons within the State who are otherwise eligible without regard to residence, settlement, or citizenship requirements. 4. Federal financial participation for medical assistance should be available to all needy individuals on the same basis. 5. The Federal Government should continue to participate financially in assistance to needy dependent children only if such assistance is available to all needy children living in the home of a relative. The circumstances of a child's birth or the suitability of the family environment should not be factors in determining eligibility for assistance, but should be dealt with through appropriate social services and judicial processes. 6. Federal financial participation in assistance and other services for needy children should be extended on a permanent basis to include both parents when in need and living in the home. 7. Provisions for Federal financial participation in the maintenance of children in foster care should be continued and strengthened. 8. Child welfare services should be broadened in scope and should specifically include services for the delinquent child and provisions for day care. Federal funds authorize and appropriated should be increased sufficiently to extend, improve and support adequate child welfare programs. Federal financial assistance to the States to stimulate and support programs for the prevention and control of juvenile delinquency should be provided. This should include research and the training of personnel. 9. Federal financial participation should be available to the States for assistance to needy disabled persons without regard to any age requirement or any requirement that a disability be permanent and total. 10. Specific provision should be made for Federal financial assistance to States to stimulate and support services and facilities to promote the health and welfare of aged persons irrespective of their financial need. 11. The Federal Government should participate financially in the costs of any State and local civil defense welfare services. 12. Federal legislation should continue to provide funds for American nationals who are repatriated from abroad and in need of assistance and other services. 13. The Federal Government, in cooperation with the States, should study: (a) the costs and policy implications of and the alternatives to removing the restrictions on Federal financial participation in assistance payments to, or in behalf of, individuals in mental hospitals, tuberculosis hospitals, and public nonmedical institutions; and (b) the costs and policy implications of exemption of income earned by public assistance recipients. Methods of financing programs 14. The continuance of the Federal open end appropriation is essential to a sound State-Federal fiscal partnership in all aspects of public assistance. Since it is not possible to predict accurately the incidence and areas of need, flexibility and comprehensiveness are necessary in financing public assistance programs. 15. Federal financial participation should be on an equalization grant basis provided by law and applicable to financial assistance, including medical care, for all needy persons; welfare services, including child wlefare; and adminis tration. 16. Any maximums on Federal participation in public assistance, including medical care, should continue to be related to the average payment per recipient and should be increased sufficiently to assure for all needy individuals reasonable standards of maintenance, comprehensive medical care of high quality and appropriate quantity, and the preservation and strengthening of family life. 17. Federal participation with respect to dependent children should be increased to a level which will assure treatment of such children equitably with that accorded other public assistance recipients. Provisions should be made so that children with earnings from employment may be allowed to retain all or part of such earnings. 18. No change should be made in the Federal matching formulas which would result in a reduction in the Federal share of State and local administrative costs. 19. Federal aid for public assistance should be on the same basis for Puerto Rico, the Virgin Islands, and Guam as for other jurisdictions. The annual dollar limitations on Federal participation for these jurisdictions should be removed. Administration 20. States should have the option to administer Federal funds for assistance and services by categories, by a combination of two or more of the present categories, or by a single comprehensive program covering all needy persons. 21. Adequate and qualified personnel is essential in the administration of public welfare programs. Administrative and service costs of State public welfare programs should be identified separately and Federal financial participation in such costs should be sufficient to enable States to provide for the adequate administration of all public welfare programs, and the rendering of appropriate services. 22. Adequate Federal funds should be appropriated to assist States in training State and local public welfare staff. 23. All public welfare programs, including financial assistance, medical care for needy persons, and other services, in which the Federal Government participates financially should be administered by a single agency at the local, State, and Federal level. 24. Federal, State, and local public welfare agencies should participate in and assist in the administrative coordination of all related programs in which there is Federal financial participation. 25. The Federal responsibilities relating to financial assistance and welfare services should be closely interrelated at an effective operating level. OASDI SOCIAL INSURANCE PROGRAMS 26. The contributory old-age, survivors, and disability insurance program, as a preferable means of meeting the income-maintenance needs of people, should be-strengthened. Among the needed improvements are: making benefit payments more adequate; increasing the amount of earnings creditable for contribution and benefit purposes in line with current earning levels; broadening the scope of disability insurance protection, especially by eliminating the require |