Suicidally motivated self-neglect, which is already a serious problem with poor old women and men, will become an epidemic.

Three quarters of the elderly poor are widows. The older they become, the poorer they are, and the larger the percentage of women. Of the 4.3 million (22%) of older persons living below the poverty threshold, almost 2.6 million or 60% of these poor were living alone or with nonrelatives. Of these, more than 2.1 million were women, mostly widows.

Instead of cutting widows' income to decrease the national deficit, older women need vast increases in aid. They deserve restitution for the years of unpaid labor in the same manner that defendents in equal pay cases receive back wages for the unequal treatment they endured. At the very least these women deserve freedom from economic want and adequate medical care in their final years.

As Congress considers the new budget, major attention should be directed toward these poorest of the poor. If emergency energy measures are needed, a minimal "lifeline" for heat and electricity should be established to insure that no one freezes to death. Social Security cost of living increases, delayed far too long already, should be made available while additional reforms to raise the system from the bottom are considered. These reforms should include coverage of homemakers, to guarantee each person security in her or his own right.

The National Organization for Women works to correct inequities between the sexes at all levels. We believe that the unity of women can move this nation away from self-destruction toward priorities based upon human need. In the present critical period we call all women to the defense of elderly women singled out as sacrifices to the economic crisis because they are poor and powerless. Together we can stop this outrage.

TESTIMONY FOR SECRETARY'S ADVISORY COMMITTEE ON RIGHTS AND RESPONSIBILITIES OF WOMEN, DEPARTMENT OF HEALTH, EDUCATION AND WELFARE

Women come in all ages. As we grow older, there are more and more of us, percentage-wise, and the problems we had when we were younger are usually accentuated. If we were poor before, we are likely to be poorer; if we were sex objects, now we are obsolete ones; if we had job problems earlier, they are far worse past forty; and if we had trouble with identity then, now we have receded into the wallpaper even as far as women's rights are concerned. So women's problems don't fade away-they end up in nursing homes. We would therefore like to present evidence to convince you that some of the most pressing problems of older women be considered for presentation to the DHEW in the development of its work priority areas for 1975.

We are particularly concerned that as rapid social changes take place in sex roles, divorce laws, employment patterns and social customs, that women whose roles were defined in an earlier day not become the victims of careless planning, and that in overcoming inequities in one group we not create new inequities for another. To prevent such negative impact, special attention should be given to the circumstances of women in the middle years and older.

To narrow the problem further, the Department of HEW should look at the growing number of older women on their own, most of whom expected to be homemakers all their lives. These women bought the social contract of man the breadwinner and woman the homemaker. They forfeited their earning capacity to the family interests, and expected to be taken care of by their men. When divorce or widowhood hit in the middle years they discovered that they fell between the cracks of all social programs. No AFDC welfare because the children were grown; no unemployment insurance (though they were certainly unemployed), no social security and no medicare.

Non-married older women single, separated, divorced or widowed are a large and growing segment of the population. There are 21.8 million women between ages 45 and 64. Two million of them live in families headed by females. Another 5.1 million non-married women live alone or with unrelated persons. Of nonmarried women 45 to 54, 72% are working outside the home, but the percentage drops to 63% between ages 55 and 64. Although 81% of women 45-54 are married, only 66.5% of women 55-64 are still living with husbands. Since these middle years are a "non-covered" or black-out period as far as protections for the dependent homemaker are concerned, this Advisory Committee might select this target group for special attention in 1975. Here are some directions that attention might go:

Health

In these middle years when few economic resources and services are available, health care needs usually increase. In addition, many non-married older women are newly poor and will not accept the stigma of welfare. Even in states where there is a "medically indigent" category, women are reluctant to apply, don't know how, or are loath to risk what small assets they may have, to qualify. Women who work are often employed part-time, and therefore not covered by company health plans, if any. The result is that middle-year women who are poor tend to neglect health needs until they become eligible for Medicare. This is unfortunate because emphasis on preventive care in these years could reduce later institutionalization and disablement. Also simple screening for such diseases as breast and cervical cancer could prevent deaths through early detection. A positive mental attitude toward the process of aging, based on knowledge and active participation in maintaining health, could prepare women for the years ahead.

The NOW Task Force on Older Women prepared for the Regional Office of HEW an outline for a health oriented WELL WOMAN CENTER for women from menopause to medicare, with emphasis on preventive medicine, healtheducation and positive aging (copy enclosed). That concept is presumably going through the labyrinth of the Department at the present time. Perhaps your committee could help stimulate enthusiasm for the idea as a model project or feasibility study. (Note: the NOW Task Force has no interest in running a center, but sees the need for such facilities).

In addition to practical models, there is great need for research and education concerning menopause. The lack of medical research on estrogen replacement therapy and other aspects of menopausal care is reminiscent of the slow start an research on sickle cell anemia. If raging hormones are said to make us unfit for the presidency and other high level positions, then attention should be given to that medical question, if only to expose the myths.

Education

Ever since Betty Friedan wrote The Feminine Mystique women have been told to follow the academic trail to create a new and independent life for themselves. Unfortunately, for those who got the message in later years, the results have been anything but encouraging. Vast numbers of unemployed teachers, librarians, social workers, etc., testify to a glut in the traditional fields, with younger applicants in a more favorable competitive position. Community colleges, which have tried to be receptive to the large number of re-entry women through development of "continuing education programs for women" have thus far failed to come to grips with the realities of post-collegiate experiences of mature women, most of whom expected employment when they finished.

Example: A divorced woman of 54 who has been a dependent homemaker for 31 years. There is little community property except a home with a mortgage. The judge is attuned to the new equality of women and awards the woman two years minimal spousal support for "retraining." She is bewildered by her new status, her self-esteem has taken a nose-dive, and she spends the two years back in college as she tries to figure out who she is. Now the support has stopped and she tries to get a job. Uncertain of herself, untrained, ineligible for government training programs, she finds that a 56 year-old woman who has been out of the job market for years can do baby-sitting (at less than minimum wage) or work in a nursing home (at minimum wage).

In war time the government can devise innumerable short term training courses to fill labor shortages in critical occupations. Our recent Task Force study of the Rosie-the-Riveters revealed that most of these women learned their dramatically new skills on the job or in very short-term courses. Could not the principles of such compressed courses be adapted to the employment needs of mature women and men? Could not some general requirements be waived, examinations be devised as alternatives for highly motivated older persons (primarily women) who need to hasten the degree process; could not evaluation be made of community experience to substitute for some general requirements? (A League of Women Voters activist probably knows more about the day-to-day workings of government than many teachers of civics courses)

What is needed are some guidelines for continuing education for women, which would include input from those who have gone back to school (and who have or have not made it) and from organizations working to aid women as they move

from dependency to self-sufficiency. The inadequacy of present curricula reflects the lack of real communication between campus and community, between the dean and real world that older women face. These Guidelines should include criteria for initial training, specifically geared to employment possibilities, review training, to update rusty skills, and expanded training, to bring women up-to-date with changes in their fields during their home-bound years. Additionally, there are women who will require career-sampling courses to decide where they are headed. Such Guidelines would at least stimulate discussion on this very neglected area.

Moving ahead, there needs to be attention to the gross age discrimination in the entire field of scholarships, student loans and admission to graduate study. These are unjust in any case, but have particularly negative impact on persons who have postponed careers to raise families, which category is almost exclusively women.

Welfare

The middle years vulnerability of homemakers through "forced retirement" of widowhood or divorce has been given scant attention. Example: a widowed homemaker of 50 has had her moderate resources wiped out by medical costs of her husband's terminal illness. She is desperate and distraught, but finds she is only eligible for modest burial funds from the Veterans' Administration. Since she is neither blind nor disabled, she is not eligible for SSI funds, yet is unable to work even if she could find a job. Her only hope is general assistance (California State average $87 per month). Unfortunately she is neither an alcoholic or drug addict, in which case she would be eligible for rehabilitation.

Question. What government programs could be extended to homemakers at age 50? to provide training. stipends and supportive services for those suddenly dumped on their own through widowhood or divorce? How can those social protections from sudden hardships won through collective effort be extended to homemakers, whether through applying the community property principle to social security, insisting upon the right and opportunity to work (including effective compliance machinery), legally viable marriage contracts which provide real safeguards, workmen's compensation coverage for homemakers, unemployment compensation for divorced women whose ex-husbands default on spousal support, or whatever solutions the creative minds in the Department of HEW can devise. The largest body of workers still left unprotected by legislation (including disability protections, social security or unemployment compensation) is comprised of homemakers.

Aging

Women's special problems don't disappear at 65, but they fall into a new classification. At that age men and women lose their sex and change into senior citizens. This new status falls within the purview of different laws, bureaucracies and disciplines. In these, older women tend to become invisible, but the constituencies of the actual programs are overwhelmingly female. Perhaps this is underplayed because a look at the startling predominance of elderly women who make up the problem areas of aging would reveal society's rewards to women for performing their traditional roles.

This past month, St. Anthony Dining Room in San Francisco called in reporters to celebrate its 11 millionth free meal. The person so honored was an 86-year old woman with income of little over $100 a month, who confided that she was "absolutely dependent" on the balanced meal served by the Catholic agency. The deputy director of the project told reporters, "The old stereotype of some

wino as the usual diner doesn't hold any more." Elderly women on fixed incomes are now the main customers.

This committee might recommend that the Dept. of HEW examine the sex differentials in aging more closely, to determine both the causes of the problems and to devise more viable remedies. For example, sixty-five is the standard mandatory retirement age for men, but women often face the same crisis at an earlier age as mentioned earlier, complete with economic, physiological and psychological trauma. Far more women end up in nursing homes than men. because elderly widowers have more options to remary someone who will tako care of them. There are many times as many elderly widows as widowers. Although HEW statistical reports do not emphasize breakdowns by sex in “Advance Report-Income and Poverty in 1872" (Facts and Figures on Older Americans. Number 7) one chart shows that there are over 5 times as many women as men 48-087-75-25

over 65 who live alone or with unrelated individuals, who fall below the poverty threshold. The fate society allocates to aged females exposes the myth of special protection better than at any other time of life.

Clearly there are no simple answers to these problems. We have presented some of them briefly to indicate why the special problems of older women should be included in the DHEW work priorities for 1975. From a positive viewpoint, concern with issues of personal interest to women who have followed traditional occupations, and with programs to ease the effects of changing sex patterns, will win support from established women's organizations, most of whose members are no longer young. In turn, broader support for programs of particular interest to younger women will be forthcoming. And lastly, each member of this committee will one day be an older woman (or man), if you live so long.

WELL-WOMAN CENTER

Feasibility study for a health oriented center for women from menopause to medicare, with emphasis on preventive medicine, health-education and positive aging.

The Middle Years Women

Outline

Difference in aging patterns of men and women have not been sufficiently considered. Because men face retirement (voluntary or mandatory) at 65, this is usually the age when specialized geriatric care and aging programs begin. But women, especially homemakers, experience similar "retirement" when they are widowed, divorced or when children leave home. During this same period they undergo the physical psychological impact of menopause.

This is also the time of life when women who were dependents (economically and personally) are increasingly on their own. Although 81% of women 45-54 are married, only 66.5 of women 55-64 are still living with husbands.

In these middle years few economic resources and services are available. Unless there are dependent children in the home, a woman is not eligibile for welfare (with its accompanying Medicare card). Unless she is blind or disabled. she is excluded from Supplemental Security Income and medical benefits. In California, average general relief awards are $85.34, with 12 counties having no benefits whatever. Furthermore, many non-married older women are newly poor and will not accept the stigma of welfare. Even in states where there is a "medically indigent" category, women are reluctant to apply, don't know how, or are loath to risk what small assets they may have to qualify. The result is that middle-year women who are poor tend to neglect health needs until they become eligible for Medicare. Women who work are often employed part-time, and therefore are not covered by company health plans, if any.

Poorly informed on health matters because of over-reliance on the physician and taboos on subjects related to the reproductive organs (i.e. older women are embarrassed by vaginal discharges, body odor, menopausal symptoms and sex) — the middle-years woman is illprepared to maintain her own body.

In a youth oriented culture middle aged women generally experience low selfesteem because of excessive value placed on youthful appearance. Many will neglect medical examinations but will never miss an appointment with the hairdresser. They will avoid a dental check-up to save money, but pay far more for wrinkle creams and hair dye.

Emphasis on preventive care in middle years could prevent later institutional care and disablement. Also simple screening for such diseases as breast and cervical cancer, which strike so many women over forty, could prevent deaths through early detection. A positive mental attitude toward the process of aging, based on knowledge and active participation in maintaining health, would help prepare women for the years ahead.

Functions of a WELL-WOMAN CLINIC

1. Examinations. Basic physical examination of chest, heart and lungs. abdominal, breast, pelvic and rectal areas. PAP smears, urinalysis, simple blood tests. Emphasis on screening for vaginal and breast cancer. diabetes, hypertension. varicose veins, hypoglycemia, foot disorders and other common health problems of older women. Conducted by nurse-practitioners, taking adequate time to explain and educate. (Women in this generation are particularly reluctant to "take the doctor's time" to allay their fears or learn what they could do for themselves in regard to health care.)

2. Information and referral. Lists of physicians and clinics as well as related services. Individual attention by medical social worker and trained assistants, to answer the question, “What are my options?"

3. Discussion and activity groups. Menopausal rap group. Weight and nutrition. Creative aging (positive support groups to combat negative self-image) Assertiveness exercises and body control. Led by staff and trained participants.

4. Educational meetings and programs. such topics as: Estrogen replacement: pros and cons; "Masterctomies and their aftermath"; "What do we have to learn to live with." Films, visual-aids and lively discussions.

5. Educational materials. Popular pamphlets and health educational materials will be available. Where nothing adequate is at hand (e.g. menopause) appropriate materials will be developed.

6. Special examination programs on rotating basis (perhaps monthly). Glaucoma, peridontal disease, osteoporosis, podiatric examinations, chest X-Rays, immunizations, etc. All with assistance of cooperating medical facilities.

7. Involvement. Participants will be encouraged to become actively involved in developing and interpreting the program to the community and making it a cooperative venture. Rather than "volunteering" in the traditional sense, women will make the center their own by developing a warm supportive atmosphere, and by advocating for the type of medical services that meet their needs.

8. Training for paraprofessionals. The best medicine for what ails many older women is a job. Practical experience to supplement courses available in the community. Programs to upgrade skills of staff (paid and unpaid).

9. Research component. The Center could provide excellent opportunities for research related to menopause and pre-geriatric disorders of women. Concentration upon this one segment of the population should facilitie investigation. However such research should be conducted with full understanding and cooperation of Center participants.

10. Health emphasis. Most medical facilities focus inevitably upon illness. Good preventive care is rare at best. A WELL-WOMAN CENTER should take the opposite perspective by encouraging women to care for themselves, to feel good at whatever age, and by developing a mutual support atmosphere which minimizes distinctions between staff and participants.

Preliminary data needed

Because of sexist bias and the presumed dependence of women on husbands, there has been inadequate study and analysis of the medical needs of the middleaged woman. Such study could start with the following questions:

1. From census data, how many women are there between forty and sixty-four, what is their marital status (40-49, 50-59, 60-64). What is their economic status, especially the non-married women? What is the ethnic composition?

2. What type of health coverage do they have? (Beware of projecting percentages from population averages? The female pattern is not necessarily the same as the male.)

3. What disorders of middle-year women are most frequent? Which of these could be most fruitfully screened by nurse practitioners?

4. How do doctors handle common complaints of women through the menopausal years?

5. To what extent do women (especially non-marrieds) have regular check-ups (PAP smears, breast, blood pressure, eye, hearing, dental etc.) during these pre-geriatric years? (Beware of averages. Some women use medical facilities inordinately, many others not at all.)

6. What kind of statistical research could be conducted in conjunction with a screening project as described above?

7. What other models are there for a preventive, positively oriented, involvement-geared health facility in this country or abroad (eg. well-baby clinics)?

PROBLEMS OF SOCIAL SECURITY AND INCOME MAINTENANCE

There have been profound social changes in the past thirty years since Social Security legislation was enacted. Adjustments have not adequately reflected these changes, nor have the basic philosophical issues been addressed. These are: the equality of women and the right to dignity in old age. In the present economic situation, older women are caught in the double traps of changing sex roles and the plight of the elderly under inflation. As the crisis deepens, we must look beneath the surface of sex differentials in law to the reality beneath, and begin to cope in a more fundamental way with the issues.