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Someone to Care

One fact stands out as we grow older: The years force our body to pay a toll. We may be rich. We may be poor. We may have the best medical care. We may have none. We may carefully choose

our diet. We may not.

But, the toll for each added year is inevitable, and the effect is at least a gradual decline in our ability to be active.

Medical science and the other sciences each year are discovering new ways to slow down the decline and new ways to rehabilitate us if we are incapacitated by sickness or injury. But scientific inquiry is a slow and painstaking process, and many of the secrets of life and health are still locked in the vault of time.

Thus, we see among our older Americans several million-mostly in their 70's, 80's, and 90's-whom the toll of the years has made frail and disabled. They need special care and attention to be active at all or to regain lost strength and abilities. They need someone to

care.

Out of their needs and the needs of other older people in the past, special kinds of health services and living arrangements have grown— nursing homes, homes for the aged, home health care, homemaker services, foster homes.

Unfortunately, the need for such services and home arrangements far exceeds the supply, and those available are often very inadequate or too expensive.

The result: Many disabled older Americans are in their own homes when they should be in homes for the aged, or in nursing homes, getting more care and medical attention. At the same time, some are in nursing homes or other institutions when they could be at home if help were available there. Others live with their families because help in their own homes is lacking.

But, with the growth in the number of older people and the realization that they have special needs, the situation is gradually improving.

This is mainly due to an increased interest in disabled older people on the part of States, communities, and private organizations. The Federal Government has played some part and, if several recommendations made recently by President Kennedy are approved by the Congress, will play a bigger part. The President has proposed a 5-year, $144 million program of Federal project, demonstration, and training grants to support pilot projects aimed at developing new and better ways for communities to meet the special needs of their older residents.

The kinds of services and living arrangements for the dependent older person vary widely.

In some cities, a wide variety of service is available to the older person who is well enough to stay at home but too disabled to do such chores as cook, clean, or shop.

Examples of good services, excellent care, effective rehabilitation, coordination of programs and facilities could be cited. But for the

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The Older American is different in one respect from all other Americans. He is older. He has more years behind him. He may have special needs because of these years. So may we all when the years of our life accumulate.

Thus, when age makes its unavoidable demands on our bodies, we may need help from our neighbors. If we can no longer live alone, we may want a specialized home but one that is a home, not just an institution. Or we may want to stay in our own house and hope that others will continue to make our house a home. Again, the Older American, despite his age, wants to live like the rest of us-in a home-his own home if possible, if not, a place that he can call home. Is this asking too much? To live at home?

Homemaker Services

Meals on Wheels

Visiting-Nurse Services

Other Home-Care Services

most part, such services are spotty, fragmentary, not nearly adequate to the need.

Two general categories of services and living arrangements are needed: Services in the home and services in nursing homes and homes for the aged or foster homes.

SERVICES IN THE HOME

Services in the home should include such aids as homemaker services, meals on wheels, shopping aid, visiting-nurse services, and counseling and other social services.

Homemaker services usually consist of sending a trained woman into private homes to help with shopping, cooking, and cleaning, perhaps to help the older person dress and get about the house, and to provide a friendly link with the outside world. The homemaker may be needed only a few hours several times a week, or she may come more regularly.

It is a flexible service and a beacon of hope to many aged people. But there are homemaker services for the aged in only 40 States and in only 134 communities. Even where the service exists, the number of homemakers actually available is often very small.

The prospects of expanding these services appear encouraging, through both voluntary organizations and public agencies. Starting on July 1, 1963, 75 percent of the costs of such programs can be provided by Federal funds in local public assistance programs. Also, funds for research and demonstration projects in this field are available to health and welfare agencies.

A homemaker program for older people in every community is now a reasonable goal, a justifiable hope.

Meals on Wheels is the usual term given a variety of portable meal services by which warm meals are made available to older people in their own homes, usually once a day. But at the last count, only 25 of these programs were in effect.

This service is sometimes combined with shopping aid and homemaker service. The combination makes it possible to help both those who like to prepare their own meals and those who need to have them prepared.

Visiting-nurse services have been provided in most urban communities since 1900, but many more visiting nurses are needed. Their job is to check on the physical condition of the older person, to be sure his medicine prescription has not run out, or to provide any other care that might be needed and that they can professionally give.

In a few communities, coordinated home-care programs are offered in order to extend many hospital services directly into the home. Under such programs, the older person's needs are met primarily by his family, with the help of a team of professionals-nurse, doctor, social worker, nutritionist, and physical or occupational therapist. In 1960, however, only 33 such programs had been established in the United States.

Even broad home-care services do not assure everything a disabled older person may need. He may require a friendly visitor, or legal protection of one kind or another. If he is receiving public assistance

or other financial aid, such help may be readily available, but, otherwise, he or his family may have difficulty in finding it.

Information and referral services are of great assistance to older persons and their families, but again complete services of this kind are offered by only a few communities. For the older person, more is frequently needed than the information and advice. He may also need help in getting to the agency which can assist him, or he may need guidance in order to avail himself of the services set up for him. Casework services, while a part of the total welfare program, are only beginning in many places to be extended to persons who are not currently receiving public assistance.

Recent changes in the social security law have broadened the possibility of these services reaching people whose needs are not complicated by lack of money for the basic necessities. But in far too many places today no casework or counseling services exist for other older people or those concerned with their care.

Even if adequate community services were available-which would permit many older Americans to remain in their homes long after their physical abilities had diminished--some would eventually need more supervision or more intensive care than can be. brought into their homes.

The next step for some would be a special type of home, such as a boarding home, group-care residence, foster home, or home for the aged or in many cases a nursing home.

HOMES FOR THE ILL OR DEPENDENT

Homes for the aged, foster homes, and other group residences today give hope that a much better situation will exist in the future than we have seen formerly-when all too often the home was institutional in character and provided little more than basic shelter and food to the residents. We see, today, experimental designs and imaginative architecture, and the development of programs of services that show much more regard to the very real needs of older people—to enable them to live with dignity and in comfort.

Church groups and fraternal orders have been leaders in pioneering new concepts and designs in varied types of housing for the elderly. The Federal Government has played an important role in the program of mortgage insurance for residential facilities, in working with local housing authorities to build public housing especially designed for the elderly, and in the direct loan program of the Community Facilties Administration to assist in construction for low-income residents.

In 1961, more than half a million older Americans lived in 23,000 nursing or other types of homes providing nursing or supportive services.

Many of these nursing homes, unfortunately, are unsatisfactory by any modern standard. Many are converted residences. Many are deteriorated and actually unsafe. The number of "acceptable" nursing-home beds is far short of the need.

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