there is a fierce desire to remain in a dwelling of one's own, among familiar and treasured possessions, even though they may be brokendown chairs or old china cups without handles. The major thrust of the project is to help the elderly achieve this goal of remaining in their own home even until death, if possible. One of the lessons we have learned is that there is an advantage of being in the neighborhood. The home visits and the store front offices of the project add a new approach to helping older people. The workers have become familiar figures as they go up and down the streets and in and out of the homes. They are viewed by the community as friends, as well as competent professionals. They can be compared to policemen on the beat, but the policeman on the beat, of course, is a thing of the past. The staff team works in the here and now, they do what has to be done. They can always be reached. There is a secretary-receptionist in each office who knows where the workers are at all times. The offices have become sort of local institutions, something like the bank and the post office and the stores. As the elderly go by to get groceries, to mail a letter or whatever, they often stop in to the neighborhood office to chat or to rest. Many of them serve an important function. They tell us when they know of a neighbor who is sick or in trouble. GEOGRAPHIC BARRIERS Another lesson which we have learned is that there are disadvantages to placing geographic limitations around services. A substantial number of the calls for the Well-Being staff have been for people who live outside of these prescribed areas. They come from relatives and friends of those who have been helped by the project, they come from public officials who get letters, especially during campaigns. They come from newspapers. Many come from Action Line, which you may be familiar with in your own paper. They come from other agencies and hospitals who can find nobody else to do the job. The visiting nurse coordinator in one of our major hospitals appealed to the Well-Being project as a "last resort." She had called everybody in town without results. A patient in her seventies had had surgery for terminal cancer of the bladder. She had been told by the doctor that she could go home, which she longed so much to do, if a way could be found to take her to another hospital in another part of town every day for several weeks for cobalt treatments. The nurse and social worker went to the hospital the same day and talked with the patient and with the doctor. They assured them that they would follow through with doctor's orders and they would take her for treatments themselves until another way could be found. She was released the next day and the social worker and the nurse went to the home. The nurse drove her to the hospital that first day and the social worker arranged with a sister who lived nearby to come into the home and stay with the patient. The nurse was able to arrange with the cancer society to take up the daily trips from there on. The conclusion is clear that we cannot confine the kind of service of the Well-Being project to any geographical boundary. In the same category are people who are under the prescribed age limits. This, too, has been found unrealistic. Human needs are universal; ill health, loneliness, lack of knowledge of rights and resources, are found in people under 65 as well as over. Men and women in their fifties, still trying to work, have the same problems as their older brothers and sisters. While these problems are not as frequent in the younger groups as in higher age levels, they cannot make a go of it without help. In fact, a consultant of the National Council on Aging who recently did an evaluation of our project suggested that consideration be given in the future to extend this kind of neighborhood-based services to all categories of persons in the neighborhoods with emergency needs. We have found that there is a high value in giving immediate attention, especially in situations where health problems exist. A substantial portion of calls which come in for Well-Being service are of the nature which require immediate attention. In order to accommodate this kind of what someone here has referred to as "putting out the fires" service, the workers have ignored hours and left their home telephone numbers where they could be reached after 5 and over weekends. Broken fingers or broken hips do not conform to any time schedule. Mr. ORIOL. I ask just what the average age is of the people who participate. Mrs. GUINEY. The people who are participating range from about 53 to 95. Mr. ORIOL. Did you discover that there were special benefits in getting mature people in this age group? Mr. GUINEY. Of getting Mr. ORIOL. Benefits. Did you discover they were more effective than younger people might get? Mrs. GUINEY. Well, we found that in the younger aged services did not have to be so intense or provided for a long time. Actually with a little lift or a little change or less intensive services, the cases could be closed. Then by continuing acquaintance with them and occasional contact, they would do all right. Mr. ORIOL. What was the training for the participants? How were the people trained to do the sort of thing you are describing? Mrs. GUINEY. You mean, the social workers and nurses or the older people themselves? Mr. ORIOL. The older people themselves. Mrs. GUINEY. Well, they have established a series of meetings on health education. These meetings are held regularly in the community, in churches, libraries, or schools, and experts from the medical profession speak on caring for the feet, diabetes, glaucoma and cancer and the rest. Old people learn from them something about the need to protect their health, some ways of caring for themselves, some ways of caring for their sick relatives in their own homes. They have a chance to ask questions and believe me they do ask them. I remember recently when we had the director of the Dental School of the University of Detroit come in to talk about care of the mouth. and teeth. Of course, many of the teeth were of the store variety. Senator WILLIAMS. What does that mean? Mrs. GUINEY. They asked many questions, everything from mouthwashes to "were electric toothbrushes better than the other kind?" and so on. These meetings are helpful not only in providing information and knowledge and in stimulating them to think and to take action on their own behalf, but they also have a social experience. They get dressed up to come to the meetings and then there are always cakes and tea and an opportunity to visit after the educational part is over. As one elderly lady said, "they don't just teach me to dance and play games, they give me some real knowledge." Mr. ORIOL. Would you just describe what one of your store front offices is like and some of the services that are available there? Mrs. GUINEY. A storefront office is the kind you see along the main street in these small communities. Senator WILLIAMS. Small communities. What do you mean, "rural communities"? Mrs. GUINEY. No, small neighborhoods within the big city. Mrs. GUINEY. Yes, the storefront office has the name of the mayor on the window and the housing department is working to try to upgrade the physical aspects of the community, to get the supermarkets to build on vacant property there, to get small business places to put new fronts on their stores, and residents to put up new fences around their houses, to paint up and fix up. They are really small offices, but most of the work is done from out of the office rather than in the office, although the older people do stop in as they go by on their way to the merchants or whatever. Does that answer it about the storefront? Mr. ORIOL. Yes. Thank you. Mrs. GUINEY. We found, I think, that one of the major advantages of this kind of a decentralized service is its flexibility. We have no formal structure to delay the delivery service. The clients are seen without any kind of application or without appointments. Information and referral services are being multiplied over the country. We have a very good one in our own community supported by United Community Services. Many existing agencies also provide these services. They are effective in telling the older people where the other resources are but, this does not guarantee the delivery of service. Our experience is that you cannot just tell them where the Detroit River is or where the hospital is, but if they are going to get service there, you have to go with them and help them to actually get the service or you have to bring the service to them. I think of a client who was a highly emotional, volatile severe diabetic, woman of 65 with a heart condition. She had just been told by a young doctor at General Hospital that she was rapidly going blind. She began a round of visits and appeals to agencies, 18 of them in all. She made unreasonable demands, she was abusive, but what she was really seeking was some help in trying to face the terrifying experience of losing her ability to see, on top of all of the other physical problems she had. Each one of these 18 agencies referred her on to some other agency. A service for the blind gave her a white cane. They told her to go to Catholic Charities. Catholic Charities sent her to Family Service. On and on she went until she finally got to a young councilman in the city hall where she had gone to see about paying her taxes. This councilman was also a professor of sociology at one of our universities and he listened to her, let her talk, let her threaten and then referred her to the Well-Being project. When we went to the home to see her, she met us at the door with a gun. She said "there is no need of coming in here unless you can do something for me" and then she held forth for almost an hour, during which we listened. Then as we listened, we tried to hear what she was saying. We heard her plead to have the benefit of the Reader's Digest. She said she loved the Reader's Digest. She had not been able to read it for 4 months. In this we saw something tangible that we could do something for her that might inspire her confidence in us. So we went out to the Library for the Blind and got a talking book apparatus and 4 months back issues of the Reader's Digest. This gave her a feeling that somebody did care about her. We were able to continue to work with her, to get her to go for regular checkups to the doctor, and to pay attention to her diet. Although she is still abusive at times, she comes to the health education meetings and she is behaving pretty well. We find that this storefront decentralized kind of structure- Mrs. GUINEY. Yes. Senator WILLIAMS. She went the whole gamut of the social service agencies. Why was it that they could not help her? Fortunately she ends up with your protective Mrs. GUINEY. Well, maybe I can take this case and follow it through for you. Most agencies have a specialized function and it often takes many kinds of service to solve one problem. Senator WILLIAMS. They were not staffed for this particular kind of service? Mrs. GUINEY. When she went to the hospital clinic for a diabetic checkup, the young doctor who discovered that she was losing her sight tried to break this gently to her, and said, "you are going to be eligible for a pension" for the blind. He referred her to the public assistance office, to apply for aid to the blind. She was found to be ineligible because she owned two houses they were in urban renewal areas and not worth much-in addition to the house where she was living. She was referred to the Metropolitan Service for the Blind. They gave her a white cane. She told them that she needed someone to sew buttons on her husband's shirt, because she could no longer do it and she would like a young girl, a child, to stay with her, who could run errands and do other things for her. On the basis of this request, they sent her to the Catholic Family Service. They are an adoption agency. She was told that people over 65 83-481 0-67-pt. 1-10 are not eligible to adopt children and she was referred on. I forget which one it was, one was a family agency. Senator WILLIAMS. For one reason or another, she was ruled out at every step along the way. Mrs. GUINEY. She didn't fit in, and no one agency had the quality of personnel, the time or didn't consider it their function. Senator WILLIAMS. Until finally she got to city hall and then this young man took the time to bring her into his office and let her talk it out. Now, is your entire budget furnished by the Public Health Service? Mrs. GUINEY. No, but it is the major source of support. The budget is about $109,000 or $110,000 a year. Public Health Service has provided about $80,000 of that. Senator WILLIAMS. Do you have a Community Chest or United Fund in Detroit? Mrs. GUINEY. Yes. Senator WILLIAMS. Are you one of their recipients? Mrs. GUINEY. Yes. The United Community Services is the agency which allocates funds raised in the United Foundation Drive to the majority of the voluntary social agencies. It is a budgeting as well as a planning agency. United Community Services absorbed certain bookkeeping, secretarial and office expenses; the Visiting Nurse Association contributed the technical supervision of their project nurses and the services of therapists, nutritionists and so forth. This amounted to about $15,000 a year, and the Public Housing Commission contributed office space and the help of their staff which amounted to about $5,500 a year. It has been mentioned here today by the last speaker that he feels very warmly toward the Federal Government, and so do I, because without that grant from the Public Health Service we would never have gotten this project off the ground. The competition for funds by established agencies in the voluntary field has made it difficult to initiate such a project. Some of these agencies have been child welfareoriented for 40 or 50 years, not recognizing the aged had problems. They don't want to change this. They still approach community problems in a traditional way and they are reluctant to establish a service for the aged, because it takes away staff and personnel from their major focus of service. Senator WILLIAMS. I regret that I could not be here to hear all of your testimony, Mrs. Guiney. How long has the Well-Being Project for Aging been in existence? Mrs. GUINEY. It came into being on June 1 of 1964, as a 3-year demonstration. Public Health Service funds ran out on the 31st of May, United Community Services has allocated funds to continue the service at its present level. We will need to find new sources of funds because of the problems that we have had to deal with, which are expensive, especially the problem of guardianship and protective care. We found as we worked with the older people that many of them were unable to manage their own money. The public assistance agency has been our largest source of referral of people whose old age assistance had to be cancelled because they |