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You have to be on the spot, to be known in the community. If you are downtown in a big building the older person thinks that he can never get service if he has to call up and wait for appointments and make out applications.

There is a close cooperation with the public assistance agency. One of the old age assistance staff referred to the project as his left arm in serving his clients. Michigan did not implement the Social Security Amendments of 1962 which provided matching funds for increased services to aged recipients. The project has helped in many ways not only those receiving assistance but in helping those technically eligible to apply for help. Many need protective care previously referred to. This is not available in Michigan and we cannot provide this with voluntary money alone.

Mr. ORIOL. Mrs. Guiney, on the subject of organization, the National Council on the Aging report on your project concludes with the recommendation:

It is recommended that a special autonomous sociomedical agency be organized to receive and disburse funds for the continuance of the Well-Being Project for the Aging. This agency should be metropolitan in character, should have representation from the professions of social work, nursing, medicine, and law; should have a built-in research function for continuing self-analysis and evaluation; and should be capable of estimating close working relationships with all other on-going services of the community.

This new agency should continue to experiment with ways of improving and meeting unmet needs.

Now, you remember the question I addressed before to Dr. Roemer and to Dr. James. They were describing health services of the future and how they might be reorganized to serve the elderly better.

Now, you have made it sociohealth, because the two are intertwined. In fact, health becomes the wedge that helps you do other social services.

This sort of central special agency to do this, do you see this perhaps as the nucleus of the kind of things that Dr. Roemer and Dr. James were talking about and that you as a person who has worked over a quarter of a century in Detroit on social problems, do you see this as the sort of thing that might work in many places ?

Mrs. GUINEY. Yes, it seems to me that the combined skills are very effective, and I would like to see an independent agency to develop this concept more fully-dental problems are acute-we almost had a dental service in connection with the project. The University of Detroit Dental School applied for a grant from Public Health Service to work out of our neighborhood office. It was approved but in the meantime the man who was the spearhead, left the university and the funds were not taken up.

Leadership is terribly important and you have to have the right climate and the people have to believe in it.

Mr. Oriol. Would a formal government agency help develop this kind of thing or might it discourage it!

Mrs. Guiney. In the community, you mean? Well, I think the local government agency is so overburdened with what they have to do now with shortages or personnel, with the constant changes and regulations in the law, with the traditional requirement of determining eligibility, I know that the state department of social services recognizes the need for service, and wants it.

Mr. ORIOL. What I was talking about was the kind of agency that could do what you had done.

Mrs. GUINEY. You mean a government agency?

Mr. ORIOL. A government agency that can get social workers toget her, get physicians and lawyers and so forth to forget the old categories of trying to fit people into different programs and to make the program more flexible to meet the needs of the people.

Do you think a government agency, when supported by a private agency as you have and all the support you have built up—I think you can take credit for having built in that climate or created the kind of climate in which this would work-given all this, could a government agency be a good innovator and work with what we already have?

Mrs. GUINEY. I am sure that Government agencies can be good innovators. In fact, I think they are becoming the major innovators. You know, it used to be that the private sector of the community began and experimented and innovated a program and then it was taken over by Government. For example: the private agency used to give the financial relief. It was then taken over by Government for many reasons, but it seems to me today it is the Government that is doing the innovating. They have the vision and they have the concern and they have, of course, knowledge and funds.

Then, of course, when they pull out, it is difficult for voluntary funds to foot the bill. The aging come in last in the race for local voluntary money because funds raised in the United Foundation Drive are already spoken for by established agencies.

RELATIONSHIPS TO HOSPITALS

Mr. ORIOL. Mrs. Guiney, it seems to me you do a service by giving home care and not adding the total burden of hospitals. Do you, in turn, get cooperation from hospitals in speeding their processing on people who do have to go? In other words, do they feel that because they have you to support them, they know that they can get a person out of the hospital faster?

Mrs. GUINEY. Yes, and we work with them. They call us. I think I mentioned one case. In turn, we can call the hospital. The other day a 94-year-old woman had a severe coronary, and was taken into the hospital.

She lived in a home for the aged. Although the doctor was ready to release her, she could not be returned to her former room in her present condition and the family was desperate to know what to do. The hospital, agreed to keep her for 3 or 4 more days until we could make a plan so that she would not die on the way.

The nursing homes will do this, too. We work with nursing home administrators, who, if we are trying to make a home plan, will keep a patient for a few more days. Hospitals are, I think appreciative of our service.

Henry Ford Hospital is our big group practice hospital. They have called us, to help persuade people to accept the kind of care that they are prescribing, because we know the

person. The social service department and the doctors work within the hospital, and patients go to the hospital to see the doctors.

We had an old lady and she was completely broke, poverty-stricken who had had open heart surgery at Henry Ford. The doctors were interested in her, and she wanted to see them. After a joint conference with the doctors, and the social service department two doctors went out to call on her.

These things are not spectacular. They just come naturally when you are working closely with the services in the community.

Mr. ORIOL. Would you not say that is the big ingredient here, concern?

Mrs. GUINEY. Somebody who cares.

Mr. Oriol. I also want to ask about physician attitudes. Did you have any plan at the beginning of your program or because of your long years of cooperation did you find that physicians were very receptive?

Mrs. GUINEY. We had the fortunate circumstance in having a very well-known and highly respected private physician as the chairman of the committee on aging of which I am the staff consultant.

Mr. Oriol. You do have widespread support throughout the medical world.

Mrs. GUINEY. Yes, throughout the medical world. The fact that the medical men were interested in this service has brought us a great deal of cooperation. Actually, we have gotten doctors to make home calls like those from the hospital and to see patients after hours. This is another thing that I think we must not lose sight of, the time limits of service.

We have learned so much from medicine about responding to need when it happens. We have to consider some way of providing 24-hour service through some kind of a telephone answering service or making staff responsible for certain weekends, certain times, so that we have coverage 7 days a week, 24 hours.

I think we have learned this. Doctors have to be available when crisis strikes, so do other services.

Mr. Oriol. I think you explained that, given us a good understanding of it.

Have you ever tried to make an estimate in dollars of how much your kind of service can save simply by keeping a person out of the hospital, for example?

Mrs. GUINEY. Well, I don't have the facts and figures but we can prove it is much less costly to keep people in their own homes even if we pay fulltime housekeepers in cost of dollars than in a convalescent home. We have cases that will demonstrate this. Under Medicaid, the public department will pay in our city $375 a month for nursing home care and some of it is less than high quality. This is a profit business, of course, and while there are some very good ones, there are some that are not very good.

Mr. ORIOL. Can you tell us offhand about how many people!

Mrs. GUINEY. I would say that we have had between 9,000 and 10,000 contacts.

Mr. ORIOL. Approximately how many people were involved in giv. ing that service. Mr. GUINEY. Well, we have a staff of seven. Mr. ORIOL. Seven?

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Mrs. GUINEY. We have three social workers and three nurses, a team of two in each office, and then we have one roving social worker who is a troubleshooter whenever one office is overworked and with cause.

Mr. Oriol. Have you ever thought of doing what Operation Reason does in Baltimore-that is, enlisting several of the elderly people living right in the neighborhood to come to do some of this outreach or policemen-on-the-beat sort of thing?

Mrs. GUINEY. Yes, we have and it has been a major concern of ours to do it. I think you can understand that in the administration of this project we wanted to learn as much as we could—we felt that it was important for the professionals to give the direct service-simply didn't want to spread ourselves too thin to take on another project. Mr. ORIOL. But now if you could have a stage 2 in this project

Mrs. GUINEY. We have been talking about this for 3 years and the committee is very concerned with this very aspect. We now have an on-going plan. If we can have an on-going agency, as recommended, with a basic source of community support, then we can try to get project grants for other projects. We cannot exist just on projects alone. With a basis of operation which is supported by Government and the local community. We could undertake what we call a home helper service.

They are already alerters, the old people are a big source of referral. Of course, they refer their relatives in Illinois and Cleveland and all over Detroit.

Incidentally, we meet those needs. But we can use the older people and we can also use the assistant to the professional, but they have to be under the guidance and the supervision of someone with an awful lot of know-how and an awful lot of moxy. In other words, a skilled professional.

This is the next thing that we want to concentrate on, the use of the older person recognizing his abilities, giving him an opportunity not to just deteriorate because he has no decisions to make. There are many able people.

Mr. Oriol. In the Williams bill you placed before
Mrs. GUINEY. What happened to it?

Mr. ORIOL. I believe it will be the subject of hearings very soon. As soon as another bill is cleared on that committee, I think they intend to turn to that.

Mrs. GUINEY. It would fit our program perfectly, but you see, we could not divert the time of the professional staff during the demonstration. We didn't have enough time to promote this kind of thing.

Mr. Oriol. That is one of the purposes of the bill, to give you just that extra bit of assistance.

Mrs. GUINEY. Yes. Then if we could get moneys to do this, we would have to have an administrator because this takes administration. This kind of program takes time. It takes knowledge of the person you are going to send out to serve the other older person and it takes work with the person who is going to be served in order to bring the two together.

It just does not happen and you can't push a button. We tried this. Years ago we felt that we learned from one of our many studies which

are gathering dust that older people wanted to work. We set up an employment project with the employment security commission, the telephone company, and our office. Every day in the front page of our newspaper there was a block prominent on the front page, which said “To employers: Would you employ an older worker? If you will, call this number."

The telephone company gave us instruments that would stretch across this room, telephones. The employment security put clerks on the telephones.

When these calls came in from employers, they went to their records of people who had said they wanted to work. We got 1,900 jobs offered in a matter of about 2 weeks, but we could not fill

them and the reason was that there was not any go-between, you see.

You could not just call up those people who had said they wanted to work and who had put à card in the employment security office, saying they wanted the job.

When you call them up and say, "Report to Tool & Die Co. on Eight Mile Road tomorrow," they said, “Oh, well, I need transportation and my glasses are not very good and 'I don't know if I could go every day and my feet could not stand it."

See, we learned from that. That was a complete flop. Only six of them continued to work. I guess 20 went to work in the beginning. We have to have the in-between of counseling helping them to get ready. We have to make arrangements for part-time work.

They cannot respond to the alarm clock at 6 o'clock in the morning and working until 5. You need to condition them, because when they have not made decisions, suddenly they are cut off from decision making, they deteriorate very rapidly.

They can be rebuilt, but this is the process. It takes time and skills. When you talk about losing the right of decision and the cost in human values as well—think of putting people in convalescent homes unnecessarily when that door opens in, the old person never makes another decision.

They can't decide even what time they will have a bath or what time they will have lunch; they make no decisions. Someone else makes them all. They go downhill just like mashed potatoes, with too much milk.

A human being can't live without the opportunity to make some decisions for himself. Those people stay there for the rest of their lives, that door never opens out.

Well, we have opened those doors out in a few cases, because in one of our communities in Detroit, a project funded by the older Americans Act has a part of the equipment—what they call a minibus— where they can shuttle the old people to the stores and to the hospital and so on.

Mr. ORIOL. Senator Williams would have been happy to hear you say that. The first minibus was developed as a result of the Mass Transit Act of 1963 and he was the chief author of it.

Mrs. GUINEY. Is that so?
Mr. Oriol. Here we have an example of a minibus.
Mrs. GUINEY. This should be most useful.

Mr. ORIOL. Is that bus designed in such a way you cannot step up into it, you can just step right ahead!

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