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Mrs. GUINEY. I have not seen the bus. It was gotten from the Olds-
mobile Co., in Lansing and it was not a new one. I think it was gotten
for little or no money and the project has not gotten too far yet, because
again they have not been able to find a person-you know, it takes a
catalyst. Well, I don't know-
Mr. ORIOL. Someone like you.
Mrs. GUINEY. Well, not a crusader, but somebody around whom
people can rally. They have not been able to find that kind of a staff.

The acute shortage of personnel is a serious problem everywhere. Our doctors have shown us that a high percentage of the people now in convalescent homes can come out given this kind of comprehensive service.

Mr. Oriol. Mrs. Guiney, you touched upon transportation and we have heard other testimony showing how difficult it is for aged, isolated, and ill persons to get around. I wonder whether anyone is thinking about just as we have school buses to round up youngsters to take them to school, might it be feasible in a high-density area to have a hospital bus or a clinic bus that would take people at regular times?

Your neighborhood storefront offices can do so much. There comes a time when they might be more intensified. Do you think that might be feasible?

USES FOR MOBILE UNITS Mrs. GUINEY. I think it would be very feasible. I think the mobile unit idea that we have learned from the health screening and TB could be useful here. As a matter of fact, one of the big automobile companies just within the past week called and said they would provide a bus and a driver and take 50 of our people on a picnic, wherever they wanted to go, out to the lake or wherever.

I think there exists in every community, and especially in ours, with the big automobile industry resources which can be tapped without too much cost. Industrial people have hearts, too and they sit on our committees

Mr. ORIOL. I would love to sit here and talk to you out of sheer fascination, but I ask Mr. Norman if he has any questions. Mr. NORXAN. No, thank you. Mr. Oriol. We have several articles from Mrs. Guiney, as well as other information, which we will seek from you on several other points we have made.

Was there anything else you wanted to say at this point?

Mrs. Guiney. I would be very happy to supply information, I feel that this was a very curtailed kind of statement I submitted, but it is easier for me to talk, as you see, than it is for me to write these things all down.

I hope we can do something in the legislative halls. Didn't Senator Moss and Senator Kennedy submit bills which would penalize the nursing homes that don't have trained administrators and staff ?

Mr. ORIOL. Yes. Mrs. GUINEY. If we could penalize States—I believe in States rights, but I tell you the direct grants that we have gotten from the national level are so much freer of redtape and do not have to go through so many hands. If direct help could be given in the areas where people live. The Medicaid example in our State has left perhaps the most needy group, the one with the dollar too much, out in the cold in terms of the costs of drugs and medicine. We did not get into this, but without the help of the World Medical Relief, who gave us $3,750 worth of drugs in the last 3 years to supply just those people who had marginal incomes, our work alone would not have saved them from going to a hospital or nursing home.

The wonderful promise of Medicaid was that for the first time in their lives they could have a private doctor and then it was cut off. The cost of drugs is prohibitive. We have worked with the private druggists in our neighborhood and we have gotten 30 percent reduction, by giving our card to the druggist. It is not unusual to get a drug bill of $30, $50, $80 a month.

I had a letter referred to me, from Niles, Mich. That is over on the border of Chicago. The head of the United Fund told of an old couple who live on social security and a private pension of $200 a month. Their drug bill is $80 a month. The letter asked if I could suggest any way to get free drugs?

The doctor is concerned. He knows that the drugs are necessary, but $80 a month out of $200 leaves little to live on.

Mr. ORIOL. Mrs. Guiney, I have received a note saying because of the unusual floor session today, we had better adjourn. We might be objected to, so I would like to thank you once again for giving us, I think, just what we needed at this point.

For the past 2 days we have been talking about problems, we have been talking about needs, we have been grouping to a sort of organization of community resources. I think you have given us an example that certainly should have a lot of study at this stage in our thinking about medical services for the elderly.

So thank you once again.

Mrs. Guiney. I enjoyed being here. I thank you for letting me tell you, haltingly as it was about our Detroit experiences. It was an honor to be included with the distinguished witnesses who appeared here this morning.

(Mrs. Guiney's complete statement follows:) STATEMENT OF MRS. MARY K. GUINEY, DIRECTOR, WELL-BEING

PROJECT FOR AGING, UNITED COMMUNITY SERVICES OF METROPOLITAN DETROIT

Mr. Chairman, thank you for the opportunity to appear here today. I have prepared a narrative report of the Well-Being Project which I will submit for the record, and then, with your permission, I would like to make further comments and perhaps discuss some of the questions which the Committee may have.

First of all, I would like to mention the objectives of the Well-Being Project which are more fully outlined in the attached evaluation report. Briefly, our goals were :

1. To develop methods of helping aging people maintain physical health while living in their own homes, and to prevent, as far as possible, the development of health crises ; and

2. To mobilize, coordinate, and realign existing services to serve the aging (See attached description of the Well-Being Project and excerpts from an evaluation by the National Council on Aging. Also, please note: A statement on Detroit's Well-Being Project for the Aging was submitted to this Committee on June 14, 1965, and appears in, “The War on Poverty as It Affects Older Amer

a

icans, Hearings Before the Special Committee on Aging, United States Senate, Eighty-Ninth Congress, Part 1-Washington, D.C., June 16 and 17, 1965.")

PROJECT'S BEGINNING

When the Well-Being Project began, a tandem of social workers and public health nurses were given a map showing the numbers of people over 65 in the three selected neighborhoods. They went up and down the streets looking for the human consequences of the statistics which the figures never show. These teams used the oldest techniques of the helping arts, practiced by the Curés in old France and by the workers in this country's early settlement houses-Hull House of Chicago and Henry Street of New York. As they talked with them on their porches, in their gardens and in their kitchens, they heard from the lips of the old people about their ideas, their interests, their fears, and their hopes. They saw the impact of the old world culture on the foreign-born in the westside area-frugal and suspicious. They saw the helplessness of those who sit in the city slums bereft of hope. They saw the boredom and dejection of those inappropriately placed in convalescent homes only because services to sustain them in their own homes are not available. Among the economically independent, these teams saw those in better homes deprived of the things that money cannot buygood health, friendship, someone to counsel with and to guide them in times of personal stress or grief. The combined skills of our teams were available to all; and they went into action on-the-spot when problems were encountered.

LESSONS LEARNED

We believe that many of the lessons learned from the Well-Being Project can be employed in rural as well as other urban communities when given the proper climate and concern for finding new ways to protect the health, the safety, and the precious personal autonomy of older people.

We have found that concern is the important component. It means someone who cares—the architects of public policy; the purveyor of public and private health and welfare services; the doctor; the social worker; the nurse; the lawyer. It calls for knowledge and skill and integrity and compassion, and-above allthe ability and willingness to blend these skills and to marshall the kinds of help needed by the sick and impoverished aged.

We have found that regardless of advanced age or regardless of economic or social class, there is a fierce desire to remain in a dwelling of one's own among familiar and treasured possessions, no matter how meager. Other lessons we have learned :

1. Advantages of services being accessible in immediate neighborhoods; 2. Disadvantages of geographic limitations;

3. Time and effort required and the need to reach out to the unserved ; high value of immediate attention to calls for service;

4. Flexibility of structure-no formal policy to hamper delivery of service;
5. Need for professional competence of the highest caliber at all levels;
6. Value of the team approach;

7. Case examples illustrating Project scope-involvement of all segments of the community; individuals helped ;

8. Obstacles encountered by the elderly in getting services from established health and social agencies. The Social Security Act and its recent amendmendts, although presently fraught with ferment, represent a tremendous social advance in health and housing and personal services for the aging. As a social worker who worked face-toface with Detroit's aged before Social Security or private pensions, I knew the alternatives well. I often accompanied the aged to the welfare office and saw them herded into a black carryall (a polite name for the paddy wagon) and driven off to the County Home with its beautiful gardens and jail-like, red brick buildings surrounded by high wrought-iron fenses and locked gates where old couples were separated. The men's and women's buildings were far apart on the spacious grounds.

The legislative reforms have brought us a long way. As wonderful as this is, the full benefits will not be reaped until we remove the barriers which still stand between the elderly individual and needed services. We cannot be complacent while tens of thousands remain unreached and unserved. The greatest stumbling block is attitudes. As Senator Smathers has said, “Many people would probably like to think that Medicare and Medicaid have solved the major health problems of the elderly.”

CONCLUSION

We would never have gotten off the ground with the Well-Being Project without the generous contribution made by U.S. Public Health Service_both through financial support and professional consultation and guidance. I thank you again for allowing me to tell you about the program.

EXCERPTS FROM EVALUATION REPORT OF THE WELL-BEING PROJECT FOR THE AGING OF THE UNITED COMMUNITY SERVICES OF METROPOLITAN DETROIT

BY THE NATIONAL COUNCIL ON THE AGING The objectives underlying the WELL-BEING PROJECT FOR THE AGING are set forth in the original proposal to the U.S. PUBLIC HEALTH SERVICE on March 17, 1964, as:

1. To develop methods of helping aging people maintain physical health while living in their own homes, and to prevent, as far as possible, the development of health crises.

2. To mobilize, coordinate and realign existing services to serve the aging. Sponsorship of the Project and responsibility for its day-to-day operations is by the UNITED COMMUNITY SERVICES, with Mrs. Mary K. Guiney, Planning Consultant, serving as the Project Director, and the funds administered by the UCS.

The financial support of the Project has been supplied by the Public Health Service through its Division of Chronic Diseases, Gerontology Branch, which allocated $79,420 for each of the first two years, beginning June 1, 1964, and $73,000 plus, for the third year which terminates May 31, 1967. The operation of this Project is unique in that:

(a) Its officers are located in neighborhoods where it is felt the need of older persons is acute, and

(b) The staff assigned to each Project includes a trained Social Case Worker and a trained Public Health Nurse. Two agencies work in close cooperation with the Project: the DETROIT HOUSING COMMISSION, through its Neighborhood Improvement Department which shares offices with the neighborhood staff and the VISITING NURSE ASSOCIATION which has assigned trained Public Health nurses on a loan basis to each of the neighborhood offices, and provides supervision for the technical nursing activities of these nurses. In addition, all of the health and social work agencies of the community are utilized by the Project both as sources of referral and as resources for the provision of services to clients or patients referred to them by the Project staff. Thus, the Bureau of Legal Aid is occasionally called upon to give legal assistance or consultation; the Family Service Agency is utilized for long-term counseling cases; hospital social service departments serve as both sources of referral and as a resource, etc. The list of agencies to which clients of the Well-Being Project have been referred occupies a full page, single space, in a recent report prepared by a consultant. That list includes public agencies such as the Detroit Department of Health, the Bureau of Social Aid for Old Age Assistance, Social Security Administration, etc., and voluntary health and welfare agencies such as hospital clinics. Neighborhood Service Organization, Homemaker Services, etc., and private physicians.

The organization of each of the neighborhood offices is unique. A social case worker and a public health nurse constitute the core of the staff together with a secretary-receptionist in the office. There is a second social worker assigned on a roving basis to all offices, and in all cases there is a social work student assigned by a school of social work. There is also an Advisory Committee in each Project office chosen from among the residents of the area served. These committees have been selected by the staff and include local merchants and articulate representatives of various types of residents living in the neighborhoods.

The operation of these offices has followed a fairly clear pattern. The three neighborhoods in which the services were established by the METROPOLITAN COMMITTEE ON SERVICES TO THE AGING were lodged in store front locations where visibility and ready accessibility were shared. In each instance the store front office was shared with the staff of the NEIGHBORHOOD IMPROVEMENT SERVICE, a branch of the Detroit Housing Commission. Thus, the status of the Well-Being Project was established, and its relationship to the City's Neighborhood Improvement Program was indicated by the name of the Mayor on the window. In addition, the partnership between the Well-Being Project and the Neighborhood Improvement Office offered an opportunity for easy communication between these two forms of service. Once the office was established and the staff employed, they spent several months calling upon the older residents of the neighborhood. They located these residents through a variety of sources, such as churches, merchants, and other organizations in the area, and went calling door-to-door to inform the residents of the neighborhood of the existence of the Project and its availability to the neighborhood's older residents for any problem with which they felt they needed help. Circulars were distributed, group meetings were addressed by the staff, and altogether an intensive effort was made to acquaint the neighborhood with the Project.

It was not long after this intensive public relations effort was begun that applications for service began to come in; people dropped into the office, others telephoned, and quite frequently other agencies began referring neighborhood seniors to the Project for assistance not readily available from the established health and welfare agencies of the community. By the time the neighborhood office was in existence for a few months, the calls for service reached such proportions as to require the full time of the staff.

Gradually intensive public relations efforts were lessened, and concentration on services directed to clients became the major order of business. In addition, the Advisory Committees were selected and regular meetings by them and the staff established.

At the same time, the staff established a system of neighborhood meetings primarily focused on health education. Although the subject matter of these meetings was usually some phase of health care, the nature of these meetings was also social in effect. Residents attending them tended to dress up for the occasion, some of them contributed cakes and cookies for the refreshment period which always followed the more formal period of the meeting. The meetings thus have taken on the character of a semi-social occasion for which residents dress up and meet their neighbors as well as learn something of benefit to themselves.

PROJECT VALUE

The Well-Being Project for the Aging provides an excellent service in response to a genuine need. Its uniqueness lies, first, in the fact that the neighborhood offices are situated in stores located in the middle of neighborhoods where the services are given. Hence, the Project is both visible and easily accessible to the residents of the neighborhood. This has made for strong indentification of residents of the neighborhood with the Project staff—so much so indeed, that a frequent comment by older residents in the area is, “What will we do if this office is closed? You are needed here."

A second factor which affects the value of the Project is its staff structure. Combining services from the two professions, nursing and social work, has proved effective in meeting the great majority of the problems which are brought to the staff for solution. For cases where these two professions need other assistance as, for instance, legal or medical help, these are brought in on a case-by-case basis.

An added factor which was clearly visible in each of the neighborhood offices was the high sen ? of dedication of the staff. Both the social workers and the nurses evinced enthusiastic response to the calls for help; they often left their home telephone numbers with clients who might have need of assistance in the evenings or during the weekends, and were not at all averse to making home calls after regular office hours, or on weekends.

There is a fourth factor which is valuable in this Project: the flexibility of its operations. The staff will go into the home of any client quickly and without any restrictions as to functional limits. This is unique in the organization of health and social agencies, where rigidity of function and procedures are sometimes a deterrent to the provision of services needed quickly and effectively.

RECOMMENDATION It is recommended that a special autonomous socio-medical 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 represen

83-481 0-67-pt. 1-11

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