absorb such costs, while, at the same time, directing energies and resources into succeeding phases of its development, will be the most efficient and most likely to survive.

In the case of the GAH, the AoA demonstration grant provided an excellent mechanism by which the Federal government facilitated the extension of geriatric facilities and services. It should be pointed out that a commitment to see the GAH through several years of development was crucial.

The desirability of creating a public body such as a geriatric authority to allow for autonomous actions is recognized as is the need for public accountability. The experiences of the GAH, particularly in seeking government aid for housing, suggest that the successful resolution of the conflicts between the two is difficult, and that

unforseen problems may arise from the compromise.

Tentative conclusions derived from our experience thus far show that:

A public body which exercises significant autonomy, and yet remains accountable to an electorate is difficult to achieve. The public nature of an authority is a source of strength and of weakness. Eligibility for funding programs and adequate flexibility and latitude in an authority's ability to obtain monies is a serious consideration. • Staff assistance for a development program is essential.

• Long term commitment and financial resources are important in enabling an agency to absorb the costs of delays which must be anticipated.

The Center staff encourages people to think carefully about their needs and desires relative to their options, and helps them find "affordable" housing or alternative living arrangements. In a typical interview we begin by exploring with the senior the possibility of remaining in his or her present home. Two categories of assistance are described: home and social services and financial aid programs.

Home and social services available in Palo Alto include visiting nurses, home health aides, homemaker services, grocery shopping services, home-delivered meals, telephone reassurance, friendly visitors, special transportation services, home repair, housing rehabilitation, and senior day care programs.

The financial aids are Supplemental Security Income, Medi-Cal (California's Medicaid Program), Rent Assistance (under the Section 8 Existing Housing Program, eligible seniors pay no more than 25 percent of their income for rent), Senior Citizen's Property Tax Assistance, Renter's Tax Credit, and the new California Property Tax Postponement Plan.

It is not enough to provide clients with objective information; they also need help in

thinking through their feelings about whether or not to move. For example, a move to a more favorable climate which seems attractive may result in a disastrous loss of social and family ties, memories, roots, and a familiar support system. A trial visit of several months to the new community is often recommended.

When a move is indicated, we advise clients to give careful thought to such basic questions as: Their financial situation (montly income; total assets; obligations) and what is it likely to be in the years ahead.

Their physical and social needs, including help with personal care and other daily activities, cleaning and other housekeeping chores.

• Their preference for a central dining room, or kitchen facilities.

Their desire for group activities, agesegregated or integrated housing, and "downtown," suburban, or country settings. Many seniors cannot answer these questions in a first interview. Most appreciate the impetus to think about them; they realize that answers are required in order to make intelligent decisions.

Staff members sometimes counsel the adult children of seniors contemplating a move. Whether the parent is present at the interview or still in a distant state, the children seem to want to "take charge." The role reversal so often seen ("my mother made decisions for me for years and now I'll make them for her") results in the denial to the parent of much needed dignity. Tactful handling of this problem by the counselor can be very valuable to the family.

During the counseling session we present a great deal of information about live care contract homes, retirement residences, apartments for independent living, residential care homes, and health care facilities. Clients are urged to visit the apartment or retirement residence under consideration. We recommend that several places be visited, so that the senior is able to make a choice. If problems arise in the future, he or she will have a more realistic idea about alternatives. The process of making a choice also provides the

opportunity of having control over his or her life. A helpful list of questions to ask, and features to look for during these visits is provided. "Where to Live"

Our counseling experiences pointed to the need for a comprehensive listing of housing alternatives, which was not available from any source in the spring of 1973. Two useful directories had already been produced by the City's Senior Adult Services, in cooperation with the Senior Coordinating Council of the Palo Alto Area, but these were limited to resources in Palo Alto and the surrounding communities. Seniors seeking housing, however, could not be so limited geographically, so the center staff developed Where to Live: A Guide to Housing and Alternative Living, which includes all "senior-only" housing in Santa Clara and San Mateo Counties.

A committee of 10 volunteers visited each of the 38 subsidized and 19 market-level housing. complexes and retirement residences in the two counties. The committee members, all knowledgeable and active in the housing field, also participated in planning the directory's format, funding, and distribution. Since such a large geographical area was included and because the innovative aspect suggested it as a model for other communities, we sought funding outside Palo Alto. The design of the book and the first printing of 5,000 copies were funded by the Association of Bay Area Governments; subsequent printings of 3,000 and 5,000 were paid for by the area agencies on aging of the two counties.

Where to Live can be used with counseling or as a substitute for it. It begins by suggesting questions one should ask before making a move. Then alternatives to moving are described, including home and social services, financial assistance, and information and referral sources. The third chapter includes a list of retirement rentals at prevailing market rates, advice on locating and selecting apartments in the community at large, and information about the five life care contract homes in the two counties. Chapter four starts with background informa

tion about subsidized rental housing (income, health and age limits, amenities, waiting lists, etc.) and lists all federally assisted developments in the two counties. A chart includes rent levels, size and setting, and available meal plans and activities for each.

The last two sections cover residential care homes and health care facilities (nursing homes). For these categories there is no listing of individual facilities; information is provided about the different levels of care, financial arrangements, and facility evaluation. Seniors are directed to the County offices which keep upto-date lists of vacancies in all licensed facilities. The directory has been of value to thousands of Peninsula seniors and their families and it has also been used as a model for other communities. Listing Service

Many seniors do not choose to live in a group setting, among other elderly people. They prefer a studio or one bedroom apartment, or a room in someone's home, and they require assistance in finding a rental. Palo Alto is Stanford University's college town, so many seniors are in competition with students for small, inexpensive living quarters.

The Senior Services Center maintains a list of older adults seeking housing as well as a file of vacancies listed by landlords who prefer older tenants. We encourage landlords to seek our clients because they are usually quiet and reliable. Matches are facilitated by Senior Center staff but no attempt is made to check references on either side of the listings. The Santa Clara County Council on Aging recently funded a county-wide Project Match, to bring together seniors who want to share housing and some of our clients are referred to this project. Rental Housing

The rental housing market in Palo Alto is characterized by two unusual statistics-a vacancy rate of under one percent and an annual turnover rate of 33 to 35 percent. This suggests that many seniors with low fixed incomes and limited mobility are at a serious disadvantage.

The Rental Housing Directory lists 900 complexes and for over half the units it describes characteristics of special interest to senior and handicapped persons. A guide to the directory is provided, allowing clients to locate all units with the combination of variables they require. For example, seniors seeking a "one bedroom apartment, furnished, downtown, no steps, permits pets, in the average rental range," will be given the addresses of complexes with this combination. They can then visit the complex and put their names on a waiting list if no vacancy exists. The Directory and Guide are available at the Senior Services Center and also at the community-wide information and referral office.

The Comprehensive Employment and Training Act (CETA) provided four full time staff members, who worked under Senior Services staff supervision, to survey all the rental housing units in multi-unit complexes in the City. Over 10 months were required to develop the list, conduct phone, mail, and on-site interviews, and transfer the data to the directory.

Several extra benefits resulted from this project including creation of a valuable data base for planning agencies and advocacy groups interested in housing, and useful updating of the land use map of the City's Planning Department. Summary

The ideal community should try to provide as many housing options as possible for its seniors including rentals of different sizes and costs, agesegregated and age-integrated units, and some which include personal care. Also needed are supportive services and subsidies to help seniors remain in their present homes, if that is the choice. But options are not sufficient-there should also be a service to provide assistance in selecting among the options.

These programs bring benefits to the entire community. Economists call them "externalities." These include the satisfaction young adults get from seeing their elderly neighbors "in good shape," the benefits small children derive from getting to know old people as well as young, and the positive effect on our attitudes toward old age.

* Dr. Kozol is Professor of Optometry at the New England College of Optometry in Boston, Massachusetts. He is the author of several books dealing with vision including Clinical Optics.

"I'm going blind," Mrs. J. said tearfully to the director of the local nutrition program. "What am I going to do now?"

That morning, Mrs. J's eye doctor told her she had cataracts-a condition which affects an estimated 912,000 Americans each year. As often happens, the diagnosis frightened her so much that she did not really listen to the doctor's reassurances that, with help, she could maintain good vision.

Like many older adults, Mrs. J. equated the term cataract with blindness. She dreaded the loss of her independence to live alone, do parttime volunteer work, and travel.

Persons working with older adults are in an ideal position to help alleviate the fears of people like Mrs. J. by providing them with the facts about cataracts-that with proper care, cataracts need not result in blindness. However, if untreated, cataracts can result in impaired vision and eventual blindness. Estimates for 1972 show that 1,670,000 Americans suffered impaired vision as a result of cataracts and another 183,000 had severely impaired vision. In addition, 48,000 were legally blind as a result of cataracts. In the vast majority of cases those affected were 65 and over.

Misconceptions Abound

Many misconceptions about cataracts stem from confusion about what a cataract is. Individuals of all ages wrongly believe that a cataract is a film that grows over the front of the eye. This is not true. What, then, is a cataract?

A lens inside the eye does the job of focusing so that person can see both distant and close objects clearly. Under ordinary circumstances, this lens, made of transparent tissue, is completely clear.

Many vision experts believe that as part of the aging process, this lens begins to lose its

transparency and becomes increasingly opaque, making it more difficult to see through the lens as the process develops. It is this opaque lens that is referred to as a cataract.

Some cataracts are related to the aging process while others are caused by injuries or disease. In rare instances, cataracts are found in infants at birth.

There is no pain involved in the development of a cataract, and the cataract usually causes very gradual changes in a person's ability to see.

This is one important reason for older adults to see a vision specialist (optometrist or ophthalmologist) periodically for a routine eye. examination. During the examination, the cataract, if present, can be detected in the early stages of development. At this time, the patient is advised about scheduling routine appointments to monitor any changes in the cataract or eye health in general.

Cataract Surgery

At present, cataracts cannot be prevented or cured. But they can be treated by surgical removal of the cataractous lens. Patients under the care of an eye specialist are referred at the proper time to an ophthalmologist who determines the type of surgery that should be performed.

It is not generally necessary to have surgery at the time a cataract is discovered. Often good vision can be maintained for some time with proper lenses which are changed as the cataract progresses.

Many people are frightened at the prospect of eye surgery but these fears are usually unwarranted. Most authorities agree that an estimated success rate of 95 percent is conservative. The corrected vision of a person following surgery is usually very good with appropriate optical correction.

Social workers in particular are often asked about insurance coverage for this type of treatment. Health insurance plans vary but many companies offer some form of coverage for cataract surgery and sometimes for eye examinations and cataract glasses.

If untreated, cataracts can result in impaired vision and

eventual blindness.