of working together "as a Family confronting problems most older people seem to have." An interview was conducted to explore the needs of each individual and the community. By using this approach, a climate of positive expectation and individual involvement and commitment was created and continues to be a strategy for encouraging participation. In a period of 10 weeks, 27 elderly persons expressed an interest in the project and came to the first meeting.

Data from the Assessment of Needs survey were presented to the members at the first meeting in the facility.

The next six weeks involved learning the names, telephone numbers, and services provided by community agencies. Twice a week, some 25 older people met at the facility to plan for two panel discussion meetings involving various agency heads who would provide information on services available to The Neighborhood Family. Through this process, the elderly learned organizational skills as well as the selection and protocol techniques needed in contacting appropriate agencies.

It took 10 weeks from the first meeting for a group of elderly people to turn the warehouse into a Center, identify themselves and their purpose, plan and execute two large panel meetings, form an administrative body, and prepare a program for an Open House.

Although a staff was offered by the JMHCMHS, the staff gerontologist chose to work alone at first. During the initial four months, no staff or agency personnel were there to impose preconceived notions of how to work with older people.

There were no agencies to extend services, no operating funds, and no administrative structure to contend with. It was important for the members to see themselves as the only participants who would transform the theoretical model into a functioning Family.

The Neighborhood Family continues to be understaffed. Aside from a full-time director, there are two part-time nurses, a full-time social worker, and secretary. Six hours of psychiatric time are available to The Neighborhood Family from the JMH-CMHS. The Family survives with the help of volunteers from the membership. Five volunteers each work 38 hours a week, and 20 volunteers work from 2 to 37 hours a week.

All Races, All Ages Band Together

Although the area defined as The Neighborhood was in the trailer parks area, we discovered at the end of the first year that only 70 percent

lived in the trailer parks. Another 24 percent lived in small private homes in areas beyond the parks. Those 50-59 years of age represent 12 percent, while those 60-69 make up 31 percent of the membership. The 70-79 age group comprises 20 percent and the 80 and over group, 9 percent.

The youngest member is 28 years of age and the oldest is 93. Eighty-five percent are white Americans; 6 percent are Black. There are very few Spanish-speaking members. However, we are seeing an increase in the number of Black elderly women, both American Blacks and Bahamian, and in the number of Asians, particularly Filipinos.

Thirty-five percent of the members have lived in Miami for less than 10 years, but 54 percent have lived in the same neighborhood from 11 to 30 years. This large group represents the elderly who did not join the flight from the inner-city. The majority live alone, and 43 percent are married. Most of the members say they had "some high school," and 27 percent finished high school.

Originally 65 percent of the members had telephones; this dropped to 56 percent at the beginning of the second year and is still dropping. We are notified of telephone cut-offs each day. When The Neighborhood Family opened, 52 percent indicated that they had cars. This has dropped significantly as insurance rates have sky-rocketed in Dade County and as members can no longer afford to maintain a car.

A levelling off is occurring as more affluent residents choose to go elsewhere, leaving The Neighborhood Family to those "who really need

it."

One of the major problems cited by the Family members is poor health. Sixty-eight percent indicate that health "prevents them from doing what they want to do." Sixty-six percent are under care for their medical problems. Eye problems, arthritis, heart trouble and hypertension are leading complaints. Reasons cited for not seeing a physician include: "It's not bothering me now," "finances," "can't find a suitable doctor," and "transportation."

In the first year, participants listed their major concerns in this order: health, money, and a desire for a better self-image. At the end of the second year they listed health, crime in the neighborhood, and finances.

A leveling off is occur

ing as more affluent residents go elsewhere, leaving the Neighborhood Family to those who really need it.

30 AGING

problems, could not come and yet supported the idea of working together "like a family." A network system was initiated in the trailer parks for these individuals. Its purpose was to keep a record of new people moving in, to communicate information quickly, to be in close contact with individuals needing services, and to keep residents informed of center services and activities.

During the first year, weekly outdoor meetings were held on a member's patio in one of the four trailer parks. This laid the groundwork for dealing with larger environmental problems within the trailer park and provided a base for collective problem-solving. After a year the environmental problems were resolved, but residents continued to be in close contact with The Neighborhood Family. They were already in the habit of contacting The Neighborhood Family for help with everyday problems and crises, and for companionship and social activities.

This year, the network meetings have been reactivated in another trailer park which the entire Neighborhood Family membership, including policy and agency personnel, identified as one of the worst crime areas in the Neighborhood Family community. Their specific objective is to "Reclaim Your Neighborhood" and the project has the approval of the trailer park owner, manager, and many residents who were already Neighborhood Family members.

Elderly members are presently offering very young mothers help with child care. Their problem list for future action is long, including removal of a dope-peddling ring, drunkenness, noise, and finally, crime.

Health Services

The Neighborhood Family provides supportive and preventive community health care. With the aid of the nurses, social worker, and "the friendly Family place," crises in health care have been largely eliminated. The Well-Adult Health Program in The Neighborhood Family now includes screening, health interviews, lectures, blood pressure and weight checks, health counseling, home visits, and an exercise program.

Project members eagerly talk to the nurses and look forward to the health interview and blood pressure reading. However, only half of them. comply with instructions or referrals. Some noncompliers voice the fear of a disability being discovered, believing that they will be rejected and forced into isolation if people knew they were not well. Some have had unsatisfactory experiences with clinic services. Others say they just

want "to go it alone." In some instances, it took a year and many interviews to identify the salient problems. Eroding the resistance of noncompliers is a continuing effort.

The nurses make home visits and hospital calls. Their persistence after two years is finally paying off. Members have begun a regular exercise program at the center, and they urge others to "see the nurse," "to go to your doctor." or "take care of yourself." There are lines for blood pressure checks. Members accompany one another to a near-by primary health care facility. Healthy older members look out for the sick. Social Services and Counseling

The Neighborhood Family provides direct and referral services involving personal economic and environmental assistance. These include food stamps, the Senior Companion Program, SSI, housing, counseling, and legal aid. Hot meals are served daily at the Neighborhood Family Center and to the non-ambulatory at home.

Individual and group therapy are provided by Family members and professional staff, along

with continuing evaluation by the psychiatrist and nurses.

Social activities include discussion groups on the development of mutually supportive activities, Thursday morning membership meetings, neighborhood improvement meetings, network systems meetings, bi-monthly trips, parties, and bingo sessions. Nothing is superimposed from above. Members continue to hold weekly meetings and to express their ideas and desires. The Board of Directors plans programs based on these ideas and members vote on the programs.

One idea which has been carried through to completion was the Italian Day, which was such a success that a Middle East Day was planned.

Public officials have also been brought in to address the Neighborhood Family group on concerns voiced in the Thursday membership meetings and on such issues as garbage fees, insurance rates, and crime. This has led to feelings of personal worth and effectiveness among the members.

The scheduling of events or programs reflects the interest and energy level of the members. The members, director, social worker, or nurses may

contribute ideas for activities, but the development of a program is a mutual effort. The Family paces the "life" of an event whether it is an hour, a day, a week, or a month.

Budget

Based on the staff-service ratio of The Neighborhood Family, this community-based program offers a structure for serving large numbers of individuals at minimal costs. Direct care services, that is, medical, psychiatric, and social services, were given to 650 people from July 1975 to July 1976. This number generated 2,500 encounters per month at a cost of $24 per member per year. This figure does not include 1,440 people who came into the Center for recreational, educational, and special events. Contributing to the low cost is the volunteer labor of 27 members and the rent-free, electricity-free facility.

Summary

We have described what can be accomplished in a two-year period in a low-income neighborhood composed of residents with multiple physical, psychological, social, environmental, and economic problems. Quasi-familial bonds and community action have developed in an area of social decay, mutual suspicion, apathy, and hopelessness.

The Neighborhood Family differs in the most fundamental sense from other service providers because it is not under the aegis of an agency extending its services to its constituents. It is free to develop its own services.

The Neighborhood Family is a communitybased and community-administered body which utilizes the services of professional personnel working as members of the Family, not apart from its "staff." The elderly participants are the decision-makers who function as peers with the professionals.

The Neighborhood Family can supplement programs in senior centers, in churches, and in community mental health centers. It warrants replication in rural areas, and with other ethnic groups.

In its third year. The Neighborhood Family model continues to prove the hypothesis that older people living in the community can work together as a Family to reduce stress from personal problems and environmental conditions.

*Neighborhood Family Services, Inc. Miami, Fla. Ms. Ross is on the staff of the University of Miami School of Medicine's Department of

ennessee has long been proud of its

T growing network of multipurpose senior

citizen centers, and for a decade, the Tennessee General Assembly has supported them with the highest level of State funds possible in the budget. In fact, the legislators have come to consider the multipurpose center as a practical focal point for the delivery of services to older Tennesseans. “Currently, the Tennessee Commission on Aging is supporting the operation of 69 centers in 63 of the State's 95 counties with State funds," says Tom Henry, TCA's executive director, "and we have as our goal establishing a multipurpose center in every county of the state."

The overall system of centers, supported both with Title V and State appropriations, includes 83 centers serving 77 counties. Last year, more than 200,000 Tennesseans 55 and older participated in center activities. TCA projects this number may reach 300,000 in FY 1979 if the network is expanded as planned.

"A senior center in every county of the State is not really a long-range goal for the Commission on Aging any longer; it is fast becoming a reality," Henry adds. "The TCA has received its greatest shot in the arm from a $1 million Tennessee General Assembly appropriation for the establishment and continued operation of multipurpose senior centers for fiscal year 1979."

In 1959 the Tennessee Medical Association recommended that 28 public and private organizations concerned with the needs of the elderly consolidate their energies by forming the Tennessee Council on Aging, predecessor of the Commission on Aging. Part of this early interest on aging was encouraged by the senior citizens clubs in the State. The Tennessee Council on Aging wanted to develop local community programs, and early regional council meetings on aging considered "senior citizen programs" at workshops.

Even earlier, the senior center concept was fostered by a study and investigation made by the Tennessee Department of Mental Health that began in 1955. Discussions in the fields of medicine, education, social work, business, and industry centered around ways of reducing the growing number of admissions of older people to mental hospitals. A research-oriented group of representatives in these fields approved the concept of establishing a community center as a service, research, and action program with the aim of preventing deterioration in the later years. Forming a single State agency for aging was another proposal arising from the discussion, and the Tennessee Council on Aging, predecessor of the Commission on Aging, was founded in 1958.

The Governor's State Committee on Aging also had an early interest in senior centers. Established in 1960 to coordinate "grass roots" input for the 1961 White House Conference on Aging, this committee helped to create interest in senior groups in each community organizing as clubs or structured organizations. After five public hearings across the State in preparation for the White House Conference, a strong impetus developed to seek funds for these senior organizations.

In 1962 Dr. William A. Keel, Program Specialist for the Governor's State Committee

idea gained a great deal of support among professionals concerned with the problems of the elderly. One of these was Sebastian Tine, then a member of the faculty of the University of Tennessee School of Social Work and a member of the State Council on Aging. Dr. Tine, now the Executive Director of Senior Citizens, Inc. of Nashville, said in a brief overview, "The Social Needs of Older People in Tennessee" (1960): "It is possible and feasible to envision communities in Tennessee in which private social agencies, municipal departments of recreation and adult education, churches, and civic groups cooperatively work out a master plan, putting some recreational program within easy reach of every senior citizen."

Within the next few years, the "vision" of having a facility within reach of every senior citizen will have been realized. However, the multipurpose senior center network will be more than recreational centers-they will be strong focal points in the statewide delivery of services as well. Thus, when the interest in aging began in Tennessee, an integral part of that focus was the senior citizens club. As this interest concentrated on the mental deterioration often associated with aging, the senior club became an important part of the solution to the problem.

In 1961 an informal directory of "Clubs, Centers, and Other Senior Citizens Groups in Tennessee" was prepared, listing some 50 organizations. A 1962 study stated "there are now five large centers and 52 smaller organized groups on aging," and in 1963, 67 separate organizations were listed.

When the Tennessee Commission on Aging became the designated State agency for aging programs on July 1, 1963, it inherited a strong interest in the senior club or center as a vehicle of service delivery to the elderly.

The Commission continued to work with these clubs and organizations, and though no large amount of money was available to train personnel or to fund projects, the idea of the center as a key feature of the aging network was fostered over the years, and a body of able personnel existed who were already thinking of the center as a multipurpose service delivery system.

An important part of the development of this program was a series of training institutes funded through Title III of the Older Americans Act from 1966 to 1969. "The purpose behind the activation of a training institute for adult leaders was to provide a corps of trained leaders to work in senior citizen centers in Tennessee. Training was directed toward providing the knowledge and skills needed to organize, develop, and supervise programs for the well-being of older people in their communities," Tom Henry explained.

The primary purpose of the institutes was to give intensive training to men and women over 50 years of age. Selection of students was made with regard to leadership ability, experience in working with the elderly, and personal qualities. The funds included scholarship amounts for each student, and final selection was made by a screening committee.

course was concerned with the psychological aspects of working with persons in the later years of life. A second course was oriented toward the administrative and organizational skills needed to initiate and maintain an effective program for the elderly. The third course taught recreational programming for older persons. All courses were coordinated with extensive field work for every student. As a result of these institutes, a directory was completed, naming almost 100 trained resource people in the field of aging. This training laid a firm foundation for the growth and development of senior centers.

Shortly after this training period, the Tennessee Commission on Aging again published The Directory of Tennessee Centers, Clubs, and Organizations for Older People (February 1971). This directory listed 103 organizations in 32 counties, but these were by no means all multipurpose senior citizen centers. They included church organizations, business organizations for retirees, and similar groups. In 1972 the