General

24. More adequate comprehensive medical care must be provided for the needy aged.

25. Increasing emphasis should be placed upon the preventive aspects of medical care of the aging. 26. Demonstration programs and experimental programs in the provision of preventive, diagnostic, and therapeutic service to the aged should be encouraged and supported.

27. It is recommended that additional facilities for the care of the chronically ill be provided, including:

(a) Institutional beds

(b) Organized home care programs. This is important since most patients are at home.

(c) Education, professional and lay, intended to develop positive attitudes towards aging and the establishment of health careers for the recruitment of workers. 28. Medical care plans should be encouraged to incorporate into their policies home-nursing and home-care services for patients after hospitalization, and to extend these services to patients whether or not hospitalized.

National Level

29. Further consideration should be given to financing the cost of medical care through increased old-age and survivors insurance payments.

30. Federal, state, local, and voluntary programs should be expanded to provide additional funds for medical facilities and medical care for the aged.

31. Consideration should be given to broadening the availability of health insurance to the aged.

32. It is recommended that studies be undertaken to determine the impact of the various methods of medical care of the aging on the families meeting these costs.

33. Nursing services in the home should be included in medical pre-payment plans.

State Level

34. It is recommended that all states take necessary steps promptly to utilize federal funds recently made available for medical care under the old-age assistance programs and for the medically indigent aged. (The State Committee initiated this recommendation.)

Local Level

35. The State should consider grants to nonprofit homes for the aged or nursing homes to expand their facilities, but such grants should be more realistic and adequate than those provided for by the federal Hill-Burton legislation, which is designed primarily for hospitals and particularly those located in rural areas.

36. Communities should develop detailed directories of available services.

37. It is recommended that every community should have a well-rounded mental health service program, including mental health clinics, in-patient services in general hospitals and day-care hospital services serving the aged as well as the general community. 38. Since it is generally agreed that periodic health examinations are a prime factor in adequately dealing with health and medical care for the well aged, particularly in terms of prevention, it is recommended that education on this point should be increased, and that periodic health examinations should be started when the person is 45 years old. These recommendations can be carried out by industry, physicians, government, churches, insurance companies, and health associations. As much as possible, this should be done at the local level and should be coordinated. The examinations could be made in physicians' offices, in clinics set up for the purpose, in hospitals, in health departments, or elsewhere. 39. Medical science has now reached the point where preventive, diagnostic, treatment and rehabilitation services can actually be effective in preventing disease and in ameliorating

General

24. More adequate comprehensive medical care must be provided for the needy aged.

25. Increasing emphasis should be placed upon the preventive aspects of medical care of the aging. 26. Demonstration programs and experimental programs in the provision of preventive, diagnostic, and therapeutic service to the aged should be encouraged and supported.

27. It is recommended that additional facilities for the care of the chronically ill be provided, including:

(a) Institutional beds

(b) Organized home care programs. This is important since most patients are at home.

(c) Education, professional and lay, intended to develop positive attitudes towards aging and the establishment of health careers for the recruitment of workers. 28. Medical care plans should be encouraged to incorporate into their policies home-nursing and home-care services for patients after hospitalization, and to extend these services to patients whether or not hospitalized.

National Level

29. Further consideration should be given to financing the cost of medical care through increased old-age and survivors insurance payments.

30. Federal, state, local, and voluntary programs should be expanded to provide additional funds for medical facilities and medical care for the aged.

31. Consideration should be given to broadening the availability of health insurance to the aged.

32. It is recommended that studies be undertaken to determine the impact of the various methods of medical care of the aging on the families meeting these costs.

33. Nursing services in the home should be included in medical pre-payment plans.

State Level

34. It is recommended that all states take necessary steps promptly to utilize federal funds recently made available for medical care under the old-age assistance programs and for the medically indigent aged. (The State Committee initiated this recommendation.)

Local Level

35. The State should consider grants to nonprofit homes for the aged or nursing homes to expand their facilities, but such grants should be more realistic and adequate than those provided for by the federal Hill-Burton legislation, which is designed primarily for hospitals and particularly those located in rural areas.

36. Communities should develop detailed directories of available services.

37. It is recommended that every community should have a well-rounded mental health service program, including mental health clinics, in-patient services in general hospitals and day-care hospital services serving the aged as well as the general community. 38. Since it is generally agreed that periodic health examinations are a prime factor in adequately dealing with health and medical care for the well aged, particularly in terms of prevention, it is recommended that education on this point should be increased, and that periodic health examinations should be started when the person is 45 years old. These recommendations can be carried out by industry, physicians, government, churches, insurance companies, and health associations. As much as possible, this should be done at the local level and should be coordinated. The examinations could be made in physicians' offices, in clinics set up for the purpose, in hospitals, in health departments, or elsewhere. 39. Medical science has now reached the point where preventive, diagnostic, treatment and rehabilitation services can actually be effective in preventing disease and in ameliorating

the effects of disease already present — in the old as well as in the young. The key points here are to actually make such services available to communities, to motivate and educate people to their use, and to remove financial barriers to such use when such barriers exist. 40. It is recommended that a community have one central facility for the treatment of chronic diseases, including the chronic diseases of older people. Such a facility may be separately administered, but should preferably have a close connection with a wellequipped and well-staffed general hospital. All facilities should be used appropriately and effectively. For example, people who need chronic hospital care should not occupy a scarce and expensive hospital bed but rather one in a facility for treatment of chronic diseases.

41. Facilities should be made available to develop abilities by the proper utilization of

existing, as well as the development of new, facilities; for example:

(a) The establishment of rehabilitation centers in proportion to the population need (b) Day-care centers

42. A home-care program should include prevention, therapy, and rehabilitation, and have a loan-closet program. There should also be available mobile dental equipment so that the patient may be cared for at home as well as in a nursing home.

43. Establishment of organized health departments covering areas sufficiently large to support a well-balanced health program, adequately staffed by prepared public health personnel, is essential to the administration and promotion of health services. (The State Committee initiated this recommendation.) 44. Housing authorities should be provided with a medical advisory group to assist in deciding when a particular tenant should be transferred to institutional care.

"A decent place to live for many of our elderly means a life worth living."

chapter 3

James Wm. Gaynor

New York State Commissioner of Housing

The three-room flat of Herman and Elsa M., an aged couple, is crowded with furniture and furnishings that once filled a seven-room house. Their $140 monthly retirement income becomes less and less adequate as the rent rises higher and higher, and the flat becomes more and more dilapidated, as does the decaying neighborhood outside. "Independence" becomes precarious when, after 42 years of work, you and your wife have $75 left for a month's living expenses after paying $65 for rent. And "retirement" under these conditions can come close to a nightmare.

THE PROBLEM

With the shift of the population from rural to urban areas, cities have become overcrowded. Consequently, city housing has become expensive, and apartments and flats are small, making it difficult, inconvenient, or imposible to provide for three-generation families.

As the number of aging increases, they become less and less able to compete for the limited housing available and suitable to their low incomes and special needs.

Thus the whole problem of housing has worsened, and threatens to become more acute in the years ahead.

The relation of income to housing is evident. Of all household groupings of the elderly in New York State, about one out of four comprise aging women living with other families. These women have a median annual income of

approximately $500. Single aging women living alone have an income below $1,000. The average rent for three-room apartments advertised recently was $60 monthly in Binghamton and $180 in New York City.

These factors indicate why the houses in which many aging live are inferior to the housing of other age groups; why a number of aging must live with their children, although neither prefers such an arrangement; and why some aging are forced against their will to live in public or private homes for the aged.

AU. S. Senate subcommittee recently found that throughout the United States "The provision of safe, sanitary, and congenial housing at a rental which older persons can afford is a major unmet need of the elderly."

Some congregate living, too, presents problems to the aging. In the past, almost all the aging who did not have homes of their own were placed in the county home and forgotten. Today our growing knowledge in medicine, psychiatry, and social work makes us more aware of the groups of aging and their different institutional needs. The healthy, the semi-invalid, the invalid, the mentally ill, the physically disabled - all have made necessary a wide variety of specialized facilities: boarding homes, private homes for the aged, nursing homes, hospital, infirmaries, out-patient geriatric clinics, mental hospitals and clinics, chronic-illness facilities.