The nonprofessional health aide could work not only in the home, but in other settings as well in the neighborhood health center and in multipurpose centers as family agents helping families to locate and obtain needed health services; in health departments as assistants to health educators, social workers, sanitarians, laboratory workers, family planning workers; in a variety of institutions and agencies as aides to those working with the mentally retarded, with crippled children, with alcoholics or narcotics addicts. And this list represents only the beginning of the possibilities for new career opportunities.

OPERATION MEDICARE ALERT

As you know, Mr. Chairman, this program was designed to use older persons as aides in a massive effort to tell older Americans about Medicare. We worked in closest cooperation with the Social Security Administration in a joint venture. This program, by older persons and for older persons, is the largest single program we have sponsored within Community Action apart from Head Start. This is true in terms of the number of Community Action Agencies that participated and in terms of the number of recipients directly benefited.

There were 467 Operation Medicare Alert projects in 47 states, Guam and Puerto Rico. Eleven of these were on Indian reservations.

This was an army of 12,471 paid older workers, along with 21,178 other senior persons who volunteered their services. These dedicated and active elders contacted 4,300,027 older persons to suggest that they consider signing for Medicare benefits. These workers arranged 9,356 meetings, which were attended by 308,375 older persons. Finally, they referred 55,597 persons to other anti-poverty programs for needed help.

Our staff is making a detailed analysis of reports from all of the Operation Medicare Alert projects. The social knowledge that is gained can help government agencies form realistic public policy.

The program made us aware of two basic needs: The desire of large numbers of senior persons for meaningful part-time employment, and the plight of many older persons who face the prospect of illness and dependency without anyone who can be counted on to care. A specific problem most often mentioned to Medicare Alert teams was the high cost of drugs that they needed.

From a preliminary report, it is evident that workers often experienced shock, surprise, and dismay at conditions they observed. Mary Stamper, a Kentucky woman, expressed a widely shared feeling when she said, "Although we got into some funny situations, others were sad, and some nights it was difficult to get to sleep remembering some of the things we had seen."

Out of the 218 reports examined to date, 80% of the agencies reported a ferment in their thinking about the traditional institutional ways to meet the problems among the aged in their communities. The most pressing needs appear to be in the area of health programs, neighborhood centers with friendly visitors, housing, and employment programs.

Medicare Alert workers proved that they were resourceful and productive. One project director described the workers' problems as one of "too much dedication" so that they would "over-extend themselves at times." The Director of the Social Services Agency of Greater Trenton in New Jersey said, "One of the few short-comings we found in their performance was their lack of fear for their own safety."

The experience of meaningful activity, even for a limited time, had beneficial effects on their personalities. A California director described these effects as follows: "Although the canvassers had great difficulties, they had a purpose and the experience was good for them physically, and having a job to do was uplifting mentally."

Adverse circumstances were almost overwhelming. The project was conducted during the ice and snow of February and March. Yet, the elderly workers walked and drove thousands of miles on the back roads of Maine and Arkansas, as well as the glazed streets of New Haven and Tulsa. They climbed millions of drafty stairs in the tenements of New York and San Francisco. Operation Medicare Alert disproved the oft-quoted saying:

"An aged man is but a paltry thing

A tattered coat upon a stick"

FOSTER GRANDPARENT PROGRAM

Now, Mr. Chairman, let me speak about Foster Grandparent Program. This program employs poor persons above the age of 60 to work on a personal basis with emotionally deprived, mentally retarded, and physically handicapped children. Many of these projects are experimental and go outside of full care institutions into public school settings and day care facilities.

As of my last report to you, there were 21 funded projects with a total of 2.7 million dollars in grants, employing more than 1,100 older persons.

Since then we have funded an additional 12 Foster Grandparent projects for $2.5 million. These projects will employ 1,067 older persons and will bring the total funded projects to 33.

Money has been allocated through Section 205 discretionary funds so that there would be a total dollar amount of 11.5 million for this Fiscal year.

We have contracted with an independent research organization to evaluate the program. An interim evaluation has indicated that the Foster Grandparents Program has given many older persons a new sense of usefulness and an increased self-esteem.

The earning of money was especially satisfying, but the social meaning of the work was most important to these older citizens. Of course, they derived immense emotional gratification from the children's attachment to them. Now, as to the impact of Foster Grandparents Program on the children.

A competent researcher in the socio-health field reported seeing Foster Grandparents handle infants with a care and understanding that exceeded average hospital staff members.

These substitute grandparents are able to get responses from infants who lay in cribs all day without moving. Children who ordinarily would not walk or talk because there was nobody with the time to devote to them are now walking and talking. Although these are preliminary and informal impressions only, the report is definitely positive in the value of the Foster Grandparent program to both its beneficiaries and our senior citizens.

Two anecdotes from the Denton, Texas program illustrate what is happening. "Ned spent his time facing into a corner and cried when approached. He had to be dragged kicking and crying to the dining room. The first change observed after his contacts with a foster grandparent was that he sat in the corner, facing the room. He has now learned to patty-cake, reach out his hands and goes to the dining room quietly, holding Foster Grandma's hand."

"Keith was known as 'the screamer.' It was an all day pattern. After contact with the foster grandparent, the screaming gradually stopped. He has begun to eat with a spoon and shows marked improvement. The staff has now revised its opinion and believes he may have a high potential."

Has the program been well received by the host institutions? Yes, A report from Denver, Colorado is typical: "Both our hospitals have said that they anticipated far more problems than have occurred. We felt that we had 'arrived' when doctors at Colorado General were writing on their orders: "Please assign a grandparent to this child." This report continued, "Stevie, a bright two-year old, in Colorado General was admitted with the diagnosis of "battered child syndrome." He had a skull fracture and massive skin lesions, which were treated like burns. He had to have painful treatment and had to have someone hold his hand when he walked for fear that a fall might injure his head again. After substained contact with a foster grandparent, he seemed to stabilize his affection. ***"

Mr. Thomas A. Tucker, President of the National Association for Retarded Children, has appraised the program in this way:

"Reports received at our headquarters from various parts of the nation indicate that the Foster Grandparents Program is meeting a vital need. Many mentally retarded children are, through no fault of their own, the victims of neglect and apathy. Your programs help to provide the individual care, affection and understanding necessary to help many of these mentally retarded children become productive, well-adjusted tax-paying citizens.”

OPERATION GREEN THUMB

This project was designed to employ retired poor farmers in highway beautification and is in operation. Green Thumb workers have planted more than 30,000 trees and shrubs and have worked on dozens of roadside parks in Oregon,

Minnesota, Arkansas, and New Jersey. The average income of these men before coming into the program was $900 per year, and the average age is 67. Many are in their mid-seventies; the oldest worker is 88. Most of them are able to put many younger people to the challenge with the amount of work they produce. State agencies have been most cooperative in supplying materials and equipment; the cost of this project is being equally divided between OEO and State highway departments. Look at a typical Green Thumb worker: Mr. Ray Pake, in Oregon, has farmed most of his life. He was receiving $35 per month Social Security and $50 from Welfare. He is now off the welfare rolls. His eyesight had been poor, but through this project Mr. Pake was examined and provided with new glasses. Mr. Pake is finding new hope in life through his job.

OTHER COMMUNITY ACTION PROGRAMS

Most Community Action Programs are developed at the local community level in response to the felt needs. CAP has been providing Technical Assistance and giving encouragement to communities which choose to include components specifically designed to serve older Americans. Here are some representative projects that have been funded through regular Community Action Agency channels:

(A) Boston, Massachusetts has recently been funded to establish Senior Citizens Centers in six target areas.

(B) Dayton, Ohio has a Senior Citizens Recreation Project in a public housing project with 1,124 participating who are over 65. They are using a team approach-nurses, doctors, counselors, and recreation leaders for arts and crafts. Their services are also available to 40 older persons who do not reside in the housing project.

(C) In Chicago, a grant provides Senior Citizens Centers where 3,500 persons over 60 years of age are offered adult education, trips, creative arts, health education, and counseling at a rate of $6 per beneficiary per month.

(D) In West Virginia, Monongalia County, the CAP has a grant to establish a recreation center in the basement of the City library, and five part-time centers in outlying areas.

(E) In New York City, the Economic Opportunity Committee of New York has a funded program, sponsored by the Federation of the Handicapped, called PATH (Personal Aides to the Handicapped) in which 250 older persons are participating.

Mr. Chairman, what I have just described to you are some of the specialized separate programs requested by communities and sponsored by the Office of Economic Opportunity specifically for the elderly poor.

PROGRAM SERVING ALL AGES

Our concept of the community action programs is to provide a comprehensive set of assistance and benefits for all the poor regardless of age. The older poor, as well as the young, are participants and beneficiaries in such community action programs as health services, homemaker services, food distribution, consumer information, legal services, social and recreational services, and adult basic literacy. Many of these components when put together with their outreach efforts are the main elements of our multi-purpose neighborhood center program of which we expect to have a total of 600 funded by June 30. We are assuring that the multi-purpose neighborhood centers are giving consideration to the poor senior citizens who are especially in need of the Centers' services.

VISTA VOLUNTEERS

Of course, we must not forget that 12% of VISTA volunteers are age 65 or This is a pioneering effort to utilize constructively the talents of older people. Some of the volunteers are

over.

(a) Edgar Slater, an 85 year old man, teaching Crow Indians a comprehensive manual arts course.

(b) George Cottell, 71, working with the Department of Welfare in Hartford, Connecticut, assisting in job placement and providing encouragement to other elderly persons.

(c) Margery Dritea, 68, working in a State mental hospital in West Virginia helping patients through music.

(d) Mrs. Maurice Frink, 75, teaching preschool children at Fort Defiance. Arizona.

Now, let me share with you a perspective from which we view problems of the older poor American. While there is much that remains to be done for the poor senior citizen, our Nation is making a major effort in meeting the economic and social needs of the aged. For example, in the Fiscal 1967 budget, it is estimated that the Federal government poverty expenditures will total $21 billion. Of this amount, it is estimated that more than 40% will benefit persons over 65 years of age.

To give a sharper focus on this, let us look at 1964, the last year for which detailed data on the number of poor are available. In that year, the 5.4 million aged poor represented % of the total poor. While we do not have sufficient data to show how much of the Federal poverty dollar went to this group, it was at least twice the proportion of the poor population. This was prior to the landmark enactment of Medicare and the OASDI and OAA increases of 1965. Further, in 1964, other poor groups' needs were even greater than those of the aged. For example, the income deficit-the amount of income needed to reach the poverty level of all families with children under 18 was 24 times that of all of the aged poor.

Older people have special maintenance and assistance needs. Many older people are very poor. But, in our concern for all poor people, we must recognize the existence of competing needs relative to a limited supply of poverty dollars. While our nation is doing a great deal for older Americans relative to other poor groups, much remains to be done. In order to bring all older people out of poverty by our minimum standards, we would have to spend in calendar 1966 an estimated additional $2.7 billion. To bring all of our poor above the poverty income line, we would have to spend nearly $12 billion a year.

Congress charged the Administration on Aging of the Department of Health, Education, and Welfare with the general responsibility for older Americans. We believe that the new Commissioner, Mr. William Bechill, and his staff are highly qualified. I am confident the Congress will assure that this agency's authorization and appropriation will be adequate. We are cooperating with and supporting other agencies of the government that have responsibilities for the aged such as the Social Security Administration, the Welfare Administration, and the Public Health Service.

A final aspect of the perspective which must be considered is the fact that OEO has a primary mission of attacking the causes of poverty. We want to prevent poverty rather than merely treating poverty's symptoms. Prevention of poverty in the older years is much more difficult to achieve.

The Administration has supported legislation to broaden benefits of Social Security and we have encouraged full participation in the Medicare program. The Congress has already taken a first step by blanketing in people over 72 and making them eligible for benefits.

While the Congress has placed emphasis on youth-type programs in the OEO legislation, such as Head Start, Job Corps, and Neighborhood Youth Corps, the Congress has recognized that the OEO program is not just a youth program, but it must serve all who are poor. In fact, the Smathers Amendment has given specific legislative direction to include the elderly. Section 610 of the Act reads: "It is the intention of Congress that whenever feasible the special problems of the elderly poor shall be considered in the development, conduct, and administration of programs under this Act."

A summary of all Community Action Programs reveals that we will spend approximately $50 million for programs that benefit the older Americans this fiscal year. These include 561 separate grants, employing about 19,000 older persons and benefiting some 4.4 million. These figures include the Operation Medicare Alert Program.

We consider this number of participants and beneficiaries, along with the dollar value of programs, to be a fair proportion considering the appalling magnitude of the needs for programs by the 32 million poor we are trying desperately to help with a mere budget of $1.5 billion for Fiscal Year 1966.

At this point, Mr. Chairman, I would like to interject a comment about our FY 1967 program. The effect of the House Committee Bill which was reported out on May 17, is to reduce funding for the Community Action Programs by more than $100 million below the President's Budget request. The changes have a restrictive effect on the proposed Fiscal Year 1967 program for the aged. We proposed

a modest $70 million for FY 1967, which corresponds to the $50 million program provided in Fiscal Year 1966.

In summary, we have developed specific projects designed to serve older persons. Our local CAA's have used their initiative and allotted their guideline funds for programs in many instances. Finally, most CAA's include those in later life in the entire gamut of program activities.

Now let me move to the third general area: the direction of our efforts for the next fiscal year.

We shall make every effort to include older persons in existing programs. We are re-evaluating existing programs with this in mind and we are studying new methods which will insure larger participation by older Americans.

We shall participate in a high level conference at Notre Dame University in August, meeting with selected authorities in the field of aging, to further refine our long range goals in this area.

By memos, surveys and on-site visits we shall assist CAA's in establishing meaningful and effective programs for older Americans to the maximum extent feasible, consistent with local initiative and available dollars.

We shall continue to make private and public agencies who also have responsibilities for the aged aware of the special problems faced by older Americans. We shall increase our efforts to make all of our staff at the local, regional and federal levels aware of the needs to include older persons in a great variety of programs. We shall continue to work with other federal agencies to alleviate the special conditions of older Americans which prevent them from having economic security and social support.

The President on April 8 asked the Secretary of Health, Education, and Welfare, to study the possibility of improving Social Security across-the-board, for the aged as well as other groups. We will continue to work with Health, Education, and Welfare, and other agencies which have primary responsibility for the income maintenance, health, housing, and other programs which represent the bulk of the $26 billion the Federal Government will spend in Fiscal Year 1967 for the aged.

CONCLUSION

In conclusion, Mr. Chairman, we are concerned for older Americans in poverty. We are aware of the problems and special needs of this age group. We shall do all that we can within the perspective of our orientation and the dollar limitation imposed upon us. The greatest assistance for the elderly must come from the primary mission agencies, especially those providing income maintenance. Only when we restore the dignity of sufficient income will the aged poor begin to rejoin the community. The local Community Action Agency may help them in this process through health centers, legal aid, neighborhood centers, and other components of Community Action Programs.

Thus, money income is part of a broader strategy to help the aged rejoin the community. We, therefore, will certainly support these agencies in developing their programs, to serve older poor Americans, and we shall make every effort to integrate this special age group into the total efforts of the War on Poverty. Senator KENNEDY. We have your testimony. Would you proceed? Mr. SHRIVER. Yes.

Mr. Chairman, I welcome this chance to discuss with you and the other members of the committee the questions involved with poverty and older Americans.

As you well know, President Johnson proclaimed May as "Senior Citizen's Month." At the close of this period of special emphasis, I would like to join with others in paying particular respect to 181⁄2 million Americans over 65 years of age. All of us need to be appreciative of the contribution of our seniors and sensitive to the special needs of this age group.

The present administration has been keenly aware of the problems of our older Americans. Let me cite some statistics here to point up the accomplishments so far on behalf of the aged:

In 1965 Federal programs for the aged totaled more than $19 billion.

In 1966, they will total nearly $22 billion.