In 1967, with the full impact of Medicare and increased Social Security, they will reach $25 billion. The sum of $25 billion is four times greater than the entire Federal budget in 1940, just a generation ago.

Twenty-two major measures enacted for the benefit of our senior citizens capped by the Medicare Act and the Older Americans Act. On April 11, 1965, President Johnson said:

The aged must be integrated into American life as full partners in the Great Society.

The statistics I have cited above show how much of that promise has already been fulfilled.

As Director of the Antipoverty Program, I am concerned with the unmet needs of the millions of Americans over age 65 who are economically deprived and often socially alienated. When a person is older and poor, he tends to be rejected by those in the mainstream of life.

All of us too easily overlook this vast group of the hidden poor, which you referred to yourself. And so today, Mr. Chairman, I would like to do three things in this testimony. I would like to try to report on the progress we have been making in OEO with respect to the older poor Americans and I shall try to set the problems of the older poor Americans in a larger perspective, and I shall try to share with you the present emphasis on programing for this age group which our staff feels is appropriate under the existing circumstances. We have been doing some things, not as much as we would like to do, but some things since I last testified before this committee on the 19th of January. Let me share some of these highlights with you. First of all, our Community Action Program, which is represented here by Mr. Hess on my left, is about to embark on a major health-aide program involving the elderly. This project which is just beginning will be funded we hope for approximately $20 million.

This is a program to recruit, select, train, and place nonprofessional workers. The project will employ many poor persons who are 45 years and older, including a large number of the older poor. Moreover, a significant proportion of the services provided by the health aides will be directed to the senior citizens who are homebound.

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 opening up, we hope, through the health aides program which, as I said, will employ a large number of older persons.

One might ask at this point why we start at age 45 rather than at a more elderly age if we are really focusing on the elderly poor. The reason is that a number of the jobs which we hope to develop in the health-aide program do require a substantial amount of physical strength.

For example, in a hospital with the strength needed to actually lift a patient and move a patient on or off of a stretcher or to carry a heavy weight some distance in the work that is required in the hospital, we believe that by starting at 45 we have a chance, therefore, to get a number of persons who would have that physical capacity, but by starting at 45 we do not mean to imply that we are going to emphasize the age groups, let us say, from 45 to 55.

We are looking forward to emphasizing, as I said earlier, the elderly poor rather than just those at that earlier age.

The second thing, which you just referred to, Mr. Chairman, is the Operation Medicare Alert. As you know, this program was designed to use older persons as aides in a massive effort to tell other 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 Headstart. This is true in terms of the number of community action agencies that participated and in terms of the number of recipients directly benefited.

For example, there were 467 Medicare Alert projects in 47 States, Guam, and Puerto Rico. Eleven of these were on Indian reservations. We had 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 and to help them to sign up for those benefits.

These workers arranged for 9,356 meetings, which were attended by 308,375 older persons. Finally, they referred 55,597 persons to other antipoverty programs for needed help.

Our staff is now 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. 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 percent 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 "overextend 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 backroads 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.1

Now, Mr. Chairman, let me speak about our 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 in January, I said there were 21 such projects which we had funded for a total of $2.7 million, employing more than 1,100 older persons. These programs, as I said, have operated now for about 6 months.

On the basis of what we found out through those programs we recently 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 will be a total dollar amount of 11.5 million for this fiscal year. The current pressure on CAP funds, however, make it necessary to defer a portion of the planned funding until July.

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 extremely important to these older citizens. Of course, they derived immense emotional gratification from the children's attachment to them.

We also made some investigations of the impact of the work done by older people on the children. Let me just say in parenthesis here that when we started this program there was a substantial amount of authoritative opinion which believed that older persons-that is, people over 60 should not be encouraged to go to work and help out these small children, especially infants.

Yeats, William Butler, "Sailing to Byzantium," 1928.

It was believed by some experts in that field of social welfare work that younger women and younger men should be employed, that people over 40 were not really qualified emotionally and otherwise to deal with these foundlings and other young children. So when we started the Foster Grandparent Program it was not as if there was no opposition to it.

The opposition may not have been very vocal, but there was a professional doubt that the foster grandparents idea would be a successful one. Consequently, the preliminary research that we have done is extremely encouraging to us.

One competent researcher reported that foster grandparents handled infants with a care and understanding that exceeded in some cases average hospital staff members.

These substitute grandparents are able to get responses from infants who lay in cribs all day without moving with nobody practically to handle them. 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, Tex., 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.

We have examples from up in New England from foster grandparents who are making clothes for these babies, and the foster grandparents, no question about it, look upon these children almost as though they were their own.

Has the program been well received by the host institutions? Yes; a report from Denver, Colo., is typical:

Both our hospitals have said that they anticipated far more problems than have occurred.

We felt that we had reached the apogee 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.

A third program that we have started, not on a very large scale yet, but it was an experimental program, as many of our programs are, is called 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 midseventies; the oldest worker is 88. Their average income, which a few short months ago was $900 per annum has now been increased by $1,500. Most of them are able to put many younger people to the challenge with the amount of work they produce.

State agencies, I might say, have been most cooperative in supplying materials and equipment; the cost of this project is being equally divided between OEO and State highway departments.

Some people who became Green Thumb workers are now off of welfare rolls, where heretofore they were on welfare rolls, and they have found a great new meaning to life. They have gotten medical assistance they didn't have before.

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.

One thing that is often overlooked that we do is the general work that reaches older people through Community Action Programs. That phrase "community action" is such a vague phrase that it is difficult for everybody immediately to understand it.

Community action affects not just younger people or middle-aged people, but it affects all people, including older people.

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, Mass., in your own State, has recently been funded to establish senior citizens centers in six target areas, one in the north end, one in the south end, one in Roxbury, one in Charlestown, one in East Boston, and one in Parker Hill.

These six centers will provide adult education, information, and referral services of other social agencies and health services for the elderly, retraining many elderly for employment, and homemaker

services.

Those are services whereby somebody goes out into the homes of the elderly to help them. This comes under our title of community action, and unless it were specifically pointed out as a method of get

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