Ohio to Illinois, to the West and the Pacific Coast, from Virginia to Tennessee to Texas. Lately, we have seen new patterns of abandonment of the elderly. In the pursuit of a career, children and their spouses are constantly reassigned from one city to another, leaving aged parents behind. In the pursuit of a better life, the younger members of various ethnic communities have moved to the suburbs, leaving their aged parents in urban areas increasingly populated by groups they regard as aliens, with as sole remaining common meeting places, churches and temples increasingly too large for their thinning numbers, and which they become more and more unable to support.

The aged suffer from many handicaps. They are poor. Most are not covered by Social Security (which had a coverage far from universal in their working days). They often have no pension. (The lack of vesting of pension contributions is one of the major scandals of our industrial life.) They are ferociously discriminated against in employment.

The aged are heirs to a myriad of degenerative diseases. They are handicapped by cardiovascular diseases, our number one cause of disability as well as our number one cause of mortality. Hypertension and atherosclerosis, leading not only to strokes and coronaries, but also to renal diseases, loss of hearing and vision, and loss of limbs; diabetes, which considerably aggravates the risks of cardiovascular diseases; arthritis, which seriously hampers their mobility. The lack of mobility due to chronic diseases is made worse by the fact that the elderly are too poor to acquire and maintain a car, are often found unfit to do so, and by the steadily worsening state (and cost) of mass transportation facilities. The aged, in this country are largely edentulous; many lost their teeth very young-lack of fluoridation, lack of availability of dental care, and the high sugar consumption in this country have seen to that. This means that they have to use their few remaining teeth, their gums and badly fitting dentures to chew their food.

We have already seen that the aged are often alone and isolated. Their children, concerned over this isolation, solve the dual problem to the parent's welfare and to their conscience by pushing the elderly into nursing homes (who would feed you if you could not get out? Who would know if you broke your hip in the bathroom?). The elderly feel about nursing homes the way the young feel about the draft. It is an abrogation of their most basic freedoms, forced upon them by the middle-class power structure-and they don't want to go but are often forced to, with their house sold out from under them "for their own good" and the capital used to incarcerate them.

The combination of poverty, chronic disabilities, lack of mobility and loneliness (and countless other factors, such as the large size of many commercial food packages, lack of storage space and refrigeration, etc.) means that the elderly are generally poorly fed, with a diet showing little variety and with no incentive to prepare, serve or consume any of the dishes which require extensive preparation. The commodity distribution program is a ridiculous answer to the problem: it is unwieldly (How are the elderly to bring their commodities home?). consists often of unfamiliar foods and usually comprises large cans which lead to a series of identical meals, with the meat often spoiling before it is finally consumed. Food stamps are vastly preferable: they have the flexibility of money but do not solve problems of mobility, preparation or loneliness. The answer is a complex one, going from reform in the Social Security and pension plan systems to better city planning and more appropriate housing for the elderly. Certainly, special nutrition programs for the elderly-bring them to community meals or bring individual meals to them. Such programs of course serve more than a purely nutritional aim: they recreate a social structure which permit human intercourse, and the provision of medical, consumer, electoral and entertainment programs. From an economic viewpoint. these programs may save the Nation a great deal of money. By providing a daily check on the particinating person, they obviate the premature institutionalization of the elderly, thus saving a great deal of unnecessary suffering and expense.

Frankly, considering that the President pronounced himself a strong sunporter of the principle of these programs at the White House Conference on the Aging in November, 1971, and that Congress passed the legislation authorizing The expenditures of $100 million in fiscal 1973 almost immediately. I am a little surprised that it has taken as long as it has for the proposed regulations to be established. Needless to say, I welcome the hearings held by the Senate Select Committee on Nutrition and Human Needs, which once again, is the necessary goad to action. I will not, in this initial statement, comment in detail on these

regulations, except to say that particular attention should be paid to the rural aged, particularly those from minority groups-Indians, Eskimos, and denizens of our island territories and dependencies. It is hard to be old in America; it is even harder to be old and black, old and Spanish-speaking, or old and Indian. Let us remember that the elderly have worked for and fought for America. Whatever we can do here is no more than a small repayment on a debt we can never redeem.

NOTES ON NUTRITIONAL PROBLEMS OF THE ELDERLY

The elderly present certain frequent nutritional syndromes which would be alleviated by the provision of regular meals supervised by dietitians.

UNDERNUTRITION

Engendered by poverty, lack of mobility, lack of teeth, sometimes impaired absorption.

OBESITY

Engendered by lack of mobility, excess of sugar, fat and other concentrated sources of calories.

ATHEROSCLEROSIS

Accentuated by inappropriate nutrition, high in saturated fat and cholesterol; the cardiovascular risk may be aggravated by excessive salt consumption in the presence of hypertension.

VARIOUS PARTIAL VITAMIN DEFICIENCIES

Low intakes of vitamin A, the B vitamins and vitamin C are common in the elderly. Certain syndromes of mental depression and confusion in the elderly are thought to be related to low B vitamins intake.

IRON DEFICIENCY ANEMIA

Recent studies show a very high prevalence of anemia among the elderly poor, both women and men.

OSTEOPOROSIS

Demineralization of bones is accentuated by diet low in calcium, lack of fluoride in water system.

DENTAL CARIES

Accentuated by diet high in sugar, low in vitmains and minerals.

DIABETES

The nutritional problems of the elderly diabetic poor cannot be solved without substantial community help. The same is true of a number of food intolerances and loss of specific intestinal enzyme activity.

COMMUNITY CENTERS FOR THE ELDERLY

Senator PERCY. Doctor, before I ask you questions, I would like to comment on the chairman's and Congressman Pepper's notes about community centers for the elderly. I think they are essential, and I did introduce a bill, S. 1588,* on April 20, 1971, with the cosponsorship of Senator Hart of Michigan, which calls for the construction of community centers. It authorizes $70 million for the first year and up to $200 million as of 1975 for their construction. I feel centers of that type, plus a nutritional program, can be an answer to prevent so many people going into nursing homes. The minute they go into the nursing home, if they are indigent, we pick up the whole cost, $500 or $600 a

See Appendix 3, p. 375.

month, and they are in an atmosphere many times that is just degrading to them. We can prevent that for a very modest cost. I think when we think about what we put into young people on dormitories on campuses, we run into billions of dollars, and certainly modest investments here for community centers would help a lot.

I would like to also comment on our commodity distribution programs. I felt rather deeply about this program because in the 1930's we were the recipients of commodity food distribution that was dropped off at the door. I can remember my Republican mother saying she voted for Franklin Roosevelt because he fed us, and that shocked my father. We were able to get food delivered. I can remember the trucks coming up delivering it.

Today, some 30 years later, we have a commodity food distribution program essentially set up for the farmers, not the recipients. What they get is what the farmers have left over. If you have a big surplus orange crop down in Florida, we will buy it up and then they get orange juice; but if we do not get a surplus crop, they do not get it; they get some other form of juice if that is in excess. The older people may get a lot of peanut butter if we happen to have an excess of peanuts in the crop and we have to sometimes get rid of it. We dump it on the elderly in 10-pound cans.

So I did introduce a bill, S. 3599,* and I just want you to know that we are now, for the first time, going to look at the program from the standpoint of serving the needs of the hungry rather than serving the interests of the farmers who are producing things in excess that we are not using. We call for small packages. We call for proper labeling and a wide distribution of products to be available, whether they are in surplus production or not, to meet the needs of the hungry.

So at least we are making a little progress in that area and I certainly know that our distinguished chairman will provide support for that legislation.

I would like to ask your judgment as to whether the regulations are sufficient to insure that menus meet the unique dietary needs of the elderly as you have outlined in your statement?

Dr. MAYER. I think that the wording is vague. I believe that rather than to try to legislate the menu we should guarantee that the menus are supervised by a qualified dietician. This is better than trying to enumerate everything that ought to be or ought not to be in the menu. I think that "knowledgeable persons," the wording of the regulation is unsatisfactory. I would like more specific wording.

Senator PERCY. What additional authorizing legislation, if any, is required to insure a nutritionally adequate diet to all senior citizens who are in need?

PROVIDE FUNDS FOR SPECIAL DIETARY NEEDS

Dr. MAYER. I would like to see some method whereby additional money, perhaps from medicare or some such source could be tapped for the many elderly who have special dietary needs. Again, I think we will probably find people going to different kinds of treatment. Some will go to the community center or wherever they are going to be fed;

*See Appendix 3, p. 401.

others to the diethetic outpatient clinic of the hospitals to get special foods; and some form of regulation which would make it easy to make that transfer of funds at the local level would be very useful.

Senator PERCY. I would like to ask you the same question I asked Congressman Pepper with respect to the $400 million being returned to the Treasury within 2 weeks now, that was authorized and appropriated by Congress. I can well understand that possibly $100 million would be unused simply because of administrative pipelines and so forth, and a desire of Agriculture to have an adequate amount flowing, but would it appear that $400 million, in your judgment, would be somewhat excessive, and does that imply to you from your knowledge that we have closed the hunger gap, or do we still have great human needs that could have been met if we had somehow found the way and had the will to do it?

Dr. MAYER. Senator, I am very glad you are asking me that question. There was an article* which has been much commented on the week before last in a widely read financial magazine, Barron's, sort of suggesting that there was no such thing as the hunger problem, that the needs were all solved and that the whole program was unnecessary.

In my experience, the needs are very great. The recent partial recession, which is attenuating itself now-but more from the point of view of industrial production than from the point of view of employment—has, if anything, increased the overall needs compared to what they were 2 years ago. The outreach of the programs is still poor. In fact, we have just found two cases of kwashiorkor, the disease caused by acute protein malnutrition, in Boston, in two Puerto Rican children. They were acutely ill, having been fed only some rice and some crackers, without their families realizing that they were eligible for outside help.

I think the Department of Agriculture can do a very much better job than is being done now in terms of making the availability of the programs known to our poor fellow citizens, particularly to those who have difficulty either reading English or do not speak English as their mother tongue.

Senator PERCY. One last question, because we have a record vote on the floor that has been called. I would like to ask unanimous consent that the editorial in this morning's Washington Post entitled "Thrift at the Expense of the Hungry,"** be inserted in the record this morning.

Senator KENNEDY. Yes.

Senator PERCY. I would like to put to you the last question that a 72-year-old woman, a diabetic, who testified before the hearings I held a week ago, asked. In a week and a half she runs out of her food stamps and does not know where she is going to get her food. She lives a mile from the Capitol. She asks this question: "Senator Percy, why are they going to give it back when I get so little?"

How would you answer that question? I said that I would open with that question when the Secretary of Agriculture or his deputy comes before us at the hearings to be held later this week or early next week. Is there an answer that can logically given to this woman? Dr. MAYER. The only answer is that we operate a system which is so complicated that the only people who receive what the law says

See Appendix 1, p. 313.

**See Appendix 3, p. 367.

they can receive are the people who are sophisticated enough to go out and press the right buttons. There has been a tremendous underutilization, not only of Government services but of volunteers, in making sure that people are reached as they ought to be reached.

NEED FOR YOUNG VOLUNTEERS

In this regard, Senator, I think that one of the events which I hope will take place as a result of the regulations and the previous legislation is a drafting of young people in these programs. The young very often get along with the old better than they get along with the generation immediately above them.

The old are not interested in seeing only older people. They are very happy to see younger people. It is a good relationship. Fortunately, at this point, young people are very much more aware of social problems and the needs for advocacy than their parents' generation is, so that the drafting of young people to work in programs of this sort is not only a way to have highly qualified free manpower, but also, to build some strong advocacy into the program and to avoid the sort of episode that you just mentioned.

Senator PERCY. Thank you very much, Dr. Mayer.

At this time we will call a panel of directors of State agencies on aging: Charles A. Chaskes, executive director, Michigan Commission on Aging; James O'Malley, acting director, New York Office for the Aging; and Mrs. Elizabeth Breckinridge, supervisor of section on Services for the Aging, Illinois Department of Public Aid.

I give an equal welcome to all witnesses, but particularly to the witness from Illinois. Now, that our distinguished Chairman has issued a sermonlike statement, he will probably be delayed for a few moments on the floor and with the media, but I know he will be right along and I think it would be his intention that we go right ahead at this particular time and he will go over the record of all the testimony given.

Have you decided in which sequence or order you would like to go? Mr. CHASKES. As president of the national association, I would like Mr. O'Malley from New York to lead off if he will.

Senator PERCY. Fine.

STATEMENT OF JAMES J. O'MALLEY, ACTING DIRECTOR,

NEW YORK OFFICE FOR THE AGING

Mr. O'MALLEY. I feel in an awkward position at this point with a lovely lady on my right-and particularly one of your constituents and a hard worker. But perhaps, Senator Percy, I can borrow on my status as a former Chicagoan and thank you for the work that you have done on this particular program, and hopefully that you will continue to do, since I have parents back in Chicago who, by age alone, at least, are considered senior citizens.

When Congressman Pepper talked about the young people in the room, I, too, was pleased, particularly because many of them are from Queens College in New York. But I was also disturbed in the sense that there were not enough older people.