the recipients of this aid may be charged a reasonable fee, by the State agency which administers the program, so that those who can afford it could join in the program fully and pay a reasonable price at the same time. Mr. BRADEMAS. That is correct. Another question on the eligible age for recipients the bill provides 65 or over, does that seem a reasonable age? Mr. BRICKFIELD. It is a good age to begin a program. Our associations feel that 55 is a good age. We are unhappy with arbitrary age limits especially when they are capable of continuing to work and either capable of continuing to want to work or need to work. Yet, 65 is acceptable to us, Mr. Chairman. Mr. BRADEMAS. Do either of the other gentlemen have any further points they wish to make with respect to this bill? I have one other question. It is my understanding that some experimental programs of this kind are presently being operated in some parts of the country under what is called project authority. Now we read in newspapers about the shortage of Federal funds for a variety of programs and it has been suggested that because of inflation maybe we should not legislate this bill but rather extend the present project program. Do you have any comment on that? Mr. BRICKFIELD. Let's go forward on both fronts, Mr. Chairman. There is a provision in the Older Americans Act, I think it is title IV, which calls for research and demonstration projects. These programs have been highly successful. Everybody is in a hundred percent agreement with the programs. If there is any shortcoming or soft spot in the title IV program it has been the lack of appropriations with which to carry out these projects. The Congress has authorized $80 million for all AOA programs. I think to date only some $32 million has been asked for and appropriated. So there have been cut backs all across the line in the Older Americans Act. We are unhappy about it. We think that this program should be fully funded in the research area. Mr. BRADEMAS. Mr. Hansen? Mr. HANSEN. I have no questions. Mr. BRADEMAS. Thank you very much, Mr. Brickfield. You have been very helpful. Our final witness this morning is Mrs. Peggy Sheeler, of Meals on Wheels, Inc., Baltimore. STATEMENT OF PEGGY SHEELER, REGISTERED NURSE, EXECUTIVE DIRECTOR, METROPOLITAN MEALS ON WHEELS, INC. BALTIMORE Mr. BRADEMAS. Mrs. Sheeler, we are pleased to have you and your associates. Would you please go ahead. If you would, as the other witnesses have done, like to summarize your statement that is fine, whatever you would like. Mrs. SHEELER. Thank you very much, Mr. Chairman. I would first like to introduce to you the lady on my right, Mrs. Eleanor McKnight Snyder, and the lady on my left is Mrs. Mary Jane Lyman, who is coordinator of Programs Development for Older People, Lutheran Social Services of Maryland. Mr. Chairman, members of the Select Committee on Education, may I first thank the committee for giving the representatives of the Baltimore Metropolitan Meals on Wheels, Inc. an opportunity to testify concerning proposed resolution H.R. 17763, providing a nutrition program for the elderly. As a background for my remarks may I first describe the Meals on Wheels program as it operates in Baltimore now. A hot and a cold meal are delivered 5 days a week, Monday through Friday. These are balanced regular diets served from nine kitchens, located in the geographic area served. Each kitchen is sponsored by a social agency, churches or volunteer organizations which are responsible for the project management. The only paid person in each kitchen is the parttime cook. The packaging and delivering is done by volunteers. Each kitchen has a steering committee of volunteers responsible for service from that kitchen. The criteria for receiving service of meals on wheels is—inability to prepare food, inability to purchase raw food, and not having anyone to do this for them on a regular basis. The menus, especially designed for the needs of the aging, are prepared by city, county and State nutritionists. The clients are screened by a registered nurse through the central intake office (made possible by a grant under the Older Americans Act, now financed by the United Fund of Central Maryland.) The policymaking group for this project is the board of directors. Two very vital points which must be emphasized are the 300 or more clients who are served every day are a very small portion of the 110,000 people over 65 in the city of Baltimore. Of these, 85 percent live in their own homes; more than one-third are chronically ill. The age span of our clients ranges from 60 to 94; the median age being 73. Second, experience has taught us that it is just a question of time before the needs of our clients will go beyond the food service. May I point out some concerns about our existing project and then relate them to the proposed bill. Since Meals on Wheels is operating in 29-50 States as far as we can determine (the Baltimore project has sent its manuals of operation and had response from 29 of the 50 States) the operations are similar. There are 1,500 volunteers who have given service, some as long as 10 years. We are concerned that the volunteer sources may become exhausted. We lack the means to effectively train the volunteers. Now we are dependent upon the related professional disciplines to give guidance when they have an opportunity. This is done by professionals in addition to their regular obligations. Therefore, guidance is not possible in a consistent way. It is just a question of time before the needs of our people go beyond the meal service. Information and referral are mandatory. Many clients lack the knowledge of good nutrition. Education is needed so that total nutrition needs are fulfilled. In direct response to the provisions of the resolution, I would like to make the following statements: As provided in section 706-nutrition and other program require ments 1. "A one-third minimum of nutritional need; actually seems conservative; this resolution will provide possiby two-thirds of the nutritional needs and guidance for the total nutritional needs. (Nutrition education, see appendage II.) 2. *** 3. "Nutrition program in a close proximity;" establishing kitchens in the neighborhood of the elderly gives the opportunity for the ethnic food patterns to be considered and implemented. In many instances, food served that disregards this, is not only unappetizing to the aged, but in their eyes is not proper. Mr. BRADEMAS. Do you mean there, for example, that some Jewish citizens may be unhappy with the food that is not Kosher or what do you mean by that? Mrs. SHEELER. Yes, sir. This has been our experience. Elderly Jewish persons, for instance, who have eaten kosher food all their lives, would sooner die than deviate from that. 4. "To utilize methods of administration including Outreach." It is vital to uncover the need and make known to the elderly, the availability of the service. It takes time for them to accept help as they have a fierce pride and independence which makes it difficult for them to be recipients. 5. The setting will be discussed in appendage I. 6. "Training"-Experience has proven that training is essential. Those working with the elderly must understand them. Another benefit of training that has been observed is an awareness on the part of the volunteers to prepare for their own senior years. 7. "To establish and administer;" in my experience it is vital that this be a multidisciplinary professional endeavor. It is absolutely essential that the medical profession, the social work profession and the nutritionists work effectively together. None of the above can meet the total nutritional needs of the elderly alone. 8. Cost-In my opinion it is essential to the human dignity of our senior people to allow them to pay a nominal fee for the service. In Baltimore we have what we consider a sliding scale for payment for meals on wheels. People of low income, limited social security, are allowed to pay a nominal amount. Those who are able to afford more, pay more for the service. 9. "Staff," it is vital that the staff be qualified. Training must be provided to assure objectivity in dealing with the clients, as over identification with their senior peer group is a natural consequence and renders their service ineffective. In the Baltimore project we have employed a 72-year-old part-time secretary and this has been one of the concerns which we have had to work through. Mr. BRADEMAS. Thank you very much, Mrs. Sheeler. Mrs. Lyman. Mrs. LYMAN. As my testimony is short, I would prefer to read it. I would like to express my appreciation to the writers of H.R. 17763 for their substantive knowledge of the nutritional and social needs of the elderly. The provisions of this resolution reflect a fine sensitivity to the needs of senior citizens and creative approaches to meeting them. In my own experience as a social worker with a church sponsored agency, which is providing meal services to over a 100 persons a day, I would like to state the food served in a social setting is an important focal point in relating to the elderly. While meeting much of their nutritional needs, this service combats the enemies of old age, which are isolation, alienation, and dependence. In establishing senior centers in churches, we find that the number of older people who will turn out for a luncheon or dinner is four to five times the number who will attend a function where food is not served. As the seniors come for a luncheon, they also engage in much needed socialization and a continuous relationship with such a group then enables them to discuss their other needs. If a qualified advisor is on the spot, much needed information and referral and counseling services can be given. (H.R. 17763, section 706-5.) Certainly, the provision to give staffing preference to qualified persons over age 65 underwrites the whole concept of concern for older people. (Sec. 796 (9).) To train the senior citizen for these positions is, of course, a necessity and again is a constructive approach to the basic concept. (Sec. 706(6).) In our own centers and clubs, we insist that older people plan and implement their own programs, thereby, decreasing the demcnic dependence now inherent in society's approach to our 20 million senior citizens. I would like to suggest that churches be considered as prime sites for these nutrition programs. Presently, churches serve as one of the few geographically decentralized institutions left in our urbanized society. Many are within walking distance or easily reached by public transportation to a large number of elderly and churches often represent the one stable institution in their lives. (Sec. 706 (3).) While the meals might be prepared in the church kitchens as is done in eight Meals on Wheels projects in Baltimore, the meals could also be easily purchased or contracted from local nursing homes, hospitals, aging homes, restaurants, or catering services. (Sec. 705 (A).) In Maryland, voluntary agencies, such as Lutheran Social Services, Catholic and Jewish Charities already have fairly close working relationships with the Maryland State Commission on Aging and certainly could establish a working and administrative relationship with the State agency which may be established to meet the requirements of this resolution. (Sec. 765 State Plans.) One specific Baltimore church is located adjacent to a public housing project and its membership drawn from the 1,800 residents of the project. Of these residents 143 are white elderly, 20 of whom are disabled. There are 80 black seniors, 30 of whom are disabled. All of the elderly are supported only by social security or welfare payments. Many of the latter need special diet allowances according to their physicians and while some receive these small allowances, or food stamps, their actual nutritional requirements are not being met. The causes reside both in the resident's inability to afford adequate food and their lack of sound nutritional advice. This particular situation is only one of many examples in Baltimore. The food service might develop through a luncheon club which could' be situated in either a church or the housing project facilities. Existing or additional social services could be attached to the program. My concluding recommendation is that H.R. 17763 should establish service to the elderly in its most creative sense as the highest priority. I thank you for the privilege of presenting this information. Mrs. Snyder. 52-766 0-71- -9 Mrs. SNYDER. Thank you, Mr. Chairman, for the opportunity to add my comments to those of the previous speakers, relative to the importance of the passage and implementation of H.R. 17763 which would add a new title VII to the Older Americans Act of 1965, as amended, to be entitled "Nutrition Program for the Elderly." As you are well aware, the Baltimore community has assumed the leadership in providing a home delivered meals service which is national recognized for its length of service, involvement of volunteers, and coordination with other health and social services within the community. We were launched with the aid of a 3-year grant through title III of the Older Americans Act. We are proud of the fact that we became established as an on-going comunity agency with community funding through the United Fund and private contributions. However, we know that we are only touching the surface of those older citizens who would be able to be maintained in their own homes if there was some provision for the preparation and service of regular meals in a convenient location. If there were available funds, we could plan the provision of the main meal of the day, which would assure between one-third and one half of the daily recommended allowances, in a variety of locations throughout the city in close proximity to the eligible individual residences as feasible, or within walking distance. These areas would include such locations as: Community centers within housing projects. Related to all of this would be a need for nutritional program that would include information to the elderly as their own personal needs for food for the additional hours of the day-say, how to prepare a simple breakfast or supper. In some areas, there might be a need to provide some dietary counseling because of modified diets for the elderly. Many older folks become food faddists and are ready to use their limited funds for all sorts of unnecessary food purchases because somebody told them it would cure some ailment. In any of these situations, there must be health and welfare counseling so that adequate referrals are made if there is a problem. We certainly know through our home delivered food services that if somebody needs a meal they need something else. Just yesterday I was counseling with a nurse who works in our medical care program and she was saving so often their referrals to nursing homes really hinge on the availability of regular meals. This becomes a vital need because no one is there to take care of them. No nutrition program should be operated in a vacuum. If there are to be community programs for feeding the well elderly, they should be planned in a homelike atmosphere with plenty of time to sit down and enjoy a meal that recognizes the cultural habits and likes of the group served. No matter what community agency operated the program, it should utilize the available nutrition consultants who are knowledgeable about the needs of the elderly. I agree wholeheartedly with the recommendations of the White House Conference on Food and Nutrition and Health that meal service can be extended effectively on a workable neighborhood basis |