We are now considering a bill to amend the Older Americans Act to provide nutritional programs for the elderly.

The Chair hopes others will indulge that brief civics lecture, and, we are now pleased to call as our first witness, Miss Martha Spurgeon, the director of public welfare in Elkhart.

Miss Spurgeon, we are very pleased to have you with us.

Miss Spurgeon was also a witness last year on the drug abuse education bill, which the House, Miss Spurgeon, has now passed and the Senate subcommittee has just this week favorably reported.

It is the hope of Mr. Hansen and me, both of whom worked on this bill, that that bill will become law by the end of this year. We welcome you back on this bill.

STATEMENT OF MISS MARTHA SPURGEON, DIRECTOR, DEPARTMENT OF PUBLIC WELFARE, ELKHART, IND.

Miss SPURGEON. Thank you, Mr. Chairman.

I would favor the amendment to the House bill H.R. 17763, nutrition program for the elderly:

One, a number of elderly people living in our county are living on social security, public assistance, or other limited incomes with no means of meeting all their needs.

I would also favor this bill because there are many people who are afraid to come in and apply for public assistance and apply for food stamps because they have a fear of change; they have a fear of lien provision.

There are many elderly people, especially those who are living alone, who find that foods are not packaged in small enough quantities, and this is particularly true of meat. When they go to the grocery story to buy, everything is in larger cans or they do not have proper refrigeration.

Many of them do not know the knowledge for purchasing proper foods, particularly older men who are left alone who have not been in the habit of cooking their own meals.

As we all know, malnutrition triggers chronic illness and this necessitates costly hospitalization and nursing home care.

In many instances elderly people are unable to prepare food because they have limited cooking facilities, and I think this is true again of those individuals who are alone or who are living in housing units and other dwellings where the rents are very high and they are unable to purchase the equipment they need.

There are many elderly people who could apply for food stamps, but we have found since our program went into effect April 1 that they are fearful of the lien, and they are also fearful their neighbors will find out about it.

They have a sense of pride. Some of them have saved money to be able to prepare for their burial when they are no longer alive.

When we tell them what the resource allowance is for food stamps or for aged assistance they are unwilling to reduce this amount.

We have tried to convince them this would be the proper thing to do, but when they sit with tears streaming down their face saying, "But I have gone hungry to save $1,000 or $1,100, I can't do it at this point," you have no recourse but to let them go.

Another aspect of this that I think of, are the people without assistance, who are on public assistance and are getting the maximum of $80 in the State of Indiana. Their needs may be $140, their rent in some instances and utilities are $70 which leaves them $10 a month for food and other things.

For this reason I feel if some program can be developed that meals could be furnished these people for a very nominal amount. It would help them.

I feel in this bill there should be a provision this would not be deducted in any way from the amount they receive.

There are some individuals only living on their social security and many of these individuals are proud people. They worked hard. They don't want to come in and ask us for any kind of assistance.

For this reason, I feel they too should be given this alternative that if they need food we should see that they get it.

I believe in the food stamp program. I sponsored this in my own department. It has been a big help, but again, the elderly people are the ones who are not coming in to apply. They are very hesitant about it.

Mr. BRADEMAS. Thank you, very much.

I will turn you over for questions from Mr. Hansen.

Mr. HANSEN. Thank you, Mr. Chairman.

We appreciate your statement. You made some very pertinent observations that I think go to the heart of the reasons for this legislation. You made a reference to the sense of pride that older people and others have commented on that, also. It is suggested that this feeling of pride can be preserved if in any kind of a program designed to furnish meals for the older people there is some opportunity for those who receive meals to make some contribution consistent with their own financial circumstances.

What is your reaction to this suggestion?

Miss SPURGEON. I feel if the person has the means to make a contribution this should be done. It will give them a sense of self-respect.

But I think it should be on the basis of what they can afford to give, not what is required for everyone. I think we should have a sliding scale.

Mr. HANSEN. Apparently this is the pattern in which the Meals on Wheels program is setup. Those who have discussed it with the committee seem to think that this is an important feature.

I expect we would have to anticipate however, there might be some who couldn't give anything and there has to be some provision made to provide meals for them.

Miss SPURGEON. This is the point that disturbs me. If they have to pay for the meals even a nominal sum, for instance if a person has $10 a month for food it would be hard to afford to pay even $1 a day.

Mr. HANSEN. I think one of the witnesses this morning made a reference to a woman paying 25 cents. That is all she could afford but apparently it was a matter of great pride with her that she could pay

that amount.

Most of these programs anticipate one meal and in many cases the meal is delivered to the home on the basis of two meals a day.

Do you think the main objectives of this program can be met with the delivery of one well-balanced nutritional meal either at the home or served at one central location?

Miss SPURGEON. I feel it could. It is my opinion older people don't eat as much as when they are middle-aged or younger and if they have one, good, well-balanced hot meal a day they could get along with two meals.

Mr. HANSEN. I have no further questions.

Thank you, very much.

Mr. BRADEMAS. Miss Spurgeon, one of the suggestions for changing the bill under consideration which has come up from many witnesses is that responsibility for administration of the program should not be assigned to the Department of Agriculture but rather to the Administration on Aging in that the Administration on Aging has primary responsibility for programs focusing on problems of the aging. Do you have any comment on that point?

Miss SPURGEON. I would say either the Department could handle it, but one thing I would ask is that it not be handed to the Welfare Department because we have so many problems now that we don't know how to control some of them. I would prefer if there is any way to keep it out of our department that it not be given there.

I really feel the Department of Agriculture should be responsible for this, particularly if there is going to be surplus commodities in the preparations of the foods.

Mr. BRADEMAS. I think it is safe to say there is not much support for providing this program through the Welfare Department system. What is the population in Elkhart County, Miss Spurgeon, if you can give us that, of persons 65 and over.

Miss SPURGEON. Now you have me.

I can give you the total population.

It is 110,000. I can't give you the age 65 and over.

Mr. BRADEMAS. Another feature of this bill places great emphasis on out-reach. That is, to be sure that persons who are eligible have an opportunity to participate and know about the program.

Do you have any comment about that?

Miss SPURGEON. I feel the program will need a lot of education and a lot of publicity. The thing that concerns me is people in the smaller communities in the county how they would be reached by such a program.

Mr. BRADEMAS. The bill as originally drafted by Mr. Pepper provides for the furnishing of a site for the nutrition programs as close as possible to the areas in which older people might be found to be living. But it seems to me from the testimony so far this would be one of the most important problems for us to resolve because there may be people who are unable to come to a site at all but must be provided their meals in their homes.

Miss SPURGEON. This is true and of course, there is no transportation such as buses. The only way these people could go would be neighbors or taxi which would be quite expensive.

I feel in establishing this is should be in centers close to the area where they have the heavier need.

Mr. BRADEMAS. The final observation I would make, Miss Spurgeon, I was quite struck by the sentence in your statement that "some elderly

people have gone without food to save a thousand dollars for burial." That seems to me to be not a situation of which we ought to be proud if people in our rich society find themselves in that kind of a dilemma they have to make a choice between eating and having enough for providing for their own burial expenses.

Miss SPURGEON. To explain further on this, a person who applies for old age assistance can have at the present time, $350 resources which can be used for burial. This is the maximum. If they have $1 over they are not eligible.

If they have insurance of say, $1,000 it must be reduced to $350. This is hard to do when they scrimp on meals for ways to pay these premiums.

In order to buy food stamps they can have liquid assets of $650. If they won't reduce it there is nothing we can do about it.

Mr. BRADEMAS. Your statement has been most helpful to us. We thank you very much for having come here.

Our next witness is Mrs. William Atwood, accompanied by Mrs. Russ R. Kennedy.

Mrs. ATWOOD. No, Mrs. Kennedy is out of town.

Miss Showalter, who is the dietitian at the Elkhart General Hospital, will appear.

STATEMENT OF MRS. WILLIAM T. ATWOOD, DIRECTOR, MEALS ON WHEELS, AND MISS SHOWALTER, DIETITIAN, ELKHART GENERAL HOSPITAL, ELKHART, IND.

Mrs. ATWOOD. Thank you, Mr. Chairman.

I am Mrs. William Atwood. I have been serving as the Director of the Meals on Wheels program here in Elkhart for the past 212, close to 3 years now.

My statement was compiled by many of the people who work on the program.

While we recognize the need for provision of meals for certain persons in our community many of whom are elderly, some disabled or temporarily unable to provide nutritious meals for themselves, it is our opinion that the provisions of these meals as prescribed in H.R. 17763 would be totally ineffective in this community for these reasons:

The elderly in this community are scattered throughout the area and could not easily assemble at a central location, especially in cold weather. The possible exception might be residents of two low-cost housing buildings in which case two separate programs would be needed.

It is our experience that nearly all of our possible clients in the Meals on Wheels program, surprising to us, are able to afford the menial charge made by the existing programs. Those who are welfare recipients are offered the program at reduced cost, but nearly all are unwilling to take advantages of this because of an unwillingness to adjust their present pattern of food intake. They are fairly set in their ways and don't like the food.

Approximately one-third of our clients are on special diets which would make the use of surplus commodities somewhat difficult.

There are many persons who are not 65 years of age and are disabled in the sense they are unable to provide for their own dietary needs who would not be covered.

The social and recreational needs in our community are partially covered by two organizations in this area and those who are ambulatory are able to attend.

The local community has been very responsive to the nutritional needs of the elderly both financially and in terms of volunteers hours and the need for Federal assistance seems unnecessary-at least the projected cost does not appear to merit the cost involved.

Mr. BRADEMAS. So, you really do not have any problems in Elkhart in this respect.

This is the first community I have visited that I have heard that. Mrs. ATWOOD. Surprising to us.

Mr. BRADEMAS. That's wonderful.

What is the population of 65 and over?

Mrs. ATWOOD. I cannot give you that right now.

Mr. BRADEMAS. You use the phrase "nearly all of our possible clients." There must be some judgment as to how many people qualify. Is the Meals on Wheels program applied to the city of Elkhart or Elkhart County?

Mrs. ATWOOD. The city of Elkhart and as far as we can make arrangements.

We talked to people in Goshen about the possible extension of the program over there. We are hopeful of getting some sort of program there on relays which has worked out fairly well.

However, as far as our possible clientele most of our are referred, well, in the beginning through their doctor; usually people being discharged from the hospital or through word of mouth.

Everyone we have met pretty much have been able to, we have said we will make this adjustment, pay what you can and they say, no, that is just fine, we will be glad to pay.

We have had some cases where some people couldn't pay anything. We have service groups who carry the word to those people.

Mr. BRADEMAS. Whom do you include in the group of persons who would qualify for a meal?

Mrs. ATWOOD. Anyone who cannot take care of their own food needs at home.

Mr. BRADEMAS. That is from preschool?

Mrs. ATWOOD. No. Usually we have some disabled people who can live in their homes but can't cook a hot food meal.

We have some couples, but mostly individuals who live alone and are elderly.

Mr. BRADEMAS. Is there an age cutoff?

Mrs. ATWOOD. No.

Mr. BRADEMAS. The reason I ask these questions is because I am trying to get a definition. As legislators we deal in hard facts and when you say nearly all of our possible clients are able to afford the minimal charge, then I am trying to understand the definition of the phrase, "possible clients."

In other words how many people in the area of service do you include in the definition?