improving the nutritional adequacy of the participants diets, and we have data to support it. Prior to the onset of the food service, 185 of our prospective clients were interviewed, and asked to enumerate all of the food eaten within the past 24 hours. This data was analyzed to determine the nutritional adequacy of their diets prior to the onset of the meal service.

We found that the average prospective participants food energy requirement was 1546 calories. In comparison, the average prospect consumed only 1123 calories a deficit of 422 calories and only 19% consumer over 1500 calories. In other words, 84% of the prospects consumed fewer than their recommended daily allowance (reduced by 100 calories to allow for error).

In contrast to this, an average lunch served at our Center contains 686 calories. This amounts to 44% of their food energy requirements so they need only eat 56% of their requirements at home.

As important as the actual calories, are the presence of the protective food groups, and the balance of the daily meal pattern. For the elderly, lunch is the main meal of the day, and should contain 6 items: 1) soup or juice; 2) meat, fish, eggs, or cheese; 3) raw salad or cooked vegetables; 4) potatoes, or bread or grain; 5) dessert (fruits, cakes); and 6) a beverage. Before the food service started, none of our prospects had all of 6 of the lunch items in their midday meal; only 1% had 5 of the items; 38% had 4 items; 34% had 3 items; 13% had only 2 items; 10% had only 1 item; and 4% had no midday meal at all. In contrast, each of our lunches contains all 6 of these suggested foods. Thus, our participants eat all six of the items, whereas no one had all (and only 1% even had 5) of the suggested items prior to the onset of service. And while there is no guarantee that everything on the tray will be eaten, our observation is that it is and some of our participants even ask for more generous portions.

Let's carry this analysis further, to discuss each of the suggest food for lunch. Each of our participants are served each of the suggested foods-that is, 100% for each. Prior to service, in contrast, only 76% had a protein (meat, fish, eggs, or cheese); only 68% had a starch (potatoes, bread or grain), only 64% had a final beverage (coffee, tea), only 42% had a desert (fruit or cake), only 30% had a vegetable (raw or cooked), and only 15% had a substantial liquid (juice or soup). These contrasts speak for themselves, and support our contention that programs like ours are a necessary ingredient in a comprehensive effort to provide the elderly with the "good life".

The deficiencies found in the lunch diets of our elderly prospects were not made up in their own meals. For the day as a whole, their diets were still very deficient. Our luncheon menu contains each of the protective food groups, although not necessarily enough to cover the entire days requirements. Before the service started 9% had no bread, cereal, or grain for the entire 24 hour period; 10% had no milk or cheese; 17% had no fish, meat poultry or eggs; 35% had no citrus fruits or other sources of vitamin C; 39% had none of the other fruits or vegetables; and 64% had no dark green leafy and deep yellow vegetables. Now none of our participants go without any of these protective foods, because each of these are included in lunch (except for the milk or cheese beacuse our meals are nondairy). We hope that the meals that the participants eat at home further supplement basic essentials. All in all, our lunches seem to be providing the core of their nutritional requirements which are necessary to self-sufficiency and good health.

With older Americans it would seem that changing practices about food would be difficult. After all, they have been doing something a certain way for so long that change seems impossible. However, what is important and probably does change is their attitudes toward food. Four out of ten of our respondents report that they are eating more now that they attend the program. This indicates not only attendance, but increased appetite, better health, greater activity, and the benefits of peer companionship. 95% report that they like to eat with other people. 90% report that they eat the way they should. In contrast, before the service started, 87% of the prospects reported that they didn't get enough food, 86% reported that they don't get the right food, and 82% reported that food doesn't taste good.

The Food and Nutrition program seems to have increased companionship among the participants. Before the luncheon program started, only 52% of the prospects said that they didn't have enough friends. In contrast, after the luncheon service started, 87% of our respondents report that they have enough friends a sharp increase. It is this heightened companionship that we believe

increases appetite, dietary adequacy, activity levels, health, and probably keep participants from entering nursing homes or other extendio-care facilities.

The project staff believes that the program has improved clients self-sufficiency and attitudes toward life and self.

With improved diets and increased companionship, we felt that our participants would become more active and develop a more positive attitude toward their life and self. 26% of our respondents reported that they do more things now some because there is more to do now, and some because they have more time now. Likewise, prior to service, only 34% felt that cooking was very easy, but now 51% find it very easy.

Attitude change has been a prominent accomplishment of the luncheon program. While the importance of these changes cannot readily be converted to dollars and cents, we feel that certain from our observations that it prolongs the life and improves the health of older Americans, and probably keeps them from resorting to institutionalization.

While we have no comparison data at hand about institutionalization prior to service, it is rare at present. While programs like ours cost money, it helps to avoid other charges to citizens when poor older people use hospitals, clinics, nursing homes, and other agencies.

Interestingly, the sharpest increase is found in "I have enough money to live on". This is evidence that our project service to stretch the social security dollars of older Americans, while providing them with a host of other services and benefits.

If one reads the statistics about the economic impoverishment that afflicts so many of our elderly, it becomes much more than statistics, it becomes criminal neglect in a land of wealth. Medicare, medicaid and other health programs at the Federal, State and Local level have enabled the elderly to be free of many physical ills and disabilities, and the expenses associated with illness. However, in many aspects things are worse now for older Americans than before Medicare. Longevity is a living death for many older people. For no matter how many doctors, dentists, podiatrists, and druggists or hospitals are available to older people, there services are a dubious gift where so many elderly are poor, go hungry and are denied a meaningful role in our society.

The double-edged nature of this role crisis must be underscored. First, if a person is going to live fifteen or twenty years beyond the arbitrary retirement age of sixty-five, it cannot fail to be noticed that our society, generally, has been strikingly unimaginative in finding new role for our elderly. Second since an activistic orientation predominates our culture, if an older person is not provided the opportunity for, is not capable of, or does not desire an activistic, achievementoriented role, his culture does not accord him status or recognition.

Advertising is geared to looking young, acting young, thinking young; and too many, of us have swallowed this heresy wholesale.

It is a heresy, and it is difficult to resist, because aging is an undeniable fact, the cosmetic industry notwithstanding, and to "remain young" simply flies in the face of a reality that should be accepted. However, the temptation to succumb in placing most values on youth, vigor, vitality, etc., are immense. It seems as though the only time an elderly person appears on television commercials is in connection with arthritis, dentures, or laxatives. Only the swinging set really has fun and enjoys life, or so they would have us believe.

Since our society places such high value on physical vitality, on the expansion of interests and activities, physical aging is utterly bound with mental health and mental disorders in the aging when they can no longer "keep up".

It takes considerable ego strength to prevent a negative self-image. Sometimes a feeling of alienation from the environment occurs.

In a recent study in New York State twenty-six percent of all mental patient admissions were over sixty-five (6,914). Mental disorders of the type character

ized by confusion, memory defect, and general weakening of the mental processes are often cared for by nursing homes and homes for the aged and are not included in the above statistics.

The most seriously disturbed, those noted in the statistics, have disorders such as delusions, hallucinations, disorders in mood or behavior that are dangerous to the person or disturbing to others. A signficant number have one or more physical illnesses, and concomitant severe emotional disturbances. What is important to note is that physical impairment seems to be connected with the patients who evidenced the most severe emotional disturbances, and that this is very likely in light of the fact that feelings or uselessness breed physical and mental disorders which cyclically produces a heightened sense of impairment and uselessness.

Interestingly, in this section dealing with geriatric psychiatry, the New York State report, in describing the treatment program that has been twenty to forty percent successful in returning patients to the community. ". . . stress developing and maintaining the dignity of the individual, the avoidance of infantilism, encouragement of interpersonal relations, and the fostering of initiative and independence by an offering of choices to the patient."

Now, gentlemen, why can't this be done in the Community before aged people end up in mental hospitals or home for the aged.

I support proposed legislation H.R. 17763. In recent years a new movement has begun to attempt to determine what roles are possible for our aged populations as increased longevity given them many years past the traditional retirement age of sixty-five. Multi-service community centers for the aged which have Food and Nutrition programs as part of their services, and which provide a variety of ways in which elderly people can have recreation, participants in creative and expensive interprises, learn new skills and find employment, organize for social action and have an an opportunity to participate in volunteer services are all provided by this bill. I believe that this legislation will take a lead in helping to create community awareness of the needs and problems of the elderly and to help bring about multi-service centers which will afford our aged the opportunity to discover the ways and means of living their later years in enjoyment and fullfilment without fear of going hungry or knowing where the next meal will come from.

A center which in part will serve the elderly should be in the "midst of things." Lovely, multi-service centers have been built (for the elderly alone), but why isolate the isolated and lonely? Being off in some part of an area away from the activities of a community reminds the elderly once again that they are no longer a part of the "actions." The Henry Street Settlement sponsors a "Good Companions" club for persons over sixty, but its facilities are located in middle of a housing development. When visiting with an elderly man of eighty-two years in a different setting, an old age home he said, "You can't remain healthy and watch old people go by with canes all the time; you have to be with the 'young' too." Fortunately, he was able to leave this Home community regularly to be with his children, grandchildren, and great-grandchildren. Many are not so fortunate.

Besides being accessible and in the midst of things, the above parenthetical reference to isolated centers built to serve only the elderly, as well as the preceding discussion implies why the elderly should be a part of a center which also serves people of other ages. The elderly should their programs take place in a center, nor should their programs take place in a center that only serves them. The "Good Companions" of Henry Street offers a good example. Their facilities, are located in a housing project, are also used by the Home-Planning Workshop of Henry Street Settlement where various groups of diverse ages engage in a variety of activities. Young mothers and teenagers come for sewing classes. Shoe repairing is taught. Woodwork and painting classes also take place. There are specific days set aside for children and teenagers, and other for adults. Though the elderly have their own programs, they can watch or casually mix with these persons of different ages. They get to know many of these people, and often become friends. Elderly persons usually enjoy the stimulation of younger people, and if they make friends with persons who are about the age of their children or grandchilren, its meaning and significance cannot be measured. Further, in this simple way, they are reminded again that society has not abandoned and neglected them, that they have not even been isolated as a group away from younger people. And what they give to the younger people cannot be measured either. Working in close proximity day after day with elderly people, has given

us the opportunity to observe the positive effects a good nutritional program coupled with a structured recreational program has on older people.

Here at the (Henry Street Settlement) Urban life Center, our members live within walking distance to our club. Most are widowed, live alone and are below subsistence level. In studies we have done with them before the program began, I discovered great deficiencies in their diets. Bread, white cheese, cream, boiled chicken, few vegetables, and not much meat staples. Much of this was due to poor nutritional knowledge, poor eating habits and an insufficient amount of money. The grant which we received has enabled us to offer our members the one nutritionally sound meal of the day.

In our program which begins at 10:00 A.M. and ends at 9:00 P.M. we have endeavored to make available to our members such programs as Dramatics, Singing, Dancing, Sewing, Crafts, Painting, Sculpture, Woodworking, Movies, Discussion Groups, Culture Groups, Nutrition Education and congenial company. Our members are totally involved. Many of them are volunteers delivering meals, to homebound elderly, working at Gouverneur Clinic, visiting the sick and ailing in hospitals and homes, cooking, cleaning, shopping and doing whatever is necessary to help one another. We have parties celebrating holidays and birthday people, bus trips to points of interest and cultural outings. In addition our members are involved in community and social action.

Chronically ill for years, isolated, lonely, they could have become patients in mental hospitals and nursing homes. Active membership in the good companions club has helped restore their dignity and renewed their interest in living.

The success of our program can be attested to by the continued growth of our membership and the continued return of old members. It is easily observed that without adequate funding, services and program such as we offer would not be available to the elderly and their existence would be as bleak as it once was. Our nation cannot afford to have that on its conscience.

"All men are created equal," including those advanced in years. Being old is not necessarily the same as being stale.

STATEMENT OF JOSEPH STRATOS, JR., CHAIRMAN, PHILADELPHIA COMMISSION ON SERVICES TO THE AGING

Mr. Chairman and distinguished gentlemen of this special committee: I wish to thank you for granting me this opportunity to appear before you and to voice my views, and those of the Philadelphia Mayor's Commission on Services to the Aging, relative to the proposed nutrition programs for our older Americans.

We of the Philadelphia Commission wholeheartedly endorse this added legislative proposal to be incorporated into the Older Americans Act and deem it a landmark for the general health and welfare of our elderly citizens. This is also the sentiment of Philadelphia's Mayor, the Honorable James H. J. Tate, who has always been deeply concerned about the elderly among us; he has constantly worked for their medical, social, and economic welfare which is certainly reflected in all service branches of our City government.

However, realizing that there must be a central focal point to coordinate the various departmental activities for the elderly and that there is also a further need to encourage and implement additional programs for the elderly, even outside the periphery of City government, Mayor Tate asked me to organize an advisory committee to keep him informed on all phases of the elderly in our community. This was four years ago when we formally set up the Mayor's Advisory Committee on Services to the Aging.

Since this was a new element in City government, it naturally had to weather the skepticisms, criticisms, and doubts of many who thought this to be possible duplication of services already being performed by other City departments. But in due time through shear persistancy and determination the Committee proved its need and worthiness with programs and services that directly touched the lives of the elderly. In recognition of its proven accomplishments and realizing the need for the continuation and expansion of its services, the Council of the City of Philadelphia in June, 1968 enacted an ordinance that changed the Committee to the Philadelphia Commission on Services to the Aging and thereby giving it legal status. Since then our programs have continued to expand for the benefit of the elderly and the community.

As stated previously, we do endorse this new legislative proposal, but based

upon our observations and experiences, I wish to elaborate upon a few items for your consideration.

I have noted, in the administration of the proposed program, the disbursement of funds would be through designated agencies within the States, similar to the methods now employed for the disbursement of funds for Title III of the Older Americans Act. This method is very good in the control of funds by the State agency for the many counties, townships, and boroughs who will be participating in the program. But it has been our experience that this does not necessarily work as smoothly for large urban cities, such as Philadelphia. Although the States try to allocate equal distribution of Federal funds, the larger cities often do not receive their fair proportionate share and encounter many delays.

May I explain this last statement: (1) It has been our experience that there is much "red tape" by the indirect state funding method. When a proposal is submitted for a grant, there appears to be different interpertations by the State agency of the Federal requirements-in fact and in spirit. This necessitates delays pending the submitting and resubmitting of new grant proposals or changes in the proposals.

(2) If the programs are to be successful, then the cities should be funded directly since their needs are many and state capitols are not always on top of the immediate urgent problems of the cities. Quite often a state official with little or no experience in the problems of the cities try to administer programs in methods applicable to townships or boroughs or rural areas.

(3) Then, too, program delays in getting state approval is often predicated upon the political atmosphere. If the state administration and the city administration are of different political parties, delays in processing proposals often ensue; it is a deliberate attempt to hold back worthwhile programs to discredit a city administration whose political views are different.

(4) As stated previously, there is too much "red tape" generated when the city cannot apply directly to the Federal government for a proposed grant. There are too many people involved causing frustration and procrastination when a proposal and/or follow-up reports are processed. As it is in our case proposals and reports go from Philadelphia to Harrisburg to Washington, then back from Washington to Harrisburg to Philadelphia, then return to Harrisburg and so on. We have experienced the foregoing delays when we applied for funding under Title III of the Older Americans Act of 1965. It took nearly two years of delays before we finally received our grant. And then we did not get the 50% Federal matching funds as expected, but a much lower percentage that was again reduced for the third project year of the grant.

In Philadelphia with a population of approximately two million residents, it is estimated there are 245 thousand elderly citizens 65 years and older. With populations of this size, it would seem more manageable and equitable if the larger cities applied directly for the Federal funding as mentioned before rather than through a State agency. As a criteria to determine direct Federal funding, cities whose population exceed a million inhabitants could be considered. Towever, this criteria could be adjusted. Most all cities, especially the larger ones, have large concentrations of the eldely. This, of course, is due to varied socioeconomic and physical factors that you gentlemen are no doubt aware of.

I would like to comment at this point about the proposed grants paying up to 90% in Federal monies to be matched by 10% from funds within the State-or the receipient. Here, again, the State determines the percentage of funds to be allocated to the grant receipient. To participate in a 90-10 fund matching program would be most attractive to a prospective grant receipient and we would definitely endorse such a program. However, as has been our experience, this could lead to disappointment, for the receipient many times may not be funded the full grant percentage amount; and in this instance I'm referring to the 90%. The receipient could be funded as low as 10%. It is, therefore, suggested that if the matching ceiling is 90%, let there be established a level below which the Federal share will not drop, say 50%.

Another program requirement is to provide meals five or more days a week. This could be re-emphasized to provide meals for the full seven days of the week. Many nutrition programs have been geared to a five-day week scheduled with no provisions for the weekend. This is a bit inconsistent with the spirit of the programs if it is to be meaningful.

To reach more of the elderly poor who may not, for varied reasons, be able to participate directly in the program, the food stamp program could be expanded to include free food stamps, based on the net monthly income limit of one or two