STATEMENT OF ROY J. PRYOR, GENERAL MANAGER OF FOREST HILL MANOR, REPRESENTING THE ASSOCIATION OF NORTHERN CALIFORNIA HOMES FOR THE AGED

Mr. PRYOR. My name is Roy J. Pryor. I am the general manager of Forest Hill Manor, located in the Pacific group. It so happens it has one home in Palo Alto, and this is a Methodist home for elderly persons. I am here today representing the Association of Northern California Homes for the Aged, an association that is made up of members of the nonprofit homes in the northern part of the State, and my comment for your general information that there is a comparable organization in southern California, much larger than the one in the north, and one in central California with headquarters in Fresno.

I might comment that we do appreciate greatly this opportunity to discuss some of the problems and needs of senior citizens, as we see them from the nonprofit-home point of view, and we are also very impressed with the fact that Congress is very much alert to these needs. I do want to make this statement, because the one statement I have here, because it contains a gist of some of the things we want to emphasize, so I will say it is most important to us that Congress is giving serious consideration to the development of ways and means to make sure that the needs and problems of elderly persons are met on a well-considered, coordinated, and integrated basis, rather than on the fragmented overspecialized basis as it currently exists in so many instances.

I have already indicated the composition of our group. It is our conviction here that we can best honor our fathers and our mothers by treating older persons as the normal adults rather than as senile, inadequate persons in their second childhoods, which they generally are not.

We insist that they must be treated as individuals and not as a category to which we attribute all the unpleasant characteristics of human beings.

So we are concerned with helping them remain independent and I would like to emphasize that helping them to remain independent, active people, as long as possible, rather than forcing them into the role of physically and emotionally dependent beings, whose one remaining purpose frequently is merely to await the end.

So this, we believe, is really an immoral conducive to physical and mental deterioration and it is a shameful waste of human resources and potentialities.

Our group has sponsors and operators of nonprofit homes for the aged, guided by high ethical and religious principles. We offer to those older persons who require it and desire it congregate living facilities which are as near to normal family life as it is possible to achieve. We seek to provide much more than just food, shelter, and medical care. We offer, in varying degrees as needed, more social activity, creative and educational activities, as well as opportunities for our elderly residents to be of service to others, both within these homes and in their adjacent communities. And you will find that by and large the residents of our homes are animated, contented people who thoroughly enjoy life.

While we do make adequate provision for medical and nursing care when needed, we encourage our residents to be as active as possible 87006-62-pt. 1-9

and to stay out of bed as long as possible; barring acute or terminal illness, we believe that the bed is the worst possible place for the person. Inasmuch as we try to provide the best normal life for our residents, we find it very difficult to do so very frequently, and as is too often the case, with nonprofit organizations, our sources of money available to us handicaps us in our efforts to provide wide-range programs of care. This is aggravated by the fact that the general and even more so the official approach to the elderly person is predicated upon overspecialized concepts, particularly those of health and welfare. There are entirely too many well-intentioned people who regard the older person as an ill person, or as one who will eventually become ill. As a result, all their efforts and planning are centered around building hospitals and nursing homes rather than on how to prevent the older person from becoming bedridden, and too early in his later years.

This is a defeatist attitude which can only be devastating and shattering to the morale and behavior of the elderly and encourage them to think in terms of ill health. True, the older person may have illness, his physical capacities do wane, but this, too, does not make of him a chronic health problem. Yet, so much of our State and Federal Government action in the field of aging is influenced by this ill health and disease concept.

It has yet to be proven that old age is a disease; nevertheless, we have placed the medical profession in the dominating position in considering the needs and problems of the elderly. The latter does need such attention, but why should it not be on the positive side? Why should not the emphasis be placed upon well older people, on prevention, I might say on restorative and rehabilitation concepts, or at least upon the slowing down of physical and mental deterioration?

Perhaps we need to take a leaf from out of the child-health programs. We could have senior citizens' clinics, and I might say this is done in a number of the homes for the elderly, much in the same order as well-baby clinics.

Another undesirable approach to old age is that the problems of aging are welfare problems. This is not so. While the elderly are by far economically disadvantaged, they still resent the idea they are indigents. They resent the implication that they have attained this unhappy status because of their own shortcomings.

Most older people have an ardent desire to retain the independence with which they have lived through their younger years. Why should they be treated as indigents or as casework problems? This fragmented approach to aging has created special problems for the nonprofit homes for the aged.

Recently, as a result of the ill health and welfare concepts of the medical assistance to the aged program, under the Kerr-Mills Act, in many States this program has become one of hospitalization and nursing home care rather than a general approach to medical care. As a result, many nonprofit homes for the aged are finding it necessary to convert a major part of their organizations to nursing home care in order to become eligible to receive State and Federal money through the medical assistance to the aged program, for this money helps them to operate without a deficit.

To provide older people with normal living arrangements, it is necessary to think of them as we would think of all people, regardless

of age, because all of us without regard to birthdays have the same basic needs. Thus, we, who are working with the normal elderly person, find it necessary to be concerned not only with housing, food, and medical care, but also spiritual needs, recreation, education, selfdevelopment, creative outlets, and opportunities for our residents to be of use to others. We could not exist for long without this kind of thinking and motivation in our nonprofit homes.

We believe that the same principles apply to older persons who are living outside of these homes and living independently. It becomes evident that the current overspecialized approach to the needs of the elderly is erroneous as well as harmful to them, and to our society as a whole; therefore, we would recommend that there be established in the Federal Government a commission on the aged and the aging which approaches the problems on a well-considered and firmly designed, integrated and coordinated interdepartmental basis. Only through such a device will it get away from dominance of the field by any one department and away from the narrow approaches such as the illness, disease concept, and the welfare indigent concept.

Normal life is not categorized in this way, nor should it be for the aged. We are of the opinion that such a well-integrated approach will help us do a better job for and with the people who come to live with us. Its impact upon our society as a whole will also be beneficial, because this attitude will encourage continued independence and activity of the elderly. It will give greater emphasis to the prevention of dementia and ill health, and will minimize the need for hospitals and nursing homes and welfare programs.

Mr. O'HARA. I want to thank you for your suggestions. I am in accord with the essence of your statement, that is, that we should be more concerned with preventing acute problems confronting the aged group. We should consider the problems before they become serious, instead of attempting to care for them after they have arisen. I hope that one of the features of any bill this committee might approve would be to stimulate more interest and activity with regard to these objectives rather than merely strengthening existing programs. Mr. Giaimo, do you have any questions?

Mr. GIAIMO. I have no questions, but I do want to thank you for your testimony, because I think that the type of testimony such as given us has been needed and is needed for the record, namely, the fact that the sociological aspects of the problem, the importance of not causing this great body of people to feel that they are left out of things, I think this is the heart of this whole matter.

us.

Mr. O'HARA. Thank you very much.

Mr. PRYOR. Thank you.

Mr. O'HARA. We appreciate your taking the time to appear before

Mr. Kuplan or Mr. Jenkins?

STATEMENT OF LOUIS KUPLAN, CONSULTANT TO THE ASSOCIATION OF NORTHERN CALIFORNIA HOMES FOR THE AGED

Mr. KUPLAN. Congressman O'Hara, I—my name is Kuplan, Louis Kuplan. While I am here as a representative, or I might say consultant to the Association of Northern California Homes for the Aged, I have had vast experience in the field of aging and gerontology.

I am currently president of the International Association of Gerontology. I am a member of the faculty of the University of San Francisco, giving courses in gerontology. I am a past president of the American Gerontological Association, so forth and so on. I have also spent many years helping establish and develop California Citizens' Advisory Committee on Aging, and I was executive director of that until 2 years ago, when I resigned to go into the work of prevention, and, Congressman O'Hara, I would like to offer a few points in the field of aging as a consultant.

I think the problem presented by Mr. Pryor which he faced among the nonprofit homes for the aging epitomizes the problem faced by our entire society in regard to the problems of the aging in their later

years.

Personally, I resent very much having to talk in the terms of problems of the aging, because I don't think they are giving perfect satisfaction to the problem. Our problem is the way society looks at the aging, the entire problem, and its antiquated notions in regard to what constitutes an older person, an older person's capabilities and potentialities. And, as Mr. Pryor indicated, the institutions are guided by a fragmented approach to the problems of the people who are living in these implications, and the only way we are going to overcome this is through a well-coordinated, integrated, planned program, both at the Federal and State levels.

While I would agree that the present special staff on aging in the Department of Health, Education, and Welfare has done an extremely fine job over the years, and I have worked very closely through these years, they are still rather handicapped in the fact they are related to one agency, to one department.

My own experience of 20 years in government service for every level of government has indicated to me, as you well know the facts, that there is such a thing as bureaucratic competition, each department wants to be the top, especially in a new field, each department wants a budget, they want a staff, they want all the honors, and unless there is some way of forcing them to work together, despite any informal arrangement, there is going to be quite a bit of sniping, and I assure you I speak from personal experience in this field.

Therefore, I think that it is extremely important that there be at the Federal level an independent agency separate from any department, because just as soon as you put it in one department, all the other departments are going to say, well, look, well, there's the Health, Education, and Welfare, this doesn't concern us too much, we might give them a little bit, but the problem is theirs, or if you put it in the Department of Labor, it begins all over again, only turned around. They will say, well, that's the Department of Labor, so on and so forth, ad nauseam. So it is essential that there be an independent agency with authority, with staff, with budget, to be able to coordinate and bring together all of these people.

Now, for instance, wherever we look at the problem of gerontology or old age, no one can draw a sharp line and say, here is where health begins or ends, this is where economics pick up, or this is where education picks up. Let's take a quick look at some of the problems that have to be included in the problems of aging, and they are akin to many of our governmental agencies. Of course, there is physical and mental

health, welfare and social security programs, housing, education, employment, income, maintenance, recreation, spiritual guidance, institutional care, nutrition, and I believe the matter of research and training, and I believe that any effective committee should also have on it representatives of the fiscal arm of the government agency involved, or the branch of government, and I even believe that certain legislative members should be represented on such committees to be able to discuss back and forth.

I think one of the most salutary developments in California was the fact our Citizens' Advisory Committee had on it representatives of both houses of the State legislature. It was a matter of them not only educating the citizens of our government, but this was also an eyeopener to the members of the legislature as to what the problems were, and they became stanch promoters in getting the program pushed.

So I believe that every branch of government must work together in any of our programs if we are going to be effective. As it stands today as I see this on an international as well as a national basis, the emphasis is mainly on ill health and disease and on welfare.

I insist that aging is not a welfare problem alone. Aging is not a health problem alone, but they are all related, because who can say, who can come and say, this is where health stops and this is where welfare picks up?

In relation to the economic ends, the economic aspects of old age are absolutely related to health, to housing, to education, all of these other things that we feel make a normal life for the older person, and they must be well considered.

I would very much like to support the statement made by Dr. Gordon and seconded by Mr. Ash that we think in terms of the aging and not the aged. I recall that the first time we had a conference on aging in California, back in 1951, we called in a group of citizens to discuss the problem for that time, and do you know what they argued about most was whether there should be a conference on aging or on the aged, because there was a desire to limit this thing right off the bat. But, fortunately, the eyes of the people who started the idea of aging won out, because aging is a relative problem. You might say, well, it was indicated by Dr. Gordon and by Mr. Ash as far as employment is concerned, a man of 40 may be superantiquated. We know that many larger offices will not hire any new girls over 28 years of age. When it comes to physical capacity, aging is something else again, and you might discuss it back and forth, when does this girl or boy become superantiquated. So all of it is a highly relevant thing, and I do think we have to keep this thing on an equitable basis, not only for an effective program, but in planning.

I am a very firm believer in work, preventive work, in the field of aging, where research, scientific, social, or economic-unfortunately, today we live with outmoded notions that old age is an evil thing, that a person 65 is ancient, degenerative. There is nothing much I can do about it. These things don't hold true. Scientists tell us today no one has a right to think of himself as being too old physiologically, before he is 75. But, on the other hand, we read in the newspapers where youngsters 17 or 18 years of age are about to die of senility, so here again we can't draw any sharp lines of demarcation, but we do have to help our people prepare for old age, because retire