unmet needs of senior citizens (65 years and older), for home-care services, with particular emphasis upon providing Homemaker Service to this group. To begin our discussion let us define Homemaker Service and the part that it plans in a home-care program. Homemaker Services is best described as an organized, communitywide, nonprofit social service, sponsored by a private or public health and welfare agency who employ qualified personnel to provide supplementary housekeeping, personal care and counseling services on a temporary basis to individuals and families during a period of personal crisis. Its primary objective is the maintenance of the household routine and the preservation or creation of wholesome family living during a time of stress. Homemaker Service is furnished to families with children, to convalescents, aged, acutely or chronically ill, disabled, and mentally ill persons, to maintain and preserve family life that is threatened with disruption by illness, death, ignorance, social maladjustment, and other problems. The services provided are those required to help maintain normal bodily and emotional comforts and to assist the client toward independent living in a safe environment. Because Homemaker Service is offered on the basis of a social diagnosis and often a medical diagnosis as well, experienced and professional persons evaluate the type of service needed and the length of time it should be provided. A homemaker is an emotionally mature, warm-hearted woman, trained with skills in homemaking who is employed by a responsible community social service agency to help maintain and preserve family life that is threatened by illness, accident, or other causes. A pleasant personality, physical and mental well-being, flexibility, understanding of illness, experience, and training, enable her to assume full or partial responsibility for adult and/or child care, household management and for the maintenance of a wholesome atmosphere in the home. She carries out these responsibilities under the direct supervision of a professional social worker employed by the supervising agency. She exercises initiative and judgment in the performance of her duties, recognizes her limitations and shares her observations and problems with her supervising social worker. For senior citizens a homemaker acts as an attending housekeeper. She is recruited from among socioeconomic levels and must possess that indispensable capacity to provide for older people an inexhaustable measure of tender loving care. She functions as a member of the health service team composed of the physician, nurse, social worker, and therapist. Homemaker Service is one of the fastest growing, most practical, recently developed social services. It was born out of necessity, because it seeks to meet the needs of a highly mobile population. This is evidenced by the fact that over 80 percent of the families in the Los Angeles metropolitan trade area had their origin elsewhere. Today, when many individuals and families have left their place of origin to seek their fortunes elsewhere, and therefore do not have the normal family support available to earlier generations, Homemaker Service acts as a substitute "old friend" by providing practical help and moral support during a period of temporary crisis. In many families of severe family or personal difficulty there is a dramatic need for services which are not necessarily dramatic in themselves. Children, shocked by an adversity they cannot comprehend have a first need for the assurance and secureness of familiar routine and warm human care. For adults trapped by circumstances, time itself is a previous commodity. Times to unravel the difficulties of the moment, to regather thoughts and to chart new directions— Homemaker Service seeks to meet these human needs in a practical, tangible way through the skilled helping hands of Homemakers. Specially trained in caring for illness and herself a successful homemaker, she is the heart of this family service. Operating under direct professional supervision and in accordance with a careful social or medical diagnosis, she may assist or lead the family in maintaining household routine, meeting problems which arise and working out satisfactory solutions. She is at once counselor, friend, teacher; a source of immediate strength and support. For each assignment a homemaker is chosen whose experience and disposition promise a friendly rewarding relationship. Based on our experience with over 1,200 cases in the last 22 years, we believe that Homemaker Service as a part of a coordinated home-care program, has clearly demonstrated that: (1) Institutional care, either in a hospital or a home (convalescent, nursing, or rest) can be either postponed or eliminated for an adult or couple living alone because of illness or infirmity. Often they cannot manage all of the necessary household duties incident to their physical safety and emotional well being. However, by the use of a few hours of Homemaker Service each day all of their important needs can be met by somebody who does the cooking, light house cleaning, laundry, shopping, and help them with their personal care such as bathing, use of the toilet, grooming, etc. (2) Length of stay in an institution can be materially reduced through the use of a homemaker who undertakes the responsibility for important and necessary household duties, thus making it possible for an adult or couple to maintain their independent living arrangements in familiar surroundings, which in itself is a very important morale factor during the recuperation or rehabilitation period. Often this can be accomplished by as little as three half-days (12 hours) of Homemaker Service per week at a cost of approximately two-thirds of that charged for institutional care in a boarding, convalescent, or rest home at payment rates prevailing in California under the medical assistance to the aged program. (3) The economic burden for the family, individual and community can be considerably lessened by the judicious use of Homemaker Service. Following is a comparison of average daily costs for various types of care and services: General hospital (basic charge) 24 persons per room. Homemaker Service (home help aid, 8 hours). $23.50 22.00 20.00 Obviously there is a difference in the quality of care and service provided by these three different services but often times the more costly service is prolonged because there is not an adequate substitute Homemaker Service. (4) The post institutional rehabilitation and recuperation period of senior citizens can be accelerated and they can be returned to a higher level of functioning in a shorter period of time by the use of Homemaker Service. This is accomplished because the homemaker can stimulate interest in the rehabilitation and recuperation treatment program by encouraging active participation on the part of the patient. This is particularly true of aged adults or couples who are living alone. The presence of the homemaker is a positive motivating force. In addition she relieves the couple or adult of household duties which may overtax their strength and jeopardize their living in a safe environment. The number of home accidents among this group is materially reduced because of the presence of a homemaker. Now let us turn our attention to the estimate of the problem in the metropolitan trade area of Los Angeles, where for planning purposes a base population of approximately 7 million people is resident within a 35-mile radius. On the basis of information secured in the 1960 census it is estimated that there are approximately 700,000 senior citizens living in the area. Based on our limited experience in Los Angeles, plus the advantage of information secured from other large metropolitan areas throughout the United States, it can be conservatively estimated that of the total number of senior citizens (700,000) approximately 5 percent, or 35,000 people, 65 years of age or older, would have a legitimate need for Homemaker Service during any given 12-month period. Further experience shows that the average senior citizen requiring Homemaker Service needs approximately 10 hours spread over a period of several weeks; the equivalent of approximately 1,400,000 hours of Homemaker Service per annum, This is naturally a statistical analysis of the problem and what is needed is a carefully controlled demonstration project which will verify need among a representative sample group. Through the use of a control group we could establish what happens to those individuals and couples who receive Homemaker Service as opposed to those who do not during a given period of time. We are pleased to learn that in the bills under consideration by your committee at the present time, some provision has been made for this kind of a demonstration project. Admittedly we are charting courses in an unknown area, and therefore, I believe that any demonstration grants provided to nonprofit socialservice organizations should have a sound, independent research and evaluation design built into the project from its original conception. Meeting the cost of Homemaker Service is a serious and complicated community problem if the service is established and maintained at the high level which differentiates it from being just a housekeeper or a practical nurse type of activity. Recently we instituted a cost accounting system under the supervision of a member of our board who is a senior partner of Price Waterhouse. For calendar year 1961 we have been able to secure fairly reliable cost data information. We have separated our fixed costs from our variable costs and therefore can fairly accurately predict our costs per hour at various volumes of service per month; as for example, 1,000 hours of memaker Service per month would cost approximately $4.35 per hour; 2,000 hours per month, about $3.85 per hour, and 5,000 hours per month approximately $2.97 per hour. Therefore, up to a point of maximum utilization of staff and facilities we can reasonably and reliably predict our cost factors. A good deal more study of this problem, however, needs to be undertaken in order to differentiate cost factors between major categorical groups such as the physically disabled, families with dependent children, senior citizens, and other groups where the primary function of the homemaker is one of counselor, guide and teacher. Let me cite for the record two typical examples of how Homemaker Service has provided necessary assistance to senior citizens: Mrs. L at the age of 80 was not only capable of caring for herself but was self-supporting as well. She managed an apartment house that she and her husband had built 30 years before. All was well until she suddenly had a heart attack and was hospitalized. She recovered nicely, however, from this. Although ready to be discharged from hospital care, she felt uncomfortable and as a matter of fact quite miserable due to an attack of shingles. Her doctor recommended convalescent care at home for a period of 2 weeks. A homemaker was assigned to Mrs. L, who was, to use her own words, "so happy and pleasant that she gave me a real lift.” After 10 days the hours of service were reduced from 5 days a week to 3 and at the end of the third week Mrs. L's health and normal cheerful attitude had returned to her and she was again able to manage on her own. This would not have been possible without the moral support and physical assistance of the homemaker in her home and the fact that she was living among her familiar and personal surroundings contributed to her rapid recovery. Now let us take the case of Mr. G who was 81 years old and not in the best condition physically or mentally, his problem being diabetes and some early senile symptoms. His 76-year-old wife got along well with him in spite of this situation and they were happy together until she suffered a fairly severe stroke. It was hoped that she would recover and although the family of her four grown sons were interested and very eager to help, none were in a position to take the elderly couple into their own home. They could, however, help financially, and this they did by contributing to the cost of having a homemaker in the home because both Mr. and Mrs. G wanted so badly to remain together in their own home rather than going into a nursing home or sanitarium. For a time Mrs. G seemed to improve but then her condition worsened and Homemaker Service provided two homemakers for around-the-clock service until a medical assessment could be made. It soon became evident that Mrs. G would not make the hoped-for recovery and then Homemaker Service was used to care for the couple while the sons made permanent long-time plans for them. The only plan that was feasible was nursing-home care and when a suitable home was found Mr. and Mrs. G were cared for there. In this case Homemaker Service was used to keep the couple together in their own home among familiar surroundings as long as possible, then to tide them over until permanent longtime plans could be made when staying in their own home was no longer feasible or practical. Now I do not want to leave the impression that Homemaker Service is the only solution for senior citizens during the declining years of their life. It is only one of several services that should be considered in the development of a wellcoordinated home-care medical program. Others obviously involve nursing service, physician home calls, physical, speech and occupational therapy. However, Homemaker Service should be considered as an integral part of the coordinated home medical-care program as it brings a unique humanitarian service to people in need at a time when they can be best served through this practical and direct application of professional social service. May I again take this opportunity to thank you for your courtesy in extending to me this privilege of discussing the use of Homemaker Service in a communitywide coordinated home medical care program. To the extent possible I would be most happy to answer your questions concerning the Service. JUNIOR LEAGUE HOMEMAKER DEMONSTRATION PROJECT FOR SENIOR CITIZENS IN WEST LOS ANGELES I. INTRODUCTION In providing home care services for senior citizens, full and careful consideration must be given to at the outset to the need for a completely integrated team approach between health, welfare and recretation services. Full recogni tion of the need for a highly developed home care team coordination of services applies to all persons over 65 years of age, whether they are suffering from either acute or chronic illness, are in frail health but not currently sick, or are those older people who consider their health is "good." The nationwide study of Homemaker Service in the United States (1958) showed that in the families receiving Homemaker Service during the study week, 91 percent of the persons 65 years of age and over were reported as sick at home. This percentage applied even for those individuals who were not severely limited in mobility. For the 9 percent reported not sick, there was evidence to indicate that the physical and mental changes of aging often are accompanied by feebleness, loneliness and lack of incentive. Descriptions of Homemaker Service programs often call attention to the fact that the companionship of a person who visits a home of an elderly person at frequent intervals stimulates interest in the activities of daily living and makes anticipation of the day to come a more pleasant experience. Homemaker Service can frequently enable an older person to assume many of the responsibilities of daily living for himself, thus reducing the cost of total care, and in many cases preserving the values of wholesome family life. Proper use of Homemaker Service also can make rehabilitation efforts more successful, and if provided at the appropriate time, can often create an atmosphere in which physical or mental deterioration can be prevented. The full value of early Homemaker Service to senior citizens needs to be stressed, as too often the homemaker is not called upon to provide service until it is too late to give maximum benefit. The limited experience of Homemaker Service of Los Angeles region shows that where there is a living spouse, the elderly couple were both partially disabled by illness, and often there was an acute onset of a medical problem which neither of them were sufficiently well enough to take care of at home. The situation, of course, is even more difficult for those living alone. In these situations Homemaker Service has been provided on the premise that, with help, the individual can be maintained in his own home and ultimately brought back to self-maintenance. Another important factor in providing Homemaker Service for senior citizens was the strong desire of the individual or couple to cling to familiar surroundings as long as possible. Where investigation of these situations indicated that a home care plan seemed feasible, Homemaker Service was provided. It is with these basic concepts in mind that this demonstration project has been developed. П. ОВЈЕCTIVES The primary purpose of this demonstration project is to determine under what conditions Homemaker Service can best assist senior citizens, having due regard for the psychological and emotional factors, health and physical conditions, and social and economic situations. Specifically, this project is designed to test the extent to which Homemaker Service can assist senior citizens to: (1) Live independently in their own home among familiar surroundings and thus postpone or eliminate the need for institutional care. (2) Reduce the length of stay in an institution by permitting him to return to his own home sooner than he otherwise could. (3) Learn better ways of meeting his own daily needs or regaining self care. (4) Adjust to retirement and reduced income. (5) Establish satisfactory physical living arrangements. (6) Meet social and civil obligations. (7) Adjust to the death of spouse and close friends. (8) Develop adequate recreation activities designed to meet their individual interest patters and limiting physical conditions. In addition, the supervising agency in close cooperation with the sponsoring agency, will administer Homemaker Service to senior citizens in such a manner as to: (1) Establish and maintain valid methods of securing reliable program statistics. (2) Establish and maintain a cost accounting system that will provide accurate cost factors. (3) Validate methods of organization and administration of Homemaker Service in a large metropolitan area. (4) Establish criteria for the acceptance of senior citizen clients for Homemaker Service. (5) More accurately identify the nature and extent of the need for Homemaker Service among senior citizens. Although these purposes and objectives have meaning for project administrators, the real warmth and significance of Homemaker Service that is rendered to senior citizens cannot be so factually explained. Clearly defined objectives are essential to the success of this project but such statements in themselves do not bring to life the warmhearted and personalized aspects of this essentially humanitarian service. III. DEFINITIONS For purposes of this demonstration project the following definitions are pertinent: (a) Persons eligible: Any person, regardless of sex, creed, color, religion, national origin, or socioeconomic status, who is 50 years or older, for whom the supporting helpful activities of Homemaker Service are recommended by the attending health or welfare service. This would include but not necessarily be limited to all clients who are acutely or chronically ill, mentally ill, disabed, or convalescent. (b) Homemaker Service is an organized community-wide social service, sponsored by a nonprofit health and welfare agency, who employs qualified personnel to furnish home care service. Its primary function is the maintenance of the household routine and the preservation or creation of wholesome family living in times of stress. Homemaker Service is furnished to families with children, to convalescents, aged, acutely or chronically ill, and disabled persons to maintain and preserve family life that is threatened with disruption by illness, death, ignorance, social maladjustment, or other problems. Services provided are those required to help maintain normal bodily and emotional comforts and to assist the client toward independent living in a safe environment. Because Homemaker Service is offered on the basis of a social diagnosis, and often a medical diagnosis as well, experienced and professional persons evaluate the type of service needed and the length of time it should be provided. (c) A homemaker is an emotionally mature, warmhearted woman, trained with skills in homemaking, who is employed by a community social service agency to help maintain and preserve family life that is threatened with disruption by illness, death, ignorance, social maladjustment, or other problems. A pleasant personality, physical and mental well-being, flexibility, understanding of illness, experience and training, enable her to assume full or partial responsibility for adult and child care, for household management, and for the maintenance of a wholesome atmosphere in the home. She carries out these responsibilities under the direct supervision of a professional social worker employed by the supervising agency. She exercises initiative and judgment in the performance of her duties, recognizes her limitations, and shares her observations and problems with her supervising social worker. (d) Supervising agency for this project is Homemaker Service of Los Angeles Region, Inc. (HMS) a nonprofit, community-wide health and welfare service agency, established under title I, part I, Division of the Corporation Code of the State of California, on March 8, 1957 (see enclosures A and B for copies of articles of incorporation and tax exemption statement). The agency initiated operations in July 1959 and is a member of the Welfare Planning Council of Los Angeles region. It cooperates with nearly 40 other community health and welfare agencies, many of whom help support it. (See enclosure C for detailed list.) (e) Sponsoring agency for this demonstration project is the Junior League of Los Angeles, with principal offices of 9641 Sunset Boulevard, Beverly Hills, Calif. IV. ESTIMATE OF NEED According to the population estimates of July 1, 1961, from the county of Los Angeles Regional Planning Commission, the population estimate for the county is 6,251,204, of which approximately 1,028,748 are resident in the West Los Angeles area. This population is divided into the following ethnic groups: Negro Asian Nonwhite subtotal__ 76, 000 13, 000 89, 000 911, 000 White--- Total 87006-62-pt. 1——13 1, 000, 000 |