PROBLEMS OF THE AGED AND AGING FRIDAY, MARCH 30, 1962 HOUSE OF REPRESENTATIVES, GENERAL SUBCOMMITTEE ON EDUCATION OF THE Sacramento, Calif. The subcommittee met at 9:48 a.m., pursuant to call, in room 2170, State Capitol, Sacramento, Calif., Hon. James G. O'Hara (acting chairman of the General Subcommittee on Education) presiding. Present: Representative Robert Giaimo. Present also: Robert E. McCord, director; Ted Ellsworth, special consultant on aging. Mr. O'HARA. The General Subcommittee on Education of the House Committee on Education and Labor will come to order. I am Representative James G. O'Hara, of Michigan, acting chairman of the General Subcommittee on Education. To my right is Representative Robert Giaimo, of Connecticut, a member of the subcommittee. With us are staff members Robert McCord and Ted Ellsworth. Mr. McCord is the counsel of the subcommittee and Mr. Ellsworth is a special consultant on the problems of the aging. The chairman of the subcommittee, Representative Cleveland M. Bailey, of West Virginia, was, because of important business in West Virginia, unable to be present at this session. The purpose of today's hearing is to take testimony with regard to a number of bills, H.R. 246, introduced by Mr. Libonati, of Illinois; H.R. 280, introduced by Mr. Zablocki, of Wisconsin; H.R. 306, introduced by Mr. Bennett, of Florida; H.R. 558, introduced by Mr. Rodino, of New Jersey; H.R. 710, introduced by Mr. Lane, of Massachusetts; H.R. 2377, introduced by Mr. Addonizio, of New Jersey; H.R. 2764, introduced by Mr. Halpern, of New York; H.R. 3071, introduced by Mrs. Pfost, of Idaho; H.R. 3739, introduced by Mr. Cramer, of Florida; H.R. 5030, introduced by Mr. Morgan, of Pennsylvania, and H.R. 10014, introduced by Mr. Fogarty, of Rhode Island. All of these bills deal with creation of a committee, bureau, or independent commission or agency to deal with the problems of the aged and aging. In preparation for the testimony, I might say that there have been many conferences on problems of the aging. The White House Conference, the most recent, included State and regional conferences, and many recommendations came from this series of meetings. One of the recommendations was that the Federal Government should assume responsibility for following up the recommendations of the Conference. Some of the State conferences had proposed that an independent Commission on Aging be established. Others proposed that an Of fice of Aging be established in the Department of Health, Education, and Welfare. The bills on which these hearings are being conducted embody one or the other of these approaches. Since the subcommittee will have to report on these bills, its members are interested in information from the aged and other citizens as well as from experts and students in the field. We are particularly interested in the following points: Whether there is a need for such an agency at the Federal level, whether there is a need for Federal financing to encourage State, local community, and private nonprofit projects, whether there is confusion due to lack of coordination and diffusion of responsibility among agencies and whether needed programs are being neglected because of a lack of funds or because there is no responsible agency to stimulate such programs. If this is true, we hope to determine the type of agency that is needed and the type of Federal encouragement needed for such activity. The first witness will be Mr. Samuel Leask, Jr., administrator of the California Health and Welfare Agency. We welcome you, Mr. Leask. Please identify yourself and proceed in whatever manner you wish. STATEMENT OF SAMUEL LEASK, JR., ADMINISTRATOR, HEALTH AND WELFARE AGENCY, STATE OF CALIFORNIA Mr. LEASK. Thank you, Mr. Chairman, members of the committee. My name is Samuel Leask, Jr., administrator, Health and Welfare Agency, State of California. The components of the health and welfare agency are the departments of social welfare, mental hygiene, and public health. I appreciate this opportunity to appear before your committee on behalf of Governor Brown to introduce the State's efforts to develop programs, resources, and services for California's older people. We, in California, are acutely aware and genuinely concerned with the problems faced by our senior citizens. Today, in California, there are more than 1,400,000 aged persons representing about 8.5 percent of our total population. The number of aged persons in California is increasing at the rate of approximately 40,000 per year. We do not look upon our older persons as mere statistics, however. We recognize that as individuals they have problems which include, for many, a lack of suitable housing, income for adequate food, funds for medical care to the actual degree needed, and an opportunity to continue to participate as respected and valued members of their family, their community, their State, and Nation. I am sure that the members of this committee are familiar with the dimensions of these problems. They constitute foremost challenges for solutions by all governmental levels, by industry, by labor, and by the great voluntary and religious organizations of our country. Recently these concerns have received concentrated attention throughout the United States. The various local and State conferences on aging and the White House Conference on Aging brought the experience, intelligence, and deep concern of those most intimately acquainted to bear on the serious problems affecting older people. In California, the legislative program Governor Brown recommended to the legislature this past year concerning our senior citizens came from the people themselves. Nearly all of the recommendations made to the members of the California Legislature were based upon positions taken during the Governor's Conference on Aging held in Sacramento in October 1961. This is why the 1961 session of the California Legislature enacted a program for the aged that places California in a position second to none among the States. We are very proud of this outstanding program which includes measures to combat job discrimination because of age; to recognize the need for retraining for older workers who need new skills to remain productive parts of our economy; to provide suitable low-cost housing; to increase the amount of income and health services of aged persons receiving assistance from our public aid program of old-age security; to implement the provisions of the Kerr-Mills bill to provide long-term care in a hospital or nursing home plus medical care after discharge for those aged persons who need help in meeting their medical expenses; and to begin a pilot program of State matching grants to encourage and promote local community programs and services for our senior citizens. The health and welfare agency, which I head, has as its principal components the departments of mental hygiene, public health, and social welfare. Today you will be hearing from representatives of each of these departments plus a number of others that have responsibility for our State programs for the aging. All of these peope are nationally recognized experts in their respective fields. They will give you more specific information on both new and established programs under their jurisdiction. They will also illustrate how Federal aid has affected these programs and indicate the desirability of new or additional Federal support where they believe it is appropriate. Mr. O'HARA. Mr. Leask, I wish you would give us an idea of the organization of your department. How is it set up, and to what extent is it comparable to agencies in other States? Mr. LEASK. Well, I might say on that point, sir, that there has been no notable change in the organization structure of the State government in California for a period of over 35 years. There were more than 40 departments and more than 300 boards and commissions reporting directly to the Governor, until the 1961 session, the same session we have been talking about, when they, the Governor, proposed to the legislature the establishment of what we call the Agency Plan, under which departments of the State, with a measure of common interests, are grouped into sort of a division or agency structure. Under eight agency administrators the agency administrators for these groups of more or less related departments coordinate, provide leadership, represent the interests of the various departments under their jurisdiction, and to some extent make policy decisions, supervise administration, interest themselves in matters of support of the budget, all that kind of thing, and in addition the agency administrators, the eight agency administrators, constitute a cabinet, a Governor's cabinet. Something we have never had in California until this time. We meet with the Governor weekly, cross agency lines, discuss and advise upon matters of moment affecting the interests of the entire State. În a few words, sir, that's the outline of the agency program. Mr. O'HARA. Mr. Leask, the organization of your agency then is similar to that of the U.S. Department of Health, Education, and Welfare, which also is composed of a number of former independent boards. Mr. LEASK. That's right. Mr. O'HARA. And agencies? Mr. LEASK. More or less the pattern after the Federal concept. that's right. Mr. O'HARA. I think California is a pioneer in this sort of thing. My home State of Michigan has done very little toward organizing its governmental units in the sort of system you describe. Mr. Giaimo? Mr. GIAIMO. So far as the agencies are concerned, do they cross over into these various agencies? Mr. LEASK. Yes, that's right, we do have within the agency-and I might say at this point that there are some questions which it seems to me are going to be resolved as time goes on and we have had some experience as to the advisability of making some changes in the components of various agencies of course, you have instances at various points which have to be given consideration, but I made two or three little notes here. Now, insofar as your mental health department is concerned, of course, we have a great program involving the long-term care for geriatrics, principally in the institutions, although we do have some outpatients interests which are incidentally expanding rapidly. We have a licensing responsibility, the nursing homes, you know, outpatient care, and the in-mental health, in-public health, we have a very important licensing division, licensing and standard setting for hospital and nursing homes, for the housing of the aged, and certain medical programs, and I may say important ones relating to the problems, medical problems of geriatrics under public health. And in social welfare, which is the big one in this field, we administer the old-age security program. We administer medical aid to the aged under the Kerr-Mills bill, as I indicated a moment ago. We have a program of community demonstration projects which of course, all of these things of which enjoy a substantial cooperation from the Federal Government, both financial and otherwise, and then we have responsibility again for the licensing of facilities for the aged, and we have a substantial program for the blind, which of course includes the aged blind. Now those are all, those programs are all within the health and welfare agency. However, under education, we have important adult education programs especially designed for the older people here in California, and the department of employment in addition to the effect that the unemployment compensation program may have, insofar as older people are concerned, has a special program designed to assist and promote employment opportunities for older people. Now, that's something we are very proud of. What I am trying to bring out is that the educational programs and the employment programs are outside the health and welfare agency at the present time anyway. Mr. GIAIMO. As a result of the aged being intermingled with nonaged agencies under the various agency headings, is there any evidence or thought along the lines that the aged suffer in relationship to the nonaged? Mr. LEASK. Well, I will have to tell you that I haven't had any evidence of that fact. You see, our programs for the aged here in California are so tremendous and so vital that we have general approbation of them, and a feeling that a great deal is being done. Now, it seems to me that with the kind of collaboration and integration that we have as between the departments, even though they are not in the same agency, that doesn't prevent us, don't you know. We have task forces, standing committees, special committees, people working together all the time, we have a good climate in that effect, and this cabinet device I have told you about is helping greatly at that point, we sit in the cabinet, you know, the top level, and discuss these possibilities and the policies and the decisions that are worked out, they are filtered down so that we do get real good crossing of the lines and cooperation and collaboration. So, I really think, to give you a direct answer, that the situation is being very well taken care of at this point. Mr. GIAIMO. Thank you. Mr. O'HARA. One of the purposes of a number of the proposals before the committee is the establishment of a system of planning grants or similar measures to assist States in establishing or improving an agency for planning and coordination of programs for the aged and aging. Mr. LEASK. Yes, sir. Mr. O'HARA. Have the structural changes in your agency assisted the State of California in more effectively coordinating and planning programs for the aged? Mr. LEASK. Well, I think they are in the process of doing just that. I think there is no question about it. I think that the we have in the works the machinery, the mechanics, don't you know, for making definite advance along those lines. We have only been in business, you know, since October 1, but the effects are already being felt. Mr. O'HARA. Mr. Giaimo? Mr. GIAIMO. Do you feel that there is a need for any Federal activity in this field? Mr. LEASK. Well, I read two of the bills, I read the-I haven't got the numbers here the Fogarty bill and then I read, let's see, which one was it?-here, H.R. 710. Now, it seemed to me that those were thoroughly typical, weren't they? Mr. O'HARA. Yes. Mr. LEASK. And I have to tell you at the outset that our relationships with Health, Education, and Welfare, the Federal, have been real good. You know, we can't criticize Mr. GIAIMO. I am glad to hear that. Mr. LEASK (Continuing). What has been going on at that point, so let's not become involved so far as I am concerned right here and probably what you regard as the basic issue, but outside of that, when I take a look at these proposals which are more or less parallel, as I |