I have chosen to discuss the problems of the aged in broad terms with particular emphasis upon the importance of total health care and ways and means of bringing adequate medical care to all of our senior citizens.

Rhode Island has more elderly people proportionately than does the average State. We have 10.4 percent of our total population composed of people age 65 and over, as against the national average of 9.2 percent. We rank 15th among all States in this respect. In absolute numbers, Rhode Island has 89,540 persons over 65 years of age.

Chronic conditions occur with much greater frequently at the older age levels, limiting the activity of more than one-third of all persons aged 65-74 and more than half of those aged 75 or older. While the aged make up only 9.2 percent of the total population, they make up 55 percent of the incidence of chronic illness among the total population. Recent statistics released by the American Podiatry Association reveal that persons over 65 have three times the incidence of foot problems as the general population (Journal of the American Podiatry Association, vol. L, 12, December 1960).

A public health official has stated that the podiatry profession can contribute greatly to preventive medicine since its practitioners are able to detect, frequently much earlier than those of other professions, the incipience or existence of chronic diseases, principally cardiovascular diseases, cancer, diabetes, arthritis, and nutritional disorders ("Public Health and the Aged," APA, L, 12, December 1960).

The total care of the patient, whether in a hospital, nursing home, or homecare program, would not be complete without foot health care. Plans are underway in Rhode Island to develop a "home care" program. This program has been in the planning stage for several years. Nursing homes, outpatient clinics, and organized "home care" programs must be made aware of the importance and availability of qualified podiatry services in Rhode Island. These professional services should be included with those of dentistry, medicine, hospital, nursing home, and public health services in planning and operating a total health care program for older persons. Furthermore, within the structures of Golden Age Day Centers, mental hygiene facilities, rehabilitation centers, and other pertinent agencies, the resources of podiatry should be made available to the elderly. The Background Paper for the White House Conference on Aging on Medical Care states, among other things, that feet are a danger point for the aged. ***** To neglect or mistreat them can result in serious setbacks. Hospitals, nursing homes, etc., have found that prophylactic foot care for their aged patients helps to contribute to the well-being of the whole person. Our geriatric patient, once moving about with painfree feet, is more easily motivated for total rehabilitation."

Rhode Island took a significant step forward when the Rhode Island General Assembly of 1961 enacted legislation to include costs of podiatry service in the Blue Cross and Physicians Service plans. The importance of health insurance for the aged cannot be overemphasized. It is well for our older people that the proposals of Blue Cross to increase rates upon the aged as of October of this year have not taken effect. Although the rates remain relatively unchanged, still they are prohibitively high in relation to what our older people can afford to pay. Many of our Rhode Island aged are undergoing hardships to keep up the payments. Moreover, the present coverage of the vast majority comes nowhere near meeting prevailing rates of hospital costs.

From now on, it seems that we are going to be concerned increasingly with increases in medical and hospital costs. Such increases make insurance coverage for the aged even more meager, so that holding the line now on increase in Blue Cross rates has not seemed to solve the problem. The hospitals and the physicians should set about seriously to implement the proposals made by Judge Harold C. Arcaro of the States Department of Business Regulation in order to bring about immediate overall economies in their operation and pass the savings on to subscribers in lower rates.

The only solution to the problem of bringing adequate medical care to the aged appears to be through health insurance operated through the social security mechanism. Blue Cross has not met and cannot meet the health and economic needs characteristic of old age because they cannot offer premiums which the older people can afford to buy.

We earnestly hope that the Anderson-King bill will be passed by Congress when it reconvenes in January. This legislation is a modification of the Forand bill and proposes basic coverage for a balanced program of medical care, de

signed to provide all persons 65 and over who are beneficiaries of OASDI with basic protection against the costs of inpatient hospital care and skilled nursing home services. It also provides for the alternative of home health care and outpatient hospital diagnostic services, with prompt payment for all such services under the social security financing system, except physicians' fees. It is not socialized medicine. It does not interfere in any way with the patient's free choice of physicians, other health personnel, and/or facilities. It also is oriented toward preventive medicine.

[Reprinted from Geriatrics, May 1961]

THE VALUE OF FOOT CARE TO THE AGED

In the past, I have commented on the great benefits that old persons can get from expert foot care. They need such care more than do the young. Obviously, they need it when they are suffering from narrowing of the leg arteries, particularly when they have diabetes. Many persons in these situations can be kept from getting gangrene of a foot or a leg by the care of a good podiatrist. As Dr. Edward L. Tarara of the Mayo Clinic recently noted, there is great danger of infection in the poorly nourished tissues of the feet of the aged. Any bruise, abrasion, or cut should occasion alarm.

Often because of the comparative insensitivity of the tissues of the aged, the old person does not become properly concerned when something starts to go wrong with his feet. As a result, gangrene may develop.

Some time ago, when I visited a large and well-run home, I was much interested to hear that the best-loved man in the place was the podiatrist, who added so much to the comfort of the old people. By keeping their feet in good condition, he enabled them to get about.

As we physicians all know, poorly chosen shoes have caused most of the trouble with the feet of civilized men. Because, until just a few years ago, women kept trying to wear shoes too small for them, many today are suffering from bunions and corns. Today, it is good to see that most girls wear soft, heelless shoes.

The December 1960 number of the Journal of the American Podiatry Association contains a symposium on the care of the feet of the aged. Besides the articles by Dr. Tarara and others, there is one by Dr. Leo N. Liss of San Francisco who tells of the fine Laguna Honda Old Peoples' Home which houses some 1,600 patients. Forty percent of them are able to be up and about. Some time ago, a podiatry clinic was organized to take care of the feet of these old people, and in 1955, four podatric externs were given room, board, and laundry at the home, in return for their giving 10 hours a week each for the care of the patients.

The results have been most satisfying, and in 1959, 3,239 patients were taken care of. With the good foot care, patients who might otherwise become or remain bedridden are kept ambulatory. And this is important because in 1950, the cost of a bedridden patient was $4.03 a day, while that of an ambulatory patient was only $1.78 a day. Obviously, the wise administrator of a home for the aged will see to it that his people's feet are given proper care.

WALTER C. ALVAREZ, M.D.

ABSTRACTS FROM CONFERENCE PUBLICATIONS AND REPORTS, WHITE HOUSE CON. FERENCE ON AGING, JANUARY 9-12, 1961

"Foot care.-Older people must be able to move about. There is no question that the feet are a danger point for the aged. To neglect or mistreat them can result in serious setbacks. Hospitals, nursing homes, etc., have found that prophylatic foot care for their aged patients helps to contribute to the wellbeing of the whole person. Podiatry has known and shown that many patients, with precisely made and fitted footgear and appliances and devices to redistribute weight stresses, will seem to have feet that are almost new. Our geriatric patient, once moving about with pain-free feet, is more easily motivated for total rehabilitation." From Background Paper on Health and Medical Care; prepared under direction of Planning Committee, Health and Medical Care, April 1960; pp. 48-49.

An example of many State reports:

"No. 34. It is recommended that nursing homes and geriatric clinics be made aware of the availability of qualified podiatry services in all major cities in Georgia; that podiatry representatives be included with dentistry, medicine, hospital, and nursing home administration and public health representatives in planning for the total health of the older citizens."-From Report of Recommendations for Georgia; prepared by the Governor's Commission on Aging; August 1960, Atlanta, Ga.

"The institutionalized or home care patient, once moving about with painfree feet is more easily motivated for total rehabilitation * * * 85 percent of older people have foot problems. Since the doctor of podiatry (chiropody) is the only person devoting his professional services solely to the foot and although he does devote considerable professional time to older people, it is necessary for him to devote more time and recruit fellow podiatrists to such service. He should engage in research; develop improved and more economical footwear and more specific pharmaceuticals for the foot. He should develop educational footcare programs for the older person."-From "Role and Training of Professional Personnel," group VI, section 10; B. Health Services, Podiatry. "*** 4. Scope and methods of participation: At the national level our Committee on Aging is stimulating, guiding, and assisting State and local committees. The American Podiatry Association is providing consultation in the development of the White House Conference on Aging program through the consultant in podiatry. At the State and local levels committees and individuals are participating in State and city conferences on aging and public education programs for senior citizen groups.'

From "Handbook of National Organizations," Department of Health, Education, and Welfare.

**** While no blueprint can be offered at this stage of deliberation, the need for diagnostic facilities, day care centers, mental hygiene outpatient and home services, "half-way houses," regional rehabilitation centers as well as new self-care and other services in hospitals has been stressed. Within these structures as well as in independent practice the resources of the dental, optometric and podiatric professions should be afforded the elderly." From "Recommendations-Governor's Conference on Aging"; State of California.

Dr. NYMAN. That concludes my statement, Mr. Chairman. If I can answer any questions, I will be glad to answer them.

Mr. BAILEY. Any questions, Mrs. Hansen?

Mrs. HANSEN. No.

Mr. BAILEY. Mr. Quie?

Mr. QUIE. No.

Mr. BAILEY. The committee appreciates your appearance in presenting this angle of the problem of the aging. We hope to be able to make some kind of a proposal that will meet with the approval of the Congress as a result of these hearings.

Thank you very much, Doctor.

Dr. NYMAN. Thank you, Mr. Chairman.

Mr. BAILEY. Mrs. Albert Smigel, National Council of Jewish Women.

Mrs. Smigel, you may further identify yourself to the reporter and proceed with your statement.

STATEMENT OF MRS. ALBERT SMIGEL, PRESIDENT, WASHINGTON, D.C., SECTION, NATIONAL COUNCIL OF JEWISH WOMEN, AND ALFRED GREENBERG, PRESIDENT, GOLDEN AGE CLUB, SPONSORED BY THE JEWISH COMMUNITY CENTER OF GREATER WASHINGTON, D.C., SECTION, NATIONAL COUNCIL OF JEWISH WOMEN

Mrs. SMIGEL. I also have prepared copies of the statement.

Mr. BAILEY. I believe there is present in the hearing room a gentle. man representing the Golden Age Club.

Mr. Alfred Greenberg, would you mind coming forward and occupying this other chair?

Mrs. SMIGEL. It is the same, yes.

I am Mrs. Albert Smigel, president of the Washington, D.C., section of the National Council of Jewish Women. Our section, comprised of 750 members, is one of the 329 affiliated units which make up a national membership of 123,000 women. I appreciate the opportunity to bring before this committee our views on the needs of the aged and aging.

Our deep interest in the problems of our older citizens, based on our organization's continuing concern for the welfare of people with special needs is not a recent nor a transitory one. Although our programs of study and action in this field were intensified in 1960 and 1961, in preparation for the White House Conference on the Aging, our activities date back to the inception of our organization in 1893. Through section participation, we had given service to institutions for the aging, visited the homebound and before the days of organized social agencies, tried to help with financial and family problems.

In the 1940's, due to a growing awareness of the leisure needs of older people, numerous projects were undertaken throughout our various sections about 235 in all. Such projects took the form of service in institutions, employment solicitation, sheltered workshops, meals on wheels, and clubs, centers and lounges.

In order to help define effective programing within these projects, an advisory committee was established by the national council in 1950. Outstanding authorities in the field were invited to serve and assist in preparing national guidelines for section activities. These experts represented such organizations and agencies as the Department of Welfare of New York City, the American Geriatrics Society, Housing and Home Finance Agency, Peabody House for the Aged and Indigent Women, New York University, the Caroline Zachry Institute of Human Development and many more.

The committee recommended the development of communitywide education programs to stimulate awareness of the needs of the aging; consideration of legislative activity; the continuance of leisure-time service projects.

Locally our service to older adults is in the form of a nonsectarian golden age club, which was started in 1951 with 35 members. At the present time the club meets twice weekly and our membership has increased to over 400 senior citizens.

Special interest groups meet during the week. Through the professional leadership provided by the Jewish community center, cospon

sors of the project, and the volunteers provided by the District of Columbia section of council, it has been possible to offer a successfully diversified program, including discussion groups, hobby clubs, choral groups, and service to homebound by the golden agers themselves. The large attendance at all meetings, regardless of weather, has been proof of the members' satisfaction and pleasure with this program.

In 1960, three very valuable studies were made by national council with the participation of the various sections and of the members of our clubs, centers, and lounges throughout the country. They

are:

1. "Spanning the Generations"-a guide for an institute on family relationships;

2. A survey of the recreational needs desired by older adults;

3. A survey of the medical costs among the members of council golden age recreation centers and participants in other council-sponsored programs for the aging in 200 communities.

I have copies of those if you would like to have them.

Mr. BAILEY. Pardon the interruption. These will be filed as part of the committee records.

Mrs. SMIGEL. Among the major conclusions drawn from the survey on recreational needs were the following which we have attempted to incorporate in our local programing.

1. The need to provide activities previously unknown or unavailable to fill leisure time productively and happily.

2. The importance of professional guidance and volunteer-professional partnership.

3. The importance of encouraging older adults to take more initiative in program planning.

4. The value of combining recreational activities with participation in educational programs, services to the community, and creative activities.

The survey on medical costs brings us to the legislative aspects of this field which have been of continuing concern to our public affairs committee and to our organization as a whole. Council has adopted resolutions on housing, medical care, and other special needs of the aging.

We have in the past and will continue to support sound programs and effective legislation contributing to a healthy family life with special emphasis on increasing needs of the aging, such as housing programs for low- and middle-income families and individuals with special consideration for the aged.

In addition, council has presented testimony in support of medical care for the aged under the social security system along the lines proposed in the administration program and incorporated in the Anderson-King bill, S. 909 and H.R. 4222.

I also brought with me a copy of a directory that has been prepared as part of a coordinating committee servicing the aging among Jewish groups and it was compiled by the National Council of Jewish Women and it was directed by B'nai B'rith, listing all the facilities that are available and recreational facilities and leisure opportunities and other pertinent facts, specialized directories, vocational rehabilitation, that would be of interest to aging.