toward implementation of these recommendations with new and expanded pro

grams.

(3) It was agreed that there was a continuing need for research, training, and evaluation programs but that Federal grants, if allocated only for those purposes, would lead many to believe that no real action program of the type desired would result. Many believe that already too large a proportion of the money available has been spent on studies and surveys and that now the primary need is some action programs that will keep up the morale of the elderly.

(4) It was also generally agreed that first priority should be given to State planning grants and that the proposal as outlined in H.R. 10014 (Mr. Fogarty) should be included in any legislation that is enacted.

(5)

Second priority should be given to State grants. In some States there is an urgent need to stimulate programs already planned but for which there is no money available in order to carry them forward.

The types of projects especially mentioned were those that would help to establish badly needed senior citizen centers. Many of the programs so essential for the aged are dependent upon the existence of a center that is available 7 days a week that can be used as a base of operations.

Great support was expressed for support for programs that would emphasize keeping the elderly ambulatory and independent so that they could care for themselves in their own homes rather than to have to be hospitalized because of the lack of some rather inexpensive programs. Among those especially mentioned were homemakers services, visiting nurses services, meals-on-wheels programs, extended out-of-hospital services, well-adult clinics such as the one that has been established in Baltimore on an experimental basis, and readily available preventive service such as exist in the public housing projects in Cleveland where medical, visiting nurses, eye, foot, and dental care are provided regularly on a low-cost basis.

(6) Of equal priority is the need for training personnel for work with the aging. This applies to persons who will actually work with the aged and to possible instructors who will be able to train such persons. It was recognized that a shortage exists that will become even more critical as the elderly population increases and as the programs for them expand.

Special need for short-term training was emphasized. Training and educational programs for persons whose work is of a nature that causes them to have considerable contact with the elderly was felt to be most important and desirable. Among the groups in this category are Department of Employment personnel, religious leaders, social workers, union representatives, personnel managers, doctors and other professional people, nurses, and others.

Much of this program could be accomplished by utilization of the grants provided for university extension programs if H.R. 11340 (Mr. Bailey) is passed. (7) Of last priority, as far as most of those present were concerned, at least at this particular time, was allocation of large sums of money for research projects that are not closely associated with action programs. It was felt that such programs are needed, that they should be part of the legislation, but that if only a minimum amount is allocated for research in this field, that it will continue in any event.

(8) Strong desire for better cooperation between State and Federal Governments was expressed. A resolution which was passed unanimously at a meeting of State representatives at the conference proposed that all grants—planning, project, training, and demonstration, evaluation, and research grants be made through an agency to be designated by each participating State.

There was considerable feeling that Federal grant money going into any State to help programs for the aged would duplicate State plans in many States and in others would actually conflict with State activities. As far as State planning and project grants are concerned, they certainly should go through a designated State agency. However, in the case of other grants, I believe that it should be the intent and policy of the Federal Government to work with such State agency but that the right to make such grants direct to nonprofit agencies or to local communities should be reserved by the Federal Government as there may be situations in which a State agency may refuse to activate a program with a nonprofit organization with which the Federal Government is working in other States and which may be in the interest of national policy and programing.

The Federal Government should also reserve the right to make direct grants to local communities, if after a reasonable time, any State fails to take advantage of whatever program may be enacted. Such a provision does exist in H.R. 10014.

(9) Finally, as to the need for a commission, most of those present probably favor an independent, high-level commission of the type proposed in H.R. 10014. However, I believe that they also hope that failure to agree upon organizational structure would not preclude the establishment of at least a minimum program at this time. Certainly they would prefer having a central office to deal with and certainly they fear that as long as the program is centered in the Department of Health, Education, and Welfare that it might take on the complexion of a gigantic welfare operation.

However, it must also be recognized that this desire for an independent commission is not the unanimous wish of State executives. All support the objectives for a commission set forth in H.R. 10014, and most recognize the failure of previous programs, such as the Federal Council on Aging, in not reaching these objectives. However, many felt that the final governmental structure to be established will be complex, that it is more important to proceed rapidly with at least a minimum program rather than to delay hoping for perfection. In view of this it is my recommendation to the subcommittee that it first explore the possibility of strengthening the alternate bill that has been drawn up by the legislative counsel by giving more explicit duties to the staff of the President's Council established therein and by making it more independent. It is also recommended that the Special Staff on Aging (Office on Aging in the alternate bill) in the Department of Health, Education, and Welfare be further strengthened and that an Assistant Secretary as head of this office be considered. Discussions have been held with the legislative counsel and alternate proposals are now being studied along these lines.

If this cannot be achieved in the short time available, then I would suggest that consideration be given to the approval of H.R. 11752 with the following additions:

(1) Provide for a separate appropriation for training programs that is identified as such.

(2) Add to H.R. 11752 the provisions for State planning grants as stated in H.R. 10014 with the following changes:

(a) Administration to be by the Department of Health, Education, and Welfare instead of by the Commission.

(b) That in addition to the planning provisions that some additional money be made available, under the same title, for planning, establishing, and expanding programs that would encourage the development of more senior citizen centers, for the development of noninstitutionalized oriented health and maintenance of health programs, and for expanding employment opportunities for the aged.

Certainly this type of legislation would not be all that is to be desired, but it would to some degree put an emphasis on action rather than on further study, further conferences, and further delay.

In the event that either H.R. 11752 or H.R. 10014 are approved, with or without amendments, but without the Joint Committee on Aging which has been proposed in the alternate bill, then I would recommend that the subcommittee do whatever it can to secure adoption of House Resolution 33, introduced by Congressman Jeffrey Cohelan, of California, which calls for a Select Committee on Aging within the House of Representatives.

Mr. TED ELLSWORTH,

NORTH KINGSTON, R.I., April 17, 1962.

Special Consultant, Subcommittee on Aging,
Old House Office Building, Washington, D.C.

DEAR MR. ELLSWORTH: I want this letter taken in the form of a testimony before the Subcommittee on Aging and added to your files.

I would like to state that the King-Anderson bill is the best of the those that have been presented which offer medical care for the aged, and it is backed by the administration. But it does not go far enough to be of value to any large proportion of the aging. In its present form, approximately 1 percent would be able to use the health care benefits. The reason for this is that the deductible amount in the bill is so large that about 80 percent of the aging would have no way of raising the funds.

For instance, they want a deductible of $10 a day for the first 9 days. That alone is $90. The first step for these people is to go to a doctor before they can be admitted to a hospital. His office call alone ranges anywhere from $5

to $10. Undoubtedly, they have to make a second trip to the doctor's office for diagnosis. In addition, there is a $20 deductible clause for the clinic diagnosis. It should not take anyone very long to figure out that it would cost about $135 before they could even get a recommendation to be admitted to the hospital. The health and welfare committee survey shows that at least 60 percent of the aging receive pensions ranging from $40 to $74 a month, which is inadequate to take care of their immediate living expenses such as food and housing. The young in the family have to supply the difference, and in most cases they are in the low-income group themselves. Therefore, they would be unable to put up any such money for the entrance to the hospital.

I have been inquiring and going to various club meetings and hearings, talking with numerous people in organizations, and they agree with me on this. I would say that the largest portion of the aged are chronically ill and need a doctor's consultation and advice. If the doctor's visits and service would be paid for by the bill, these people could get the care they need.

I suggest that the Subcommittee on Aging submit an amendment to the KingAnderson bill to strike out all deductibles and to write in that doctors' office fees and services be included. I have talked to leaders in organized labor, and they tell me that they are willing to bet that this kind of amendment is needed by the people; and the present bill is of little value without such an amendment.

I know that you will find that all of the aging groups in the country will also back this type of amendment. I also believe that the President of the United States would back this type of an amendment to the bill. At least I am going to write and ask him for his support.

I would appreciate your advising me what could be done or will be done along this line.

Very truly yours,

Hon. CLEVELAND M. BAILEY,

JOHN F. KINDER.

BALTIMORE, Md., April 19, 1962.

Chairman, Subcommittee on Education and Labor,
Washington, D.C.:

The Baltimore City Commission on Problems of the Aged supports H.R. 10014, the creation of the U.S. Commission on Aged. We wish to stress the urgent need for a strong Federal coordinating agency and the importance of a comprehensive grant program for projects related to problems of aging for the Commission.

STANLEY Z. MAZER, Executive Secretary.

STATEMENT BY ALVIN T. PRESTWOOD, COMMISSIONER, ALABAMA STATE DEPARTMENT OF PENSIONS AND SECURITY

I am Alvin T. Prestwood, commissioner of the State Department of Pensions and Security in Alabama (the State's public welfare agency) and chairman of Alabama's followup subcommittee on carrying out the recommendations of the 1961 White House Conference on Aging. I work closely with Hon. John Patterson, Governor of Alabama, who has offered to our State constructive leadership in the area of planning for senior citizens. Governor Patterson is chairman of the State board of pensions and security and both he and I were members of Alabama's official delegation to the 1961 White House Conference on Aging. In 1960 and again in 1961 Governor Patterson personally called conferences in Alabama to deal with the subject of aging.

I wish to present some of my thinking in regard to some of the proposed legislation now before the Congress which has to do with the planning for senior citizens. My comments, of necessity, will be general and not directed to any single proposal. Of primary interest to me, however, is coordination at the Federal level of efforts in behalf of the aging. I recognize that bills have been introduced that would establish new agencies or separate commissions on aging, while other measures would set up divisions within existing agencies. I cannot be explicit for many reasons and I feel that the subject is so important that more time should be given to a study not only of the proposals but of what needs to be done before decisions can be reached as to methods.

When I participated in the White House Conference in 1961 I was a member of the group considering Federal organizations and programs. I asked for assignment to this section because of my tremendous concern over the need for

coordination of activities for the aging at the Federal level. The deliberations of the committee presented widely divergent points of view. Most States do feel a need for more direct guidance from the Federal Government. At the same time, there are differences as to whether such guidance should come from an overall independent planning or coordinating body or commission, or should flow through the U.S. Department of Health, Education, and Welfare. There are real and understandable questions as to how the coordinating body should function and how it should be accepted by the States. This is one of the reasons it appears to me that action on this matter should be deliberate and should be based on full knowledge of needs as well as of mechanisms that might be adapted to meet them.

In Alabama there is a legally constituted State committee on aging. This body, however, has no funds for a permanent staff and serves purely in an advisory capacity. Under its direction Alabama has a subcommittee, of which, as I have indicated, I am chairman, geared to follow up on recommendations of the White House Conference. Of particular concern to me is a fuller development of public awareness of the effects of aging on society, and of organization of local committees to study local needs and resources.

Thus, as I see it, there is need for a coordinating body within each State and for a coordinating body at the national level. I do not feel in a position to take a firm stand on how such bodies should be organized and set up. I would point out, however, that no coordinating body should interfere with operational programs. Though such bodies might offer useful guidance in development of special demonstration projects or research, I would not consider it their role to come between cooperative programs performed by more than one agency, public and/or private, whether these be two agencies within a State, or a State-level agency and a Federal or national agency.

I have indicated that I am interested in the whole broad field of aging and in full coordination of programs in the field. I do not want to go into further detail on all of the different aspects of aging and all of the different areas where resources should be developed. I should like to cite two needs that are of primary importance to me as administrator of the public welfare program in Alabama.

It is probably obvious that I am going to point to the importance of income maintenance of older people and to the necessity for their being able to have their health needs met. Everyone knows that a "living" is essential for every human being. He must have the means in our present society to purchase the necessities of life-food, clothing, shelter, etc. He must also have an opportunity to receive medical care which is essential if he is to live out his three score years and ten. In Alabama we view with pride the fact that our average old age pensions (old age assistance) have risen in the past 4 years from $38 to more than $63. We are making payments today on the basis of 100 percent of unmet budgeted need up to a maximum money payment of $75. We know that our standards could be more liberal and that this is actually a minimum level. At the same time, Alabama has made more progress during this period than any other State. Our rate of growth is about five times that of the average old age assistance payment in the Nation. Along with this progress we have made gains in other fields, but we recognize, for example, that more public low rent housing geared to the needs of the aging is needed and will make living conditions more suitable for persons dependent on old age pensions.

Thus, I see the need of coordination at the State level in the same way that I believe that other States, like us, see the need for Federal coordination. It would be helpful to look to Washington for facts about what programs are in operation and for an understanding of the approaches needed to get help at the State and local level. At present there is a veritable kaleidoscope of Federal agencies with programs that affect seniors citizens. Many of these programs and services overlap and frequently two or more have similar purposes. The Department of Health, Education, and Welfare, for example, has specific responsibilities for the social security program (insurance and assistance) and for many other services. Since the needs of the aging are basically the needs of all adults, however, they cut across activities of such Federal agencies as the Department of Labor, the Veterans' Administration, the Department of Agriculture, Housing and Home Finance, to mention but a few. How is a State to know where to go for what service?

Perhaps the most useful service a Federal level coordinating body could offer the States would be that of disseminating information on what the various pro

grams are and how they operate. Obviously, needs are more clearly determined by State and local groups. Oftentimes, however, resources are least where need is greatest. It is easy to know how to get Federal aid when a particular county, city or State is declared to be a disaster area, but it may prove confusing and channels may seem indirect in securing other aid that is there for the asking. Also, local groups may need assistance in seeing some of the broader perspectives of aging. For instance, some needs are obvious to us all. Others are clear only to those who have made a study of the subject of aging.

We are also proud in Alabama of our new medical services for the aging. We have offered care in a licensed nursing home for many years to persons on old-age penison rolls who needed it. Now it is possible to make higher allowances and payments that are more realistic in terms of rates charged. A contributing factor to this progress has been the Kerr-Mills legislation of 1960. Also, under Kerr-Mills, we have developed a program of hospitalization for old-age pensioners as well as limited office visits to physicians following hospitalization. The hospitalization covers only acute illness or major injury and is limited to 15 days to a fiscal year. The physicians' services are also limited as to the amount per visit and the total expenditure.

A third medical program for the aged under Kerr-Mills is Alabama's new medical assistance for the aged. This includes hospitalization on a similar basis to the program for pensioners except there is a deductible item of up to $50 on each period of hospitalization unless it is a direct transfer. Physicians' services are included in MAA and are the same as for pensioners.

I should like to point out that we in Alabama believe that Kerr-Mills legislation is vital, too, in developing medical care programs and we would favor its continuance. In addition, and along with it, we would like to see enacted a program of financing medical care for the aged through social security. We do not see any reason for considering that these programs cannot exist side by side.

Alabama is a case in point. At the end of the 1961 calendar year there were an estimated 265,000 Alabamians in the 65-and-over age bracket. About 153,000 of these were social security beneficiaries. About 100,000 were receiving oldage pensions. There was an overlapping of about 25,000 who received both pensions (assistance) and social security. Thus, only 37,000 Alabamians were not included in either program though some of these undoubtedly would have been eligible for social security if they had chosen to retire.

As I see it, social security medical care would benefit the 153,000, some of the 37,000 and would take from those eligible for old-age pension medical care the 25,000 who are included in the social security beneficiaries. The result would be a reduction to 75,000 of the potential medical care load of pensioners and would also sharply reduce the number potentially eligible for MAA, which now has a rather strict income limit in Alabama. The results would mean that benefits under the Kerr-Mills program could be more adequate and eligibility requirements more liberal.

In brief, while I am fully aware that the total needs of the aged are the same as the total needs of all people, I think that adequately meeting the income and health problems will enable aged persons more nearly to meet their other needs. It is for this reason that we in Alabama place our first emphasis here.

In conclusion, I want to see coordinated efforts at the Federal and State levels and greater public awareness that aging begins at birth and will at some point influence the lives of every American.

TESTIMONY BY W. P. KENNEDY, PRESIDENT, BROTHERHOOD OF RAILROAD

TRAINMEN

I address myself to the proposed legislation to deal directly and comprehensively, yet practically, with the many problems of aging and the aged which are properly the province of government.

In doing so, I want to commend all those who have so selflessly and ably labored to bring this tremendously important complex of problems before the American people and put it in focus for legislation to be enacted now. In this connection, my two good friends, Senator Pat McNamara and Congressman John Fogarty, authors of identical bills S. 2779 and H.R. 10014, are to be singled out for special mention and commendation because they have made such searching studies of these problems and come forward with such vigorous reports and proposals.