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With an eye to upgrading the quality of the nursing service rendered in nursing homes, it is important to have proper licensing and inspection of nursing homes. Where the legislation is not adequate on this score, State commissions should look to an improvement of the laws governing these matters.
As an inevitable concomitant of the foregoing it is important to make certain that the State pay a reasonable rate for the old-age assistance recipients who are patients in nursing homes, whether proprietary or nonprofit. A State cannot expect to obtain proper nursing services for its wards, unless it pays for the cost of such care.
In our State we were fortunate in the 1961 session of our general assembly to have all three of the foregoing aspects incorporated in legislation. Provision was made for State grants for the construction of nonprofit nursing homes. The combined State and Federal grants will now pay for two-thirds of the cost of building and equipping nonprofit nursing homes. Licensing laws were strengthened and the rates paid for the care of old-age assistance recipients was increased, not sufficiently but at least substantially.
Whatever your individual position, or that of your State commission, may be with reference to payment for medical care for the aged, it would seem to be inexcusable not to take advantage of such benefits as may now be available under existing legislation. Therefore, if under present legislative authorization your State cannot take advantage of the Kerr-Mills Act, it would seem to be essential to have legislation passed which would permit your State to avail itself of the benefits of this act, and then have your State adopt a plan which is sufficiently liberal in its means test and broad enough in the scope of the services provided to make a substantial contribution to those older citizens who are in the class of the medically indigent.
I shall not enter upon a discussion of the proper methods to provide medical care to the far larger group of older citizens who are neither medically indigent, nor sufficiently well heeled to pay the enormous expenses of protracted illness. I shall merely say that it is certainly incumbent upon us to see that some effective legislation is promptly passed providing for the health care of such elderly.
Housing.—The housing needs of the elderly have fortunately received very encouraging attention from the Federal Government. The provisions made for public housing for the elderly, the provisions made under section 231 of the Housing Acts of 1959 and 1961 for insurance of loans for housing for the elderly, and the direct loan program of section 202 are all important efforts of the Federal Government to encourage construction of housing appropriate for the elderly.
Moreover, some States have entered into a similar program of their own. Those of our States that have not done so, might consider whether we have left an area uncovered. We might especially inquire whether, under our State laws, local housing authorities can be created to operate with Federal funds for the establishment of public housing in rural areas, as well as in urban areas. If our State laws do not provide for the establishment of such authorities, this might certainly constitute an area for legislative action.
Along somewhat similar lines, I should like to direct your attention to a program which, it is expected, will be incorporated in a bill to be presented to this session of Congress. The problem we have been confronted with in Baltimore is that in areas where urban renewal is being undertaken, many homes which need renovation are owned by older people who cannot obtain the necessary amount of credit from conventional lending institutions to make the legally required repairs. As a result, these elderly become subject to eviction under the renewal program. To meet this problem, a proposal will be presented to Congress for Federal insurance of fixed-term mortgages on such dwellings of elderly homeowners. The mortgages which the Federal Government would, under the terms of such a law, insure would require the regular payment of interest, but would not require amortization until the property changed hands either by conveyance or at death of the occupant. It is felt that an older person might be able to meet the interest on a mortgage, if he were not required to amortize the mortgage at the same time, and that with Government insurance of such a mortgage, a lending institution would be able to advance the money for the rehabilitation of the home of the older person. The older person would, therefore, not be ejected from his home, but would have a renovated home during the balance of his life. We invite your support for this new approach to a housing problem for many elderly. Kindly speak to your Senators and Congressmen about it.
I have personally long been concerned about the way we build our public buildings. Many of them look very impressive with their imposing entrances at the head of a long series of steps. Would it not be reasonable to expect every tax
financed building intended for general public use to have at least one entrance on ground level, or accessible by ramp rather than by stairs. The older members of the community, as well as other citizens, should have easy access to such public buildings.
Education and recreation.—Under this topic I shall merely ask a few ques tions. Does your State law provide for courses in adult education in your school system? Does your State department of education have a supervisor of adult education? Do your county and community school systems provide corriculums in adult education? If they do so provide, are the courses offered at times and in places which make them accessible to the aging? Are they tuition free courses? I raise these questions merely to suggest that these are areas which might be considered as subjects of legislation, if your laws are silent on these matters.
As far as recreation is concerned, do the facilities made available for the pub lic generally adequately provide for the older members of the community? Are the recreation centers open and available to them? Are there parks and walking places, as well as playgrounds and baseball diamonds? Are there supervisors of parks and recreation who take an interest in the outdoor activity of the older, as well as of the younger, members of the community?
II. In answer to the question: How can a legislative program be developed which is fair to the community as a whole as well as to the aging, I shonld like to say simply that our best safeguard is to develop State commissions which are well balanced and representative of all points-of-view in the community. If your State commission on the aging determines what legislation shall be sponsored and that commission is a representative commission, you have the best possible guarantee of a balanced program. It has certainly been my experience as presiding officer of our commission that no one proposal made to our commission passes without considerable scrutiny. There are always members present who raise the point that we must keep in mind the total community, as well as the aging whom we are specifically organized to protect and assist. Only one or two such advocates of the general interest are necessary to keep a commission from developing a one-sided program.
III. Finally, how does one get legislation passed? Let me say to begin with that it has been our experience that if a commission is legislatively active, a State legislature will recognize it and give it work to do. For example, it has been customary in our State to refer many important pieces of legislation to our legislative council for study and recommendation before the full general assembly acts upon such legislation. However, recent sessions of our general assembly have referred several pieces of legislation which had a bearing on the welfare of our older citizens, to our commission instead of to the legislative council. This included a nursing home construction bill, income tax legislation for the elderly, bills outlawing age discrimination in employment, child-parent support laws, and similar legislation.
As we are all aware the work for the passage of a measure should begin long before it is introduced in a legislature. It should start as soon as a position has been taken by the State commission and a selling job should be done with the legislators while they are still home and before the legislature meets. Getting the legislator to understand the measure thoroughly before he becomes immersed in a vast stack of legislation is important. Likewise, letting him know how many of his constituents will benefit from the proposal is extremely important.
If the proposal is a constructive one there are many organizations and individuals whose support can be and should be enlisted. However, we of the aging brigade have a strong reserve contingent in the members of the golden age clubs, who have a direct stake in any legislation we may propose. There is no reason whatsoever why these club members cannot be called upon to support the proposals made by commissions on the aging. Their votes are as effective as younger votes and these citizens have more time than many others to con municate with their legislators. They should be conscious of their citizenship responsibilities, and if they are not, it is our task to educate them along these lines.
The old adage that "it is well to have a friend at court” is especially true with reference to legislation. Therefore, it is important to maintain close contacts, not only with the public at large, but especially with the administration, with the budge bureau, and with the members of the general assembly individually and collectively.
Whenever possible obtain administration approval of your proposal in advance of public announcement of the proposal. Likewise, if it involves a budgetary
appropriation, keep the budget bureau well informed. The same goes for the heads of the departments of government involved in the legislation.
Finally, let me suggest that it is not well to shy away from including legislators in the membership of your State commissions. Take them into your confidence, make them a part of your organizational setup, keep them well informed of what your commission is doing and needs. It has been my personal experience that serving both in our general assembly and on our State commission has worked out to the benefit of both, and established that close liaison between the two which was very desirable.
RESEARCH AND DEMONSTRATION IN A STATE UNIT ON AGING: PROBLEMS AND
By Irving L. Webber Ph. D.? In today's world, "research” is an almost magical word which commands attention, inspires respect, and creates, in some degree, the kind of awe formerly reserved for the term "science.” It is hardly surprising, therefore, that there has been some tendency to think of research as a cure-all through the use of which any and all problems can be dealt with and dispatched once and for all. This has led in turn to a disposition in some quarters to jump on the research bandwagon, and in a good many cases the vehicle has not been the one best suited to getting individuals and agencies to their destinations. This morning, therefore, I think it is important to give some sober attention—as a preliminary to discussing research and demonstration in terms of methods and problems to the practical question of who should do research and who should not do research,
First it will be helpful to state as exactly as possible what I understand "research" and "demonstration" to mean. For the present purpose “research" is defined as the application of the scientific method to solving a problem, testing a hypothesis, or discovering new phenomena and new relations among phenomena. Among the familiar elements of the scientific method are objectivity; systematic, orderly procedures; and careful and precise reporting of methods that will permit independent replication by other investigators. Although this definition removes from the research category certain kinds of datagathering activities that often are designated by the same term, this is not to imply that such nonscientific investigations or studies are less worthy or of a lower order. Rather, it is to emphasize that they are different and that they are not included in the meaning of the word "research” as I shall employ it today.
"Demonstration” refers to the planner trial under controlled conditions of a new or different method of providing a service. The purpose of a demonstration is to provide evidence through the actual operation of a service or program that it constitutes a way of solving a problem or meeting a need which is suited to the particular community, or that it offers advantages over existing methods or programs. Generally speaking, a demonstration project is planned to run for a limited length of time, often but not always with the support of other than community funds, with the expectation that its continuation will be dependent upon local acceptance and funding following the test period. Inasmuch as a demonstration is essentially a trial intended to show what a given method can accomplish in a particular setting, care is usually taken to assure that the results of the program can readily be evaluated.
It is clear enough that "research" and "demonstration" are quite different; one, as defined here, is a scientific procedure, while the other is an operational procedure which may or may not involve the precision of science. Now I should like to return to the fundamental matter of the proper role of the State unit on aging in relation to research.
The section of the White House Conference on Aging which directed its attention to State organization made two recommendations having to do with research. It stated that the “responsibilities of such a State unit should in
1 Prepared for presentation before the conference of State executives for aging, Apr. 11, 1962, Washington, D.C.
* Research social scientist, Pinellas County Health Department, St. Petersburg, and associate professor of sociology, University of South Florida, Tampa.
$ See Henry P. Fairchild, “Dictionary of Sociology," New York: Philosophical Library, 1944.
clude * * * the following: To gather and disseminate information about research and action programs, and provide a clearinghouse for current plans and ongoing activities” and “To encourage State departments, universities, and other appropriate agencies to conduct needed research in the field of aging." Thus the members of the State organization section failed to recommend that a State commission or committee on aging conduct research on its own and, by implication at least, urged that the unit limit itself to the functions of stimulating others to carry on needed investigations and of cataloging relevant projects.
It seems to me that this interpretation of the responsibility of the State unit is, in general, logical and defensible. Scientific research can be carried on most fruitfully under certain conditions that are unlikely to exist in a State unit, espe cially one that is new and small. These conditions include a well-trained professional staff, the intellectually stimulating atmosphere created by the presence of others with similar training and interests, adequate libraries, and freedom from operating responsibilities. Colleges and universities, especially those with graduate programs, are the institutions most likely to provide these conditions, but they also are found occasionally in other institutions and agencies, both public and private. Commonly, then, the State unit will be making the best use of resources and accomplishing its research purposes most efficiently and effectively if it relies on such other institutions and agencies.
On the other hand, there may well be instances in which a given State commission or committee does have the qualified personnel, the interest, the proper intellectual environment, the access to libraries, and the necessary funds to make it entirely appropriate for the agency to engage in its own scientific research. The public agency with which I am associated is carrying on a research program of considerable magnitude in connection with an operating program at the county level and in the absence of a direct university connection. But such cases will probably continue to be exceptional, occurring only sporadically around the country.
What, then, is the proper role of the State unit on aging in regard to research? Two elements in this role have already been defined by the White House Conference recommendations. By gathering and disseminating information about current research, demonstration, and program activities, the State unit can perform a valuable service. Usually it will prove to be the only agency in a given State whose special interest in aging and the aged makes it the logical clearinghouse for such data. Quite as important is the task of encouraging and aiding other institutions and agencies to conduct investigations for which it sees a need. Because of its special vantage point, the unit on aging can perceive problems requiring study in order to further its own program, and often it will be in an excellent position to stimulate and even to assist others in designing the desired investigations.
Thus far I have used the word "research" only in the sense of scientific studies, and I have stressed that these can usually be performed to best advantage outside the official unit on aging. But at this point it is essential to identify the category of fact-gathering activities referred to earlier as falling outside the realm of scientific research as it is usually understood. No term fully de scriptive of such studies is in general use, but they are characterized in most cases by dependence on secondary rather than primary data. Examples are compilations of research reports bearing on a given problem or topic, surveys of action programs, collections of published or unpublished statistical data re lating to a particular area of interest, or questionnaire surveys of State agencies in order to summarize all services relating to leisure activities of the aged.
Studies of the kind just mentioned should, in my opinion, be a responsibility of State units on aging and ought indeed to constitute an important aspect of their work. Typically there is a good deal of information available regarding the kinds of problems we face, but it is scattered about in numerous publications, annual or special reports, agency files, and elsewhere. Much can be learned and a great amount of light can be shed on the nature and extent of problems and ways to deal with them if the State unit undertakes to compile and review critically such information. The recent State reports prepared for the White House Conference illustrate what can be accomplished with little cost and limited personnel when existing data are made use of.
Finally, the State unit might well accept considerable responsibility for stimulating, initiating, and perhaps conducting demonstration projects. Since demonstrations involve the provision of services, they fall within the action
U.S. Department of Health, Education, and Welfare, special staff on aging, "The Nation and Its Older People," Washington: Government Printing Office, 1961, p. 268.
frame of reference which is especially suited to the State agency. They use knowledge gained in another community, showing the suitability of methods and techniques for our own community. Thus they can contribute importantly to the improvement of the lot of the elderly in a State.
Sometimes there is a tendency to deprecate the value of demonstrations on the ground that the usefulness of the methods has been made clear elsewhere and that such evidence ought to be adequate to influence their acceptance in our State or community. This is a questionable line of reasoning. Those persons and groups within a State or community that have control over public and private funds often tend to be skeptical of the applicability to their own situations of new methods that may have worked well in other States or communities. This attitude is based in part on the conviction frequently expressed that the conditions in other places—that is, the people and their needs, the cultural milieu, the health and welfare agencies and their relationships to each other—are so different as to invalidate comparisons. Hence a local demonstration may be well-nigh essential to obtaining the required acceptance and support at the State or community level. Therefore, the State unit will be well advised to give thoughtful consideration to those instances in which a well-planned and well-executed demonstration project can advance significantly the number and breadth of services available to the people it serves.
In what has been said thus far about demonstration projects it has been assumed that evidence of success in a project will be followed automatically by continuation of the service with the aid of regular rather than special funds. Such a sequence cannot, of course, be taken for granted. To pave the way for such a desired outcome, one essential is to design the project with due consideration to evaluation of the results. This requires, first, that the goals or objectives be set out clearly, so that there can be no doubt, when the data are analyzed at the conclusion of the trial period, whether the project did succeed or fail. It requires, also, that, if at all possible, some quantitative measures of the effectiveness of the service be devised so that the conclusions as to the outcomes of the demonstration rest on something more substantial and more defensible than personal judgments. In addition to building adequate evaluation into the design of the project, it is highly desirable, if not essential, to insure widespread understanding and enthusiasm by bringing key community leaders into the whole process of planning, operating, and evaluating the undertaking. If this last task can be accomplished, and if the desirability of the service can be clearly established, then the final step of followup should be relatively easy to take.
These, then, are the principal activities in research and demonstration to which State units should address themselves, in my judgment. Having set i forth these four major functions—the clearinghouse function, the stimulating
function, the information gathering and analysis function, and the demonstration function—as a framework within which to consider the topic, I should now like to turn to some special aspects of these matters.
The task of assembling information about current research and action programs is properly seen as a basic function. It serves as a means of keeping the State staff well informed about activities and resources, tends to direct attention to the unit on aging as a State resource, and aids both in exploiting the knowledge to he gained from familiarity with what is being done and in avoiding duplication and undesirable overlapping in efforts. Among the major sources of such information are the colleges and universities. Recently the Institute for Social Gerontology of the University of Michigan has made a new survey of training activities in the field of gerontology, and this can serve as a useful guide to the specific departments and other units of the colleges and universities in which gerontological work is in progress. It is likely also that some of the State departments, particularly welfare, health, vocational rehabilitation, and the employment service, will have work underway that is more or less directly in the field of aging and the aged. Certain serial publications include either lists or news accounts of current research and action projects. Particularly valuable are Aging, the monthly newsletter of the Special Staff on Aging: The Gerontologist, published quarterly by the Gerontological Society ; An Inventory of Social and Economic Research in Health, issued annually by the Health Information Foundation; and Sources of Morbidity Data, prepared each year by the Public Health Service and published by the Government Printing Office. Compilations of members' research in progress are prepared annually by a number of professional societies and by local, State, and regional gerontological societies.