To be effective in stimulating and coordinating research and demonstrations, a State unit must establish and maintain liaison with those institutions and agencies in which investigations are underway or are likely to be undertaken. Since each of these research units, in most cases, has its own policies and may, in fact, be involved in a long-term program of studies, it is unrealistic to expect to exert much influence in the short run on the kinds of problems given attention. Consideration should be given to forming an advisory committee whose members represent the major units doing research. Such a committee can be an excellent mechanism for drawing the key people into thoughtful consideration of the questions for research and for communicating to them a sense of urgency regarding the development of new knowledge that will contribute to the solution of pressing problems. If the advisory committee on research on aging wishes, it can go beyond periodic meetings to hold seminars, workshops, and conferences or even to publish descriptive lists of research in progress.

In connection with studies and demonstrations to be performd by the State unit on aging with its own staff, both preparation of project applications and sources of financial support require some discussion, and the two are interrelated. The writing of the application for support is an exacting task. Although a wide variety of relevant matters has to be taken into account in the preparation of a particular document, a few elements must nearly always be kept in mind; and these are among the criteria of acceptability that will be invoked by those who review the statement of the project and measure it against other applications competing for funds.

A first step in formulating and refining the question for study or demonstration and in shaping the design of the investigation is to become thoroughly familiar with reports of previous work having to do with the problem. The advantages are probably obvious: Your own study can begin at the frontier of knowledge, building on and adding to what has already been learned by other investigators, and you will avoid the danger of proposing to study what previously has been established. Moreover, the statement regarding the project must describe its relationship to earlier studies, and it is of first importance that your discussion demonstrate that you are familiar with the more significant work of other students.

The plan for the study or demonstration should be clearly described. This sounds like a superfluous statement of the obvious, but the experience of reviewing bodies proves that applicants often fail in this respect. Sometimes writers founder on the shoals of technical language peculiar to their own fields but not readily understood by nonspecialists, but more generally procedures are not described fully enough or certain steps in the process are not described at all. The crucial fact is that those who must pass judgment on an application usually are entirely dependent for enlightenment on what is in the statement of the project; they cannot be assumed to have any other knowledge that will aid them in their job.

The plan must be logically organized and internally consistent, of course, and it must show that the writer is thoroughly familiar with practical conditions bearing on his work. For example, a design requiring interviews in a sample of proprietary nursing homes would be suspect if it did not reveal an understanding of the need to obtain in advance the approval and hopefully the support of the State and regional associations of nursing home operators. Of basic importance, also, is making the application consistent with the published policies (if such exist) for the grant program under which the request is being filed. Still more generally, the applicant should be aware of the desirability of narrowing the scope of his project, because of the tendency which usually prevails is to attempt to accomplish too much in a given undertaking.

In this brief discussion it is not possible to consider the broad matter of the techniques and methods best suited for use in studies performed by State units on aging; a much longer paper would be required to do justice to that one topic alone. Much will necessarily depend on the competence of the investigative personnel. To have a chance of success, the application should demonstrate that qualified people will conduct the study, and in this connection it is helpful to be able to identify and provide biographical information about the actual investigators if they are known; because of the known difficulty of recruiting competent investigators, there may tend to be some skepticism about the possibility of a nonuniversity unit being able to engage the people it needs. In either event, the application will in most instances be strengthened by inclusion of the names of consultants who will work with the study staff, especially if the consultants are authorities in their fields.

These few remarks regarding the preparation of applications have suggested some of the desirable procedures and some of the common pitfalls. An even more hurried treatment of the fundamental question of sources of financial support is necessitated by time limitations.

5

Private foundations comprise a very large number of fund-granting institutions with extremely varied fields of interest. The 1955 edition of the standard work, American Foundations and Their Fields listed approximately 4,500 foundations. Relatively few of these are likely donors since a study conducted by the Inter-University Training Institute in Social Gerontology and reported in 1958 identified a total of only 536 foundations and governmental agencies, on the basis of the description of their fields of interest, as possible sponsors of studies in aging. Nevertheless, approximately 40 private foundations affirmed their interest in the field of social gerontology, and 15 of them had previously supported or were then supporting programs in the area."

Some foundations, especially those with active programs in gerontology, have prepared statements describing the kinds of studies they are prepared to encourage. These will prove exceedingly helpful to the prospective applicant. Most of the others will respond to letters of inquiry outlining their specific or general interests. Some of these foundations, such as the Ford Foundation, the W. K. Kellogg Foundation, the Rockefeller Foundation, and the Russell Sage Foundation, are well known; others, such as the Barker Welfare Foundation, of Chicago, the Earhart Foundation, of Ann Arbor, and the Lilly Endowment, of Indianapolis, are less familiar. For the State unit on aging, the numerous foundations which restrict their grants to limited geographical areas should be of particular interest, for they are likely to regard favorably certain kinds of projects that their national counterparts would find outside their proper realm, and they are somewhat more likely to be receptive to requests to support data gathering and analysis studies and demonstrations of purely local or State value. Here, as in the case of those agencies without geographic limitations on their grants, the primary guide is American Foundations and Their Fields.

A striking characteristic of the present situation is the increasingly large role being played by governmental agencies in the support of research and demonstration, a trend which applies with equal force to the field of aging and the aged. In contrast to the private foundations, few of which have developed structured programs providing a framework within which the applicant can work, the governmental agencies typically offer funds for the support of studies and demonstrations focused on well-defined and sharply limited program objectives. In this instance, therefore, it is essential to obtain and study the official documents which provide guidance in measuring the relevance of proposed inquiries against the criteria of the grant programs.

The U.S. Department of Health, Education, and Welfare is the major fundgranting agency for our field of interest. Among the units of HEW now pursuing active programs are the Public Health Service, through the National Institutes of Health and the Bureau of State Services, the Office of Vocational Rehabilitation, the Office of Education, and the Social Security Administration. Detailed information about the interests of these agencies is available from the respective units; and the regional representatives on aging can be most helpful to State staffs in guiding them to the particular programs most likely to offer assistance for the projects with which they are concerned.

Several other Federal departments likewise conduct and in some cases support studies of aging and the aged but it is not possible to consider these here. The intricacies of the numerous governmental programs are such that expert guidance is essential to most of us. This is available through the Special Staff on Aging, the departments in Washington, and the regional offices of the agencies.

I began by stating my conviction that the State units on aging will be well advised, in general, to avoid the temptation to invade the field of scientific research and continued by sketching the large area of studies and demonstrations which appear to constitute the legitimate field of activity for such State units. Little is known about our field compared with what needs to be known, and carefully planned and executed investigations and demonstrations hold out the

Wilber Rich, "American Foundations and Their Fields, seventh edition, New York: Raymond Rich Associates and Marts & Lundy, Inc., 1955.

J. H. Britton and H. L. Orbach, "Foundation and Government Support for Social Gerontology: A Survey Report," newsletter of the Gerontological Society, September 1958. ?A list of the foundations and governmental agencies which responded to the questionnaire can be obtained from the Institute for Social Gerontology, Üniversity of Michigan, Ann Arbor.

87006-62-pt. 1-37

hope of more rapid progress in the years to come in improving the health and welfare of the elderly. Research, however defined, is not a panacea; nevertheless, it is the indispensable means for insuring that forward fovement for which we all wish.

CURRENT PROPOSALS FOR FEDERAL LEGISLATION ON AGING 1

(By Wilbur J. Cohen, Assistant Secretary for Legislation, Department of Health, Education, and Welfare)

I am indeed glad to greet so many representatives of States concerned with the problem of aging. To have this large group of representatives here from every part of the country to discuss the problems of older people gives encouragement and support to all of us. We are ever mindful in this Department that the older people of the country are not here in Washington, they are in your local communities out there in every State of the Union. Laws may be passed here in the Nation's Capital to relieve these older people of some of their fears about health and economic security, but the real work to help bring meaning into their lives must be done where the aging people are.

All of us here know something of the great need in the field. There is much to be done at every level of government. Progress in medical science has provided us with the means to prolong life, but our society has not devised ways of insuring adequate food, shelter, and medical care for those added years. We have not made the cultural adjustments necessary to enable the retired person to find new activities and roles, to keep him conscious that he is still a part of society, and a part of life.

The Federal Government has done a great deal through several important pieces of legislation. Through the social security system we provided a base for retirement of workers, and public assistance for the indigent. Today's statistics reveal, however, that what we thought would be adequate retirement income for the aged is not adequate because of the inflationary trend that besets our economy. A look at income figures gives us some measure of the inadequacies in the incomes for older people. Fifty-three percent of the aged have less than $1,000 a year income and half the elderly couples have less than $2,500. Congress has shown its willingness to liberalize benefits through the several amendments to the Social Security Act but the relationship of benefits to past income is not in the proportion contemplated when the act was passed. In the field of medical care we have tried to provide for the indigent but we have not done too well for the people in the middle income group. More than half our older people are unable to afford the hospital care they need. We have only 500,000 nursing home beds today, and only 180,000 of them are staffed to provide skilled nursing care. We need more trained medical personnel and personnel in other fields to serve the elderly. We have need for better housing, and more homes for low and middle income older people. We need to do a great deal to eliminate the age discrimination in employment. We need more opportunities for retraining and rehiring older people and above all we need to devise ways by which we can plan activities so that the lives of older people will be more meaningful.

All of these needs of our aging population are of great concern to us. Tangible, on-going programs for older people are being carried out by six different agencies within this Department. They range from the various studies of aging in the National Institutes of Health, to the projects for the rehabilitation of older people in the Office of Vocational Rehabilitation.

Secretary Ribicoff's interest in the subject of aging led to his appointment of Dr. Donald P. Kent, as his Special Assistant for Aging and Director of the Special Staff on Aging. You are already aware, I am sure, of what the special staff is doing. You will hear much more in these few days of the role it can play in helping you with the programs you plan in your States and local communities.

We are pleased in this Department to know that there are now 45 active State Commissions on Aging. It is even more gratifying that 35 of them are permanent as contrasted with 22 permanent State Commissions at the time of the 1961 White House Conference on Aging. As a part of my duties I keep in close touch with Dr. Kent, and I know a great deal about the progress you are making.

1 Address before the conference of State executives on aging, Washington, D.C., Apr. 10, 1962, 7 p.m.

When this administration came into office a little more than a year ago, we had plans for legislation to help meet many of the needs I mentioned earlier. Some of the legislation hasn't been enacted as fast as we had hoped but the progress that has been made is quite significant. What I would like to do this evening is to summarize the principal measures bearing on the problems of aging that have already passed and then to review for you the important bills we hope will be enacted before the end of this session. I know that Secretary Ribicoff mentioned some of these matters when he welcomed you yesterday.

The Community Health Services and Facilities Act passed last year had as one of its major purposes the improvement of the out-of-hospital health services for older people. Two of its most important provisions in my mind are First: the authorization for an expanded program of matching grants and other services to States to build up community health services for the chronically ill, and second, an appropriation authorization increase which would double the annual Hill-Burton grant funds available for construction of nonprofit nursing homes. These provisions should enable many localities in your States to move ahead on the construction of skilled nursing homes to provide professional nursing care for older people instead of the custodial "bed and board homes" with which we have had to be content in the past. Expanded homemaker services. and nursing care for the homebound are other activities that could be assisted under this law.

I wonder if you are also aware that the Community Health Services and Facilities Act authorized a new program of special project grants to conduct studies, experiments, and demonstrations for developing new or improved methods of providing out-of-hospital community health services particularly for the chronically ill and the aged. The Public Health Service is now receiving applications from communities who have projects they believe worthy of support.

This fall there is to be a full and comprehensive review of the Hill-Burton Act and what will be needed in the way of legislation next year to enable that program to fill the gaps in the construction of hospitals and related facilities for the health care of all people and particularly the aged.

Last year the Congress also passed amendments which provided some bobtailed benefits to the Social Security Act. These obviously did not satisfy everyone but they did bring some economic relief to a large number of older people. As you know, the amendments provided benefits for men at the age of 62 on a reduced basis, similar to that previously provided for women. As a result of this particular amendment 300,000 men have been added to the social security roles and eventually about 30 percent of all men between 62 and 65 are expected to take advantage of this new provision. Other amendments increased widow's benefits, increased the minimum monthly benefit and liberalized the retirement earnings test.

Another accomplishment of the last session of Congress was the enactment of amendments to the Housing Act which authorized $150 million for a Federal housing for the elderly program. The Special Staff on Aging has been working very closely with the Housing and Home Finance Agency, as the Secretary reported to you, and that program is going forward rapidly. It is one small start to be sure, but a very important one for older people.

Now coming to the legislation that is still pending in this session of Congress the first bill in which I think you'll be interested is the public welfare bill (H.R. 10606) which has passed the House and which we hope will be considered in the Senate very soon.

The need for this bill has been given wide attention because of the criticism of the aid to dependent children program. But out of it grew the need for development and expanding rehabilitation services so that public assistance recipients could be trained and helped to be self-supporting.

The bill as it passed the House, would authorize a 75-percent Federal matching in all public assistance titles for certain services which are to be specified by the Secretary of Health, Education, and Welfare. These will be services designed to retain capability or self-care and to reduce dependency, and would, I should think, include such services to the aging. Under this provision 75percent matching would be allowed for the training of personnel who are employed or who are preparing to work in State or local welfare agencies. I can't overemphasize too much that particular title because as you know one of our greatest difficulties is finding trained people to work with public assistance recipients.

The bill as it passed the House would increase the Federal share of the matching for the monthly payments of recipients under programs for the blind, the

aged, and disabled. These provisions add $140 million to the cost of the bill and were not recommended by the Department. Whether or not they will be retained in the final version of the bill I don't know.

The new bill would make permanent the authorization, already in the Social Security Act, for Federal funds to increase the number of trained people for work in the public assistance program. The authorization would be limited to $32 million for fiscal year 1963 and $5 million a year thereafter. In reporting out the bill the House Ways and Means Committee expressed its hope that the Congress would appropriate an adequate amount of money under this particular title because it is convinced that one of the most important elements in all constructive welfare programs is an increase in the supply of trained personnel. The House took no heed of the wishes of the Ways and Means Committee, however. It appropriated no funds under this title when it passed our appropriation bill last week. We expect to make an appeal to the Senate for these funds.

The welfare bill provides that a State may combine its programs for old-age assistance, aid for the blind, and to the permanently and totally disabled, and medical care for the aged if it so wishes. The advantages of the new combined title would mean that States could get more favorable medical matching for the blind and the disabled because they would be able to average all the payments together. Combining the programs would also simplify the administration. Another provision of the new bill is that demonstration projects do not need to be submitted as part of a total State plan as is required under the present law. The committee in reporting out the bill expressed its belief that often this requirement stands in the way of experimental projects which are designed to test out new ideas and ways of dealing with public welfare recipients. Consequently, if your State agency or a community within your State has a project designed to improve rehabilitative services or the technique of administering assistance which it believes to be of such worth that it should be tried, it could be approved even though it were not considered a part of the general State plan.

The second piece of pending legislation that I would like to discuss with you are the bills which would establish a National Institute of Child Health and Human Development. As you know, all the institutes we now have out at the National Institutes of Health are disease oriented. This administration believes that if we are ever going to find out the answers to the whole genetic-growthaging process we have to begin at the conception, and watch the full maturation process. We have to study the forces that are brought to bear on human development itself: to study the way the baby grows into childhood, the child into adulthood and adults through middle age and into old age, if we are to get the kind of light we need on both the physical and emotional problems of children and those of aging people.

The Fogarty-McNamara bill would provide grants to each State for the establishment or improvement of State agencies; for the development of programs; and for special projects which would coordinate and expand activities in the field of aging. It would also provide such amounts of money as needed to assist the States in administering this program.

The bill would also authorize direct Federal grants to public or nonprofit private agencies for demonstration, research or training programs relating especially to education, welfare, recreation, and other problems of the older persons. The entire program would be administered by a bipartisan, threemember commission appointed by the President.

This Department wholeheartedly supports the objectives set forth in the Fogarty-McNamara bill because they are the goals toward which your activities and the programs of our Department are directed. There are other provisions, however, with which we do not find ourselves in agreement.

The part of it with which we particularly disagree is the provision to create a separate Commission on Aging which would be set up to administer grants and supervise programs. It is our opinion that establishing a commission having such responsibilities within the Federal governmental structure would be breaking long and well-established precedent. Other Federal commissions are regulatory in nature, are designed to study and make recommendations regarding a specific problem, or to give visibility to the Government's concern about a particular situation or issue. A Presidential Commission can do these things very well but it is doubtful that it is the most effective instrument for supervising and carrying out an operating program.