11. The Federal Government should participate financially in the costs of any State and local civil defense welfare services. 12. Federal legislation should continue to provide funds for American nationals who are repatriated from abroad and in need of assistance and other services. 13. The Federal Government, in cooperation with the States, should study: (a) the costs and policy implications of and the alternatives to removing the restrictions on Federal financial participation in assistance payments to, or in behalf of, individuals in mental hospitals, tuberculosis hospitals, and public nonmedical institutions; and (b) the costs and policy implications of exemption of income earned by public assistance recipients. Methods of financing programs 14. The continuance of the Federal open end appropriation is essential to a sound State-Federal fiscal partnership in all aspects of public assistance. Since it is not possible to predict accurately the incidence and areas of need, flexibility and comprehensiveness are necessary in financing public assistance programs. 15. Federal financial participation should be on an equalization grant basis provided by law and applicable to financial assistance, including medical care, for all needy persons; welfare services, including child wlefare; and administration. 16. Any maximums on Federal participation in public assistance, including medical care, should continue to be related to the average payment per recipient and should be increased sufficiently to assure for all needy individuals reasonable standards of maintenance, comprehensive medical care of high quality and appropriate quantity, and the preservation and strengthening of family life. 17. Federal participation with respect to dependent children should be increased to a level which will assure treatment of such children equitably with that accorded other public assistance recipients. Provisions should be made so that children with earnings from employment may be allowed to retain all or part of such earnings. 18. No change should be made in the Federal matching formulas which would result in a reduction in the Federal share of State and local administrative costs. 19. Federal aid for public assistance should be on the same basis for Puerto Rico, the Virgin Islands, and Guam as for other jurisdictions. The annual dollar limitations on Federal participation for these jurisdictions should be removed. Administration 20. States should have the option to administer Federal funds for assistance and services by categories, by a combination of two or more of the present categories, or by a single comprehensive program covering all needy persons. 21. Adequate and qualified personnel is essential in the administration of public welfare programs. Administrative and service costs of State public welfare programs should be identified separately and Federal financial participation in such costs should be sufficient to enable States to provide for the adequate administration of all public welfare programs, and the rendering of appropriate services. 22. Adequate Federal funds should be appropriated to assist States in training State and local public welfare staff. 23. All public welfare programs, including financial assistance, medical care for needy persons, and other services, in which the Federal Government participates financially should be administered by a single agency at the local, State, and Federal level. 24. Federal, State, and local public welfare agencies should participate in and assist in the administrative coordination of all related programs in which there is Federal financial participation. 25. The Federal responsibilities relating to financial assistance and welfare services should be closely interrelated at an effective operating level. OASDI SOCIAL INSURANCE PROGRAMS 26. The contributory old-age, survivors, and disability insurance program, as a preferable means of meeting the income-maintenance needs of people, should be strengthened. Among the needed improvements are: making benefit payments more adequate; increasing the amount of earnings creditable for contribution and benefit purposes in line with current earning levels; broadening the scope of disability insurance protection, especially by eliminating the require ment that the total disability be of long-continued and indefinite duration; and extending coverage to earners and their dependents still excluded. 27. Health costs of old-age, survivors, and disability insurance beneficiaries should be financed through the OASDI program. The health costs of aged, surviving, and disabled individuals and their dependents who are not insured OASDI beneficiaries should be met through an effective governmental program. Arrangements for achieving this objective should take into account the priority needs of the groups to be served; availability of facilities, personnel, and services and protection and encouragement of high quality of care, including the organization of health and related services to effect the most appropriate utilization of services and facilities. 28. The funds of the insurance program should be available to help restore persons on the OASDI disability rolls to gainful employment since such expenditures would result in a net saving to the fund and increase the number of persons rehabilitated. 29. To the extent that changes to improve the OASDI program increase the cost of the program, contributions should be increased to insure the financial stability of the program. 30. The membership of the Advisory Council on Social Security Financing should include representation from public welfare. Unemployment insurance 31. The unemployment insurance program, as a preferable means of meeting the income-maintenance needs of unemployed people and as a means of keeping the need for public assistance to a minimum, should be strengthened. Among the needed improvements are: Establishing Federal standards which would assure more adequate benefit payments including benefits for dependents; extension of coverage to earners still excluded; provision for a minimum duration of benefits, provision for more equitable eligibility conditions; provisions for less restrictive disqualification requirements, and an increase in the amount of earnings creditable for contribution and benefit purposes in line with current earnings levels. There should be Federal provision on a permanent basis for extended benefits during any period of extended unemployment. Other social insurance 32. The Federal Government should provide leadership, funds, and research in order to give more effective aid to the States in the improvement of State workmen's compensation programs. Study should be given to ways of improving and extending, on a sound social insurance basis, temporary disability insurance benefits and workmen's compensation programs, with emphasis on planning for effective medical care and vocational rehabilitation. PLANNING, RESEARCH, AND DEMONSTRATION 33. An advisory council on public welfare should be appointed periodically to study and report on all aspects of public welfare, with particular emphasis on keeping the program in line with changing social and economic conditions. 34. The Federal Government should provide leadership and adequate funds for research and demonstration and for special projects directed toward the reduction of dependence, and the strengthening of family life. RELATED PROGRAMS 35. The Federal Government should provide leadership, funds, and research for the promotion of health and the prevention of sickness and disability contributing to dependency. Federal health programs should establish guides to encourage and enable State and local health departments to make a more effective contribution to broad programs of physical restoration. The amounts authorized and appropriated for maternal and child health and crippled children's services should be increased. 36. Public welfare has a responsibility to assure that comprehensive rehabilitative services are made available to persons who require them. Adequate funds should be available to public welfare agencies to carry out their responsibility to restore individuals to self-care and independent living and to strengthen family life. Public welfare agencies are concerned with the availability of adequate vocational rehabilitation services for individuals who can benefit from them. Since many eligible individuals still are deprived of vocational rehabilitation services, such services should be strengthened so that all vocationally handicapped persons who present reasonable possibilities of attaining a vocational objective would be served. States should be permitted to designate the State agency which can most effectively administer the vocational rehabilitation program. 37. Federal programs should provide more effective aid to help meet the needs of mentally retarded and other handicapped children. 38. Federal programs should provide more effective aid to help meet the needs of migratory workers and their families. 39. Federal leadership and provision for appropriate financial assistance for urban renewal, the revitalization of communities where unemployment is heavy and persistent, and the retraining of unemployed workers should be strengthened. 40. Work opportunities at prevailing wages, not competitive with regular jobs in private or public employment and with other appropriate safeguards to protect the health and dignity of the worker, should be available to able-bodied recipients of assistance for whom jobs cannot be found within a reasonable time and for whom such work opportunities are desirable. Such work should, where possible, provide training and be directed toward the preservation and development of work skills. Federal financial participation should be extended to include payments to recipients assigned to such projects. 41. A program with Federal participation should be established for the training and the employment of youth through projects for the conservation of natural resources and the provision of community services. OAKLAND, CALIF., April 20, 1962. Mr. TED ELLSWORTH, Special Consultant on Aged and Aging, DEAR MR. ELLSWORTH: On March 31 I spoke to sity in regard to the boarding homes for the aged. were interested in receiving. you at the Berkeley UniverThis is the information you THE IMPORTANCE OF THE BOARDING HOME FOR THE AGED AND ITS PLACE IN THE COMMUNITY I. Functions of boarding home Custodial care and supervision for the aged who are no longer able to care for themselves due to: (a) Poor eyesight, blindness; (b) improper diets; (c) forgetfulness; (d) confusion; (e) shakiness; (f) incontinency. The above conditions necssitate being placed in a homelike atmosphere with understanding guidance and care. II. The boarding home and rehabilitation This is one of the most important phases of a good home: (a) Create new interest in life; (b) help them to make new friends; (c) create a sense of belonging and being wanted; (d) create community participation by having them give something of themselves to others; (e) attend activities outside of the home; (f) participation in arts and crafts. Please read the enclosed booklet "Recreational Activities Outside the Home." III. The boarding home and patient These are the various emotional problems of some elderly people: (a) A feeling of complete uselessness; (b) a feeling of rejection by the family; (c) many have outlived all friends and relatives, therefore, no will to live; (d) a feeling of being an outcast by the community; (e) a feeling of being in the way. IV. Future of boarding homes We feel the boarding home for the aged should be given greater consideration and recognition on Federal level. The current emphasis of Federal, State, and county seems to be toward pushing nursing homes and hospital care for the aged. We would like to point out that both nursing homes and hospitals are oriented to care for the sick, while boarding homes emphasize individualized care and attention geared to their interests and needs in a homelike atmosphere with normal social and physical activities. V. Boarding homes and the taxpayer Boarding home care can and does save the taxpayer money through prevention and rehabilitation without necessitating long term costly nursing home or hospital care. VI. Boarding homes and financing The cost of a new facility in California for a boarding home is the same as a nursing home. One exception, we do not need 8 foot corridors and 4 foot doors. Why can't we qualify for the same financing as nursing homes under FHA? Why aren't we considered under the King-Anderson bill? We hope that you in Congress will recognize that our small proprietary homes have rendered good service to the elderly people, have helped them to stay in their own communities, and have encouraged them to take up new interests. If you wish to assist us in helping our elderly people consideration should be given to making some of the following programs possible: 1. Make grants in aid to pay for a substitute to operate our homes so that we can take time off for 1 week each year to take in-service training under adult education which will help us to do to a better job. 2. Furnish equipment and craft materials to elderly people so that we can encourage them to take up hobbies. 3. Furnish leadership for development of skills in our guests by extending the services of teachers and recreation leaders to them. 4. Make grants to tax-supported and voluntary agencies who extend their programs to homes for the aged. N.B. Boarding homes are also referred to as rest homes, guest homes, or senior care homes. Number of aged in homes vary from 1 to 15 people. These are licensed by the county welfare agency. Homes of 16 or more are licensed by State social welfare. In Alameda County this represents 165 county licensed homes and approximately 40 State social welfare licensed homes for the care of ap proximately 2,500 elderly people. Yours very truly, GLADYS FLECK, Member, State Board of Directors, East Bay Association of Nursing Homes, Sanitariums, Rest Homes, Homes for Aged. APRIL 9, 1962. To: Mr. Ted Ellsworth, special consultant on aged and aging, General Subcommittee on Education, Committee on Education and Labor. From: Oakland Recreation Department, Arroyo Viejo Center, Joan Avila, director, Oakland, Calif. Subject: Information concerning the history and operation of a recreation program for guests of rest homes in the Oakland area. HISTORY The Happy hours club, composed of guests of rest homes, first met April 18, 1960. The program was initiated by the rest home operators in the Oakland area. The club was cosponsored by the Alameda County Welfare Department and the Oakland Recreation Department. The Oakland Recreation Department provided the facility and a recreation director to work with the group. Alameda County Welfare Department provided a social worker who attended all functions, helping where possible. The operators of the rest homes provided the working nucleus-leading singing, leading games, securing outside entertainment, taking care of refreshments, etc. The expenses of the actual program were provided by the operators (cost of food, tickets to special entertainment, etc.). The Alameda County Welfare Department was a source of some donations, such as prizes for contests. The Oakland Recreation Department provided materials for decorations and the director acted as a resource person, helping to guide the planning and operation of the program. In January 1962, the Alameda County Welfare Department withdrew their sponsorship, feeling that the group was self-sufficient to the degree that the assistance of the social worker was no longer necessary. The Oakland Recreation Department now has the full sponsorship of the group. The operators and the recreation director meet monthly to plan future programs and discuss areas of concern. The operators are organized into committees so that all phases of the program are covered. Each operator pays $1 dues per month to alleviate the operating costs. OPERATION OF THE RECREATION PROGRAM The basis of operation has been explained above. Operators bring their guests by private car to the Arroyo Viejo Center one afternoon per week for a program of community singing, visiting, games, refreshments, and special entertainment. Special dinners and festivities are held around the holidays. The group takes excursions to see special community entertainment (Christmas pageant, carnival, etc.). The purpose of this recreation program is to give these rest home guests a new interest, a new lease on life. Their participation in the program is sought after in whatever way possible; for example, the guests made over 70 yarn dolls for their charity project. Monthly bulletins are sent to the rest homes-listing the program, information for operators, announcing the names of those celebrating their birthdays, etc. The attendance at the weekly programs varies from 25 to over 100 (averaging 40 per meeting). SUGGESTIONS 1. Funds to alleviate or cover the cost of transportation to the center; cost of hiring people to babysit while the operators bring some of their guests to the program or when the operators attend the operators' meeting; and funds to help with the costs of refreshments, special dinners, and trip expenses. 2. At present the Oakland Recreation Department cannot give more of the director's time to this program. But, it would be desirable if the director could spend one-fourth or more of her time with the group doing resource work, searching out special projects for the group, and possibly setting up home visits for recreation purposes. STATEMENT OF MRS. BARBARA BRIGHT, SAN DIEGO, CALIF. I am Mrs. Barbara Bright, a social worker employed by the Community Welfare Council as director of the Senior Citizens Information Center. There are relatively few professional people in this country working exclusively with the general problems of aging. I feel that in my position I am able to have a unique knowledge of the very varied needs of our senior adults. In trying to assist these people and provide sound planning for their unmet needs, it is essential to have adequate consultation service from the State and Federal Governments. In considering what service these governmental levels could be, it is important to keep in mind that no one from the outside, no matter how well versed, can come into a community for a few days and provide an adequate plan. Local planning must be done by local people, with the very necessary assistance of outside specialists. The Senior Citizens Information Center provides a direct service to the area on the many specialized facilities for the elderly. In the past 3 years, over 4,000 people have been helped to determine and to use a wide variety of services. As I talk with these people, I feel that I not only have a direct knowledge of their needs, but also I realize the great need for help in planning solutions to their problems. Every day I come up against the question of the satisfying use of leisure time. Recreational facilities are fairly well supplied in this area, but many a time a retired person will come into my office after the "honeymoon of retirement" is over, saying "I am sick and tired of playing games, I want to do something useful." Too frequently persons in their seventies will call to say they are getting desperate because their social security check of $54 will not cover even the basic needs and all capital reserves are used up. Often these persons do not know where help is available or they have always had strong feelings about the word "charity." With counseling help they are able to explore the possibilities for self-support or are given help in understanding and accepting agency assistance. I don't think I need to tell this group about the frequent requests received for obtaining essential medical care. Nursing home care often presents a large and frightening problem to the elderly and their relatives. Some progress is being made on a national basis to assist with the financial phase of this problem, but consultation help is needed from State and Federal levels in order to provide necessary information for our community to develop a comprehensive plan on the many aspects of adequate care for the chronically ill. As Dr. Robert Morris of Brandeis University has said, 75 percent of all funds for the aged |