Senator EAGLETON. I would also be curious to know the reaction of any of the restaurant chains that are in the program as to whether they are satisfied with the program. Is it a total loss to them or something they break even with? Are they happy with it? Mr. WALTERS. Mr. Tarr was out at the California State Federation convention and all the information we have had is that the number of participating restaurants has gradually increased. There are more today than there were 6 months ago. From that point of view, it must be somewhat popular. Mr. TARR. Yes; that is the way I understand it. It is growing in popularity and importance. Mr. WALTERS. But we will endeavor to try to break it down and get some real figures, and I feel reasonably sure that especially the chain restaurants in San Francisco will have some statement or some figures they can give us. Senator EAGLETON. Fine. Thank you, Mr. Walters and Mr. Tarr. We will now hear from the American Association of Retired Persons, Mr. Bernard E. Nash, executive director, and Cyril Brickfield, legislative counsel. (No response.) Senator EAGLETON. All right. Dr. Douglas Holmes, director, Center for Community Research, New York City. STATEMENT OF DR. DOUGLAS HOLMES, DIRECTOR, CENTER FOR COMMUNITY RESEARCH, NEW YORK, N.Y. Dr. HOLMES. Thank you, Mr. Chairman. By way of a preamble, I wrote this literature before having read the bill in question. Our words sometimes come back to haunt us, but in this case my remarks would have been different had I read the bill. Since there is so much in the prepared statement which is really repetitious of testimony already presented here today, I wonder whether I might just enter it into the record, introduce myself, and make a few brief extemporaneous comments. Senator EAGLETON. Excellent. Your prepared statement in full will be made part of the record. (Prepared statement of Dr. Douglas Holmes follows:) My name is Douglas Holmes, and I am the Director of the Center for Community Research, a non-profit organization located in New York City. The Center has been involved in three demonstration and research programs funded by the Administration on Aging, which have bearing on today's hearing. First, in collaboration with the Associated YM-YWHAS of Greater New York, of which the Center is an affiliate, a group meals program for the aged was maintained for two years, funded under Title IV of the Older Americans Act of 1965, Public Law 89-73, as amended. Second, Center staff currently is working on a National Study of meals programs for the aged, supported by the Social Rehabilitation Service, Department of Health, Education, and Welfare, focusing first on group meals programs, and currently upon home-delivered meals for the aged homebound. Third, we are conducting a study of the potential held by the aged, themselves, for providing mutual self-help activities, in times of acute need and/or stress. I cite these programs only to provide some understanding of the basis from which I make the following remarks. However, I must add a cautionary note: only the Nutrition Program has been completed the other two projects are far from their scheduled completion dates, and hence only tentative suggestions can be drawn from their operation to date. What I will do in this statement is discuss four factors which I consider central to any consideration of the need for, and nature of, nutrition programs. These are: 1) the concept that a program is necessary, and that such devices as income supplements are not adequate; 2) the concept that although the provision of group meals in a social setting may be most effective in meeting the unfulfilled needs of the aged, there is a need for programs of home-delivered meals to the homebound, as well; 3) the concept that just as nutrition programs must take into account a variety of factors which impinge upon the older adult's ability to receive adequate nutrition, so there are a variety of ancillary services which most economically could be provided through the auspice of nutrition programs; 4) finally, the realization that there is the crucial need for major public support, on a continuing basis, for nutrition services to the aged. -2 As you know, in 1968 the Congress appropriated funds to the Administration on Aging in support of a research and demonstration program to improve nutrition services to older Americans. This support was reflective of the knowledge that adequate nutrition is a major concern for many of the twenty million Americans who have reached the age of 65 - every tenth person in the nation. Among these twenty million, close to five million, or one of every four aged persons, have incomes below the poverty level established by the Social Security Administration. However, limited income and lack of information constitute only two of the many factors which lead to malnutrition among the aged. Practitioners and experts working with the elderly have reported with consistency that the nutritional difficulties of the aged are compounded by physiological, social, and psychological factors associated with aging and retirement. For example, concomitant with the process of aging is a reduction in the basal metabolic rate, and a slowing of the digestive processes. Dental problems, reductions in perceptual acuity of taste, sight, and smell, conditions such as arthritis, and limitations in mobility all contribute to the inability or disinclination of the aged to seek and receive adequate nutrition, by themselves. Probably of equal importance are various social and psychological factors, of which isolation probably is paramount. Cut off from other family members, unneeded in former roles, very often the aged person feels that the regular preparation of meals is simply more trouble than it is worth. In short, there are many barriers to the receipt of adequate nutrition among the aged, which go far beyond low income, per se. Related to this is our experience, as well as the experience of others, that those who need nutrition services the most are those who are least apt to receive them. That is, it is the most isolated, often the most disabled, aged individual who simply cannot provide adequately for himself, even if financial resources are sufficient is generally not the case. which Jeanette Pelcovits, Nutritionist and Specialist in Aging, on the staff of the Administration on Aging, and I collaborated in the preparation of a position paper, entitled: "A Nutrition Program for Older Americans" (HEW, 1970). This document is available, and thus I will not quote from it at any length. However, I do feel that it would be appropriate to quote the following from the conclusions presented in this paper: "...It has become apparent that the mere provision -3 alone; it would not help the invalid to shop; I hope that the preceding material underscores my first point, namely, that it is necessary to develop and maintain nutrition programs, on a continued basis. Results to date suggest most strongly, as was indicated above, that the provision of an income subsidy alone will not go far toward the alleviation of nutrition problems among many of the aged. a My second point, as mentioned initially, is that there is a need for two broad types of programs: group meals in social setting, and home delivered meals to the homebound. To date we have information developed during the course of 31 group meals programs which were supported by the Administration on Aging. These are the only group meals programs of which we are aware; currently, however, we are evaluating data collected from all the states, which may reveal the presence of additional programs I must add, however, that this appears unlikely. All of the programs supported by the Administration on Aging have five common elements: 1) locating and reaching the elderly; 2) group meals in a social setting; 3) nutrition education; 4) the provision of ancillary services; and The 5) evaluation. The existence of all these elements in each of the programs is again reflective of the need for an organized, multi-faceted approach to the problems of nutrition among the aged. Again, they speak to the need for a comprehensive nutrition program, rather than the mere provision of a subsidy. provision of meals in a group setting is highly desirable, as it fosters social interaction, facilitates the delivery of other services, and meets emotional needs of the aged, while improving their nutrition. Reports from all of the projects consistently indicate that the aged participants have "improved" along a number of dimensions: nutrition, health, social activities, morale, etc. While it may be agreed that a group meals program in a social setting is apt to be maximally advantageous to aged participants, it also must be recognized that there are many of our nation's aged for whom such participation is impossible, for reasons of geographic isolation, physical impairment, emotional impairment, etc. For these many of our citizens, there is a need for comprehensive home delivered meals programs. My own feeling is that through appropriate intervention, many of the "homebound" may eventually be able to participate in group meals programs. The Center for Community Research has contacted every municipality, every county health department, and department of welfare, and every organization known to be serving the aged, in the United States. Through this effort, which I believe to |