Health and Geriatrics Clinic, had an opportunity to observe at close range those who served. He testified: 16

"I think that as a result of some of the persons working on Medicare Alert, we were able to note that the incidence of their coming to the doctor was decreased. They were much better. They had less physical and psychological problems, so on the whole I felt that Medicare Alert to the people who I was affiliated with was a good venture, but I do feel that more moneys are needed by the community to support and bring our elderly citizens back into the mainstream of community life."

Finding No. 5. One of the services necded by older Americans visited by Medicare Alert workers is home repair and home maintenance service.

Examples of this need were cited by Mr. Carbray, as follows: From the report of a Medicare Alert worker in the Culver City area: 17 The most crying need that I found was for help in cleaning up the dark, dirty, unaired homes of people who live alone. Yards are uncut, trash piled high, screens torn or broken. The whole place is in a state of dilapidation. These people are not well enough to do for themselves and either have no one to help or their families are neglecting them ***. I found one lady, crippled with arthritis * * * who was cutting her own lawn when she could hardly walk on her stiff limbs * * *. She was mentally alert and took pride in her place, but she could surely use a little help.

From the report of a Medicare Alert worker in the Watts area: 18

I found this place in a terrible condition. From the outside one would think no one lived there. The windows were broken and fixed with boards. The weeds were knee high. This man needs surgical appliances * * *.

Another Medicare Alert worker in the Watts area reported: 19

A 95-year-old man living alone * * * His house needs painting and plumbing work.

Finding No. 6. One of the services needed by older Americans visited by Medicare Alert workers is senior centers.

One of the witnesses at our hearings, Mr. Lawrence Cook, of Washington, D.C., recommended:

20

Provide more recreation centers conveniently located, Senior Citizens' clubs, social centers in the churches for these people who need to be returned to the land of the living.

Director R. Sargent Shriver of the Office of Economic Opportunity, testified: 21

Out of the 218 reports examined to date *** The most pressing needs appear to be in the area of health programs, neighborhood centers with friendly visitors, housing, and employment programs.

Finding No. 7. One of the needs found by Medicare Alert workers is the need for home health services and other health assistance. An example of the need for home health services was given by one of our witnesses, Dr. Harold L. Sheppard, chairman of the OEO Advisory Committee on Programs for Older Persons and a member of the

10 Hearing, p. 56. 17 Hearing, p. 70. 18 Hearing, p. 71. 19 Hearing, p. 70. 20 Hearing, p. 55. 21 Hearing, p. 10.

Advisory Committee on Older Americans. He quoted from the daily diary of a Medicare Alert worker as follows: 22

B

Could not sign, Rwas very ill*** the county nurse came after him. Today they called the neighbors to come after him but neighbors refuse to take him back because they are unable to take care of him. His age, 87 years old.

Mr. Carbray, quoting a Medicare Alert worker in the Exposition Park area: 23

Some of the people I contacted need medical aid, teeth, glasses *** and help *** One lady was sixty-nine years of age. She is a registered nurse who works nights. She takes care of her paralyzed sister *** Eventually she intends to retire from work, but would like some help to care for her sister.

area:

Mr. Carbray, quoting a Medicare Alert worker in the Culver City 24 "In Redondo Beach I found an elderly woman ***. She appeared very unhappy and was suffering from arthritis in her hands and legs ***. There was no one to take her to see a physician." Mr. Carbray, quoting a Medicare Alert worker in the Glendale area: "I met a lady who was so sick that she couldn't talk. She didn't have anybody to take care of her."

25

Presumably, some or most of these needs will be met more adequately now that Medicare has gone into effect. To the extent that there is still room for improvement, the Subcommittee on Health of the Special Committee on Aging has primary responsibility and jurisdiction to make findings and recommendations on health needs of the elderly. We commend to that subcommittee these findings resulting from Operation Medicare Alert.

Finding No. 8. One of the needs found by Medicare Alert workers is the need for better housing arrangements.

Mr. T. H. Lynch, Duquesne, Pa., Medicare Alert worker, testified at our hearing: 26 "In the heart of one of the towns I visited a building in which two old people, a man and a woman, lived in separate apartments. There was a store on the ground floor. There was an office above it, and down the hall, which was dimly lit, these people lived. There were no fire escapes ***

"This building is just a firetrap and the old people would just be cremated. When that door leading to the office above the store is locked at night, that's it. The old man who lives alone uses crutches and I watched him and it took him 5 minutes to get outside to the street. This is how some elderly poor live. I visited a two-story shack which was heated by a gas space heater on the first floor. There were no vents and the fumes were so overpowering that I had to leave because I felt that I would be overcome."

27

Mr. Edward L. Robinson of Wyandotte. Mich., vice president of the Detroit Metropolitan Council of Senior Citizens, testified at our hearing: "I would like * * * to tell of the need for decent housing for thousands of low-income senior citizens living in the Detroit area. Vast areas in Detroit have been cleared under the urban renewal program. However, no low-cost housing projects have been erected on the cleared land. Instead, a number of high rise apartment build

22 Hearing, p. 44. 23 Hearing, p. 71. 24 Hearing, p. 67. 25 Hearing, p. 68. 26 Hearing, p. 76. 27 Hearing, p. 72.

ings occupy this land. Rents in these buildings start at $125 and go to $250 a month or higher, far too high for people who once lived in the cleared areas * * * After building four freeways through Detroit, they have now started condemning property for a fifth, the Jefferson freeway, which will run right through an area largely populated by senior citizens."

Mr. Carbray quoted Medicare Alert workers in the Los Angeles area, as follows:

A Medicare Alert worker in the Glendale area: 28 "I visited a man 72 who lives in a house made of boards and stones."

A Medicare Alert worker in the Watts area: 29 "Extreme poverty is most prevalent in one area. The meager income is from either social security or the State. The housing is dilapidated. The filthy tenement dwellings are in need of many repairs. Many should be condemned as a residence. People residing there, in many cases, are disillusioned and bitter about their existence ***. Some residential hotels for these people are in very bad condition, and are in need of inspection."

A Medicare Alert worker in the Exposition Park area: 30 "One gentleman, 71 years old, appeared very nervous and was living in a small house which had few conveniences. On other calls, I have noticed few utilities *

“A

Another Watts area Medicare Alert worker:31 "A feeble old lady lives alone in a very old house that was condemned. She received eviction notice and had no place to go. She was so nervous she was unable to fill out her Medicare card or look for another place to live."

Another Subcommittee of the Special Committee on Aging, the Subcommittee on Housing, is working on problems and opportunities of the elderly in the field of housing. We commend to the members of that subcommittee and to the members of the Housing Subcommittees of the Senate and House Banking and Currency Committees these examples of the need for prompt, effective action to make available more adequate housing for the impoverished elderly.

Finding No. 9. One of the service needs found by Medicare Alert workers is the need for adult education programs.

Mr. Carbray quoted two Medicare Alert workers who found a need for English language classes for foreign-born elderly Americans. A worker in the Culver City area commented: 32 "Language barrier is the number one cause of loneliness, since it impedes communication with others."

Another worker in the Culver City area said: 33 "The most common and interesting need of the elderly of the foreign-speaking families was their need for outside of the home activities. One in particular was Japanese and had no recreational outlets because she could not speak English. She wanted to know if there was a senior citizens center where some of the persons spoke her language."

Adult education programs for the elderly could make a significant contribution toward solving the problem of loneliness in old age, which was discussed in our Finding No. 1. Not only would the group learning

28 Hearing, p. 69.

20 Hearing, pp. 69-70;

80 Hearing, p. 70. 31 Hearing, p. 68.

82 Hearing, p. 67:

33 Hearing, p. 69

situation bring many lonely seniors together to form new friendships, it would also serve to open new windows for them on the world in which they live, and give them new interests to share with others.

Finding No. 10. Operation Medicare Alert demonstrated the need for services to find elderly individuals who need services which are already available in their communities and to advise them of the availability of those services and of the steps which must be taken in obtaining them.

Undoubtedly, many of the elderly whose needs were described in Findings 1 through 8 above live in communities which provide services to meet those needs. However, being isolated and unaware of those services, they are no better off than if the services were completely unavailable. Accordingly, even if communities do everything possible to meet the service needs outlined in these findings, there will still be a need for one additional service, that of finding the elderly who need these services and advising them how to avail themselves of them.

III. RECOMMENDATIONS

Recommendation No. 1. The subcommittee renews and reemphasizes its recommendation and the recommendation of its parent Committee on Aging, that legislation be enacted authorizing the establishment of a National Senior Service Corps or Talented American Service Corps.

This recommendation was made by our subcommittee and the Special Committee on Aging as recommendation No. 8 of the special committee's report entitled "Services for Senior Citizens" (S. Rept. 1542), which was issued on September 11, 1964.34 Since then, two types of bills have been introduced in the Senate and House of Representatives to implement that recommendation. One type is that represented by bills like S. 2877, introduced by Senator Harrison A. Williams, Jr., with the cosponsorship of Senators Kennedy of Massachusetts, Kennedy of New York, Clark, Douglas, Hart, Hartke, Neuberger, Pell, Randolph, Ribicoff, and Yarborough, to authorize a National Community Senior Service Corps.35 The other type are bills like S. 3326, introduced by Senator George Smathers, with the cosponsorship of Senators Long of Missouri and Randolph to authorize a Talented American Senior Corps. A number of House bills of these types have been introduced.

The implementation of this recommendation could help meet the following needs discussed in our findings:

Finding No. 2-Loneliness.-Service corps members could serve as some of the personnel needed to conduct local programs combating loneliness among seniors, such as friendly visitors and telephone reassurance services. As described in earlier hearings of this subcommittee,36 local friendly visitor services receive information concerning elderly individuals, shut-ins, and others who are lonely and need visiting, and these local voluntary organizations recruit and enlist volunteers who are willing to serve as friendly visitors, and arrange for the visits to be made. Telephone reassurance services arrange for isolated older individuals to be telephoned at set times each day to make certain they are all right. As an incidental function, they provide a human contact each day for those who are called, which can be helpful in relieving loneliness.

Service corps members can also help attack the problem of loneliness in old age by doing as those who served in Medicare Alert did: going throughout their own communities interviewing their fellow older residents to determine their needs. As was the case with Medicare Alert, they would doubtless find many isolated, lonely older persons. The names of these individuals could be referred to friendly visitor organizations and others who are in a position to help.

34 P. 8. S. Rept. 1542, 88th Cong., 2d sess.

35 A favorable report on S. 2877, amended, was issued by the Senate Labor and Public Welfare Com mittee on Oct. 13, 1966 (S. Rept. 178, 89th Cong.) The bill was passed by the Senate on Oct. 21, 1966. 36 Pt. 1, hearings entitled, "Services for Senior Citizens," 88th Cong., 2d sess., Washington, D.C., Jar 19, 1964, pp. 55-59.