NEEDS FOR SERVICES REVEALED BY OPERATION MEDICARE ALERT (A Report by the Subcommittee on Federal, State, and Community Services of the Special Committee on Aging, U.S. Senate) I. INTRODUCTION On December 28, 1965, Director R. Sargent Shriver of the Office of Economic Opportunity announced that war on poverty funds had been set aside for Operation Medicare Alert, and invited applications from community action agencies who were interested in carrying out such projects. From then until May 31, 1966, the deadline for signing up for part B voluntary insurance under Medicare, 466 community action grants totaling $7,200,000 were made for Medicare Alert projects in all States except Alaska, Idaho, and Wyoming. Each of these projects employed elderly individuals to inform the elderly in their respective areas of their rights and opportunities under recently enacted Medicare legislation and to assist them in signing up for Medicare benefits within the time limit set by law. While this was the primary purpose of Medicare Alert, a valuable byproduct was the opportunity given the elderly individuals on Medicare Alert teams to visit with others of their age group in their own homes and to discuss their needs with them. Our Subcommittee on Federal, State, and Community Services called a hearing for June 2, 1966, in Washington, D.C., to receive testimony from Medicare Alert team members and others as to needs for services which were found during the active phase of Operation Medicare Alert. This report summarizes the major findings of the subcommittee based upon that hearing, and offers some recommendations for meeting the service needs which were presented to the subcommittee. The value of this hearing was not only in the questions it answered but was also in the questions it raised. It indicates to the subcommittee a number of areas in which it should be working on a longrange basis. Hearing entitled "Needs for Services Revealed by Operation Medicare Alert," Subcommittee on Federal, State, and Community Services, Senate Special Committee on Aging, 89th Cong., 2d sess. Hereafter referred to as "hearing." 1 Briefly summarized, the findings and recommendations in this report are as follows: Finding Finding Page 1 Operation Medicare Alert was a success, both from the standpoint of the numbers of the older Americans who were informed of their rights under Medicare and assisted in signing up for benefits, and also from the standpoint of the insights gained into the needs of our Nation's elderly. 2 Loneliness is one of the most serious problems of many older Americans visited by Medicare Alert workers. 3 3 3 Many older Americans visited by Medicare Alert workers 4 5 4 5 Among many older Americans, there is a need to be useful One of the services needed by older Americans visited by 6 6 One of the services needed by older Americans visited by 6 7 8 One of the needs found by Medicare Alert workers is the 6 7 9 10 One of the service needs found by Medicare Alert workers is 8 9 The subcommittee renews and reemphasizes its recommenda- The subcommittee renews and reemphasizes the recommenda- Page 10 11 II. FINDINGS Finding No. 1. Operation Medicare Alert was a success, both from the standpoint of the numbers of the elderly who were informed of their rights under medicare and who were assisted in signing up for benefits, and also from the standpoint of the insights gained into the needs of our Nation's elderly. During the active phase of Medicare Alert, a total of 3,841,027 older persons were contacted on an individual basis, and were advised of their rights under Medicare. Of these, 18,048 were escorted to social security offices, and 55,597 were referred to antipoverty programs for assistance. While this is a remarkable record in itself, it is not the full measure of the success of Medicare Alert. The program was also successful from the standpoint of the insights which were gained into the needs of our Nation's elderly population. This will be helpful in planning to meet those needs at all three levels of government, Federal, State, and local. The needs which were uncovered are discussed in findings 2 through 10. Operation Medicare Alert was also successful from another standpoint. As discussed in our Finding No. 4, it met the need of the elderly to be active and useful. Finding No. 2. Loneliness is one of the most serious problems of many older Americans visited by Medicare Alert workers. Over and over the witnesses at our hearing reported having found loneliness while visiting for Operation Medicare Alert. In their own words: 2 Mrs. Lillian Allan, chairman of the Hudson City Senior Citizens Recreation Club, Jersey City, N.J.: "Loneliness, loneliness, loneliness-this is the word which best describes what our club members came up against when they sought to locate the old people to urge them to sign up for Medicare. "We found people hidden away in cold, lonely rooms, deserted by their children, often ignored by their neighbors. They were frightened old people and they yearned for companionship. "I want to tell you*** about the sad experience of one of our club members. She found an old gentleman who was just so happy to have a visitor that he was very distressed when she had to leave to visit others. He urged her to come back to visit him. She intended to do so as soon as she could-and she explained to him that when her Medicare Alert project was over she would call again and chat with him. She said he seemed intensely lonely. "Imagine her distress when she read a newspaper shortly after Medicare Alert ended. She was actually getting herself ready to go and visit the old man when she read in the newspaper that he had hanged himself. This is a terrible example of the effect of loneliness on the aged." 2 Hearing, p. 46. Mr. Walter Newburgher, president of the Congress of Senior Citizens of Greater New York: "In community after community reports came back from people who were told, 'No one has knocked on my door for 6 months.' This program helped us reach many of the loneliest of our elderly, the most needy and isolated." Mrs. Frances Maletz: "In my experience as a team captain in the far Northwest of Washington, D.C., we found that loneliness and withdrawal among older people knew no social or economic standards. The community aids went from home to home, apartment to apartment, and reported each more beautiful than the previous one, and the loneliness of the elderly people more pathetic in each case. In the area in which I live, there is little economic poverty. But there are great pockets of poverty of the spirit, and the result is loneliness and withdrawal." Mr. James Carbray, Whittier, Calif., quoting a Medicare Alert worker in the Hollywood area:5 "The worst needs I found were loneliness, medical and surgical needs, and poor living conditions." 6 Mr. Carbray, quoting a Medicare Alert worker in the Culver City area: "Most of the aged are lonely and want to talk to someone. I found one lady alone in her apartment crying. She said that she had no close friends in California." Mr. Arthur Capone, Medicare Alert project director, Revere, Mass.: "The results of our house-to-house canvasses revealed loneliness, poverty, and dejection among the elderly who lived alone * * * while we are not unfamiliar with the problems of the elderly, we didn't really understand the depths of loneliness-and the widespread need for companionship which exists among older people-until our work on "Operation Medicare Alert" ** *they showed themselves as being literally starving for companionship." Finding No. 3. Many older Americans visited by Medicare Alert workers need homemaker services. Testimony on this need received at our June 2 hearing: Mr. Carbray, quoting the same Medicare Alert worker in the Hollywood area: "There was a woman, age 87, living with her sick and helpless sister. They were not getting proper food due to the fact they could not go out to the store. They depended wholly on their neighbors which is a hit-and-miss arrangement." 10 Mr. Carbray, quoting a Medicare Alert worker in the Glendale area:9 "I visited a real old lady * * * When she told me her story, she was in tears. She begged me to find out if there was any way of getting someone to help her with her needs; such as helping her to take a bath or going to the store and helping her to do her cooking." Mr. Carbray, quoting a Medicare Alert worker in the Watts area: "Mr. and Mrs. are old. Their house is in bad condition and needs cleaning. Neither is able to manage the home." Mr. Carbray, quoting a Medicare Alert worker in the Exposition Park area: "In my recent contacts I have come across the husband past 65 but still working. The wife will be 65 later this year. is totally blind and needs help in cleaning the apartment.' a Hearing, p. 50. 4 Hearing, p. 54. 5 Hearing, p. 67. 6 Hearing, p. 67. She area: 11 66* * * 12 Mr. Carbray, quoting a Medicare Alert worker in the Culver City a call made in Lawndale discovered a woman living in a home with her son ** *She was obviously being neglected in personal care. Her body was covered with sores. She needed someone to clean up the dirty dishes, feed her and help her to keep clean." Mr. Carbray, quoting a Medicare Alert worker in the Central area: 12 "A woman 80 years old lives with her grandchildren who work every day, leaving her alone to care for herself. She attempts to care for herself but in so doing she caught a dish towel on fire and sustained a bad burn and she ruined the carpet after turning the faucet on, letting the water overflow. The grandchildren can find no one to care for her for the small sum they can afford to pay. "An elderly couple both are partially disabled. The wife is very heavy and can hardly get around due to trouble with her feet. The husband is very weak from several operations. They need someone to shop for them and help with the housework. One man living alone in the most unsanitary conditions, spends most of his time in bed. He doesn't have adequate personal or bed clothings. He is not physically able to clean the place and once in a while a neighbor fixes him something to eat. The most urgent needs seem to be help in the home, personal counseling, companionship and reassurance to feel it's worthwhile living." Mr. Carbray, quoting a Medicare Alert worker in the Watts area: 13 "A 95-year-old man living alone needs clothes, food, and dentures. He seems healthy. The neighbors feed him. A lady in her seventies had a stroke. She needs someone to help with her housework and shopping." Finding No. 4. Among many older Americans, there is a need to be useful and active, and Operation Medicare Alert satisfied this need with respect to the relatively few elderly individuals who had the privilege of serving in it. 14 One of our witnesses, Mrs. Fulton Hines, of Plainfield, N.J., said: * I feel just to give them (the elderly) more money and to tell them to stay in a backroom or just be isolated and lonely is not the solution because they have talents and they should be allowed to use them. Let them earn. Let them get out and act. They want to do We found that for the older people working for medicare * hope was renewed." that * * * * * Another witness who worked in Medicare Alert, Mrs. Frances Maletz, of Washington, D.C., testified: 15 "I had always been active; I raised a family. But with my family grown, I began to recognize that some mornings I didn't want to get up. This work gave me a new lease on life. I renewed my interest in people and the community. Our people do not want this program to end. They have regained their spark and they feel the need to be a part of the community in the fullest meaning * We want to feel independent and we want to feel useful." ** That service in Medicare Alert benefited the physical and psychological health of the elderly who served therein was testified by Dr. John A. Algee, who, as a physician with the District of Columbia Adult |