This

those receiving benefits to $1,200 per year in outside income. limitation takes from our economy many persons who still have much to contribute. It also places a burden on social agencies to look after persons who are capable of looking after themselves if given a chance.

TAX ASSISTANCE

I would like to have the subcommittee give consideration to some kind of Federal program to assist older people who own their own homes to pay local property taxes. Our senior citizens want to meet their responsibilities as members of this community, but tax time often works a hardship on those whose incomes are limited to small pensions. Every time taxes become delinquent or special relief has to be given, total city services suffer. I propose that the Federal Government develop some sort of tax assistance program for persons over age 65 whose total income is less than $1,000 a year. Such a program would help maintain the dignity of our senior citizens and help assure sufficient resources for local services.

FEDERAL SCHOLARSHIPS

You will be hearing from many experts about the importance of study and research into the special problems of the aging population. I urge that this subcommittee endorse a Federal program of scholarships to encourage research into the economic, social, and health problems of the aging. I believe that the most important part of such a scholarship program would be making funds available to local officials and agencies for the further education of those persons already working in this field.

The problems of an aging population are nationwide. They are not limited to any one community. Public officials must be prepared to meet the challenge of a population of older years. We must give up the notion that the problem can be solved by building more old people's homes and institutions. This is a costly process and does not make the best use of community resources. Our senior citizens expect to carry their share of the responsibilities of citizenship. We as public officials must help them to do so. I urge the subcommittee to do all in its power to help us at the local level to meet these challenges. Thank you very much.

DISCRIMINATION IN EMPLOYMENT

Senator MCNAMARA. Thank you, very much, Mayor Davis. Your statement is certainly going to be very helpful to the committee and we appreciate your being here very much. I was glad you stressed this discrimination as to the aged, because several States already have passed State laws prohibiting discrimination because of age and employment, and since we have a law in Michigan that does prevent types of discrimination, I hope some day we too will add a prohibition against discrimination because of age.

Mayor DAVIS. I think it is a lot more important than discrimination because of other things because it affects so many of our people and I know in Grand Rapids we, of course, consider ourselves a little bit unique in this. We have a larger percentage of homeowners who are

residents of the city and they are in that aged group and the kids move outside the city but the oldsters remain.

Senator MCNAMARA. Yes, we find that in so many areas, where actually it appears on the face of it that people own their houses, but the maintenance is so high on the house-though they had to have it in past years so they could raise their children-and it now gets to be a burden.

You mentioned many people receiving a thousand dollars or less who are in this area of the aged and the aging. Actually our studies have indicated that 60 percent, three out of every five, who are over 65 years old fall in the category of having a money income of less than a thousand dollars a year, and this indicates the enormity of the economic problems involved.

Mayor DAVIS. It is unbelievable in this country that people should exist on such a small amount.

Senator MCNAMARA. Thank you again, Mr. Mayor. You have been helpful to the committee and you can be sure your recommendations will be given very serious consideration by the committee. We are very happy to have a representative of the State of Michigan here this morning, Dr. Albert Heustis. Dr. Heustis is the commissioner of the Department of Health, Lansing, Mich, and he has had great experience in this area, and we are very happy to have you here this morning, Dr. Heustis.

Will you come up to the mike. I see you have a prepared statement, and we will be very happy to see that prepared statement, together with any other material you have is submitted in its entirety, or is inserted in its entirety at this point in the record. You may proceed in your own manner, Doctor.

STATEMENT OF ALBERT E. HEUSTIS, MD., M.P.H., STATE HEALTH COMMISSIONER, LANSING, MICH.

Dr. HEUSTIS. Thank you very much, Senator McNamara, and Mr. Ford. I speak as the State health commissioner representing an organization in Michigan with some 85 years experience in protecting the public health. Our law is very broad. It says the State health commissioner shall have power over the interests of the life and the health of the people of Michigan, and this includes the older folks as well as the younger folks.

I would like to begin by sharing with you a quotation from the December 1955, issue of our department publication-"Michigan's Health"-which describes what old age could be, as follows:

This is the comfortable time. It is the time when past tense rivals the present; "have done" competes with "will do." It is a time beyond the fret of ambition-of release from anxiety and escape from competition. It is a time where the distillate of experience is finally crystallized into wisdom, when the long search for self is ending and a concern for others can become paramount.

This is quite a challenge and the question before us is how do we help more older folks realize such rewards. This particular problem is accentuated because of our longer life spans, because of technological advances, the concentration of our population, the mobility of our people, changes in housing and changes in the family life.

We see many practical ways to overcome barriers to a ripe old age and we would like to suggest some of the potentials.

You have been kind enough to place in the record the document we prepared, and I would particularly call attention to "Building Michigan's Health" which is a report of the Michigan Public Health Study Commission under chairmanship of Prof. Wilbur Cohen, of Ann Arbor. I also would call your attention specifically to material shared with you in the report "Michigan People Past Forty-five." We think those two parts of the document are extremely meaningful. In addition to these exhibit materials, we would like to emphasize some of the points with the help of some slides. But to begin with, we would like to present for your consideration three basic ideas that are important to the health of the senior citizens.

HEALTH EDUCATION FOR AGING

The first one is salesmanship; the second is finding disease early; and the third is the partnership in care.

First-salesmanship. Many of my colleagues in public health call this health education. Others might call it motivating, attitude change or even canalization. I am inclined to call it salesmanship because that is what it is. This salesmanship would be designed to stimulate individual action; to get folks to plan for their older age before they reach those golden years; to use the resources available today-such as going to the doctor and taking the doctor's advice. It would stimulate community programs-the services communities need to get the greatest return from the least possible amount of money. And it could stimulate the health professions as well-stimulate them to help bridge some of the gaps that now exist, and to take advantage of some of the newer things that can help meet the health problems of older age groups.

EARLY DISCOVERY OF DISEASE

The second main idea concerns itself with finding disease early. One of the great tragedies of our time is the lag in the discovery of diseasethe lag in the use of the tools we already have to find disease early. Ideally, everybody should get to their physician periodically, not for just a physical examination, but for a periodic health appraisal, which includes much more than a physical examination. But if every older person in Grand Rapids should try to do this, they would find that there is not enough medical manpower-not even enough to take care of the sick people, and do the job the way it should be done. Thus, we in the State health department are interested in screening-screening in cooperation with private physicians to try to find some way where nonmedically trained people, in most instances, can screen out those people who have the greatest reason for seeing their physician, and then see to it that those people get to their private doctors for diagnosis and any needed treatment.

There isn't anything new about this idea of screening. We have been taking chest X-rays for tuberculosis for more than 20 years, and other States have, too. And here in Michigan we have been hunting for vision defects and hearing losses in children for a long time.

The new thing is the different types of tests. One test I will review a little later checks for cancer of the mouth of the womb in womencervical cancer. It is a very simple test in which scrapings can be made by any physician in his office. These can be placed under the

microscope and we can find cancer of the cervix. This is important because every year some 400 Michigan women die of this disease.

There is diabetes-a progressive disease. If found early-in most cases, though not all-it can be successfully treated and complications can be prevented. In Michigan, over 1,500 people die from diabetes each year.

There is glaucoma-causing from 12 to 14 percent of blindness in adults. This can be found early by measuring the pressure in the eyeball. Again, not all glaucoma can be prevented from advancing and causing blindness, but a great deal of it can, and I will shortly show some pictures to indicate how this can be done.

We need to experiment more with screening, using a battery of screening tests, where you bring people together and use these and other tests all at the same time. We would suggest that others follow the examples set in Grand Rapids and elsewhere-to try to have welfare recipients, industrial groups and other adults take a battery of screening tests. This should be done through organized programs in which the procedure is worked out in cooperation with the private physicians, and all persons with positive findings are referred to their physician for whatever diagnosis and treatment they may need.

THE RANGE OF HEALTH CARE

The third idea, in addition to salesmanship and finding disease early, concerns the partnership in care. I like to think of it as a multistage rocket. The first stage, and the one I think deserves greatest emphasis, is home nursing-nursing services in the patient's own home; the second stage is the care in nursing homes; the third might be in the chronic disease facility; and the fourth in the acute general hospital. They are used in life in the reverse order, and most emphasis over the years has been placed upon acute hospital care rather than upon services such as home nursing.

In Michigan we have some 15 visiting nurses associations. These are centered in metropolitan areas. Some of the VNA's work closely with the local health department, as they do in Grand Rapids. We have used some of the Federal funds made available to us by the Public Health Service to strengthen these services, but in our present situation, it looks as though the farmer at home with a stroke has a long time to wait for this type of help.

NURSING HOMES

The Michigan Department of Health inherited responsibility for licensing nursing homes and homes for the aged in 1956. We have 572 nursing homes which have four or more beds each, and thus must be licensed under our law. These homes have room for almost 16,000 patients. Almost 75 percent of these homes now meet our minimum requirements for a full license, but in the last 3 years, 125 homes have closed, changed location or reduced bed capacity-in most cases because they could not meet the bare minimum standards. There are two main problems: how to help the homes improve and how to foot the bill. Recently, a sample survey of costs was made in one area of Michigan. Thirty-three nursing homes shared their cost figures with The costs, of course, are none of our business, because under the

us.

law we are concerned entirely with patient care. But these homes volunteered to share their costs with us, and we found that from onehalf to two-thirds of the homes, depending on bed capacity, apparently were caring for public assistance patients at rates less than operating costs.

This simply means that if we put our own mothers into a nursing home, in addition to paying our taxes, we have to subsidize the public charge patients in the nursing home because the government does not pay its share. We think government should pay the reasonable cost of the needed care for public assistance patients in nursing homes.

CHRONIC DISEASE FACILITY

The last type of service we emphasize today is that given by the chronic disease facility. In Michigan we have these in several stages of development, and we also have what are called county medical care facilities. I trust those from the social welfare department will discuss the medical care facilities more completely because these are under their jurisdiction.

The Saginaw chronic disease hospital unit is a good example of this type of facility. Saginaw folks spent $150,000 of local money in 1958 to build a chronic disease hospital, which is adjacent to their tuberculosis hospital. The unit accepts only public charge patients at the present time, so that those who can pay their own way have no possibility of service, and this is unfortunate because the hospital does have some available bed space. This is the halfway house between the acute general hospital or the nursing home or the patient's own home. It shows what a medium size community can do. The proper blend of home care, nursing homes, and the chronic disease facility can help those in private medicine and those in the voluntary general hospital work together toward a greater and more effective partnership.

BENEFITS OF HEALTH SCREENING PROGRAMS

Now if we may have the first slide, please.

These are results from nine cervical cancer screening projects financed with Federal funds. Almost 4 cases per 1,000 screened were found. This can save lives.

Here we see my associate, Dr. Richard Levy, who will be here for the entire day and will answer any questions you may have after I leave, drawing blood for a diabetes test. We use a machine (a clinitron) to test the blood sugar in a matter of 2 or 3 minutes.

Diabetes screening using clinitron (10 projects) June 1957 to March 1959 Screened.

New cases_.

New cases (per 1,000 screened).

27,780

117

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