distance and the people get up in the morning and walk to the center hall hand have their meals and recreation and medical treatment there. We have several cooperatives down there run by the older people themselves. They elect their officers and carry on the financial part of the institution, and then finally we have the Little Sisters of the Poor-I am sure you have run across them in your previous testimony throughout the country-it is a rather modern establishment; 25 bed capacity. The only stipulation or qualification for admittance is that the applicants have no other means of support.

On top of this institutional structure is a coordinating agency called the department of aged. It is supported by Community Chest money. The purpose is to coordinate the nine institutions in that area and to refer and counsel various people on finances and make referreals to other agencies.

Moving over to the diocese of Lansing this year we opened a new home in Flint much on the order of Carmel Hall. It is a renovated hotel and has a capacity of 150 people, open to not only citizens of Michigan but all kinds of people and citizens regardless of race or creed throughout the country.

The Grand Rapids diocese, the largest in the State, has 29 counties and ranges from Barry in the south to Cheboyan in the north and goes up to the western shoreline of Michigan with a population of 150,000 Catholics. There are two homes in Grand Rapids-one the Little Sisters of the Poor which is operated by the same order as I mentioned in Detroit, and has 136 beds and I think it is the second oldest in the State-1884 it was opened. St. Ann's home with a capacity of 61 here in Grand Rapids was opened in 1951. These are the only two instances in this diocese.

On the eastern side of the State, we have Saginaw, 1 home and 60 beds, opened in 1951, located at Saginaw.

That completes our institutions. We have none in the diocese of Marquette which comprises the whole Upper Peninsula. In addition to these institutions we have 22 family agencies located throughout Michigan which have available some type counseling facilities for the aged. They are very meager, I would say, largely referral type services.

Now let me give you a few generalizations, Senator, with respect to these institutions. All of them are operated by religious communities and women. From 1950 to 1958 we have increased our bed capacity 65 percent. In that same period we have increased our expenditures 800 percent. All are self-supporting. The average cost per resident is about $105 per month. The lowest ranges I think around $70 but the highest goes up to around $165 and $180, in some of the facilities.

ADDITIONAL PROFESSIONAL PERSONNEL NEEDED

I would like to spend just a moment on some of the problems we have in these institutions. First is the waiting list we have been coming across. When Carmel Hall was opened several years ago we had a waiting list of 3,000 people. Three thousand people applied that could not be admitted. A few have been worked off of that waiting list. It is largely a problem of low-income housing and with respect to our facilities, and it is very difficult to make available facili

1

ties for those that have meager income. Second, we have a pronounced shortage of social workers that have some background, some training, some experience in the field of the aging. We have one outstanding institution here at the University of Michigan, the institute of gerontology, which is probably one of the finest in the country but it is just barely making a dent in supplying trained people in this field, and I would like to suggest the subcommittee consider the possibility of some kind of Federal scholarship program in this area for creating some incentives to get additional trained people in this area.

SHORTAGE OF FACILITIES FOR CHRONICALLY ILL

Third, and foremost, we have a quite critical need in terms of facilities for the chronically ill. All of our institutions having these facilities are overcrowded and those that are without them obviously cannot take people that are bed patients or need skilled nursing care but this just isn't a problem of our group. It is a problem the whole State of Michigan faces, and I imagine the Nation as well. Again, for example, by conservative estimate we are 16,000 beds short here in Michigan of skilled nursing homes. In 34 out of 60 areas in the State, and areas are defined as one or more counties, there are no skilled nursing facilities whatsoever.

Next year the hospital survey and construction department of Michigan has $331,000 appropriation available for construction facilities in this area. It is estimated they would need three times this amount to do the job effectively, and I hope this might be a consideration of the subcommittee as well. Not a Federal question but one we think is highly important and I would like to put it in the record is the problem of getting a State commission on the aging for Michigan. As you probably know we have had a bill in the Michigan Legislature for 2 years. It passed the house both times but somehow just can't get out of the senate. Of course, we realize we have a critical financial situation but we would hope the legislature would give serious consideration to this bill as a means of coordinating all of the various problems of the aging, helping the local communities and coordinating the work of the State agencies.

Incidentally the bill has bipartisan support.

EXPANSION OF PARISH-CENTERED PROGRAMS FOR AGED PLANNED

In conclusion I would just like to say a word about the future of our program in the State, and the direction we would like to see it take. Most of the experts in our group feel that the parish, of which we have some 650 throughout the State, would be the ideal unit for developing and expanding a program for the aging. Parishes are located in neighborhood setups within easy walking distance for the aged. They have the spiritual counselors. It has the plant capacity, the volunteer manpower, and the recreational facilities to do this kind of a program and we feel it would be a terrific progressive move if we could develop this kind of a program and make sort of a second home, you see, for the old people that are used to this pattern of parish life.

43350-60-pt. 6- -9

That's about it. I want to thank you very much for having me here.

Senator MCNAMARA. Thank you for being here. The statistics that you bring us are very interesting to the committee. Three thousand people waiting on the list for admission to Carmel Hall which has a capacity of 1,000 is a fact of staggering impact.

Mr. COOMES. 525.

Senator MCNAMARA. It is an indication of the great need in this

area.

Mr. COOMES. Primarily low income people. They have a certain allotment for low income in order to finance the building, so we would like to have more than we get but this is the primary restriction. Senator MCNAMARA. Do you estimate half of the people there pay their actual cost or less than half?

Mr. COOMES. We have statewide statistics on that. Fifty-two percent of the institutions that we covered in our survey estimated people pay their own bills and 20 percent are dependent on OAA or public assistance. Seventeen percent are depending on Catholic aid exclusively and there is about 11 percent that are partly dependent on OAA or PA. I will make this available to you.

Senator MCNAMARA. We would like to have it for our records. You mentioned that many have no other means of support.

Mr. COOMES. Yes, this is in reference to the operating policies of the Little Sisters of the Poor.

CO-OP HOUSING FOR THE AGED

Senator MCNAMARA. How many people did you say you have in co-op housing in the Wayne County area?

Mr. COOMES. It is very few. Around 50. Fourteen at one, 13, 25 in another. Very small homes in the older section, and one, incidentally, is in the Cork Town area run by Father Kearn and they describe the purpose of this institution is to keep people out of the flophouses, and give them a little sense of home management.

Senator MCNAMARA. They actually run their own operations from start to finish?

Mr. COOMES. That's right.

Senator MCNAMARA. They get a great deal of comfort out of the fact it is their home and they operate it just the same as any other household.

Mr. COOMES. On democratic procedures.

Senator MCNAMARA. Do they get help from visiting nurses dropping in occasionally, and things like that?

Mr. COOMES. Yes, several volunteer groups assist them.

Senator MCNAMARA. You think this is a movement that should spread and is it a good way to handle the situation?

Mr. COOMES. I think it actually-it works very effectively in that area. I couldn't say as to other communities but we are willing to take a good long look at it.

Senator MCNAMARA. Get away from institutional types, and see if they are not happier in this type of environment?

Mr. COOMES. Yes.

Senator MCNAMARA. It is their home, and they have greater pride in the operation. I think maybe there is a great need for expanding such programs, and I think yours is the only organization that has made much headway in this field. Do you feel the Federal Government has a greater role to play in all of these problems?

Mr. COOMES. As I have indicated in my testimony, I think I pointed out in the area of providing additional appropriation to the area, skilled nursing and I think we have barely made a dent. The 1950's was a decade of calling attention to the problem. We are just beginning to alert the people and I am grateful the subcommittee has taken on this chore, and I think it will make the public more aware of the problem.

Senator MCNAMARA. In your Carmel Hall operation, do you have some special floors set aside for people who can't come down for their meals who are actually bedridden?

Mr. COOMES. No, we have a section for the chronically ill but when they are admitted they must be mobile and almost all of them take their meals in a central restaurant, and it is a very beautiful restaurant as is the whole home, if you have seen it.

Senator MCNAMARA. You do admit couples also?

Mr. COOMES. Yes, about half our homes have couples, or more. The Little Sisters of the Poor have couples and this is the growing trend too.

Senator MCNAMARA. This is something-certainly I know you encourage this trend because people reaching this stage in life need the comfort of each other more than any time in their whole life. There are so many places that are called institutions where the man and the woman are really separated at the gate, and go in different sections, and you get away from that in your Carmel Hall operation.

Mr. COOMES. We try to.

Senator MCNAMARA. Do you think the old age assistance program provides sufficient assistance for older persons? Can they live at Carmel Hall, for instance?

Mr. COOMES. It would be very difficult. Actually, we would like to see this increased substantially. As I indicated the $105 average applies; it would not cover the new institutions where vast amounts of capital expenditures-I am talking about millions; Carmel Hall iswell, it is mortgaged to $4 million, and this requires and it has to be operated on a self-supporting basis, and you just can't run an institution like that on $90 a month, and it is the same in our Flint home, so we would feel, a great deal more facilities would be available if this rate was increased.

Sentor MCNAMARA. You feel one of the greatest problems is financial and medical care?

Mr. COOMES. I will have to plead lack of knowledge on that question. I will have to examine it further. We didn't cover it in our survey.

Senator MCNAMARA. You covered more with housing?

Mr. COOMES. That's right.

Senator MCNAMARA. Thanks very much.

Mr. COOMES. Thank you very much.

Senator MCNAMARA. We would like to have that additional infor

mation for our records.

Mr. COOMES. Yes.

(The prepared statement of Mr. Coomes follows:)

PREPARED STATEMENT OF FRANCIS J. COOMES

The Catholic Church in Michigan has an established reputation for services to the aged dating back to the early part of the 19th century. The early efforts of the church in this field were largely confined to volunteer groups cooperating with several religious orders, quite often on an informal basis.

The services offered to the aged by Catholic agencies and institutions in 1959 consisted of counseling by professional trained caseworkers in agencies located throughout Michigan, and residence care in 14 institutions with a total capacity of 1,400.

Among the earliest to establish a formalized residency care program for the aged were the Little Sisters of the Poor, who established a home in Detroit in 1874. The congregation of the Little Sisters operate 309 homes for the aging throughout the world. The stated purpose of their work is to care for those older people who have not sufficient means to pay their way elsewhere. While retaining this pholosophy since the order's establishment in 1839, the Little Sisters of the Poor run a modern, well-organized home in Detroit with a capacity of 220 people and a considerable waiting list. The greater majority of older people in the home are not expected to reimburse the institutions for any part of the cost of their maintenance. The Little Sisters also operate a home for the aged in Grand Rapids with a capacity of 136 persons.

It was nearly a half century later before the next Catholic institution for the aged was established. In 1919, St. Joseph's Home for the Aged was founded in Detroit by the Carmelite Sisters of the Divine Heart of Jesus. In 1936, a new and modern home was purchased which presently provides lodging and care for 82 guests. The home offers a complete program of social, cultural, recreational, and religious activities.

Twenty-two years passed before other aging institutions were established. In 1941, St. Elizabeth-Briarbank and Villa Franciska, providing resident care to the aging, were founded in Detroit with capacities of 41 and 20 respectively. St. John's Cooperative House was founded in 1946 to provide residential care to older men of marginal income. Individual needs are met by pooling finances and other resources for collective use.

The period of greatest expansion of institutional facilities for the aged o curred in the years from 1952 through 1958, primarily in the Archdiocese of Detroit. Seven additional agencies or institutions were established to provide service to the aging. Sixty percent of the total statewide institutional capacity for the aged were developed during this 6-year period. Along with the construction of new facilities which received nationwide attention, came the introduction of new concepts and techniques for the housing and care of the aged, which emphasized the independence of movement and increased services in the areas of health, recreation, and leisure-time activities.

With the sudden growth of aging institutions, the need to coordinate and plan under the direction of a single agency became apparent in the Archdiocese of