ONE ASPECT OF SERVICE

In the area of recreation which is one facet of service rendered by our city, I asked the director of recreation to compile a résumé of yearly activities broken down into age groups served and the approximate cost of serving the recreational and community needs of each age group. Per capita cost was considered and reported upon. The recreation director's report stated that as far as our program for the aged and aging is concerned, we offer a purely social recreational program. Out of approximately 650 to 700 residents eligible for this program, we are serving about 140. While we feel that what we are offering this group is worth while, we feel that on the basis of what we are spending and the services we are extending to all of the other age groups, our program is totally inadequate. If limitations were not placed on our services due to a limited budget, limited staff, and limited facilities, we could and should offer the aged and aging a well-rounded program which would answer their needs far beyond those of a purely social and recreational nature.

The following is a table of estimated cost and attendance of our recreational program:

What sets the aging and aged apart from other groups? This question has several answers, beginning with the physical characteristics that differentiate a senior citizen from other age groups. Their mental attitudes toward society and the other groups defined as having an age in common sets them mentally and emotionally apart. Identification with the past day through their social unbalance then tends to be reinforced from day to day. Summed up, this means an attitude on their past formulates and is compounded by an impression made on other age groups which in turn becomes the attitude of these groups. End result: identification in fact of the aged and aging as a separate group outside of other age groups.

THE SIMILARITY

The exact quotation from Shakespeare's "Merchant of Venice" escapes me, but "If you cut me, do I not bleed? If you pinch me, do I not feel pain?" is appropriate. We all share similar feelings in the pleasure and pain principle. We are all motivated in varying degree by similar things.

To be old can mean another identification with that of the very young, for in many cases the same amount of attention given to the very young and schoolage child must be given to the aged and aging.

The basic premise is that similarity exists between all ages when it is permitted, with the exception of the very old and infirm and the very young Homo sapiens.

FORCED ROLE PLAYING

Some of the effects of forced role playing dissimilarity in the aged and aging role may be the crux of the entire problem once it has been established that aid is necessary. The general tendency is a withdrawal from active integrated social life with other age levels. A general tendency toward a clannish existence is the rule with little interplay in the community's social and civic affairs.

There appears to take place as a part of the role of the aged and aging a relegation to unclear thinking and attitudes in the frustrated "what's the use" phrase on their lips. Carried a bit further, the frustration may find an outlet in alcohol and in instances as acts against nature. More than once our police

have been confronted with seemingly illogical answers to questions of "Why did you do this?" Invariably the individual states he did thus and such on an impulse.

PURIFICATION OF OUR CONSCIENCE

The needs are great to combat the problems we are facing. If even for the selfish motive of salving our conscience, aid to our senior citizens must become a reality. Probably this portion of my statement should be entitled "Needs in Our City."

Our need is for additional resources with which to construct the necessary facilities to service our people, to conduct programs that have been desperately needed years ago. I list for one the need for a true community center where all age levels may congregate some to conduct normal social affairs, some to merely seek the solace of a quiet newspaper and periodical reading room, and others a place to meet and greet new and old friends of long standing—a community center where a variety of activities are carried on and where all may be served.

Our needs include such facilities and services as outpatient public health nursing clinics where physical attention is just one segment of the service, a facility and service of which the emotional well-being of those cared for is equally of prime consideration. Connected and inseparable is our need for a convalescent and nursing home to attend to the chronically ill of the aging.

To emphasize the above as a desperate need, our city of Two Rivers, Wis., is currently appealing to the National Government with respect to converting our present critical hospital facilities into such an institution and aid in erecting a new wing in its place.

THE WAY BACK

As a prime goal in any proposed program to aid the aged and aging, emphasis should be placed on integrating our senior citizens back into the society they are forced in too numerous instances to leave.

Programs whose emphasis is recreation should recognize the importance of integrating the aged and aging with all age levels participating whenever practical. The barriers should be dropped and the emphasis should be placed on participation and not so heavily on competition.

The process of integration can also be carried on at the level of avocational activities. Herein lies a fertile field to explore for providing active and interesting outlets for the aged and aging at and with other age levels.

Finally, an academic program should be created to teach and publicize the integrating process, and to furnish the aged and aging with information necessary to discharge their legal responsibilities; i.e., wills and old-age assistance insurance. The academic approach should be carried on simultaneously with

other age groups.

CONCLUSION

The city of Two Rivers earnestly appeals to the Congress of the United States to make available the necessary resources to the local level for the programs outlined in the text of this statement. It is our opinion that the National Government is the authority capable of providing for the aged and aging in our time. We in cities are capable of administering to our people, but lack the necessary resources to provide programs that even approach adequacy.

PREPARED STATEMENT OF THE MICHIGAN SOCIETY OF ARCHITECTS

The Michigan Society of Architects, speaking for the organized architects in Michigan, is indeed grateful for this opportunity to air its views and to make known some of its problems when dealing with housing for the aged and aging. In stating that they are interested in housing for the aged, they mean that they are interested in all the aspects and all the problems that need to be solved for the aging. Because for an architect to design a small home, an institution, or a nursing home, he must be familiar with the wants and limitations of the people for whom this is to be built. The larger his background in this field the better service he can give, and for that reason alone it behooves him to gain knowledge wherever he can.

It may seem absurd to many that so much has to be learned about housing for our older citizens, but the rapid changes in the social and economic pattern

explain why this is so. However, to a limited degree the aging are housed today and in many instances well housed. So when taking stock of the situation, a pattern emerges which in rough outline is something as follows: Elderly people sometimes are housed in:

(a) Single or double detached dwellings. These may be in groups or scattered through the community. Complete independence for the occupants. (b) Row houses, one or multiple story. This type makes for lesser independence but gains a great deal in sociability and ease of care.

(c) Apartment buildings. This way of living has an attraction for many because little or no upkeep is required of the occupant.

(d) Institutional living. This has been in use for a long time, and for those who do not mind a certain restriction of independence it is a good life with better opportunities for care when faculties are failing.

(e) Nursing homes. For the care of the chronically ill or temporary care for those who need it due to special circumstances.

These types of housing are owned or operated by:

(a) Private individuals for detached dwellings.
(b) Churches.

(c) Labor organizations.

(d) Fraternal organizations.

(e) Government-Federal, State, or local.

(f) Private groups, nonprofit.

(g) Private groups, profitmaking.

In addition to housing there are other aspects of the problems of the aged and the aging which call for the skill of the architect in some ways, such as occupational therapy, physiotherapy, recreation, and medical service.

Any in many cities there are flourishing drop-in centers, places where people of 60 and over meet for social purposes. Another fine feature in use in some cities is what is known as meals on wheels, where a central kitchen prepares food which is delivered to the house or apartment of an older person who is in need of this.

In the creation of all the different things mentioned, an architect can and must render service. The architects of Michigan are ready and willing to render such service. Then what is it that they would like to ask from or recommend to the Federal Government?

In single houses aid is needed in financing, and even though the Housing Act of 1956 does provide in a large measure for relief, not many older people seem to make use of this opportunity, due to lack of knowledge on their part or difficulties in obtaining such loans. Ownership and operation of retirement villages and institutions have been handled adequately by churches, labor, fraternal, and other organizations, and it is recommended that wherever possible that pattern be continued. Government to have a share only where conditions make it impossible for others to operate effectively. However, financial aid will be needed and this could be granted by the Federal Government on a matching basis.

As to technical knowledge much has been gained and some architects are fully competent to handle any phase of these problems. However, there is little documented knowledge available. The only way that this can be promoted at present is for someone to write a book or many books, something that is still in its beginning and should be encouraged. The Federal Government is in a much better position to conduct research in the purely technical field and as a result of such research can establish standards and issue recommendations. Individual architects and even their professional organizations will never be able to do this themselves to the extent that the Federal Government can. Government can set up certain criteria; they can compile and coordinate present knowledge which now is scattered all over the country. Matters of zoning, land utilization and community planning can be explored, and aid given in programing for nursing homes, old-age homes, and other institutions.

In all these things the architects of Michigan and other States are willing to cooperate and assist. They already have made some significant contributions and are anxious to do more. It is a great opportunity to appear before this committee, something that is truly appreciated. We thank the committee for the time it has given us and for the courtesy shown.

PREPARED STATEMENT OF THE KENT COUNTY (MICH.) MEDICAL SOCIETY

On behalf of the Kent County Medical Society I would like to thank the subcommittee for choosing Grand Rapids as one of its study cities. Having somewhat less than 400,000 population it is representative of the majority of the Nation's communities, even though its percentage of over-65-aged persons is above average.

We commend you for seeking a broad appraisal of the problems of the aged and aging and thank you for inviting us to appear here today to tell you of our concern for and activities in easing those problems in our city, particularly as they pertain to health.

The biggest problem of health care facing the elderly (or any other segment of the population, for that matter) seems to be the availability of health care, and the ability to budget or pay for it.

We have faced up to these problems as a profession and for years have repeatedly urged the establishment of a medical school in the Grand Rapids area. The value to our community of such a facility would be incalculable.

Also, the doctors of medicine in this area always have cared for their patients, elderly or otherwise, on an individual personal basis, without regard to the patient's inability to pay.

Beyond this, however, recognizing its further responsibility to the community, the Kent County Medical Society, through its committees and individual members, has pursued some notable programs, which bear brief description.

(1) Two of the society members serve on the Coordinating Council for Aging of Kent County. This is an organization of lay, business, labor, and professional representatives which tries to explore and solve the problems of health, housing, finance, employment, recreation; in short, anything that affects the comfort, health, and happiness of the older age group.

(2) Through cooperative effort with the department of social welfare and members of the staff of the Maple Grove facility (a domiciliary hospital for the indigent of Grand Rapids and Kent County) a committee of the Kent CMS has screened the patients for rehabilitaion and classification according to physical ailment. Following this screening many of the elderly have been discharged to their homes and ultimately returned to gainful employment.

(3) In cooperation with the county and State health departments, the county welfare office, and the coordinating council for aging, the members of the Kent CMS will examine and carry out a survey of all applicants for welfare between the ages of 60 and 70. To determine their physical needs, particularly of rehabilitation, these examinations will include a complete history (medical and social) and a complete physical with laboratory work indicated.

(4) The individual physicians, in cooperation with the social welfare department and other local, State, and Federal agencies, provide medical care to the older age group in their homes, in the office and in convalescent homes, under a reduced fee schedule as agreed upon with those agencies.

(5) A countywide working agreement has been made by the Kent CMS with the social welfare department for the care of the acutely ill indigent patients in local hospitals, by society members.

(6) Since 1946 the Kent CMS has maintained, through the physicians' telephone exchange, a 24-hour emergency call service. On page 250 in the city telephone directory yellow pages appears a 2- by 21⁄2-inch advertisement which reads: "Emergency medical service: If you are unable to reach your family physician day or night, call GL-93511. Public service of the Kent County Medical Society."

On page 251 another ad of the same size reads: "For information about doctors and medical care call GL-84157. A public service of the Kent County Medical Society."

On page 252 a similar ad reads: "Emergency medical service-If you are unable to reach your family physician day or night, call GL-93511. For information about doctors and medical care, call GL-84157. A public service of the Kent County Medical Society."

The doctor who is on emergency service each day provides care without regard to the patient's ability to pay.

(7) The members of the society are continually active in the promulgation and implementation of sound forms of prepayment insurance programs for those over 65 years of age. We are confident that voluntary insurance programs will be more satisfactory to provide personalized medical care than governmental forms of insurance.

(8) The society is cooperating with the Kent County Health Council and the Coordinating Council for Aging in recommending that a special survey be taken of the city and county facilities for the care of the chronically ill, convalescing, and rehabilitation (particularly of the higher age group), such as one proposed by Anthony J. J. Rourke, M.D., New York.

(9) The society is cooperating with the coordinating council for aging in establishing a program of occupational therapy for the area nursing homes. A training program has been planned for the volunteers who are to carry out this program. This we feel will be a great advance in rehabilitating these people, giving them an interest, and a determination to improve their own health. Health has been defined by former physical education professor of Columbia University, Dr. J. F. Williams, as not simply freedom from disease, but that quality of life which permits a person to live most and serve best.

The

(10) An advisory committee of the Kent CMS is working with the Visiting Nurse Association of the Community Health Service, helping to plan a program of home nursing care and give medical guidance to the organization. Visiting Nurse Association works in concert with the public health nurses. Its members give all types of nursing care for patients in the home under doctors' orders, regardless of the patient's age or ability to pay.

(11) The Kent CMS cooperates year around with the county health department in maintaining the highest standards of healthy care in area convalescent homes, which are occupied principally by persons over 65 years of age.

(12) The Kent CMS helped organize and sponsor the Kent County Health Council, which concerns itself with problems of the aging in its overall activities. The health council is made up of leading lay and professional citizens who are interested in promoting better health programs in the area.

(13) The Kent CMS members participate in all local voluntary health programs, such as examinations in the cancer detection center, examination of specimens taken during diabetes detection week, cooperating with and advising the special committee of the rehabilitation league and many other organizations, both through committee effort and individual initiative.

(14) The members of the society are active in area civil defense. Their work during the tornado of April 8, 1956, without thought of fee or financial gain, exemplifies the readiness of Kent County physicians to serve this community in whatever way needed.

Much study is being given currently to the problems of our senior citizens. Some new ones will emerge; the solutions to them will be more evident from continued study. In the meantime every one of the programs noted here is being projected into the future, in the continuation of which we pledge our wholehearted support.

The problems of the aging are problems of the community. We have seen Grand Rapids people serve the needs of the Grand Rapids community. We will continue to do this, whether it be for the aged and aging or any other group of our citizens. Our feeling is that there is no organization better prepared and in closer contact with the older group than the medical profession, and through our combined efforts we can give to this group of individuals a fuller life.

PREPARED STATEMENT OF INTERNATIONAL ASSOCIATION OF MACHINISTS,
DISTRICT NO. 97, AFL-CIO

The International Association of Machinists AFL-CIO members in the Grand Rapids area are divided into basically two groups, those with high skills such as tool and diemakers and journeymen machinists which comprises approximately one-half of our membership and the other half fall roughly into the semiskilled and so-called unskilled groups where lesser training is needed.

Needless to say the lesser skilled workers in the machinists have the same problems of getting jobs when laid off, especially when over 45 and all the other usual problems of retirees when they retire, however, we in the machinists locally have not negotiated compulsory retirement plans except in a few instances and then at age 68 or higher, we have many members still working after 65 even up as high as 82 years.

The craftsman group or journeyman machinists have had only minor problems of unemployment locally with comparitively ample opportunity to hold or get new jobs because of the more favorable job opportunities for skilled workers. This does not mean they have as great an opportunity to get work after 50 or