INCOME MAINTENANCE

In planning, we feel that a segmented approach which treats problems of the aging from just any one of these standpoints is unrealistic, and a well-balanced community program must take into consideration all of these. Going in-I don't want to take a lot of your time, because I know there are a lot of witnesses-but in the field of income, the problems of inadequate income, our most recent information shows that as of February 1959, in Allegheny County there were 7,200 recipients of old-age assistance and 103,911 recipients of old-age and survivors insurance.

About a year ago there was an increase in the old-age assistance maximum grants. They were increased by about 50 percent, to $99.60 a month, and in our opinion this has been a help, but we don't know, frankly, how many older people are on that borderline between what you might call a healthful situation and mere subsistence. This is one of the things that we hope, in a future comprehensive plan, to deal with.

HEALTH

In the field of ill health one of the underlying problems of course is the shortage of homes and hospital care for older people. For instance, there is a waiting list, I believe, at Kane Hospital and Kane Hospital is having difficulty sending out from its fine facilities those patients that do not really any longer require hospital treatment. Mayview and Woodville State Hospitals similarly have large numbers of patients who do not require or can't benefit from psychiatric hospital treatment, but who do need some sort of supervised care. The number of such people in the community is not known, but a representative of the department of public assistance estimates that in its caseload alone there may be as many as 2,000 people who should have some type of custodial or supervised living arrangement.

Kane Hospital, with the help of a number of agencies that have been cooperating, including our own, is making a beginning in a foster-home program, which will meet the problem of taking people who no longer need hospitalization but need some sort of supervised care, taking a few of these selected older people and putting them into foster homes. We think this is at best a limited program, has limited potential, and there is still a great need for some type of custodial care beyond that now available.

HOUSING

In the field of inadequate living arrangements you are going to hear from one of our panelists here, Mr. Tronzo, who knows a lot more about it than we do. I don't think I should go into that in great detail.

We do have 23 fraternal and sectarian hospitals for the aged in Allegheny County, but they all have waiting lists, as far as we can ascertain. They are caring for an estimated 2,300 aged persons.

When we last made a survey in 1956, we found they had a waiting list of 650 applicants, and there is reason to believe that these lists have grown since.

Senator CLARK. I get the sense of a feeling on your part that while there has been a substantial and increasing local effort, that it is not going to be possible to meet the need with local facilities. Am I wrong in that?

Mr. BLOCK. That would be, I think, our feeling, although we have a plan to do a comprehensive survey in this field and we are a little reluctant to give you any flat conclusions. There is need for stronger local effort. I would doubt whether the funds available locally and the facilities available locally can handle this problem as it grows.

Of course, we all know from the statistics that you quoted that this is a growing problem. I do think that there is going to be some need for housing, perhaps institutional care, and I think on the voluntary side we can probably do quite a bit in the field of leisure time, the handling of those problems.

Senator CLARK. I would think that the leisure time field would be one where the local effort might be commensurate with the need.

One of the problems that occurs to me-I wonder if you feel the same way is that with considerable effort it is possible to establish the need for a workable program, but then you have the problem of how you are going to finance it.

Mr. BLOCK. Right.

Senator CLARK. And to what extent can private interests, local, State, and National interests, afford to meet the needs in view of many other needs in our civilization? I think this is the most puzzling problem of all.

Mr. BLOCK. That is why we think it needs very careful planning, because you could spend a great deal of money on any one segment and not have a good plan.

Senator CLARK. The study you have in mind will be financed by the health and welfare council?

Mr. BLOCK. Partially by our budget, but I think we would have to have supplementary moneys to do the plan in the way it should

be done.

Senator CLARK. Using tax money or foundation money?

Mr. BLOCK. Maybe private sources.

Senator CLARK. One important thing would be to coordinate that study with the larger programs so you just don't get a study divorced from any of the other related agencies or problems.

Mr. BLOCK. I certainly would hope we could get some guidance along those lines.

In this field of voluntary service, we suggest in our written report, for instance, a counseling center for older persons which would give them information about what resources are available for them. We think there is a great ignorance of what facilities are now available. Senator CLARK. Whose job do you think it is to make that information available and spread it?

Mr. BLOCK. I think this might well be done on a voluntary basis, this might well be done by a united fund agency, but I have no idea until we study this.

We conclude in this statement by saying that there is a wide gap between the problems and the community's capacity to deal with those

problems, as you mentioned, and we feel that the gap will continue to grow unless there is some special effort to prevent it, and we are very concerned about the problem of financing. A full complement of services would be expensive, and there is increasing resistance in the community to adding to the burden of taxation or voluntary giving, so we have to have a good plan which the public will accept as necessary, and then I think we can meet them through voluntary funds and

tax money.

Senator CLARK. Thank you very much, Mr. Block. I think only for the record, but somewhat in defense of the staff, a pretty detailed letter was sent to Mr. Elmer Tropman of the health and welfare council, outlining five specific matters we would like to have you comment on. Perhaps you never saw it.

Mr. BLOCK. My apologies, sir.

Senator CLARK. At this point, your formal statement will be made. a part of the record.

(The prepared statement of Mr. Block follows:)

PREPARED STATEMENT OF WILLIAM BLOCK, PRESIDENT OF HEALTH & WELFARE ASSOCIATION OF ALLEGHENY COUNTY

My purpose here today, as president of the health and welfare association, is to present an overall picture of the local needs and resources of the Allegheny County aged population. I am representing a citizens' planning, coordinating, and research organization which works in all aspects of the health and welfare field. It is therefore consistent with our role in the community that I try to provide the total perspective on problems of the aged. My brief survey of the state of affairs will be elaborated upon by the statements of representatives of other community agencies which give services to aged persons in specific fields.

The health and welfare association, like many of its counterparts in communities across the Nation, has long focused on bringing to public attention the problems of aged persons in the community. We feel that much progress has been made in the matter of public education. While some progress has been made in the creation of resources to meet needs, far too little has been accomplished to date.

The health and welfare association has organized its approach to the problems of aging on the basis of four broad categories: inadequate income, ill health, unsatisfactory living arrangements, and unsatisfying use of time. We recognized that any specific problem within any of these broad categories is interrelated to problems in other categories. We hold that a segmented approach which treats problems of aging from a single standpoint is unrealistic and will not lead to an eventual well-balanced community program. For this reason the health and welfare association is now embarking upon a long-range planning project which will serve as a guide to the balanced, coordinated development of services to meet the variety of problems which result from the aging process. In our concern as a planning body, we make a distinction between those aged persons who are self-sufficient to the extent that they do not need outside assistance and those who have problems. Therefore, not all of the estimated 160.000 persons over 65 in Allegheny County are in current need of health, welfare, and recreation services. What number actually is in need, we cannot accurately measure. But the number with obvious problems coming to the daily attention of agencies is great enough to justify the community's intensive efforts on their behalf. Furthermore, we know that because the rate of increase of older people was twice that of the total population between 1900 and 1950, we can expect a continuing increase in the volume of problems by virtue of the increase in the aged population.

IN ADEQUATE INCOME

The root of many of the other problems occurring in old age can often be attributed to the loss of earning power. In Allegheny County we have the usual programs to protect aged individuals against complete indigency. Our most recent information shows that as of February 1959 in Allegheny County,

there were 7,258 recipients of old-age assistance, and 103,911 aged recipients of old-age and survivors insurance. Almost a year ago significant progress was made in this State when old-age assistance maximum grants were increased by about 50 percent to $99.60 per month.

Perhaps the most acute problem now with us is the matter of medical care financing. Aged individuals who are self-supporting while in good health can suddenly become medically indigent if they are without substantial resources or health insurance. Even on this matter we are not without some recent gains, insofar as some voluntary health insurance plans have been made available to persons over 65.

We do not have at our disposal at this time an overall assessment of the economic health of our aged population. We are gratified with the gains made recently, however modest. But we believe that a significant number of aged persons are living close to the borderline between a health existence and mere subsistence. We must be on guard continually to insure that such individuals do not become a continuing burden on the community simply because adequate income is unavailable to prevent a breakdown in their physical or emotional well-being.

ILL HEALTH

As for the problem of ill health, we know from our everyday observation that the aged suffer disproportionately from chronic illness. Also, there has been a tremendous rise in the number and proportion of aged in our mental hospitals.

In Allegheny County we have been fortunate in the acquisition of the John J. Kane Hospital for the chronically ill. In its total patient population of approximately 2,000 is a large proportion of aged persons. We have only a few institutions providing nursing care under nonprofit auspices and an unknown number of proprietary nursing homes. Many of these facilities are substandard and need immediate improvement in physical construction and personnel. Despite these resources, we are still faced with a shortage of facilities as attested to by waiting lists for admission into some of these institutions.

One underlying cause of the shortage is the fact that hospitals in this community are increasingly having to care for aged people who require health supervision and living arrangements but not expensive hospital care. This is true of our voluntary general hospitals, of Kane Hospital, and the two State mental hospitals which serve this county.

Kane Hospital estimates that some 350 of their patients do not really, any longer, require hospital treatment. Mayview and Woodville State Hospitals similarly have large numbers of patients who do not require or cannot benefit from psychiatric hospital treatment, but who do need supervision. The number of such people in the community is unknown, but a representative of the department of public assistance estimates that in its caseload alone there may be as many as 2,000 people who should have custodial or other supervised types of living arrangements.

Kane Hospital is making a beginning in a foster home program which will meet this problem for some few selected older people. It seems apparent, however, that the foster home program can and should be only a segment of the total community program for meeting the needs of this large group of older people.

INADEQUATE LIVING ARRANGEMENTS

This last thought leads logically to consideration of the closely related problem of inadequate living arrangements. In Allegheny County, we need more of the kind of home care and home services which you will hear of today in order to enable aged people to remain in their own homes as long as possible. But there is growing conviction that we should also make public provision for the kind of intermediate care program which the Veterans' Administration has developed. Even in the absence of actual illness, age and infirmity frequently bring on the need for life simplification, for fewer chores and decisions, for less complicated interpersonal relationships than family living always imposes. Our present 23 fraternal and sectarian homes for the aged cannot meet the total need either in terms of their size or financing. At present they are caring for an estimated 2,300 aged persons. When we last made a survey in 1956, we found that they had combined waiting lists of 650 applicants, and there is reason to suspect that these lists have grown since.

Important strides have been made in Pittsburgh in opening living accommodations to aged persons in public housing. Representatives of the housing authority are here to describe this in greater detail. These opportunities are

primarily for aged persons who do not need the protected environment of an institution. But an interesting experiment is now being conducted to provide a small flavor of the protected environment to some aged residents of public housing. I refer to a demonstration project being coordinated by the health and welfare association in which three voluntary casework agencies are cooperating with the Pittsburgh Housing Authority in providing housekeeper services to aged residents who could not maintain required housekeeping standards without such help. The community chest is financing the project, which thus far has served only a small number of persons. If proved successful, it is hoped that the service can be established as an ongoing community program.

UNSATISFYING USE OF LEISURE TIME

Perhaps the most widespread, though not necessarily the most dramatic, problem of old age is inactivity and a sense of being no longer productive. The problem can become so serious as to lead to a feeling of hopelessness and a subsequent predisposition to mental and physical illnesses.

Recreational activities represent one solution to this problem. In Allegheny County a number of Golden Age Clubs have been organized in the past several years. These are scattered haphazardly about the county and, therefore, not available and accessible to all who might profit by them.

A hobby show, started by the health and welfare association, and now sponsored annually by the Pittsburgh Press and the Junior League, has offered an important outlet for use of time by stimulating the assumption of hobbies and handicrafts.

Several organizations sponsor summer camps for oldsters during 1 or 2 weeks of the summer season.

The Council of Jewish Women sponsors a lounge for senior citizens. These recreational opportunities for occupying one's time are scattered and relatively few in number. We do not have special programs of providing parttime or sheltered work opportunities to retired workers who are more in need of keeping occupied than they are of earning income. We need locally such programs as sheltered workshops for the aged, senior achievement programs, organized use of panels of retired experts for consultative purposes, and programs of a similar nature.

MAKING AVAILABLE SERVICES MORE ACCESSIBLE

Until we are able to fill all the gaps which now exist-and we know this will take time we must insure that our presently available services are used effectively and efficiently by those who need them most. One method for insuring this, as well as representing a needed service in itself, is a counseling center for older persons. The basic objective of such a center would be to provide information and counseling to older persons to enable them to handle their problems by a mustering of their own resources either with or without help from other community agencies. The center would provide a central resource to the community for information and advice on problems of the aged and otherwise stimulate the meeting of needs of the aged.

CONCLUSION

In conclusion, I would like to point to the general fact that there is a wide gap between the problems presented by our rapidly increasing aged population and our community's capacity to deal with those problems. The gap will continue to grow unless special effort is made to prevent it. Such special effort should recognize that a full complement of services will be expensive and that there is increasing resistance in the community to adding to the burden of taxation and voluntary giving. Therefore, we must be certain that our plans for the development of services are sound; that they will provide efficient, effective services without wasteful duplication. If the public has confidence in our estimates of the need and in our programs for meeting the need, we can be confident of enthusiastic public support. The planning which the health and welfare association hopes to undertake in this field will, we trust, help to engender such public confidence.

Senator CLARK. Congressman Moorhead, will you let us have the benefit of your thinking?