ment of so-called shelter workshops or older citizen enterprises supposedly on a nonprofit basis. I don't care to touch on whether it is a nonprofit basis or not, but if these establishments were used for the purposes of retraining the displaced worker and putting him into private industry, then those nonprofit organization would be doing a good job.

The establishment of these organizations takes work out of present plants on a subcontract basis, tears down standards of wages, and creates an unfair competitive situation for the employer who wants to be decent and hire employees with decent wages and fringe benefits. It is rather difficult for a labor organization to attempt to organize a so-called place that is supposedly doing a social good, thereby arousing a lot of undesirable publicity, but this is coming into play more and more so far as the placement of the so-called older worker is concerned.

RETRAINING

We believe that, if the older worker is going to be placed on the job and I am speaking about the one who does not have a needed craft or skill-a program must be substituted for retraining of that worker for specific employment, not really to take him away from the street, so to speak, and keeping him at a bench and training him for a job that is not there. Industry must come up with its future program of employment possibilities and potentials so that the vocational schools and others being trained in that direction, and we will really be training for the employment of a work force and not give unemployed workers another skill that industry can't use.

Now, part of the problems of a so-called older worker is covered under the FEPC in Pennsylvania, and the executive director, Elliott Shirk, is here and will touch upon it, but, as far as organized labor is concerned, they have been fighting for seniority, which means the retention of the older worker, and have placed no barriers as far as the employment of older workers is concerned. I don't believe that, with the exception of apprenticeship agreements, there is any age barrier in any of the organizations that are represented by either the A.F. of L. or CIO in Pennsylvania.

Senator CLARK. There are quite a lot of apprenticeship barriers on the AFL side, are there not?

Mr. BLOCK. But that is usually the age of 25, before he can start an apprenticeship. That is for old employees in the industry, as such. I mean over 25, but in the employ of the company, and have already made arrangements and got a certain amount of apprentice training time credit for the amount of time spent in the plant.

Senator CLARK. Let me interrupt you for a moment to say that we are running quite a way behind schedule, and we will complete this panel and then recess very briefly so that the chairman can get a sandwich, and we will try to get back in at 1:30, but those who were to be called at 11:40 and who are now pretty well behind, if you would like to get a quick sandwich and come back, that would be agreeable. If, on the other hand, you want to sit it through, I will try to get to you no later than 1:30.

Mr. Block.

Mr. BLOCK. I would merely like to reemphasize this thing that is coming up in Philadelphia as well as in other cities, and that is the senior citizens enterprise. We believe any retraining should be done with Federal funds under the Social Security Act, as part of the unemployment compensation, whether it is done under the present measure or some future measure. We believe there is capable leadership available for retraining if there can be a meeting of the minds of industry, labor, and the public, which industry placing on the table their need for future employment.

If there are any questions, I will be glad to answer them, sir. Senator CLARK. I think we will hold them for a minute, Mr. Block. Thank you very much. It is very interesting.

Mr. Elias Cohen, we are happy to have you, sir.

STATEMENT OF ELIAS S. COHEN, COMMISSIONER, OFFICE FOR THE AGING, COMMONWEALTH OF PENNSYLVANIA

Mr. COHEN. I would like to take just a moment to describe something about my office, which is one of the major units in the department of public welfare. It has as its primary-indeed, its onlyconcern the problems of the aging. We have in that connection, I think, something unique in terms of its affiliations with a cabinet department-unique in terms of organization throughout the country.

OFFICE FOR THE AGING

Our concern falls along two principal lines: First, the development of community programs, community education, the stimulation of the several agencies and professional groups in the community which have to do with the aging to expand or enlarge upon their outgoing programs or to create new ones.

Senator CLARK. Mr. Cohen, when was the office for the aging first set up within the department of welfare?

Mr. COHEN. In August of 1956, sir.

Our second concern is with the regulation, supervision, direction, licensing, and development of institutional facilities for the aged and aging, including nursing homes, convalescent homes, nonprofit homes for the aged, county homes, and commercial boarding homes for the aged.

In that connection, we attempt not only to do a job of policing, as it were, but a job of education and, as I said, development. We would like to do more planning in terms of development of a system of facilities so that there would be an appropriate coverage throughout the State. We also attempt to provide for a system of institutional care or concept of institutional care that permits free flow of service between institution and community service.

We feel that our type of organization—that is, the attachment to a major department in the executive branch-has special values over what seems to be a more typical arrangement; that is, the commission or special committee on the aging. It is my opinion that the development of commissions and committees on the aging represent a perversion of the typical use, traditional use of commissions and special committees, which have been designed and more appropriately used

for regulatory functions where independence is essential: The civil service commission, public utility commission, security commission, and so on. Committees and commissions have also been used to examine special problems which are a one-shot affair-investigating committees, reorganization commissions, et cetera.

Senator CLARK. What is the budget for your office for the biennium? Mr. COHEN. That is approximately between $400,000 and $500,000. Senator CLARK. How many employees do you have, presently?

Mr. COHEN. A total of 30. That includes all of our clerical staff and our professionals. We have 10 people in the field to regulate some 900 institutions, supervise 900 institutions. I have three people to do community organization.

Senator CLARK. Are they under civil service?

Mr. COHEN. Yes, sir.

Senator CLARK. Is that by executive order or by law?

Mr. COHEN. That is by executive order.

Senator CLARK. Of Governor Leader?

Mr. COHEN. That is correct.

Senator CLARK. What is the salary range for your professionals? Mr. COHEN. Our professionals range from $5,800, minimum starting salaries, to about $7,200.

Senator CLARK. Have you had any recruitment problem?

Mr. COHEN. No.

Senator CLARK. Are there any educational requirements for professional employment?

Mr. COHEN. Yes, sir. For our field staff that goes into the nursing and convalescent homes and homes for the aged, we require work to the level of a master's degree either in the professions of medical social work or in the profession of nursing care. In our community organization area we require work to the level of a master's degree in social work.

Senator CLARK. Thank you.

Mr. COHEN. As concerns the problems of older people, I have two principal points. We approach the problems of older people— that is, when I say "we" I am talking about the professional groups, the professional agency, and, indeed, this includes the public and private agencies-we approach the problems of older people with a remarkable lack of precision. We use a relatively small number of solutions which appear to us to be simple. Actually, they are very costly. We seem to rely upon institutionalization or the granting of direct assistance.

In the past 3 years in which I have held my position, there has been an increase in beds, institutional beds, of approximately 5,000, going from 37,000 to 42,000 beds. This has come about in a period of what is generally acknowledged as a time of tough enforcement. This represents, according to my estimates, an investment of about $30 to $50 million in construction, and I hasten to point out that this is a net addition of beds. This isn't simply replacements. This is a net addition of 5,000 beds.

During that same period of time we have seen very little increase in community-based services which have as their focus the 95 percent of the older people who are not in institutions. We have seen perhaps two or three day-care centers arise, and I talk about centers with a

wide range of medical, counseling, and recreational services. I have seen no new home medical care programs.

Senator CLARK. In terms of regular medical care, is it not true that there has been a movement in Philadelphia or in the State to think in terms of medical programs for all age groups, or have you not noticed that?

Mr. COHEN. I could not honestly say, particularly in the public field, that our public recreation departments have devoted very much attention to what can be done for the upper aged groups.

Senator CLARK. I think Bob Crawford would disagree with you, but he is not here.

Mr. BLOCK. The Amalgamated Clothing Workers and certain other unions in Philadelphia have instituted on their own, programs for the older workers, and the Electrical Workers Union are starting a community service organization for retired workers and older workers when they are away from the shop so they can maintain contact with community agencies.

Senator CLARK. I know there are facilities specially set aside in many of our recreational areas for activities that are of interest to older groups.

Mr. COHEN. Let me hasten to say that we can point to something of everything. We have a little piece of everything in Pennsylvania, but when we think in terms of a million and a half people over 60, or more than a million who are over 65, we are really nit-picking, if I may say so.

Senator CLARK. I agree with that.

FRAGMENTATION OF SERVICE

Mr. COHEN. There are few social agencies which are prepared or able to serve an older person who comes in with a whole host of problems a health problem, housing problem, a problem of relationships with his family, a problem of something to do. How many agencies are willing to do more than a simple job of referral and go beyond saying "OK; you go to public assistance and over here to the clinic and over here to the adult health and recreation center"? How many are willing to take the time and energy to provide the casework supervision to follow through and see that a client gets the kinds of things that he needs?

You see so many agencies which seem to pull the older person apart. They will take care of his heart. They will take care of his cancer. They will take care of his diabetes. They will take care of his arthritis. But we find very few general-practice clinics. It is not realistic to assume that an older person is going to go sit on a hard bench at a clinic for 2 hours to have his heart checked and then go someplace else and have something else checked, and so on. He is a whole person. He is entitled to the kind of medical examination, diagnosis, care, and treatment in the same way that most of us anticipate we would get when we go to a physician for a regular checkup.

Senator CLARK. I just interject the comment that if you had had the occasion to have a wide-range physical checkup lately, as I have, you will find that no matter what your age is, you go in a sheet from one department to another and sit and wait until the X-ray technician

or doctor is willing to take you on, and then wait several days until you get a report. This seems to be necessary medical bureaucracy. I do not think it is confined to older people.

NEED FOR COMMUNITY RESOURCES

Mr. COHEN. My first point is that we do not invest in community services to any substantial degree through public, private, or voluntary resources, and I must stress, because I am afraid the roof will come in on my head, and I must stress this, "in any substantial degree." There are, as I said before, bits and pieces.

Senator CLARK. Why not?

Mr. COHEN. Well, I think part of it is that the culture doesn't think very much of older people, so we look for solutions that will put them aside; this is one of the reasons why we seize on institutional care as

one of the measures.

Senator CLARK. This is historic, is it not? And to some extent it arises out of a very laudable investment some years ago, in line with the thinking of that day, in homes for the aged by religious groups and other civic-minded people. To some extent it goes back to the old poorhouse complex, doesn't it?

Mr. COHEN. There is no question about that. And, of course, the Social Security Act in 1935 put prohibitions on public participation in public assistance given in public institutions. This was one of the most important measures to try to reverse the trend toward institutional solutions. It is historical. It is very complex, and it has its roots in a whole host of things. So far as institutions are concerned

Senator CLARK. Before you get to institutions-as I take it, your view is that we ought to deemphasize institutionalism and place far more emphasis on what, for want of a better word, I will call ambulatory care.

Mr. COHEN. That is correct; and I am going to try to tie my two point together. So far as the institutional program

Senator CLARK. You did not have the nerve to put in the record that bad pun that we have an "edifice complex," but I think we do. Mr. COHEN. I let myself run away there.

Senator CLARK. It is a good one. I think it is pertinent.

Mr. COHEN. I will say, so far as institutions are concerned, I feel that there is an almost universal failure to provide institutional care for the aged and aging consonant with 1959 knowledge. In Pennsylvania, of the 900 institutions in this State, there are less than a dozen, less than a dozen institutions which are prepared and ready, organized, staffed, equipped, and imbued with the philosophy of full range of services to meet the needs of older people. I am talking about social services, casework with families. I am talking about the "rehab” services that Dr. Kraft described. I am talking about activity therapy, in addition to good medical and nursing care.

INSTITUTIONAL CARE

Senator CLARK. I would like to highlight that statement of your about the 900 institutions. I think it is one of the most important facts that has been brought out today. You have supervisory responsibility for 900 institutions primarily concerned with care of the aged?