Mrs. STROEBER. Yes. They enjoy getting together. If somebody misses, they will say, "What was the matter? Why weren't you here before?" Of course, those that live here in town can come every day up until I think on Saturday and Sunday it is not open, but they can come every day.

For us in the outlying districts, the bus just comes once a week. It takes a different corner of the county on different days, so we don't get in every day.

Did you hear the music when you came in?

Senator CLARK. Yes, I certainly did.

Mrs. STROEBER. There is always some kind of entertainment. It is not always music-sometimes it is something else-but there is always some kind of entertainment. I think the last of the month there is a bingo game; I always notice that there are a lot more people here the day of the bingo game.

Senator CLARK. So it is not just nutrition; it is a social get-together. Mrs. STROEBER. Yes; socializing for a great many people. That has not been my reason for coming, because there is a little country church quite close to me. I am out in my own community and it is not necessary for me to come for that social life, though it is nice. As far as to come every day, I would not have time.

Senator CLARK. You have to look after the cattle, you said.

Mrs. STROEBER. Yes, and I have to take care of my flowers and garden. Anyone who has a garden knows that weeds grow.

Senator CLARK. I want to ask Mrs. Anderson some questions, if I

may.

I was interested in the fact that you said that the doctors used to come to Melcher to the clinic from Des Moines. Did they come once a week, or what was that arrangement?

Mrs. ANDERSON. No, they came every day from the osteopathic college and they had been doing this for 2 or 3 years. It seemed to be going fine. They had a good business, but for some reason they decided they didn't want to drive down there any more. They were there for 5 days a week.

Senator CLARK. Now you have no doctor at all?

Mrs. ANDERSON. We have no doctor at all; no. Years ago, Melcher had several doctors and dentists.

Senator CLARK. How big is Melcher?

POPULATION: 931

Mrs. ANDERSON. Well, as of the 1970 census, it was 931. It never was a great big town.

Senator CLARK. That is a big town.

Mrs. ANDERSON. A big town, but I think around 1,200 is what it was at its peak.

Senator CLARK. That is a big town for me. I was raised in a town

of 450.

Mrs. ANDERSON. Then we have a large one. We have several new homes going up and the younger people are staving there, driving to Des Moines, Newton, or Knoxville to work. What we need is a good road.

Senator CLARK. Now, according to my notes, there was also a pharmacy in Melcher until this spring; is that right?

Mrs. ANDERSON. Well, it was a sundry store. There was no pharmacy there, but the medicine was ordered from the pharmacy at Knoxville. One of the men that worked at the VA hospital picked it up and brought it in, so that was the one service that we could depend on. Senator CLARK. Now you have lost that?

Mrs. ANDERSON. We have lost that.

Senator CLARK. So you have lost the medical center and the ability to get prescription drugs delivered in that way?

Mrs. ANDERSON. That is right.

Senator CLARK. If you need prescription drugs now, what do you do?

DRUGS DIFFICULT TO OBTAIN

MIS. ANDERSON. Well, we wait until we can go to Knoxville and get them. Most everybody goes to the doctors there at the Collins Hospital Clinic. They can get their medicine there through the doctor or they can go to the drugstore in town and get their prescriptions filled. Senator CLARK. Do a good number of people in Melcher receive benefits under block loan?

Mrs. ANDERSON. Yes. There are several of the old ministers still living there, but there are a lot of widows, too; several of them are getting it.

Senator CLARK. I know the long period of time that it takes to process the claims is the major complaint. I noticed you said that, too. Mrs. ANDERSON. Yes.

Senator CLARK. What happened was, as I recall, about 2 years ago we passed new legislation saying that everybody who failed to qualify-and you referred to this in your statement-could reapply, and so suddenly there were literally tens of thousands of people who reapplied at the same time and it became an enormous problem.

Mrs. ANDERSON. Yes. I thought that was probably the problem because I had not heard for so long. Of course, when you are just sitting there wondering and waiting, all you are thinking about is yourself. I had just given it up. I thought, well, it is just one more time that I didn't get anything, but I would not give up as long as there was anything that I could do.

Senator CLARK. So as far as you are concerned, the major benefit of the programs that exist now is that you get black lung benefits and social security?

Mrs. ANDERSON. Yes.

Senator CLARK. What about the meals program-do you have access to that?

Mrs. ANDERSON. We don't have it in Melcher, but they have it in Knoxville. The people that want to go over there. We have one van which makes the trip at 9 o'clock and then there is another one at 10. If they want to eat, they try to go on the 10 o'clock van so they will be in Knoxville longer and will be able to eat. If they go at 9 o'clock, they come home before the time for the meal.

Senator CLARK. Do you have any housing programs in Melcher? Mrs. ANDERSON. No. We need that, too.

Senator CLARK. Let me ask Mr. Goeldner a couple of questions, if

1

I have a copy here of a magazine article published by the Department of Health, Education, and Welfare called Aging, the November 1963 issue. That is some time ago-nearly 13 years. It has an article in it about Earlham and their homemaking/home health aide nursing services, and so forth.

I was wondering if you might talk a little about some of the things that have happened in Earlham. It looks like you were doing these things already 13 years ago—a number of these new programs now in homemaking/home health care aides, and so forth. Tell us a little bit about the services affecting older people in Earlham.

Mr. GOELDNER. Well, we felt it would be well to keep the people in their own homes as long as possible, so we worked out this program with the assistance of some of the county welfare people in HEW. The State department of health was the agency that put up the assistance money, so we set this program up for the Earlham community. After it was in operation for a year or so, HEW suggested that we expand it, so presently it covers the entire Madison County.

Mrs. Murray Smith, who was here this morning, is presently director. When we first set up this program we had a number of different kinds of assistance, such as homemakers, meals-on-wheels and handyman services, friendly visitation or telephone visitation, visiting nurse, and transportation services.2

There was an elderly gentleman there who contributed his time. I think they paid him a quarter for each trip if he brought somebody downtown, or a little more if he took them to Dexter, Des Moines, or someplace else to the doctor.

We found that with this program many of the people spent their remaining days in their own home; otherwise, they would have had to go to a nursing home or some other place.

Some of them required more assistance than others. Maybe a homemaker would come in for half a day, two or three times a week or, if the person needed more help, they would come in every day for a part of the day.

Senator CLARK. Now, would you talk a little bit-in case there are people here who have not been involved in homemakers-about how they come into the home once a week, or more than that, and what kind of things they do?

HELP IN THE HOME

Mr. GOELDNER. Well, as people grow older, they need more help in things like vacuuming their house, cleaning the house or they need to have someone come in and prepare a meal for them. This was before we had congregate meals.

Maybe if there are some dirty dishes stacked up, they would wash the dishes any particular need that the person might have. They might do a little laundry work for them or just take care of the extra things that take a little burden off the older person.

Senator CLARK. I am reading from the recent article that says that they had a meeting in Earlham with the home health aides, as well as homemakers, and the homemakers had assisted in 61 homes. I assume that is in one county.

1 See appendix 1, p. 39.

2 See brochure, appendix 1, Item 1, p. 41.

Mr. GOELDNER. That is Madison County.

Senator CLARK. During the month of June, totaling 844 hours of service by-in this case it was home health aides and 35 visits to patients' homes were made by registered nurses. Can you talk a little about the home health aides and the nursing programs?

NURSES VALUABLE IN HOME HEALTH

Mr. GOELDNER. Well, I think the nurse, when she visits the home, if necessary, is capable of giving shots, taking blood pressure, and seeing that the person is taking their medicine properly--things of that

nature.

Senator CLARK. So between those various programs, your people are able to live in their own homes much longer than they would otherwise.

Mr. GOELDNER. Yes, many of them have. Some of them lived out their remaining days; I know three persons now in nursing homes, but they lived in their own homes 10 years longer than they could have otherwise.

Senator CLARK. What about nutrition programs now in Earlham? Mr. GOELDNER. Well, Earlham participates in the congregate meals program. Then, of course, the county bus comes over on Tuesdays to take those who need to ride the bus.

In the beginning when we first started congregate meals in the aging program, some of the people said, "Well, that is just for poor people," or "It is charity," or the like. They are getting over that

notion now.

I think, as it was brought out here before, the people enjoy visiting, reminiscing, playing games, or having some music like they have here in the multipurpose center.

Senator CLARK. I want to thank you all very, very much for your testimony. It was most interesting. Thank you very much.

We are going to hear next from Dr. Woodrow Morris, and then following Dr. Morris we are going to be hearing from the other panel this morning with Mr. Joe Pals, Mrs. Forsyth, and Dr. Fickel. Woodie, come right on up here, please.

We particularly wanted to have the doctor with us today because he played a very major role, in fact, in two White House Conferences on Aging, and I know he was appointed by the President to the National Task Force on Aging in 1970. I know that the chairman of this committee also appointed him a member of an advisory board of the committee in 1971.

I must say that I regret that in recent days Iowa has lost his services as chairman of our commission on aging. I think he knows more about problems of aging than anybody I ever met.

So we are particularly happy, Woodie, to have you here. You just proceed in any way you think appropriate.

STATEMENT OF DR. WOODROW MORRIS, ASSOCIATE DEAN, COLLEGE OF MEDICINE, UNIVERSITY OF IOWA, IOWA CITY, IOWA

Dr. MORRIS. Thank you, Senator Clark, for those kind words. I am not sure that it is all true, however, because I am following a panel that just participated a few moments ago who said almost all of the things I want to say better than I can probably say them.

I appreciate that panel's presentation very much because it was a most interesting discussion, and maybe what I can say will illuminate a little further some of the things they said.

I am delighted that you are back home, Senator.

Senator ČLARK. Thank you.

Dr. MORRIS. We are always glad when you come back and conduct these important hearings. It is good to see Mr. Oriol, John Guy Miller, Miss Kilmer, and other members of the staff here.

Senator CLARK. I just want to say before you start, because I didn't make this a part of the record, that Dr. Morris is associate dean of the College of Medicine at the University of Iowa.

Dr. MORRIS. Well, as most of you folks know, I have been long interested in and deeply concerned about the need for us as a society to provide the kinds of programs and services which elderly people need and want.

I have been very pleased at the progress which has been made in this country and here in our State in working toward these objectives. But as an Iowan of some 28 years, I am particularly concerned that we not simply pay lip service to the elderly or mislead them into believing programs and services will be available, only to have them never reach fruition in reality.

This sort of misleading is already all too prevalent in what I consider the broken promises which strew the path of the medicare program. It concerns the delivery of medical care and the provision of long-term care facilities in adequate numbers and quality to respond to the health care needs of our aging and aged citizens.

Similar remarks might also be made about the hopes engendered in the hearts and minds of the elderly that up-to-date, 1976 housing will be made available to them, only to have time pass with little or nothing actually happening in the way of actual construction of adequate housing for those who need it most.

I was delighted to hear Mr. Sprunger talk about the housing program here in Winterset, and I cannot help but think that many folks may be sitting in the audience wondering why they can't have that kind of housing in their communities. That concerns me, too.

Far too many of our older adults are living below the poverty level with no truly creative plans or programs on the drawing boards to permanently solve this problem.

It is true that we have social security and supplemental security income programs, but neither has been able to keep pace with the inroads of inflation, and neither was designed to permit older people to maintain the standard of living to which they have been accustomed or are deserving.

But these remarks are focused on the elderly in general; in Iowa and in other Midwestern States, in particular, we have a special problem, and that is the rural elderly-those to whom Senator Clark is addressing these hearings this week.

A SPECIAL PROBLEM IN IOWA

Unhappily, so far as I am aware, there is no national or State of Iowa policy regarding the rural elderly. Even a cursory examination of the situation of the rural elderly will suggest that they are all too