fourths of the elderly in the State believe that their health is superior to that of other people their age.

The problem, of course, for the elderly is that they are more subject to illness and disability than younger age groups. Older citizens average 6.5 physician visits per person per year. One out of six of them will be hospitalized during the year and once in, they will average a 12.2-day stay. Estimated annual health care costs for the elderly have increased from $791 in 1970 to $1,052 in 1973. This is a 24.8 percent increase in 3 years. At the same time, the older citizens share of health costs increased from 32.5 percent in 1970 to 35.1 percent in 1973. Present trends indicated continued increases in health care costs and unless major changes occur in government coverage, one can anticipate that the older citizens share of health costs will also continue to increase.

SHRINKING INCOME

In South Dakota, the older citizens have less than 50 percent of the income of the younger population. About half the older South Dakotans in 1970 had incomes of under $3,000 a year. In fact, almost 30 percent of the old South Dakotans had incomes of less than $2,000 a year. Unfortunately, over 1 percent exist on incomes of less than $500 per year.

It is amazing to think that in modern, industrial America, one out of every five poor people is 65 years of age or older. Unfortunately, many of these individuals became poor upon reaching age 65 through forced retirement, or as a result of health problems.

The income of the elderly population will become increasingly important. Should price increases continue, their purchasing power will become increasingly less. Also should earlier retirement ages come about, we will experience a substantial increase in the number of elderly poor.

The older citizens spend a greater percentage of their income on food, shelter, and medical services and care than younger individuals. They often have a great deal of difficulty finding basic needs, such as clothing in shopping areas. In other cases, the older citizen does not buy other items or luxuries because they simply cannot afford to purchase them or is unaware of available aid. In fact, in 1970 only 6 percent of the older South Dakotans were using food stamps. Fortunately through the use of the State Tie-Line and other services, the State has done an excellent job of attempting to extend this service to the people.

In 1974, about 14 percent of the older Americans were still in the labor force. Some 19.3 percent of the older male workers are employed in agricultural jobs which tend to be lower paying. This is an important factor to be aware of in South Dakota, for the older citizens in this State have some additional employment opportunities available to them in agriculture which are not available to older urban citizens.

About 61 percent of the old South Dakotans never completed elementary school. Some 14.5 percent attended less than 4 years of high school. It is interesting to note that over 10 percent attended college and that over 4 percent were college graduates or more.

While older South Dakotans had a median formal education of almost 9 years in 1970 future estimates indicate a significant increase in median school years completed in the future. By 1990 the older citizens will have a median formal education of almost 12.4 years. In other words, over half the elderly in the State will have completed high school. The effect of this change can be very significant since better educated citizens will place different and additional demands on government, business, and society.

Some 53 percent of the older South Dakotans are married, according to the 1970 census. It is important to note, however, that while almost 70 percent of the older males in the State are married, only about 40 percent of the females in that age category are married. Men are more favored in terms of living with a spouse in later years, particularly because society allows them to reach down and have second marriages with senior sweethearts who are younger than they. This disparity will have implications for housing needs, the incidence of personal isolation, family relationships and income among the elderly in the next 15 years. Most older men will be married and over 80 percent of the older women will be widowed and/or unmarried.

Over 63 percent of the older South Dakotans live as families. Nearly 30 percent live alone or with nonrelatives, and over 7 percent are in institutions. Over three times as many older women than men live alone or with nonrelatives.

In South Dakota over one-fourth of the older citizens live alone. Most of these individuals are active and able to take part in community life, but thousands do live in isolation. Almost 16 percent of the aged in the State do not receive one telephone call a week. Over 10 percent of the older citizens are not visited by another person at least once a week.

Fortunately, the State, the Federal Government, and citizens groups are working to end isolation through programs providing: transportation, senior centers, nutrition programs, telephone reassurance, friendly visiting, and other services. In the period from 1960 to 1970, a significant shift took place among older South Dakotans. They tended to move into small towns and especially the urban areas of over 10,000 population. Among the reasons for this movement are: a greater concentration of medical services, increasing availability of low-income housing, the opportunity to be closer to others, better transportation, and more recreational activities.

In South Dakota today, 18.9 percent of all registered voters in the State are 65 years of age or over. Presently there is no significant evidence to indicate that older citizens vote as a block. They tend to either follow their own traditional party lines or vote independently, as they have for so many years of their lives. Needs

At age 65 years and over, one does not automatically desire to become a hermit. Older South Dakotans have the same needs for familial and social relationships as the rest of the population. Unfortunately, society tends to isolate or allow the isolation of a large number of aged individuals.

The older citizen needs cultural and recreational activities, just as members of the younger generation do. Some of these needs can be met through senior centers. Other recreational needs can be met through community recreation programs, clubs and organizations, and family participation.

Like all people, the older citizen needs good health, both physical and mental. They need access to good medical care. They also need nutritional programs to assure an adequate diet.

They need to be able to afford the food necessary for health, as well as the clothing necessary for warmth and protection. One would think that with a market of about 22 million older Americans, some clothing company would be able to provide them with fashionable, protective clothing at a reasonable price. Older South Dakotans also need adequate housing if they are to live as they should. It should provide adequate space, necessities, comfort, and be attractive. They need good access to utilities and repair services at reasonable costs. Their residential areas should be safe and adequately protected by police and fire departments.

The older citizen needs areas to walk in, play in, or to just sit. They need transportation from their residence to areas of activity within the community, for example to stores, doctors' offices, parks, and senior centers. They also need means of getting to church when they desire to attend. Too often younger individuals fail to recognize the importance of religion in the daily life of the older person.

The older citizens need an adequate income on which to live. As mentioned previously, most of the elderly poor in this Nation were not poor until they had to retire and their income was cut off. If they must live on a substandard income, they must not be expected to carry the same tax burdens as those individuals still employed. They also need tax reform on real estate taxes and estate taxes, since they should not be taxed out of their home or estate.

For those 7 percent of the older South Dakotans who receive institutional care, there is the need to be visited, the need to be treated as individuals, and the need for help. Just placing an older person in a nursing home or extended care facility does not end one's responsibility to a mother or father or aunt or uncle. Those people living in institutions still have wants, needs, and desires. Try as they may, the institutions cannot meet all of them, for family love and involvement are essential needs of the older citizens, whether at home or in an institution.

The older South Dakotan also needs an advocacy system. In many cases they need someone to help them and do not know where to go. They need legal advice, help getting better housing, better health care, work, recreation, housekeeping services, rehabilitation services, and other people. They need advocates in these areas and information on how to get help with these needs.

The greatest need of the older citizen is the need to be needed. Fortunately in many families the older members are needed and actively involved as long as they live. In other cases, individuals are healthy or involved enough that they are always needed. But for some older citizens, the need to be needed was lost with the arrival of retirement or illness.

For these people, the State and Federal Governments, senior centers, care facilities, schools, groups, and individuals, are becoming increasingly active and creatively involved in developing and implementing ways in which the older citizen can realize their need to be needed. The South Dakota Office on Aging develops, sponsors, and assists communities in the implementation of programs such as: meals-on-wheels, senior centers, telephone reassurance, retired senior volunteer program, foster grandparents, in-house services, and many others. These programs and others have been developed in communities across the State and Nation. The State of South Dakota has introduced the Tie-Line (1-800592-1865) to put the older South Dakotan and others in contact with individuals and agencies who can answer their questions and assist in solving their problems. Organizations such as the congress of senior organizations, the South Dakota Association of Health Care Facilities, and others are working for the interests of older South Dakotans in relation to their service areas. Gerontology Association for Training and Education (GATE) is a statewide consortium of education, statewide older American organizations, and others working together to inform and assist the older citizen.

The State and Federal Governments, each of these organizations, and interested individuals have as their purpose to provide the older citizen opportunities to utilize their ideas, knowledge, and talents for benefit of others—to fulfill-the need to be needed.

Future trends and implications

(1) If the low birth rate of the last 15 years continues for an extended period of time, South Dakota will experience a significant increase in the number of older citizens. This increase could be even more spectacular by an increase in the life expectancy and lifespan of the population.

(2) New health technology may reduce or slow the aging process and therefore increase the median age, the life expectancy, and the number of older citizens. This would require substantial increases in demands for services to that segment of the population.

(3) New health technology may expand life expectancy so that societal substitutes for dying may have to be found that operate in the same way retirement serves to substitute for death in industrialized societies, creating opportunities for younger cohorts advancing in age.

(4) The increase in the absolute number of elderly residents in South Dakota will generate need for additional services from both public and private sectors. Although proportional pressures on the active working population to support the elderly in the State will not increase, elderly residents may seek a greater allocation of State resources and demand more expensive programs in their behalf.

(5) The dramatic changes in the sex ratio and the decline in the proportion of elderly married women will increase feelings of isolation and cause further "anomia." especially for those women who locate their personal status in the status of a husband. New forms of polygynous marriage, or formalized living arrangement may become socially legitimated among and for the elderly.

(6) Health care for the elderly will become more centralized in larger South Dakota communities where a variety of medical services and specialties are available.

(7) The nursing home will continue to be the main reason for the existence of several small South Dakota communities. One cannot anticipate a significant decline in the number of older citizens in these facilities until out-migration of the young is reduced significantly.

(8) The rising costs of health care will bring about increased pressures on government to pick up a larger share of medical costs for the aged. This pressure will come not only for the elderly but also the children of the aged. (9) Technological change is progressing at such a rapid rate that increased numbers of individuals will be forced to leave the labor market at younger ages. This would result in a change in the senior population since retirement could begin at 55 or 60 years of age. To accomplish this would likely require a guaranteed annual income.

(10) At the same time, one must also be aware of the fact that future senior South Dakotans share environmental histories that provided more educational opportunities, associated higher occupational and income statuses and exposure to an era of expanding public welfarism may mean that they will be less inclined to accept reduced status positions within the larger society than are the elderly today. A number of factors will help contribute to this:

(a) During periods when larger numbers of children enter adulthood, the availability of surplus but recently trained young adults tends to make the labors of older citizens obsolete and unvalued. The fact that the number of children now born who are advancing toward young adulthood is lower than for previous decades will mollify this obsolescence and devaluing.

(b) Higher completed education levels among the elderly may fortify their legitimate feelings that they have "wisdom" strengthened by experience which ought not be disregarded. From the knowledge and skill perspective, old age and status may become positively related.

(c) Nostalgia may replace scientism and technology as a fundamental American value. If so, the elderly will have an advantage.

(d) Previously, two aspects of retirement explain in part the perceived loss of status by the elderly. At retirement a person not only severs his connection with an organization, but he also relinquishes his occupational location in society. Without these two affiliations, the retiree usually becomes a person of unknown and uncertain achievement. Elderly in the next decades may not be so willing to relinquish their status locations, especially when they share higher educational levels within a leisure oriented society where work opportunities for all age groups are few.

(11) Due to changes in environmental histories, the elderly of tomorow will insist even more persuasively that relative poverty and lack of access to employment are not necessary concomitants of aging, but are the consequence of educational shortcomings and insufficient retraining. Demands for continuing education for the elderly and developmentally oriented learning opportunities will increase.

(12) Continued attempts will be made by government and concerned groups to break down the barriers of isolation. One such attempt could well be the development of service careers which cater to the total needs of the isolated or confined individual.

(13) Programs will be called for and developed to provide residential services, companionship protection, etc., for older citizens within a community environment. The emphasis will be to keep the individual out of the extended core center and in the community as long as possible. Small rural South Dakota communities might well serve as the test models for such programs.

(14) The changes in the magnitude of out-migration from South Dakota will reduce isolation and feelings of relative deprivation among the elderly as younger kinfolk remain in their locality. More sophisticated technology in communication and transportation services will further inter- and intragenerational interaction, as the machine substitutes for interfacial contact. The advent of new childbearing patterns, whereby the having and rearing of children is not conditional upon female fecundity, may delay parenthood until later years. In this event, a societal norm may assign child bearing and rearing responsibilities to the aged.

(15) Future voting impact of the older citizen will not become especially significant unless their number increases dramatically or they begin to vote as a block. As of yet there is little indication that either will occur. However, serious economic or health problems could bring about a change in these habits.

CONCLUSION

Today, one out of every eight people in South Dakota is 65 years of age and over. The people of South Dakota and the Nation must understand that most of the older Americans are individuals who have worked hard during their lifetimes, only to be retired by society when they reach 65 years of age. The elderly will play more significant roles in South Dakota and the Nation in the future. A consequence will be the expansion of human services for senior citizens and possible modifications in governmental and social policy and programs. We must remember through all this that the greatest need of the older citizen is the need to be needed.

Senator CLARK. Now I do want to say that we have some forms back on the table which are provided for any of you who would like to make

further comments or anyone who would like to submit any information for the record. It will be put in the printed record as if presented here. It simply says: "Dear Senator Clark: If there had been time for everyone to speak at the hearing in Sioux Falls, S. Dak., on August 18, 1976, on "The Nation's Rural Elderly,' I would have said," and then you write your remarks, sign your name, and so forth. You may take these home if you like and mail them to me. Our record will be open for about 30 days. We have to receive it within 30 days in order to have it printed.

Incidentally, anyone that would like a printed copy of these hearings, or the others that we are holding around the Midwest, please just give us your name and address and we would be happy to provide that for you, too, or give it to the center here and I am sure they will pass

it on.

We have about 2 minutes. I would like to try to take any questions. or comments from the floor. I wish we had more time, but I know that this room has to be used.

Let me just say that it has been very valuable to us; it has been very useful to us. I think we have had a great number of witnesses today and I think what we have seen, if I can just summarize it in 20 seconds, is that the unique problems, really of rural areas, have a great deal to do with mobility-with transportation. It does not make much difference if you have a hospital, a doctor, or some kind of health facility if you cannot possibly get to it. So transportation seems to emerge, at least out of this hearing, as being enormously important.

Also, the problems of health care. As we heard from one of the last panels, the problem is really one of getting some kind of extendersome kind of health care. It may not be a doctor, but some kind of health care must be made available in the smallest of communities, and we must have some kind of satellites around, at any rate, from the larger communities so that people could at least have the basics of health care. We have heard a good bit about nutrition programs, about how valuable they are, and the fact that they need to be extended. We have heard something about the problem of employment, particularly the Green Thumb program and how important that is-how valuable it is on reservations and in other parts of the State.

So I think we have had some good testimony, some testimony, in fact, that we really had not received before in either Iowa or Nebraska. So we are very pleased that you came and very pleased that you gave this testimony.

The hearing is recessed. We are going to Canton.

[Whereupon, at 11:45 p.m., the hearing was recessed.]

BUS TRIP TO CANTON, S. DAK.

[The following comments took place on the bus ride to Canton, S. Dak., in RSVP vehicle.]

Senator CLARK. How big is Canton?

ANSWER. 2,600. It has been 2,600 for a good many years.

Senator CLARK. How far are you from Iowa?

ANSWER. Half a mile.