is a little more complicated in the rural area, which implies that you are actually going to have more health services; you are also going to have to determine whether it is economically, effectively, and efficiently better to bring services to people or bring people to the services. This, of course, raises the problem of transportation, because in either direction you need transportation. There you have trade-offs between the time and the expense of the person bringing the service, and the cost of the transportation of bringing the large numbers of people to the service. There are some interesting experiments where there are interesting and involved systems of transportation that bring people to the county seats for 1 day a week in which it provides as many services as possible. Then in the evening bring the people back in a big circle and then you have emergency service on the other days of the week serving those counties, and so on.

I think there are all kinds of fascinating experiments. I am hoping that gradually the information on the referral system to the national clearinghouse could arrange for the exchange of that. An interesting technique, for instance, is setting up a nutrition site in a kitchen of a large farmhouse and bringing six, seven, and eight people from the surrounding area who have meals cooked by the farm lady. And somebody from some central office comes up to provide the services.

Mr. BRYAN. The rural people need the recreation and the socialization perhaps more than the urban people do. The urban people have more means to get to social services, and they have more services available.

Mr. SCOTT. I think it is interesting to note your analysis of the original intent of the Older Americans Act in relation to how the various State units on aging have found themselves lodged within the State bureaucracies, where some of them do maintain somewhat of an autonomous stance and have tried to influence, across program lines-be it mental health, et cetera, versus other State units that have found themselves within a welfare department, a social services department, or an umbrella agency-to identify, simply as another social services program, but responsible only for aging.

I think it is a very interesting comparison from State to State as to how people perceive the purposes of the State units on aging.

Mr. BROTMAN. We had hoped to recommend to the State units-but at that time we were a part of the Welfare Division of HEW and could not get the recommendation out.

Senator CLARK. Without objection, the prepared statement of Mr. Brotman will be inserted into the record now.

PREPARED STATEMENT OF HERMAN B. BROTMAN

My name is Herman B. Brotman. Prior to my retirement from the executive branch, I was an assistant to the Commissioner on Aging; currently, I am a consultant to this committee. I have been asked to take as few minutes as possible at the start of this panel discussion to summarize some basic data to highlight the differences between urban and rural aged. To this end, I have prepared six tables to accompany this statement and request that they be incorporated into the record.

The data relating to health come from 1972 health interview surveys by the National Center for Health Statistics in HEW; the remaining data comes from the 1970 dicennial census conducted by the Census Bureau. The Census Bureau defines rural areas as places of less than 2,500 persons. Farms are defined by a

combination of acreage and dollar value of sales. If there is time later in this session, I should like to say a word about the difficulty of finding data classified by urban-rural definitions and the census preference for a metropolitan-nonmetropolitan classification.

Table 1 shows that older persons, like the rest of the population, are more than 70 percent urban but are very slightly more prevalent in rural areas than is true of younger persons. Black and other nonwhite older persons tend, to a greater extent than the white, to live in urban rather than rural settings. Much higher proportions of older than younger persons are foreign born with the highest proportions in the “others” and in the whites and they are most prevalent in the urban

areas.

Table 2 shows that the rural aged tend to be somewhat younger than the urban aged and that the preponderance of women among the aged is much more marked for the urban aged than for the rural.

Table 3 shows that the urban older women tend to be widows while the rural older women tend to be wives. The vast majority of older men are married with wife present regardless of location.

Table 4 presents what is commonly considered one of the best single indicators of overall status on an average basis, i.e., years of schooling completed. As might be expected, females have more schooling than males, older people have less schooling than do the younger, and the rural aged have less schooling than the urban aged. It is interesting to note that while the younger rural farm population has less schooling than the younger rural nonfarm resident, the reverse seems to be true for the aged.

Table 5 presents a summary of income situation by computing the proportions of elderly living in households with total incomes below the official poverty threshold for that specific kind and size of family. In addition to the fact that about twice the proportion of older people are poor as compared to the under-65, the very highest proportion of poor are found in the rural nonfarm areas, then comes the rural farm, and finally the urban—in which still one in eight family members and every second older person living alone or with nonrelatives is poor.

Table 6 presents an overall indicator of health status by showing the impact of chronic conditions on mobility, the ability to get around. Unfortunately, these data are tabulated by metropolitan-nonmetropolitan areas rather than urbanrural but it is safe to infer that rural suffer more interference with mobility and will need more services in this regard than will the urban.

TABLE 1.—PERSONS OF ALL AGES AND 65 PLUS, BY RESIDENCE, COLOR, AND NATIVITY, 1970

TABLE 2-PERSONS OF ALL AGES AND 65 PLUS, BY RESIDENCE, BY AGE, AND SEX RATIO, 1970

TABLE 3. PERSONS AGED 65 PLUS, BY RESIDENCE AND MARITAL STATUS, 1970

TABLE 4.-MEDIAN YEARS OF SCHOOLING FOR PERSONS AGED 14 PLUS AND 65 PLUS, BY RESIDENCE AND SEX, 1970

TABLE 5. PERSONS AGED 65 PLUS LIVING IN "POOR' HOUSEHOLDS, BY RESIDENCE, 1970

TABLE 6.-MOBILITY LIMITATION DUE TO CHRONIC CONDITIONS, PERSONS OF ALL AGES AND 65 PLUS, BY RESIDENCE IN STANDARD METROPOLITAN STATISTICAL AREAS, 1972

1 Does not need the help of another person or a special aid but has trouble in getting around freely. 2 Able to go outside but needs the help of another person or of a special aid such as a cane or wheelchair in getting around.

Senator CLARK. I know some of you have planes to catch. I thought we might close with Mary Ellen Lloyd. She has some film slides for us to view. They are not home movies, but they are on Virginia. Please proceed.

Ms. LLOYD. If you have any questions as I show them, please ask. This is one of our Head Start kitchens. It shows the CAP agency components working together.

We have five transportation aids and one of them is a cab driver. We use one agency vehicle; otherwise, they use their own cars. Mr. SCOTT. What is that blue object?

Ms. LLOYD. Oh, that is a waste basket made out of—

Ms. MYERS. No, the box that

Ms. LLOYD. It is a waste basket made out of egg cartons. Is that what you mean?

Dr. MORRIS. We could not make it out.

Ms. LLOYD. That is one of their craft projects.

About 67 percent of our participants are female. However, this particular site is about evenly divided.

Volunteers help at the site. We have a site supervisor for each site, but she could not do it alone.

Next one.

FELLOWSHIP AT PROGRAM SITES

The most important aspect of our program is the fellowship. They are really having a good time.

We can go rapidly through these. They show some of our activities at the site. That is an old game called fox and geese that has been revived.

This is a game that is called Dutch shuffleboard. We brought one unassembled to each site, and the participants sanded and sealed it and put it together. It is popular with both the men and the women.

This is a fancy scrabble game. It has a revolving base. This site has three or four scrabble games going at once.

At this site they use as many household items as possible for their crafts. They use all kinds of plastic bottles and tops. Like that little vase with the flowers. The vase is a bottle top. These can be done very cheaply.

The women love to make quilts. They do them to give away or to sell. These were for Head Start children.

Here are the ditty bags they made for the Veterans' hospital.

Representatives from the Virginia Commission for the Visually Handicapped gave this program. They are demonstrating talking books to a lady who is legally blind, and here they are showing a gentleman how to use a letter guide.

From time to time ministers come to preach.

These two gentlemen and this lady are participants at the site and they take about 15 meals to the homebound every day. Here they are visiting with the people to whom they have taken a meal. Sometimes the homebound become involved in the crafts being done at the sites; for instance, they might make a square for a quilt.

They often have to drive way out into the country and walk through the mud to get to some of the homes.

This was Senior Citizen Day at Dublin Community College and some portraits of happy senior citizens. They had box lunches for everyone. They all really dressed up. They had up to 200 people that came to the Senior Citizens Day-140 of them were from the nutrition sites.

She won the prize for being the oldest; she is 95. She is very active. These were just a couple of happy people I took pictures of. Senator CLARK. Very good.

We appreciate all of you coming. We look forward in working with you. Thank you for coming.

Mr. BRYAN. Thank you Senator. We appreciate the opportunity. [Whereupon at 2:55 p.m. the hearing was adjourned.]