Appendix I. Questionnaire on research in aging.... Question No. 1. Is there an imbalance in amounts being spent on medical-biological research on aging as over against social Question No. 2. Is there a need for improving the governmental procedure of grants and public investments in aging research? Question No. 3. How much should be expended on "policy Question No. 4. Should large block grants be encouraged?__ Question No. 5. Are you satisfied with the nature and composition of research grant and study awards committees?__--- Question No. 6. What should be the relationship between govern- mental and private foundation investments in aging research?. Question No. 7. Is aging research such a new and emerging area that financing and encouragement for researchers in this field Question No. 8. How much should be invested in aging research Mr. MCNAMARA, from the Committee on Labor and Public Welfare, submitted the following REPORT together with MINORITY VIEWS SUMMARY AND RECOMMENDATIONS "The status of the individual must remain our primary concern. So begins the report of the President's Commission on National Goals, published in late 1960. The gradual but revolutionary changes in the age structure of our population make this principle more important than ever-especially to our senior citizens. We have created a society in which most individuals survive well beyond the years they spend in gainful livelihood, and continue to contribute to the progress of their local communities and their Nation as a whole. Our changing population pattern dramatically reveals more and more persons living to see their own children become grandparents. In only a brief 10 years, since 1950, we have witnessed an increase by 1 million in the number of women who have become elderly widows, with no increase in the number of men who have become elderly widowers. Every sign on the superhighways of modern medical science points to further gains in longevity for elderly individuals at the older ages. When we contemplate these and other trends it should be no wonder that the primary concern of this subcommittee not only is with the status of the individual who today is designated as "old" but also with the status of the individual who tomorrow, or the next day, or next year, will bear that label. The subcommittee's 1960 report and this present report of 1961 both contain extensive information on the status of America's older men and women- a status which for the most part corresponds neither with their desires or needs. Nor do they correspond with the goals and ideals which we have established for ourselves as a prosperous, compassionate people. The recommendations flowing from these two reports signify a major effort on the part of the Congress to establish a coordinated series of actions and programs aimed at correcting and improving the status of the Nation's growing population of senior citizens. Such recommendations should be based not only on systematic examination of interrelated factors; the actions and programs they envisage should also be flexible without being erratic. The problems they attempt to tackle cannot be viewed as if they were merely a repetition of old and "normal" phenomena which we have always had with us. If there is any underlying theme in the work and deliberations of the subcommittee, it is that we are faced with a new set of social and economic conditions in which an unprecedented number of older citizens increasingly find themselves. It is in this spirit that the subcommittee presents the following recommendations which give first priority to passage of medical insurance for the aged through social security, includes new legislative proposals for 1961, and concludes with recommendations for enactment of specific bills introduced for action in 1960. A FIRST PRIORITY I. Financing the provision of health services Without question, the primary problem of our increasing population of retired older citizens remains the question of meeting the costs of basic health care at a time when their income is low, potential or actual illness or disability at its peak, and the relative cost of health services, enormous. The following chapters on health status and on the income of the aged population demonstrate this clearly. 1. As a first priority for 1961, the subcommittee recommends that legislation be enacted to provide for the financing of a balanced program of health services, including hospitalization, outpatient laboratory diagnosis, skilled nursing home care, home health services and, within actuarially feasible limits, part of the costs of expensive medicines, for all retired elderly persons, under a separate insurance fund to be collected and administered by the Social Security Administration. As part of the same legislative proposal, the subcommittee includes as eligible for health benefits, not only those retired senior citizens covered by the OASI system, but those who were never able to achieve such coverage. The cost of including the group outside of the OASI system will be covered by appropriation from general revenues. The net cost to the Federal Government will be relatively small since most of the funds will be offset by present Federal expenditures for medical care under old age assistance, medical assistance for the aged and other programs. The extension of the social insurance principle embodied in the social security program (OASDI) to finance such a health care program is firmly believed by the subcommittee to be the logical solution to this No. 1 problem of retired elderly men and women. It is the most efficient and economical solution; it is aimed at preventing and reducing dependency in old age; it will be uniform in application; it will ultimately protect nearly all retired older citizens; the recommended benefits are based on the desire to prevent illness and to restore truly adequate health levels, as much as possible. NEW RECOMMENDATIONS FOR ACTION IN 1961 In the second year of its activities, the subcommittee considered additional areas dealing with the improvement of the lives of aged Americans, present and future. It makes the following additional recommendations: II. National Institute of Gerontology The findings of research, both basic and applied, hold the brightest promise for the future well-being and usefulness of older persons. The spectacular success of medical and biological research in overcoming polio, in attacking tuberculosis, diphtheria, smallpox, and pneumonia, hold similar promise for preventing or ameliorating the diseases of old age. Research in the social sciences can pave the way for sustaining the vibrant, productive contributions of older persons, rather than relegating them to passive dependency. The crucial thing is that progress in the modern world depends in large part on science and the scientific method. eaten *** Science is something that enters into all the minutiae of life. We cannot brush our teeth without it. We cannot eat or drink without science coming in to tell us what should be It tells us how to blow our noses and indicates with whom we may shake hands and whom we should avoid. There is hardly a point in life at which science does not tell something about the conduct that is an essential part of our living.1 The several sciences have actual and potential contributions to make in the slowly, but definitely emerging fields of geriatrics and gerontology. But they need a large-scale stimulation to coordinate, expand, and hasten the specific application of research methods in these fields and to make known the results of such inquiries. The shortcomings that now exist in funds, personnel, and in the nature of most grants for age-related research, call for a major improvement if we hope to avoid a hit-or-miss, wasteful approach to the problems of an aging population. What is needed is a program of long-term research projects adequately financed and directed, on a coordinated basis. 2. The subcommittee recommends the establishment of a National Institute of Gerontology with a staff of competent scientists from the biological, physical, and social sciences. It further urges legislative support for an improved program of well-financed research and training at the Institute, and through grants, at other research organizations, especially universities, for the systematic development of interdisciplinary research programs in geriatrics and gerontology. III. Multipurpose senior citizens centers Good health and adequate income are the first two important goals of aged men and women in our country. But even with these goals partially achieved, there is still the problem of the use of retirement time. It is easy to assert that an aged person's family should serve as the circle of his social relationships and activities. But many older persons have no such families for this purpose; other aged find that their adult children cannot completely fulfill this purpose and a need exists for useful activities beyond the family circle; and finally, many 1 G. H. Mead, "Movements of Thought in the Nineteenth Century," University of Chicago, 1936, p. 603. older persons prefer to include in their activities others of their same generation-in such groups age is not a stigma or a barrier to full recognition as an individual. Above all, older, retired persons need a place where they can continue contributing to their fellow men through important voluntary service in their home communities. Unfortunately, at the present time, the opportunities for such participation and for such voluntary activities are lacking, despite the notable exceptions in various parts of the country-examples of which are described in chapter VI. 3. The subcommittee recommends that the Federal Government join with States, localities, and nonprofit organizations to stimulate and help finance senior citizens centers with qualified staffs and with programs of education, recruiting, and training for community service, counseling, and other activities in keeping with the needs of older citizens. IV. Mental health and aging One of the end-products of the current low status and relatively deprived position of so many aged persons in our society is the high rate of mental disorders in the upper age groups, disorders that are not always associated with physical changes in the organism. This situation has led to disproportionately high rates of admissions into mental hospitals among the aged. One out of every three persons admitted to a mental hospital today is 60 years of age or over. While the proportion of patients under 65 in mental hospitals has decreased in the past 20 years, the proportion over 65 has increased by 40 percent. The tragic element of this trend is that we have much of the knowledge through proven research to either prevent hospitalization in the first place or to discharge early approximately half of the admissions. To do so, however, requires a heavy investment in trained personnel to undertake early diagnosis and treatment right in the community and to give intensive treatment in hospitals. It also requires available facilities as alternatives to mental institutions such as day and night hospitals, clinics and social services so that a person can be helped right in his own home. In this manner we can make the investment pay by restoring huge numbers either to productive activity or to more independent living. The subcommittee believes that an effective attack on mental illness should be met by a cooperative Federal-State-local sharing of the financial burden. This conclusion is also the major recommendation of the monumental report of the Joint Commission on Mental Illness and Health, Inc., which was established by the Congress and given $1.5 milllon to undertake a 3-year comprehensive study of mental illness and mental health. Over 30 organizations, including the American Medical Association and the American Psychiatric Association, participated in this historic study which recommended that the Federal Government join the States in a financial breakthrough of such proportions as to be commensurate with the size and quality of the problem. 4. The subcommittee recommends a program of Federal grants to the States, utilizing the well-accepted Hill-Burton formula, to provide necessary community mental health facilities for prevention or early treatment of mental health problems of older persons in their home |