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The Older American is different in one respect from all other Americans. He is older. He has more years behind him. He may have special needs because of these years. So may we all when the years of our life accumulate.

Thus, when age makes its unavoidable demands on our bodies, we may need help from our neighbors. If we can no longer live alone, we may want a specialized home but one that is a home, not just an institution. Or we may want to stay in our own house and hope that others will continue to make our house a home. Again, the Older American, despite his age, wants to live like the rest of us-in a home-his own home if possible, if not, a place that he can call home. Is this asking too much? To live at home?

Homemaker Services

Meals on Wheels

Visiting-Nurse Services

Other Home-Care Services

most part, such services are spotty, fragmentary, not nearly adequate to the need.

Two general categories of services and living arrangements are needed: Services in the home and services in nursing homes and homes for the aged or foster homes.

SERVICES IN THE HOME

Services in the home should include such aids as homemaker services, meals on wheels, shopping aid, visiting-nurse services, and counseling and other social services.

Homemaker services usually consist of sending a trained woman into private homes to help with shopping, cooking, and cleaning, perhaps to help the older person dress and get about the house, and to provide a friendly link with the outside world. The homemaker may be needed only a few hours several times a week, or she may come more regularly.

It is a flexible service and a beacon of hope to many aged people. But there are homemaker services for the aged in only 40 States and in only 134 communities. Even where the service exists, the number of homemakers actually available is often very small.

The prospects of expanding these services appear encouraging, through both voluntary organizations and public agencies. Starting on July 1, 1963, 75 percent of the costs of such programs can be provided by Federal funds in local public assistance programs. Also, funds for research and demonstration projects in this field are available to health and welfare agencies.

A homemaker program for older people in every community is now a reasonable goal, a justifiable hope.

Meals on Wheels is the usual term given a variety of portable meal services by which warm meals are made available to older people in their own homes, usually once a day. But at the last count, only 25 of these programs were in effect.

This service is sometimes combined with shopping aid and homemaker service. The combination makes it possible to help both those who like to prepare their own meals and those who need to have them prepared.

Visiting-nurse services have been provided in most urban communities since 1900, but many more visiting nurses are needed. Their job is to check on the physical condition of the older person, to be sure his medicine prescription has not run out, or to provide any other care that might be needed and that they can professionally give.

In a few communities, coordinated home-care programs are offered in order to extend many hospital services directly into the home. Under such programs, the older person's needs are met primarily by his family, with the help of a team of professionals-nurse, doctor, social worker, nutritionist, and physical or occupational therapist. In 1960, however, only 33 such programs had been established in the United States.

Even broad home-care services do not assure everything a disabled older person may need. He may require a friendly visitor, or legal protection of one kind or another. If he is receiving public assistance

or other financial aid, such help may be readily available, but, otherwise, he or his family may have difficulty in finding it.

Information and referral services are of great assistance to older persons and their families, but again complete services of this kind are offered by only a few communities. For the older person, more is frequently needed than the information and advice. He may also need help in getting to the agency which can assist him, or he may need guidance in order to avail himself of the services set up for him. Casework services, while a part of the total welfare program, are only beginning in many places to be extended to persons who are not currently receiving public assistance.

Recent changes in the social security law have broadened the possibility of these services reaching people whose needs are not complicated by lack of money for the basic necessities. But in far too many places today no casework or counseling services exist for other older people or those concerned with their care.

Even if adequate community services were available—which would permit many older Americans to remain in their homes long after their physical abilities had diminished-some would eventually need more supervision or more intensive care than can be. brought into their homes.

The next step for some would be a special type of home, such as a boarding home, group-care residence, foster home, or home for the aged or in many cases a nursing home.

HOMES FOR THE ILL OR DEPENDENT

Homes for the aged, foster homes, and other group residences today give hope that a much better situation will exist in the future than we have seen formerly-when all too often the home was institutional in character and provided little more than basic shelter and food to the residents. We see, today, experimental designs and imaginative architecture, and the development of programs of services that show much more regard to the very real needs of older people to enable them to live with dignity and in comfort.

Church groups and fraternal orders have been leaders in pioneering new concepts and designs in varied types of housing for the elderly. The Federal Government has played an important role in the program of mortgage insurance for residential facilities, in working with local housing authorities to build public housing especially designed for the elderly, and in the direct loan program of the Community Facilties Administration to assist in construction for low-income residents.

In 1961, more than half a million older Americans lived in 23,000 nursing or other types of homes providing nursing or supportive services.

Many of these nursing homes, unfortunately, are unsatisfactory by any modern standard. Many are converted residences. Many are deteriorated and actually unsafe. The number of "acceptable" nursing-home beds is far short of the need.

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Source: Adapted from 1959 survey of 8.977 patients. Pennsylvania Department of Public Welfare, "Costs of Providing Care in Pennsylvania Nursing Homes and Related Facilities," November 1961.

Chart 9

All States have licensure programs for nursing homes. Because of the shortage of well-designed, well-equipped, and well-staffed homes, however, the licensing standards often represent scarcely minimal requirements.

The Public Health Service defines the various kinds of homes serving the aging according to type of care provided:

• Skilled-nursing homes which provide skilled nursing care as their primary and predominant function. In 1961, there were 9,700 of this type with 338,700 patients.

• Personal-care homes which primarily provide domiciliary or personal-care functions but may also provide some skilled nursing care. In 1961, there were 11,100 with 207,100 residents. • Residential-care homes which have primarily residential or sheltered-care functions but which also provide some skilled nursing care. In 1961, there were 2,200 with 47,000 residents. Very few of even the best skilled-nursing homes provide restorative and rehabilitative services.

Yet, there is evidence that physical rehabilitation for chronically ill bed patients over 65 could restore many within a year to ambulation and partial self-care and that many so restored would not require continued institutional care.

Some of the inadequate medical-care and restorative services in nursing homes are due to the traditional attitude toward them as the last stopping place, the point of no return.

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