ACTION IN MAINE

Politically, it has been said that "as Maine goes, so goes the Nation."

With regard to the old-age problem, Maine ranks third in the percentage of senior citizens to total population, and it has taken steps to meet the challenge. A model home for old people in Sanford is replacing the antiquated city farm. Portland and Bangor have already accomplished this.

In Madawaska citizens are building the St. John's Valley Security Homea combination hospital and home for old people from towns throughout the valley.

At Thayer Hospital, Waterville, a geriatric clinic has a program of comprehensive medical care. A rehabilitation evaluation clinic is being set up. Last year 18 businessmen took over Passamaquoddy Village, a model town for WPA workers in the 1930's, and turned it into a craft and recreation center for retired persons. There is low-cost housing where senior citizens may live out a stimulating and interesting life.

AWARE OF PROBLEM

Mrs. Hazel Warren, executive secretary, Maine Committee on Aging, summed it up this way:

"Cities and even small communities are aware of the aging problem. Every day we get calls for consultations, suggestions, and material from throughout the State."

In the golden State of California, problems associated with the "golden years" are expanding because of the ever-increasing influx of retired persons. Enrollment was conducted last month in the "MD Plan-65"-a physician's approach to providing health insurance coverage for those aged with low or modest incomes.

California's was one of the many State medical society followups of the recommendation made by the American Medical Association house of delegates in December 1958, to adjust fees in order that needy senior citizens could avail themselves of health insurance protection.

Thus far, 22 different Blue Shield plans have over-65 insurance coverage in 19 States. There are five private insurance carriers offering special plans for the aged so that this type of coverage is generally available on a nationwide basis.

RETIREMENT HOMES

Californians also are busy providing retirement homes.

In September, construction will begin on Wesley Palms, a new $3.5 million, 40-acre Methodist retirement facility in San Diego. Approximately 400 oldsters will live there. The health unit will include a reception room, three examination rooms, and a physical therapy unit.

The Southern California Presbyterian Homes, a nonprofit corporation of the church, has two residential developments for the aged. In Pomona, plans have been made for a $3 million Congregational Homes project.

HOME, HOSPITAL

In the Midwest, Presbyterians have announced plans to build a 43-acre village in Evanston, Ill., where some 600 retired persons will enjoy the security of a home and hospital care.

Residents will make a downpayment and pay for operating costs monthly. The new system will be tailored to fit the savings accounts, pensions, and social security payments of many people.

Nebraska-a State nationally recognized for its long-living citizens—already has a retirement village on the outskirts of Hastings.

Called Good Samaritan Village, it is sponsored by an organization related to a Lutheran Church. The new town now occupies 50 acres and has available 450 apartments in one-story concrete structures originally used by Government workers during World War II.

Now under construction, or soon to be built with Hill-Burton aid, are a $1.5 million, 120-bed chronic disease center at Dodge County Hospital; a 38bed chronic disease center in Sidney; a 20-bed nursing home addition to the Cozad Hospital, and a 20-bed nursing home unit at Henderson Community Hospital.

The 90-bed Madonna Home was opened in Lincoln, Nebr., July 1, after renovation by the Benedictine Sisters, of Yankton, S. Dak.

CHRONIC ILLNESS

Plans are being discussed to build a chronic disease center adjacent to Lincoln General Hospital. The unit, estimated to reduce costs from $20 to about $8 per day for indigent patients, was recommended by Lancaster County's Medical Advisory Committee.

In Omaha, Immanuel Deaconess Institute (Lutheran) is campaigning to raise $250,000 for a unit to care for the chronically ill.

Montana is on the move in the Rocky Mountain area to meet problems of health care for the aged through programs best suited to its widely scattered population. Robert Munzenrider, director of the State's division of hospital facilities, says:

"We are making headway in the nursing home problem. There are 10 facilities being constructed or definitely in the planning stage."

He notes a trend toward combination general hospital-nursing home programs in Montana because of the sparse population.

HOMES INCREASING

Salt Lake City has an active geriatric program which is replacing the oldstyle infirmary care.

Salt Lake City also has Utah's newest facility to provide care for the aged infirm, St. Joseph's Villa. Operated by the Sisters of Charity of the Incarnate Word, it is a modern building offering cheerful, homelike living quarters for single or married persons.

State authorities report the number of homes for the aged is increasing and that the level of care is being improved because of the influence of civic and medical groups and a State law that requires inspection and approval of nursing homes.

In the Pacific Northwest, Washington welfare officials and medical leaders agree that providing health care for the aged is not too serious a problem be cause of very liberal State welfare laws.

The State's 23 medical-service bureaus, sponsored by county medical societies, all have over-65 programs. Rates and services vary, but all provide good coverage for the retired person.

Dr. Byron Francis, Seattle, chairman of the Washington State Medical Associations' Committee on Aging, says progress in the area shows that "something in the nature of voluntary health insurance can be worked out to provide health care for the aged, rather than requiring Federal aid or an extension of social security."

REDUCED RATES

Next door, in Oregon, the State medical society is coming up with a plan for prepaid medical and surgical care at a reduced rate for persons over 65 of modest income and resources.

Oregon's outstanding contribution to graceful aging is Willamette View Manor, a beautiful $2.5 million retirement hotel on the outskirts of Portland. Oregon Physicians Service provides residents with a comprehensive hospitalmedical-surgical plan at very low cost. Built by Methodists, it is open to everybody.

Oregon's retired teachers are planning a similar facility in the near future. On the opposite corner of the Nation, Florida, with its high concentration of retired people, is continuing its pioneer work to keep oldsters happy.

Gov. LeRoy Collins has a citizens committee on health, which has placed great emphasis on the study of problems of the aged. Research in aging is going on constantly at the Institute of Gerontology, Miami School of Medicine. Members of the institute are looking forward to the completion of an ambitious project which is being sponsored by the Lutheran senior citizens foundation. It will be a 60-acre site south of Miami, where residents will live in cottages surrounding a village green. Health care will be provided. Here the institute will conduct intensive research on aging.

LOW RENTS

Miami has planned two low-rent public housing projects for persons over 65. Maximum rent will be 20 percent of a person's income, with a ceiling of $30 a month and a minimum of $20.

At Pensacola, Luther W. Ratley, chairman of the senior citizens Village program of the Kiwanis Club, reports the club is acquiring 25 acres for a low-rent housing project. They plan to build apartments for 50 couples.

"We feel our local project is somewhat different from many other retirement villages," says Ratley. "It will be self-supporting and thereby help maintain individual responsibility and the dignity and self-respect of the individual." The Presbyterian Senior Citizens Home at Bradenton, now under construction, will accommodate 144 senior citizens.

Lanark Village, 65 miles southwest of Tallahassee, is a self-sustaining little city for oldsters which has a well-equipped health center. Developers are offering to subsidize a doctor.

MODEL VILLAGE

In the Southwest, a committee of over 60 Oklahoma City leaders-known as Senior Citizens, Inc.-is planning a model village for the aged.

It will be constructed on a 320-acre tract and will include a rehabilitation and convalascent hospital, workshops, a shopping area, parks, recreational facilities, and a chapel.

Senior Citizens, Inc., has set a goal to provide housing for 500 individuals within 5 years.

Also in Oklahoma City, work has started on a home to be built adjacent to the recently opened Baptist Memorial Hospital. It will include 60 to 65 individual brick residences, plus 4 dormitory-type buildings, a dining hall, a recreation area, and a park.

Briefly, these are highlights of other State activities in meeting the problems of an increasing old-age population:

Alabama.-Gov. John Patterson plans to appoint a council on aging. Episcopal and Methodist groups are spearheading help for the aged in Birmingham.

Arizona.-Last December, 200 representatives of civic and welfare organiza. tions attended the State's first conference on aging. Within the past 5 months, two surveys have been made of the old-age problem. State has new Blue Cross-Blue Shield program for people over 65.

Arkansas.-Fifty-patient Sparks Manor Geriatric Unit in Fort Smith was completed last November at cost of over $1 million. Programed this year is another 50-person Methodist nursing home. Arkansas Medical Society has agreed to the principle of accepting lower fees for the aged.

Colorado. State has some 150,000 persons over 65. Some 52,000 have sufficiently low income to qualify for State's liberal old-age pension plan. Pensioners have a $10-million-a-year fund for health care needs. On July 1, they be gan receiving limited home and office calls.

Connecticut.--In Hartford County, old and chronically ill patients receive medical care on sliding-fee basis through the Greater Hartford Home Care Plan. This is a privately financed organization administered through the city health department and community chest. Connecticut Medical Society has moved to provide lower fees for the aged and insurance firms have expanded policies to include over-65 coverage at generally lower premiums.

Delaware.-Gov. J. Caleb Boggs last month signed into law a bill to create a State division of the aging.

Georgia. A joint council to improve the health care of the aging has been formed. Patterned after the national joint council, it includes the State's medical, dental, hospital, and nursing home associations.

Indiana.-A day center for the aged, oriented on a general health basis, has been operating for a year in Indianapolis under the sponsorship of health agencies and a Jewish boarding home for the aged. In Allen County, the State board of health is cooperating with the Visiting Nurses Association in a pilot study to provide home care for stroke victims. Teachers are planning a retirement community on a 46-acre tract near Greenwood.

Iowa.-Most of the larger religious groups and fraternal organizations are operating homes for the aged. Newly established "Senior-65" plan provides prepaid medical and hospital insurance. State Health Department's Division of Gerontology, headed by former AMA president Dr. Walter Bierring, is promoting health-care programs at the community level.

Kansas.-State medical society has formed a committee on aging which is working with State board of social welfare to see if the aged can be cared for more efficiently in nursing homes than in hospitals. Four Congregational churches in Topeka are working on plans for an old people's home on a 10-acre tract.

Maryland.-State commission on aging was created this year to coordinate programs of agencies and departments.

Michigan. In April, an 11-member Governor's temporary commission on aging was appointed. An outstanding example of housing for the aged is Carmel Hall, operated by the Carmelite Sisters in Detroit. It is a former downtown hotel which was converted to give oldsters a complete recreational and therapeutic program. Presbyterian Village, a community for the elderly in Detroit, is another example of housing for aged. Michigan State Medical Society has recommended that Michigan Medical Service (Blue Shield) offer its contract to persons over 65.

Mississippi.-Blue Shield-Blue Cross package plan for senior citizens is now operating. In April, Kuhn Memorial State Hospital was dedicated at Vicksburg. It includes a $400,000 chronic care wing with 100 beds. The Nursing Home Association is engaged in a self-improvement program to elevate standards.

Missouri.-At St. Louis Chronic Hospital, Dr. Joseph P. Costello, Jr., medical director, and Joseph B. Shank, administrator, are working to get oldsters out of hospital beds and back on their feet. A center for senior citizens at the hospital encourages senior citizens to dance, play games, and just talk.

New Jersey.-Nine hospitals in the Newark area offer low-cost or free clinic care to the aged. Newark approved 500 low-cost housing units for the aged this month. State commission on aging has been established. Twelve of twenty-one counties have homemaker services, which provides trained women workers to help with family routines.

New Hampshire.—Medical society's committee on geriatrics is working closely with Gov. Wesley Powell in reviewing existing programs for the elderly and the need for developing new medical and health care facilities.

North Carolina.-Baptists have just built a $500,000 building for care of aged at Winston-Salem. Presbyterians are engaged in campaign to raise $750,000 for a similar facility at High Point. Duke University Regional Center for the Study of Aging is planning a $750,000 building for research.

Ohio.-Better Housing League of Cincinnati plans a 50-unit, motel-type, nonprofit, geriatric community. Cincinnati also is planning a downtown recreation center for the elderly. Montgomery County (Dayton) Health Department is studying the possibility of providing visiting nurse assistance for the elderly. In Toledo, unusual and beautiful apartment buildings-designed for retired people are under construction. The cluster of buildings will eventually form a retirement city of 2,000 oldsters.

Pennsylvania.-Last December, the Normandie Hotel in Philadelphia was converted into a "Retirement Hotel Club." Philadelphia Housing Authority just completed its first project for the aged. The city also recently saw the opening of a new clinic designed for older people. The Einstein Medical Center announced a new home-care program for the aged. Housekeeper Service for Older People is operating in Pittsburgh.

Rhode Island.-First administrator of the division of aging, Mrs. Roberta B. Brown, has been appointed.

Tennessee.-Asbury Acres, an 82-acre housing project for the elderly, is now under construction near Maryville. Supported by the Methodist Church, it will provide meals, recreation, and spiritual and medical help. Presbyterians in Nashville have announced plans for a senior citizens apartment building.

Texas.-State is tackling the problem of the aged, but officials admit they have a "long way to go." San Antonio Housing Authority is building an apartment unit for the aged which will have services of visiting nurses. A Texas Joint Health Council for Aging is being formed.

Virginia.-State established a commission on aging last year. The Richmond Council of Women's Organization is working on a plan called "meals on wheels." This program, tailored after one in wartime Britain, would supply the elderly with two meals a day.

West Virginia.-State Conference of Methodist Churches voted last month to sign a long-term lease for the former children's and orthopedic hospital at Milton. It will be turned into a residence and care center for the aged. Methodists will pay the town an annual rental of $40,000 for the buildings located on beautiful hillside. Gov. Cecil H. Underwood named a citizens committee to explore and report on problems to legislature.

The CHAIRMAN. Dr. Swartz, you are recognized.

Dr. SWARTZ. Thank you, sir.

Mr. Chairman and members of the committee, as Dr. Larson has told you, the medical profession is opposed to H.R. 4700, 86th Congress, now pending before this committee.

Before presenting my statement, I should like to thank the committee on behalf of the American Medical Association for the opportunity to testify.

The fundamental and overriding reason for the opposition of medicine to this legislation is that it would, in our opinion, result in poorer, not better, health care for the people of this country.

The American Medical Association's objective is, and always has been, to work toward the better health of Americans of all ages.

We are for all proper courses of action which will help us attain that objective. We are against any course of action which hinders or prevents it attainment.

As a doctor, it is my daily responsibility to help the aged, to treat them, to help them help themselves. And, believe me, gentlemen, one of the best ways to understand the problems of the aged is to serve them as a physician.

It has been my experience that the aged want just about the same things that all the rest of us do, to be part and parcel of their environment; to feel that their skills and talents have value, and can still be used, to be productive, to be loved, to belong.

There is no doubt about it. The problems of the aged are far broader than those of health alone.

Consider, for example, the field of employment where compulsory retirement policies often undermine the individual's ego, his will to live, his feeling of usefulness.

Able and anxious to work, he frequently finds his abilities no longer in demand. Unnecessarily placed on the shelf, he feels as if he has been cashiered out of the human army without rank, weapons, medals, or identification.

The public fails to realize that the older citizen continues to have many special needs in the fields of housing, in recreation, in finding acceptance and understanding within the community.

He also needs, above all, preparation in advance if his added years of life are to be full and rewarding.

These are not health problems, but they bear on health. And until society recognizes this, it will continue to consider in a piecemeal, hit-or-miss way, a problem that requires a broad, total approach.

Concern for these problems animates all thoughtful people. I can assure you that the doctors of the country are extremely concerned. For they know, as well as any group, that behind the array of statistics are individual men and women, that while each human being is alike, each is also very different.

And so when physicians hear broad statements about the problems of the aged, when they are asked to consider the across-the-board solutions that are proposed, they tend to apply the acid test of personal experience.

Would these proposed solutions really work?

Would they really help the people whom the doctor serves, the individual patients whose problems and needs he knows so intimately?