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2. Employment and maintenance of income

This committee's principal concern is with determining the need, finding opportunities, and securing resources to help older people continue to be employed. Its achievements to date are:

(a) Appointment of subcommittee to obtain information from individuals and employers, and to explore ways and means of providing employment opportunities and services for older people;

(b) Obtaining cooperation of Indiana Employment Security Division for establishment of an employment registration and placement service for those over age 65. The job placement service was inaugurated on October 24, 1957. Services rendered as of February 20, 1958, are 51 registrations, 71 interviews, 21 referrals, 15 job placements, and 18 employers' use of services; (c) Acquaintance of local employers and prospective employees with the plan for Senior Achievement, Inc.

3. Fact finding and research

This committee, in cooperation with the university, is concerned with the planning, coordination, and conduct of various community surveys. To further its work:

(a) Subcommittees have been appointed to meet with, to evaluate and to assist in the preparation of the surveys which are being planned by the committees ;

(b) A special census to determine the actual population of Bartholomew County was completed. The census project is the largest undertaking of the foundation to date. It involved organizing the county into township and city block areas in order that canvassers would be contacting people in the vicinity of their own homes. Subdivisions were set up in each of these areas and each was led by a chairman who received special training for this purpose. More than 600 volunteers contacted about 10,000 families in the county.

The information obtained from the census has already proved to be valuable to some groups in the community. Some representatives of city, county, and township school systems have been able to pinpoint several specific problems related to expansion and future development and therefore have been better able to deal with these problems.

In addition, one of the major benefits is that many of the canvassers learned more about their community and became aware of the problems connected with the aging and the aged in Bartholomew County. Drawing on data from this census, several research projects have already been started, such as:

(1) Survey of attitudes of the high school students toward the aging population;

(2) Poll of the attitudes of adults by decades in relation to the aging; (3) A study of leisure time activities for individuals who have lived 10 years beyond the expected life span ;

(4) The development of an instrument for measuring attitudes of the adult population.

The census project was completed with the preparation and distribution of a report on the census of Bartholomew County in December 1957.

(c) Reports outlining the factual information desired by each committee have been prepared and submitted to the university, and are the basis for the proposed survey.

4. Health (mental and physical)

This committee is primarily concerned with studying the health needs and related problems of the individual, availability and use of community resources, and additional services and facilities required to meet the needs of the growing number of older persons in the county. This committee has progressed by(a) Exploring data relative to health problems of the aging and the aged;

(b) Appointment of liaison representatives to all committees;

(c) Appointment of subcommittees for program, recruitment, projects, and statistics;

(d) Group experience in thinking through and developing information needed to plan for health needs of the aging and the aged;

(e) Preparing a schedule of questions for securing information about health problems of individuals;

(f) Undertaking an analysis of community facilities available for health services.

5. Housing and living arrangements

The purpose of this committee is to study and evaluate needs and desires of older and retired people as related to housing. It also seeks to determine how housing for them can be improved. Its activities to date include:

(a) Preparation of a questionnaire for a housing survey in the area of institutional and private housing;

(b) Joint meetings with the health committee;

(c) Appointment of liaison representatives to other committees;

(d) Sponsoring of community meetings on housing for the general public; (e) Cooperation with county official bodies in developing plans for a new county home.

6. Recreation and leisure time activities

This committee is concerned with investigating the need for additional recreational programs and facilities for people of retirement age and with planning to meet these needs. To date, this committee has—

(a) Compiled and submitted to the fact finding committee a list of questions to which answers are needed for effective long-range planning;

(b) Sponsored a fun fest for senior citizens, at which questionnaires on areas of interest were filled out;

(c) Appeared before the park board to inform them of programs and plans of this committee;

(d) Secured the cooperation of the city department of parks and recreation;

(e) Cooperated in a general community meeting on recreation.

7. Religion and retirement

This committee is concerned with collecting information about the churchrelated activities of individuals and programs and services for the elderly presently provided by various churches. This information will be available to all churches as an aid in planning programs to meet the needs of the elderly. This committee's accomplishments include:

(a) Study and preparation of a list of questions to secure information about individuals and church programs for the elderly;

(b) A public meeting on "Church Members in Later Maturity," held to focus the attention of the community on some of the problems of the aging and the aged;

(c) Meetings with the ministerial association for the purpose of interpreting the aims of the foundation and enlisting the cooperation of the churches.

WHAT ARE THE PRESENT PROGRAM PLANS?

The seven study committees are continuing their analysis of the problems of the aging and the aged. Program plans currently being initiated by the several committees are:

A. Public meetings on special topics as determined by committees, to be conducted in cooperation with the adult education division of the Columbus city schools;

B. The forming of subcommittees to collect information and to initiate studies and projects;

C. Recreation programs for the aging and the aged as a demonstration of need;

D. The sponsoring of a social recreation leadership institute of general community interest in cooperation with the Indiana State Board of Health;

E. The instituting of a series of craft classes in cooperation with the Columbus Department of Parks and Recreation;

F. Collaborating with the Bartholomew County Health Council with respect to problems of the aging and the aged in the conduct of its current evaluation of community health facilities;

G. Contacting the elderly about the extent of their participation in church activities;

H. Creation of program subcommittees responsible for developing interesting content and variety in method at all levels.

I. Continuation of the current series of preparation for retirement discussion groups, with plans for a repetition of the same series in the fall.

J. Continuation of the employment registration and job placement service in cooperation with the Indiana Employment Security Division.

K. Establishment of a work project for senior citizens, such as Senior Achievement, Inc.;

L. Continued study and evaluation of the activities and accomplishments of each committee.

The interest of the community is not only reflected by citizens participation on the study committees but also by the character of the continuing organization which has been created by a representative group of civic leaders. The committees, in their planning, anticipate involving an increasing number of citizens in the activities of the foundation.

Eventually, through the processes of group study and action, and through involvement of many individuals, it is expected the citizens of Bartholomew County will have a better understanding of the problems of the aging and the aged.

WHAT MAY WE EXPECT AS OUTCOMES?

A. Better appreciation and understanding of the conditions and problems which arise as a result of aging and retirement from work;

B. Knowledge of how to work together more effectively to meet community problems as they arise;

C. Realization that all individuals have problems with which they must make adjustments for effective living;

D. A better understanding by individuals of what they can do to prepare themselves for later life;

E. Achievement of positive attitudes toward retirement from an individual and a community point of view.

F. Better use of community facilities and resources by the aging and the aged;

G. Information basic to providing facilties and services necessary to meet the problems of the aging and the aged;

H. Development of a model community self-study guide;

I. Accumulation of data and the reporting of a total experience which may be useful to other communities.

WHAT IS THE VALUE OF COMMUNITY PARTICIPATION ?

The means of arriving at the end result often is as important as the result itself. The processes which the community uses will determine its success in reaching the ultimate goals. The sharing of experiences and exchange of data among committee members, community groups, and agencies create a better understanding of the problems of the aging and the aged.

The power for meeting situations and achieving results rests in the ability of the people to express themselves, to communicate, and to learn how to utilize other resources in addition to their own initiative for finding solutions to problems.

The retirement study project in Bartholomew County may be viewed as a genuine grassroots activity, indicating that the community is willing to take the necessary steps to solve its own problems. In the light of past occurrences, there is no question that the community also has the ability to solve these problems. As this study progresses and knowledge is gained, it may well serve as a basis for studies by other communities and may help them in problem solving. If so, its results will be felt throughout the entire State.

But in Bartholomew County there is hope for more than statistics-there is hope for a better community in which lives can be lived to the end with satisfaction and enjoyment.

STATE AND NATIONAL SIGNIFICANCE

Community self-studies such as the citizens of Bartholomew County are engaged in appear to be rare. Inquiries from various Indiana communities have indicated a strong interest in knowing how they are going about it, not only in factual findings but in program framework. It is anticipated that the

data and experience gained in Bartholomew County will prove useful in the development of other similar programs in many counties of Indiana.

The Indiana State Commission on the Aging and the Aged has from the outset evinced great interest in the study. Inasmuch as the State commission's funds do not permit establishment of community projects, the Bartholomew County retirement study is serving the commission as a laboratory and as a pilot project.

It is our further belief that the information and data garnered in Bartholomew County will prove of value to many other communities in the United States and to the whole "aging" movement.

Nationwide attention has already been attracted in many ways, as illustrated by the recognition given to this study by the U.S. Department of Health, Education, and Welfare in the February 1958 issue of its publication, “Aging.”

INSURANCE FOR THE AGED

The physicians of Indiana have offered to the people of Indiana since 1946 a complete hospital, medical, and surgical insurance program. This protection has been available to all regardless of age, color, or creed. It has been available to all without regard to physical condition, and no physical examination has been required. It provides for complete payment for a semiprivate room in a hospital and full payment for all hospital services, regardless of cost. It provides for all professional services in the hospital, as well as emergency outpatient hospital services. In addition, it provides for payment for surgery in the hospital, home, or physician's office, and for the physician's call on the patient in the hospital for medical cases, surgery calls being covered under the surgery section. This program costs a single individual $7 per month or the family of two or more $12.40 per month.

Under

We are, therefore, of the opinion that H.R. 4700 does not meet the need nor solve the problem for the people who are covered or eligible for coverage under social security. We firmly believe it is only a vote-getting mechanism and a means to further increase the tax burden upon the people of this Nation. present findings on a national basis, less than 1 percent of the people will receive benefit from this program, and even that benefit will be limited. The truly indigent will not be covered, as the great majority of them are not participants in social security.

We believe further study should be made of the people falling in this age group, and that such study should be made upon a local basis. This is the only true means of finding what problems, if any, exist, and then intelligently developing a program to met any found problems.

We believe the proposals in H.R. 4700 are ill advised, unrealistic, and usurp from the people the right to exercise their own initiative in solving their needs at the local level. Therefore, we respectfully request your committee to continue to hold this proposed legislaton until such time as the communities of our Nation have an opportunity to complete work now being undertaken. Private initiative, self-reliance, and human ambition have been the strength in building our great Nation-not confiscatory taxes and Government paternalism. We work as doctors of medicine to extend the life and improve the health of the people of America-we do not subscribe to any program which would bring about moral decay in the self-reliance and self-initiative of these same people. Let us think about ways to rebuild our Nation and our people to new ambitions and new strength, and stop the weakening process which is a part of paternalism. We, the medical profession-and we feel we can say the same for the religious groups and the people of every community throughout the land-can assure you those who are unfortunate will not be allowed to suffer in want. But we believe we can accomplish this better and more economically than it can be done by Federal legislation.

Thank you for the opportunity to present our views.

TESTIMONY OF GLENN R. PETERS, M.D., ON H.R. 4700, THE FORAND BILL Mr. Chairman and members of the Ways and Means Committee, my name is Glenn R. Peters. I am a doctor of medicine, practicing surgery in Kansas City, Kans., and am currently president of the Kansas Medical Society. I am

grateful for the opportunity Mr. Mills has afforded the medical society I represent to express our view on H.R. 4700, the bill intending to provide certain medical and hospital benefits to that segment of our aging population that can qualify under the social security program.

The Kansas Medical Society and I, personally, as a physician, hope the committee will see fit to reject this measure upon the grounds that have already been presented to you by representatives of other medical societies. These include the radical expense Mr. Forand's proposal will incur upon the public, the deviation of this proposal from the standards of democracy upon which this Nation was founded, and the demonstrable fact that the benefits here offered can more adequately and more economically be obtained through other means. I wish to support the views of spokesmen from other medical societies on those arguments and beg to discuss only the last-mentioned point—the fact that other programs can offer a more adequate solution at less cost than is to be provided in the bill now under your consideration.

First, by way of introduction, may I remind you that no one will deny the existence of a problem with reference to health care of the aged. We also admit to the argument that this problem is as yet in large measure unsolved. We must remember, however, that the problem is a new one which was not even anticipated when the present aged population was building its retirement program. In 1900 life expectancy in the United States stood at 49 years. The jump to 70 years was never seriously expected until it had suddenly been attained. So the problem came upon us before we were prepared to meet it. Even this is not as disastrous as may be deduced from statistics. I know that the aged ill are being cared for in Kansas. I know they will continue to be cared for and that the ability to pay is not a prerequisite for medical attention. Therefore, it is contrary to fact in my State to suggest this bill must pass if the aged are to escape neglect by the medical profession.

We believe the aged do not want charity, and we propose they do not need charity, even when offered in the disguise of Federal assistance, whether it is doled to them from the right hand of welfare or by the left hand of social security.

All over this Nation, and that includes the State of Kansas, people are now becoming dedicated toward giving our aging population a solution that will leave them independent and will retain for them the dignity of choice in their health care. In direct opposition to some public expression on this subject, I am convinced the average senior citizen would still prefer to handle his own affairs if the way to do so might be shown him.

The suddenness with which this problem came upon us left everyone unprepared, but we have reason to be encouraged over the enthusiasm with which all segments of the population are exploring the subject. Today, we do not have the answer, but the answer will be found, and it will be a better solution than here offered under H.R. 4700. Of that I am sure. I am sure, also, that this better solution cannot be achieved if the present bill is enacted into law because the sheer magnitude of Federal intervention will stifle free enterprise.

So it appears to the Kansas Medical Society that the Federal Government can afford to take a long and serious look at what is being tried, that calm judgment should rule on whether such efforts have a reasonable chance for success, and that the gentlemen on this committee should weigh with care the question of whether the Federal Government would serve the aged better by assuming their obligations and prescribing the circumstances of their care or by assisting local or private projects that could function if a stimulus were offered.

In Kansas we are trying a variety of experiments and will attempt still more in a most sincere effort to solve this problem. Commercial insurance companies, national as well as local in scope, are now searching statistics for an estimate of the basic cost for health care of the aged. We have a firm commitment from some, and believe others will follow, that they will write such insurance at cost with no profit to the company if the medical profession will contract to make this a service, as contrasted with an indemnity plan.

In Kansas we already operate a service program under Blue Shield, and I believe I know Kansas physicians well enough to gamble they will do this for the aged population, also, if the fees for service are at least reasonable and if insurance companies will prepare contracts with realistic benefits. We are spending many hours on this effort and believe a low-cost insurance-type program can be evolved that the aged will like, that the insurance company can sell, and that the physician will respect.

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