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Mrs. WHEELER. Oh, yes.

Senator PELL. I understand that they don't like using the food stamps, why is that?

Mrs. WHEELER. Well, I mean we find people that use them—but they think it is charity. So what I do is to try to convince the seniors that it isn't charity to get their Social Security check-and the food stamps are just like that. The Government wants you to have them-so take them.

Senator PELL. How much reluctance do you find on the part of the older citizens to using food stamps !

Mrs. WHEELER. Well, like I say, it was hard to convince them. We talked to them and we keep talking to them. They might say no today but next week—if we keep talking to them—they will say yes.

Senator Pell. I would like, again, to have the audience participate here. I am not going to ask about your own case at all, so you can be perfectly objective in the matter. Those of you who think the Food Stamps program is a good program and can see the advantage-hold up your hands; those of you who think it is a poor program, and wouldn't take advantage of it. Those who approve it, hold up your hands. All right. Those that don't think it is good, and don't approve, hold up your hands. It seems pretty general.

Mrs. WHEELER. The food stamps, we have to go by guidelines; and that is, if one person makes $180 and they have $2,000 in the bankthe guidelines only allow them to have $1,000. I know what they spend the other $1,000 on. A lot of these seniors save their money for a burial-or, something like Mr. Jalette was talking about—a hearing

—a aid—and they are trying to save the money. They know they can't be helped from the welfare or Medicare, so they save this money for this. When I find them, they get on.

MONEY SHOULD BE SPENT ON NEEDS

Senator Pell. This is my question—what percentage of these people are holding on to some money for burial, when it should be spent on present needs?

Mrs. WHEELER. A lot of the seniors—like I just said-some of them have $8,000 in the bank and are living on $100 a month. Some have $4,000 in the bank and are living on $60 a month, and they are starving; but they won't take their money out of the bank because they are saving it for their burial. I know this doesn't sound right, but I tell them-instead of saving money for burial go see the undertaker man and make a contract with him, and use up that money-let's get on the food stamps.

Senator PELL. What is the average cost of the minimum contract? I agree with that advice of Mrs. Wheeler's, too. What would be the cost of the average contract for burial?

Mr. JALETTE. I recently took a survey on this, Senator, and the figure is around $850 for a decent burial.

Senator PELL. Does the audience think it is more or less? More.
Mrs. WHEELER. About $1,500, I think.

I don't try to get involved with the burial. I just tell them to call, you know, the undertaker. Some of them look at you cold; but, then they get the food stamps and they love me.

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Senator PELL. You have a lot of good advice. I thank you both for coming

Now, we have a final witness, Mr. John Symznkywicz, who was at one time in my office and now is the executive director of Woonsocket Family and Child Services and who has become a very responsible citizen and I believe he has a statement to make.

STATEMENT OF JOHN SYMZNKYWICZ, EXECUTIVE DIRECTOR,

WOONSOCKET FAMILY AND CHILD SERVICES

Mr. SYMZNKYWICZ. I am the director of the Woonsocket Family and Child Services, which is a United Fund agency, and I have a statement to read; but, because of the lateness of the hour, I will just submit it and hope that it will be entered into the record.

Senator PELL. Without objection it will be included in the full record.*

Mr. SYMZNKYWICZ. I did write down a few things here; and I hope, afterwards, that some of our older friends will come up and share their experience with the Senator. I must say that people in Woonsocket-particularly older people—are hard working people; very hard working people, who have made very great contributions to the growth and development of our country. They have fought in wars, they have raised children, they have produced goods and services that are necessary for our country's growth. The absolute minimum that our society can give these people, in return for this, is good and adequate health care. I don't really think there should be much question about the individual premium problem that older people have to pay—that should be eliminated. I think by their taxes over the years and their great contributions they have paid time and time again for that.

The Division of Aging, Mrs. Slater's organization, has done a study and they have made this recommendation. I was also a delegate and a speaker at the pre-White House Conference that was held in October; and that was the recommendation that I made there, too—to eliminate extra cost which you have to pay as a premium. I also think there is no question that the limit

for nursing home care and for home health care should be extended. I think there are controls on the local level. Miss Huggins and her nurses, for instance, are very competent professionals who aren't going to abuse that service—they can make objective decisions as to the need. I think the limit should definitely be increased in those areas. I also think that older people are entitled to an extension of the coverage to cover eye glasses, hearing aids, homemaker services, and auxiliary food care services. That is the minimum that we can deliver as a society to those people who have made this contribution over a number of years.

Our agency has a homemaker service program. This is a program used when an older person needs some help in the home. One of our homemakers-usually an older lady herself—will go into the home and help keep the home together; so that the person

can avoid having to be placed in a nursing home. We have many more people who help on a weekly basis, with shopping or just friendly visiting back and forth, so they can maintain their home and still be productive members of our society and our community. In 1970, we had 105 homemaker cases and half of them I believe 55—were older people. Now, of this 55 only half had their homemaker services paid by public assistance or Old Age Assistance. The other half had to pull on their own savings, with their own inadequate Social Security check, to pay for the cost. Now, none of these could pay the full fee. But even at 50 cents or a $1 an hour, for the homemaker service, this was a burden on them and the person who needed the service. Therefore, we would like to recommend-along the whole line of extending the services on the Medicare bill—that the homemaker services be included. The Division of Aging has made this recommendation, and the older people, the delegates to the pre-White House Conference have made that recommendation. I hope, Senator, that you will be successful in getting that bill passed that you are cosponsoring. Thank you.

* See p. 184.

PREPARED STATEMENT OF JOHN SYMZNKYWICZ Older people in Woonsocket and the entire nation have always been, and still are, hard working people. They have, through their work and labor, contributed to the development of America; struggled with her problems and contradictions, raised her children into manhood, fought her wars; and produced the goods and services that are crucial to a society's survival. They have been the engineers ; the doors, the people of action who have made America run. Older people today have the wisdom of hard experience and we should learn from their sweat and work, without which nothing we have today would have been possible. No one can question that their contribution has been indeed great. Because of this, older Americans should not be forgotten, should not be separated from the mainstream of society, should not be isolated, ignored or pushed around. A society or government that does not recognize the contribution of its older, hard working people can only be considered primitive; can only be termed backwards. Such a government that does not provide adequate and effective medical care, income, and social services for the very people who have made so many contributions and sacrifices could only be said to be barbaric—could only be seen as not truly working in the interest of the people.

Therefore, there should really be no question as to the merits of eliminating cost to the individual of Medicare, Part B, or of eliminating such things as fifty dollar deductables or 20% coinsurance provisions. There need be no real debate on extension of Medicare coverage to include a wider range of services. There should be no question that older people are entitled to the finest in dental care, podiatry, optometry, custodial health care, drugs, homemaker services, and diagnostic services. There should also be no real debate or opposition to extending the 100 day limit on skilled nursing care or the 190 day limit on mental health care. There should be no mention of making the older American pay a premium for such coverage—he has paid time and time over through his work and his taxes. We, and older Americans should not really have to be lobbying for these things; nor should older Americans have to be asserting various forms of political pressure and maneuver to get Medicare and Medicaid, and the health delivery system to meet their needs. Certainly the provision of health care when needed is the absolute bare minimum that the United States and its Congress can insure for those people responsible for its growth and development.

But we are here today to give our own opinions and share our experiences. Our agency, Woonsocket Family and Child Service, a United Fund agency, delivers homemaker services to families in need. This type of service usually is given in a medical situation—a mother might be in the hospital or recuperating from an operation for a period of weeks, or simply be too ill to carry on her duties as mother or wife; or an elderly couple or individual might be becoming infirm and in need of help to keep their home functioning. In situations like this, one of our trained homemakers, most of whom are experienced, aged people themselves, can enter a home on a regular basis and work with the residents to help with the housework, shopping, and cooking, and generally be a supportive friend and companion, and concretely work to keep the home together. In this way the household is not broken up, the children are not separated or placed in a foster home, nor is the aged person forced to enter a nursing home or other type of institution. In 1970, we handled 105 homemaker cases. Of these, 55 were with aged families. Usually, these families consisted of a single elderly person who usually had few relatives and friends, and who probably faced placement in an institution unless we were able to get a homemaker to visit them regularly. Many of these aged clients had their homemaker service paid for through Old Age Assistance direct vendor payments. Approximately half, however, either did not qualify for public assistance or did not wish to receive public assistance, and were forced to rely on their own resources for homemaker services. Full fee for such service is $1.85 per hour plus homemaker transportation costs. Very, very few of our elderly clients, struggling on inadequate and unrealistic social security payments, can afford to pay such a fee. Even with a sliding fee scale which lowers individual costs to perhaps fifty cents and a dollar per hour works an unnecessary economic burden on the aged person as well as the homemaker program itself. Such a situation, if allowed to continue threatens the existence of such preventive medical programs in the community, and without such programs, more and more aged people will be forced to continue living isolated, marginal lives, and be forced into nursing homes before it is really necessary.

I would therefore like to forcefully recommend that pending Medicare legislation be structured so as to include coverage of homemaker service, as well as home health aide care, as part of a comprehensive extension of medical services to aged Americans. I would simply like to reiterate and reinforce the recominendations of the Rhode Island Div. on Aging study, entitled, Aging in the Rhode Island Community, 1970, which pointed out the needs for such an extension of coverage in Medicare for homemaker services, foot and eye care, drugs, and custodial health care. I would also like to reiterate the recommendations of the delegates of the Rhode Island Pre White House Conference on Aging held in October, 1970 at Rhode Island College. As a panel discussion speaker, I was privileged to work closely with the aged delegates who hammered out a series of recommendations relating to health care and Medicare. Among those recommendations which I hope the Congress will give the fullest consideration were:

“Resolved that the Conference go on record as recommending increased benefits under the Medicare program, in particular that the Federal Medicare program be extended to include the cost of prescription medicine, glasses, dental care, dentures, podiatry, optometry, and hearing aids"

Resolved that the guidelines of the Federal Medicare program be liberalized to include homemaking services." Finally, I would like to reiterate the often desperate plight under which Older Americans are often forced to struggle, particularly in the areas of effective and adequate health care. I hope that you, Senator Pell, will take back our experiences in dealing with these very difficult problems, and that you will be successful in insuring the health needs of our older citizens, a cause which I know you sincerely champion.

Senator Pell. That is very good and it is a very specific situation that I would like to see included, only don't forget that it always takes a majority in both the House and the Senate to make something come into being. We sometimes try and pass the buck to the administration but, very basically, we in the Congress, when we want to do something in a major way, whether it be health for the aged or health care in general, or the war in Vietnam or wages and price controls, we have the power to do it but we sometimes lose some of our courage and don't do it and pass the buck to the President, and I hope that public opinion around the country will restore us the courage to take the steps in the Congress that should be taken if the administration itself will not do it.

Now, I want to open the meeting to any of you who had a particular idea or thought. Would you identify yourself for the court reporter, please?

STATEMENT OF MRS. TELLIER, WOONSOCKET Mrs. TELLIER. Senator Pell and my dear friend, John Skiffington, and all my friends from Kennedy Manor; I am here today, Senator, to tell you about what we call “Gay 90's.” I was hospitalized for 412 weeks and when I came back I didn't know anything about this, but they sent my lunch every Wednesday. If you think that wasn't a thrill—because I couldn't do it. I would like to take the opportunity to thank every one of the nice workers there; and, at the same time I thought of you, Senator, and I met you before and I am always with you, you know that. You are always welcome in Woonsocket.

Senator PELL. Thank you very much indeed.
Mrs. TELLIER. It is a good program and I hope it stays.
Senator Pell. We will do our best. Would you identify yourself!

STATEMENT OF JOHN KIRK, WOONSOCKET Mr. KIRK. My name is John Kirk. I am a member of the senior citizens group. One thing that I hope the Senator will include in his report today is that we are the victims of insurance companies in this country. Insurance companies dominate our Social Security benefits. We used to have $50 deductible and it has now been increased to $60. The cost of your Medicare has been increased. If you buy a home you have to deduct it; if you buy an automobile you have to deduct it. Senator Kennedy has said that the insurance companies throughout this country are putting up magnificent buildings, and they are wealthy people. What are they doing for us only abusing us !

What I maintain, and think should be done, is that the Administration on Aging in the Federal Government should be run as the Veterans' Administration is run. The Veterans Administration has been a credit to this country and has always helped in need. I would like to see this program follow the same procedure as the Veterans' Administration has done and eliminate these insurance companies. It would be far better for each and every one of us in this country who are served under the aid of Social Security or Medicare. Thank you.

STATEMENT OF MR. CORNETT, CUMBERLAND Mr. CORNETT. Senator, ladies and gentlemen; I think most of you out there have met me. As chairman of the steering committee of the State for the pre-White House Conference I met you up there with Senator Pastore; Mr. Hunt, from Boston; Mr. Williamson, from the Division of Aging—and so on down the line. I would like to put across to you something, if I may. It isn't what we say here—it is what you do after you get through talking about it.

Senator PELL. Amen.
Mr. CORNETT. I have been working on this now for 2 years. I hope

I that I am not stepping out of line but I want to get this across, if I can, for the simple reason that the White House conference will be in November and I hope to be there. I must say that I am quite thrilled about what is going on here in this building. The only thing I can say about this whole thing that is going on here—and what we are talking about here—is money. Every time I go into the Division of Aging

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