it is suggested that leaders in the private pension industry cooperatively take steps to bring about voluntary solutions to problems such as the need for early vesting, portability, survivors benefits, complete disclosure to participants, and fiduciary responsibility. It is suggested likewise that State and local governments take steps to strengthen their pension programs in the same manner.

With the modifications in Federal programs and the termination of the support of many Federal-State welfare programs, State and local governments are urged to commit monies from federal revenue sharing to assure that there is no curtailment in service programs that are basic to the income maintenance of older persons. Finally States should enact pass-along legislation to allow Social Security beneficiaries to retain more than the minimum $4 a month of the recent 20% increase in benefits when applying for welfare aid.

NUTRITION

The concept that proper nutrition is essential to good health is widely accepted but not commonly put into practice. Proper nutrition is far more unlikely among those elderly living on small incomes, alone or with only their spouses, in small quarters with limited space for food storage and poor food preparation facilities.

When shopping for food the elderly find that the foods, especially prepared foods, packaged in the small quantities suitable for their needs have the highest unit prices. Processors and retailers should be encouraged to develop packaging techniques and to take other measures so that "single servings" of foods may be sold at lower unit prices within reach of the elderly on low incomes.

State and local restaurant associations should encourage members to provide low-cost meals to the elderly at off-peak hours, a practice which would result in more efficient use of facilities and personnel and might even reduce food wastage.

The Nutrition Program established under Title VII of the Older Americans Act promises to provide meals fulfilling 1/3 or more of the Recommended Daily allowance (RDA) served in group settings through consumer contribution. The $100 million of Federal funding originally authorized for the first year, however, will provide only 250,000 meals daily for potential beneficiaries. States, through Revenue Sharing or other resources, must supplement the Federal funds so that the Titled VII Nutrition Program can benefit a much larger percentage of the elderly than can be assisted by Federal funding alone.

People receiving benefits under the Supplemental Security Income stand to lose substantial purchasing power when they will no longer be able to participate in food stamp and commodity distribution programs when H.R. 1 is implemented on January 1, 1974. In anticipation of this, States should enact legislation to set an adult assistance level such that recipients will receive additional purchasing power to offset the loss of food stamp and commodity assistance plus inflation.

Encouraged through leadership by State officials and agencies, local communities must increase the effectiveness of current programs without increasing their costs. They must also expand existing programs and initiate new programs which will serve the large number of elderly (more than 8,000,000) who can not be reached by currently proposed Federal funding for Title VII. The expansion of current and the initiation of new programs presumes the expansion of outreach

programs begun in August 1972 with the Federally-sponsored Project FIND. These developments must be based on a well organized, dedicated volunteer effort comparable to that which arose in this country under the stresses of World War II.

Volunteer efforts must be coordinated to prevent duplication of effort. They must be complemented by an efficient, dedicated, cost-conscious, well-paid group of state employees who will coordinate Federal, regional and state-wide projects with those projects developed at the local level and supported by volunteers.

The state agency employees and the leadership of the volunteer groups must monitor legislative action within states to make certain that Federal matching funds are not lost through oversight or failure to meet certain deadlines. Political lobbying is an important function of volunteers. Monitoring the manner in which Federal revenue sharing is disbursed within states and constant pressure on state political leaders to obtain a large portion of shared revenue for nutrition and allied programs for the elderly are essential.

Spelling out details for each state or jurisdiction is impossible. However, spotlighting a common denominator for all political subdivisions is certainly possible. This common denominator can best be described as attitude. An attitude which demands an end to malnutrition among the elderly, an attitude which insists on making good nutrition a key to eliminating the boredom, ennui and sense of living death experienced by millions of our aged is essential.

Attitude is not created merely by need of the consumers or by demand from their more knowledgeable advocates. It must be developed by an educational process among all age groups. Certainly, the well-nourished two-thirds of the nation's elderly need to be educated about their less fortunate fellows in the same age cohorts. They must learn rational methods of resolving nutritional problems and must be trained to refect appeals by food-faddists and quacks who victimize not only the well-to-do elderly but the poor as well. Education about aging as a biologic, sociologic and economic phenomenon should accompany education in nutrition and health for all persons regardless of age. Changing attitudes toward the elderly is possible; state and local efforts toward inducing this change through education are the keystones of resolving the nutritional and related problems among the aged today.

While some jurisdictions have taken deliberate steps to resolve existing problems on their own, many have postponed truly forceful action because of the long delay in Title VII appropriations by the Federal government. Such procrastination is most unfortunate.

Even with full Federal funding, Title VII will help resolve the nutrition problems of a small percentage of those in need. The remainder must be assisted by state and local action. Title VII should be regarded as an incentive to states and local communities to develop the attitudes and the programs run by volunteers which will, hopefully, in a few years care for the remaining of the elderly in need.

PHYSICAL AND MENTAL HEALTH

The delegates to the WHCOA strongly recommended that all elderly have access to basic preventive and restorative health services provided as a part of an overall community health care system. In addition they called for adequate preparation of professional personnel and also for techniques to finance facilities and programs needed for comprehensive programs.

Implicit in these recommendations was the recognition that many elderly have limited resources to meet their health needs, local systems of health care are non-existent or inadequately geared to meet the needs of the elderly, that there is an inadequate investment from any source in quality programs for the elderly, and that there is inadequate supply of interested, committed and competent health professionals in this field.

Calls for ombudsmen and concern about the quality of service further indicated a lack of confidence in the system and the ability of the elderly to negotiate it.

The Federal response to these recommendations is uneven. In some areas steps have been taken to meet some of these and in others there has been some retrenchment.

Local and State governments should examine the opportunities available to them to fill in lacunae in all these recommendations. Illustrative of areas of concern are:

1. The maintenance of effort and supplementation of medicaid, eligibility levels, the degree of cost sharing and the scope of services all lie within the competency of the state government to a large degree. There is a clear mandate from the Conference delegates that Medicaid payments and services, in particular, not be cut back.

2. It is estimated that up to 50% of those facilities which heretofore have given what might be called intermediate care will significantly fall below the standards of the Life Safety Code, modeled by ICF regulations. This along with the number of nonconforming skilled nursing facilities would seem to occasion the need for significant outlays of capital for the replacement of facilities. States might well take initiatives to create funding opportunities for approved sponsors to upgrade, replace beds or develop new facilities.

3. Various state licensures inhibit the maximum use of facilities and programs to serve the elderly and should be examined.