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icans, Hearings Before the Special Committee on Aging, United States Senate, Eighty-Ninth Congress, Part I-Washington, D.C., June 16 and 17, 1965.")

PROJECT'S BEGINNING

When the Well-Being Project began, a tandem of social workers and public health nurses were given a map showing the numbers of people over 65 in the three selected neighborhoods. They went up and down the streets looking for the human consequences of the statistics which the figures never show. These teams used the oldest techniques of the helping arts, practiced by the Curés in old France and by the workers in this country's early settlement houses-Hull House of Chicago and Henry Street of New York. As they talked with them on their porches, in their gardens and in their kitchens, they heard from the lips of the old people about their ideas, their interests, their fears, and their hopes. They saw the impact of the old world culture on the foreign-born in the westside area-frugal and suspicious. They saw the helplessness of those who sit in the city slums bereft of hope. They saw the boredom and dejection of those inappropriately placed in convalescent homes only because services to sustain them in their own homes are not available. Among the economically independent, these teams saw those in better homes deprived of the things that money cannot buy— good health, friendship, someone to counsel with and to guide them in times of personal stress or grief. The combined skills of our teams were available to all; and they went into action on-the-spot when problems were encountered.

LESSONS LEARNED

We believe that many of the lessons learned from the Well-Being Project can be employed in rural as well as other urban communities when given the proper climate and concern for finding new ways to protect the health, the safety, and the precious personal autonomy of older people.

We have found that concern is the important component. It means someone who cares-the architects of public policy; the purveyor of public and private health and welfare services; the doctor; the social worker; the nurse; the lawyer. It calls for knowledge and skill and integrity and compassion, and-above allthe ability and willingness to blend these skills and to marshall the kinds of help needed by the sick and impoverished aged.

We have found that regardless of advanced age or regardless of economic or social class, there is a fierce desire to remain in a dwelling of one's own among familiar and treasured possessions, no matter how meager.

Other lessons we have learned:

1. Advantages of services being accessible in immediate neighborhoods; 2. Disadvantages of geographic limitations;

3. Time and effort required and the need to reach out to the unserved; high value of immediate attention to calls for service;

4. Flexibility of structure—no formal policy to hamper delivery of service;
5. Need for professional competence of the highest caliber at all levels;
6. Value of the team approach;

7. Case examples illustrating Project scope-involvement of all segments of the community; individuals helped;

8. Obstacles encountered by the elderly in getting services from established health and social agencies.

The Social Security Act and its recent amendmendts, although presently fraught with ferment, represent a tremendous social advance in health and housing and personal services for the aging. As a social worker who worked face-toface with Detroit's aged before Social Security or private pensions, I knew the alternatives well. I often accompanied the aged to the welfare office and saw them herded into a black carryall (a polite name for the paddy wagon) and driven off to the County Home with its beautiful gardens and jail-like, red brick buildings surrounded by high wrought-iron fenses and locked gates where old couples were separated. The men's and women's buildings were far apart on the spacious grounds.

The legislative reforms have brought us a long way. As wonderful as this is, the full benefits will not be reaped until we remove the barriers which still stand between the elderly individual and needed services. We cannot be complacent while tens of thousands remain unreached and unserved. The greatest stumbling block is attitudes. As Senator Smathers has said, "Many people would probably

like to think that Medicare and Medicaid have solved the major health problems of the elderly."

CONCLUSION

We would never have gotten off the ground with the Well-Being Project without the generous contribution made by U.S. Public Health Service--both through financial support and professional consultation and guidance. I thank you again for allowing me to tell you about the program.

EXCERPTS FROM EVALUATION REPORT OF THE WELL-BEING PROJECT FOR THE AGING OF THE UNITED COMMUNITY SERVICES OF METROPOLITAN DETROIT

BY THE NATIONAL COUNCIL ON THE AGING

The objectives underlying the WELL-BEING PROJECT FOR THE AGING are set forth in the original proposal to the U.S. PUBLIC HEALTH SERVICE on March 17, 1964, as:

1. To develop methods of helping aging people maintain physical health while living in their own homes, and to prevent, as far as possible, the development of health crises.

2. To mobilize, coordinate and realign existing services to serve the aging. Sponsorship of the Project and responsibility for its day-to-day operations is by the UNITED COMMUNITY SERVICES, with Mrs. Mary K. Guiney, Planning Consultant, serving as the Project Director, and the funds administered by the UCS.

The financial support of the Project has been supplied by the Public Health Service through its Division of Chronic Diseases, Gerontology Branch, which allocated $79,420 for each of the first two years, beginning June 1, 1964, and $73,000 plus, for the third year which terminates May 31, 1967.

The operation of this Project is unique in that:

(a) Its officers are located in neighborhoods where it is felt the need of older persons is acute, and

(b) The staff assigned to each Project includes a trained Social Case Worker and a trained Public Health Nurse.

Two agencies work in close cooperation with the Project: the DETROIT HOUSING COMMISSION, through its Neighborhood Improvement Department which shares offices with the neighborhood staff and the VISITING NURSE ASSOCIATION which has assigned trained Public Health nurses on a loan basis to each of the neighborhood offices, and provides supervision for the technical nursing activities of these nurses. In addition, all of the health and social work agencies of the community are utilized by the Project both as sources of referral and as resources for the provision of services to clients or patients referred to them by the Project staff. Thus, the Bureau of Legal Aid is occasionally called upon to give legal assistance or consultation; the Family Service Agency is utilized for long-term counseling cases; hospital social service departments serve as both sources of referral and as a resource, etc. The list of agencies to which clients of the Well-Being Project have been referred occupies a full page, single space, in a recent report prepared by a consultant. That list includes public agencies such as the Detroit Department of Health, the Bureau of Social Aid for Old Age Assistance, Social Security Administration, etc., and voluntary health and welfare agencies such as hospital clinics. Neighborhood Service Organization, Homemaker Services, etc., and private physicians.

The organization of each of the neighborhood offices is unique. A social case worker and a public health nurse constitute the core of the staff together with a secretary-receptionist in the office. There is a second social worker assigned on a roving basis to all offices, and in all cases there is a social work student assigned by a school of social work. There is also an Advisory Committee in each Project office chosen from among the residents of the area served. These committees have been selected by the staff and include local merchants and articulate representatives of various types of residents living in the neighborhoods.

The operation of these offices has followed a fairly clear pattern. The three neighborhoods in which the services were established by the METROPOLITAN COMMITTEE ON SERVICES TO THE AGING were lodged in store front locations where visibility and ready accessibility were shared. In each instance the

store front office was shared with the staff of the NEIGHBORHOOD IMPROVEMENT SERVICE, a branch of the Detroit Housing Commission. Thus, the status of the Well-Being Project was established, and its relationship to the City's Neighborhood Improvement Program was indicated by the name of the Mayor on the window. In addition, the partnership between the Well-Being Project and the Neighborhood Improvement Office offered an opportunity for easy communication between these two forms of service. Once the office was established and the staff employed, they spent several months calling upon the older residents of the neighborhood. They located these residents through a variety of sources, such as churches, merchants, and other organizations in the area, and went calling door-to-door to inform the residents of the neighborhood of the existence of the Project and its availability to the neighborhood's older residents for any problem with which they felt they needed help. Circulars were distributed, group meetings were addressed by the staff, and altogether an intensive effort was made to acquaint the neighborhood with the Project.

It was not long after this intensive public relations effort was begun that applications for service began to come in; people dropped into the office, others telephoned, and quite frequently other agencies began referring neighborhood seniors to the Project for assistance not readily available from the established health and welfare agencies of the community. By the time the neighborhood office was in existence for a few months, the calls for service reached such proportions as to require the full time of the staff.

Gradually intensive public relations efforts were lessened, and concentration on services directed to clients became the major order of business. In addition, the Advisory Committees were selected and regular meetings by them and the staff established.

At the same time, the staff established a system of neighborhood meetings primarily focused on health education. Although the subject matter of these meetings was usually some phase of health care, the nature of these meetings was also social in effect. Residents attending them tended to dress up for the occasion, some of them contributed cakes and cookies for the refreshment period which always followed the more formal period of the meeting. The meetings thus have taken on the character of a semi-social occasion for which residents dress up and meet their neighbors as well as learn something of benefit to themselves.

PROJECT VALUE

The Well-Being Project for the Aging provides an excellent service in response to a genuine need. Its uniqueness lies, first, in the fact that the neighborhood offices are situated in stores located in the middle of neighborhoods where the services are given. Hence, the Project is both visible and easily accessible to the residents of the neighborhood. This has made for strong indentification of residents of the neighborhood with the Project staff-so much so indeed, that a frequent comment by older residents in the area is, "What will we do if this office is closed? You are needed here."

A second factor which affects the value of the Project is its staff structure. Combining services from the two professions, nursing and social work, has proved effective in meeting the great majority of the problems which are brought to the staff for solution. For cases where these two professions need other assistance as, for instance, legal or medical help, these are brought in on a case-by-case basis. An added factor which was clearly visible in each of the neighborhood offices was the high sense of dedication of the staff. Both the social workers and the nurses evinced enthusiastic response to the calls for help; they often left their home telephone numbers with clients who might have need of assistance in the evenings or during the weekends, and were not at all averse to making home calls after regular office hours, or on weekends.

There is a fourth factor which is valuable in this Project: the flexibility of its operations. The staff will go into the home of any client quickly and without any restrictions as to functional limits. This is unique in the organization of health and social agencies, where rigidity of function and procedures are sometimes a deterrent to the provision of services needed quickly and effectively.

RECOMMENDATION

It is recommended that a special autonomous socio-medical agency be organized to receive and disburse funds for the continuance of the Well-Being Project for the Aging. This agency should be Metropolitan in character; should have represen

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tation from the professions of Social Work, Nursing, Medicine and Law; should have a built-in research function for continuing self-analysis and evaluation; and should be capable of establishing close working relationship with all other ongoing services of the community.

This new agency should continue to experiment with ways of improving and meeting unmet needs.

Senator GEORGE A. SMATHERS,

MOST HOLY TRINITY RECTORY,
Detroit, Mich., June 17, 1967.

Chairman, Subcommittee on Health of the Elderly, Special Committee on Aging, U.S. Senate Building, Washington, D.C.

HONORABLE And Dear SenATOR: This letter is written in behalf of the petition made to the Federal Government to assist in the work done by the Well-Being Project, a program initiated by the Metropolitan Committee on Aging here in Metropolitan Detroit.

I am a parish priest in the Inner-City of Detroit and have followed the work of the Well-Being Project with great interest over the years of it's existence. I could enumerate many case histories in which their work is illustrated, but I cite only two. Their work seems to be most effective because it is not work that stays in an office and requires aged people to come to them. They are constantly seeking out those who are in the greatest need and their effectiveness has been very good.

The first case is one of an old woman, quite intensive alcholic, living in a horrible old house in squalor. By reason of the team work; the nurse, the social worker, and the secretary by repeated visits convinced the woman of her illness and her ability to live in better circumstances where she would have a fine room in a hotel designed for the aged, and good food. After visits to her that were friendly and gracious she saw the wisdom of this and left her house. The things she wanted were carefully picked up and packed for her. Whether she has surmounted the alcholic problem I do not know, but certainly she was very happy in her move and this was a most difficult thing. Other people had tried to get her to move without success.

The second case involves a very neurotic woman living in an extremely noisy apartment, crowded and unkept. Repeated visits to this woman convinced her that her health required a quiet place. The social worker then worked hard to get her aid budget moved up so that she could move to a fine campus living quarters called Kundig Center for the Aged. She is very happy there, her health has improved, and her outlook on the world has helped her conquer her neurosis.

There are similar cases but primarily the effect of this team work is most interesting because they constantly are in poor neighborhoods.

They have established a wonderful esteem for their agency and the word-ofmouth gives them so much attention and so much work that they really could benefit a great deal if your esteemed agency would help them establish more teams, not only in this town but in every Metropolitan Center where the aged are in such large numbers.

Respectfully submitted,

FATHER CLEMENT KERN.

Mr ORIOL. The subcommittee will hold future hearings on the subject, but we don't have a date at this time.

(Whereupon, at 12:55 p.m., the subcommittee recessed, to reconvene at the call of the Chair.)

APPENDIXES

APPENDIX 1

ADDITIONAL MATERIAL FROM WITNESSES

ITEM 1: INFORMATION FROM REPRESENTATIVES OF DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

A-MEMORANDUM UPDATING REPORT TO THE PRESIDENT

NOTE.-A Report to the President on medical care prices by the Department of Health, Education, and Welfare, dated February 1967, is printed in full beginning on p. 319 as appendix 3. A memorandum updating that report to June 22, 1967 was submitted by the Department of Health, Education, and Welfare at the request of the Special Committee on Aging, U.S. Senate as follows:

Now then, what effect has Medicare had on the costs of health care? It might be said that the Medicare and Medicaid programs are helping the elderly to avoid the difficulties others of our population are facing. Medicare is most effective in the areas where costs have been rising more rapidly-inpatient hospital care and physicians' services.

Recent Price Rises to December 1966

Between 1960 and 1965, medical care prices rose at a rate of between two and three percent per year. In 1966, however, the Medical Care Index increased 6.6 percent-the largest annual increase in 18 years.

The 1966 acceleration in medical care prices was largely accounted for by substantial increases in the prices of both major objects of medical care expenditures-hospital and physicians' services.

Hospital daily charges, which had been rising about 6 percent per year between 1960 and 1965, went up 16.5 percent in 1966 the largest annual increase in 18 years, since the post World War II inflationary period. The increase in hospital daily charges was particularly sharp in the second half of 1966-11.5 percent as compared with 4.5 percent for the first six months.

In contrast, physicians' fees, which had been rising about 3 percent per year in the period 1960-65, went up 7.8 percent in 1966. This was the largest annual increase since 1927. Physicians' fees increased 3.8 percent in each half of 1966. Drug prices have not been a major factor in rising medical prices. There has been no appreciable change in the drug component of the Consumer Price Index during the six-year period ending March 1967. The prices of prescription drug items in the CPI actually declined by almost 12.0 percent in the past six years. Drug industry sources give a slightly different picture than the Consumer Price Index. The average retail price per prescription, as reported in the American Druggist, increased at an annual rate of slightly less than one percent per year between 1960 and 1966.

The average prescription price reflects the use of new drug products, and changes in the quantities of drugs prescribed. In contrast, the Consumer Price Index reflects changes in the unit price of the same or similar drug items over periods of time.

PRICE RISES, 1967

In the first quarter of 1967, the rate of increase in medical care prices continued at about the same pace as in the last quarter of 1966. They rose 2.0 percent in the first quarter of 1967. While physicians' fees continued to rise at about the same rate as in 1966 (1.9 percent increase for the first three months of 1967), hospital daily room rates have continued to rise at a rapid rate, up 6.1 percent in the first quarter of 1967.

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