Hearings, Reports and Prints of the Senate Committee on Labor and Public Welfare

has nothing to do with the issue of separation of church and state, for it should be obvious that the welfare of the community is as much a part of the responsibility of the church as it is of the state.

We averaged ten meetings per week. Organized labor, civic association, fashionable matrons and retired domestics engaged enthusiastically in our program, telephoning and canvassing.

Statistically for the entire program we had 269 paid workers, 191-55 years and over, and 178 of these could be classified as poor. 644 volunteers participated, of whom 560 were 55 years and over. We mounted a telephone campaign from March 10 to March 31, reaching 125,000 people in the city; 10,600 of the eligible were contacted by speeches and other means; 109 meetings were arranged, with as estimated total average of 75 people per meeting. We actually visited 53,111 eligible people. The Community Aides personally signed 8,175. We used 16 interpreters, speaking Spanish, Italian, Polish, Yiddish, Russian, German and French.

We worked 29,591 hours at a unit cost of 70 cents per signature. Certainly few worthwhile programs in the history of the government can be classified as having such a small cost factor.

As a result of this program 25 of our Community Aides found steady employment; some of the older citizens have been used as teacher aides and some of the foreign language people found work in neighborhood businesses.

What does this mean in relation to the people in the program?

First, we developed an esprit de corps among the elder citizens which must not be lost.

Second, we were able to call upon their skills and experiences in many ways. For example, when Social Security gave us 9,000 cards belonging to recipients. we were able to use several retired postal employees to sort these cards not only by zones, but even to streets and blocks. We gained two objectives: utilizing skills, keeping old people working.

Third, the older people have ideas as to how to develop and continue to be of use in and service to the community. For example, in making their rounds they found many lonely, withdrawn older people. They felt that by two weekly visits they can assuage the loneliness, the heartbreak and the withdrawal which is all too prevalent among older citizens who for too long have been either ignored or neglected.

They were appalled at the conditions of these older people. Housing and general living conditions need rectification.

It is their idea that through such community efforts many of these people can be usefully returned to the mainstream of the community. They would like to supply radios for people who, because of failing eyesight, cannot watch television. They would like to be able to read to the deprived children to bring them further into the mainstream. They have suggested that they could in their visiting, bathe, clean, and even cook for some of these older people.

Through them all ran a concurrent theme of these ideas, the emptiness of lives and the aloneness of old age which these community aides found in their visits throughout the city.

Nor were these problems only among the elderly poor. The problems existed, they found, among the more affluent older people. Left to their own devices, devoid of companionship, deprived of simple homely interests through the neglect of too busy children, these older people throughout the city in all walks of life had demonstrably a somewhat haunted bearing. We strongly feel that our program did much to at least bring this out and for many we brought them out of themselves. Still 250 people was hardly enough to reach the thousands who must be reached. Ours is a rich country, rich in human resources; ours is a country with a rich culture. There is obviously a growing need and a challenging demand which must be met. Medicare Alert has tried to meet the challenge. We feel it was eminently successful as a beginning, but only as a beginning. Much more must bedone, much more can be done.

I. Findings of fact, opinions, and impressions

The following findings of fact, opinions and impressions stated at evaluation meetings are listed roughly in order of stress given by individual participants in their presentation or by the strength of their reaction to conditions observed. The order in no way reflects the weighting the elderly poor would give in expressing their own needs.

1. Most Aides, even those who are very poor themselves, were shocked at the abject poverty in which a great many of the elderly live. Many were more upset

that so many had no proper bed or bedding on which to rest, than at the dirt, the rats, the falling plaster and the thoroughly dilapidated houses sheltering many of the elderly poor.

2. All Aides reported on the almost complete isolation, the extreme loneliness and the almost bitter withdrawal of the elderly from the community, and they found that a large number of the elderly have no means of communication with the outside world except by word of mouth. They have no radio, no TV, no telephone. They cannot read the newspapers because they have no glasses to correct faulty vision, or have cataracts on the eyes, or are illiterate. This finding is true of the elderly in the city as well as in the rural areas.

3. The isolation goes deeper. The elderly poor feel cut off and rejected by the community around them. They complain that they have no friends, that relatives and neighbors seldom bother to visit or ask about them or their needs. They are withdrawn.

4. Most of the Community Aides are active church members. At some point or other, almost all of them realized that their own church and churches in general are unaware of the great need of the elderly and the contribution that participation in church life could make in breaking the ring of isolation most elderly feel.

5. The very poor elderly complained bitterly about their lack of money. They were particularly bitter that they were asked to spend $3 per month from an already too meagre income to buy a government insurance. "If the government wants to help, why doesn't it give the insurance instead of taking away $3 we need for food?", was the most frequent complaint. Many of the very poor refused to sign at first, giving as a further reason their inability to pay the deductible $40 and $50 of the two insurance plans. So why part with $3 of scarce food money.

6. The able-bodied complained that they were able and willing to work but could find nothing to do. A great many had stopped looking, believing the search for work was hopeless, and finding the experience too frustrating.

7. Most Community Aides reported a great need for the barest necessities, although complaints of the elderly poor themselves did not always mention these things. Besides radios, beds and bedding, the most frequently mentioned were clothes, shoes, furniture, cooking utensils and personal grooming needs such as combs, brushes, mirrors, shoe polish, tooth brushes and toothpaste.

8. The need for dental care was obvious. So was the need for eye-glasses and hearing aids.

9. Perhaps strangely, the elderly poor spoke of their present medical needs only casually, but the fear of crippling illness was so hauntingly present that, in the final weeks, most of the very poor signed for Medicare, although complaining the while that they really couldn't afford to spend "eating" money for medical insurance.

10. Some complained they couldn't read or write and expressed the desire to learn.

11. Most of the elderly poor are unaware of help that is available in the community and, without assistance and prodding, probably would not make the effort to seek outside help if they knew about it. They know that DPW exists but have no idea as to whether they themselves are eligible for supplementary grants. Many are afraid to apply. Very few had ever heard of the food stamp program. Even the few who have benefited from MAA did not realize that this is a continuing program of medical assistance for the needy aged. Many have legal problems but are unaware that free legal assistance is available.

12. Mental health problems were mentioned by only a few Aides. They seemed to expect signs of mental problems and so found them less noteworthy than other conditions they had not expected.

II. Summary of problems

The problems are easy to identify. They seem to fall within certain broad categories:

1. Insufficient income, often below the welfare level or the eligibility for food stamps or surplus foods.

2. Extreme isolation, loneliness and withdrawal from the community. 3. Identification of physical health needs and their correction, i.e., eye, mouth, ears, mental health.

4. Lack of some of the barest necessities for living and communication, i.e., beds, bedding, furniture, radios, etc.

5. Lack of knowledge of where to turn for assistance.

III. Programs that can be started immediately

A start toward meeting some of the needs of the elderly can be made immediately using presently available funds. Meanwhile planning and programming other more difficult projects that would require additional funding, can proceed. 1. Follow-up work is needed to ensure that the elderly poor who made initial enrollments in Medicare actually complete the enrollment, i.e. fill out the full application form and furnish proof of age. This is actually the responsibility of the Social Security Administration, but from our experience with Medicare Alert, it seems unlikely that all of the most needy elderly poor will be certified by July 1, 1966, unless we give assistance to the Social Security Administration. The elderly can be brought to small meetings in their immediate neighborhood to complete their Medicare enrollment. These same small group meetings can be used to open up the Public Assistance, Food Stamp and MAA problems. At these meetings and in home contacts, our Aides can get basic income and expenses information for each enrollee and counsel and assist them in applying and qualifying for these three forms of public assistance. At the same time other problems are sure to come to light and many referrals can be made to existing community resources. Here again, follow-up contact should be made to make sure the elderly get the needed assistance.

2. The churches can be stimulated into active work with the elderly; first in offering assistance in attending regular church functions, secondly in establishing weekday programs for the elderly, and thirdly in establishing friendly visiting and telephone committees. If as many of the small enrollment meetings as possible are held in churches, such meetings can help introduce the churches to other needs of the elderly.

3. Encourage the establishment of Senior Citizens Groups under various sponsorships, i.e. Recreation Department facilities, Veterans' Organizations, Service Clubs, churches, trade unions, Boy Scouts, Girl Scouts, social agencies, etc.

Assistance can also be given to existing groups to step up their recruiting and member participations. All groups should be encouraged to plan self-help activities in addition to their present social and recreation activities. They can set up welfare committees, visiting committees, home service committees, etc. A small staff to stimulate and help guide Senior Citizens Groups would greatly increase their effectiveness and rate of growth.

Note: If the proposed joint operation with Social Security is not possible, i.e. they refuse to allow our Community Aides to participate in enrollment procedures, an alternative procedure would be block meetings directly on the subject of welfare, food stamps and MAA.

IV. Longer range programs

The programs here listed require more time to develop and would need additional funding. Much information such as income level, expenses for rent and food, known medical needs, etc., can be gathered by Community Aides as a part of their activities listed in Section III above. Such information is needed to help evaluate the real need for specific programs and to help tailor the exact scope of services. This list of programs is not all inclusive, nor is it intended to indicate that each and every program should be developed in the Washington Metropolitan Area.

1. A well-rounded area program for the elderly poor of a limited area with Garfield Terrace facilities as the geographical focal point. This should be a model or demonstration project including: a geriatic clinic to inventory the physical and mental needs of the elderly, a visiting nurse program, a homemaking service, an employment service, a counseling service, a recreation and an education program.

2. A Senior Citizens Manpower Corporation, as a cooperative employment agency, managed and run by the elderly.

3. A radio and TV Loan Service. Loan sets to the elderly, replace them as needed, thus maintaining contact. Ideally, repair and maintenance should be built into a manpower training program in electronics, an area of manpower shortage.

4. A program to supply certain basic necessities, such as beds. Collection of contributed items, santizing, repair and maintenance could be contracted to Goodwill industries.

5. Service project: provide assistance in shopping, transportation to hospitals, baseball games, some home-making assistance and training, etc. This could be a combined project employing both elderly and youth.

6. Block organization of the elderly as well as their integration into existing block organizations. One of the functions of such block organizations would be to inventory the needs of the elderly.

7. Develop leadership for Senior Citizens Clubs.

8. Explore possibility of "meals on wheels" project for sick and shut-ins. (Possible also as a small busines venture).

10. Job training for the 55 and over group in marketable skills.

11. The establishment of "drop-in" centers in areas where the elderly poor make up more than 10% of the population.

12. Learning and study projects at various levels of reading skills.

ITEM 2

APRIL 22, 1966.

Memorandum To: Mr. W. Grinker. From: W. Cook. Subject: Medicare Alert: Preliminary summary of findings of need in elderly populations and suggestions for immediate and long-range programs. Operation Medicare Alert had as a strong secondary purpose the finding and the recording of the physical location of the elderly (age 65 and over), especially the elderly poor and the securing of definite impresions regarding their expressed needs and their observed needs. The information thus gained was intended as source material for developing useful programs to meet the discovered and known needs of the elderly poor. While no specific facts or observations were gathered for the age group 55 to 65, it seems safe to assume that most of the needs of the 65 and over group also largely apply to the 55-65 group.

The facts, impressions and opinions included in this report result from:

1. Attendance at contractors' staff meetings, conferences with Project Coordinators, Team Captains and individual Community Aides, attendance at meetings of the elderly poor developed by various Medicare Alert teams for Medicare enrollment, and observation of many team members at work in the field.

2. Report and evaluation meetings held with each of the 15 teams separately during the first ten days of April to get a first-hand report from each Community Aide and Team Captain. Representatives of the respective contracting agencies participated in these meetings, and in many cases volunteers and representatives of cooperating agencies were included. Individual Community Aides and Team Captain participated actively in the discussion for two hours or more. Experiences described were very similar from team to team; however, individual reports of Community Aides and Team Captains varied considerably in form and in factors stressed.

1. FINDINGS OF FACT, OPINIONS AND IMPRESSIONS

1. Most Aides, even those who are very poor themselves, were shocked at the abject poverty in which a great many of the elderly live. Many were more upset that so many had no proper bed or bedding on which to rest, than at the dirt, the rats, the falling plaster and the thoroughly dilapidated houses sheltering many of the elderly poor.

3. The isolation goes deeper. The elderly poor feel cut off and rejected by the community around them. They complain that they have no friends, that relatives

and neighbors seldom bother to visit or ask about them or their needs. They are withdrawn.

5. The very poor elderly complained bitterly about their lack of money. They were particularly bitter that they were asked to spend $3 per month from an already too meagre income to buy a government insurance. "If the government wants to help, why doesn't it give the insurance instead of taking away $3 we need for food?" was the most frequent complaint. Many of the very poor refused to sign at first, giving as a further reason their inability to pay the deductable $40 and $50 of the two insurance plans. So why part with $3 of scarce food money?

8. The need for dental care was obvious. So was the need for eyeglasses and hearing aids.

9. Perhaps strangely, the elderly poor spoke of their present medical needs only casually, but the fear of crippling illness was so hauntingly present that. in the final weeks, most of the very poor signed for Medicare, although complaining the while that they really couldn't afford to spend "eating" money for medical insurance.

10. Some complained they couldn't read or write and expressed the desire to learn.

12. Mental health problems were mentioned by only a few Aides. They seemed to expect signs of mental problems and so found them less noteworthy than other conditions they had not expected.

II. SUMMARY OF PROBLEMS

The problems are easy to identify. They seem to fall within certain broad categories:

1. Insufficient income, often below the welfare level or the eligibility for food stamps or surplus foods.

2. Extreme isolation, loneliness and withdrawal from the community. 3. Identification of physical health needs and their correction, i.e. eye, mouth, ears, mental health.

4. Lack of some of the barest necessities for living and communication, i.e. beds, bedding, furniture, radios, etc.

5. Lack of knowledge of where to turn for assistance.

III. PROGRAMS THAT CAN BE STARTED IMMEDIATELY

A start toward meeting some of the needs of the elderly can be made immediately. Meanwhile planning and programming other more difficult projects that would require additional funding, can proceed.

1. Follow-up work is needed to ensure that the elderly poor who made initial enrollments in Medicare actually complete the enrollment, i.e. fill out the full application form and furnish proof of age. This is actually the responsibility of the Social Security Administration but from our experience with Medicare Alert,

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