Now, Senator Smith, you are on this committee and you are very familiar with the problems as they face the Federal Government. I just say this: As I see it there are three points that we who are in the Federal service need to know and want the facts as best we can get them on this subject of retirement income.

First, whether nursing homes are being well run or not. Now all who are here know that in the old days hospitals and hospital care were very much less expensive than they are today so that people could stay longer in the hospitals if they had to and then go to their homes in relatively better physical condition. Now today hospitals are so expensive that people cannot afford to stay in them for a very long period of time so that they want to go or may have to go to these homes where they can get care and yet not have as an expensive overall daily cost as they do at the hospitals. So what we want is a greater number of these nursing homes rising. We want them well run, we want them safely run. We know that there have been several bad accidents in this State, one I think in this State and several elsewhere, and we want them to have as little, if you want to call it that, as little overall regulation that will hurt their services rather than help them. That is one point.

Now the second point is that, as we all know, there are more people becoming older and staying reasonably healthy but needing care in their old age. So there are a greater number of people who desire this care in homes. Perhaps they cannot afford their own home or they have children with a large number of grandchildren, so that they want to go somewhere else in their older age. That is another point that involves us in the Federal Government.

Then the third point of course, as Senator Smith and I know from our experience in the last session and the session before, is the question of aid to the elderly, whether that should be on the social security basis or whether it should be on a volunteer basis. That brings up a very important problem that we will face in this session of the Congress.

So we have these three points that really come down to the basic fact that there are more elderly people today in our State and in our Nation than there were 15, 20, and 25 years ago. How are we going to look after and help those elderly citizens to a healthy and happy old age and at the same time not burden them, burden our administration either State, local or national-with too much regulation.

Now I know that my colleague, Senator Smith, has studied this subject in Washington. I am confident that you ladies and gentlemen who are here today will help him to reach a thoughtful conclusion that he will bring to his colleagues in Washington as to what we are doing here in Massachusetts, what we can get Federal assistance to do more properly and helpfully and at the same time keep our elderly people in a contented and happy and healthy basis.

Senator Smith, I thank you very much for this opportunity to be here with you today. I am sure that this hearing will bring fruitful results to you and to all of us in the Federal service.

Senator SMITH. Thank you very much, Senator Saltonstall, for your very fine remarks. We certainly appreciate your taking the time to join us today.

Our next witness this morning will be Mr. Richard Steinman, Committee on Aging, Community Services of Greater Worcester.

It is a pleasure to have you with us, Mr. Steinman.

STATEMENT OF RICHARD STEINMAN, PROJECT DIRECTOR, COMMITTEE ON AGING, COMMUNITY SERVICES OF GREATER WORCESTER

Mr. STEINMAN. Thank you, Senator.

Mr. Chairman and members of the committee, I am Richard Steinman, project director, Greater Worcester Project on Aging, Community Services of Greater Worcester, Mass., Inc.

In August 1960, in competition with 120 other American communities, Community Services of Greater Worcester was honored by the Ford Foundation with a grant to demonstrate, over a 3-year period, sound methods of organizing community services for older people. Among the seven communities to receive these grants Worcester was the only one east of the Mississippi River.

I came to Worcester in 1960 to direct this project, and it will interest you Senators from Massachusetts to know that the whole nationwide project is being conducted under the leadership of the Florence Heller Graduate School for Advanced Studies in Social Welfare at Brandeis University.

My remarks will be divided into two parts: First, reflecting the work of those I represent; and secondly, stating positions which are not necessarily those of Worcester citizens but which I judge would be helpful to the Senate Special Committee on Aging.

PART I

Citizen leaders of Worcester are working to increase the well-being of nursing home patients by promoting closer working relationships between nursing home operators on the one hand and the medical and welfare community on the other. By reducing mutual suspicion and enhancing cooperation between nursing homes and services their patients need, it is believed that patients can be more individually selected for nursing home care, more vigorously restored-once in a nursing home—to maximum functioning, and more actively helped to return to community life as a result of therapy prescribed and received. There is documented experience that approximately 25 percent of the patients in a chronic illness facility can be rehabilitated significantly.

Very simply, we recommend-and are striving to demonstrate in Greater Worcester-that the nursing home become a part of a network of health and welfare services enabling older citizens to remain in or return to their own homes or comparable private homes. This network would consist of the physician and social worker (reviving the time-honored but now all too little practiced home visiting of their respective professions); the dentist whose testimony was very rewarding this morning; the visiting public health nurse and the licensed practical nurse whose services are ever-increasingly devoted to the aging and chronically ill; the physical and occupational therapists whose value to the patient in his own home the community has

hardly begun to grasp; the homemaker whose availability in the United States lags shamefully behind that in our sister countries of Western Europe; the nutritionist who, when permitted to, sees and alleviates the half starvation (which frequently opens the gates to disabling illnesses) of many older people living in lonely isolation, whether in the centers of our crowded cities or on far-removed farms; and the therapeutic recreationist, librarian, and friendly visitor who bring meaningful diversions and companionship into the patient's home.

I would like to mention here how pleased I was to hear Mr. Connelly testify about the recent work conducted under State auspices and with his federation's cooperation, concerning attempts to provide therapy and recreation to nursing home patients. There was some question about what this might cost, and it might interest this committee as well as those working on it here in Boston to know that Connecticut has started a program whereby the State provides 60 cents per day per patient in nursing homes for the sole purpose of serving those patients with therapeutic recreation. This demonstrates the importance that the Legislature of Connecticut attaches to the therapeutic recreation for these patients.

A significant number of patients could be saved by such a network of services from ever having to enter nursing homes or hospitals.

In the opinion of Dr. Samuel Bachrach, chairman, Committee on Aging, Worcester Community Services, the nursing home can become an important steppingstone back to some degree of independence for from 25 to 50 percent of older people entering nursing homes. There would be certain patients who could return from hospital to community by way of nursing homes if the latter would serve as halfway houses offering the network of active therapy described above. Thus the patient could again be on his way toward being on his own: in a rest home, a foster home, a group residence, a hotel, an apartment, or a relative's home.

In other instances Dr. Bachrach suggests doctors might refer their patients directly to nursing homes for treatment and convalescence. The Senate committee can readily see the concomitant effects this would be likely to have on the availability of hospital beds, thus helping to lessen the need for hospital expansion.

PART II

The following are comments which, in part, are my individual judgments, and not necessarily those of Worcester Community Services.

This work of Worcester's Committee on Aging suggests exciting opportunities to nursing homes: opportunities and challenges. A question of key importance-and I hope it is eventually answered in the affirmative-will be: Can the proprietary nursing home, operating as it does as a profit-making business in the great American tradition of free enterprise, overcome the pitfalls encountered some decades ago by the proprietary hospital which, except for a few isolated instances, had to evolve into the nonprofit hospital we know today in order to be able to offer the network of expensive medical and related services which medical progress made necessary?

If the American nursing home will strive to change its status from a point-of-no-return facility to that of a vital partner in rehabilitation and long-term care, serving younger chronically ill patients as well, it can become, so to speak, a revolving door through which patients return to the community rather than an end-of-the-line terminus which it is for so many today. Many of us in related professions would be glad to assist in bringing this about.

I referred earlier to care by relatives. When mutually satisfactory to all generations involved, this can be ideal. You have, however, been offered considerable testimony that it often does not work.

Recent anthropological evidence indicates that, contrary to commonly held assumptions, acceptance of responsibility for the care of parents is not necessarily a natural consequence to family life. Whereas parental love for the child, and desire to protect and rear him, is clearly an instinctual drive, the reverse-love for the parent, and the desire to contribute to his well-being-is something children must learn, and are not born with. An extension of this finding suggests that the middle generation, striving to nurture its offspring fully, is caught in a cruel vise when society expects it to care for parents with equal zeal.

Prof. Alvin L. Schorr points out that

It was only when an economy that separated wages from ownership meant that the old person was no longer in control, that many adult children had reason to examine their willingness to help their parents * * *. It is in the 20th century that the idea has achieved wide currency and effect that an adult should voluntarily sacrifice his own, his wife's, and his children's resources to assist his parents before the community will assume responsibility.

There is not time for me to present today the brilliant development of this idea recently published by my distinguished colleague, Dr. Esther Lazarus, director of the Baltimore Department of Public Welfare, but it is listed in the footnote and I recommend it very highly to a dedicated group of public servants such as this Senate committee and would be happy to provide it as an appendix to my testimony. In closing, however, you might find rewarding, as I did, the following tale with which Dr. Lazarus opens her paper:

A pious, 17th-century Jewess relates the tale of an eagle that set out to cross a windy sea with his fledgling. The sea was so wide and the wind so strong that the father bird was forced to carry his young one in his claws. When he was halfway across, the wind turned to a gale and he said, "My child, look how I am struggling and risking my life in your behalf. When you are grown up, will you do as much for me, and provide for me in my old age?”

"My dear father," the eaglet replied, "it is true that you are struggling mightily and risking your life in my behalf, and I shall be wrong not to repay you when you are grown old, but at this critical time I cannot bind myself. This, though, I can promise: When I am grown up and have children of my own, I shall do as much for them as you have done for me."

Thank you, sir.

Senator SMITH. Thank you very much for this very fine testimony, Mr. Steinman.

Earlier in your remarks you mentioned what foreign countries are doing in this field. I should like to mention at this point that Senator Clark, who is a distinguished member of this committee, was in Stockholm during October, and has made a very fine report on the services for the aged in Sweden which will be published soon. I think you will find it extremely interesting.

Senator Saltonstall, do you have any remarks or questions?

Senator SALTONSTALL. No. I thought that was a very impressive paper, particularly the last part.

Mr. STEINMAN. Thank you, sir.

Senator SMITH. Thank you.

Now before declaring the session in recess I would like to remind you that we will resume at 2 p.m. when we will have our town meeting aspect of the conference and allow speakers to state their views on the various problems of the aged.

Thank you very much.

(Whereupon, at 12:20 p.m., the hearing was recessed, to reconvene at 2 p.m. of the same day.)

AFTERNOON SESSION

Senator SMITH. The second session of the hearing on problems of the aged conducted by the Special Senate Committee on Aging will please come to order.

This afternoon we have a meeting here based on the town forum plan where members from the audience will be allowed to speak. We request that you limit your remarks to 5 minutes. There are many people here and I welcome you all. I must say that this is probably one of the finest gatherings, the greatest group of people that we have had during our hearing. It certainly shows the keen interest that you people have in the problem facing us today and the very human problem. I am very glad to see you and look forward to hearing your testimony.

If you will, step forward and give us your name for the record so that we can have this permanently. If you care to state your age, that would be of interest to the committee, too, I am sure.

STATEMENT OF PROF. FRANCIS L. HURWITZ, DIRECTOR OF SPECIAL PROGRAMS, CENTER FOR CONTINUING EDUCATION, NORTHEASTERN UNIVERSITY, BOSTON, MASS.

Mr. HURWITZ. My name is Francis L. Hurwitz. I live in Brookline, Mass. I am director of special programs and associate professor of adult education in the Center for Continuing Education at Northeastern University. I trust what I have to say is in order for this afternoon's session. I do not have prepared notes but I have an outline so that I will be able to keep within the 5-minute limit.

Senator SMITH. That can be made a permanent part of the record if you wish after you are through.

Mr. HURWITZ. All right, sir.

I thought it incumbent upon me to submit for your consideration some of the aspects of the educational program of my department as it has been involved with nursing home administration. I do so because I was in attendance in the morning session and heard the presentations that were made, several of them having had reference to the university. I refer to Commissioner Tompkins, Dr. Rubenstein, and Mr. Connelly.

I feel that the mere reference to the educational pursuits of nursing home administrators, while no doubt are considered important to you for what they may import, I believe it needs no interpretation but