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⚫strict government regulation of skilled and intermediate nursing facilities,

"county nursing home ombudsman.

..

Jobs and Income Assistance. Dr. Alex Comfort, who
spoke at the San Diego conference, emphasized employ-
ment as a necessary source of income and self-esteem for
all people, no matter how old.

County officials likewise focused their attention more
on jobs than on income assistance. Much of the discus-
sion centered on the federal government's employment
programs, in particular the CETA (Comprehensive Em-
ployment and Training Act) program. Demands were
made for increased funding for part-time community ser-
vice jobs funded by Title IX of the Older Americans Act.
Ending mandatory retirement was a pervasive theme.
Affirmative action plans were called for "in industry and
government (including elected offices).'

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The private sector was also mentioned consistently.
"Jobs-subsidized or not," one group said. Other themes
were the need for meaningful employment, rather than-
in Dr. Comfort's words-"dilution, make-work or cheap
labor," and the related need to develop second-career op-
portunities.

Parenthetically, although mentioned by about 20 per
cent of the groups, education was always envisioned as a
cultural experience, rather than as an avenue to employ-
ment or second careers.

Discussion about income assistance concentrated on
county efforts to secure reductions in bills from fuel and
utility companies and to obtain discount programs from

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county merchants. Several groups, however, turned their
attention toward the federal government's Social Security
and supplemental security income programs. Usually the
groups simply asked the federal government to assure
the elderly "an adequate income." However, one group
pay raises.
suggested the elderly's benefits be tied to congressional

Housing. Like health care, housing is a large category. It
includes not only public housing for the elderly but also
rent subsidies, housing repair and rehabilitation, in-
sulating houses to conserve energy, and several
suggestions that offer alternatives to institutionalizing
the elderly in nursing homes.

"

Among the alternatives, foster homes for the elderly
was the most common. A few groups wanted to
strengthen the family role in housing the elderly: "recon-
sider totally a realignment of family responsibilities,'
"regroup families-encourage extended families." Other
housing alternatives included shared housing (two or more
elderly people who share an apartment or house) and
"transitional living quarters." The latter were said to be
for "elderly persons leaving institutions and re-entering
the community."

Congregate housing* was mentioned twice in the east,

*Congregate housing is a facility for frail elderly who need assistance
but not continual nursing care. The major features are (a) a central kitch-
en and dining area where residents may take meals, and (b) some as-
sistance with household chores and personal care.

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once in the midwest, and several times in California.

Calls for more public housing for low- and middle-
income elderly appeared most often on the east and west
coasts. The stress in the midwest was on home repair,
energy conservation, and housing subsidies.

A midwestern group also called for "housing coun-
seling" for the elderly. One west coast group pointed to
the need to coordinate home repair and maintenance
programs with "subsidized employment programs." At
the Washington conference the focus was often on the
federal government. In particular, the Department of
Health, Education, and Welfare (HEW) was called on
to coordinate its programs with the Department of Hous-
ing and Urban Development. County officials said they
were tired of providing social services at public housing
sites that should have been provided by HEW.

Nutrition. Expansion of the meals-on-wheels program
was the most common priority in the category. Next
came calls to make congregate meals supported by Title
VII of the Older Americans Act available seven days a
week (instead of the usual five days). Third, county of-
ficials wanted education about nutrition and meal
preparation offered at the congregate meal sites (as is
required by federal regulations). The fourth priority:
"upgrade the quality of meals served at nutrition sites."

Several officials mentioned a need to open up school
lunch programs to elderly people living nearby.

Transportation. Judging by the disparity of transpor

tation priorities, counties face considerably different
situations-different geography, different housing pat-
terns, different levels of existing services.

Some counties called for "specialized transportation,"
"portal-to-portal transportation," "demand-responsive
transportation services." Conversely, just as many
groups called for making public transportation more ac-
cessible to senior citizens: "staff and money for full
utilization of buses," and "escorts on public transpor-
tation."

Some officials thought integration of the transpor-
tation services of human service agencies is the best way
to solve their problems. Others sought to establish
"transportation consortia" among the agencies that ser-
ved only the elderly. Still others were looking toward
development of "feeder systems" that tied the elderly in-
to mass transit facilities.

Several groups called for "overcoming insurance hazards
in transportation." Other groups called for more federal
assistance to rural areas to "expand transportation ser-
vices to and within rural areas.'

Only one group-in Kansas City-looked to the school
system for assistance: "use monies for school buses to
provide transportation for elderly."

Information and Referral. Demands for information and
referral services focused primarily on a need to make in-
formation about services available to elderly people who
do not live in easily accessible (to county agencies)
locations such as public housing sites. "Outreach,"

12

"county-wide outreach, "increased outreach programs
utilizing telephones and postal carriers" were typical
priorities. Consideration for the nonaccessible elderly
seems also to underlie priorities such as "neighborhood
drop-in I & R centers in schools, churches, banks,
savings-and-loans," "newspapers and other media for

seniors."

"

"

Some priorities reflect a concern about the content of
information-for example, "realistic information on
levels of services available," and "information geared to
educating the entire family.

Legal Services. This category can be summed up as a call
from three-fourths of the groups for "more legal ser-
vices." Consumer protection and "help with wills" were
the only elaborations.

Senior Centers. Almost all priorities in this category in-
volved multi-purpose senior centers-that is, centers that
offer a range of health and social services along with
facilities for recreation. A few groups mentioned the need
for "strategically placed" or "neighborhood" centers.
Protective Services. One group best summed up what
county officials believe is necessary for those no longer
able to be responsible for themselves: "something bet-
ween conservatorship and a good friend."

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The need for these services was mentioned much less in
the midwest than on the two coasts.

Volunteer Services. According to the priorities in this
category, volunteers seem to be needed primarily for
telephone reassurance. Next come "companionship" or

leads a discussion

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