have them fragmented. At the local level, communities face great problems of how to put these programs together, and I think if we truly want to prevent chronic disease, then I think we have to mount this within the framework of the social and family situations.

Senator NEUBERGER. Thank you, Dean Beattie.

The next witness will be Rev. Robert P. Slattery, who is the director of the Cardinal Ritter Institute, St. Louis, Mo.

For some years now, I should tell the audience that the Committee on Aging has been keenly interested in practical programs conducted for older Americans. In Greater St. Louis there is the Cardinal Ritter Institute; it is a separate department of Catholic Charities. It has pioneered in several important new programs and particularly the home care project underway. We are very honored to have Rev. Robert P. Slattery, who is director of that institute, here today.

STATEMENT OF REV. ROBERT P. SLATTERY, DIRECTOR, CARDINAL RITTER INSTITUTE, ST. LOUIS, MO.

Reverend SLATTERY. I should preface my remarks by saying this statement is of His Eminence Cardinal Ritter, and he asked me to express his regrets that his attendance was not permitted here today. In 1863 Lord John Acton wrote:

There is an outward shell of variable opinions constantly forming around the inward core of irreversible dogma, by its contact with human science or philosophy, as a coating of oxide forms around a mass of metal where it comes in contact with the shifting atmosphere. The church must always put herself in harmony with existing ideas, and speak to each age and nation in its own language *** From time to time a very extensive revision is required, hateful to conservative habits and feelings; a crisis occurs, and a new alliance has to be formed between religion and knowledge, between the church and society.

The late Pope John XXIII and Pope Paul VI have spoken loudly, clearly, and often on the reconstruction of the social order that is demanded by the crisis of our times.

Two of the basic tenets flowing from the recognition of need for reform or updating of the church-and seen as essential ingredients in forming this necessary alliance with the world of today are

One, the ever-present need for a critical and practical appraisal of the situation of the church in all its social, economic, health, and cultural settings.

In brief, living in our own times, accepting the inevitable_results of the evolution of human society and finding ways of adapting our individual skills and our relations with one another to the circumstances in which we actually live.

And, two, an openminded, sustained, and humble discussion that would cross all denominational barriers, a positive attempt to discuss differences and seek unity.

To paraphrase Pope Paul's message to the Catholic University of America on his recent visit to the United States: Catholic agencies should pursue their work in full concert with all other efforts being made in the United States. Great progress has already been achieved in interagency collaboration which is productive of mutual respect and esteem.

In light of this general framework the church through its organizational structure seeks to extend its interest and concern to all men of good will and seek solutions for common community problems.

One important area of great concern and interest is the matter under discussion today; namely, a national program for the early detection of tendencies toward chronic illness.

At the onset I must state that my remarks on this subject reflect the thoughts of an interested observer and reporter-not those of an expert in the health field.

It is generally agreed that the problem of chronic disease seriously affects the welfare of the community-both young and old alike. It has been increasing in the past 10 years. Chronic illness, particularly in the aging population, has brought social, economic, and medical problems of vast proportions. A considerable body of documentation has demonstrated its serious effect on large numbers of people, its long and costly disability process and the fact of it becoming the leading cause of death.

Aware of the growing number of older persons and the concomitant increase in chronic illness, Catholic Charities of St. Louis has given serious thought and study to meet the shifting needs of people confronted with this problem.

Beginning in 1950, Catholic Charities, with the assistance of both local and national consultants, conducted a complete and thorough survey of the needs of the aging in Greater St. Louis, and the ability of existing resources to meet those needs. This survey considered each institution and nursing home separately and every patient or client was individually interviewed.

Carefully studied and reviewed in each instance were the buildings themselves, their conformity to standards, and their suitability to the purposes for which they were being used; intake procedures and methods; financing; programs, which included medical care, diet, recreation, nursing, and rehabilitation; and staff.

Also studied at that time were the nine Catholic hospitals and their aged and chronic sick patients as well as hospital programs for the aging.

This survey included also the study of a total parish and the aging living in their own homes or with relatives in that parish. This was intended to broaden the scope of the survey to include all aging, both those caring for themselves or living with their relatives, as well as those who needed the help of an agency or institution.

Because of the increasing number of aging in our area and as a result of these surveys, services and programs were developed and expanded. Institutional buildings were remodeled or improved to meet current standards; volunteer programs were developed; a hotel was purchased and remodeled to provide residential care for 240 aging people; 1 institution was converted from a combined maternity hospital, infant home, and home for the aged to an institution offering both residential and nursing care for the aged; and another changed from residential to nursing care.

A decade of valuable study experience and the recognized need for specialized services to the aging in the Greater St. Louis area culminated in 1961 in the establishment of a separate department of aging in the Catholic Charities organizational structure. In January 1965, the agency acquired its own distinct status and is now known as the Cardinal Ritter Institute of St. Louis-with the primary goal of providing creative care for the older person.

Some of the chief functions of the institute are:

It assists 23 institutions, homes for the aged, nursing homes, and hospitals in planning and developing programs and services for the aged and chronically ill in the Greater St. Louis area.

It provides creative care for the individual older person including nursing, social work, and home health aide and other paramedical services.

It develops programs such as home care for the older person. This latter program, home care, was made possible through a 3year grant award from the U.S. Public Health Service in 1964 for the purpose of establishing, operating, and evaluating a nonhospital-based, community-oriented comprehensive home care program for the aged and/or chronically ill.

The jurisdictional boundaries of this program have already expanded from one local cooperating hospital to three at present with the inclusion of seven additional hospitals in the very near future. The ultimate plan would include all St. Louis City and County and neighboring county, and this program, I might add, is also certified under the Medicare law.

In brief, the institute seeks to demonstrate the effectiveness of a comprehensive home care program by achieving these objectives:

To keep the older person in the familiar surroundings of his own home.

To keep the older person out of nursing homes and homes for the aged as long as possible.

To free hospital beds for the acutely ill.

To prevent medical indigency by preserving the older person's

resources.

To prevent or postpone disability.

In the general area of prevention of chronic illness, several notions can be stated. First, our approach has been oriented more toward prevention of progression rather than prevention of occurrence of chronic illness.

For example, the home care program has provided an excellent opportunity to demonstrate this prevention of progression approach for the aged and/or chronically ill. This approach takes into account the acute conditions and accidents which aggravate chronic illness. It accomplishes this end by use of the trained professional and nonprofessional members of the home care team in detecting symptoms which forecast conditions of acute illness or potentially hazardous conditions in the home.

The results, obtained on this score by varied research methods, have thus far been encouraging. In particular, one home care team member, the home health aide, has proved to be an invaluable informational source in this regard.

In addition, the information obtained by this method is relayed to the patient's private physician at regular intervals or sooner-all dependent upon the nature of the patient's progress or nonprogress. Armed with this material and aware of the constant monitoring by home care team members, the physician's time and effort is maximized and he, therefore, can provide better quality care to the patient.

Similarly, a program of prevention-partly prevention of progression and partly prevention of occurrence is conducted in the institu

tional settings in the archdiocese of St. Louis. It consists of a thorough social and physical examination required of every new applicant and repeated regularly. This serves the purpose of determining the applicant's eligibility for the home and, if found eligible, helps decide what services are required.

The examples cited demonstrate a concern and familiarity with the personal health and social catastrophes that beset the aged and the chronically ill person. While helping the individual cope with his particular problem is important, we feel that we have a more important obligation; namely, to help the community cope with the underlying causes that create the problem of chronic illness. This means developing a clear understanding of the problem focally, the resources that can be brought to bear, and joining with other agencies, both private and public, in mounting an effective attack on the conditions which deny security and opportunity to the older person.

In keeping with the letter and spirit of the foregoing thought, the Cardinal Ritter Institute seeks the first goal of prevention-prevention of occurrence. It sees that the only hope of stopping the progress of chronic illness lies in early detection systems with proper followup procedures. We see early detection systems with appropriate followup as a tremendous aid in pinpointing the precise level of care for the patient along the health care continuum.

For example, the data obtained from the detection system, properly assessed and followed up with the physician's diagnostic evaluation, would give some better clues to proper patient placement-whether a home care program, or nursing home, or custodial home, or hospital is the proper environment in terms of the total medical and social picture elicited.

In addition, the institute in an attempt to maximize delivery of quality health care has submitted a demonstration proposal to the Administration on Aging. The proposal presents an organizational restructuring as a means of utilizing in a maximum way the scarce professional personnel and institutions available and at the same time making sure that people are receiving the level of services which they need and are not "overplaced" or "underplaced."

It is an attempt to get away from the fragmented service pattern so common to the health field today and the creation of a new living organizational structure-not one inured to a past social environment. We, therefore, don't see the implementation of an early detection system for chronic illness being determined by limited health care personnel. In fact, we see this prevention aspect as a fertile area for new job opportunities opportunities for the vast untapped reservoir of the disadvantaged groups in society.

In light of the preceding it becomes quite clear that chronic illness which virtually incapacitates people completely and permanently is one of the great challenges confronting the Nation today. For some the statistics on the mounting tide of chronic illness and its damaging effects may seem distant or academic in nature only. If, however, one could go behind the statistics to the individual or individuals affected -one would then be better able to measure its damaging effects by seeing it engulf the individual or family in pain of despair or deathby seeing it sap the foundation of family life and community life in all parts of the country.

If we have the necessary foresight and fortitude to disavow our present fireman's approach to the problem of chronic illness, we truly recognize the shifting pattern of illness today and give proper recognition and attention to the maintenance of good health as a priceless possession for ourselves and for our children. If the development of a national plan for early detection and prevention of chronic illness could be implemented which would but partially alleviate or minimize the awesome social, economic, health, and personal losses, it would be a blessing to the Nation. It would be a first step but a meaningful one to restore the worker to industry, the citizen to society, and the man to himself.

If I may be permitted a digression-the St. Louis Football Cardinals were blessed with victory over their opponent 2 Sundays ago because they used a pretty good "prevent defense" against the long pass in the closing quarter of play. It may not always work but when it does-there is joy and happiness in St. Louis. The point is that perhaps we ought to consider the merits of a national "prevent defense," as it were, against chronic illness.

In sum, we wholeheartedly support and endorse a national plan for prevention and detection of chronic illness.

Let us subscribe to Emerson's dictum, namely that

The first wealth is health. That sickness is poor spirited and cannot serve anyone; that it must husband its resources to live. But health answers its own ends, and has to spare; runs over and inundates the neighborhoods and creeks of other men's necessities.

Further, borrowing from and applying the practical wisdom of the late Pope John XXIII to the challenge before us, let us strive more to find points of agreement in this area than to explore every minor area of difference. Let us never, "under pretext of the better or the best, omit to do the good that is possible and therefore obligatory.' Let us as Pope John stated, "Put our hands to the plow, and not spend our days merely wringing them."

Our involvement in this health prevention effort is motivated by a desire to serve. We feel that we have a contribution to make, and we seek to make it..

The beautiful words of Pope Paul VI before the United Nations come to mind here:

We have nothing to ask for, no questions to raise; we have only a desire to express and a permission to request; namely, that of serving you insofar as we can, with disinterest, with humility, and love.

In a sense, we offer the treasures of the church; the service of our institutions and agencies, the support of our people, the depth of our experience, the guidance of our beliefs, the comfort of our love. We want to participate in the great health and social welfare efforts of our day.

Senator NEUBERGER. Thank you very much for bringing this fine message and testimony from Cardinal Ritter.

Now, I know that you are bringing the message for him and you have already professed that you are not an expert in this area, but I am fascinated with one of the points in the Cardinal's remarks, and that was the home care program, I think this is one of the areas that we are far behind in from a federally supported standpoint, and the