Agencies would be reimbursed for services to persons actually served.

It would still be quite possible, indeed necessary, to have consumer protection. This is an area in which work in regard to services for older citizens is needed anyway. Recall Arkansas Congressman Pryor's efforts in regard to nursing homes standards. Health and welfare services in America as they apply to all citizens, but especially to older Americans, have long needed their own Ralph Nadar and some Raiders. We need consumer protection. The sort of system of services proposed here would not militate against them. In fact, it might accomplish greater consumer protection than our society has ever had. The market nature of available services would in itself be the beginning of an accountability mechanism.

Financing.-Public funding of services, that is, Federal, State, and local financing of social services for the elderly American would still be necessary. There would be no reason why competitors should not (in a given service) represent both the public sector and the private sector. Subsidies are far from unheard of in the private sector of the economy anyway. Our nation has farm subsidies; we have a variety of other subsidies; and subsidizing the private sector of the economy is hardly new. Such subsidization would clearly be necessary and would be completely in keeping with present economic policy and practices. Where costs might be excessive, competition could be limited or eliminated (one example from the health field might be hospital construction).

Fostering indigenous control.-An approach of this kind might also have one other tremendous advantage. It could conceivably encourage cooperative effort in neighborhood groups and various organizations of aged citizens to plan and operate their own services, possibly in competition with commercial or other non-profit efforts. It could go far toward encouraging indigenous involvement in planning, development, and operation of needed services for the aged. It could facilitate the involvement of people in developing and operating their own programs, such as transportation, housing, leisure-time activities, or any of a variety of other services. In other words, where costs would not be excessive, the approach suggested here would foster, not stifle initiative in planning, development, and program operation. In the beginning of far too many Title I programs, when initial promises have been made by a local voluntary fund about

potential participation, those promises all too frequently begin to evaporate as the fourth year nears. In fact, "cracking" voluntary united financing with a new agency has always been difficult. The approach suggested here would foster rather than put up roadblocks and stifle fiscal initiative.

Consumers would have to have options within any given area. For example, Senior Citizen Centers might compete. This could mean both commercial and non-profit homemakers or whichever of the social credits local, State, or national legislation would deem necessary and available for all older citizens. Thus, new agencies would obviously need to be encouraged, not discouraged. This has been the case only in some instances in the operation of Title Ill across the nation. The credit card system could be essential. It is, of course, interrelated with the income maintenance question, but there would need to be either the cash equivalent of such services or credit cards for their utilization. It could be coordinated or directly administered as part of Social Security benefits on an insurance principle but with financial participation from general revenues as well (as is now the case with Part B of Medicare). Agency income would be dependent upon consumer demands and satisfaction. Such an approach would be particularly useful and probably even desirable for many of the services needed by Older Americans. Above all, that will require a lot of new ideas and social

invention.

Strengthening federal mandates.-Such basic entitlement system with its highly debatable competitive and profit-making possibilities may not occur in this nation very soon, but it is an experiment that might well be tried, despite costs, known risks, and even possibly some adverse consequences. Therefore a third optionone that is quite traditional-is offered here (of course, any of these options require a much greater fiscal contribution from the Federal level). It would be to mandate states to operate defined programs (they could be quite specific and selective or quite comprehensive) in all of the State's political subdivisions (usually that means counties). In other words, it would opt for new State plan requirements and would eliminate the block grant nature of the present Title III thrust as the basic method of financing services for the aging. Of course, an immensely greater fiscal effort in support of Title III might do the job. Perhaps, however, Title III should

Mobilization for Aged

Finally, one other possibility is offered for

consideration. It is modeled on Mobilization for

Youth and can be styled "Mobilization for Aged."

in roughly an 80-square block area of the Lower East Side of Manhattan, Mobilization for Youth was a monumental effort to deal with the causes and consequences of low income and poverty, the plight of the urban poor, and the blight of urban America. Innovations that were initially developed by MFY include the welfare rights movement and legal aid for the poor, all of which have analogies for older Americans as well. Other MFY efforts included experience in self-help efforts, consumer cooperative experi

"

ments, and much of the thrust for "new careers,' However that concept is defined, whether new packaging of existing careers, new combinations of skills heretofore partialized into a variety of disciplines, assumption of tasks previously performed by highly paid and scarce profesionals by indigenous on-the-job trained persons, or new training and credentialing routes to old established occupations. MFY had a major impact on involving people in planning, developing, and carrying out the services that they need in order to realize their full human potential to overcome obstacles, to enhance and enrich their social functioning. Such a monumental effort, called "Mobilization for Aged" also may be needed today in regard to older citizens.

MFA would begin by selecting an appropriate target area. It could be a segment of a metropolitan area, a small city, a county. Having chosen such an area, MFA would then mount a variety of planning, organizing, supportive, remedial, innovative, and enrichment programs and services. At the same time it would be necessary to develop well-defined outcomes measures ranging across the entire range of social. health, educational, intellectual, and economic needs and indicators of the aged. Then a careful record would be required on the impact of this sort of blanket coverage of all needs and problems of older citizens however they may be defined in a given area.

At least a 5-year period would be indicated in order truly to test what can be and what cannot be done. It would be a multi-million dollar effort. Not only would it test what we think we know, but at the same time it would also be

variety of human services. Hopefully it would also discover new ways of achieving some of the goals for the aged toward which many of us have worked.

The auspices for such an effort might well include subsidized commercial enterprise as well as involve the Administration on Aging, the Social and Rehabilitation Service, the particular State and local welfare programs that would be involved, the National Institute of Mental Health, private foundation effort (local and naticnal), and perhaps a great many other sponsors and auspices.

Summary

Our impressions suggest that tokenism, inequality, and traditionalism result in a massive inadequacy in Title III as a design for serving the elderly in the United States. To be sure, the level of funding constitutes a major cause of this inadequacy. However, we are not at all certain that even a 20-fold increase of funds within the same design would result in adequate services.

Effective mechanisms of coordination and control at Federal, State, and local levels do not exist. Since these prerequisites for centralized planning are not present, one option we have suggested is a market approach to planning and delivering services to the elderly. As a beginning this paper also proposes a large-scale demonstration effort we have called Mobilization for Aged.

Massive effort is necessary and is necessary now in all areas of programming for older Americans. This paper has also noted that a potent force for producing such effort, the potential political "clout" of 20 million enfranchised elderly Americans, is not being mobilized. In order to be adequately funded and effective, any program concerned with a constituency of millions, such as Title III, cripples itself unless it draws on its full political potential.

References

Administration on Aging. Communities in action for older Americans: A report of progress under Title III of the Older Americans Act, Publication No. 258, July, 1968.

Hammond, P. E. (Ed.). Sociologists at work. New York: Basic Books, 1964.

Vidich, A., Bensman, J., and Stein, M. Reflections on

community studies. New York: Harper & Row, 1965. Warren, R. Alternate strategies of inter agency planning. mimeo, n.d.

Warren, R. The decartelization of the human services, mimeo, n.d.