Senator EAGLETON. Let me also identify some individuals who will be here with me at the head table and, if I have to take a phone call or something from Washington, he will preside while I am absent briefly. To my right is Mr. James Murphy, who is the chief counsel to the Subcommittee on the Aged of the Labor and Public Welfare Com

mittee.

On my left is Mr. Bob Bosch, who represents me in Kansas City, operating our full-time Kansas City office in the Federal building downtown.

With no further ado, we will now be about the business for which we have called this meeting.

I would like to now call as the first witness the Honorable Harry Wiggins. He is the western district judge, as most of you know, of course, of the Jackson County Court.

It was originally scheduled that Presiding Judge George Lehr of the Jackson County Court would be with us also. As many of you know, we were forced to reschedule these hearings because of votes on the Senate floor and in rescheduling it to this day, Friday, it ran into a conflict with George Lehr that he simply could not avoid, so he sends his apologies.

Likewise, we were also to have had as an opening witness, Mayor Charles Wheeler of Kansas City. Again because of the rescheduling dilemma, Friday being the day, a full day, of the council meetings in which, of course, the mayor participates, he unavoidably had to be absent. We are sorry that we had to change these dates because we would like to have heard from both of them.

In introducing Judge Wiggins, although he needs no introduction, let me say that he, Judge Lehr, and Mayor Wheeler created the Kansas City city-county area commission on the aged.

What is the exact title?

Mr. WIGGINS. Joint city-county committee.

Senator EAGLETON. Joint city-county committee, of which they designated Judge Harry Wiggins to be the chairman. So he comes here with good credentials and he also comes here as my good friend. Harry.

STATEMENT OF HON. HARRY WIGGINS, WESTERN DISTRICT DISTRICT JUDGE, JACKSON COUNTY COURT, MO.

Mr. WIGGINS. Thank you very much, Senator.

On behalf of the mayor of Kansas City and the presiding judge of the Jackson County Court, I have the pleasure of welcoming you and your committee here for these hearings which have long been anticipated in Kansas City and Jackson County. We appreciate the fact that you would come here. Mayor Wheeler and Judge Lehr. both, were unable to be present today for the reasons you have stated, and they specifically asked that I tell you and the persons here that they greatly appreciate your interest and the fact that you have come here.

I do not have a lengthly, detailed statement which I would make today. I have a few comments which I will give.

I would like to introduce the members of the joint city-county committee who are present here today:

Dr. Frances Gaw, Mr. David Carr, Rev. Richard Ash, Mrs. Rose Belove. If other members of the committee are here, I haven't seen

them. Mr. Henry Tomlinson is present Mr. Tomlinson was a delegate to the White House Conference on the Aging.

Our committee has recently been expanded by the addition of Judge Bauman of Clay County, and Judge Bauman will add to the aspects and purposes and work of the committee.

The purpose of the joint city-county committee on the aging, as created by the mayor and the presiding judge, is to coordinate under an umbrella-type association all of the programs for the elderly in Kansas City and Jackson County and to expand the activities and scope of the present city-county office of the aging. That office is directed by Dr. Doarn, who is present this morning, with Dr. Wicks who, I believe, sponsored the creation of that office.

Our committee is totally opposed to lengthy additional studies by consultants who, at great expense, will tell us that the elderly have needs. We know that, and the greatest need of all is not studies but action programs to meet the problems.

In my brief part of this hearing, let me point out some of the critical needs which have been brought to the attention of our committee in the first few weeks of its existence. There are several really expert witnesses to follow who will present suggestions for solutions to these needs.

Senator, in your comments you mentioned housing programs with the Department of Housing and Urban Development. Too many people seem to think that elderly persons need only nursing home care. Too few people understand that many elderly persons live in horrible housing conditions:

(a) In Kansas City and Jackson County, approximately 30 percent of aged households have incomes below the poverty line.

(b) For these households, an expenditure for low but adequate standards of housing would absorb 40 to 50 percent of total income.

(c) Only 10 percent of eligible households live in governmentassisted housing.

As far as income itself is concerned, too few people understand the abject poverty of elderly persons living on fixed income:

(a) Fourteen percent of all aged couples have incomes before the poverty line.

(b) Forty-five percent of elderly individuals living alone are similarly impoverished.

(c) In all, one-quarter of the population over the age of 65 live in poverty.

(d) Ten percent of the 65 and older population have incomes so inadequate as to qualify for State welfare cash benefits.

Health care for the aged which is available is so fragmented and so lacking in continuity that it does not meet the needs. Furthermore, health care is too costly even with medicare and medicaid. In the spring of 1969 a retired couple's medical costs for maintaining good health would have consumed 11.2 percent of their total budget even with the $346.48 per capita reimbursement by medicare for the aged in Jackson County for 1969. This reimbursement for hospital and/or medical insurance in Jackson County was 25.2 percent greater than Missouri's and 9.8 percent greater than the U.S. per capita reimbursement. These are some of the barriers which stand in the way of resolving illness among the aged and aging. These barriers, plus

nutrition, rehabilitation, and the main causes of death and disability are the variety of health needs to be considered.

The problem of nutrition is tremendous. Many elderly persons are simply alone and discouraged and have neither the financial ability nor appetite to obtain and prepare an adequate diet. Meals on wheels programs should be expanded. There may be hundreds of people living within a walking radius of this building who may go hungry today.

Under the new food stamp program which will become effective in Jackson County approximately April 15, this will allow the use of food stamps for meals on wheels, for hot meals, for persons who need them.

In the area of employment, I think we find one of our greatest tragedies. Many persons who fall within the elderly category are fully capable and anxious for an opportunity to work and assist in solving their own potential problems and those of their fellow senior citizens, and they know better than anybody else what that problem is. In Jackson County and Kansas City a senior services aides program has never been implemented, but it should be.

Transportation is an acute problem. Reduced public service fares and special additional must bus services are badly needed in this

area.

Judge Lehr asked me to mention for him this morning a very brief statement, which I will read.

In the area of relief for the elderly, one of the most frustrating and disturbing problems is the delay and technical difficulty in qualifying for Federal aid and assistance. Procedures should be streamlined for quick access to programs intended to help those in need.

A unified Federal approach through a revenue-sharing method would vastly improve the situation in this county and at other levels of government. I urge that the committee consider this approach as one of its prime goals.

Jackson County has shown what can be done on a local level by the acquisition and rescue of Mission East Nursing Home, the building where we meet today. The ability to do more of this on a local level would make needed services more available to the people for whom they are intended.

Judge Lehr was the prime person responsible for saving this building when it was threatened with closing late last summer.

I might mention that Senator Eagleton was in constant telephone touch with us when the negotiations to save this building as a nursing facility were underway.

I think it might be closed today, Senator, without your help and assistance at that time. We greatly appreciate it.

The conclusion which I have prepared for my remarks you have already given because the conclusion is that perhaps one of the greatest problems of all is the tremendous duplication and proliferation of programs throughout all units of government. Various agencies of different departments within the Federal Government have responsibilities and funds. One central office of the aging to administer all Federal programs, to coordinate the effort at all levels of government, would be a vast improvement. Competition and bureaucracy between persons, however sincere they may be, to perform the same service for the same people is ridiculous, and only hurts the people for whom the service is intended.

That concludes the remarks I had prepared, Senator. I wish to thank you on my own behalf and on behalf of the committee I represent for allowing me to testify here.

I have filed a written summary of these comments which contains some statistics in numbers, which are probably meaningless to go into at this point.

I also have a copy of a survey made on the problems of the elderly in Jackson County which I will file with this subcommittee with your permission. But statistics are not nearly as important as people and the problems those people have. That is what the committee hopes to do and we know that we can count on your assistance in trying to bring that help to Jackson County and Kansas City.

Thank you.

Senator EAGLETON. Thank you, Judge Wiggins. I appreciate the kind remarks which you made during your testimony.

May I say it is a pleasure for our office to cooperate with you on these aging matters.

We have liaison now between Judge Wiggins, who is, as I previously said when I introduced him, the coordinator between the city and the county and hopefully can serve in that capacity in our Subcommittee on the Aged. So I think it is fortuitous and perhaps very beneficial to know that we have this close contact.

Let me underscore two parts of Judge Wiggins' testimony. I agree with everything he said in the testimony but I want to highlight two parts.

On the second page, he wrote, "Our committee is totally opposed to lengthy additional studies by consultants who at great expense will tell us that the elderly have needs." To that I say, "Amen." It is a game that is played in government, it is played in city halls, it is played in State capitals, it is played in Washington, D.C. I call it the study game. If you have a problem, a situation that needs some attention, and you are really not ready to do anything about it, you study it. That is, you appoint a citizens' panel, nice people, some professionals, some from the public, citizens at large, et cetera. You say, in 2 years or so give us your findings, but study, study, as if the problem would suddenly evaporate into thin air.

I can't tell you exactly how many, but I will bet you in my office I must have 300 or 400 studies piled up in various corners, some of them very thick, some not so thick, some of them as big as a phone book, studies, studies, studies.

Problems with respect to the aging have been identified for many years; the ones that Judge Wiggins ticked off here, housing, health, nutrition, employment, transportation. You could add to that list, but those are six of the vital areas. So I very much enjoyed this sentence of Judge Wiggins. We are not going to try to study things to death. We know what the problems are and we ought to be doing something rather than study.

Finally, he says, in the last paragraph, which is really right down my alley, the diffusion of these aging programs through the various labyrinths in Washington, Transportation, the Department of Health, Education, and Welfare, HUD, you could add others, OEO, is such that it is almost impossible even for a capable person like Judge Wiggins to try to know all the various programs that are scattered here, yon,

and elsewhere. They are very loosely amalgamated and there needs to be a greater degree of cohesion, coordination.

I just wanted to highlight those two parts of the judge's testimony. I thank you.

Mr. WIGGINS. Thank you, Senator.

Senator EAGLETON. Our next witness, and we are very privileged to have this gentleman with us, is Dr. Wallace Graham, major general of the U.S. Air Force, retired. People in this area will well remember him as being formerly the U.S. Surgeon General and the personal physician for President Harry Truman.

We are very pleased to have Dr. Graham.
Doctor, we welcome you.

STATEMENT OF WALLACE GRAHAM, M.D., MAJOR GENERAL, U.S. AIR FORCE (RETIRED), FORMER U.S. SURGEON GENERAL, PERSONAL PHYSICIAN FOR PRESIDENT HARRY TRUMAN

Dr. GRAHAM. Thank you, Mr. Senator.

Mr. Murphy, Mr. Bosch, Judge Wiggins, honored people: This is one of the greatest honors that I could have in talking with such an august body. I mean this very sincerely. This is really the height of our U.S. Government in action, to have a great man among the men we have here today, Senator Eagleton, taking his time, his valuable time, to come here and listen to us, and I won't say our grievances but our pleas. I am talking also to my malnourished friends. If they are as fat as I am, how could they be not well nourished?

Ladies and gentlemen, I operate 5 days of the week, and it just struck me last night to pick up a chart, just one at random. I didn't pick out any one particular chart. I told my nurse I wanted a chart of anybody 60 or over, because I would like to see the protein level. I have made a study of the protein levels of our people here in the United States where I have been and where I have practiced, and I find that their healing processes and their aging processes are certainly debilitated and slowed up because of their lack of nutrition.

Here in the United States where we have everything in the world, we can't have a lack of nutrition, can we? No. But lack of proteins slows down our glandular elements, ages us much faster, increases our arteriosclerosis and all this business, and we take in our cholesterol along with it.

I am not here to go into the dietary mismanagement of every individual but to plea mostly for the modification of Public Law 416 to make the American objective the same as the overseas objective in protein deficiency.

As I was going to say, this one chart, this is just one individual, 60 years of age, and you will notice these various lines (indicating) and you will notice the proteins here (indicating) are low by 10 and the albumen here (indicating) is low by 20. Now 3 out of 5 individuals past 60 or practically everybody in a particular hospital are deficient in protein, or protein and albumen both, in this land of plenty. Isn't that amazing? Well, all we have to do is find more steaks.

Senator EAGLETON. Let me ask you here, doctor, because I don't want to interrupt your train of thought, you said the protein was low by 20 and the albumen by 10?

Dr. GRAHAM. Yes.