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P^'^1^%,^ YORK STATE JOINT/'TEGISLATIVE COMMITTEE

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NEW YORK STATE JOINT LEGISLATIVE COMMITTEE ON PROBLEMS OF THE
/ AGING*

Senator Thomas C. Desmond, Chairman

Assemblyman William M. Stuart, Vice-Chair- Senator Thomas F. Campbei;

Senator Fred G. Moritt i

Assemblyman Leonard Farbstein, Secretary Assemblyman Harry J. Tifft "
Senator S. Wentworth Horton Assemblyman John E. Johnson

Ex-Offlcio Members

a^TfT ^^f,""i^^- ^^'"^•'i;^- ^'■«'''''"/ ^™ 2V'" of the Senate; Speaker Oswald D. IlErK,
Trr R -jiff^'^^'^/ Senator Elmer F. Quinn, Minority Leader of the Senate: Arrembly.ian
LEE L. Mailler Majontij Leader of the Assembly: Assemblymax Irwin Steingut. Minority
oTiLni '^rr^^^- ^^^^™K Walter J. Mahoney, Chairman of the Senate Committee

Z^ W^!'\!!'7%"''^''^'' °- ^^■''^'^^^^- Stephens, Chairman of the Assemhh, Commit-
Tee on \\ ays and Means.

Committee Staff

.Vlbert J. Abra^fs f

Director

Consultant:

. I~;ii-ii'kl:iii(l.

John A. Ruskowski . v

Associate Director

(ieoro-e A. Yapfrer; Office Staff: Helen Ernest, William M, Scheidlei-. Pauline
Kilnii \\('i(lk:iin, ami Chiii-les (.'. Derby

General Advisers ,

."\Ii.ss (ila.lys Fish,.,- Director „f Old A-e Assistance, Xew York State Social ^Yelfare Depart-
in , uiss Alice M. Loomis, Conimnnity Consultant .,n Services for the Aued. Rochester

n n 1 Q ""i ^^-'^"'^iPS; Miss Ollie A. Randall. Consultant <,n Services for the A-ed, C„m-

ninnity Service Societv of New York

I r I ' cur A '^Vii-T^-—rr r*^wivv»-;4- + «„ , f^„^,y^^^^

Dr. C. Waitl (laiii
Dr. Louis I. Dul)liii. I
Edwaid J. Stieglitz, (1

nf Nutrition, Cornell 1
li'iu-; nf till' 01,l,.r p,.,>

Ad^

:\li-. Han.ia ,1. Car
Hanover. Sei'ietai y, Xe
and Industry Associatic
JFr. P. ('. \Vol/.. Assists
Tieorge H. J'feif. Gener
Industrial I'n.lilenis and
Eesearrli Director, I'nit

iliss Sara .\r, M,-(
tratcn-. Special Ser\ ires
visor. Homes for tlie .\
President of tlic Will
Headworker of Inion >

LEGISLATIVE DOCUH

'■'On .Inne i2 1 . lll.'i{|.
Asseinlilviiian Karlistein
tile ('ojiiniittee.

UNIVERSITY
OF FLORIDA
LIBRARIES

loi'iety of Xe^\' York County;

ife Insurance ('oni]ianv: Dr.

Dr. Clive M. Met'ay. 'Selio.d

,il(igist (HI Adjustment Prolj-

Elderly

ligaiiizations; i[|-. Harcdd C.
. President of tlie C'omineree
.'i]itlu'o|i Chemical Ciun]iany;
k Coni]iany. Koelu'ster; yir.
ui. Clnurman. Committee on
rk. and .Mr. Sol n Kaikin.

erly

; .Mr. Harry Le\ine. Admiuis-
s .Marion C. ^[nlligan. Sn|ier-
; Mrs. Charles A. Kiegelman,
nd .M]-. Clyde E. Murray.

NO. 12

11 Hernard -\ustin re|ilaced
Hannifoi-d was a|i|)ointed to

Introduction

By Senator Thomas C. Desmond
Cliairman, Xew York State Joint Legislative Committee on Problems of the Afino-

(5'

IF YOUTH luiist be served, age merits its own
rewards. For it has served. And is eager to
continue serving.

Our Committee, in its studies of the aging, has
found that our older persons do not ask to be served ;
they plead only to be allowed to serve. They ask for
a chance to serve in industry, civic work and chari-
table efforts.

And yet, society shunts the older person out of
productive, useful life. Somehow in our national
race for expansion and wealth, we have ovei'looked
not only some fundamental human values but also
some productive values. For with all the tremendous
talent and energy that bless our wonderful American
young.sters, we can ill afford in terms of dollars aud
cents to lose the "know-how" and productive power
of our 45-plus, 55-plus, and 65-plus groups.

Too. we can ill afford, if we wish to expand the pur-
chasing power of our economy, to keep our older
persons in a financial ghetto of dependency. It
doesn't make sense. It doesn't make us strong. It
doesn't make for .justice.

The Hidden Disaster

Wc hiuiian beings move quickly and usually effec-
tively when disaster strikes. An explosion, an earth-
quake, or a train accident will throw gOv.;rni:icntal
machinery, community agencies and neighbors into
high gear to care for the unfortunate victims whose
agony is laid bare before our very eyes.

But when millions of older persons face the slow
death of forced retirement, when millions of persons
face the hidden disaster of old age on relief rolls,
when thousands of oldsters are thrust into mental
hospitals although all they may need is love and
understanding, when millions of oldsters are consigned
to a lonely old age, we move at a painfully slow rate.

That is why a grey-haired man. his head buried in
his arms, cries out, "Nobody cares." He might be in
your community and probably is. Maybe he needs
only companionship. Maybe he needs a job. Perhaps,
a doctor. It may be that all he needs is renewed con-
fidence. But whatever his problem, we in our neigh-
borhoods, our communities, states and Nation have
the wealth, the energy, the technical skill to see to it
that our older persons have a chance to make their
later years happy years.

Does nobody care? Our Committee recognizes an

increasing will to do. As the needs of the elderly
become better understood, communities are here and
there rising to the challenge. Industry itself, con-
fused as it is about its relationship to the elderly,
arbitrarily banning the hiring of older persons, spends
nearly a billion dollars a year for pensions, and
grants generous privileges to its senior workers. The
problems of the aged are complex. Some of the solu-
tions will be inexpensive; others will be costly. But
we can, under our free enterprise system, meet this
challenge. Our productivity, combined with our
humanity, will surmount obstacles.

In this report, the third of our Committee, a wide
range of armament is recommended to combat the
trend of the past fifty years toward squeezing more
and more of our older population out of productive
and useful life.

But there are many of our aging who look forward
to retirement. There are others who cannot work. For
these, improved nursing homes, better hospital facili-
ties for the chronically ill, adequate housing to meet
the special needs of older persons, widespread com-
munity recreational facilities, a social security system
that really makes oldsters secure, and other such aids,
discussed in this report, are urgently needed.

The Inc'i-i'liiars Responsibility

There is no doubt that government has a large role
to play in this field. And vet, while our Committee's
endeavors are necessarily and primarily geared to
governmental action, we must enijihasize that the
individual nmst help by developing his own resources.

All of us have within ourselves the capacity to
enrich our own lives to the very end. AYe all have the
responsibility for doing our own planning for our-
selves, so long as we can.

If you work in a plant that has a compulsory retire-
ment system, for example, it is sheer folly to do noth-
ing to prepare yourself for the day when you will be
retired. It is sheer folly, realizing that as you age
you are subject to deterioration of physical tissues and
to disabling illnesses, not to attempt to prevent chronic
ailments by having periodic medical examinations,
eating nutritious foods, and, in general, living
wisely. Many of the problems you will face in the
later years can be anticipated. Some of the prob-
lems of later life can be prevented early in life. And

it is rarely that you are too old to begin to overcome
them. The best way to plan for a happy old age is
to plan for tomorrow's happiness today.

Of course, cooperative action will be needed when
individuals cannot cope with their own problems.
That is why social agencies, medical groups and gov-
ernment need to wake up to the growing challenge
that alreadj' confronts us.

Government can, for example, accumulate all avail-
able data on the problems of the aging. Government
can raise and make available the sums needed to
undertake basic research in this field. Government
can make available facilities for use of the aging,
whether it be housing or sheltered workshops. Gov-
ernment can remove some of the causes of unhappiness
among the aged.

And yet, the thought remains: we cannot legislate
happiness for young or old. Happiness is earned.
It is achieved usually by effort, integrity and under-
standing.

In "Birthday's Don't Count," our Committee
presented a wide range of social, economic and medi-
cal problems which particularly afflict the elderly,
and explored possibilities of certain avenues of state
action. In "Never Too Old," the employment diffi-

culties of the aged were emphasized. In this, our
third report, particular stress is laid upon the role
of local communities in dealing with the aging, and in
charting a definite blue-print for state-action. How-
ever, even as this report goes to press, our Committee
is exploring two hopeful new facets for state activity
in the field of housing and sheltered workshops. Plans
for the aging, we can readily see, will never be final;
they -ndll change as understanding enlarges, as times
and conditions change, as problems are altered.

Our Committee is encouraged by the amount of
stimulative work it has been able to do in arousing
governments on all levels, social agencies, and other
groups of various types to an increased awareness of
the problems of the aging, and what can be done to
meet them. In our State in particular there has been
a great awakening of interest.

The "talk-talk stage" is behind us. We are emerg-
ing from the planning stage. As the second half of
the twentieth centurj' opens before us, we are entering
the action stage.

The future for older persons is not black. We shall
bulwark it with economic security, strengthen it with
true social security, and buttress it with inner
security.

Can industrj' afford tu lose productive power of such vigorous oldtr
workers a? James Currie (above), a pi]>e still operator for an oil
refinery?. (Drawn for The Lamp, .Standard Oil Co. of N. J., by
Charles Goldhamer).

TABLE OF CONTEINTS

pai;e

Iiitroduution by Senator Thomas C. Desmond 1

Committee Findings and Recommendations 5

The Governor's Views by Governor Thomas E. Dewey 53

What Can the Local Community do for its Elderly? by Miss Alice M. Loomis 54

What Westchester Communities are Doing for their Elderly by Miss Lillian A. Quinn. ... .58

What Syracuse is Doing for its Elderh' by Dr. Raymond G. Kuhlen 60

The Needs of the Aged in Xew York City by Miss Flora Fox 63

New York City's Work with the Elderly by William Posner 68

Some Elements of an Action Program for the Elderly by Miss Ollie A. Randall 72

Need for a Citizens' Committee on the Elderly by Miss Ollie A. Randall 7.5

Employment of our Elderly by Robert C. Goodwin 78

Labor and its Older Workers by Harry Becker 82

How Long do our Workers Last ? by Ewan Clague 87

Business Conditions Today Demand Seasoned Executives by John R. Powelson 91

New Jobs at 65 by Senator Thomas C. Desmond 93

Public Health and Our Older People by Dr. Leonard A. Scheele 98

Medical Care for Prolonged Illness by Dr. E. M. Bluestone 102

Hospitals and Our Elderly by Dr. Marcus D. Kogel 106

The Physicians' Contribution to a State-wide Program for the Aged by Dr. Frederic D.

Zeman 110

The Functions of a Geriatric Clinic by Dr. Robert T. Monroe 114

Medical Aids and Benefits at 40. 00 and 80 by Dr. C. Ward Crampton 118

The Veterans Administration and Geriatrics by Dr. James M. Dunn 121

Environmental Health and Aging Population by M. Allen Pond 123

Geriatrics — A New Frontier by Senator Thomas C. Desmond 128

Need There be Death ? by Dr. Paul A. Zahl 133

A Psychiatrist Looks at the Aging by Dr. G. M. Davidson 136

Family Care for the Aged by Miss Hester B. Crutcher 139

Y'ou Can't Retire on Your Money Alone by Senator Thomas C. Desmond 140

State Aid for Recreation Centers by Harry Levine 144

Financing Old Age by Dr. Henry W. Steinhaus 146

Trends in Old Age Assistance by Miss Jane M. Hoey 148

Older Persons Have Special Housing Needs by Dr. Bertha Kraus 154

Educational Needs of the Older Adult in Rural New York State by Mrs. Henrietta Rabe. . . 160

Librarians and Our Senior Citizens by Albert J. Abrams 166

Canada and Its Aged by Professor John S. Morgan 173

Appendix:

Recommended Legislation 176

Index 189

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Our Findings and Recommendations

To the Governor and Legislature of the State of New York:

< ( ■ .^OKSAKE US not in our old age. ' '

From millions of the elderly iu this coun-
try eomes this plea. An appeal as ancient as
the beginning- of family and tribal living, it is today
no less demanding, no less urgent, that it has echoed
through the centuries in all civilizations that neglected
the old.

Sometimes spoken midst tears. Sometimes written
in a pathetic shaken scrawl. Often-times expressed
only in the dark shadow of fear and anguish that
flits across a wrinkled face pondering: the present and
the future.

Poverty. Sickness. Loneliness. Humiliation. Fse-
lessness. These are too often the rewards of survival
until old age.

Yet it need not be !

A society that has reached into the atom itself for
power, that has erected huge skyscrapers of steel, that
has flown armies across the far seas, that has given
man a higher standard of living than ever before, that
has shown man can live in diguitv as a free human

Talent knows no age barriers.

Self-employment keeps many oldsters self-supporting, useful
and happy.

being in a free, jiopidarly governed order, can cer-
tainly ease the plight of our elderl.v.

The jiroblems of our aging are not insurmountable.

Some there are who have conquered the obstacles
I if old age b,v themselves. "We often see those who,
though the.v may not have much worldl.v goods, face
old age with courage and confidence that the last is
the best yet to be, with the serenity of humans who
have found comfort and hope in devotion to God, or
iu philosophic adjustment to life, or even with zest
for yet another adventure, another accomplishment if
it be only another endeavor to understand life itself,
or to render another service to others less fortunate.

Others need the help of their fellow man, whether
by individuals or by cooperative associations known
as governments, to fight the ills that plague our old-
sters.

Our Committee is convinced that societ.v can re-
claim to usefulness many of our oldsters who are 210W
disabled, economieallj- or physicallj-. Our Committee
is convinced that limited only b,v humaia intelligence
we can change man's Last Years to creative Golden
Years.

We believe that here lies one of the great challenges
of the 20th century. For if we in this century can
remove the fear of destitution in old age, if we can
restore to our older persons the dignity of status which
comes through usefulness and through mutual under-
standing, we shall indeed be solving one of the most
complex problems that has plagued mankind.

And the heartening conclusion reached by our Com-
mittee is that it can be done !

Not with any panacea. Not with any "one-shot"
pill that cures the disease but kills the patient. Nor
can it be achieved over-night. Nor by yielding to
pressures of sly promoters of economic artifices seek-
ing political or personal advantage by capitalizing on
the fears and needs of our elderly.

It is to the economist, the social worker, the indus-
trial manager, the labor leader, the psychiatrist, the
geriatrician, and the adult educator that we must
turn for guidance.

In our Committee 's efforts to approach the problem
scientifically, we have done just that.

Social and Economic Changes

Our Committee in its two previous reports, "Birth-
days Don't Count," and "Never Too Old," has pre-
sented an accounting of the tremendous upsurge in
the numbers of our elderly and of the spectacular so-
cial and economic changes of the past century which
have altered the status of the older person and pro-
duced so many heart-breaking difficulties for our
elderly.

We shall not elaborate on these causative factors,
except to point out that the number of persons 65 and
over in New York State has doubled since 1930, and
by 1960 it will have doubled again ! Our total popu-
lation increased 71 per cent in the past 40 years but
the increase in older persons has been more than
three times as fast, or 258 per cent. In 1850, life
expectancy was 40 years ; one hundred years later, it
is about 68 years.

But it is not alone the impact of numbers that con-
cerns us. The industrial revolution, the change
from an agricultural to a factory civilization, and the
concomitant movement from farm to city have pro-
duced a tremendous change in the living patterns of
our older persons.

The small city apartments, the trend to smaller
families, the mobility of labor, the modern wage-in-
come patterns, and the emphasis on specialization are
pressures which have produced an upheaval in the
position of older persons in our society.

Society did not foresee the impact of these develop-
ments and scarcely understands that they lie at the
root of many of the social and economic difficulties of
our elderly today. With the result that society has
been picking up the human wreckage and trying to
mend it together with the scotch tape of old age
assistance and the adhesive of social security.

Areas of Neglect

Before attempting to develop a program for the
aging, it is necessary to know the basic needs and

wants of the elderly. Our Committee has reported
on these in previous reports, so we shall not repeat
them here. However, it is abundantly clear to our
Committee that there are large areas of neglect in our
handling of the elderly that need to be brought to the
attention of our people and our public officials.
Today, in this country, we are :

1. Providing social security that is noble in con-
cept but petty in the pittance which it allows.
Not only does the Social Security Act, as pres-
ently in force, not provide any real measure of
security but in such provisions as that which
bans payments to those earning more than
$14.99 a month in covered employment, it is
anti-social.

2. Spending millions for old age assistance, but
hardly a dime, except for work recently under-
taken by this Committee, to find out how we
can prevent oldsters from needing to apply
for assistance.

3. Dumping our oldsters into mental hospitals
in many cases because we do not know what
to do with them.

4. Kicking men and women out
of our shops, factories and
governments at age 65
though they are still able to
work, need work and want
to work.

5. Refusing to hire men over
45 and women over 35,
though our Nation needs
more production to increase
our standards of living.

6. Forcing older persons to retire, though retire-
ment is often a death sentence.

7. Setting up huge public
housing projects but bar-
ring our older persons.

8. Establishing recreation pro-
grams for youngsters but
ignoring the recreational
needs of our oldsters.

9. Devising miracle treatments
of the aged and wonderful
new diagnostic aids, while providing few facili-
ties for the oldsters who are chronically ill.

10. Shoving oldsters into nursing homes, boarding
homes and old age homes, but failing in many
instances to prevent such homes from being
turned into dismal death depots for persons
waiting release from life, or from being turned
into monej' rackets.

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11. Thrusting oldsters into
county homes which are iu
some cases scandalouslj' in-
adequate, firetraps, dreary
dungeons filled with despair.

12. Attempting to plug vip the
flood of human i^roblems
with which the oldsters are
faced by concentrating

solely on economic security and totally ignoring the
emotional security needs of the aged, their need to be
wanted, loved, useful, their psychological needs.

The conditions which have been highlighted here
are present throughout our country. They are not
characteristic solely of our State, or of our o^vn com-
munities. Nor is our 12-point indictment directed
against the Federal Government. Our governments
can move no faster than the people permit. And

our people, let us frankly state, have not demanded
action. The public has not had the facts. Facts
often have been unavailable in the infant science of
gerontology, which deals with the aged. Or where
the facts have been available, they have not been
dramatically brought to the public's attention.

Here in the State of New York, virtually until our
Committee was created, there was little awareness of
these problems, except by a few private agencies, a
handful of social workers, and a few medical men,
whose warnings went unheeded year after year.

Our Committee has stimulated in virtually every
city in this State not only a greater awareness of the
urgency of the problems of the elderly on the part of
civic leaders, not only a better understanding of the
needs of the elderly, but also an active willingness to
root out these evils, which we believe will be of tre-
mendous long-range benefit.

Our Committee is the first such agency set up by

A study in intense concentration by aging minds that are still young.

any state. As such we felt we had a definite responsi-
bility to handle our obligation in a mature, non-
partisan manner.

We soon found we had to assume some functions not
legislative in a narrow sense, such as educating- of
responsible community leaders, encouraging, prodding
and stimulating State and local officials, and while
these activities may not produce legislation, undoubt-
edly they will bear fruit in better service to our old
folks.

This Committee has excluded from its official in-
quiries (a) the field being covered by the Ostertag
Committee on Interstate Cooperation, whose sub-com-
mittees are considering the problems of social welfare
administration and financing, including adult institu-
tional care; and (b) the field covered by the Mailler
Health Preparedness Commission, the Hospital Study
Committee, and Joint Hospital Survey and Planning
Commission, which agencies have considered the prob-
lems of medical care, hospitalization and chronic ill-
ness of the elderly.

Our Committee has concentrated its attention large-
ly though not entirely in six main fields: (a) employ-
ment problems of the elderly; (b) recreational needs
of the elderly; (e) health needs of the oldsters; (d)
community services to the elderly; (e) integration of
State programs for the elderly and (f) development
of an informed grouj) of medical, labor, industrial,
social work, and religious leaders in this State who
will be informed in this field and who will be able to
provide a continuing medium for advancement of the
interests of the elderly apart from any governmental
agency.

Basic Principles Guiding Our Committee

We come to you with no panacea or legislative cure-
all for the problems of our oldsters. We carry no
elixir of youth in our files.

Our Committee is guided by five basic principles :

1. Activity is a biologic duty.

2. Oldsters must feel wanted and useful.

3. Aging is a personal and local phenomenori.

4. Until we know far more about the aging than ive
do, seek a diversity and fluidity of approaches
and services and institutions rather than at-
tempt now to freeze into law a single line of at-
tack or encourage a single kind of institutional
care.

5. The seeds for a happy old age are best planted
early.

We shall not elaborate in detail on these largely
self-explanatory guide-posts. The late Dr. Alexis Car-

rel pointed out that "to those whose forces are de-
clining appropriate work should be given, but not
rest." We urge Grandpa to get out of the rocking
chair; we want to encourage activity, whether it be
work, social activity, recreation or any other kind of
activity for older persons. The psychiatrists speak of
the "lethal cessation" of activity, and Dr. Edward J.
Steiglitz, renowned geriatrician, emphasizes to our
committee that inactivity speeds up the degenerative
processes. The phantasy of retirement and old age
as a period of the Grand Loaf must be erased, for
nature eliminates those who have relinquished their
functional usefulness.

Activity is not enough. It must, in part, at least be
purposeful. The older person must, like all of us. feel
that he is doing something that is useful. This feel-
ing of utility becomes especially vital in old age be-
cause oldsters very commonly feel re,iected, bei-ause
they are rejected.

We all age difl'erently. The aged have no monopoly
on aging ; nor youth on youthf ulness. Some at 65 are
young ; some at 35 are old. We age differently men-
tally and physiologically ; and different parts of our
body age at different rates. Beyond that, the needs
of the aged differ greatly. Thus we must avoid, as
much as possible, a broad sweeping treatment of the
aging and attempt, as far as possible, the individual-
ized, personalized, local approach of the ease-worker or
the modern group techniques of therapy. The closer
we can bring service agencies to the aged, the more
effective they will be.

Gerontology is in its infancy. We know little about
our old folks. We know little about how to care for
them. We aren't sure, for example, whether we need
regional hospitals for the chronically ill in a few cen-
ters in the State, or many wards or cottages set iip in
connection with our local general hospitals. We
aren't certain as yet whether we should set up settle-
ments of old folks or bring them into neighborhoods
with younger people. Our Committee believes that
at this stage in our evolution toward services for
older people it would be unwise to freeze into law any
one type of approach or service to older persons. We
are only in the planning and experimental phase of
our development to a more mature handling of our
oldsters.

Finally, we are convinced that those of us who are
thinking about the elderly of the future would do well
to be concerned about child welfare today, for the
patterns of adjustment of the individual to his en-
vironment are determined early in life. The crabby
crotchety oldster of 76 was probably a miserable
man in his 40s, an irritable youth, and a sniveling,
brat in knee-pants. The well-adjusted, happy old-
ster of today was probably full of life and pep and
ambition in his younger days.

A New Era for Our Elderly

Despite the tragic situation in which many of our
elders find themselves, we believe we are on the brink
of a new era of tremendous progress insofar as our
oldsters are eoneerned.

Our Committee senses an awakening of society not
merely to the statistical facts of life, that more of us
are living longer and that the number of our elderly
is booming, but also to the fact that we have been
wasting one of our great human resources, our elderly.
Too, society is gradually learning about old age. its
limitations and its possibilities.

We are coming to understand that the Brotherhood
of Man does not merely encompass a Brotherhood of
Young Men.

Moreover, we are witnessing before our very eyes.
though our people little realize it. tlie development of
a new "breed" of oldsters. It is not only the Bernard
Baruchs, the Herbert Hoovers, the (irandma Closes,
the Connie Macks, the Arturo Toscaninis. who are
contributing theii- talents to our country though past
three score and ten. but also the oldsters who live on
your block and ours, our elderly neighbors. News-
papers daily lierald the exjiloits of septuagenarians,
octogenarians and nonagenarians. A 77-year old
great-grandmother is still an active barber in a small
Vermont community. A 101-year old man in New
Hampshire takes a 25-mile hike. A Massachusetts
man, age 95, plays golf. Mr. Joseph Merrit of Goshen,
N. Y., is an active lawyer at age 94. Adolph J. Cohn,
of New York City, delivered an oration on his iKith
birthday, and exulted, "I'm so doggone old, the in-
surance company is going to have to pay me off. I
was supposed to die first. But I'm alive. And I feel
fine, considering my youth, of course. " ' A retired cot-
ton broker of New York City swims happily on his
93d birthday, and goes up for a plane ride with a
"young" pilot of 62 years of age.

Dramatic new discoveries in medicine are bringing
relief to our oldsters. The synthetic adrenal "'lantl
hormone, cortisone, and an adrenal cortex stinuilating
hormone from the pituitary gland, called ACTH, is
effecting amazing benefits to sufferers from painful
rheumatoid arthritis, and they show promise of com-
bating certain aging processes.

New findings in preoperative and postoperative
management, anesthesia, operative techniques and
early ambulation are combining to lower surgical
mortality in middle age and old age, and are helping
to restore older persons to vigor and activity where
just a short time ago they would have been bed- or
chair-bound invalids, racked with pain.

New drugs have been found of help in combating
muscular tremors which often plague older per.sons.
And a new compound, called reticulo-endothelial im-

Old and young enjoy adventure of air-flight.

muue sera, is believed to give physicians a powerftd
weajion in combating degeneration of conn(>ctive
tissues.

Our Connnittee is understandably excited by the
awe-inspiring results being achieved by Dr. Howard
A. Kusk and his associates in rehabilitating old per-
sons, and by the home care experiments in New York
Citv.

A young oldster who went back to school bones up for exam.

The current move to elevate standards in nursing
homes and old age homes, the establishment of foster
homes for the elderlj', the growth of non-resident aid
by old age homes, all these are but a portion of the
many recent developments which argur well for our
older persons.

Plans for the creation of a National Committee on
the Aging under the temporary sponsorship of the
National Social Welfare Assembly, along the lines our
Committee has proposed for a State-Wide Committee
on the Aging, mentioned later in this report, are also
noteworthj\ In New York City, the Mayor has ap-
pointed an Advisory Committee on the Aged.

A survey undertaken b.y our Committee indicates
that schools of social work slowly but surely are tak-
ing the first painful steps to altering their curricula
to make a place for study of the aged and training of
personnel .specially qualified to care for the elderly.
Keports to our Committee from medical schools, long
resistant to the idea of teaching geriatrics, show that
the ranks of those preparing to be specialists in med-
ical treatment of the aged are growing. Psychologists
and psychiatrists are turning their attention for the
first time to mental and emotional problems of our
elderly. Family welfare agencies, religious and non-
denominational welfare groups are devoting increas-
ing attention to the aged. The creation of a State
affiliation of councils of social agencies in New York
State, with a special committee on the aged, will mean
stimulation of more local activity in behalf of the
aged. Recreation clubs for the elderly are springing
up throughout the State and country. Emploj^ers,
pressed by demands for private pension funds, are
supporting an expansion of social security protection
for the aged.

Tlie drive bj^ unions for pensions has focussed at-
tention of the entire country on the need for im-
proving the economic cushion provided by the Social
Security Act.

All these developments, when seen in proper his-
torical perspective, indicate that the second half of
the 20th century will yield more than mere promises
and hope for our oldsters.

The State's Stake

The State already has a heavy financial stake in the
])roblems of our older persons.

It embraces an annual $29,613,02.3 State tax load
to meet old age assistance payments for nearly 120,-
000 persons.

It covers custodial and medical care for 22,500
oldsters in oi;r State mental hospitals, at a cost of
over .$20,000,000 a year.

It includes a substantial portion of State aid for
cancer and tumor clinics, which sei-ve primarily our
older age groups.

{('Durfcsii Piiilxjilii Home for the Affcd.)
Dressing up is morale booster at any age.

If we add to these costs the payroll tax on employ-
ers and employees for the Federal Old Age and Sur-
vivors Insurance, or the $44,445,538 a j^ear Federal
contribution to old age assistance in this State, or
local costs for old age assistance and old age homes,
or the burden assumed by private groups in this
State for supporting old age homes and nursing
homes, chronic disease hospital wards mainly for the
elderly, visiting nurse service for the aged, and many
other such programs, or if we were to include the
extra-long payments to elderly on vinemployment in-
surance rolls because they cannot obtain work, we gain
some appreciation of the staggering burden already as-
sumed by citizens of this State for aid of our elderly.

State Activity

But this summary of some of the State's financial
obligations in alleviating the plight of the elderly
does not present a full picture of the extent to which
the State of New York aids its oldstei-s.

There are a myriad of State activities directly af-
fecting the aging, and we are happy to report that
coincidentall}^ with the creation of our Committee,
various State departments have stepped up tlieir
services to the elderly, have re-examined their jiro-
, grams, or have increased the tempo of their researches
into the needs of the elderly.

A 64-year old man, disabled by a fracture of both
legs, was guided by the vocational rehabilitation unit
of the State Education Department. This agency
guided the man into a profitable rooming house ven-
ture. A 72-year old man, sufl^ering from an affliction
of the legs that barred his return to his former job,
was placed through this agency's help as a landscape
gardener.

The State Education Department, through its
Adult Education Bureau, is promoting a variety of
courses especially for older persons, in old age homes,
day centers, and factories, as well as in schools.

Pension funds of various charitable and teaeliers
groups are supervised bj' the Insurance Department,
which also exercises general supervision over the va-
rious insurance companies which sell group retire-
ment and welfare policies. The State Bank Depart-
ment similarly supervises banks which are often
named as trustees of various industrial pension funds.

The Social Welfare Department has appointed sup-
ei'visors to cheek on nursing and old age homes and
is developing standards for these institutions. This
department also supervises the grants of old age as-
sistance by local welfare departments. And when
Mr. B., an old age assistance recipient, deems his grant
is inadequate, he can appeal to the State Social Wel-
fare Department for a hearing. This department is

setting up in-seiwice training for local welfare vv'ork-
ers. It has encouraged improved medical care for the
destitute aged. Too, it operates at Oxford, N. Y., the
only State operated home.

The State Labor Department, through its Bureau of
Research and Statistics, is beginning to compile ease
histories of successful employment of older persons,
and has initiated a series of studies dealing with older
workers. The State Employment Service, under the
State Labor Department, has set up an experimental
unit in Manhattan to place older persons seeking
clerical jobs, and is slowly expanding this valuable
type of work to other areas and other types of posi-
tions.

The State Mental Hygiene Department cares for
22,000 persons who are over 65 in its mental hospitals.
Last year it launched an experiment at Willard State
Hospital in which naval barracks at nearly Sampson
are being used to determine the practicability of cot-
tage care of the harmlessly senile. This department
has placed 827 persons over 60 years of age in foster
liomes and is developing its family eare program.

Tlie State Housing Division has set aside some 53
apartments at the Fort Greene Housing Project for
older persons, and of course, when older persons live
at the site where slums are demolished for new state-
aid public housing projects, they are given priority
in renting the new apartments. This division is un-
dertaking an analysis of its research data to sift out
all available facts relating to the living conditions
of the elderly.

State Health Commissioner Herman E. Hilleboe
recently informed the American Public Health As-
sociation that his No. 1 health goal was better care
for the chronically ill and aged. This represents a
major shift in emphasis in the thinking of this de-
partment along lines urged b3^ our Committee. Many
of the services rendered by the Health Department
from its cancer work to its tuberculosis program di-
rectly aid the elderly.

The State Retirement Fund in the State Depart-
ment of Audit and Control directly affects former
State and local employees as well as older workers now
employed by the State or local governments.

There are a host of other State services to the elder-
ly ranging from free fishing licenses granted by the
Conservation DeiJartment to oldsters, to bath treat-
ments by the Saratoga Springs Authority especially
popular with older persons, and which are free in
some instances to persons on old age assistance need-
ing the therapeutic aid of the baths there.

Our i^urpose in recording these activities is to un-
derscore the diverse relationships between a modern
state and its older people. It also may help the
reader to understand why our Committee believes
there is need for coordinating State activities.

ANNUAL PARTIAL COST TO THE PEOPLE

OF NEW YORK STATE OF CARE FOR

OLDSTERS

Old Age and Survivors Insurauee pay-
roll deduction $322,800,000^

Private industrial pension payments . . . 135,000,000-

Old age assistance, Federal, state and

local payments 87,600.000

Care of elderly in State mental hospitals 20,1 00, 00(1 •

Homes for the aged, public expenditures

for 5,000.000^

Elderly in State prisons, cost of care for l,.iOO,0()0"'

Assistance to elderly blind 1,000,000"

Benefits to elderly veterans and A'eterans

dependents 28,()()(1.0()()'

$601,000,000

1 Fiscal year in48-4!1.

2 No accurate data available for state or Xatimi on private
industrial jiension payments. This figure is HI per cent of
the estimated national figure for employer-employee contribu-
tions to industrial pensions.

3 Fiscal year 194.S-4!! iiuiintenaiice cost; does not include
construction or depreciation costs of buildings.

i Data relates to 194fi, from Xe\v York State Department of
Social Welfare.

■' Estimate based on ratio of 65-and-over age group in prisons
to total prison population as of January 1, 1948; cost esti-
mates based on per capita costs in 1940.

« Based on ratio of persons (io and over in u]istate caseload,
for calendar year 1947.

" Based on ratio of persons (!.) and over receiving disability
pensions and survivor death claims from World War I and
previous wais and estimated cost in maintenance in veterans
hospiitals and homes.

Community Programs

One of the most stirring advances being made in
the State toward alleviating the plight of our elderly
is being made by local private agencies, which are
taking the lead in their communities in awakening the
people to the need for aiding the oldsters and often
in actually operating new services for the aged.

A state-wide survey made this past year by our
Committee shows that old folks are getting more at-
tention than ever before from their home towns. Local
activity in the field of the aging is beginning to
boom.

Our Conmiittee has attempted to stimulate tliis de-
velopment, provide a source of information for the
local agencies, and channel their etforts into the most
productive avenues.

Recreation centers for oldsters are being set up in
many communities. Old age homes slowly but stead-
ily are improving their standards of service. Health,
welfare and iiulustrial organizations are joining to
plan connnunity-wide welfare programs for the
elderly. A variety of research is being initiated, and

new ways for dealing with ailing oldsters are being
developed.

We find that New York City and Rochester are fore-
most in advancing the interests of the elderly in our
State. Rochester, by virtue of a gift from the local
"Women's Educational and Industrial Union to the
Rochester Council of Social Agencies, has appointed
a Community Consultant on the Aged to spur on
services of oldsters and coordinate work dealing with
them.

Rochester's social agencies are outstanding in their
advanced planning for the elderly. This city has
what our Committee believes to be the only geriatric
clinic in the State, operated by the Baden Street Set-
tlement House. Rochester's Planning Commission
has assigned a staff member to report on housing for
the elderly. The local Welfare Department has made
studies of oldsters on old age assistance rolls. Old
age liomes for the first time are being encouraged to
lift their standards. Recreational projects have al-
ready been set up for oldsters. Rochester knows what
it needs to do for the elderly, and is prepared to do it,
limited only by available funds.

New York City, through the leadership of the Wel-
fare Council of New York and the Community Serv-
ice Society of New York, is bringing together public
and private institutions, agencies and individuals
dealing with the elderly for a unified attack on old age
jiroblems. ]Miss OUie A. Randall, Consultant on the
Aged for the latter organization, is an unofficial New
York City ambassador to its elderly people.

New York City's Hospital and Health Departments
arc taking a world-wide lead in studies of degenera-
tive diseases which afflict the elderly. The city is also
pioneering in providing housekeeping services and
home care for sick oldsters who often respond best to
help in their homes rather than in hospitals. New
York City has the first geriatric unit set up by any
local health department in the country. The Hos-
jiital Department, guided by the able medical counsel
of Dr, Howard A. Rusk, is doing miraculous wn'k in
rehabilitating the elderly for work.

New York City's Welfare Department is providing
staff personnel for the world renowned Hodson Recre-
ation Center for oldsters in cooperation with private
agencies.

Social welfare organizations in various communities
are setting up special committees for the aged. In
the long run these will prove to be major steps for-
ward, for they will provide the necessary leadership
and |)lanning needed for total community programs.

Syracuse recently established such a committee un-
der the leadership of the Onoiulaga Health Associa-
tion. The Committee is headed by Dr. Raymond G.
Kuhlen, nationally known Syracuse University psy-
chologist specializing in problems of the aged, who

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COMMUNITY RECREAT-
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already has a large number of research projects under
way and is starting to mobilize communit.y support
for recreation and adult education jjrograms for the
elderly. A presentation of the Sj'raeuse program is
detailed elsewhere in this report.

Buffalo has set up a special committee on the aged
under its Council of Social Agencies, and it is work-
ing toward educating trustees and administrators of
old age homes toward modern concepts in handling
institutionalized elderly. The Committee is also de-
veloping craft and reei'eational programs for oldsters.
The Buifalo Fire and Welfare Departments recently
joined in surveying old age nursing and boarding
homes. The Forty Plus Club of Western New York,
with its headquarters in Buffalo, has helped many
top notch executives obtain jobs though they were in
upper age brackets.

In New Rochelle, Port Chester, White Plains, Ossin-
ing, Tarrytown, Yonkers, Mt. Vernon and Tuckahoe,
"senior canteens" have been set up largely through
the support of the National Council of Jewish W^omen.
Local recreation commissions in Westchester Count.y
are being stimulated to think in terms of old people as
well as young people.

Troy and Yonkers are now considei-ing setting up
committees on the aged through their local social wel-
fare agencies. The Community Chest and Planning
Council of Utica is launching a study of hospital
facilities for the senile in the Utica region.

Jamestown's Recreation Department has organized
a ' ' Golden Age Society ' ' to handle recreation for old-
sters. At present, it has 341 members, the oldest of
whom is 93. The group has picnics, trips, lectures,
plays and other entertainment to make life worth liv-
ing for its members. The club has a special shut-in
program for its bedridden members, one of whom has
been in bed for 25 years.

These are but some of the developments in our com-
munities. Others are cited in more detail in other
parts of this report.

The New York Plan

The heart of our proposed plan for New York State
is stress upon a local community approach, an empha-
sis upon a variety of modes of attack on the problems
of the elderly, and a provision for linking private and
public agencies in the communities for a united drive
to aid our oldsters.

In this, our third report, we present as definite and
concrete a program as can reasonably be achieved at
the present time.

The program calls for :

1. Teamwork between Federal, State and local
governments, and between government, indus-
try, labor and citizen groups.

2. A "home-town" approach to the myriad prob-
lems of the aging, recognizing that the
strength of our country lies in great measure
in vitality of our local communities and in the
intelligence and public spiritedness of our
local community leaders.

3. The preventive approach, which seeks to con-
centrate on preventing our oldsters from
needing to fall back on old age assistance, or
from needing hospital facilities, or from need-
ing to be institutionalized in old age homes, by
providing job opportunities, health services
and adequate housing for older persons. Here-
tofore most thinking in connection with the
aged was centered on trying to ease the woes
of the elderly rather than aiming to prevent
them.

4. A diversified, multi-pronged attack on the
problems of the elderly, rather than a single
approach, characteristic of the Beveridge plan
in England and the California approach in
this country.

5. Integrating services for the aged with general
community services for all citizens whenever
possible instead of separating old people from
the remainder of the community.

The iDlan calls for establishing:

1. A permanent home-town job-finding service for
older persons, with local citizenry joining with
the local employment service offices, to conduct
an educational campaign designed to encour-
age the hiring of older workers, break down
artificial age barriers in local plants, furnish
counseling service for older persons, and
utilize local schools and hospitals for re-
habilitation of the elderly job seeker for work.

2. A community recreation program in each lo-
cality to meet the needs of the elderly, such
recreational facilities, to be sponsored by local
fraternal, church, civic and welfare organiza-
tions and official agencies; such recreational
facilities to be of the day care center type or
the club type depending on the size and needs
of each community, but in all cases emphasizing
not merety recreation in a limited play sense,
but also opportunity for creative, jjurposeful
activities. The program should not be limited
to a particular building or facility, but should
spread out to embrace old age homes and nurs-
ing homes.

3. Adequate facilities for the chronically ill in
each community, as may be recommended by
the Joint Hospital Survey and Planning Com-
mission, more liberal admission policies of the
elderly who are chronically ill by local hos-

pitals, provision of home care and housekeep-
ing services for those who often do not need
expensive hospital service, and adequate clin-
ical and diagnostic service for the elderly.

4. Improved standards of institutional care, in
nursing homes and old age homes, by licensing,
education and supervision, as may be recom-
mended by the Ostertag Joint Legislative Com-
mittee on Interstate Cooperation and the State
Social Welfare Department.

5. Local adult education opportunities for old-
sters, embracing a wide range of courses suit-
able for oldsters, such as hobbies and crafts,
and also courses dealing with health care after
60, how to adjust to retirement, etc. Such
courses should be given not only in schools, but
wherever convenient for the elderly, in plants,
old age homes, private homes, and civic centers.

6. A new concept in local health departments
geared to adjusting services to an aging popu-
lation, with development of health education
programs, geriatric clinics wherever possible,
and a shift in emphasis by local voluntary
health agencies from the communicable dis-
eases to the degenerative diseases.

7. Local mental hygiene program designed not
only for younger persons but also for the mid-
dle aged and oldsters, to block the impact of
senility.

8. Financial counselling service by the commun-
ity's bankers, businessmen and social workers,
to low and moderate income groups so that the
best use may be made of available income by
our elderly and near elderly and so that some
may be prevented from needing old age as-
sistance.

9. A program to inform the public regarding the
needs of the elderly on old age assistance, the
extent to which local welfare departments are
meeting these needs, and the granting of old
age assistance to the needy according to their
needs, based not on a meagre subsistence or
sustenance level, but on a decent. adef|uate
American standard of living.

10. A local agenc.y in each community composed of
private and public groups to coordinate the
local old age program, inventory and develop
local resources for the aged, and educate the
community to the needs of the older people.
The local councils of social agencies, already in
existence, provide a ready-made organizational
pattern capable of providing the leadership
urgently needed in urban areas. In non-urban
areas, perhaps existing committees of the State
Tuberculosis and Public Health Association, of
the State Charities Aid Association, and vari-

ous farm groups, such as the Grange, F'arm
Bureau, Home Bureau, and the Extension Serv-
ice, can provide the central direction and lead-
ership needed.

This is a local program that calls for social engi-
neering that can be launched by our communities
without waiting for a beneficent State or Federal
Government to prod, finance, or supervise local efforts.

Some communities are already taking action along
these lines as we have indicated in another part of
this report. This multi-purpose drive is practical,
because individual segments of it have already been
tested in various communities.

The State's Role

But our Committee believes the State must bear its
share of the responsibility. Our communities are
already heavily burdened with debt and tax levies.
Our Committee believes that the State has these pri-
mary obligations in this field :

A. Provide financial assistance wherever justified.

B. Provide the technical assistance and standards
needed to assure uniform, high-level adminis-
tration.

C. Spark its own agencies to a wider appreciation
of the needs of the elderly.

D. Provide a central coordinating agency of vari-
ous departments to give the State program
leadership, direction and coordination.

Specificallj^ our Committee recommends:

1. Creation of a special counselling and placement
service in the State Employment Service, to aid
older persons obtain jobs. Our Committee be-
lieves every local ofSce of the State Employment
Service should have one or more placement ex-
perts, depending on the size of the community,
who is familiar with the emotional, medical and
economic problems of the older persons, who is
familiar with local job opportunities for older
persons, who is trained in "selling" older per-
sons to industry, and who has the special zeal
and ability to counsel older workers so that they
will have renewed confidence in their abilities.

2. Creation of a permanent, full-time agency in
the State Labor Department to promote the em-
ployment of the aging through education and
research designed to break clown age barriers in
industry through development of job analysis
studies, case histories, etc., publicity aimed at
breaking down the several myths which retard
the hiring of older persons, and to collect data
on employment of the elderly which will aid

the employer and employees alike, sueh as
information on pre-retirement counselling poli-
cies, private pension plans, etc.
Provision of state-aid for recreation centers for
the elderly in the same manner it has authorized
state-aid for recreation centers for youths. "We
recommend that the Legislature appropriate lOe.
of State-aid for each person 60 years of age or
over to each community matching this aid dime-
for-dime. We believe the State will be buying
itself a bargain through such aid, that it will
decrease the ratio of increase of our elderly in
our mental hospitals, and that it will help restore
vitality to our elderly.

Creation of Division of Adult Hygiene and
Geriatrics aimed at shifting emphasis in the
State Health Department from communicable
diseases to the degenerative diseases which are
now the leading causes of death.
The Legislature should proA'ide the Adult Edu-

cation Bureau of the State Education Depart-
ment with the funds necessary to establish a
state-wide adult education program aimed at
our older persons, by encouraging localities, in-
dustries and labor organizations to organize
courses, by training teachers for the special
techniques needed in motivating older persons
and by providing leadership to carry out plans
already well formulated by this bureau.
In all state-aided public housing pro.jects, a
small percentage of apartments be set aside for
older people at least in proportion to the number
of elderly in the community as a whole.
A permanent State council on the elderly de-
signed to pi-ovide the central coordinating ma-
chinery needed to provide official leadership in
the field of the aged for the various State de-
jiartments.

Adoption of a law banning discrimination
auainst older persons seeking anv State or local

NUMBER OF PERSONS AGE 20 TO 64
FOR EACH PERSON AGE 65 AND OVER

AGE 20

fc4

\Q£ CS a, OVER

I860 175

W ^^v ^^V ^^r ^Ir ^hV ^^V ^^V ^^^P ^^^P ^^P ^^r ^^r ^^^r ^^^r ^^V ^^^r ^^r ^^^r

1900

12 5

f llllllllllf I I

I960

1,7

2000

4.6

rffff f

1850-1900- FROW U 5 CENSUS DATA

1950 -2000- FROM ESTlMATtS PUBLISHED BY BUREAU OF THE. CENbUb 1947

{('oiirlesu Xational Iii(li(nhi(il Conference Hoard. )

Speci

Stim

Slate
She

the employer and employees alike, sneh as
information on pre-retirement counselling- poli-
cies, private pension plans, etc.

3. Provision of state-aid for recreation centers for
the elderly in the same manner it has authorized
state-aid for recreation centers for youths. "We
recommend that the Legislature appropriate 10c.
of State-aid for each person 60 years of ace or
over to each community matching' this aid dime-
for-dime. We believe the State will be buying
itself a bargain through such aid, that it will
decrease the ratio of increase of our elderly in
our mental hospitals, and that it will help restore
vitality to our elderly.

4. Creation of Division of Adult Hygiene and
Geriatrics aimed at shifting- emphasis in the
State Health Department from communicable
diseases to the degenerative diseases which are
now the leading causes of death. ,

5. The Legislature should proA-ide the Adult Edu-

cation Bureau of the State Education Depart-
ment with the funds necessary to establish a
state-wide adult education program aimed at
our older persons, by encouraging localities, in-
dustries and labor organizations to organize
courses, by training teachers for the special
techniques needed in motivating older persons
and by providing leadership to carry out plans
already well formulated by this bureau.
In all state-aided public housing projects, a
small percentage of apartments be set aside for
older people at least in proportion to the number
of elderly in the community as a whole.
A permanent State council on the elderly de-
signed to provide the central coordinating ma-
chinery needed to provide official leadership in
the field of the aged for the various State de-
partments.

Adoption of a law banning discrimination
against older persons seeking any State or local

NUMBER OF PERSONS AGE 20 TO 64
FOR EACH PERSON AGE 65 AND OVER

AGE 20

IVGE IS £,OYER

I860 175

m ^^v ^^P ^^P ^HT ^^P ^^V ^^V ^^P ^^V l^r ^^r ^^r ^^F ^^v ^^r ^^r ^^r ^^v

1900

12 5

f lllllllllll I I

1950

1.7

2000

4.4

fffff f

1850- 1900- FROW US CENSUS DATA

1950 - 2000- FROM ESTlMATLS PUBLISHED BY BUREAU OF THE CENbUb 1947

(Courtesy Natioual huUi.'iliial Conference Hoard.)

CITIZEN'S COMMITTEE

COMMUNITY PROGRAM FOR THE AGING

185

190

196

20C

{Co

license, permit, or certificate, or admission to
any state-financed, administered or approved
course. While our State is admirably free of
any such discrimination, we have found that
applicants for vocational-industrial teacher
training courses set up by the State Education
Department are barred if they are over 40
years of age, a policy that blocks able, skilled
middle-aged and elderly mechanics, for exam-
ple, from serving as teachers.

State-wide Citizens Committee on the Elderly

Our Committee recommends that there be estab-
lished in this State a State-wide Citizens Committee
on the Elderly.

We have already initiated moves leading to the cre-
ation of such a group and believe that perhaps one of
our most worth.y long-range accomplishments will
be tlie impetus given to the establishment of such a
group.

Such a private committee, representing the think-
ing of labor, industry, and farm organizations, and
religious, medical, and social welfare groups, can
bring to bear upon the old age problems in our State,
sound, mature intelligence.

Such a non-official group is needed to review leg-
islation introduced affecting the elderly, mobilize pub-
lic opinion for sound legislative or administrative ac-
tions aifecting the elderly, prod public officials to
greater efforts in behalf of the aged, act as an unoffi-
cial auditor of the State's activities for the elderly,
stand as a bulwark against "panacea" pressures
which might throw the State into bankruptcy, and
ser-\e as a vital link with any national committee set
up in this field, and aid local councils of social agen-
cies in their efforts to alleviate the plight of the
elderly.

This, then, is the New York Plan. It is not a com-
plete, final and definitive plan. But it is believed to
be the best plan that our Committee can propose at
this stage in our social evolution, and with the pres-
ent limitations on the scope of our Committee's
activities.

Man's Quest for Security

There is a disposition among some publicists and
officials to view the current drive for security for the
aged as a new trend that stems from a weakening of
the moral fibre of our people.

This line of reasoning totally ignores the physiolog-
ical and psychological drives and the socio-economic
factors which underlie the search for security.

Man has always sought security.

He sought it in the caves. He sought it in nomadic
tribes which travelled far to find food in abundance.
He' sought it under the protection of lord-subject re-

lationship and under master-slave relationship, and
when he found no real security in any of these, he
sought security in freedom.

The baby who wails when it does not receive its
milk on time is crying out not only with the pangs of
hunger but with fear of loss of its security. The baby
grown to manhood searches for security through his
own labors, through religion, through family rela-
tionships, through participation in a free society.

Speak to the psychiatrist and he will say : ' ' The man
who loses his sense of security is lost. Today mental
institutions are jammed because so many people have,
for a variet}' of reasons, lost their sense of security."

And so the quest of our aged for a modicum of se-
curity in their old age lies deep rooted in the physiol-
ogy and mentality of man. And if it erupts in modern
man as a drive for pensions, or old age insurance,
should it not be viewed as stemming in large measure,
at least, from the change from a rural economy to an
urban economy, from an agricultural economy to an
industrial economy, from a society where families
lived in large homes ample for three generation units
to one of small apartments where two generation units
are often cramped, from conditions which often bring
our people to later maturity shunned by an industrial
society and haunted by fears of destitution and a
paiiper's grave.

The financial needs of the elderly are real and
urgent. Of 6.3 million nonfarm families with incomes
below $2,000 in 1948, more than one-fourth, or 1.7
million, were headed by persons over 65.

Half of the families headed by persons over 65 had
incomes below $2,000 a year.

A study of old age and survivors insurance recipi-
ents indicated that 69 per cent of the nonmarrie^ per-
sons and couples living alone and drawing OASI
checks received a total annual income from all sources
of less than $1,000, and practically all of them were
below the $2,000 level.

The problem is not should we provide a measure of
security for our aged, but rather :

(a) how much security can our industrial economy
afford to provide now and in the foreseeable
future ; and

(b) how can we channel the drive for security into
proper avenues.

We have today a 250-billion dollar economy. Some
economists, more optimistic perhaps than others of
their colleagues, believe we shall have a national pro-
duction in 1975 of 500 billion dollars.

How much of this production can we siphon oS for
protection of the aged? This is a problem national,
rather than state-wide in scope, and requires a degree
of study that has not been given as yet by anyone in
this country.

UNEMPLOYMENT INSURANCE

COMPARISON OF CLAIMANTS EXHAUSTING BENEFITS DURING

FIRST TWO POSSIBLE WEEKS IN BENEFIT YEAR

,,000^-^ 1948 vs 1949

I4,000

"-"-.....^^^ New York State

12,000

--^^

p......^.^^^

lOiOOO

^"^■^.^.^^

I^;^

-^..^^^

r^^^"--^^^^

^Aiii^Hii^^r

-^^^

^^-^^

- 14,000

8,000

^^"^~~~~

>-^it^--j

^^^

^»J^

- 13,000

6,000

Jy 1949 IC^

- 12,000

- 11,000

4,000

\^^

t^ 1-.

- 10,000

2,000

- 9,000 if)

^'''''°o^ 948^1 1;

- 8,000 Z

- 7,000 2

'^ \^ ^ft m^

^ 6,000 _j

.^^ X. m »\

^ Nv M m

^ 5,000

^'^ x. m»^

-4,000

'^^ ^ ml

- 3.000

X "- X ml

-2,000
^ 1,000

X »■

^^ \1^

^ 0

cr x^

, V z

„**

WHERE OUR OLD FOLKS GET THEIR INCOME

Major Source of Income for People Aged 65 and Over

9% LIVE ON PSCOME
FROM l>'\ESTMEyrs

22% GET PtBLrr
ASSLSTANCi

% OFT PRrVATE
AS>I_->TA>CE

18% LHE

ON INCOME

FROM PEPeiONS

^Giff/i/iic fi/wr/^

V/iai/6- i.'J

From THE INSTITUTE OF LIFE INSURANCE

60 EAST 42nd St., NEW YORK 17, N. Y.

'!« 'liriiicH of&'fntiifiri atiff &!eiea>c/i

To cushion the economic blows which strike our peo-
ple in old age, our country has developed three basic
types of financial aid :

1. Contributory old age and survivors insurance ;

2. Old age assistance;

3. Industrial pensions.

What Security Costs

Oitr Committee estimates that the annual cost of
providing old age security in its three major forms
in this country is approximately 4.7 billion dollars, or
2 per cent of the country's national production.

Cost of Old Age Security in the U. S. A.

(10.-)0 est.)

Cost to taxpayers of old age assistance .$1,380,000,000

Cost to employers and employees of old age

and survivors insurance ' $2,000,000,000

Cost to employers and employees of private

pension systems '. .$1 ,3.50,000,000

.$4,730,000,000

And are our oldsters obtaining financial security
from this nearly five-billion-dollar-a-year outlay by
taxpayers, employers, employees and consumers?

The answer is no !

How Much Security

Both old age insurance and old age assistance bene-
fits are below a decent living standard. And until re-
cently, the average industrial pension paid little more
than the monthly grant to a recipient of old age
assistance.

There can be little security on $26 a month. Yet
that is the average benefit under the old age and sur-
vivors insurance system to single workers.

And the average benefit to couples under OASI is
$41 at a time w^hen the Federal Government itself con-
cedes that a minimum food bill alone for a retired
couple costs $45 a month !

Old age assistance payments average $45 a month
per recipient in this country. And until the recent
drive for $100-a-month pensions by unions, private
retirement systems paid an average of about $50 a
month retirement benefits.

Moreover, the OASI system, which is supi^osed to
provide for "social security" actually provides in-
surance benefits for only 1,900,000 elderlj^, whereas
our relief system of old age assistance provides wel-
fare grants to 2,735,000. And probably less than
500,000 ex-workers are receiving industrial pensions.

Thus 50 per cent more persons are receiving old age
assistance than are receiving old age insurance !

And oldsters on old age assistance are receiving 70
per cent more in average monthly benefits than are
those on the OASI rolls !

The chaotic condition of our security provisions for
the aged are apparent. The OASI was intended to
do awaj^ with the need for most of the oldsters apply-
ing for old age a.ssistance. Yet, as Miss Jane Hoey,
Director of the Bureait of Public Assistance of the
Federal Security Agency, informed our Committee,
due to the inadequacies of the old age insurance pro-
. gram, old age assistance has grown beyond its in-
tended scope and resijonsibilities.

The failure of the old age insurance system led to
the recent $100-a-month pension drive by unions,
adding another complication to the already sadly en-
tangled old age security system in this country.

Oldsters and Economic Protection*

Old age assistance . .

OASI

Private pensions . . .

Oldsters Receiving

Benefits

2,73.5,000

1,900,000

500,000

Citizens "Covered"

2,735.000

35,500.000

11,500,000

* There is considerable duplication in these figiu-es, which
are suggestive rather than definitive.

OASI

The OASI program fails to cover 23,000,000 work-
ers, the self-emploj-ed, the household workers, govern-
ment employees, employees of non-profit organizations
and farmers.

Basic flaws in the old age insurance program, in
addition to inadequate coverage and inadequate bene-
fits, are :

1. The ban on any recipient of old age insurance
earning more than $14.99 a month from any em-
ployer covered by the Social Security Law.

2. Unduly restrictive eligibility requirements for
older workers. Special allowances should be
made in establishing eligibility requirements for
those who were already at the higher ages when
the system began.

3. Failure to encourage oldsters to continue to
work by not allowing pension payments to ac-
cumulate during period of employment past re-
tirement age.

4. Failure to grant dependency benefits to women
who have accumulated primary benefits and fail-
ure to start benefits for women at age 60 instead
of 65. Todaj' more than half of the married
men at 65 have wives who are 60, only one in
50 have wives who are 65. This means that most
married oldsters must support their wives on a
single pension. Moreover, women of 60 find it
practically impossible to obtain jobs.

5. Failure to recognize the change in wage levels
since 1939, by requiring contributions be paid
only up to $3,000 of salary, thereby keeping re-
eeijits and benefits below proper levels.

Fortunately, as this is written, there is a drive on
in Congre.ss, to extend the Social Security provisions
affecting the aged. Our Committee hopes that the old
age and survivors insurance system is developed into
a real old age security system or is fundamentally re-
cast so that the goal of universal coverage is attained
and an adequate benefit obtained.

Our Committee urges, however, that the entire prob-
lem of integrating old age insurance, old age as-
sistance, and industrial pensions be thoroughly ex-
plored by national authorities.

Our Committee will gladly cooperate with national
authorities to the end that a decent old age security
system is established. Our present system has failed,
and merely to patch it up here and there is to store
up troubles for the years that lie ahead.

Old Age Assistance

Old age assistance is bread, butter and bed money.

It affects the elderly quickly, directly and basically.
It provides the means of obtaining a bag of coal for a
cold flat, a pair of eye-glasses for a near-sighted old
man, or a woolen nightgown for a frail, impoverished
widow. It may help pay for a cancer operation, for a
needed sedative, or for nursing home eare.

Across the nation, one out of four oldsters is on

old age assistance rolls. In New York State, one out
of ten is on OAA.

Today, the staggering sum of approximately $87,-
000,000 a year is being spent by Federal, State and
local governments within New York State for old
age assistance.

The Cost of Old Age Assistance in New York State, 1949

Total %

Federal Aid $40,445,538.32* 46

State Aid ,$29,613,023.18* 34

Local Spending $17,524,640.81** 20

$87,583,202.31 100

* Includes aid for local administrative purposes.
** Approximate.

Federal and State aid represents 80 per cent of the
total cost, with localities contributing the remaining
20 per cent.

The number of persons on old age assistance in this
State hit a peak in 1941, when 121,578 persons re-
ceived this welfare grant. During World War II,
the numbers on OAA declined, as industry opened its
gates to the elderly. In the post-war period, the
trend has been upward once more, although the
number on OAA in this State has not yet reached the
pre-war peak. In November, 1949, OAA recipients
in New York State totalled 119,113.

As pointed out earlier, our Committee has not had
the responsibility of studying old age assistance, for
it is being reviewed by the Ostertag Joint Legislative
Committee on Interstate Cooperation.

The Social Security Act makes certain require-
ments mandatory if states are to secure Federal money
for the categorical program of OAA, AB and ADC.
The act provides states cannot establish conditions
limiting residence and citizenship too greatly. As-
sistance must be provided equitably and must be paid
in cash. To this extent these programs have an un-
derlying similarity throughout all the forty-eight
states in the country.

However, we should like to note here that the OAA
system in this country is in a very jumbled condition.
Each State has a virtually different assistance plan,
with different eligibility rules and payment standards.
The following table indicates to some extent the dif-
ferences in payments and coverage :

Old Age Assistance in Selected States

Average State

fo of Pop. % of oldsters Monthly Per Capita

State over 65 receiving OAA Grant Income

Colorado 8.0 48 $83.00 $1,482

California 7.6 31 70.70 1,643

Washington ..7.4 38 66.87 1,395

Xew York .. 8.2 10 52.61 1,781

Louisiana 5.5 82 47 . OS 892

The need for developing a sound pattern of aid to
the elderly was dramatically highlighted this past

130,000

110,000

90,000

70,000

OLD AGE ASSISTANCE RECIPIENTS

NEW YORK STATE

1933-1948

50,000,
1933
1934

y 194

^^^ 1942

1945

1946

1947

130,000

60,000
50,000

1948

year when California was thrown to the brink of
bankruptcy by a referendum, subsequently over-
ruled by the people themselves, which put 41.000
additional persons on OAA rolls, removed family re-
sponsibility for the elderly, and boosted payments.
In the State of Washington, OAA payments consti-
tute 43 per cent of the entire State budget, although
a poll conducted there indicated that 81 per cent of
the public is in the dark on how much persons on
OAA receive.

We believe there is similar lack of information
among our own people. In order to protect old age
assistance recipients, local welfare departments have
gone to extremes in keeping their operations in the
dark. Occasionally financial data as to total expendi-

tures or total case loads are released, generally a
meaningless jumble of statistics at best. Little men-
tion is made of the needs of the elderly, and of the
needs being met and those unmet.

Our people are entitled to know what is being done
for their aged neighbors and what their needs are.
The local welfare departments will be pleased, our
Committee feels, with community reaction, if they
pursue a policy of telling the public of the plight of
some of the needy aged, what is being done to help
them, and what needs to be done. We believe that in
many cases there will be an outpouring of public
support, financial and service, beyond that provided
for by public budgets.

Our Committee suggests that local welfare depart-

meuts, while keeping the identity of their OAA recipi-
ents confidential, indicate to the press the problems
being faced by oldsters in our communities.

Our Committee suggests that leading civic leaders,
bankers, labor leaders, medical men, be invited by
local welfare departments to see from typical case
records what the needs of the elderly are, whether they
are being met and what can be done to meet them.

We wvge that local welfare departments examine
their public relations programs, if they have such
programs, and create them if they do not have them.
This should be done not to "build up" the depart-
ment's prestige but to increase public understanding
of the needs of our oldsters and what is being done to
meet them. We believe that our local welfare de-
partments have much to be proud of in the work being
done to ease the plight of our elderly, but our com-
munities simply are unaware of what is being done.

Despite the fact that OAA is costing the Nation
$1,380,000,000 a year, little is known about our old
age recipients.

Who are they? Are they "every-day" persons, of
average intellect and backgrounds, or are they mainly
a special "problem" group of persons? What are
the long-range and short-range reasons for those un-
fortunates needing old age assistance ? Was it mainly
a long history of low-wages, which make it impossible
to raise a familj- and at the same time put aside enough
money for old age ? Was it perhaps a sudden collapse
of one's business or health? Do oldsters rush to get
on OAA rolls at age 65 or do they prefer to work?
And what can the comnn^nity do to prevent persons
from needing old age assistance ? Or — have they just
lived too long? These fundamental questions, as our
Committee noted in our previous report, "Never Too
Old," have not been answered.

Our Committee has undertaken, through a study of
a sample of representative OAA cases, to answer these
questions. This work is now going on.

To present an idea of the human aspects of the OAA
cases being handled by local welfare departments, and
to indicate some of tlie salient features of these eases
that should be of interest to our communities, we wish
to record here .iust four cases as prepared by our re-
search staff.

Tlie Case of Miss B.

Miss B., 69-year old spinster, worked for many years
as a .supervising typist and stenographer for'oiie of
the large insurance companies, headquartered in New
York City. She helped support her widowed mother
for many years. Then, when two years from obtain-
ing a company pension, she was stricken with a heart
attack. She had $1,000 in the bank. Her company
provided some compensation for a year.

Then, funds exliausted, her heart willing but weak,

her hearing diminishing, she had to go on Home Re-
lief. For 10 years she was on HR, until at age 65,
she was shifted to OAA.

Miss B. didn't do too well in elementary school, went
to business school where she studied typing and .ste-
nography.

Today, she lives with her OAA widowed sister in a
plain flat. Her sole pleasure .seems to be visiting her
niece. Case worker reported "these two women live
ver-\- (|uiet hum-drum lives, seem to be satisfied with
it."

They have to use toilet on second floor .jointly with
other people, do not have provision for getting hot
water in quantity, so have to heat water on stove.
Their flat is not very Avarm. Recently she fell in her
kitchen, chipped her shoulder, lay 20 minutes before
help came.

During World War II, Miss B. at age 63, anemic,
deaf, sought work, together with her virtually sight-
le.ss sister. "I'll have to be eyes for her while she
will have to be ears for me," she said. Wanted job at
local hotel because she thought her sister would take
the instructions from the supervisor and relay them
to her ! Tlu^y went from one factory to another.
Their old insurance comi^any turned them down —
"there are plenty of women much more alert than
the.y seeking jobs; even tliough they maj' not have
insurance experience, they are preferable." Social
worker thought the sisters could in 1943 not do eight
hours hard woi'k, but might do eight hours at some-
thing light.

Mam F< (it tires

1. Indication that overwork caused heart attack
that caused her inability to work.

2. Although onl.y two years from pension age from
a life insurance company she received an allow-
ance for onl,y one year.

3. This woman tried to get work though anemic,
and extremely hard of hearing.

4. Living with her OAA sister has eased each oth-
er's burdens, helped fight loneliness, perhaps
even helped nutritionally for a person often
doesn't like to cook for himself or herself only.

5. Seem to get along satisfactorily withoiTt hobby.

CfiiicJuslnns

1. Overwork was probably due to caring for in-
firm mother and at same time doing own work,
raising question of how far parent-child obliga-
tion should be pressed.

2. Failure of the employing insurance company to
vest pension rights in emplo3'ee resulted in this
woman going on OAA after receiving one-year's
allowance and exhausting $1,000 savings.

3. Health was the factor that led to uueniploya-
bility.

4. Possibility of referring Miss B. to mail order
work or envelope addressing for local firms in
her own home might have been explored, as she
could have during the war apparently done some
light work from time to time and was good
typist. Homework possibilities need intensive
exploration.

5. Modern retirement plans which permit optional
retirement at earlier age than normal will ease
plight of some persons in similar situation, who
are hit hy chronic disabling ailment shortly be-
fore reaching retirement age.

The Case of Ed the Stable Hand

This is the story of an old bachelor who lives rather
placidly on his old age assistance allotment, in a house
owned by his brother. Ed grew up skilled in the care
of horses. He finished 8th grade and for the remain-
der of most of his working days worked as a stable
liand. "When the depression came, he was thrown out
of work for a j'ear before he came on work relief for
a short time. Then he got his old job back as stable
hand at a country estate. When 1941 came, we see
him back at the welfare office, this time for OAA.
He wants work but can't get it.

Living with him in his brother's home is his brother
and the latter 's children, and his sister, to whom he is
closely attached. When she becomes ill. having a foot
amputated, he stays home da.v after day taking excel-
lent care of her. She dies not long afterward, and he
becomes disconsolate. He is no longer interested in
seeking work. He becomes rheumatic, and because he
is skilled only with horses, he is deemed ofScially un-
employable. He begins to limp. Meanwhile his
brother loses his own store, goes to work in a liquor
store, and Ed takes care of him when he is ill. Ed's
onl,v fun in life is "going out seeing old cronies on
the .street."

In 1947, case worker reports he has onl,v 1 shirt, 2
pairs of pants, and 2 pairs of underwear. In 1948,
his niece and her husband move into the house which
is converted into two apartments, but he doesn't get
along well with her husband, so he stays out as much
as he can. He helps with the furnace, cuts grass for
a woman across the street for 50e. occasionally, and
wants a janitor job.

Main Features

1. Lack of training for anything except care of
horses handicapped this man in search for
position.

2. This man is able even at age 74 to do light work
or work that requires no constant standing.

0. This man was narrow ^-isioned throughout his
life, perhaps through limited education ; range of
activities are narrow now.

4. The relative placidity of this case is attribu-
table in part to rather constant, steady living sit-
uation with his own family.

5. He never earned enough dtiring his lifetime
caring for horses to provide for his old age.

Conclusions

1. Again we see that living with famil.y tended to
provide happiness for the oldster.

2. Failure of adju.stmeut with younger generation
also is seen.

3. Failure of this man to train for anything expect
work with horses handicapped him in later life.

4. Family responsibility, brother-sister, and broth-
er-brother relationships, are demonstrated.

•5. Need for social situation, enabling oldsters to
get together, is seen.

6. Psychological aspects of work-desire seen in wish
to withdraw from labor force on death of sister
and re-awakening of desire to work, later.

7. Sttrely. society coitld have fotind a place for a
man skilled with liorses; surely someone needed
this man btit the two were not brought together.

8. Need for more than one occitpational skill indi-
cated.

9. Few of present OAA cases are eligible either for
primary or dependency benefits of OASI.

The Case of Mrs. G.

Mrs. G., a widow of some 22 years, managed to get
along by herself, as a domestic, and probably with
some accumulated savings, until her physician told
her that her health was too poor to contintie working
any longer. She was 66 when she gave up her part
time work which paid $10 a week and two meals a
day. The knowledge that her working clays were over
and she would have to go on OAA came as quite a
shock.

Mrs. G's httsband had worked for 20 consecutive
years for a local gas and light company before his
death, but had never qualified for retirement benefits.

This OAA recipient has serious high blood pressure,
and needs much rest and medical eare. She has been
very fortunate in finding accommodations at a board-
ing home with other older women, some of whom are,
like herself, on OAA. She has plenty of opportunity
for the peace and quiet she needs, and yet does not
lack companionship.

Main Features

1. Mrs. G.. who was not prepared for employment
at time of widowhood, did not have sttfficient

earning capacity to put money aside for tlie day
when she would not longer be able to work.

2. The four children of Mrs. G. were all married
and unable to contribute toward her support, al-
though they did give her presents for Christ-
mas, on her birthday, and on Mother's Day,
which were apparently sizable enough to help
Mrs. G. out some.

3. At 66 Mrs. G. was working and might have con-
tinued working imtil the time of her death if a
physician had not told her to stop.

4. Mrs. G. is skilled in needlecraft, such as crochet-
ing, but it has remained onl.y a hobby, and
means of providing attractive but inexpensive
Christmas presents for her children.

Conclusions

1. Compan3^ pension plans, even though they be
meagre, might save many couples or the sur-
vivor from public assistance. OASI will help,
but it is too recent to benefit most of our present
oldsters.

2. Protection against the heavy expenses of chronic
illness so prevalent in old age would help old-
sters conserve savings they might have from
their working years.

3. Opportunities for homework might enable old-
sters with skills to turn hobbies into profit.

The Case of Miss A.

Miss A., 83, lives with her 85-year-old sister who is
also on OAA.

Miss A. worked for years as a domestic, until she
could no longer work. At age 74 ( !) she had to C|uit
and go on OAA. Rheumatism and an infected leg
caused her to have to quit work.

She lives comfortably with her sister in a three-
room apartment in a good section of town. She aids
her sister when the latter is ill, and the sister cares
for her when she is ill. She is remarkably healthy
for her age.

Her landlord likes the cheerfulness of both sisters,
allows them considerable freedom to use his own
apartment and the sisters regard themselves as sort
of members of his family, has kept rent low, aided
them on various occasions.

Mai7i Features

1. Here is a woman who worked till age 74 when
she was attacked by rheumatism.

2. Her years of low wages as a domestic precluded
any possibility of substantial savings.

3. She and her sister live comfortably and happily
together, social worker reports, aiding one an-

other when necessary, providing company for
each other.
4. Amiability has improved their lot by resulting
in having their landlord assist them in various
ways.

Conclusions

1. OASI doesn't help domestics any.

2. Case suggests possible need for experiment in
attempting to get more OAAers of suitable tem-
perament to live together, to relieve loneliness,
to help each other, etc.

3. Good humor aids throughout life, even into the
late years.

Industrial Pensions

The problem of industrial pensions has come to
the fore, as predicted in previous reports of our Com-
mittee.

Today, more than 11,500.000 American workers, or
nearl.v one out of every six, from elevator operators
to corporation presidents, are piling up pension credits
in retirement funds. We believe that employers and
employees are pouring $1,350,000,000 a year into
these pension pools.

Our Committee estimated last year that over a
quarter of a million men and women are receiving
$150,000,000 a year in pension checks from their for-
mer employers. It should be noted that this averages
about $50 a month per pensioner. This average
monthly pension is probably a little higher this year,
as the effects of the $100-a-month pension drive by
unions go into operation.

Industry is pouring enormous sums into pension
plans. Marshall Field & Co. allocates $2,000,000 a
year into its retirement trust. Shell Oil Co. spends
$9,100,000 a year for pension allocations. When the
Gannett Co., Inc. announced early this year it was
establishing a pension fund for its employees, the
estimates of employer contributions alone for past
ser^^ces of employees came to $6,000,000.

In the current hubbub over industrial pensions, it
may be well to note that the New York State Chamber
of Commerce has said : "It is good business as well as
good morale for management and workers to cooper-
ate in promoting sound insurance plans to protect
wage earners against the hazards of old age. ' '

It was industry, interestingly enough, that initiated
pensions, which were in the past often deemed to be
"pie in the sky" by labor leaders. And industrial
pensions have proven to be good business for industry
because it steps up morale of employees, helps re-
cruit a higher type of worker, provides for orderly
retirement of workers, in addition to providing tax
benefits for the company and meeting the company's
moral obligations to its faithful workers.

Our Committee's survey of companies having pen-
sion plans indicates that business likes pensions be-
cause they are a precise business-like way of han-
dling workers.

Organized labor switched from an anti-pension at-
titude to an aggressive pro-pension stand because So-
cial Security pajTnents proved to be so inadequate,
because pay-rises were largely halted in recent
months, and because of a rising concern with older
workers.

To the worker, industrial pensions have their ad-
vantages and disadvantages. Private pension plans
tend to restrict the worker's mobility, and tie him
down to one company, one community. The plans
give him practically no protection if he wishes to
quit or is fired even after long service to the company.
Furthermore, they generallj' require such long pe-
riods of service to qualify so that as a practical mat-
ter only a small percentage of our workers may ever
qualify for the pensions.

On the other hand, so long as Social Security pay-
ments are so niggardly, our people will seek to supple-
ment them by industrial pensions.

As Governor Thomas E. Dewey pointed out in his
1950 message to the Legislature: "some of these pen-
sion plans are contributory ; others non-coutributory ;
some are funded on a reserve basis and thus safe-
guarded to some extent against defaiilt; others are
completely unfunded and unsaf eguarded ; some are
correlated with the national insurance system while
others are not."

Oiir Committee is concerned over six main defects
of the current retirement systems :

1. The plans fail to take into consideration fluctua-
tions in the cost of living.

2. Inadequate and usually no government super-
vision to assure adequacy of the pension systems
exist.

3. The plans themselves operate as a barrier to the
employment of the older worker.

4. The plans foster compulsory retirement on a
chronological age basis rather than selective de-
activating of older workers based on fitness.

5. The plans fail to provide some retirement pro-
tection for employees who work for many years
for a concern and then leave or are discharged
before retirement age.

6. The plans tend to restrict the mobility of work-
ers and keep them tied down to one employer.

Industrial pensions probably cannot cover the self-
employed, the domestics, the farmers, nor can it
adequately cover those employed in small stores or
marginal firms, thus leaving without protection mil-
lions of our people, in the same manner as does our
OASI system. Industrial pensions must be viewed as

supplementary to the social security system, not as
a substitute, and must be integrated with it.

This whole subject needs further study by national
and state authorities, as well as by industry and labor.
Our Committee will gladly assist in any such deliber-
ations.

Our Committee feels very stronglj-, however, that
while social security is a necessai\v part of the protec-
tion we must afford our older people, it is folly to at-
tack the problems of the elderly as though merely
boosting OASI coverage and payments or increasing
old age assistance grants or simply giving everybody
who reaches 65 a pension of some sort is the whole
answer to the problems of our old folks.

Social security for the aged is an important element
but only one element in a sound program for the aged.

UN and the Aged

Our couutrj- may possibly save itself from making
dismal errors made by other countries in dealing
with the elderly if we have sufficient information
available.

The organization best equipped to roundup the
world's experience in dealing with housing for the
aged, recreation for the aged, social security, mental
care of the aged, and care of the chronically ill, is
the United Nations. It has the staff, facilities and
status to assemble data on a world-wide scale.

Our Committee urges that the appropriate office of
the United Nations be authorized to spearhead a drive
to bring about better conditions for the elderly of all
nations by acting as a central depository of old age
data, by exchanging old age information, by assem-
bling world leaders in geriatrics, housing for the
aged and related fields for the exchange of experiences
and viewpoints.

Eniployment Problems of the Elderly

Director Robert C. Goodwin of the U. S. Bureau of
EmplojTuent Security informed our Committee that
a survey made by his agency produced five major find-
ings, all of which, incidentally, are in accord with
the findings of our own committee :

1. In labor markets with little unemployment there
are substantially fewer jobless among the older
workers as compared with the younger workers ;

2. As emploj'ment increases, employer specifica-
tions with respect to age are tightened and the
percentage of older workers jobless increases ;

3. Older workers, once separated from a job, take
longer to find employment, and if not re-em-
ployed at their regular work, are usually down-
graded in skill and pay ;

4. Discrimination against older worker varies not
onlv with conditions of the labor market but also

with oc'C-upatiou, industry and worker eharaeter-
isties.
5. In all areas surveyed, there were signifieaut re-
strictions against older workers.

Our Committee has in its prior reports, "Birthdays
Don't Count," and "Never Too Old," explored the
trends in employment of the elderly, emphasized the
need for utilizino- the experience of our older persons
in our productive forces, warned of the wide-scale
prejudice against hiring of workers over 45, and
tracked down reasons for discrimination against the
elderly. Our Committee set forth a reasonable pro-
gram that the State should undertake, revolving
around two main concepts :

1. Provision of special counselling service for older
workers in the State Employment Service, so
that more oldsters would be placed in job,s.

2. Establishment of a long-range education and re-
search program in the State Labor Department
designed to break down the bias that exists
against hiring the aged.

Our first proposal provides that the State Industrial
Connnissioner shall establish in the State Employ-
ment Service a special counselling and placement
service for the 45-year and over job applicants.

The placement service will :

1. Appraise the capabilities of older workers seek-
ing employment ;

2. Advise, guide and direct oldsters to employment
opportunities ;

3. Encourage older workers to seek work for which
they are best suited ;

4. Build up the self-confidence of the unemployed
oldsters ;

5. Survejr local job opportunities for older persons ;

6. Educate and encourage industry to hire older
workers.

The proposal envisions that a small corps of highly
skilled old age placement experts will be set up to
train and supervise placement officials in local employ-
ment service offices and act as consultants in this field.
It contemplates that one or more placement workers
in the local offices will be given the special training in
placing older workers, in dealing with older persons,
and in trying to break down the resistance of em-
ployers to hiring older persons. Once trained, these
placement workers will act as special task forces as-
signed to handle the bulk of older applicants for jobs.

The recommendation is based on the successful ex-
perience of the Canadian Employment Service, the
Forty-Plus Clubs of Western New York and New
York City, and the Federation Employment Service
in New York Citv.

In Toronto, 1,400 out of 2,200 applicants in the
upper age brackets obtained jobs after special coun-
selling, and now receive salaries ranging from $30 a
week to $12,000 a year. The special counselling serv-
ice for older workers even placed an 83-year old !
The Forty Plus Clubs are day after day finding jobs
for older executives. The Federation Employment
Service increased placements 68 per cent when it
launched a special drive to obtain jobs for oldsters.

Our Committee was informed latest available fig-
ures indicate that 168,000 persons receiving unemploj^-
ment insurance in this State are in the 45-year and
over age bracket; that 63,900 persons receiving such
insurance are 60 and over. Thirty-three per cent of
the women and 44.5 per cent of the men receiving un-
employment insurance are 45 or more.

A study in the Eochester office of the State Employ-
ment Service indicated that applicants 40 years old
and over represent 40 per cent of all job seekers, but
only 11 per cent of the job opportunities are filled by
these older workers. Obviously, a special drive must
be made in behalf of the older jjersons.

AVhen a j^lacement worker, as at present, has to ob-
tain jobs for all age groups, he tends cjuite under-
standably to concentrate on the 18-35 age group,
where success is most easily obtained. Emphasis on
the younger age groups helps build up his ratio
of placements to applicants, makes his record look
better, and enables him to avoid spending longer pe-
riods trying to place older persons.

Mr. William Green, President of the American Fed-
eration of Labor, informs us that he favors establish-
ment of counselling and placement services for older
workers. And we are certain that the CIO and or-
ganized industi'y likewise will actively join to support
such a move.

Unless our State and local communities make a de-
termined, all-out effort to obtain jobs for older per-
sons, costs for old age assistance, pensions and hos-
pital care will soar to dangerous heights. Moreover,
our elderly may become easy prey to shrewd pro-
moters seeking to take advantage of their discontent.
Today, discrimination against the elderly in industry
is plunging many oldsters into mental depression
which hastens senility. Our State hospitals are
jammed with men and women who became senile be-
fore their time.

Our proposal represents a new approach to the old
age problem. Up to the present, government. Fed-
eral, State, and local, has been concentrating on the
■wrong end of the old age problem. It has been con-
cerned almost exclusively with keeping oldsters alive
through old age assistance or keeping them out of
harms way in mental hospitals. We must now make a
shift toward a positive approach. We must emphasize
efforts that will prevent persons from needing old age

-26

Employers who study the problem know you can't find better, more loyal workers than middle-aged and elderly women

like these.

assistance and from needing care in mental hospitals.
Jobs are a large part of the answer.

Jol) Counselling

Director Robert C. Goodwin of the U. S. Burean
of Employment Security informed our Committee that
his agency would establish an experimental coun-
selling unit for older workers in a local employment
service oiBce in this State in 1950.

The New York State Employment Service is co-
operating with the United States Employment Service
in a .study of the placement of older workers which is
now being undertaken in five cities throughout the
country. The cities participating in this study are
New York City ; Houston, Texas ; Columbus, Ohio ;
one city in California and one in Peunsvlvania, both

unanuounced as this report is being written. This
study will be made for a six-mouth period from Janu-
ary through June, 1950, and the purposes of this stttdy
are to tr.y to ascertain on a sampling basis in respect
to unemployed persons over 45 .years of age who are
seeking employment through the public Employment
Service :

1. The size and characteristics of tliis group of ap-
plicants including the magnitude of this prob-
lem in relation to the total unemployed.

2. Employer attitudes and practices in the new
hirers of persons in this group.

3. The peculiar employment problems presented by
this group of applicants.

4. The effectiveness of existing public employment
services facilities in helping this group.

■27

5. New or additional techniques in counselling,
classification, employer contacting, publicity,
telephone soliciting, etc. which may be effective
in helping this group.

In New York City this study will be made in the
Queens Industrial Office, the Commercial and Profes-
sional Office, the Manhattan Needle Trades Office and
the Hotel and Service Office, thus covering a cross-
section of all occupations and industries with the ex-
ception of domestic and farm placement.

In each of the offices in New York City, and as a
matter of fact, in each of the cities participating in
the study, the sampling will be small because the
number of staff all of the cities can assign to this
study is very small.

In New York City it is expected to include a sam-
pling of approximately 3,000 persons over 45 years
of age for the experimental group and the same
number of similar persons for the control group. In
the other cities participating in the study, approxi-
mately 750 persons will be included in the experi-
mental group and the same number of similar persons
in the control group.

However, for New York City and for the country as
a whole it is felt by authorities that this sample is
sufficient for the purposes of the study.

It is expected that the studj' will result in consid-
erably greater knowledge about the employment prob-
lems of the unemployed older worker and techniques
that can be applied in the Public Employment Serv-
ice to assist him in securing employment than we
now know.

Our Committee notes with pleasure that in the past
year there has been a more enlightened attitude in
the State Emi^loyment Service regarding the need
for and desirability of special service for older work-
ers. We hope this will develop into a full-blown, all-
out special effort to place our middle aged and elderly
workers in jobs.

Our Committee further urges that the State Labor
Department, through the State Employment Service,
prepare suitable literature aimed at helping our
older workers who are seeking jobs. Many of our
oldsters who suddenly find themselves out of work
have not had the experience of writing for a job, or
of being interviewed for a job, perhaps for 20 or
more years. They don't know how to proceed on
what many of today's youngsters would consider ele-
mentary matters. The older worker seeking a job is
discouraged ; he needs encouragement, direction. Un-
til such time as counselling and placement service is
available to our older workers, the State Employment
Service should attempt to help the older persons by
mass media, pamphlets and brochures, radio and
newspapers.

Homework and the Aged

The possibility of directing older persons into home-
work strikes our Committee as being a definite possi-
bility for meeting the needs of some elderly men and
women who cannot travel to factories or work in
stores, or who can work only part-time. Social work-
ers are not as yet fully conscious of homework op-
portunities in their local communities for providing
employment for older persons. Too, the historical
background of homework, with its tradition of ex-
ploitation of workers, has developed a trend toward
curtailing homework. This whole subject needs
further exploration. Today, 8,379 persons in this
State have homework permits. About 824, or 10 per
cent of these, are 65 or more. Only 59 of the 824 are
males.

Homeworkers with Permits under the General Homeworker
Order in New York State
Spring, 1949
Age

Under 20 31

20 and under 30 877

30 and under 40 2,133

40 and under 50 2,179

50 and under 00 1,639

60 and under 70 1 ,208

70 and over 312

Oldsters Inc.

Our Committee has been thrilled by the Mohawk
Development Service Co., Inc., of Schenectady, com-
posed entirely of men who are over 65 !

This company, engaged in drafting and new prod-
uct development, will not employ anyone who has not
reached retirement age.

It was organized by men who refused to be shunted
aside by industry's compulsory retirement policy.
Today you can see 70-year olds in the company han-
dling contracts rolling in from American Locomotive
Co., Ludlum Steel Co., General Electric Co., the
Atomic Energy Commission, and others. A fuller
account on this company of oldsters is contained in
another section of this report.

While the Mohawk Development Service Co. does
not establish a pattern that will solve the employment
problems of oldsters, it does indicate very dramat-
ically that (1) at least some older workers can siie-
cessfully compete in the industrial market today. (2)
that skills of workers do not suddenly rust away when
they reach their 65th birthday, and (3) that at least
some oldsters in our local communities can organize
for production themselves — without government help
and without special consideration from industry.

Anti-discriniinalion Law

Our Committee is alarmed at the persistent, sense-
less barring of older persons from jobs. The help

wanted advertisements are rife with age qualifications
which sicken the spirit of our able elderly and unneces-
sarily load our old age assistance rolls. The ads say
stenographers must be between the ages 18 and 25 ;
salesmen over 45 are not wanted; engineers over 35
need not apply. Such arbitrary age barriers are
without economic justification and are cruel to our
more mature workers who do not ask preference, only
an equal chance based on ability.

Scientists have emphasized to our Committee that
chronological age is meaningless, that everyone ages
differently. Economists know it is short-sighted of
industry indiscriminately to bar older persons from
work only to support them through taxes. Our Na-
tion needs the added productivity of our elderly.

While we are reluctant to sponsor a crack-down on
industrial personnel policies by law, there mav be

little alternative unless management stops making
industrial "DPs", displaced persons, out of our older
persons. Unless industry curbs arbitrary age dis-
crimination based solely on birthdays, it certainly will
face legislation of some type barring age limits for
.job applicants, just as the State has already banned
discrimination against race, color or creed.

Our Committee has studied the Massachusetts law
adopted in 1937 to attempt to ban discrimination in
the hiring and firing of older workers.

This law declares it to be against public policy to
dismiss from employment any person between the ages
of 45 and 65, or to refuse to employ him, because of
his age.

This statute, which does not apply to domestics or
farm laborers, declares null and void any provision of
any contract or agreement that shall ' ' prevent or tend

This man keeps young by riding a useful hobby. He's too busy to keep running to doctors with imaginary aches and pains.
{Courtesy Hodsoii Center of ,Yeic York.)

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to prevent" the employment of any person between
the ages of 45 and 65 because of his age. The hnv
compels emjiloyers to keep age records of their
workers.

The law authorizes the State Commissioner of Labor
and Industries to summon before him any em]}loyei'
believed not to be complying with the law. After a
hearing, if the Commissioner deems the employer has
violated the law, he may publicize that fact in any
newspaper or newspapers or in any other manner
deemed approjiriate.

If this law gave any hope of helping our oldsters
obtain employment, our Committee would reeounnend
its adoption in this State. However, Ave have been
informed by the counsel of the Massachusetts De-
partment of Labor and Industries that the depart-
ment's experience "has been limited to two or three
cases, all many years ago, undoubtedly because of
the weakness of the law. It was not necessary in any
case, to publish the name of an offender."

From other sources, our Committee learns that the
law has been ignored and unenforceable. For exam-
ple, every company having a pension plan in Massa-
chusetts presumably would be sub.ject to tlie adverse
publicity provided by the law, since pension plans
undoubtedly "tend to prevent" the employment of
older persons.

Even if teeth were put in the law, by providing for
fines or imprisonment, or both, or by making offenders
ineligible for state contracts or other benefits, it would
still be unenforceable since companies can tell an
older applicant for a job he is too intelligent for the
job, or that the opening has been cancelled or any of
a hundred reasons commonly used by personnel man-
agers.

The Massachusetts law has failed.

Its adoption in New York State would probably
fail also.

Our Committee is exploring other possibilities of
legislative action to curtail the brutal age discrimina-
tion that flourishes.

Our Committee is not proposing the older workers
be legislated into jobs.

We do wish to see unreasonable barriers to their
employment eliminated. We do wish to see men and
women hired on the basis of ability rather than arbi-
trary age specifications.

Our Committee believes that the counselling service
which it proposed can render enormous effective aid
in obtaining jobs for oldsters. Our Committee be-
lieves that the State Labor Department can aid by a
permanent educational and research campaign.

However, we should like to emphasize that here
again, our local communities should not wait for
State action or depend on State action alone. Each
local community can organize home-town campaigns

for okler workers. Through councils of social agen-
cies where they exist, through other citizen or official
groups in other areas, local factories, stores, and of-
fices can be solicited for jobs for older workers, ap-
jiraisals can be made of local obstacles in the way of
obtaining employment for older workers, and the
full force of home town pressure can be lirought
against offending concerns which refuse to hire our
middle aged and elderly workers. Organized local
drives for jobs for the elderly can succeed.

Unions and Oldsters

Our Committee lias launched a pioneering study of
labor unions in relationship to older workers. We
have queried every international union, CIO, AFL,
and independent, in this country. Returns ha^-e come
in gratifying numbers, and are now being analyzed.

The survey covers age barriers to union member-
ship, age of union leaders, union pensions, burial pro-
visions, union old age homes, union security rules,
compulsory retirement rules, provisions for downgrad-
ing super-annuated members, medical service pro-
vided, special services and recognition rendered to
older workers, and a series of questions about attitudes
of older union members.

Obviously, as unions come increasingly to play an
important role in the economy, it is essential that we
have an understanding of their activities as they re-
late to the older worker.

The variety of relationships of older workers to
unions can be seen from the fact that the United
Brotherhood of Carpenters and Joiners of America
has nuiintaiued an old age home since 1929 at Lake-
land, Florida, and that the International Typo-
graphical Union has maintained a home for aged and
disabled members at Colorado Springs, Col., since
1892.

Of course, one of the basic ways of assiiring our
oldsters a place in our labor force, without blocking
avenues of promotion or job opportunities for younger
people, is to make certain that tlie Nation needs an
eximnding labor force ; then all who can work and
want work will have work, regardless of age.

The variety of pension plans involving unions is re-
flected in the experience of locals of the International
Stereotypers and Electrotypers I'nion of Nortli Amer-
ica. Some locals have no pension protection, others
are protected by employer sponsored plans not
covered in union contracts, still others are uiuler
100 per cent employer financed pensions. Other locals
of this union have joint employee-employer pensions
financed on 50-50 basis, and still other locals, we find,
have some members "pensioned off" by the employers,
on a handout basis, rather than on an actuarially
sound plan or contractual arrangement, with amounts
paid solely at the discretion of the employer.

We note in some returns already studied that a few
unions report no difficulty in obtaining jobs for older
members. This is true of the Seafarers International
Union of North America, which through its own hir-
ing halls controls assignment of seamen to work and
sends men to jobs solely on the basis of length of time
out of work, regardless of age. It is true also of the
International Union of Journeyman Horseshoers of
the riiited State.s and Canada, which reports that
older persons ari:- preferred by race tracks because of
their experience.

We note that many unions are giving special recog-
nition to the aged in the form of special dinners, spe-
cial pins, free lifetime or honorary memberships, etc.

The unions seem to indicate that older workers
tend to make better members because of their greater
matui-ity and stability, because they had to work
harder to build unions, and because their long experi-
ence lias taught them the need for organization.

When our survey is completed, a thorough ref)ort
will be made.

In this connection, it should be noted here that a
study by the Division of Research and Statistics of
the State Labor Department indicates that when
unions have contracts with employers permitting em-
ployees to be discharged "for cause", age itself is not
deemed to be sufficient cause.

Induslry and the Aged

While private enterprise is guilty of erecting unfair
age barriers which keep vigorous, able oldsters from
working, American businessmen are engaging in an
amazing variety of activities to help our oldsters.
This bright side of the old age picture in industry is
generally unknown not only to the public, but to the
rank-and-file of industry itself.

A survey our Committee completed shows that
these beneficial activities range from wholly gratuitous
allotments by the Standard Oil Co. of New Jersey to
its pensioners who receive under $3,000 a year, to a
donation of recreation hall facilities by Stroock & Co.
of Newburgh, one of the leading woolen mills of this
country, for a clubhouse for the oldtimers of the com-
munity.

American businessmen are not only pouring $1,-
350,000,000 a year into retirement funds for workers,
but also spend another $1,000,000,000 a year for the
Federal old age and survivors social security pool.

The Shell Oil Co. lias hired a psychologist to advise
their older workers facing retirement on how best to
adjust to "retirement shock". Other companies are
beginning similar activity. Some concerns have set
aside special work for older men and women to suit
their capabilities. Companies throughout the coun-

try are communicating with our Committee, asking
for information and help in dealing with older
workers.

A department store makes a special point of em-
ploying elderly women as salesladies because they
are kind and patient. One company which employs
many elderly has no formal retirement system, but
grants workers who retire a weekly allowance, and
regularly sends its infirm elderly ex-employees hot
meals from the plant cafeterias.

The W. and L. E. Gurley Co. of Troy, engineering
equipment manufacturers, as reported in "Never
Too Old", employs many old-timers successfully.
Over 10 per cent of its workers are 70 years old or
more; 20 per cent are over 60. It has, for example,
successfully taken a blacksmith retired from the U. S.
Watervliet Arsenal as being too old and re-trained
him in a short time as a lathe operator.

Some firms show amazing consideration for their
elderly employees, not only by granting them longer
vacations, permitting them to sit at their work, and
exempting them from punching the time clock, but
also by permitting them to quit earlier each day, be
served first and obtain special diets in the factorj'
cafeteria, and to use private or freight elevators
banned for other workers.

One company sends its plant cars to the homes of
its retired employees to bring them to weekly social
gatherings at the factory. Others keep oldsters on
the payroll although they can produce little due to
chronic illness.

Group life insurance, health and hospitalization
policies taken out by companies are proving a tre-
mendous economic aid to oldsters who otherwise
would be ineligible for insurance coverage.

American businessmen are giving generously of
their money, time and facilities to ease the plight
of older workers. Industrial management, unfortu-
natel.v, hasn't applied to mass employment policies
the lessons learned from numerous isolated examples.

It is unfair to condemn industry as a whole for the
callous attitude of some companies toward the elderly ;
many concerns are acting humanely toward older
workers. Wild charges and indiscriminate abuse of
all industry for the unfair practices of some will not
be helpful. Our Committee is campaigning vigor-
ously against arbitrary age barriers to employment;
but we believe industry is entitled to just credit for its
numerous helpful achievements in the aid of old-
timers.

We shall make progress toward fairer treatment of
older workers seeking emploj'ment not by recrimina-
tions, but by working out various complex problems
involved, in a spirit of mutual understanding, trust
and faith.

State Civil Service

Our Committee made a studj' which indicates that
civil service now offers proportionately more employ-
ment opportunities for the agiuji- than private busi-
ness does. State and local governments are prohibited
by law from erecting unreasonable age barriers and
from forcing older workers to retire early.

A study of 5,050 applications made for our Com-
mittee by the State Civil Service Department showed
that of the applicants, 695, or more than 13 per cent,
had passed their 45th birthday. Almost half of these
qualified for appointments in jobs ranging all the
way from elevator operator to child psj'chologist.

By contrast with industry's widely prevalent preju-
dice against employing older workers, the State Civil
Service Law declares void any attempt by New York
State or its subdivisions to discriminate because of
age against any persons physically and mentally quali-
fied to compete in an examination.

The State Civil Service Law states (sec. 25-a) :

"Notwithstanding any provision of law to the
contrary, except as herein provided, neither the
state civil service commission nor any municipal
civil service commission shall hereafter prohibit,
prevent, disqualify or discriminate against any
person who is physically and mentally ({ualified
from competing, participating or registering for
a civil service competitive examination or from
qualifying for a position in the classified civil
service or be penalized in a final rating by reason
of his or her age. Any such rule, requirement.
resolution, regulation or penalization of such
state or municipal commission shall be void.

"Nothing herein contained, however, shall pre-
vent such state or municipal commission from
adopting reasonable minimum or maximum age
requirements for positions such as policeman,
fireman, prison guard, or other positions which
require extraordinary physical effort, except
where age limits for such positions are already
prescribed by law."

A similar provision bans discrimination in promo-
tion examinations.

The United States Civil Service Commission in-
formed us : " The age of applicants is, of course, not a
factor in our examining standards or placement policy
in the federal service."

Government has heard the plea of the geriatricians,
the specialists in aging, that workers be judged bj-
their health and ability, not by the number of their
birthdays.

Oddly enough, the "over 45" group, which has
itself suffered humiliation and frustration in finding
employment, expressed the greatest interest in a

State examination for Employment Interviewer in
the Division of Placement and Unemployment Insur-
ance. Of 180 applicants in this classification 71 quali-
fied for appointment. Other examinations popular
with the 45-plus group were assistant accountant,
senior engineering aide, general clerk, assistant archi-
tect, library assistant, social worker and elevator
operator.

At the retirement end of tlie two-way squeeze
against the older worker's opportunity for useful em-
ployment, civil service is again more liberal in its
policies. About two-thirds of private companies hav-
ing pension plans set the compulsory retirement age
at 65. The New York State Employees' Retirement
System permits a member to retire at age 60, al-
though he may continue to age 70 if he wishes and is
]ihysically (|ualified. After age 70 he may .-.till be
retained at the request of a department head with ap-
proval of the State Civil Service and Pension Com-
missions.

The average age of retirement in the State service
in 1948 was approximately 66, six years above the
optional minimum. Still contributing members in
the State Ketirement System are 993 men and women
who have reached or passed their 70th birthday, al-
tliough this number includes some elected officials.

The Federal Government also sets its compulsory
retirement age at 70, but New York City, most lib-
eral of all in this respect, sets the maximum retire-
ment age at 80 !

Our Committee notes with approval that the State
Retirement Fund has speeded up payments of retire-
ment checks and death awards. It approves of the
new system of calling the attention of employees by
personal letter two years before they retire and again
one year before they retire of the need for preparing
themselves for retirement.

Our Committee is glad that the Legislature took the
first steps at the 1949 session to remove a legal bar-
rier which blocked State and local pensioners from
obtaining part-time jobs with local governments.

Our Committee urges that some form of recognition
be given to State and local employees who have served
faithfully until retirement. Some token of apprecia-
tion for loyal service through the years is merited.

Our Committee again urges that the desperate
plight of many State pensioners be eased and is happy
that the Legislature passed in 1949 a proposed con-
stitutional amendment which will need to be voted
on again at the 1951 session, authorizing the Legisla-
ture to provide for an increase in amount of pensions
of State and local retirement systems.

Vocational Rehabilitation

The term vocational rehabilitation means far more
to our Committee than its customarily restricted ap-

plication only to those who have been disabled. Many
of our older persons who are fit, but have for one rea-
son or another lost their old skills, or need to learn
new skills due to technological advances, or simply
need vocational counselling which will make them
employable, need vocational rehabilitation.

Our Committee has recently received a report from
the U. S. Office of Vocational Rehabilitation dealing
with rehabilitation of persons 45 years old and over
during the 1948 fiscal year.

It indicates that 11,438 persons in this age group,
or 11 per cent of all age groups, were rehabilitated.
The comparable figure for 1947 was 8,600 persons,
19 per cent of all age groups.

In 1948, the number of persons 65 or over at the
time rehabilitation started was 882, compared with
654 the previous year.

Men constituted over three-quarters of those re-
habilitated in the 45-plus age group. Over a third of
the 45 and over persons were dependent on their
families or on public or private relief before rehabili-
tation services were started. About 12 per cent were
living on either workmen's compensation or insurance
benefits and about 39 per cent were in jobs which
they were in danger of losing because of their disabili-
ties.

Disabilities were largely impaired arms, or legs,
amputations, visual and hearing defects.

Most of these persons were on the active rolls less
than one year before they were placed on jobs.

Services rendered them included medical, surgical
and psychiatric treatment, appliances and hospitaliza-
tion, vocational training, training in use of appliances,
self-adjustment training, occupational tools and li-
censes, counselling and guidance.

This is merely suggestive of what can be done to
aid older workers.

The small proportion of oldsters receiving the bene-
fits of vocational rehabilitation is indicated by the
following table :

Persons Receiving Vocational Rehabilitation, by Age, New
York State, (1948-49 fiscal year)

Total All Ages 3,042

Age 42-47 280

Age 48-59 360

Age 60 and over 67

Our Committee believes that vocational rehabilita-
tion of older persons in this State is subordinated be-
cause of a pessimistic outlook that much cannot be
done for oldsters. Our Committee recommends that
if a comprehensive study is made of State rehabilita-
tion services covering all age groups that it include a
determination as to how rehabilitation services can
be brought to more of our middle aged and elderly.
If no such survey is planned, our Committee pro-

poses to inquire into the rehabilitation of those in
upper age groups.

Our Committee recommends that the Federal Secur-
ity Agency make available funds for a special pilot
study of the degree to which vocational rehabilitation
service can effectively be rendered to persons on old
age assistance and old age insurance rolls. The ex-
perts on vocational rehabilitation have given little
attention in the past to the needs of the elderly be-
cause of a pessimistic outlook regarding their possible
emplo.ymeut. However, this antiquated viewpoint
needs to be eliminated. We believe that if competent
vocational rehabilitation experts were permitted them-
selves to examine old age assistance records, for ex-
ample, to determine which persons might be rehabili-
tated, and then were to attempt rehabilitation of
these individuals, they would find a surprising pro-
portion might benefit by their talents. At any rate,
such a study would give us the information regarding
vocational rehabilitation of the elderly that is not now
available.

The Health of Our Eklerly

In the field of health, the State has reached a turn-
ing- point. We must now shift from traditional em-
phasis upon communicable diseases to degenerative
diseases.

The need for such a change has been explored in
previous reports of our committee.

Tuberculosis in 1900 was the leading cause of death ;
today, heart disease is Killer No. 1.

Pneumonia in 1900 was KiUer No. 2; today its
place has been taken by cancer.

Cerebral hemorrhage was seventh ranking killer in
1900; today it is third.

However, few health departments in this country
have geared themselves to the new trend in diseases.
Many such departments are still fighting battles won
long ago.

Where is the emphasis on heart disease 1 We do not
find it in any public health department!

Examine the public health literature that is avail-
able. Booklets, brochures, pamphlets, radio scripts
are abundantly available on the feeding of children.
But you can find very few leaflets on nutrition of the
middle-aged and elderly.^

Where is the health department that has set out to
campaign for periodic comprehensive health inventor-
ies for the middle aged and elderly, so essential to
prevention of disease ?

Our Committee finds :

1. Few of our elderly are given a chance of ob-
taining guidance in adult hygiene ; emphasis to-
day is on curing diseases, not preventing them.

1 The Community Service Society of New York, a private
welfare organization, recently issued an excellent pamphlet.

Blaze Kills Elderly in Nursing Home

Three elderly persons were
burned to death early this
year in a blaze that seared a
Cobleskill, New York, con-
valescent home.

A frame building, no sprinkler system or automatic warning
This death bed was standing within three feet of the space device, bedrooms for the elderly on the second floor, space
heater. heaters in bedrooms of the oldsters spelled tragedy.

2. We are in need of better diagnostic and clinical
facilities for the elderly so that degenerative
ailments can be checked before they have ad-
vanced too far.

3. We urgently need expansion of our visiting
nurse services and housekeeping and home care
services.

4. We lack trained medical personnel to deal with
the elderly; we lack geriatric clinics; research
in geriatrics is woefulh' inadequate.

5. We need closer check on nursing and convales-
cent homes.

Our Committee is convinced that there should be
set up in the State Health Department a unit on Adult
Hygiene and Geriatrics to bring to our middle aged
and elderly the benefits of the latest discoveries in
science.

Our Committee in "Never Too Old" has outlined
10 specific functions of such a unit. But above all we
believe such a unit will provide the working mechan-
ism for our State Health Department to cope with its
No. 1 health problem, the health of oiir aging popu-
lation.

Our Committee has excluded from its consideration
work already covered or being covered by other leg-
islative committees or commissions. It has therefore
not inquired into the problems of the chronically ill
or into the question of licensing nursing homes.

However, since many persons reading this report
will be deeply interested in these two vital phases of
the old age problem, our Committee would like to
note that the Joint Legislative Committee on Inter-
state Cooperation, headed by Assembhonan Harold
C. Ostertag, has been studying the nursing home situ-
ation, and that the State Department of Social Wel-
fare, with the aid of the Interdepartmental Health
Committee, recently studied 1,000 nursing homes up-
state and is now planning to develop such a set of
standards.

Governor Dewey in his 1950 message to the Legisla-
ture said : ' ' We shall also have to plan a program for
developing more and better facilities, including both
nursing and boarding homes and public and private
institutions for the aged as well. These efforts will, I
am confident, assure to the chronically sick, elderly
people, the kind of care, comfort, and safety they
should have."

Two recently issued reports by State agencies deal-
ing with the chronically ill were "From Blueprint to
Reality," the report of the Joint Hospital Survey and
Planning Commission, and "A Pattern for Hospital
Care," final report of the New York State Hospital
Study, known as the Ginzberg report, made to the
Joint Hospital Survey and Planning Commission.
"From Blueprint to Reality" estimated that two

million persons in New York are suffering from some
chronic disease, and that half of these are 45 or more.
The report estimated that 23,000 additional chronic
hospital beds are needed, half in New York City and
the remainder in upstate New York, and recommended
that such facilities be developed only as units of gen-
eral hospitals. It further urged construction of five
150-bed chronic disease centers upstate and provision
for equal facilities in New York City.

The Ginzberg study, however, states: "We do not
recommend that general hospitals undertake large-
scale expansion of facilities to care for chronic pa-
tients, but we do recommend improvement in the
quality of services provided for them."

Thus, as our own report is being written, the State
policy on this vital and complex problem is apparently
in a fluid state, that is, no decision has been made
whether or not to create additional beds for the
chronically ill.

Both the report of the Joint Hospital Survey and
Planning Commission and the Ginzberg report should
be carefully studied by all persons interested in the
problems of older persons, although their main con-
cern is hospital care regardless of the age of the sick.

AVe list here, without comment, since it is outside
the province of our committee, the recommendations
of the Ginzberg study :

"The State should:

"1. Subsidize the expansion of services, par-
ticularly diagnostic services, to ambulatory pa-
tients by making limited grants to hospitals will-
ing to develop adequate programs.

"2. Act to improve the quality of the care now
being provided in nursing homes and in the in-
firmary sections of public and private homes
through the establishment of a comprehensive
system of inspections; and to establish minimum
standards which must be met if persons on public
assistance are to be cared for in these institutions.

"3. Seek to raise the level of care currently be-
ing provided for individuals with mental diseases
or disorders by expanding the facilities of State
mental hospitals sufficiently to meet the estimated
increase in the number of patients, to replace beds
in obsolete facilities, and to reduce overcrowding.
Further, it should raise the salary scale now in
effect for psychiatrists and other professional per-
sonnel and should expand and improve the train-
ing opportunities for all personnel.

"4. Develop a comprehensive program for the
sound expansion of mental hygiene clinics now
being operated by the State and voluntary
groups.

"5. Review the existing rehabilitation pro-

grams uow being supervised by the State Dejjart-
ments of Health and Education with the aim of
increasing their scope and improxing their qual-
ity, particularly b,y integrating the vocational as-
pects of rehabilitation with more effective em-
ployment service and by promoting the special-
ized training of doctors and other professional
personnel in order to exploit fully the potentiali-
ties in medical rehabilitation.

"6. Act to raise the rate at which it reimburses
local government for its share of the cost of car-
ing for patients with tuberculosis from a maxi-
mum of $2.50 a day to $3.75.

"7. Improve the administrative structvire
through which it discharges its responsibilities
for hospital care by establishing a State Hos-
pital Commission to be concerned with raising
the quality of care, developing sound methods of
determining hospital rates, and insuring that
the public interest in hospital operation is
furthered.

"8. Devote adequate resources to research in
every phase of hospital care, particiilarly prob-
lems connected with the effective care of psychia-
tric patients and patients suffering from long-
term illness.

"9. Promote the expansion of training facili-
ties for all scarce categories of medical personnel,
particularly for psychiatric social workers, phy-
sical therapists, and occupational therapists.

"Local Government should;

"1. Adopt a more liberal approach toward
certifying as public charges older patients who
could profit from general hospitalization.

"2. Establish rates of payment to private
nursing homes and homes for the aged which
would enable them to provide a higher level of
service in general and a higher level of medical
care in particular.

"3. Agree to pay reasonable fees to voluntary
hospitals that provide good diagnostic and thera-
peutic services to ambulatory patients who are
on the public assistance roles.

"4. In New York City, take every possible ac-
tion to expand and improve the facilities avail-
able for the care of patients with tuberculosis,
because those presently available are grossly in-
adequate.

"5. In New York City, act in cooperation with
the leaders of voluntary hospitals, Blue Cross, and
other groups to increase the numbers enrolled in
hospital prepayment plans so as to reduce the
pressure for admission for free care in the munic-
ipal hospitals.

"Voluntary Groups should:

"1. Improve the quality of hospital care
through stricter control over the work of all mem-
bers of the hosiDital staff", and reduce the costs of
hospital care by effective management, which im-
plies that boards of trustees must grant adequate
powers to their hospital administrators and sup-
port them in the exercise of these powers.

"2. Recognize their responsibility to make the
facilities of voluntary hospitals as available as
possible to all competent doctors in the commu-
nity and not to permit the hospital to be used for
the private advantage of a limited group of
individuals.

■"3. Secure through voluntary efforts some of
the requisite funds to experiment in better ways
of ijroviding, at the lowest possible cost, a high
level of hospital care, such as the expansion of
services for patients with long-term illness and
for patients who can be treated on an ambulatory
basis.

' ' 4. Realize that the continued operation of the
voluntary hospital system depends to a very large
extent on the expansion of enrollment in hospital
prepayment plans that provide adequate coverage
for the maximum number of persons. Voluntary
groups should therefore act cooperatively to in-
sure the accomplishment of such a result in the
shortest possible time.

"5. Multiply their efforts to secure a larger
amount of charitable contributions to accomplish
essential reforms, such as the replacement of ob-
solete facilities, and exercise prudence in the ex-
penditure of these funds by avoiding the unneces-
sary expansion of facilities.

"6. Recognize the fact that no hospital can be
self-sufficient, and act therefore to improve me-
chanisms, such as regional hospital councils, for
promoting the coordination and integration of
hospitals. The entire hospital system will thus
discharge its responsibilities more effectively.

"7. Take cognizance of the significant role of
government in the provision of hospital care, and
realize that a well-functioning and efScient hos-
pital system for the community at large depends
on the cooperation of voluntary and government
groups working in the public interest."

Our Committee has been fortunate in having the
benefit of the advice and judgment of Dr. Howard A.
Rusk, who points out :

"It is imperative that full advantage of the
techniques of rehabilitation must be taken in the
management and care of the aged and chronically
ill in the State of New York, not onlv so that thev

can be given the dignity, self-satisfaction and in-
dependence which comes from ability to care for
one's self, but also in order to reduce the in-
creasing overwhelmingly-high costs of custodial
and hospital care.

"Much of the acute financial plight of both
municipal and voluntary, as well as state hos-
pitals, is caused by the increasing numbers of
chronically ill and aged persons who enter the
hospitals and stay for long periods. The Depart-
ment of Hospitals in New York Citj' are occupied
by patients with long term illnesses. The per-
centage in voluntary hospitals is said to be around
20. In a survey in Syracuse, it was found that
84 per cent of 902 successive patients in medical
wards were chronically ill.

"It is agreed that a great many of the chron-
ically ill and aged must have general hospital care
initially. Many, liowever, remain in the hospital
purely because of the lack of any place to which
they can go if they are discharged. Convalescent
or nursing homes are totally inadequate to meet
the need, and patients discharged to their homes,
where there are no facilities for their care, fre-
quently must be readmitted to the hospital.

"One of the great needs is provision for total
treatment of the chronically ill and aged in terms
of their total problems. Many such persons can-
not be rehabilitated to the extent of employabil-
ity, but a great percentage can be rehabilitated
to the point of sufficient self -care so that they are
able to live at home, requiring a minimum of aid
from other members of the family.

"The Veterans Administration and a few
civilian hospitals and agencies have shown that a
great many chronically disabled and aged per-
sons can be rehabilitated to the point of self-care
and independence in performing the normal ac-
tivities of everyday living. They have also dem-
onstrated that such programs provide for im-
mense economic savings not only from those pa-
tients who are thereby able to live at home, but
in nursing care and other costs for patients, who
must continue to live in an adult institution.
However, in most of our civilian hospitals, the
patient does not receive the services he needs to
achieve this degree of self-sufficiency. Hospitals
complain that the chronically ill and aged are
responsible for their crowded conditions, but do
little to provide their patients with the necessary
retraining oppoi'tunities that will permit them to
leave the hospital.

"In reviewing the study made in New York
State on the medical, social and institutional as-
pects of chronic illness, j-ou will see that almost
70 per cent of the 139 hospitals surveyed ac-

cepted chronic patients, but relatively few had
specialized departments for their care. The great
majority frankly admitted trying to avoid their
admission, and in answer to the question ' Do you
have satisfactory arrangements for referring in-
dividuals who require further care?', of the 118
hospitals replying, 92 said that they did not.
They cited insufficient facilities, poor staffs, re-
luctance of patients to go to county, city or state
institutions, and excessive costs.

"I feel that primary among the needs of our
aged citizens is the opportunity to do something
purposeful and constructive. The majority have
worked steadily and industriously in a society
that respects only the productive ; the ending of
ability to do productive work, even though it need
not be for material gain, is, for most, a tragedy.
It symbolizes the end of independence and pur-
pose in life. In overlooking purposeful activity,
we have neglected to use one of the most valu-
able tools in the management of the chronically
ill and aged. All who have gone through an in-
stitution have noted the apathy and hopelessness
of the residents. There are always a few, how-
ever, who are bright and active. They are the
patients who have volunteered or been assigned
to tasks within their physical capacities.

"Like work for the homebound, the vise of work
therapy in adult institutions requires not only
imagination but close supervision to prevent ex-
ploitation, but it pays tremendous dividends by
providing a purpose in life for the individual.
The opportunity to work, and if possible to earn,
is necessary therapy if patients are to live in
dignity rather than desolation.

"Dr. Marcus Kogel, Commissioner of Hospitals
in New York City, and I have had several tenta-
tive meetings preliminary to establishing an ac-
tivity program at the Farm Colony in New York,
and our medical staff at the Rehabilitation and
Physical Medicine Service at Bellevue Hospital
has already completed a medical survey prior to
the establishment of such a program.

' ' The pi'oblem of providing an integrated serv-
ice for the chronically ill and aged is a complex
one. It affects tremendous numbers of persons,
numerous diseases and types of disabilities, vary-
ing types of medical and semi-medical institu-
tions, and, particularly, all community service
agencies. This has been shown particularly well
in the excellent studies on chronic disease con-
ducted by the State Department of Health and
the work of the Joint Legislative Committee on
the Problems of the Aging. There is one facet
of the problem that stands out glaringly at the
present time. That is the need in our general

hospitals and adult institutions to provide dy-
namic training programs which will enable many
of the so-called invalids disabled by chronic dis-
ease or age to live independently within their own
homes. ' '

Commissioner Marcus D. Kogel of the New York
City Hospital Department, whose brilliant efforts to
increase the number and quality of facilities available
to older persons and the chronically ill have made
New York City a world leader in this field, has pre-
sented to our Committee a basic plan for adapting a
general hospital to the increasing number of aged
patients. This includes development of a chronic dis-
ease wing, small suite of rooms for temporary care of
non-custodial psychotics, a dynamic rehabilitation
program, an active home care program, and expanded
services for ambulatory patients in its outpatient de-
partment. His views are presented elsewhere in this
report.

Dr. Frederic D. Zcnian has informed our Commit-
tee that from 75 per cent to 8.5 per cent of all internal
medicine will in the near future deal with care of the
elderly. It is therefore vital that the whole problem
of establishing geriatric clinics be explored. The
pioneer work of Dr. Robert T. Monroe at the Peter
Bent Brigham Hospital, described elsewhere in this
report, indicates what excellent results can be ob-
tained when skilled technicians deal with diagnosis
and rehabilitation of the elderly. We already have a
small geriatric clinic in operation by a voluntary
agency in Rochester. The full cooperation of the
State Health Department should be given this clinic
so that it might operate as a controlled experiment in
clinical service for the aged.

Mental Hygiene

Approximately 25 per cent of the persons in our
mental hospitals in this State are 65 years old or more.

Nearly 21,000 of the 81,500 persons in our State
mental hospitals are in this upper age bracket.

The cost of maintaining our older persons in State
mental hospitals was $956.27 per capita during the
1948-49 fiscal year, or a total cost of $20,081,670 !

In previous reports, we have noted that the per-
centage of first admissions to our State hospitals of
persons in the 60-plus age group has more than
doubled in the past 20 years.

The reasons for this increase are many. Since more
persons are living longer, more of us are reaching a
period when mental disorders due to aging and physio-
logical changes are likely to appear. An upward
trend in the rate of psychoses of old age may also be
due to improvements in detecting mental maladjust-
ment. Too, the stepped up pace of living and the
tendency of present families to accept less responsi-
bility for their elders, the lack of rooms to care for

oldsters, all these have tended to increase the number
of elderly in our mental institutions.

Many authorities, including our own State Mental
Hygiene Commissioner, Frederick MacCurdy, are con-
vinced that a substantial number of elderly are being
admitted to mental hospitals who should not be there
at all.

The Commissioner has emphasized that our mental
institutions were not built to accommodate any large
number of elderly incurable patients. Others point
out that the harmlessly senile are often channelled to
State hospitals simply because no other facilities are
available to them. Commissioner MacCurdy has told
our Committee that about 93 per cent of the general
hospitals in this State will not even keep a patient
showing mental symptoms as a hospital patient, al-
though often they need medical and nursing care, not
mental care.

Dr. Kenneth Keill, director of the Willard State
Hospital, has set up at nearby Sampson Naval Base a
program for caring for 1,000 elderly mental patients
in the 60-69 age group in cottage type buildings.
Classes have been set up in occupational therapy. A
recreational program has been developed. The pa-
tients eat cafeteria style, just as though they were
ordering meals at an ordinary cafeteria. Doors are
unlocked, a procedure that in the ordinary mental hos-
pital would be amazing. Patients are virtually free
to come and go as they please on the premises. This in
itself. Dr. Keill has informed us, serves to minimize
the problems; and ability to wander about during the
daytime permits a using-up of the energy so that Avhen
bedtime comes, the patient is ready to sleep without
the need of medication.

Dr. Keill states that the Sampson Division, in
charge of Dr. Guy M. Walters, hopes by studying the
physical conditions of this largely uniform group, by
making studies of behavior, psychological studies,
laboratory investigations of blood, urine and other
body excretions, as well as the field of nutrition, to
arrive at some conclusions as to the causes and treat-
ment of this increasingly large problem.

The large case-load in our mental hospitals is un-
fortunatel.v shifting emphasis in the Sampson Divi-
sion from basic, urgently needed research on the care
of the elderly mental cases to that of simply provid-
ing custodial care.

Our Committee urges that full financial support be
given by Federal and State governments to the Samp-
son Division, to the end that there may be developed
a sounder, less costly method of caring for the harm-
lessly senile.

Our Committee is happy to report that the State
Department of Mental Hygiene published recently a
series of leaflets called "Guideposts to Mental
Health, ' ' and one of the leaflets dealt with mental hy-

AGE LIMITS FOR ISSUANCE AND CANCELLATION

OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS

BY INSURANCE COMPANIES

LICENSED IN THE STATE OF NEW YORK

■■■FEMALE SAME AS MALE.
ESZ23 FEMALE 5 YEARS LESS.
I IFFMAI F MORE THAN 5 YEARS LESS

ACCIDENT DISABILITY

<^
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LIMIT

■

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I

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RETIRE-
MENT

■

■ ■

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3
■ ■

Dann

■ ■■■

■

■ ■■

■ ■

50 55 60 65 70 75

MAXIMUM AGE OF ISSUE

80 NO

LIMIT

giene of older persons. This leaflet represents prac-
tically the first piece of health literature dealing with
the ajred issued by the State, except for those pub-
lished by our own Committee.

Our Committee is convinced that the spread of men-
tal hygiene clinics and a broad-scale educational pro-
gram directed toward helping persons adjust to life's
problems are fundamental. We are convinced that a
mental hygiene program that starts with children and
adolescents and continues through all the age brackets
M-ill be able to keep substantial numbers of persons
from ever needing old age assistance.

Our Committee is convinced that when our local
communities adopt broad programs for our aginsi' pop-
ulation, covering job campaigns and counselling, bet-
ter housing, recreational facilities, adult education,
home care services, etc., as proposed by our Commit-
tee, the proportion of oldsters needing mental hospital
care will be substantially reduced.

Our Committee has been very much impressed by
the fact that psychiatrists in our State mental hos-
pitals have in many instances actually been "geriatri-
cians" since they have dealt largely with older per-
sons over a long period of years. And it seems to us
that in all the thinking that has been going on with
regard to the elderly the State psychiatrists have not
had an opportunity to give the many groups in the
community the benefit of their advice and judgment.

Our Committee believes it will be helpful if State
psychiatrists who have cared for the elderly were to
meet with a select group of representatives of social
welfare organizations, public and private, for an ex-
change of views on problems of mutual concern. One
problem on which the State psychiatrists can help is
in setting up standards so that old age homes, nurs-
ing homes, and social workers will know when an eld-
erly person should or should not be referred to a
State mental hospital.

Since 1933 the State of Xew York has been placing
mental patients in homes other than their own for
care. These "foster homes" serve as an opportunity
to adjust gradually to the community once more,
without disturbing family influences which in some
cases were responsible for the mental break down.
Social workers aid the elderly person who has been
assigned to a foster home, and instruct the family
caretaker. Miss Hester B. Crutcher, Director of So-
cial Work. State Jlental Hygiene Department, has
informed our Committee that of 1,284 persons placed
in foster homes from State mental hospitals, 743 are
over 60 years old. "While this type of care needs to be
used carefully and perhaps offers little hope for mak-
ing an appreciable dent in the total case-load handled
by State mental hospitals, it demonstrates sufficient
promise to warrant its expansion to the greatest ex-
tent possible.

Our Committee further urges that the Mental Hy-
giene Department allocate Federal research funds to
conduct a study, at the William Hodson Community
Center, of the place of a recreational day-care center
in a community mental hygiene program. The Hod-
son Center and others have made an amazing record.

In six years of operation with a membership of
nearlj' five hundred whose average age is about 74, not
a single member of this center has had to apply for
admission to a State hospital. Moreover, the crafts
taught, the feeling of usefulness engendered, and the
social parties held by the group, seem to give the old-
sters a reason for living, and a new and happier out-
look on life.

Libraries and Our Elderly

In another section of this report, there is a com-
prehensive analj'sis of a survey undertaken by our
Committee of the relationships of libraries to the elder
people in our communities.

Summarizing here, we found that libraries are ren-
dering many new services especiall.y helpful to old-
timers, including use of ceiling projectors for the bed-
ridden, book delivery to old age homes, nursing homes,
hospitals and the ill confined at home, bookmobiles to
reach persons in rural areas, and provision of meet-
ing space for clubs for oldsters.

Librarians made a special plea for publication of
books in large type for persons with "tired eyes."

Some librarians have taken a key role in commu-
nity planning for the elderly.

The provision of state-aid to libraries, as presently
jjroposed by various groups, would enable the libraries
to undertake far more work with older persons than
is now possible, the librarians point out.

Here again our local communities have a challenge
that can be met. The libraries are established to
meet the needs of all the community, not just the
young. Yet some libraries are operated as though
an oldster is an intruder.

Libraries can play an important role in a com-
munity old age program, not only by merely making
available books, but by rendering a host of services
ranging from aiding workers to plan for retirement
to providing a planned social-educational program
geared to older persons.

Insurance and the Elderly

Our Committee, through the cooperation of the
State Department of Insurance, recently surve.yed the
regulations of 71 insurance companies in New York
State to determine how the practices of these com-
panies affected our older population.

We found :

1. Nearly half the companies will not issue a health

AGE LIMITS FOR ISSUANCE AND CANCELLATION
OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS

BY INSURANCE COMPANIES
LICENSED IN THE STATE OF NEW YORK

^iW FEMALE SAME AS MALE.

e::::::^ FEMALE s years less.

1 1 FEMALE MORE THAN 5 YEARS LESS AND DISMEMBERMENT

ACCIDENTAL DEATH

NO
LIMIT

RETIRE-
MENT

I-

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7 5

■

3
1

■ ■

DDDnD

■

mmmm

■■■

■

103

■■■

MAXIMUM AGE OF ISSUE

75 80 NO

LIMIT

AGE LIMITS FOR ISSUANCE AND CANCELLATION
OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS

BY INSURANCE COMPANIES
LICENSED IN THE STATE OF NEW YORK

— FEMALE SAME AS MALE.

f;;;:;::;:i FEMALE 5 years less.

I IFFMAI F MORE THAN 5 YEARS LESS

LIMITED POLICIES

z
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LIMIT

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RETIRE-
MENT

•

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■

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■■■■■

■mn

MAXIMUM AGE OF ISSUE

75 80 NO

LIMIT

insurance policy to anyone over 55 ; most of the
rest set 60 as the top age.

2. More than half the companies refuse to sell hos-
pitalization coverage to persons over 60.

3. Most companies will not sell accident disability
policies to those over 65.

4. Most companies will not write accident and sick-
ness policies for persons above 55.

5. Highest age at which life insurance is generally
sold is 65, but you're lucky to be able to buy it
after age 50, due to physical qualifications that
must be met.

Group health insurance does not exclude persons of
any age working in a covered concern. But upon
quitting or retiring, an employee's policy is auto-
matically cancelled. Group life insurance provides a
conversion right upon retiring or leaving a firm, but
the premiums at higher ages are almost prohibitive.

We have reason to believe that the situation is even
darker for the elderly than the survey shows because
many insurance comjianies impose lower age limits
than their written regulations indicate.

Our findings demonstrate that the elderly, who
need insurance most, cannot now buy it. Tlie 22 per
cent of our population who are over 50 years old. and
their families, are vitally concerned about the age
limits imposed by the insurance concerns. It is a
problem that has been neglected and will become of
increasing importance, for the number of our aged
is rapidly increasing.

Health, ho.spitalization and accident coverage are
suspended just at the time when such protection is
needed most, in old age, when medical care require-
ments reach a peak, but earning power sinks to a
low ebb or vanishes.

The survey raises a host of vital questions for ad-
vocates of both voluntary and compulsory insurance.
Does either system intend to provide coverage for
the elderly: or will it continue to leave them out in
the cold ? If oldsters are to be covered, will insurance
costs for younger persons become crushingly high?
Is it possible to provide some compromise solution,
with private comjianies either pooling their poorer
risks, as in workmen's compensation, or receiving a
rebate from government for covering older persons?
These are issues which must be met.

The wiping out of the savings of low-income and
middle-income groups by long illnesses thrusts them
on old age assistance rolls, into county old age homes
and infirmaries, public hospitals and nursing homes,
the expenses of all of which are footed by the tax-
payers. Thus taxpayers as well as the elderly have a
decided stake in this issue.

Pertinent figures on practices of insurance
companies follow :

TABLE I

Age Barriers Erected by Most Insurance Companies

Maximum Age Cancellation

Type of Policy at Issuance Age

Accident and Sickness 55 60

Hospitalization 60 60 or 65

Accident Disability 05 70

Accidental death and disineniber-

ment 65 70

Limited policies 05 70

Industrial policies life insurance

paid up at 65 44 —

paid up at 75 65 —

Life insurance 65 —

TABLE II
Cancellation Age for Health Insurance

Cancellation Age Number of Companies

55 1

00 34

05 15

70 4

SO 1

No limit (?) 5

TABLE III

Life Insurance Issued by a Typical Company, According to

Age
-^S*" % of New Insurance

o-4'J 92.45

50-59 0.07

60-70 .88

100.00

TABLE IV

Cost of Life Insurance by Age

Age Life Expectancy Annual Premium per $1000

25 42.12 years $20.24

45 25.21 ■ 39.53

65 11.55 07.46

70 8.99 127.97

One of the large commercial insurance com-
panies states its age limit for joining is 55. There
is no age limit for continuing accident insurance,
"except for 80 per cent reduction of the death
benefit at age 70 ; health insurance is reduced 40
per cent at age 60 but may be continued to 65 ;
hospitalization benefits mav be continued to age
65."

Our Committee calls upon insurance companies, the
Blue Cross Plan, and the Blue Shield Plan, to initiate
experimentally at first, contracts which will provide
wider services, particularly in diagnosis, and which
will provide our older persons with an opportunity to
insure themselves.

However, insurance companies have an obligation
that goes far beyond seeking to develop contracts that
will meet the needs of older persons for life, acci-
dent, health and hospitalization insurance, although
this is tremendously important in itself.

AGE LIMITS FOR ISSUANCE AND CANCELLATION
OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS

BY INSURANCE COMPANIES
LICENSED IN THE STATE OF NEW YORK

^^ FEMALE SAME AS MALE.
EZS3 FEMALE 5 YEARS LESS.
1=: FEMALE MORE THAN 5 YEARS LESS HOSPITAL EXPENSE

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LIMIT

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RETIRE-
MENT

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■■

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■■■■

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MAXIMUM AGE OF ISSUE

75 80 NO

LIMIT

j45

The insurance companies have an enormous oppor-
tunity to provide leadership in a nation-wide cam-
paign directed to our older citizens. The insurance
companies have the finances, the know-how and the
direct interest so they can effectively reach our older
persons with health guidance material so sadly lack-
ing today.

The insurance companies have a direct stake in at-
tempting to organize pre-retirement counselling pro-
grams in industry, as part of a "packaged" pension
plan which tliey could offer to industry. One' of the
largest manufacturing concerns in this country, with
one of the large.st pension systems ever purchased
from an insurance company, informed our Committee :
"You would think the insurance companies would get
busy and save industry from the ill-will now develop-
ing because older workers simply are unprepared for
compulsory retirement called for by the pension
plans."

Our Committee believes that the insurance compan-
ies themselves have the responsibility of initiating,
with the aid of government, industry and labor, a
plan for preventing pension plans from restricting tFe
job opportunities of older workers. Today, placement
workers from Buffalo to Long Island inform us that
it is practically impossible to place older workers in
companies that have pension plans. The ill will which
such a policy brings forth against private enterprise
is too powerful to be ignored. Age barriers against
employment of older workers must be reduced and
m this campaign the insurance companies must play
a major role. Too many of our older persons are
being thrust onto relief and old age assistance or are
having their spirit sag to new lows because pension
plans are belicxed to be keeping them from produc-
tivity. The help of insurance companies is going to be
needed, if this problem is to be solved.

Social Workers

Our Committee has come to a new understanding of
the value of the work being done in our various com-
munities in this State by trained social workers.

There is too wide acceptance by the public of the
caricatured concept of the typical social worker as
either an under-sexed or over-sexed female collesje
graduate who wears a fur coat and impossible bon-
nets and sprinkles polysyllabic impracticalities in her
speech as she somewhat haughtily and arrogantly in-
terviews our impoverished people in their slum dwell-
ings.

The joke is in poor taste. Furthermore, the picture
is untrue. Most important, it is serving to deter
able young men and women from entering a field of
work, which like that of the religious leader and the
physician ministers to the urgent needs of our people
without thought of selfish motives.

Our Committee has found, through its numerous
contacts with social welfare groups, both public and
private, and through its study of old age assistance
cases and how they are handled, that actually our typ-
ical, trained social worker is likely to be a hard-work-
ing, underpaid expert in the art of human relations,
who is helping oldsters to meet life's problems when
they can least help themselves. We have found them
bringing comfort, hope, and cheer to older persons,
aiding them to obtain needed medical help, helping
them find a place to live, assisting them in ironing out
family difficulties, guiding them to available commu-
nity facilities, encouraging them to regain their self-
confidence, working out family budgets with them,
telephoning employers to see if they can get them
jobs, arranging for visiting nurse service, fighting
with hospitals to get them admitted, calming" their
fears; yes— and in one instance, shoveling coal for
an elderly old age assistance client who was ill!

The social worker in her direct contact with old per-
sons has an unparalleled opportunity to interpret
them and their needs to the community. She has not
taken full advantage of her first hand knowledge of
the human side of the old age assistance programs to
do this. She has considered the recipients' interest and
their protection against any form of exploitation, this
being her primary responsibility and has not been
effective in promoting community understanding of
the group as a whole because of this.

We have found that our social workers combine a
natural sympathy for the unfortunate together with a
practical, realistic view which seeks to protect public
funds and understands that the most effective help
that can be given is self-understanding and the de-
velopment of ability to care for one 's self. If there be
cynical wasters of public funds among our social
workers, if there be insolent case workers, they are
certainly not typical, and certainly no more numerous
among social workers than among the general public.
Our Committee has been astounded at the com-
paratively low salaries, the cost of 80 per cent of
which is footed by Federal and State governments, be-
ing paid to public social workers whose professional
training is often at least the equivalent of teachers,
whose work often entails large responsibilities for
easing the plight of our elderly and for authorizing
expenditures of large sums of public money. Such
workers are earning as little as $40 a week in some
areas of the state, not only less than teachers but less
than laborers, and many of them can foresee with con-
siderable degree of accuracy that they themselves will
some day be old age assistance recipients because of
the inability to set aside a reasonable cushion of funds
for their own old age.
Our Committee urges:
1. That salaries of social workers in our communi-

ties be raised to a level commensurate with the
training required for the profession and with
the responsibilities imposed on them.
2. That the State Social Welfare Department im-
pose a suitable penaltj^ upon any local govern-
ment which bars social workers from attending
professional social work conventions or State in-
service training courses.

Our Committee believes that the social worker has
a key role to play in the New York Plan. The social
worker has prime responsibility for awakening the
local communities to the needs of the aged, for the
social worker knows intimately what they need. We
believe that the social worker because of his broad
training in dealing with human beings is best equipi^ed
to bring the program to fulfillment. Social workers
are today hiding their work behind a cloud of obscur-
ity and anonymity. Our Committee calls upon social
workers to publicize the needs of human beings in
their care, for we believe that once the communities
truly know the need, they will be generous in sup-
porting the social worker and the destitute.

College Courses in Gerontology

Our Committee surveyed 486 colleges in this coun-
try to determine to what extent our institutions of
higher learning have adjusted their curricula to the
needs of an aging population.

We found that you can now go to college to learn
how to grow old successfully, that oldsters are becom-
ing objects of serious study for the iirst time in the
history of higher education, that college students are
being taught how to adjust to their elders, how to take
better care of oldsters, and how to prepare themselves
for later maturity. Courses run the gamut from pen-
sions and social security problems of oldstei's to
psj'chological difficulties and recreational needs of
the aged.

Many colleges are re-appraising their curriculum
in terms of giving liberal arts students some under-
standing of the medical, social, psychological and
economic problems of the elderly, helping students
learn to prepare for later maturity, not just for post-
college careers, and specialized training of nurses,
social workers, medical students, occupational thera-
pists, personnel administrators and psychologists in
dealing with the aged.

Accidents of the Elderly

Our Committee recommends that the State Division
of Safety undertake au educational campaign de-
signed to reduce the tremendous number of accidents
that befall our older persons.

Mrs. G., 72, rises from her bath, slips and breaks

PRINCIPAL TYPES OF NOME ACCIDENT FATALITIES IN 19*7

0-4 YEARS

lf-14 YEARS

SSS"" ...1

Mittsirx _^

MIIB4JX ^^

HUiUUU 17% 1

F»US TX J

MIWII !• 1

tU€lft4t» '" t

Hiaijii27x
MUK2I%

..J

QIUUHK .^

nusl2%

lt-44 YEARS

4f-M YEARS

6f YEARS AND OVER

Dins 12%

NI50II ,.,

(MMTMO 107.

FUlS I4T.
FltUIMS iir.

^^JU

ACCIDtNT FACTS l«4t UMm

her hip, precii^itating a general break-down of her
physical and mental condition.

Mr. B., 69, hobbling along with his cane, and a bit
forgetful, comes to an intersection, fails to look up
and down the road, starts to cross. He sees a truck
bearing down on him, but he can't move quickly
enough to dart out of harm 's way ; he is struck down.

Today such accidents are common.

Falls account for 78 per cent of all home accident
fatalities to older laersons in this country, with burns
causing 7 per cent of such deaths.

Deaths by motor vehicles rank second only to falls
as the cause of accidental fatalities to older persons-
Eaeh year, some -5,000 oldsters are hit by cars or are
injured while riding in vehicles.

Of the elderly pedestrians who are injui'ed or
killed, 30 per cent were crossing between intersections,
15 per cent were crossing at an intersection but
against a signal, and 22 per cent crossed at an inter-
section where there was no signal.

Our Committee is convinced that the annual cas-
ualty rate involving older persons can be reduced by
adoption of a state-wide safetj' campaign directed at
our elderlj'.

The State Division of Safety should, among other
tilings :

1. Stimulate local safety campaigns in our various
communities designed to combat the toll taken
by accidents to our older folks. Local welfare
offices handling old age assistance, district offices
handling old age insurance, old age recreation
clubs are but some of the agencies that could
be used to disseminate information.

2. Encourage wider use of safety equipment and
devices in the home, such as grab bars and rails
near bathtubs, non-skid rugs, better lighting on
stairways.

Warn oldsters of the need for special precautions
while walking in traffic and use of simple tech-
niques such as wearina' white mufflers or gloves
while walking on dark roads.

4. Develop among architects an understanding of
the special safety needs of older persons, so
that old age homes, nursing homes, and other
buildings erected for older persons can be as
accident-proof as possible.

5. Encourage medical groups to initiate studies of
the i:)hysiological and mental aspects of falls.

Adult Education

Our Committee in previous reports has indicated the
need for developing an adult education program to
cover the needs of older persons.

Dr. R. J. Pulling, director of the Adult Education
Bureau in the State Education Department, presented
to our Committee a stimulating, provocative program
for adult education for older persons.

We are happy to report that Dr. Pulling 's bureau
has emploj'ed a part-time specialist to encourage locali-
ties to develop adult education programs for older
persons, for the older worker seeking to adjust to
impending retirement, for the oldster who wants to
keep useful and busy, for the elderly who are miser-
able because they can find nothing to occupy their
time, for the oldster who wants to learn a hobby or
craft.

New York State thus steps out ahead of the rest
of the Nation by initiating an educational program
geared to older persons. Today, courses can be given
in factories, old age homes, recreation clubs for older
persons, as well as in civic centers, libraries, shojis,
studies and even in jarivate living rooms.

A report by the U. S. Office of Education indicated
that there were in 1947-48 only 25 courses for per-
sons past retirement age given in the entire country
and said it was the least widespread type of adult
education.

The State Education Commissioner, Francis T.
Spaulding, has informed our Committee, "We are
very much concerned about doing tlie kind of job that
needs to be done in connection with education for
older people."

Our Committee believes :

1. The work of the Adult Education Bureau should
be expanded to develop a comprehensive pro-
gram of adult education for older persons, as
outlined in "Birthdays Don't Count," by Dr.

Pulling.

2. The State Education Department's relationship
to older persons extends far beyond that of sim-
ply adult education. It covers, for example,
library service to the elderly, vocational rehabil-
itation, licensing of teachers for adult education
work, state-aid to recreation centers doing edu-
cational work approved by local boards of edu-
cation, and an examination of the entire elemen-

tary and secondary school curricula to determine
how youngsters can be prepared to adjust to
older persons, frequently a sore-point at pres-
ent, and how youngsters can be prepared not
merely for a post-school career but for a well-
rounded life throughout maturity. Therefore,
our Connnittee urges that the department set
up an interdepartmental committee to explore
all facets of education in an aging population.

•'!. The State Education Department should allo-
cate funds for research on the educational needs
of older persons. Very little basic research has
been done in this field.

4. Our Committee urges the State Education De-
partment to re-examine its own discriminatory
policy regarding older persons. Today, a per-
son desiring a license as a teacher of shop or
trade subjects is barred from admission to quali-
fying courses of instruction if he is more than
40 years old. Many able craftsmen, technicians,
skilled workers who would make splendid teach-
ers and who in their later years might wish to
teach are barred by this regulation.

Recreation for Oldsters

Recreational clubs for our eldei'ly are mushrooming
up all over the State in heartening numbers.

Churches, women's groups, fraternal organizations,
industrial clubs, and local recreation departments are
sponsoring recreational facilities for oldsters.

This is a trend that our Committee is stimulating
and wishes to stimulate further.

No community should fail to provide recreational
facilities for its elderly.

rnfortunately, too many of our localities provide
playgrounds for children, tennis courts and baseball
fields for adolescents and young adults, but neglect
entirely the recreational needs of our elderly. It is as
though suddenly when a man or woman becomes 60
or 65 he or she no longer needs recreation.

The day care centers for oldsters such as the Wil-
liam Hodson Center in New York City are proving
to be a mental tonic for oldsters. Senescence is appar-
ently retarded by the activities of these recreational
and social centers, which replace the activities of the
working day for the elderly. The record seems to in-
dicate that at Hodson Center, for example, the old-
sters live 10 years longer than most people in the
same age group, and retain their mental stamina
longer too.

Why do oldsters like to join these kinds of activity?
One says: "It's a retreat for displaced persons in our
society, the elderly". Another says these clubs "put
new energy and love in j-our heart." A widow says,
"it takes vour mind off things, like the loss of a dear
one."

Fingers that have lost none of their nimbleness with the years help keep these men alert and usefully occupied.

Ill Newburgii, New York, an outstandinu' recrea- ].

tional club for oldsters. Club 60, is sponsored by the
Junior League. F'acilities are provided by the eu- 2.

lightened management of S. Strooek & Co. The c-lub 3.

is run on a democratic basis by the oldsters themselves.
Significantly perhaps, the idea for the club stemmed
from a social worker in the local welfare department,
who was aware of the needs of the older persons in 4.
the community.

Until the State's recreational work is organized on
such a basis that it can stimulate community recrea-
tion programs covering all age levels, our Committee
believes that separate state-aid for recreation centers
for oldsters is justified. The State now provides aid 5.

for recreation centers for youngsters. It is no less
important that we encourage recreational centers for
oldsters.

Our Committee recommends:

pro-

The State grant state-aid for recreational
grams sponsored by local communities.
The stati' aid he limited, at first, to cities.
That the larger cities in the State investigate the
desirability of establishing day care centers in
lieu of or in addition to clubs which meet per-
haps once a week or even less frequently'.
That in accordance with the recommendation of
our Advisory Committee on Recreation, the
amount of state-aid should be 10 cents per per-
son who is 60 or over in a particular community,
based on the most recent census, this sum to be
matched on a 50-50 basis by the locality.
Every elfort be made by the State Education
Department to eliminate the snag in New York
City where suitable teachers of crafts, hobbies,
arts and skills of various sorts suitable for recre-
ation centers for oldsters are barred because thev

lack the formal education requirements for
academic instructors.

6. Every local recreation department develop spe-
cial facilities for oldsters, such as lawn bowling,
checkers, croquet, horseshoes, etc.

7. That State parks make available similar facili-
ties for oldsters wherever possible and that such
facilities be publicized so that more oldsters
will take advantage of them.

8. That the State develop a comprehensive recrea-
tion program for persons of all age groups, so
that special emphasis on one age group, whether
youth or the elderly, will be unnecessary.

Housing for the Elderly

In previous reports, we have called attention to the
need for providing space in public housing projects
for our older persons. We recommend a change in
the Federal Housing Law which bars older persons
from federally aided housing projects, urged that an
analysis of the market for housing the elderly be un-
dertaken by the State Division of Housing, advocated
that cottage-type living arrangements for the elderly
as now set up in certain Florida and New Jersey com-
munities be explored, and urged that insurance com-
panies explore the possibilities of investing in housing
projects for the elderly.

We doubt that the answer to housing the elderly lies
in establishing communities for the elderly alone.
Our older persons like to be near younger people,
prefer not to have to live solely with others of their
own age group ; as a whole they want to be part of the
whole community, not segregated into old age colonies.
Of course there are exceptions, but the experience
abroad seems to be that when entire apartment houses
were set aside in special areas for older persons, old-
sters did not like the arrangement. Sweden, for ex-
ample, after a number of experiments, is shifting from
apartments exclusivelj^ for the oldsters to ones which
contain persons of all age groups.

Foreign countries have had considerable experience
with housing of the aged, ranging from public hostels
provided for by England's National Assistance Law
of 1947 to Cologne's housekeeping park apartments
for aged persons of limited income. The experiences
of England, Belgium, Denmark, and other countries
need to be sifted, to determine what we can learn to
aid us in housing our own elderly.

Available figures for this country indicate that most
of our elderly live in private homes of their own
(68.8 per cent). And there is little doubt but that in
most eases the best housing for oldsters is their ovra
home, although this may not always be true especially
when they become infirm or senile. About 21.9 per
cent live with relatives, which in many cases is satis-

factory, enables the oldster to feel useful, solves an
economic situation ; but which in other cases may
prove unsatisfactory if there are problems of adjust-
ment, undue feeling of dependence, and constant bick-
ering. Over 5 per cent share the home of a non-
relative. Four per cent reside in institutions.

The Central Bureau of the Jewish Aged has re-
ported to our Committee: "In the field of private
housing, furnished rooms and small apartments are
available to older persons but they are not adapted
to their specific needs. Frequently an older person
lives alone on resources which are not adequate for his
comfort and well-being. For example, a frequent oc-
currence is the disiDossession of a lone aged person
from a furnished room when he requests or requires
extra attention or services from the landlady. We
have seen many self-sufficient older persons become
fearful and insecure after such experiences."

The bureau advocates that the community take re-
sponsibility for further stimulation of the public
housing authorities and private endeavor toward the
building of housing projects with a recognition of the
older persons as a potential and suitable tenant.

Today, in New York State, there are in state-aided
public housing projects 99 apartment units of the
one-room type presumably suited for older persons,
plus 111 more such under construction. These in-
clude 56 units specially set aside for oldsters at Fort
Greene Houses in Brooklyn, 39 at Lilliam Wald
Houses in Manhattan, 4 in Melrose Houses in the
Bronx, 100 in the Governor Alfred E. Smith Houses,
and 11 in the Farragut Houses in Brooklyn.

There are, in addition, seventy-one 2-room, bedroom
units designed for two persons in the Farragut
Houses, Albany Houses in Brooklyn, and the Flush-
ing Houses. There are also a total of 772 units, 2-
room, 1-bedroom, designed for two persons in our
state-aid housing projects.

However, provisions for housing our elderly in pub-
lic housing projects still consist almost entirely of the
56 apartments in the Fort Greene projects, plus such
other apartments as are provided for elderly slum
dwellers whose old apartments were torn down in
slum clearance projects.

We are happy to note from the 1950 message to the
Legislature by Governor Dewey that "active con-
sideration is being given to the problem of housing the
aged, which has been repeatedly recommended by the
Joint Legislative Committee on Problems of the
Aging."

The State Housing Division, we are informed, is
sifting all available information on living needs of
the elderly. Kochester is making the first really com-
prehensive study of the housing needs of its older
persons. Data which the U. S. Census Bureau plans
to compile in 1950 will give us for the first time in-

formation we need to plan a rounded program for
housing our older people.

Continuation of Our Committee

Our Committee believes that it is in the public in-
terest that our Committee be continued another year.
This recommendation is urged upon us by private
social agencies upstate and in New York City, by
medical, industrial, labor and connnunity leaders, as
well as by Governor Dewey in his 1950 message to the
Legislature.

The problems of the aging are so vast that to probe
into them is to attempt to cover most of the major
problems of life itself. Our entire economy and our
entire problem of human relations are affected by
the many ramifications of the problems of the elderly.

Our Committee has made an attack on some of the
more urgent problems and recommended a broad pro-
gram that obviously could not cover all the aspects
of the problems of the elderlj^ The Governor has
asked that we extend our Committee's activities to
enable us to join with national authorities in working
out a basic solution to the problem of economic pro-
tection of the aged. We shall be glad to do so.

Our Committee believes that a great deal of work
needs to be done with personnel managers, housing
experts, and mental hygiene authorities. Our Com-
mittee, if continued, plans to (a) keep close cheek on
the job counselling experiment mentioned in another
section of this report, (b) determine from its survey
of old age recipients what further local communities
can do to prevent oldsters from needing old age as-
sistance, (e) seek to develop with the aid of the State
Insurance Department some sound method of prevent-
ing, in a just manner, insurance companies from using
the annual renewal clause in health and hospitaliza-
tion policies to bar continuation of insurance to
elderly policyholders once they become ill, and gen-
erally to bring the insurance companies to develop
their own programs for the elderly, (d) continue to
work with industrial and labor groups to break down
age barriers in industry, ( e) work toward closer liaison
between the State Mental Hygiene Department and
our private old age homes and social welfare agencies,
and (f) appear before congressional and national
administrative agencies in the field of labor, social
security, health, and education, to give them the bene-
fit of our findings.

Condolences

Our Committee wishes to express to the family of
our former colleague, Senator Rhoda Fox Graves, who
died at age 73, our deepest sympathy in their loss.
Senator Graves was sincerely interested in improving
the welfare of our older persons and aided our com-

mittee greatly by her sympathetic understanding of
the plight of many of our elderly.

Our Committee was also grieved at the loss of one
of its able advisors, Dr. Stephen R. Monteith, of
Nyack, who was Chairman of the Sub -Committee to
Study Geriatrics of the New York State jMedical So-
ciet}^ and who was giving the medical profession in
the State outstanding leadership in the social aspects
of geriatrics.

Acknowledgments

Again our Committee must record its obligation to
the member agencies of the Welfare Council of New
York for continuing through the year to provide our
Committee with information, guidance and inspira-
tion.

We cannot possibly note here all the individuals
and organizations who aided our efforts, without ex-
tending this report to encyclopedia proportions.

Wc are indebted to Parke Davis & Co., Newsweek
Magazine and Standard Oil of New Jersey Inc. for
their cooperation in providing free of charge to our
Committee expensive color plates which would have
otherwise been unavailable, to NEA for the use of bril-
liant cartoons dealing with the elderly and various
member agencies of tlie Welfare Council of New York
for various photographs.

We must, however, make special mention of the in-
debtedness of our Committee to the Community Serv-
ice Society of New York and its consultant on the
aged. Miss Ollie Randall, who has given freely of her
counsel and her wide experience to our Committee.

The Committee is also especially appreciative of
the cooperation given by Miss Gladys Fisher of the
State Social Welfare Department, Dr. Charles A.
Pearce, and his reseavcli staff in the State Department
of Labor, and Dr. R. J. Pulling of the State Depart-
ment of Education.

To the many colleges and universities, labor unions,
industrial concerns and councils of social agencies
which cooperated in furnishing data to our Commit-
tee, we express our gratitude. We are particularly
grateful to the medical men, such as Dr. C. Ward
Crampton, Dr. Robert T. Monroe, Dr. James M. Dunn,
Dr. Frederic D. Zeman, and New York City Hos-
pital Commissioner Marcus D. Kogel for giving our
Committee the benefit of their advice and judgment,
in some cases at considerable inconvenience to them-
selves.

Our Committee wishes to thank the various Fed-
eral Departments, such as the Veterans Administra-
tion, the U. S. Labor Department, the Social Se-
curity Administration, and the U. S. Public Health
Service for authorizing their key ofScials to aid our
Committee by furnishing data and advice.

Our deep gratitude goes to the members of our Ad-
visory Committees and to the various State Commis-

sioners who have provided information and guidanee,
to Mr. Albert J. Abrams, who directed the work of
our Committee and drafted this letter of transmittal
for our review, and to Mr. John A. Ruskowski, who
aided greatly in the preparation of this report and in
the work and studies of our Committee.

We are also indebted to the many older persons
who furnished our Committee with invaluable infor-
mation on their personal problems and thus enabled
us to gain an insight into the real and human difficul-
ties which confront so many of our elderlv.

Nature of This Report

Like its predecessors, "Birthdays Don't Count,"
and "Never Too Old," this report consists of two
basic sections. The first contains this letter of trans-
mittal. The second section consists of various papers
and reports prepared for our Committee by some of
the Nation's outstanding authorities on problems of
the aging, and other analyses which our Committee
tliought should be brought to the attention of all con-
cerned with the plight of our elderly.

NEW YORK STATE JOINT LEGISLATIVE COMMITTEE ON PROBLEMS OF THE AGING

Senator Thomas C. Desmond, Chairman

Assemblyman William M. Stuart, Vice-Chairman

Assemblyman Leonard Farbstein, Secretary

Senator Thomas F. Campbell

Senator Fred G. Moritt

Senator S. Wentworth Horton

Assemblyman Harry J. Tiflft

Assemblyman John E. Johnson

The Governor's Views

By Governor Thomas E. Dewey

{Excerpts from HhiU Message to the Leyislalure)

THE PROVISIONS for the aged in this eountry are
today in a chaotic condition. The national old-
age and survivors insurance system under the
Social Security Act, passed fourteen years ago, as now
constituted, is a failure. Its benefit payments are in-
adeciuate, and unless the system is recast fundamen-
tally, it will continue to fail for another ten to fifteen
years to meet the needs of our older people. Moreover,
many people are not even co\-ered by the system.

The joint national-state public assistance system was
established originally as a stopgap to take care of the
needy aged who could not immediately be brought
within tlie scope of old-age and survivors insurance.
Actually it overshadows the insurance system. It
provides larger benefits than old-age insurance and
threatens to become a major fixture in our national
life. Yet, it does not provide a pcrniancut solution to
the problem.

In the meanwhile, through the efforts of govern-
mental and industrial employers and more recentl.v
of labor unions, pension funds for industrial and gov-
ernmental employees have grown considerably in
number and scope. Some of these are contributory,
others non-contributory ; some ai'c funded on a reserve
basis and thus safeguarded to some extent against
default ; otJiers are completely unfunded and unsafe-
guarded; some are correlated with the national insur-
ance system while others are not.

The State of New York, witli its vast and increasing
aged population is vitally concerned with the intro-
duction of some order into this confusion of conflicting
trends. We are concerned about a sound reorganiza-
tion of the national old-age insurance s.vstem which
will meet the needs of our population and the pojiula-
tion of other states.

We also have a responsibility to correlate our State
and municipal retirement plans with the national
insurance system ; and, wherever practical, to assist
industrial employers and labor unions to develop
jointly soundly conceived retirement systems.

This can not be done without a more thorough study
of the entire problem than has yet been made. We
must find solutions which will stand through time. I
reconnnend, therefore, to your Honorable Bodies that
the Joint Legislative Committee on the Problems of
the Aging be continued and expanded in order to
carry forward its excellent work in this field and to
include within its perspective the problems of old-age
pensions and insurance. This Committee should also
be able to make effective presentation of the needs of
this State in the national deliberations on the prob-
lems which may take place during this year.

Housing

Although the low rent housing program is primarily
intended to accommodate family groups, active con-
sideration is being given to the problem of housing the
aged, which has been repeatedly recommended by the
Joint Legislative Committee on Problems of the
Aging, in the first project built with State funds,
provision was made for one and two room apartments
suitable for occupancy for aged persons. In all our
State-financed public housing, whether the project is
in the planning stage, under construction or in opera-
tion, provisions have been made for small size units
with a view toward alleviating the housing problems
our our older citizens.

Nursing Home Care

All of us have a relative, or friend, or know about
someone who is receiving nursing home care or who
rei[uires such care. This situation constitutes a health
problem as well as an economic and social problem to
which your State Administration has given extensive
study and upon which it has acted. In recent years
there has been a substantial increase in the number of
our chronically ill, an increase tliat stems from the
fact that we are living longer and have become an
aging population.

Many of our chronically ill do not rerpiire hospital
rare but do reipiire nursing and other services which
are not available in the average home. As a result,
there has been a tremendous expansion in the nursing
home field. To learn what kind of cai-e these aged
men and women are receiving and to obtain the funda-
mental facts of this relatively new nursing home
economy, the State Department of Social Welfare
recently made an intensive survey of nursing homes
in upstate New York. (Nursing homes in New York
City are licensed by the New York City Department
of Health.) Approximately one thousand homes were
surveyed. As one might expect, they were found to
be good, bad and indifferent. Many of them should
not be called nursing homes. They are merel.y board-
ing homes. A report is now being prepared on the
findings.

The responsible owners of these homes, which are
proprietary in nature, want standards to be set, as a
protection to the patients and to themselves. The
State Department of Social Welfare, with the help of
the Interdei>artmental Health Council, is now plan-
ning to develop such a set of standards.

We shall also have to plan a program for developing
more and better facilities, including both nursing and
boarding homes and public and private institutions
for the aged as well. These efforts will, I am confident,
assure to the chronically sick, elderly people, the kind
of care, comfort and safetv thev should have.

What Can the Local Community
Do for Its Elderly

By Miss Alice M. Loomis

Community Consultant on Service for the Aged, Rochester Council of Social Agencies

WHAT can a community do for its elderly?
First, very decisively a communitj^ can and
must choose its course of action with its older
residents. If no active choice is made, it may drift
into many unrelated projects, all very kind in inten-
tion, some glamorous, but always with a possibility of
unseen misery and dissatisfaction and a tidal wave of
unwise appropriations. Thus the community's deci-
sion has been reached by the default of its citizenry ;
everyone except a few promoters maj' suffer.

A local program for t!ie elderly can be effective only
when the local connnunity takes the initiative in
forming or formulating a sound program for all its
aging population without regard to social or eco-
nomic status. To wait until a program has been sup-
erimposed from higher levels and then to object to
state or national domination is futile. Local initiative
and responsibility as a foundation for a sound pro-
gram are mandatory, inescapable.

Effective service for and with the elderly depends
upon a full and sympathetic partnership between the
local community and upper governmental iinits. in-
tegrated with a common purpose, and a division of
responsibilities clearly determined.

Assuming that a community decides to chart its
course, rather than to drift or to be pressured into
action, how does it get started?

Eager learners are these oldsters when you have something
worthwhile to teach them.

First, a few people with vision urgently feel a
certain need and get an idea of doing something about
it. Other sponsors soon become interested. Golden
Age clubs for lonely older people are a frequent start-
ing point.

The imagination that leads to a first step soon re-
veals numerous other needs, but limited knowledge,
time and funds may discourage the pioneers from
attacking all the problems thej^ have brought to light.
This is perhaps fortunate, for then other people with
competence in various fields must be drawn in.

If these people, all touching different facets of the
community begin to consider a central problem, then
a community object will be developed. Whether this
originates outside or within a community formally
organized planning group, the integration of the"
forces into an effective enterprise can, in all likeli-
hood, be best achieved through the medium of a
Council of Social Agencies or some similar coordi-
nated medium.

The problem of what a community must do for and
ivith its elderly would be overwhelming, if it were not
seen in sections in each of which there is a community
leader with his own special skill. From the coopera-
tive thinking of these leaders comes the decision as
to priority of action.

Guideposts

There must be fundamental agreement on the
principle that the program must provide the fullest
possible participation of older people. Participation
by the elderly was a necessity in our former rural
economy. Today in an urban society, with the in-
creasing proportion of older people in the population,
tlie o]iportunity for the elderly to share, -as far as
their abilities permit, in the life about them requires
a i-earrangement of many recent practices. This re-
arrangement offers a challenge. It is in the local com-
munities where the elderly live, languish and vote that
this challenge must be met. When older persons lack
outlets for their energy — mental, social, physical —
responsibility rests upon the community to find suit-
able opportunities that will help to keep the elderly
off the scrap heap. For example, even the feeble home-
bound have found satisfaction in as simple a tasls as
stuffing Christmas seals in envelopes.

While there is a wide variety of fiekls, discussion of
the application of the principle of participation is
limited here to recreation, health, housing- and em-
ployment.

Recreation is the starting point in most communi-
ties; unfortunately, in some it is the limit of the ex-
pression of community interest. Recreation for the
elderly in all its forms should have the single objective
of increasing opportunity to enjoy to the full the leis-
ure of later years. Three guideposts may be of
assistance.

One, the number of older people with leisure is
con.stantly being increased by those who differ from
the average old person in the past. They have better
health, they have worked shorter hours, had more
vacations, traveled more. They have had more op-
portunity for varied interests and quite a number
have larger pensions. With all the pressure that has
been associated with these gains, however, the great
need of many is knowing how to enjoy leisure, that is
retraining for leisure. This is a challenge to the
Adult Education Section of our public schools as
well as to many other parts of a community.

These newly retired and soon to be retired are prob-
ably any community's largest reservoir of unused
human resources. They have much to give of time,
energy and skill. With their need to learn new ad-
justments, they should be of immense help in the
general thinking on the place of the older person in
our modern society. There are no answers in the
books.

Two, the less active and formerly busy citizens
should be kept fully informed of available cultural
resources. This can only be achieved by continuing
search and frequent publication. Churches, fraternal
organizations, libraries, art galleries, museums, city
departments, public utilities, and many others have
extension, social service or public relations depart-
ments with rich offerings. A Senior Citizens Calen-
dar, compiled by a committee of lay and professional
workers, is of value to any city.

Three, there are latent powers in all but the genu-
inely senile. The response in new paths may be slow
and timid, but the joy of learning even the simplest
thing is a, creative experience that prolongs and deep-
ens life. One has but to visit the occupational therapy
department in a. home for the dependent aged or
chronically ill to realize what .skilled leadership can
do to arouse and make fruitful the innate desire to
learn ; or to visit a camp for elderly people where the
pains of sunburn and mosquito bites may replace those
of arthritis and heart attacks.

A better understanding of the health needs of an
aging population will lead to many changes. It may
be necessary for the higher governmental levels to
assume greater responsibility for the chronicallv ill

and for the research needed to reduce their number.
Certainly the community will improve its immediate
services as it adopts a more constructive attitude to-
ward the treatment of its aged ill. More and better
nursing homes are needed wherein illness is not pre-
sumed to be a prelude to death.

In one city, the addition of a physio-therapist to the
staff of nursing homes, under the direction of a for-
ward-looking County Department of Social Welfare,
is hastening the recovery from such misfortunes as
fractures and strokes, thereby accelerating the flow
of patients from the hospital at $11 per day, to
nursing homes at $125 monthly, to boarding homes at
$75 monthly and, in fortunate cases, to their own
homes. Each step represents an increase in the in-
dependence and happiness of an older person and a
decrease in the cost of the care.

Preventive and constructive services are needed for
both physical and mental health. For example, much
more is known than practiced in nutrition of the
aged. In many communities there are from one to a
dozen agencies touching this subject. Yet physicians
continue to prescribe care for the aged persons suffer-
ing mainly from malnutrition.

In the prevention of mental illness a community
can do much by drawing older people into normal ac-
tivities. Tliis sounds deceptively simple and the re-
sults may seem at times to be miraculous. An old
man in one city, formerly an active respected citizen,
was beginning to sit quietly and stare blanklv, en-
tirely withdrawn and apparently ready for a mental
hospital. He was persuaded to become a day visitor
at a home for the aged where he met men of his own
age. He entered into their activities and shortly an
alert, old man was searching for a room near the
home where a blind acquaintance could live and share
with him the home's activities. Perhaps skilled case-
work and a progressive home for the aged were part
of the miracle.

It cannot be said too often that the physical and
mental health of our aging population is conditioned
by the physical and mental health program for all
ages provided by the local community.

Housing Action

Housing for the aged hopefully is passing from the
public conscience and discussion stage to that of
definite civic planning and action. Yet does any city
know how much of the living space so sorely needed
by younger people is in the large apartments and the
large houses that are wearing out old people because
there are no small comfortable quarters for them?
Knowledge is not lacking as to the kind of housing
needed. A few units have been built with extra con-
sideration for safety and with services available as
needed — food, shopping, laundry, housekeeping.

Private investment in this type of housing is reported
to be a sound financial venture.

Even without new housing many feeble old people
L'ould remain longer in their own homes or the homes
of overburdened families, if only they had supple-
mented housekeeping, nursing and shopping services.
Any hospital can report what the lack of these serv-
ices is costing the elderly and the taxpayer. One of
the next steps in many communities, and it can be an
immediate step, is the fitting of these services in
Avith those already established.

In at least one city in Xew York State the local
planning commission is assuming responsibility for a
survey of the housing of its elderly residents. From
such definite knowledge practical housing plans can
be developed.

Eniploynient

To say that older people exjierieuce difficulty in
securing and holding gainful employment is merely
a reaffirmation of the obvious. In the main, this is
due to conditions largely beyond the control of local
industries and local communities. Many questions
of general policy are, as yet, unanswered, biat they are
continually arising in every community. Should the
termination of employment be determined by chron-
ological age or by productivity? If based solely on
productivity, how will the lieads of young families be
affected? This is a serious and unsolved problem.

Should the comnmnit.y offer guidance to the re-
tired person who is contemplating the investment of
his life's savings in a small business? Cannot a busi-
ness clinic be created for the elderly as for other
groups? How can job finding for the elderly be best
achieved ? To what extent will a sheltered workshop
contribute to the well-being of tliose no longer able to
meet the demands of modern business operations?

With a better understanding of what con be ahead
for eacli of us there should be fewer tragedies such
as that of the university professor who. on retirement,
had been greatly honored for his 40 years of service.
His widow startled her associates by saying that the
university would be kinder to shoot its retiring pro-
fessors than to put them on the shelf alive.

Also, the local community must exjilore prepara-
tion for retirement. Too frequently the stui-dy and
productive worker suddenly on retirement finds him-
self unadjusted to great blocks of free time and suf-
fers from the "bends" by coming too rapidly from
the deep waters of a job to the shallows of idleness.
The program of preparation for retirement should
cover a minimum of at least five years. It is a major
personnel operation by which the employee is helped
to appreciate the eventual freedom from the many
years of responsibilities. At the same time assistance
should be extended in the development of interests

which will give zest for living. Here leadership must
be given by the employing organizations with the
assistance of other community resources. No single
group can do this alone. The grafting of a new and
fruitful life is a matter of common concern. Interests
should be directed into constructive channels, not only
for the benefit of those who are retiring, but for the
benefit of the community because there is a wealth of
untapped skills and abilities which should be used
for the community's benefit. One does not lose all his
strength the day after retirement. This reservoir of
constructive forces should be tapped and the variety
and quality are great.

A positive approach must be made; the sense of
being needed must be fostered; busy work alone will
not meet the needs of our aging people. This can
be a realistic program. Already two leading industries
in Rochester are attempting to work with such a pro-
gram which will utilize many of the community's
resources.

To develop gradually a durable program for the
elderly, including new practices in employment and
recreation, housing and health there is needed an un-
derlying social philosophy. One important method of
interpreting this philosophy is the consistent selection
and vivid presentation of news which portrays needs
and how they are being, or should be met. An excel-
lent example of this type of reporting was a series of
six articles on the various facts of the local program
published in the Rochester Democrat and Chronicle.
There is a wealth of material which can be used,
showing how sound planning and courageous action
not only pays in human happiness, but in the long
run can save the dollars of the taxpayer and con-
tributor. Thi-ough planning and interpretation, manj^
of the mistakes that have been made for creating un-
necessary pi-ojects or by abolishing otliers of real
worth becau.se of the lack of facts, can be avoided. A
program cannot advance without community under-
standing.

Local Action

There has been a disposition on the part of many
conniiunities to await governmental action, especially
on the higher levels, to solve the problems of the ag-
ing population. However, in those communities where
responsibility has been assumed, and discussion as
well as action has been had, interest and financial
support increasingly have been offered by voluntary
sources. Within the past year in one city a long-
established local organization, the Women's Educa-
tional and Industrial Union, gave a recent legacy to
the Council of Social Agencies to carry on a project
for the development of a comprehensive program for
the aged. A community consultant on services to the

ai;ed lias been employed, and a eoimnunity focus has
beeu established. To further euriuh this effort, the
Junior League has given sufficient funds to the coun-
cil for a series of institutes on the agino' population.
Neither of these generous gifts — and the.y may be
only the beginning of additional tinaneial support —
would have been forthcoming had there not beeu an
organized effort in the community to do something for
and with the elderly in their midst.

It is becoming increasingly clear that a successful
program is dependent upon the courage and action
of local communities in close sympathetic partnei'.'ihip
Avith the state and Federal governments. Each has

its important role to play. In New York State, we
are beginning to see a consolidation of effort, and
there is gradually evolving a program insuring the
elderly both protection as needed and continued op-
portunity to share in community life. The recent
creation of the New York State Association of Coun-
cils of Social Agencies and the proposed nnofficial
State Council for the Elderly will inevitably act as
crystallizing and unifying forces. With the leader-
ship of the members of the Joint Legislative Commit-
tee on Problems of the Aging, the communities in New
York State can definitely progress in their efforts to
meet the needs of our aging population.

What Westchester Communities Are Doing

for Their Elderly

By Miss Lillian A. Quinn

Executive Secretary, Westchester County Council of Social Agencies

THERE is growing recognition in "Westchester
county, its cities and towns, that an aging pop-
ulation brings new community responsibilities
that call for new services and the extension or adapta-
tion of established services. A wide variety of organ-
izations are operating specialized services not in ex-
istence a few years ago. Other organizations, such as
the Westchester Nursing Council and the Westchester
Chapter of the American Association of Social Work-
ers, are making the needs of aging jDeople the subject
of open program meetings this year. Mention is
merel,y made in passing, to Old Age and Survivors In-
surance and to old age assistance, since these are
available throughout the State.

The greatest recent strides in Westcliester services
to the elderly are in recreation. Local sections of the
National Council of Jewish Women operate five
senior canteens in Mt. Vernon, Poi't Chester, New
Rochelle, White Plains and Yonkers. Neighborhood
House sponsors a senior canteen in Tarrytown. The
Junior League of Bronxville ran a senior canteen in
Tuckahoe on a demonstration basis, which it is hoped
the local Recreation Commission will continue.

The Golden Age Club of the Ossining Recreation
Commission provides a recreation center for older
men. This Golden Age Club started by chance, in
one sense. The Ossining Recreation Director saw
three elderly men huddled together under the eaves of
a closed building on a rainy day. Being a friendly
person, he said, "Why not come around the corner,
and wait until the shower is over, in the Recreation
Center ? ' ' They replied that they thought it was only
for young folks. "Not at all," he said, "it's for the
people of Ossining — no upper age limit."

That was the beginning of a growing group who
not only formed the club and meet in the recreation
center, but do all sorts of entertaining and useful
things together between times, as a group or in two
and threes.

The County Recreation Commission has conducted
two informal conferences this year on the recreation
needs of old people to focus the attention of local
recreation leaders, lay and professional, on expand-
ing their programs to serve old as well as young.

The Pelham Junior League with the aid of the
Public Library of New Rochelle conducts a "Pony

Keeping the elderly occupied at creative tasks is one of the
functions of old age homes.

{Courtesy Pcabody Home for the Aged.)

Express." The league delivers books, furnished in
the main by the library, to shut-ins, most of whom
are in the upper age brackets. They collect the books
later, as they bring new ones.

County Home

Tlie County Home, a division of the County Depart-
ment of Public Welfare, has much entertainment fur-
nished by Women's Clubs, Service Clubs, fraternal
orders and others. The Committee of 100 of the
Scarsdale Women's Club has provided a public ad-
dress system for the auditorium and improved sound
equipment to moving pictures. A well known Chil-
dren's Theatre, with its base and workshop in the
count.v, has for several years had its tryouts at the
County Home, before taking to the road. These are
very popular events with the residents of the home.
The County Home also has a full time occupational
therapist. This position is on the county payroll.

Another division of the County Department of
Public Welfare, the Department of Family and Child
Welfare, is making progress on recruiting volunteers
to take occupational therapy into those nursing homes
where their old age assistance clients are boarding.
This department is very conscious of the need — for

both psychological and economic reasons — for gainful
employment, at least part time, for its older clients,
some of whom are able to carry part-time jobs and
eager for them. Thus far little progress has been
made in finding such opportunity. The local offices
of the New York State Employment Service are, how-
ever, aware of and concerned about employment needs
of older people. To the limit of their facilities they
offer employment counselling for older people.

Westchester's seven private family agencies — Cath-
olic Charities and Westchester Jewish Community
Service, county-wide; and five non-sectarian societies
in local communities in the south of the county — oiler
general counselling service to aging men and woiuen.
Westchester Jewish Community Service has a depart-
ment for services to the aged. The Yonkers Family
Service has a staff member whose special responsibility
is for its older clients.

Visiting Nurse Associations, of which there are 16 in
Westchester, covering the sis cities and all but two of
the 18 towns, are providing nursing care at home to
many old people. The Westchester Nursing Council
(a voluntary federation of these 16 associations) is
focussing the attention of its members on their elderly
patients and, as mentioned, will have one of its four
program meetings on geriatrics this j'car.

Inquiries received at the Information Bureau of
the Westchester County Council of Social Agencies
are predominantly about care for elderly people ; and
among these, the most frequent is for nursing home
care.

Nursing Homes are licensed by our departments of
health and the Information Bureau lists only licensed
homes. Fuller information is often needed than the
license report requires. With the assistance of the
Medical Social Work Section of the council, a corps
of volunteers visited nursing homes which uniformly
welcomed these visits.

The volunteers' reports yielded useful data to the
Information Bureau; and, as an important by-prod-
uct, increased interest in the needs of elderly joeople.

There are a number of instances where a hoarding
home, rather than a nursing home, is needed. Though
there is interest in many quarters, in the development
of hoarding homes for the elderly, as yet few such
homes are available.

The Council's Section on the Needs of the Aging
was formed because of tlie number of inquiries in the
Information Bureau about service for the elderly.
This report is largely from that section, of which
Mrs. Louis Rose, of Scarsdale, is chairman.

What Syracuse Is Doing for Its Elderly

By Dr. Raymond G. Kuhlen

Chairman, Syracuse Committee on the Aged

SYRACUSE has (iiily
recently begun or-
ganized planning
and effort directed toward
meeting the needs of its
elder citizens. While tliere
have been various activi-
ties under way in Syra-
cuse prior to 194D, it was
not until March, 1!U!).
that a group of individ-
uals representing various
aspects of community life
met together under the
auspices of the Onondaga
Health Association to
form a "Committee on
Programs for Older People."

The description that follows will be devoted mainly
to an outlining of the point of view and general plans
adopted by that committee, but will also mention
other activities, which have come to the writer's atten-
tion, some of which were under way long before this
committee was organized and others which were un-
dei'taken later, but quite independently of the local
committee.

Just who are the ' ' older people ' ' whose needs should
be met ? I should like at the outset to invite your at-
tention to the possibility that those over 60 — and a
particular segment, such as welfare cases — will un-
doubtedly restrict planning. For early fact-finding-
purposes and initial program planning, the older
group may, perhaps arbitrarily, be defined as includ-
ing those people over 60.

For long-term program purposes, it must not be
forgotten that:

(a) aging is a gradual process characterizing the
adult life span,

(b) individual differences in rate of aging are
tremendous, for example: menopause has been re-
ported in the late 20 's, senile dementia as young as
the early 40's,

(c) people do not age intellectually, emotion-
ally, and physiologically at the same rates and that
chronological age is not the best index of any aspect
of a^g, and

(d) perhaps most important for our purposes, that
the most constructive efforts to promote welfare in

old age must be begun
prior to old age. Ad-
mittedly there are advant-
ages in focusing the early
efforts of the community
on the older groups but
long-term efforts will be
most effective if objectives
are broadly conceived not
simply as "meeting the
old age problem," but
rather as fostering a pro-
gram which will result in
a wholesome maturing of
individuals into an enjoj^-
able, full and useful later
life.

The best time to begin personal planning for old
age is right now. It is in adult life — early, middle
and late maturity — that the foundations for good
adjustment in old age are laid. The community must
be concerned not only with those individuals who
become clients of welfare agencies, but with the total
group of oldsters many of whom have unmet needs
which communities, geared to the welfare and care
of youth, have to date largely neglected.

Areas for Action

Now what about projected areas of activity? At
the very outset of community planning, there should
be explicit awareness of the various facets of the
problem, even though progress cannot immediately be
made on all fronts. A narrow initial view is apt to
result in a narrowly conceived program, and failure
to capitalize opportunities that ma.v arrive because
their relevance is not sensed. The Syracuse com-
mittee has set up the following areas for study and
possible future activity :

1. Research and Evaluation: Clearly the scope
and specific nature of the problems must be defined if
good progressive planning is to proceed. Some perti-
nent statistics can be obtained with relative ease from
census reports or agency files. Much of the more vital
information regarding unmet needs of older individ-
uals will require special research, by interview, into
needs and problems as they are experienced by older
people themselves. Later, when programs are in-

aiigurated, plans should be made to assess their ef-
fectiveness in meeting the existing- problems. Only
through such research etforts can the most effective
programs be plauned and revised, and only through a
research pi'ogram can the local experience be made
available to other communities in their efforts to meet
similar problems.

2. Recreation and Group Activities : Older people,
in jiarticular, need activities which will stimulate in-
terests, broaden views, give purposes in living, provide
social contacts with others of similar age. Other
cities (notably New York City and Cleveland) have
reported unusual successful experiences with pro-
grams designed especially for the aged. This question
shoidd be studied with a view to the development in
Syracuse of a broadly oriented program which should
include the early establishment of a recreation center
for oldsters and the stimulation of various organiza-
tions witliin the city to develop appropriate programs
of group activities for their older members.

3. Work and Economic Security: There seems
little question but what having something to do, hav-
ing a sense of personal work and usefulness, are funda-
mental considerations in the achievement of a well ad-
.iusted old age. Early objectives of efforts in this
area might include assessing the adequacy of social
security and other old age pension allotments, a study
of problems of retirement, the possible establishment
of a "sheltered workshop" for oldsters. Long range
thinking and planning may be fruitful with respect
to ways in which industry might better utilize the
capacities of older workers and to ways in which re-
tirement might be handled (perhaps gradual retire-
ment with an emphasis upon retiring to something
rather than from Avork) so as to foster better adjust-
ment. Since older workers have been shown to possess
certain desirable qualities to a greater degree than
younger workers and are only slightly, if any less,
productive, it appears that some progress might be
made through an "education" program designed to
correct misconceptions. The attention of both labor
and management should be directed to such matters.

4. Adult Education: It is becoming increasinglj^
recognized in education circles that the great unfilled
need in this field involves the adult population. State
aid is already available for adult education programs
under the public school program, and the Universitj'
College of Syracuse University is geared to serving
the needs of the young adult in the community. Cur-
rently these programs serve primarily the needs of the
young adult and to some lesser extent the middleaged
group. Study of the possible further contributions of
these programs might indicate ways in which the

needs of the old age group might be met. There ap-
pears to be need for education at the adult level
which would include special short-term "courses"
(perhaps of only a single meeting) designed to meet
the demonstrated needs, interests and capacities of
various adult age groups.

5. Counseling and Referral: The development of
general programs to meet group needs can do much tt)
alleviate the problems of older age groups. However,
some agency shoidd be established which would con-
cern itself with the luiique needs and problems of the
individual. This agency would counsel older adults
with respect to their personal problems and marshall
community resources to meet the needs of particular
individuals. Methods of meeting this need for indi-
vidualizing a broad program and the drawing up of a
recommended program for action (possibly a local old
age counseling center) is worthy of attention.

6. Public Information and Publicity: A major
problem will be the stimulation of general interest in
the problems and needs of the older individual as a
means of enlisting support for a program designed to
meet these needs. This will entail a carefully planned
educational and publicity program including appro-
priate publicity in press and radio, the planning of
general educational campaigns (including for exam-
ple a possible "conference" or "institute on aging").

7. Institutional Care : A substantial number of old
people must be cared for in institutions and homes.
Most such homes are crowded and a large backlog of
applicants awaits every vacancy. The special prob-
lems encountered in the operation of such homes
should be identified, and ways of making the programs
of these institutions more effective in promoting the
welfare and good adjustment of the residents should
be explored. Other possibilities for providing cus-
todial care, e.g. in private homes, are worthy of inves-
tigation.

8. Nursing and Medical Care : 111 health and other
physical defects characterize the older age group more
than any other segment of the population. Care of
the chronically ill and the incapacitated present a
special community problem. Social study should be
directed to these methods by which such care can
economically be provided to the best welfare of the
recipient, to the development of techniques for deal-
ing with the geriatric patient, and to the education of
nurses and others in the care of the older person.
Special inquiry might well be directed toward a sur-
vey of nursing and convalescent homes with a view to
possible bettering and extension of their services.

9. Housing: Many communities, particularly
large cities, are including in their housing programs

special facilities adapted to the requirements of older
people. What the situation is in Syracuse is unknown.
Studies should be instituted to inquire into the pres-
ent housing arrangements of older adults with a view
to the preparation of recommendation for possible
future construction of public or private housing, and
the preparation of reports and recommendations pre-
senting the needs of the older individual, where it
seems appropriate to do so, in connection with any
pending local or State legislation.

Points of Actual Progress

The foregoing concerns plans, and that represents
the main efforts to date. Obviously, however, plans
must be translated into action if the community is to
benefit. Although the committee referred to earlier
has been in existence only about eight months and
wheels are already beginning to show some evidence
of getting into motion. And perhaps just as impor-
tant, other things are happening which suggest that
various groups are independently interested in the
problem and are doing something about it. This is as
it should be, because the problem is complex and can
best be met through varied efforts of varied groups.

First, what has been the nature of the committee's
activities since drawing up its plans? Progress has
been made along three lines :

(A) There has been progress in fact-finding-. Cen-
sus data have been examined to determine the gross
number and the areas within the city whose popula-
tions contain the largest proportion of people over 60.
The Council of Social Agencies has made available to
the committee an analysis of the extent to which the
caseload of various welfare agencies is made up of
older people, and of the types of problems which they
present. Plans are now being made for a more inten-
sive inquiry into the needs of older people who are
not clients of agencies.

(B) Progress is being made toward the establish-
ment of a recreation center and "sheltered work-
shop." It is likely that this will be established in a
portion of a building recently made available for a
sheltered workshop for the handicapped.

(C^ There have been efforts designed to stimulate
local interest in the problems of the aging through
contacts with various groups not originally associ-
ated with the committee, through appropriate press,
radio and television activity, and through the inclu-
sion of a lecture and discussion of problems of old
age in local "Mental Hygiene Institute."

What of the activities of other groups? Obviously,
almost all welfare agencies ai-e concerned with the
problem to some extent, and some agencies, such as
the local Social Security Office, have some aspect of

the "old age problem" as their primary concern. I
have not made an actual survey of aU that is being
done by groups other than the committee.

(a) Kesearch and Instruction at Syracuse Univer-
sity : Sj'racuse Universitj' was one of the first to
establish a course in psychology of adult life (1941)
and now in addition to that course conducts regularly
a "research seminar in the psychology of maturity
and old age." An extensive research program in the
psychological and social aspects of aging has been
underway for some time and is continuing.

(b) Adult Education: There are two programs of
adult education in the eitj' — one under the auspices
of the public school system (supported by State
fiTuds), the other as part of the program of Syracuse
University's "University College," a community col-
lege. In the public school program a course on
psychological problems of adult living (including old
age) is being conducted for the first time and a survey
of adult needs in education is planned for next sem-
ester.

(c) The local Visiting Nurses Association has long
been interested in the problem of aging and is cur-
rently conducting an in-service study program de-
voted to geriatric problems.

(d) A very active women's club (the Onondaga
Guild) is devoting most of its attention to promoting
the welfare of the residents in the Onondaga County
Home, but is at the same time stimulating interest in
the problems of aging on the part of a substantial
number of people.

(e) The local American Pension Club has an active
recreational program. Participants are members of
approximatel.v 50 years of age and over.

(f) A "Golden Age Club" has recently been estab-
lished as a part of the Salvation Army program.

(g) A local group work agency, The Huntington
Club, has activities for all age groups, and is now in
l^rogress of planning activities for older people.

These are the activities that have come to the speak-
er's attention. Some have been operative for several
years. Others have just begun or are in the planning
stages.

To representatives of those communities who al-
ready have an active program for the aged and aging
this enumeration of activities may seem very insig-
nificant indeed. To those in Syracuse interested in
the future, they represent heartening signs of an em-
erging program. Even in its beginning the picture
is characterized by an active and growing interest on
the part of various groups who are making A^ery dif-
ferent, but individually important, contributions
along the line of their special interests, talents and
facilities. And there is a desirable type of coopera-
tion and inter-stimulation.

The Needs of the Aged in New York City

By Miss Flora Fox
Executive Director, Central Bureau for Jewish Aged

THE Central Bureau for Jewish Aged, by vir-
tue of its function and unique position in the
chain of community services for the Jewish
aged, has had unusual opportunitj' to learn about and
understand the problems and needs of the Jewish
aged. Established in 1945 as a membership organi-
zation, the bureau's affiliates include the Jewish
family agencies, homes for the aged and chronically
ill, hospitals, recreation agencies and the Federation of
Jewish Philanthropies of New York, from which the
bureau derives tlie largest proportion of its financial
support. The bureau has become the generally ac-
cepted medium for the exchange of ideas, the evalua-
tion of programs and their implementation where
feasible.

The bureau functions in many ways : through direct
service to individuals and their families, giving them
guidance in working out plans for their care and
consultation with community agencies on behalf of
aged persons; through study of the needs and ])rob-
lems of the Jewish aged ; through consultation on
aspects of the care of the aged, both general and
specific; through cooperation with and participation
in the activities of other groups, particularly the "Wel-
fare Council of New York City, concerned with the
care of the aged in the total community ; through
leadership in the coordination of present services and
facilities for the Jewish aged now provided in the
community — institutional, hospital, family service and
recreation ; through leadership in the establishment of
new or expanded facilities and services and in the
sponsorship and stimulation of member and other
agencies.

The bureau believes that the following are the cur-
rent outstanding needs of the Jewish aged as based
on its initial 1946 Survey of the Needs and Facilities
for the Care of the Jewish Aged in New York City
whose findings and recommendations have been cor-
roborated and substantiated in supplementary sur-
veys, and in collateral studies and day-to-day experi-
ence. The bureau wishes to point out that the needs
enumerated here are not peculiar to the Jewish aged
but are common to all needy aged persons.

The Chronically 111 Aged

The bureau's 1946 survey revealed a need for addi-
tional institutional facilities for the care of the chron-
ically ill aged. Since then, experience has indicated

that a gi'owing number of elderly persons need such
care because they cannot be served adequately in their
own or in relatives' homes. Particularly noted is the
increasing number of chronically ill persons in cri-
tical condition who require immediate care outside of
their own homes but who have no funds for nursing
home care — the only resource immediatel.y available.
When persons can accept public facilities — we have
the added problem of Orthodox Jewish persons who
are unhappy in a non-Jewish setting — there is an un-
duly long delay in gaining admission to the city homes.
If admission can be arranged to city hospitals for
these patients, experience indicates that they will not
be kept indefinitelj^ because of the necessity to reserve
beds for the acutely ill. Under these circumstances,
patients are frequently sent back to unfavorable liv-
ing arrangements.

Member institutions, stimulated and encouraged by
the bureau, are attempting to help meet this problem.
Some have modified building plans to care for addi-
tional chronically ill persons rather than for the well
aged. Others, who were not planning further expan-
sion, have embarked on fund raising campaigns to
erect facilities for the sick. We can look forward, on
the basis of tlie present plans of eight Jewish institu-
tions, to a considerable increase in the number of
available beds for the chronically ill. However, they
will still serve but a fraction of the numbers of per-
sons requiring this service.

The Mentally Infirm

In this group fall those mentally deteriorated per-
sons who are characterized by such symf)toms as for-
getfuluess, garrulousness, talking to one's self, dwell-
ing in the past, the gradual breaking down of habit
patterns, such as failing to dress properly or main-
taining former good table manners, wandering off,
getting lost. These persons do not belong in a State
hospital but cannot be cared for by institutions for
the aged under their present set-up. Faced by the
lack of proper facilities, the indigent and those whose
families cannot care for them find their way to the
State mental hospitals. This is an unhappy situation
for the aged when they are aware of their surround-
ings and for their families also because of the stigma
which is still attached to mental hospitals. It is also
an expensive way of earing for this type of patient.

The bureau gave serious thought to its responsibil-

ity for the problems posed by the mentally infirm
aged. After due consideration, it was felt that this
problem which is in essence universal might better be
handled cooperatively with all sectarian and non-
sectarian groups through the Welfare Council already
actively engaged in formulating plans for obtaining
understanding of the problem and the methods for
meeting it.

Nursing Homes

Many of the aged awaiting admission to institutions
and many who can continue to remain in the commun-
ity outside of an institution have needed the services
of nursing homes for custodial purposes or for tem-
porary convalescent or nursing care during an acute
illness. The bureau has seen the establishment of an
increasing number of nursing homes throughout the
metropolitan area. These homes which are independ-
ently administered, except for minimum health and
building requirements set by the Departments of Hos-
pitals and Buildings, have no professional supervision
as to physical standards of care, admission require-
ments, personnel qualifications or facilities. Essen-
tially operated for profit, they present varying de-
grees of standards of care and have charges for the
service which often bear little relation to the care
provided and the ability to pay. With few exceptions
the clients of the bureau can only afford a minimum
rate.

The bureau believes that a sound nursing home
program should be set up with adequate supervision,
standards and services at a rate that is flexible to
meet the various economic groups who need this serv-
ice. The bureau has taken part with other health and
welfare agencies of the Welfare Council in encourag-
ing the Department of Hospitals to develop a program
in this area of service which will more realistically
meet the demand.

Boarding Arrangements

Many elderly persons no longer have their own
family ties and greatly prefer living in a family home
to living alone or in an institution. In this kind of
set-up, their need for personal attention, supervision
and guidance is fulfilled along with their need to con-
tinue to be part of the community. They may require
varying degrees of physical care, companionship and
family life. The bureau advocated that this type of
service be explored and studied as to its potentialities.
The Jewish Community Services of Queens-Xassau.
stimulated by its membership in the bureau, under-
took to set up such a program through its Private
Residence Plan. Under this pilot pro.ieet, 35 persons
have to date found this way of living a very meaning-
ful one. In a few instances, where the client was on
the waiting list of a home for the aged, he deferred

admission, preferring the boarding arrangement from
which he derived satisfaction and security.

There are other persons, however, who, though they
have no desire to enter an institution, still are afraid
to remain alone and seek some kind of semi-institi\-
tional living arrangement where they will find iude-
pendence, privacy and freedom of movement along
with a degree of protection. The financial status of
many of these people is in the middle and lower in-
come groups — some being on public assistance — so
that their ability to pay is a limited one. Thus far
there are only two projects of this t.ype in the com-
munity, the Tompkins Square Houses of the Com-
munity Service Society and the Apartment Pro.ieet of
the Home for Aged and Infirm Hebrews which have
between them facilities for a total of approximately
150 persons.

The bureau recommended that the experience of
the two projects be studied as to their applicability to
other groups in the Jewish community and that the
possibility of expanding the services of other institu-
tions in the same way be ascertained. The Brooklyn
Hebrew Home and Hospital, which now serves the
chronicall.v ill aged, is formulating plans for such an
apartment project to serve well orthodox aged.

Public Housing

The bureau, as part of other community groups in
the Welfare Council, recognized that practically no
public housing had been erected to meet the specific
needs of older persons.

In the private field of housing, furnished rooms and
small apartments are available to older persons but
they are not adapted to their specific needs. Fre-
quently, an older person lives alone on resoiirces which
are not adequate for his comfort and well-being. For
example, a frequent occurrence is the dispossess of a
lone aged person from a furnished room when he
requests or requires extra attention or services from
the landlady. We have seen many self-sufficient older
persons become fearful and insecure after such experi-
ences. Many of these people seek admission to a home,
though with proper and suitable living arrangements
they could remain in the community.

The bureau has advocated that the community, pro-
fessional and lay, take responsibility for further stim-
ulation of the public hoiising authorities and private
endeavor toward the building of housing projects
with a recognition of the older person as a potential
and suitable tenant. The bureau has participated in
conferences with the New York City Housing Author-
ity along these lines.

Medical Care

There are very limited medical facilities for conserv-
ing and improving the health of the aged person liv-

ing- ill the community. Cliiiic-al facilities are i're-
((ueiitly inaccessible and jnst as frequently are not
adapted to meet the specific needs of the older person.
For those not able to attend clinics, there is a serious
laclc of provision for home medical care if they are
unable to pay for private service or are not under the
care of agencies which provide medical attention in
the home. Some people in this group may be able to
obtain occasional and ofttinies emergency medical
care but cannot plan for any continuity -which may be
medically recommended to insure their maximum
functioning in the community.

The bureau therefore believes that present facilities
should be expanded and, if required, new facilities be
developed to furnish ncessary medical care in clinics
and in tlic Homes of aged persons adapted to their
particular needs.

Honieinaker Service

There are very limited resources for visiting liome-
niakers in general and their availability to the aged
is restricted by the individual policies of the agencies
providing this type of service, since they are not
specifically geared to the needs of the aging. Par-
ticular limitations are found in the restrictions on
length of time the homemaker may remain in a home,
as the aged need long-term service — sometimes over a
period of months in view of the long waiting periods
for admission to institutions.

The bureau advocated that homemaker service be
expanded and adapted to the special needs of tlie
aged individual with recognition of the necessity for
flexibility in type, length and cost of service. In line
with this thinking, the bureau in March lf)-tS initiated
a Home Care Program to be sponsored .iointly Avith
the Home for Aged and Infirm Hebrews and the -lew-
ish Family Service. An important feature of this
]ilan to maintain elderly people in their own homes
is the homemaker service. The clients for the project
are selected by the Social Service Department of the
Iiome and remain under their supervision. All serv-
ices and facilities of the home are available to the
clients. They feel secure because the home has guar-
anteed to them that tliey will be transferred to tlie
institution when they can no longer remain safely in
their own homes even with homemaker service. The
Jewish Family Service with a long experience in ad-
ministering homemaker service provides homemakers
who are especially geared to the needs of the aged.
Not only is this an effective and satisfying way of
extending service to elderly people but it is also a
less costly method of care than institutionalization.
In addition, it helps to reserve beds in homes for tlie
aaed for those who need them the most.

V'isiting Nurse Service

Home nursing care is availabh- in all the boroughs
to individuals in all economic levels without discrim-
ination as to age, color and religion. However, the
nursing service is most usually set up for short-term or
a time-limited nursing need of people and only in
sjiecial instances are the established nursing services
now able to offer indefinite care. Many of our aged
fall into the latter group and cannot depend on this
service witli any real sense of security. The bureau
has advocated that the visiting nurse service be ex-
panded to provide long-time service according to the
needs of the aged indix-idual.

Recreation

The bureau recognizes that tlie aged, like all people,
need activity and association with other persons of
similar interests and age. Frequently problems oc-
cur in families with older persons because the latter
feel bored and neglected. The William Ilodson Cen-
ter, the first recreation project for the aged in New
York City, demonstrated the value of group activities
in restoring and building up an aged person's confi-
dence and desire to continue being active. The com-
munity, alerted by this example, has made consider-
able progress in establishing more recreation centers
for older persons as part of an expanding program.
These programs at this time are limited to those who
are able to reach the centers, but make no provision
for those who are lioinebound because of illness or
inclement weather.

The bureau has recommended that there be an ex-
pansion of the present recreation program and the
development of a home recreation program for those
patients who are only semi-ambulatory as indicated
above, or who are permanently or temporarily con-
fined. In this connection, the bureau together witli
the Jewish Welfare Board is instituting a program to
enlist the interest and assistance of Jewish community
centers and "Y's" in making their facilities and
technical skills available to elderlj- persons.

Adult Education

The bureau has recognized the value of the various
activities which fall within the scope of adult educa-
tion as aids in helping people to accept, adjust to. and
find satisfaction in their latter years. For some in-
dividuals classes, lectures, discussion groups are more
satisfying than the handicrafts, for example. These
activities can be an important adjunct to. or part of,
the programs of recreation centers and institutions
for the aged.

The bureau has participated in discussions on this

subject. It supports any planning toward the exten-
sion of adult education for the benefit of older people.
Its further development to include the homebound
would be desirable.

Employment

The iiroblems faced by the elderly in the employ-
ment field are known to the bureau, more through its
participation in the Welfare Council's activities in
this area than through its own experience, since rela-
tively few persons come to the bureau who are phys-
ically able to work. Inability to obtain or hold posi-
tions because of age is a most devastating experience,
and much must be done to change this situation.
Therefoi-e. the bureau supports the employment pro-
gram for the aged, set up by the New York State Joint
Legislative Committee on the Aged.

Federation of Jewish Philanthropies' Plans
For the Aged

The Jewish Federation, as part of its Building
Fund Campaign for expansion, modernizatif)n and
research, includes a number of plans for the aged.
They are :

Development of an annex to their present in-
stitutional facilities with 395 beds to provide full
medical, recreational, religious, social and occu-
pational therapy programs. This is the Kings-
bridge House in the Bronx, which is already un-
der construction, and hopefully will be in oiiera-
tion early in 1950.

Two 100-bed apartment projects in Brooklyn
and Queens or the Bronx.

Establishment of boarding homes in which 15

Shown above are members of the Hodson Center cleaning dishes after a club party. Doing dishes becomes fun when

everyone helps.

persons will live with private families on foster
home basis.

Three year experimental program administered
bjr the Home for Aged and Infirm Hebrews, pro-
viding home medical care for 125 aged persons to
continue living at home.

Three-year continuation of the homemaker
service demonstration program as mentioned
earlier in the Home Care Project.

A new nursing home in Queens or Westchester
to serve at least 50 persons.

What the State Can Do

The bureau has itself undertaken and stimulated
the development of various services in the community
for the care of the Jewish aged, kno^ving full well
that these services would meet but a small fraction
of the total needs. It engaged in these activities to
demonstrate the validity of certain services, in the
hope that not only private agencies would follow suit
but that the public agencies would be encouraged to
set up similar projects on the needed larger scale. The
bureau believes that the State can give assistance in
man,v ways, in the following areas :

1. The chronically ill — by helping in the establish-
ment of more beds for those who cannot be
eared for at home and the further development
of home care under hospital supervision for
those sicked aged who can remain at home
with the aid of such services as visitng physi-
cians, nurses, homemakers and occupational
therapists.

The mentally infirm— through the provision of

more appropriate care for them than is now
available.

Nursing homes — by the establishment of public
nursing home services and by enabling public
and private agencies to make joint financial ar-
rangements allowing for subsidies. This would
permit flexibility in creating a total community
plan.

Boarding homes — by making possible their ex-
pansion through the availability of more funds
to enable public assistance recipients to pay
higher rates.

Public housing — by encouraging the construc-
tion of more units especially adapted to older
persons.

Medical care — by promoting better understand-
ing of the diseases which seem to predominate
in the latter years, and by taking steps to off-
set the generally accepted belief that little or
nothing can be done about them ; by the estab-
lishment of better clinic facilities for older peo-
ple and by fostering greater understanding of
the older patient on the part of hospital staffs.

Homemaker service — by making possible the
expansion of this service in public hospitals
and public Avelfare programs.

Recreation and adult education — by making
available increased funds for expansion.

Employment — by lending administrative sup-
port to the educational program of the Joint
Legislative Committee on Problems of the Ag-
ing— and its successor, with employers and
employees.

New York City's

Work with

The Elderly

By William Posner

Chairman, Conference Group on Welfare of
the Ac/ed, Welfare Council of Kew York City

IT HAS become rather customary, in this complex
society in which we live, to speak with gloom
about the many social problems that face us and
the difficulties that stand in the way of their solution.
The problems of the elderly are indeed no exception
to this rule. That the elderly are fast becoming our
number one social problem is all too clear to informed
persons everywhere. Perhaps fewer persons are aware
of the difficulties inherent in the resolution of those
problems. It would be only fair to say though that
even in this regard the past few years have seen a
crescendo of activity — at least in the social welfare
and medical fields — in behalf of the older person and
real efforts have been made to recognize and cope with
many aspects of the situation.

"Without wishing- to minimize the seriousness of the
problems facing the elderly nor to underestimate the
tasks lying ahead, I should like, if I may, to deviate
somewhat from the accepted rule and present a picture
of creative activity and accomplishment in behalf of
the aged.

Welfare Council of New York City

Any description of what New York City is doing for
the elderly must take into consideration the activities
of tlie Welfare Council — the agency which has major
responsibility for city-wide planning and coordina-
tion. In the "Welfare Council, social agencies have
found a common meeting ground for the discussion
and study of the problems of older people and, in many
instances, the council has served as a catalytic agent
in facilitating the implementation of programs by
these agencies. Although not essentialh' an operating
agency itself, the council has, nevertheless, initiated
projects later taken over l)y others. Represented in
its membership are sectarian as well as non-sectarian
agencies — private and public agencies alike — all work-
ing together for the general welfare of the community.

The "Welfare Council can thus point with pride to
its record of accomplishment in behalf of aged of
New York City. For almost 25 years it has, through
its sections, committees and conference groups on the
Welfare of the Aged, provided leadership and initia-
tive in helping to focus the attention of the lay and
professional community on the older persons in our
midst.

The AVelfare Council was among tlie first organiza-
tions to establish an Information Bureau for the Aged
as an aid to aged persons seeking information about
facilities. It established a reporting system to inform
member agencies of vacancies, admissions, rejections.
and duplicate applications. This reporting system
was later taken over by the State Department of Social

Welfare. The Welfare Council was active in the legis-
lative area by helping to pass and later to draft amend-
ments to the original Old Age Assistance legislation.
The council developed a statement of minimum stand-
ards for homes for the aeed which became a model for
use throughout the country. Through constant revi-
sions, it has had wide national and international use.
This important statement had the effect not only of
raising standards of existing homes for the aged, but
served as a basis for the development of new institu-
tions.

The council worked relentlessly for the employment
of trained social workers and other personnel in homes
for the aged. It arranged for a course in "Mental
Hygiene for the Aged" for lay and professional woi'k-
ers. It worked closely with the New York State and
City Housing Authorities in an effort to make special
provision for older persons in public housing projects.
As a result of this collaboration, 50 apartments were
planned and provided in the Fort Greene Housing
Project in Brooklyn for elderly persons. As far as is
known, no similar public facilities for the elderly exist
elsewhere in the T'nited States. This is a real tribute
to the public officials responsible for this development.

In the area of recreation for the older person, the
Welfare Council was among the first to recognize the
need for such programs and has gi^'en help and guid-
ance to public and private agencies alike. In addition,
the council has since 1947 sponsored an annual hobby
show for persons over 60. The third annual Hobby
Show in 19-19 had 854 individual participants and was
seen by more than 15,000 persons. This project has
had the effect of pointing dramatically to tlie recrea-
tion needs of older persons.

These and many other accomplishments have had a
definite bearing on current developments in programs
for the aged in New York City.

Four .Areas of Concentration

At the present time, New York City is concentrat-
ing its efforts on four major areas of interest : hous-
ing, employment, chronic illness and recreation.
With respect to housing, it is worth noting that the
building plans of many homes for the aged are now
coming to fruition. It is expected that within the
coming year approximately 500 additional beds will
have been provided in institutions for the aged. In
addition, this year will probably see the expansion of
the apartment project idea. This, as you know,
makes it possible for older people to live in the
privacy of institution sponsored apartments. An
interesting experiment in foster homes for the aged
is likewise going on. This has demonstrated the feas-

ibility of keeping those older persons who do not
want institutional placement in the community.
Similarly, there has been an expansion of home care
projects for older persons by hospitals, homes for the
aged and family welfare agencies. In providing
home medical care, the services of visiting nurses and
homemakers, these agencies have made it possible for
older persons to remain in their own homes much
longer than was previously possible. This has proved
valid not only psychologically but has been found to
involve less cost and expense to agencies.

Although housing: facilities are of immense impor-
tance to older persons, there is perhaps nothing which
contributes more to their difj-nity and self-respect than
employment through which they can contribute to
their own maintenance and needs. Educating prospec-
tive employers and the community at large to the ad-
vantages of employing an older person is a struggle
which is no less New York's than other communities'.
This is an area that one group or even many high-
minded groups cannot, in and of themselves, tackle. It
is a problem that requires the concentrated coordin-
ated, and cooperative efforts of the private social
agency, government, industry, labor, and otlier com-
munity agencies, for solution. It is our feeling that in
this sphere the State, through its established facilities,
can play a role of real leadership. It must be recog-
nized, however, that serving the older person in em-
ployment requires special skills and special training.
It is our feeling that once specially trained staff is
made available, tliey can function and give help to
older persons through the existing employment and
placement facilities of the State.

The care of the chronically ill is receiving attention
on many fronts. Chronic illness is a scourge which
affects persons of all ages. The Welfare Council's
concern with the need for special care for this group
of our poijulation was instrumental in the setting up
of new facilities for them. The council's Nursing Home
Stud.v. completed in 1947, recommended the develop-
ment of visiting housekeeper service and other types
of home care, which could help remove many of the
chronically ill from hospitals where they hardly be-
longed and merely added to the congestion of N. Y.
City's hospitals. This study has been looked to for
guidance in the development of new rules and regula-
tions for supervising and licensing nursing homes in
this city.

At the present time. Welfare Council is engaged in
studying one aspect of the problem of the chronically
ill. This .study is concentrating on the chronically ill
now living in homes for the aged which have no hos-
pital facilities. It is our hope that this may result in
the setting up of standards for the care of these
patients in homes for the aged.

Much thinking is going on in New York City in
extending recreational and leisure time activities for
the older person. The need for such programs has
been long established, and the Welfare Council has
worked closely with both public and private agencies
having such programs. There is still, however, much
confusion as to the objectives of such a program.
To many older persons, these activities must become
a substitute for the lack of employment opportunities.
To others, these programs are ways of filling the need
for companionship. The definition of objectives is
the only way to determine the types of programs
to set up as well as the settings in which the pro-
grams are to operate. There is a growing realization
that programs for older persons must become part
of the group work program of the community as a
whole. This means that community centers — if they
are to serve the total community — must provide for
the needs of older persons in the same way they pro-
vide for the youth and young adults. A Welfare
Council Committee on Recreation for the Aged is now
working actively on many of these problems.

Need for Community Action

In pointing up these major areas of activity for
the older person, we, of the Welfare Council, believe
that the time has come when a concentration of effort
on the part of itself and social agencies alone is no
longer adequate. The impact of problems which the
community is facing in relation to the older citizen
is such that it reciuires the attention of the whole
community. The Welfare Council is a coordinating
agency for social agencies and as such has its finger
on the pulse of the community. Social agencies them-
selves, however, cannot substitute for the "grass
roots'' activities which local groups and lay councils
can initiate and achieve. We therefore wish to submit
for serious consideration the need for organizing
neighborhood, city-wide and state-wide councils for
the elderly. These groups can serve as the catalytic
agents in bringing to the attention of civic groups
and governmental agencies the needs of the aged and
stimulate activity by and for them as groups and as
individuals. To a large extent, the Joint Legislative
Committee on Problems of the Aging has been very
effective in this regard. It is important, however, to
plan a continuing and long range program which the
committee has so ably begun.

Looking Ahead

In reviewing the past and present programs for
the aged, we cannot help but look to the future. As
time goes on there will undoubtedly be an increase
in the number and types of programs. It is quite
likely that as communities begin to feel the impact of

the numbers of older eitizeus and the need to do
something about the resultant problems, many
projects will be embarked upon. One would indeed
be hard put to deprecate these projects or to disparage
the high-mindeduess which may impel the communi-
ties to implement them. "We should like to submit
the proposition that if we are to serve our older
citizens intelligently, the essential question we must
face is not "What type or how manj- projects is it
necessary to set up" but rather, Hoiv are these
projects to operate in order for the older person and
the community to derive most therefrom. The implica-
tions of this question are many. Basically it means
that once we have become aware of the existence of
the need, we must analyze and evaluate existing facili-
ties as well as current thinking in order to know how
best to meet these needs. To say that older persons
require recreational activities and that programs are
therefore necessary is a statement of the need. In
considering the implementation of this, we will need
to know how recreational programs can help older
persons. A knowledge of this how will make it pos-

sible for us to know better what type of facility to
set up.

"With respect to housing facilities for older persons,
the same principle must hold true. It is fairly
generally agreed today that the community must con-
sider varied types of facilities for older persons :
institutions, apartments, foster homes, etc. Before,
liowever, we embark on these programs, we must first
know how older persons can be cared for in these
facilities. A knowledge of the how will often make it
possible for us to revise our estimate of what to do.

"We recognize fully that all that has been done thus
far for the older citizen has only scratched the sur-
face. There is real need for continued creative think-
ing in this area. Needless to say the Joint Legislative
Committee with which Welfare Council has main-
tained close liaison has contributed immensely to
our better understanding of the older person.

In looking toward the future we must evaluate
also the past and the present and it can truly be said
tliat in relation to its elderh- New York has been in
tlie vanguard.

Some Elements of an Action Program

for the Elderly

By Miss OUie A. Randall
Consultant on the Aged. CoiiiiininUi/ .S'rrticf fiucieiii of Seir York

THE INTERESTS of the iiicreasiug nuinbei" of el-
derly citizens are very intimately bound up with
the interests of the whole state-wide community
and only by a very careful assessment of those inter-
ests and ways of safeguarding them can we be assured
of the essential balance in the State's program for
gTOiips of all ages.

As one examines the almost startling statistics one
is impressed by the fact that New York State with its
million and more oldsters — 65 years of age and over —
has approximately 10 per cent of the total national
population of persons of this age group, and New York
City about 5 per cent. These figures are rough, but
they are accurate enough to give us all pause, espe-
cially since the ratio of older persons is growing to
such huge proportions and the ratio of persons 15
years of age and under is decreasing at a similarly
alarming rate.

INew York State

Those of us wlio have made older people one of our
major concerns for a number of years are very proud
and grateful that New York State has already recog-
nized this situation, and its seriousness, in a number
of ways, but in none which is having such wide-spread
response as that of the appointment of the Joint Leg-
islative Committee on Problems of the Aging and the
Aged under the able chairmanship of Senator Des-
mond. The approach of this Committee to the task of
studying the multiplicity of problems of older people
has, it seems to us, been most constructive since they
have up-to-date directed their efforts primarily toward
discovering the facts as to the employment of older
people in the state, and to finding ways and means of
keeping persons stiU able to work, in spite of their
chronological age. in the numbers of the gainfully
emi^loyed.

This is not simple, since we are still saddled with
attitudes and prejudices about older people as to
their ability to perform, which have little to do with
either the present day abilities of older people, or with
the kinds of demands which are actually made upon
them today. These still need to be changed. But one

very important thing is being accomplished — that at
least both employers and equally, if not more impor-
tant, emploj-ees are beginning to be conscious that
they must examine what happens in placement and
employment and in firing in the light of new knowl-
edge, new experience, and new social demands.

This is the right kind of education, and is very
timely. While action is slow in coming, there is a
beginning which is encouraging. New York State
maj- not be actively interested in what it does in-
directly and incidentally for citizens of other states,
but it is possible to report that everj'where one travels
and this subject is under discussion, there is a note
of genuine envy in the voices of persons from other
parts of the country as the.y comment, "But we don't
have a Joint Legislative Commission — You in New
York State are way out in the lead!"

Need for Leadership

This kind of leadership is most vital at this time, for
we must keep a focus directly upon our aging and
aged citizens to be sure that what is done for them is
not onlj' in their interests but that it does not simul-
taneously jeopardize the interests of the rest of the
community. We cannot afford a repetition of Cali-
fornia, "Washington State, nor of Colorado, where the
oldsters, admittedly with charlatan or self interested
leaders, deliberately took matters in their own hands,
with rather devastating results.

Old people are apt to see their needs in terms of
money, Avhich essentially they may be, but which they
are certainly not in their entirety. However, to most
of us who have worked with and for them for a num-
ber of years there has come a conviction that with
New York 's very sound old age assistance program as
a foundation, there can be very positive results in
ultimately reducing the amounts spent for this pro-
gram if efforts are directed toward satisfying some
of the less tangible but equall.v vital needs. Speaking
as a citizen from New York City I might say that I
have hope that the State Department of Social Wel-
fare's study of the needs of people on public assistance
may be helpful in this. We especially need its i-esults

in New York City where the present administration's
drive for "eeonomy" is j^rovinn- quite a social and
economic hazard for older people who must apply for
assistance.

Hous

iNeeds

I should like to emphasize the need of some provi-
sion of housing other than institutional housing. I
am convinced that now is the time for some very sound
planning at the State and local levels which may help
reduce to some extent the tremendous State expendi-
tures which loom ahead of us in our institutional pro-
gram. It has been demonstrated by actual experience
that when decent and comfortable housing is i^ro-
vided for older people, with auxiliary visiting services
and supervision wlien and if required, the cost of

theii- care is not only radically reduced but that they
often never have to apply for institutional housing.

Therefore Ave believe that Governor Dewey and
Commissioner Stichman can render a real service by
studying the potential market for low rent housing
among this proportion of our citizens, and make some
provision for it in what the State plans to do in allo-
cating funds from the money now available for si^b-
sidizing local projects.

With approximately two-thirds of the oldsters in
the low income brackets — through help from families,
old age assistance, old age and survivors' insurance
and pensions — but on fixed income or low earnings, it
seems both logical and fair that some proportion of
them be so accommodated, even if the number be
small. This seems es]iecially true since it will not be

Can adult education attract the older person? Ans.

Yes, present experience clearly indicates oldsters want to learn and
can learn.

loug- before they will constitute an even larger propor-
tion of the total low income group, and tliat will be
long before the life of the newly bi^ilt housing is over.
The 1950 census schedules are being designed to get
information on living arrangements, income, and
family status. Some of the facts gathered in several
pilot studies are already available and should be
helpful. Rochester is through its own planning com-
mission making an analysis of these needs and possi-
bilities. I am no economist, or city planner, but this
suggestion seems to make sense from the point of view
of both in the light of the estimates of the experts !

Commissioner Stichman has already publicly ex-
pressed his interest in the housing needs of older peo-
ple at a hearing of the Desmond Committee (1947),
and of late in the press and over the radio in low rent
public housing. It would be extremely gratifying if
these two interests could find endorsement by the ad-
ministration and support in local communities so that
accommodations could be included which would be
suitable for older people and smaller families. It is
my personal belief that eventiially this would mean
more satisfactory lives for the people themselves, but
that it would mean fewer persons having to be admit-
ted to homes for the aged and to mental hospitals.

Adult Education

May I add a word on adult education. In this
service, and in the administration's effort to improve
the library services in the State, we see a very useful
ally in our efforts to maintain for a longer period
healthier and more contented mental and emotional
attitudes on the part of older adults. If the staff can
be made available, along the very imaginative and
practical lines being developed by Dr. R. J. Pulling
and the State Department of Education, and local
boards of education can be persuaded to avail them-
selves of what the state offers, we are assured of more
and better leisure-time activities which can minimize
the discontent and unhappiness induced by idleness
and uselessness. With leisure time a commodity en-
joyed by more and more of us as working hours be-
come shorter, the habit of using it wisely and con-
structively should bring good results if younger and
middle aged adults are encouraged through the use
of these facilities.

All of us hope that in 1950 the Joint Legislative
Committee on Problems of the Aging and Aged will
be continued, and definite plans toward a State group
of citizens to succeed it when and if it is discontinued
\Yill be made.

Need for a Citizens^ Committee on the Elderly

By Miss Ollie A. Randall

Consultant on the Aged, Community Service Society of Xew York

LLOYD George once wrote that "bow we treat
our old people is the crucial test of our national
quality." Coining nearer home, in both time
and space, one of our o\vn local statesmen, Dr. Louis I.
Dublin, speaking at the 19-17 annual public hearing of
the New York State Joint Legislative Committee on
Problems of the Aging, pointed out that "we should
see to it that a group of public spirited citizens in the
community is especially concerned aboiTt (them) —
older people."

Certainly the existence of the Xew York State Joint
Legislative Committee on Problems of the Aging is
evidence of our attempts to improve the quality of
state responsibility and of the value of an organized
group of citizens who will conscientiously and intelli-
gently address their efforts to the problems faced by
older people, which consequently are faced by the
community as a whole. That it has had official status
is another fortuitous circumstance. The stirring pub-
lic interest — the actual collection of data — the distri-
bution of those data to ever-growing numbers of per-
sons concerned but not informed about the problems
of aging and aged people — all serve a social purpose,
the importance and validity of which can no longer
be questioned.

The legislative committee has its own peculiar place
in our State program, which is to some extent pre-
scribed and circumscribed by legislative statute. I
should therefore like to put it to you that one of the
problems which we as citizens who are not members
of the government in any official capacity must solve
is how we are going to capitalize on work which this
committee has done, and is still doing; and how to
continue in force, as well as to direct, the activity
which has been initiated and the momentum of it.

Today, when we go to discuss the special needs of
older people — whether those needs have to do with
financial support, employment, recreation, hospital
care, education, and especially the social services — we
are met with the statement that old folks are just
people and must be treated just as are other people in
the community. This is a fundamental human and
social fact — and no one would quarrel with the situa-
tion were that fact the guiding principle today. Then
there would be no necessity for committees, commis-
sions or councils, about which we are talking.

The fact of the matter is that old people are not
being so treated. Let us not fool ourselves about

that, nor let us evade issues by lip service to what
becomes a wearisome, meaningless platitude. Old
people in growing numbers are dislocated persons in
almost any family or community, and equal oppor-
tunity to participate in family and community life
is denied them in many instances on the mere basis
of their chronological age.

Consideration of them in relation to any one of
the needs listed above is usually conditioned by the
age of the individual, and the availability of what
the community has to offer a citizen is determined by
his age. While age is permitted to act negatively as a
barrier, we are on the other hand told it is not sound
to plan positively for older people on this basis, this
in spite of the fact that what is done for children
and adolescents is geared to their special needs, which
have been isolated and studied in all instances ex-
perienced by the persons providing the service. "We
have not yet reached that stage of development in our
provisions for older people.

Basic Knowledge Lacking

Few of us — although years are being added unto
many more of us daily — have actually experienced
old age when we are trying to help an old person
make his plans; what old people in our midst should
have is only 7iow being studied, and rather spottily at
that. Our resources — or rather our lack of them —
and our prejudiced opinions — really determine what
we think about the old person, rather than real
knowledge about the individual himself.

Therefore it is my personal conviction that we still
must have in the community — at the local, state and
national levels — citizens whose appointed task it is to
keep a watchful eye upon the interests of older citizens
— upon what is being learned that can alleviate their
present unenviable status, and to see what action is
necessary.

At a City Council meeting in a nearby state there
sat two members of that council who saw eye to eye
neither in matters of politics nor of conduct. One
member was in the habit of coming to meetings some-
what obviously under the influence of liquor, much to
the disapproval and disgust of his opponent.

After a rather disturbing experience at one session,
in which the intoxicated gentleman behaved in his
usual undignified manner, his opponent deliberately

paused and pointedly said. "ilr. Mayor, we have all
been hearing recently a great deal about Alcoholics
Anonymous. But must we also be burdened with
Alcoliolics Conspicuous ? ' '

What I am trying to indicate here is that alcoholics,
either as individuals or as members of a group, do not
become "anonymous" until after a period of rather
"conspicuous" difficulty, and that by the same token
as that, we cannot expect a constructive or desirable
Old Age Anonymous — or even Synonymous — with the
rest of .society, until after a period in which there has
been sufficient focus of attention and emphasis so
sharpened that there is, for a period of time, an Old
Age Oonspicuous. We are, I believe, in that stage
of social development now, in the hope that through
our planning, old jDCople can before too long a time
become sociallj' normal in that they are again natural
and integral members of their communities.

To achieve that degree of social normalcy they
should be able to call not only upon specially inter-
ested citizens, but upon those who combine this inter-
est with a responsibility for making that interest
count in terms of desirable community action.

For the next few years at least we must then liave
within (jovcrnmcnial units those who will make it their
business to know how they can improve the status of
older people.

We shall in addition require this group of "]inblic
spirited" citizens in conjunction with each civic unit
of go\-ernment continuously to inventory and appraise
what is being done, what more should be done, and
stimulate the necessary action wherever action is called
for. For instance, the Mayor of the City of New Yoi-k
has recently appointed a Mayor 's Advisory Committee
for the Aged, with a charge which covers the res])on-
sibility of advising on the whole broad scope of
services which the older citizens of this great city
require.

National Organization

Simultaneously there is being considered the organ-
ization of a national group which will hopefully have
not only the same function and an even more active
one for the Nation as a whole, so as to avoid in the
future the .sporadic and undirected programs now
being undertaken without reference to what is al-
ready known or available. For these two reasons
alone, even if we were not already convinced of the
necessity of a state-wide committee of citizens, it
would appear to be logical that there be such a group
to serve as the natural channel between the local
groups in villages, towns, cities and eoimties, and to
the national group.

One of the most pi-ized principles of our national
and state government is that of state and local auton-

omy. There is nothing in the suggestion that there
is a statewide committee which would jeopardize the
application and operation of that principle. In fact
it would encourage the adaptation of services to the
individuality of the local situation. It should how-
ever also act to stimulate the right liind of local action
— and to help in coordinated planning so as to pre-
vent some of the necessary duplication in experimen-
tation and effort which is taking place — those motions
which are being wasted when every motion should be
made to count.

A council for the elderly is proposed for New York
State in a bill introduced during the 1949 State legis-
lative session, copy of which is to be found in "Never
Too Old." This provides for an official council, with
direct participation by members of the administrative
units of State Government. This has real virtue and
may have a place in our pattern of State organization,
but I should still like to see a group of citizens, given
official status either by independent organization or
on a commission basis or by appointment by the Gov-
ernor, as being possibly more effective because of the
free wheeling nature of their organization.

Since the interest of so large a group of voting citi-
zens is at stake, these should be continuously viewed
objectively by persons who have a sympathy for and
understanding of older people.

However, they must similarly be so viewed tliat the
present imbalance in social j)rovisions, weighed as it
is in favor of the young, is not continued by an equally
dangerous overweighting in favor of older people.

California's Sad Experience

Someone in Washington facetiously suggested re-
cently that perhaps what we should or ought to do on
a national basis is to buy the State of California and
use it for a i-etreat for all older j^eople with their
$100 pensions. This would be no more fantastic than
the recent situation in which that State was in effect
sold out^for the benefit of the old folks in the popula-
tion at the expense of the younger people, and even
at the expense of man.y of the civic institutions which
are essential to maintain a decent level of living for
tlie very oldsters demanding the financial support
which was wrecking the State's economy. This experi-
ence can "happen here" — by "here," I mean New
York State or almost anywhere else in the United
States, either right now or in the near futur(>. Per-
haps this horrible example of charlatan leadership in
California has served a very salutary purpose. We
still learn painfully by way of what Commissioner
Ivuth Taylor calls "the obvious" if not actually by
way of the ver_y ' ' conspicuous. ' ' New York State has
almost roughl.y 10 per cent of the total number of
legally aged jpeople in the country — and New York

City has almost 5 per cent of them. "While our pro-
grams are generally quite sound, it is within the
realm of credibility and of possibility that in some
sections of the State dissatisfaction could easily lend
itself to making people receptive to this dogmatic pic-
ture of a personal Utopia in old age. It is for all of us
to remember that no ntopian plan, established at the
expense of the rest of society, or out of step with con-
temporary social life of the communitj% has ever sur-
vived— nor should it. But citizens' groups can un-
dertake to inform and educate all of us that an old
person's Utopia can and should actually be — for each
of ns — that of having an equal opportunity with oth-
ers to be persons and personalities in our own rights
in society, with our fair and earned share of what
the community offers.

The need for a citizens' committee in the interests
of older people lies primarily in the necessity for an

indejtendent, socially informed group in the com-
munity to :

1. Supplement and complement the work of legis-
lative commissions such as the Joint Legislative Com-
mittee on Problems of the Aging, and of adminis-
trative councils such as that endorsed by this Com-
mittee proposed in the 1949 legislative session ;

2. To assist in coordinating the work of private and
voluntary groups or agencies, so that there may be
ob.iective evaluation of resources, services, and the
gaps in these ;

3. To educate the community at each level of gov-
ernment as to needs and progress in meeting these ;

4. To stimulate the right kind of intelligent leader-
ship ; and

5. To promote the kind of action which will improve
the standard of well-being of the total community,
whether that be local, state or national.

Employment of Our Elderly

By Robert C. Goodwin
Director, Bureau of Employment Security, The United States Department of Labor

I NT TACKLING the problems of the older worker, we
are really trying to resolve a paradox. As stated
by Dr. Bortz. former president of the American
Medical Association, "With one hand modern society
does everything possible to extend the life of man,
while with the other, it writes him off as useless be-
cause of the date on his birth certificate." Our eco-
nomic and social thinking has lagged far behind our
scientific advances so that although we have added 17
years to our average expectation of life at birth be-
tween 1900 and 1945, the labor force participation
of the elderly has gotten smaller.

This matter is not one of mere academic interest to
us who are concerned with the administration of un-
employment insurance and employment service pro-
grams. Our interest goes beyond the general social,
political, and eeouomie significance of tlie ]3roblem to

the very heart of our operations — the matching of men
and jobs. Hundreds of times a month, the drama of
older workers seeking employment is played in our
1,800 local offices across the country.

Basic Trends

An employment service operating only 50 years ago
would have been very little concerned with the prob-
lems of the older worker. At that time we were still
a relatively young nation with a median age of 22.9
and with only 4.1 per cent of our population 65 years
old and over. Two-thirds of these older workers
were in the labor force. Although industrialization
was already well under way, there was still a large
farm population, and a substantial proportion of our
people were self-emijloyed or worked for small estab-

Too Old? Too Old for What?

This oldster's daily job would tax many a youngster.

lisliments — all of which was conducive to the employ-
ment of older workers.

The emploj'ment service of 1940 was confronted
with (luite a different set of considerations. A de-
clining birth rate, an increase in the life span, and
the virtual cessation of immigration all helped our
Nation to get older. Our median age in 1940 had
reached 29.0. Those 65 years and over represented
6.8 per cent of the population but only 43.4 per cent
of these workers were in the laber force and 13 per
cent of them were unemployed. About half had been
jobless for at least a year. In periods of large-scale
unemployment, the older workers are by far the hard-
est hit group.

Manpower shortages, resulting from World War II,
suddenly opened the door to the older worker. It is
estimated that in April 1945, 2,600,000 more workers
aged 45 and over were employed than would have
been expected from long-term prewar trends. After
the war, millions left the work force. Among the
men, however, the big decline occurred in the younger
gi'oups, particilarly those under 20. It is significant
that the labor force contracted less among the older
workers. Even today, the older worker is holding his
own. According to the Bureau of the Census, 4.5 per
cent of the labor force of those 55 to 64 years were
unemployed in October 1949. The corresponding fig-
ure for those 65 years and over is 3.8. This compares
favorably with the 5.7 unemployment rate for all
ages. Despite this present status and despite the re-
cent spurt in the Nation's birth rate, there is reason
to believe that basic trends will reassert themselves
and tlie problem now latent will again become acute.

Resuhs of Recent Study

The Bureau of Employment Security and the affili-
ated State employment security agencies are in an
excellent position to study the job problems of the
older worker. One of the more significant studies re-
cently undertaken was an analj^sis of the experience
of older jobseekers in six communities selected from
different parts of the country and representing vary-
ing conditions in respect to the extent of unemploy-
ment. In a sense, the six communities may be con-
sidered as reflecting unemployment conditions under
different phases of our business cycle. The cities —
Dallas, Birmingham, Denver, Rochester, Toledo, and
Portland, Oregon — represented labor market condi-
tions that ranged from very tight labor supply to
substantial labor surplus.

The survey reaffirmed conclusions previously ar-
rived at and uncovered some new findings.

1. The study revealed that in the labor markets
with little unemployment, there are substantially
less jobless among the older workers as compared

with the younger. In five out of six areas, the pro-
portion of workers 45 years and older registered with
tlie employment services was less than their percentage
in total work force. This was especially true in Dal-
las,- a tight labor supply area. Here, older workers
accounted for about 36 per cent of the area's labor
force and yet only 21 per cent of those registered for
work. Portland, on the other hand, with a large
labor surplus, was strikingly different. Workers 45
years and over represented 37 per cent of the total
work force but were 43 per cent of those registered.

2. As employment increases, employer specifica-
tions with respect to age are tightened and the per
cent of older workers among the jobless increases.

3. In both tight and loose labor markets, older
workers, once separated from the job, take longer to
find employment. If not re-employed at their reg-
ular work, they are usually downgraded in skill and
pay. Ill all six areas studied, nlder workers sought
jobs longer than did the younger workers.

In Birmingham, for example, 26 per cent of the
workers under 45 years remained in the active files for
over two mouths while older workers for the same pe-
riod accounted for some 35 per cent. Other evidence
of longer unemployment is available from unemploy-
ment insurance experience. In Rochester, insured
workers who used up all of their benefit rights in 26
consecutive weeks of unemployment included larger
priiiiortions of the older workers.

4. Older worker discrimination varies not only
with the condition of the labor market but also with
occupation, industry, and worker characteristics. It
was found that (1) low age limits were set on un-
skilled jobs that required strength; (2) there w'ere
few restrictions in the low-paid and undesirable serv-
ii-e occupations; (3) restrictions were not too rigid in
skilled occupations requiring long training periods ;
(4) they were, however, quite rigid in white collar
jobs.

5. In all six areas, there were significant restric-
tions against older workers. For example, 51 per
cent of all job orders received in Portland specified an
age limit of under 45 years. This was the area with
the greatest labor surplus. In Dallas, and Denver,
discrimination was less severe but still significant.
Age limitations in both cities were found on about
33 per cent of all job orders. In Birmingham, 79
per cent of the orders were restricted but much of
that was due to the great physical requirements tif
lieavy industry.

Common Fallacies

The reasons for discrimination against the older
worker are many but, in the main, are based upon
mistaken notions.

I. "Hiring older workers will increase my work-
men's compensation rate," is a frequent objection.
To this the Association of Casualtj' and Surety Com-
panies replied:

''Let this be understood — there is no provision
in workmen's compensation insurance policies or
rates that penalizes an employer for hiring a
handicapped worker. There appears to be much
misinformation on this poiirt. Therefore, to
erase any misunderstanding, these are the facts.
Workmen's compensation rates are determined
by two factors: (1) Eelative hazards in the com-
pany's work and (2) its accident experience.
The formula for determining the premium rates
makes no consideration for the type of personnel
involved. . . . The insurance contract, therefore,
says nothing implied or direct about the physical
condition of the worker that the insured may
hire."

II. "Older workers are more likely to become in-
jured on the job," is another favorite standby. Yet,
in the study on "Absenteeism and Injury Experience
of Older Workers," prepared by the Bureau of Labor
Statistics, Mr. Max D. Kossoris found in a study of
work conditions of about 17,000 workers in a variety
of 109 manufacturing industries that the only disad-
vantage of the older worker is that their disabilities
last longer once they are injured. But on the whole,
thej' are likely to be absent less frec[uently and less
likely to be injured than the younger worker.

Ill: "Older workers are less profitable." Why in-
vest in training oldsters who won't be around jnuch
longer" — these comments overlook studies that indi-
cate that older workers are more experienced, have less
outside distraction, are more conscientious, and often
are as productive as younger workers. Undoubtedly,
old age weakens ability on those jobs requiring energy
and speed. But even on such jobs, the decline from
age 50 to 75 is slight and varies with the occupation.

As for an investment in training, there is more than
one case on record where the so-called older worker
outlived his younger detractor.

IV. Pension plans are a favorite justification for
personnel policies that bar older workers. In view of
the current widespread trend to adopt pension plans
through collective bargaining, this is rapidly becom-
ing a serious consideration. It is, however, j^ossible
to adjust pension plan formulas so that the hiring of
older workers does not create an undue burden upon
employers. The extension of collective bargaining
agreements to the extent that they affect seniority pro-
visions have been a major factor in protecting job
rights of older workers.

V. "You can't teach an old dog new tricks," or
sometimes it is more euphoniously stated as fear that

the older worker may carry over old work habits in-
stead of responding to the ways of the new establish-
ment. Stated either way, it mi.srepresents the ease.

Proposed Program

What to do .' A program for the older worker must
point in two directions :

(a) Toward the elderly who want to retire, and

(b) Toward those who wish to remain in the labor
market.

At the present time the older worker has no real
choice since pensions are generally much too low to
permit retirement regardless of inclination.

For those who wish to retire, the obvious need is
for extension of coverage and liberalization of Old
Age and Survivors Insurance, old age assistance, and
other forms of categorical relief in whicli older work-
ers participate. Moreover, payments under such pro-
grams should be adjusted to changes in the cost of
living.

However, there is a great deal of evidence indicat-
ing that many workers wish to remain in the labor
force bej-ond the "legal old age" so-called of 65.
This was evidenced, for example, by the reluctance of
those older workers who came into the labor market
during the war to leave when hostilities were over.
Moreover, we are told by the medical profession that
such participation, is good for them. A marked in-
crease in deaths among workers soon after they retire
has been noted. The economists add that it is good
for society too, since it increases the productive units
in the community and permits a higher standard of
living.

One particular concern is with that part of the
program which facilititates the continued participa-
tion of older workers in productive employment. The
basic approach to the problem must be a local one.
That is not to say that the Federal and State Govern-
ments have no role. On the contrary, there are such
vital activities of the Federal Government as voca-
tional rehabilitation, public health programs, accident
prevention, adult education and training, job clinics
for older workers, etc. We do not propose to attempt
to legislate older workers into jobs. It may, however,
be advisable to remove those legislative barriers which
make it difficult for older workers to remain em-
ployed. A ease in point would be the ban prohibiting
Social Security pension payments to accumulate dur-
ing periods of employment past retirement age.
There is also much that the state and private agencies
can and have been doing. The activities of this
Committee are perhaps one of the best examples of
that.

The major program must be individual and per-
sonalized. This requires a thorough knowledge of

the local labor market including' information on the
size, nature and job requirements of employers as
well as full knowledge of the job history and abilities
of the older job applicants.

The local offices of the Employment Service have,
through its employer relations program, been con-
ducting a campaign to promote the hiring of older
workers and otlier special groups by educating the
employers to the usefulness of these workers. "We have
attempted to point out to employers the implications
of improved medical science on longevity, and the
higher levels of physical abilities of the older work-
ers. We have tried to get employers away from
counting birthdays and to have them tliink in terms
of occupational or physiological age. Through its job
analysis program, the Employment Service is in a
position to undertake job engineering projects that
will show the types of jobs best suited for the elderly.
Through its counseling and selective placement tech-
niques, the Employment Service has been rendering
personalized service to the older workers.

Job Counselling for Older T^'orkers

As was reported to your Committee last year, the
New York State Employment Service recognized the
special problems of the older worker and has revised
its counseling program accordingly. Personnel en-
gaged in interviewing, counseling and job solieitiition
on behalf of older workers were given special training.

These changes were the result of an experiment
which involved setting up a small unit at the X. Y.
City commercial office to deal exclusively with the
placement of clerical jobseekers 50 years of age and
older.

Between November 1947 and November 1948, a
total of 1,120 referrals were made to employer inter-
views. Of those interviewed, 305 or 27 per cent were
placed in jobs. The usual experience in clerical re-
ferrals is 40 per cent. A check made three months
later of the 25 workers showed that 18 were still
employed.

A majority of openings secured for the older work-
ers were obtained by persistent telephone solicitation.
Complete analysis of the applicant's experiences and

personal qualifications was followed by careful presen-
tation of his best features to selected employers. A
total of 933 such employers were given the telejilioue
sales talk on behalf of specific older applicants.

ilost placements were made in small companies
where there were no pension plans. It was found
that older workers needed individual selling as long
as there is employer resistance. It was also evident
that a sales presentation placed upon the concept of
an age handicap does not get results.

The success of this experiment in spotlighting spe-
cific i^roblems and suggesting solutions has encour-
aged the New York State Employment Service to ex-
tend the project to tlie Queens Industrial office, the
]\Ianhattan clerical and professional office and the
domestic, and household office. The possibility of
conducting similar experiments in Buffalo is also be-
ing considered. Any agency like the Employment
Service while it can do much, swims upstream until
there is more recognition of the problem by employ-
ers and positive action to remove artificial barriers.

Another illustration of positive programming for
the older worker was reported by the Employment
Service in Miami. Florida. Here, several veterans
who had heLJ responsible front office jobs in the hotel
industry found that thej' could no longer secure this
type of work. The problem of these older workers
was discussed with the Hotel Association and a coop-
erative program set in motion. A training program
was instituted covering such jobs as transcript writ-
ers, auditors, food control and other jobs in the iTotel
industry that could utilize the knowledge and skills
these older workers had acquired through the years.
Jobs were then solicited for each of these veterans in
the occupation for which they had been training. No
longer were these older j^eople compelled to say to
emploj'ment managers. "I am 49 years old — and liave
been for many years."

Any program, no matter how well conceived, runs
the risk of being scuttled during the period of large-
scale unemplo^yment. Older workers have a very spe-
cial interest in maintaining the economy at high em-
ployment levels. Unless Ave are able to do this, the
rejoinder to "Life begins at 40" will invariably be
"Do vou call that living?"

Labor and Its Older Workers

By Harry Becker

Director of the .S'oci'ni Security Department, United Aulomobile Workers of America. CIO

THE LABOR-MANAGEMENT contracts nego-
tiated during 1949 have more than tripled the
number of workers covered by some type of
health, welfare, or retirement benefit plans under
collective bargaining agreements. By the end of 1949
such benefits probably reached 10 million workers
and their families.

At the same time, labor lias continued to woi'k for
the expansion and streugtheuiug of governmental
l^rogTams for social securitj' because we recognize
that governmental programs must assure a basic floor
of protection for all people wherever they may live
and whatever their occupation.

Pensions and Social Security

It is not a question of public programs versus col-
lective bargaining programs. The purpose of work-
ers' security programs set up under collective bargain-
ing is to supplement the floor of protection established
by governmental programs to the extent necessary to
Ijrovide adequate security against the unpredictable
economic hazards arising from sickness, disability
and old age.

There are those who feel that as labor makes gains
in workers' security programs under collective bar-
gaining, pressure for broadened governmental pro-
grams will be reduced. This is not, in fact, the case.
Evidence already jDoints to a change in employer

'II

attitudes toward governmental social security pro-
grams. Now that labor has established the principle
that social security is a right growing out of employ-
ment and that the cost of protection is as much a cost
of doing business as wages, employers are beginning
to realize as never before that government action is
necessary. Emplo3'er groups which only a few
months ago were indifferent to the expansion of the
Federal Social Security system are now saying that
it is time to expand this system, if programs for work-
ers' security are going to be established through col-
lective bargaining to supplement inadequate public
benefits. As employer groups learn at first hand the
complexities of financing and administration of
security benefits and services, the need for universal
programs becomes more apparent.

One example of current thinking of management
on this problem may be seen in a speech made by C. E.

Luxurious old age home established by the carpenters' union

Wilson, President of General Motors Corporation, in
Detroit on November 15, 1949 :

"If the present social security pensions were
approximately adequate when the law was
passed, they are certainly inadequate now. They
do not reflect the change in the purchasing
power of the dollar. Social security pensions
were not increased as wages and collections were
increased. It would seem reasonable with the
minimum wages increased from forty to seventy-
five cents per hour to increase minimum pensions
in about the same proportion."

Changing Conditions

"Why are workers so concerned about security today 1
The need for security has grown out of the economic
and social changes accompanying this country's devel-
opment from a pioneer agricultural community to the
greatest industrial nation on earth. The need does
not arise because individual workers are deficient or
inadequate or less self-reliant than workers of an
earlier time.

In 1775 when the founders of our American govern-
ment talked of the Rights of Man — the Rights to
Life, Liberty and the Pursuit of Happiness — they
thought that the right to own property provided
suflBcient economic protection for the individual. At
that time most Americans were self-employed on
farms, or owned the tools needed to earn their living.
Today, more than three out of four persons in the
United States are employees. As workers have
moved from farms to factories they have grown away
from self-sufficiency. A lay-off at the factory, or a
period of illness can exhaust a worker 's savings very
quickly, yet he must continue to buy food and to pay
for shelter if he is to continue to live.

The problem of security is complicated by the grow-
ing numbers and proportion of the aged in our popula-
tion. In 1900 onlj' i.l per cent of the 76 million per-
sons living in the United States AA-ere 65 years of age
or older. In 1950 more than 11 million people will be
over 65. This will be 7.7 per cent of the total popiila-
tion. By 1980, it is estimated that 22 million, or 12
per cent of the population, will be older than 65.

There are several reasons for this increase in the
older population. "We are producing fewer children,
and we have restricted immigration. Then, too,
Americans are living longer because of better medical
care and public health measures and because of
higher living standards. American life insurance
companies in the early nineteenth century assumed,
on the basis of experience, that the expected life of
females at birth would be 18.1 years, and that of males
14.2 years. By 1900 life expectancy at birth had

risen to almost 50 years, and by 1940 to 62 years.
More recent estimates place life expectancy at 67 years.
Although there are more and more people in the
older age groups employers generally are not willing
to hire older workers. Furthermore, new inventions
and developments continue to make many occupations
obsolete. The older worker may not get a chance to
learn a new job even when he would be able to do so.
And there are not as many job opportunities for older
people in towns and cities as there are on farms.
During the peak of wartime emploj-ment, only one-
third of the men and women 65 years of age and over
were gainfully occupied. Today, not more than one
out of every four aged persons are working for a
living. Thus, there is a critical problem of old age
dependency.

Savings for Old Age

Few, if any, workers' families are able to save
sufiicient money out of current earnings to insure
themselves a modest standard of living after retire-
ment— even though these savings may be supple-
mented by Old Age and Survivors Insurance benefits.
Similarly, few individuals, acting alone, can budget
for protection against major medical and hospital
expense. The Detroit auto worker, for example, has
an average monthly income of about $260, if !he
works 11 months out of 12. It costs a family of four
in Detroit over $280 a month to maintain a "modest
standard of living." This budget includes an allow-
ance of $8 to $10 a month for hospital and medical
care, but it requires about $20 more each month than
the average monthly income received. Thus there is
no margin at all for saving.

Yet the worker who wants to receive an income of
."{flOG a month beginning at age 60 and who buys an
annuity at age 30. for example, would have to make
payments of about $36 per month for 360 consecutive
months. This woidd mean a total savings of approxi-
mately $13,000 which is, of course, out of the question
for industrial workers.

Inadequacy of OASI

Our present social security system is completely
inadequate to meet the needs of working people for
protection when the.v are "too old to work and too
young to die", when they are ill. and when they are
unemployed. The old age retirement benefits, for
example, fall far below the minimum relief budgets
in our cities and towns. The Federal Old Age and
Survivors Insurance benefit for a worker and wife,
both over 65, averaged $42.39 a month in Michigan
in 1949. But an elderly couple living in Detroit
needed about $143 a month for a modest standard of
living. ■ I ■

"Workers should uot have to look to poor relief and
to charity as tlieir principal floor of security when
they are unable to work. Yet this is, in fact, the case.
For the country as a whole, in June, 1948 — a period of
high level employment — there were 216 persons receiv-
ing public assistance for every 1,000 persons over 65.
Even in Michigan, where industrialization permits
broader coverage under the Federal insurance system
than in many other states, more than 20 per cent of
the persons over 65 were dependent on public relief
for security in their old age. This does uot include
those additional persons receiving poor relief and
private charity. These persons are without other
resources because savings and property were liqui-
dated before they subjected themselves to the indig-
nity of the "means test."

Insecurity Hastens Aging

The UAW-CIO has extensive data on the problem
of the aged and infirm worker in meeting living
expenses after leaving employment. Hundreds of
case stories have been obtained which show the grad-
ual destruction of personality when the worker
realizes that he cannot work any longer, exhausts his
resources, faces the public relief office, becomes ill
and struggles unto death with the problem of how to
provide himself with the barest essentials of life. In
the abstract these facts do uot have the same meaning
as they do when we know the individuals affected.

The social service department at the UAW-CIO
medical clinic in Detroit has recorded many stories
from individual workers which show this pattern of
lost morale and human waste. Diu'ing the 19-30 's
workers exhausted all of their resources either because
they were unem]iloyed or because members of their
families were nnemploj'ed. With the full-employ-
ment years during the war the older workers, particu-
larly, attempted to save. ]\Iauy made down-payments
on homes and paid accumulated debts. Illness struck,
as it often does especially with older people, savings
disappeared, homes were lost, and finally public poor
relief was applied for. In other instances, premature
superannuation occurred because of the anxiety of
workers who were approaching the time when they
feared they would no longer be able to work. Over
half of the more than 1,000 workers seen each month
at the ITAW-CTO clinic have illnesses which the
doctors say have been caused or made worse by basic
feelings of insecurity. ]\Iueh of this insecurity is
related to fear of what will happen to the worker and
his family when he can no longer work.

A ' ' means test ' ' program should not be the answer
to the economic needs of the worker when he is "too
old to work and too young to die." Charity is not
the democratic answer to this need. It is time that we

provided income maintenance benefits as a matter of
right instead of falling back on charity programs as
our basis floor of protection for an aging population.

UAW-CIO Program

To give adequate protection to workers against the
economic hazards of age, incapacity (both temporary
and permanent) and death, the UAW-CIO is seek-
ing expansion of the governmental social security
programs — both in amounts and in coverage — and
is asking for a comprehensive and integrated system
of benefits in the programs established under collec-
tive bargaining. These benefits are: (1) pensions
for people who are too old to work or who become
disabled and cannot continue to work; (2) medical
care programs which lift from the worker and his
family the existing economic barriers to necessary
hospital and medical care; (3) rehabilitation serv-
ices to help the disabled worker return to gainful
employment; (4) payments to maintain family in-
come during the illness of the wage earner; and (5)
survivor's benefits when the wage earner dies pre-
maturely.

These benefits should be adeiiuate for their purpose
111- they should not be adopted. It is better to start
with fewer and adequate benefits than to spread the
money available for protection too thinly and fail to
provide real security for any of the common hazards
of life. Benefits under collective bargaining programs
should be sufficient to siistain the worker and his
family on a modest standard of living. They should
not be so low that supplementation b.v public relief is
necessary. The floor of protection provided by govern-
ment jirograms must be considered in establishing the
amount of the benefits under workers' security collec-
tive bargaining programs. But the necessity for addi-
tional relief pa.vments must be avoided.

The workers' security programs under collective
l)argaining are intended to provide benefits supple-
mentary to the government floor of protection. Thej^
are particularly necessary in industrial and high cost
of living areas. Programs under collective bargaining-
are also adapted to meet the needs of particular groups
of woi-kers and to provide a flexibility not possible
under government programs. This flexibility in the
collective bargaining programs makes it possible to
establish demonstrations and pilot plans which can
provide experience for expansion and extension of
much needed piiblic programs. This is jiarticularly
true in the field of medical and hospital care, where
government experience with prepaid care is still very
limited.

There are three important principles around which
collective bargaining programs for workers' security
are being developed. These are: (1) universal cov-

€rage — that is, every worker covered by the collec-
tive bargaining agreement as well as his immediate
family must be given the protection provided by the
program ; (2) employer-financing — that is, employer
payments sufficient to meet the cost of the program ;
and (3) joint union-management administration of
the employee-benefit fund.

Universal Coverage Is Basic

AYhy is universal coverage essential? "When a retire-
ment income program is won through collective bar-
gaining it is in lieu of other alternative economic gains
and is won on behalf of all workers. Therefore, every
worker in the bargaining unit must be covered. To
restrict coverage to certain classes of workers is
neither justified nor feasible.

Restrictions on coverage in pension plans have been
developed largely because of the employer's desire to
reduce the cost of the jdan. Kestrictions in pension
plans outside of collective bargaining have tended to
exclude older workers, to provide for a waiting
period, or to establish earnings qualifications. A
program under collective bargaining is intended to
accomplisli protection for all the workers. To exclude
the older workers delays the effectiveness of the pro-
gram and fails completely to meet the immediate
problem.

The requirement of a waiting period before a worker
may participate has no validity for plans developed
through collective bargaining. T'nder these plans
woi'kers earn old age security during their working-
life as a part of their compensation. Hence they
should receive credit from their first day of service,
and a waiting period is inequitable.

Similarly, an earnings qualification is not justified
in a retirement program established through collec-
tive bargaining. Workers in the lower wage brackets
need a pension plan even more than the higher wage
group ; it is more difficult for the lower income groups
to save.

Furthermore, coverage of all workers has the prac-
tical advantage of contributing to the stability and
actuarial soundness of the program and permitting
many econnmies in administration.

The Employer Should Pay

Employer-financing is probably the most debated
and the least understood of these principles. There
are a number of reasons why employers should finance
the security programs set up under collective bargain-
ing. In the first place, it is the only practical and
effective way to secure coverage for all the workers
in the group. Contributory plans in industry have

failed to enroll all employees. Inclusion of all mem-
bers of a group is essential to an effective program of
security protection.

The employer-payments agreed to in collective bar-
gaining are not gratuitous payments. They are not
something for nothing. The basis for the employ er-
' payment is that a worker, by the performance of his
job, earns a retirement income and other social secur-
ity protection as a deferred part of his earnings.

Funds for worker security programs come from
industry irrespective of whether they are paid directly
to provide benefits or whether they are deducted from
employer-payments to employees and then used to pro-
vide benefits. It makes no economic difference whether
the employer makes the payments directly or whether
they pass through the hands of employees — if em-
ployer payroll deductions can be considered to pass
through the hands of employees!

The employer allocates funds for the repair and re-
placement of his machines as a cost of doing business.
The repair and replacement of his "human machines"
is no less a legitimate responsibility of industry. The
Federal tax regulations recognize emplo,ver-payments
for retirement and health security programs as an
"ordinarv and necessary expense" of doing business
and allow the employer full deductibility for such
payments.

On the other hand, monies technically paid to the
worker and then deducted from his wages by his
employer are taxable to the worker. A dollar paid by
the emplo.ver to the worker and then "checked-off"
for benefits results in onl.v 84 cents available for
workers' security benefits. This means that with
employee-financing, or the payroll check-off method
of financing, the employer must pay almost $1.20 in
wages to produce one dollar which is available for
workers' security.

Joint Union-Company Administration

Joint union-management administration of the
employee-benefit fund is essential. It is through this
joint administration that the programs can be adapted
to meet the needs of particular groups of workers and
can be kept flexible. It is not i^raeticable to work out
all the details of pension and medical care programs
in collective bargaining. After agreement has been
reached on the broad policy provisions of a program,
responsibility for developing it should be delegated to
a joint board of trustees who can, in addition, review
the program periodically and arrange for modifica-
tions which may be necessary from time to time.
Workers are the group most directly concerned with
the proper functioning of tlie program, and where
they have an effective voice in its administration, a
better program results.

Flexible Retirement Age

There is a fourth principle which is important — a
flexible retirement age. Workers security programs
should permit workers to retire at the point at which
they become superannuated. Workers should not be
required to retire at a fixed age. The proper point
for retirement differs for each individual and the
reasons for retirement likewise vary from individual
to individual. Therefore there should be sufficient
flexibility with respect to retirement age to permit
each worker to retire on an individually determined
basis. This means that retirement should be per-
mitted throughout the span of years in which work-
ers most frequently become superannuated.

A flexible retirement age is needed because super-
annuation is only in part related to the individual's
chronological age. The onset of disqualification be-
cause of old age and iufirinity is also a function of the
original equipment of the individual, of the effects of
environmental factors, and of the appearance of
chronic conditions. A worker may become super-
annuated before 65 as well as after 6.5. Age 65 has
been most often adopted as the retirement age because
it has been thought that persons tend to oiTtlive their
usefulness on the job at about this age. Age 65 has
been generally accepted as the average age for retire-
ment of salaried or ofBce workers.

If it is desirable to permit retirement for sedentary
workers at 65 it follows that persons engaged in physi-
cal work should be permitted to retire somewhat
eai'lier, if they so desire. There is considerable sup-
port for age 60, or even an earlier age, as the point at
whicli retirement may be permitted. For some individ-
uals, however, superannuation may not occur until
some years after 65. This variation between individ-
uals as to when superannuation takes place is recog-
nized in Labor's thinking about retirement age.

Individual Security Means Community Security

Workers ' security programs have value not only for
the worker, but for industry and for the community.
The worker need no longer fear the economic hazards
of age, incapacity, and death. He can look forward to
a decent retirement income when he is too old to work.
He will have insurance against death or total and
permanent disability. He need no longer fear the
unpredictable and unbudgetable cost of hospital and

medical care. When he cannot work for reasons of
sickness or accident his family living expenses can be
met, even though on a somewhat reduced basis. And
when he is unable to do his usual job for reasons of
accident or sickness, rehabilitation services will be
available to help him back on his feet.

All of these things mean that the worker will be
more secure about his future. His savings will not be
exhausted with a single illness. Homes can be bought
with a knowledge that illness in the family will not
mean a loss of eqiaity. Necessary medical care and
hospitalization will not be delayed for economic
reasons. This adds up to an increased sense of well-
being and increased self-confidence on the part of the
worker — a happier and more secure worker.

The advantages of workers security programs to
industry areas great as the advantages to the
worker. Companies which have put health and wel-
fare plans into effect have reported that improved
labor relations and public relations have resulted,
productivity has increased, and absenteeism and
labor turnover have decreased.

Worker security programs mean as much to the
community as they do to the worker and to industry.
They mean fewer persons on public relief and charity
programs. They mean a healthier community because
the people of which it is composed are happier and
more secure.

Such programs mean more assurance for workers
who want to make commitments for such long-time
purchases as homes. They mean fewer uncollected
accounts for merchants. As the President's Steel In-
dustry Board stated, in its report :

"The inauguration and operation of insurance
and pension programs will make a considerable
contribution to the attainment of the economic
stability so necessary at this time. With the
knowledge that the economic hazards of life will
be at least partially met, workers will be more
apt to help sustain consumption spending at a
high stable level,"

The UAW-CIO believes that the sooner we face the
problem of providing an adequate workers' security
program, the easier it is to solve. Each year of post-
ponement of security programs is costly for the work-
ers, for industry, and for the community.

How Long Do Our Workers Last?

By Ewan Clague
Commissioner of Labor Statistics, V. S. Department of Labor

THE LENGTH of Working life of American workers
is a highly important field of inquiry for
those concerned with the economic and social
problems of older w'orkers in our modern economy.
For, by comparing the ages at which workers cease
gainful activity with their total life expectancy, we
have a significant measure of the magnitude of the
problem of old-age dependency as it affects the indi-
vidual worker.

In order to make available basic data on this aspect
of manpower utilization, the Bureau of Labor Statis-
tics has taken the actuarial techniques of the conven-
tional life insurance tables and adapted them to the
measurement of working life. These tables show the
ages at which men enter the labor force, the ages at
which they stop working either because of death or
retirement, and the average number of years of work-
ing life remaining to them, at given ages. These
materials will be published, in detail, in a forthcom-
ing bureau study. I shall refer briefly here to a few
of oxiT major findings.

Under 1940 conditions of mortality and of labor
force participation, the average male worker aged 20
could expect to remain in the labor force — either
working or seeking work — for an additional 41.3
years, or to age 61. However, he could expect to live
for an additional 46.8 years, or until age 67. So, on
the average, he could anticipate a gap of 51/2 years
between his working life and his total life span.

I would like to stress two things about these figures.
First, they are averages. They include men who "die
in the saddle, ' ' as well as men who are exposed to pro-
tracted periods of retirement, after they have stopped
working. Under 1940 conditions, about half of all
men workers could in fact expect to continue working
until death or fatal illness. For the remainder, the
period of retirement was much greater than the aver-
age. If we assume the life expectancy of retired men
at any age to be the same as for all men at that age,
the average life span in retirement for men retiring at
age 60 or later was approximately 11 years.

Secondly, as in the case of the standard life insur-
ance tables, the estimates of working life simply
describe what would happen if an existing pattern of

mortality and retirement prevailed throughout the life
history of a generation of workers. They are not fore-
easts and do not attempt to predict, for example, the
conditions a young man will in fact be exposed to in
the course of the next four or five decades.

B.v comijaring the pattern of working life of 1940
with that prevailing in other periods, we can however
gain valuable insight into the factors underlying the
growth of the present problem of old-age dependency.
A century ago, or even more recently in our history,
there was very little difference between a man's work-
ing life span and his total life span. Life expectancy
was short and only a small proportion of the popula-
tion survived until ages which are now considered con-
ventional for retirement. Moreover, we were pre-
dorainantl.v an agrarian economy. As an independent
farmer or craftsman, the older worker was often in a
position to continue in an active, productive role until
the very end. For most workers, there was no sharp
break in emploj^ment. but rather a tapering off. Re-
tirement, as we know it today, was the exception
rather than the rule.

Changes in Work-Life Pattern

Let us consider the work-life pattern of men in 1900,
.since comparable data for prior periods are not read-
ily available. At the beginning of the century, the
20-year-old white man had an average life expectancy
of 42.2 years, or about 5 years shorter than his coun-
terpart in 1940. His working life expectancy of 39.4
years was, however, only 2 years less than in 1940.
On the average, therefore, he could expect slightly
under 3 years outside of the labor force, as compared
with 5I/2 years in 1940.

From this simple comparison we can diagnose two
of the basic elements in the long-term economic prob-
lem of the aged. On the one hand, the advances of
medical science enabled a growing proportion of the
population to survive into old age. On the other
hand, employment opportunities did not keep pace
with this increase in the aged population. There was
a steady shift from agriculture and the small handi-
craft trades to large-scale urban industry, with its
emphasis on speed, its rigid work schedules and its
dilution of skills. The older worker was no longer

able to slow down i>radually on tlie job, but at some
stage — ofteu at some fixed ehrouologioal age siieh as
65 — he "was forced to make a complete break with em-
ployment. As a result, there was a long-term down-
trend in the average age of retirement and a Aviden-
ing gap in the period of old-age dependency.

This basic problem was, moreover, intensified by
the great depression of the thirties. The burden of
unemployment fell heavily on the older workers, who
— once laid off — found it increasingly difficult to se-
cure reemployment. By 1940, after a decadd of
severe unemployment, there were many older workers,
iu their fifties and sixties, who were still able to work
and willing to work, but who, after prolonged unem-
ployment, had given up the search.

But with wartime mobilization and postwar pros-
perity came ample evidence that many of these older
workers were in fact capable of productive employ-
ment. Large numbers re-entered the wartime labor
force while others postponed their retirement. This
pattern moreover has continued into the postwar
period, so that substantially greater numbers of older
workers are now in the working force tlian would be
expected from prewar trends.

These changes have had a pronounced efi:'eet on the
pattern of working life. As a result of further ad-
vances in medical science and the general improve-
ment of living standards, the 20-year old male worker,
under 1947 conditions, could expect to live an addi-
tional 48. 2 years, a gain of almost IV^ years over
1940. At the same time, his average work life expect-
ancy also increased by l^A years, to 42.8 years, largely
due to the increased proportions of older men, in their
late fifties and sixties, who were found in the post-
war labor force. Thus, in contrast to the long-term
trend, there has been no further widening iu the re-
tirement gap during the current decade.

These comparisons suggest alternative patterns for
future trends in the work life span. A resumption of
prewar trends, on the one hand, would mean a rapid
widening of tlie period of dependency and would cor-
respondingly add to the economic burden of old-age
dependency. Under this assumption, the gap be-
tween total life expectancy and working life expect-
ancy will widen to almost 10 years in 1975, as com-
pared to 51.0 years in 1947 and less than 3 years in
1900. On the other hand, if we can maintain the cur-
rent pattern of labor force participation, the increase
in life expectancy will be added )nainly to the period
of productive life. Even under these conditions, there
will, however, still be an increase of about l^ years
in the average period of retirement, due simply to the
fact that under the improved mortality conditions
projected for 1975, a larger proportion of young men
are likely to survive to retirement age.

Old Age Dependency Increases

It is clear from these comparisons that we are
faced with a major and growing problem of old-age
dependency, even under relatively favorable assump-
tions. However, if we fall short of our full employ-
ment goals and if we fail to provide adequate work
opportunities to those older men and women who
want to and are able to work, the problem will be
greatly magnified.

There will be mounting pressures for an expansion
of old-age benefits and growing demands for a pro-
gressive broadening of the eligibility conditions. The
increased span of enforced idleness in old age will
place a heavy financial burden not alone on the aged
themselves, but on those in the labor force who will be
contrilmting to their support, either directly as indi-
viduals, or by increased levies on their current earn-
ings.

There is, however, nothing inevitable about these
long-term trends. I believe that legislators, who are
iu a position to determine public policy, can do a
great deal, in conjunction with labor and manage-
ment, in promoting employment opportunities for the
older workers and extending their working life span.

As a guide to constriictive action, we shall, of
course, need much more detailed information than I
have thus far presented. The public health specialist
has available detailed statistics on the incidence of
disease and the causes of death, to guide him in form-
ulating an effective health program. In similar fash-
ion, we must know much more about the types of
workers who are at present most vulnerable to prema-
ture aud involuntary retirement, about their occu-
pation and industry and their geographical location.
We also need direct information as to the specific
causes of their withdrawal from gainful activity.
At present this area is still largely unexplored from
a statistical viewpoint.

The City vs. Oldsters

On the basis of our present knowledge of the Amer-
ican labor market and of conditious in various occu-
pations, it is possible, however, to focus on certain
broad sectors of the labor force, where the problem
is likely to be most severe. First, we know that the
working-life span is shorter for the city worker than
for the farmer. Secondlj^ in the nonagricultural sec-
tor of the economy, the period of retirement is likely
to be longer for the wage or salaried emploA'ee than
for the man working on his owm. account, as a business-
man or an independent professional.

]ii tliis broad area of uouagvieultural eiuploynient
there are wide difPerences, too, in the severity oF the
employment problem of older workers. There are
many employees of mature age, in executive, super-
visory and professional positions, whose experience
and judgment render them increasingly useful to
their fii-m. However, in the great mass of industrial
and clerical jobs, which bulk so large iu our modern
economy, the opposite is more frecpientlj^ the ease.

For many of these workers, the major threat to a
full well-rounded working career is the gap between
the individual's occupational working- life and his
total potential working life. The most obvious illus-
tration is in the case of those jobs which involve very
high physical requirements. Professional athletes or
airline pilots or other men engaged in hazardous or
strenuous activities are required to be iu perfect or
uear-perfect physical condition. At some stage, and
well before the end of their normal, working life, men
in these jobs — even though a select group, to begin
with — are compelled to shift to a less exacting tyiie of
work.

Tlie situation of airline pilots, though extreme, may
serve to point up the problems which may be en-
countered under these circumstances. Airline pilots
as a group are predominantly young men — both be-
cause of the very stringent physical qualifications they
must meet under the Civil xVir Regulations and be-
cause of the very recent growth of the oceui^atiou.
Thus, since 1940, the number of pilots employed by
the scheduled airlines has tripled. Although there
have, of course, been individual problems of superan-
nuation for pilots, there has not as j-et been a mass
problem. But within the coming decade or two. a
large proportion of tlie present pilots will be in their
forties and fifties ; clearly many of them will no longer
be able to meet the current physical standards. Where
will they go? The types of ground jobs on the air-
lines for which they may qualify or which they are
likely to consider suitable are necessarily limited. Ee-
tirement also is not the solution for them. The only
alternative for many will be a completely new occu-
pational orientation.

Less spectacular, but of much wider significance, is
the situation of many other workers who find that as
they grow older and slow down, they can no longer
meet the pace of modern industry, although they may
still be capable of gainful employment. If they re-
tain their jobs with their emj^loyer, this ijroblem —
though still a real one — may be dealt with in a quiet,
unobtrusive fashion. In many industries, seniority
gives the older worker a substantial measure of se-
curity. And, apart from this form of protection,
many employers have adopted policies to shift their
older employees to lighter, less exacting duties.

Stranded in Middle Life

However, in our dynamic economy, there is the
ever-present danger that these workers may get
stranded in the middle of their woi-king life. Periodic
business recessions, or simply the normal turnover of
business establishments, may cast them in the role of
a jobseeker. Technological or style changes may de-
press their industries or render their skills obsolete.
Shifts in consumer demand and the changing pattern
of industrial location may also have the same effect.

Once the man past his forties is forced into the labor
market, his problem of adjustment may prove to be a
difficult one. ilany employers are reluctant to hire
older workers, unless they have some special qualifica-
tions. The very seniority rules which protect him on
the job work to his disadvantage when he is on the
outside. And the prospect of "starting all over
again," to a man of mature years and responsibilities,
is not a very appealing one.

What can we do about this dilemma of the older
worker? I will not presume here to attempt to spell
out any detailed solution. From this brief review it is
apparent that we are dealing with a highly complex
problem. It is a problem that we are approaching
with all too meager factual resources, although the
Xew York State Joint Legislative Committee on Prob-
lems of the Aging has performed an outstanding serv-
ice in this respect, in a.ssembling and evaluating the
available data. It is, moreover, a problem which is
growing in dimensions each year, and which will com-
mand the combined resources of the Federal and
State and local governments, of labor and manage-
ment, and of many community groups, if it is to be
dealt with effectively.

In conclusion, I would, however, like to refer to one
general course of action which merits your considera-
tion. You are all familiar with the general theme of
"physical fitness."' Institutions such as life insur-
ance companies, particularly, have a strong and obvi-
ous interest in jDromoting improved health standards,
proper diet, adequate exercise and other hygienic
measures which will have the effect of extending the
average life expectancy. The community at large has
an interest, too, in extending the period of working
life.

To this end, we should inaugurate a program of
"vocational fitness," designed particularly to meet
the needs of middle-aged workers. We must first, of
course, determine what particular types of jobs are
adapted to their background and abilities, by care-
ful studies of the job requirements, the conditions of
entry, the productivity of older workers on these
jobs and other pertinent information. We must, at
the same time, improve our technical know-how in
testing and counselling older workers.

With this type of information, we may be in a posi- hearted cooperation of labor and management groups

tion to conduct an effective campaign to encourage and must be part of a broader campaign to expand

mature workers to undertake adult education and vo- employment opportunities for the older worker,
cational retraining programs. Preferably, these pro- All this may seem like an ambitious project, but if

grams should be conducted, not when the worker is it succeeds in extending the period of productive

out of work, but when he is still on the job. In order life for even a fraction of our labor force, it will

to be effective, these programs must obtain the whole- prove to be a sound investment.

Business Conditions Today Demand Seasoned

Executives

By John R. Powelson

President, Forty Plus Club of X. Y., Inc.

THE EXECUTIVE, over 40, seeking employment is
often ruled ont of competition without even a
hearing under today's employment practices.
Tlie following alleged reasons are those mosf fre-
quently given :

1. Company pension and group insurance plans.

2. Company traditional policy of employing only
younger men.

3. Reluctance, based on fear by young company
executives, to employ older men.

4. Company fixed policy of promotions of execu-
tives from within.

To arm the executive, over 40, against such hiring
procedures, the idea of the Forty Plus Club was born.
More than 10 years of successful operation have
proved that these employment problems and preju-
dices ran be overcome. Since 1938 Forty Plus Clubs
have been organized coast-to-coast, including such
cities as New York, Boston, Buffalo, Philadelphia,
Cleveland, Detroit, Chicago, Los Angeles and San
Francisco.

Typical of the overall operation, is the Forty Plus
Club (if New York, Inc., which maintains headquarters
at 250 West 57th St., New York City. Founded in
1939 the ob.jectives of this non-profit organization are
to secure executive employment for members by their
own cooperative efforts ; to offer members encourage-
ment, inspiration and assistance ; and to create in the
minds of prospective employers a realization of the
value of mature experience, seasoned judgment and
trained business knowledge.

To function efficiently the club maintains five
committees :

1. The Admissions Committee — which carefully
screens and investigates applicants.

2. The Marketing Committee — which keeps up con-
stant liaison with industry and business by
means of personal calls and printed matter.

3. The Placement Committee — which recommends
members for job openings, and arranges per-

sonal interviews at the request of the potential
employer.

4. The Public Relations Committee — which pre-
pares press releases, radio scripts, paid adver-
tising, trade paper press copy, and supplies
speakers for Chambers of Commerce, Trade
Associations and Service Clubs.

5. The Resume Committee — which helps members
prepare resumes of business experience.

The Forty Plus Club has strict membership require-
ments which act equally for its own protection as
well as that of the employer. To qualify a member
must be an American citizen, 40 j-ears old or over,
show a satisfactory educational record, have demon-
strated executive ability, and have earned a minimum
of $5,000 yearly.

As a result of this strict screening, only 8 per cent
of the applicants are accepted. Experience shows
that most of the club's members are undergoing tem-
porary unemployment not through any basic faults of
their own, but rather through the inevitable industrial
readjustments following a national emergency, merg-
ers and combinations of circumstances beyond the
individual 's control.

The club realizes that the American economy — vast,
successful and envied by all nations — represents in
the last analysis the sum total of the know-how,
energy and creative genius of all elements of the
population. America today is taking positive political
action in the matter of conservation of natural re-
sources ; water, forests, oil and soil. Failure bv gov-
ernment and business and industry to conserve equally
important human values, to gainfully employ the
hard-won experience, the seasoned judgment, the in-
grained habit-of-work, as possessed and best exempli-
fied by the over-40 executive age group, only serves to
subtract from the maximum productive effort which
is the American goal.

As evidence of the success in this direction of the
club's efforts, it is interesting to note that since its
formation in New York, more than 1700 have been

placed in executive jobs. Employment records reveal agencies. The enlightened employer can profitably

moreover, that virtually no labor turnover has been utilize the club's services by passing along to the

created by the hiring of Forty Plus members, which Placement Committee executive job specifications as

in itself is at once a tribute to and justification for they develop, thereby extending to the club's member-

the strict admittance standards in force. The sea- ship an opportunity to compete for such positions,

soned employee appreciates and holds his job. The club cannot emphasize too strongly or too often

The Forty Plus Club of New York, Inc., invites the the time tested fact that there is "no substitute for

cooperation of Federal, State and local government experience."

New Jobs at 65

By Thomas C. Desmond

CliuiiDiaii, yeic Yo) Ti- State Joint Leijinlutiie Commil lee on I'lohleriis of the Ar/iiig

YOU MIGHT have wondered why a squad of old-
sters, with lunch boxes under their arms, were
trooping- daily into industrial Schenectady's
squatty, red-brick savings bank. "Were they coming-
to carry off their life's savings in food boxes"? Or
was the savings institution providing- an assembly
hall for the local Townsend Club '? Neither explana-
tion seemed plausible.

The man who had tiie answers was a 72-year old
honorary Kentucky Colonel, Laurence A. Hawkins,
slight of build, but no light-weight in the engineering
profession.

For 33 years Hawkins was executive engineer of the
research laboratories of Schenectady's mammoth,
sprawling General Electric Works. He holds more
than 50 important patents, mostly in railwa.v sig-
nalling, and is still young enougli to en.i'oy motoring
and swimming.

But when World War II ended he was told,
''You're too old. You "11 have to retire." Hawkins
found himself idle for the first time in his life, in the
midst of a veritable reservoir of highly skilled workers
who had been shelved in this home of the giant Gen-
eral Electric and American Locomotive Companies.
"Wouldn't some of these men," Hawkins asked him-
self, "be happier if they could find some way to util-

ize their valuable exi)erience, skills and knowledge?"
He wasn't sure, but he decided to find out.

Hawkins sought out two other men who had been
sacrificed by indu.stry on the altar of compulsory
retirement. One was tall, black-haired Arthur K.
Smith, 70 years old. former manager of the Turbine
Engineering- Department at General Electric. The
other was short, stocky, bespectacled Ray Stearns,
also a septuagenarian, for many years manager of
the Aeronautics and Marine Engineering Department
of General Electrii-. and prime developer of the B-29

* Reprinted, vrith additions, from Reader's Digest, June.

inso.

71-year old J. H. Bush studies designs for turbo-generator.

J. R. Foulder, 69-year old draughtsman, talks over
a production problem with 73-old President Hawkins.

Two 68-year olds, Manager
H. S. French (left) and John
Bach, cut tracing paper.

David Lockerby, 70, works on a
turbine design.

armament system during World War II. "This re-
tirement is hell, ' ' they told him. ' ' There 's still plenty
of spark left in our systems. But the young bucks
don't want us around."

The trio remembered a top designer they knew in
turbine, an engineer in railway signalling, a leading
draftsman in switchboard engineering. All had been
forced out of their jobs by age limits. What had
become of these men? Were they in Florida or
California, sunning themselves on the beaches ; or
were they still in their home town, chafing at their
enforced idleness, with time weighing heavily on
their hands?

Hawkins and his SS men went on a man-hunt.
Most of the men they wanted to see were still around.
And they weren't happy. True, some were collect-
ing pensions, and social security besides. But these
were old-timers who had been in the harness for 30
or 40 years. They were beginning to show the effects
of being suddenly shaken from their orbits and sent
home to think about the past. "Go back to work?",
one exclaimed. "This sounds like a dream come true.
But who 's going to hire a man in his late sixties ? ' '

There was one answer which Hawkins and his asso-
ciates saw: a company made up entirely of retired
employees! If you're rejected by employers become
your own employer. ' ' That will show them we 're no
old fogies", they chorused. But there were mam-

questions and problems. What could such a company
sell ? Where was the capital to come from ? Would
there be enough work to make the venture worthwhile ?
Where would a new company find plant space in
booming, already overcrowded Schenectady ?

This time it wasn't a man-hunt. Hawkins and his
band, in grim earnestness, set out on a survey to de-
termine what product thej' could sell. "Sorry'', they
had to tell one manufacturer. "Materials for what
you want are still too scarce. We couldn't risk it."
' ' Wish we could do business with you, ' ' they told an-
other, "but your potential market is too limited."
Finally the opportunity struck. Skilled draftsmen
were found to be in demand to take work on a con-
tract basis. Hundreds of old-timers in Schenectady
could do drafting. And the business was there wait-
ing.

The big trouble now was that practically all the
prospective employees had been retired by the same
large company, General Electric. This new business
organization was to be no mere offshoot of a huge
electrical corporation. It wanted to stand on its own.

It needed an "uptown" man with no industrial con-
nections.

Encouraged with their initial progress, but still
beset with serious obstacles, Hawkins and his men
placed their ideas and their headaches before hand-
some, aggressive, and fortyish Kilgore MacFarlane,
president of the Schenectady Savings Bank, an up-
towner known for his business acumen. "You fellows
are doing a grand thing," MacFarlane told his visi-
tors. "Count me in to help in any way I can. Inci-
dentally, we have some unused space here in our bank
building. If I talk this over with the Board of
Directors and tell them your story, maybe you can
locate here."

MacFarlane agreed to serve as treasurer of the
nebulous company, which now incorporated under the
name of Mohawk Development Service. The rest of
the roster of officials and employees sounded like a
"Who's Who in Engineering and Drafting." Hawk-
ins became president. Stearns was made secretary
and general manager. Smith assumed the title of
vice-president and chief engineer. Among the em-
ployees were 70-year old EUery Steadwell, who was
responsible for the design of 60-inch searchlights. J.
Roy Foulder, a 69-year old graduate of Brown Univer-
sity who had been supervisor of drafting at the Amer-
ican Locomotive Company, and a group of other old-
sters as familiar in engineering as the .slide rule.

Labor Satisfied

Things were looking brighter for the infant con-
cern. Maybe too bright. Rumors were rife that ilDS
had come under the watchful eye of organized labor.
Members of the Draftsmen's Union at General Elec-
tric demanded to know what this new venture was all
about. From the soot-covered, dingy building in the
congested railroad area, which houses Local 301 of the
United Electrical Workers, there was an ominous, un-
easy silence. The men of MDS waited anxiously to
see if the axe would fall. Finally the attitude of
labor began to crystallize.

"We're not opposed to the employment of older
workers," explained Local Business Agent Leo Jan-
dreau, veteran of many a tough labor scrap. "On
the contrary, we're all for it. But this could be a
move by some of the corporations we have contracts
with to get around the retirement rule."

There was a campaign imderway to get Schenec-
tady's big plants to liberalize their pension provisions.
Labor officials didn't intend to have these industrial
giants arguing that more and better pension plans
were unnecessary because they had found a way to
take care of their older employees by letting them
work for themselves as long as they wanted to. Why
was it, labor wanted to know, that ilohawk Develop-

ment Service was drawing its employees from the re-
tired ranks of only one company, and that the same
company had already offered some contracts?

The men of MDS had the answers ready : General
Electric had a surplus of work which its own em-
ployees couldn't handle. The men in the new com-
pany were familiar with General Electric products.
They could do a good job from the very beginning,
without extensive training, and without delay. True,
most of the original work was coming from one com-
pany, but Mohawk Development Service was free to
take, and indeed was anxious to get, work from wher-
ever it might come.

Labor was soon satisfied that the new company was
not a "branch" of General Electric, and that it was
serving a useful purpose by preventing the rustinc' of
skills, and probably adding years to the useful lives
of older men who wanted to work. MDS went aliead
with the blessings of organized labor.

Started on Little Capital

The corporation was launched with a capital of
(inly $2,000. That isn't enough to buy a new auto-
mobile, even a low-priced one these days. But it paid
the rent for a while. It bought pencils and stationery.
It paid for drafting boards, paper, drawing ink. T-
squares, desks and filing cabinets.

From there on the oldsters pitched in themselves,
swung hammers, pushed planes and saws, and out of
rougli boards constructed needed work tables. They
designed their own lighting equipment. There was
no thought of the arthritis, stiff joints, and wrinkled,
tired hands which supposedly make the elderly unfit
for any kind of physical effort. These oldsters, saw-
ing boards, skillfully putting the pieces together,
helping to construct a modern workshop by their own
sweat and toil were unmindful, in their enthusiasm, of
the common picture of the elderly, tired, weak and
miserable.

In March, 1948, not many months after a bold, new
idea stirred in the imaginative mind of the old "Col-
onel", the doors of MDS were wide open for business.
Six old-timers rolled up their sleeves. In a Ions, low
room, where floating lamps flooded tables sticking up
in rows like tank traps, thej- quietly took their places
and went to work. They turned out designs and blue-
prints for turbines, turbo-generators, diesel engines
and large motors. No "E"s" for excellence were
sought by the oldsters. The many favorable comments
from satisfied customers, the new contracts that came
rolling in from American Locomotive, Ludlum Steel,
the Oil Institute of New York, and a host of other
concerns, were the only citations the oldsters wanted.
As orders piled up more pensioners were taken off the
shelf.

At the end of its first year ilohawk Development
Service had 16 employees. The number zoomed
through 1949 ; and President Hawkins is looking for
other fields in which to siphon machinists and engi-
neers, de-activated by private industry solely because
of the number of birthdays they have seen.

j\IDS has been cleared for work on government con-
tracts coiniected with the defense program. In fact it
has taken contracts from the Atomic Energy Com-
mission, (^irasping the sturdy, prison-like bars which
cover the long, narrow windows of the Schenectady
Savings Bank, Hawkins once remarked, "AYe couldn't
he better prejiared to protect any kind of secret
material.

MDS, like many other companies, has erected rigid
age barriers. You might be the best draftsman or
engineer in the world, but you don't stand a chance
here unless you can prove that you're over 65, and
once retired by private industry. Present employees
range in age from ()(i to 7-4. They have a good in-
come. They are happy, because they are contributing
something to society, and, above all, because they have
a chance to prove that older workers can produce
profitably. They are paid the same hourly rates as
prevail at General Electric for comparable work.
They can utilize their skills, and they are not snb.-ject
to another compulsory retirement age rule. There
are no time clocks at MDS, for none is needed. AYh(>n
rows of bright lights are flicked on, and the rustle
of drawing paper heralds the beginning of a new
work day, you can be sure that it's never later than

8:30 A.M.

The old-timers took a lot of good-natured ribbing
-when they went back to work again. Their younger,
former fellow-workers at General Electric and Amer-
ican Locomotive greeted them with "Hello, Tom.
How are thing.s at the old age home"?"' or "^Making an-
other try at it. Bill? AYhy don't you old dnffers ad-
mit you're through and take it easy?"

It might have been just such barbs which helped
the company to succeed, for the oldsters made up their
minds that they simply couldn't aft'ord to fail. Suc-
cess became a matter of personal, self-esteem

Typical of the employees at MDS is 68-year old
Charles Spinnler, an able, retired G. E. Engineer,
now "nn-retired". He had been on the shelf for two
years when he was contacted by the Hawkins, Stearns,
Smith team. Does he feel that the older men are cap-
able of doing as good a job now as they did when they
were with G. E. or Alco? Here's his answer: "These
men are better now than before they reached retire-
ment age. They still have their skills. There's no
fooling around on the job here. Every man knows
his work and goes right at it. We still take a lot of
kidding from our young friends at other plants.
AYe're confronted with a challenge. It's a matter of

preserving our own esteem and confidence. \Ye are
working harder and better than we ever did before,
because we know we just can't fail and still hold our
heads up. It's a matter of proving to ourselves, as
well as to others, that we aren't old or useless. We're
goins' to show everybodv that we're far from washed
up."

Low Absenteeism Rate

Employees at Mohawk Development Service work
on an hourly basis. Since they are all in the upper
age brackets it was anticipated that some of them
might be laid up occasionally, and unable to work
because of illness. One emijloyee was out for five
months. The company paid him nothing for this
time, but when he was able to come back he resumed
liis old job. However, this case of prolonged illness is
unusual in the brief history of MDS. The absentee
record shows that the men are actually out less than
thej- were before they were pensioned by their or-
iginal employers. "All our men put together,"
President Hawkins laughs, "couldn't keep a doctor in
aspirin, or a hospital in ether,"

Today, MDS is a bustling, profitable concern. It
offers to industry services in the fields of engineering
and drafting, and consultants on any electrical or
mechanical problems. As General Manager Stearns
explains, "Undertakings such as ours can be planned
to supplement, not necessarily to compete with, local
industries. Setting up a reservoir of skilled older
men to serve as a stand-pipe to take on peak loads of
existing industries helps them to stabilize their pay-
rolls, minimizes frequent hiring and firing, and
heightens their emplo.vees' sense of security in their
jobs. We do not fear competition if it comes. MDS
is not a charitable organization. We have unsur-
]iassecl efficiency to sell. In our field we are satisfied
that we have the best skills, minds and experience
tliat money can buy,"

The books of ]\IDS have consistently shown jet black
instead of red. Employees have been well paid, and
have even been given sizeable bonuses at Christmas
time.

Hawkins' only complaint is that government tax
policies are hard on new companies like his. Kates
on gross income and undistributed profits are so heavy
that the accumulation of capital for expansion is next
to impossible. He would like to diversify the type of
work being done. For instance, Hawkins is dream-
ing of the day when MDS will be able to open a ma-
chine shop, and hire some of the skilled, pensioned
machinists in Schenectady. In fact he is already
looking around for a spot to locate the machine shop.
But it will take considerable money to do this. A
machine shop is quite different from a draftsmen's

office. A more elaborate and expensive plant will be
necessary. And machines cost money, far more than
tracing paper, thumb tacks and drawing boards. The
head man at MDS figures that about $25,000 will be
needed before the company can exjoaud into other
kinds of work. But to a small, young lamb in the
industrial jungle $25,000 is more than just pin monej-.
Nevertheless, the man who has already performed a
modern busiues miracle on a shoestring is confident
that his dreams will be realized.

Supposing that Hawkins can eventually hire 15
or 20 "superannuated" machinists to make models of
new products, or to take other special development
work. Perhaps the total number of MDS personnel
will reach several hundreds. The possibilities are
great. If older men can form their own profitable
business corporation in Schenectady, why can't the
same be done bj' other groups of oldsters in Detroit,
New York City, Chicago, Boston, or Pittsburgh, or
wherever you find men with skills ? A hundred elderly
employees here and another hundred there can, in
the aggregate, number manj^ thousands.

Dr. Roger I. Lee of Boston, former president of the
American Medical Association, warns us that "Death
comes at retirement." One of America's leading ex-
perts on aging. Dr. Edward J. Stieglitz, informs me,
"Premature retirement while still vigorous, ambitious
and anxious to serve can be a major disease." The
eminent physiologist. Dr. Anton J. Carlson, ?ays,
"We are contributing to biologic i^arasitism and de-
generation of lunnan society as well as wasting valu-
able resources by keeping in idleness older workers
able to perform useful service. Work is a biologic and
social duty as long as we can carry on."

Laurence A. Hawkins and his associates have found
a way to do something that these experts on aging
have been advocating for years. Their imaginative
and financially successful attack on premature retire-
ment and widespread prejudices against hiring the
elderly may set the pattern which will not only keep
manj' off public old age assistance rolls, but which
will provide satisfying work, make men live longer,
and give society the benefit of an untapped reservoir
of mature judgment and unequalled skills.

Public Health and Our Older People

By Dr. Leonard A. Scheele

Surgeon General of the United States

THERE is 110 t)uestioii that the increasing- propor-
tion of older people today presents the Nation
with its foremost problem in the conservation of
hnman resonrees.

Public health is only one facet of the very broad
problem this Joint Legislative Committee on Prob-
lems of the Aging Committee is considering. But I
hope it will not, be thought mean to subordinate the
importance of other aspects of the problem when T
say that public health is the key. if not the definite
solution to the total problem of aging.

I am sure that my colleagues from the Social Se-
curity Administration, the Bureau of Labor Statistics,
the Veterans Administration, the hosjiitals. and other
related fields will agree that plans for the emjiloy-
ment, welfare services, housing-, recreation, medical
and hospital care for older people depend primarily
upon the health status of the group. Of equal impor-
tance in our .ioint considerations is what public health
does — or could do — to improve the health of all adults.
The effect of the aging- of the population on public
health, and vice versa, has been described many times.
Keports of the Bureau of the Census show that the
proportion of persons 45 years of age and over, rose
from 18 per cent in 1900 to 27 per cent in 1940. It is
estimated that these age groups at present account for
29 per cent, and that by the year 2000, 40 per cent of
the population will be 45 years of age or over. One in
every five persons is in the middle age group — 45 to
64 years ; fifty years from now, that ratio will be one
in four.

Age Shifts

These shifts in the age composition of the po]iula-
tion have been brought about largely by ma.ior de-
creases in mortality among- children and young adults
since 1900. The decline in the birth rate (up to about
10 years ago) and restrictions on immigration have
also contributed to the trend.

Some students of demography have been concerned
lest the proportion of aged persons impose a severe
burden upon the economy of the Nation, and par-
ticularly upon the young adults in the producing age
groups. From the public health point of view, how-
ever, the aging of the population, in itself, is not an
alarm signal. Ou the contrary, it testifies to ad-

vances made by public health and medical services in
reducing the mortality among children and young
people.

There is one fact associated with the aging process,
however, that is a clarion call to public health. The
aging of the population is reflected in mortality sta-
tistics with a greater proportion of total deaths now
occurring at the older ages. Nearly 80 per cent (78
per cent) of all deaths occurring at the present time
in the Ignited States are among persons 45 years of
age and over.

The increase in the proportion of deaths among
older people has accelerated during the past 30 years.
In 1920, only 50 per cent of all deaths occurred in
the 45 and older age groups. By far the largest in-
creases have occurred in the definitely old age brack-
ets. Whereas in 1920, persons 65 years of age or
older accounted for only 29 per cent of the deaths,
today practically half of the Nation's mortality oc-
curs among our older people.

Public Health a Practical Science

Public health is not only a humanitarian science ;
it is a practical scienc(\ The philosophy and practice
of public health are to attack the causes which pro-
duce the highest proportion of deaths and disability
iu the population. As in the past, mortality statistics
are the most accurate indices available to us for de-
termining our major problems both as to cause.^ of
death and disability and as to the specific population
groups exposed. Today, those data tell us that most
of our problems are the chronic and degenerative dis-
eases, and that mortality from these and other causes
is concentrated in the older age groups. This is the
challenge to all agencies and groups concerned with
the well-being of our older people.

About 45 years ago, public health workers heard
another such challenge. The Bureau of the Census
in 1904 published a report on the mortality and vital
statistics recorded in the 1900 censiis. It showed
that more than 30 per cent of all deaths occurred
among children under five years of age. Childhood
and youth — from birth to 25 years — then bore about
the same burden of mortality that our older people
now bear. Moreover, the principal causes of death
in these groups were infectious, diseases.

The answer to that challenge is written in the his-
tory of public health. The major eanses of mortality
were attached vigorously in the sueceedino- years.
Control of infectious diseases, maternal and child
health care, improved sanitation and nutrition, com-
bined with advances in the medical treatment of many
diseases, have brought about a striking reduction in
the general death rate and in the mortality from
numerous specific causes.

It is not possible to select a single year in which
the impact of scientific advances "begins" to be re-
flected in our mortality data. To bring the accelerat-
ing trend into closer perspective, however, let us con-
sider the past thirty j-ears.

Death Rates by

Age

The general death rate in the United States has de-
clined from 1,300 per 100,000 population, 1920. to
about 1,000 at the present time. During that period
the death rates for nephritis, pneumonia and influ-
enza, and tuberculosis have declined markedly in all
age groups. However, the decline has not been so
rapid in the age groups over 45 as it has been at the
younger ages.

The death rates for accidents, except motor vehicle
fatalities, have declined in all age groups among per-
sons 75 years or older. The reductions among infants
under one year and among persons 65 to 74 years,
however, are relatively slight.

The rates from motor vehicle accidents have in-
creased among all age groups except among children
of school age, 5-14 j-ears. The proportion of deaths
from this cause among older people, however, has not
increased substantially.

The mortalitj- experience due to heart disease, can-
cer, blood vessel lesions of the brain, and diabetes
mellitus, illustrate most forcibly the growing problem
of degenerative diseases among the older age groups,
45 years and onward.

Since 1920, the death rate from heart diseases, all
ages, has more than doubled. But in all age groups
under 25 years, the rates have been amazingly re-
duced. The rate of decline has been fairly constant
since 1925 for the age groups 1-24.

In the same period, the death rates from heart dis-
ease have increased in every age group from 35 years
and over, but most markedly at ages 55 and onward.
Because large numbers of persons are surviving to
advanced ages, we can assume that the death rate
from heart diseases for the total population will con-
tinue to rise. As the infectious diseases, such as
measles, scarlet fever, rheumatic fever, and syphilis,
come more and more under control, we' may also ex-
pect a greater concentration of heart disease deaths

in the older age groups. That trend is already ap-
parent. About 95 per cent of the heart deaths at
]iresent occur at ages 45 and over, as compared with
84 per cent thirty years ago.

It has been estimated that by 1980, even with no
increase in the death rates for heart disease in the
older age groups the total death rate from heart dis-
eases would be about 452 per 100,000 population, as
compared with the present rate of about 321 per 100,-
000. On such a basis, heart ailments would then be re-
sponsible for about one-third of all deaths in the
United States.

The situation with respect to cancer somewhat re-
sembles that of heart diseases. The cancer death rate,
all ages, has increased from 83 per 100,000 population
in 1920 to about 133 at the present time. Except in
infancy, the age-specific rates have risen in all age
groups, with the major inci'eases among persons 65
years of age and over.

Although there has been some decline in death rates
by age, vascular diseases of the brain has become the
third leading cause of death in the United States. All
but a verj- few deaths occur at ages 45 years and over.
The decline in the death rate from diabetes mellitus all
ages, is due principally to reductions in the younger
age groups. The rates from this cause increased con-
stantly at ages 55 to 74 between 1920 and 1940. Part
of the increasing death rate in the older ages may be
attributed to the prolongation of life of the young
diabetic through the use of insulin.

Killers and Cripplers

I am well aware that these data do not present the
still larger problem of disabling illness among our
older people. The conditions I have mentioned not
only kill — they make invalids of millions. But we are
all aware that many of the major crippling diseases
do not at the same time produce high death rates.
Arthritis, rheumatism, high blood pressui-e, other
metabolic diseases, mental and nervous ailments, for
example, are responsible for a large proportion of the
disabilities that keep older people from leading a nor-
mal, productive life.

That older people can be productive, has been
proved over and over again. More than one-fourth
of the 16 million women employed during AYorld War
11 were over 45 years of age. The number of older
men working during the war was even greater.

If we are to deal effectively wdth our aging popu-
lation, however, we must plan to conserve and em-
ploy the productive capacities of our older people to a
far greater extent than in the war years. And we
nnist plan to do so continuously and not as an expedi-
ent in emergencies. Work and a respected place in

society are as essential to healthful living as food and
shelter. If the longer life which modern technology
has fashioned for us is to be worth living, we must
try to make it healthier, happier, and more jsroductive.

This objective points up my earlier statement that
public health is the key to the solution of our prob-
lems. Building on the experience of our health agen-
cies, both official and voluntary, we must rapidly de-
velop effective methods for combating the chronic
diseases which are concentrated among older people.
"We must at the same time learn how to restore to
their highest possible levels of health, the millions of
men and women who are already disabled by disease
or premature "old age." These goals can be attained
if all groups who have anything to contribute join
together, with firm purpose to solve the many specific
and difficult problems inherent in such a task.

The task undoubtedly is formidable. It will draw
upon practically all fields of medical and public health
sciences. It will reach deeply into the social sciences.

Research Needed

The fundamental solution, of course, will come
from scientific research. At present, we have scant
knowledge of the causes of some of the major chronic
diseases, such as arteriosclerosis, hypertension, arth-
ritis, cancer, coronary occlusion, mental diseases, and
so on. We must eventually learn the causes. In the
meantime our abilities to control the course of tiiese
conditions in the patient, and even to reduce their in-
cidence in the general population, are much greater
than is often realized. There are reasons for real
optimism.

The most recent drastic proof of progress is the dis-
covery that hormonal compounds, such as cortisone
and ACTH, may be effective in the treatment of
arthritis. Even more promising is the fact that these
and other steroids provide new research tools for the
investigation of many of the most baffling chronic
maladies. Our ignorance today may disappear in the
light of new knowledge tomorrow.

Recalling progress in other chronic diseases, we find
additional grounds for optimum. Malaria, one of the
most devastating chronic infections, has almost dis-
appeared from the United States. Syphilis and tub-
erculosis— two other chronic infections — are being
rapidly reduced to a relatively low rank as causes of
death and disability. The control of syphilis eventu-
ally will show, even in the older age groups, substan-
tial reductions in syphilitic heart disease and psycho-
ses due to syphilis. Recent improvements in treatment
now make it possible to control undulant fever as a
chronic disease.

In the past two years, the Federal Government,

numerous voluntary agencies and private foundations
have greatly augmented research in the chronic dis-
eases and physical medicine, through aid to the Na-
tion's institutions and individual scientists. Prom
this expansion of scientific study, we can expect rapid
advances in one or more phases of chronic disease
control.

How, then, shall we begin to apply widely the exist-
ing knowledge of chronic diseases? How prepare for
future advances?

Control of many of the chronic diseases is a prac-
tical goal. The public health concept is to build a
long range program upon prevention, early diagnosis,
adequate and continued treatment, and rehabilitation.

As in the great campaigns against syphilis and
tuberculosis, we can go out into the highways and by-
ways and search for the undiscovered cases among
the supposedly healthy people. We can not only
search for the frank cases of disease, but for the con-
ditions that predispose to chronic illness or that are
its precursors.

Mass Screening

The Public Health Service, in cooperation mth
State and local health departments, is already experi-
menting with methods to extend mass case finding
techniques for several chronic ailments. In about 30
minutes, an individual passing through a "screening"
line can be given a chest X-ray; blood tests; urine
analysis ; blood pressure determination ; measurement
of height and weight ; and tests of vision and hearing.

The results of such combined case-finding pro-
grams indicate that if 1,000 apparently well adults
are given the battery of tests, over 900 instances of
chronic disease or defect would be found.

Tuberculosis, other diseases of the lungs, syphilis,
diabetes, anemia, high blood pressure, obesity, and
defects of vision and hearing can thus be "screened"
out for diagnosis and corrective treatment. Many
individuals will have multiple symptoms, especially
in the older age groups.

Chronic diseases occur singly, over long periods of
time, usually without obvious signals to the patient.
Epidemic diseases strike swiftly, affecting large groups
in short order. No community can or would ignore an
epidemic. The multiple screening plan would serve
to arouse both families and communities to active
concern for the prevalence and threat of undetected,
untreated chronic disease.

Watch That Fat!

On the preventing side, early treatment can greatly
reduce the disability clue to chronic disease and can
prevent premature death. One of the immediate

100

values of public health activity in this field would be
the control of obesity. The relation of obesity to
heart disease, hypertension, and other chronic dis-
eases is well known. The death rate among persons
55 years of age and over, who are 40 per cent over
weight, is 65 per cent higher than among people in
the same age groups who are of normal weight. Such
data support the need for developing an obesity con-
trol program.

It is far more difficult for an obese person to main-
tain normal weight, once he has achieved it, than to
bring his weight down to normal. Medical supervision
may be needed for long periods. The Public Health
Service is supporting joint projects in obesitj^ con-
trol, with the New York City Health Department and
the Boston, Mass., Dispensary. In the latter, experi-
ments are being conducted to determine whether
psj'chological factors that adversely influence weight
control can be overcome by group therapy.

Many new and improved tests are being developed.
Mass ease-finding tests for heart disease and cancer
will be added in the foreseeable future. If, in the
meantime, our multiple screening methods are or-
ganized and operated to smooth functioning, we will
be in a position to detect and place under treatment
manj' more adults who need preventive services, treat-
ment, and rehabilitation.

Community Services Needed

The quality of medical and hospital care for the
chronically ill and for the aged can be improved most
rapidly by organizing our existing community serv-
ices effectively, even while we are trying to build the
additional facilities which we need. The home care
project developed by Doctor Bluestone at Montefiore
Hospital in New York is destined to be emulated in
many parts of the country. The outstanding charac-
teristics of this program are the planning and team-
work which assure the patient continuous supervision
and expert care, without the often fatal break be-
tween hospital service and discharge to the home or
to a nursing or boarding institution.

Rehabilitation

Rehabilitation — the fourth basis of chronic disease
couti'ol — is of equal importance with the other three.
All services designed to care for the chronically ill
and aged will contribute in some degree to improve-
ments in their health status. The advantages of a
rehabilitation program to restore physical and mental
functions are so obvious, however, that the provision
of facilities and services for this purpose cannot be
omitted from any sound plan for older people. Re-
habilitation services can be integrated with a chronic
disease control j^rogram, despite the variation in or-
ganizations conceimed.

The citizens of every community possess qualities
of leadership needed to plan and establish a system of
integrated hospital, medical, public health, and re-
habilitative services. "We only need to find better
waj's of organizing and administering out services.
Recent amendments to the National Hospital Survey
and Construction Act make it possible for the Public
Health Service to aid State and local governments,
public and private non-profit institutions in studies
and demonstrations leading to coordinated systems of
hospital care. Such research will involve the integra-
tion of large teaching hospitals, regional and small
ciimmunity hospitals. It will involve, in many in-
stances, the relation of nursing and convalescent
homes, out-patient services, housekeeping, visiting
nurse, and medical social services to hospital care.

In no other field is there greater need for coordi-
nation of facilities and services than in programs for
the better health of older people. Public health work-
ers, social welfare agencies, hospital administi'ators
the country over are increasingly aware of the need
for action. Such official groups as this joint legisla-
tive committee illustrate the widening public interest
and the deepening public concern. The problems are
both perplexing and vast. I am confident that if the
persous all concerned with solving the problems of
aging will work together with firm purpose and self-
lessness, keeping the interest of the individual patient
uppermost, we shall work out effective methods for
ensuring better health to our older people.

10]

Medical Care for Prolonged Illnesses

By Dr. E. M. Bluestone

Director, Montefiore Hospital for Chronic Disease, Sew York City

THREE vital agents are involved in any discussion
of the economics of medical care for prolonged
illness: (a) the patient, (b) philanthropy and
(c) government. In the voluntary, non-profit hos-
pitals of this country the income from all patient
sources toward the cost of their maintenance last year
was 89 per cent. The relative burden of cost for
their care on philanthropy and government was, there-
fore, 11 per cent. It is only necessary to add that if
philanthropy does not make good its share, it is clear
that government must be invoked and no one has the
right to complain when, in circumstances like these,
government does step in to help dependent people
who cannot help themselves or get volunteers to help
them.

What I am stating here applies to any hospital, or
any type of medical care, which the sick, the near-
sick or the recently sick may require. However, as we
transfer these observations from the so-called ' ' acute ' '
general hospital to the "chronic" hospital, in an age
when such artificial and demoralizing distinctions are
still being made as a matter of actual practice, we
cannot help noting that the contribution of the patient
toward his care is progressively reduced with the
continuance of his illness. Patient suffering from pro-
longed illness, known too often as ' ' chronic ' ' patients
in tlie hopeless and incurable connotation of the term,
become involved eventually in a vicious circle from
which the philanthropist, with or without tlie help
of the taxpayer, must provide an escape. Poverty
and prolonged illness pursue each other relentlessly
where society does step in to break the circle.

In the only voluntary general hospital of its kind
in America devoted to the scientific care of prolonged
illness, namely Montefiore Hospital in New York City,
the total contribution of all of its patients toward their
care, on a comparable basis, is 24 per cent. In this
hospital ward patients, as part of the total patient
group, contribute only 6 per cent toward their main-
tenance. The burden that must be borne by philan-
thropy and government, with patients suffering from
prolonged illness, becomes heavier as the patient's
financial reserves disappear.

This financial problem is before us more pressingly
than ever, in view of the sheer numbers of people
suffering from prolonged illness and, in particular,
the relation of such illness to the aging process. There

are worse things in this world than d.ying young, or
dying suddenly. We are learning painfvilly that
there is such a tragic thing as dying on your feet, in
a wheelchair, on a stretcher, or in bed, over long
period of time. We should therefore be as much con-
cerned with the discomfort and unhappiness as we
are with pain and with the prevention of death. Pro-
longed illness is more characteristic of age than of
youth, though by no means limited to age. The rea-
son for this is that the human body, as it wears out
and as it acquires a succession of medical episodes
through life, becomes progressively less resistant to
the ravages of illness. We are getting considerable
help these days through the wonderful contributions
of scientific medicine, but the net effect of these con-
tributions is to prolong life in terms of years. The
productive medical scientist has been placing in the
eager hands of the social worker golden opportunities
for joint effort in the exercise of a relatively new
specialty, known as social medicine or human ecology,
which has for its ultimate objective the happiness of
the aged as well as of all others who can benefit from
its ministrations. It is to this specialty that philan-
thropy and government must look in a joint effort to
solve the problem created by age and by dependence
generally.

Acute and Chronic Cases

These thoughts lead me to complain about the dif-
ference between acute and chi'onic or, what is more
to the point, between the urgent and the non-urgent
in community-reaction to varying pressures. It is
now clear to any student of medicine and the social
sciences, that the distinction still being made, to the
detriment of the patient suffering from prolonged ill-
ness, between "acute" and "chronic", is a survival
of the pre-scientific era. The response to urgency has
thus far governed the charitable heart, but I submit
that the acid test of charity, in its most philanthropic
sense, is the response which it makes to less urgent
situations — to the unvoiced appeal of the patient suf-
ferer from prolonged illness. Response to urgency is
compelling and relatively satisfactory. As long as
the feeling of mutual aid prevails among men we wiU
be able to count fully and heavily on it in acute situ-
ations. But we have come into an era of longer life,
and of relatively longer periods of illness which may

102

lead to social dependence. We have also come into an
era of greater availability of medical and social ways
and means of dealing with them and the sooner we
plan for the less urgent, the better. The threat of
imminent death, and the presence of agonizing signs
and symptoms, will revoke an immediate response in
almost every case.

"We must now accept a cardinal jn-inciple of pre-
ventive medicine coupled with a cardinal principle of
social medicine, under which every effort must be
made not only to prevent illness but, if we are suc-
cessful in these efforts, to prevent death, chronicity,
complications, sequelae, relapses, and social depend-
ence. How is this to be achieved ; what is the cost of
achievement, and what are its benefits?

How long can we continue the unjust, inequitable
and often indecent distribution of medical facilities
which characterize our time? Tlie acute general
hospital has a try at the condition. If it succeeds
through its ovm efforts, with or without the help of
Nature, well and good but. if the condition does not
respond quickly to treatment, the patient must look
to his safety and his comfort elsewhere. But where
does one find a medical facility whicli is the equal of
the general hospital ? It is not enough to point with
pride to the achievements of the modern general hos-
pital and to say, which is relatively true, that it is the
very best resource of civilization for the practice of
scientific medicine. Why does it limit its benefits so
severely? What about the non-acnte — that vast seg-
ment of suffering humanity which is less vocal, still
needing a hospital bed and er|ually deserving of the
best that scientific medicine affords. The clinical and
social problems confronting the "acute" general hos-
pital are relatively simple and more quickly dealt
with. They are more dramatic for the ]ihilanthropist
and more spectacular for the clinician. However, it
is the patient suffering from prolonged illness with a
difficult, stubborn, and often complicated clinical con-
dition which gives a slow response, if any. to treat-
ment, that remains an eternal cliallenge to tlie man
of science, to philanthropy and to government.

No one seems to differ, in principle, in the conten-
tion that neither age nor duration of illness should
stay the hand of the planner in the field of medical
care yet, in practice, all but the acutely sick are out-
siders as far as the superb facilities of the modern
general hospital are concerned. Look into your non-
acnte medical facilities, and the exceptions which
prove the rule, and you will agree that we must seek
new, more equitable and more decent ways of dealing
with humanity's problem of medical disability. The
science of medicine must share the wealth in snch a
way that those people will benefit from it who need it.
foi' this is the essence of medical philanthropy. The

social workers, and the rehabilitationists working in
the medical field, are leading the way. How long can
the "acute" general hospital limit its magnificent
facilities to those alone who enjoy the benefit of a
snap diagnosis, as well as a snap diagnosis of a short-
term illness in the admitting room?

I
The Plight of the "Chronics"

Let me state the case this way. There are three
major reasons why an "acute" general hospital trans-
fers patients suffering from non-acute illnesses to
other institutions. The fir.st is the progressive loss
of interest in such patients by the medical staff. This
is due to the fact that these patients are considered to
be unproductive and therefore undesirable. The re-
sult is that the administration of the hospital is under
pressure to get such patients out, regardless of the
fact that there is no better facility in the world for
their care at a time when their need for a hospital
bed continues. This lack of clinical currency as well
as the lack of financial currency can, however, be com-
pensated for by (a) financial subsidies to doctors to
make up their losses from private practice ; ( b ) labor-
atory facilities for the stimulation of scientific talent
and Scientific interest in tlie problems of prolonged
illness, and for tlie recruitment of additional doctors
with selective interests in the various aspects of pro-
longed illness; and (c) classrooms and conference
rooms to stimulate the teaching.

Every bed in everj^ hospital, no matter where it is
located or by whom occupied, is potentially a teaching
bed and potentially a research bed.

The first reason for the transfer out of the "acute"
general hospital of a non-acute patient vn\l disappear
as the planner proceeds to apply these remedies and
integrates functional and structural facilities for the
combined benefit of both stages of illness.

The second reason for the transfer of a patient
suffering fom prolonged illness out of an "acute"
general hospital in his progressively meager financial
contribution toward his care. But this reason for
transfer too can be satisfactorily met by a subsidy to
the hospital from one source or another. What the
patient cannot contribute himself toward the cost of
his care must obviously be contributed either by phil-
anthropy and/or government. Once the medical
needs of this kind of patient are established he should
be assigned to whatever facility can do him the most
good regardless of his financial ability.

The third reason for transfer is the greater relative
need of the available bed in the "acute" general hos-
pital by the acutely sick patient. If the supply of
beds is not e((ual to the demand then obviously the
most urgent must be dealt with in the order of their
urgency, but this reason for transfer must disappear

103

where supply can be made to iiaeet the demand. In-
stead of establishing- the additional required bed at a
distance from the prime diagnostic and therapeutic
facilities of the general hospital, it should be estab-
lished within the hospital compound. This can in-
deed be done much more inexpensively within the gen-
eral hospital, since it avoids the expense of duplica-
tion and the handicap of distance to all concerned,
unless, the hospital can continue to furnish the re-
quired medical care to the patient in his own home.
We shall still face the danger of neglect of the
chronic sick in the presence of the acute, because of
the transfer of interest, sympathy and attention from
the former to the latter, but this will in the end dis-
appear. There is far more danger of neglect w'ith the
rustication of the non-acute patient at a distance
from the best of medical cart at a time when he may
need it most.

Medical Crumbs

Besides, the tenacity and stubbornness of prolonged
illness must be mat^'hed equally by tenacity and stub-
bornness in the medical and social scientists who are,
in turn, supported by jDhilanthropy and government.
This can only be accomplished if the patient is kept
before their eyes and not transferred to a spot where
he can gaze at the landscape while waiting for
medical crumbs to be thrown in his direction.

These remarks are limited to the patient suffering
from acute illuess as well as to the patient suffering
from prolonged illness. It is of the greatest impor-
tance not to confuse either of these with (a) the con-
valescent type of patient or (b) the so-called cus-
todial tjTie. The convalescent patient is safely on
the road to recovery from an acute or chronic illness
and may or may not need the continued use of a hos-
pital bed. The custodial type has made only a partial
recovery and is left with a burnt-out disease, an ir-
reversible scar or a residual handicap, which may or
may not require a hospital bed, but for social rea-
sons sometimes requires some kind of institutional
care. It ■^^'ill readily be seen that the aged patient falls
into one or the other of these four categories : acute,
chronic, convalescent or custodial. He is, besides, an
unattractive problem in preventive medicine and in
social medicine. It is a mistake to thing of his illnesses
as coming under the single heading of any such social
specialty as geriatrics. Whatever his illness, it be-
longs to the specialist who has been trained to deal
with it. The geriatrician can only hoi^e to be a case-
finder, a coordinator and a general practitioner to the
aged, as the doctor often is to the young.

New Criteria for Hospitals

Let us now bring these thoughts together, developed
largely in a great hospital laboratory for the study

of social medicine, and see the program for medical
care as a whole. Until such time as we are able to
build in accordance with this blueprint, we can at
least elaborate a functional coordination which will
lead by planned steps to the ultimate achievement of
the program.

To begin with, distinctions between acute and
chronic should disappear and a new criterion for the
admission of a patient to the general hospital should
be recognized and implemented, namely the need for a
hospital bed. Regardless of other consideration, this
need for a hospital bed should control admitting
policy. A patient who needs a hospital bed for the
care of his condition, acute or chronic, should get it
in one location, the general hospital. Broadly speak-
ing, these needs are (a) a period of close observation
in the highly concentrated diagnostic and therapeutic
atmosphere of the general hospital, where medicine
is practiced intensively and scientifically on a group
basis; (b) what is popularly known in the hospital as
a "workup"; (c) some form of service like a major
surgical operation; and (d) some form of treatment
which can only be administered on the hospital prem-
ises, like deep radiotherapy. These are the four major
criteria for admission to hospital beds. The poverty
of the patient, or the desire of the doctor for the con-
centration of his patients in one area for his personal
convenience, are in themselves invalid criteria for hos-
pitalization and represent a very expensive form of
care which can in fact be avoided. When the patient
does not need a hospital bed for his particular condi-
tion, or when he no longer needs a hospital bed, the
same quality of care must be offered by the liospital
to him in his own home, or in a substitute for his
home — an intermediate type of institution, preferably
though not necessarily on hospital grounds.

Transit of Patients

Let us see how the factor of urgency applies in such
a combined and integrated intramural and extra-
mural setup where the hospital radiates scientific
care directly to the patient if he is indigent, or in co-
operation with his doctor if he is not. With the dis-
appearance of the solid wall of the hospital, figura-
tively speaking, and the appearance in its place of a
combined stationary and mobile service, by which
most of the scientific facilities are centralized intra-
murally, the factor of urgency can be related by a
simple formula to the factor of distance. The greater
the urgency of the patient's condition, the less the
distance between him and the central facilities of the
hospital. The less the urgency of his condition, the
greater the distance. To illustrate, the patient who is
exsanguinated, or in shock, must remain within the
hospital operating room till the urgency of his con-
dition is at least partially relieved. With progressive

104

relief he can be removed (al to a recovery room
along-side (b) to a room on the same floor (c) to a
room on a floor above or below (d) to a room in a
pavilion alongside (e) across the street and, finally
(f ) to his own home, or to a substitute for his home.
Hospital care accompanies him in every ease, reduc-
ing its intensity to meet the requirements of medical
necessity. Hospital cpiality is guaranteed to the pa-
tient at all times. He is as much a hospital patient in
his home as his former neighbor who remained on
the hospital wards. The same social and scientific
hierarchy stands guard over him, under the protect-
ing Avings of the hospital, and there is a free exchange
of intra-mural and extra-mural patients on a priority
basis.

In a teaching hospital, the teaching material and
the opportunity for teaching thus provided in a com-
bined program, are priceless. In a hospital fortunate
enough to do scientific research, the patient is under
observation and control under this combined plan for
a period of time which is limited only by death.
Such a complete, comprehensive and continuous plan
of medical care has no equals and no competitors in
a democratic society. The hospital and its out-patient
department representing the intra-mural services, and
the home and the substitute for the home representing
the extra-mural services, employed for the benefit of
the indigent, the insured groups and those who can
afford care on an individual fee basis, can do away
with the inequities and the indecencies which are still
being tolerated. In no other way can the taxpayer,
philanthropist, medical man of science and social
worker generally serve the sick and the near-sick to
better advantage. Select your patient, or the clinical
condition from which he is suffering, and the doctor
working in collaboration with the social worker can
find for him in this combined i^lan of medical care the
place he needs most. And let me remind yon at this
point that when the problem of prolonged illness will
be solved we shall know that we have solved almost all
of the problems of medical care.

"We shall doubtless find that we need less beds with-
in hospital buildings than we thought we needed when
we were engaged in expansive and expensive post-
war planning onl}- a few years ago, and also that we
need more trained personnel, combined with inore
scientific facilities, in the hospitals that we now have.
TVe need more financial subsidies, more teaching and
more scientific investigation in modernized buildings
which, until structural unification can be worked out,
should have the benefit of functional unification. On
the other hand, the housing expert should take into
account the incontrovertible fact that better housing
means less of a burden on the community for hospital-
ization.

We have oversold the hospital to the public. For-
tunately the way back is inexpensive. With a cost
of two dollars per cubic foot of hospital construction,
and with the present-day requirement of 10,000 cubic
feet to serve every hospital bed, the capital investment
is rapidl}' becoming unbearable when the facility is
used indiscriminately. Moreover, the cost of mainte-
nance has risen to unbearable heights on behalf of too
many people who do not require such costly facilities.
In circumstances like these we must look to the inex-
pensive bed in the home of the patient and use it to
his best advantage. Far more important, however,
than the prevailing high costs of medical care is the
opportunity which extra-mural hospital service radi-
ating into the patient's home affords for the individ-
ualization of care on a personal basis. The mainte-
nance of the identity of the patient, his privacy, his
self-respect, his freedom of movement unhampered by
demanding neighbors who are strangers to each other
in the hospital ward, and his presence in the bosom
of his family in the natural environment of his home,
improve his comfort and speed his recovery. The
patient has, indeed, the pleasant illusion that the hos-
pital exists for him alone and that it stands ready, as
it indeed does, to serve him under all circumstances.
Let me remind you that, with the best intentions in
the world, the hospital, knowing the patient an aver-
age of only eight and a half days and applying a
mechanical routine in his care, cannot help adding in-
sult to injury. It should not be offered as a resource
unless there is no better method of dealing with the
patient's problem.

Home Care Cost Lower

With an experience of almost three years in the
field of comprehensive home care under hospital
auspices, we found the cost of such care to our hos-
pital, on a comparative basis, to be approximately
one-fourth of the cost of ward care. Moreover, we
have approximately one-fourth of the cost of ward
care. Moreover, we have found that patients are
more comfortable in their homes and we confidently
expect to prove by statistics that they get well
quicker at home because of the added factor of per-
sonal comfort which dominates the mental attitude
of the patient and his family.

It is our hope that hospitals generally will adopt the
criteria for admission which I have outlined here, and
distribute patients in wards, in out-patient depart-
ments, in the homes of these patients and in substi-
tutes for these homes, under the protecting wings of
these hospitals, to the end that every man, no matter
what his age or how long the duration of his illness,
will find readily available to him the exact facility
which he requires to restore him to health.

105

Hospitals and Our Elderly

By Commissioner Marcus D. Koegel

Commissioner of Hospitals, New York City

HOSPITALS are places for the congregate care of
tlie si<'k whether the illness be acute or chronic,
and the victim of disease young or old. How-
ever, the two extremes of ages are often forced npon
hospitals even though no disease is present. The hos-
pitalization of the well baby, because society has failed
to provide a more suitable shelter for the infant or
of the elderly, and for no better reason, constitutes
the imposition upon our hospitals of a great burden
aside from the potential and actual damage to the
innocent recipients of our charity, by an intimate asso-
ciation with disease and disability.

The jn'oblem of the child, however, is a minor one
compared to the growing problem of the aged. In
dealing with this situation we must develop some fun-
damental concepts. One of these is that general hos-
pital facilities should be used for the elderly requiring
active treatment of either an acute or chronic illness
and that some other type of accommodation is needed
for the infirm aged, the physically handicapped aged
or for the oldsters who are well and homeless.

We can shout this principle from the rooftops but
as long as those other types of accommodations are
not provided — the backlog of patients unsuited for
active hospital care continues to tie up costly hos-
pital beds and services.

Our adult general hospital population has under-
gone a shift in age distribution in the direction of the
older age groups. This is not unexpected when one
considers the increase in the percentage distribution
of the elderly in the general population of New York
City. The 1948 population estimate assumes a total
of one-half a million people (541,678) 65 years of
age and over which is more than double what it was
in 1930. Older people get sick more often and stay
sick for longer periods. As Professor Ginzberg so
aptly puts it, by lengthening the average span of life
we have "traded a lessened mortality in the earlier
years for an increased morbidity in the aged."

Glamour Cases

Our general hospitals do not take kindly to the
elderly sick. They have been geared to the dramatic
illness, the crisis, the hectic flush, the high fever. Our

whole philosophy is one of youth and glamour and
plenty. The aged patient brings apathy, garrulous-
ness, irreversible damage and incontinence. None of
this is pleasant.

Our reorientation must begin in the schools of medi-
cine and in the schools of nursing and we must find
some means to awaken the present schools of nursing
and we must find some means to awaken the present
generation of practitioners to a greater interest and
a more dynamic approach to the problems of the aged
sick.

An important reason for the disinclination of the
general hospital to treat the oldster is that there is
often tlie strong possibility that the bed will be tied
up indefinitely. Delays are frequent in discharging
elderly people after they have received the maximum
benefit from hospitalization. Often there is unwill-
ingness on the part of the patient to exchange the
sheltered environment of the hospital for the discom-
forts of a home long since preempted of affection or
warmth. Then there is the resistance on the part
of the family to the return of the aged one to the
family hearth. In a city such as ours with restricted
accommodations and every cubic foot of space worth
its weight in gold and filial devotion at a low, the bur-
den of care of the aged at home may become intoler-
able.

There is one segment of the elderly sick whose re-
ception in our general hospitals is downright hostile.
I have reference to the senile psychotic. There is no
hiding place for this unfortunate individual and
irrespective of the physical condition, he is sum-
marily relegated to a facility for the care of the
insane. Many mental conditions of the aged are
transitory but the disturbance must be brief indeed
if the patient is to escape the stigma of commitment
to a State institution.

I do not propose that the municipality assume the
responsibility for the patients with personality disin-
tegrations and psychoses which have every appearance
of being permanent. "We must however develop a
more compassionate approach to the short-lived epi-
sode of confusion and disorientation so often a con-
comitant of medical and surgical ailments in the
elderlv.

106

Five-Point Progi-ani

What rearrangement is necessary so that the ^'en-
eral hospital may adapt itself to provide properly and
economically for the steadily increasing number of
aged patients ?

1. It should develop a clirouic disease wing or unit
where the aged patients can be transferred as
soon as the acute episode of the illness is over
and prior to transfer to home care or discharge
to home, to a nursing home or custodial institu-
tion. The close relationship of such a wing to
the general hospital will make readily available
all of the hospital services and good care can be
furnished the patient at a cost much below that
in the acute section of the hospital.

2. It .should provide a small suite of sound-proof
rooms and ancillary facilities for tlie temporary
care of the non-custodial psychotic.

3. The general hospital must organize a dynamic
program of rehabilitation which in the aged will
be geared to develop in the patient the ability to
meet the daily demands of Living and to restore
him to the greatest degree of usefulness and
self-sufficiency.

Idleness and inactivity encourage deteriora-
tion and a breaking down of morale; therefore,
if planned activities and interests are available,
mental and physical deterioration is less pro-
gressive. It is well for these patients to know
that while they are ill there is a definite plan
for their rehabilitation — a program of activities,
■\vithin their area of accomplishments, which will
help them to re-establish the normal pattern of
living and restore feelings of confidence and
self-respect.

4. An active home care program must be estab-
lished. The extension of hospital care into the
home is no longer in the experimental stage or
on a demonstration basis. The highly success-
ful program of the Department of Hospitals and
the splendid pioneering efforts of the ]Montefiore
Hospital in New York have established home
care as a necessary tool in any system of com-
prehensive hospital care.

5. The general hospital must strengthen its serv-
ices for the care of the ambulatory patient and
make it possible for the ambulant aged to re-
ceive prompt attention and good care in its Out-
patient Department. In order to insure the
maximum utilization of outpatient services it
may be necessary to develop a voluntary motor
corps for the transport of the elderly to and
from their homes. Thought will have to be
given to the elimination of the architectural bar-

riers which render access to clinic services a
nightmare to the disabled and infirm. Above
all, the bustle and the hurry and the attitude of
disinterest and irritation Avill have to be re-
placed and the elderly patient made to feel that
lie is wanted and that the hospital services are
there to benefit him.

Whatever the initial outlay for these changes, the
end results will reflect great savings. The bottle-
necks which tie up active hospital beds with inactive
patients, the mental and physical deterioration of the
neglected elderly patient — all these will cease.

Reorganization Only Part of Answer

Unfortunately, however, the problem of hospitals
and the elderly is not solved with the reorganization
and modification of the services in general hospitals.
Today the patient over 65 makes up almost 7 per cent
of the population of New York City. By 1960 lie is
expected to account for 9 per cent of the total popula-
tion and by 1980 for over 11 per cent.

To supplement the chronic disease service of a gen-
eral hospital we still need in a city such as ours a hos-
pital of the type of the Bird S. Coler Memorial Hos-
pital. This 2,000 bed facility now going up at the
north end of Welfare Island wiU provide the outlet
for the chronic disease units of the general hospitals.
It will take the bedridden chronically ill and aged
patients, the handicapped and the infirm for whom
other arrangements cannot be made. This will be by
no means considered the end of the line, for the most
active reliabilitation program will be developed. Care
will be individualized and every effort will be made
to get the patients out of bed — to take care of them-
.selves and restore self-confidence and some measure of
independence.

Affiliation of the hospital with a medical school will
assure a continuation of professional interest and
the aA-ailability of even the most highly specialized
medical services. Experience has taught us that it is
unwise to isolate a hospital of this type geographically
from the professional skills that are required to serv-
ice it. In fact, the closer this type of hospital is to a
general hospital the better for all concerned because
it is then possible to integrate the services with a gen-
eral hospital and to arrange for the rotation of the
house and resident staffs through this unit.

To maintain the interest of the professional staffs
it is imperative to provide incentives in the form of
research facilities. This not only attracts good men
to the hospital but pays valuable dividends far out
of all proportion to the small investment in space and
equipment. At the Bird S. Coler Memorial Hos-
pital we not only failed to do this but we were lax in

107

planning adequate X-ray and laboratory services.
These deficiencies will be remedied. Actually it was
no one's fault. Our thinking hadn't crystallized to
the point where we were sufficiently sure of ourselves.
We know now that the apathetic era of care for the
chronically ill belongs to a bygone day and that we
have now entered a new age when the most hopeless
patient is approached in the spirit of hopefulness and
with an enthusiasm and zeal that transcends all diffi-
culties.

In a city the size of ours there is room for still an-
other t.ype of hospital in which the elderly make up a
considerable proportion of its population. I have ref-
erence to a research center in chronic diseases of the
type of the Goldwater Memorial Hospital. This was
planned as the laboratory where selected jDatients
and selected diseases 'would be studied so that some
light could be shed on the aging process and the long
term illnesses that plague our people. Here new tech-
niques would be developed in treatment and special-
ists and technical personnel would be trained to take
care and take their place on the staffs of other hos-
pitals to practice and teach what they have learned.

Unfortunately the numbers of chronically ill, aged
and infirm grew rapidly to such large proportions
that in no time they choked the adult services of our
general hospitals and flowed over and inundated all
of our homes and units designed for their care, in-
cluding the Goldwater Memorial Hospital. As a con-
sequence, the research activities of the Goldwater
Memorial are limited and this great hospital will not
be able to fully carry out its purpose until our con-
struction and modernization program has been con-
siderably advanced.

In spite of all handicaps, however, the Goldwater
Memorial Hospital has made many significant and
fundamental contributions.

Full justice cannot be done to the subject of hos-
pitals and the elderly without some discussion of the
special needs of the aged and what specifications are
required in the hospital environment to meet those
needs.

Special Environment Factors

The aged require a familiar, pleasant and homelike
environment with more than the usual physical com-
forts, protection from accidents, and special psycho-
logical and emotional support.

Physical comfort includes such items as warmth,
good ligliting, an adequate place for personal posses-
sions, easily accessible toilet and bathroom facilities,
privacy (small units), quiet (soundproof areas), com-
fortable furniture, suitable clothing and shoes in
good repair, between meal snacks if and when desired,
a magnifying glass and hundreds of other little things

which make for comfort and whicli are of paramount
importance to the elderly.

Protection from accidents is particularly important
in this group as older bones are more brittle, older
eyes are less keen and the recuperative powers of
older bodies are less responsive. Protection from ac-
cidents implies attention to well-lighted stairways and
corridors, sturdy railings in good repair, ramps where
possible instead of stairs, stairs free from impedi-
ments, non-skid floors, rubber mats in the bathroom
for use in the bottom of the tub to prevent slipping,
thermostatically controlled water, plumbing in good
repair, hand rails and elevated rests in bath tubs to
eliminate the possibility of slipping and to make get-
ting in and out of the tube less taxing, electrical ec|uip-
ment in good repair, wires completely insulated and
sturdy plugs and switches conveniently placed to
eliminate the need for searching for them in the
dark, low beds for the ambulatory patient to prevent
falls.

Furniture in the patient unit shoixld not be too
hard and not too soft, not too high and not too low.
It sliould be anchored, as the elderly patient is apt to
lean against beds, tables and chairs and lose his bal-
ance. Armchairs should be provided. Wheelchairs
sliould be equipped with special foot pedals. Me-
clumieal devices facilitate lifting heavy, helpless pa-
tients from their beds and prevent injury to woi'kers.
Beds equipped with protective sides prevent falls
from bed. Doors sufficiently wide to admit wheel-
chairs permit easy transportation of patients.

Furniture should not be moved after the older per-
son retires so that if he awakens during the night he
will not be unfamiliar with the arrangement. Night
lights eliminate the confusion caused bj' darkness.
All of these are means of protecting the elderly
against injury.

The older person must be encouraged to give
thought and attention to items of personal hygiene.
Good iDlanning of the bathroom and toilet facilities
will help the oldster take better care of his personal
needs.

Bathrooms sliould be equipped with movable shower
sprays and the cubicles should be sufficiently wide to
permit the entrance of wheelchairs. I do not know
the solution to the bathtub situation except to elimi-
nate bathtubs. However, we need bathtubs at the
appropriate height for the ambulatory patient; at
stretcher height for bed patients ; low tubs for arth-
ritics so that they can step into them without danger
and portable tubs for jjatients who cannot be trans-
ported to the bathroom. Some day somebody will
actually take the bull by the horns and eliminate all
bathtubs.

The toilet stalls must be wide enough for wheel-

108

chairs aud hand rails must be provided so that the
patient can support himself. Commode-like toilet
seats are necessary. Call bells should be provided
in all areas, and jDatients taught their function. Wash
basins and mirrors should be placed at a convenient
height to enable -n'heelchair patients to use them com-
fortably.

Feetling the Elderly Patient

The elderly patient offers a challenge to the dieti-
tian who has advanced to the point where she is ready
to revise the old concepts and discard the practice of
limiting their diet to the bread, tea aud applesauce
regime which has been too long a common and wide-
spread procedure.

It is essential that the nutritional elements of an
adequate diet be supplied in generous amounts, and
in a form which can be masticated and digested by
the elderly person.

We in the Department of Hospitals have in recent
years accepted this challenge and completely revised
the feeding program in the units devoted to the care
of this group. The menus were greatly expanded to
insure a higher nutritional value, a greater variety
of foods was provided, aud the preparation of many
foodstuffs elaborated.

Specific food increases included a greater allow-
ance of milk, ice cream and other dairy products,
more citrus fruit in a form suitable for the aged, a
wider variety of frozen and fresh fruits and veget-
tables, larger allowances of meat, poultry and fish
and a wider selection of desserts and food adjuncts.
The size of the portions were somewhat reduced in
order to allow for the patient's capacity.

Too much emphasis cannot be placed on the im-
provement of the food's appearance, the adjustment
of tableware and cutlery to the handling abilities of
the elderly person, and the decor of the dining area.

Certain structural arrangements must be made for
feeding areas — gently sloping ramps leading into the
dining rooms, or small dining rooms close to the pa-
tient's bed location, wide aisles between tables and
specially sturdy construction of chairs and tables.

Table service is usually the wisest choice for elderly
people, but where the psychological aspect of self-help
is important, partial cafeteria service can be effective
therapy.

In liuspitals where the stay of the chronically ill
or the elderly is prolonged and the number to be
cared for is great, beauty shops must be provided for
the ladies and barber shops for the men. The ladies
also need readily accessible to them a place to wash
intimate personal things.

There is a great need among the elderly patients for
recreational and social activities and they should be
given the opportunit.y for religious observance.

I have carefully steered clear in this presentation
of the public home for the aged and the nursing home.
Both these facilities are essential elements in a pro-
gram for the elderly. The large nursing home in fact
often approaches closer to the hospital and our public
homes frequently become filled with sick aged who
overflow their infirmaries and should be in hospitals ;
on the other hand the chronic disease service of a gen-
eral hospital or the chronic disease hospitals have
many patients who require only shelter and affection.

The nursing homes can stand considerable improve-
ment in the quality of care they render and this is an
area in which we hope to exert some influence in the
future. We are verj^ anxious to develop a type of as-
sociation which will permit us to transfer to the nurs-
ing home from the hospital patients suitable for home
care but who do not have a proper home. Today our
home care program is limited to patients where the
home environment is suitable for the extramural care.

The hospital care of the aged is merely one facet of
a large problem. A major effort of the community
should be to keep the aged at home as long as they can
be kept there with comfort and safety. Serious
thought should be given towai'ds the provision of
dwelling units and community services designed espe-
cially to make the same i)ossible and every assistance
should be rendered to simplify the extension of hos-
pital care into the home when this becomes necessary.

We will never have enough hospital beds for the
aged sick or public homes for the homeless aged if the
individual permits himself to be easily swayed to sur-
render to the community the ver.y personal responsi-
bility which is his for the care of the aged and infirm.

No public home can ever take the place of the
family hearth and no hospital bed can ever compete
for comfort and security with the bed in one's own
home.

lUiJ

The Physicians^ Contribution to a State-wide

Program for the Aged

By Dr. Frederic D. Zeman

Chief of Service of the Home for Aged and Infirm Hebrews, Neiv York City

THE WORD "geriatrics'' is an extremely iiseful
word, gathering- into a very short space a num-
ber of varying concepts. But the word geria-
trics should not be interpreted to mean that the care
of the aged is necessarily a medical specialty, for ac-
tually all the medical specialties with the exception of
pediatries and obstetrics have to do with old people
in one waj- or another.

Furthermore, it must be realized that tliese prob-
lems are increasing so rapidly that we maj^ reason-
ably expect that the care of the aged is going to, in a
very short time, comprise 75 or 85 per cent of what we
call internal medicine.

It is, therefore, worth while today to discuss what
the physician's responsibility is in relation to these
problems and to point out the many ways physicians
come into the picture, and, furthermore, to point oiit
something as to what physicians have been doing in
this State and throughout the Nation.

About two years ago I spoke before the Annual
Conference of the New York State Conference of So-
cial Welfare at Buffalo on a state-wide program for
the aged and the chronically ill. At that time I drew
up as much for my own information as for the in-
formation of my audience a diagram which indicates
the set-up or the possible set-up of a state-wide pro-
gram.

Soeio-Medical Aspects

Now, I have been very fortunate in my own train-
ing. I was taken in at a very earl3' age by a very
remarkable group of social workers associated with
the Welfare Council of New York City. And, through
their efforts and through their continued queries, I
was led to go further into the social aspects of these
problems than many of my colleagues, and so there-
after I began to be confronted with two concepts.
One is the general principle of the Welfare Council
as a coordinating agency for all of the activities in a
community, and, secondly, the principle of a central
control bureau for the care of a particular group in
the community. I was helpful a few years ago in
setting up such a bureau for the care of the Jewish
aged in New York City, and this bureau has been

functioning most successfully under the direction of
Miss Flora Fox for a period of years, now, and it
serves as a central office where old people in need of
assistance can not only find information but can be
examined, their functional capacities can be deter-
mined, and advice can be given to them on the basis
of a careful medical and social service study.

Now, as chart indicates, you will find on the topmost
level the Legislature of the State, meaning the Gov-
ernor, the Senate and the Assembly — all the elected
representatives of the people — and, in association -with
them on this highest level I have placed the State
Health Department, the State Department of Social
Welfare, the State Department of Mental Hygiene
and the State Medical Society. These groups would
send, according to my plan, delegates to a State Coun-
cil for the Aged and the Chronically 111, and the State
Couu(ul would work in each community through a
Local Council or Welfare Council for the Aged or
Chronologically 111.

You will be interested to see how many agencies in
eacli community would naturally share in the work
of the local Welfare Council. You will find that im-
mediately involved are the hospital service — social
service departments, private social welfare agencies,
the Bed Cross, the Visiting Nurses Associations, the
County Medical Society, and the citj* or county health
departments, the city or county public welfare de-
partments, and mental hygiene agencies. That is a
very large and diverse group, and each one is par-
ticularly interested in certain aspects of the care of
the aged, and each one has a definite and important
contribution to make. Therefore, their co-ordina-
tion, the integration of their acti\aties, is something
we must try, as citizens, to accomplish.

These agencies, working together, would then set
up a Central Bureau, and that would have a medical
and social service staff, and operate out-patient de-
partments. Thej' would also operate recreational
agencies for the aged, which have been so successfully
designed in this city by the Department of Public
Welfare under the leadership of Mr. Harry Levine.
Sheltered workshops would also be one of their func-
tions, but I want yoii to realize particularly the other
agencies that would be involved : the general hospitals,

AN INTEGRATED PLAN fOU THE CARE Of THE CHRONICALLY SICK AND AGED
IN NEW YORK STATE

BY FRtDLRlC D. ZEMAN. M.D.

STATE LEGISLATURE
SENATE ASSEMBLY

STATE DEPT. OF HEALTH

STATE DEPT. OF
SOCbU, SELFAKE

STATE DEPT. OF
MENTAL HYGIENE

STATE COLNCIL

fOR AGED AND

CHRONICALLY SICK

VISITING NVBSE
j^SSOCUTION

HOSPITAL SOCLVL
SEKVICL DEPTS.

PKIVATE SOCIAL
HELFARE AGENCIES

I LOCAL COl-NCIL '

FOR AGED AND

CHRONICALLY SICK

CENTRAL BlREAl |

MEDICAL STAFF |

SOCDU. SF EVICE STAFF I

COUNTY
MEDICAL SOCIETY

CITY OR COUNTY'
HEALTH DEPTS.

CITY OR COUNTY PUBLIC
HELFARE DEPT,

MENTAL HYGIENE
AGENCIES

GEM R4L liOSPITALS
PRI\ATE 4; PI BLIC

RECREATIONAL
AGENCIES FOR AGED

SHELTERED VtORKSIIOPS

' F OR aiRONIC ILLNESS I

IMVERaTY
MFDICAL SCHOOL

STATE GERONTOLOGY

' CARE PROGRAM I

PRI\ ATE HOMES
FOR THE AGED

STATE HOSPITALS
FOR MENTALLY SICK

RESEARCH LAD.

SPECIAL HOI SING

FOR AGED AND
CIUIONICALLY ILL

Note: Existing ageDcies are indicated by solid lines.
Proposed agencies are indicated by dotted lines.

public and private. As Dr. Mouroe pointed out. the
general care in the liospitals lias steadily increased.
Two men on the staft' of Bellevue not loug ago wrote
an extremely interesting article under the title of,
"The Patients Are Older and Stay Longer." Then,
coupled with that, you have the private homes for the
aged, the state hospitals for the mentally sick, the
state hospitals for chronic illnesses, and the university
medical schools. Then it would be necessary to in-
clude a State Gerontology Eesearch Laboratory as
weU as special housing for the aged and chronically
ill.

Now, as you see, many of these agencies are already
in existence. It would be necessary to create certain
new ones, such as the State Gerontology Research
Laboratory. The state hospitals for chronic illness, I
believe, may be on the way. They have been highly
recommended by the Health Preparedness Commis-
sion of this state.

The home care program is something we should
give a great deal of attention to. It is actually the
future hope for the care of the aged. We have set
up such a bureau in the Central Bureau for Jewish
Aged, and in cooperation with the Jewish Family
Service, particularly through their home-maker's
service, and under our home care or extramural pro-
gram, as we prefer to call it, we provide for old
people in their own homes, visiting physicians, visit-
ing nurses, visiting houseworkers or homemakers,
and we hope, in time, to supply visiting occupational
therapists and visiting volunteer visitors.

The number of old people is increasing so rapidly
that institutional care is no longer possible, even if it
were desirable. It certainly is not desirable except
for people who are chronically ill in one way or an-
other. Our whole effort must be to extend this home
care program. But I want to say, however construc-

111

tive theoretically this home program is, it presents
certain defects from the standpoint of the mental at-
titude of the prospective client. We have found from
experience when old people come to us asking admis-
sion to the home they only do so after they have spent
long hours of soul searching, long hours of sti^dy and
discussion with the family, and when they ha^-e finally
made up their minds they want to go into an institu-
tion tliey will not be put off with a substitute program.
It is, therefore, necessary that we educate the public
in the ways of the home program, and one of the
waj's we do that is to assure our home care clients
when the time comes they need institutional care thej^
will have a first priority on the services of the institu-
tion.

Attitude of Physicians

I want to point out particulaidy that the physicians
of this state and the physicians of the Nation are
deei^ly and profoundly interested in and aware of
these problems. I have had the same experience that
Dr. Monroe has had with colleagues who seem to
think that they can still practice on what they learned
in medical school about old people, and who seem to
think there is nothing more that the.y can learn, even
today. I have also had the experience of being
treated with rather poorly concealed contempt and
condescension by some of my colleagues who can't
understand how I can possibly be interested in old
people. Actualh' these men are missing out on one
of the great experiences in a physician's life if they
have never had the opportunity of taking care of old
people. "Whereas the younger person expects ever.y-
tliing as a matter of course, the old person is so used
to being pushed around by his family, and so forth,
than when he meets a physician who brings to him
the understanding that Dr. Monroe does, for instance,
he is put a little off balance and he doesn't know just
how to take it, and his gratitude is something that is
really touching and puts the physician distinctly on
his mettle and makes him think that this is a human
being for whom he must put forth his very best
efforts.

As Dr. Monroe pointed out, today we are able to do
most important things for people medically. The con-
trol of infections of old age by antibiotics has changed
the picture completely. The death rate from penu-
monia has dropped spectacularly. A fatality from
disease like erysipelas is almost unheard of nowadays,
and it is possible to treat infections of the genito-
urinary tract and infections of the peritoneal cavity
with the greatest success. There was a time not so
long ago that a surgeon who would operate on a
patient 70 years or over would have been looked at
askance by his colleagues — as one who had an itching
scalpel. Today it is a common practice in your hos-

pitals to operate on patients over 80 — and to operate
on them successfull}\ And the two most important
things that contribute to that are improved anti-oper-
ative and post-operative care, and improved anaes-
thesia, and the use of anti-biotics and the abundant
use of penicillin and plasma.

The physician's responsibilit.y is in his institutional
work, in his work in the general hospitals, in the hos-
pitals for chronic diseases, and in the homes for the
aged, too. The homes for the aged, as presently con-
stituted, form a great area for the practicing young
jjhysieian to earn his reputation. They contain mate-
rial which is, for the most part, untouched for the
phj'sician with an investigative turn of mind, and
which will afford him the opportunity of doing work
of real value.

Now, the physician in industry has a responsibility
to old people because it is up to the lahysieian to de-
cide what a man's functional capacity really is be-
cause, as this Committee has so widely publicized,
birthdays don't really count — it is what a man can
do really counts — his functional capacity — and it does
not parallel the number of years you have spent upon
this earth, as we all know.

The physician has a great responsibility for educa-
tion. At the Home for the Aged and Infirm Hebrews
we are conducting a course for graduate physicians
and have, for the past five years and, with my col-
leagues, we give about 18 hours each semester, under
the auspices of the College of Physicians and Sur-
geons, given partly at the home and partly at the Mt.
Sinai Hospital, in the care of the aged. The regis-
tration is graduallj- increasing — although I must say
the biggest registration we had was in the first two
years after the war, when men could take the course
under the G.I. Bill of Rights.

In addition, we have at the home an affiliation with
the Division of Nursing Education of Teachers Col-
lege, Columbia University. I think it is greatly to
the credit of the educators that thej^ realize that the
work later on of the nurses is going to be largely work-
ing with the older people. We started off two years
ago with a one Aveek course for those people studying
for higher degrees of nursing in Teachers College.
That work has been extended to a two-week course,
one week of which is devoted to work in our occupa-
tional therapy department and the second week to
taking care of old people. In addition, we now have
student nurses sent down just briefly for a visit from
the St. Luke's Hospital and Presbyterian Hospital.
Which shows that these teachers of even undergradu-
ate nurses appreciate the significance of the problem.

Research Needed

The need for research does not need to be empha-
sized or enlarged vipon. We have gone a long way but

112

there are still many basic, fundamental problems to
be explored. The research in this department must
be forthcoming in order for us to make further
progress. And that brings me to the responsibility
of the physician as a member of the district profes-
sional societies — as a member of the county, state and
national organizations. These organizations are also
doing their part. The American Medical Association
has co-operated with the American Public Health As-
sociation and two other national organizations in set-
ting up the Committee on the Care of the Chronically
111, which is about to start functioning under the
leadership of Dr. ilorton Levin, late of the New
York State Department of Health and the Executive
Secretary of the Health Preparedness Commission.
The New York State Society has a Study Committee
on Geriatrics and the New York County Medical So-
ciety has a Sub-Committee on Geriatrics, headed by

Dr. C. Ward Crampton. So that I think you will
realize that these problems of the aged require intense
and hearty co-operation between physicians and the
social workers and the nursing profession for the
proper functioning of any kind of set-up that is de-
vised for their solution. I think it is interesting to
realize that the very first group in the field met at a
meeting of the New York Academy of Medicine in
192S, and at that meeting some of the noted authori-
ties from this country and from England spoke and
really gave us the first impetus to the scientific study
of the problems of the aging in this country, Avhich
culminated some 11 or 12 years later in the publica-
tion of the work of Dr. Cowdry "Problems of the
Aging," which has gone into a second edition and is
just about to go into a third edition, and which actu-
ally forms the Bible and reference book of physicians
workins' in this field.

113

The Functions of a Geriatric Clinic

By Dr. Robert T. Monroe

Peter Bent Brigham Bospital, Boston, Masfiachnsetts

OLD AGE is tlie time of life when persistent dis-
eases occur most frequently, and when scars
of accidents and disease, and deficits of all
sorts, steadily accumulate. No one, in fact, can live
beyond middle life without sho^Aang some evidence of
the ravages of time. And so, old people are the big
problem in our hospitals and other institutions. In
the Peter Bent Brigham Hospital, with which I am
connected, one in every three medical service admis-
sions is OA'er 61 years of age. This hospital does not
take children under 12, and the proportion of old
people in general liospitals probably is less, but it is
not likely that they are under one in five.

A survey of the almshouses of Massachusetts four
years ago showed that two-thirds of the occupants
were over 65 years of age, and two-thirds of them
were bed or semi-bed patients. I would guess that
age-composition of our nursing homes is equally
weighted in favor of old people. Yet old people make
up less than 10 per cent of our population.

Old people need their full share of hospital facili-
ties. They respond as favorably to the amazing anti-
biotics as their younger neighbors. Surgical proce-
dures are now about as safe for them, also, and they
need no longer be denied curative or palliative opera-
tions because of age. A very great improvement in
the quality and the duration of life is available to
them.

But I do not believe that they need as large a per-
centage of our general hospital facilities as they now
preempt. It is obvious that many sick old people go
to hospitals for minor troubles because they have no-
where else to go. This is a waste of both money and
space. For hospital study and care are the most ex-
pensive form of medical service, and in many areas
there are too few beds to i^ermit them to be occupied
without regard to a priority of needs.

When we have hospitals for chronic diseases, and
wards for the same purpose in general hospitals, thej'
will be used very largely b.v old people. In them we
can take excellent care of patients with complications
of diabetes mellitus, others with persistent heart or
kidney failure, and those with fractures and arthritis.
They can be our best resource to study the means for
rehabilitating patients with paralysis and inadequate
circulation. But, again, we must guard against their
becoming repositories for terminal care. It is un-
likely that we shall ever have so many beds for chronic

disease that we can tolerate indefinite residence in
them.

Nursing homes enter the picture here. Some will
be for custodial care of patients who have been dem-
onstrated unable to improve on active treatment.
Other homes will be for the advancement of convales-
cence to the point where families can take over. Still
others may be for minor acute illnesses, such as grippe
and sprains, in patients, especially old ones, whose
resources at home need such supplementation. If
enough of these nursing homes are administered and
staffed by local general hospitals, the quality of their
care will raise the standards of all above their present
deplorable level.

Geriatric Clinics Needed

This completes the list of buildings that seem to be
needed to provide for all types of medical care. Yet
one needs little acquaintance with old people to see
that there must be one more facility. That is a clinic
set up especially for them — geriatrics clinic, if you
wish. It is the purpose of this paper to describe its
functions, and it is based upon 10 years' experience
in one. We are well aware of the value of heart
clinics, cancer clinics, well-baby clinics, child guid-
ance clinics, and many others. I believe that geriatric
clinics will become as useful in time.

The functions of a geriatric clinic are three, in gen-
eral. In the first place, it fosters the maximum phy-
sical fitness in old age. The disabilities of old people
require only occasional bed care. Most of the time
the patients are able to be up and about, and it is
at this level, in these intervals of relatively little
trouble, that much can be done to promote health and
stave olf the recurrences. When a patient has re-
covered from heart failure or a coronary artery occlu-
sion, he needs to be seen frequently if he is to regain
confidence in living and to learn what he can do and
what he cannot do. His heart disease is not cured in
the sense that his heart loses all traces of trouble, but
in the great majority of instances that heart can give
a satisfactory account of itself for a very long time.
Most old people have high blood pressure ; they, too,
need to report frequently to learn that it is not dan-
gerous or disabling. Most old people have pain that
suggests arthritis and all of them can be shown to
have the degenerative changes that are called hyper-
tropic arthritis. Yet the correction of postural and

114

other mechanical stresses, aud constant instruction in
the need for exercise and physical play, relieve
most of them. Physicaltherapy is helpful but not
often neeessarj'; it cannot take the place of teaching-
old people how to regain comfort and the exhilaration
of active normal living. Patients with peptic lilcer
need frequent consultation, to be sure that they eat
normally and regularly, and to catch the significance
of symptoms that might mean activity of the ulcer or
other indigestion. The diabetic needs regular i-eview
of his diet, his insulin dose, and Ms general status.
The old man who has had a stroke does better if he is
coached to restore function in paralyzed muscles or to
develop substitute function in others, and to face the
futui'e without undue fear of other strokes. My ex-
perience has been that these, and other chronic dis-
eases, can be kept from progressing, or can be kept at
tolerable levels, and j^atients can be maintained in in-
dependent living outside of hospital situations to a
surprising degree, by regular visits to a geriatric
clinic. The difficulties of seeing, hearing and moving
about, which we assume must come with years, makes
other old people, Avithout obvious disease, relax their
grasp upon objective living. They, too, perform better
with suitable mechanical contrivances and with the
will to play that comes from ability to plan. This is the
modern meaning of Juvenal's phrase "'INIens sana in
corpore sano," a sound mind resides in a sound body.
The second function of a geriatric clinic is to offer
general guidance to old people. Probably few of us
enter upon old age with delight. The general custom
is to shudder as we come into each decade, starting
with the age of 30, and to have well developed fears by
the age of 60 that we are losing or soon will lose men-
tal competence. We picture the farther reaches of
age as a twilight darkening into night. But the
facts are not as bad as fancy. A recent statistical
survey of 8,000 men and women over 61 years of age,
who were studied on the medical service of my hos-
pital over a period of 30 years, revealed that only 2
per cent were senile, 12 to 15 per cent more had
arteriosclerotic psj^choses, and about 10 per cent had
temporary p.syehoses in relation to serious bodily dis-
ease. Most of the rest of these individuals, around 70
per cent, were normal mentally or depressed by their
circumstances. The reactive depression, then, looms as
the big hazard to normal functioning in old age. The
loss of a spouse, the loss of family or friends, tlie loss
of a way of life, the loss of a job and economic inde-
pendence, the necessity for resort to charitj^ lack of
resources to express an aptitude or make new attach-
ments to life, preoccupation with pain or difficult
breathing, inadequate care in illness, inadequate con-
tact with surroundings due to poor eyes and ears, are
a few of the eaiises. i\Ialnutrition. whether from dis-
ease, from poverty, from faulty habits, or loss of ap-
petite due to sadness or lack of incentives to eat, adds

to the depression. The vicious circle is made to spin
faster by sj^mpathetic friends aud physicians who
take old people at their face value and say, ' ' At your
age, what can you expect?"

Empathy and Sympathy

The geriatrician knows that empathy is better than
sjrmpathy. He has the difficult task of looking
through both ends of a telescope at once. He focuses
as sharply as he can upon the mental or physical
disease of his old client, and he does all that is pos-
sible to improve it ; and he uses a wide-angle lens upon
the total circumstances of the person who has the
disease. lie knows that satisfactory adjustment to
joersistent disabilities and deficits may be attained
only after the patient's general health is attended to
or after life has again come to have value and interest
for him. Happy degrees of recovery are possible
at every age, but the best results are to be obtained
among persons in early old age. Here is a field of
preventive medicine that is, currently, practically un-
tilled. No geriatrician can do it all alone. His clinic
raiTSt provide him with manj- resources or he uiust
have access to them.

In or near the geriatric clinic there must be a phy-
sician who can assess the capacity and the mental
status of an old person accurately without bias. Only
thus will mistakes be avoided which arise from ac-
ceptance of his impracticable day-dreams or from dis-
may with his present situation. In other words, harm
can be done by untutored uplift as well as by a faint-
hearted spirit. One who dares to advise an old per-
son must know the facts and abide by them. Next,
the clinic must have access to means for re-education.
Some education can be directed toward new jobs,
to the development of hobbies and handcrafts. Adult
education courses in public schools and as private ven-
tures are available for a few; they will have to be
directed more particularly to old people if they are to
fulfill their needs. Old people need general ediTca-
tion also. We must remember that education is a
drawing out process, an unfolding that can be made
to continue as long as life lasts. It is most effective
in association with others. Public library lectures
have been shown to be useful in Cleveland. I hope,
eventually, that regular classroom work can be in-
stituted for old people who wisli replenishment and
reactivation of their minds.

The geriatric eUnie must have an agency that can
place old people in jobs. Normal old people wish to
work, to be useful, to be independent as long as pos-
sible. Those who do not, have a psychological or
physical impediment worthy of correction. Present
difficulties in finding employment for old people de-
mand solution. For denial of work means sentencing
an old person to charity and its psychological trauma

115

or to existence on savings and pensions with isolation
from active society.

The clinic must concern itself with the living situ-
ations of- old people. It must find quarters for them
where they can have harmonious contacts with others,
where they can be assisted to maintain independent
homes by making housekeeping and shopping easy.
It must see to it that optional diets are possible and
that appetite is stimulated by sociability. These are
difficult goals to meet, and lead us to plan for special
housing facilities for old people. The clinic, in its
program for rehabilitation, must also seek to jjrovide
social association for those who have lost family and
friends. Therefore it is interested in the formation of
clubs in churches, schools and other neighborhood lo-
cations ; it tries to find opportunities for physical play
on public playgrounds and parks, and in square
dances and bowling alleys; and it hopes to promote
reasonable vacations in the country or on the sea-
shore.

These are the tools for general guidance. All these
activities are slanted toward the poor because there
are so many of them. It must be recognized, however,
that the independent and wealthy are equally in need
of rehabilitation and the means to procure it. And it
cannot be emphasized too often that our attention
should be directed primarily toward preventing and
repairing the breaks which produce physical and per-
sonal deterioration in old age.

The third function of the geriatric clinic is research
and teaching. The field of research is broad, as al-
ready shown. It involves studies along social, psycho-
logical, educational, occupational, recreational and
financial lines. In the more narrow field of medicine,
the clinic must collect statistics on the incidence of
diseases and disabilities of all kinds in old age, and
discover important interrelationships. They are pro-
fuse and valuable in pediatrics. It must produce a
new medical history form, because the old patient's
past experience with accidents and operations and dis-
ease mean much in his current standing, and because
his family relationships, occupation, education, social
resources, living arrangements, food habits and daily
schedules show what he is. It takes an hour to pro-
duce a good history on middle aged patients. It takes
four or more interviews of an hour each to produce
one on an old patient. It is time well spent ; it is, in-
deed, indispensable if the patient is to receive intelli-
gent care. In the physical examination, the clinic
needs to study the significance of such items as changes
in body weight, changes in blood pressure, variations
in vital capacity, the sensitivity of the carotid sinus,
the status of the peripheral circulation, and the in-
tegrity of the main nerve pathways in addition to the
usual complete survey. In the laboratory, the clinic

wishes to obtain data that will help to identify anemia
and diabetes early, and bj- X-ra}' films to pick up any
form of pulmonary tuberculosis. Therapeutically, the
clinic can study proper methods of caring for minor
illnesses and for persistent disease and disabilities,
and it can learn what happens over a long i^eriod of
time to old people who are supported in their illnesses
and their total situations. At present our textbooks
contain little information and much misinformation
on these points. Pharmacologically, the clinic studies
the differences caused by age in dosages of drugs and
in the selection of sedatives and analgesics.

All of these projects are planted most fruitfully in
research and teaching institutions. They have the
resources in equipment and workers, and they have
the drive and the critical capacity which the geriatric
clinic needs to share. In them the geriatricians can
secure opportunities to supervise the care of old
patients on the hospital wards as well as in the out-
door department, and in them medical students, house
officers, nurses, social workers, physiotherapists, dieti-
cians and others can come to understand old people.

But chronic disease does not attract temporary re-
searchers, who wish short problems, and old people
are so complex and individual that they usually over-
whelm beginners in medicine. I have not been able to
produce a single disciple so far. Discounting per-
sonal inadequacies, I blame this failure on the youth
of medical students and the fact that I do not yet
have the clinic services in full operation. When we
do, I have confidence that we can employ the services
of students of all sorts for short periods and make the
experience an exciting and useful one to them. But
since there are many old people in every locality, it
seems proper to suggest that geriatric clinics be estab-
lished in every general hospital that has clinics. They
should also be placed in community health centers,
and, when we get them, in old age housing projects
and old age centers. The more of them there are, the
more adequate will be our real knowledge of the prob-
lems of aging, and the more we can claim that there
is a science and art called geriatrics.

Staffing the Clinic

As to personnel, the geriatric clinic needs, first of
all, a physician willing to study chronic diseases and
the wide-ranging influences that bear upon old age.
Without him, there is no clinic. He ought not to be
hard to find, now that we are beginning to realize the
functions of the clinic. The second indispensable
member of the clinic is the social ser^dce worker.
She knows much more of the human side of old peo-
ple than doctors do, and she can unlock the commun-
ity resources that are available. The other members

of the team can be borrowed on part time from the
hospital or parent organization. They are a clinic
secretary, a laboratory technician, a dietician, physio-
therapist and psychologist. A nurse is necessary if
much treatment is done or if supervision is extended
to the homes of the patients.

'My friends object to all this saying that they are
more geriatricians than I am because thej' can take
care of more old people than I do, and that there are
so many oldsters that we must rely upon the general
practitioner to do the job. Granted. But this as-
sumes that there are enough general practitioners,
that they are alert to the problems of age, and vigor-
ous in their attack upon them. The general practi-
tioner learns his pediatrics from child specialists and
clinics for children. We must produce clinics and
specialists that can supph^ him with a comparable
body of information on patients at the other end of
life. It is also objected that all this is higldy theor-

etical and complicated, and that it presupposes a non-
existent faith in the value of old age and a degree of
cooperation from old people that is doubtful. I agree
only that these ideas are not yet demonstrated in op-
eration. I contend that they are sound, that the
faith in age can be evoked in most of us, and that old
people will respond when they find the understanding
guides. It is hard work, for it must be with individ-
uals, and not with large groups; and it does not al-
waj's succeed. But it is satisfying work, and the qual-
ity will improve. Finally, it is objected that the
clinic is very expensive. It need not be so at first.
Even with all the workers and resources that have
been mentioned, the annual expenses Avould be met,
in terms of communitj- cost, by the rescue of no more
than a score of old people from charity and their res-
toration to economic independence. Then the claims
of Robert Browning's Eabbi Ben Ezra will not seem
absurd.

^\>

\^{>}\4

/y^

ylL*AJik^

COPR. 1949 BY NEA SERVICE, INC. T. M. REC. U. S. PAT. OFF.

"It isn't age that's causing your trouble — why, even I
get a crick in my back when fall sets in!"

117

Medical Aids and Benefits at 40^ 60 and 80

By Dr. C. Ward Crampton

Chairman, Subcommittee on Geriatrics, Medical Society of New York County

THERE are aids, benefits, advautages and blessings
which medicine can bring to men at the age of
40, 60 and SO who have been given only the
ordinary treatment for obvious disease. Tlie treat-
ment of disease in the elderly is receiving increasing
attention. The provision of aids, benefits and life en-
richment is not.

We projwse, therefore, that every conimimity should
establish a clinic primarily to develop a service for
these higher degrees of health and vigor for the
elderly. In this field much more can be done than is
generally supposed. We are wasting money; we are
losing years of happiness and service. Hospital beds
and wheelchairs can be relieved. Many a weak and
hopeless old man can be brought to his feet alert,
cooperative and eager. Tliis and more has been done
for many individuals and groups in hospitals and
homes. It can be done again and again when people
know the facts, and are prepared to give the time and
make the effort. How can this be done ? Let us ex-
amine the facts.

At the age of 60 a man's body is a documentary
record of his past years. He shows accumulated dam-
ages, defects, tissue poisoning, stagnation and stai-va-
tion with half-cured illnesses and infections — evil
things. These are the results not of time but of haz-
ards that occur in the passage of time. Our enemy is
not age, it is damage. It is not chronological age but
anatomical, physiological, pathological and psycholog-
ical damage. At any age, 40, 60 or 80, these accumu-
lated burdens, defects and deteriorations by thorough
examination can, in large part, be discovered and
identified. This examination takes much time, skill,
experience and devotion.

The evils thus disclosed can be partly removed or
neutralized. The man is thus unburdened and re-
freshed. Although this may look like rejuvenation,
it is not, for nothing will restore youth. But it does
take away removable burdens incidental to aging.
We may call this rehabilitation or we may coin a
term "de-aging."

The examination takes several visits. In introduces
the de-aging procedures. These, in turn, continue to
develop into a continuing program of medical watch-
fulness, care, coaching and pre-trouble maintenance

throughout life. Thus, there are three services: (1)
Examination (2) De-aging (3) Medical Care and
Guidance. The examination has been develoi)ed and
reported. It is brought up to date in the January
1950 issue of The Journal of Geriatrics. At this time
we shall present in brief the seven essentials of de-
aging, outline the cure and security program and
suggest a basic plan for the Geriatric Clinic designed
to give all three services. Now, the essentials of de-
aging which have already proven themselves in prac-
tice:

1. Attack Infections: These can be found locally
in teetli, tonsils, sinuses, gall bladders, prostate and
tubes. Undiscoverable infectious may be evidenced
by the sedimentation test, leucocytosis with a blood
shift to tlie left, blood complement fixation, pulse
speed, as an element in constitutional diseases — artliri-
tis, iritis, neuritis and myositis often endured as ''just
aging."

These infections can be attacked locally when found
and attacked from the rear by anti-biotics, antigens,
selective chemical agents and supported by other de-
aging efforts.

A single method of attack is always incomplete.
Mono-diagnosis and mono-treatment are always de-
ficient. Holism is wisdom and modern science ap-
plied. Illness has as many roots as a tree and health
has as many branches.

2. Nutrition: There are both dangers to be avoid-
ed and privileges to be gained by diet. Protein, cal-
cium and iron are commonly sub-optimum and fats
in excess.

This topic was fully presented to the meeting of the
Joint Committee on Nutrition in December 1947. It
was widely noted and utilized, most recently in
Nutrition Review VII, 10, October 1949 where ex-
amination and techniques are presented. While diet
is important, digestion, j^rocessing, transformation
and vitilization of food by body cells are far more
important and more often neglected. All of these
essential life jDroeesses maj- be found disordered and
all may be ordered to advantage.

3. Vitamins: Selected vitamins taken in quanti-
ties far in excess of dietary needs may be used as

118

medicines and as cures, aids, benefits and blessings.
Bi maj- rescue an old person from mental stagnation.
Bi2 has a special service in an anemia and the oil
solubles, A, D and E may demonstrate results in tis-
sue improvement. Shrunken subcutaneous tissue of
the clawlike hands of the aged sometimes seem to be
changed most happily. Further reports await clinical
trial, more exact measurement of benefits and accumu-
lation of data by the years. This urges more research.

4. Remove Stagnation : Life is action. Stagnation
probably kills more people than fatigue. Bed rest
has its dangers. Bed exercise will help rehabilitation.
In our geriatrics examination every organ should be
tested for hidden sabotage. For example, colonic
delay of a week is possible for one with daily evacua-
tion. This is damaging, discoverable and correctable.
Body condition depends upon inter-organic teamwork.
A fine hard-working heart can be ruined by a lazy
liver and an harassed kidney which in turn are
helplessly damaged by poor nutrition badly guided
by a negligent mind. It might often be written "he
died of a heart attack caused by undiagnosed mental
anemia. ' '

5. Endocrines: The endocrine glands give a good
example of a team of specialists working together as in
football. The efficiency of each gland and their inter-
departmental teamwork should be assa,^'ed as an
"endocrine efficienc.v formula" written for each per-
son. A single hormone, even the male sex hormone
is less and less used alone. The male and female gland
extracts, prescribed together with pituitary, adrenal
or thyroid (depending upon the pensonal endocrine
formula) is an example of the direction of progress.
One physician reports from the use of balanced hor-
mones "improvement in well-being, strength, endur-
ance, initiative, energy, sleep and sex with less head-
aches, nervousness, arthritis jiains and tensions." In
short, less evil, more good in life. The teaiuAVork
principle in endocrine therapy is. in turn, only one
part of the seven-fold program of de-aging.

6. Structure: The years bring fatigues and dam-
ages to the body structure. The head is bowed, the
back is bent, ribs and chest cramped, joints stiffen.
This is anatomical aging. Much of this is preventable
and correctable. It is thrilling to see a man five years
in bed, get up and walk, dress himself and go back to
work. Rusk, Deaver and Trevor llowell and others
have done this. This is structurable rehabilitation,
anatomical de-aging. It releases hospital beds and
saves hospital bills. It re-makes lives. It can be done.

7. Psychological Techniques in De- Aging: You
cannot get a man out of bed if he wants to stay there

autl it pays to be sick. Where there is no vision of
interest, action, service and personal worth he will
slowly perish. Yet the last five years may be the
finest of all life.

An eifort may be made to take a man from grub-
bing in the refuse of existence and bring him to the
Laud of Beulali, content with life and eager for his
next estate. This is a challenge to physician, ixsycho-
therapeutist, family, nurse, social worker and spiritual
guide.

The physician can do much. The body can be made
to help the mind and the mind taught to h<'lp the
body, for the body and the mind are at the mercy of
each other. Early as well as late psycho-aging can be
much prevented and corrected by the use of tech-
niques in the anatomical, psychological and patholog-
ical de-aging referred to above. Thiamini' chloride
alone maj- lift the burden of despair, defeat and dull-
ness but accompanied b,v such things as prostatic mas-
sage, physiotherapy, calcium, iron and needlinu' of
painful trigger points in crippled muscles ma\' with
teamwork and psychotherapy open new and bright
h(n-izons with all the later j'ears.

This is an outline of the seven factors of de-aging.
Much has been done but it will readily be seen that
much more needs to be done. New methods to be
explored, present plans further tested, improved, dis-
carded or extended and given wider application. This
is work for every community under state aid and
guidance. De-aging introduces the third geriatric
service as follows :

1. Life-Long Geriatric Service: The program of
de-aging continues and develops into life-long service
of medical watchfulness, care, protection, prevention,
benefits, blessings, cure and security. This is like the
service of an athletic coach Avho watches his athletes
and keeps them in best condition for the race of life.

The medical coach has the great advantage of the
full record of the de-aging service and the examina-
tion and the life record upon which it is based. He
knows what troubles have been conquered or half-
conquered and tend to crop up again. He knows
tendencies and weaknesses as well as sources of
strength and tested ways of cures and repair. The
"trainee" may get advice at any time by teleplione
and save a call. He will come in to be re-checked on
the actual condition of his heart, circulation, blood
pressure, nutrition, digestion, cholesterol, blood sugar
or nitrogens, capillaries and veins, joints, nerves, ex-
ercise and diet. He will be inspected for any possible
signs of oncoming chronic disease, deterioration or
breakdown.

The service is preventive, constructiA'C, curative and
life-sustaining and life enriching.

119

Community Approach

This is the ideal. It has been done. It can be done
better and better. This program of medical service,
care, cure and seenrity and benefits should be ex-
tended to all. How should this be accomplished?
Each community should give its own answer for itself
in the establishment of a Three Service Geriatric Serv-
ice Station. The following may serve as a guiding
plan.

The Geriatric Clinic and De-Aging Station

The clinic should be established in connection with
a standard hospital. This clinic should be manned by
physicians of experience over 50 or 60 years of age,
preferably over 70. They may even be called back
from retirement or old age homes and they will render
a great service.

In advance of the opening of these clinics it may
be suggested that the State Department of Health
call upon the several communities to nominate phy-
sicians to take charge and direct the clinics. They
may be brought for a refresher course to Albany,
New York and Buffalo and put through the Geriatric
Examination and De-Aging Service themselves. This
will give them an intimate experience with the work-
ing of the plan. They will benefit themselves and be-
come good examples. Nothing could be better than
personal demonstration. This is a further develop-
ment of the reciprocal examination plan of the Com-
mittee on Longevity of the Class of the College of
Physicians and Surgeons of 1900, of which the writer
is a member.

The clinic may be open once a week, for example
Wednesday morning from nine to twelve. The ex-
amination will be made on appointment and will con-
sist of three visits of one hour each. The fix'st visit
will be devoted largely to interview, thorough history
and consultation. The man will be given time to tell
all his troubles. The usual medical examination will
be given with special geriatric tests; stress tests will
be given on each organ.

The next visit will be at the end of seven days.
This week's interval is used to great advantage. A
complete record will be made of four days' diet, rest,
work, smoke, drink, et cetera in detail and in writ-
iu'i-. A complete history questionnaire of the medical
type will also be filled out.

Tests of the kidneys and intestinal tract efficiency

will be made covering four of the seven daj's. A
urinalysis made immediately after this four day food
and test record gives far better information than can
be obtained by the customary methods.

The second visit sizes up the whole man, his whole
life. We write down a diagnosis, efficiency indexes
of each organ, and each system, lay out a program
for rehabilitation and de-aging.

A full written report is given to the examinee to
take to his own physician or to go to one or more
special clinics for treatment and further diagnosis if
necessary. A most important feature is this complete
record in writing which is furnished to the examinee
for him to take anywhere to any doctor, at any time
for the rest of his life, a Basic Record.

The basic record idea has made some headway in
the last 40 years. The New York State Medical So-
ciety approved the plan 10 years ago and recently re-
affirmed its opinion.

The Geriatric Station will work with all medical
social and educational services in the community. It
will give its services in clinics, hospitals, homes and
institutions.

The clinic, in addition to examination, de-aging and
service, will have a special division for record and
research; men of 40 years or under will offer them-
selves as guinea pigs. They will be examined thor-
oughly (the whole man, the whole life.) A record
will be filed. Thej^ will be re-examined annually as
long as they live. Our purjDose is to gather data on
the hitherto unknown processes of aging and the hid-
den beginnings of chronic disease.

This plan was announced two years ago and has
been generally approved. The University of Minne-
.sota and the Mayo Clinic have already independently
begun work in this direction and others have the
matter under consideration.

We now suggest that each city and county in the
State call a council of medical, social and civic lead-
ers to start these stations at the earliest opportunity.

We recommend the development of a Bureau of
Geriatrics at Albany consisting of the several com-
missioners of health, welfare, education and other
services with representatives of the medical, social,
civic, economic, indiistrial and educational organiza-
tions of the State. Let them organize, guide and sus-
tain Geriatric Stations based on the plans outlined
above but developed, improved and applied by the
combined wisdom, experience and devotion of all con-
cerned.

120

The Veterans Administration and Geriatrics

By Dr. James M. Dunn

Assistant Chief of Physical Medicine, Rehabilitation Division, Department of Medicine and Surgery of the United .States

Veterans Administration

MODERN medieiue and the modern standard of
living have raised the life expectancy of man
to a new high level. This trend is continu-
ing. It has resulted in an intensification of all the
problems that concern the aging whether they are
sick or well.

If one spends the first 20 to 25 years of his life in
preparing himself to assume the responsibilitie.? of
Ills vocation and is required to cease those activities
at some arbitrarily determined age, it may be readily
seen that the productive years of his life are markedly
limited.

Throughout the history of the United States, the
rights of the individual and his co-equal responsibil-
ity to his fellow-citizen and to his government are
traditional. Does one become less of an individual
when he reaches a given birthday? Must he be de-
clared obsolete? Is it necessary for him to become a
burden to other people?

It has been said that the average individual uses
about 15 per cent of his potential physical and men-
tal abilities. It appears that there should be ample
scope for one to contribute to his own support and to
continue to make his contribution to his community
within the 85 per cent not ordinarily used, provided
he is mentally and physically able to do so.

The normal individual wants to work so that he
may support himself and his dependents and maJie
his contribution to his community. Within the
foreseeable future, roughly one-half of the popula-
tion of the United States will reach retirement accord-
ing to present retirement procedure. It is estimated
that 40 per cent will be 45 years old or older by
1980. Present economic trends seem to indicate that
relatively few people will be able to acquire enough
means to support themselves adequately during a
lengthened expectancy after retirement. Conse-
quently, the working half of the population will be
saddled with an intolerable burden through taxation
or otherwise, unless a solution is found to the economic
problems of the aging. That is the thing we have to
think of in going into this entire question of the ag-
ing population.

Now as to women in careers outside of their homes,
I attended a meeting down in Washington the other
dav where somebodv made the mistake of calling the

guiding spirit of the household a housewife, and he
was very promptly told they were not housewives but
they were homemakers, and that is a career.

Women in careers outside of their own liomes pre-
sent similar problems. Women whose sole career cen-
ters in the home usually continue in their life voca-
tion until they attain their full expectancy. They
tend to slow do\vn gradually and naturally. Perhaps
this is one reason why the life expectancy of women
is generally longer than that of men.

It would seem that aging men and career women
have the inherent right to continue in gainful, pleas-
ant and constructive occupations as long as they live,
provided they are physically and mentally able to
do so. Such occupations may well be avoeational.
One who has been able to acquire a competence should
be free to pursue the activities of his choice. How-
ever, he too should pursue a regiilar and productive
occupation if he so chooses. Many aging people are
happy when they are able to earn the means, over and
above whatever pension they have earned heretofore,
to live in their own homes ; it seems tliat they sliould
be afforded the satisfaction of doing so.

The aging who are not mentally and physically fit
are entitled to the best medical care through hospitals,
rehabilitation centers and out-patient services.

Treat Aged as Individuals

I had been a physician engaged in private practice
up to the end of World War II, and I know the
philosophy of the physician. He is out to earn his
way through life by creating as much happiness as he
goes along as he is capable of doing. The cornerstone
of his ethical conduct is always and ever that which
concerns the welfare of the patient. I say that here
because I feel that each of the different partial solu-
tions that we have to the problems of the aging lias a
limited value. 1 couldn't take exception to one
of them. But we must not forget that the cataly-
tic agent that goes on in the crucible containina- all
those different ideas and forces will only make the
correct physiological reaction if the catalyst is cor-
rect— and that catalyst is the moral side — the attitude
of people who give that particular service. It is not
enousrh to have a courageous plan aboiit hospital
construction; you have to have the human element.

121

Those people who are aging; there are no two alike
in the world. They are individuals.

No matter how good an operating plant, no matter
how good a medical care plant is or how good the so-
cial services are, in their application they are no bet-
ter than the people who handle them. That means
you, and it means me. Yon have to have that corner-
stone of ethics.

It seems that the pension systems in vogue among
the industries of the country, voluntary insurance
s3-stem, the possibility of developing crafts character-
istic of local communities, the constructive work be-
ing done by the United States Public Health Service,
the activities of the Veterans Administration, the
various State hospital systems, the private hospitals
in the various communities, and old age and retire-
ment systems — should all be studied with a view to
approaching the integrated solution of the problems
of the aging.

AVe must have an integrated program.

The Veterans Administration is vitally concerned
with the problems of the aging. In 1940, 20 years
after the first World War, there were approximately
16.000 members in the domiciliary homes of the Vet-
erans Administration. The total number of veterans
was approximately 4,000.000. There are now approxi-
mately 18,500,000 veterans. It is estimated that there
will be required approximately 75,000 domiciliary
homes 20 years hence, provided the same legal basis
for eligibility exists then as exists now. There are at
present 112,000 beds in Veterans Administration
hospitals.

Despite the fact that 75 per cent of the patients
presently receiving hospital treatment are veterans
of World War II, the average age of the veteran
patient is 55 years. Twenty years hence the average

age of the veterans entitled to hospital, domiciliary
and out-patients care will place them definitely
among the aging segment of the general population.

The Veterans Administration is studying this prob-
lem with the greatest of interest, in order to meet its
obligation and in order to make its contribution to the
total problem incidental to the aging population. On
the other hand, the findings of the New York State
Joint Legislative Committee on Problems of the Ag-
ing will assist iu pointing to a practical solution to
some of the veterans' problems relative to its seg-
ment of the aging population.

We try to get the man back on the job or have him
transferred to another job if the job he has is such
that he can't go back to it. We are trying to solve
part of the i^roblem before it happens with the
younger group of our veteran patients, and I may
say that we are having a fair degree of success.

Considering the intrinsic human values, such as the
love of home with all its family association and its eon-
notation for the future of the state, it is impei-ative
that we pause before we embark upon an expansive
and costly plan of constructing public institutions to
house the growing aging segment of our population, as
a substitute for the traditional home, which, after all,
is the foundation of our way of life.

The aged worker is not a psychiatric case or an
orthopedic case or a geriatric case ; he is a man or
woman with individuality and dignity and rights and
duties, and it is our business to see to it that we do not
blame our industrial people because they can't con-
tinue a man when he is no longer able to continue a
job that he has been doing all his life in the physical
field. But we have a challenge to see if he cannot be
transferred to a job less strenuous mentally or phy-
sicallj', where he can continue working efficiently.

122

Environmental Health and
Aging Population *

By M. Allen Pond, F.A.P.H.A.

Chief, Division of Engineering Resources, Public Health Service — Federal Security Agency, Washington, I). C.

CHANGE in the ag-p composition of a population is
always the result of the simultaneous action of
complex factors. For example, during- the past
half-century, when the sharpest recorded changes in
life expectancy and average age at death occurred, the
American people have enjoyed progressively higher
standards of living and better nutrition. They have
become better educated. Transportation has im-
proved. The nation lias become more urbanized. Ad-
vances in the medical sciences have made possible the
prevention of some diseases, the cure of others, and
better management of most. Xot the least important
factor has been the establishment of environmental
barriers against the spread of disease.

On the debit side of the ledger there have been two
world wars. Increased mechanization of the factory
and home have increased accident hazards. Xew
and deadly materials have been discovered and come
into wide use. The tempo of life, botli urban and
rural, has increased.

AVe liave had, then, a variety of forces — mostly bene-
ficial— working upon the population. Tlie net result
has been that the average unit in the population has
been made to live longer. However, as the average
lengrth of life has been extended, so too lias the time
over which the indi^'idual is exposed to the favorable
and unfavorable conditions tluit influence his func-
tion and development.'^

It so happens that the principal recognized luizards
to health in the early part of life are primarily exogen-
ous, while those that are significant in later life seem
to be largely endogenous. This may explain in pai-t
why the engineer, by establishing environmental bar-
riers against the spread of couuuunicable disease, has
contributed directly to increased longevity. It sug-
gests, also, that the physical environment may not be
a direct etiological factor in organic disease. How-
ever, as Frank points oiit, tlie problem of aging is
not purely a biological one, but has large cultural,
social and psychological implications. -

* Presented at a Joint Session of tlie Epidemiology, Food
and Nutrition, Health Officers, and Statistics Sections of the
American Public Health Association at the Seventy-seventh
Annual Meeting in New York, N. Y., October 27, 1949. Re-
printed from American Journal of Public Health, January,
1950.

Health in an Aging Population

It is our purpose here to examine some of the health
problems associated with an aging population and to
speculate on the significance of the physical environ-
ment in relation thereto. As a by-product, it may be
possible to hazard a prediction as to the role of the
engineer in chronic disease prevention and control.

The subject is so complex and intangible that dis-
cussion of it nuist appear discursive, and no obvious
lioint of departure suggests itself. As a baseline, it is
important to recognize that the objectives in environ-
mental healtli are (1) to establish physical barriers to
prevent the spread of disease, and (2) to provide
surroiuulings that will hd]) maintain vital resistance
and promote jiositive health and a sense of well-being.
The engineer is concerned primarily with inanimate
matter and directs his attention not to people but to
the pliysical en\'ironment in and with which they
nuist live. He is equipjied to prevent but not to cure.

The keys to successful ptiblic health practice are to
be found in the understanding of the etiological and
epidemiological characteristics of diseases of eomnni-
uity-wide importance. For instance, it was impossible
to develop effective environmental health pros'rams
until there Avas i-easonably precise knowledge about
the causes and mode of spread of typhoid fever, the
dysenteries, yellow fever, malaria, and cholera, to
name a few communicable diseases that have been
controlled by sanitation measures.

There is an analogy between our position at present
relative to the prevention of chronic disease and the
situation that existed before the germ theory of dis-
ease was enunciated. Then, blood-letting and bed rest
were advocated but used only after the illness ap-
peared. Now in our chronic disease programs early
diagnosis is emphasized. Yet. in genei'al. treatment
for most of the organic diseases is largely palliative
and destined to postpone rather than prevent death
from the diagnosed cause of illness.

Until more light is shed on the cause or mechanism
of those diseases most frequently attacking older
adults, efiiciency in preventive programs will be diffi-
cult. Environmental health measures, if they are to
play any role in chronic disease control, must either
await the accunmlation of essential knowledge, or

123

they may be direeted at raising the standard of living
with the knowledge that such activities usually benefit
the public health.

In spite of this generally pessimistic note about the
present role of environmental health workers in the
attack on health problems associated with the aging
population, it is possible to comment positively, or at
least to discuss hopefully, certain aspects of the
subject.

Environmental Cancer — For example, in the field
of cancer prevention there are certain definite signs
that environmental controls may be expected to be
useful. Even though there remains a vast ignorance
as to the carcinogenic properties of the environment,
there is an increasing literature on environmental can-
cer, almost all of which is industrial in origin.^ As the
use of known cancer producing materials becomes
more widespread and as more becomes known about
the carcinogenic spectrum, it is likely that greater
attention will be paid to non-industrial environments.

Of the few recognized carcinogens occurring in the
natural environment, solar radiation and radium are
among the best established.

It is the artificial environment of our industrial so-
ciety that has created more serious carcinogenic po-
tentialities. Soot and certain waste products from
the fractionation and distillation of coal and petro-
leum, as well as the wastes from the smelting and
processing of certain metals may jarodnce cancer.
Fully 90 per cent of the known environmental car-
cinogens never existed in dangerous concentrations
until industrial processes brought workers into con-
stant and close contact with them."

It is indulging in pure speculation to attempt to
prophesy the role that the engineer may play in can-
cer control. Indiistrial hygiene engineers already
are concerning themselves with the protection of work-
ers against excessive exposure to known carcinogens.
It may be too early to train large numbers of engi-
neers in cancer control, but there should be no delay
in interesting at least a few in this field.

Heart Disease — Undoubtedly the potential death
toll from diseases of the heart and circulatory system
has been reduced by communicable disease control and
treatment of recognized heart ailments. Engineering
control of health hazards associated with envii-on-
mental defects has helped prevent tlie spread of in-
fections known to be precursors of heart disease. For
practical purposes, however, little has been done to
develop a physical environment in which those with
heart afflictions may be protected against unnecessary
additional cardiac damage.

Glickman and his coworkers, reporting on the ef-
fects of sudden environmental temperature changes

on cardiac patients, note few differences between the
response of those with cardiac ailments and those in
the control group. ^ They conclude that the differ-
ences may as well have been related to the aging
process.

These observations may be used to illustrate an ad-
ministrative problem. From the engineering stand-
point it is interesting that there were differences ; but
until their practical significance is assessed, there is
little reason to reconsider air conditioning, ventila-
tion or heating standards. In other words, the mere
revelation of hitherto imkuown facts cannot without
intei'pretation be used as a basis for changing stand-
ards or practices.

It is imijossible to resist a temptation to draw an
analogy between an important engineering research
finding a quarter of a century ago and the role of the
physical environment in heart disease. Talbot dem-
onstrated that relatively mild stresses applied repeat-
edly caused failure in railroad rails resistant to much
greater stresses applied a few times or continuously."
Is it fair to assiune that the stresses inherent in fre-
quent, literally thousands of stair ascents may ulti-
mately produce cardiac failure in persons with mild
or unrecognized heart disease ?

Mental Health — The potential of the physical en-
A'ii'onment to i^roduee mental health problems remains
to be defined. Certain characteristics of dwellings and
working places are known to cause tensions, but there
is insufficient epidemiological evidence upon which to
base activities aimed at controlling environmental haz-
ards to mental health. It is likely that the physical
environment pe?' se seldom produces mental illness,
although it may serve as a contributory factor by in-
creasing the hazard of breakdown in persons on the
threshold of mental illness.

Studies of the livability of low-rent dwellings have
shown that inadequate storage space and unsatisfac-
tory room layouts, among other factors, make house-
keeping difficult and unpleasant.'' If we accept the
premise that longevity implies more prolonged expo-
sure to the continuing hazards of living, such harass-
ments as these may be especially significant for older
people. Kecommendations for the design of housing
for elderly persons take these points into account.'"^'
However, research is needed to substantiate or refute
tlie group judgments underlying such recommenda-
tions.

Housing — A thorough knowledge of population
statistics is basic for the planning of housing.^^ De-
signers and builders of houses have not yet shown that
the.y appreciate that changes in the age composition
of the population are paralleled by changes in family
composition and size. At both ends of the adult span

124

of life, single-person families are more numerous than are insecure, experience in London, England, and

in the age group from 25 to 64. Except in large cities,
little has been done to provide housing for one- and
two-person families, partieularlj- for those in the twi-
light j^ears of life. Even in the best planned modern
housing developments attention is rarely paid to de-
sign for elderly tenants.

There is mde agreement among students of the sub-
ject that housing for elderly people needs sjiecial con-
sideration as to location, design, and equipment. ^'^^
In general, all new housing projects should contain
provisions for persons of all age groups, and the able-
bodied eldeiiy should be housed with the rest of the
community.

Older persons are ordinarily housed more safely in
single-story units than in dwellings containing stairs.
It is not so widely realized that special attention
should be paid to provision for warmth, layout for
efficient and easy housekeeping, and accident preven-
tion. It is desirable also to provide communal facili-
ties and easy access to such neighborhood facilities as
stores, churches, theaters, and public transportation.
Furthermore, the question of elastic design (i.e., pro-
vision for easy modification of dwelling size to take
care of changing family needs) has hardly been ex-
plored.

If housing plays any role in determining the health
status of a community, it is obviously related to the
health uf old persons and the infirm.

Accidents — Death rates from accidents tradition-
ally have been highest in the age group 65 and over.
In 1947 the accidental death rate for persons in this
age group was 286.8 per 100,000, of which fatal falls
accounted for 59 per cent and motor vehicle mishaps
represented 17 per cent.'- The accidental death rate
for persons 45 to 64 years old was 68.5 per 100.000.
The number of permanent disabilities produced by
accidents is significantly larger than the number of
deaths.

More than 3 out of 4 fatal home accidents among
persons 65 years of age or older are caused by falls,
and in 1947 accounted for more than 15,000 deaths.
These accidents occurred in various parts of the house,
although the bedroom was the most frequent site.

The causes of accidents are manifold. In older per-
sons especially, physical deficiencies and poor judg-
ment are frequently cited as contributory causes.
However, structural or mechanical defects that pre-
dispose to accidents should not be overlooked by the
health official concerned with accident prevention. In
the design, construction, and maintenance of shelter
for the aged and infirm, special attention should be
given to the elimination of accident hazards.

Atmospheric Pollution — Although the epidemio-
logical bases for a large scale attack on air pollution

Donora, Pa., during the late fall of 1948 focuses atten-
tion on the potential hazard presented by smog (i.e., a
combination of smoke and fog).

Acute mass disasters from atmospheric pollution
are spectacular events because of the resulting num-
ber of deaths and disabled persons encountered. How-
ever, such catastrophes occur rather infrequently and
result from iinusuallj' massive exposures. In point of
fact, the}- are of lesser importance than more wide-
spread and less obvious injuries to health occasioned
by the prolonged action of lower concentrations of
atmospheric impurities on larger population groups. ''^
Nevertheless, Whipple many years ago pointed out
that epidemics in the ultimate may serve as life savers.
The London and Donora incidents may well become
the incentives to basic work in this field.

In London, deaths from aU causes during the week
of the widelj- publicized intense fog of November,
1948, rose sharply in comparison with previous weeks
and with the same week in previous years." Death
rates from bronchitis and pneumonia were more than
double those for the same causes during each of sev-
eral preceding weeks. Possibly the most significant
public health aspect of this particular London fog is
revealed by analysis of the age grouping of fatal eases
of bronchitis and pneumonia. For both diseases, the
greatest excesses in mortality rates occurred among
persons 45 years of age and older, the peak being in
the age group 65 and over. Among persons under 45,
there were no significant differences between either
the crude or the respiratory disease death rates for
preceding weeks and those for the foggy week.

At Donora, all of the fatalities which were attrib-
utable to the smog incident occurred among persons
over 52, the mean average and median ages being 65."
The Public Health Sei'vice investigation of the situa-
tion revealed also that there was a significantly higher
incidence of serious cases among persons in the older
age groujas. Similar crises had occurred previouslj'
in the community, probably being associated with ad-
verse atmospheric conditions. An interesting side-
light of the inquiry was the revelation that there ap-
peared to be a positive correlation between the sever-
ity of the affliction and certain aspects of housing
quality.

Roth and Swenson, in an unpublished study of the
irritant aspects of atmospheric pollution, point out
that irritation appears to increase with age and that
susceptibilities vary widely and are greatest for per-
sons whose ej'cs or nasal passages are inflamed.'" In
their reference to the implications of age, they show
that college students require a concentration of about
four times the strength of the irritant (e.g., formalde-
hyde vapor) needed to produce equivalent irritation in

125

persons over 50. Furthermore, susceptibility appears
to increase with age even in older persons.

As a result of these isolated experiences, is it fair to
assume that older people are especially susceptible to
the hazards of atmospheric pollution ? Is it likely that
older persons, who may have less efficient or more
worn out respiratory or circulatory systems than
j'ounger members of the community, when exposed to
abnormal atmospheric conditions maj^ be seriously em-
barrassed ? What specific air pollutants are most sig-
nificant in producing excess morbidity and mortality ?
Answers to questions such as these will be important
in planning and operating community-wide projects
for the control of air pollution, and will also play a
role in increasing life expectancy.

Care of the Chronically 111 — The increase in recog-
nized chronic disease has created a need to plan for
and ijrovide a variety of facilities for care of the
chronically ill. Therein lies a fertile field for engi-
neering study and progress in the design, construc-
tion, equipment, and maintenance of hospitals, in-
firmaries, nursing homes, and outpatient centers.

Hope recently has outlined some of the environ-
mental sanitation problems in the national liospital
survey and construction program.^" As he ijoints out,
it is one of the few activities in which the engineer is
identified with the care and treatment of the ill and
infirm. With rare exceptions, there is little evidence
that sanitary engineers involved in hospital design,
construction, and maintenance have concerned them-
selves j'et with much beyond their traditional inter-
est in water supply, plumbing, and waste disposal. In
the field of radiation therapy alone, there appears to
be abundant need for public health engineering skill
in the design and maintenance of treatment rooms and
equipment. Furthermore, increased use of radioac-
tive materials in medical research and patient care
will pose a variety of new problems in radiation pro-
tection and hospital waste disposal.

Even casual observation of relatively modern plants
for the care of the chronically ill reveals the need for
substantial extension of knowledge concerning the
thermal environment, illumination, noise, and mate-
rials of construction as they relate to elderly persons
and the infirm. Standards are based insecurely on
group judgment supported largely by limited physio-
logical research on young, healthy adults. In spite of
the inherent difficulties of carrying out controlled
laboratory studies on persons past middle age, serious
consideration should be given to necessary physio-
logical and psj'chological research on elderly persons.
Without the basic data which can be obtained only
through such research, it is unlikely that there will be
significant improvements in the physical standards for
shelter for the aged and infirm.

Discussion

It is clear that i^lanning an environmental health
program for the aging population is not only complex
but at present must be based largely on speculation.
Intuitivelj' we are led to believe that the physical
environment will ultimately be demonstrated to be
significant in the etiology of organic disease. Factual
bases for such an assumption are inadequate.

The immediate problem, from the engineer's
standpoint, seems to be one of gathering and analj'z-
ing data concerning the relationships between the
environment and the health of older people. Little is
known of the physiological and psychological respon-
ses of the aged and chronically diseased to sharp
changes in th environment. The implications of
micro-changes are virtually unknown.

In spite of the lack of factual bases for action, sound
judgment dictates that the solution of health problems
among the aging poiDulation will involve preventive as
well as curative measures, and that the preventive pro-
gram will include environmental controls as well as
improvements in personal hygiene. Present knowl-
edge sui^ports the belief that the physical environment
contributes to the causes of cancer and accidents ;
further, it points up a relationship between environ-
ment and the course of mental illness and of diseases
of the heart and circulatory system. Is it unreason-
able to expect that knowledge to be gained in tlie
future will bear out these facts?

This discussion would be incomplete without men-
tion of the public health significance of the continuing
application of basic sanitation measures. Although
many of the diseases normally resulting from an in-
sanitary environment have been brought under con-
trol, eternal vigilance will be necessary to preserve the
gains already made. It would be patently absurd not
to maintain existing barriers against environmental
hazards to health. Measures to prevent the spread of
enteric and insect- and rodent-borne diseases are as
important for the aged as for the young. For this
reason alone, health agencies must promote widespread
application of existing sanitation knowledge to pre-
vent preventable diseases. Such action will raise the
standard of living and bring measurable health bene-
fits to all segments of the population.

It has already been mentioned that increased long-
evity also increases the period of time during which
the human organism maj' be exposed to environmental
hazards. Despite the success which has attended engi-
neering efforts to improve and protect water, milk, and
food supplies, and to control disease-carrying insects
and rodents, there remain a large number of unsolved
sanitation problems. Food-borne disease seems to be
on the increase.'* New problems are appearing in

126

water supply." The radiologioal health field is in its
infancy, and the surface has only been scratched in
the hygiene of housing-.-"

There is acute need to realign official and voluntary'
forces to strengthen sanitation activities throughoiTt
the Nation. Serious personnel shortages exist, and
many existing sanitation workers are inadequately
trained. Most are poorly paid. There are literallj'
thousands of conflicting ordinances, codes, and regu-
lations in effect which serve to impede uniform and
coordinated action. Although i^rogress is being made,
sanitation activities continue too frequently to be
carried on as isolated programs comparatively iusid-
ated from other components of the public health effort.

For all these reasons it is encouraging to note that
plans are being laid by the National Sanitation Foun-
dation, in cooperation with numerous official and vol-
untary agencies, to launch a nationwide sanitation
program. For the first time on a broad scale, atten-
tion is being given to the development of community
interests in all aspects of environmental health, with-

out which progress in the future will be painfully
slow. It has been comparatively easy to apjily a few
successful control measures to protect water and milk
supplies, or to eliminate insect- or rodent-breeding
])laces. It is more difficult to control widespread haz-
ards that result from liumau frailties.

As we enter into the era when chronic disease be-
comes a major public health problem, it is likely to be
A'ital that everyone — not just the waterworks official
or milk-plant operator or restaurateur — be concerned
with enviroinnental barriers against disease. The
whole realm of sanitation practice in all likelihood
will change dramatically during the next quarter cen-
tury. A safe and healthful environment is now and
will become increasingly inqiortant to the aijing pop-
ulation.

It is important, therefore, that sanitation personnel
be prepared to assume new responsibilities and deal
with new problems. Public interest is likely to pro-
mote professional awakening. A nation-wide sanita-
tion program will stimulate both.

References

1 Boone, B. B., and Ciocco, A. Cartliometric Studies on Chil-
dren. I. Stethographic Patterns of Heart Sounds Observed in
1,482 Children. MUhank Mem. Fund Quart.. 17::!23 (Oct.),
1939.

2 Frank, L. K. Foreword to Problems of Aging by E. V.
Cowdrey. Baltimore: Williams & Wilkins, 1939.

3 Hueper, W. C. Environmental and Occupational Cancer.
Suppl. 209. Puh. Health Rep., 1948.

* Hueper, W. C. Environmental Cancer. Bethesda: Xatl.
Cancer Inst., 1949, 19 pp.

5 Glickman, N., Inouye, T., Keetou. R. W., Callen, I. R.,
Hick, F. K., and Fahnestock, M. K. Physiologic Adjustments
of Xormal Subjects and Cardiac Patients to Sudden Change in
Environment. Presented at 55th Annual Meeting of American
Society of Heating and Ventilating Engineers, Chicago, Jan.,
1949. ' Preprinted from A.S.H.V.E. Journal Section, Heating,
Piping and Air Conditioning.

6 Talbot, A. N. Progress Reports Nos, 1-5 of Committee on
Stresses in Railroad Track. Proc. Am. Ry. Eng. Assn. Vols.
19, 21, 24, 20, 31. 1918, -20, -23, -25, -29.

^Livability Problems of 1,000 Families. Fed. Public Hous-
ing Auth., Washington, Bull. 2S. Oct. 1, 1945.

8 Anon. Old People's Welfare. The Natl. Council of Social
Service, Inc. London, 1947, 72 pp.

9 Anon. The Care and Treatment of the Elderly and Infirm.
British Med. Assn. London, 1947, 28 pp.

11 Matthews, Olive. Housing for Old and Single People.
Inst, of Housing, Inc. Birmingham, 1938, 15 pp.

11 Lansing, C. F. Studies of Community Planning in Terms
of the Span of Life. New York Citv Housing Auth. 1937,
43 pp.

t-'^ Accident Facts. 1949 Ed. Natl. Safetv Council. Chicago,
96 pp.

13 Editorial. Industrial Pollution iif Human Environment.
J.A.M.A., 140:1342 (Aug. 27), 1949.

"Logan, W. P. D. Fog and Mortalitv. Lancet, 256:78
(Jan. 8), 1949.

15 Schrenk, H. H.. Heimann, H., Clayton, G. D., Gafafer,
W. M., and Wexlcr, H. Air Pollution in Donora, Pennsvlvania.
Pub. Health Bull. 306. Washington, 1949, 173 pp.

i<5 Roth, H. P., and Swenson, E. A. Physiological Studies of
Irritant Aspects of Atmospheric Pollution. LTniv. of Southern
Calif. School of Med., Los Angeles (Oct. 15), 1947, 48 pp.
(unpublished) .

17 Hope, M. C. The Hospital Survey and Construction Pro-
gram: Environmental Sanitation. A.J.P.H., 39:893 (July),
1949.

IS Summary of Disease Outbreaks from Water, Milk and
Milk Products, Other Foods and Undetermined Vehicles, Div.
of Sanitation, P.H.S., Mar., 1949.

IS Borts, I. H. Water-Borne Diseases. A.J.P.H.. 39:974
(Aug.), 1949.

=0 Johnson, R. J. The Housing Act of 1949 and Health De-
partment Programs. Pub. Health Rep., Vol. 64, No. 43 (Oct.
28), 1949.

127

Geriatrics — A New Frontier

By Senator Thomas C. Desmond
Chairman, New York State Joint Legislative Committee on Problems of the Aging

THE TOWNSPEOPLE in a small, New England com-
munity had gathered once again to honor their
oldest neighbor and friend, Jim Burroughs. As
they pressed around him to offer their good wishes on
this, his 96th birthday, the question came up as it had
so many times before : "Jim, what's the secret of your
long life and good health?"

Jim paused and thought for a moment. "You
know," he said, "every year you've asked me that
I've probably told you something different. This year
I 'm going to tell you the truth. The reason I 've lived
so long is because I never died."

Jim Burroughs' explanation was much more rea-
sonable than the hundreds of longevity secrets offered
by the elderly. These range from sleeping late morn-
ings and smoking a pipe after lunch to rising early
and shunning tobacco.

Scientists scoff at the suggestion that any of these
countless schemes offered by the oldsters as the keys
to longevitj' have any real value. They tell us that
our hope lies not in an elixir of youth, not in any
stay-young-and-be-happj' prescription, but in the
work of a new breed of scientists called geriatricians.

You will be hearing more and more in 3^ears to
come about geriatrics. It is a new branch of medicine
which aims not merely to stretch out the years of life
but to make them brimful of vigor.

Geriatrics (the word is derived from two Greek
words, geras, meaning old age, and iatrikos-e-on, be-
longing to medicine) is the medical aspect of aging.
Just as the pediatrician specializes in the health of
children, the geriatrician specializes in the health and
well-being of the elderly.

' ' The aim of geriatrics, ' ' says Dr. G. "Ward Cramp-
ton, Chairman of the Geriatric Committee of the New
York City Health Department, "is to retard, modify,
defeat, postpone, and neutralize the progressive de-
terioration and disabilities associated with aging."

At Cornell and Columbia Universities, in Indiana
and Illinois, in Baltimore and Boston, researchers are
intensifying their efforts to find the answer to the age-
old question, "What makes people grow old?"

Medical societies are beginning to set up geriatric
committees. A Geriatric Bureau has been established
in New York City 's Health Department. Medical spe-

* Reprinted from June, 1950, issue of Today's Health.

cialists have organized the American Geriatrics So-
ciety. The American Pharmaceutical Manufacturers'
Association, in cooperation with the American Medical
Association, has launched a foundation to study de-
generative diseases. Homes for the aged and chron-
ically ill are adding clinics for the oldsters.

Activity in the medical field of aging is booming like
stocks in a bull market. Why the accelerated interest ?

With startling rapidity the population structure of
our Nation is changing toward an ever-increasing pro-
portion of the elderly. If present trends continue,
by 1980 some 40.4 per cent of the population will be
45 years of age or more.

One of our top scientists has estimated that 30 per
cent of persons who have reached 65 owe their sur-
vival to advances in public health and medicine since
they were born. Once people died young. Now they
have an even chance to live to be happy oldsters. We
are at a turning point in medical research. From now
on the emphasis will be on chronic illness and degen-
erative diseases.

Public health agencies have largely subdued the
infectious diseases and plagues. Only 50 years ago
the greatest killers were tuberculosis and pneumonia.
Today these diseases have been pushed down to rel-
ative unimportance. Rearing their heads defiantly
instead are heart disease, cancer, and cerebral hem-
orrhage. These are among the chief cripplers of the
oldsters.

While we have given people bonus years of life, not
much has been done to make these years vigorous,
and free of fear of the merciless onslaughts of time.
Unless something is done to prevent it, one-half of
the children born this year will ultimately die of de-
generative diseases of the circulatory system and kid-
neys.

The Age Fighters

A small band of geriatricians, armed with the con-
viction that many of our middle-aged people are be-
ing consigned to old age long before their time, are
searching for clues which might lead to longer and
better living.

Theories on what causes trouble in later years are
numerous. Some geriatricians Relieve that it is the
failure of the various systems of organs to work to-
gether properly ; others suspect that clumping of cells

128

in the blood vessels may be the cause of decline in the
aging; still others regard chemical processes and
nutritive factors as the fields of study promising the
greatest rewards.

Ill-supported in their important work and toiling in
relative obscurity, the age-fighters are hammering at
different fronts, but driving toward a common goal :
more life in more years of life.

The key to perpetual youth may never be found,
but in their quest the researchers expect to turn up
the answers to many puzzlers : "Why does the heart
weaken after middle age? Why do arteries harden
and joints become knotted and stiff? Why does the
hairline recede and the waistline bulge? In short,
what can be done to put off the dreaded period of the
Great Decline 1

Geriatricians already confidently predict that by
1960 life expectancj^ will climb to 70 years, and they
see no reason why man's life span cannot be boosted
eventually to 100 years. They point out that a dog is
fuUy grown at two and has a life expectancy of 12
years ; a cat at 2^/2 years is fullj^ grown and has a
life expectancy of 10 years; at four a horse is fully
grown and has a life expectancy of 25. Accordingly,
if man is physically mature at 25, he should have a
normal life span of 150 years.

The Russian scientist, Alexander A. Bogomolets, de-
veloped ACS (antireticular cytotoxic serum) which
he thought might prolong human life to a century and
a half. Groups in Texas and California have taken
up the study of ACS, and are investigating intensively
its potential benefits.

At Cornell University Professor Clive M. ]\IcCay
has been conducting a series of brilliant experiments
with dogs and white rats which offer startling new
clues for prolonged vitality. He has found that life
can be extended and youthful characteristics main-
tained by control of a single factor : food.

The geriatricians will be the first to tell you, how-
ever, that you are wishing for the moon if you expect
to have the elixir of youth handed to yon on a silver
platter. On the other hand, we are assured that on
the basis of what v.i now known, we can not only
extend the average life 10 more years, but insert the
extra decade in the prime of life.

Prepare in Youth for Age

The time to prepare for age is in youth. Your 30th
birthday is not too soon to decide whether at 60 you
will be as young and vigorous as the man of 40, or
whether you will present the common picture of the
average man of 80, old, weak, and miserable. Tou
must seek and earn health as your years advance; it
will not be thrust upon you.

The only hope you have of avoiding old age is to die
young. If you expect to continue living, you have two

alternatives: you can shut your eyes to disagreeable
facts and hope to escape them (which you can't), or
you can anticipate the problems of age while your
mind is still vigorous and make plans to meet them.
If you have elderly parents or relatives, chances are
that you have already seen or soon will see insidious,
degenerative diseases of the mind and body at work.
Old age is peculiarl.y the field of chronic disease, which
causes a million deaths annually. Virtually every
family feels its tragic, lingering sting.

Geriatricians tell us that to avoid many of the pit-
falls of the later years of life we should cushion our-
selves early against the shock of old age. Don't make
the mistake of Mrs. Emilj' Camp, a 60 year old widow,
wlio earefullj^ camouflaged her snow-white hair with
jet-black dj-es, hid her wrinkles under layers of make-
up, and wore the gay-colored, youthful clothes of a
Hollywood starlet. She tried to look and act forty,
and almost had herself believing that she was. One
daj' while she was standing in a crowded bus, however,
Mrs. Camp received a light tap on the shoulder from
a pink-cheeked teen-ager who had politely risen to
offer her a seat. Mrs. Camp forced a smile and
nodded appreciativeh^ but she slid down heavily as
though she had experienced her first taste of death.
She had never faced the fact that she was growing
elderly, and that others could see it.

In industry each year thousands of older workers,
untrained and unprepared for retirement, are turned
out to become burdens on their offspring and sink into
stupor and inactivity. Industry brands them "too
old," and it comes as a crushing blow. Dr. Theodore
G. Klumpp, noted scientist and business executive, de-
clares that "Any biological organism that has been
accustomed to a set routine for 40 or 50 years can't
suddenly be shaken from its orbit without untoward
consequences." The age-fighters tell us that leisure
without useful activity can be a trap. Tou can't re-
tire from life, but you can retire to new interests : that
small business you wanted to start; the book you al-
ways thought of writing; the summer camp you
planned at the lake; the flower garden you pictured
in your back yard. Your third and fourth and fifth
decades are not too soon to cultivate the hobbies and
activities that vsdll serve you a lifetime. Retirement
should be welcomed as the beginning of a new career ;
it should not be dreaded as the end of life.

The present hope of geriatrics is not just to tack
on to your twilight of life a few more years to be en-
dured in senility and chronic illness. The chief aim
is to conserve your vigor, brain and skills so that you
can maintain your active participation in society.

Dr. Nathan W. Shock, who is heading the Geriatric
Unit of the United States Public Health Service at
Baltimore City Hospitals, says: "We are not inter-
ested in finding waj's to allow people to live longer

129

thau they alreac\y do. What we are interested in is
finding ways to help them to live out their normal
life spans as vigorous, useful citizens."

At Welfare Island, where New York City's tax-
payers have put wp the money to build a hosj^ital and
to defray the operating costs of laboratories for the
purpose of studying chronic diseases. Dr. J. Murray
Steele, who is in charge of the work, expresses a simi-
lar view. "The philosophy of the project," Dr. Steele
explains, "is not primarily to increase the life span of
the aged individual, but to increase his 'sjDan of
health', so his last years will be spent in 'reasonable
comfort and happiness', and he will not become a
burden to the community."

Geriatrics applies to everj- year of life, for every
year has its effect on the succeeding ones. But it is
often around the age of forty that the signs of wear
and tear during life begin to become readilj^ detect-
able. Fort}' is certainly not "old age". It is merely
the beginning of senescence, the normal process of
aging. The two most critical decades for you from the
medical viewpoint are the years between 40 and 60,
when warning signals are beginning to appear, but
while there is still enough "youth" left with which
to work.

Mrs. George Piske, an alert, intelligent housewife of
40, startled the members of her bridge club by an-
nouncing that she had made an appointment for her
first comprehensive health examination in preparation
for her later years. "Have .vou gone out of your
mind?" chuckled her friends. "Why there's obvi-
ously nothing wrong with you. Why don't you enjoy
life. You're just looking for trouble."

That's precisely what Mrs. Fiske intended. She
was looking for trouble, trying to ferret it out before
it could do much damage.

The apparently health}', "youthful" geriatric pa-
tient like Mrs. Fiske is the age-fighter's delight, but,
unfortunately, as rare as a string of lakes in a desert.

If you wait until you have been floored by heart
trouble, arthritis or some other insidious degenerative
disorder, you have waited too long. Dr. Edward J.
Stieglitz, pioneer age fighter, and Chief of Staff of
Suburban Hospital in Bethesda, Maryland, tells us
that the subtle, stealthy signs of depreciation are
seldom obvious. They don't jump up at you and ring a
bell. High blood pressure may exist for 20 or 30
years before it moves in for the kill. Long before
diabetes becomes crippling there is a period in which
the victim's ability to utilize sugar is but moderately
impaired.

Most of the patients who come to the clinician in
later life are looking for a cure after the damage has
been done. They gambled on being among the lucky
few whom nature does not treat harshly; and they
lost.

Peoi^le do not age at the same rate or in the same
way. Even in the same person organs deteriorate at
different rates. We are told that a 60 year old man
may have a 70 year old heart, 50 year old kidneys, a
40 year old liver ; and he may be trying to live like a
30 year old. Another sijecialist in aging compares
the later years of life to a foot race. If the stop
signal were suddenly given, every participant would
be at a diff'erent point.

Then too, we are told that there are many kinds of
aging : anatomical, physiological, psychological, bio-
logical, hereditary and statistical. Probably the least
important of these is your age measured merely by
the number of birthdays you have had.

The geriatrician will take you at 40 or 60 or 80, and
he will do the best with which he has to work. In
e-\'ery case he emphasizes that the treatment must be
individualized. He has to know medicine, but he
must also know the man.

The basic step in "de-aging" is the complete health
examination, sometimes called the "health inven-
tory." The geriatrician wants to know what your
condition is and how it got that way. He wants to
"measure" your health, for he knows that health is
only relative. He wants to know something about
your forebears, for a 60 year old man whose parents
died at 40 is potentially far diff'erent from a 60 year
old whose parents and ancestors averaged 90 at death.
He is interested in the accidents and the illnesses of
your youth, for they may have left sears which crop
up again in maturity. He wants to know about the
stresses you have iindergone, mental and physical,
during am- period of life. He wants to know some-
thing about your daily routine and habits : what you
eat, how well }'ou sleep, what narcotics or stimulants
you use, and how often.

Chances are your personal medical history is
sketchy and inaccurate, and that it is incomplete is
certain.

Health Report

Doctors have long advocated the health report card
or "health passport" which would be a birth-to-
death summary of your physical condition and back-
ground, so that any physician who treats you will have
at his disposal comprehensive knowledge of yotir med-
ical biography.

^Medical societies in various states have already pro-
loosed that state health departments establish for
each person born a continuing health record, to be
issued with the birth certificate and used by the in-
dividual throughout life.

No law comi^els you to do so, but the medical men
tell us that you will have a great head start over the
familiar geriatric cripplers if you will keep a complete

130

health and medieal record yourself as accurately and
as faithfully as you can.

As one age-fighter has said, "We seldom see any-
thing but the XYZ of life. Equally important to us
are the ABC's, through Q and R and S. With the
blank spaces filled in. the doctor could prolong life,
ease suffering, and occasionally even snatch his patient
from a menacing doom. ' '

Fortunately, the disabilities of aging come slowly
and in varying degrees, so that there is an opportunity
for the patient to ad.just himself to them if he wishes.

The greatest dangers to watch for as you grow old
are maLnutrition and physical and mental unfitness,
which are present to some degree in almost every per-
son over 60 years of age. They are at the core of
many of the degenerative disabilities of later years,
and they often begin in youth and middle life.

Dr. Joseph T. Freeman, of Doctor's Hospital, Phil-
adelphia, recommends a diet for the aging that is
"relatively high in protein, average in carbohydrate,
and low in fat."

Dr. Crampton tells us moi-e specifically how a 60-
year-old should modify his eating habits compared
with a 30-year-old. He indicates that compared with
recommended standard requirements for the j'ouug'er
person, the sexagenarian should consume : 10 per cent
more protein. Vitamin E, calcium, iron, and phos-
phorus ; 15 per cent more iodine : aud from 20 per
cent to 25 per cent more Vitamin A. thiamin, niacin,
riboflavin, folic acid, Vitamins C and D ; and 20 per
cent to 25 per cent less fats and carbohydrates.

The significant conclusions of tlie hunger-fighters
and age-fighters on diet for the elderly can be summed
up in these five major points :

1. Shed unhealthy, excess fat and hold your belt-
line down.

2. Drink your tea and coffee if you like it, but
don't neglect milk. If you have given it up go
back to it. Get a pint to a quart a day.

3. Forget the toast and tea fad of Grandmother's
day. Get an optimum diet, rich in vitamins and
proteins.

4. Have your weight checked periodically. Ask
your doctor to plan a diet to fit your individual
needs if necessary, and obtain his recommenda-
tions on vitamin and mineral supplements.

5. Don't spare the fruits and fruit juices, and
don't spurn leafy vegetables as being "weeds".
They will help you keep in trim.

At his geriatric clinic in Boston, one of the first such
clinics in the world. Dr. Robert T. Monroe has found
that much that passes for senility turns out to be
merely physical or mental unfitness. This is true of
much feebleness, frailty, unsteadiness, awkwardness.
undue fatigue, and shortness of breath.

He has found that regular exercise and play (such
as simple games and dancing to restore the sense of
timing and coordination) have beneficial effects on
patients with high blood pressure, h^qjertensive heart
disease, arthritis, tremors, and hemiplegia. "Here,"
says Dr. Monroe, "is a field of rehabilitation as ex-
citing and rewarding as that with war casualties."

Dr. Monroe's observations have been further veri-
fied at the Hodson Community Center in New York
City, where outings, games, meetings and crafts are
provided for oldsters. The expected average life span
(if the old folks who find companionship at the Center
and participate in its recreational programs has been
extended 10 years. From an age group in whic]i men-
tal disturbances and senility take a liuge toll, there
has not been a single case of a referral to a mental in-
stitution of an oldster at the Hodson Center I

The man who keeps up his associations as he grows
older, retains an interest in what is going on about
him, and develops hobbies and useful activities to
take up his idle time will remain young, no matter
liow white his hair.

Obviously, the handful of geriatricians in the coun-
try cannot take care of a vast army of old timers
whose needs range from mere sympathetic understand-
ing to treatment of severe heart disease. But you can
look for help to any physician who is geriatric-minded.
The point to remember is that the usual health ex-
amination today is for the purpose of detecting any
ailments you might have. The kind of "anti-aging,"
pre-disease examination you must seek is one of prog-
nostic value ; one that will not only measure your
health, but help you to know what it will be five or 10
or 15 years from now. If you are an avid tennis en-
tliusiast at 30, you want to know what pitfalls to
avoid, what to do so that you will still be playing a
good game 10 years hence. If you're a top bowler
in your league at 40 you don't want to be sitting on
the sidelines at 45. Xo matter how old you are, you
want to free yourself of anxiety over premature dis-
ability and iirolonged invalidism in the years to
come.

Through "stress tests," the geriatrician can give
you some indication of what your future health status
might be. He does this by placing upon the organs a
load corresponding to the wear and stress they will
undergo in another decade or two. Commonly used
stress tests are reaction of blood pressure to cold
water wrist submersion ; the electrocardiogram before
and after measured step climbing; aud the compari-
son of the horizontal and standing blood pressure.
In this way he can find weak spots in your body.
Following analysis of your detailed and searching
"history," a careful examination of your body, and
a frank discussion of your anxieties, emotional con-
tiicts, and adjustments, the geriatrician can give vou

131

guidance in nutrition, exercise, recreation, posture,
mental outlook, and proper environment to suit your
condition. If he finds that your heart is weak or your
liver is bad, his method is one of support. He tries to
build up all the other organs to their full efficiency to
buoy up the stragglers; to reduce the load they have
to carry. He can gauge j'our limit, and say "Keep
within your limit and you will be safe."

You acquire confidence after your health inventory,
for now you know what you are, and what you can
and should not do. You have been relieved of manj'
of the bugaboos of age. You go out to face a brighter
world with a spring in your step and a smile on your
face.

You go back for periodic check-ups, and thus keep
your health and vigor at or near their maximum.
Just as in youth you insure yourself for economic se-
curity ill later years, you have insured yourself for
physical and mental security.

Geriatrics promises less but delivers more than the
quick cure-alls and youth-restorers we read about and
liear about so often. The frontiers of knowledge in
geriatrics are constantly being extended, and further
dramatic advances are inevitable.

There is no route to earthlj^ immortality, but there is
a road to a longer and happier life if you will keep
looking ahead, and seek the proper guidance along
the wav.

132

Need There Be Death?

By Dr. Paul A. Zahl

Associate Director of the Hnskins Lahoratoric.i. ycir York Citii

WITH his emergeuce from total animalism into
a state of high subjectivity, man has suddenly
(that is, within the last 5,000 years) turned
the tables on nature. No longer do species and evolu-
tionary considerations compel his activities ; the psy-
chological gro\vth of the individual in relation to his
fellows is the keyiaote (still unrecognized by many)
of the Coming World. How eminently frustrating,
then, when thoughtful man — ever obsessed by the will
to live — knows that he has but a few decades of crea-
tive existence before he must succumb to evolution's
most uncharitable and sardonic ruling.

But must he yield forever to nature's disinterest in
individual survival? Is it an absolute cyclicity with
which men go down into extinction every generation,
to be replaced by a new crop of germ-cell bearing
tyros ? Well, there is still the reasonable hope that if
scientific aspiration and technological progress can be
prevented from withering in the dust of crumbling
social institutions, then individual wisdom and experi-
ence may some day be permitted to gather cumulative
strength, instead of ebbing back to zero with each
aged generation. . . .

When our neolitliic ancestors buried weapons and
travel accouterments with their dead, they were pre-
mising an existence beyond the grave. In the millen-
nia after those dawn days, the human creature came
to see himself as a diial entity composed of mortal
body and immortal soul; the phenomenon of human
life was even construed by some as a spiritual test
trip between two eternities. In beliefs ranging from
nirvanaistic foreverness to complete corporeal resur-
rection, we have never ceased hoping, dreaming, pray-
ing that death is not the end. Hence, when the
biologist ponders the mysteries of life's transcience,
he is acting in the tradition of all men.

Biological Questions

Only a few years ago the biologist would have de-
iSned death as an irreversible cessation of metabolic
activity. But today, far more than the philosopher,
he has had to revise his conception of mortality. Can-
not the viruses, dried to a state of zero metabolism, be
preserved indefinitely, thereby virtually negating
death? Do not experiments in which microbes are
frozen into suspended animation, to be revitalized at

1 Reprinted from The American Scholar, spring issue, 1049.

will, change our ideas of biological time, and the
meaning of death?

In order to reveal the basis and extent of these
emendations, it is relevant perhaps to begin with an
inspection of life and death among man 's evolutionarj^
forebears.

The first inhabitants of our planet were not subject
to death. As single cells, they grew until reaching a
fixed size limit, then divided in two, leaving no par-
ent— and no corpse.

In the course of evolutionary time, organisms came
to consist of many cells, the vast majority of which — •
relegated to subserve supportive and nutritive func-
tions— were shorn of their original capacity to repro-
duce the whole organism. Further division of labor
occurred; and as millions of years rolled on, the
cellular constituency of advancing organisms became
highly diverse and astronomically large. There were
tissues which served to digest food for the entire organ-
ism ; others specialized to deliver nutriment to every
cranny of the body ; still others assigned for integra-
tion and courier detail, for locomotion, excretion, pro-
tection. But ever secluded and sheltered within each
organism were the precious germinal cells, waiting but
to pass on the species, ere the body died.

Motivation for the epical developments which com-
prise what we know as organic evolution, lay in the
fact that multicellular animals had long since aban-
doned sunlight as the source of primary energy, and
so were impelled to sharpen their efficiency in the cap-
ture and devouring of their evolutionary collaterals.
The whole "aim" and "purpose" of the outer body
was to nurture and protect its wards — the reproduc-
tive cells — and to deposit them, when ripe, for fusion
with those of the opposite sex.

In life's two-billion j'ear reaction chain, no value
was assigned to post-reproductive maintenance of the
individual organi.sm. The diversity and survival-fit-
ness of evolving species were enhanced by this gener-
ation-to-generation scheme, this life-death-life-death
pattern, since in the mixing of mutated genes during
fertilization, ofi'spring difi'ering from either parent
were produced. Only those individuals whose consti-
tutions enabled them to cope with endless geological
and environmental shifts on the planet, survived to
pass their valuable new gene combinations into the
main stream of the species' germ plasm. Thus, sur-
vival of the evolving species, not of the single being.

133

was the i^reemineut goal of animal evolution. The
institution of death arose as a result of this null
value placed on the individual onee it had passed on
the family torch.

Senescence and death are by no means universal
biological phenomena ; they are but the price paid for
high specialization and for an advanced evolutionary
l^osition. Perennial organisms, for example, are in
fact not subject to senescence, and never wear down
to natural exjDiration. This condition prevails, pre-
sumably, because the body tissues of such organisms
have not been specialized to the point where they
have wholl.v lost their reproductive capacity. A single
mangrove sjDrout maj' spread to a continuous net over
many square miles of brackish swampland, its in-
definite increase being limited only b.v competing
vegetation or other environmental restrictions. Per-
ennialism applies, in addition, not only to such not-
able examples of non-aging as the giant sequoias, but
to the teeming bacteria, fungi and algae ; and also to
many of the lower multicellular animals which grow
and bud very much like plants. Among organisms of
this class, life can be stopped (as it is most often)
only by accident, attack by preying organisms, or
severe environmental adversity."

The life-span of those higher organisms whose
body cells have lost their species-reproduction capac-
ity, always begins with the activation of a previously
dormant egg cell, and continues from birth to death
in a series of intergrading growth stages. No known
consciousness of self exists in the embryo, which is
Ijarasitic on the mother (as in mammals), or depend-
ent on a store of yolk which the mother has provided
for embryo nourishment (as in the egg-laying forms).
Birth is usually associated with a release from this
dependency, although in many animals, especially the
mammals, a post-partairiency relationship persists for
a considerable time.

Life's course after birth includes a progressive self-
awareness, varying widely from species to species, and
ostensibly reaching its highest expression in man.
Concomitant with this "subjective" development, the
organism becomes sexually mature, and sets out to
repeat the life-cycle pattern of its parent-predecessors,
employing perhaps half its total lifetime in reproduc-
tive activities aimed at species perpetuation. The
body then progresses without choice through tissue
degeneration into death.

Gene-determined Life Span

The span allotted from birth to the onset of senes-
cence of the body super-structure is gene-determined,
and subject to Avide species variation, A tiny animal
called the rotifer completes its entire cycle within a
few days, during this period having passed on its un-
dying germ cells. The mouse does not age and die
until one to two years have elapsed ; some reptiles live

to exceed a hundred and fifty years; and the ele-
phant's longevitj' is proverbial. Moreover, there is
no apparent relationship between the size of an
organism and its life expectanc}'. A man is smaller
than a cow, yet lives much longer. The parrot's nor-
mal span may approach the human three-seore-and-
ten.

Of course not all, indeed very few such death-
destined individuals realize their full life-jjotential,
which for most mammals is calculated to be about six
times the period from birth to maturity. The nature
of the competitive biological milieu is such that inis-
hap, nutritional deficiency, or invasion by predatory
microbes usually terminates life long before true old
age has set in. In man, these factors have been con-
siderably minimized, making the "sere and yellow
leaf ' ' stage all the more conspicuous. Perhaps half of
civilized man's total personal activities — accident
avoidance, food consumption, rest, h.ygiene, medical
therapy, etc. — are aimed at deferring death.

The non-perennial organism which ages and finally
dies when the life-potential has dissipated itself, may
well be compared to a clock which stops ticking once
the spring tension fails. But spring tension alone
does not determine the life-span, for the rate of a
clock's ticking obviously fixes the speed at which its
spring energy is spent. This applies analogously to
the organism.

Since the speed of "ticking" within the body is
broadly conditioned by the temperature at which it
occurs, thermal changes may alter the life-span.
Fruit flies maintained from birth at 30 degrees cen-
tigrade go into senescence within 21 days; at 10 de-
grees centigrade they do not succumb to old age and
natural death until almost 200 days have elapsed.
IMoreover, temi^erature afi'ects not only the length of
the life-cycle; it changes markedly the organism's
subjective sense of time. Insects, for example, when
fed at a set hour each day become conditioned and
will anticipate feeding by arriving punctually at the
trough. If the temperature of the environment is
raised, they come too early ; if lowered, too late.

Immediately one wonders why the Eskimo and,
say, the desert Bedouin do not show high discrepancy
in their time senses, or indeed Avhy the former does
not vastly outlive the latter. The answer is clearly
that mammals possess an efficient internal regulating
system which, irrespective of external temperature,
maintains the inside fires bi;rning at a constant rate.
Insects, again, lacking themostats — like all other ani-
mals, except mammals and birds — tend to adopt the
temperature of the air around them. It is interesting
to note that when something goes wrong with the
human thermostat, as in fever, the time sense is com-
pletely upset, and events race crazily.

We have said that the rate of metabolic "ticking"
determines the lensth of time during which a given

134

life-potential is expended, and that this rate is to a
considerable degree fixed by the temperature at which
the body chemistry functions. Improving on the ex-
periment with the fruit flies, could we not reduce the
internal temperature of higher animals to a point
where the life-span could be increased indefinitely, or
at least suspended? Happily or unhappily, this is
not possible at the present state of the biological art.
The delicately balanced organ and tissue relation-
ships within the mammalian body are such that a
droj] in internal temperature of only a few degrees is
quickly fatal.

But among the non-mammalian species some sug-
gestive experiments have been performed — spectacu-
larly successful among very low species, disappointing
among creatures even as high as the insects. The re-
search and interpretation of Basile Luyet explains
why. If protoplasm is frozen by ordinary means,
there develop tiny water crystals which, sharp and
angular, cause irreparable damage to fragile struc-
tural arrangemeiats within the cell. On the other
hand, if freezing is accomplished so rapidly and to
so low a temperature that ice crystals do not have a
chance to form, protoplasm assumes a vitreous or
non-cr.vstalline condition.

This vitreous state is achieved bj' rapid immersion
of the material into liquid nitrogen (195 degrees be-
low zero centigrade) or some similar low-temperature
fluid. Essential to the procedure is that the transition
from normal temperature to that of vitrification be in-
stantaneous; and that in thawing, the change be
equally rapid. Present techniques do not allow such
lightning thermal shifts in any biit microscopic or-
ganisms, undoubtedly because of the longer time re-
quired for heat transference in large masses of cellu-
lar material. Thus, only the viruses, bacteria, pro-
tozoa, and .some of the smallest multicellular animals
have been successfully vitrified, and thereby trans-
muted into a state of passive immortality. The plat-
form demonstrator who re-vivifies a "frozen" fish
would find with a little dissection that only the outer
scales were actually frozen.

Of profoiuid significance is the possibility of vitri-
fying spermatozoa, and perhaps even ova, for per-
petual storage. This has actually been accomplished
in the case of spermatozoa, although the technique is
not developed to the point where it has practical ap-
plication. We may expect that in the not too distant
future, vitrified sperm banks will be employed in
animal husbandry. The implications of their use in
human euthenics are breathtaking. . . .

The Coiled Spring

More directly cogent than thermal manipulation to
the problems of aging and death is the plausibility of
somehow altering the spring which lies coiled to a pre-

determined tension within every individual of every
non-perennial species. The tortoise drives ahead for
more than a century ; the human being for three-score-
j'ears-and-ten ; the rotifer for only eight days. Is it
not possible to identify the factors that preordain the
shortness of individual existence, and i^erhaps to con-
trol them!

This question, asked so early in the Atomic Era, still
seems unfortunately to connote fantasy. Obviously,
we cannot yet supply a complete or even a satisfactory
answer. On the other hand, we may infer from the
absence of inevitable death among the lower organ-
isms that there is nothing in the fundamental nature
of protoplasm that demands a wearing-out. A man is
protoplasm ; a sequoia is protoplasm. One has a
death-terminated life-cycle ; the other does not. A
man is a mammal ; so is a mouse. Yet one lives thirty
times longer than the other.

Many crude attempts have been made to probe the
human aspects of such gerontie enigmas. The elixir
of life has prayerfully been sought in glandular ther-
apy, connective tissue extract treatment, reduction of
bacterial toxins within the body, nutritional manipu-
lation, and so on — but vainly, for such gropings have
been based on the shaky premise that senility is due to
the break-up of a single tissue or physiological sys-
tem. Current physiological intelligence indicates that
true aging derives not from the wearing-out of a single
body unit, but rather from an over-all deterioration
genetically intrinsic to the physiological organization
of each species.

One would expect a more fruitful approach to the
problem of man's mortality to lie in a further quest
for fmidamental knowledge of the nature of organ
and system relationships within the body, and of the
subtle genetic means by which they are influenced.
Modern gerontologists are just beginning to look into
such aspects of biochemistry as molecular degradation
and .synthesis, membrane permeability, energy, ex-
change, dynamics of gene determinism — to list them
all would constitute the outline of a physiology text-
book. It does not require a seer's perception to real-
ize that this class of phenomena will have to be eluci-
dated far more fully before etfective thought can be
devoted to the challenge of obviating that deep-seated
rusting which leads so inexorably to senescence and
death. Perhaps in this inaugural age of science, man
will begin to supplant his traditional but fading
dream of life-after-death with a new and vigorous
search for biological, and so psj'chological, immortal-
ity.

To those who would worry about the staggering
implications of literal immortality, may one add, in
genuflection, that there will be time enough to deal
with that greatest of all challenges : the patterning of
values, motivations and reproductive mores in a so-
ciety whose citizens are assured perpetual life.

135

A Psychiatrist Looks at the Aging

By Dr. G. M. Davidson
Maiihaftan State Hospital, Ward's Island, Xeiv York

NEEDLESS to say that a long life without health is
not only an individual but a national tragedy.
Therefore, no effort is too costly to remedy the
situation. The problem of aging is very complex, has
many aspects and issues inclusive of the psychiatric.

My presentation is limited to an approach of basic
evaluation of the aging process.

To begin with, I would like to point out certain
fallacies of thought which in my opinion handicap
progress. Due to our traditional materialistic ediica-
tion we are looking for a cause and effect relationship
in anj' jjroblem we may be interested in. This atti-
tude, however, has proven inadequate in its applica-
tion toward problems pertaining to human nature.
In fact, biology has definitely established that what
may be considered "the cause" of a condition is often
not the cause at all, and that causes are multiple. To
illustrate, there is an organic brain disease known as
Korsakoff disease of which a most characteristic sign is
a certain tj-pe of amnesia. The latter was always con-
sidered due to the pathology of the brain of such
subjects. However, I was able to show that amnesia
could be lifted in some cases by means of sodium
amj'tal and that in such instances it was possible to
ascertain that amnesia is essentiallj^ psyehogenetic in
origin; the organic implication belonging to other
factors in the problem as a whole.

Alice in Wonderland

Another difficultj^ in our approach toward problems
related to manifestation of human nature is our ig-
norance regarding the bodj'-mind relationship. We
are still under the spell of the "old" dualism, which
makes, to quote von Hornbostel, "sound and sight,
inner and outer, body and soul, God and the world to
fall apart." Perhaps the difficulty will be best illus-
trated if I should quote to j^ou from Alice in Wonder-
land. As you recall, Alice was verj' much annoyed
with the sudden vanishing and reappearing cat, and
asked him to stop the practice. The cat complied
vanishing this time slowly beginning with the tail
and ending with the grin which remained for some
time after the rest were gone. "Well I have often
seen a cat without a grin," thought Alice, "but a grin
without a eat ; it is the most curious thing I ever saw
in all my life." However, it is not only Alice that
might be surprised bj' such a phenomenon. ^lany

educated people including some medical men still
identify the mind with the brain and cannot "see"
the mind without the brain. In other words they in-
sist that the grin and the cat can be only seen to-
gether. The latter "logic" is definitely not logical
clinically. For instance we know from experiment
that a A-isual image may outlast the stimulus that pro-
voked the image ; we know that mental growth con-
tinues after phj'sical growth ceases; we know that a
mental reaction which may be ushered in by a phys-
ical cause may continue after the physical cause sub-
sides. It should, therefore, be the ambition of the
psychiatrist to be able to reach ultimately conclusions
of physical changes in the organisms on the basis of
psj'chological sjTnptoms. This falls in line with the
experience of Alice in Wonderland. If so. how can
we scientifically outline the quoted allegory?

It is this way : We identify the individual in space
and time as the "total personality" which means to
regard him as a Avhole inclusive of his past and his
environment. The total personality is composed of a
multitude of parts which are trained by experience
to work in harmony for the benefit of the totality.
Depending upon the liarmony and unity achieved and
the compensatory abilitj' for incurred damages, there
may be all degrees of functioning up to a point of
maximum efficiency. Disharmony or unrepaired dam-
age may result in clumsiness in its mind expression,
failure in more pronounced states, and disaster in
severe expression. In search to measure the totality
in action I applied Sherrington's view on the coordi-
nated neurological mechanism which he called the
final common path. My studies have convinced me
that there is a common final path of the total per-
sonality which I identified with affectivity (according
to a standard dictionary affectivity means to aspire ;
to aim; bent of mind; used synonymously with emo-
tionality). It is in harmony with the view that the
mental and the physical are separate of one and the
same, the totality, which may be measured by diftVrent
methods. Affectivity is regarded as the evolutionary
outcome of the original irritability of the cell which
in turn may be identified as the "mental component"
of the cell. Affectivity is the measure of the bodily
power to absorb and reflect stimuli. This approach
suggests that the release of personality disorders is
caused bv manv factors among which I distinguish :

136

Factors in Personality Disorders

1. Factors belonging to the evolution and integra-
tion of the total personality and expressed in disorder
of the total affectivity and its constituents (such as
social, sexual, etc. impulses), a disorder which is con-
sidered iu turn the biological background of what is
known as "mental conflict;"

2. Factors belonging to the maintenance of equilib-
rium and rooted in the system of defense of the total
personality (physically — impairment of homeostasis;
mentally — impairment of mechanism, such as the
mechanism of repression, compensation, etc.) ; and

3. Precipitating and aggravating factors (emo-
tional, traumatic, etc.) which overcharge our capacity
to react, or participate in dissolution of the total per-
sonality.

AVith the foregoing in mind and with emphasis on
the fact that psychopathologj' may give clues of
changes in the organism, I tried to isolate certain
phenomena which could be applicable in a longitud-
inal way, to manifestations of aging. Now comes the
question. "What do we mean by aging and when does
aging begin? In answer, some see aging as begin-
ning with conception and terminating in death, which
view, while correct in a philosophical sense, is incor-
rect clinically since it confuses at some phases of life
growth with decline. Another opinion is that aging
begins some time about middle age. This is also in-
correct for the reason that chronological age does not
coincide with the ph.ysiological and the psychological
age. And when does middle age set in? That is an-
other question. I would think that aging is a phase
in the life process of the individual Avliich starts some
time after maturity (according to a standard diction-
ary, maturity is a process brought about b.y comple-
tion and development for any function appropriate to
its kind ) . According to my investigation aging begins
at about the end of the third aud the beginning of the
fourtli decade of the life of the individual and is
manifested by a set of psychological phenomena. It is
at this time that the individual may cast a glance
into the future and the unknown. He develops inse-
curity to which he reacts with an anxiety state ; the
idea of death may cross his mind with all the disquiet
that it may cause. Other symptoms may follow.
The mentioned phenomena may be mild iu their ex-
pression or more severe, depending upon the original
emotional constellation of the individual.

For those who are very concrete in their attitude,
or for those who are burdened with problem of cause
and effect relationship, the foregoing conclusion and
the following discussion will be difficult to accept.
However, as far as I am concerned, I believe that the
mentioned symptoms and the similar ones which may
be observed at middle life or advanced age are essen-

tially of the same origin. I mean to say that certain
mental manifestations associated with involution ot
the individual (change of life), can be observed in the
agitated and depressed type of senile psychosis known
as agitated depression, as well as those similar symp-
toms which occur in agitated depression at any age,
and dift'er only in their strength of expression, which
is due essentially to the psj'chology and phj'siology of
the respective age. For instance, the emotional state
of involutional melancholia, in addition to the aspect
of anxiet.v, has an admixture of remorse and nostalgia.
The nuclear motive of these mental states is the fear
of death and of the unknown (in so many instances
the fear of life), which in turn is the result of other
psychodynamics of the total personality. This may
be applied also to other mental states with due con-
sideration to the individualit.v of the case.

If this view is correct then there is hope that the
individual may be spared these incapacitating states.

It has been established that in the mentioned neuroses
and psychoses, the subjects are of a certain make-up
which is marked by traits of oversensitivity, scrupu-
losity, overorderliness, stinginess, etc. The traits are
considered as "reaction formations" due to faulty
early socialization, and thus may be avoided by proper
education.

Cerebral Arteriosclerosis

Another point that I would like to discuss is the
question of cerebral arteriosclerosis which we encoun-
ter in persons of advanced age. We do not know
exactly what cerebral arteriosclerosis is due to. But
we do know that the process is selective. It used to
be said that a man is as old as his arteries. This is
not cpiite true ; however, it may be said that arterio-
sclerosis may be related among other things, to the
individual's ability to disperse cholesterol. This
would refer to hormonal and dietary factors, as well
as to the function of the reticuloendothelial system
(belongs to the system of defense of the personality).

Diagnosis of cerebral arteriosclerosis is often diffi-
cult unless there are pronounced focal symptoms, and
other organic conditions are excluded. However, the
diagnosis of early cerebral arteriosclerosis may be
made on mental lines. A particular irritability and
emotional instability ma.v be an early sign. These emo-
tional states are undoubtedly an unconscious reaction
to his failures due to aging. Depressive states may
be rooted in involutional changes which may go on
in the same period. Acute vascular conditions may
be suspected from the manifestations of acute dis-
turbances in orientation and memory. The more
severe disturbances of memory or language are due to
impairment of the symbolic formulation of thought,
which has an emotional as well as neurological aspect.

137

As far as cerebral arteriosclerotic dementias are
concerned, we have no adequate tests to measure them.
In some respects they are similar to other dementias,
such as senile ones, which ^ye shall discuss presently.
Generally speaking, studies of the brains of cerebral
arteriosclerosis subjects do not produce definite evi-
dence to account for the clinical manifestations. I
believe that the studies on the subject do not reveal
any factors which could be considered solely due to
aging'. It refers rather to factors working upon the
life process in general. Therefore, one may hope also
here that better knowledge of the nature of arterio-
sclerosis will help in prevention of the difficulties
which arise from this acquired condition.

Senility

I want to discuss briefly still another point which
is a pathological appendix of aging, and Avhich is
spoken of as senility. The latter in its height of ex-
13ression is known as senile psychosis. I have already
mentioned one type of si^ch psychosis, the agitated
and depressed type. There are other types, such as :
the paranoid type, the confused type, the type of sim-
ple deterioration, etc. Approaches from the angle
of the final conunon path we identify the situation
with dissolution of atfectivity (interestingly enough
the French psychologist Ribot studying at the turn
of the century the senile states and emphasizing the
loss of memory discussed very ably the progressive
changes in emotionality). In examining the various
types of senile psj'choses we come to the conclusions
that the respective type of reaction is rooted in the
potentialities of the personality of the individual.
For instance a person with a poor system of defense
will show simple deterioration. A well equipped per-
son will develop trends which in turn may help him
to be better preserved. In the confused states we may
have a toxic factor, etc. Regarding intelligence in
the senile cases I wish to repeat that we have no ade-
quate tests to measure it. It is to be noted that in-
telligence seems to improve after treatment of the
subject with vitamins B and C. Concerning memory,
I like to say that a loss of the latter may occur at any
time during life. It ought to be noted that memory
is only important as an instrument of adju.stment.
To function properly there nrast be integration of
new with old memories. This integration is weak-
ened in the aged for the reason of dissolution of
emotionality. It is the emotional link which is essen-
tial for integration of new with old memories (com-
pare with our "loss" of nu^mory for infantile experi-
ences ) .

Studies of senile brains do not produce satisfactory
evidence to explain the clinical manifestations. In
fact, there is no correlation between the findings of

the brain and clinical phenomena. Therefore, one
may assume, at the jDresent state of our knowledge,
that there are no specific causes for the process of
aging. The causes are multiple. It is the people
themselves, their mode of life with all the traumatic
influences that are responsible for the jiathological
states of the aging. The release of the condition being
in harmonjr with the outlined three groups of factors
responsible for the release of any personality dis-
order, as discussed.

Conclusions

In summing up I would like to emphasize the fol-
lowing psychiatric observation :

1. ^Ve are ill-prepared in meeting our aging. In
fact we meet aging grudgingly and react to its
perception with anxiety which is an alarm sig-
nal of the .system of defense, and in i^ronounced
instances with morbidity.

2. Normal aging is marked by a decline in func-
tion which is taken care of by the system of de-
fense of the personality — in both its physical
and mental aspects — as seen from measurement
of biological time and mental manifestations.

3. In pathological aging there is an abnormal
weakening of the system of defense, which
reaches its height of expression in dissolution
of affectivity, conditions which require most
urgent study. (The workings of it is seen in the
various types of senile jisychoses with all its
' ' negative ' ' compensations. )

4. The system of defense of the personality may
be vulnerable on more than one score. There
may be hereditary and constitutional factors re-
sponsible, yet unknown. "We do know, however,
that infectious, traumatic and emotional factors
play an important role. Therefore one may
conclude that proper education, proper applica-
tion of physical and mental hygiene guided by
a sound philosophy of life which shall provide
the individual with social, economic, sexual and
emotional security will help him and society to
avoid the calamities of aging as observed in our
times.

5. Finally it nuist be pointed out that the road of
of achievement of normal aging for all is a
long and thorny one. Our knowledge of the
problem is very meager. The time is short and
only a \'igorous research program may help.
For research two elements ai-e needed : ideas and
financial backing. Fortunatelj- there is abun-
dance of both in this country. Therefore, we
may look with confidence in the future. But
wc have to go to work riuiit awa\-.

138

Family Care for the Aged

By Miss Hester B. Crutcher
Director of Social Work, yew York State Mental Hi/yiene Department

SINCE 1933 the State of New York has developed a
program of placing patients in homes other than
their owu for care. This method of care is used
for the patient for whom it will have definite thera-
peutic value. In this instance, the famil.y care home
serves somewhat the same purpose as a convalescent
home might for patients who had been treated in a
general hospital. This offers the patient the oppor-
tunity of making his community adjustment grad-
ually and without the pressure he would feel from
his own family to work or to assume other responsi-
bilities which he may not feel equal to doing.

In the family care home the social worker from the
hospital encourages the patient to do what he feels
able to do and gradually to assume the responsibilities
of community life. The family caretakers are given
instructions as to what the patients' needs are and
how these needs should be met. They give him sup-
port and encouragement so that he win make progress
and yet not feel that any pressure is put upon him to
assume the responsibilities he carried before his ill-
ness.

Therapeutic family care has been used for elderly
patients as it is felt that with this support they can
find a niclie for themselves in the community and
eventually make a permanent adjustment with the
help of old age assistance or other community agen-
cies interested in helping the aged.

Foster family care is also used for patients, many
of whom are aged, who have profited all the.y can from
hospital-treatment but who do not need the various
highly specialized services of the hospital. Those pa-
tients are often confused, forgetful and unable to take
adequate care of themselves but they are not danger-
ous to themselves or others. They need the careful
supervision of the hospital social service and the pro-
tection offered by an understanding family. With
this they can enjoy varying degrees of freedom in

community living and they are much happier than
they are in the institution.

Family care in the State of New York has devel-
oped slowly. During the war the securing of families
interested in this project was difficult because in many
families both husband and wife worked or pei-haps
they opened their homes to daughters and children
whose husbands were in service — thus they had no
space for patients. Since the war the housing short-
age has continued to hinder the development of this
program. We should also mention the fact that the
shortage of both psychiatric and social service staff
during the war was an added factor preventing the de-
velopment of family care. In spite of this relatively
slow development it has been shown that with ade-
quate psychiatric social service supervision, and ade-
quate medical personnel to select patients, that family
care offers a valuable source of exit from our institu-
tions which can be increasingly used both for the
benefit of the patient and the community.

We feel that the development of family care might
be one way of decreasing the necessity for new build-
ings; we know that it is less expensive than hospital
care and that the satisfaction to the individuals who
enjoy the benefit of familj^ care is something that can-
not be measured.

At the present time there are 2,000 patients placed
in foster homes bj^ the institutions of the department.
Of the 1,284 placed by various State hospitals. 743
are over 60 years of age and 84 of the State school
patients are over 60. Incidentally, in this group of
patients past 60 there are 27 men and 36 women who
are past 80 years of age.

From the above figures it will be noted that al-
ready the State has used family care quite extensively
for elderly patients. We believe that foster home care
for elderly patients is a resource which has shown
its value and which should be more extensively
developed.

139

You Can H Retire On Your Money Alone

By Senator Thomas C. Desmond

Chairman, Xew York State Joint Legislative Committee on Problems of the Aging

YOU have seen them ; ouee they were dyna)nie ex-
ecutives or vigorous professional men ; now, they
aimlesslj^ IDutter about the garden or gloomily
reek themselves on some hotel porch in a futile effort
to find peace of mind in retirement. Many succumb.
The doctor's certificate may read "coronary throm-
bosis" or "cardiac failure" but the physician knows
the real cause is "retirement shock," inability to ad-
just oneself to retirement.

They are the victims of the myth that all one needs
for successful retirement is ample annuities, a bulging
investment portfolio, or an adequate pension. Finan-
cial preparation for retirement, an expression of high
resolution and character, is the foundation on which a
retirement structure must be built ; but it is only one
part of a livable edifice.

Physicians today warn us to erase from our minds
the phantasy of retirement as the period of The
Grand Loaf. Activitj' is a biologic duty. It is viola-
tion of this fundamental precept that makes retire-
ment, as currently envisaged bj' many people, as

* Reprinted from
Estates.

the ilai'ch, Ifl-'H) issue of Trusts and

■.**■

)^H

igm

^- ^^Bl

Olders tind croquet fun, but also need constructive activity.

Two of the world's greatest living conductors,
Arturo Toscanini and Serge Koussevitzky, are
82 and 74 respectively. Verdi wrote his greatest
opera "Otello" when he was 74, and "Palstaff"
when he was 80. Between the ages of 70 and 83,
Commodore Vanderbilt added about $100,000,-
000 to his fortune. Titian, at 98, painted his
masterpiece of the "Battle of Lepanto. " Kant, at
74, wrote his "Anthropology," "Metaphysics of
Etliics," and "Strife of the Faculties." Ber-
nard Baruch, at 76, represented the country on
the Atomic Energy Commission. Root revamped
the setup of the World Court at 84. Edison de-
signed, built and operated chemical plants after
he was 67. — (Excerpt from "Need 65 Be Time to
Eetire?" in The Management Review.)

Writing is retirement career for many.

dangerous as toying with a high-voltage wire. Func-
tions and living tissues that are not used decline and
atrophy. Nature tends to eliminate those which have
relinquished their functional usefulness.

Dr. Edward J. Steiglitz of Washington, D. C, one
of the world's leading specialists dealing with the
aged, points out that while we cannot halt deteriora-
tion or aging of muscular and nervous s.ystems, its
speed can be altered ; aging can be hastened or slowed
down. Inactivity speeds up degeneration.

140

Dr. Theodore G. Klumpp, president of the Win-
throp Chemical Co., says, "Any biological organism
that has been accustomed to a set routine for 40 or
50 years can't suddenly be shaken from its orbit with-
out untoward consequences. Dr. Lydia G. Giberson
of the Metropolitan Life Insurance Company speaks of
the "lethal" cessation of activity.

Famed physiologist A. J. Carlson of the University

Psychiatrists warn that idle retirement is likely to
aggravate our personality defects, to evoke deep irri-
tations, and make us childish and petulant to such an
extent as to transform a fine citizen into a liability.
Retirement unwisely planned tends to bring forth
weaknesses of childhood that have been consciously
or unconsciously repressed through an active life.
The mental experts find that the man who wishes to

"Thirty-nine days until I have to retire! I've looked for-
ward to this all these years — till nowl"

of Chicago and the late Dr. Alexis Carrel, one of the
greatest scientists of our era, have both warned
against the ''rocking chair" phantasy. "When we
are in idle retirement," says Dr. Carlson, "we are
contributing to biological parasitism and degenera-
tion of human societj- as well as wasting valuable hu-
man resources." Dr. Carrel pointed out that leisure
is even more dangerous for the old then for the young,
that inaction impoverishes the content of time. "To
those whose forces are declining appropriate work
should be given, but not rest," he advised.

"rest" or "live the life of Reilly" is either indulging
in a phantasy or is simply running away from life,
due to past failures, inadequately rewarded.

Our mental hospitals are flooded with elderly who
are not insane but simply confused, harmlessly child-
ish or depressed, senile largely because they permitted
their minds to rust away.

The Best Rule to Follow

Science therefore calls for viewing retirement in a
new light, in which it must be :

141

(a) fitted to the iudividual's needs,

(b) in whieli activity must not cease, antl

(c) in wliicli it must be oonceiA'ed not as a
"drawing- baclv, " but rather as a new turn in
life's road, filled with new challenges, new oppor-
tunities.

When Should You Retire? Wim-e some of us are
old at 45. while others are young- at 80, no general
rule can be given as to when we should retire. Since
one "s chronological age is unimportant compared with
one's physiological or mental age. New York State
Health Commissioner Herman E. Hilleboe says, "a
fixed age for retirement is absurd."

The best rule to follow is to retire when you can
afford to. want to, or have to, due to inability to con-
tinue, and then be certain you don't merely vegetate
but retire to something.

Examples of Successful Kelirenienl

We can learn much from those who have retired
successfully. When Dr. Frank P. Graves, former
New York State Commissioner of Education, noted
educator and holder of 40 honorary degrees, retired,
he decided to go back to school and become a lawyer,
something he had always wanted to be. In his 80s,
Dr. Graves found a new, satisfying career. Mr. Ber-
nard Baruch has found in retirement a busy, vital,
rich career advising- governments and stimulating
much needed health research. Freed of administrative
details and responsibilities, three of General Electric
Company's top scientists, Drs. Willis R. AVhitney. 82;
Irving Langmuir, 67 ; and William D. Coolidge, 76,
all officially "retired" from the company, have re-
turned to their laboratories to find new' challenges and
satisfactions in working, perhaps at a more leisurely
pace than previously, in the new fields of radar, tele-
vision and atomic energy. Note that all tliese men are
useful and needed.

Synthesizing the findings of science with 'he per-
sonal experiences of the successfully retired, there are
five basic principles for making- retirement a golden
era of satisfaction and happiness :

1. Start planning the non-fiscal aspects of retire-
ment when j^ou initiate your fiscal program for
retirement. Begin in your 30s and 40s to work
on your plan.

2. Don't stop working abruptly; slow down t'-radn-
ally.

3. Make useful activity the core of your retirement
plans.

4. Develop now an interest outside your business or
profession that you can ride as a hobby when
you retire.

5. Devote part of your retirement to civic or char-
itable service.

Successful retirement is one of the most difficult
achievements of a lifetime, as hard as the climb to the
top in business or finance or law-. It requires careful
thought. Too many persons begin in their 30s and
40s to invest in amiuities or to build up investments
for retirement, but neglect until the day thej' retire
planning what they are going to do -with their retire-
ment years. Allow yourself at least 10 .vears, if pos-
sible, to develop and test j'our plan.

Don't Slop — Slow Down

Above all, don't stop working until other interests
are ready to absorb and keep alive your mental ener-
gies. This slowing down process may consist of eas-
ing off the number of hours you work at the office ;
taking longer or more frecjuent vacations; gradually
shifting responsibilities to younger associates ; or cut-
ting down on activities that drain your energies, such
as business travelling, sales promotion work, supervi-
sion of personnel. This slow-down will also enable
you to give your program a pre-retirement trial.

The core of successful retirement is useful activity.
But what constitutes "useful" activity? Again, the
answer depends on the individual. A retired sales
manager foiind that operating a small gift shop was
useful, pleasurable, and kept him sufficiently active to
suit his needs. Another retired "big business" execu-
tive organized a .small woodworking plant in his gar-
age to produce hand carved trays that sell successfully
by mail. This man had alw^ays been an organizer and
reveled in his ability to weld together a small organi-
zation that makes a profit without much effort on his
part. A third "retiree" when advised at age 82 by
his physician to "take things eas.y, " moved his real
estate business from his office to his home, where he
still works at it part-time. These men are all still
productive and the years sit lightly on their shoulders.

And Get a Hobby-Horse

All of us, to grow old gracefully, need to develop —
as early as we can — interests outside of business. Age
is no excuse. Dr. Noland D. C. Lewis, noted ps.vchia-
trist, points out that a man of 65 can learn more easily
than a boy of 12. If you don't like to play golf, skip
it. If you despise gardening, avoid it. But keep an
open mind about hobbies. In retirement yoii need
leisure time activity to supplement your useful work.

Many a businessman who sneered at such activities
as painting, photography, writing, sculpturing or
carving has found such hobbies a "blue chip" invest-
ment for contentment in retirement. In many com-
munities you will find handicraft schools or Y.M.C.A.
hobby clubs where businessmen are preparing for
their retirement.

142

Oue of the basic emotioual needs for sueeessfnl re-
tirement is to feel needed. And certainly one field in
which our senior citizens — men and women — are
needed is that of civic and charitable work in every
commnnity. Many of our philanthropic and ednca-
tional organizations are stafi:ed by well-meaning ama-
teur administrators; they need help in modernizing
their work, they need counsel. Some agencies need
investment eoimsel; others need aid in giving finan-
cial counselling to families in trouble. ^lany need
help in soliciting funds from industry and financial
organizations.

Our health associations, family welfare agencies,
local groups combatting juvenile delinquency, the
Red Cross, the Boy Scouts of America, and church
organizations, urgently need part-time volunteer aid
that our retired executives and professional people
can give. We need more businessmen of ability on
our boards of education, on our hospital boards of
directors. "Work with such groups will be enormously
rewarding, absorbing and xiseful. It will give zest to
your retirement years.

Selling the American System

I\Iany of our businessmen earn their livelihood
selling products, services or ideas. In retirement they
can use their talents to render a patriotic service of

utmo.st importance bj- "selling" the people of their
respective communities on the American system and
the achievements of American initiative ; on the role
of capital in producing new standards of living ; and
on the simple economic facts of American life. Many
retired American businessmen will find this role of
"salesman emeritus" to be enormoush' satisfying and
challenging. And it is a job that needs to be doue.

Underlying the activity program for retirement
years there must be a solid bedrock of financial secur-
ity. This is needed to make the retirement program
feasible, to erase the possibility of financial stress and
to pro-\-ide an emotioual stability that stems from the
knowledge that the later years are provided for. One
who is not a financial expert should consult one of the
host of experienced fiscal advisers, such as trust offi-
cers, who are skilled in portfolio iilanning for retire-
ment. The stakes are too high to depend on .amateur
counsel, tips from well-meaning friends, or intuition.
Retirement can be an era of achievement as well as
calm, of usefulness as well as restfulness, which will
keep one youthful in spirit.

If you would avoid the boredom of unplaimed re-
tirement, the restlessness of useless activity in your
later years, the dulling of mental powers in idle
leisure, start now to avoid the hazards of the mental
"bends" that come with sudden, unplanned retire-
ment.

Let me grow lovely, groiriiip old.
So many fine things do.
Laces and ivory and gold
And silks need not be neir.

And there is healing in old trees.
Old trees a glamour hold ;
Why may not I, as well as these.
Grow lovely, growing oldt

Autlioi' Unknown

143

State Aid for Recreation Centers

By Harry Levine

Administrator, Special Services for the Aged, New York City Department of Welfare

I SHOULD like to pay tribute to the splendid
achievements of the Desmond Committee. In the
very brief period iu which it has functioned, it
has made a most important contribution to the field of
old age. Through its jjublished material and its abil-
ity to reach the community it is making the leaders in
many fields and the community, itself, aware of the
problem and the possibilities of a concrete practical
program. It is making a lasting contribution to the
16 million Americans past 60.

Since time immemorial, man has counted longevity
amongst the blessings, particularly when few achieved
it. Now that we have achieved the three score and
ten years for the many, those who have achieved it
doubt it's blessing and with good reason. There are,
however, some blessings. Todaj', the man of 60 or 65
is a much different person from the man of 60 or 65
of the 1800 's or 1900 's. He is a much younger per-
son. He is much healthier, stronger and more dy-
namic. When the average life expectancy was 35 in
1800, a person of 40 was comparatively old ; when we
achieved an average life expectancy of 45 in 1900, a
person of 50 was a comparatively old person. Now
that we live to almost 70, a person of 40 or 50 is com-
paratively young.

In a shorter lifetime, he worked as many hours as
he now does in a longer lifetime. He works under con-
ditions much more favorably to his health in terms of
sanitation, heat, light and transportation. In the
past, if he managed to reach 65 he was a tired old
person. Today, a 65 year old person has an interest
in and a zest for living, a need to be active and to par-
ticipate— and why not, for at 55 he has a life expect-
ancy of close to 20 years; at 60, at least 16 years; at
65, 13 years. Even at 70, he still expects to live for 10
more years. If you add 5 or 10 years of unemploy-
ment, that is the lot of many people. Before they
reach 60 or 65, you have another lifetime to account
for. Actually that lifetime cannot be accounted for.
It is generally wasted. It makes little contribution to
the family and to the community and mueli less to the
older person. It is difficult to accept the fact that the
lifetime of millions of people in the United States is
wasted, but what is even more difficult to accept is
that from these millions — with little to do, with no
positive interest, unwanted, feeling themselves a bur-
den— deterioration and illness becomes their dailv ex-

perience and for many, many thousands mental hos-
pitals become an unnecessary and undeserved inhu-
man and bitter ending.

I just had occasion to check the figures of Brooklyn
State Hospital. As of October 1, 1949, they had
1,165 men and women patients over 60, 71 were 85 to
89, 28 were 90 to 94, 3 were 95 to 99 and 1 was even
over 100. It is difficult to contemplate that an indi-
vidual may enter at the age of 60 and live for 40
years in a mental hospital. Kings County has 1.800
patients who are past 60 and they send more than
100 patients a week over 60 to other State hospitals.
The Manhattan State Ilo.spital advises that of their
4,000 patients, 1,971 are over 60 years of age. There
are 153 on convalescent status. Dr. Travis writes that
it is amongst the latter group that people should avail
tliemselves of our day center activities. I am very
deeply concerned with the 153 convalescent patients,
but I am even more concerned with the people who
may get into mental hospitals — particularly when we
are advised that 75 per cent of those already in men-
tal hospitals could have remained in the community
with a little help, and even now, most of them do not
belong there. Old age homes care for approximately
1 per cent of our older people. I am interested in the
more than 90 per cent. The lack of information and
lack of understanding of our older people not only
makes possible the fact that over 60 per cent of all new
admissions to mental hospitals in New York State are
people over 60, but it makes possible the consignment
of most of our older people to our economic, social and
cultural scrap heap.

"When a man or woman stops working in his or her
regular occupation ; when there is no longer a family
to raise ; when an older person must learn to live alone
after the death of a lifetime partner ; unless there is a
place where they are needed, where they could con-
tinue to make a contribution; where they could con-
tinue to be active, they begin to lose their feelings of
adequacy and worthwhileness. Time begins to hang
heavy on their persons and their personalities, par-
ticularly during the working hours between 9 :00 a.m.
to 5 :00 P.M., when everj-one else around them is occu-
pied and functioning. I believe it is then that de-
terioration sets in and illness becomes confused with
age and eventually part of it. There must be a place
in the community for the older person — a plac-e that

144

can maintain a feeling of usefulness and adequacy and
belonging for the countless numbers who need it and
want it.

Day Centers Needed

When we begin to analyze what really can be done
for the older person, not in the near future, but now,
we feel more and more that the development of a well
planned integrated system of day centers for older
people is one of the realistic practical programs that
can be developed today. "When Dr. Charles Kidd an-
ah-zed the problem, he pointed out that a smaller pop-
ulation of older workers will be in the labor force in
1960 than in 1948, despite the recognition that there
will be a tremendous increase in the number of older
people. There is a steady marked decline of older
people in the labor force. For example, in 1890, 70
per cent of men 65 and over were in the labor force.
By 1940, this figure declined to 42 per cent and will
decline to 36 per cent by 1950; and by 1960, he pre-
dicts it may be as low as 30 per cent. It becomes even
more apparent when Dr. Ewan Clague points out
that among persons 65 to 74 one-half are not affected
by chronic disability and impairment. Only 5 out of
every 100 persons were classified as invalids, and
there is a growing diiference between ability to work,
work itself and the life span.

The daj- center can be a substitute for the loss of
the work day; the da.y center can be instrumental in
prolonging the period of usefulness ; it can extend the
feeling of acceptance and belonging in the older per-
son; it can give meaning to the latter part of life by
developing a dynamic program for the older person.

It is generally accepted that each individual ages at
his own speed or pace and in the same individual dif-
ferent functions age at different rates. It is, there-
fore, the content age rather than the birthday or
chronological age that becomes important in working
with older people. We hope that in these day centers
medical findings will be utilized to help the older per-

son to a realization of the remaining strengths avail-
able to him and to plan for its utilization. We also
are aware that people have many areas of competency
that a busy work life has not permitted of develop-
ment. We hope, through a testing process, to uncover
these area's and combine those areas of competency
with the strengths remaining to the individual.
The day center program has for its ob jectiA'es :

1. The promoting of the social and emotional ad-
justment of the older person through activity.

2. To make possible for the older person the maxi-
mum use of the capacities least impaired and
of capacities least used.

3. To promote community usefulness by having the
older person fit to participate in voluntary pro-
grams in the community.

With a case work, group work and personal coun-
selling program, the older person can maintain a pe-
riod of well being for a much longer time than is pres-
ently the case. We believe, through the various ac-
tivities developed at the centers, that it is possible :

1. To lessen the need for mental hospitals. We
haven't had a single admission to a mental hos-
pital from our centers in the sis years ox its
existence.

2. To lessen the need for clinics and general hos-
pitals. Our people stop going to clinics after a
period at the center.

3. To cut the period of iUness from a matter of
years to a matter of months. Their illness is
usually of short duration — a matter of weeks or
at most months.

I do hope that the committee wiU see fit to recom-
mend the appropriation of at least one million dollars
to extend this program throughout the State. I be-
lieve the appropriation will, in turn, save many mil-
lions for the taxpaj'ers in the State.

OUR NEW OLDSTERS

"Xoting the interest you are taking in the
conditions of the 'oldsters,' of which I shall
soon he a member, 1 am writing to j'ou for
information."

Letter to Senator Desmond from 80-year old
Mr. W. H. Singer, of Olean, New York, Jan. 29,
1950, inquiring whether he can take a job with-
out impairing his old age assistance benefits.

145

Financing Old Age

By Dr. Henry W. Steinhaus
Research Assistant to the President of the Equitable Life Assuravre Society

SojiE 60 years ago, on June 22, 1889, to be
specific, the first Social Insurance Pension Sys-
tem in the world became law in Germany. Dur-
ing these 60 years the extension of life has intensified
the problem of livelihood after retirement but no
satisfactory basis has been developed for financing
old age pensions on a national scale.

There are two principal methods of financing a
national pension system. One involves a pay-as-you-
go system under which pensions are paid out of
current revenues. The other involves complete fund-
ing under which capital is accumulated during the
working years of a generation, sufficient to pay pen-
sions after retirement without additional financing.
Between these two extremes are various other methods
under which some reserves are accumulated to pay
part of the pensions but ultimately reciuiring subsidies.

Pay-as-you-go vs. Funded System

The original Social Securitj' Act of 1935 employed
the method of funding. When the act was amended
in 19-39, a pay-as-you-go system was substituted,
modified somewhat by a small contingency reserve.
However, this reserve actually rose to $12 billion
due to tlie inflation of wages on which contributions
are based, and it looks as if the pay-as-you-go system
had turned itself into a funded system under which
the scheduled tax rates would be entirely sufficient
to maintain the present structure of benefits.

If inflationary developments of the relatively mild
character of the last few years are sufficient to turn
one type of funding into the other, there would seem
to exist most serious ob.jectious to the adoption of a
fully funded system. Nevertheless, H. R. 6000 again
has proposed funding of pensions. Reserves would
accumulate which would reach even without any
further inflationary development nearlj- $100 billion
over the next 30-40 years.

There is obviously no guaranty under either system
of financing that the old age pensions will accomplish
what they were supposed to do, namely, to establish
at least a minimum of financial security for our aging
population. Current pensions average $25 monthly,
and while they may be raised to an average of some
$44 next year, there is obviously no guaranty that the
purchasing power of these $44 will be maintained. If

our deficit spending and easy money policy continues,
the chances are that the purchasing power of the pen-
sions will steadily decline and that adjustments in
benefits will always lag by several years. At the same
time payrolls and contributions would be higher than
anticipated.

In 1935, opponents of the funded system compared
the loroposed $47 billion reserve to our then national
debt of some $30 billions and wondered what the Gov-
ernment wo\;ld use for investments. This objection
was taken care of quite neatly, and even a $100 billion
reserve could apparently be handled. However, in
order to create this reserve, we must withdraw from
current income billions of dollars annually.

These withdrawals would be in addition to any
required by supplementary private pensions. Since
the Government has the taxing power, it could always
pay the promised pensions. Congress willing, whether
or not the reserves existed. Private pensions, how-
ever, have obviously lao security behind them except
the funds already deposited. If the pension movement
spreads and millions of our citizens obtain a supple-
mentary pension guaranteed to provide $100 a month
including Social Insurance pensions, the annual
charge would be prohibitive. On a funded basis it
costs about 6 per cent of payroll to provide private
pensions to supplement those proposed under H.R.
6000, or $6 billion annually for a $100 billion payroll.
This amount added to the taxes proposed for the
Social Insurance pension represents a sizable propor-
tion of our national capacity to save.

The withdrawal of funds of such magnitude would
probably cause a decline in consumption, because price
rises necessitated by increased employer costs will
cause deferment of spending by a population whose
income is also reduced by direct contributions for
Federal and private pensions. If the Government
attempts to replace this deficiency by additional deficit
spending, an inflationary cycle would be set in motion
and deflate the purchasing power of the pensions.

We cannot increase our standard of living by print-
ing money and distributing it. I think the public
understands this by now. We cannot create old age
security by putting away current earnings without
actually reducing our standard of living accordingly.
This the public does not understand yet. In either

146

case, the economy will adjust itself ai^tomatically by
inflation. Attempts to provide artificially more finan-
cial security than there is have perhaps the pleasant
illusion of a chain letter that benefits the first few
recipients of income, but the outcome is a rude
awakening of those who expect a benefit later on.

Three Point Programs

It is not conceivable that there would be a single
answer to all these problems, but there are a few
things that can be done. First of all, we must attempt
to stabilize the span of retired life by encouraging
deferment of retirement. Fortunately, the genera-
tions living under the favorable health conditions of
today appear to bring into their old age an improved
vitality. This improvement in vitality may permit a
deferment of retirement for those able to maintain
employment.

Second, the Federal (Joveriiiuent should abstain
entirely from withdrawing purchasing power by
means of payroll taxation for the purpose of building
up additional old age reserves. The reserve of $12
billion by itself would be sufficient to pay the pen-
sions proposed under H.R. 6000 for the next six
years, without requiring additional contributions. If
payroll taxes are held at low levels, a greater number

of individuals will be able to provide a competence for
their old age, and thereby minimize the national
problem.

Tliird, we should explore non-monetary financing of
old age security. Up to this point we only reviewed
the problem of providing a pension payable in cash,
and it was the accumulation of money of declining
purchasing power which caused all the difficulties.
One of the biggest items on the budget for the aged
is the cost of living quarters. Only too often exorbi-
tant rents eat up much of the money grants and leave
little for comfort. Owuersliip of living quarters effec-
tively provides an inflation-proof roof over the head.
The European patteni of living of the aged has
emerged as centered around living quarters, either in
large settlements or in individual homes and apart-
ments of income-producing types.

There are many problems involved in furthering
non-monetary financing of old age. An equitable
method must be found to transfer ownership from
generation to generation. The taxation of sucli dwell-
ings must be handled in such a way as to avoid undue
burdens on both the aged and the community.

There are other items in the budget of the aged
which may lend themselves to non-monetary storage.
In my opinion, the greatest hope for old age security
lies in our success in exploring and activating non-
monetarv methods of financing old age securitv.

147

Trends in Old Age Assistance

By Miss Jane M. Hoey
Director, Bureau of Public A.sKisluiicc, Uvileil .s'/ofrs ftocial Security Administration

AS AN introduction to the subject of trends in
old age assistance perhaps it would be desir-
able to state some basic assumptions underly-
ing the need for and objective of an old age assistance
program.

Man is a nation's greatest asset, whatever his age —
not just -when he is young — and whatever his race,
nationality, religion, physical or mental capacity, per-
sonality, or social or economic status. The family,
whatever its composition or age of its members, is the
basic unit of our civilization and needs to be developed
and preserved whatever the cost. Thei'e is no sub-
stitute for the family nor for the care and affection
which most members of a family give to each other.

The Nation has an obligation to man, always to re-
spect his dignity, his integrity, and rights as a
human being, and to help him develop all his capaci-
ties to be productive, and to support himself and his
dependents, and to contribute materially, culturally
and spiritually to his own growth and development
for the benefit of society. The Nation, through its
various governmental units and private agencies, has
an obligation to make possible normal family life
through such measures as will protect health and de-
velop wholesome surroundings in which man can live ;
to establish and maintain a decent standard of living ;
to provide such services as education, health, and wel-
fare as are necessary to promote public welfare ; and
to encourage private institutions and agencies in giv-
ing services which are helpful to man and families as
these services are needed and desired. It is because
of our failure to live up to our theoretical assumptions
in practice, and because of the facts of change in our
population and the varying needs of groups such as
the aging, that we must reconsider our plans, our
attitudes, and our programs.

When the Social Security Act was passed in 1935 it
was in the middle of a depression and millions of
workers of all age groups were unemployed. There
was a generally accepted idea at that time that older
workers should retire and thus leave jobs available
for younger workers. During the long period of the
depression, large numbers of older workers who were
unemployed used up their savings and other resources
and at 65 were almost eompletel.v destitute. There-
fore, a long-range plan for meeting need caused by
certain common standards, unemployment and old

age, was developed under the Social Security Act.
Provision was made for unemployment insurance,
State administered, and old age insurance, later
changed to old age and survivors ' insurance, a Federal
plan financed through contributions of employees and
employers. However, no provision under the Social
Security Act was made for large numbers of workers,
chiefly those in agriculture and domestic servants.
Also there were many who were then aged and in
need and who could never be covered by the insurance
programs. So for this latter group the Social Security
Act i^rovided grants-in-aid to states to help them give
more adequate financial aid and other services to their
needj' aged living in their own homes or in private
institutions or boarding homes. Because this needy
group was so numerous and because it took so long
for persons to qualifj^ under the old age insurance
program, many persons, aged and others, assumed that
the onl}^ program for care of the aged with which the
Federal and State governments were concerned was
old age assistance. For this reason and because for a
long time there have been individuals and groups ad-
vocating "pensions for the aged," some state legisla-
tures have tried through the old age assistance pro-
gram to guarantee a minimum income to the needy
aged and have liberally interpreted need. Because
old age insurance benefits are inadequate to meet the
average need, many beneficiaries of old age insurance
are also eligible for supplementary old age assistance,
and 10 per cent are in receipt of it.

H.R. 6000

If changes in the Social Security Act, such as are
proposed in H.R. 6000 arc euacted, this may change
drastically the trend in old age assistance in the fu-
ture. It may also change community attitudes toward
the need for a flat pension. An Old Age and Survivors
Insurance program for all employed persons and with
benefits adequate in amount to meet average need,
supplemented by an old age assistance program for
the needy aged, would seem to be a desirable objective
toward which we have made real progress, biTt which
needs extension and strengthening as indicated bj^
present congressional action.

Old age assistance is a program of financial aid and
other services to men and women who are at least 65
years old and who do not have enough income and re-

148

sources to secure the uecessities of life — food, shelter,
clothing, medical care, etc. The program was in-
tended to supplement insufficient incomes of indi-
vidual people ; and to supplement other plans and
programs that provide income after 65. These pro-
grams have not been developed as anticipated, and
old age assistance has grown beyond its intended
scope and responsibilities. To understand past trends
and to plan for the properly limited function of old
age assistance in the future we must look, in passing,
at some other pertinent developments in the United
States.

As most of our jDrograms and jjlans for old age se-
curity are oriented toward age 65, that age has be-
come unfortunately synonymous with old, retired, dis-
abled, and sometimes useless. Unless community atti-
tudes and our programs are redirected toward a
worker's ability to maintain himself as long as he is
able and wishes to do so, many of our citizens over
65 will be sentenced to a life of inactivity. To avoid
this sentence, we must overcome these confusing and
misleading concepts and attitudes they reflect. We
must assert our conviction that people over 65, like
those of 20 and 40, have the right and the responsi-
bility to use fully their capacities for work, play and
participation in community affairs. For ethical, social
and economic reasons we cannot afford to retire work-
ers automatically on their sixty-fifth birthday.

Although we should modify our fixation on age 65
as the benchmark for retirement, we must keep in
mind that the rate of people who reach that age is
growing more rapidly than the population as a whole.
In 1880, persons 65 and over constituted 3.4 per cent
of the population; in 1940, 5.7 per cent; in 1960. 9.2
per cent; in 1975, 11.3 per cent. In 1948 there Avere
11 million persons 65 and over; in 1960 there Avill be
15 millions.

ReBources of the Older Worker

"We are all too familiar with the truth of the state-
ment that cmployimeni opportunities of older workers
deteriorate. It has been confirmed recently by a study
of the United States Employment Service conducted
in six areas in the spring of 1949 at the height of the
recent recession. In a period of declining employ-
ment, marginal workers and particularly men over 45
and women over 35 are among the first to be laid off.
This is especially true of unskilled workers. Unem-
ployed men over 45 and women over 35 take longer
than those in younger age groups to find new employ-
ment. If not re-employed in their former regular oc-
cupation, they are nearly always required to accept
employment at lower skill and pay levels. Such em-
ployuient policies are hardly in line with the unequi-
vocal statement of economists that our economy can-

not get along without the older worker, if it is to be an
exj^anding economy of the type they forecast.

The majority of retired workers are not likely to
maintain themselves from savings of their own. One
example may be enough to show this :

In November 1949, it cost a family of four in De-
troit $280 a month to maintain itself at a modest
standard of living. Two hundred sixty dollars per
month is the average wage of the Detroit automobile
worker, if he works 11 out of 12 months. Thirty-six
dollars is the monthly premium for a private annuity
that assures him an income at the age of 60 of $100 if
he starts buying it at the age of 30 and pays for 360
months. This is, of course, impossible for most fac-
tory and farm workers.'

Private pension plans are estimated to cover about
four million workers, many of whom are also entitled
to Old Age and Survivors Insurance benefits. The es-
sential purpose of these plans is to remove those work-
ers from the employment rolls who are past a specified
age, usuallj- 65.

Union w^elfare funds were established as early as
1867, Avhen the Brotherhood of Locomotive Engineers
developed a death and accident benefit plan. Their
recent spectacular expansion is due in part to the lack
of provision for sickness and disability insurance
under Old Age and Survivors Insurance. Today these
union plans according to Harry Becker of the United
States Automobile Workers, protect nearly four mil-
lion workers, about five times the number in 1945.

Old Age and Survivors Insurance, in 1935, when
the Social Security Act was passed, was expected to be
the major source of economic security for the retired
worker. Because of the program's limited coverage
and inadequate benefits, this intent of Congress has
been realized only in part. Out of 57,000,000 workers
in civilian employment in .Tune 1949, some 22,000.000
were in jobs that provided no ci-edits under the Old
Age and Survivors Insurance jDrogram. The number
of beneficiaries aged 65 and older was then about
1,800,000 ; the number had almost tripled since 1945,
but was still 836,000 fewer than the number of old age
assistance recipients, now 2.6 million in June 1949.
The average monthly old age insurance benefit was
about $26.

If H. R. 6000 becomes law, its liberalizations for
Old Age and Survivors Insurance would be felt
gradually in old age assistance, as the program ma-
tures ; but we could not look to an immediate realign-
ment of responsibilities between the programs.

As previously indicated, the vigorous efforts of the

1 Summarized from "Supplementary Security Programs
under Collective Bargaining" Harry Becker, Public Welfare
Kovember 1949, Vol. "7, Number 11, p. 208.

149

so-called pension movements make it hazardous to
predict that the future will assign to Old Age and
Survivors Insurance its major role and to old age
assistance its minor place among Social Security pro-
grams. In fact, these movements are a direct threat
to Old Age and Survivors Insurance. They exert
strong political pressure to expand old age assistance
into a non-contributory pension program for all per-
sons aged 65 and older, their cost to be met from cur-
rent taxation. The success of these efforts is obvious
in Louisiana, Washington, California, and Colorado,
as is their impact on governmental expenses anct tax-
ation. For instance, Louisiana in 1949 has the highest
per capita state tax revenue in the country, $85.59 as
compared with $79.75 in Washington, $72.47 in
California, and $70.60 in Colorado.- The rise and
fall of the movement in California may not be an
omen of future developments. However, California's
experience illustrates what happens when old age as-
sistance is promoted with little considerations of the
requirements of other needy people in the State or of
the other types of public services which need financ-
ing, such as education and health. Through tliese
efforts has been created an imbalance in program
planning and adequate consideration to all interests
has not been given in some states. On the other hand,
these pension movements have made positive contri-
butions by drawing attention to the needs of the
aged and securing more adequate assistance in a num-
ber of states, and by strengthening the conviction
throughout the country that old age assistance comes
to people as a right and not as a gratuity.

Grants-in-aid for Old Age Assistance

As a way of decentralizing operation and in order
to leave Avith the states full responsibility for admin-
istration of old age assistance and other public as-
sistance and service programs, the FederaL Govern-
ment established under the Social Security Act grants-
in-aid to the states. The conditions for state receipt
of such funds are stated in the act, including the
maximum amounts of Federal funds available to
match state funds. In the fiscal year of 1950 the
Federal Government will expend over one billion dol-
lars for public assistance to 41/2 million needy per-
sons and the state governments will spend about an
equal amount. For old age assistance the Federal
share in 1950 will be about $850,000,000. As of
October 1949, the number of recipients is about
2,700,000.

The imbalance in provisions as between programs
under the Social Security Act can best be illustrated

^ State tax collections in 1949 exclusive of unemployment
insurance tax. Bureau of the Census.

by the amounts granted to states under the Social
Security Act since the beginning of these programs
in February 1936 through October 1949. The total
amount in round figures for public health service
grants, the three programs under the Children's
Bureau — crippled children, maternal and child health,
and child welfare services ; the administration of em-
ployment security; and the three public assistance
programs — old age assistance, aid to dependent chil-
dren, and aid to the blind — was seven billion dollars,
almost five billion of which went for old age assistance
and one billion for aid to dependent children. The
Federal agency matches state fmids up to certain
maximums and the higher income states generallj^
make Ingher appropriations.

In the Nation as a whole, old age assistance pro-
grams have developed gradually toward more ade-
quate payments and coverage, toward more equitable
treatment of individuals, and more efficient operation.

Old age assistance laws have existed in the United
States since 1915, when the first one, later found un-
constitutional, was passed in Alaska. Montana fol-
lowed in 1923, Nevada and Wisconsin in 1925. By
1935, there were 32 states that had enacted legislation
and paid old age assistance under these laws. Ten of
these states began payments only in 1934 in an-
ticipation of the Social Security Act.

Recipient Rates and Amounts of Assistance

In December 1935, 42 states had submitted plans
for the administration of old age assistance to the
Social Security Board. All states and territories had
an approved plan by December 1938. Since then the
number of recipients has grown from 1,779,292 to
2,700,000 in October 1949. Almost one out of every
four persons, aged 65 or over, is now on the old age
assistance rolls. The number of beneficiaries of this
program is greater than in any other public program
except those for veterans. In October 1949 the aver-
age assistance payment was $44.37 as compared with
$29.75 in July 1945. This average payment today
buys onlj' 11 per cent more consumer goods and serv-
ices than in 1945. The cost to the Federal Govern-
ment has more than doubled since 1945.

Assistance recipient rates and amounts of assistance
still varj^ widely among the states. In June 1949,
810 out of 1,000 aged persons were on the assistance
rolls in Louisiana, 601 in Oklahoma, 103 in New York,
66 in New Jersey, and 109 in Pennsylvania. In June
1949, the average monthly payment in California was
$70.55 and Mississippi $18.80. In New York it was
$52.74. This range between average payments is
obviously much greater than the range between the
cost of living in these states. If we want to appreci-
ate what the individual payment may mean to indi-

150

vidual meu aud women who must live ou it, we can-
not think onlj' in terms of national averages.

Perhaps the most significant development in the
shifting pattern of state recipient rates has been that
of the development of a rather clear-cut relationship
Detween the per capita income of the states and the
proportion of aged persons on assistance.

States with a low per capita income have now, in
g-eueral, the high recipient rates. This situation is
quite different from the situation in 1940. In that
year, Nevada aud Xew York, states with a high per
capita income, had recipient rates of 334: and 128
per 1,000 aged 65 and older; and Arkansas and
Mssissippi, states with a very low per capita income,
had rates of 185 and 193; today the figures are re-
spectively 220 and 103 for Nevada and New York,
and 403 and 480 for Arkansas and Mississippi. In
eight states, most of which rank low in per capita
income, more than 400 per 1,000 are receiving aid.
Five states, four of which rank high in per capita
income, had a rate below 100 per 1,000.

If we relate this pattern to the pattern of distri-
bution of old age and insurance benefits, it becomes
clear that in the agricultural states the old age as-
sistance program carries an extra burden of needj'
persons out of proportion to that of industrial states.
Eleven (except West A'irginia) of the twelve states
(Mississippi, Arkansas, South Carolina, Alabama,
Kentucky, North Carolina, Tennessee, Georgia, Louisi-
ana, Oklahoma, New ilexico, West Virginia) that had
the lowest per capita income in 1947 rank high in the
relative number of old age assistance recipients and
low in the proportion receiving Old Age and Survi-
vors Insurance benefits in June 1949. In that month,
14 states had more beneficiaries of Old Age and Sur-
vivors Insurance than recipients of old age assistance.
Nine of these states, largely industrial, had per capita
incomes above the national average in 1946-1948.
The 14 states are Connecticut, Delaware, District of
Columbia, Indiana, Maine, Maryland, Massachusetts,
New Hampshire, New Jersey, New York, Oregon,
Pennsylvania, Rhode Island, Virginia. Increased Fed-
eral financial participation has been an important
factor in enabling states to raise assistance payments.

Following the enactment of the 1948 amendments,
most states reported increases in average payments.
Manj^ of these resulted from raising the monej^
amounts assigned to individual items in the state 's as-
sistance standards, from adding items to the stand-
ards, or from raising maximums. From June 1948 to
June 1949 the average increase was $5 or more in 15
states, and from $4 to $4.99 in eight states. Among
the states that increased payments by smaller
amounts, the largest single group included those in
which state funds were inadequate and cuts in pay-
ments to recipients would have been made had there

been no additional Federal funds. Some of the states
with smaller increases also added relatively large num-
bers of recipients to their assitsance rolls.

In New York State, recipients benefited from the
1948 amendments by an average monthly increase of
$3.30. Since the New York provisions for financing
the program require that the localities meet 20 per
cent of the total paj-ments, the localities had to appro-
priate additional funds to meet their share of the in-
crease since assistance rolls have continued to expand.

Services Delerniiiiing Eligibility

From statistical case records we know that the ways
by which assistance is provided is improving in many
places. Applicants receive aid Avitli less delay. In
1946, for instance, only 31 states made the first pay-
ment less than a month after the receipt of the re-
quest for aid. In 1948, 39 states managed to do so.
This administrative progress, although only two or
three weeks, may seem a very long waiting period to
the needy applicant. More and more recipients are left
free to spend their assistance payment according to
their ovm choice and judgment as required in the
Social Security Act. In our review of state practice
for 1947-48, which was limited to one or a few coun-
ties in each state, serious questions were raised in
four states onlj' about a violation of the requirement
that assistance be paid without direction on the spend-
ing by the agency. However, practices which do not
restrict outright the recipient's use of the money, but
are not in accord with the principle of nnrestricted
cash i^avnnents. are unfortunately still found in sev-
eral states. It is difficult for some workers to draw
the fine line between counseling on appropriate uses
for money and instructions on how to spend it. The op-
portunity for a hearing before the state agency is
available to dissatisfied claimants in all states. The
promptness and ease with which this opportunitj- is
given varies considerably.

While average assistance payments still differ wide-
ly among the states, distinct progress has been made
within a good many states toward the equitable deter-
mination according to uniform state-wide standards
of assistance.

Medical Care

While the public assistance program is primarily
concerned with money for maintenance when medical
care is not available fi-om other sources, it must be
provided by the assistance agency. The provision of
medical care or of money for its purchase has steadily
increased. In 11 states maximums on assistance pay-
ments may be exceeded for that purpose. In Louisi-
ana it may be raised to $90 for that purpose ; in Mon-
tana it may be increased to $90 for nursing care, and

151

to $100 for liosi3italization. In addition to amounts
made available to recipients to i3a.y for medical care,
most agencies — among them New York — that provide
such care, pay vendors directly for some medical serv-
ices. Such vendor payments are most likely to be
made when large bills for hospitalization or other ex-
pensive treatment are incurred. Four states meet
the entire cost of medical care through vendor pay-
ments. Federal financial participation is not available
for the expense of vendor payments and for expenses
that exceed the Federal maximum. Under H. R. 6000
vendor payments may be made but the maximum on
individual payments for old age assistance is $50 per
month for assistance and medical care. This would
be entirely inadequate. Providing $6 pev month on
the average for each old age assistance recipient would
be a much more adequate amount.

Other Services

Throughout the countrj-, many public assistance
workers give additional services, such as counseling
to and referrals of claimants to other social agencies.
These services are so closely integrated with the work-
ers' activities in determining eligibility that their
statistical enumeration and identification in case rec-
ords is not often feasible.

We can identify those services that are provided
by special stafl:s, such as homemaker services, as given
in New York City, through which people are helped
to stay in their own homes when their ability to man-
age them is failing. In several states (Illinois, Texas,
and Michigan) state and local staffs develop ways of
making sheltered care available to aged recipients.
In many large and small communities and probably in
all states, top administrative staffs cooperate in com-
modity planning for health and welfare services.

Legislative Trends

Trends toward liberalization and expansion of the
assistance programs continued in legislation enacted
in 1949, a year when nearly all legislatures were in
session. The trend, generally, was toward increasing
the amount of assistance paid to needy people and to
making moi'c needy people eligible for aid by repeal-
ing restrictive conditions of eligibility. Little legisla-
tion was enacted which restricted the scope of the as-
sistance programs. This is interesting because many
legislatures had previously appointed committees to
study the operation of the public welfare department
S]iecifically, or as part of a larger study of state gov-
ernment. One reason given was to see whether the
assistance rolls could be reduced.

In previous legislative sessions there have always
been some areas of public assistance administration

in some states that have suffered set-backs, although
legislation as a whole was constructive. In 1917, leg-
islation affecting the responsibility of relatives to sup-
port their kin, and the recovery from estates of recipi-
ents for assistance granted, restricted the states' pro-
grams in some instances. These same areas were
singled out for attention in 1949.

Some Liberalizations

For instance : In 1949 eleven states amended their
laws with reference to minimums and maximums on
old age assistance payments. Eight states raised the
maximum, two established or changed the minimum ;
Connecticut deleted its maximum altogether. Five
states liberalized residence provisions, including one
that repealed the residence reciuirement. Some re-
l}ealed the clauses requiring the recovery of assistance
granted from the estate or resources of a recipient.
Arizona modified its citizenship requirement and
tempered the provision that made acceptance of em-
ploj-ment a condition of eligibility. Massachusetts
jDrovided an additional item in its assistance stand-
ards, namely, $4 for leisure time activities, and the
state is to reimburse the locality for this amount of
money in full, notwithstanding any other provisions
concerning reimbursement. Eight states passed leg-
islation affecting persons in institutions or needing in-
stitutional care. This reflects the continued interest
of legislatures in this area and the discussions in
Congress that considered a relaxation of provisions in
titles I and X which jDrohibit Federal financial x^ar-
ticipation in joayments to inmates of public institu-
tions.

Restrictive Legislation

The outstanding concern of legislatures with the
l^roblem of dependency arising from desertion of par-
ents is also noticeable in provisions affecting adult
children who refuse to support their parents. Seven
states this year enacted statutes jDroviding for inter-
state cooperation in obtaining support from desert-
ing relatives. Several other states passed other pro-
visions to strengthen the responsibility of public agen-
cies to secure support from relatives.

If property was transferred for other than fair con-
sideration within a specified period, this was made a
bar to eligibility in several states.

The rigiit to recover from resources of recipients of
assistance paid was written into some laws, as well as
penalties for any fraudulent action in connection with
the receipt of assistance.

Miscellaneous Provisions

There was also considerable activity in providing
for changes in state organizational patterns in some

152

states, and in others for a modification in the division
of fiscal responsibilities between state and counties.
Some of the latter should prove to be of considerable
help to those counties that have found it hard, if not
impossible, to raise their share of money for assistance
expenditures.

Conclusion

The increasing' interest in and understanding of
the problems of an aging population hopefully make
themselves felt in many ways. An Old Age and Sur-
vivors Insurance program expanded to cover all em-
ployed persons, including agricultural workers, would
in the not too distant future reverse the trends toward
an expanding old age assistance program, and restrict
the latter to the function of meeting the needs of a
relatively small number of needy people who for some
exceptional reason are not entitled to Old Age and
Survivors Insurance benefits or find them inadequate.

The social insurances should be the basic form of
security against need when people cannot work and
support themselves.

A basic minimum guaranteed to workers through
their own and their employers' contributions would
maintain in this country the mobility of labor, a
right which is important for us to maintain.

If these developments come to pass, both programs
can assume their resi^ective major and minor func-
tions in a comprehensive plan of the American com-
munity for its older citizens.

Such a plan should be based on the following facts :
Chronological age per se does not establish a barrier
to continued economic self-maintenance, employment,
rehabilitation, or to phj'sical and mental health. Al-
though disabling conditions accompany the aging
process in many cases, aging itself must not be treated
as a disability. The community as a whole depends
increasingly on the contribution of aging persons, and
they miist be urged to participate in planniu'r and
working with the younger people. Although it may
be necessary to do so for an interim period, we are
not interested in setting up special welfare services for
the aged, but we are interested in establishing for all
people who want them social and eonomic reso'arces,
built \^^ in balance within nuv total I'couomy.

153

Older Persons Have Special Housing Needs

By Hertha Kraus

Associate Professor of Social Economy, Bnjn Maicr College

A RAPIDLY expaiiclino- literature on the aging popu-
lation agrees substantially on the facts pre-
sented in the box on this page. Where and
how do these people live now?

Case studies and experience have shown tliat living
in their own home, even with insufficient care, is pre-
ferred by most elderly people. There is infinite re-
luctance to move into institutions, or to share the
home of near relatives, unless forced by dire economic
need, serious physical incapacity, or utter lack of
suitable housing. In a New York City study of more
than three thousand inquiries concerning aged, 87.5
per cent related to living arrangements — where, how,
with whom to live !

It may be a.ssumed that within the census group of
24 per cent, living with children or close relatives,
many aged would have preferred independent homes
if available. Increasingly, in the wake of a changing
culture pattern of family life, this arrangement is also
the preferred choice of the younger family. Urban
and apartment living, simplified housekeeping, and
fewer children have combined to reduce the usefulness
of the resident grandparent within the family cycle of
the younger generation, except for emergencies.

Needs of Chronically 111

The need for more adequate care for the chronically
ill, including more adequate housing, has been studied
widely in recent years. Occasionally it has been dram-
atized when serious incapacity affects a comparatively
small group who.se tragic handicap is war-related, for
instance in the case of the paraplegics. Legislation
enacted in 1948 (IIR 4244) has authorized the Vet-
erans Administration to pay 50 per cent of the cost
(not exceeding $10,000) of a suitable housing unit
for any veteran entitled to compensation for perma-
nent and total service-connected disability "due to
siiinal cord disease or injury with paralysis of the legs
and lower part of the body," Eligible veterans may
obtain model plans and sneeifications of suitable hoiis-
ing units without cost. The paraplegics' plight is an
extreme illustration of the plight of an infinitely
larger and steadily in reasing group of the popula-
tion, which, despite considerable handicap, may live

■Reprinted froiii J(mrn;U of Housing, Jan. 1950.

and desire to live in their own homes — not in institu-
tions and commercial nursing homes — if suitable
homes can be found with adequate equipment and a
chance for housekeeping and attendant care as needed.

It is well known that a substantial part of the
chronically disabled group are identical with the aged
population; others are somewhat younger. In the
case of disabled children and adolescents, suitable
arrangements involve the entire family home to which
these young people belong. They do not, in the main,
represent a peculiar housing problem. It is among the
middle aged and elderly living alone, or with a
spouse or close relative (possibly away from home for
most of the day as the main wage earner) that a
demand for adapted living arrangements has arisen
that requires attention. They represent a substantial
group.

In 1933, Mary C. Jarrett found tliat many chronic
patients in hospitals and in their own homes need only
attendant care but actually receive hospital and
skilled nursing care, at high cost, because more suit-
able facilities are lacking. In turn, they deprive oth-
ers of urgently needed qualified hospital service, of
which there was and remains a serious shortage.
Many patients must be kept in hospitals beyond the
point of need for hospitalization; at the time of pos-
sible discharge, they and their relatives, assisted by
case workers, are frustrated by the utter lack of pro-
visions suitable for living M-ithin personal limitations.
Plans for additional hospitals for the chronically ill,
for public, voluntary, and commercial nursing homes
— all urgently needed in most communities — will only
meet a small fraction of the problem, which in the
main requires the facilities of family homes, not of
institutional care.

Mentally 111

Realistii' attention should also be given to the very
frequent incident of failing mental powers among the
aging. According to expert opinion, our over-
crowded mental institutions today are forced to house
large numbers of elderly patients who do not require
the treatment facilities nor the type of custodial care
provided in them.

In planning for dwelling units suitable in design
for the handicapped, it should be remembered that
the frecpiency of chronic disabling illness is consid-

154

FACTS ON OLDER PERSONS IN POPULATION
OF THE UNITED STATES*

NUMBER OF PERSOXS

In the year l!l(l(l — :1 luillidii

ti.-) AXD OVER

In the year lll4(i — 10. .'i iiiil-

liim

In the year HIT.") — 17 to 20

niillinn (estimate)

MARRIAGES

LIFE SPAN

EMPLOYMENT

INCOME

HOUSING

ilaniages with both man
and wife suryiying haye 30-
year ayerage span.
Last child of aboye couple
marries, on the average, at
end of .28 years of couple's
uuirried life — leaving one-
fourth of coujile's married
life as two-person family.
Of men (i.i and over, 04 pci
cent are married with s|>oum.
present — only 34 jier cent of
women in same age grou|i.

Average wife usually lives
13 yeais after luisband'-'
deatii.

Average husband, in family
where wife dies prema-
turely, survives si.\ years.

About 50 per cent of men
continue in gainful employ-
ment beyond age of 65 :
about 8 per cent of \vomen.
At age of 75, percentages
drop to 17 and 2.
In December 1!I4(;, of 10.5
million persons 05 and over.
3.0 employed (including
900,000 wives of earners) —
3.9 million benefited from
social insurance, olil age as-
sistance, institutional I'arc.
etc.

Of 2.5 niillion liusband-wife
families, where head 05 and
over, 9.1 per cent had in-
comes less than $500 ; 28.5
per cent, .$500-$1500; 20.3
per cent, .$1500-$2500.
In 1946, old age and sur-
vivors benefits averaged
$25,80 per month, per per-
son; grants from old age
assistance, $35,31.

Private homes of their own
— 68,8 per cent (about half
of them, one- and two-per-
son households)
Shared liome of relative —
21.9 per cent

Shared home of non-relative
— over 5 per cent
In institution.s — 4 per cent.

erably greater ainon<i' low-ineonie groups than amono-
the more comfortable.

Ilousiug- for those seriously handicapped by phys-
ical or mental disabilities should be seen as an inte-
gral part of a housing program for an aging popnla-

tidii. The recjiiirements are identical, although slightly
different in degree, not in character of need. The tran-
sition from full to impaired capacity may be slow and
hardly noticeable ; it may also be sudden. It must be
assumed that the majority of all aged persons suffer
from one or several impairments, whether actually
diagnosed as sucli or not. Dwelling units planned
for the aged and suitable for them in design and sup-
plemental facilities should not be reserved rigidly for
people of a specified chronological age. They should
also be available, as an imjiortant community resource,
for those of younger age grottps who require the same
provisions because of actual disability. Of all per-
sons suffering from invalidity, 50 per cent are in the
age groups over .55 ; their integration should not offer
a seriotts problem.

In developing different ])atterns for senior dwell-
ings, special attention should also be paid to the
problem of the aging farmer ready to retire but with
no ]ilace to go. It has been estimated that about 12
l)er cent of all farm operators — over 800,000 — are now
in this age group; at the same time there is consider-
able demand for farms by .voung families eager for
independent operation. In addition to sound oppor-
tunities for reinvestment after selling his farm, the
elderly farmer and his wife want a suitable and com-
fortable dwelling near familiar surroundings, per-
haps in a suburban cluster around the county seat.
The.v ma.v also become interested in biis.v and con-
genial communities in a more favorable climate, delib-
erately planned for meeting the increasingl.v effective
demand of senior hotiseholders.

Experience lo Date

In this coinitry, the develo])ment of non-institu-
tional housing for aged has not .vet gone beyond a few
units, valuable as illusti'ative samples and pioneering
ventures. Until very recentl.v, the housing needs of
the aged were considered onlv in general, as part of
every cross section of the ]iopulation, none of which
should be overlooked. For the last 10 years, however,
there has been growing recognition of a widespread,
serious, and utterly unmet need of very considerable
scope. In earlv postwar Congressional hearings on
the housing bill that became law last year, the repre-
sentative of the American Public Welfare Association
testified that the housing need of the aged is among
the most serious. The housina- platform of the
American Association of Social Workers also demands
special attention to such housing.

Local housing authorities, too, are beginning to pay
some attention to the need. As a widespread policy,
most public housing projects have excluded elderly
people living alone, even couples, in order to give
preference to families with children. A noticeable ex-
ception is the New York City Housing Authority.

155

Their Fort Greene Iloiises, built, with State funds,
includes apartments built for the aged. Another
unique public housing project for the aged is a small
colony, Roosevelt Park, Millville, New Jersey — a
development of 18 bungalows.

The State of "Washington has been the first to en-
courage cooperative housing for small groups of
elderly people, as a design for living peculiarly suit-
able for those of independent spirit and eager for con-
genial associations combined with low-cost living.
Each project is sponsored locally by some civic associ-
ation. Units of older persons have been helped to set
up cooperative households in dwellings adapted for
this purpose. Most of the residents are recipients of
old age assistance grants, with the Washington State
Department of Public Assistance encouraging the
venture, but not financing it.

Starting in New York City, but later moved to
Newark. New Jersey, a similiar cooperative housing
project was developed for aged, mostly refugees from
central Europe. The Cooperative Residence Club,
Inc., has established a unit for approximately 55 resi-
dents (also an additional summer unit in New Eng-
land), financed and operated as a nonprofit coopera-
tive association.

Among the best known humanitarian developments
are two New York City apartment houses for aged,
providing sheltered living — Tompkins Square House,
containing 60 units of one or two rooms, operated by
the Community Service Society of New York, and an
expanding apartment project operated since 1939 bj^
the Home for Aged Infirm Hebrews.

Finally, two small "villages" for aged, developed
under private auspices, may be mentioned — the col-
ony of the Motion Picture Country Hoiise Association
in San Fernando Valley, California and the new ven-
ture of The Loyal Order of Moose, developiuc the
fraternity's City of the Aged at Moosehaven (near
Jacksonville), Florida, expected to become at some
time also a research center for gerontology.

Experience Ahroad

Foreign countries have paid considerably more
attention to the peculiar housing needs of the aged,
living on restricted means, although the provisions
are not yet adequate in any country. Municipal hoiis-
ing projects with simple housekeeping facilities for
aged women have been a common resource in mam'
European countries since the middle ages. A modern
version of the same plan was developed in Cologne,
Germany, in 1926 when the city established a unit of
800 housekeeping apartments for aged individuals
and couples of limited income, grouped around a
park. Rentals included nursing and housekeeping
aid, also complete laundry service for all tenants.

England, Denmark, Sweden, and Holland, among
others, have developed extensive dwelling units for
aged as part of their public housing programs. Eng-
land has for manj- years allocated 1 per cent of public
housing to the aged. In that country, the report of
the Survey Committee on the Problems of Aging,
sponsored by the Nuffield Foundation, which has made
a nationwide study covering numerous aspects of
needs and services, suggests "as the most intelligent
guess" that a minimum of 5 per cent dwelling units
specifically suited to the needs of the aged should be
available throughout Britain. The rejDort emphasizes
that meeting this figure will require a quota of build-
ing and remodeling in most areas substantially be-
yond the 5 per cent average. England's National
Assistance Law of 1947 also includes definite provi-
sions for the expansion of senior housing facilities, in
the main in the form of public hostels. All plans re-
flect a realistic appreciation of their needs and the
very sound observation that larger housing units,
scattered through the communities, will become avail-
able for families with children when aged individuals
and couples will be offered new small units designed
for them. Building these small units Avill obviously
be less expensive than the development of an equiva-
lent number of dwellings for growing families, which
often must include new school projects.

In addition to expanding non-institutional housing.
Great Britain is also engaged in building small public
homes, allowing for a maximum of freedom and
privacy despite institutional management. Volun-
tarj' agencies are also encouraged and assisted to con-
tribute within the next few years a sizable number of
small hostels for aged residents.

Among a wide range of Swedish projects, homes for
"pensioners" and the Flower Courts of the Flower
Foundation have become well known as representing
an enlightened social housing policy.

In 1938, the International Federation for Housing
and Town Planning studied the various housing proj-
ects for aged in 13 difi'erent countries and published a
summary of interesting information on senior housing
in Belgium. Denmark, France, Germany, Great Brit-
ain, Holland, Itab', Latvia, Norway, Roumania, Swe-
den, Switzerland, United States.

Next Steps

It is of great importance that the housing market
should begin to respond with definite plans to the
housing demand of a 10 million, plus, population
group of adults, steadily increasing in actual numbers
and in proportion to the total population. Com-
munity planning for most of their needed facilities has
barely begun.

Clusters of senior dwellings — remodeled older lious-

156

ing or newly built — must soon form an integral part
of all public and private housing developments, to be
scattered over many different neighborhoods and to
be offered on every price level. Such units may be
developed in cottage and bungalow courts, as part of
multiple dwellings and mixed with apartments of
other sizes, or as solid wings of apartment houses.
They may expand to entire suburban neighborhoods
or even individual communities, especially in southern
climates.

xVrchitects and builders should also be encouraged
to give increasing attention to a pattern for which we
may assume effective demand. Single family dwell-
ings could be planned with the attachment of small
housekeeping units with a separate entrance, offering
considerable privacy. Such combination \inits would
have the following advantages. They may be part of
a wise and practical retirement plan: the housekeep-
ing annex may serve as an income-producing unit, or
as a suitable home for adult children, single or mar-
ried, while the senior familj- will live in the larger
home during the expansive part of the family cycle.
On retirement, the senior family, or widowed parent,
may move into the annex, now using the main house
as an income-producing unit. Such combination
would provide some economic security developed over
a period of j'ears. It would add to emotional security
by continuing family and neighborhood contacts de-
spite advancing j^ears and shrinking income. It would
give access to essential housekeeping and nursing aid,
as necessarj-, to be provided by the younger family
in the main dwelling, presumably close relatives. It
would allow mutual aid to flow both ways, for instance
during periods of illness or absence of the younger
family when grandparent aid may again become im-
portant. At the same time residents in the housekeep-
ing annex would not affect the family pattern of either
the younger or the older family unit and would not
force two or three generations into a common rhythm,
thus protecting the privacy and living arrangements
of each group.

Design

Good design for all types of units, in single and
multiple dwellings, remodeled and new, will be essen-
tial. It should be worked out jointly by architects,
homemakers, physicians, social workers, and nurses.
American studies of such design should cover the best
layout and equipment for individual units, within the
limits of economic planning, and the equally impor-
tant layout and equipment for essential group facili-
ties (service centers) that must supplement individual
units. Some of the design developed abroad may be
found very suggestive indeed, since it aims at widely
identical, common human needs.

Good design for a housing program for the aged
must be guided by the following essential re(|uire-
ments.

It must provide an adequate number of siriall
dwellings suitable for one to two persons, at low and
middle price levels. All dwellings must be easy to
manage and require only a minimum of housekeeping
effort. They must also be carefully freed from com-
mon hazards likely to injure persons of slowed reac-
tions, impaired vision and hearing, and decreasing
mobility.

A certain proportion — possibly 20 per cent — must
be planned specifically for persons actually incapaci-
tated, so as to accommodate the seriously infirm, in-
cluding those of the middle aged group. Their de-
sign must be adapted to the needs of individuals who
may require help in bathing, toileting, dressing; who
may have to grope their way or may be tied to wheel
chairs. Such conditions will affect the measurements
of individual rooms, doors, stairwaj's, elevators,
ramps, porches.

Good design will reduce the exceedingly high home
accident rate among elderly people; the elderly die
from accidents that younger people survive easily. A
special study of fatal accidents of the 65 and over
group in New York State in 1947 has shown that four
out of five home accident fatalities were caused by
falls. Burns and poisonous gases ranked second and
third as the greatest killers. Inadequate housing
often ijroves disastrous when advancing age brings
weaker vision and hearing, and poorer coordination.

Group Services

Finally, senior dwellings must be planned in clus-
ters large enough to allow for the economic develop-
ment of group services by which each individual unit
may be reached as needed and which must be seen as
an essential supplement of each unit. Group services
will center on housekeeping, attendant, and nursing
aid. There must also be recreational facilities, pro-
vided in- and out-of-doors, suitable in layout and pro-
gram for seniors of mature interests and limited
mobility.

The physical base for such group services must be
included in the basic design of each housing develop-
ment but their operation should not necessarilj' be a
function of the landlord. Group services may be
sponsored bj^ nonprofit agencies, by churches, by co-
operative associations, by public or private community
agencies. For the middle and higher income levels,
some of the facilities may be managed commercially,
in the form of service occupations.

A typical service center for senior dwellings would

157

offer one or several social rooms adjacent to outdoor
living- space. It -would also provide a housekeeper
service operated by a small staff of visiting housekeep-
ers and practical uurses for part-time care in the resi-
dents' o-wn homes, except for disabling illness of verj'
extended duration or requirino- institutional service.
In units planned for a sizable number of senior d-svell-
ings, a local infirmary iinder the care of the central
housekeeping and nursing service may become desir-
able.

All services must be directed and coordinated by a
qualified resident hostess, a strong liuman link be-
tween the individual elderly residents (and their
absent families) and each of the technical and per-
sonal aids available for meeting typical needs.

A financial program for more adequate senior hous-
ing throughoiit the country may -\vell relate to the
substantial funds which, under a nationwide con-
tributory old age and survivors insurance plan, are
set aside year bj' year for providing more old age se-

curity for the people. In contrast to most countries,
United States legislation confines the investment of the
accumulated moneys under the Federal Insurance
Contributions Act to investment in Treasury notes.
The Old Age and Survivors Insurance Trust Fund
now has total assets of well over $8 billion, growing
bj^ approximately $1 billion every year. The Treas-
ury notes yield revenue ranging from 1% per cent to a
maximum of 3 per cent. "While there can be no ques-
tion of the safety of such an investment, its social
validity may well be doubted. It would seem very-
appropriate to allocate a limited fraction of the an-
nual investment of this fund to investment in hous-
ing, with preference given to such housing projects —
public, cooperative, and other acceptable forms —
which would yield a sizable number of low and me-
dium cost units suitable for senior residents. In for-
eign countries social insurance funds have long been
used as a major lever in a progressive, socially directed
housing policy.

Sumptuous old age home of the United Brotherhood of Carpenters and Joiners of America at Lakeland, Fla., cares for 300.

158

159

Educational Needs of the Older Adult in
Rural New York State

By Mrs. Henrietta Rabe

Supervisor, Education for the Aging, Bureau of Adult Education, New York State Education Department

The following paper is a field report made to Dr. R. J. Pulling, Chief of the
Bureau of Adult Education of the New York State Education Department.
Our Committee believes this report uncovers attitudes and has educational
implications of utmost importance in the development of programs for older
persons living in rural areas.

THIS report is based on a study of eight widely
scattered villages in New York State having a
population of 2500 or less. In contrast to the
city, where public and private agencies are a chief
source of information on the older adult, getting the
picture rural-wise necessitated speaking with individ-
uals such as the principal of the central district
school; the librarian; directors of homes for the aged,
both public and private; the local historian; clergy-
men; officers of local clubs and organizations, includ-
ing the Grange and the New York State Farm Bureau
Federation; as well as to shopkeepers, particularly
those shops where people are inclined to "visit."
Typical of such shops are the feed store, the barber-
shop, the drugstore, the garage, and the tavern.

No study of this type would be complete withoitt
getting the point of view of the older person himself.
Therefore, a number of older persons were interviewed
in each of the villages studied.

In making this study no attempt was made to get a
comprehensive picture of the total needs of the older
person on such problems as employment, health or
housing. Education assumes these needs to be neces-
sarj- concerns of other agencies. However, some con-
sideration had to be given to economic and social fac-
tors, because of their direct relationship to needs that
can be served through education.

The value of this study is not as it relates directly
to the communities studied, but rather as it relates to
the larger picture rural-wise. In order to serve this
larger purpose, consideration also was given to certain
population characteristics of rural New York State.

Some Pertinent Population Characteristics
of Rural New York State

1. The older adult makes up a larger proportion of
the rural farm and rural non-farm regions than of the

urban population. One out of every twenty persons
in urban areas is in the older bracket (45 and over),
but in farm regions the ratio is one out of ten.

2. The rural non-farming population includes the
highest percentage of widows in New York State.
Many sucli widows come from urban centers as well as
from farms, concentrating in villages and non-farm
residences.

3. One of the significant changes in the population
of New York State in the past decade is in the number
of persons living in rural areas who do not farm.
This has resulted in part from the fact that mam^
folks, on retirement, return to a rural community',
where, in manj- cases, they lived earlier in life.

Economic Status of the Older Adult

Figures are not available to contrast the proportion-
ate number of dependent adults in rural farming and
rural non-farming regions with those in urban re-
gions. The following facts are significant, however,
with resjject to the rural scene: (1) the home farmer
in most cases continues to operate his farm beyond the
usual age of retirement; (2) the farm laborer in nor-
mal times finds his employment dependent upon phy-
siological capacity rather than chronological age ; and
(3) the non-farming group, inclitding the manual
laborer, the skilled craftsman, the store worker, etc.,
seems to be less discriminated against than citj^ work-
ers because of age.

Few farmers today give up their farms after reach-
ing the customary retirement age. When the farmer
finds himself less able to operate his place, he con-
tinues to maintain it as his homestead and either rents
the farm out on shares, permits a married child to
operate it, or cuts his farming down to a minimum.

In normal times the farm laborer in his fifties and
sixties who is known in the community does not find

160

S-io

"These beautiful May days don't appeal to me as much as
they did once — can't play hooky from anything!"

COPR. 1949 BY NEA SERVICE, INC. T. M. REG. U. S. PAT. OFF.

161

that his age is a bar to emi)loymeut. In the case of
the aged single farm worker, it is not uncommon for
him to be employed for room, board, and a little
spending money in return for working conditions
which are commensurate with his physical capacity,
namely, lighter woi-k, a slower pace, and short work-
ing hours.

Most villages have a number of more or less retired
people, but the men frequently find odd jobs avail-
able locally. There seems to be a ready willingness
on the part of local merchants to give work to older
men when they are considered a part of the commu-
nity. Another explanation for this is that the older
person generally is willing to accept a lower wage
than the younger worker in the community who, for
the most part, commutes to the nearest city for
employment.

Comparatively few aged people in rural regions are
to be found in homes for the aged. County welfare
departments make it a practice, wherever possible, to
place applicants in boarding homes. In the communi-
ties studied, about 90 per cent of the residents of the
county homes are men, mostly without families, who
are considered difficult to place in boarding homes.
A large i^ercentage of these men listed their former
occupation as manual and farm laborer.

No attempt was made, for purpose of this stud3'', to
get a break-down of the number of people receiving
old age assistance in the different connnunities. How-
ever, there may be some value in giving this picture
for at least one of the communities.

In a village having a population of about two thou-
sand there are 53 people 65 years of age and over who
are receiving old age assistance. This figure includes
21 people who are in niirsing homes, 11 in boarding
homes, 16 who maintain their own homes, and 5 who
live with relatives.

Social Status of the Older Adult

The older person in rural regions continues in the
mainstream of community activities along with other
age groups, ofttimes maintaining jjositions of leader-
ship. For example, in the communities studied the
board of trustees of the library and the school board
were composed largely of men and women in their
seventies and eighties. In one community the presi-
dent of the school board is a man seventy-six years of
age. In another, the president of the board of direc-
tors of the librarj- is ninety years of age.

In church groups as well as in siich organizations as
the Grange, the Masons, Odd Fellows, Eastern Star,
Rebekah, Garden Club, and Historical Society, the offi-
cers are largely from the older member group. The
Home Bureau and farm cooperatives, with their wo-
men's auxiliaries, are other groups in which many
older people participate.

Club activities such as the above loom very large
in the social life of rural dwellers. The average adult
belongs to at least one organization in addition to
church affiliation. The Central District School is
another center of activity for many adults.

With respect to family relationships, even in rural
life, there seems to be a consistent pattern of prefer-
ence on the part of aged parents to live apart from
their married children. Only out of necessity does
the parent give up his home to live with a married
child. It was repeatedly stated by school principals,
by clergymen, as well as by individuals, that even in
the rural community, the strong family tie of the
past has undergone a change.

Prevailing Attitudes of Rural Dwellers

The expressions of rural dwellers and those closely
concerned with rural issues not only help to point up
existing needs but give some indication of the ob-
stacles in the way of initiating a program of educa-
tion in the interest of the older adult. For this rea-
son some characteristic expressions are being included
in this report.

1. The question "How do older people in the com-
munity spend their time?" brought forth such
responses as :

Protestant minister: "Our most active church mem-
bers are the older people — particularlj- the older
women. ' '

Lihrarian: "A lot of older men and women come to
the librarj' regularly, not always to read, biit as an-
other i^lace to go, and to chat. ' '

School principal:

(A) "They remain active in their clubs. We have
about thirt_v clubs in this town, including civic, church
and fraternal groups. Many of the officers of the
clubs are old folks."

(B) "About twenty per cent of the adults attend-
ing our evening classes are fifty j'cars of age and
over."

Director, private home for the aged: "Our ladies
enjoy sewing, reading, and bridge playing. On Sun-
day most of them go to one church or another. Some
of them are active in the Woman's Club."

Director, county home for the aged: "Nothing. You
couldn't get those people interested in anything."

Garage owner: "A few of the men come around reg-
ularl}^ They like to sit around and play cards."

Tavern owner: "They come in every day for a glass
or tM'o of beer and sit around."

162

Retired railroad worker: ''I listen to the radio a
lot. At night I visit at my neighbor's and watch the
television. ' '

Retired school teacher: "I read a lot and belong to
the Garden Club and Historical Soeietj-. We have a
study group in the Garden Club."

Former city dweller: "I do all sorts of odd jobs
around town. A man's got to keep busy."

Farmer, age seventy: "There are plenty of chores
for an old farmer. And I belong to the Masons and
Grange. Rarely miss a meeting. ' '

2. In an attempt to discover the existing- social
pattern for ' ' talking' things over ' ' in the rural com-
munity, the question was asked, "What has taken
the place of the 'cracker-barrel' discussion groups?"

Protestant minister: "Nothing — unless perhaps the
meeting room at the fire-house. No matter when you
go by, you'll find a few men sitting around there
talking things over."

School lyrincipal: "]\Iy guess is that the radio has
taken its place, but that doen"t allow them to express
themselves, nor does it have the same social value."

Town Historian: "With automobiles, they're able
to get around more to club meetings. ' '

Medical doctor, age 74: "People don't talk poUtics
over as much as thej^ used to."

Catholic priest: "The railroad shack (gate house)
is a meeting place for a number of the older men in
the village. Once in a while I join them."

3. In answer to the question, "Do you feel that
there is a need for educational activities designed
especially for the older person?" the following were
typical responses :

School principal:

(A) "Possibly, but it would be diffleult to reach
some of the older people who probably need it most.
Many old folks are reluctant to start new things."

( B ) "If we did have special programs for the older
folks here in the central school it would be all right
for those in the village, but how about those outside of
the village where transportation would be a prob-
lem?"

Officer— New York State Farm Bureau: "With the
growing interest of the adults in the activities of the
central district school in my o^^^l community, I would
be inclined to think tliat the older adults would re-
spond to a program planned for them. As I see it,
they do have real needs that coukV be ser\-ed by the
school. I wish there was some way that the school
could help the older person who finds it necessary to
supplement his income, which is a serious problem
for iAanj,_(^widows and spinsters, "; _

Catholic priest: "I think it would be a very good
thing to provide such activities for the older folks,
and certainly well worth trying. I approve of the
idea whole-heartedly."

Director of Youth Center: "I don't see why the
older folks couldn't use the center same as the young
folks do. We could give them space here if the
school were to furnish leaders for their activities.
They certainly could use the place before the kids
get there. That would make it a real community
center. ' '

Librarian: "It would be easy to form a discussion
group from among those older folks who come to the
library."

Welfare officer: "Our recipients of old age assist-
ance who live in boarding homes are old and I do not
believe they are interested in outside activities. Those
living in their own homes have home duties and are
not people that would be interested in any sort of
activities. ' '

President — Garden Club: "Yes, I do. I know it
would be a good thing for people like the couple next
door. They keep entirely to themselves. He has a
lieart condition, and when he goes, she'll be lost."

Officer — New York State Grange:

(A) "The farmer is conservative and doesn't take
quickly to new ideas such as that, but I believe that
once he is sold on its value, he'll go in for it whole-
lieartedly. ' '

(B) "Because of mechanization, even the older
farmer is able to get his work done and still have time
for other things."

Protestant Minister:

(A) "Yes. I do, not only for those that are able to
get around but for the home-bound. Many of my
older church members are finding it difficult to get
out, and I know how important it is for them to keep
up contacts with the outside."

(B) "It isn't only the old foU?s that need help,
it's youth too, I plan to devote a series of sermons on
the need for re-evaluating our attitude toward old
age and on the 'Fourth Commandment'."

Implications for Education

Inasmuch as many rural dwellers continue to work
beyond the customary age of retirement, it would seem
that there is less need for recreation centers, as such,
or for additional clubs of t^he "Golden Age" variety
such as seem necessary in large communities.

Nevertheless, there are certain conditions that
could be improved for the older adult . through the
provision of activities which are not commonly avail-
able in a small community. , Such .activities could
reasonably be provided by the public school through
its adult edueatiqn program,, and wpxild.^ bring benefit

KSr

not only to the individual, but to the larger social
group. A description of such activities comijrises the
balance of this rei^ort.

1. The older adult needs to be kept flexible in his
thinking and up-to-date with respect to technological
and social change.

The rural coinmuuity is verj^ much influenced by
its large proportion of older men and women who con-
tinue to function either as leaders in civic organiza-
tions and fraternal cluibs or as members of such
groups. As such, they either have a direct influence
on others or are tliemselves subject to influence with
respect to their attitudes, their tliinking, and their
voting. Our aging ijopulation will verj^ significantly
liave an effect upon the Nation politically and eco-
nomically ; and in local matters the increasing propor-
tion of older men and women will have a direct bear-
ing on whether the community is to be a static or a
dynamic one.

It is, therefore, of utmost importance that the older
person be kept informed and helped to understand
social issues and community problems. If this is not
done, the older per.son who tends to be fixed in his
thinking, translating the x^resent through the i^ast,
might be resistant to change, even if it means social
improvement. There is also the danger that this large
unit of our population might be used politically for
selfish purposes. Therefore, it is to the best interest
of the individual as well as the community for the
older person to be exposed to ideas tliat are different
from his o^vn and to the changes that are continually
occurring in the social and political structure of the
world.

As a solution to this need tlie public school can
organize "old timer" discussion groups on a wide
variet.v of topics, including issues of local, national,
and world concern.

2. The older adult needs accurate information
about and help in adjusting to the changes of aging.

To better understand what is involved in the process
of aging — the limitations that come with age as well
as the plus values — the older adult needs to become
informed on such matters as the following :

(A) Financial problems of older people

Social security, old age assistance, employment op-
portunities for older workers, self-employment

(B) Physiological aspects of aging
Health education courses

(D) Nutritional needs

(E) Adjustments in family and other social rela-

tionships
Grandparent education, living with other adults

(F) Forming new concepts of successful living
Working for satisfactions in later life in contrast to

worlcing for money

(G) Agencies serving the aged

Public health facilities, mental hygiene clinics, visit-
ing nurses, recreation centers, employment centers,
nursing and old age homes.

These and similar topics could be built around sepa-
rate short-unit courses consisting of lectures and dis-
cussion groups. For such to be most effective, the in-
dividual must have a chance to discuss his own per-
sonal problems. Courses of this type would not only
have value for the older person biTt for the middle
aged person who is giving thouglit to successful re-
tirement and old age. '

3. The older adult needs to feel useful.

The desire to be useful and have social approval is
present tliroughout all of normal life. The increased
leisure that comes with a diminution of the activities
of earlier life should make it possible for a person to
attain new goals which bring added satisfaction to the
individual and enrichment to the community. Yet
many older men and women find themselves witli little
to do and think about because earlier in life they
lacked the time or the opportunity to develop vital
interests and skills other than that of their job. This
is a particularly serious problem for many widowed
and unmarried women.

Pastimes of a purely recreational nature, or cus-
tom-made fun, although an important aspect of liv-
ing, will not over a long period of time be a satisfac-
tory substitute for productive activitJ^ The solution,
rather, lies in the acquisition of skills that have in-
herent possibilities for creative expression, growth,
and self-development and that can contribute some-
thing of value to the social group. The wliole gamut
of the arts and crafts as well as the pure and applied
sciences offer rich interests for all age groups ; but the
added hours of leisure as life advances permits the
older person to develop special skills in these areas,
to read and plan, and to develop judgment and self-
criticism.

From the point of view of the community, creative
activity such as the above means raising the cultural
level and adding a valuable local resource. Imagine
am' village enlivened by periodic art and craft ex-
hibits, or having recurring musical activities per-
formed by choral groups, string quartets, and small
orchestras! Think of the value to the community in
having a group of men and women who are studying
local conservation needs with respect to water, soil,
timber, wildlife, and other resources; or who are
rendering a service to the field of professional science
through the collection and recording of data on the

164

distribution and life histories of local animal and
plant life !

Other than the personal satisfactions which creative
activity affords, ofttimes it oilers an opportunity for
self-employment, and thus its value is increased, for
some older men and women are seeking ways of sup-
plementing their financial resources. Many a person
has been able to find for himself a new source of in-
come through creative interests — the painter ; the tex-
tile designer ; the lampshade decorator ; the designer of
greeting cards; the craftsman who makes jewelry,
wood sculpture, pottery, metalwork, leather goods ; the
weaver; the woodworker who builds models of all
sorts or who makes toys, furniture, and novelty items ;
the photographer; the animal fancier; the gardener
who grows a new or special quality fruit, vegetable
or flower.

The public school has the facilities and the person-
nel to provide training in a wide variety of creative
activities that will do much to make up the last period
of life one of activity and usefulness. The typical
arts, crafts, and science courses offered in the evening
adult education program may not be the answer. To
be most effective, a program planned for the older
adult might have to include a greater variety of sub-
jects to fit many different interests, given at a time
that corresponds with the older person's habits, and
offered at a place suited to his convenience, witli the
work geared to his slower pace.

4. Many older adults need opportunities for devel-
oping social skills and finding new social relation-
ships.

A problem common to many older people, regardless
of where they live, is that of loneliness, some causes of
which are mobility of married children, retirement,
and loss of spouse and friends. This, again, is a great
concern of many widowed persons ; and according to
statistics, 43 per cent of the married women of this
country are widowed at age 65. The problem is also
a serious one for many elderly couples who have
moved to a rural community upon retirement. Lack-
ing roots in the community the newcomer frequently
does not possess the social skills and the know-how of
making new social relationships.

The public school in providing programs for older
adults will also help them develop social skills. The
school is present in all communities, it is familiar to
all and is accepted by all. By tradition it is accus-
tomed to working with people of all tji^es and back-
grounds. It has facilities and equipment which fre-
quently are not present elsewhere in the comnmuity.

Therefore, the public school seems to be the logical
center in the rural community for making available to
the older person opportunities for meeting and mixing
with others whom they otherwise might not have a
chance to meet.

Through activities within the school the individual
will be thrown in contact with people of like as well
as different interests. This is a good social experience
for the individual, and in addition, such exposure
could very well result in a choice of new activities
which might become an important part of his own
living.

Thus the public school, in becoming a center of ac-
tivity for the older men and women of the community,
would help them to keep mentally pliable and alert,
which is good mental hygiene, and in addition would
jjrovide concomitant social skills, important to many
older people.

Summary

All of the activities suggested above and others of
value can easily be defined as good adult education
and are possible of attainment in any community
which is large enough to maintain a public school.
These activities could be made available within the
school itself as well as to study groups that might be
formed within such local organizations as the Grange,
the CTarden dub. Historical Society, Woman's Clubs,
and church groups. A program such as this could be
supported jointly by the community and state-aid.

The needs of the older person, as contained in this
report, are not to be interpreted as applying exclu-
sively to the residents of a small community. Defi-
nitely not I The need to feel useful, the need for social
relationships are not needs of the aged alone any more
so than the need to be mentally agile and up-to-date
on social change are needs of only rural dwellers.
Such needs are common to all adults, varying onlj- in
scope and satisfied in different ways at different stages
of lifetime.

Our problem is to attempt to isolate the needs of
the older adult that can be helped through learning
activities; to evaluate such needs within the frame-
work of the small community ; and to recommend ways
in which the public school can function in this area of
service to the total community. These recommenda-
tions are based on the premise that the need for educa-
tion is continuous throughout life and that it is the
responsibility of public adult education to provide
opportunities for such education wherever and for
whomever the need exists.

165

Librarians and Our Senior Citizens

By Albert J. Abrams
Director, New York State Joint Legislative CommHtee on Problems of the Aging

WHAT should be tlie relationship of a librarj^
to the elderly of the communitj^? What spe-
cial services do onr libraries render to our
elderly? What types of books and magazines do the
elderly prefer?

Interest in these questions is high among both
gerontologists and librarians. The g-erontologist is
concerned with fitting the library into its proper
niche in an over-all program for the elderh^ The
librarian is affected for if libraries are to be
djTiamic, vital agencies they must keep pace with
shifting community needs, and serve the elderly as
effectually as they serve other groups in the popula-
tion.

The demographic factors which impel an examina-
tion of the role of our libraries in serving the elderly
are these :

1. A spectacular increase in the number of our
elderly, mounting from 1,100,000 in 1870 for
65-plus age group to nearly 12,000.000 in 1950.

2. The tremendous increase in the span of life,
from roughly 4S in 1900 to 67 in 1948.

3. The fact that at age 65, the average person has
a life expectancy of 12 years.

4. While the proportion of elderly in our com-
munities is mounting sharply, the proportion
will vary considerably according to types and
locations of communities.

The socio-economic factors which eaU for librarians
to examine their services to the elderly are these :

1. An amazing growth of retirement programs,
now covering 10,500.000 workers.

2. The prevalence in industry of compulsory retire-
ment at age 65 for men, age 60 for women.

3. Age barriers which prevent men 40 and over
and women 35 and over from obtaining jobs.

4. Better educational background of the "new"
old compared with the elderly of prior decades.

These trends add up to this : more and more of our
elderly who are making xip a larger proportion of
our population have and will have more and more
time for reading.

To gain an insight into the work being done and
the work that should be done by libraries for our
elderly. State Senator Thomas C. Desmond, Chair-
man of the New York State Joint Legislative Com-

mittee on Problems of the Aging, queried 150 li-
brarians responsible for community libraries ranging
from a one-room rural library at Haines Falls to
the mammoth New York City Public Library system.
Their answers disclose that by and large our li-
brarians are aware of the challenge that the increas-
ing number of our elderly presents to our libraries,
are alert to the opportunities that exist for helping
our oldsters, and are eager to be of service to our
senior citizens. The main handicap in serving the
elderly appears to be not a deficit of zeal or will, but
a deficit of finances to expand library services.

The Library and Other Coinniunity Agencies

The library is but one community agency capable
of being geared to the needs of the elderly. The li-
brary must join with the schools, the recreation cen-
ters, aud the "60-plus" clubs, for example, to meet
the needs of the senior citizen for cultural, leisure-
time activities. In some communities, the libraries will
set the pace for other agencies ; in others, it will for
good reasons play a role minor to other agencies.

Whether the library is leader or follower, it is im-
portant that the library staff join with other groups in
planning community programs for the elderly. The
Desmond survey showed that the Rochester Public
Library is in close contact with the Rochester Council
of Social Agencies which is formulating a compre-
hensive program for the aged, and with neighborhood
groups organized by the Council. In this way, both
the council and the library are enabled to move
forward together to serve the elderly. The Brooklyn
Public Library woi-ks intimately with the Brooklyn
Council for Social Planning and its Superintendent
of Branch Libraries serves as a member of the Com-
mittee on Services to the Aging. Such close working
relationships enable the library to keep in touch with
new developments which may affect the library, to
share in serving the elderly most effectively, and give
other agencies the benefit of the library's experience
with the elderly.

Relationship of the Library to the Elderly

Just as a philosophy of life or at the very least
an attitude toward life enables one to adjust best
to the daily vicissitudes of li^ang, libraries need to

166

adopt some goal or rationale in attempting to serve
the community and the various segments of the com-
munity. The Desmond survey indicates that librarians
have an understanding of the difficulties of the aged,
and the variability among them, needed to chart a
sympathetic program for them.

"Growing old is a peculiar thing," says Librarian
Helen A. Stratton of the Binghamton Public Library,
"Its worst tragedy is that most elderly persons feel
young and think young, but have not the outward
appearance or quickness of youth. It does not hurt
to be labelled a ' teen-ager ' but it does hurt to be con-
tinually reminded that one is old."

The Acting Secretary of the City Library of Pough-
keepsie. Miss Amy Ver Nooy, points out that the
"aged of the future have had a different past from
the aged of the present," and then asks, "Will their
interests be the same as the interests of the aged of
today? Have they not actively participated in a
different world throughout their working lives?"

The need for making distinctions in various age
groups even among the elderly is noted by Miss Lucy
E. Franeher of Swan Library, Albion, who says :
"there seems to be a great difference between the
60-75-year-olds and those approaching 80. The first
group can do considerable solid reading and are
capable of following time-consuming interesting
hobbies. The latter seem too feeble in physique and
sometimes mentally to do more than read the lightest
fiction and sometimes not even that. Whatever con-
structive work done should be for the 60-75 age
group." However, librarians should not fall into
a very common trap by confusing chronological age
with physiological or mental age. The geriatricians
emphasize that chronological age is of little sig-
nificance, that some people are young at 80, others are
old at 45 ; some at 75 have the heart, arteries, and
alertness of a man of 35, others at 50 have a physio-
logical and mental age of 80.

The gerontologist eager to see the elderly served
may receive a temporary slight jolt when he awakens
to the fact tliat libraries are created to serve all age
groups, and that as librarians point out, it is dedi-
cated to the entire connnunity, not to any particular
segment.

Librarian Alice II. Smith of the Arcade, N. Y.,
Free Library, bluntly says, "In my opinion, the
elderly should be treated by the library exactly as the
younger borrowers are treated." Director Isabel D.
Clark of the White Plains Public Library informed
the Desmond Survey: "The relationship of a library
to the elderly of the connnunity should be much the
same as to all other groups, namely, to provide whole-
some recreation and lifelong education to every citizen
who needs it. Because a larger proportion of the
elderly and the very young find it impossible to go

their library it is important that means be provided
to reach these people where they live."

Mrs. Marie B. Higgins, librarian of the Rennselaer
Public Librarj', points out tliat tlie "important serv-
ices a community library can offer elderly people
are easy accessibility, absence of stairs, comfortable
reading facilities, good lighting, and an adequate
book selection, all items which in library service are
needed by the public as a whole."

Sylvia C. Hilton, Librarian at the Scarsdale Public
Library, comments, "I note a growing consciousness
among libraries, churches and cities to the old as a
different and separate group. In our libraiy, if
we liad the space or facilities, we woTild answer any
need for group activities with the emphasis on the
interests, such as hobbies, rather than on age."

Esther Johnston, Chief of the Circulation Depart-
ment of the New York Public Library, says, "the
library best serves the older man or woman when it
does not strive to set him or lier apart from the
younger members of the community."

The "equal treatment" concept received support
from Librarian Sarah Corwin of the Newburgh Pub-
lic Library who states, ' ' the relationship of the library
to the elderlj- of a community should he .just about
what it is to any of its borrowers : ready and willing
to help wherever possible, but Anthout emphasis on
the oldster part." Alice L. Jewett, Chief Librarian
of the ilount Vernon Public Library, elaborates on
this viewpoint: "The relationship should be the same
as to any other group in the community, a recogni-
tion of the existence of such a group, a conscious
effort to supply their needs, and such special services
as seem to be justified in view of the services provided
by other local agencies. ' '

Some librarians think their major contribution to
the elderly can be "courtesy and comfort." Binham-
ton's Librarian, Helen A. Stratton, says, "In a li-
brary the elderly should be greeted cordially, helped
to a certain extent (not too much) . . . and they must
never be hurried." Mrs. Estelle Harrower, of the
Amsterdam Free Library, says the library should be
a place for the elderly to rest and relax as well as to
take a book.

The relationship of the library to the elderly will
depend largely on the librarian's concept of the total
role of the library. If viewed as simply a place where
a variety of books are available free of charge, the
library will tend to be static, restricted; if viewed
as an agency for bringing knowledge and enjoyment
to all the people of the community, the library will
be dynamic, its services varied. Tlie gerontologist in
his zeal to provide services to meet the needs of the
elderly must keep a reign on his enthusiasm, for the
library is dedicated to all the community, not to one
segment. The library, on the other hand, in its

167

efforts to "play fair" with all groups must conscien-
tiously seek to establish the needs of the elderl}-, and
determine what it should do in justice to all to meet
those needs.

Segregated Book Shelves Opposed

The Desmond Survey elicited the practically
unanimous opinion of librai'ians against setting up
special book shelves for the elderly. Thus Director
F. L. Gates of the Syracuse Public Library says, ' ' we
do not approve of calling special attention in the
library to these people on account of their age."
Librarian Sara Corwin of Newburgh reports that at
one time she did provide special shelves for oldsters
but it was not successful, for the elderly do not want
"to be considered different."

Mrs. Stephen Leeehuer of the Croton Free Library
summed up the viewpoint of the librarians when she
advised, ' ' many people of 60 would be rather insulted
or annoyed to be considered in the elderly group."
To which Librarian Helen M. MacDonough of the
Baldwin Public Library adds, "no one likes to be
singled out as 'old'. For example, books on handi-
crafts and other home activities useful to retired
per.sons as well as others are easily available in all
libraries. They do not need to be especially grouped
for the elderly. Such a grouping would be resented
by some."

Librarian Anne F. Hammersley of the Hamburg
Free Library says, "our library does not feel any of
the readers are 'old.' "We may take more care to
find out what they want and to help them individu-
ally, but that is all."

Most gerontologists would probably agree with the
librarians that segregation of the elderly in the library
would not only be resented by the elderly but would
tend to further isolate the oldsters physically and
psychologically from the total population and thereby
be harmful. However, it should be pointed oiit firmly
that this does not mean no special effort should be
made to serve the elderly. It does not mean for
example that clubs and hobbies for the elderly should
not be encouraged in the library. It does not mean
that shut-in service for the elderly who are ill should
not be provided. It simply means that shelves
specially set aside for old folks are unwise, and that
insofar as practical services should be based on func-
tion rather than age. Thus we see no reason why
libraries cannot have special shelves for books on
"Fun in Retirement."

Reading Preferences

Supporting the argument against special book
shelves for the elderly is the conclusion of librarians,
as reported to the Desmond survey, that our senior

citizens have as wide a reading taste as many of our
j'ounger people. Librarian Francis R. St. John of the
Brooklyn Public Library reports, "reading of older
people cannot be typed. Their reading tastes stem
from their backgrounds." Miss Thelma R. King of
the Steele Memorial Library, Elmira, says, "By and
large they keep the same reading interests they always
had." At the Floyd Memorial Library, Greenport,
Librarian Gladys K. Pemberton finds the "reading
interest of people over sixty does not vary any
noticeable extent from that of a person ten or twenty
j'ears younger. The usual reading interest of middle
life carries over to the later years. Miss Helen Lud-
low, of the Thrall Library in Middletown, says: "it
is almost impossible to generalize about the reading-
tastes and habits of this group. Older people tend to
read much the same kinds of books as they did in
younger days."

Pointing out that for many the years between 60
and 70 are "the reading years," Librarian Mary L.
McCabe, Corning Public Library, says many of these
senior citizens have their own reading lists saved
through the years, and that there are more older peo-
ple with a fine appreciation of books than we some-
times realize.

Despite the agreement that the reading tastes of
the elderly (the Desmond survey used 60 years and
over as the dividing line because some arbitrary figure
had to be used) could not be typed, the librarians
nonetheless showed surprising uniformity in report
that women over 60 like best light stories with happy
endings, with a minimum of profanity or sex or
realism. This was as true for elderly women who
live in the cities as for those living in suburban and
rural areas.

Other types ranking high on Grandma's "hit
parade" of books are mysteries, light humorous non-
fiction, religious fiction, and early 20th century light
novels by authors like Grace Livingston Hill Lutz
and Mary Waller. The books serve, the librarians
reported, to take the elderly back to their youth, to
escape life problems or simply to "pass time."

The elderly male rates westerns as tops, with the
"whodunits" a close second. The older male likes
books with plenty of action. As one librarian empha-
sized they prefer a minimum of "gooey romance,"
and will not be found dead with a novel by Faith
Baldwin.

A substantial number of libraries indicated that the
size of type frequently is the deciding factor in
determining whether an older person will read a par-
ticular book. In fact, some attributed the popularity
of westerns among the elderly males to the fact that
these books often had uncrowded pages of clear type.

One interesting fact elicited by the Desmond survey
was that books such as "Peace of Mind" apparently

168

is not as popular with the 60-plus age group as with
the 40-50 age class. No reason was given for this
preference.

There was a noticeable absence of statistical data
on reading habits of the elderly.

However, the librarians seemed to be iu general
agreement that newspapers are preferred to maga-
zines by the senior citizens, and that the "Reader's
Digest, " " Life, " " Time, " " Saturday Evening Post, ' '
"Colliers," "Ladies Home Journal" and "Women's
Home Companion" were favorites among the maga-
zines.

Some librarians, such as Miss Ludlow of Middle-
town reported "oldsters do not make much use of the
magazine racks."

Many librarians reported they have what is known
to them as an "old timers' morning club" consisting
of elderly who come in to read the daily newspapers.

Clubs for Oldsters

Several librarians indicated their familiarity with
the "Live Long and Like It" club for oldsters
sponsored by the Cleveland, Ohio, Public Library, and
some expressed the desire to form similar groups.
Thus Mrs. Elizabeth F. Kelly of the Freeport
Memorial Library saj'S, "For the past year I have
been giving considerable thought to what this library
can do for the elderly people. I would like very much
to form an organization for them."

In some communities, such clubs are already in
operation sponsored by churches. Junior League
organizations, recreation commissions and other local
agencies. Librarian Lucy E. Francher, Swan Library,
Albion, reports she has given up the idea of forming
a 69-plus club because "all the oldsters we know of
belong to church groups, fraternal organizations,
D. A. R. or a study chib."

It is clear that whether "Golden Age" clubs should
be organized at all or whetlier the library or some
other group should sponsor "Golden Age" clubs
should depend on local conditions.

At ilount Vernon, a recreation center for the
elderly has been set up on library property in an old
house adjacent to the library itself, by the Mount
Vernon Chapter of the National Council of Jewish
"Women.

Some libraries which may not sponsor or organize
such clubs may help by providing meeting space;
others may have no meeting room facilities. Thus in
the one-room library at Haines Falls, it is impossible
to provide quarters for oldsters clubs. Others, such
as the library at Kingston, reports, throus'h Librarian
Mary A. Schaeffer, that it is situated in the center
of the city which spreads over a very large area, mak-
ing it difficult for manv of the oldsters to use it. Even

some big city libraries, such as those in Rochester,
report they do not have room or facilities for inviting
oldsters clubs to meet there.

At Watertown, Librarian Helen M. Talbert notes
that meeting rooms of the library are open to all
groui:)s in the city, and points out that many clui>
women are in the 60-plus age bracket and make use
of the meeting rooms. Elmira and Rome, N. Y., both
report they have meeting rooms, but that no group
of older persons has taken advantage of them. The
Corinth Free Library expects to have meeting rooms
available in the new building to be erected in the near
future.

At Freeport Librarj', a group of older women meet
in the library's High School Room two hours a week
and discuss American and English literature. Inter-
estingly enough this group started with a leader, but
when the leader became ill, the oldsters were obtaining
so much enjoyment from it that they have carried on
by themselves.

At the Your Home Public Library, at Johnson City,
club rooms are used by the Townsend Club and the
industrially affiliated Endicott-Johnson Thirtv Year
Club.

The Rochester and New York Public Libraries coop-
erate with old age groups by sending out lecturers,
book reviewers, and motion pictures to them. The
New York Public Library sends through its branches
cartons of books to recreation centers for the elderly.
At stated periods the books are returned to the
brandies and a new collection issued.

The Brooklyn Public Library, on the other hand,
which has an active and varied program dealing with
the elderly, prefers to bring recreation clubs for the
oldsters into the library for discussions of books of
interest to them. Also, Elementary English Classes
of the Adult Division of the Board of Education, com-
posed mainly of older persons who have been in this
country for many years, visit the libraries.

Shut-in Service

Shut-in service by libraries ranges from delivery of
books to the housebound and the hospitalized to that
of providinar ceiling projectors for "Books on the
Ceiling." It may involve operation of a "Book-
mobile" or consist simply of selectinor appropriate
books for the ill to be picked iip b.v friends or
relatives.

The importance of shut-in service can be seen from
the fact that according to a national survey one out
of six persons at any given time is afflicted by chronic
disease. Since the elderlv are especially hard hit
by chronic, degenerative diseases, shut-in service is
particTilarly helpful to the older age groups.

Librarians may gain a new insight into the abilit.v

169

of oldsters to gain benefits from reading, from the fact
that at a state mental hospital a library of books
has been set aside for the senile psychotics! Even
these unfortunates, harmless but suffering from
melancholia, forgetful and perhaps at times confused,
confined to a state institution, find comfort and
relaxation in books ! We mention this merely to
emphasize the need for not under-rating the capacitj^
for our elderly to enjoy books.

The Desmond survey found that the Western Union
Telegraph Company at one time provided an inex-
pensive delivery service for persons desiring books
but this was discontinued.

On the other hand, at New Rochelle, Library
Director Josephine H. Edwards reports that its
shut-in service circulated during the 1948 calendar
year 8,784 volumes. This consisted of monthly
deliveries of carefully selected titles to people unable
to come to the library or who have no one to send
for their books. This library, interestingly enough,
plans to cooperate witli the local Visiting Nurse
Association which is launcliing an active program for
the elderly, and we can visualize in the future the
visiting nurses bringing library books to the confined
or directing the library to those who though confined
need library services.

The Cornell Library Association at Ithaca reports
it could probably arrange pickup and delivery to
bedridden patients through friends of the library
"if the need were indicated."

Unfortunately, tlie lack of personnel is handi-
capping shut-in service. The Fulton Public Library
had to discontinue it because they "had no one to
deliver the books." Miss Helen H. MacDonough of
the Baldwin Public Library says the delivery service
to bedridden oldsters would be desirable "if our staff
were large enough to handle it."

Mrs. I. D. Clark, director of the White Plains
Librarjr, expands the concept of shut-in service
significantly by pointing out that "mature and kindly
volunteers who could deliver carefully selected books
to house-bound folks and take time to talk with
them or interest them in a hobby could add immeasur-
ably to the happiness and contentment of this group
of citizens. Such a plan would probably keep an
appreciable number of possible inmates out of hos-
pitals and institutions for the mentally disturbed."

It is probable that no large staff- is needed to handle
a shut-in service supervised by the library but
adminisicred by local civic or women's clubs, who
would arrange for pickups and delivery service of
books. Nurses and doctors would in many instances
be glad to cooperate by encouraging bedridden old-
sters to use the shut-in service.

Bookmobile service is approved by many libraries,
if funds are available. In New York City older

people who do not live near any branch library use
the service provided by the bookmobiles. And at
little Haines Falls, Librarian Era Zistel reports their
bookmobile "makes the rounds during the summer;
in the winter we provide no service, due to lack of
funds." In Mount Vernon, bookmobile service was
withdrawn, but was missed so keenly by two homes
for old ladies at outlying sections of the city that
arrangements have been made to send them a carton
of about 40 books each month, partly of the library's
choosing but largely the selection of the women them-
selves, reports Chief Librarian Alice L. Jewett.

Which brings us logically to the service rendered
by libraries to the many elderly who are in old age
homes, hospitals, nursing homes, boarding homes, and
similar institutions. The geriatricians advise that
as time goes on the variety of facilities for caring for
oldsters will increase, so in seeking to reach the elderly,
libraries will need to keep alert.

The Buffalo Public Library, reports Librarian
Alexander Gait, conducts a branch library for
patients at the Meyer Memorial Hospital, a county
institution, but has no services in connection with any
of the other liospitals. Mr. Gait says, "for many years
we have hoped to have similar services in the other
hospitals, but have never had the money to take care
of this work ; the same is true of old people 's homes. ' '

At Eliiiira, the library in cooperation with the
Junior League provides books for two hospitals and
one convalescent home. Through the Extension
Division of the Rochester Public Library, books are
sent to the Presbyterian Home, the Rochester Friendly
Home, the Church Home, and the St. John's Home
for the Aged. The Sj^racuse Public Library serves
hospitals, nursing homes and homes for the aged.
The Hempstead Library provides books for the elderly
at the Nassau County Poor House. The New York
Public Library cooperates with the United Hospitals
Associations in furnishing books to liospitals.

Librarian Lucy E. Fancher of Swan Library,
Albion, cites some of the headaches involved in
shut-in service. She discussed with a Brownie leader
the possibility of having her girls take books and
return them for old peojjle in convalescent homes.
The proposal was viewed favorably. Then Miss
Fancher connnnnicated with tlie convalescent homes.
One owner objected that it would be too much trouble
to keep track of books. At another home, she ran
into the fact that some of the elderly had cataracts
which prevented their reading ; others kept busy with
other activities, ranging from crocheting to conduct-
ing an extensive correspondence; still others simply
were not interested. However, at a third home she
found a desire expressed for the service. But by this
time, the Brownies had already been assigned to
another activity.

170

As nursing and convalescent homes come nnder
stricter supervision and tlieir standards become
higher, librarians will find that the directors of such
institutions will come increasingly to welcome the
service of the libraries.

At Port Jervis, Librarian Leona Edith Dugan
tried sending books to the local hospital but the
nurses felt they were too busy to collect and return
them to the library and since none of the library
staif had a car the service was discontinued. On the
other hand, the library at Rome, N. Y., successfully
operates a regular pickup service at the Oneida
County Home.

It is not enough merely to offer such a service, to
issue a statement to the press or post a bulletin in
the library or even to send an announcement to the
various institutions aiul homes. The service offer must
be carried into the homes and institutions by the
librarians, bj' nurses, doctors and relatives. If the
library believes tliere is a real need for this type
of delivery service in the community, it must sell the
idea to the community.

In small communities especially, the added work
of initiating and supervising this service would be
slight, if tlie aid of civic and fraternal groups were
enlisted to furnish transportation, and pickup serv-
ice. Many fraternal groups have permanent com-
mittees to visit their sick, and these perhaps could
be enlisted to bring with them not only flowers aud
good cheer, but also books.

Because so many of our elderly are iunuobilized
through falls or chronic illuess, the use of ceiling
projectors became an important factor in enabling
them to read, in providing them an opportunity to
pass the time pleasurably. The Great Neck Library
provides such projector service. The Hempstead
Public Library reports that its ceiling projectors and
microfilms are enthusiastically received by the elderly,
stating that "patients in their SO's whether at home
or in an institution have enjoyed reading our 'Books
on the Ceiling.' "

At Gloversville, the library and Lions Club jointly
oi^erate the ceiling projector service, with the club
informing the library as to persons entitled to use
the machine, delivering and returning the machine,
and the library responsible for record keeping and
maintenance of the projector.

Miscellaneous Services

A miscellaneous number of library services avail-
able to all age groups are of especial interest to the
elderly. Hobby exhibits often held their attention
and interest. The Great Books Discussion groups
and Book Review meetings frequently are a source of
enjoyment to older people. Some libraries attempt

to help oldsters who have difficulty reading by having
a recording machine for them, or conducting record
concerts. Some librarians make a special effort to
obtain books for "tired ej^es."

In some communities, the most practical service that
could be rendered the eldex-ly, the librarians say,
would be to put the adult reading rooms on the
ground floor, where the elderly could get to them
without ardiTous climbing of steps.

Conclusions

Like Chief Librarian Francis R. St. John of the
Brooklyn Public Library, "we feel that the elderly
constitute a very important group in the community
and one which has been rather neglected." As
Senator Desmond says, "Librarians must face the
fact that our people are living longer, are remaining
vigorous and alert longer, and are having increased
leisure time." Our communities and state must at
the same time appreciate the fact that if library serv-
ices are to be expanded to meet the needs of the
elderly, financial assistance will be needed.

From the experiences and opinions of the librarians
as expressed to the Desmond survey, we draw these
fundamental conclusions, as basic precepts which
might well govern libraries in serving the elderly of
their community :

1. Libraries are dedicated to serve all the com-
munity. Therefore, it should examine the com-
position needs of the community and its patrons,
and attempt to serve all in just proportion.

2. Communities differ not only in the proportion
of their elderly but also in the educational back-
grounds of their elderly. Therefore services
of libraries to the oldsters vrould vary from
community to community as local needs dictate.

3. The library sliould join with other community
agencies in planning loi'al programs for the
elderly. The services the library renders to
the oldsters should depend in part on the extent
and character of services provided by other local
agencies, to prevent unnecessary overlapping
and duplication and omissions.

4. Library programs for the elderly need frequent
auditing and review, for a program designed
for the oldsters of 1950 may be outmoded by
1955. The library should keep pace with the
changing backgrounds and needs of the elderly.

5. Librarians, educators, and other qualified
authorities agree that education, which begins
at our entrance into this world (if not sooner),
should not end until we make our final exit.
Thus the adult education programs of our com-
munities should be geared not only to the young
and to the middleaged but also to our oldsters.

171

6. Segregated book shelves for the elderly are
unwise; activities should be set up on a
functional rather than a chronological age basis,
whenever possible. However, clubs for oldsters
and hobby shows for oldsters serve an import-
ant function of bringing groups of elderly
together, enlarging their social scope, revital-
izing lives allowed to become shriveled up and
narrow.

7. Libraries can best serve the elderly by :

(a) bringing the elderly into the library by

(1) making the library a hospitable,
pleasant place to visit, with the library
staff prepared to be especiallj- kind
and patient with oldsters who may be
hard of hearing, inattentive, demand-
ing, etc. because of peculiarities of the
aging process.

(2) organizing and directing clubs for
oldsters if none exist in the community'.

(3) providing, if available, meeting space
for clubs for the elderly.

(4) arranging for "Great Books" discus-
sion groups, Book Reviews, talks, and
movies in the library, if facilities are
available.

(5) make available radio and recording
rooms for those whose sight is impaired.

(6) encourage hobby showings for the
elderly.

(7) keep needs of elderly in mind wlien
ordering books.

(b) bringing the library to the elderly by:

(1) providing delivery service with the aid
of volunteer groups, if possible, to the
bedridden at home, or those unable to
get to the library.

(2) providing book service for public and
private hospitals, old age homes, nurs-
ing and convalescent homes, and
recreation clubs for elderly.

(3) arranging for lectures, book reviews,
and movies by library staff at meeting
rooms of old age clubs.

(4) providing "books on ceiling" projector
service for the bedbound.

Librarians have an opportunity in many com-
munities to lead the way to better community under-
standing of the needs and abilities of the elderly, to
demonstrate that many of our elderly are capable of
contributing a great deal to society, and to smash
the common concept of the library as only a place
where books are borrowed.

Let us remember that you can judge the cultural
level of a community by the care and attention it
gives its elderly.

It may take some patience and tolerance in dealing
with some of our elderly ; but then, these qualities are
needed in dealing with some librarians, young or
old, for we are all humans. However, few services
of the librarian will yield such tremendous satisfac-
tion as those arising from the knowledge that they
are giving our neglected elderly new hope, new vistas,
and new happiness, in their last years.

172

Canada And Its Aged

By Professor John S. Morgan

Associate Professor of Social Work, Universitii of Toronto

THE Government of Canada has just appointed
a special Committee of members of the Senate
and the House of Commons to stiidy the needs
of the aged. This is sj-mptomatic. The pressure of
events is compelling the Canadian people to re-assess
the provisions now made in Canada for its older
citizens. This increased concern however, is due to
a number of factors, some of which are typical of the
situation in the United States, and some of which are
peculiar to the Canadian scene.

As in the United States, the number of older citizens
proportionately to the whole population has been ris-
ing during the first half of this century. For example
in 1921 the age group over 60 represented 75.1 per
1000 : in 1931 it was 83.9 ; in 1941 it was 102.1 per
1000;^ and there is no doubt that the Census for 1951
will show a further substantial increase. Further-
more, as reported in a recent article prepared by the
Bank of Nova Scotia,^ the numbers in the upper half
of the "working-age" group are also rising. "Even
with no further reduction in mortality rates, the num-
ber of persons in Canada aged 45-64 will increase
from about 2V2 millions in 1949 to some 3V2 millions
in 1971, and they will then make up perhaps 40 per
cent of those in the most active years of working life
(20 to 64) as against 331/3 per cent at present." So
that, although the age structure of the Canadian
nation is relatively that of a "young nation" as com-
pared with all the "Western European nations and is
perhaps a little "younger" than that of the United
States, the time has now arrived when the growing
numbers of older citizens has become a matter of
serious concern to the people of Canada.

Over-Emphasis on Youth

In Canada, as in the United States, the patterns of
employment accepted by both labor and management
have tended to put an overemphasis on youth. Since
so much of Canadian industry until very recent years
has been primary industry of a heavy type— such as
logging, lumbering, mining, agriculture— the emphasis
on comparative youth and physical strength has been
even greater than in the United States. Employers
in Canada have accepted without serious thought all

■ iThe Canada Year Book 19',S-',9. Ottawa: The Kings
Pi-inter, 1949.

2 Young and Old: The Changing Age Pattern. The Bank of
Nova Scotia Monthly Bulletin, February, 1950.

of the myths about the difficulty of employing older
workers which have been so thoroughly exposed by
the New York State Joint Legislative Committee on
Problems of the Aging in its two. reports. There is,
therefore, the same need in Canada as in the United
States for research into the work capacities of older
workers, and the same urgent need for public educa-
tion on the necessity to revise accepted but now out-
dated employment practices.^ The developing services
(if the National Employment Service in providing
special counselling services for older workers has
already been reported at length in Never Too Old
and needs no elaboration here. It is being extended
to the larger Employment Offices in the industrial
parts of Canada.

Unlike the United States of America, Canada has
no Social Security Act and no coherent set of plans
or provisions for meeting the basic economic needs of
dependent L-itizens. The main reason for this Ues in
the field of political science. Canada is a federal
country but responsibility for health and welfare has
been adjudged to lie with the Provinces, so that when-
ever a question of economic security legislation arises,
Canada runs into a confused political discussion about
jurisdictions in which the needs of people tend to get
lost in the heat of the battle for Provincial rights. The
last occasion on which an attempt was made to improve
the system of economic assistance to aged persons was
in 1945 when a Dominion-Provincial Conference was
called to consider among other things a re-alignment
of responsibilities for health and welfare between the
Federal and Provincial legislatures. This Conference
got involved in a fruitless discussion of powers of
taxation and was abandoned before the proposals con-
cerning the needs of the aged were seriously con-
sidered.

The main provision for economic aid to the aged in
Canada is made in the Old Age Pensions Acts. The
first Act was passed in 1927 when the Dominion Gov-
ernment was authorized to pay one-half of the net
cost of pensions up to a maximum of $20 a month to
British subjects of 70 years of age and over whose
income did not exceed $365 a year, who had resided
in Canada for 20 years and in the Province in which

3 See "Unemployment Among Older Workers 1945-49". The
Canadian Labour Gazette, November, 1949. Ottawa: The
Kings Printer, 1949.

173

application was made for five j'ears or more. The
Provincdal Governments then passed Provincial Acts
(British Columbia in 1927 being the first and the
Province of Quebec in 1936 being the last, excluding
Newfoundland which passed appropriate legislation
in 1949 upon Confederation) which set np the admin-
istration and established these non-contributory
means-test pensions within the minima laid do^ai in
the Dominion Act of 1927. In some Provinces, a share
of the half not coming from federal funds was paid
by municipalities, but this practice was soon discon-
tinued.

This meagre provision has been extended and lib-
eralized on several occasions. In 1931 the Federal
Government's share was raised to 75 per cent of net
pensions, in 1937 blind persons became eligible for
pensions at age 40; in 1943 the maximum i^ension was
raised to $25 a month ; in 1944 the maximum permitted
income was raised to $425. A major revision took
place in 1947, liberalizing the conditions of the means
test, including the blind at age 21, and raising the
maximum monthly rate of pension to $30. In 1949
the maximum rate to which a 75 per cent Federal
contribution can be claimed was raised to $40 a month.
Since 1942 some provinces have paid supplemental
allowances from provincial revenues ; these have
varied in amounts and from time to time, the present
situation being that only three Provinces and the
Yukon territory are paying suiiplemental allowances.

Excluding any provincial supplements, the position
in ]\Iarch 1950, then, is that Old Age Pensions are
payable to persons aged 70 or over when the annual
income, including pension is not more than $600 for
a single person or $1,080 for a married person, or

$1,200 for a person married to a blind person. Admin-
istration is the responsibility of the various Provinces,
Federal supervision being confined to audit of the
accounts. ^Yith the exception of medical care pro-
visions in some Provinces, there is little or no service
to pensioners.

From the inception of the fir.st Old Age Pension
Act in 1927 to September 30, 1949, the Federal Gov-
ernment had spent $585,896,316.93. The annual cost
of these pensions has been rising steadily, and will be
substantially increased by the 1949 increase of maxi-
mum pension rate to $40 a month. It is this steadily
rising charge on the budget which has influenced the
Government to re-examine the whole situation.

The need for better provision can be even more
clearly seen from the following table.

Since the Canadian Old Age Pension is only given
after a fairly stringent means test, it is clear that
nearly half of all Canadians over 70 years of age have
been unable to provide for their old age, and by far
the greater number of these have so little income that
they qualify for the full pension.

Medical Care jirovisions are available to old age
pensioners under the Provincial administrations in
Ontario, Saskatchewan, Alberta, British Columbia and
Nova Scotia. The typical arrangenaent is for the
Provincial Government to make an agreement with
the provincial Medical Association or the College of
Physicians and Surgeons, that recipients of old age
pensions may receive office care from their own phy-
sicians, with a limited list of permitted medicines,
the administration of the scheme being in the hands
of the medical society, which pays the physicians from
a fund provided by the Province on a per capita per

Statistical Summary as at September 30, 1949

Alberta

British
Columbia

Manitoba

New
Brunswick

Newfoundland Nova Scotia

1. Number of JOld Age Pensioners! 15,777 27,085 16,139 15,935

2. Number in receipt of Maximum Old Age

Pension' 12,189 20,458 12,918 7,438

3. Percentage of pensioners' to population

70;years of age or over 47.81 43.90 46.24 70.82

4,559

4,215
(max. S30 month)

36.19

19,287
6,590

56.73

Prince Edward North West

Ontario Island Quebec Saskatchewan Territories Yukon

1. Number of Old Age Pensioners' 80,731 2,853 66,674 16,230 19 83

2. Number in receipt of Maximum Old Age

Pension' 65,304 1,085 52,876 11,384 19 75

3.' Percentage of pensioners' to population

70 years of age or over 35.27 46.02 52.79 47.18 10.38 25.30

NOTES. 1 and 3 from the Quarterly return Old Age Pensions and Blind Pensions in Canada as at September 30th, 1949, published
by the Old Age Pensions Division, Department of National Health and Welfare, Ottawa, 1949. Percentages based on
estimated population as at June 1st, 1948, except Newfoundland, Yukon and Northwest Territories based on 1941 Census.
2 from a return furnished in the House of Commons, Nov. 3rd, 1949. (Report Col. 1394) All cases not reviewed under
1949 changes in pension rates.

174,

day basis for each recipient of pension on the Provin-
cial records. Hospital care, except in Saskatchewan
and British Columbia, falls under the provisions for
the care of indigents in the Public Hospitals Acts of
most, if not all of the Provinces. Saskatchewan and
British Columbia have contributory hospital insur-
ance programs for the whole population of the
Province. There has been little supervision of the
kind of medical care given, and little or no research
or action in the rapidly developing medical science of
geriatrics.

The care of the aged in other waj^s than by means
of pensions is more fragmentary and varies from
Province to Province and municipality to municipal-
ity. It is very difficult to get at the real facts of tlie
situation for the facts are hidden and little research
has been done. It has been suggested that for some
of those under 70 years of age, the Unemployment
Insurance Fund is being used for economic support
altliougli the recipient and the Unemployment Insur-
ance Commission are well aware that the recipient is
only "able and willing to work" as a polite fiction to
keep him within the statutory requirements of the
Unemployment Insurance Act. The hospitals and
mental hospitals of every Province contain large num-
bers of elderly people who are classed as chronically
ill or mentally ill, but whose real need is geriatric care
and rehabilitation.

The long tradition of municipal responsibility in-
herited from the old English Poor Law reaches into
some of the Canadian Provinces more than others.
Thus in most Canadian Provinces there are still munic-
ipal homes (or "'^joor houses") "which shelter a num-
ber of elderly people who are there because their
parishes or municipalities of residence can find no
more suitable form of care for them. In Quebec
Province, with the long standing tradition of the
Roman Catholic Church, there are many old people in
religious institutions, which receive support from the
Province under the Quebec Public Charities Act.
Ontario has recently made a valiant effort to encour-
age the conversion of the old municipal homes in the
Province into more adecpiate homes for the aged, and
in its recent Homes for the Aged Act has offered sub-
stantial financial assistance to municipalities to build
new and more modern homes for the aged. These
provisions and those of the other Provinces care for
some of the aged who cannot, mostly for reasons of
physical or mental health, be cared for in their own
homes.

The need for better housing for older people is
beginning to receive some attention in Canada. Here
and there experiments are being tried which have
much promise for the future. A block of flats for
older people has been built in Burlington, Ontario, by
the Canadian Legion, and is expected to operate on a

self-sustaining basis now that the capital cost has been
found. The famity welfare agency in Montreal has
converted a legacy into the Belvedere Apartments for
older citizens in the center of the city. The develop-
ment of well-established private agencies which have
created homes for older people, such as the Sunset
Lodge of the Salvation Army has been the subject of
special attention in the city of Toronto. These are
only examples of a number of experiments and exten-
sions of existing services which are being developed
to meet the growing need of places where an old per-
son or an old couple can seek and find adecpiate shelter
within their very modest means; but the supply falls
far short of the need. Large numbers of older people,
especially in the industrial towns and cities, .still live
in conditions of squalid discomfort.

Here and there in Canada there are experiments in
recreation for older people and recreation agencies are
giving this matter some but not enough attention.
The activities of the Gordon House Settlement in
Vancouver provide one examijle of a well planned
programme of recreation activities for its older mem-
bers. The Second Mile Club of Toronto, supported by
the city council as well as by the Community Chest of
the city, is au experiment in the development of a
club for older people, in which they can not only get
recreational activities but develop a new social life for
themselves. Service clubs in a number of cities are
beginning to interest themselves in the needs of the
aged. These are all beginnings, but they are few in
proportion to the need.

Canada Starts Old Age Work

Canada is just beginning on the long task of pro-
viding for its aged. Many plans are being aired.
The Senate-Commons joint committee will be a.sked to
consider various proposals for better economic aid;
contributory insurance will be proposed, on the pat-
tern of Old Age and Survivors Insurance in the
United States or the Retirement Allowances of the
British National Insurance Act: universal no-means
test allowances (or "birthday pensions for all") of
the kind recently suggested by Mr. Alton Linton,
testifying on Bill H.R. 6000 before the Senate Com-
mittee on Finance, in the United States will be pro-
posed : the needs of older citizens in terms of jobs,
housing, medical care, and social services (such as
those now provided under the British National Assist-
ance Act) will be presented. There is much good-will,
some anxiety, and not a little confusion. Constitu-
tional problems, financial and administrative difficul-
ties, political promises and counter proposal lie ahead.
The studies of the New York State Joint Legislative
Connuittee on Problems of the Aging cannot but be a
valuable aid to careful examination of the facts and
hopefully to the beginnings of wise solutions.

175

APPENDIX
RECOMMENDED LEGISLATION

STATE OP NEW YORK

No. 743
IN SENATE

January 23, 1950

Int. 734

Introduced by Mr. DESMOND-

-read twice and ordered printed, and when printed to be committed to the
Committee on Finance

AN ACT

To create a counselling service for older workers in the labor department, and making an appropria-
tion therefor

The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Explanation — Matter in italics is new; matter in brackets [ ] is old law to be omitted.

Section 1. Article twenty-four of the labor law and
section eight hundred fifty to eight hundred fifty-five,
both inclusive, comprising such article, as last renum-
bered by chapter tliree hundred seventy-seven of the
laws of nineteen hundred forty-five, is hereby renum-
bered article twenty -five and sections nine hundred to
nine hundred five, respectively, and such law is here-
by amended by inserting therein a new article, to be
article twenty-four-A, to read as follows :

ARTICLE 24-A

Counselling Service for Older Workers

§ 825. The industrial commissioner shall establish
in the New York state employment service a coun-

selling service for older workers. Such counselling
service .shall appraise the capabilities of the older
workers, advise, guide and direct older workers to
employment opportunities, encourage older workers to
seek the work for which they are best suited, and give
them confidence in their abilities and perform such
other functions as the industrial commissioner shall
deem desirable to counsel older workers successfully.

§ 2. The sum of fifty thousand dollars ($50,000),
or so much thereof as may be necessary, is hereby
appropriated to the state department of labor for the
purposes of this act. The moneys appropriated by
this act shall be payable from the state treasury on the
audit and warrant of the comptroller on vouchers cer-
tified or approved in the manner provided by law.

§ 3. This act shall take effect immediately.

17(1

STATE OF NEW YORK

3rd Rdg. 388

Chapter 598, Laws of 1950
Nos. 162 9, 3354

IN SENATE
February 8, 1950

Int. 1536

Introduced by Mr. DESMOND — read twice and ordered printed, and when printed to be committed to the
Committee on Internal Affairs — reported favorably from said committee, committed to the Committee of the
Whole, ordered to a third reading, passed Senate and xVssembly but not delivered to Governor, vote reconsid-
ered, restored to third reading, amended and ordered reprinted retaining its place in the order of third read-
ing

AN ACT

To amend the town law, in relation to the regulation of private sanatoriums, convalescent homes,
homes for aged or indigent persons, day nurseries, hospitals, rest homes, and buildings used for simi-
lar purposes

The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Explanation — Matter in italics is new; matter in brackets [ ] is old law to be omitted.

Section 1. Paragraph numbered twenty of section
one hundred thirty of the town law, as amended by
chapter three hundred thirty-eight of the laws of
nineteen hundred thirty-nine and renumbered by
chapter one hundred twent.y-sis of the laws of nine-
teen hundred forty-four, is herebj' amended to read
as follows :

20. Hotels, inns, boarding houses, etc. Regulating
hotels, inns, boarding houses, rooming houses, lodging
houses, associations, clubs or any building or part of
a building used in the business of renting rooms,
individual or several, and also private sanatoriums.

convalescent homes, homes for aged or indigent per-
sons, day nurseries, hospitals, rest homes or any
h nil ding or part of a huilding used for similar pur-
poses, containing a total number of beds, cots or simi-
lar equipment providing sleeping accommodations for
more than five persons; specifying the type of con-
struction, the manner of their running and operation
and prescribing regulations assuring proper sanita-
tion [and], cleanliness and fire protection.
§ 2. This act shall take effect immediately.

This bill was adopted by the Legislature, and is now Chapter
598 of Laws of 1950.

177

STATE OF NEW YORK

No. 2286
IN SENATE

February 21, 1950

Int. 2109

Introduced by Mr. DESMOND — read twice and ordered printed, and when printed to be committed to the

Committee on Civil Service and Pensions

...U ;'. ■ -■ . . AN ACT

To amend the civil service law, in relation to the suspension of pensions

The People of the State of Neiv York, represented in Senate and Assembly, do enact as folloivs:
Explanation — Matter in italics is new; matter in brackets [ ] is old law to be omitted.

Section 1. Section thirty- two of the civil service
law, as added by chapter seventj^-eight of the laws of
nineteen hundred thirty-two, is hereby amended to
read as follows :

§ 32. When pension [and annuity] suspended.
1. If anj' j)erson subsequent to his retirement from the
civil service of the state, or of any municipal corpora-
tion or political subdivision of the state shall accept
any office, position or employment on and after July
first, nineteen hundred thirty-two to which any salary
or emolument is attached in the civil service of the
state or of any municipal corporation or political
subdivision of the state, except the office of inspector
of election, jury duty, poll clerk or ballot clerk under
the election law, or except the office of notary public
or commissioner of deeds, or an elective public office,
any i^ension [or annuity] awarded or allotted to him
upon retirement, and payable by the state, by such
municipal corporation or political subdivision, or out
of any fund established by or pui'suant to law, shall
be suspended during such service or employment aud

while such person is receiving any salary or emolu-
ment therefor except reimbursement for traveling
expenses.

2. The provisions of this section shall he suspended,
until Jidy first, nineteen hundred fifty-two, to the
extent ne'cessary to permit a retired meniber to con-
tinue as such and to earn not to exceed seven hundred
fifty dollars per calendar year as compensation in any
position in government service or public service, pro-
vided:

(a) His retirement allowance, computed without
optional modification, does not exceed fifteen hundred
dollars per year, and

(b) He duly executes and files with his retirement
system a statement that he elects to have the provi-
sions of this subdivision apply to him. A7iy statement
executed and filed pursuant to this subdivision may
be ivitlidrawn by a retired member at any time by a
statement similarly executed and filed.

§ 2. This act shall take effect immediately.

178

STATE OF NEW YORK

No. 2289
IN SENATE

February 21, 1950

Jut. 2112

Introduced by Mr. DESMOND — read twice and ordered printed, and when printed to be committed to the

Committee on Finance /

AN ACT

To amend the labor law, in relation to creating an office on employment of older workers, defining its
powers and duties and making an appropriation therefor

The People of the State of New York, represented in Senate anel Assembly, do enact as follows:

EXPLANATIOX — Matter in italics is now; mattcv in brackets [ ] is old law to be omitted.

Section 1. Article twenty-fonr of tlie labor law and
sections eiglit hundred fifty to eight hundred fifty-five,
both inclusive, comprising- such article, as last renum-
bered by chapter three hundred seventy-seven of the
laws of nineteen hundred forty-five, is hereb.y renum-
bered article twenty-five and sections nine hundred to
nine hundred five, respectively, and such law is hereby
amended by inserting- therein a new article, to be
article twenty-four, to read as follows :

ARTICLE 24

Office for EaiPLOYiiENT of the Older Workers

Section 825. State office for employment of the older
workers.

826. General purposes and duties.
' 827. Director.

828. Duties of director.
§ 825. State office for employment of older workers.
The industrial commissioner shall establish an office
for the employment of older workers, composed of
three representatives, each from employer and em-
ployee organizations, respectively, and one representa-
tive of the general public, who shall be the chairman.
They, by a majority vote, may designate one of its
members, other than the chairman, as a vice-chairman
to act in the absence or inability of the chairman.
Each member shall be appointed for a term of three
years and shall hold office until his successor shall be
appointed and has qualified. Vacancies shall be filled
by appointment by the commissioner for the unexpired
term. The members of the council shall receive no
compensation but shall be reimbursed for transporta-
tion and other expenses actually and necessarily

incurred in the performance of their duties under this
article.

§ 826. General purposes and duties. The office
shall :

a. attack age barriers to employment through re-
search and education.

b. launch a sustained drive to encourage employers
to hire elderly workers.

c. compile for industry a list of jobs for which the
elderly have been found particularly suitable.

d. conduct studies on utilization of aging man-
power in industry.

e. in cooperation with the homework bureau de-
velop a sound program for expanding work of oldsters
at home.

f. help in developing retaining facilities for the
aging.

g. encourage creation of sheltered workshops.

h. develop pamphlet on community iises of retired
workers.

i. help prepare workers for retirement.

§ 827. Director. The industrial commissioner shall
appoint a director who shall be technically trained
with adequate administrative experience in personnel
and social welfare work and who shall receive a sal-
ary to be fixed by the office within the amounts made
available by appropriation. The director .shall serve
at the pleasure of the industrial commissioner.

§ 828. Duties of director. The director shall: (a)
be the administrative head of the office; (b) appoint
and remove from time to time, in accordance with law
and any applicable rules of the state civil service com-
mission, such employees and technical experts as he
may deem necessary for the efficient administration
of the work of the office. The compensation of such

im,!

employees and technical experts shall be fixed by the
director within the amounts made available by appro-
priation; (c) investigate and report from time to
time upon the facilities and services which are needed
or which may be needed to promote the interests of
aging and elderly workers of the state and make such
recommendations as may prove beneficial and useful
in carrying out the provisions of this article; (d) ad-
vise and cooperate with emploj'er and employee or-
ganizations on matters relating to the rehabilitation
and employment of aging and elderly workers; and
(e) perform such other duties as maj' be necessary to
carry out the provisions of this article.

§2. The sum of fifty thousand dollars ($50,000),

or so much thereof as may be necessary, is hereby
appropriated out of any moneys in the state treasury
not otherwise appropriated and remaining to the
credit of the state purposes fund in the general fund
and made immediately available for use by the office
for older workers, including expenses of maintenance
and operation and personal service of employees, in
carrying out the provisions of article twenty-four of
the labor law as added by this article. Such money
shall be paid out of the state treasury on the certifi-
cate of the industrial commissioner after audit by and
upon the warrant of the comptroller as provided by
law.

§ 3. This act shall take effect immediately.

180

STATE OF NEW YORK

No. 2290
IN SENATE
February 21, 1950

Int. 21i;{

Introduced by Mr. DES^IOXD — read twice and ordered printed, and when printed to be committed to tlie

Committee on Finance

AN ACT

To amend the public health law, in relation to instituting and developing an adult hygiene and geria-
trics division in the department of health and making an appropriation tlierefor

The People of the State of New York, represented in Senate and Assembly, do enact as follows:
ExpLAXATiox — ilatter in italics is new; matter in brackets [ ] is old law to be omitted.

Section 1. The public health law is hereby amended
by inserting therein a new article, to be article
twenty-three-A, to read as follows :

ARTICLE 23-A
Adult HYcrENE and Geriatrics

Section 460. Adult hygiene and geriatrics.

461. Purpose and functions.

462. Powers and duties.

§ 460. Adult hygiene and geriatrics. The state de-
partment of health shall establish an adult hygiene
and geriatrics program, designed to improve and pro-
tect the health and vitality of middle aged and elderh^
citizens of the state.

§ 461. Purpose and functions. The department, at
the discretion of the commission, shall :

1. Plan the change in emphasis on public health
work from communicable diseases to degenerative dis-
eases and chronic illnesses.

2. Develop a program for integrating all public
health department activities, ranging from cancer con-
trol division, public health nurses, district health offi-
cers, health education division on the utilization of
geriatric techniques.

3. Develop a program for periodic comprehensive
health inventories, for the middle aged and elderly.

4. Plan and promote a health education program
for the elderly.

5. Set up a "pilot" old age clinic at a general hos-
pital.

6. Develop plans for exjDanding the facilities of
chronic illness centers to include old age clinics.

7. Explore possibilities of reducing cost and im-
proving care of the chronically ill through use of non-
institutional facilities.

8. Develop, carry out and stimulate laboratory,
clinical and statistical research on health problems
of older people, as may be recommended by the state
medical society or other agencies.

9. Carry on a program of professional education
and training of medical students, physicians, and
nurses in the prevention, medical, and nursing care
of diseases of older people.

§ 462. Powers and duties. The commissioner shall
have the power and it shall be his duty to employ such
assistants and personnel, within the amount of the
appropriation, as is necessary to carry out the provi-
sions of this article.

§ 2. The sum of fifty thousand dollars ($50,000),
or so much thereof as may be necessary, is hereby
appropriated out of any moneys in the state treasury
not otherwise appropriated and remaining to the
credit of the state purposes fund in the general fund
and made immediately available for use by the state
department of health, including expenses of mainte-
nance and operation and personal services of em-
ployees, in carrying out the provisions of article
twenty-three-A of the public health law as added by
this article. Such money shall be paid out of the
state treasury on the certificate of the commissioner
of health after audit by and upon the warrant of the
comptroller as provided by law.

§ 3. This act shall take effect immediately.

181

STATE OF NEW YORK

No. 2291
IN SENATE

February 21, 1950

Int. 2114

Introdiiced by Mr. DESMOND — read twice aud ordered printed, and Avlien printed to be committed to the

Committee on Finance

AN ACT

To amend the executive law, in relation to creating a state council on the elderly; defining its func-
tions, powers and duties and provitling for the appointment and term of office of its members, and

making an appropriation therefor

The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Explanation — Matter in italics is new; matter in brackets [ ] is old law to be omitted.

Section 1. Article fifteen of the executive law, and
sections two hundred and two hundred one compris-
ing such article, as last renumbered by chapter seven
hundred sixty-three of the laws of nineteen hundred
forty-five, is hereby renumbered article sixteen and
sections two hundred fifty and two hundred fifty-one,
respectively, aud such law is hereby amended by in-
serting- therein a new article, to be article fifteen, to
read as follows :

ARTICLE 15

State Council on the Elderly

Section 200. Council created; employees; utilization
of departmental personnel and as-
sistance.

201. Definitions.

202. Purposes and duties of council.

203. Director.

20-t. Duties of director.
205. Grants.

§ 200. Council created; employees; utilization of
departmental personnel and assistance. 1. A state
council on the eldery is hereby created to consist of
nine members to be appointed by the governor, among
which there shall be a representative appointed from
each of the following: department of education, de-
partment of labor, department of social welfare, de-
partment of health, and division of housing-. Three
members shall be appointed for a term to expire Janu-
ary fifteenth, nineteen hundred fifty-two, and two
members for terms to expire on January fifteenth,
nineteen hundred fifty-three, two members whose
terms shall expire on January fifteenth, nineteen
hundred fifty-four and two members whose terms
shall expire on January fifteenth, nineteen hun-

dred fifty-five, and their successors shall be appointed
for a term of four j'ears. Vacancies for causes other
than expiration of terms shall be filled for the re-
mainder of the unexpired term. The governor shall
designate one of the members to serve as chairman of
the council. The members of the council shall be
allowed their actual and necessary expenses incurred
in the performance of their duties under this act, but
shall receive no compensation for services rendered
pursuant to this act.

2. The council may employ and at pleasure remove
such officers and employees, and such expert and
clerical assistants as it deems necessary and may fix
their compensation within the amounts made avail-
able by appropriation therefor.

3. To effectuate the purposes of this act any de-
partment, division, board, bureau, commission or
agency of the state or any political subdivision may
23rovide such facilities, including personnel, assistance
and data, as will enable the council properly to carry
out its activities and effectuate its purposes hereunder.

§ 201. Definitions. ■ As used in this act,

1. "Council" shall mean the state council on the
elderly created by this act.

2. ''Director" shall mean the director of council to
be appointed under the provisions of this act.

§ 202. Purposes and duties of council. The coun-
cil shall :

(a) Encourage the coordination of the work of
various state departments and agencies dealing with
the elderlj^

(b) Interpret the needs of the elderly to the vari-
ous state departments and to the public.

(e) Stimulate research on problems of the aging.
(d) Encourage organization of old age committees
in each local community.

182

(e) Spear-head a state program for the elderly,
giving it leadership, direction and support.

(f ) Report annually on facilities, progress and ac-
tivities of public agencies dealing with the elderlj'.

§ 203. Director. The council .shall appoint a direc-
tor who shall be responsible to the council, and who
shall receive a salary to be determined by the commis-
sion. The director shall serve at the pleasure of the
eommi.ssion.

§ 204. Duties of director. The director shall

(a) Appoint and supervise and direct all officers,
agents and employees necessary to carry out the pro-
visions of this act.

(b) Study and report to the council upon the facili-
ties and services for the elderlj^ which are needed or
which exist within the state and by consultation with
the authorities in charge.

(c) Assist in the correlation and development of
programs for the elderly, pro^'ided that surveys of the
recreation facilities and programs of local agencies
shall be made only upon their reciuest.

(d) Advise and cooperate with and encourage com-
munity recreation agencies interested in the use of
or the development of recreation facilities and pro-
grams for the elderly.

(e) Advise the administrative officers of all state
agencies authorized by law to perform sei'vices for the
elderly of regular meetings of the commi.ssion and of
such special meetings as may consider matters relating
to their specific responsibilities, and invite such offi-
cers to attend and participate in deliberations of the
commission without the authoritv to vote.

(f) Encourage and render assistance in the promo-
tion of training programs for volunteer and profes-
sional personnel dealing with the elderly in coopera-
tion with other agencies, organizations and institu-
tions, and may encourage the establishment of stand-
ards for recreational personnel.

(g) Assist any department, commission, board,
agency- and officers of the state in rendering services
for the elderlj- in conformity Avith their respective
authorized powers and duties and encoi^rage and as-
sist in the correlation of state and local activities for
the elderly.

(h) Perform such other duties as may be pre-
scribed by law.

§ 205. Grants. The commission, with the approval
of the governor, may accept as agent of the state any
gift of funds for the purposes of this act.

§ 2. The sum of fifty thousand dollars ($50,000),
or so much thereof as ma.y be necessary, is hereby ap-
propriated out of any moneys in the state treasury not
otherwise appropriated and remaining to the credit
of the state purposes fund in the general fund and
made immediately available for use of the state coun-
cil on the elderly created bj- this article, including
expenses of maintenance and operation of the council,
and for personal service of emploj'ees, in carrying out
the provisions of this article. Such moneys shall be
paid out of the state treasury on the certificate of the
chairman of the council after audit by and upon the
warrant of the comptroller in the manner provided
by law.

§ o. This act shall take effect immediately.

183

STATE OF NEW YORK

Nos. 2293, 3054 ■ Int. 2116

IN SENATE

February 21, 1950

Introduced by Mr. DESMOND — read twice and ordered printed, and when printed to be committed to the
Committee on Judiciary — committee discharged, bill amended, ordered reprinted as amended and recom-
mitted to said committee

AN ACT

To amend the civil rights law, in relation to providing that applications for licenses, certificates or
permits from the state may not be denied because of maximum age limits

The People of the State of New York, represented in Seriate and Assembly, do enact as follows:
Explanation — Matter in italics is new; matter in brackets [ ] is old law to be omitted.

Section 1. The civil rights law is hereby amended shall be denied because such person is over any

by inserting therein a new section, to be section sev- specified age. Nothing herein contained, however,

enty-three, to read as follows: shall prevent the state board of social welfare from

§ 73. No application by a person who is in all other adopting reasonable age requirements for licenses,

respects qualified for any license, certifi.cate or permit certificates or permits for foster mothers in charge of

issued by the state or any department, commission, infants and children,

authority or agency thereof, or by any municipality, § 2. This act shall take effect immediately.

184

STATE OF NEW YORK

No. 2294 Int. 2117

IN SENATE

February 21, 1950

Introduced by Mr. DESMOND — read twice and ordered printed, and -when printed to be committed to the

Committee on Taxation

AJN ACT

To amend the tax law, in relation to allowing contributions made or amounts paid by employees to
pension trusts or retirement plans maintained by their employers

The Peo'ple of the State of New Yoi'k, represenfed in Senate and Assembly, do enact as foUoivs:
ExPLANATlOK — Matter in italics is new; matter in brackets [ ] is old law to be omitted.

Section 1. Section three hundred sixty of the tax maintained hy the taxpayer's employer in an amount

law is hereby amended by adding thereto a new sub- not exceeding in the aggregate, five hundred dollars.

division, to be subdivision nineteen, to read as follows: § 2. This act shall take effect immediately and shall

19. Contrihuiions made or amounts paid, withlield be applicable to returns for any taxable year begin-

or incurred by the taxpayer during the taxable year ning on or after January first, nineteen hundred fifty-

with respect to any jjcnsion trust or retirement plan one.

185

STATE OF NEW YORK

Nos. 2273, 3091
IN SENATE

February 21, 1950

Int. 2096

Introduced by Mr. CAMPBELL — read twice and ordered printed, and wlien printed to be committed
to tlie Committee on Finance — committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee

AN ACT

To amend the social welfare law, in relation to adult recreation and making an appropriation therefor

The People of the State of A"cw Yoi'k, represented in Senate and Assembly do enact as follows:

Explanation — Matter in italics is new; matter in brackets [ ] is okl law to be omitted.

Section 1. The social welfare law is hereby amended
by inserting therein a new article to be article ten-a,
to read as follows :

ARTICLE 10-A
Recreation fob the Elderly

Section 481. Declaration of intent.

482. Adult recreation council created ; func-

tions, powers and duties.

483. Powers of cities with respect to recrea-

tion for the elderly.
483-a. Adult recreation projects ; apiDroval.
483-b. State aid.
483-c. Withholding state aid.
483-d. Grants.

§ 481. Declaration of intent. Recreation is a basic
human need. The state of New York has already
authorized a program of state-aid for recreational
facilities for youth. However, the recreational needs
of our senior citizens have not as yet been met. Many
of our older persons, shunted aside by industry, lead-
ing lonely lives in what should be golden years, room-
ing in dreary boarding houses or crowded in with rela-
tives, feeling unwanted and insecure, and plagued by
boredom, are in urgent need of recreational facilities
for the preservation of their mental and physical
health.

The tremendous increase in the number of our
elderly, the longer life span now vouchsafed our
people, the huge burden on our state and citizens of
persons on old age assistance rolls, the mounting
costs, for care of the chronically ill, and for Avards for
the senile in our mental institutions, together with
the real loss to our economy entailed by loss of the
production of which many of our elderly are cnpable,
are but some of the factors that cry out for establish-
ment of a recreational program for the elderly. There
is ample evidence that a recreational program can
retard some of the characteristics of senilitv, encourage

the vocational rehabilitation of the elderly, and give
new zest to their lives.

It is the purpose of this bill to encourage establish-
ment of recreational programs for the elderly which
will promote (a) the social and emotional adjustment
of the older person by making it possible for him to
find companionship and create an environment that is
favorable to continuing growth and give him a sense
of personal stability and security, (b) the rehabilita-
tion of the personal efficiency of the older individual
by making it possible for him to make maximum use
of his time and of cajiacities least ini]iaired, and (c)
community usefulness by creating a feeling of ade-
quacy and accomplishment through activity.

§ 482. Adult recreation council created; functions,
powers and duties. There is hereby created in the
state department of social welfare an adult recreation
council to consist of five members to be appointed by
the state commissioner of social welfare, including the
dii'ector of adult education of the department of edu-
cation, ex officio. The council shall have power to
organize, elect a chairman and seci"etary, adopt,
promulgate and make effective, plans, rules and
orders with respect to the furnishing of recreation in
school buildings and properties or elsewhere for
adults over sixty years of age.

§ 483. Powers of cities with respect to recreation
for the elderly. 1. Each city of the state is hereby
authorized to furnish and foster recreational actiAa-
ties for adults over sixty years of age, as may be
authorized by the council, and to receive and expend
moneys from the state, the federal government or
private individuals, corporations or associations for
furnishing such recreation in accordance with plans,
rules or orders of the council.

2. The furnishing of such recreation is hereby
declared to be a proper municipal purpose for which
the moneys of such city may be raised and expended.

3. The chief executive of a city may appoint a rec-
reation for elderly committee to advise and assist in
the provision of such recreation and facilities therefor.

186

§ 483-a. Adult recreation projects; approval. 1.
Any city desiring to establish a recreation project for
the elderly may apply to the council for its approval
of its plans. The application shall be in accordance
with rules, plans and orders promulgated by the
council, shall be in writing and shall specify the
nature of the project in such detail as the council
shall require.

2. No application for the approval of plans for a
recreation project for the elderly shall be considered
which has not been first approved by the governing
body of the municipality making application.

3. The council may approve or disapprove the pro-
posed project as filed or if its modifications are con-
sented to by the applicant, approve the same with
such modifications.

4. The approval of any proposed project by the
council shall authorize the municipality to establish,
operate and maintain the recreation project, and shall
be entitled to state aid as hereinafter set forth; pro-
vided, however, the council may at any time subse-
quently withdraw its approval or require changes in
a plan or program previously approved.

§ 483-b. State aid. 1. Each city operating or main-
taining a recreation i^roject hereunder shall submit
to the council quarterly estimates of anticipated
expenditures for operation and maintenance of the
recreation project, including also rental of buildings,
purchase of equipment and administrative expense,
not less than thirty days before the first days of the
months of April. July, October and January, in such
form and containing such information as the council
may require. At the end of each quarter each city
shall submit to the council, in such form as the coun-
cil may require, a verified accounting of the fi.nancial
operations of such project during such quarter
together with a claim for reimbursement of one-half of
such amount as herein provided.

2. The council shall thereupon certify to the comp-
troller for payment by the state of one-half of tlie
entire amount of such expenditures as approved by
the council ; provided, however, that the amount of
state aid shall not exceed the sum of one dollar for

each ten persons over sixty years of age, residing in
the municipality, as shown by the last preceding fed-
eral census, nor in any event more than one-half the
amount of such local expenditures for such project.

3. For the purpose of reimbursement by the state,
administrative expenses shall include compensation
for personal services i^aid by a municipality to any
employee, for the purpose of administering the bene-
fits provided bj' this act.

§ 483-c. "Withholding state aid. The council may
authorize or require the comptroller to withhold the
pa^mient of state aid to any municipality in the event
that such municipality alters or discontinues, without
the approval of the coi;ucil, the operation of a recrea-
tion plan approved by the council, or fails to adopt or
change a plan as recommended by the council, or fails
to comply with rules or regulations established by the
regents.

§ 483-d. Grants. The council, with the approval
of the commissioner, may accept as agent of the state
any gift or grant for any of the purposes of this
article, and any moneys so received may be expended
for any of the jourposes of this act in the same manner
as other .state moneys appropriated for the purposes
of such adult recreation.

§ 2. The sum of fifty thousand dollars (.$50,000),
or so much thereof as may be necessary, is hereby
api^ropriated to the social welfare department out
of any moneys in the state treasury in the general
fund to the credit of the state purposes fund not
otiierwise appropriated, and made immediately avail-
able for the purposes of this article, including
approved payment, of state aid, and, to the extent of
not over ten thousand dollars thereof, for expenses of
maintenance and operation of the department and
personal services of employees, in carryina- out the
]irovisions of this act. Such moneys shall be paid out
of the state treasury on the certificate of the commis-
sioner after audit by and upon the warrant of the
comptroller.

§ 3. This act shall take effect August first, nineteen
hundred fifty.

187

STATE OF NEW YORK

No. 2173

IN SENATE

February 20, 1950

Int. 2022

Introdufed by Mr. HORTON — read twice and order printed, and when printed to be committed to the

Committee on Finance

AN ACT

To amend the education law, in relation to providing for adult education for older persons, and making

an appropriation therefor

The People of the State of New York represented in Senate and Assembly, do enact as fuUows:

Explanation — Matter in italics is new ; matter in brackets [ ] is old law to be omitted.

Section 1. The education law is hereby amended by
inserting- tlierein a new section, to be section forty-six
hundred fifty, to read as follows :

§ 4650. Adult education for middle-aged and elderly
persons. The eclitcation department shall stimulate
the development of adult education for middle-aged
and elderly persons. Such program shall include, but
not be limited to, pre-retirement counselling, classes
in health education for older persons, education for
leisure time in retirement and classes in crafts or other
suitable activities or subjects of interest to older per-
sons. The department shall train teachers in the
motivation and instruction of older persons.

§ 2. The sum of fifty thousand dollars ($30,000),
or so much thereof as may be necessary, is hereby
appropriated to the education department out of any
moneys in the state treasury in the "-eneral fund to
the credit of the state jiurposes fund not otherwise
appropriated, for the purpose of carryiim- out the
provisions of this section. Such funds shall be pay-
able on the audit and warrant of the comptroller on
vouchers certified or approved by the commissioner
of education, in the manner provided by law.

§ 3. This act shall take effect immediatelv.

188

INDEX

Abrams, Albert J., inside front cover, 52; article by, 166-172

Accidents, among elderly. 47, typical cases, 47, suggestions in
preventing, 47; number of, SO, 99, 125; protection from, 108;
increase in hazards, 123; causes of, 125, 157

ACS (antireticular cytotoxic serum), 129

ACTH, 9, 100

Activity, purposeful, S

Adult education, 15, 16; in factories, old age homes, recreation
clubs, etc., 48; courses in country, 48, 01. 02, 65; sugges-
tions for state action regarding, 67, 74; need for in rural
areas, 160-165

Adult hygiene and geriatrics, proposed division of, 16, 36

Advisory "Committee on the Aged, New York City, 10, 76

Age barriers, 15, 29, 51

Aged, emotional and psychological needs of, 7, cost of homes
for. 12; (see also elderly)

Aging, mental and physiological, 8, National Committee on
the, 10; State Wide Committee on the, 10; kinds of, 130;
(see also elderly)

American Public Health Association, 11

American Public Welfare Association, 155
Arteriosclerosis, cerebral, 137, 138
Arthritis, 9, treatment of. 100, 114

Assistance, public. 53, 84

Atmospheric pollution, 125

Austin, Assemblyman Bernard, inside front cover

Banking Department, Ne\v York State, 11

Barkin, Solomon, inside front cover

Baruch, Bernard. 9; 140, 142

Basic record, 120

Becker, Harry, article bv, 82-86; 149

"Birthdai/s Don't Count." 2, 6. 26. 48, 52

Birth rate. U. S., 83

Blind, elderly. 12

Bluestone, Dr. E. M., 101, article by, 102-105

Blue Cross, 44

Blue Shield, 44

Boarding homes, 6; suggestions for state action regarding, 67

Bogomolets, Dr. Alexander A., 129

Bookmobile service, 170

Bortz, Dr. Edward L., quoted, 78

Bronchitis, 125

Buffalo, city of. 14

Bureau of Adult Education, New York State, 16, 48, 160

California, State of, old age assistance experience in, 76
Campbell. Senator Thomas F., inside front cover, 52, proposed

legislation by, 186-187
Canada, aged in, 173-175
Canadian Employment Service, 26
Cancer, deaths from, 99, environmental, 124
Cancer clinics, 10
Carcinogens, 124

Carlson, Dr. Anton .J., statement on retirement bj', 97, 141
Carrel, Dr. Alexis, 8, 141
Census, 1950, 74

Central Bureau for the Jewish Aged, 50, 63, 111
Cerebral arteriosclerosis, 137, 138
Child welfare, importance of, 8
Chronically ill, 1, 13, 36, 53, 63, suggestions for State action

regarding, 67 ; in New York City, 69 ; mass screening of,

100; care of, 102-105, 126; housing needs of, 154
Citizens Committee on the Elderly, proposal for, 17, need for,

75-77 ; functions of, 77
Civil service, 33
Clague, Commissioner Ewan, article by, 87-90; 145

Clinics, cancer and tumor, 10

Clinics, geriatric, 12, 15, 30, 65, 114-117, personnel needed,
116

Cohn, Adolph J., 9

Coler Memorial Hospital, 107

Collective bargaining, 82

Colleges, gerontologj" courses in, 47

Communicable diseases, 123, 128

Communities, role of in aging. 2, 12, 13 (chart), 14; provid-
ing recreation, 48-50 ; possibilities for action, 54-57 ; need
for action, 70; place in health work, 101; geriatrics clinics
in, 118, 120

Community Service Society of New York, 12, 51, 64, 72, 75

Connective tissues, degeneration of, 9

Conservation Department, New York State, 11

Coolidge, Dr. William D., 142

Cortisone. 9. 100

Cost of living, 25, 149

Councils of Social Agencies, Association of. New York State, 57

Counseling services, financial, 13, 15; employment, 15-16, 26,
51, 173, personal problems. 61, 104

Cowry, Dr. E. V., 113

Crampton, Dr. C. Ward, inside front cover, 51, 113, article by,
1 18-120, quoted, 128. recommendations on nutritional needs.
131

Crutcher, Miss Hester B., 41, article by, 139

Custodial care, 64

Davidson, Dr. G. M., article by, 136-138

Day Centers, need for, 145, objectives of, 145

Deaths, Chief causes of, 34, 98-99

Degenerative ailments, 36, deaths and disabilities from, 99,

128
Dependency, old age, 88
Depression, mental, 115
Derby, Charles C, inside front cover
Desmond, Senator Thomas C, inside front cover; introduction

by, 1-2; 52. 72, 74. article by, 93-97, article by, 128-132,

article by, 140-143; 144, survey of libraries by, 166, 168,

171, proposed legislation by, 176-185
Dewey. Ciovernor Thomas E.. 25, 36, 50, 51 ; statements by

from 1950 message to legislature, 53, 73
Diabetes mellitus. deaths from. 99, hospital treatment for, 114
Discrimination, 10-17, 26, 28, 79, 91
Drugs, new discoveries in, 9

Dublin. Dr. Louis I, inside front cover, quoted, 75
Dunn, Dr. James M., 51, article by, 121-122

Economic security, 61

Education Department, New York .State vocational rehabili-
tation unit. 11; Adult Education Bureau, 11, 13, 48, 74, 160

Elderly, number of, 6, 16, 72, 98, 155, 173; needs of, 6; areas
of neglect regarding, 6 ; hopeful outlook for, 9 ; cost of care,
12; health oit, 34; accidents of, 47; housing of, 50, 154-159;
nutrition of, 55, 131; employment of, 56; group activities of,
61; council for 76: productive capacities of, 99; hospitaliza-
tion of, 102-105, 106-109; mental health of, 136-138; family
care for, 139; economic status of, 160-162; social status of,
162; in Canada, 17.3-175

Emotional problems, elderly, 10, 137

Employees, number of, S3 ; security program for, 85

Employment, problems of, 2, 6, 29, 51, 56, 66; suggestions for
State action regarding, 67 ; in New York City, 69 ; article on,
78—81; common fallacies in, 79; reasons given for age
barriers in, 91, chart, 155

Employment Security, United States Bureau of, 25, 27, 78;
recent studies by, 79

189

■«v;=9^

Employment Service, New York State, 15, 59, 81

Endoerines, 119

Environmental health, 123-127, references on, 127

Ernest, Helen, inside front cover

Exercise, 131

Family care, of elderly. 139

Family welfare agencies, 10

Farbstein, Assemblyman Leonard, inside front cover, 52

Federal Housing Law, recommended change in, 50

Federal Security Agency, Bureau of Public Assistance, 19, 34

Federation Employment Service, 20

Federation of Jewish Philanthropies, plans for aged of, 60

Financial counseling, 13, 15

Financial needs of elderly, 17

Fisher, Miss Gladys, inside front cover, 51

Fort Greene Housing Project, 11, 69, 156

Fortv Plus Club of New York, 26, 91

Fort'v Plus Club of Western New York, 14, 26

Foster homes, 10, 11, 41, 69

Fox, Miss Flora, article by, 63-67; 110

Freeman, Dr. Joseph T., 131

Garno. Harold J., inside front cover

Geriatric Clinics, 12, 15, 36, 65, 114-117, personnel needed, 110

Geriatrics, 10, Rochester Clinic, 12, 36, 59, 61, 64, 110;

"de-aging", essentials of, 118-119; 128-132
Gerontology, 7, 8, 47
Giberson, Dr. Lydia G., 141
Ginzberg Report (See also New York State Hospital study),

36-37" 106
Goldwater Memorial Hospital, 108
Goodwin, Mr. Robert C, 25, 27, article by, 78-81
Government, role of in aging, 1, 2
Graves, Dr. Frank P., 142
Graves, Senator Rhoda Fox, 51
Green, William, 26
Grays insurance, 44, 51
Gurley, W. and L. E. Company, 32
G^vyn, Lewis R., inside front cover

H. R. 4244. 154

H. R. 6000, 146, 147-148, 152, 175

Hanniford, Assemblywoman Elizabeth, inside front cover

Hanover, Harold C, inside front cover

Hawkins, Dr. Laurence A., 93, 96, 97

Health, of elderly, 34. 55, 98-101, 123-127, inventory, 130

Health Department, New York State, 11

Heart diseases, deaths from, 99, hospital treatment for, 114,
environmental factors in. 124

Heck, Assemblyman Oswald D., inside front cover

Hilleboe, Commissioner Herman E., 11, quoted, 142

Hobbies, importance of, 131, 142

Hodson Community Center, 12. 41. 48. 65, 131

Hoey, Miss Jane M. article by. 148-153

Home accidents, (graph) 47, typical cases, 47, suggestions
for preventing, 47

Home care. 9, 13, 36, 102-105, 107, 111

Homcmaker services, 65, 111; suggestions for State action
regarding. 67

Homework. 28

Hortou, Senator S. Wentworth, inside front cover, 52, pro-
posed legislation by. 188

Hospital facilities, 1,' 8, 102-105, 100-109, 114

Hospitals, mental, 6

Hoover, Ex-president Herbert, 9

Hormones, 119

Housing, 1, 2, 6, 16; experiments in foreign countries, 50;
State-aided units for elderly, 50 ; statement by Governor on,
53 ; imjiortance of in communities, 55, 62 ; private and
public, 04, 73; .suggestions for State action regarding, 07;
in New York City, 69, 155-156, planning of, 124-125; needs
of elderly, 154-159; abroad, 156; design for, 157

Housing Division, New Yoi'k State, 11, 50

Illnesse.s, Chronic, deaths from, 99
immigration, 83, 98
Inactivity, effects of, 8

Incomes. 17, 19 (chart), 155 (chart)

Industrial pensions, 12, 19, extent of, 24, 82, 146

Industrial revolution, effects of, 6

Industry, age bias in, 1 ; benefits to older workers, 32

Infections, treatment of. 118

Infectious diseases, deaths from, 99

Information, public, concerning elderly, 61

Instability, emotional, 137

Intitutional care, 61, 63

Insurance, 41, age limits, (graphs) 40, 42, 43, 45; group

health and life. 44, liealth and hospitalization, 51
Insurance Department, New York State, 11
Insurance, unemployment, 11, 18 (graph), 26

Jamestown. City of, 14

Jewish Aged, Central Bureau of, 50, 03

Jewish Philantliropies, Federation of, plans for aged, 66

JeAvish Women, National Council of, 14, 58

Job-counselling, 51, 81

Job-finding service, 14

Johnson, Assemblyman John E., inside front cover, 52

•Joint Hospital Survey and Planning Commission, 8, 14, 36

Joint Legislative Connnittee on Interstate Cooperation, 8, 15,
20, 36

Joint Legislative Committee on Problems of the Aging, inside
front cover ; Findings and Recommendations of, 5-52 ; Gov-
ernor's recommendations reaarding. 53 ; leadership of, 57,
06, 67, 72; 70, 71, 74, 75,^77, 89, 98, 122, 144, 106, 173,
175, recommended legislation of, 170—188

Keill, Dr. Kenneth, 39

Kidd, Dr. Charles, 145

Kidney diseases, hospital treatment for, 114

Klumpp, Dr. Theodore G., inside front cover, quoted, 129, 141

Kogel, Dr. Marcus D., 38, 39, 51, article by, 106-109

Kossoris, Max D., SO

Kraus, Professor Hertha, article by, 154-159

Kuhlen, Dr. Raymond G., 12, article by, 60-62

Labor Department. New York State, Bureau of Research and

Statistics. 11; State Employment Service, 11
Labor force. U. S., 78-79, 87 ; in world War II, 88, changes in,

145
Labor Statistics, Bureau of. U. S., 80, 87, 98
Labor unions. 31, 53; in relation to older workers, 82—86,

welfare funds of, 149
Langmuir, Dr. Irving, 142
Lawton, Dr. George, inside front cover
Lee, Dr. Roger I, statement on retirement, 97
Legislation, recommended, 170-188
Legislatiire, New York State, 33, 36, 110
Levine, Harrv. inside front cover, IIO, article bv, 144^-145
Lewis. Dr. Noland D. C, 142
Libraries, in relation to elderly, 41, 166-172, Adult recreation

in. 48
Licenses, qualifications for, 48
Life expectancy, 6, 78, S3, 87, 123. 129. 144, 155
Living standards, 123, 124
Loomis, Miss Alice M., inside front cover, article by, 54-57

MacCurday, Dr. Frederick, 39

MacFarlane. Kilgore, 95

Mack, Connie, 9

Mahoney, Senator Walter J., inide front cover

Mailler,' Assemblyman Lee B.. inside front cover, 8

Mailler Commission (See New York State Health Prepared-
ness Commission), 8

Malnutrition, causes and results of, 115

Manhattan State Hospital, 130, 144

Marriages, 155

Mass screening, 100

Massachusetts Law, age discrimination in employment, 29, 31

McCanlley, Miss Sara M., inside front cover

McCay. Dr. Clive M. inside front cover, 129 '

Medical care, 04 (see also geriatrics); suggestions for State
action regarding, 67 ■ '" '

Medical examinations, 1 . ■ ; r ..; '■

Medical schools, geriatrics in, 10

190

teai!^^^

}

m, 10, 12;
population

106

Medicine, advances in, 9, 87, 121, 128

Mental hospitals. New York State, patients in and cost of,
10, 11, 12

Mental hygiene, 13, 15, 39

Mental Hygiene Department, New York State, 11, 51, 139

Mental problems, elderly, 10, 13, 03; suggestions for State
action regarding, 67; causes of, 115; environmental factors
in, 124; housing in, 154

Merrit, Joseph, 9

Metabolism, 133

MohaAvk Development Service Company, 28, 93—97

Monroe, Dr. Robert T., 39, 51, HI, 112, article by, 114-117,
clinical observations of, 131

Montefiore Hospital, home care project at, 101; care of pro-
longed illness at, 102-105

Montieth, Dr. Stephen R., 51

Morgan, Professor John S., article by, 173-175

Moritt, Senator Fred G., inside front cover, 52

Mortality rates, 87, 98, by age, 99

Moses, Grandma, 9

Motor vehicle accidents, deaths from, 99

Mulligan, Miss Marion G.. inside front cover

Murray, Cl3'de E., inside front cover

National Assistance Law of 1947, Great Britain, 50

National Committee on the Aging, 10

National Council of Jewish Women. 14, 58

National Employment Service, Canada, 173

National Hospital Survey and Construction Act, 101

National Sanitation Foundation, plans of, 127

National Social Welfare Assembly, 10

Needs of elderly, financial. 17

"Never Too Old," 2, 6, 22, 26, 32, 36, 52, 76, 173

Newburgh, City of, 49

New Y'ork City, Advisory Committee on the Aged

needs of aged in, 63-67; work with elderly, 68-71;

changes in, 106; hospitals in, 106-109
New York City Health Department, 12, 128
New York City Hospital Department, 12, 38, 39, 04,
New York City Welfare Department, 12
New Y'ork Plan, 14-17, 47
New Y'ork State, older persons in, 10; activities for older

people, 11; obligations toward older people, 15
New York State Association of Councils of Social Agencies,

57
New York State Chamber of Commerce, quote from on pensions,

24
New York State Education Department, 48, 74
New York State Health Department, 11
New York State Banking Department, 11
New York State Civil Service Law, 33
New Y'ork State Conservation Department, 11
New York State Education Department, 11, 160
New York State Health Preparedness Commission, 8, 111, 113
New Y'ork State Hospital Studv (see also Ginzberg Report),

36-37
New York State Housing Division, 11, 50
New York State Insurance Department, 11
New York State Joint Legislative Committee on Problems of

the Aging, inside front cover; Findings and Recommenda-
tions of, 5-52; Governor's recommendations regarding, 53;

leadership of, 57, 66, 67, 72; 70, 71, 74, 75, 77, 89, 98, 122.

144, 166, 173, 175; recommended legislation of, 176-188
New Y'ork State Labor Department, Bureau of Research and

Statistics, 11, 32; State Emplovment Service, 11, 15, 26, 27,

28
New York State Legislature. 33. 36, 110
New Y'ork State Mental Hygiene Department, 11, 39, 139
New York State Retirement Fund, 1 1

New Y'ork State Safety Division, educational campaign of, 47
New York State Social Welfare Department, 11, 12, 15, 36, 47;

survey of nursing homes by, 53, 69, 72
New York State Woman's Relief Corps Home, 1 1
Nursing homes, 1, 6, 10, 13, 38; statement by Governor ou,

53; standards for, 53, 61, 64; suggestions for State action

regarding, 67; functions of, 109, 114
Nursing service, visiting, 11, 65
Nutrition, 55, 109, 118, 123, 131

Obesity, 101

O'Dwj'er, Mayor William, 10, 76

Old age assistance, 6, pajTnents in New Y'ork State, 10, 12,
20; Federal contribution toward, 11, 12, 20, 150; local costs
for, 11, 12, 13, 20; 19; number on, 20, 21 (graph) ; typical
cases, 22—24; prevention of need for, 51; liberalization of,
80; trends in, 148-153; recipient rates and amounts imder,
150—151; services determining eligibility under, 151, medical
care under, 151, other services under, 152, legislative trends
in, 152

Old age homes, 6, 10; local costs for, 11, 12, 13; adult educa-
tion in, 48, 51, 69, number in, 144

Old Age Pensions Acts, Canada, 173

Old Age and Sui'vivors Insurance, 11, 12, 19; flaws in program,
20, 25, 53 ; liberalization of, 80 ; inadequacy of, 83 ; benefits
under, 83; extension of, 148, 149, 153; fund assets of, 158;
contributory feature of, 175

Onondaga Health Association, 12, 60

Operative techniques, 9

Osertag Committee (See Joint Legislative Committee on Inter-
state Cooperation) 8, 15, 20, 36

Paralvsis, treatment of, 114

Pearc'e, Dr. Charles A., 51

Pensions, 1, 10, 12, 19, 24, 53, SO, 82, 122, 146-147, 149,

Canada, 173
Personality disorders, 137
Peter Bent Brigham Hospital, 114
Physical therapy, 115

Physicians, role of in program for aging, 110-113, 116
Pneumonia, 125
Pollution, atmospheric, 125
Pond. M. Allen, article by, 123-127
Pope, Col. Allan M., inside front cover
Population, U. S., increase in, 6, age changes in, S3, 106, 149,

173, characteristics in New York State, 160
Posner, William, article by, 68-71
Powelson, John R., article' by, 91-92
Prisons, cost of care of elderly in, 12
Psychiatry, and elderly, 136-138, 141
Psychology, techniques in "de aging", 119
Psychosis, senile, 137
Public assistance, 53, 84
Public healtli, IT. S.. 98-101, 12.3-127. 128
Puljlic Health Service, U. S., 51, 125

Public housing, 6; suggestions for State action regarding, 67
Public information, on elderly, 61
Publicitv. concerning elderly, 61
Pulling,' Dr. R. J., 48, 51, 74, 160

Quiun, Senator Elmer F., inside front cover
Quinn, Miss Lillian A., article by, 58-59

Rabe, Mrs. Henrietta, article b}', 160-165

Radiation therapy, 126

Randall, Miss OIlie A. inside front cover, 12, 51, article by,

72-74; article by, 75-77
Recommended legislation, 176-188
Recreation, community, 1, 6. 13, 48-50, 54, 61; clubs, 10, 12,

48; Adult education in, 48; State aid for, 10, 49, 144-145;

in New Y'ork City, 65 ; suggestions for State action regard-
ing, 67 ; in New York City, 69
Rehabilitation, vocational, 33, persons receiving in New Y'ork

State, 34; physical and mental, 101, 114, 116, 118
REIS (Reticulo-endothelial immune sera) 9
Research in aging, 2, need for, 100, 112
Retirement, 1, 6, 8, systems, defects in. 25; state and municipal

plans, 53; preparation for, 56, 61, 129, 142; coverage, 82;

ttexiliilitv in age of, 86; projections for future, 88: article

on, 140-143
Retirement Fund, New Y'ork State, 11
Riegelman, Mrs. Charles A., inside front cover
Rochester, New Y'ork, activities in aging, 12; Council of

Social Agencies, 12, 166, housing in, 50; industries in, 56;

financial support for, 57 ; census study in, 74
Roche-fit er Democrat and Chronicle, article on local prosram

in, 56 ^ °

191

JAW 2 4

Date Due

Rose, Mrs. Louis, 59
Rural areas, education needs of ol
Rusk, Dr. Howard A., rehabilitati
Ruskowslvi, John A., inside front

JAN 9>

Safety Division, New York State,

Sanitation, 123

Saratoga Springs Authority, New

Savings, for old age, 8.3, 149

Scheele, Dr. Leonard A., article b

Scheidler, William M., inside fror_

Second Mile Club, Toronto, Canad"

Security, 17, 61

Senescence, effect of recreation on, '

Senile, cottage care of, 11, psyche

Senility, 138

Seniority, 89

Sheltered Workshops, 2, 61

Shock, Dr. Nathan W., quoted, 15

Shut-in service, library, 109

Smith, Arthur R., 93, 95

Social Security, 1, 6, 10, 20, 53, "
148, 150

Social Security Administration, t -

Social Welfare Department, New
47 ; survey of nursing homes b.^ -

Social work, schools of, 10

Social workers. 46, 47. 116, Amer -

Spaulding, Dr. Francis T., 48

State Charities Aid Association. -

State Wide Committee on the Ag

Stearns, Ray, 93, 95

Steele, Dr. J. Murray, quoted, 13C

Steingut, Assembhnuan Irwin, in _

Steinhaus, Dr. Henry W., article

Stephens, Assemblyman D. Malloi ,

Stichman, Commissioner Herman T., 73, 74

Stieglitz, Dr. Kdward J., inside front coyer,
retirement bv, 97, statement on
130, 140

Stress tests. 120, 131

Strickland, Pauline T., inside front cover

Stuart, Assemblyman William M., inside front cover, 52

Sweden, housing experiments in, 50

Syphilis, 100

Syracuse, city of, 14, activities for elderly in, 60-62; Univer-
sity research and instruction at, 62

Tax revenues, state, 150

Therapy, physical, 115, radiation, 126

Tifft, Assemblyman Harry J., inside front cover, 52

Tompkins Square Houses, 64, 156

Health Association, 15

f, 84, 88
-, 11, 18, (graph),
rkers of America

26, 148
(C. L 0.),

82-86;

-' Employment Security, 25, 27

■ice Commission, 33
-alth Service, 51. 100, 101, 122, 125

urity Administration, 51
-Administration, 51, 121-122, 154

s from, 99; signs of, 137

1, U. S., 51, 98, 154

ierly, 12, 121-122, dependents of, 12,

'l, 36, 59, 62, 65

"m, 33, persons receiving in New York

-"ront cover
', 10
-V York City, 12, 51, 63, 64, 69, 110;

York, activities for elderly in, 14,

statement
degenerative disorders

-142
H.. inside front cover
11
C. E., excerpt from speech by, 83
C, inside front cover

Wilson,

Wolz, r.

Women's Educational and Industrial Union, 12, 56

Work-life pattern, changes in, 87

W^orkshops, sheltered, 2

W^oman's Relief Corps Home, New York State (Oxford, N. Y. )

11
Working life span, U. S., 87-90; variations in by occupations,

89
Workmen's Compensation, 80

Yaeger, George A., inside front cover
Yonkers, city of, 14

Zahl, Dr. Paul A., article by, 133-135

Zeman, Dr. Frederic D., 39, 51, article by, 110-113

192

/v/"

Young at any age mam
301N532y

3 lEbE D34^fl m7i

Additional copies of this report are available free of charge by writing to
Slate Senator Thomas C. Desmond, Chairman, New York Stale Joint Legis-
lative Conunittee on Problems of the Aging, 94 Broadway, Newburgh, IV. Y.

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