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This file contains materials relating to the Council of State Governments, the Meals - on - Wheels program, Older Americans Month, the American Association of Retired Persons, the National Retired Teachers Association, Grady Means, and Decker Anstrom.

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Aging - General (3)

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This file contains materials relating to the Council of State Governments, the Meals - on - Wheels program, Older Americans Month, the American Association of Retired Persons, the National Retired Teachers Association, Grady Means, and Decker Anstrom.

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Sarah C. Massengale Files (Ford Administration)

Sarah Massengale's Health, Social Security and Welfare Files

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1976-11-30

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1976

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1974

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The original documents are located in Box 2, folder "Aging - General (3)" of the Sarah C. Massengale Files at the Gerald R. Ford Presidential Library. Copyright Notice The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the United States of America her copyrights in all of her husband's unpublished writings in National Archives collections. Works prepared by U.S. Government employees as part of their official duties are in the public domain. The copyrights to materials written by other individuals or organizations are presumed to remain with them. If you think any of the information displayed in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential Library. THE WHITE HOUSE WASHINGTON January 20, 1976 MEETING WITH MEMBERS OF THE AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP) AND THE NATIONAL RETIRED TEACHERS ASSOCIATION (NRTA) Wednesday, January 21, 1976 2:45 p.m. (10 minutes) State Dining Room From: Jim Cannon I. PURPOSE To greet the members of the Legislative Council of AARP and NRTA and to receive a book from the Presidents of the organizations. II. BACKGROUND, PARTICIPANTS & PRESS PLAN A. Background: The Legislative Council of AARP and NRTA will be meeting in Washington to determine their legislative objectives for 1976. AARP and NRTA are two groups, jointly operated, which represent about 9 million older persons. Both have very active, well thought of volunteer programs. The Presidents of AARP and NRTA will present to you a book written by the founder of the two organiza- tions which expresses the author's and the group's philosophy of the importance of self-determination and of service by older persons to the community. After you and Mrs. Ford greet them, the group will be taken on a tour of the White House. B. Participants: List attached at Tab A. C. Press Plan: Full Press Opportunity. Meeting to be announced. III. TALKING POINTS To be provided by Paul Theis. FORD LIBRARY & GERALD LEGISLATIVE COUNCIL OFFICERS Miss Mary Mullen Mr. & Mrs. Douglas O. Woodruff President, NRTA President, AARP Laguna Beach, CA Salt Lake City, UT Dr. & Mrs. J. Cloyd Miller Mr. & Mrs A. H. Van Landingham President-Elect, NRTA President-Elect, AARP Albuquerque, NM Morgantown, WV Mr. & Mrs. George Schluderberg Mrs. Maud Haines Chairman Chairman NRTA Board of Directors AARP Board of Directors Baltimore, MD Portland, ME Mrs. Ruth Lana Miss Hariet Miller Honorary President Acting Executive Director Long Beach, CA Washington, D.C. MEMBERS Mr. J. E. Aldridge, NRTA Miss Oranda Bangsberg, AARP Jackson, MS Oshkosh, WS Miss Kathleen V. Boyd, NRTA Mr. Henry Bertuleit, AARP Narragansett, RI Fremont, CA Mr. & Mrs. Allen Campbell, NRTA Mr. Frank DeLamar, AARP Laguna Hills, CA Margate, FL Mrs. Irene Dunstan, NRTA Mr. & Mrs. Ed W. Eggen, AARP Denver, CO Portland, OR Mrs. Beatrice Harvey, NRTA Mr. Clarence A. Grant, AARP Lewisburg, WV American Fork, UT Mr. & Mrs. Henry McHargue, NRTA Dr. & Mrs. John Gregan, AARP Seymour, IN Manchester, CT Mr. & Mrs. C. B. Murray, NRTA Dr. & Mrs. Clayton D. Hutchins, AARP Albany, NY Bethesda, MD Mr. William J. Powell, NRTA Dr. Esther Prevey, AARP Taylor, PA Kansas City, MO Dr. Grady St. Clair, NRTA Mr. & Mrs. Edgar Scheid, AARP Corpus Christi, TX Baton Rouge, LA Mrs. Vera Weinlandt, AARP Bloomfield, NJ *Miss Mullen and Mr. Woodruff will present the book to you. JOINT STATE LEGISLATIVE COMMITTEE CHAIRMEN Mr. & Mrs. T. Preston Turner, NRTA Richmond, VA Mr. Isaac Fine, AARP Falmouth, MA Mr. Creel Richardson, NRTA Ariton, AL Mr. & Mrs. George Saunders, AARP Sun City, AR Mr. & Mrs. Francis W. Beedon, NRTA Muskegon, MI LEGISLATIVE STAFF Mr. Cyril F. Brickfield, Counsel Mr. Peter W. Hughes Mr. Harmon Burns, Jr. Assistant Legislative Counsel Assistant Legislative Counsel Mr. Laurence F. Lane Mr. Malachy M. McPadden Legislative Representative Legislative Representative Mr. James M. Hacking Mr. David Lambert Legislative Representative Legislative Representative Mr. David M. Dunning Mr. Kirk Stromberg Legislative Representative Legislative Representative Ms. Faye Mench Mr. John Mulholland Legislative Representative Legislative Representative Mr. John B. Martin Mr. William Rehrey Legislative Consultant Legislative Representative Ms. Laurie Fiori Senior Secretary ADVISORS Mrs. Zmira Goodman Mr. Ed Malone Mr. Walton Kurz Mr. Lloyd Singer THE WHITE HOUSE WASHINGTON January 20, 1976 MEETING WITH MEMBERS OF THE AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP) AND THE NATIONAL RETIRED TEACHERS ASSOCIATION (NRTA) Wednesday, January 21, 1976 2:45 p.m. (10 minutes) State Dining Room From: Jim Cannon I. PURPOSE To greet the members of the Legislative Council of AARP and NRTA and to receive a book from the Presidents of the organizations. II. BACKGROUND, PARTICIPANTS & PRESS PLAN A. Background: The Legislative Council of AARP and NRTA will be meeting in Washington to determine their legislative objectives for 1976. AARP and NRTA are two groups, jointly operated, which represent about 9 million older persons. Both have very active, well thought of volunteer programs. The Presidents of AARP and NRTA will present to you a book written by the founder of the two organiza- tions which expresses the author's and the group's philosophy of the importance of self-determination and of service by older persons to the community. After you and Mrs. Ford greet them, the group will be taken on a tour of the White House. B. Participants: List attached at Tab A. C. Press Plan: Full Press Opportunity. Meeting to be announced. III. TALKING POINTS To be provided by Paul Theis. FORD i LIBRARY GERALD LEGISLATIVE COUNCIL OFFICERS Miss Mary Mullen *Mr. & Mrs. Douglas O. Woodruff President, NRTA President, AARP Laguna Beach, CA Salt Lake City, UT Dr. & Mrs. J. Cloyd Miller Mr. & Mrs. A. H. Van Landingham President-Elect, NRTA President-Elect, AARP Albuquerque, NM Morgantown, WV Mr. & Mrs. George Schluderberg Mrs. Maud Haines Chairman Chairman NRTA Board of Directors AARP Board of Directors Baltimore, MD Portland, ME Mrs. Ruth Lana Miss Hariet Miller Honorary President Acting Executive Director Long Beach, CA Washington, D.C. MEMBERS Mr. J. E. Aldridge, NRTA Miss Oranda Bangsberg, AARP Jackson, MS Oshkosh, WS Miss Kathleen V. Boyd, NRTA Mr. Henry Bertuleit, AARP Narragansett, RI Fremont, CA Mr. & Mrs. Allen Campbell, NRTA Mr. Frank DeLamar, AARP Laguna Hills, CA Margate, FL Mrs. Irene Dunstan, NRTA Mr. & Mrs. Ed W. Eggen, AARP Denver, CO Portland, OR Mrs. Beatrice Harvey, NRTA Mr. Clarence A. Grant, AARP Lewisburg, WV American Fork, UT Mr. & Mrs. Henry McHargue, NRTA Dr. & Mrs. John Gregan, AARP Seymour, IN Manchester, CT Mr. & Mrs. C. B. Murray, NRTA Dr. & Mrs. Clayton D. Hutchins, AARP Albany, NY Bethesda, MD Mr. William J. Powell, NRTA Dr. Esther Prevey, AARP Taylor, PA Kansas City, MO Dr. Grady St. Clair, NRTA Mr. & Mrs. Edgar Scheid, AARP Corpus Christi, TX Baton Rouge, LA Mrs. Vera Weinlandt, AARP Bloomfield, NJ *Miss Mullen and Mr. Woodruff will present the book to you. JOINT STATE LEGISLATIVE COMMITTEE CHAIRMEN Mr. & Mrs. T. Preston Turner, NRTA Richmond, VA Mr. Isaac Fine, AARP Falmouth, MA Mr. Creel Richardson, NRTA Ariton, AL Mr. & Mrs. George Saunders, AARP Sun City, AR Mr. & Mrs. Francis W. Beedon, NRTA Muskegon, MI LEGISLATIVE STAFF Mr. Cyril F. Brickfield, Counsel Mr. Peter W. Hughes Mr. Harmon Burns, Jr. Assistant Legislative Counsel Assistant Legislative Counsel Mr. Laurence F. Lane Mr. Malachy M. McPadden Legislative Representative Legislative Representative Mr. James M. Hacking Mr. David Lambert Legislative Representative Legislative Representative Mr. David M. Dunning Mr. Kirk Stromberg Legislative Representative Legislative Representative Ms. Faye Mench Mr. John Mulholland Legislative Representative Legislative Representative Mr. John B. Martin Mr. William Rehrey Legislative Consultant Legislative Representative Ms. Laurie Fiori Senior Secretary ADVISORS Mrs. Zmira Goodman Mr. Ed Malone Mr. Walton Kurz Mr. Lloyd Singer DRAFT file #1 STATE OF THE UNION MESSAGE SECTION ON THE ELDERLY [1976] The elderly are a special concern to me. They have contributed to our society over the years and have earned a well -deserved retirement. Because so many elderly persons are living on fixed incomes, the single most important problem affecting them today is inflation. As I said before pledge to continue all efforts to combat the inflationary trends and to restore economic stability. I believe that this, more than anything else, will help the elderly, as well as all other Americans. I am also very concerned about the isolation of older people and its bad effects on them. To combat isolation and to keep the aged involved in the life of the community, we have established a national network organization. It consists of the Administration on Aging in the Department of Health, Education and Welfare, State Agencies on Aging, 489 Area Agencies on Aging, and 682 local agencies. Through this stimulated network, the development of community centers is where the elderly can come together to socialize and to have a hot meal. The community center provides a place and people that care and are all interested in those that come. I am also concerned about the elderly when they are ill, and I am especially concerned when they have to move GLRALD FORD LIBRARY 2 out of their own homes. We are making every effort to help the elderly stay in their own homes and communities. We are trying to help the older person retain their independence and mobility with innovative demonstration projects in transportation. Through the networks, we Forexample, provide supportive social services. A homemaker comes to the home of an older person to help clean, make repairs and provide companionship And The Meals on Wheels program brings a hot meal to an elderly person right at home. The importance of volunteers in these efforts cannot be overlooked. The nutrition program for older persons is now serving approximately 250,000 meals five days a week at about 4,900 sites. Approximately 62,000 volunteers are giving their time and effort to implement this program. In addition, 158 national voluntary organizations are partic- ipating in a program -- Project Independence -- sponsored by the National Council on Aging and designed to assist in the delivery of services which will enable older persons to continue to live in their own homes. When an older person does become ill, the medicare and medicaid systems provide doctor, hospital and support services. JE'1975 Last year $ $10.7 bull from medicare and $ $ 5.billion 12.6 bellion benefits 2.3 from medicaid Dayments was spent to provide care for the elderly. Per the elcleily. We are making every effort to assure and upgrade the quality of services delivered through medicaid and medicare and at the same time to control the increases in cost. 3 As a general rule we prefer to see people living a normal life at home and in the community. Unfortunately, at times it is necessary to leave home and be cared for in an well being institution for long-term care. To assure the safety of these persons, we have developed life and safety standards for nursing homes. This is of the highest priority. We also are carefully reviewing the questions of disa- bility and long-term care. We are making an assessment of needs and an evaluation of current and proposed programs and will be making recommendations in this area. I am very pleased that the National Institute on Aging which was recently organized under the National Institutes JnF475 of Health has an active research program on aging ^ $ 5.1 $ million & 10. mellions on were spent on in-house research and studies and grants to extramural research. private researchers. Finally, the financial situation of those over 65 is one of my major concerns. A financial backstop and income security is provided to the elderly poor through the Supple- mental Security Income program. Great improvements have been made through SSI; a million more people are now receiving these income supplements than previously. It is a tremendously effective system. It is new and it was implemented rapidly. Administration of the program is being improved and streamlined minimai to deliver services with minimal problems and additional cost to the taxpayer. 4 Income security for retiress is of paramount importance. We are closely watching the social security system. Let me reassure you that it is a sound system and we will see that it stays sound. We are taking steps necessary to ensure the stability of the Social Security System and desure to Ensure that our children will also benefits from the system as we do. #2 STATE OF THE UNION DRAFT STATEMENT - ELDERLY We have arrived at a point where government is too big and imposes too many rules and regulations on American citizens and enterprise. As you know, am attempting to reduce the size of the government and to return a greater degree of freedom and initiative to our citizens. There are, however, certain functions of government which have evolved over time which are proper and necessary. One of these in which I believe is the responsibility to provide for older Americans -- people who have worked long and hard and have contributed to the well-being of our country. We now assist the elderly in many ways. I believe that we should continue to do so. There will be disagreement about the level of funding for these programs, but I think we can all agree that the elderly have earned our support and assistance. Because so many elderly persons are living on fixed incomes, the single most important problem affecting them today is inflation. As I have said before, I pledge to continue all efforts to combat the inflationary trends and to restore economic stability. I believe that this, more than anything else, will help the elderly, as well as all other Americans. Older Americans are aided by a variety of programs including health services, transportation programs and social services. Let me describe just a few of these. GERALD FORD LIBRARY - 2 - To combat isolation and to aide the aged in staying involved in the life of the community, we have established a national network organization. It consists of the Administration on Aging in the Department of Health, Education and Welfare, and state, area, Agencies on Aging and local agencies on aging. Through this network, the delivery of a variety of services for the elderly is coordinated. Such things as the development of community centers is stimulated where the elderly can come together to socialize and to have a hot meal. These community centers provide a place for working and socializing and people that care and are interested in those that come. We are making every effort to help the elderly stay in their own homes and communities. We are trying to help the older person retain their independence and mobility, with, for with example, innovative demonstration projects in transportation. Also, through the networks, supportive social services to help the elderly keep their homes are provided. For example, a homemaker comes to the home of an older person to help clean, to make repairs and to provide companionship, And the Meals on Wheels program brings a hot meal to an elderly person right at home. The importance of volunteers in these efforts cannot be overlooked. The nutrition program for older persons is now serving approximately 250,000 meals five days a week at about 4,900 sites. Approximately 62,000 volunteers are giving their BERALE FORD LIBRARY - 3 - time and effort to implement this program. In addition, 158 national voluntary organizations are participating in a program -- Project Independence -- sponsored by the National Council on Aging and designed to assist in the delivery of services which will enable older persons to continue to live in their own homes. When an older person does become ill, our health system through medicare and medicaid provides doctor, hospital and support services. In FY 1975 $12.6 billion in medicare benefits and $2.3 billion in medicaid benefits was spent to provide care for the elderly. We are making every effort to assure and upgrade the quality of services delivered through medicaid and medicare and at the same time to control the increases in cost. Generally, I prefer to see people living a normal life at home and in the community. Unfortunately, at times it becomes necessary to leave home to be cared for in an institution for long-term care. To assure the well-being and safety of these persons, we have developed life and safety standards for nursing homes. I consider this to be of the highest priority. We also are carefully reviewing the questions of disability and long-term care. We are making an assessment of needs and an evaluation of current and proposed programs and will be making recommendations in this area. - 4 - I am very pleased that the National Institute on Aging which was recently organized under the National Institutes of Health has an active research program on aging. In FY 75 $5.1 million was spent on in-house research and $10.2 million on extramural research. Finally, the financial situation of those over 65 is one of my major concerns. A financial backstop and income security is provided to the elderly poor through the Supplemental Security Income program. Great improvements have been made through SSI; a million more people are now receiving these income supplements than previously. It is a tremendously effective system. It is new and was implemented rapidly. Administration of the program is being improved and streamlined to deliver services with minimal problems and minimal additional cost to the taxpayer. Income security for the retired is of paramount importance. We are closely watching the social security system. Let me reassure you that it is a sound system and we will see that it stays sound. We are taking steps necessary to ensure the stability of the Social Security System and to ensure that our children will derive benefits from the system as we do. [Fab 1976] We are a nation that is aging. Today one of every seven Americans is over 60, as compared to only one in 15 at the turn of the century. By the year 2000, over 40 million persons will be in this category, 9 million more than today. As a people, we are living longer and better than our ancestors. There are many accomplishments we can take pride in as we pause to reflect on our progress this Bicentennial year. But we know that many who grow old in America today have inadequate income, health care, nutrition and lack the opportunities to remain involved in society. Our progress confronts us with a challenge to assure that older persons ALD FORD LIBRARY continue to share and contribute to the life and wealth of our society. We have made progress in recent years in our efforts to meet this challenge. We have responded, for example, to recommendations made at the 1971 White House Conference on Aging to enact a Supplemental Security Income program, increase social security benefits more than the cost of living, liberal- ize the social security retirement test, increase benefits for delayed retirement, eliminate some of the inequities in payments to women, and protect 35 million workers investments in private pension plans. A major accomplishment has been the strengthening of the Older Americans Act. Today nearly 500 Area Agencies on Aging are in operation in communities throughout the country coordinating comprehensive service systems for older persons. - 2 - Also, the Title VII Nutrition Program provides for about 300,000 hot meals for older persons at 5,000 sites all over the nation. However we have no reason to be complacent. Conditions call for continued and intensified action for the aging. I have supported the concept of the Older Americans Act since its inception in 1965 and signed the most recent amend- ments into law this past November. A key component of this Act was the national network on aging which provides a solid foundation on which action can be based. I am pleased that the Federal Government has helped to set up this network composed of State and Area Agencies on Aging and 700 nutrition agencies. The system, with the assistance of thousands of volunteers -- many of whom themselves are older persons -- can and must assure older persons an active role and place in community life. Another concern of mine is that the voice of the aged, as consumers, be heard in the governmental decisionmaking process. The network offers opportunities for this through advisory council membership, public hearings, and input in the priority setting process at the local level. - 3 - Another concern of mine is that the voice of consumers, both young and old, be heard in the governmental decision- making process. The network offers opportunities for this: -- Area agencies are responsible for establishing priorities for services for older persons at the local level where older consumers can communicate and influence the process; -- Older consumers have the opportunity of testifying at public hearings on the annual plans of the State, Area and Nutrition Agencies on Aging. -- At lease half the members of every State, Area and Nutrition Agency on Aging advisory council must be older consumers. The ultimate objective of the national network on aging is to make contributions to developing at the community level a coordinated and comprehensive system for the delivery of services to older persons -- a system which will enable older persons to live in their own homes for as long as possible. I join with all Americans in expressing the hope that this objective can be achieved. This will call for hard and creative work at all levels of the network -- Federal, State and Area. I call upon all Federal Departments and Agencies to cooperate in facilitating the coordination of all available Federal resources for services for older persons at the State and - 4 - community levels. I laud the efforts made by the Administration on Aging and the Federal Departments and Agencies who have signed agreements to work together to avoid waste and over- come administrative difficulties. In addition to the progress made by these programs, income security is essential to the continued well-being and quality of life of those over sixty. Therefore, I am asking the Congress to grant a full cost of living increase in social security benefits in 1976. This will help those on fixed incomes to FORD LIBRARY & keep pace with the cost of living. I am very concerned about the financial integrity of the Social Security trust fund. Unless we take action soon, the fund will be exhausted by 1983. To protect the social security system, on which so many citizens rely for income security, I am submitting legislation to the Congress to increase payroll taxes by three-tenths of a percent each for employees and employers. This increase will cost workers less than $1 a week and will help stabilize the trust funds so that current and future recipients can be assured of the benefits that they have earned. Another crucial problem with the Social Security system is a flaw which overadjusts the benefits of future retirees to inflation. The current formula which determines future benefits for workers increases the weighting of earnings by the rate of inflation. Since wages normally grow with inflation, the - 5 - result is an overcompensation -- commonly referred to as a "coupled" system. Since there is a consensus that the in- flation adjustment in the formula should be eliminated, thus "decoupling" the system, I am submitting legislation to the Congress to "decouple." This change will not affect the cost of living increases in benefits after retirement. The normal health care needs of older Americans, with the special medical problems of aging -- degenerative and chronic disease -- require greater resources and commitment than the rest of the population. Many of those medical needs are not through the normal health care delivery system with the support Medicare and Medicaid. One major problem facing Older Americans and their families is that of catastrophic illness. Few can afford to bear the costs of prolonged illness. To alleviate the threat of this financial burden, I propose that Medicare beneficiaries be provided protection against catastrophic health costs by limiting the amounts an individual must pay annually to $500 for covered hospital care and $250 for covered physicians' services. While this will result in increased cost sharing by persons eligible for medicare steps will be taken to control the amount doctors and health insti- tutions will be reimbursed. I have pointed out, our progress has been substantial; but the challenge grows. Every resource of government must be brought to bear to continue to meet the changing needs of - 6 - older Americans, as well as, offer complete opportunity for those over 60 to participate fully in that process. Only in this way can we assure that our performance meets our promise. We are a nation that is aging. Today one of every seven Americans is over 60, as compared to only one in 15 at the turn of the century. By the year 2000, over 40 million persons will be in this category, nine million more than today. While it is true that as a people, we are living longer and better than our ancestors I know that many who grow old in America today have insufficient income, inadequate health care, poor nutrition and lack even the most basic opportunities to remain purposefully involved in society. We therefore must recognize the challenge of assuring that older persons continue to share in and contribute to life in our communities. As President I intend to meet this challenge. I am pleased today to submit to the Congress two proposals that address income and health security. I feel that my proposals offer significant improvements in the quality of life of older FORD & LIBRARY GERALD Americans. We must begin by asserting that the value of the Social Security system is beyond challenge. Maintaining the integrity of the system is a vital obligation each generation has to those who have worked hard and contributed to it all their lives. I strongly reaffirm my commitment to a stable and financially sound Social Security system. My 1977 budget and legislative program include several elements which I believe are essential. First to assist in protecting our retired and disabled citizens against the hardships of inflation, my budget request - 2 - to the Congress includes a full cost of living increase in Social Security benefits, effective July 1, 1976. The Social Security trust fund is currently paying out more in benefits than its payroll tax receipts. To insure the financial integrity of the trust funds, I am proposing legislation to increase payroll taxes by three-tenths of one percent each for employees and employers. This increase will cost workers less than $1 a week more and will help stabilize the trust fund assets so that current and future recipients can be assured that they will receive the benefits that they have earned. I am also taking steps to avoid serious future financing problems which will result if we do not act now to correct a flaw in the current system which overadjusts the benefits of future retirees to inflation. The current formula which determines future benefits for workers overcompensates for inflation. This change will not affect cost of living increases in benefits after retirement and will in no way alter the benefit levels of current recipients. I believe that the prompt enactment of these proposals is necessary to revitalize our Social Security system and to keep it strong for future generations. The normal health care needs of older Americans, with the special medical problems of aging -- degenerative and chronic disease -- require greater resources and commitment than the rest of the population. Many of those medical needs are met - 3 - through the normal health care delivery system with the support of Medicare and other Federal health programs. I have identified three issues related to the operation of the Medicare program for which I am recommending solutions. In my State of the Union Address I proposed catastrophic health insurance for everyone covered by medicare. This proposal is based on my conviction that there is a need to protect the aged and the disabled from the extraordinary hospital and medical costs of prolonged illnesses. To alleviate the threat of this financial burden, I propose that Medicare beneficiaries be provided protection against catastrophic health costs by limiting the amounts an individual must pay annually to $500 for covered hospital care and $250 for covered physicians' services. The burden of catastrophic illness can be borne by very few older people. This proposal will eliminate this fear from the lives of the elderly and their families. Added steps are needed to slow down the inflation of FORD LIBRARY & 938870 health costs and to enable the financing of this catastrophic protection. Therefore, I am recommending that the Congress limit increases in Medicare payment rates in 1977 and 1978 to 7% day for hospitals and 4% for physician services. Additional cost-sharing provisions are needed in order to encourage economical use of services for short hospital stays and routine physician care. Therefore, I am recommending that patients pay 10% of hospital and nursing home charges after - 4 - the first day and that the existing deductible for medical services be increased from $60 to $77 annually. Some of the savings from placing a limit on increases in medicare payment rates and some of the revenue from increased cost sharing will be used to finance the catastrophic program. I believe that the effect of short term costs in- creases will be greatly outweighed by the benefits of catastrophic protection. In addition to submitting proposals relating to income and health services, I desire to underline my conviction that current conditions call for continued and intensified action for the aging on a broad front. We have made progress in recent years. We have responded, for example, to recommendations made at the 1971 White House Conference on Aging to enact a Supplemental Security Income program, increase social security benefits more than the cost of living, liberalize the social security retirement test, increase benefits for delayed retirement, eliminate some of the inequities in payments to women, and protect 35 million workers investments in private pension plans. In addition we have continued to strengthen the Older Americans Act. I have supported the concept of the Older Americans Act since its inception in 1965 and signed the most recent amendments into law this past November. Funds available - 5 - for programs administered by the Administration on Aging under this Act have increased from $44.7 million in FY 1972 to $270 million during the last fiscal year. A key component of the Older Americans Act is the national network on aging which provides a solid foundation on which action can be based. I am pleased that the Federal Government has helped to set up this network composed of 56 State and 489 Area Agencies on Aging and 700 nutrition agencies. These nutrition agencies provide 300,000 hot meals a day five days a week. The system, with the assistance of thousands of volunteers -- many of whom themselves are older persons -- can and must not only help meet the needs of older persons but also Another concern of mine is that the voice of the aged, as consumers, be heard in the governmental decisionmaking process. The network on aging offers opportunities for this through membership on advisory councils, participation in regional public hearings, and involvement in the priority setting GERALD FORD LIBRARY process for services at the local level. The ultimate objective of the national network on aging is to make contributions to developing at the community level a coordinated and comprehensive system for the delivery of services to older persons. I join with all Americans in expressing the hope that this objective can be achieved. This will call for hard and creative work at all levels of the network -- Federal, State and Area. I call upon all Federal Departments and Agencies to cooperate in facilitating the coordination of all available Federal resources for services for older persons at the State and community levels. I laud the efforts made by the Administration on Aging and the Federal Departments and Agencies who have signed agreements to work together to avoid - 6 - waste and overcome administrative difficulties. These agreements will help to make available to older persons a "fair share" of the resources requested in my 1977 budget in such areas as housing, transportation, social services, law enforcement, adult education and manpower -- resources which can play a major role in enabling older persons to live in their own homes for as long as possible. Five percent, however, of our older men and women require the assistance provided by skilled nursing homes and other long term care facilities. An ombudsman process, related solely to the persons in these facilities, is being put into operation by the national network at the level of the Area Agencies on Aging. It is my hope that this program will not only help to resolve individual complaints but that it will also facilitate citizen involvement in the vigorous enforcement of Federal, State and local laws designed to improve health and safety standards as well as quality of care in these facilities. This nation can do no less for those who spend the last days of their lives in institutions. We must never lose sight of our obligations to help deal with the needs of older persons. At the same time we must not overlook the fact that older persons constitute one of the nation's greatest resources because of the contributions they are capable of making to our society. We are seriously - 7 - short-changing our nation when we deny older persons the opportunity for continued productive involvement in our society. This is why my budget for 1977 calls for increases in the ACTION programs designed to provide older persons with the opportunity for constructive service. Non-involvement on the part of older persons leads oftentimes to rapid mental and physical deterioration in their lives. It like- wise, by depriving us of their services, leads to the weakening of the nation. [End with either paragraph one or two] Paragraph 1 And it is as a Nation that we meet these challenges of assuring a fair share of progress for those who have con- tributed so much to our history. Each generation of Americans is engaged in a tradition of growth and progress. Each generation's success can be measured by its ability to recognize, reward, and renew the contributions of its older citizens. I intend to do all that I can to see that this generation of Americans does measure up. Paragraph 2 Today's older persons have made more significant contributions to the strengthening of our nation than any other - 8 - generation of older persons in our history. Many of them have lived through two world wars and the hostility in both Korea and Vietnam. They have provided the nation with a vision and strength that has resulted in unprecedented advancements in all of the areas of our life. Our moral strength can and will be judged in no small part by our recognition of this significance of their contribution. Our commitment to doing everything we can to respond to their needs, and our deter- mination to draw on the strength which they represent as they continue to live among us. Above everything else we will be judged by our ability to ensure the fact that in the last years of their lives they are treated with dignity. These are the goals to which I am committed as I continue to work with the Congress in this all important area of our national life. We are a nation that is aging. Today one of every seven Americans is over 60, as compared to only one in 15 at the turn of the century. By the year 2000, over 40 million persons will be in this category, nine million more than today. While it is true that as a people, we are living longer and better than our ancestors I know that many who grow old in America today have insufficient income, inadequate health care, poor nutrition and lack even the most basic opportunities to remain purposefully involved in society. We therefore must recognize the challenge of assuring that older persons continue to share in and contribute to life in our communities. As President I intend to meet this challenge. I am pleased today to submit to the Congress two proposals that address income and health security. I feel that my proposals offer significant improvements in the quality of life of older Americans. We must begin by asserting that the value of the Social Security system is beyond challenge. Maintaining the integrity of the system is a vital obligation each generation has to those who have worked hard and contributed to it all their lives. I strongly reaffirm my commitment to a stable and financially sound Social Security system. My 1977 budget and legislative program include several elements which I believe are essential. First to assist in protecting our retired and disabled citizens against the hardships of inflation, my budget request FORD LIBRARY & GERALD - 2 - to the Congress includes a full cost of living increase in Social Security benefits, effective July 1, 1976. The Social Security trust fund is currently paying out more in benefits than its payroll tax receipts. To insure the financial integrity of the trust funds, I am proposing legislation to increase payroll taxes by three-tenths of one percent each for employees and employers. This increase will cost workers less than $1 a week more and will help stabilize the trust fund assets so that current and future recipients can be assured that they will receive the benefits that they have earned. I am also taking steps to avoid serious future financing problems which will result if we do not act now to correct a flaw in the current system which overadjusts the benefits of future retirees to inflation. The current formula which determines future benefits for workers over compensates for not affect inflation. This change will include a continuation of the cost of living increases in benefits after retirement and will in no way alter. effect] current the benefit levels. of current Recipients I believe that the prompt enactment of these proposals is necessary to revitalize our Social Security system and to keep it strong for future generations. The normal health care needs of older Americans, with the special medical problems of aging -- degenerative and chronic disease -- require greater resources and commitment than the rest of the population. Many of those medical needs are met - 3 - through the normal health care delivery system with the support of Medicare and other Federal health programs. I have identified three issues related to the operation of the Medicare program for which I am recommending solutions. In my State of the Union Address I proposed catastrophic health insurance for everyone covered by medicare. This proposal is based on my conviction that there is a need to protect the aged and the disabled from the extraordinary hospital and medical costs of prolonged illnesses. To alleviate the threat of this financial burden, I propose that Medicare beneficiaries be provided protection against catastrophic health costs by limiting the amounts an individual must pay annually to $500 for covered hospital care and $250 for covered physicians' services. The burden of catastrophic illness can be borne by very few older people. This proposal will eliminate this fear from the lives of the elderly and their families. Added steps are needed to slow down the inflation of health costs and to enable the financing of this catastrophic protection. Therefore, I am recommending that the Congress limit increases in Medicare payment rates in 1977 and 1978 to 7% day for hospitals and 4% for physician services. Additional cost-sharing provisions are needed in order to encourage economical use of services for short hospital stays and routine physician care. Therefore, I am recommending that patients pay 10% of hospital and nursing home charges after ID Some of the savings from placing a limu on F revenue from increased cost sharing will he used to increases in medicare pay nent rates and some of the finance the catastrophyce program. the first day and that the existing deductible for medical services be increased from $60 to $77 annually. believe increases that the effect of short term costs' will be greatly outweighed by the benefits of catastrophic protection. In addition to submitting proposals relating to income and health services Idesire to underline my conviction that current conditions call for continued and intensife action for the agung on a broad front We have made progress in recent years, in our efforts to meet this challenge. We have responded, for example, to recommendations made at the 1971 White House Conference on Aging to enact a Supplemental Security Income program, increase social security benefits more than the cost of living, liberal- ize the social security retirement test, increase benefits for delayed retirement, eliminate some of the inequities in payments to women, and protect 35 million workers investments in private pension plans. GERALD FORD Inaddition we have continued to strengthen the older Americans Act. I have supported the concept of the Older Americans Act since its inception in 1965 and signed the most recent amendments into law this past November I am requesting an operative budget of $253 million for FY 1977 for the continuation of this act. A key component of the Older Americans Act is the national network on aging which provides a solid foundation on which action can be cased. I am pleased that the Federal Government has helped to set up this network composed of 56 Funds available for programs administered bythe administration on Aging under the Act have increased from $44.7 million in FY1972 to 1270million during the last fiscal year. - 5 - State and 489 Area Agencies on Aging and 700 nutrition agencies. These nutrition agencies provide 300,000 hot meals a day five days a week. The system, with the assistance of thousands of volunteers -- many of whom themselves are older persons -- can and must not only help meet the needs of older persons but also assure them an active role and place in community life. Another concern of mine is that the voice of the aged, as consumers, be heard in the governmental decisionmaking process. The network on aging offers opportunities for this through membership on advisory councils, participation in regional public hearings, and involvement in the priority setting FORD LIBRARY & 92 process for services at the local level. The ultimate objective of the national network on aging is to make contributions to developing at the community level a coordinated and comprehensive system for the delivery of services to older persons. I join with all Americans in expressing the hope that this objective can be achieved. This will call for hard and creative work at all levels of the network ---- Federal, State and Area. I call upon all Federal Departments and Agencies to cooperate in facilitating the coordination of all available Federal resources for services for older persons at the State and community levels. I laud the efforts made by the Administration on Aging and the Federal Departments and Agencies who have signed agreements to work together to avoid - 6 - waste and overcome administrative difficulties. These agreements will help to make available to older persons a "fair share" of the resources requested in my 1977 budget in such areas as housing, transportation, social services, law enforcement, adult education and manpower -- resources which can play a major role in enabling older persons to live in their own homes for as long as possible. Five percent, however, of our older men and women require the assistance providee by skilled nursing homes and other long term care facilities. An ombudsman process, related solely to the persons in these facilities, is being put into operation by the national network at the level of the Area Agencies on Aging. It is my hope that this program will not only help to resolve individual complaints but that it will facilitate citizen involvement Ln also lead to a continuing demand on the part of our citizens the for a vigorous enforcement of Federal, State and local laws designed to improve health and safety standards as well as quality of care in these facilities. This nation can do no less for those who spend the last days of their lives in institutions. We must never lose sight of our obligations to help deal with the needs of older persons. At the same time we must never overlook the fact that older persons constitute one of RISCH es the nation's greatest assets because of the contributions they are capable of making to our society. We are seriously - 7 - short-changing our nation when we deny older persons the opportunity for continued involvement in the life of our day. This is why my budget for 1977 calls for increases olderpersions in the ACTION programs designed to provided with the old, opportunity for constructive service. Non-involvement on the part of older persons leads oftentimes to rapid mental and physical deterioration in their lives. It likewise, by depriving us of their services, leads to the weakening of the nation. And it is as a Nation that we meet these challenges of assuring a fair share of progress for those who have con- tributed so much to our history. Each generation of Americans is engaged in a tradition of growth and progress. Each generation's success can be measured by its ability to recognize, reward, and renew the contributions of its older citizens. I intend to do all that I can to see that this generation of Americans does measure up. Today's older persons have made more significant contributions to the strengthening of our nation than any other generation of older persons in our history. Many of them have lived through two world wars and the hostility les in both Korea and Vietnam. They have provided the nation with a vision and strength that has resulted in unprecedented advancements in all of the areas of our life. Our moral strength can and will be judged in no small part by our recognition of this the significance of their contribution, Our commitment to doing everything we can to respond to their needs, and our deter- mination to draw on the strength which they represent as they continue to live among us. Above everything else we will be judged by our ability to ensure the fact that in the last years of their lives they are treated with dignity. These are the goals to which I am committed as I continue to work with the Congress in this all important area of our national life. THE WHITE HOUSE WAS-INGTON January 8, 1976 MEMORANDUM FOR: FROM: WILLIAM NICHOLSON my MIKE FARRELL SUBJECT: National Retired Teachers Association/ American Association of Retired Persons The Legislative Council of the above organizations will be meeting in Washington on January 21, 1976. Following a luncheon they will be coming to the White House for a special tour at 2:45 p.m. They have asked if the President and Mrs. Ford might meet them at some point during their tour. The Legislative Council members represent both AARP/NRTA and come from all sections of the United States. The purpose of the meeting is to determine their legislative objectives for 1976. The two organizations have eight million members. By copy of this memorandum, I am asking Ted Marrs and Jim Cavanaugh to give you their recommendations directly. A list of attendees is attached. Thank you. FORD LIBRARY "y GERALD CC: Ted Marrs Jim Cavanaugh Susan Porter THE WHITE HOUSE WASHINGTON January 8, 1976 MEMORANDUM FOR: FROM: WILLIAM NICHOLSON my MIKE FARRELL SUBJECT: National Retired Teachers Association/ American Association of Retired Persons The Legislative Council of the above organizations will be meeting in Washington on January 21, 1976. Following a luncheon they will be coming to the White House for a special tour at 2:45 p.m. They have asked if the President and Mrs. Ford might meet them at some point during their tour. The Legislative Council members represent both AARP/NRTA and come from all sections of the United States. The purpose of the meeting is to determine their legislative objectives for 1976. The two organizations have eight million members. By copy of this memorandum, I am asking Ted Marrs and Jim Cavanaugh to give you their recommendations directly. A list of attendees is attached. Thank you. FORD LIBRARY & GERRLD CC: Ted Marrs Jim Cavanaugh Susan Porter LEGISLATIVE COUNCIL OFFICERS Miss Mary Mullen Mr. & Mrs. Douglas O. Woodruff President, NRTA President, AARP Laguna Beach, CA Salt Lake City, UT Dr. & Mrs. J. Cloyd Miller Mr. & Mrs. A. H. Van Landingham President-Elect, NRTA President-Elect, AARP Albuquerque, NM Morgantown, WV Mr. & Mrs. George Schluderberg Mrs. Maud Haines Chairman Chairman NRTA Board of Directors AARP Board of Directors Baltimore, MD Portland, ME Mrs. Ruth Lana Miss Hariet Miller Honorary President Acting Executive Director Long Beach, CA Washington, D.C. MEMBERS Mr. J. E. Aldridge, NRTA Miss Oranda Bangsberg, AARP Jackson, MS Oshkosh, WS Miss Kathleen V. Boyd, NRTA Mr. Henry Bertuleit, AARP Narragansett, RI Fremont, CA Mr. & Mrs. Allen Campbell, NRTA Mr. Frank DeLamar, AARP Laguna Hills, CA Margate, FL Mrs. Irene Dunstan, NRTA Mr. & Mrs. Ed W. Eggen, AARP Denver, CO Portland, OR Mrs. Beatrice Harvey, NRTA Mr. Clarence A. Grant, AARP Lewisburg, WV American Fork, UT Mr. & Mrs. Henry McHargue, NRTA Dr. & Mrs. John Gregan, AARP Seymour, IN Manchester, CT Mr. & Mrs. C. B. Murray, NRTA Dr. & Mrs. Clayton D. Hutchins, AARP Albany, NY Bethesda, MD Mr. William J. Powell, NRTA Dr. Esther Prevey, AARP Taylor, PA Kansas City, MO Dr. Grady St. Clair, NRTA Mr. & Mrs. Edgar Scheid, AARP Corpus Christi, TX Baton Rouge, LA Mrs. Vera Weinlandt, AARP GERALD R. LLBRARY FORD Bloomfield, NJ JOINT STATE LEGISLATIVE COMMITTEE CHAIRMEN Mr. & Mrs. T. Preston Turner, NRTA Richmond, VA Mr. Isaac Fine, AARP Falmouth, MA Mr. Creel Richardson, NRTA Ariton, AL Mr. & Mrs. George Saunders, AARP Sun City, AR Mr. & Mrs. Francis W. Beedon, NRTA Muskegon, MI LEGISLATIVE STAFF Mr. Cyril F. Brickfield, Counsel Mr. Peter W. Hughes Mr. Harmon Burns, Jr. Assistant Legislative Counsel Assistant Legislative Counsel Mr. Laurence F. Lane Mr. Malachy M. McPadden Legislative Representative Legislative Representative Mr. James M. Hacking Mr. David Lambert Legislative Representative Legislative Representative Mr. David M. Dunning Mr. Kirk Stromberg Legislative Representative Legislative Representative Ms. Faye Mench Mr. John Mulholland Legislative Representative Legislative Representative Mr. John B. Martin Mr. William Rehrey Legislative Consultant Legislative Representative Ms. Laurie Fiori Senior Secretary ADVISORS Mrs. Zmira Goodman Mr. Ed Malone Mr. Walton Kurz Mr. Lloyd Singer (call 12-19 from Fack) Aging Nev. 'callaghan - D.800 D. re AOA t New. AG repub , Declar Ans trom: days ago sworn motion from A.G., Robert List asking Fl. to disqualify sulf appt. admin hearing offecer to administer Mg + attached sworn affaudaul fr Roger TROUNDAY due Are dept of human resources believes it. is prejudiced impactial are officer to preside based on that - OAA granted motion - telegram to AG BERALD R. FORD acapting Meassitate delay - mid Jan AG to myor n Sou, funding FY76 state plan submitted - OAA intention indicated cd continue to operate underprovisional F4 75 State plan until usue is resolved continue to operate under provisions of FY IT. state plan continue to receive quarterly allotments fi. Treasury larea asencies out of business on 12/31/75 at 522350 state initiature - wd be out of compliance according to OAA. (has become I tates rights issue in nev) F leming will talk to O'callaghan 4 be calls Fleming spoke with Troundy (spi) today- both asseed had no choice but to so along w w/Fy 75 plan d 2 aua agencies until issue is resolved (inspite of usial action) file HEALTH. DELICATION AMD WELTARE Agua DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE U.S.A. WASHINGTON, D.C. 20201 OFFICE OF THE SECRETARY Office of Human Development Administration on Aging November 25, 1975 MEMORANDUM FOR: THE HONORABLE SARAH MASSENGALE SUBJECT: Nevada Fiscal Year 1976 State Plan on Aging Attached for your information, is a copy of the Federal Register Notice of Hearing on the FY 1976 Nevada State Plan on Aging, published on November 19. As you will note, Commissioner Flemming will be the hearing officer. The letter to Governor O'Callaghan, which is included in the hearing notice, outlines the issue to be considered at the hearing, scheduled for December 19. I'll keep you posted on developments on this. I appreciate all the help you've provided us on this issue, and if I can be of any assistance please don't hesitate to call me. Decker Aake Anstrom Sincerely, Assistant to the Commissioner Attachment GERALD R. LISBANY FORD 53608 NOTICES Signed at Washington, D.C. on Novem- Quality and available to the public on Shipping may write to Mr. William Bris- ber N, 1975. December 1, 1975. Copies of the state- tor, Office of Domestic Shipping, Mari- E. J. PERSON, ment will be available for public inspec- time Administration (M746), 14th and E Acting Executive Vice President, tion at the following locations: Streets NW., Washington, D.C. 20230. Commodity Credit Corpora- Maritime Administration, Office of Public Phone-(202) 967-5110. tion. Affairs, Room 3895, Department of Com- Dated: November 14, 1975. merce, Washington, D.C. 20230. [FR Doc.75-31190 Filed 11-18-75;8:45 am] Martime Administration, Eastern Regional ROBERT J. PATTON, Jr., Office, 26 Federal Plaza, New York, N.Y. Assistant Secretary. 10007. Farmers Home Administration Maritime Administration, Central Regional [FR Doc.75-31291 Filed 11-18-75;8:45 am] Notice of Designation Number X 266] Office, 701 Loyola Avenue, New Orleans, La. 70152. MINNESOTA UNITED STATES INFORMATION Maritime Administration, Great Lakes Re- Designation of Emergency Areas gional Office, 666 Euclid Avenue, Room 600, AGENCY Cleveland, Ohio 44114. U.S. ADVISORY COMMISSION ON The Secretary of Agriculture has de- Maritime Administration Western Regional INFORMATION termined that farming, ranching, or Office, 450 Golden Gate Avenue, San Fran- aquaculture operations in the following cisco, California 94102. Meeting Minnesota Counties have been substan- Any questions concerning the statement Pursuant to the Federal Advisory tially affected as a result of the natural should be directed to Dr. Sidney R. Galler, Committee Act (Public Law 92-463), no- disasters described for each county: Deputy Assistant Secretary for Environ- tice is hereby given of a meeting to be mental Affairs, Department of Commerce Auoka-Excessive rainfall May N to July 5, held on December 8, 1975. The session D.C. 20230, 202/967-4335. Per 1975. A severe windstorm June 29, 197 to file written comments should will commence at 9:15 a.m. in Room 660 Drought July 10 to August 1, 1975 sales to Dr. Galler prior to February at 1776 Pennsylvania Avenue, N.W.. Clearwater-Excessive rainfall, hair 1976. Washington, D.C. The subject of the flooding June 1 to July 7, 1975. meeting is "The USIS Program in Pine-Excessive rainfall, hall, high winds and draft statement entitled, "Mari- flooding June 10 to July 15, 1975. Tornado Europe." time Administration Chemical Waste In- June 2, 1975. The session will be open to the general cinerator Ship Project", refers to pro- Washington-Excesse rainfall, hall, high public. Persons wishing to attend the winds and flooding April 25 to July 5, 1975. posed assistance to private industry to Commission's meeting should contact Mr. Tornadoes May 19, 1975 and June 1, 1975. aid in the building of several chemical Louis T. Olom, Staff Director. U.S. Ad- sate incinerator ships in the United Therefore, the Secretary has dest visory Commission on Information, States to be used for the disposal of toxic ignated these areas as eligible for Emer- Room 1008, 1750 Pennsylvania Avenue, chemical wastes (approximately 450 gency loans, pursuant to the provisions N.W., Washington, D.C. 20547, telephone pages). of the Consolidated Farm and Rural De- 632-5210, SO that adequate space will be velopment Act, as amended by Public By order of the Maritime Subsidy assured. Written statements concerning DC and the provisions of 7 CNR Board, Maritime Administration. the topic set forth in the agenda should 1832.3(b) including the recommenda- also be submitted to Mr. Olom. Dated: November 14, 1975. tion of Governor Wendell R. Anderson WALTER W. JONES, that such designation be made. ROBERT J. PATTON, Jr., Chief, Applications for Emergency loans must Assistant Secretary. Management Division. be received by this Department no later [FR Doc.75-31290 Filed 11-18-75;8:45 [FR 75-31176 Filed 11-18-75;8:45 am] than December 22, 1975, for physical losses and July 26, 1976, for production DEPARTMENT OF HEALTH, losses, except that qualified borrowers SECOND NATIONAL CONFERENCE ON who receive initial loans pursuant to this DOMESTIC SHIPPING EDUCATION, AND WELFARE designation may be eligible for subse- Notice of Meeting Administration on Aging quent loans. The urgency of the need for Notice Is hereby given that the De- NEVADA: FISCAL YEAR 1976 STATE loans in the designated areas makes it partment of Commerce, Maritime Ad- PLAN impracticable and contrary to the public ministration, will hold the Second Na- interest to give advance notice of pro- Notice of Hearing tional Conference ON Domestic Shipping posed rule making and invite public par- Notice is hereby given that in keeping in March 1976. The onference will focus ticipation. with section 305(c) of Title III of the on increasing productivity in the mari- Older Americans Act of 1965, as Done at Washington, DC., this 13th nustry. amended, and 45 CFR 903.19 of the Fed- day of November, 1975. The Conference will be held at The eral Regulations (Sec. 305(c) Pub. L, 93- FRANK W. NAYLOR, Jr Fairmont-Roosevelt Hotel in New Or- 29, 87 Stat. 36-45 (42 U.S.C. 3021-3025): Acting Administrator, Louisiana, on March 9, 10, and 11, 38 FR 28045), and the request of the Gov- Farmers Home Administration. 1976. ernor thereunder, the Commissioner on [FR Doc.75-31288 Filed 11-18-75;8:45 am] The purpose of the Conference is to Aging will hold a hearing to decide explore techniques for improving pro- whether the Fiscal Year 1976 State Plan ductivity in domestic waterborne com- submitted by the State of Nevada under DEPARTMENT OF COMMERCE merce through the exchange of ideas and section 304 of the Act conforms to the information. Identification will be made Federal requirements which pertain to Maritime Administration of those key factors which are essential the State's request to be designated CHEMICAL WASTE INCINERATOR SHIP in the formulation and development of single State planning and service area PROJECT productivity measurements and goals. under Section 307(a) of the Act. Fol- Draft Environmental Impact Statement The agenda for the Conference is struc- lowing is the notice of hearing from the Notice of Availability so that productivity challenges for Commissioner to the State of Nevada domestic waterborne shipping indus- which states the time and place for the Notice is hereby given that copies OF and segments of that industry such hearing, the issue which will be con- the U.S. Department of Commerce inland waterways, Great Lakes, sidered. and a reference to the rules of Environmental Impact Statement the andidomestic ocean interests, will be practice and procedure which will be Maritime Administration Chemical followed. NOVEMBER 17. 1975. Waste Incinerator Ship Project will be Anyone wanting information on the DEAR GOVERNOR O'CALLAGHAN: I have re- filed with the Council on Environmental Second National Conference on Domestic celved your telegram of November 4 stating FEDERAL REGISTER, VOL 40, NO. 224-WEDNESDAY, NOVEMBER 19, 1975 NOTICES your wish to have a hearing in response to by the criterion: whether the State Agency all holders of new drug my October 23 letter of intent to disapprove is better equipped than the existing area became effective prior to the State's request to be designated as a agencies to carry out the Title III Program. The discussion on the criterion seemed to be 1962 were requested to single State planning and service area and the Fiscal Year 1976 State Plan for Title III irrelevant. Food and Drug under the Older Americans Act of 1965, as I very much regret any misunderstanding containing the best data amended. which may have resulted from my letter of support of the effectivent I wish to notify you that I have scheduled October 23. The letter was not intended to products for the claimed indicati the hearing for 9:00 a.m., December 19, 1975 notify you of any final disapproval action as information was needed to fact) to be held in Room 302, Federal Building, 705 it expressly recognized the requirements of determination by the Food North Plaza. Carson City, Nevada. I am en- the law relative to the opportunity of a State Administration, with the closing the Rules of Practice and Procedure for a hearing. Until such time as the matter established for the proceedings which have of the Title III State Plan for Nevada is re- the National Academy of Scient been adapted from those published for hear- solved by the hearing, the operations of the tional Research Council (NAS ings on conformity of State public assistance Title III Program will continue to be gov- whether each claim in the plans to Federal requirements set forth at 45 erned by the currently approved State Plan supported by substantial evidence CFR Part 213. for Fiscal Year 1975. fectiveness, as required by the I shall serve as the presiding officer for the Please get in touch with me if you have Amendments of 1962. The hearing. I have designated Mr. Robert Hunter, any further questions. some new drug applications Superintendent, West Nevada Agency. Bureau Very sincerely and cordially yours, came effective prior to October of Indian Affairs, Stewart, Nevada 89437, as the Administration on Aging Hearing Clerk. ARTHUR S. FLEMMING, did not submit information He shall perform those duties and responsi- Commissioner on Aging. the July 9, 1966 notice and the bilities set forth in the enclosed Rules of Any individual or group wishing to therefore, were not reviewed by Practice and Procedure. participate as a party shall file a peti- NRC. Some of the firms that The issue to be considered at the hearing is whether or not the evidence submitted by tion with Mr. Robert Hunter, Superin- submit the data requested are not the State of Nevada in support of its request tendent, West Nevada Agency, Bureau reinvited to do so on or before for designation as a single State planning and of Indian Affairs, Stewart, Nevada 89437, ary 19, 1976. service area, as well as any other relevant telephone: 702-882-3411, within 15 days evidence which may be adduced, support a In some cases, failure to sur after the date of publication of this no- conclusion under the criteria set forth at tice, and shall serve a copy on each party requested information was due 45 CFR 903.57(f) (2) that there are circum- of record at that time. Such petition sponsors' lack of further interest stances relating to the State which justify approval of its request to be designated as shall concisely state (1) the petitioner's products. In other cases, the a single State planning and service area. interest in the proceeding: (2) who will supplements to the new drug As stated to you in my letter of October 23, appear for petitioner: (3) the issue on tions had been approved after Oc based on the evidence submitted in the State which petitioner wishes to participate; Plan, the State did not appear to have met and (4) whether petitioner intends to 1962, may have led the sponsor the test for designation as a single State present witnesses. clude that the effectiveness planning and service area. The State's justi- Individuals or groups may be recog- been resolved by those approval fication did not address the question of nized as parties, if the issues to be con- whether or not the State is too small to be approvals, however, were divided effectively. It also failed to respond sidered at the hearing have caused them a complete review of the entire to the related criteria which concern whether injury and their interest is within the tion and did not constitute a the State has been constituted as one area zone of interests to be protected by the for other purposes and whether State law governing Federal statute. The Commis- tion that all claimed indicat proscribes the division of the State into areas sioner shall promptly determine whether supported by substantial evide for the administration of area plans by local each petitioner has the requisite interest effectiveness. agencies. Absent a presentation on these in the proceedings and shall permit or considerations, we assumed the answer to In general, the pre-1962 produ be negative in each instance. We noted that deny participation accordingly. Where were not submitted to Academy for purposes of implementing the National petitions to participate as parties are made by individuals or groups with comprise three groups: 1. Those Health Planning and Resources Development Act of 1974, the State of Nevada has divided common interests, the Commissioner identical, related, or similar itself into areas which coincide with the may request all such petitioners to des- in 21 CFR 310.6) to products boundaries currently established for the ignate a single representative, or he may reviewed by the Academy and Title III Program. In addition, relative to the criterion con- recognize one or more of such petitioners similar conclusions are applicable cerned with the effect of the size and distri- to represent all such petitioners. The 2. Those that are not identical bution of the older population on the dis- Commissioner shall give each petitioner or similar (as defined in 21 CFI tribution of management and coordination resources, it was asserted in the evidence written notice of the decision on his pe- to Academy-reviewed products. submitted in the State plan merely that the tition, and if the petition is denied, he which sufficient information sparse population of the State should be shall briefly state the grounds for denial. available to the Food and Drug taken into account; and that savings. in the amount of $200,000 would accrue to the State Further information on the hearing istration upon which to base to support social services for older persons may be obtained from the Office of the sion as to effectiveness. by abolishing area agencies and thus their Commissioner, Administration on Aging, 3. Those products that are associated administrative costs. My letter of October 23 pointed out that, although the Room 4030, Donohoe Building, 400 Sixth tical, related, or similar Cas question of sparse population may be rele- Street, S.W., Washington, D.C. 20201, 21 CFR 310.6) to Academy vant, there was no documentation of the size telephone: 202-245-2205. products and for which the Fn and distribution of the older population. nor any showing of a pertinent relation between Dated: November 14, 1975. Drug Administration now this factor and how resources might be dis- ARTHUR S. FLEMMING, mission of data and informatic tributed differently than they are at present. Commissioner on Aging. cerning effectiveness Moreover, we were unable to understand how the State arrived at the alleged savings of [FR Doc.75-31175 Filed 11-18-75;8:45 am] The holders of the follows, $200,000 in administrative costs. Section drug applications are now 303(e) (1) of the Act prescribes that funds awarded for planning and administration Food and Drug Administration supplement their new drug with data and information of area plans by area agencies may not OX- Docket No. 75N-0213] effectiveness. Persons ceed fifteen percent of a State's allotment for PRE-1962 NEW DRUG PRODUCTS NOT area planning and social services. cal, related, or similar drug REVIEWED NY NAS-NRC On the question of the State's capability that are not subjects of to perform area agency functions for the Invitation To Submit Data drug applications may 8/80 entire State, the justification appeared to In a notice published in the FEDERAL and information concerning respond to a question other than that posed REGISTER of July 9, 1966 (31 FR 9426), tiveness of such products. FEDERAL REGISTER, VOL. 40, NO. 224-WEDNESDAY, NOVEMBER 19, 1975 Aguing - older amer act 11/14 problem in Nevada state Plans talked w/state plan for aged wanstrom + Pleming Fleming disapproved Oate Oct hearing set for Novil cancelled - HEW coursel's of advice inion since noha of hearing had leot been published in Fedl Register hrs 2e scheduled for Dec 19 will be publis had 11/15 or 11/17 N 80. Cor Michael 0 Callaghan very upset- S playing both ordes 1- will get plan approved in court cug want purblesh notice 2 - can't want till Doc 19 for Lrg. Fack called back t assured Sou that F leming will be there Fack asked that Mathews respond to letter rutby Jen. Layalt ASSERIT GERALOR. R. FORD Sarah THE WHITE HOUSE WASHINGTON November 19, 1975 Dear Governor O'Callaghan: Thank you for your telegram of November 3, expressing your concern about HEW's letter to you on Nevada's 1976 State Plan on Aging. I am pleased to tell you that Commissioner Flemming is planning to attend the scheduled hearing in Carson City on November 14, 1975. I am sure that this meeting will be a productive one. If I can of any further help, please do not hesitate to contact me. Jim James H. Falk Sincerely, Associate Director Domestic Council The Honorable Mike 'Callaghan FORD LIBRARY y GERALD Governor of Nevada Carson City, Nevada 89701 Sen V Cancilled cong there NEV was ready. Fed was NOT. failed to give (Dec 19th) 3 2 3 5 6 1 2 3 WHD 055 WAA364(1923) (2-046590E307)PD 11/03/75 1922 4 - ICS IPMRNCZ CSP 1975 NOV 3 FM 7 38 5 á 7028821890 TDRN CARSON CITY NV 252 11-03 0722P EST 7 8 PMS HONORABLE JAMES H FALK, ASSOCIATE DIRECTOR, DOMESTIC COUNCIL 9 , DLR 10 11 WHITE HOUSE 1600 PENNSYLVANIA AVE 12 WASHINGTON DC 20500 13 14 BOTH A LETTER (RECEIVED OCTOBER 28 1975) AND A TELEGRAM (RECEIVED 15 NOVEMBER 3 1975) FROM ARTHUR S FLEMING, COMMISSIONER ON AGING, OHD 16 17 DEPARTMENT OF HEW, RELATIVE TO NEVADA'S SUBMISSION OF ITS FISCAL 18 YEAR 1976 STATE PLAN ON AGING IS OF A GRAVE MATTER TO ME. 19 20 21 COMMISSIONER FLEMING'S LETTER (DATED OCTOBER 23 1975) DISAPPROVES 22 23 NEVADA'S PLAN, WITHOUT FIRST AFFORDING THE STATE REASONABLE NOTICE 24 AND OPPORTUNITY FOR A HEARING UNDER SECTION 305 (C) PL93-29. 25 25 2 5 2 3 4 5 6 COMMISSIONER FLEMING'S TELEGRAM (DATED OCTOBER 31 1975) OFFERS 7 3 NEVADA NOVEMBER 14 1975 AS A SCHEDULED HEARING DATE IN THE STATE 9 CAPITOL IN CARSON CITY. BOTH COMMUNICATIONS ARE CONSIDERED AFTER THE 10 11 FACT IN LIGHT OF A DECISION BY COMMISSIONER FLEMING "NOT APPROVING" 12 NEVADA'S FISCAL YEAR 1976, STATE PLAN. 13 14 15 IN ORDER TO RESOLVE THIS MATTER EXPEDITIOUSLY, THE STATE OF NEVADA 16 17 AGREES TO THE HEARING DATE SUGGESTED BY COMMISSIONER FLEMING. AT THE 13 SAME TIME, I URGENTLY REQUEST THAT COMMISSIONER FLEMING APPEAR 19 PERSONALLY IN CARSON CITY AS THE REPRESENTATIVE OF THE FEDERAL 20 21 GOVERNMENT. HE MAY, OF COURSE, WISH TO BRING A NUMBER OF SUPPORTING 22 23 STAFF MEMBERS BUT I BELIEVE HIS APPEARANCE IS ESSENTIAL IF THE 24 QUESTION IS TO BE RESOLVED TO THE SATISFACTION OF ALL CONCERNED. 25 26 QUITE FRANKLY, I AM SURPRISED THAT THE PLAN WAS NOT APPROVED. IT HAD 4 5 2 3 6 ( 1 2 3. 4 * 5 6 THE SUPPORT OF US SENATOR PAUL LAXALT, CONGRESSMAN JAMES SANTINI, 7 3 THE ADVISORY COMMITTEE TO THE STATE DIVISION OF AGING SERVICES, THE 9 NEVADA DEPARTMENT OF HUMAN RESOURCES AND NUMEROUS STATE LAWMAKERS. 10 11. THANK YOU FOR YOUR ATTENTION TO THIS CRITICAL MATTER. 12 MIKE OCALLAGHAN GOVERNOR OF NEVADA 13 14 NNNN 15 16 17 18 19 20 21 22 23 24 25 26 December 2, 1975 NOTE TO SARAH MASSENGALE Attached is a set of reports from the National Council on Aging which may be of use to you in preparing a list of possible initiatives for the a aged for the State of the Union. While some of these are pure flack, most may be of use and are certainly worth reviewing. When you've had a chance to take a look at these, let's sit down and make up a laundry list of possible initiatives, along with some indication of what costs might be attached to the initiatives and what policy implications of the initiatives are. G.E.M. Attachment GERALD R. LISBERY FORD * # OFFICE OF THE VICE PRESIDENT WASHINGTON December 2, 1975 NOTE TO SARAH MASSENGALE Attached is a set of reports from the National Council on Aging which may be of use to you in preparing a list of possible initiatives for the aged for the State of the Union. While some of these are pure flack, most may be of use and are certainly worth reviewing. When you've had a chance to take a look at these, let's sit down and make up a laundry list of possible initiatives, along with some indication of what costs might be attached to the initiatives and what policy implications of the initiatives are. G.E.M. FORD is LIBRARY GENALD Attachment OFFICE OF THE VICE PRESIDENT Correspondence Control Unit Form Correspondence Response From The National Council on the Aging, Inc., 1828 L St., NW, Washington, DC Subject 1975 Public Policy Statements of the National Council on the Aging Form Number Control Number 14114 Special Instructions John Veneman FYI, NAN OVP Form 003 March 1975 GPO 570.505 MC The National Council on the Aging, Inc. 25 Years of Service to the Elderly 1828 L STREET, N.W. WASHINGTON, D.C. 20036 202/223-6250 November 17, 1975 GEBREOF FORD LIBRARY Dear Colleague: The National Council on the Aging is pleased to send you the 1975 Public Policy Statements from the NCOA Board of Directors which were issued at our 25th Annual Meeting held in Washington, D.C. in late September. As you may know, NCOA is a private nonprofit organization whose membership consists of individuals and organizations who serve the nation's older citizens. For 25 years, we have provided leadership in the field of aging to public and private agencies at the national, state and local levels. NCOA believes that the voluntary sector has a vital role to play in the development and implementation of a public policy responsive to the needs and capacities of the nation's older citizens. As firsthand observers of the elderly's needs, those working in the field are able to evaluate the effective- ness of programs and services designed to serve the older population. NCOA is convinced that it can and must serve as a conduit of such information to policy- makers at all levels of government. Because the development of policy statements is an ongoing process, we are interested in your comment on them. In the coming months, NCOA will use the enclosed papers as a basis for additional policy statements. We hope you will keep these and forthcoming statements as a cumulative record of NCOA's position on issues affecting the lives of older Americans. NCOA's 25 years of service have demonstrated the significance and validity of the private sector's involvement in the creation of an effective public policy in aging. Following the lead of the elderly themselves, and working with organizations and individuals concerned about the wellbeing of older persons, NCOA will continue to encourage a social policy responsive to the aged. We look forward to facing that challenge in cooperation with you in the years ahead. Sincerely, Albert Albert J. J. Abrams Abrams President President Vice Presidents Secretary ALBERT J. ABRAMS MOTHER M. BERNADETTE DE LOURDES, O. Carm. HUGH W. GASTON, A.I.A. HOBART C. JACKSON Executive Director JOHN W. MOORE, JR. Treasurer JACK OSSOFSKY SIDNEY SPECTOR JAMES R. GUNNING PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH CRIME AGAINST THE ELDERLY HOUSING INDUSTRIAL The elderly, especially the urban elderly, are the most GERONTOLOGY INTERNATIONAL vulnerable victims of the recent dramatic increase in crime in MEDIA America. Millions of the aged are virtual prisoners in their own homes, self-confined victims who fear even going out in RESEARCH & EDUCATION the streets. The quality of life for thousands and thousands RELIGIOUS INSTITUTIONS AND ETHICS of elderly people is degraded not only by the existence of RURAL AFFAIRS robberies, assaults, fraud and rape, but also by the threat SENIOR CENTERS of such crimes. In a recent NCOA study conducted by pollster SOCIAL SECURITY, PENSIONS & INCOME Louis Harris, those over 65 rate crime or the fear of crime MAINTENANCE SOCIAL SERVICES as their most serious personal problem. Unfortunately, there is no reliable index of the volume of such offenses against the elderly. Numerous studies show- ing the high numbers of unreported and underreported crimes also indicate that the elderly are more likely to be silent victims. In addition, reported crime records only note the age of the criminal, not that of the victim. NCOA believes that a number of steps must be taken FORD LIBRARY ALBERT J. ABRAMS, President The National Council on the Aging, Inc. JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Crime 2 immediately, at both the national and local levels, to make America safe for its nearly 21 million older citizens. 1. A national Senior Citizens Crime Index should be developed to moni- tor the growth and delineate the development of offenses against older people. 2. The Law Enforcement Assistance Administration (LEAA) of the Justice Department should undertake studies to determine how localities may best cope with the problem of crime against older people and to use its re- sources to fund programs which protect the elderly. local 3. Local police authorities should be encouraged to set up strike forces to prevent attacks on the elderly and to pinpoint the locations and modus operandi of the attacks. 4. Local police should undertake regular visits and liaison to facilities used by the elderly such as senior centers, housing projects, etc. 5. Self-help programs which train the elderly themselves in crime- prevention procedures should be developed. 6. Senior center leaders should be trained to train their members in P crime prevention. 7. Community watch programs, involving community groups of all ages (teen patrols, radio-dispatch cab drivers, police hookups, high school student escorts, etc.) should be established to be alert to threatening or suspicious activities. 8. Patrol of streets (perhaps by retired policemen or police cadets) and areas older people use that have high incidences of criminal activities should be encouraged, and escort services to and from transportation ser- vices to housing projects, shopping malls, senior centers, clubs, clinics, etc., should be set up. Crime 3 9. The police should train and assign the elderly stay-at-homes or home- bound to observe streets or sections of their neighborhoods, and to report suspicious behavior to police. 10. Regular police security checks of buildings and sites housing the elderly should be made (just as the fire department makes regular fire prevention inspections). 11. Housing for the elderly should have installed (on government subsidy or as tax-deductible expense) burglar-proof photoelectric beams on win- dows and doors, one-way glass, TV monitors in elevators and corridors, and central alarm buzzer systems linked to police dispatchers or patrol units. 12. Since crime against the elderly is reduced in specific housing as com- Boo pared to intergenerational housing, more housing especially for the elderly should be encouraged and built. 13. Government checks should be mailed to banks for individual deposit; banks should provide free checking accounts for the elderly. 14. An offense against an older person should be made a Federal crime if committed in Federally funded facilities such as housing projects, centers, etc. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September 1975 ARTS HEALTH EMPLOYMENT HOUSING INDUSTRIAL The nation is experiencing its highest unemployment GERONTOLOGY rates since the Depression. Millions, regardless of INTERNATIONAL occupation or age, are suffering. Middle-aged and older MEDIA workers, with heavy family and financial responsibilities, RESEARCH & EDUCATION tend to suffer special hardships when the economy takes RELIGIOUS INSTITUTIONS AND ETHICS a downward turn. Men and women over 40 constitute almost RURAL AFFAIRS half of the present labor force and more than a fourth of SENIOR CENTERS all unemployed. As Bureau of Labor Statistics figures SOCIAL SECURITY, PENSIONS & INCOME indicate, they undergo longer terms of unemployment than MAINTENANCE SOCIAL SERVICES younger age groups. They tend to drop out of the labor force through discouragement in a futile job search. Advocates of a broader definition of unemployment believe that present figures--which categorize discouraged workers as not-in-the labor force--understate by a considerable extent the true unemployment rate. Middle-aged and older workers are often victims of age discrimination on the part of both employers and employment-manpower service agencies. The National Council on theAging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Employment 2 One goal of a national employment policy should be to assure continued participation for all age groups since it is a major factor in a full and satisfying life style. It should also be noted that periods of unemployment have serious repercussions in terms of unemployment insurance, welfare costs and social security benefits. The basic premise of employment and manpower programs from the inception of the Wagner-Peyser Act of the 1930's to the categorical manpower develop- ment and training programs of the 1960's to the present Comprehensive Employment and Training Act (CETA) approach, has been that all Americans in need of assistance related to employment may fully participate in available programs. The desired outcome is free access for all individuals to the job market regardless of age and other possible limiting factors over which the individual worker has no control. The Comprehensive Employment and Training Act (CETA) There is no question that middle-aged and older workers are not receiving an equitable share of manpower services through the CETA and the United States Employment Service networks. These groups of workers lack priority in these systems - only 4 to 8 percent of the CETA participants are men and women over 45 and analysis of Employment Service data reveals that middle- aged and older workers are less likely to receive services than those under age 40. NCOA's concern, therefore, with the current regulations pertaining to CETA is that they in no way guarantee improved status for middle-aged and older persons in need of employment assistance. CETA regulations must be established which assure that funds allocated to prime sponsors are equitably distributed to all participating age groups. Employment 3 NCOA recommends that the Department of Labor include the following general guidelines and specific changes in revised regulations pertaining to Title I and II of the Comprehensive Employment and Training Act. Prime sponsors and their agents in order to assure fair and equitable participation of middle-aged and older men and women of all racial and ethnic backgrounds in CETA programs must include within any state plan an analysis of the universe of need of individuals they intend to serve by age and sex categories. The following groupings are suggested: Under 22; 22-39; 40-54; 55-64; 65+. An appropriate reporting system should be standardized whereby Prime Sponsors and any Subcontractor can report comparative services to age groups on a quarterly basis. Prime Sponsors should see to it that middle-aged and older individuals, familiar with the manpower and employment needs of workers over 40, are included in fair proportions of all state and local manpower planning committees. Any Prime Sponsor with responsibilities for implementing a Title II Public Employment Program must develop an Affirmative Action Plan to ac- commodate individuals within the protected group of the Age Discrimi- nation in Employment Act. All state and local government and/or public employers are now covered and bound by federal age discrimination in employment legislation. Middle-aged and older workers, by reason of their long neglect on the part of the Department of Labor, should be regarded as a new minority. Each Prime Sponsor, therefore, should be bound to submit within his state plan special training and technical assistance provisions to agents, or subcontractors on how to: Assess the needs of middle-aged and older workers within a community. Develop outreach capabilities to bring these older workers into CETA training and employment programs. Develop special training methodologies and skill conversion tech- niques for middle-aged and older men and women. Develop job placement strategies, in cooperation with other employ- ment related agencies (e.g., the State Employment Security Agency) for those older individuals. Appropriate Prime Sponsors should be informed and directed by the Man- power Administration that it is their responsibility to support all Senior Aide programs currently being funded by the Department of Labor through national contractors. These are programs of demonstrated effectiveness. Employment 4 A separate title should be established under CETA that will address the manpower needs of the middle-aged and older worker, just as the Job Corps has been established for youth. It is important to note that al- though older workers were specifically mentioned along with Indians and youth in Title III, no money has ever been appropriated for this group. Age Discrimination in Employment (ADEA) The Age Discrimination in Employment Act (ADEA) has recently fostered significant legislative, administrative and judicial activity. The law's major objective is to eliminate discrimination against individuals between 40 and 65 years of age in matters of hiring, job retention, compensation or other terms, conditions and privileges of employment. ADEA promotes a policy of employment according to ability rather than age. Despite recent legisla- tive improvement in the Age Discrimination in Employment Act, systematic implementation and enforcement is needed. In addition, because any worker, regardless of age, should be evaluated according to functional ability, NCOA recommends that the present upper age limitation for application of ADEA be removed. To ensure uniform national standards protecting all citizens against discrimination in employment, NCOA further recommends the establishment of one national regulatory body with the authority and resources to enforce effectively one federal statute which prohibits employment discrimination on the basis of race, color, religion, sex, national origin, age and handicapped status. * Mandatory Retirement A recent survey conducted by Louis Harris and Associates for NCOA * Basic recommendation from the Federal Civil Rights Enforcement Effort 1974, U.S. Commission on Civil Rights, July 1975. Employment 5 found that a large majority of Americans feel that "nobody should be forced to retire because of age," and a smaller majority agree that "most older people can continue to perform as well on the job as they did when they were younger." Yet in mid-1974 there were over four million unemployed or re- tired persons age 65 and over who wanted to work but were not employed, com- pared to some 2.5 million who were working full-or part-time. NCOA strongly urges that flexible rather than fixed retirement ages be adopted by employers and unions, allowing those who wish to retire early or at the "normal" retirement age of 65 to do so and allowing others to work as long as they are able, perhaps as determined by a physical examination or an objective scale such as that employed in the Industrial Health Counseling Service for the last four years in Portland, Maine. The fact that not all employers require mandatory retirement is evidence that flexible retirement is administratively feasible. United States Employment Service To increase services to middle-aged and older workers, NCOA recommends that the Manpower Administration mandate that the Older Worker Specialist be a full-time position at the state and local office level and institute a sys- tem for financial incentives to local offices that do an outstanding job of placing older workers. In addition, we recommend that the Manpower Adminis- tration set up on a pilot basis an employment service based on the 40-plus methodology to test techniques and procedures for adequate service to middle- aged and older workers. Senior Community Service Project (SCSP) The Senior Community Service Project has clearly demonstrated that older workers can adequately carry out diverse work assignments, involve people in Employment 6 meaningful relationships, motivate them to initiate action on their own behalf, mobilize community resources and generally serve as a bridge between the consumer of services and the agency providing the services. It has also demonstrated that the program participants measure up in all ways to stand- ards for younger workers - and often exceeded these standards. SCSP is a manpower model for the older disadvantaged worker. It has successfully carried out its primary mission of providing meaningful public service em- ployment for older workers. NCOA believes that the funds available for this program and similar ones are totally inadequate and that steps should be taken by the national Manpower Administration, local prime sponsors and national contractors to establish these projects at the local level on a permanent basis. Functional Capacity NCOA believes that middle-aged and older persons should be assured of opportunities for continuing employment. The extension of employment oppor- tunities for this group and the removal of barriers to their employment remain primary goals. There is a need for the expanded use of techniques which have been developed for relating the functional abilities of workers to the func- tional requirements of jobs. In general, functional capacity and not chrono- logical age must become the primary employment standard. Pre-retirement Planning Planning ahead for retirement can significantly reduce the mistakes and frustrations that accompany a trial-and-error approach after retirement. Pro- blems may still arise, but the individual will be better prepared to cope with them. The three critical elements are opportunity and incentive to plan, and concrete, relevant data on which to base the planning. Employment 7 NCOA recommends that the Federal government recognize the need for planning and assume a partnership with educational institutions and private industry by funding research and training programs, sponsoring demonstration projects and providing incentives for employers to pay the tuition for appro- priate courses as well as setting an example as a model employer. Second Careers A change in mid-life from one job pursuit to a different field is no longer considered unusual in our rapidly changing society. For some workers, because of technological displacement or involuntary early retirement, the need for a second career is a necessity. To fill the need, career oriented educational and training programs should be developed which are aimed not at the beginning worker but at those who must transfer from one career track to another. Women and Minorities Unemployment and poverty among middle-aged and older single women and members of minority groups are particularly severe problems. NCOA urges that special attention be paid to the employment problems of these groups in Employment Service job development and in training programs. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH ENERGY AND THE ELDERLY HOUSING A limited supply of electricity, natural gas, fuel and INDUSTRIAL GERONTOLOGY motor oil at inflated prices is potentially damaging to older INTERNATIONAL people themselves, as well as to the institutions and pro- MEDIA grams which serve them. As the price of energy continues to RESEARCH & EDUCATION rise, increasing numbers of older people living on fixed in- RELIGIOUS INSTITUTIONS comes will be forced to decide between heat or food. Cost-of- AND ETHICS RURAL AFFAIRS living increases in Social Security and Supplemental Security SENIOR CENTERS Income benefits are quickly eroded by inflation in this area SOCIAL SECURITY, PENSIONS & INCOME alone. Already inadequate public and private transportation MAINTENANCE SOCIAL SERVICES becomes either too expensive or non-existent. The loss of volunteer drivers due to the lack, or high cost, of gasoline can cripple many programs geared to serve older Americans, in- cluding homemaker-home health aide projects, escort services, meal deliveries and senior centers. Reduced heat in the home aggravates arthritis and many other chronic conditions that affect the elderly. The benefits of programs, including those authorized under the Older Americans Act, are reduced because The National Council on eAging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Energy 2 appropriations do not include increased costs for lighting, heating, cooking and transportation. To avoid and/or alleviate these present or potential problems, NCOA recom- mends the following: 1. The development and implementation of a national energy policy should assure that all citizens are equitably treated and particularly that the elderly and other vulnerable groups are not adversely affected. 2. The use of any gasoline allocation formula should include extra supplies to agencies who operate elderly transportation services and unrestricted access for volunteer agency drivers. 3. Any fuel allocation and/or rationing, if developed, should take into consideration the special needs of the elderly. 4. Government program regulations which restrict reimbursement of drivers should be changed periodically to reflect the higher price of gasoline. 5. The appropriations for service programs dependent on energy re- sources should be increased to account for inflation's impact on the cost of energy. 6. The Federal government should institute a program of low-cost loans for housing insulation. 7. Comprehensive consumer information on energy conservation and rights should be developed for the elderly and effectively distributed to them. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH HEALTH OF THE ELDERLY HOUSING INDUSTRIAL Good health is a basic ingredient of a satisfactory life GERONTOLOGY for all people. For older Americans this goal is more diffi- INTERNATIONAL cult to attain and maintain than for the remainder of the MEDIA population. Growing older is almost always accompanied by RESEARCH & EDUCATION an increasing need for health care services (people aged 65 RELIGIOUS INSTITUTIONS AND ETHICS and over, while approximately 10 percent of the population, RURAL AFFAIRS account for 30 percent of health care costs). SENIOR CENTERS While recognizing that good health should be a public SOCIAL SECURITY, PENSIONS & INCOME policy goal for all Americans, the National Council on the MAINTENANCE SOCIAL SERVICES Aging is particularly concerned that there be a public commit- ment to assuring that the necessary steps are taken so that older Americans can live healthfully and can choose and pur- chase appropriate health care services. NCOA believes that the final responsibility for compre- hensive health services, both physical and mental, for older Americans lies in the public sector at the Federal level. The objective of such health services should be the provision of The National Council on theAging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Health 2 expanded and specialized health programs and facilities and rehabilitative and preventive care, including mental health services, for older persons. The pro- vision of these facilities and services must be complemented by the establish- ment and enforcement of national standards to guarantee quality physical and mental health care and decent living conditions. Therefore, NCOA supports the early establishment of a national health security program which incorporates the following principles: 1. Comprehensive physical, mental, environmental and social health care benefits for all Americans; 2. The integration of Medicare into a national health security program for Americans throughout the life span; 3. The elimination of all co-insurance, deductibles and premiums; 4. Administration and fiscal management of the new health security program by a public agency without an intermediary between the providers and the public agency; 5. Financing of the health program through general revenues and payroll taxes. 6. Consumer participation of the aged in the development and implementa- tion of this program including involvement in quality controls (in such areas as accessibility, acceptability and accountability) and in cost controls. 7. Coverage for the full range of long-term care services, including home-based, community-based and institutional-based services, with appro- priate quality and cost controls specifically designed for the aged. 8. Monies allocated to research and output measurement to include appro- priate attempts to develop criteria for evaluation of health care delivery to the aged related to functional capacity, ranging from minimal self-care Health 3 to full independence; and 9. The exclusion of means tests from any aspect of the program. Pending the establishment of a national health security program and recog- nizing that health care costs are now increasing 50 percent faster than the economy as a whole; that per capita health care costs in 1973 were 3 1/2 times greater for people aged 65 and over than for younger age groups; that Medicare, which covered 49 percent of the total costs for medical expenses in 1969 cover- ed only 38.1 percent of these expenses in 1974; and that skyrocketing costs of health programs do not reflect advances in health services for older people, NCOA recommends: 10. The present Medicare and Medicaid programs should be improved and expanded immediately to meet more adequately the health needs of older persons in relation to such matters as length of stay in acute hospitals; extended care and nursing home facilities; psychiatric hospitals; cover- age for home care; diagnostic and preventive services; and out-of-hospital drugs and medicines; the elimination of the premium paid for Medicare Part B and the co-insurance features related to hospital care. 11. Greater coverage should be provided for dental care, eye and hearing care and aids as well as for other prosthetic devices which contribute to social and health functioning, and which facilitate mobility. 12. A nation-wide program of comprehensive long-term care for older per- sons suffering from chronic disease and disabilities must be developed. Such a program should include specialized health programs and facilities for rehabilitation and resocialization as well as alternatives to insti- tutional care, such as health maintenance organizations, neighborhood clinics, day or night hospital care, and home care services. Health 4 13. Present standards of care should be better enforced and, when promul- gated, vigorous state implementation of national standards for nursing homes and personal care homes should be encouraged. This should assure not only the safety and appropriate levels of health care for older per- sons, but also the inclusion of social care perspectives which help to preserve the human rights and dignity of the older residents. 14. The encouragement of specialties in geriatric medicine and other health professions should be a matter of national policy, with funds made available for recruiting and training these specialists required to staff a comprehensive health service for older persons. 15. A national policy and program on the physical fitness of older Ameri- cans should be developed and coordinated. bebraqxe [atiqzod-90-suo bns 8 ,II 28 Itew 28 bas bita mergoiq sbiw-noitma A SI bequieveb bits bits amstgorg dised bestislooga bluode METROTA 8 2.S Ilew bns boodroddigien as Isnoisus PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH THE DEVELOPMENT OF SOCIAL UTILITIES FOR LONG-TERM CARE HOUSING The growth of the nursing home industry in recent years INDUSTRIAL GERONTOLOGY has been phenomenal; and, for the most part, caused by the INTERNATIONAL introduction of Federal funds through Medicare and especially MEDIA the Medicaid program. In fact, public funds now account for RESEARCH & EDUCATION approximately $2 out of every $3 in nursing home revenues. RELIGIOUS INSTITUTIONS In 1973, Medicare contributed $200 million and Medicaid $2.1 AND ETHICS RURAL AFFAIRS billion to the industry. In addition, there are almost 50 SENIOR CENTERS other Federal programs which assist nursing homes. These pub- SOCIAL SECURITY, PENSIONS & INCOME lic funds support an industry in which 77 percent of the nurs- MAINTENANCE SOCIAL SERVICES ing homes are operated for profit, 15 percent are philanthropic, and only 8 percent are government owned. Despite this rapid growth and public support, a recent study by the Subcommittee on Long-Term Care of the Senate Special Committee on Aging concludes that there is no coherent policy on the long-term care of older Americans. As a result, in too many cases, public funds are used to perpetuate defi- cient care for thousands of older people, thus causing them The National Council on theAging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Long-Term Care 2 to live in unconscionable conditions. That Senate report concludes that the majority of nursing homes in the country do not meet minimum standards of acceptibility. It is critical that the Federal government redirect public funds to en- courage the development of quality long-term care institutions. Therefore, NCOA believes that there should be a systematic diversion of Federal funds now being spent on proprietary nursing homes (estimated between $3.5 and $7.5 billion) into public or private nonprofit social utilities for long-term care. By social utilities we mean facilities or services not exclusively oriented to the care of in-patients, but also planned to provide services beyond their walls. In other words, those facilities would become an integral component of the service delivery network to the elderly throughout the community. The possible services are many and diverse - day care, congregate dining, disease detection, intellectual and social programs, group and individual counseling and psychotherapy, outreach care, social services and health educa- tion. Thus, while offering a quiet sanctuary for those who require it, these facilities for long-term care could also become lively places with ties to the larger community. Instead of the dread of inhumane treatment or the fear of being left in a home only to die, an older person entering such a facility would expect and receive the kind of care which offers rehabilitation and a renewed sense of hope and self-esteem The elderly need and deserve long-term care facilities geared to meeting the full range of their medical and social needs, places where they can go and be assured of quality treatment. In the best tradition of American society, public support for the social utilities described here would reinforce competi- tion in the nursing home industry and encourage proprietary homes to develop similar constructive programs. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH NUTRITION FOR THE ELDERLY HOUSING INDUSTRIAL Proper nutrition is a prerequisite of good health, but GERONTOLOGY it is often hard for older people to maintain an adequate diet. INTERNATIONAL Poor nutrition is frequently found among older adults because MEDIA they live alone; they are often frail; and many more are poverty RESEARCH & EDUCATION stricken. Inflation has increased food costs alone by 20 per- RELIGIOUS INSTITUTIONS AND ETHICS cent in the last year. Thus, the elderly poor are forced to RURAL AFFAIRS "pay more to eat less." To ensure an appropriate public com- SENIOR CENTERS mitment to providing adequate nutrition benefits for older SOCIAL SECURITY, PENSIONS & INCOME Americans, NCOA believes: MAINTENANCE SOCIAL SERVICES 1. Title VII of the Older Americans Act should be fully funded to provide the necessary support for the Nutrition Program for the Elderly which, despite its success, now reaches only a minority of those who need such support. 2. The food stamp program should have an expanded out- reach as well as an improved administration in order to be of greatest value to older persons. 3. Information about the influence of nutrition on the The National Council on Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Nutrition 2 aging process should be incorporated into all health education programs. Such programs should be given in the public schools, be an integral part of the health education functions of the proposed national health security a program, and be a significant part of senior center programs and of other services through which large numbers of older persons can be reached. 4. Standards for nutritional quality for food services for older people should be established at the Federal level and be included in the licensing to and inspection procedures in every state and community. 5 PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH THE RURAL ELDERLY HOUSING INDUSTRIAL Until very recently there has been a large migration of GERONTOLOGY the American people from rural to urban areas. Thus, people INTERNATIONAL residing in rural areas faced a dramatic reduction in income, MEDIA a lack of essential services and, of course, a reduced popula- RESEARCH & EDUCATION tion. Rural America became less visible in terms of priority RELIGIOUS INSTITUTIONS AND ETHICS in Federal and state programs. What was once the backbone of RURAL AFFAIRS the country became a skeleton, standing alone and forgotten. SENIOR CENTERS Interestingly, the same could be said of the older adult SOCIAL SECURITY, PENSIONS & INCOME throughout America. For an older adult living in rural America, MAINTENANCE SOCIAL SERVICES the problems of poverty, isolation, poor health, inadequate housing, and lack of visibility were compounded. However, recent migration trends seem to be changing. The population is now leaving urban areas for rural ones, al- though services are not so quick to follow. The National Council on the Aging calls for a national effort through the voluntary public and private sectors to utilize the capabilities of rural older adults to restore them to productiveness and to expand The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Rural Elderly 2 and develop services to enable rural older adults to enjoy a life of dignity, health, and safety. To this end, we make the following recommendations: In non-metropolitan society, pensions or annuities are almost non- esistent. Therefore, older adults rely on social security benefits or income maintenance programs for their only source of income. To relieve the burden of these often inadequate income levels for older adults in rural areas: 1. An accelerated effort to develop rural manpower programs should be made to enable older adults to remain self-sufficient. 2. An income maintenance program tailored and directed to meet the needs of the rural older adult should be established. Such programs should take into account the traditional multi-generational family model which is still common in rural America since this structure often prevents older family memebers from receiving full income benefits al- though they must contribute to the family's income in order to avoid impoverishing them. 3. An effort by Federal, state and local governments must be made to protect the independence of rural older adults by reduc- ing property taxes, especially those of persons on limited incomes. Noting that in 1973 the U.S. Department of Health, Education and Welfare spent only $7 million out of $175 million on health services delivery in rural areas although statistics show that approximately 140 rural counties in the nation do not have a physician and very limited auxiliary health services, NCOA recommends the following: Rural Elderly 3 4. The Federal government should collaborate with medical schools in planning for special stipends for medical students who make a commit- ment to serve in rural areas (as well as other delivery areas) following their training as well as field placements during their training. 5. More support should be given to developing other professionals such as doctor's assistants, nursing and medical aides to provide supportive medical servcies to older adults in rural areas. 6. Mobile health service units, mini-medical clinics, visiting nurses services and emergency transportation services should be developed to alleviate this serious problem. 7. More emphasis should be given to medical service development, linkage of auxiliary services and provisions to enable the utilization of these services. Public transportation is virtually non-existent in most rural areas and medical and social facilities are too distant from residential areas to be reached by taxi or by walking. These conditions immobilize older adults and keep them from making social contacts and reaching professional services. NCOA recommends: 8. The National Mass Transportation Act of 1974 should be re-examined and new allocations made to offer more than token assistance to rural areas. 9. Efforts should be made toward ensuring the full development and utilization of volunteer transportation services, minibus services and school buses during "off hours" to fill this transportation gap. 10. State Public Commissions should remove those regulations which might restrict the implementation of transportation programs, and state Agencies on Aging should be prepared to follow up such action with Rural Elderly 4 recommendations of transportation programs which would benefit the elderly. Sixty percent of the substandard housing reported in the nation's counties is in rural areas; one-fourth of those dwellings are occupied by the older adult. NCOA recommends the following: 11. A major national housing focus must be directed at rural America with particular emphasis given to the housing needs of older adults. An ef- fort to broaden the programs of, and the appropriations for, the Farmers Home Administration specifically to meet the housing needs of rural Amer- ica would be an important step in this regard. 12. Legislation should be enacted to make available funds for low-interest rate loans for major home repairs. The development of community services to provide minor home repairs could enable many older adults to maintain their independence by remaining in their own homes. Many others, by using their skills in carpentry, masonry and plumbing could earn extra income. 13. Planners and administrators should make greater efforts to provide social services, which are so often dénied the rural elderly because of their limited mobility, with public housing projects for the elderly. .e to по PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH HOUSING FOR THE ELDERLY HOUSING INDUSTRIAL With the moratorium on subsidized housing, instituted GERONTOLOGY in the last several years, the need for suitable housing for INTERNATIONAL older persons has reached critical proportions. Waiting MEDIA lists for existing low and moderate income housing for the RESEARCH & EDUCATION elderly are extensive and growing. Hundreds of thousands of RELIGIOUS INSTITUTIONS America's older people are forced to live in environments AND ETHICS RURAL AFFAIRS which are substandard, too expensive, too difficult to main- SENIOR CENTERS tain, too inefficient for their age and capacities. SOCIAL SECURITY, PENSIONS & INCOME Older people everywhere find it difficult to understand MAINTENANCE SOCIAL SERVICES why a demonstrated need for a program which has been singularly successful - financially and socially - should be suspended and unfulfilled. Because of time, because of special needs with age, older Americans require a special priority today. They have the right to make independent choices of their living arrangements regardless of their current income situation. These choices can include single family homes, independent apartments, FORD LIBRARY The National Council on theAging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Housing 2 congregate facilities and rehabilitative centers. In all instances, such housing should have easy access to senior center activities, health services, therapy programs, nutrition programs, cultural activities - all designed and implemented to maintain independent living even when disability occurs. NCOA has the following specific recommendations: 1. To achieve independent choice of living arrangements, all the programs of low and moderate income housing authorized by the Congress should be used fully and immediately. Of vital importance in this regard is the full implementation of the Section 202 Program. Congress has authorized and appropriated substantial funds for a new beginning of this very suc- cessful program of housing for the elderly. The Administration should accept this action and institute an effective program of direct financing both in the construction period and for the permanent loan for qualified nonprofit applicants. 2. Such loans should have available to them a special set-aside of Sec- tion 8 subsidy to ensure that low incomes will not bar older people from suitable housing. This is a priority, major action required today. 3. There should also be enactment and execution of full appropriations under the Section 8 Program and Section 236. These programs individually, and especially in combination, could generate the volume of specially- designed housing older Americans need and require. 4. In addition, a substantial program of special grants to senior citi- zens who own their own homes should be underway on a sizeable basis. This will permit older persons of modest incomes to improve and rehabilitate their own homes and to go on living independently in neighborhoods of their own choice. 5. In any housing program, more than sheer shelter is required. Urgently Housing 3 needed senior centers, adequate nutrition programs, physical and occupa- tional therapy, health programs, cultural enrichment programs, etc., should be financed by grants, rather than out of the rents of residents. 6. Administration of the subsidy programs must be realistic if the pro- gram is to be effective. This means reassessing fair market rents, con- struction costs, methods of financing and speed of administrative pro- cessing. 7. New construction should be emphasized. Too many older persons live in homes which are too old and too inefficient for them. They require having arrangements suitable to their age and physical conditions at rentals and prices they can afford. 8. A major national focus must be directed at rural America with particu- lar emphasis given to the housing needs of older adults. An effort to broaden the programs of, and the appropriations for, the Farmers Home Ad- ministration specifically to meet the housing needs of rural America would be an important step in this regard. 9. There is a great need for a new investment in research on the physical and social aspects of housing for the elderly. New generations of older Americans with different values and different abilities will soon consti- tute our retirement populations. We need to evaluate the past, conduct research on the frontiers of our knowledge and develop criteria for the near future. 10. There should be legislative enactment creating the Office of Assistant Secretary of the Department of Housing and Urban Development for Housing for the Elderly. The field is so large and so important that overall policy and planning should be centered by law in an Assistant Secretary with trained staff to ensure effective knowledge, coordination and administration. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH RESEARCH ON AGING HOUSING INDUSTRIAL During the past decade there has been a substantial de- GERONTOLOGY gree of Federal government support for research and develop- INTERNATIONAL ment of social, behavioral and biomedical research on aging. MEDIA This has come through as many as 30 government agencies and RESEARCH & EDUCATION departments, each of which has found that it needs to support RELIGIOUS INSTITUTIONS AND ETHICS research on problems of aging and evaluation of its programs RURAL AFFAIRS for the elderly. SENIOR CENTERS There is naturally some question whether this variety SOCIAL SECURITY, PENSIONS & INCOME of research projects and programs is well planned and coordi- MAINTENANCE SOCIAL SERVICES nated so as to cover essential problems without overlapping in some places or causing serious gaps in other areas. The situation is now ripe for a major effort to get more coherence and better planning into the Federal government's support of research on aging. The new National Institute on Aging is almost ready to function and its National Advisory Committee has been at work for several months. Also, the Department of Health, Educatio The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Research 2 and Welfare has a Federal Council on Aging consisting of non-governmental per- sonnel which advises on programs in HEW. We urge these two groups to get together, and perhaps to jointly create a Task Force on Research and Development in Social Gerontology, with the mission of producing a Five Year Plan for government support of research and development in this area. Some of the most needed research can be foreseen. NCOA recommends: 1. Studies of methods of providing long-term care of elderly persons in feeble physical condition should be undertaken. This involves studies of standards and methods of financing nursing homes; as well as studies of facilities that can serve home-bound or physically impaired people through home-maker services and home-delivered meals - thus avoiding the cost and difficulty of moving into a nursing home. 2. Research should be started on ways of protecting the incomes of elderly people from erosion by monetary inflation. 3. Senior centers should be carefully studied. These agencies are in- creasing in numbers, and probably are the most useful single service facility for the elderly. A variety of model programs should be studied, evaluated and then those that work well should be spread over the land. 4. Television and radio programs, as well as the printed media, should be monitored and evaluated for their values to elderly viewers. Possibly some experimental programs should be created and tried out. 5. Research should be done on the adequacy of existing retirement roles and programs for development of new retirement roles. 6. Factors that affect policies governing retirement age should be studied. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH RETIREMENT INCOME HOUSING INDUSTRIAL In the last few years, there has been a sharp reduction GERONTOLOGY in poverty for persons 65 and older, from one out of four INTERNATIONAL older Americans in 1969 to one in six by 1973. Nevertheless, MEDIA the elderly are still the most economically disadvantaged age RESEARCH & EDUCATION group,since the proportion of aged living in poverty (16.3 per- RELIGIOUS INSTITUTIONS AND ETHICS cent) is higher than for any other age group. The majority RURAL AFFAIRS of aged persons in poverty are women living alone. SENIOR CENTERS Many more older Americans, although not considered to be SOCIAL SECURITY, X PENSIONS & INCOME in poverty, do not have incomes sufficient to meet a modest MAINTENANCE SOCIAL SERVICES standard of living. Almost half of all aged couples have in- comes below the Bureau of Labor Statistics intermediate budget for a retired couple ($6,041 in 1974) which was recommended as a standard by the 1971 White House Conference on Aging. Thus, the nation has still not achieved the long-sought goal of an adequate retirement income for all even though in- come maintenance for the aged has been improved in three major areas: Social Security benefits have been substantially raised; GERALD LIBRARY FORD ALBERT J. ABRAMS, President The National Council on the Aging, Inc. JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Retirement Income 2 the old age assistance welfare program has been federalized by enactment of the Supplemental Security Income program administered by the Social Security Administration; and, private pensions have been made more secure by the pen- sion reform law. At the same time that these improvements have been made, however, infla- tion has offset their impact on retirement income. Social Security increases have lagged behind price increases, particularly in the areas where the elderly have their greatest expenditures--housing, food, medical care and transporta- tion. In the SSI program, recipients in at least 21 states will not even re- ceive the benefits of a recent eight percent cost-of-living increase which they are entitled to along with other Social Security and SSI recipients. Reduced Social Security taxes because of the recession and a long-term change in the population mix, have generated questions about the financing of the Social Security program. The National Council on the Aging has addressed itself to the financing aspects as well as to the adequacy of benefits in a statement adopted earlier this year. The goal with regard to financing is to bring income and outgo of the Social Security trust funds into balance within the next few years and maintain them in balance over the long-range future. There is no need to achieve a close balance in the present recessionary period or to maintain such a balance in the future over every year or short period of years. The suggested measures to achieve this goal are: 1. The amount of earnings subject to Social Security taxes and counted in determining Social Security benefits should be increased substantially, as of 1977, from the present $14,100, and from then on adjusted, on an automatic basis, to increases in average wage levels. An increase to $24,000 in 1977 could be expected to bring the Social Security system as Retirement Income 3 a whole (cash benefits and Medicare) into financial balance for the next several decades without an increase in the tax rates. 2. Beginning in about 1985 and increasing over the following three or four decades until covering about one-third of costs, a contribution from general tax revenues should supplement employer and employee tax contri- butions to the Social Security cash-benefits program. The general revenue contribution should begin within the next decade and be phased in gradu- ally. In order to achieve more adequate Social Security benefits (and sup- plemental work income) the National Council on the Aging recommends: 3. An increase in the amount of earnings covered (see above no. 1) which would lead to higher future benefits and therefore greater economic secur- ity for workers in the middle and upper income brackets. 4. Gearing benefits to total wages in covered employment instead of to changes in the cost-of-living. Thus, as standards of living and levels of living increased for the working population, the retired would have a share in the increases. 5. Abolishing the premiums paid by beneficiaries for Part B Medicare. 6. Increasing the amount a Social Security beneficiary may earn in a year without reduction in benefits from $2,520 to $3,000. The objective of the Supplemental Security Income program for the elderly is to provide an adequate standard of living for those who do not have income, or enough income, from Social Security, pensions or savings. It provides a fed- eral "income floor" for those without other adequate income resources. Experi- ence with the program has shown, however, that although there are some 2.3 million aged persons receiving benefits, there are still many aged persons not receiving benefits to which they are entitled, and that implementation of the Retirement Income 4 program is reducing already limited benefits. E To achieve the goal of bringing all eligible aged persons into the program and to provide a more adequate income from SSI benefits, NCOA recommends that the Social Security Administration take the following, necessary administrative steps: 7. Field visits to those potential beneficiaries who are homebound and unable to come to local SSA offices. 8. Development and implementation of a permanent outreach and information program to inform potential recipients of their rightful benefits. 9. States should be mandated to pass along all cost-of-living increases in the federal portion of the SSI payment by requiring states to at least maintain supplementation payments at June, 1975 levels. 10. SSI recipients should be guaranteed that SSI benefits will not be re- duced when Social Security benefits rise. 11. All applications for SSI benefits should be processed with the utmost promptness, preferably within thirty days. The present $100 advance should be increased to cover the full amount of the standard monthly pay- ment for two months, and the present provision for advance payments on the basis if presumptive disability should be broadened to include presumptive blindness. 12. Legislation should be enacted authorizing the Secretary of HEW to provide a permanent mechanism for on-going emergency assistance, as often as needed, effective within twenty-four hours of a recipient's application for such aid. 13. The use of an Ombudsman at the state or regional level to respond to claims that individuals have been denied benefits to which they are enti- tled should be studied and seriously considered for use in the program. Retirement Income 5 The Employee Retirement Income Security Act of 1974 provided some new pro- tections and guarantees for the some 30 million employees covered by private pension plans. Enforcement of the new pension reform law has just begun and it is too early to assess its impact. Studies will be needed (and some are provided in the law) to determine its impact in such areas as the employment opportunities of middle-aged and older workers, the improvement of survivor provisions and the expansion of private plan coverage. The provision establishing individual retirement accounts for those not covered by other pension plans is already quite popular, but there is little information if the additional requirements provided by the law have had any effect on establishment of additional group plans. It is important that additional plans be established to extend coverage for less than half of the work force in private industry is now covered by re- tirement plans. NCOA recommends two goals with regard to private pensions: 14. Existing pension plans should continue to be liberalized with regard to such features as early vesting, portability between employers and the provision of survivor benefits. 15. The establishment of new pension plans should be encouraged so that coverage would be extended to a larger proportion of the workforce. Specific legislative and other recommendations await further study and ex- perience under the new pension reform law. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH EXTENSION OF THE GENERAL REVENUE SHARING PROGRAM (STATE AND LOCAL FISCAL ASSISTANCE ACT OF 1972) HOUSING INDUSTRIAL Since the inception of the General Revenue Sharing Pro- GERONTOLOGY gram in 1972, the National Council on the Aging has provided INTERNATIONAL technical assistance to public and private local, state and MEDIA national agencies serving the elderly and poor on how they RESEARCH & EDUCATION should go about obtaining their "fair share" of the allocated RELIGIOUS INSTITUTIONS funds. We were pleased that social services to the poor and AND ETHICS RURAL AFFAIRS aged was one of the priority areas in which local governments SENIOR CENTERS were required to spend their funds. Yet a recent study by SOCIAL SECURITY, PENSIONS & INCOME the General Accounting Office revealed that less than half MAINTENANCE SOCIAL SERVICES of one percent of the total monies authorized for expendi- ture by the local governments surveyed were directed speci- fically to programs to benefit the aged. To compound the problem, cutbacks in and even complete elimination of cate- gorical programs benefiting the poor and aged have been jus- tified on the existence of general and special revenue shar- ing funds to take their place. It is clear that, without additional safeguards in the The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Revenue Sharing 2 legislation being drafted to extend the program, the needs of the poor, par- ticularly the elderly poor, will not be a significant objective of revenue sharing programs. Therefore, NCOA urges the Congress and the President to support in any legislation extending the State and Local Fiscal Assistance Act of 1972 the following provisions: 1. A restriction on the use of general revenue sharing funds by both state and local governments to the eight priority areas in the current legislation. 2. A requirement that states and local governments spend no less of these funds on social services for the poor and aged than the percentage of aged and poor in that particular political jurisdiction as deter- mined by Bureau of the Census data. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL ARTS September, 1975 HEALTH SENIOR CENTERS HOUSING INDUSTRIAL GERONTOLOGY Findings from the National Institute of Senior Centers' INTERNATIONAL Multipurpose Senior Center Research Project affirm the role MEDIA of the Senior Center as a community focal point for older RESEARCH & person services and activities. Nutrition, health and social EDUCATION RELIGIOUS services plus educational, recreational and community service INSTITUTIONS AND ETHICS opportunities are made accessible and available for older per- RURAL AFFAIRS sons through Multipurpose Senior Centers in thousands of com- SENIOR CENTERS munities throughout the country. There are, however, great SOCIAL SECURITY, PENSIONS & INCOME MAINTENANCE gaps in the development of Multipurpose Senior Centers. In SOCIAL SERVICES rural areas, for instance, where services are particularly sparse and accessibility a major problem, there are great num- bers of older persons who could benefit from Center services; yet, these are the communities which do not have sufficient local resources for such programs. NCOA thinks the following steps are necessary: 1. The Congress should appropriate funds to provide Title V of the Older Americans Act with the means to do The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Senior Centers 2 the task it was authorized to accomplish. At the minimum, each planning and service area should have a Multipurpose Senior Center from which ser- vice delivery could be coordinated - in a sense the action arm of the Area Agency on Aging. 2. A Part C for Title V of OAA, which would provide assistance to exist- ing programs which qualify or have the potential to become Multipurpose Senior Centers by authorizing grants to sustain all or part of the costs of staff, should be developed. The current focus of Title V is too limited. It reflects a major restriction on service delivery through- out the Older Americans Act - no support for ongoing programs. Emphasis is on new projects, with nothing to maintain services and activities which have been proven to be life-sustaining to millions of America's aged. 3. Community Development funds should be authorized for nonprofit Senior Centers in addition to those which are publicly sponsored. We also urge the Department of Housing and Urban Development to encourage support of Senior Centers in the Community Development program. The extension and ultimate funding of Title V remains the primary route of Federal support for Senior Centers. Reports from around the country indicate that centers are not receiving monies under the Housing and Community Development Act of 1974. Although Centers were specifically designated by the Congress as eligible recipients of such funds, little support has emerged. 4. The Administration on Aging should encourage Area Agencies on Aging to develop service contracts with Senior Centers whenever possible, thus recognizing and extending the comprehensive service delivery system which Multipurpose Senior Centers represent. 5. The Administration on Aging should provide support for the development of standards for Senior Centers. This would be an important step forward Senior Centers 3 in the provision of services for older people because it would assure more consistency in quality and a means to maintain programs meaningful to the community and to older persons. The Senior Center field as a whole should assist in the development of these standards and be involved subsequently in their adoption as a means of promoting the best for those who deserve the best - the older people of America. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH SOCIAL SERVICES AND THE ELDERLY HOUSING INDUSTRIAL A social service system exists to help individuals and GERONTOLOGY families to make optimal use of the resources which exist to INTERNATIONAL sustain and enhance social functioning in our very complex MEDIA society and its physical environment. Social services are RESEARCH & EDUCATION needed by all people at some time in their lives to maintain RELIGIOUS INSTITUTIONS AND ETHICS or to attain their roles as socially or economically produc- RURAL AFFAIRS tive members of society, and to effectively cope with their SENIOR CENTERS environment. SOCIAL SECURITY, PENSIONS & INCOME The elderly particularly, because of their vulnerability MAINTENANCE SOCIAL SERVICES and the impact of their problems on family and society, as well as their relatively little knowledge about the social inter- ventions which are needed, represent a primary target for social services. The provision of social services in their preventive, supportive and restorative functions can provide for the individual and collective needs of older persons. Social services can include a wide variety of individual and group or community services, such as nutrition, health, The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Social Services 2 educational or recreation and involve not only delivery systems but policy for- mation, training, education, and research. Transportation as well is an impor- tant ingredient of services and a link to resources in the community. Where responsibility rests for providing needed social services for the aged has not been clearly defined. Neither has accountability been clarified nor the mechanisms for this developed. Perhaps most importantly, the resources which are provided are insufficient. Social services have developed in three separate systems, one private profitmaking, and the others private-voluntary and public. None of these systems functions adequately for the aged and the separation of the three sys- tems has been dysfunctional to meet all needs of the total elderly person. The identification of this group as a special category to receive government re- sources has weakened not only the principle of right to service but the integra- tion of all services, private (profit-making and voluntary) and public, into one cooperative system which functions effectively. The National Council on the Aging is aware of the wide disparity which exists at present between the needs of the elderly and the social services which are provided to meet the greatly varied needs and wishes of this diverse popu- lation. No national policy now exists regarding meeting the needs of all Ameri- cans; this should be a primary goal. There should be a public commitment to the elderly so that necessary steps may be taken to ensure that the gap be closed between service needs and services for Older Americans. The new Social Service Amendments of 1975 (Title XX) basically represent special revenue sharing as applied to public service programs. Unfortunately, Title XX does not provide for the provision of essential services and omits the specific language permitting group eligibility or standards for adult care; it does not define strongly what constitutes an eligible service. What is most Social Services 3 important, moreover, is that no attempt has been made to coordinate this social service program with other programs - private and public - which provide services to the elderly. NCOA has continually worked for improvements to insure that the current delivery and future expansion of critical social services to older Americans be facilitated. Delivery and expansion of services, however, is not enough. NCOA is concerned with regulation and means to insure the quality of the services. The assumption is that there will be little change this year in provision of social services, and the present pattern will continue until review and planning can affect new modes of implementation. Since Title XX provides for public review and comment, mechanisms for utilization of these to maximize allocations for the elderly are essential. In this way changes may take place in direct response to service needs of the elderly. The National Council on the Aging makes the following policy recommenda- tions accordingly: 1. Title XX should make explicit that services be designated for the el- derly specifically, so that low-income elderly are not in competition with other groups for services; 2. Group eligibility in the provision of services to adults should be al- lowed under Title XX. 3. Standards which ensure quality adult care must be established under Title XX. Funding to ensure enforcement of these standards through inspec- tion and education must also be forthcoming. 4. Attempts should be made to coordinate the Title XX programs with other service programs private or public which serve older people. 5. Provision of services under any law is useless unless knowledge and access to the services is made readily available to the group which needs Social Services 4 them. Thus, a system which will provide information and make referral for the elderly to link them to services should be developed. 6. Transportation is a means to bring services and older people together. Mass transportation and/or diverse mobility systems which are responsive to the unique needs of older people should be developed. 7. Levels of appropriation for services should meet the massive needs of al the elderly. Insufficient funding represents tokenism and results in notiques inadequate services and blocks access to services. bas welver Itsms bas Inipor to sebivorq XX to nso gninnsiq esimixum 03 to amainadosm brus welver allduq Yam YAM Yitable edit TO? visable to absen solvers 02 звлоqает JOSTID ni -abnemmost volloq galwollo? gnigA and no Isnottal edT : Vignibroos anoit -Ie and TOY betengleeb ed accivate Jade siotiqxe exam bluoria XX state .1 date moith ni for STR Virable emooni-wol 02 Vireb aquorg Terito -In ed bluods attubs 03 accives to nolaivorq ni vilidigile quord .S XX GIGHT Tobnu bewol Tebnu bedalidares ed serm 9780 Jluba VILLAUP STURNS daidw E -beqant riguords prodit 30 STUDIO 03 galbaut .XX GIJIT ed 0218 Jewm notisoubs bns nois TOMAO drive emstgorq XX GIJIT grit ejanibrooo of ebam ad bluode AddressA .A eiqosq Tablo 9VIS2 doldw studuq TO атетдота solvres bns egbelwomd seeinu at wal Yns Toban esolvres to noteivor9 .Γ absen doine quots arts of eldellava Ylibser abse al esolving and of 889006 PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH TRAINING AND EDUCATION HOUSING Training INDUSTRIAL GERONTOLOGY With what is bound to be a major expansion of services INTERNATIONAL and programs for the elderly during the next few years, there MEDIA is a growing need for continuing education of people in the RESEARCH & EDUCATION field. NCOA believes the following steps are necessary: RELIGIOUS INSTITUTIONS 1. Continuing education and supplementary training AND ETHICS RURAL AFFAIRS programs for people who wish to serve as staff members SENIOR CENTERS of area agencies, as staff members of senior centers, SOCIAL SECURITY, and as staff of long-term care institutions should be PENSIONS & INCOME MAINTENANCE SOCIAL SERVICES supported. 2. The present flow of young people through doctoral programs in gerontology and related disciplines should be maintained. The provision of a limited number of fellowships for doctoral candidates in the spring of 1975 is commendable and should be continued. 3. Training grants for university programs in the social and biological aspects of aging should be maintained with The National Council on theAging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Training and Education 2 funds that will guarantee the supply of research and university teaching personnel at a somewhat increased level. 4. The continuing needs for training persons at the doctoral and the semi-professional levels should be coordinated with the aid of the National Institute on Aging and the Federal Council on Aging. The time has come to set up an ongoing program for at least five years, with funding author- ized by the Congress. Appropriations for training have been $8 million in the most recent years, and support should be continued at this level, or increased over the next five years. Education Programs of general cultural and socio-civic education provided for people in their 50s, 60s, and 70s are now beginning to catch the attention and interest of mature people much more than they have in the past. This is partly due to the ingenuity and effort of educators, working especially in community colleges and in extension divisions of the state universities. It is also partly due to the increasing level of formal education of elderly people. Within ten years, the majority of people aged 65 will be high school graduates. And those who have the most formal education are the ones who want more continuing education. To encourage and meet this growing interest, NCOA recommends: 1. Educational programs should be effectively free of tuition charges for all people over age 60, which means that colleges and public schools should have access to Federal or state funds to support such programs. 2. Legislation has paved the way for support of continuing education pro- grams, but very little money has yet been appropriated and made available. Federal funds should be appropriated specifically for these programs. 3. Curricula regarding the aging process should be developed and intro- duced at all educational levels. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH TRANSPORTATION AND THE ELDERLY HOUSING Transportation provides a link to needed services for INDUSTRIAL GERONTOLOGY the elderly, who are more reliant on transportation than any INTERNATIONAL other segment of the population. Yet the elderly are least MEDIA likely to be served by the present transportation system. RESEARCH & EDUCATION Most transportation money goes to networks serving the pri- RELIGIOUS INSTITUTIONS vate automobile, and the elderly are generally non-drivers. AND ETHICS RURAL AFFAIRS Where transportation is available - and almost none is avail- SENIOR CENTERS able in rural areas - the elderly either can't afford it or SOCIAL SECURITY, design, routing or scheduling make use of facilities difficult. PENSIONS & INCOME MAINTENANCE SOCIAL SERVICES Thus, barriers are created to service and employment for the elderly, particularly the elderly poor. NCOA, therefore, re- commends: 1. The Federal government must take the leadership in increasing the mobility of older people through subsidies and promotion of free or low-cost coordinated, accessible transportation systems with special attention to their unique needs. Ultimately, the responsibility in this The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Transportation 2 area must rest with state, regional and local transit authorities. 2. The provision of transportation is an essential part of any social service, welfare or health program serving older people. Any of these which receives subsidy from local, state or Federal government should include transportation as the vital linkage between the older person and the service. 3. Funds should be provided by all levels of government to test out new alternative ways to provide low-cost transportation to meet the needs of older persons in both urban and rural areas. 4. Older people themselves should be actively involved in the planning, policy making and development of transportation programs designed to serve them. TO ISTUT to ni .1 to gaissomont TO to bns 03 OFFICE to all TVEN THE NOV 20 1975 VICE PRESI 0.0 odsa-essisos PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH OLDER AMERICANS AND THE ARTS HOUSING INDUSTRIAL For 25 years the National Council on the Aging has GERONTOLOGY INTERNATIONAL sought to facilitate the full utilization by the aged of ser- MEDIA vices and programs that could make their lives more meaningful and personally gratifying. RESEARCH & EDUCATION NCOA continues to seek new alliances that can improve the RELIGIOUS INSTITUTIONS AND ETHICS quality of life for older people particularly as that quality RURAL AFFAIRS relates to the loneliness, isolation and lack of new social SENIOR CENTERS roles that exist in the world of the aged. Leaders and policy- SOCIAL SECURITY, PENSIONS & INCOME makers in the burgeoning field of cultural services must be MAINTENANCE SOCIAL SERVICES increasingly made aware of how the arts network, both public and private, can serve and be served by older Americans. Agencies and practitioners in the field of aging must become active advocates for older persons in the field of the arts. NCOA believes that while the aged's involvement in cul- tural services and programs may not be a matter of life and death for older persons, it can be a matter of happiness or unhappiness, usefulness or uselessness. The overall goal in The National Council on theAging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Arts 2 this area is to ensure that older persons have an equal opportunity, with other population groups, to participate in and have access to cultural pro- grams and services. In addition, NCOA recognizes the need to preserve the folklore and for- gotten arts of America, including the ethnic heritages of our diverse popula- tion, for the enjoyment of all citizens. It is the older adult who has the knowledge and skills not only to produce such crafts and artwork, but also the capability to teach others the techniques of these accomplishments. With these goals in mind, NCOA makes the following recommendations: 1. The arts constituency should be broadened to include the elderly. 2. The quality of arts programs now available to older people should be upgraded. 3. New employment opportunities for artists young and old in the field of aging should be provided. 4. Art forms which otherwise might be lost forever must be preserved. 5. Support for the arts should be broadened through better use of the energy and ability of older persons whether as volunteers or as paid professionals. 6. Arts resources at local, state and national levels in both the pub- lic and private sectors that are currently overlooked or underused in the field of aging should be mobilized. 7. Local initiatives to preserve the folklore and forgotten arts of America can be encouraged by developing co-ops and/or channels to the retail market where they can reach the consumer. Any public effort to develop such channels should ensure that the proceeds of sales benefit the older artisan. 8. Older artisans should be given opportunities to share their knowledge Arts 3 with others and be provided opportunities to improve their skills. Both Federal and state governments need to be sensitive to these needs and provide avenues by which this unique talent can be shared and enhanced. To date, cultural services for, with and by the aged is a concept without priority status in either the arts or aging fields. We recognize that pro- moting a new concept which is not considered as important as survival support services is difficult at best and is more so in two fields that are currently underfunded. The arts are primarily concerned with survival of cultural insti- tutions and the individual artist. Likewise, practitioners in aging emphasize survival and support of aging service agencies and the aged themselves. Never- theless, NCOA remains convinced that there is something positive for both the arts and the aging fields in the marriage we have proposed. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH THE PRESIDENT'S RESPONSE TO HOUSING THE ANNUAL REPORT OF THE FEDERAL COUNCIL ON THE AGING INDUSTRIAL GERONTOLOGY INTERNATIONAL The National Council on the Aging urges the President to MEDIA reconsider his rejection of the major recommendations made by RESEARCH & the Federal Council on the Aging in its first annual report. EDUCATION The Federal Council on the Aging was established by the RELIGIOUS INSTITUTIONS AND ETHICS 1973 Amendments to the Older Americans Act to advise and RURAL AFFAIRS assist the President on the special needs of the elderly. SENIOR CENTERS Members of the Council were confirmed by the Senate on June 5, SOCIAL SECURITY, PENSIONS & INCOME 1974, and, on March 31, 1975, as required by law, they sub- MAINTENANCE SOCIAL SERVICES mitted their first annual report to the President. On July 2, President Ford transmitted that report with his comments to the Congress. NCOA believes that, because the FCOA is composed of lead- ing experts from the field of aging, the recommendations and advice in that report deserve more consideration than the President's negative comments gave them. It is especially unfortunate that the first official dialogue between the GERATO FORD LIBRARY The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Federal Council 2 President and the FCOA should be so negative. We hope that this is not the beginning of a pattern of animosity which would destroy a potentially valuable relationship for all concerned - particularly for the nation's 21 million older people. The President criticized the report for being "limited to a particular area of interest and advocacy." NCOA believes this criticism is inappropriate and unjustified. The Congress established the FCOA to perform a limited and particular function which it also considered essential; that is, the Council was to provide advice, assistance and advocacy on the special needs of older Americans. The FCOA's first report definitely fulfills this mandate. NCOA has consistently supported the major policy recommendations con- tained in the FCOA report: The development of high standards of safety and care in nursing homes and the rejection of Administration proposals to cut back Federal programs essential to the welfare of the elderly. We congratulate the FCOA on its initial efforts and look forward to the findings and recommendations of its ongoing studies. NCOA remains hopeful that, in the future, the President will be more receptive to the recommenda- tions of the Federal Council on the Aging. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH THE MEDIA AND THE ELDERLY HOUSING INDUSTRIAL Because the Media reflect society's perception of older GERONTOLOGY INTERNATIONAL persons and also make these perceptions self-fulfilling, the MEDIA National Council on the Aging believes that the Media must RESEARCH & make a major nationwide effort to develop greater public un- EDUCATION derstanding of the diverse character and characteristics of RELIGIOUS INSTITUTIONS AND ETHICS older persons. NCOA, through the National Media Resource RURAL AFFAIRS Center on the Aging, has developed recommendations for a new SENIOR CENTERS focus within the Media on a more positive and accurate por- SOCIAL SECURITY, PENSIONS & INCOME trayal of older men and women. MAINTENANCE SOCIAL SERVICES 1. The Media should enable more older persons to play a fuller role in the community by exposing and reducing ageism and discrimination by increasing public under- standing of the older population's value. 2. The general public should be educated to a better understanding of the processes and potentials of aging. Everyone ages and therefore has a stake in assuring that society provides the elderly with opportunities The National Council on the Aging, Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Media 2 and options making it possible for them to live a full and contributing life. 3. The Media should stimulate consciousness-raising among the elderly themselves to enhance their own sense of worth and power. 4. The social issues and programs which affect the elderly should be dealt with more fully so that lack of information or misinformation does not prevent them from participating in activities and assistance pro- grams which are available. 5. Staff should be developed with special knowledge in the area of aging, perhaps to monitor neighborhoods with a high concentration of elderly residents and report accurately on developments within them. 6. More cultural programs which are for, by and with the elderly should be initiated by the broadcast media. PUBLIC POLICY NC BOARD STATEMENT OF DIRECTORS GENERAL September, 1975 ARTS HEALTH THE SPIRITUAL WELL-BEING OF THE ELDERLY HOUSING INDUSTRIAL Spiritual well-being is the affirmation of life in a GERONTOLOGY relationship with God, self, community and environment that INTERNATIONAL nurtures and celebrates wholeness. MEDIA The spiritual is not one dimension among many in life; RESEARCH & EDUCATION rather it permeates and gives meaning to all life. We call RELIGIOUS INSTITUTIONS AND ETHICS attention to this fact of life: To ignore or to attempt to RURAL AFFAIRS separate the need to fulfill the spiritual well-being of man SENIOR CENTERS from attempts to satisfy his physical, material and social SOCIAL SECURITY, PENSIONS & INCOME needs is to fail to understand both the meaning of God and MAINTENANCE SOCIAL SERVICES the meaning of man. We recognize that human wholeness is never fully attained. Throughout life it is a possibility in process of becoming; thus, it is no less important to the older man and woman than it is to the adolescent. In the Judeo-Christian tradition, life derives its significance through its relationship with God. While we acknowledge and respect the rights of others to have other frames of reference, we reaffirm our belief that The National Council on the Aging. Inc. ALBERT J. ABRAMS, President JACK OSSOFSKY, Executive Director 1828 L St., N.W., Suite 504 Washington, D.C. 20036 25 Years of Service to the Elderly 202/223-6250 Spiritual Well-being 2 it is this relationship with God that awakens and nourishes the process of growth through wholeness in itself, crowns moments of life with meaning and extols the spiritual fulfillment and unity of a person. 1 Spiritual wholeness is the right of all people. So that older persons can achieve and maintain a state of spiritual well-being and fulfillment, the National Council on the Aging recommends the following: 1. The spiritual leadership of the nation should address itself to a greater commitment of psychic and financial resources toward serving the elderly. While meeting the needs of the elderly and working for programs that contribute to the well-being of the elderly, religious bodies should attempt to ensure that older persons share in the planning and implemen- tation of all programs related to them, and that these programs are directed not only to the independent aged in the community, but also to the elderly living in public or private institutions. 2. The religious community should take it upon itself to become the prime impetus toward developing special understanding and competency in satis- fying the spiritual needs of the aging among its members and among those who deliver services to the aging in private and public agencies. 3. Religious bodies should take the initiative in developing a greater sensitivity toward, and appreciation of, the cultural and ethnic diversity of our nation in order to better serve the elderly. They should work closely with the diverse minority communities to ensure that cultural or language barriers to communication are broken down without destroying the common ethnic or racial identities which bind those communities and which give greater meaning and identity to so many older people. 1 The introduction was adapted from a statement on Spiritual Well-Being developed by the National Interfaith Coalition on Aging at its Fourth Annual Meeting, April 29-30, 1975, in Washington, D.C. Spiritual Well-being 3 4. Religious organizations should be aware of agencies and services other than their own which can provide a complete ministry to older per- sons. Other organizations designed for the benefit of older persons should develop, as part of their services, channels to persons and agencies who can help in spiritual problems. 5. Religious bodies have traditionally and properly developed their own philosophies. In this context, they should work together with the elderly and coordinate their efforts with other groups to develop and declare an affirmation of rights for the elderly as well as to become actively concerned with spiritual, personal and social needs. Such ef- forts would work to ensure the basic values of all while guaranteeing the basic right of freedom of religion. 6. Religious bodies and the government should affirm the right to, and reverance for, life. In that framework, we believe an individual has the right to choose to die a natural and dignified death. When there is no reasonable expectation of recovery from physical or mental disability, an individual should be allowed to die and not be kept alive by artificial or heroic means. Medication should be mercifully administered during times of terminal suffering, even if it hastens the moment of death. Such a decision by an individual does not ask that life be directly taken, but that dying be not unreasonably prolonged. This decision should be made by an individual for himself or herself. To ensure that such a request for a natural death is understood and not abused by others, individuals are urged to compose living wills. These wills would communicate the conscious desire to be allowed to die even though the individual be unconscious or otherwise incapacitated near the moment of death. 7. Institutions caring for the aged should provide the opportunity for Spiritual Well-being 4 chaplaincy services. In all cases, however, the aged resident should be the sole arbiter of the religious denomination and degree of any assistance provided. 8. The government should cooperate with religious bodies and private agencies to help meet the needs of the elderly, but, in doing so, should observe the principle of separation of church and state. We hope that these recommendations will stimulate a rededication of national efforts toward enriching the lives of older people. In particular, we seek a society and spiritual atmosphere in which the elderly can grow to accept the past, to be aware and alive in the present, and to live in hope of fulfillment. TO to eldanoaser bluode Isubivibni rus bereteinimbs bfuode TO 8 Innimed to Isubivibni ns notaloeb ed bluorie ed Jasupot E daus STUDEN oT TO Heamid Isubivibni ne sisubivibni beauds bris boozatebau et ISTUJAN & of begtu STS Isubivibni riguods neve 03 bewolls 03 to TO abivorq bluode begs .T December 2, 1975 NOTE TO SARAH MASSENGALE Attached is a set of reports from the National Council on Aging which may be of use to you in preparing a list of possible initiatives for the a aged for the State of the Union. While some of these are pure flack, most may be of use and are certainly worth reviewing. When you've had a chance to take a look at these, let's sit down and make up a laundry list of possible initiatives, along with some indication of what costs might be attached to the initiatives and what policy implications of the initiatives are. G.E.M. Attachment GL34L0 FORD LIBRARY OFFICE OF THE VICE president WASHINGTON November 20, 1975 MEMORANDUM FOR ART QUERN FROM: GRADY MEANS all SUBJECT: Initiatives for the Aged I've been a little concerned that, in the midst of proposing limitations on OASI benefits, consolidation of OAA programs with other service programs, and other similar suggestions, that someone is going to ask what positive initiatives we have advanced to help the aged. Along this line, I asked John Martin (former head of AOA) to lay out some ideas on initiatives to support the aged. His suggestions (attached) can be summarized as follows: -- Federalization and consolidation of welfare; -- better coordination of retirement systems with welfare; -- decouple SSA benefits; -- Age Discrimination and Employment Act of 1967 -- increase funding and extend coverage to workers over 65; -- raise the earnings level in the retirement test or eliminate the test altogether; -- allow the use of General Revenue Sharing funds to match Title XX funds; -- support the comprehensive Medicare Reform Act of 1975 to upgrade Medicare; -- Federalize Medicaid; - 2 - -- support the Barber Conable Medicare/Long Term Care Act or at least visibly elevate the level of the discussion; -- implement Federal controls of health care costs and State regulation and physician and hospital fees; -- reaffirm support for the SSI program and raise the benefit levels to the standard set by the CSA Income Poverty Guidelines. Many of these proposals are contained in whole or in part in our initiatives. Some of the others may be relatively inexpensive to institute and be worth including for visibility as well as substantive purposes. I think we should discuss these and other possible options. Attachment CC: Sara Massengale NATIONAL AMERICAN RETIRED ASSOCIATION TEACHERS OF RETIRED ASSOCIATION PERSONS November 13, 1975 Mr. Grady E. Means Office of the Counselor to the Vice President 268 Old Executive Office Bldg. Washington, D.C. 20500 Dear Mr. Means: In the course of our recent discussion you encouraged our Asso- ciations to submit to you a statement of the major issues or initiatives affecting our older population which we feel the President should embrace in his State-of-the-Union message. What follows is an attempt to outline a few such initiatives which seem to us to be of preeminent importance in the lives of older Americans and which we believe would warrant legis- lative and executive action. Each one can be developed in greater depth, if you desire. BUDGET CONTROLLABILITY Our Associations appreciate the Administration's concern over the rate of growth in federal spending. We, too, are concerned. However, we do not believe that short-term federal expenditure reductions in vital programs are an acceptable remedy for the problem of budget controllability or for an inflation, which is generated by too much public and private spending in an economy producing at or near capacity. We do not feel that the federal government's limited budget controllability over the short term is a significant constraint on its ability to exercise counter- cyclical fiscal policy. The federal government has the power to raise or lower taxes to restrain or stimulate the economy. We think short-term fiscal policy shifts should be made on the revenue side of the budget rather than on the expenditure side. As means for bringing the rate of budget growth under greater control over the long term, our Associations suggest federali- zation and reform of our inefficient, duplicative, and wasteful patchwork of cash and in-kind welfare programs and legislation BERALD R. LIBRARY FORD Mary Mullen Douglas O. Woodruff Bernard E. Nash President, NRTA President, AARP Executive Director National Headquarters: 1909 K Street, N.W., Washington, D.C. 20049 (202) 872-4700 - 2 - to coordinate the primary retirement systems with each other and with a reformed welfare structure. Moreover, by adopting the Social Security Advisory Council's proposal to decouple the indexing of social security benefits from the indexing of future retiree earnings records, the system's earnings replace- ment ratio should be stabilized and future cost brought under control. AGE DISCRIMINATION The opportunity to work and to earn a living is a critical need of most Americans. Age discrimination is one major barrier to the employment of older persons. While the Age Discrimination in Employment Act of 1967 prohibits discrimination against per- sons between the ages of 40 and 65 in matters of hiring, compen- sation and other terms, conditions and privileges of employment, age discrimination remains a widespread practice. Such dis- crimination can be subtle and difficult to prove. Often the victim himself comes to believe that the discrimination is some- how justified and fails to protest. Yet, age discrimination is based purely on myth. A 1971 survey conducted by the New York Commissioner of Human Rights has demonstrated that older workers perform as well as and in some cases noticeably better than workers of younger age groups. Our Associations believe that the enforcement of the Age Dis- crimination in Employment Act of 1967 should be stepped up and that increased funding and increased staff should be provided to the Age Discrimination and Equal Pay Branch of the Labor Department's Employment Standards Administration. The budget request for fiscal year 1976 of $2.2 million is far below the authorization level of $5 million. Furthermore, we urge the Domestic Council to recommend to the President that he request that the Age Discrimination in Employment Act be amended to cover workers age 65 and older, as well as those between the ages of 40 and 65. There can be no logical reason for arbi- trarily ending the protection of the law as soon as a worker has reached his 65th birthday. Legislation eliminating the upper age limit of the Age Discrimination in Employment Act of 1967 has been introduced in both the House and the Senate, but no action has been taken during the 94th Congress. Execu- tive approval would greatly improve its chance of passage. SOCIAL SECURITY RETIREMENT TEST Still another barrier or disincentive to work which is placed in the way of older persons is the "retirement test" or "earnings - 3 - limitation" which is placed on the recipient of Social Security. Under present law, an individual may not earn more than $2,520 a year without losing Social Security benefits--$1 for every $2 earned above $2,520 until all benefits are lost. Our Associa- tions urge immediate liberalization of the retirement test to $4,000 with a view to ultimate abolition of the test. We feel that the retirement test, as it is now constituted, poses a virtually insurmountable barrier to continued employment by low-income workers--the very group which would benefit most from continuing to work past age 65. We are advised that 600,000 workers between age 65 and 71 will have all of their Social Security benefits withheld in 1975 and 800,000 will have some of their benefits withheld. It has been estimated that 600,000 are receiving full benefits but are intentionally holding their earnings down because of the penalty. We thus have a total of two million workers affected by the retirement test. The GAO has estimated that complete elimination of the test for all persons over 65 would cost approximately $2 billion, taking into account increased payroll and income taxes. Action short of complete elimination would obviously cost less. * So long as the retirement test is still in effect, we feel that the Social Security benefits of an individual who continues to work past age 65 and who continues to pay into the Social Security system should be readjusted on an actuarial basis at the time of retirement to reflect his increased contributions and decreased life expectancy at the time of retirement. REVENUE SHARING Congress now has under consideration the extension and revision of the revenue sharing act (State and Local Fiscal Assistance Act of 1972). We are aware that the President has presented his recommendations to Congress for the extension of this Act basi- cally in its present form. Our Associations feel most strongly that general revenue sharing should be renewed, but we have a serious question rising out of the fact that although one speci- fied priority category in Public Law 92-512 is "the poor and aged," far less than one percent of these moneys appear to have * The Social Security Advisory Council has considered this question recently. Their conclusions are set forth in Appendix A. They propose a reduction in the withholding rate for earnings above the annual exempt amount of $1 for every $3 up to twice the exempt amount and thereafter $1 for every $2. Cost for 1976 would be $600 million. - 4 - been devoted to benefits for this needs category. Instead, local communities appear to have preferred to spend these addi- tional funds on fire equipment, police protection, and similar needs rather than to increase the availability of social services to the elderly. We are aware of the obstacles to earmarking these funds in a general revenue sharing act. As an alternative, therefore, we urge the President to recommend the removal of the prohibition against use of revenue sharing funds for matching contributions in federally funded programs, particularly as to social services grants under Title XX of the Social Security Act. This should be coupled with a requirement for state and local maintenance of effort in present funding levels. This approach would have two favorable results. First, rather than violate the sacred principle of general revenue sharing by arbitrary earmarking provisions, this proposal would increase the incentives for local communities to fund social services pro- grams without making such allocation a requirement. Second, through the incentive mechanism, chances are improved that social services programs would be expanded in order to receive the optimum match under Title XX and, at the same time, extended to meet the required maintenance of effort by the local govern- ments. HEALTH PRIORITIES Improve Medicare-- In face of the fact that Congress lacks the consensus to enact a national health plan, we urge the Presi- dent's support to give priority attention to improving the Medi- care program. Our nation's older citizens, who as a class face the highest incidence of illness and disability and are least able to pay for adequate health protection, cannot and should not be asked to wait any longer for Congressional action to re- solve the inability of present programs to provide quality health care. We call attention to one measure before the Congress that seriously deals with each of the points which we suggest needs to be addressed in improving the program per- formance of Medicare. The legislation is S. 1456, the Compre- hensive Medicare Reform Act of 1975. The product of more than two years of study, this measure, which incorporates the key recommendations of the 1971 White House Conference on Aging, offers a comprehensive approach to meeting the health needs of the aged. Federalize Medicaid--A second high priority in our view is the necessity to federalize Medicaid. It is apparent that the only - 5 - way to overcome the shortcomings of the Medicaid program is to follow the experience which we have gained in the income- maintenance area and have the federal government assume the primary responsibility for standardizing the Medicaid program. The present Medicaid program meets neither the principle of equity nor the principle of allocation efficiency. There are great variations in coverage of different families and indi- viduals who are equally poor. There is also coverage in some states for persons who are not poor, and no coverage in other states for those who are. We have 52 different programs with 52 different benefit packages. Long-Term Care--The recent disclosures of abuses in nursing home facilities has stimulated both executive and Congressional review of our nation's long-term care sector. We see a specific need for an elevation of the discussion from one focused on incremental reform to one which places an emphasis on the optimum use of our health resources by developing a health- social services delivery system. We solicit the President's support in the elevation of the priority given to long-term care. Legislation has been intro- duced in the Congress by Congressman Conable of New York to establish a comprehensive national policy on long-term care as part of the Medicare structure. Senator Beall of Maryland will be introducing the Conable measure within the Senate with certain technical amendments to perfect the delivery mechanism. Given the inability of present public policy to stimulate sufficient quality resources to meeting the special needs of the chronically ill, there is growing support for a federal stimulus to organize available community resources at the local level and under local control for the provision of such care. Presidential acceptance of the program-design suggested in the Medicare/Long- Term Care Act would be consistent with the Administration's efforts to encourage alternatives to costly institutional nurs- ing care and to stimulate retention of individuals within their communities through the mobilization of local resources. Restrain Health Care Inflation--Although our Associations are not in favor of blanket economic controls, since such controls produce great disruption and misallocation of resources in essen- tially competitive markets, we are prepared to accept the im- position of selective controls as a first step toward restraining inflation in the health sector. The economic stabilization pro- gram was reasonably effective in suppressing the rate of infla- tion in health care costs. In the absence of such controls, we have witnessed a wholly unacceptable rate of price increases - 6 - which result in an increase in both the Medicare program costs and the out-of-pocket expenditures of the Medicare recipient. Our Associations would favor vigorous action by the President, first, to return to controls with respect to the health indus- try and, second, to propose more fundamental reforms which, when implemented, would make the controls unnecessary. We believe that long-term control of the problem of rising health care costs will require the imposition of prospective budget- ing for institutional providers, stronger internal controls on the part of hospital management, regional health resource planning, containment of physician charges beyond negotiated assignment, implementation of the professional standards review organization network to assure proper utilization of health care services, and controls on third-party insurance reimburse- ment policies. SUPPLEMENTAL SECURITY INCOME PRIORITIES We must emphasize that the Supplemental Security Income pro- gram has worked to the betterment of most eligibles. While inflation has eaten away many of the real gains which the pro- gram payment levels had aimed to secure and while the process- ing of claims has fallen short of expectations, comparatively speaking, the Supplemental Security Income program is a major improvement over the earlier federal-state matching grant-in- aid programs for income maintenance for the aged, blind and disabled. We emphasize this point because we fear that assort- ed criticism of the program may create an unhealthy climate of regression rather than progression. We would encourage the President to reaffirm his support of the program. The major thrust of such reaffirmation could be through calling for a raising of the benefit levels under the SSI program to the standard set by the Community Services Administration Income Poverty Guidelines.* The significance of this change would be to provide the minimum income support which the aged, blind and disabled deserve. The original consideration of the Title XVI program was steeped in the politics of the Family Assis- tance plan. While we recognize the numerous economic trade- offs, which occur at the margin in discussing an income main- tenance program for those who are capable of gainful employ- ment, the shamefully low assistance levels presently advanced in the SSI program neither provide the dignity, which should be shown to the aged, blind and disabled for whom alternative * See Appendix B. - 7 - sources of escape from poverty are unavailable, nor sustain an independent living within the mainstream of community in- volvement, which is the essential thrust of related social programs administered by the Department of Health, Education and Welfare. Sincerely, John John B. B. Martin Mastin JBM:sgd FORD LIBRARY 'y 07V839 APPENDIX A SECTION 3. LIBERALIZE PROVISIONS OF THE RETIREMENT TEST Despite basic agreement with the concept of the retirement test, the Council recognizes that negative consequences arise from its application. Under the present $1-for-$2 withholding rate for earnings above the exempt amount, the additional earnings a beneficiary re- ceives over the exempt amount may result in little additional net income to the worker when allowance is made for the additional effects of Federal income, OASDHI, State, and local taxes, in addition to work-related expenses. Thus, the retirement test discourages work by healthy and able individuals aged 65-71. At the moment there is much concern over unemployment, but recent and current low birth rates will soon cause a decline in the rate of increase in the labor force. The Council is, therefore, concerned with provisions of the law which may act to discourage participation in the labor force. In addition, the burden of the retirement test probably falls most heavily on low-income individuals who do not have access to private insurance, pension plans, savings, or other sources of nonwork income to supplement their social security retirement benefits. Such indi- viduals are most likely to be dependent on additional income from gainful employment to supplement social security benefits after "retirement." The Council believes that the most appropriate means for mitigating the disincentive effects of the retirement test and the heavy burden it imposes on low-income workers aged 65-71 is to reduce the with- holding rate on earnings which are just above the exempt amount. The Council proposes to establish three levels of earnings that would be subject to different reductions in benefits. The first level would include earnings up to the annual exempt amount as defined in the present law ($2,520 in 1975). As under the present law, no benefits would be withheld from earnings within the first level. The second level would include earnings between the annual exempt amount under the present law and twice this annual exempt amount ($2,520 to $5,040 in 1975). Earnings within this level would be subject to a withholding rate of $1 in benefits for each $3 earned, instead of the present withholding rate of $1 for every $2 earned. The third level would include all earnings in excess of twice the annual exempt amount under the present law (i.e., $5,040 in 1975). The withholding rate at this level would be, as under present law, $1 in benefits for each $2 of earnings. The provision of the law which automatically adjusts the exempt amount assures that the second level of earnings, to which the $1-for-$3 withholding rate is applied, will increase in the future as general levels of earnings rise. The main effect of this liberalization would be a significant reduction in the benefits withheld from individuals who earn between one and two times the annual exempt amount. For example, under present law, a worker who earned $5,040 in 1975 would have $1,260 of social security benefits withheld. Under the Council's proposal, this indi- vidual would have only $840 withheld, corresponding to a 1/3 reduction in the burden of the retirement test. The table below illustrates the effect in 1975 of the proposed reduction in withholding rates for earn- ings in the second level. The percentage reduction in the amount withheld is greatest at the lower level of earnings, where the needs of social security benefit recipients may be presumed to be greater. Withholding Withholding Percentage under under reduction in present proposed amount Annual earnings law liberalization withheld $2,520 0 0 $5,040 $1,260 $840 33.3 $7,560 2,520 2,100 16.7 $10,080 3,780 3,360 11.1 It is estimated by actuaries of the Social Security Administration that this liberalization of the withholding rate would increase the cost of the program by an average of 0.04 percent of taxable payroll over the next 75 years (about $0.6 billion for months in 1976, the first full calendar year). APPENDIX B* CSA poverty guidelines for all States except Alaska and Hawaii Family size Nonfarm family Farm family 1 $2,590 $2,200 2 3,410 2,900 3 4,230 3,600 4 5,050 4,300 5 5,870 5,000 6 6,690 5,700 For family units with more than 6 members add $820 for each additional member in a nonfarm family and $700 for each additional member in a farm family. CSA income poverty guidelines for Alaska Family size Nonfarm family Farm family 1 $3,250 $2,750 2 4,270 3,620 3 5,290 4,490 4 6,310 5,360 5 7,330 6,230 6 8,350 7,100 For family units with more than 6 members add $1,020 for each additional member in a nonfarm family and $870 for each additional member in a farm family. CSA income poverty guidelines for Hawaii Family size Nonfarm family Farm family 1 $2,990 $2,540 2 3,930 3,340 3 4,870 4,140 FORD LIBRARY is GERALD 4 5,810 4,940 5 6,750 5,740 6 7,690 6,540 For family units with more than 6 members add $940 for each additional member in a nonfarm family and $800 for each additional member in a farm family. * Chapter X, Part 1060, Title 45, Code of Federal Regulations, Attachment A. GENER hold WE PRI of The Council of State Governments FCb: STATE GOVERNMENTS November 13, 1975 Mr. James H. Falk Associate Director Domestic Council The White House Washington, D. C. 20500 Dear Jim: You will recall that I promised to send you a letter concerning the National Symposium on Aging / that will be held in Washington on Thursday and Friday, February 26-27, 1976. These sessions will be the culmination of a cooperative HEW-CSG project designed to prepare and disseminate the best possible suggested state legislation in the field of services and assistance to senior citizens. A major portion of the attendance will come from state and local elected officials and administrators of programs for the aging. The National Symposium will come at a point in the project when we have identified priority issues for States through regional forums. We will have drafted suggested state statutes and will be considering policy issues highlighted in the forums. The purpose of the Symposium will be to explore the broader implications of these issues for the quality of life of older Americans. Naturally, the thrust of federal goals and priorities in this area is of great import, and our activities would be greatly enhanced by White House participation. We would be honored if the President or his representative would address the Sympo- sium on the morning of February 26 at the Mayflower Hotel in Washington. Dr. Arthur Fleming, Commissioner of the Administration on Aging, joins me in urging that The White House and Domestic Council play an appropriate role in the Symposium. Dr. Fleming has over the years worked with us on a number of projects which sought to improve inter- governmental relations. Both of us believe that this is another worthy effort in that direction. Cordially, GM Brevard Crihfield Executive Director BC:id FORD LIBRARY is 938870 DEC 81975 P BOX IRON WORKS PIKE TEI (606) 252.2291 ES Aug 94th Congress 1st Session } COMMITTEE PRINT CONGREGATE HOUSING FOR OLDER ADULTS Assisted Residential Living Combining Shelter and Services A WORKING PAPER PREPARED FOR USE BY THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE NOVEMBER 1975 Printed for the use of the Special Committee on Aging FORD LIBRARY is GERALD U.S. GOVERNMENT PRINTING OFFICE 58-430 WASHINGTON : 1975 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price 80 cents PREFACE President John F. Kennedy, in his "Message on Aid to Elderly Citizens" in February 1963, focused at one point on "a substantial minority" of older people who, "while still relatively independent, require modest assistance in one or more major aspects of daily living." To help them-and to defer their potential need for nursing home or hospital care-President Kennedy proposed group residential facili- SPECIAL COMMITTEE ON AGING ties "with housekeeping assistance, central food service, and minor FRANK CHURCH, Idaho, Chairman nursing from time to time." HARRISON A. WILLIAMS, JR., New Jersey HIRAM L. FONG, Hawaii Soon after the Kennedy message, several Federal agencies worked JENNINGS RANDOLPH, West Virginia CLIFFORD P. HANSEN, Wyoming EDMUND S. MUSKIE, Maine cooperatively to establish pilot projects in Georgia, Nebraska, and EDWARD W. BROOKE, Massachusetts FRANK E. MOSS, Utah CHARLES H. PERCY, Illinois Ohio. These projects are still very much in existence, and there is EDWARD M. KENNEDY, Massachusetts ROBERT T. STAFFORD, Vermont much to be learned from each of them. WALTER F. MONDALE, Minnesota J. GLENN BEALL, JR., Maryland But the logical next step-a national effort to help assure semi-inde- VANCE HARTKE, Indiana PETE V. DOMENICI, New Mexico pendent living to older persons with impairments of one kind or an- CLAIBORNE PELL, Rhode Island BILL BROCK, Tennessee THOMAS F. EAGLETON, Missouri DEWEY BARTLETT, Oklahoma other-has been taken only partially. JOHN V. TUNNEY, California Congress, in 1970 1 and again in 1974, enacted legislation authoriz- LAWTON CHILES, Florida ing "congregate" units and facilities in federally assisted public hous- DICK CLARK, Iowa JOHN A. DURKIN, New Hampshire ing. One reason for the concern about the elderly in public housing was their fairly large numbers: about 40 percent of the heads of house- WILLIAM E. ORIOL, Staff Director holds in such projects are 62 and over. Another is the fact that many DAVID A. AFFELDT, Chief Counsel residents have lived in such units for many years and have a high VAL J. HALAMANDARIS, Associate Counsel ratio of chronic illnesses or disabilities. JOHN Guy MILLER, Minority Staff Director PATRICIA G. ORIOL, Chief Clerk For reasons made clear on the following pages, public housing con- gregate authority has not been widely used. And yet, as the author says SO emphatically: Prepared by Marie McGuire Thompson, Commissioner, U.S. Public As could be anticipated, an increasing number of public Housing Administration, 1961-67 housing agencies are faced with the fact that either they must (II) evict the more frail or impaired who cannot sustain the shop- ping, cooking, or heavy housekeeping chores designed for the hale and hearty, or they must develop-on a crash and, per- haps, ill-founded basis-some semblance of the services these aging occupants need to maintain at least semi-independence in a residential setting. This warning is worthy of immediate examination and, indeed, it recently received attention at a hearing by the Subcommittee on Housing for the Elderly.2 That hearing, however, was not limited to congregate shelter in public housing, just as this working paper is not. Rather, the public housing situation serves as an early indicator of the extent to which the need for assisted group living will grow unless that need is more fully understood and acted upon. 1 Legislation introduced by Senator Williams was incorporated as a section of Public Law 91-609, the Housing Act of 1970. 2 "Federal Response to Housing Needs of Older Americans Service Needs of the Elderly in Public Housing,' by the Subcommittee on Housing of the Elderly, Senate Special Com- mittee on Aging, Oct. 7, 1975. Washington, D.C., Senator Harrison A. Williams, Jr., pre- siding. (III) IV As the author of this working paper puts it: Although particular attention is paid to public housing in this report, the principles underlying the program enacted in 1970 and reaffirmed in 1974 are equally applicable to the de- velopment of congregate housing under other public programs or in the private market. Tenant characteristics and basic op- CONTENTS erations will be similar even though the financing and spon- sorship may differ. Page Additional perspective on the potential need for congregate hous- Preface III ing was provided at the recent hearing by a witness 3 who estimated Introduction 1 that better than 3 million older persons in the United States today PART 1 can be considered to need assisted housing. Of these, 2.4 million are candidates for residential congregate housing with services. If the Background 4 Early support for the congregate housing concept 5 services are not provided, said the witness, the entire 3 million may be Early experiments in congregate public housing 6 forced to resort to nursing homes-80 percent of them unnecessarily. The Toledo and Columbus, Ohio, developments 6 At a time when there is much talk about so-called alternatives to in- The Alma, Ga., development 7 stitutionalization, it would seem that congregate housing should rank The Burwell, Nebr., development 7 high. Additional experience in South Dakota and Texas 8 Statutory authority for a national program 8 At a time when the Federal share of nursing home expenditures is Status of the program today 10 almost $4 billion yearly, the need for less costly alternatives becomes even more obviously urgent. PART 2 The Subcommittee on Housing for the Elderly and the entire Sen- The potential resident population of congregate public housing 12 ate Special Committee on Aging are in the debt of Marie McGuire Size, age, health, and income characteristics of potential population 12 Thompson for writing this working paper and for sharing it so Population size 12 generously with members of this committee and the entire Congress. Age 13 Health 14 Dr. Thompson has, over a period of decades, insisted that human Income 16 considerations are at least as essential in housing as are financing Who can be served 17 considerations and physical design. Moreover, she has backed up her Guides to measure functional capacity 18 thinking with action. As executive director of the San Antonio Public PART 3 Housing Authority from 1949-61, she paid special attention to the shelter needs of the elderly. A demonstration project, Victoria Plaza, General planning and design considerations 21 Site selection 22 won national attention and still serves as a model public housing proj- Development size 23 ect for gerontologists and architects. She then served as Commissioner Kitchens and bathing arrangements 24 of the U.S. Public Housing Administration from 1961 to 1967 and Dining and other spaces 25 later served the Department of Housing and Urban Development as Licensure 26 a specialist on housing for the elderly and handicapped. Since 1973, PART 4 she has been housing specialist for the International Center for Social Gerontology. Operational considerations 27 Roles and functions of management and staff 27 Her working paper is timely and thought-provoking; and her rec- Tenant selection 28 ommendations are worthy of extensive consideration by Congresional Terminating occupancy 30 units with an interest in housing or aging, or both. In the interest of Congregate meals service 30 providing information and ideas needed for full public discussion of Meeting the costs of meals and services 32 Group activities 33 the wide range of housing needs of older Americans, the Subcommittee Linkages for housing and services 35 and Committee are happy to offer Dr. Thompson's working paper for review and thought. PART 5 FRANK CHURCH, Chairman, Conclusion 36 Special Committee on Aging. Recommendations: Congress 38 HARRISON A. WILLIAMS, Jr., Chairman, Department of Housing and Urban Development 38 Department of Health, Education, and Welfare 38 Subcommittee on Housing for the Elderly. State governments 38 Local housing authorities 38 dential Washington, D.C. Dr. Donahue also gave this definition of congregate housing Gerontology, "A resi- 3 Wilma Donahue, Ph. D., director of the International Center for Social The future 39 hygiene, tenants and transportation, which are required to assist impaired, but not 111, personal elderly environment which includes services, such as meals, housekeeping, health. (V) as they grow older." to maintain or return to a semi-independent life style and avoid institutionalization VI PENDIXES Page in Toledo and Columbus, Ohio 41 "A Place With a Plan for Total 43 rovided to Worley Terrace residents by Department of Mental Hygiene and CONGREGATE HOUSING FOR OLDER ADULTS 44 executed between the State of Ohio ropolitan Housing Authority and ap- By Marie McGuire Thompson* Government 45 Commissioner, U.S. Public Housing Administration, 1961-67 greement between the State and the (Toledo) 49 INTRODUCTION 52 52 The congregate public housing program provides local housing au- 52 between the Alma Housing Authority thorities with an opportunity and a challenge to expand the choices ontractor 54 now available to low income older persons to select a living environ- meals facility 57 ment best suited to their personal and social needs, functional capaci- ties, and financial resources. Enacted in 1970 as part of the Housing 58 58 and Urban Development Act, the program encourages the develop- 59 ment of residential settings to accommodate older people, as well as handicapped and displaced persons, who need some services to sustain independent living but not enough to warrant institutional supervi- sion and care. Statutory authority for the program was retained in the 1974 Housing and Community Development Act (title II, section 201 (a) (7) It is assumed that programs will be funded and activated if they fulfill the goals of the legislation and the related HUD regulations. Local and county housing authorities have already established a successful record in providing residential environments for older peo- ple who can and prefer to live independently. Since 1956, in over 3,000 localities throughout the United States and its territories, they have helped develop some 600,000 specially designed dwellings to as- sure low-income elderly persons safe, comfortable shelter at rents they can afford. These accommodations also provide tenants with an active environment filled with a wide range of social, recreational, and leisure pursuits to offset loneliness and improve the quality of their retire- ment years. Even today the number of applicants on waiting lists for these units far exceeds the number of dwellings available. However, many tenants now in public housing have "aged" in their present quarters as have those in private housing in the community. As could be anticipated, an increasing number of public housing agencies are faced with the fact that either they must evict the more frail or impaired who cannot sustain the shopping, cooking, or heavy housekeeping chores designed for the hale and hearty, or they must develop-on a crash and, per- haps, ill-founded basis-some semblance of the services these aging occupants need to maintain at least semi-independence in a residential setting. There can be little doubt that the demand and need for resi- dential living with basic services will increase dramatically within the next decade, and probably more markedly after that. The number of "middle-old" and "old-old" aged Americans is *For additional biographical details. see preface. Dr. Thompson received editorial assist- ance in preparing this report from Mr. D. J. Curren. (1) 2 3 growing faster than that of almost any other age group. Given Although particular attention is paid to public housing in this such a trend, there will be greater and greater need for assisted report, the principles underlying the program enacted in 1970 residential living arrangements with services similar to those and reaffirmed in 1974 are equally applicable to the development rendered in a family setting for an older relative. of congregate housing under other public programs or in the Congregate housing is one achievable answer to this imminent rise private market. Tenant characteristics and basic operations will in demand and need. Under the congregate public housing program, be similar even though the financing and sponsorship may differ. local housing authorities can provide residential environments for their tenants who are substantially intact and well elderly, but whose functional capacities are somewhat limited due to diminished physical or mental energy, impaired mobility, or special social or economic con- ditions. This type of housing resource planning is an alternative to institutional living when that level or extent of supervision and care are not required. Other similarly impaired elderly, already in institu- tions, might return to semi-independent living if they could relocate in a setting which includes access to services designed to strengthen their capacity for self-support in a living arrangement more attuned to their desire to continue to participate in community life. For other low-income older persons who are becoming frail through advancing age or diminished capacities, congregate public housing could serve as a "next step" program, providing a range of services to sustain their maximum potential for self-management and thus reduce any unnecessary dependence on inappropriate, costly institutional care. The distinguishing characteristic of congregate public housing, and one critical to its success in serving the special needs of this portion of the low-income older population, is the range and quality of services available to sustain independent living among tenants whose functional capacities vary at different stages of the aging process. In the planning, design, and operation of this type of public housing, housing authori- ties will need to reach out and establish linkages with other local resources, since the provision of coordinated multiple services will require careful planning in order to adapt them to tenant require- ments. Together with local service agencies, housing authorities will need to explore ways to coordinate Federal, State, and local support now available to help provide housing and services at costs that tenants can afford. They will also need to study ways in which local and national programs (such as those funded under the Older Americans Act or title XX of the Social Security Act) can help provide reason- able assurance of continuity of services in the future. Finally, housing authorities will need to develop and foster a new kind of management and staff who are trained in general property management and tenant- landlord relations but also are skilled in relating housing and service support to each tenant's need and capacity to live successfully in a con- gregate residential environment. This report is designed to assist public housing officials and others working with them to consider the major factors affecting the design and scope of congregate housing for the elderly. These factors include the particular population and area of need to be served; special fea- tures involved in the planning and design of congregate housing; issues which may arise in relation to management and staff responsi- bilities, such as the meals service and group activities; and sources of support to cover the full costs of providing housing and services to residents on low, fixed incomes. 58-430-75-2 5 difficulties, or to explore its potential benefits as a residential alterna- tive for large numbers of the frail aged who need housing with basic services in addition to leisure and recreational activities. EARLY SUPPORT FOR THE CONGREGATE HOUSING PART 1 CONCEPT BACKGROUND In 1950, the first National Conference on Aging stated that it "felt a definite handicap that complete data are not available on the appor- There is no single meaning or definition of the term "congregate tionment of older people by types of living arrangements, such as housing" upon which all agree. The term is used loosely in this coun- independent living quarters, homes (shared) with married children try to describe any type of collective or group living arrangement, or relations, boarding homes, or congregate living quarters." supervised or not, ranging from large scale, campus-type develop- In 1961, the White House Conference on Aging recommended that ments to small cooperative housing projects or boarding homes some- "a Federal definition of terms relating to various types of institutions times organized by older people themselves. and care be formulated SO that there can be a common understanding Nor does "congregate" fully describe the nature and purpose of this of terms generally used for allocation of funds and financing to meet type of housing. It is, however, the term used in the 1970 and 1974 the continuum of independent-to-dependent living arrangements." The Housing and Urban Development Acts to describe housing with food range of types of needed housing was outlined by delegates and firm and other services for the elderly under provisions of the low rent recommendations were made to proceed with the development of vari- public housing program. ous levels of housing and services. One definition of congregate housing is: President John F. Kennedy, in the following excerpt from his a residential environment which includes services, such message on Aid to Elderly Citizens (issued February 21, 1963, cf. as meals, housekeeping, health, personal hygiene, and H. Doc. 72), recommended group residential facilities as a comple- transportation, which are required to assist impaired, but not ment to Federal provisions for independent living (which had been ill, elderly tenants to maintain or return to a semi-independ- enacted in the period from 1956 to 1959) and a nursing home pro- older.* ent life style and avoid institutionalization as they grow gram (enacted in 1961) Congregate public housing can be best understood as another resi- GROUP RESIDENTIAL FACILITIES dential environment for the elderly which is adapted in design and For the great majority of the Nation's older people, the operation to the realities of the aging continuum. It can be expected years of retirement should be years of activity and self-reli- to serve those of a more advanced age, those with decreased ance. A substantial minority, however, while still relatively and mobility levels, and those who retain the capacity and desire energy for independent, require modest assistance in one or more major as much self-management as possible. In short, such a setting offers aspects of their daily living. Many have become frail physi- aids to continued community living, thus delaying or avoiding pre- cally and may need help in preparing meals, caring for living mature reliance on institutional care. Congregate public housing is quarters, and sometimes limited nursing. neither a care home nor a medical facility; it is residential in char- This group does not require care in restorative nursing acter. The services provided to tenants should be related to and be homes or in terminal custodial facilities. They can generally consistent with this residential atmosphere. They should offer neither walk without assistance, eat in a dining room, and come and continuous supervision nor skilled nursing care. Instead, services go in the community with considerable independence. They should aid tenants in managing the range of activities of daily inde- want to have privacy, but also community life and activity pendent living such as housekeeping assistance as needed, personal within the limits of their capacity. They do not wish to be aid in special circumstances, and the preparation of nutritious, bal- shunted to an institution, but often they have used up their anced meals. resources, and family and friends are not available for sup- The purpose and value of congregate housing for the elderly have port. What they do need most is a facility with housekeeping been recognized and discussed for more than two decades by govern- assistance, central food service, and minor nursing from ment officials, professionals in the field of aging, and older people time to time. The provision of such facilities would defer themselves. But until now little has been done to encourage its devel- for many years the much more expensive type of nursing home opment throughout the country, to resolve financing and operating or hospital care which would otherwise be required. [Em- phasis added.] tology, Washington, D.C. *Developed by Dr. Wilma T. Donahue, director, International Center for Social Geron- To meet the special needs of this group, facilities have been constructed in many communities, and many more should (4) 6 7 be constructed. Such buildings can be small, with facilities project boasts one dining room while the Columbus project has a for group dining, recreation, and health services; and they series of small dining rooms in different locations in an attempt to should be integrated with the various community resources simulate a family-size grouping, a concept imported from Sweden which can sustain and encourage independent living as long and more expensive to operate. (Additional design and operational as possible. I am requesting (a) that the Housing and Home information on both are provided in appendix 1, p. 41.) Finance Administrator give greater emphasis to the con- In Toledo, 30 of the 100 residents were dischargees from the Toledo struction of group residences suitable for older families and State Hospital and 56 of those in the 256-unit Columbus project were individuals who need this partial personal care, and (b) that from the Columbus Hospital or from nursing homes. Since more mas- the Secretary of Health, Education, and Welfare, using the sive services were provided in Columbus, the age of the tenant group funds under the proposed Senior Citizens Act and other re- was higher, averaging 84 years at initial occupancy. In each project sources already available to his Department, work with com- all staff concurred that without a development of this kind with three munities to assure that health and social services are pro- essential services-meals, housekeeping, and personal assistance when vided efficiently for the residents of such facilities in needed-at least 50 percent of the residents would have to turn to accordance with comprehensive local plans. nursing homes. Indeed numerous occupants have been transferred from public housing for independent living to congregate housing as EARLY EXPERIMENTS IN CONGREGATE PUBLIC their need for services became essential to continued residential living. HOUSING THE ALMA, GA., DEVELOPMENT² Following this Presidential directive, the Housing and Home Finance Agency, the Public Housing Administration, and the De- The Alma, Ga., project is a one-story development with 40 units of partment of Health, Education, and Welfare cooperated in formulat- congregate housing (without kitchens) and 12 housekeeping units with ing joint policies on housing and services. A formal agreement was kitchens. The tenants in congregate housing are provided a full meal signed between the Commissioner of Welfare for HEW and the service for $45 per person per month those in housekeeping units may Commissioner of the Public Housing Administration to work together also participate if notification is made to the kitchen. A strong buddy to support efforts by local housing and welfare agencies to imple- system exists between the hale-and-hearty older persons and others less ment a congregate housing program. able. The development is located next to the county hospital and a Because there was no statutory authority to provide Federal support nursing home. The meal service (originally provided by the hospital) to cover the costs of central dining rooms and kitchens, equipment, meal is now provided under a private contract and prepared in the kitchen preparation, and other services, these early efforts were limited to of the project. The congregate units with no kitchen do have a small pilot congregate housing projects in Alma, Ga.; Burwell, Nebr.; and Toledo and Columbus, Ohio-all of them communities where State There are no formal housekeeping services; heavy housecleaning is refrigerator and a counter for a hot plate, coffee pot, toaster, et cetera. and local support was strong and included contractual guarantees performed by the maintenance staff. (For further details, see appendix to provide meals and other services. In all cases, local hospitals 2, p. 52.) provided the meals service. THE BURWELL, NEBR., DEVELOPMENT 3 THE TOLEDO AND COLUMBUS, OHTo, DEVELOPMENTS 1 This 50-unit project, occupied in 1967, consists of 30 housekeeping one-bedroom units in five brick buildings and 20 new housekeeping The two congregate public housing developments approved for units in the congregate living area which is part of the community Toledo and Columbus, Ohio, accommodated elderly patients relocated building with recreation room, community living room, and kitchen from State mental institutions as well as elderly persons from the for tenant gatherings and events. Occupants are provided a living- community. The State accepted responsibility for the additional sleeping room, bath, and storage. Meals are prepared and delivered construction and operating costs of supporting the dining service, three times a day, 7 days a week, by Community Memorial Hospital provided staff for recreation and health programs, and guaranteed and Nursing Home located a block from the project. Meals cost $2.70 the provision of supportive services for the full 40-year financing a day. Income limits for occupancy are $3,500 for one person and period of both developments. These experiments were successful and $4,000 for two persons. Areawide recreation and craft programs are proved to be economical to the State. In Columbus, the Department provided under title III of the Older Americans Act. Featured in of Public Welfare's Homemaker Service is headquartered in the de- the community dining room are a double fireplace and round tables velopment and is available to tenants at no cost. The homemakers also with captain's chairs. (Additional details are provided in appendix 3, assist with bathing or dressing upon request. Approximately 50 percent p. 58.) of the tenants avail themselves of the housekeeping service. The Toledo Experience in Burwell and in Alma, towns considerably smaller than Toledo and Columbus, evidences the ability of congregate public 1 Program detail was contributed by Patrick J. Feeny, director, Columbus Metropolitan Housing Authority, and by staff and personnel of the Ohio State Mental Hygiene and Correction Department and the Ohio Commission on Aging. 2 Information contributed by Wilfred B. Smith, executive director, Alma Housing Authority, 801 12th Street, Alma, Ga. 3 Contributor: Dorothy Van Diest, executive director, Housing Authority, P.O. Box 899, Burwell, Nebr. 8 9 housing in all sizes of communities to provide a residential environ- (12) The Secretary shall encourage public housing agen- ment which includes services required to assist impaired, but not ill, cies, in providing housing predominantly for displaced, elder- elderly tenants to maintain or return to a semi-independent lifestyle ly, or handicapped families, to design, develop, or otherwise and thus avoid institutionalization as they grow older. As the man- acquire such housing to meet the special needs of the occupants ager of the Burwell congregate development stated: "All tenants and, wherever practicable, for use in whole or in part as living in the congregate facility would be in a nursing home if it were congregate housing: Provided that not more than 10 per not for this type of housing and the services provided." centum of the total amount of contracts for annual contribu- tions entered into in any fiscal year pursuant to the new ADDITIONAL EXPERIENCE IN SOUTH DAKOTA AND TEXAS authority granted under section 202 of the Housing and Urban Two other congregate public housing developments in South Dakota Development Act of 1970 or under any law subsequently enacted shall be entered into with respect to units in congre- and Texas, while not part of the original experiments undertaken in the mid-1960's, should be noted as well. gate housing. "As used in this paragraph, the term 'congregate housing' The Felix Cohen Memorial Building on the Pine Ridge Indian means low-rent housing (A) in which some or all of the dwell- Reservation in South Dakota is composed of a large community center for many reservation activities and is combined with a limited number ing units do not have kitchen facilities, and (B) connected with which there is a central dining facility to provide whole- of rooms with bath for elderly Indians.⁴ Furnishings, art, and sculp- some and economical meals for elderly families under terms ture were contributed by friends and associates of the late Felix Cohen. and conditions prescribed by the public housing agency to Meals are prepared and delivered by the adjacent hospital. The oper- ation of the facility, which is part of the family public housing on permit a generally self-supporting operation. Expenditures the South Dakota reservation, is more related to the culture of the incurred by a public agency in the operation of a central din- Oglala Sioux than to the usual congregate concept, but it has served ing facility in connection with congregate housing (other and continues to serve a need. than the cost of providing food and service) shall be consid- ered one of the costs of administration of the project." In Texas the Housing Authority of Mineral Wells leased a number of rooms with bath in a vacation-type hotel typical of the city for the Statutory authority was now provided for a congregate housing permanent use of low-income older tenants. The room rent is con- program which included coverage of the costs of the dining facility and tracted for and the hotel provides a full meal service commensurate equipment. No subsidy, however, was provided to cover any deficit with the ability of tenants to pay. caused by the inability of low-income elderly tenants to pay the full cost of meals and other services. This meant that tenants would have STATUTORY AUTHORITY FOR A NATIONAL PROGRAM to be selected according to their ability to pay rather than on the basis of their need for housing with services. This fact, as well as a wide- It was not until 1970 that a nationwide congregate public housing spread lack of experience in a new kind of housing management which program was enacted into law as a supplement to successful low-rent required relating housing and services to the functional capacity of residential developments for independent living for the elderly. Rec- each tenant, probably have made most housing authorities reluctant ognition of this gap in housing and its tragic personal consequences to enter this field. As a result there has been little production of con- for those not needing or desiring institutional care led to the enact- gregate housing and little encouragement to do so.⁵ If responsibility ment of the program in section 207 of the 1970 Housing and Urban for aspects of service and care were shifted to State and local agencies Development Act. Section 114 of this act also provided for congregate skilled in these areas, the building or acquisition of appropriate con- housing by private groups under FHA sections 221 (d) (3) and 236. gregate housing facilities would undoubtedly be accepted willingly by follows: Provisions in the law relating to low rent public housing read as local public housing agencies, the majority of which have programs for the well elderly but few local service-oriented facilities in which to 50 STAT. 895; 42 U.S.C. 1415 relocate tenants who can no longer maintain fully independent living. After enactment of the program, releases from the Department of CONGREGATE HOUSING FOR THE DISPLACED, ELDERLY, Housing and Urban Development emphasized that "congregate hous- AND HANDICAPPED ing will serve those who cannot sustain or do not desire independent living in housekeeping units." It was acknowledged that although this SECTION 207 type of housing must be free of architectural barriers, its success would Section 15 of the United States Housing Act of 1937 is be related primarily to the range and quality of services available to amended follows: by adding at the end thereof a new paragraph as tenants. With regard to the meals service, the HUD Management Guide for Congregate Housing (H.M.G. 7460.1) stated that "many of the congregate housing tenants will not be able to afford the entire cate *This of their rights. He is credited with securing voting rights for all Indian a tribes. strong 4 The late Felix Cohen was a distinguished scholar of Indian affairs and advo. the New Senate Jersey. then chairman of the Senate Special Committee on Aging and Williams, a member Jr., of of section was suggested and sponsored by Senator Harrison A. 5 In contrast, housing authorities have responded well to the need for conventional housing for the elderly 3,511 of these authorities operate in 4,676 localities throughout Banking, Housing and Urban Affairs Committee. the United States, with developments especially for the aged operating in more than 3,000 localities. 10 11 cost of the food service program. Some sources of regular subsidy- a grand scale. Despite statutory authority for without it, we local can State or local, public or private-will have to be found in order to gram expect on little effort to develop this type of housing make the food service in congregate housing financially feasible." today or State support for food and services being reasonably guaranteed. should In 1971, as one effort to solve this problem, meetings were held with Until this support is assured, imaginative housing agencies the Department of Agriculture to obtain permission to use food stamp proceed that State and local service agencies can provide the necessary to develop such needed living arrangements by devising funds ways coupons to pay for meals in congregate housing. Although not pro- hibited by law, this use was not permitted by departmental policy to supplement construction dollars available from HUD. which restricted food stamp use for meals prepared outside the home Whatever final decisions are made on the public housing program not to those prepared in restaurants. This ruling was changed as of July the need for congregate housing in one form or another will grow, other 1974 to allow elderly persons over the age of 60 to use food stamps as only for elderly tenants in public housing, but also for persons in in- payment for prepared meals in noninstitutional settings and com- terest of groups. States, cities, and public and private developers in providing Center income Recognition of this is evidenced by the increasing munal dining facilities if the meals service was approved by the Food and Nutrition Service, was nonprofit, and did not use federally such facilities for a range of income groups. The International studies donated food in meal preparation. Part 270.2 (m), chapter II, title 7 for Social Gerontology, a nonprofit research organization, has the of the Code of Federal Regulations was amended to include communal underway to more clearly define the congregate housing concept, will also dining facilities as consistent with section 10(h) of the Food Stamp potential occupants, and services needed. In November 1975 it assisted Act of 1964, as amended. hold the first national conference on congregate housing, or to In 1972, with the passage of the National Nutrition Program for residential living, to delineate the services needed, the resources afford this the Elderly, some public housing developments which had the neces- sary space began serving free meals to their tenants and to older per- type of living, and the market and need for this housing program. provide them, the costs in relation to incomes available to sons in the neighborhood. However, the scope of this program did not Without administrative or legislative action at all government environ- levels, provide the long-term guarantees for food and other services required institutional care facilities will continue to be the final living in congregate housing to assure its financial feasibility. As a result, ment for too many older persons who could maintain an independent that building or remodeling facilities to accommodate the provision of food the glaring in the housing continuum for some of the older popula- lifestyle with a minimum of assistance. Yet there is little doubt and other services could not be justified. Delegates at the 1971 White House Conference on Aging again. tion is the need gap for a program that is residential in nature, provides those called for a national statement of goals on providing a spectrum of community orientation for the occupants, and also provides housing for the elderly which would respond to the level of assistance supportive services that maintain the resident in this living arrange- life but they required at various stages of the aging process. These included ment despite chronic conditions or frailty. Adding years to long-term facilities for the sick; facilities with limited medical care depriving the elderly of the opportunity to remain active in society and and with food and homemaker services for those who needed continual to the fullest extent of their capacities creates self-pity, apathy, the supervision and assistance; congregate housing with food and per- despair among many older people. It also robs the community of sonal services for those who required some assistance but not medical and contributions of its most experienced citizens. Primarily the most care and who sought independence with security; and housing for presence then, the concept of congregate housing should be seen as that independent living with recreational and activity programs provided. viable solution to premature reliance on institutional care when With regard to the recommendation on congregate housing, Dr. Wilma level of medical supervision is not required. T. Donahue, director of the International Center for Social Geron- tology and one of the planners of the 1971 conference, observed: It is significant that these recommendations were made nearly a year after the Congress had passed a bill, which the President signed on December 21, 1970, making provision for congregate housing for the elderly. It is perhaps because there was a long lag in implementing the act that the dele- gates to the conference in December 1971 did not address themselves to its provisions and possibilities. STATUS OF THE PROGRAM TODAY The inability of many low-income older persons to pay for food and other services, in addition to rent, remains the major barrier to the nationwide implementation of the congregate public housing pro- 6 Toward a National Policy on Aging, Proceedings of the 1971 White House Conference mendation IV. on Aging (Washington, D.C.: U.S. Government Printing Office), volume II, p. 32, recom- 58-430-75-3 13 offer nursing care even though not all residents may need it. Of the 27 million persons over age 60 living in housing units, it is estimated by one authority that 200,000 to 300,000 would choose to relocate in con- gregate housing each year. Most of this number would probably be PART 2 single or widowed women, a group which has demonstrated a strong desire for companionship, independence, personal service, and security THE POTENTIAL RESIDENT POPULATION OF in their living accommodations. Numerous studies of elderly occupants of nursing homes, care homes, CONGREGATE PUBLIC HOUSING and State institutions indicate that a number of them had no choice of An understanding of the probable characteristics of the any other residence because there were no alternative accommodations resident population must underlie the design and operation potential of adapted to their levels of competence. A recent survey of nursing homes stated that: of the an adequate response to the diversity of need among this pro- vide gregate housing. It is obvious that no single type of housing will con- an astonishing number of the people should not be there and housing types and residential settings oriented to consumer variety need of older population. Instead, efforts must be made to offer a segment at all. Every critical student of nursing homes has come to that conclusion, they vary only on the percentage of population for whom varying types of congregate housing would the be preference. This chapter identifies some characteristics of healthy patients. The U.S. General Accounting Office, after studying a sample of patients in Michigan, concluded that of appropriate. Subsequent chapters discuss the planning and almost 80 percent (297 out of 378) did not require skilled in facilities to accommodate this group as well as factors involved design nursing care. A 1971 study of New York City medicaid pa- congregate housing operation and management. tients in nursing homes, by the State comptroller's office, found that from 53 to 61 percent of the patients did not need SIZE, AGE, HEALTH, AND INCOME CHARACTERISTICS to be there. Daphne Krause of the Minneapolis Age and Op- OF POTENTIAL POPULATION portunity Center, which has studied homes in that area, gave a figure of 30 to 40 percent. In Cleveland, the head of the There is no way to assess specifically the current need or demand nursing home medicaid program put the proportion of pa- congregate public housing except by inference from our for tients unnecessarily in homes under her jurisdiction at 90 and stages of the aging process. Specific numbers, income people at various observation, and knowledge of the housing needs of older experience, A percent.⁷ study in England determined that 95 percent of the elderly could housing adequacy alone do not reflect the potential market levels, live independently, i.e., not in institutions, if adequate home care this congregate housing among the older population who might choose for and other services were provided. A Danish study of the aged divided realities type of residence if it were readily available. However, given them into three groups: Group 1, representing 80 percent of the undertaken of growing old and considering the early results of the elderly, were able to manage fully on their own; the 10 to 15 percent that in the preceding chapter), a valid assumption can be (ref- erenced by the International Center for Social Gerontology surveys in group 2 needed some help but not that provided by an institution; and only the 3 to 4 percent in group 3 needed institutional care (this environment an increasing number of older people will require a made latter group compares with the 5 percent of older Americans in insti- to offset premature reliance on an institution supportive or to tutions). In Denmark, housing and service programs are designed afford them an opportunity to leave one and relocate elsewhere. to remove or prevent difficulties which cause the aged to be classified in group 3. Among the many programs there which bolster inde- POPULATION SIZE avoid any slide into group 3 through a loss of interest in life precipi- pendent living are special vacations for those in group 2 to help them include people in the United States who need or prefer living quarters that Data are not available from which to predict the number of older tated by inactivity or withdrawal. sonal provisions for both independence and some nonmedical AGE care. were living in group quarters that did not provide aged and older services. According to the 1970 census, 593,000 persons per- 60 The 1970 census figures also give us some insight into the current Another 238,000 resided in "other" types of group nursing trend toward longevity among older Americans. They should provoke including be mental and other hospitals. Some portion of this latter quarters, serious analysis of our existing housing programs for the aged and and might social enabled to live outside these facilities if appropriate shelter group should reinforce our efforts to provide a spectrum of varied living for environments were available. The same might also be true arrangements for this growing number of older people who will live some portion of the 277,000 persons living in old age homes that longer and will manifest a greater diversity of housing preferences (12) Mary Adelaide Mendelson, Tender, Loving Greed (New York: Alfred A. Knopf, Inc. 1974). Distributed by Random House, N.Y. 15 14 This same survey showed that 3.1 percent of the men and 6.9 percent and functional competencies. Although competence was not a factor of the women in the 65-79 age group had diabetes; 47 percent of the in the census statistics, conclusions were drawn which foretell the men and 55 percent of the women had lost all natural teeth but had sat- components: dimensions of the emerging need for congregate housing with service isfactory dentures; 17.7 percent of the men had moderate to severe eye defects, 49 percent had mild defects, and 33 percent had good vision. From what we know now, we can count on large numbers of With respect to orthopedic defects, 17.4 percent of the men and 19.7 elderly in the future. They will be better educated, and prob- percent of the women were affected. ably more affluent than today's older people. Fewer will be The problem of incontinence in later years is erroneously thought to working. Unforeseen breakthroughs in medicine-especially be widespread. Yet the survey of occupants aged 65 to 74 in nursing in the fields of heart ailments and cancer-could mean longer and personal care homes revealed that 77 percent had no problem; 7 life expectancy. percent had a partial problem; and 16 percent had complete disability. In the decade 1960-70 there was a 13 percent increase in In the group aged 85 or older, 68 percent were not affected by the total population but a 21 percent increase in the elderly. In just half a century there has been a gain of 20 years of life incontinence. Diminished hearing is another characteristic of the older age group. for the average person. In addition, the average age within the The rise of impairment in hearing as people age is quite dramatic- elderly group has also increased. Those 75 years of age and the rate of impaired hearing for persons 65-79 is about 40 times that over represent 38 percent of the elderly group.⁸ for those 18 to 24 years of age. The percentages of people with some Another view of the increasing life span among the aged (which hearing impairment range from about 7 percent for the middle- of speaks to the size, age, and health of the potential occupants of con- aged group to 30 or more percent for the older group. Many cases those gregate housing) is: half of all people now 65 and older are age 73 or hearing impairment can be improved by a hearing aid. Among more. Of every 100 older persons today, 63 are under age 75; 31 are 45 or older with a hearing loss in both ears, about one in five uses a between ages 75-84; and six are 85 or more years old. It has been cal- hearing aid, according to data from household interviews in the sur- culated that there has been a 700 percent increase in the population vey. 10 This characteristic also has design and operational implications. aged 65 and over from 1890 to 1970. It appears that the maximum Also of significance in considering tenant characteristics is the state- increase in the elderly population in the years ahead will be in the ment in the survey that: over 75 and over 80 age categories. Medical research has shown that the most striking change in recent mortality trends is about 80 percent of persons at about age 85 have some type of disability the widening gap between the death rate for men and that for usually trouble with posture, balance, or mental alertness. women in the older age group. For example, among white men at ages 45-64 the death rate in 1940 was about 50 per- HEALTH cent higher than for white women. In 1950 it was about 80 for women. A similar but narrower divergence characterizes percent higher and by 1968 it was more than double the rate Although a complete health profile of potential occupants of con- gregate public housing is not possible to document, it may be helpful the rates for men and women of races other than white.¹¹ to consider a national health survey that illustrates some of the health conditions which limit activity among the elderly. Perhaps the most significant statistic is the walking status of occu- Arthritis ranked second after heart disease as the major cause of pants 65 years of age or older of nursing and personal care homes: activity limitation among older people. About 271,000 arthritics are in 61 percent had no walking problem; 17 percent had partial disability nursing homes. Yet only 28 percent of nursing home patients with only; and 22 percent were completely disabled.¹² arthritis were bedridden. A 1962-63 survey showed that over 50 percent of all middle-aged men and women had some degree of arthritis. Of category, the health survey report showed that a comparatively small Despite these and other health aspects of persons in the older age those between ages 65-79, some 50.3 percent of the men and 44.9 per- percentage were limited in normal activity due to chronic disease. A cent of the women had moderate or severe forms of arthritis with some full reading of the statistics leads to the conclusion that congregate limiting effect on mobility. On the basis of these findings we can as- housing with food and other services could indeed serve a large group sume that for many or most, including the nonbedridden in nursing of elderly persons who are capable of substantial, though not total, homes, there is sufficient mobility along with general good health independence, given a housing design and a staff sensitive to their to permit occupancy in congregate housing, although extensive arthri- needs. It is only logical to conclude that the benefits of improved medi- tis may require some assistance in bathing and provision for the use of cal care and treatment that have resulted in prolonged life should also design. mobility aids, an important consideration in physical and program result in the opportunity for continued independence even with some limits on mobility. If this is to be a reality for low income older per- U.S. Department of Commerce. Social and Economic Statistics Administration. Bu- 10 HEW Public Health Service, National Center for Health Statistics, "Health in the Office. June 1973), pp. 5. 14. reau of the Census, "We the American Elderly" (Washington, D.C.: Government Printing Later Years of Life." Health p. 28. Service, National Center for Health Statistics, "Health in the 11 HEW Public Center for Health Statistics, "Health in the Later Years of Life" (Washington, D.C.: Gov- 9 U.S. Department of Health, Education, and Welfare, Public Health Service. National Later 12 HEW Years Public of Life. Health p. 7. Service, National Center for Health Statistics, "Health in the FORD ernment Printing Office, October 1971). Later Years of Life," p. 51. GERALD LIBRARY 16 17 sons, congregate public housing is one answer. It should be made available in some relative proportion to the number of dwellings for governments are essential to help meet the shelter and service needs of fully independent living and be located in the same neighborhood. many low income elderly. These programs serve as a backup to hous- ing for the well and active elderly and help make public housing agen- cies more responsive to the needs of the growing number of persons INCOME living well into the older age categories, at a time when their meager On the subject of income (which relates to the ability to pay for savings are being eroded by inflation and their need for services is institutional care) the 1970 census indicated that 19.2 percent of the increasing. Although there are always costs to consider in launching 7 million elderly heads of households had annual incomes below the any comprehensive program, it should be evident that congregate poverty level in 1969. The older population had exactly half the housing will help save some of the funds now spent to provide insti- annual income ($4,200) of the population as a whole, while older per- tutional environments for many who do not need that kind of expert sons not living in families had median annual incomes of only $1,813.14 care. The census also showed that of the Nation's 63.4 million occupied WHO CAN BE SERVED housing units in 1970, 17.5 million were headed by a person aged 60 or older. 15 Of these, 12 million were owner-occupied and 5.5 million were No single definition can encompass all applicants for congregate rented. The largest group of the elderly lived in the central cities of housing, but it can be expected that they will represent various age metropolitan areas. Proportionately, however, the aged formed a larger groups (usually those more advanced in years), different levels of health, and a broad range of functional capacities. Some will be able segment of the population in small towns than they did in cities, to maintain an independent life style with only minimal use of sup- suburbs, or farms. In towns of 1,000 to 2,500 inhabitants the elderly represented 13.6 percent of the population. 16 These figures indicate portive services; others more dependent will require a variety of social, that in planning housing programs, we should not overlook the need personal, and health services to carry out daily activities. Among them there will be successive stages of decline in energy and mobility levels to build in small communities to enable older persons to continue to live among friends and relatives in their own home towns or in towns and, as a result, a lesser degree of self-reliance and possibly self-con- fidence. But most will have consciously selected a congregate living where they have resided most of their adult lives. Statistics for New York City reveal yet another profile of the plight arrangement because they desire to live as independently as they can of some older Americans in securing housing and services. Out of and are willing to utilize services to sustain that life style. Managers and staff should be aware of this positive motivation for self-reliance 947,878 persons aged 65 and over (12 percent of the city's population), one of every three was age 75 or older; three-fourths suffered one or and reinforce it regularly, especially to counter any symptoms of with- drawal which may occur among those who become discouraged by more chronic health ailments; over half had incomes of $3,000 or less; and a third received $2,000 or less a year. In testimony before the U.S. advancing age and the limitations on mobility which often accompany Senate Special Committee on Aging, New York City officials said that it. older people needed a wide range of services in their homes and neigh- Can the robust and vigorous aged be combined with the more limited and successful in a congregate housing development? There They concluded: borhoods, yet such services were almost nonexistent or too expensive. is no categorical answer either way. No doubt the less competent aged will apply in greater numbers because they need the kind of services The kind of environment in which an older person lives out available. Applicants may also include the mentally retarded, the his retirement years, his level of income, and the opportunities physically handicapped, and those with one or more chronic health for constructive use of leisure time are as essential to positive problems, but all of them can be expected to be motivated by a physical and mental health as are the number and quality of desire to remain active in the community to the limit of their ability. It hospitals, doctors, and nurses. Older people, given a decent is suggested that if the hale and hearty elderly are housed with the income and a range of supportive services within the com- more frail and impaired, the percentage of the latter should be kept munity, have shown that they can live with chronic illness and well below that of the well and active. Among applicants there un- still function positively as members of society. doubtedly will be a large proportion of widows, some of them just Congregate housing with services was recommended, with provi- beginning to adjust to living alone and welcoming the kind of warm neighborhood as well as to tenants. sions for these services to be made available to the elderly living in the and stimulating friendships that often flourish in group living situations. From these statistics and observations on the age, health, housing, Although this report focuses primarily on congregate public hous- and income of the older population, it can be readily inferred that ing for the elderly, it should be noted that this type of housing can congregate housing programs assisted by Federal, State, and local also provide the shelter and services needed by the moderately and severely handicapped as well as mildly retarded adults, many of whom Incomes 13 U.S. and Department of Housing and Urban Development, "Older Americans: Facts About are now unnecessarily in institutions. It can offer a familial setting 14 U.S. Housing" (Washington, D.C.; Government Printing Office, October 1973), p. 7. 15 Department of Commerce, "We the American Elderly,' p. 12. with surrogate parents and services. It can be a resource for profession- "Housing U.S. of Department Senior Citizens," of Commerce, HC (7)-2. Notice to Correspondents, November 16, 1973, on al organizations whose members are skilled in the delivery of services 16 U.S. Department of Commerce, "We the American Elderly," pp. 6, 7. to particular groups and recognize the importance and need for the 18 19 most normal possible community-based living environment. Provision cedures functional capacity of the applicant. Preference may given result, for screening and selecting tenants should be related be primarily to of this type of housing can be accomplished through leasing arrange- ments with local housing authorities under which these organizations to the people whose health is good and whose expectations, individual's as a poten- would retain full responsibility for management functions or through older essentially different from those who are ill. An seriously. agreements under which the housing authority would contract for or are tial for living harmoniously with others should be weighed the perform the managerial functions. The restraints might be those per- are some relatively objective guides to help direct process with taining to income limits on eligibility as well as occupancy and con- struction standards. Since the 1974 Housing and Community Devel- of tenant in institutions, they suggest practical measures by The first There screening and selection.¹⁷ Although developed for which use to tally disabled, congregate housing would serve those needing assistance opment Act specifically covers the housing needs of the developmen- patients person's level of function and degree of competence. developed at assess these a guides is the Physical Self Maintenance Scale for with daily living activities. Other physically or mentally handicapped the self care. The second, also developed at the center, the of Philadelphia Geriatrics Center to measure a person's capacity is the persons could sustain completely independent living arrangements. It must be emphasized, however, that while many handicapped per- personal Instrumental Activities of Daily Living Scale which measures community. sons need only the removal of architectural barriers to be able to live handicapped or retarded would require a more concentrated residential in the usual types of housing and environments, the more severely The Living (ADL), measures the relationship of functional to eval- capacity third scale, called the Index of Independence in capacity of an elderly person for continued living in the Activities of milieu in order to ensure the provision of needed services. The 1974 Daily the accomplishment of daily activities. It provides a means bathing, Housing and Community Development Act now makes it possible for to functional independence or dependence in six categories: unrelated persons to share rooms and bath in HUD-assisted develop- uate dressing, toilet performance, transferring (from a prone to an upright ments, thus permitting a most sensible solution for meeting the needs of such groups. Group housing programs are usually recommended for position and back again), continence, and eating. evaluation process similar to that guided by these standards three scales, to the physically or mentally handicapped who need assistance with nor- mal activities. Experience in European countries has demonstrated the in An particular the ADL Index, would be useful in setting activity guide in congregate housing. On the highest scale (independence live inde- tenant selection as well as facility design and pro- in social and economical advantages of such housing, especially when its in a normal neighborhood undoubtedly is the preferred solution if costs are compared to those of institutions. Community-based housing grams all six categories) the applicant would obviously be able to to dividends. training programs for normalization are to yield their expected pendently for weakness such as impaired vision. Those independent in all six but might require congregate housing with services com- in pensate all but one category a might be eligible, but those dependent variations In addition to generating the construction of new facilities, it is would require alternative housing arrangements. (These suggested that interested organizations or individuals investigate the underscore the importance of utilizing skilled intake procedures.) use of well-located existing housing, including foreclosed or HUD- The evaluation of an elderly person's locus on the independence-to- with acquired housing, and encourage local public and private housing dependence scale could be made in three stages. For example, she could sponsors to respond to the special housing needs of these groups as as a condition of HUD-financed assistance. part of the recommendations of the housing assistance plan required regard bathe alone in a sponge bath, tub, or shower. On the other hand, leg or to bathing, a person would be independent if he or he she need help in bathing only one part of the body, such in as these a The underlying principle of congregate housing-providing living the may back, or may need total help to bathe at all. If ranked considered and mentally handicapped persons. Of course, the emphasis in design, arrangements with supportive services-is viable for many physically latter or two categories, however, he or she still should be operational details, and staff training will require some adaptation eligible for congregate housing. and modification. With respect to dressing, a person may be able to get dressed for with- tying GUIDES TO MEASURE FUNCTIONAL CAPACITY shoelaces help; or fastening a back zipper, or may need total help. out he or she may be able to get fully dressed except Being ranked in the first two categories should not exclude an applicant would. The functional level of applicants can be measured in part by care- from congregate housing, but being in the third and final reasonable one to with an assist from services should be certified by a physician, prefer- ful health screening procedures. Their ability to remain independent In applicants to be fully independent. When continence the third ADL category-toilet performance-it is is con- ably on a standard form developed by the local housing authority. sidered require as a factor in selection, full independence should be required to This is important because the applicant or his or her family may not although occasional accident might be expected. With regard he she recognize or acknowledge the presence and influence of seriously transfer ability, an a person would be considered independent if of or diminished capacities which could hinder a successful adaptation to a congregate living environment. can or some other support. If the person is not ambulatory to some get in and out of bed or a chair alone even with the use degree, a cane to a thoughtful and sensitive plan. In general, the policies and pro- It is obvious that the selection of tenants should be made according the 17 For section. a description "A Symposium of these on guides the Assessment and their development of Functions and of rationale. the Aging see Adult," papers The in Gerontologist, Vol. 10, No. 1, Spring 1970, pp. 18-53. 58-430-75-4 20 he or she should not be in housing. In the final would be required ADL cate- temporarily It is providing meals to an ill person in his her for those with arthritis except for or health (such as aide a nurse in the care home if he or she resides there applicant suggested that a doctor or other person attending or the room. his her who serves the person who lives in the or a home PART 3 and or identify competence in performing activities of independent community) verify Although not any other serious health problems he or she living GENERAL PLANNING AND DESIGN should and psychological be characteristics as well as his social measured on the ADL Index, an individual's may suffer. CONSIDERATIONS of considered in making a thorough, informed process they need to be evaluated in the screening and selection adaptive when abilities Allow me to emphasize again that congregate housing for the aged factors suitability. is The essential concern in judging these determination is neither a care home nor a medical facility. It is a residential envi- needs to function to ascertain what type and how much assistance and physical ronment offering services to sustain self-reliance. The services assure more, sponsoring concern housing authority should manifest as regard, the adequately in congregate housing. In this a person not only material comfort but also social, recreational, and cultural activities adapted to a wide range of individual functional capacities. stantial summary, while exact figures are unavailable, there operation. In for the individual as for a successful housing much, if not As a result, provisions for a service component should be included throughout the process of planning and designing congregate housing pendently portion of the older population who able is a sub- facilities. The range, type, and extent of services to be provided will growing need provided some degree of assistance is are readily to live inde- be determined generally by the characteristics and needs of that por- housing is for the limited assistance offered in available. The tion of the aged population to be accommodated. Some of the types cannot are afford relatively to healthy but frail, who have low persons who still caused by the increasing number of elderly congregate public of services that might be matched to tenant needs are listed in the fol- lowing chart. complete, functional living. For those elderly persons with independent or semi-independent buy the services needed to support incomes, and who NEEDS AND SERVICES FOR CONGREGATE HOUSING RESIDENTS available in relative impairment, congregate housing should some, but not Needs Services hood. living and should be located in the same dwellings neighbor- for fully independent proportion to the number of local be made Satisfaction and social Supportive Developmental Protective Survival Food, clothing, shelter, Love, recognition, Financial, health, Recreation, employment, Service to assist income, health, belonging, crea- housing, nutri- education, crafts, reli- individuals security. tivity, recreation, tion, transporta- gion, cultural events, seriously impaired participation, tion, information social activities, library by mental or achievement, and referral, legal services, volunteering, physical meaningful aid, homemaking, telephone reassurance, dysfunction. activity, counseling, friendly visiting, resident Similar to self-respect, day care, discount organizations. supportive self-sufficiency, services. services. social status. Although aging people are changing people, their personalities, long established preferences, and psychological need for continuity in social relationships persist and should be respected in designing any type of living environment for them. Architectural criteria developed for pub- lic housing for the well elderly will also be applicable to congregate housing, with special added emphasis on safety from accidents, ac- cessibility for the handicapped, and simplicity of arrangement to en- sure minimal housekeeping requirements and compactness for con- venience and economy. This chapter discusses other special factors re- lated to site selection, size of the development, apartment kitchens, bathing arrangements, and general spaces which should be considered in the design of congregate housing. (21) 22 23 SITE SELECTION marily on its proximity to health, social, and recreational facilities, trained health-sustaining services such as giving shots, taking Others health personnel are essential to handle crises and to blood counter that, given the chronic health problems of tenants, provide The selection of a site for congregate housing should be based pri- shopping areas, and public transportation. Because this type of hous- minimal supervising or administering medication, and when providing needed, con- in- ing is designed to assist less energetic people to continue to participate pressures, and referral to appropriate health centers Podiatry in the community, it should be in an active area where there is easy sultation placement in a skilled nursing facility if required. services. It is orientation to various age groups who reside, work, shop, and play in cluding dental care should be included among these minimal would give the area. If shopping is not convenient, serious thought should be and that medically trained person on the premises help is given to including the essential commodities in the development. The argued residents a greater a sense of security knowing that competent their mental planner must also remember that because there may be crippled or at and often affecting their physical well-being, justifies any Geriat- hand when needed. This assurance alone, benefiting extra handicapped residents, excessive slopes and the need for steps should be negotiated on minimum ramps. avoided. Changes in levels should not be included unless they can be cost, rics Center states a general principle with which these proponents to health it is concluded. Dr. M. Powell Lawton of the Philadelphia mobility and a decreasing sense of orientation, the location of struc- Since the environment must be adapted to those with lessening agree: in his own treatment is a critical item in any decision in-house "The capacity of the individual to seek medical care or about par- an tures and spaces becomes more important. There also should be more attention to the exterior social environment to encourage residents to health component include office space in the development trained appropriate ticipate living situation for him." Alternatives to an for private move around outside and not remain sedentary indoors. Attractive physicians or a focal point on the premises rented to a person walks around the grounds with benches for resting and conversation as to handle health emergencies. well as displays of scheduled events all help offset the tendency to withdraw. Plants, kiosks, open-air restaurants, fountains and basins, DEVELOPMENT SIZE aviaries and fish ponds, flower and other markets as well as attrac- tions on the main thoroughfare might be considered. A day center in Experience in other countries strongly indicates that small develop- of 20 to 30 units are more desirable for residents of congregate the building or nearby which attracts older neighbors could be planned as part of the environment to broaden contacts and interests. ments housing. Simple scale is essential if each tenant is to be familiar met. to the and staff and to have his or her needs adequately All places where tenants gather, indoors or out, should enable them This manager does not mean that congregate housing must be one type only. to to observe and be stimulated by the ongoing behavior of more active There can and should be variations from a small planned home people. The coming and going within a development is as important as group the to see everyone who comes and goes and to be responsible a housing of varying size and design. A concierge plan, enabling activity associated with the street scene. We should expect that con- gregate housing sites will be clustered near maximum traffic areas rather than in isolated areas even though the latter may be beautifully planned and furnished. number of large homes have been remodeled into small bed/sitting for manager each resident, has been used with success abroad. In some places room activity and service centers. Through convenient, easily- much flats. Some older houses have been combined with new structures Another important factor in site selection is its proximity to a health health facility without assistance, would alleviate the necessity use for nosis and treatment of residents. This would permit tenants to the facility to handle crises as well as provide convenient access for diag- containing managed accommodations and through encouragement to do that as older and in-house health component, and would provide a resource to housing an for people gained confidence which led to greater independence and to themselves and for others as possible, it has been found fuller, service staff for consultation. happier seven or eight residents was adequate for managerial duties lives. Experience abroad indicates that one housekeeper in several There are two contrary views about the relationship of medical fa- cilities to congregate housing. Some feel strongly that health care is the developments. The British Ministry of Housing has set standards for building units old cilities should be used as a base from which to deliver home proper concern of the community and its resources; that geriatric fa- ices to the community. Why then, they ask, should health-oriented care serv- fa- people's rare. This ruling has the added benefit of dispersing concentrations. homes SO that properties containing more than 75 the elderly are cilities be placed in housing as a potential detraction from the residen- very small rather than packing them into large difficult to tial atmosphere and as a daily reminder of disease and death? In-house in Economic groups considerations apparently make it increasingly build such housing in less than 100 units in this country. Yet structure experi- or reinforce a sense among tenants that they are isolated from cause the services shared with no one from the outside, they add, may also ence size alone conveys an institutional atmosphere. Studies for the dictates that a set of small buildings is preferable to one in Bel- sonnel ing facilities would lead to an underutilization of scarce medical community. Some argue that small scattered medical programs in hous- whose and the Netherlands include mention of a "care home" well. The gium frail elderly surrounded by small units for those who are limited and, even if staffed by doctors and nurses, would render per- lems wing and an outpatient clinic, would serve a range of chronic prob- care. Proximity to a hospital, particularly one with a geriatrics only services of the care home are available to both groups. In event, congregate public housing should be "homey" resident and with more expertise, they conclude. uncomplicated, any putting the least possible demand upon the and and providing him or her with a world of familiar objects spaces. 24 25 Although economy of scale can be justified in housing for the well sociability among tenants and guests. Snack kitchens located on each elderly, the emphasis in congregate housing should be on tenant need, floor have not proved feasible primarily because of the problem of on managerial capability to have knowledge of each tenant, and on identifying and safeguarding the individual's food to prevent its use programs which offset any feeling of isolation from society. The im- and consumption by others. Floor-by-floor kitchens have proved to be personal atmosphere often prevalent in large developments could well a management problem and have not achieved their purpose. defeat the purpose of congregate housing. Moreover, the older person The second alternative is to furnish apartments with small portable who is experiencing some decline in functional competency is more equipment that can be easily removed when tenants become too frail sensitive to change in his or her environment than are middle-aged or or disoriented. Wide fireproof shelves with convenience outlets and fully active older people. A small place where one is known and where a small cupboard are provided to hold hotplates, small ovens, toasters, one feels a sense of belonging tends to bring happiness, joy, and com- coffee pots, and refrigerators, with the water supply drawn from the fort. bathroom. Kitchen equipment should be easy to remove or to be dis- The proven value abroad of small intimate structures or groupings connected when safety requires it. In Europe small equipment is less might suggest to this country a wider use of rehabilitated existing expensive than larger models, but in this country we can expect that dwellings for congregate housing for the aged, when properly located small equipment produced for special luxury purposes might not and economically feasible. represent an economy. Another area of concern in the dwelling unit is the bathing arrange- KITCHENS AND BATHING ARRANGEMENTS ment. Most older women today prefer a tub. However, if concern is for safety and self-management, a sit-down shower appears essential, One area of controversy in congregate housing is whether or not given the impaired mobility to be expected among some tenants. If to provide individual kitchens or kitchenettes in each apartment. The there must be soaking for therapeutic reasons, one tub for general use law governing the program permits them to be in all apartments or may be installed. However, this arrangement tends to be institutional in some or in none. Despite the requirement of a central meals service and the tub is rarely used unless lifts, operated by an attendant, are in the development, many social scientists believe that it is important available. Every effort must be made to design a bathroom that most to include at least a minimal kitchen in individual dwellings. They re- can use without assistance. gard it as particularly significant for former housewives, long ac- A 24-hour switchboard is a preferred emergency alert system, but customed to cooking, to be able to prepare some snacks between meals if this is not possible, an alarm bell should be in the bathroom as well or refreshments for visitors. Thus a semblance of independence is re- as by the bed and should be monitored 24 hours a day. The bell system inforced. The kitchen area is seen as important also because it may in- also should automatically open the apartment or room door. clude a refrigerator for cold drinks and ice and cabinets for storage of Finally, it is of the utmost importance that, if a unit is to be occu- one's own china, glass, and favorite coffee pot. From this viewpoint, the pied by a married couple or by two persons, there must be two connect- kitchen is a sustaining aspect of everyday life and permits a degree ing rooms to permit privacy from one another due to different time of self-respect, self-management, and personal identity sometimes lost and activity schedules and also to permit isolation during illness. in communal dining. Others argue that if one is too frail to shop and prepare his or her DINING AND OTHER SPACES own meals regularly, one would be ready to release the full responsi- bility for these tasks to management and rely on staff expertise to as- Because the nature of congregate housing differs from that of sure nutritious balanced diets. In addition, at times there may be dan- housing for independent living, the spaces allotted for staff and other ger to the tenant and others by exposure to a stove or hotplate in an activities will differ. There must be room to accommodate managerial apartment kitchen. The gas may be turned on, but not ignited; the and maintenance functions, housekeeping functions, possibly a general electric stove may be on but, if not glowing, may well burn an unsus- laundry and sewing room for clothing repair, a central dining room pecting tenant or guest with diminished alertness and agility. Forget- and kitchen, and possibly one general bathroom with a lift or hoist. If fulness and temporary disorientation can be expected to occur among medical facilities or therapy rooms are provided, these add another tenants from time to time. There has been ample experience of the dimension to consider in assigning space. need to remove cooking equipment from some units as the tenant ages. In spaces intended for group activity the main concept must be to There may be occasions when the extra costs of kitchen plumbing, bring people together and not isolate them from each other, even space, and equipment in individual quarters will cause congregate when different activities are underway. Adequate space is needed housing to exceed feasible limits. Without individual kitchens, the de- for participants and observers alike. All activity spaces should be vis- velopment then becomes a hotel or club living arrangement. ible, easy to find, and on the ground floor. Color coding of the walls Two solutions to this problem have been developed in Europe. The and floors plus the use of graphics, plants, and other distinctive objects first is to provide a snack bar (generally related to the dining room) will be helpful in pointing out directions and decreasing disorientation where hot or cold drinks, ice, cookies, fruit, and other pick-up items and fear of embarrassment. may be obtained at all hours. Food may be consumed in the immediate Design of the dining area is of particular importance. Large spaces area or taken to one's room. This concept has been found to promote in the room should be broken up either by walls or half-walls, planters, 26 furniture, or other devices. Ten to 15 people in an area encourage social interaction and rapport. Large spaces are more impersonal and lonely. Tables should vary in size, ranging from those accommodating two persons to those for eight. Small round tables are pleasant for inti- mate dining and chairs with handles are recommended. Tenants should be allowed to choose their dining companions. Decorations should be PART 4 gay and cheerful, and be changed occasionally to spark interest. Fresh flowers always are enjoyable. The dining room should be open to OPERATIONAL CONSIDERATIONS natural light, have a view of the outdoors, and be near the lobby or its extension to afford a view of the street scene and to provide a space The success of the day-to-day operation of congregate housing re- for waiting before meals. Dining is the main occasion of the day for quires attention to several factors the special relationship and respon- many, and groups may be expected to form and stay together in the sibilities of management and staff to the individual tenant; the food adjoining lobby before and after meals for conversation and other and housekeeping services; a mix of group activity programs; and activities. Lobby space also can provide overflow space for dining knowledge of and familiarity with local resources to tap in establish- guests. ing and maintaining linkages for the provision of shelter and services. Opinion is divided as to whether meals should be served or offered This chapter touches briefly upon major considerations in each area. cafeteria style. Many frail elderly, especially the handicapped with mobility aids, may not be able to manage their trays without help. ROLES AND FUNCTIONS OF MANAGEMENT AND Having meals served at one's table adds a touch of dignity, particularly STAFF at the dinner meal, and especially if the waiters or waitresses are teenagers. One achievable combination that provides food selection Because congregate housing is designed to provide a residential without having to carry a tray is the popular salad, dessert, and bev- environment in which older people can receive services to sustain inde- erage tables with the entree served. (For additional details, see part 4.) pendent living, its management and staff will assume roles and func- In summary, the ideal to aim for in planning for general spaces as tions different from their counterparts in the management of housing well as other previously mentioned features in congregate housing is for the well elderly. In addition to their usual responsibilities for the to provide the right home, in the right place, at the right time, with care of property, rent collection, and personnel selection and training, the right services. Rightness, as discussed here, means planning the managers will have overall charge of the: design, location, and interior atmosphere to fit the age, health, and personal preferences of the frail elderly. -Screening and selection of suitable tenants. -Development and/or supervision of a nutritious food program. LICENSURE -Arrangement and overseeing of housekeeping and personal serv- ices delivery. Another complicating factor is the term "congregate housing" which -Provision of leisure time activities related to tenant capacities and refers to many different kinds of living arrangements with a wide local resources. range of functions, and this creates confusion. Some States may require -Arrangements for 24-hour surveillance. licensing of housing which provides service elements. State laws vary -Development of procedures for handling emergencies. both in concept and in semantics. If licensing is required, this may While warmth, understanding, and mutual respect are character- entail more construction costs to provide institutional design features istics of all successful housing management, in congregate housing even though the Department of Housing and Urban Development stip- there is required an additional awareness of the health profile and ulates that congregate housing is to be distinctively residential in functional competency of each tenant. Occupants will be further reas- character and not institutional. Under licensing regulations, unneces- sured by the ability of the manager and staff to respond to any health sary and rigorous qualifications for staff would be required, thus boost- or accident emergency due to age or partial disability. In order to ing operating costs. know and use nearby medical facilities, managers and staff must estab- Federal and local building standards should suffice since congregate lish cordial relations and specific arrangements for assistance with hos- housing is not conceived of as a "care" or "health" facility as defined pitals, nursing homes, and other health resources when these are not by the nomenclature used by most States. The HUD Guide on Con- available in any in-house medical unit. gregate Housing Management states on the subject of licensing: It is obvious that 24-year surveillance by the resident manager or "Where licensing requirements are imposed by State or local licensing an alternate is essential in congregate housing. After office hours the officials, the sponsor will submit evidence that the proposal will meet emergency call system should operate in either's quarters. At no time the applicable State or local agency guidelines and requirements." must the alert system be unmanned. Many have found that the 24-hour Since licensure may make congregate housing infeasible, the sponsor switchboard is the best solution, with the telephone provided by the should make clear that its project is a residential development with services and not an institution. (27) 58-430-75-5 28 29 development as a utility service comparable to gas, lights, and water. sonal services. As time passes, valet service and care of clothing may If the manager or the alternate do not have a health services back- be required in addition to meals served in the room during illness. In ground, training should include some time spent in health or institu- other countries we find such tasks performed by "matrons" or "war- tional facilities to learn basic approaches to emergency care. Doctors, dens" substituting for the services that would be provided in a family nurses, medical corpsmen, and hospital aides may be available to offer setting. Finally, the cost of rent, food, and services must be within the this training in emergency care to housing management or even to paying ability of the tenant if the selection of tenants is to continue act as housing managers. to give priority to those with the greatest need. Food subsidy or a Once a resident's feeling of insecurity in time of need is supplanted sharing of food costs may be essential to operational feasibility for by a sense of being secure, needed, and wanted, his or her spirit tends the elderly at or near the poverty level. to revive, causing a heightened interest in daily living and a decrease As has been repeated many times throughout this report, the chief in the scope and volume of daily complaints. All occupants will be concern of management and staff should be the well-being of each relieved of the necessity of daily meal preparation and heavy house- tenant, responsiveness to his or her needs, and measures to ensure his keeping in compensation for their frailty. With their personal posses- or her safety and comfort. A tenant's life may depend on prompt sions retained in a cordial atmosphere, tenants will feel a sense of action by trained staff in the manager's absence. As in all aspects of continuity with their former lives, while the manager and staff will congregate housing, the management must recognize that for some tend to be regarded as an anchor to windward, a strong leadership tenants there will be a thin line between independence and depend- symbol for security and stability as well as for the stimulation and ence, at least temporarily. But independence should be bolstered and provision of activity and creativity within an environment free from dependence discouraged for any length of time if the residential char- tension. In performing these functions it is suggested that the man- acter of the facility is to be maintained. ager and staff regard tenants as younger people grown older but Unless housekeeping aid is a traveling service, another staff person retaining the habits, virtues, and failings of a lifetime of working, may be a "matron" or "housekeeper" who has charge of scheduled loving, and living. housekeeping assistance, whose day and time for work is known to To reiterate, by providing various degrees of support, congregate and expected by the tenant. This home aide might also provide the housing should help relieve nursing homes and other care institutions required personal care such as help in bathing or dressing for a tem- of those who do not require medical or nursing care and should offer porary period or on a regular basis for some, e.g., those with arthritic another housing resource to sponsors of housing for independent arms or backs or the handicapped. Concern for grooming, care of living whose tenants may need a "next step" type of residence. For clothing, or help in writing letters might be included as well in staff tenants, congregate housing and its management should provide duties. In any event, the housekeeping aid should be carefully sched- opportunity to maintain relationships with the community and should uled and understood by the resident. serve as a shield from the stresses of intergenerational friction or While such assistance may be minimal or temporary, its need should dependence. be anticipated. Some of the "family-type" services could be performed Particularly sensitive areas for management and staff concern are by volunteers, including other tenants organized to offer small services tenant selection and the occasional need to terminate occupancy. to their neighbors. This buddy system may sometimes be more welcome and acceptable to tenants than aid from staff or volunteers who are TENANT SELECTION strangers. Tenant groups can also be formed to alert management and staff to the needs and problems which arise among the tenants them- One area of critical and sensitive concern is the tenant screening selves. and selection process which will be determined largely by the charac- As the physical or mental capacity of the tenant lessens, counseling teristics of the aged population to be served. As factors in the process becomes more significant for meeting financial, health, legal, burial, these characteristics cannot be neatly defined. Some applicants might or other needs, with the management substituting for the family if be able to sustain themselves in housing for independent living, while none is available or calling upon local specialists to handle situations others may be closer to the need for a care or medical facility. Tenant as they arise. At least one private counseling room should be provided selection cannot then be a routine process based solely on age, income, and be large enough to accommodate family members. If this is not or other legal eligibility criteria. The major determinant instead must possible, the manager's office should be used to ensure privacy. be a judgment on the applicant's ability to remain self-reliant with The focus of service programs in congregate housing will be on the aid of services offered in the housing development. Since each aids to independent living in order to offset reliance on medical facili- applicant will see his or her own state of health and competence dif- ties except in those cases where the individual's health has deteriorated ferently, a careful and objective screening process is required. beyond the capacity of the nonprofessional, in-house health unit or Since the characteristics of tenants in congregate housing will vary staff to resolve. The type and limitation on services should be clearly tremendously, and no precise general definition is possible, we can outlined to the applicant and his or her family prior to occupancy. assume that a housekeeping service, at least once a week for heavy Careful handling is needed when a tenant must be removed from cleaning, should be part of the operating plan for the development. congregate housing and transferred to a higher level of care when Some tenants may need help with bathing, dressing, and other per- more intensive services are needed. If possible, the manager should FORD & GERALD 30 31 investigate local resources and facilities, as well as associated costs, against the time when temporary or permanent removal may be re- on Aging, for example, it was noted that many older people of Chinese quired, in order to offer appropriate advice. This should be part of origin suffered much unhappiness in nursing homes because they were not served the kinds of food they were accustomed to and could not the preoccupancy management plan. develop a taste for other diets. This may be only one example, but TERMINATING OCCUPANCY variations in tastes can be expected and adequate responses should be planned. Permanent relocation outside the development is a sad and difficult Meal preparation and service is a highly specialized profession. It period. Family, friends, ministers, doctors, and others interested may be contracted for with caterers, may be supplied by other housing should be consulted and involved in the transfer process. This should developments with expertise in this area, or may be negotiated with not be the full responsibility of the housing manager even though he hospitals, schools, or other similarly equipped organizations. It should can provide valuable aid. In case of death, the manager can help in not be perceived as a service which volunteers (including tenants) can the disposition of the tenant's possessions. Most probably a physician provide regularly even though they may be excellent cooks. Continuity should make the final decision on relocation. It should never be neces- of the meals service must be assured as part of the management plan. sary to resort to legal eviction. Food served should meet the standards for required daily nutrients as The housing authority should formulate specific rules to govern determined by a dietitian, and the premises should be operated in temporary removal: how long the apartment or room will be kept keeping with local health regulations. Because meals are part of the vacant awaiting the tenant's return; what rent will be paid during housing service, tenants have a right to expect them to be handled the absence, and by whom; and what procedures should be followed professionally. Volunteer assistants, however, can be helpful at times. for proper notification when the waiting period is over. If there is a For example, tenant-prepared meals could be planned for those occa- possibility that the tenant may return, 3 months is suggested as a sions when professionals are off duty or for special events or holidays. minimum for holding the premises, providing the rent is paid during Of course, alternatives should be explored before deciding how to this period. Keeping his or her home bolsters the tenant's hope of provide the meals service. Will it be less expensive to have meals return. If there is a reasonable hope that he or she will return, the brought in and perhaps only heated or kept warm in the kitchen peace of mind of the absent ill resident should take precedence over This would offer a savings in space and equipment. In this regard, it a potential new occupant. is best to consult experienced food handlers who do not have a stake In summary, although there is no sharp line between strength and in providing meals to the development. Other housing developments frailty, the presence of services which characterize congregate housing that serve meals might also be an initial contact. Another could be should not decrease the special residential atmosphere created by a local hospital which may be willing to provide meals at cost. A fourth such practices as having the key to one's own door, the right to come alternative would be other local institutions that have learned how and go at will, and the right to expect courtesy, cheerfulness, and to take advantage of the economy of scale in providing food. Probably security. Management and staff will soon be aware that the elderly, the largest "institution" serving meals is the United States military; despite chronic health problems, possess a variety of strengths and aside from any advantage it may enjoy in food purchasing, its expe- resources for meeting their own needs but too often are not encouraged rience would be invaluable. Restaurant associations could also help to utilize them fully. explore the options, showing which methods would be more successful at less cost. In congregate housing for low income elderly, economy CONGREGATE MEALS SERVICE in food costs will undoubtedly be one determinant in choosing a food service method. However, arrangements should be made for the de- Since congregate dining is a central feature of this type of housing, velopment to be the occasional recipient of delicacies which the food a full meals service with required tenant participation is recommended budget would not regularly support, such as gifts of special foods for whether or not some of the dwellings have kitchens. Whereas housing festive occasions. for the well elderly may include some meals service at the discretion of Because a cafeteria provides a greater range of choice, is informal, tenants, it must be remembered that in congregate housing balanced, and saves the work and expense of table service, housing managers nutritious meals are one of the essential services provided to maintain and some tenants opt for it. However, in making this choice, the prob- health and energy among tenants. As a result, the requirement to able characteristics of most tenants should be kept in mind as well participate in the meals service and to meet some of its costs should be as the probability that frailty may increase. Some will not be able to fully discussed and understood by the applicant at the time of leasing. handle a tray in addition to a mobility aid. Those in wheelchairs may As in all aspects of housing management, it should be possible to not be able to see or reach the food, causing an embarrassing depend- have tenant input with regard to meals and the food they enjoy and ence on attendants or neighbors. Uncertain steps, ambling gaits, or prefer. Although certain types of food are necessary to provide essen- trembling hands may cause apprehension and spillage. On the other tial daily nutrients, such expression of dietary preferences should be hand, having meals served at individual tables can add a touch of encouraged. This is obvious for those on specially prescribed diets, graciousness to dining, especially if the menu offers some room for those with chewing or digestive problems, and others with lifelong choice and if, as previously mentioned, the waiters or waitresses are regional or ethnic tastes. During the 1971 White House Conference teenagers (at least on weekends). As a compromise, the entree could be served and a buffet table set up for salad, dessert, and beverages. 33 32 Too often the hours for serving meals are determined by staff and dining spaces. There also may be an added cost for footage and requirements and not by tenant preferences. As a result, meals may that construction because use of nutrition program funds requires serving be scheduled too early or too close together. Experience indicates eligible low income elderly from the neighborhood as well as occupants in most housing developments the main meal is preferred in the eve- in the development. Selective modernization of existing housing with ning. This gives tenants something to anticipate, continues a lifetime Din- a more reliable estimate of the date of occupancy might prove more custom, and enables them to assemble afterwards for socializing. and 6 feasible in determining food and other service arrangements under should be no earlier than 6:30 p.m. Scheduling it between 5 Federal programs subject to annual appropriations. State and local ner is regarded by many as characteristic of an institution fixed and can funds could help resolve this dilemma particularly if the need is p.m. be embarrassing when guests are invited. People also have pat- included in the State plan for the use of funds made available under terns about the hour for breakfast. If possible, this should be flexi- title XX of the Social Security Act. ble to accommodate both early risers and late sleepers. A self-service An increasing number of housing authority developments offer space arrangement open from 7 to 10 a.m. is most acceptable and may also re- for use in providing the meals service funded under title VII of the been found that those who eat breakfast late usually do not quire only one staff person to oversee and replenish stock. It has want Older Americans Act. In other sites informal arrangements have been made for a part-time meals service (generally, a lunch served 5 days lunch but will wait until dinner to eat, thus settling for only two a week) provided by a local service agency. daily meals with small in-between snacks. Others will want three In a study, completed this year, comparing the operations of public meals a day, and these should be offered, although a light lunch (a housing for the elderly and those of the 202 direct loan program, Dr. M. Powell Lawton found that meals were less expensive at the former. sandwich with soup or salad) is acceptable. The best way to discourage hoarding of food in rooms is to provide The mean cost of lunch in public housing (the only meal offered with accessible snack bar with fruit, cookies, and drinks open at any any frequency) was 58 cents, while in the 202 projects the mean cost an and all hours. Vending machines could be set up to offer additional of breakfast was 54 cents; for lunch, 88 cents; and $1.41 for dinner. choices. A portion of the dining room may provide a comfortable familiar Factors contributing to the lower cost of meals in public housing were place to sit and snack and, without question, could become a with the type of personnel preparing meals, the type of meals service, and spot for socializing. It may even become the space most used, the subsidy for meals consequent to their provision by local service music added to enhance its relaxing qualities. In one development, organizations. Tenants prepared meals at 65 percent of the public the dining room is only cleared at 4 p.m. to provide time for dinner housing sites offering them only 10 percent of the 202 sites had tenant- arrangements. It is a favorite gathering and sitting place. prepared meals, while 83 percent employed staff or a concessionaire From time to time it will be necessary to provide meals to sick or to cook. Cafeteria-style service was utilized in 75 percent of the public convalescent tenants in their own rooms. The critical decision involved housing sites as compared to its use in only 28 percent of the 202 is when to terminate this service. In one housing development, for sites. Waitress service was also used more frequently at 202 sites. example, room service is stopped after 3 days unless there is to a The study also indicated that at 94 percent of the public housing physician's statement to the contrary. If the tenant does not return sites meals were paid for restaurant style, i.e., at each meal served; the dining room even though the doctor certifies that he or she can at 50 percent of the 202 sites meals were paid for as taken at 25 percent do only tea and toast are delivered to the room. A checkoff system they were mandatory and their cost was automatically included in at mealtime so, is a good way to be alert to absenteeism and any possible the rent; at 6 percent meals were optional but if taken their cost was included in the rent; while at 19 percent there were other arrangements need for assistance. for payment, such as billing once a month for meals taken. MEETING THE COSTS OF MEALS AND SERVICES GROUP ACTIVITIES Because the law does not provide a subsidy for food and service costs (although kitchen and dining equipment may be charged to adminis- Congregate housing should provide space for group and socializing trative expenses), the local housing authority must select tenants ac- activities not unlike those spaces provided for the well elderly. Al- cording to their ability to defray food and service costs in addition to though we can expect that the activities undertaken will be less vigor- rent. Although the legislation foresaw the need for supportive serv- ous and that there will be more observation and less participation, the ices to sustain the less vigorous elderly in a residential setting, no hous- need of tenants for stimulating activity should prompt serious con- ing funds are available to provide them. As a result, the local housing sideration of the variety of social, mental, physical, and cultural stim- authority must rely on local service agencies to ensure the operational ulae appropriate to their capacities. There should be opportunities in feasibility of congregate housing developments. this environment to perform tasks, to have recreation, and to be self- The title VII nutrition program for the elderly might offer a solu- maintaining. In-house activities should range from those directed tion in some locations if the scheduling of completion of congregate toward occupants with considerable potential for independence to housing can be meshed with the availability of nutrition funds and those suited for persons with limited personal resources. Dr. M. Powell with reasonable assurance that they will continue over the years. Logi- Lawton puts it very well when he states that "the resident's physical cally, this should be required as a condition for approval of the kitchen 35 34 and mental well-being depends on his not being challenged beyond be taken not to develop more than a few essential regulations. Manage- ment and staff will be working with experienced adults, not delinquent his resources." stated that remaining active in some and social social children who need to be disciplined. One successful housing develop- Other psychologists longevity have on physical, psychological, The richer the ment bed." of this type has only one regulation: "You may not smoke in role levels, affects thus a improving person's the quality of it his offers, or her the life. more fully does it LINKAGES FOR HOUSING AND SERVICES program the and need the for more security, opportunities affection, and stimulation. to the elderly Naturally who feel we Since enactment of the Older Americans Act in 1965 and subsequent satisfy some programs to be more attractive who feel entitled to amendments, all States and most communities have a number of serv- can expect were" and less so to those dis- ice agencies concerned with the well-being of older citizens. A knowl- "as young advantages as they ever and treatment because of advancing alienate residents age or and edgeable local committee or board of professionals in these services is special which tend to pacify may Psychol- ability. Programs to organize around issues vital to them. capacities essential in planning and operating congregate housing. Success must be built on a solid base of knowledge regarding the consumer. While block their tell us potential that artistic, mechanical, and judgmental and reasoning skills aging means change, to live is to function and retain a sense of being ogists intact until late in life; verbal recall of information a part of the human community as well as retain control of one's own are highly stable; among a small minority where the lapse is should remain reasonably and the facility for long-term related to life for as long as possible. Providing this opportunity to older persons is the joint responsibility of the housing and service agencies. This in is retained except health problems. As a result, activity programs shrinking world specific physical residents with normal alternatives to their in the develop- turn offers a chance for both groups to develop more program integra- tion on behalf of the aging whom both desire to serve well. provide diminished by change at different points and desires which is of aging. In short, residents have alone. needs Activities help The responsibility of service agencies is no small one in congregate housing since neither the local housing authority nor all tenants will mental processes do not have the resources to fulfill and usefulness. be able to defray the total cost of meals and other services. Some local which provide they a means basic to achieve data available this fulfillment to differentiate between who activities require housing authorities may choose to release full operational authority for the vigorous, Institutions which also characteristics of the There is little well elderly and those for older serve people the well elderly to an agency or agencies following the pattern of many senior centers in housing developments and to their boards and staff who are trained supportive be the services. richest resource for guidance. The of activities. in mobilizing community support resources and in conducting group activities. The directors and staff of local institutions for the care of might tenant body will largely determine the type order. and scope the aged also represent a valuable, experienced resource in service However, a few general be emphasis observations on maintaining are in interest in community tenants methodologies at the least cost and with maximum efficiency. Some of these techniques may be applicable to the operation of congregate affairs There to should offset isolation. The management placed should on quiet encourage games which do housing. They are also a potential resource for trained staff or for aid to participate. sustained A preference could The be housing development may lectures, include in training staff in the service aspects of congregate housing. Finally not require with comfortable energy. fixed seats since are movies, entertain- these organizations may, as needed, provide the diagnostic expertise musicals, an auditorium church services, plays, and sing-alongs staple to determine the degree of services needed by tenants or the potential time sequence when they must be institutionalized and be helped to adjust to the relocation. ment Because the youngest born in the early 1900's, adult and gen- appealing to many. of the elderly in public housing education (with programs an aver- age age of 72) were transportation, labor-saving technology, them abreast of on eral communications, life sciences would be of genuine interest to keep contemporary future changes. and still interest many. The development could who have provide dif- a potting stooping, and small plots (perhaps around popular. Gardening room may for house plants, a wall garden for trees) those for miniature ficulty gardens. Garden lectures need and to nourish shows will a continuing also prove sense should of adventure. be Opportunities The elderly for also outdoor activity, the community especially with in groups, something to enjoy pro- vided, upon arriving including at walks their offer into an destination. excellent chance Holidays for and outings special and occasions, should be birthdays, such observed as through such group as listening planning. to the radio or watching other television of housing. may Activities time schedules than in types should require Observance more of restrictive a quiet nap period may also be indicated, but care 37 confidence that the individual resident's interests will be paramount in determining the aid sought and received. The difficulties facing boards and staff at local housing authorities should, however, be recognized, analyzed, and resolved. First of all, we may ask if the responsibility for further development of congregate public housing should remain with existing local public housing agen- PART 5 cies with years of experience in providing housing for independent living, or if a new agency should be formed in the community to dis- CONCLUSION charge this task. One city-Holyoke, Mass.-has chosen to set up a geriatrics authority to build and operate any facility with a med- Whitman has wisely observed, "It is provided in the shall essence come of ical or potential medical care component. This authority enjoys the things Walt that from any fruition of success, no matter what, full powers of a local housing authority and is charged with providing forth something to make a greater struggle necessary." a range of care under established State standards. Congregate housing of low rent residential developments for the well chronically elderly in this community might be expected to be assigned to the geriatrics and terminally the ill have led naturally to the exposure of the service needs The success expansion of institutional care facilities for the limitations authority. Congregate public housing most certainly is within the province and respond to the entire range of shelter and in hous- of local housing authorities and other sponsors, not only by statute, of both the to elderly throughout the aging continuum. This gap the frail but also by the standards of logical and sound social planning, if among ing can and should be filled by congregate facilities for responsibility is shared with the community in coordinating housing and services. This competency is implicitly acknowledged when con- elderly. low rent public housing program enjoys the deep this subsidy structing housing for the well elderly, all of whom are at least 62 The to house the elderly with low incomes, and it is to offer program meals years of age upon occupancy. In housing well elderly persons, how- needed must look to provide housing developments which and ever, it is logical to plan alternative housing arrangements as they that we services to sustain an independent life style for the poor local age and become less active. While most of the harshest human losses and other Launching a congregate housing program requires con- and adjustments accompany the later years, none cuts so deeply into the near authorities poor. to reassess their functions and their potential including an individual's strength of spirit as does the necessity to leave a housing the needs of all older persons in the community, matching familiar home and environment, friends and neighbors, and move tributions in to housing for independent living. It also involves and prematurely to a distant facility where support is provided. How tenants and services to needs in a rapidly changing personal that much more sensible it is if, when selecting sites for independent liv- facilities situation rather than limiting service to a single category, this of ing arrangements, we also plan to locate a congregate housing facil- social well and active low income elderly. Perhaps because landlord-tenant type ity nearby to reduce or alleviate the traumatic experience of uproot- of the is departure from the traditional concept of responded to ing, loneliness, and abandonment. The current HUD policy of limit- housing a only a few local housing authorities have enacted in ing the time for holding property excess to the needs of a specific responsibility, and challenge of the congregate housing program hesitate, prob- development should, in the case of housing for the well elderly, not the need Although there may be reasons causing them to of housing only be changed but also logical use of this contiguous land or ac- 1970. the most prevalent one is the awareness that this type with quisition of sufficient land for congregate housing should be en- ably depends for its successful operation on firm, contractual Îinkages couraged and, in time, required. It is significant that the States have special advantages over local sponsors in the section 8 subsidy pro- local service understandable agencies. that the ramifications of housing, food of older and grams under the 1974 Act. They are given top priority, have less It is services, and personal aids for large numbers housing competition to have plans approved, and do not have to go through housekeeping in institutions are virtually unknown in public meet this as much red tape or checking procedures as of this writing. The status people not few pioneers. Unless we are more willing do so), to may of the section 8 program in the movement for congregate public except among (and a we now have statutory authority to we alter- housing is still untested, as are the special advantages awarded the drastic know need if congregate housing can offer a viable residential is States. However, since housing authorities are creatures of the States, never for low income frail elderly. The other alternative social or con- and since all States are seeking suitable alternatives to costly institu- native of unneeded institutionalization, whatever the be to "resi- eco- tions and have control of the distribution of service funds, the tinuation If the latter should be true, our efforts should On the climate appears favorable for a close partnership that could relate nomic costs. institutions, a less happy and more difficult goal. ability to to both State-Federal financing and State-provided services. dentialize" just as public housing with its rents related income to elderly, Congregate housing legislation per se does not speak to all the other hand, financial apprehension for many low meals and other elements needed to achieve a successful program through public or pay can remove public housing with its provision of needed, with private sponsorship, even though all the elements for a successful SO services too congregate can remove anxiety about obtaining help when national program of congregate housing are both legislated and (36) funded. The central problem is the fact that a variety of agencies 39 38 are together, this desperately needed type of living arrangement responsible for pieces and parts of the total. Unless they are ability and costs, if any, as well as assurance of continuing support. Knowledge of all local and State program potentials to achieve a brought succeed. Coordination can be commanded by the Congress, can feasible operation should be explored. cannot executive departments, and by State governments. Or reliance and local THE FUTURE by continue to be put on voluntary commitments by State of some to achieve a workable program, even at the loss At present the provision of and funding for congregate housing agencies by individual agencies. But for the future, the congregate insufficient must be the mutual responsibility and goal of Federal, State, and local autonomy will be only a limited national resource it is service and housing agencies, working together to ensure the support housing to accommodate program increasing demands and need for it, unless needed for food and other services essential in congregate housing. planned and funded as a housing/service program. Such coordinated action by housing and service agencies at all levels will decide the future life style of many of the Nation's older persons RECOMMENDATIONS now deprived of opportunities to retain and enhance their independ- ence as they grow older. What will that future be? CONGRESS Should make provision for a food and service operating subsidy avail- able congregate in the community or cannot be programed by service agencies for housing sponsors if such services are not now in proposed congregate housing for the low income elderly. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Should explore ways to work with and through appropriate under- State agencies to encourage and assist local housing authorities to take congregate housing programs with services assured. Should develop acceptable design criteria related to the special thus oc- in order to assist them to cope with the environment and be- avoid cupants or delay institutionalization (in short, develop standards yond those dictated by structural considerations). DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Should identify, marshal, and encourage the use of funds now avail- from all sources to underwrite costs of food and other essential services, able specifically in support of planning and funding congregate be trans- housing. As an alternative recommendation, funds should service com- ferred to HUD and earmarked for use in the food and for ponents of congregate housing when proposals are cleared con- struction funds. STATE GOVERNMENTS Should catalog the funding and service resources available within to State as well as those from HUD and HEW to enable them of the respond to requests from local housing authorities seeking use resources essential to the success of congregate housing. Should appropriate funds as needed to supplement service costs of potential low income residents of proposed congregate housing. LOCAL HOUSING AUTHORITIES Should plan for congregate housing by identifying potential well oc- cupants plus the local availability and cost of services required. avail- (some of whom may be now residing in housing for the The elderly), planning and operations budget should set forth local service APPENDIXES Appendix 1 CONGREGATE HOUSING DEVELOPMENTS IN TOLEDO AND COLUMBUS, OHIO The congregate housing developments in Toledo and Columbus, Ohio, have several experimental or exploratory aspects: -To determine the need for and the utility of such developments for the elderly who need or want meals, housekeeping, and other services to maintain residence in a semi-independent "home" setting. To determine whether community-based public housing for the elderly is a viable alternative for elderly persons unnecessarily committed to the State's mental institutions or released after treatment and rehabilitation. -To explore ways to coordinate Federal-State-local elements of a plan to provide shelter and services to elderly persons in the com- munity and to elderly patients discharged from State mental institutions. In all three aspects these developments have been and continue to be successful, both socially and financially. The Ohio effort began with contractual agreements on financing between the Federal Government and the State of Ohio. The two pub- lic housing developments for the elderly (100 units in Toledo and 246 in Columbus, both furnished and unfurnished) were designed as effi- ciency and one-bedroom housekeeping units with kitchens. It was agreed that the allowable community space was insufficient to accom- modate the supportive services, in particular, the central dining room and kitchen, as well as the usual space for recreation and leisure pur- suits. The State of Ohio, therefore, contributed the land for both proj- ects valued at $376,000 in Columbus and a like amount in Toledo, both parcels in prime locations. The savings in land costs to the housing authority and the Federal Government were then applied to the cost of the additional needed space, primarily the central dining room and kitchen (for the provision of which there was no statutory authority in the mid-1960's when these developments were launched). As a further contribution, the State accepted responsibility for providing all needed services under a 40-year contract guarantee for occupants in each project. Staff of State mental institutions screen elderly patients and select those whom they feel could adapt to com- munity living and mix comfortably with non-institutionalized elderly tenants drawn from the community. (Hospital dischargees comprise (41) 42 43 approximately one-third of the total tenant body.) The housing au- A. WORLEY TERRACE, COLUMBUS: "A PLACE WITH A thority manages the properties in each project, but all services are PLAN FOR TOTAL LIVING" provided by the State through the Hospital, the Commission on Aging, the Department of Public Welfare, or other State resources. THE PLACE Rental income goes to the housing authority the State receives pay- ment for other services including food (two meals a day, 7 days a week, Worley Terrace is a new approach in housing for the elderly. It is at $45 a month for individuals and $55 a month for a couple). Milk, a demonstration project-a pioneer venture-in providing surround- bread, butter, and fruit may be taken from the dining room for snacks ings, activities, nutritional meals, services, and programs at a low between meals. While all tenants at Worley Terrace in Columbus must cost to enrich the lives of older persons; to provide a life of dignity pay for their meals whether taken or not, the Toledo plan does not and self respect; to offer an opportunity to alleviate loneliness, and require this (except for dischargees from the hospital who are encour- to provide privacy. These are normally available only to persons with aged to take a full meals service at least during the first month of much higher incomes. occupancy). The major food components are prepared at the hospital It will serve as an example for the whole country showing what in each city and then delivered to the project. (Article B of this can be done to help keep residents well and happy by preventing appendix outlines the additional services provided in the developments physical and mental problems through suitable housing and availa- and by whom.) bility of varied services. The melding of resources for funding and services has represented THE LOCATION an economy to the State and a more wholesome and acceptable living On a broad meadow in a park-like setting south of West Broad arrangement for older persons. At the conclusion of a recent survey of these developments by the Street on the west side of South Central Avenue, Worley Terrace is International Center for Social Gerontology, Washington, D.C., the within walking distance of a number of churches; public transporta- interviewer summed up the findings as follows: While the frail elderly tion and shops are a mere two blocks away in either direction-to the from the communuity benefited from these programs, the real focus is north at Broad and Central and to the south at Sullivant and Central. on providing an alternative to institutionalization for residents whose mental health requires a supportive environment to enable them to THE APARTMENTS manage independent living. Both developments provide excellent ex- The beautifully designed efficiency and one-bedroom apartments, amples of the extensive array of services that can be mobilized from located in four one-story buildings and in a six-floor building, are existing community service agencies which, supplemented with basic owned and managed by the Columbus Metropolitan Housing Author- services, can create an assisted residential living environment that still ity, and the services are provided through the State of Ohio, Depart- manages to focus on independence to the maximum extent possible. ment of Mental Hygiene and Correction. Lounges for the use of the In Ohio it appears that sharing responsibility-with Federal sup- residents are available in each building, and resident dining rooms for port for congregate housing construction and State support for the meals and facilities for laundering are conveniently located. provision of services-has offered a workable solution to problems Each apartment has a kitchen with electric range and refrigerator, encountered in offering congregate housing to older persons as an draperies in colors and patterns coordinated with the apartment alternative to institutional living or as a preventive measure making color scheme, private bath, and ample closet and storage space. Utili- institutionalization unnecessary. Similarly, in smaller towns, such as ties are furnished and on-site parking is available. Alma and Burwell (cited in part 2 and in appendixes 2 and 3), the combined resources of the local housing authority and other agen- THE COMMUNITY CENTER cies willing to underwrite services have helped to make this type of pro- gram a workable alternative to institutional living. The congregate A center by location as well as by name, the community center is concept in housing can also be applied to housing for some of the surrounded by the garden areas, pools, patios, and covered walkways physically or mentally handicapped now living in institutions. that separate it from the dwelling buildings. Here are the craft rooms, The Ohio developments, as well as others cited in part 2, are the auditorium, the clinics, the meeting rooms, all the facilities neces- still operating successfully. They can serve as a valuable resource in sary for the provision of a total service program for the community. future efforts to research and evaluate the benefits of congregate hous- ing to low income elderly with some degree of physical or mental THE PLAN impairment and to those agencies that sponsor and support it as an additional community service. The community services are provided through the State of Ohio Articles A and B that follow provide a more detailed descrip- Department of Mental Hygiene and Correction. In this exciting con- tion of one of the Ohio developments-Worley Terrace in Columbus- cept for a total living plan, these services are provided: and of the range of services available to residents. Articles C and -Meals, two nutritious meals a day, lunch and dinner, planned by D present samples of contracts and lease agreements related to the a dietition. Toledo project. *Excerpts from a brochure distributed by the Columbus, Ohio, Metropolitan Housing Authority. 44 45 -Health care through a regular program of examinations and medi- in to units by nurses as indicated; therapy consultation as need indicates. cation by physicians, psychiatrists, podiatrists, and dentists Screening programs as deemed necessary. The resident will be responsible for the fee for professional services the health clinic. -Social and recreational programs that provide a choice of leisure the -Barber and beauty shop service. covered by plan A and/or B of the medicare program and/or title 19 of the Social Security Act. time activities covering everything from ART to a trip to B. Assistance will be given the resident to help with individual prob- lems, including welfare and social security. -Furnished ZOO. Apartments (optional) including carpeting, plus al- C. Recreation and leisure time activities. Residents will be encour- most everything else (soap, tissues, mop) needed for total living. aged to participate in a variety of programs designed for their en- joyment and to alleviate loneliness, stimulate interest, improve mental and physical health, and be of general benefit to them. THE COST These will include instruction in arts and crafts, development of 25 percent of income for rent. hobbies, dances, movies, and other recreation and educational pursuits. Plus $45 per month for meals, $90 per couple. There will also be opportunities to help others through community Plus $15 per month for furniture, $25 per couple. services. D. Barber Shop and Beauty Parlor. The beauty and barber shop YOU ARE ELIGIBLE IF: will be open on specified days. Service will be by appointment with the beautician and barber in the community facilities building. -You are 62 years of age or older. Under this agreement, men will receive one haircut every 2 weeks; -You are disabled. women may have one hair wash and set every 2 weeks, one hair trim -You are a resident of Franklin County. once a month, and two permanents a year. Any additional beauty or -You receive a net annual income of not more than: barber shop services will be made between the resident and operator $4,700 for one person, and paid for by the resident. $5,500 for two persons. -You have assets totaling less than $12,500. II. FURNITURE AND FURNISHINGS -You wish to take advantage of this brandnew plan for total living. Furnished units will include adequate and appropriate furniture as B. STATEMENT OF SERVICES PROVIDED TO WORLEY well as furnishings such as: sheets, pillow cases, bath and hand towels, TERRACE RESIDENTS BY THE STATE OF OHIO, DE- and wash cloths. In addition, a pillow, blankets and bedspread will be PARTMENT OF MENTAL HYGIENE AND CORRECTION, furnished. Soap, toilet tissue, and detergents for laundry will also be provided and issued on a scheduled basis. MAY 1, 1970 III. MEALS The Department of Mental Hygiene and Corrections provides per- sonal care services, furniture and furnishings, and meals for occupants Two nutritious meals a day, planned by a dietitian, will be provided. of the Worley Terrace, Golden Age Village, as follows: Assistance in selection and substitution of foods will be given by the food service personnel to control special diets. I. PERSONAL CARE SERVICES Personal care services are primarily for social orientation, to keep C. SAMPLE OF THE CONTRACT EXECUTED BETWEEN residents well, to give them a feeling of security and well-being, and THE STATE OF OHIO AND THE TOLEDO METROPOL- to enable individuals to live independently longer than would other- ITAN HOUSING AUTHORITY AND APPROVED BY THE wise be possible. FEDERAL GOVERNMENT A. Health services. A registered nurse or licensed practical nurse is on duty 8 hours a day, 5 days a week, and will give (1) routine health This Agreement, entered into this day of 19-, by and assistance; (2) assistance to residents in procedures prescribed by the between the Toledo Metropolitan Housing Authority of Toledo, Ohio, doctor; (3) make appointments with a physician or specialist for herein called the "Local Authority," and the Ohio Department of specific health needs when indicated; and (4) assist the doctor in the Mental Hygiene and Correction, Columbus, Ohio, herein called the health clinic. Clinic service does not include nursing care services. "State," By appointment with the clinic nurse, the following health care will Whereas, the Toledo Metropolitan Housing Authority is a body be provided at designated times: routine medical visits to the health corporate and politic created, organized and existing by virtue of the clinic; routine dental, podiatry, including minor treatment; general laws of the State of Ohio; and physical examination once a year, if necessary or desired; immuniza- Whereas, the Ohio Department of Mental Hygiene and Correction tions as necessary and advisable throughout the year; emergency visits is a Department of the State, created, organized and existing by virtue to of the laws of the State of Ohio; and 47 46 tation of bids for the construction contracts by the Local Authority; Whereas, the Housing Authority and the Department of Mental and that all proposed changes in plans and specifications involving Hygiene and Correction may enter into contracts with each other by areas outlined in Exhibit "A" must first be submitted to said Director virtue of State law; and for his approval prior to the operation of the changes. Whereas, the Local Authority has received from the Public Housing 3. Provide furniture and equipment for the community space to a Administration approval for a proposed project of one hundred (100) maximum cost of $10,000. dwelling units for elderly persons of low income and approval of a It is further promised and covenanted by and between the parties as site for said units which is located near and southwest of downtown follows: Toledo and consists of an area of 7.50 acres bounded by State-owned SECTION II land on the east and north, the Southland Shopping Center on the west, and Glendale Avenue on the south; and 1. That the Local Authority will assume and bear all costs and ex- Whereas, the Local Authority proposes to enter into one or more pense for the construction and development of the low-rent dwelling contracts with the PHA for loans and annual contributions in con- units to house elderly persons, and other facilities, to the maximum nection with the development and administration of such low-rent extent permitted by PHA regulations and standards, and that the housing for elderly persons, all pursuant to the United States Hous- State will assume and bear all costs and expenses for the construction ing Act of 1937, which Act, as amended to the date of this contract, is and development in excess of the above provided amount as provided herein called the "Act," and pursuant to the provisions of the "Hous- by the following distribution: ing Authority Law" of Ohio; and Square feet Whereas, the Local Authority is desirous of accomplishing the with- Total square feet in nondwelling facilities building 8,550 in project by obtaining the assistance and cooperation of the State in Total square feet in the lounge areas (497 square feet times 4) 988 such undertaking; and Total (actual) 10,538 Whereas, to obtain such assistance and cooperation, the State must perform certain obligations in accordance with the provisions of the Local housing authority can provide: Management 500 Act to comply with the applicable provisions thereof: and Clinic 500 Whereas, the State has determined that it would be advantageous Maintenance 800 in furtherance of the program to provide for elderly persons in Com- Community facility space 2,250 munity facilities, in conjunction with and in cooperation with the Local Authority in the mutual development of the within referred Total square feet on nondwelling facility space (allowed) 4,050 to project on the within referred to site; and Total square feet in nondwelling facilities building and lounges Whereas, by said mutual development, the PHA, through the Local (actual) 10,538 Authority, will contribute financially to the development of the Com- Total square feet provided by local housing authority (allowed) 4,050 munity Facilities to the fullest extent provided by the rules and regu- Total square feet to be provided by the State 6,488 lations of the PHA; Now, therefore, in consideration of the mutual covenants and prom- Cost ises set forth in this agreement, the Local Authority hereby agrees to Total estimated cost, 10,538 square feet times $16.50 $173,877 the following: SECTION I Structures, $173,877 times 61.6 percent $107,108 Administration, $40,507 times 6 percent 430 1. Acquire the necessary site for the construction and development Planning, $102,023 times 6 percent 6,121 of not less than one hundred (100) low-rent dwelling units to house Site improvement, $54,800 times 6 percent 3,288 elderly persons and for the Community Facilities, which site is set Total $118,947 forth and described in the approved plans on file in the office of the Local Authority and referred to as an area 7.50 acres, more or less State will also provide: bounded by State-owned land on the east and north, and Southland Community facility kitchen equipment $25,000 Community facility air conditioning 10,000 Shopping Center on the west, and Glendale Avenue on the south. Community facility furniture and equipment (additional) 10,000 2. Construct and develop on the site area not less than one hundred Change in 50 efficiency dwelling units (increasing glass area (100) dwelling units to house elderly persons and construct and de- door to exterior patio; outside patio; exterior dwelling unit velop community facilities on said site, all in accordance with Public division wall) Increase ($500 per dwelling unit times 50 Housing Administration and the Toledo Metropolitan Housing Au- efficiencies) 25,000 thority approved plans and specifications on file in the office of the Total State will also provide $70,000 Local Authority; provided, however, that all plans and specifications used as a basis for contract award shall be submitted by the Local Au- Estimated grand total State will provide $188,947 thority to the Director of the Ohio Department of Mental Hygiene The above estimated State cost is 11.5 percent of the total project development cost of $1,638,378. and Correction, Columbus, Ohio, for his approval prior to any solici- 48 49 2. That the Local Authority will lease to the State, certain areas 2. Prevailing Salaries or Wages: Any contracts entered into or aris- as indicated on the attached exhibit "A" for a term of forty-four (44) ing from this contract shall provide for the payment of not less than years or the term of the Authority's bond financing, whichever is the salaries or wages prevailing in the locality of the project. as pre- longer, with an option to renew upon the same terms and conditions determined under applicable federal, state, or local law. as set forth in the lease agreement, a copy of which is attached, marked 3. Officials Not to Benefit: No member or delegate to the Congress or "Exhibit A," and made a part of this agreement as though fully re- resident commissioner of the United States of America shall be ad- written herein. mitted to any share or part of this contract or to any benefit to arise SECTION III therefrom. 4. This agreement shall not become effective until it shall have A. The State, in consideration of the mutual covenants of the par- been approved by the Public Housing Administration. ties herein, will pay the funds necessary for the performance of the 5. This agreement shall bind and inure to the benefit of the suc- State's part or parts of this agreement in accordance with the fol- cessors and assigns of the parties hereto. lowing schedule: In witness whereof, The Ohio Department of Mental Hygiene and The total payments by the State shall be made in thirteen install- Correction has caused its name to be signed to this instrument by ments of which twelve installments shall be equal. Each of the twelve , Director, and the Toledo Metropolitan Housing Au- equal installments shall be determined by dividing the total State's thority has caused this instrument to be executed on its behalf by payment by thirteen. The total State payment shall be as provided for , Chairman, and , Secretary, on the day in Section III herein, based on the construction contract award amount and year above mentioned. for the total project. The thirteenth and final installment shall be the above amount adjusted to the cost or credit of all changes in the OHIO STATE DEPARTMENT OF MENTAL HYGIENE AND plans and specifications as approved by the Director of the Ohio De- CORRECTION partment of Mental Hygiene and Correction, Columbus, Ohio, the Local Housing Authority and the Public Housing Administration. By The first installment shall be due and payable upon the award of Director the construction contract with succeeding installments due and pay- able upon written request to the Director of the Ohio Department of TOLEDO METROPOLITAN HOUSING AUTHORITY Mental Hygiene and Correction, Columbus, Ohio. Final payment to be due upon the completion and acceptance of the Project from the By Chairman contractor. B. Termination or Failure to Complete Construction: In the event the Authority for any reason discontinues, or fails to complete con- By struction of the Project, the State shall have the right to receive a Secretary refund of its funds advanced under the provisions of this contract. The completion of the transaction fulfilling the election shall mutually D. SAMPLE OF THE LEASE AGREEMENT BETWEEN THE release each party from the provisions of this contract. STATE AND THE LOCAL HOUSING AUTHORITY (TOLEDO) SECTION IV This Instrument of lease executed this day of Prior to the use of any of the non-dwelling space by the State, and 19-, by and between the Toledo Metropolitan Housing authority, before construction is completed, the Local Authority and the State hereinafter known as the "Local Authority", and the Ohio Depart- will submit to PHA for its review and approval the following: ment of Mental Hygiene and Correction, Columbus, Ohio herein A. The occupancy policy to govern tenant selection. Said policy will called the "State," WITNESSETH: be the same one now being used by the Toledo Metropolitan Housing Now, Therefore, the Local Authority, in consideration of rents, Authority for all other projects under its jurisdiction. covenants and agreements hereinafter stipulated and performed by B. A service plan for food, health, medical, recreational, social and the State, does hereby lease to the State the following described prop- educational services. erty: SECTION V The Commuunity Center Section known and referred to as the Community Facilities of Project OHIO 6-13 and five lounge areas, A. SPECIAL CONDITIONS accessory grounds and site improvements, all of which are set forth 1. Non-discrimination: There shall be no discrimination by reason on the approved plans and specifications on file in the office of the Local Authority. of race, creed, color, or national origin, against any employee or appli- To have and to hold the above described premises with all the cant for employment qualified by training and experience for any appurtenances thereto for and during a term of forty-four (44) years, work under this contract. 50 51 commencing on the day of , 19-, at a rental of one has caused its name to be signed to this lease by its Director on the dollar ($1) per year; said lease for the term of forty-four (44) day and year above written. years to be automatically renewable forever for successive terms of one (1) year each, unless terminated by the State upon written notice Signed and Acknowledged in TOLEDO METROPOLITAN of one hundred eighty (180) days prior to termination. the presence of HOUSING AUTHORITY The State as Lessee further agrees and covenants with the said Lessor, its successors and assigns as follows: 1. That it will conduct and operate the aforementioned Community By Facilities and appurtenances thereto for recreation, educational and Chairman social purposes, primarily for the benefit of the tenants occupying the adjacent housing units. The Local Authority may periodically (not less frequently than one year) review and evaluate the program By and services being provided, and the State will in all ways reasonable and consistent with its facilities, adjust and adapt its program in Secretary accordance with such findings. 2. The Lessee will pay gas, electric and water charges for the Com- munity Facilities and will provide ordinary Maintenance and all Signed and Acknowledged in OHIO DEPARTMENT OF janitorial services in all areas assigned under this lease. the presence of MENTAL HYGIENE AND 3. That Lessee will not assign this lease, or underlet said premises, CORRECTION or any part thereof, without the written consent of said Lessor. 4. That Lessee will at all reasonable times permit said Lessor or its agents, to inspect and examine said premises, or any part thereof. 5. That the Lessee shall not discriminate against any employee or By applicant for employment, nor uses of the Community Facilities, be- Director cause of race, creed, color or national origin. This provision shall be included in all subcontracts. 6 That the Lessee shall comply with the provisions of the Anti-Kick- back Act (Title 18, U.S.C.A., Section 874, and Title 40, U.S.C.A., Section 276c) as amended. 7. That no member of or delegate to the Congress of the United STATE OF OHIO States of America or Resident Commissioner shall be admitted to any COUNTY OF LUCAS SS: share or part of this contract or to any benefit to arise therefrom. 8. That it is understood and agreed that this agreement shall not Before me, a Notary Public, in and for said County, personally become effective until it shall have been approved by the Public Hous- appeared , Chairman, and , Secretary, ing Administration of the Department of Housing and Urban Devel- who acknowledged that they did sign said instrument as such Chair- opment of the United States Government. man and Secretary of the Toledo Metropolitan Housing Authority, It is further stipulated and agreed by and between the Parties that, and on behalf of said Toledo Metropolitan Housing Authority, and in case of damage to the Community Facilities from an insured peril, that said instrument is their free act and deed as such Chairman and the amounts received in payment of such damage shall be expended Secretary of the said Toledo Metropolitan Housing Authority and in repairing, rehabilitating or restoring such facilities. their free and corporate act and deed of said Toledo Metropolitan It is further agreed by said Lessee that failure to substantially Housing Authority. comply with any of the foregoing covenants or conditions shall at the IN TESTIMONY WHEREOF, I have hereunto subscribed my option of said Lessor void this lease, and render the same null and name and affixed my official seal this day of , 19 void and shall constitute a ground of forfeiture and ejection. The Local Authority, for itself and its successors and assigns, here- by covenants and agrees that the State, paying the rents and keeping Notary Public, Lucas County, Ohio and performing the covenants of this lease on its part to be kept and performed, said State shall peaceably and quietly hold, occupy and Commission Expires enjoy said premises during the term of this lease and all renewal peri- ods thereof, without hindrance or molestation by said Local Authority. IN WITNESS WHEREOF, the Toledo Metropolitan Housing Authority has caused its corporate seal to be affixed and its name to be signed to this lease by its Chairman and Secretary, and the State 53 tor can be placed) for toaster, coffee maker, etc. The maintenance de- partment keeps all units sprayed for infestation control. The cost of this mandatory service is 50 cents a month. This amount is collected with the rent. Residents in units with kitchens are not eligible for meals in con- Appendix 2 gregate units unless they are ill and unless prior arrangements have been made. Residents in congregate units may have guests for meals if CONGREGATE HOUSING, ALMA, GA.* advance notice is given. The charge involved in this case is $1 per per- son. Meals are served at 8 a.m., noon (the main meal time), and 5 p.m. A. PROJECT DESCRIPTION (on Sundays and major holidays this meal is a sack lunch with a sand- wich, milk, and fruit). Sun City Courts in Alma is a pilot project of elderly congregate The State department of health will not permit tenants to work in housing. The congregate facility consists of 40 apartments, each with a the kitchen unless they have a health certificate. Therefore, we have a living room, bedroom, and bath. These apartments are arranged contract with a qualified person to be responsible for the food prepara- around open courts and connected to each other and to the community tion and planning of meals. (A copy of this contract is included in building by covered walkways. Also in the same project are 12 elderly article C that follows.) units designed as a contiguous related element. The 12 elderly units Residents seem to enjoy helping with fresh vegetables for the meals are not connected to the congregate facility by covered walks. Each or freezer, such as shelling peas, snapping beans, shucking and grating apartment in the elderly units includes a complete kitchen, as well as corn, cutting okra or anything that can be done in the community building. Youth workers in the CETA (Concentrated Employment living room, bedroom, and bath. The community building is centrally located and contains the ad- and Training Act of 1974) program perform the garden work and ministrative offices, the dining facilities for all congregate units, a gather vegetables. This is at no cost to us for 32 hours per week. large lounge, a library area, an activity room, and a kitchen. Mail is Applicants are advised that if they are on a special diet, the meals delivered to this building where each tenant has a private locked mail program cannot prepare special food for them; however, if they are box. Also in the project are two laundry-lounge buildings that con- selective in the cafeteria line, they can select food that will meet their tain a room which can be used for family gatherings and special oc- requirements. We do not employ a dietitian, though we are careful casion parties. Each is equipped not only with washer, dryer, ironing about highly seasoned food and sweets. Meals vary from day to day. board and drying yard, but also a lounge and a small kitchenette. The Each day of the week there are different meats (usually a choice of community building, as well as the laundry-lounge buildings, are air two), vegetables, and dessert. Offering a choice among foods has helped conditioned year round, and each dwelling unit and other facilities are reduce complaints. connected to a central television antenna system. Color television is No housekeeping service is furnished except for heavy work, such as window washing and polishing floors. This is done by the maintenance provided in the library-lounge. The site for the development was chosen because it is in the block department when needed. If a resident has a short-term illness, help is next to the hospital, county health facility, and a nursing home. The offered; only at this time would meals be sent to the bedside. If a congregate development was arranged SO that each occupant can main- tenant becomes ill during the night, an alarm system can be used to tain his individuality and privacy, but still be part of a closely ordered ring a warning in the adjacent apartment and to switch on a red light on the front porch. This is another aspect of the "buddy system"- community. The units are equipped with special features for elderly persons such neighbor helping neighbor. Each apartment also has a telephone in as lever-handled hardware, no steps between porches and interior case a doctor or an ambulance must be summoned. spaces, showers with seats and safety glass, individual heating units, Applicants for congregate housing must be ambulatory and not on a and a signal light system on the exterior to be used if help is needed. special diet. In case of doubt, a doctor's certificate is requested. Other- Also, each congregate unit has a plastic topped counter in the bedroom wise, it would be left to the applicant to choose what type of unit he or on which a hot plate can be used for heating soups and beverages. she prefers. The community building has an office for the Sun City Courts Di- When a tenant becomes ill or is otherwise unable to care for himself rector (who lives in the development) and offices for the Executive or herself, we contact a member of the family or a doctor. In most cases, Director of the Housing Authority of the City of Alma. he or she would be admitted to a nursing home. We will hold the apart- ment until the person's ability to return to congregate housing is deter- B. RANDOM OBSERVATIONS mined by the doctor. However, the apartment rent and meal charges would have to be paid during this absence. Congregate units with no kitchens are equipped with small refrig- Combining the hale and hearty with the frail is one of the most erators and a snack unit, i.e., a counter (under which a small refrigera- pleasant features of the elderly program. Tenants seem most happy to help one another when needed. They enjoy the fellowship and pro- tive director, Alma Housing Authority, 801 12th Street, Alma, Ga. 31510. *This appendix includes excerpts from materials submitted by Wilfred B. Smith, execu- grams together. Tenants in congregate housing are paying for meals (52) 54 55 and other services, therefore, we see no feeling of lesser status among will utilize the Housing Authority's facilities and prepare meals for them or on the part of other tenants. residents of such project, In our opinion the occupants of congregate housing live a happy life Now, therefore, it is mutually covenanted and agreed by and between after they become unable to prepare a well-balanced meal by taking ad- the parties as follows: vantage of congregate housing. Otherwise they would have to resort 1. The Housing Authority will make available to the Contractor for to a nursing home. The most difficult time is the adjustment period for her use and the use of her employees, those portions of Project Ga- an elderly person who has for many years lived with his or her family 133-4, Alma, Georgia, now designated and used as a kitchen and dining and now must adjust to our rules and regulations, meal schedule, and area located in the central building, together with all necessary kitchen new neighbors. and dining room furniture, fixtures, equipment, supplies, and other The many programs for the elderly have been most helpful. The personalty as is necessary in the premises. Older Americans Act was utilized for social services for the elderly as 2. The Housing Authority will at its expense furnish to the Con- long as funding was available. We have continued this service under tractor all of the foods, meats, soaps, cleaning materials, and other sup- the model cities program and now under the financing of title VI pro- plies and groceries, together with a menu or bill of fare describing in grams of the Social Security Act (title VI has now been folded into detail the various meals to be prepared by the Contractor. provisions of title XX of the same act). We have two fulltime workers 3. The Housing Authority shall be responsible for the payment of all for social services and activities. SSI (the supplemental security in- utilities necessary for the preparation of food and meals in the de- come program) has helped tenants meet the need for cost of living in- scribed kitchen, including but not limited to heat, lights, electricity, creases in many areas, even though our meal cost has not increased. and such other forms of energy as are necessary and usual in the Rent adjustments have been made according to income. Rent has aver- premises. aged $40 per month, exclusive of food and services. 4. The Contractor, by the use of such facilities, will prepare the The incomes of the 56 tenants in residence are derived from a variety foods furnished by the Housing Authority, according to the menu of sources: 7 received only social security (SS) 17, SSI only; 13, a furnished not less than 30 days in advance, and will daily make three combination of both; 6 received SS and income from interest; 4, SS nourishing meals available to all residents of the Housing Authority's and a VA pension; 1, SS and a private pension; 3 received railroad Project Ga-133-4, regardless of number. She shall at all times keep retirement; and 1 each received the following alone-an annuity, a the kitchen and dining area assigned to her care in a clean condition, government pension, a VA pension, SS and earnings, and income carefully cleaning and storing all dishes and cooking utensils after derived from sale of home. each meal. Meals will be prepared under such conditions and in such The oldest resident was born in 1886 and the youngest in 1927. Ten manner as meet the requirements of the Health Department of Georgia of the original residents (1967) are still in the project. and the Housing Authority. 5. The Contractor shall, at such times and upon such forms as the C. MEALS SERVICE CONTRACT BETWEEN THE ALMA Housing Authority shall furnish, report the use and disposition of HOUSING AUTHORITY AND AN INDEPENDENT CON- foodstuffs furnished her for preparation. 6. The Contractor shall personally prepare such food or shall per- TRACTOR sonally supervise its preparation. She shall, at her own expense, employ STATE OF GEORGIA) such cooks, aides, and assistants as are necessary for the prompt prepa- COUNTY OF BACON ration and service of such meals, and shall pay for herself and em- ployees all taxes and assessments for Federal and State taxes and This Contract and Agreement, made and entered into this day unemployment compensation, and all other legal charges against her of 19-, by and between Housing Authority of the City of compensation or the compensation or wages paid her said employees. Alma, Georgia, of the first part, hereinafter referred to as the "Housing 7. In consideration of the preparation and service of such food and Authority," and , of the second part, hereinafter re- meals and other services performed under the terms of this contract, ferred to as the "Contractor." the Housing Authority will pay the Contractor, promptly at the end Witnesseth: of each calendar month wherein such services are performed the sum That whereas, the Housing Authority operates what is known as of One Thousand and Fifty Dollars ($1,050) per month." Should this Project Ga-133-4, designed and used specifically as living quarters for contract terminate at any time prior to the end of any month, there elderly low income families and individuals wherein centralized feed shall be an accounting between the parties, and the Housing Authority ing facilities are provided, and shall pay the Contractor the sum of $34.52 for each day performed Whereas, the Housing Authority owns and has ready for use the req- under this contract, not previously compensated. uisite tables, chairs, stoves, tableware, pots, pans, and all other equip- 8. In addition to the consideration named in paragraph 7 and else- ment and supplies and equipment necessary to prepare food for the where in this contract, the Housing Authority will pay to the Contrac- residents of such project, and tor the sum of One Hundred Sixty Seven Dollars ($167), and shall Whereas, the Contractor is an experienced, well trained person, well *Raised to $1,100 in 1975. skilled in the preparation and service of food and regular meals, who 56 57 thereafter annually commencing on March 15, 1975 and on March D. COST SAMPLES, CONGREGATE MEALS FACILITY, 15 of each year thereafter so long as this contract remains in effect, HOUSING AUTHORITY OF THE CITY OF ALMA, pay to the Contractor One Hundred Sixty Seven Dollars ($167). 9. It is expressly understood and agreed that the payment of such ALMA, GA. sum annually is reimbursement by the Housing Authority to the Con- Charts on the following pages include tractor for Workman's Compensation and Products Liability Insur- ance Premiums, which insurance is required by the Housing Authority. -Balance Sheet at December 31, 1974. It is further expressly understood and agreed that should such insur- Statement of Operations for the Year, January 1, 1974-Decem- ance terminate during the policy period in any manner so that a return ber 31, 1974. premium shall be payable, the Contractor will pay an amount equal to -Reconciliation of Changes in Congregate Meals Trust Advances such return premium to the Housing Authority. Held by the Housing Authority of the City of Alma, Year Ended 10. This contract may be terminated with or without cause by either December 31, 1974. party upon 60 days' written notice to the other. Unless earlier termi- COST SAMPLES-CONGREGATE MEALS FACILITY, HOUSING AUTHORITY OF THE CITY OF ALMA, ALMA, GA. nated, this contract shall terminate on the day of , 19-. Statement of operations for the year Jan. 1, 1974, 11. It is expressly understood and agreed that this contract does Balance sheet at Dec. 31, 1974 to Dec. 31, 1974 not create a relationship of landlord and tenant, employer-employee, Trust advances by city and or master and servant between the parties. The second party is an Assets county Income Expense independent contractor. She covenants and agrees to hold the Hous- Advance to hous- $21,089.76 Total advances, $21,552.20 Meals for $22,329 Management $11,767.00 ing Authority harmless from any and all claim, demand, damage, and ing authority. Jan. 1, 1974. tenants. costs. Inventory-food 801.43 Add: 1974 inter- 1,076.29 Meals for 268 liability in any way arising from the use of such kitchen, dining room, Food costs 11,057.28 est income. others. and premises used by her, or from the preparation and service of food Inventory-sup- 237.06 Deduct: Deficit (500.24) Miscellaneous 263.74 plies. from feeding Total 22,597 supplies. and meals to residents of the described project and others served by operation. Other costs 9.22 her on the premises. She shall, from time to time, as required by the Total assets 22,128.25 Total trust ad- 22,128.25 Total 23,097.24 Housing Authority, account for all cookery and tableware and other vances, Dec. 31, 1974. Net deficit for 500.24 items of personalty used by her in the preparation of food and tables. year. Representatives of the Housing Authority shall at all times have the right to enter upon premises used by the Contractor for the purpose RECONCILIATION OF CHANGES IN CONGREGATE MEALS TRUST ADVANCES HELD BY THE HOUSING of inspection and examination, and otherwise. AUTHORITY OF THE CITY OF ALMA, YEAR ENDED DEC. 31, 1974 12. No agreement between the parties hereto shall be binding or have legal effect unless contained in this contract or endorsed hereon Congregate feeding Net trust in writing. accounts advances Cash Investments payable held IN WITNESS WHEREOF, the Housing Authority has caused its duly authorized officers to affix the name and seal of the Authority, Balance Jan. 1, 1974 $84.62 $21,243.30 ($847.97) $20,479.95 and the Contractor has hereunto set her hand and seal, the day and Transfer to investments, February 1974 (308.90) 308.90 Interest income for year 1,076.29 1,076.29 year first above written. Net deficit for year (500.24) (500.24) Decrease in inventories 33.76 33.76 Decrease in feeding accounts payable (11.23) 11.23 Housing Authority of the City of Alma, Georgia (L. S.) Balance Dec. 31, 1974 (701.99) 22,628.49 (836.74) 21,089.76 Adjustment required: Transfer from investments 500.24 (500.24) By Balances as adjusted (201.75) 22,128.25 (836.74) 21,089.76 Chairman of the Board Attest Executive Director (L.S.) 59 Three factors determine the rent: (1) size of apartment; (2) num- ber of persons in family; and (3) income. The rent, based on 25 per- cent of adjusted income, includes all utilities such as heat, electricity, water, garbage service, maintenance, and free laundry facilities, but Appendix 3 does not include telephone. A maintenance man is hired by the housing authority for the care of the lawns, and to keep the walks and drives PARK VIEW PLAZA,* BURWELL, NEBR. free from snow. MANAGEMENT A. PROJECT DESCRIPTION The owner of the project is the housing authority of the city of Bur- This 50-unit housing project was financed and built by the Burwell well. Commissioners are: B. W. Wagner, Sr., chairman; O. W. John- (Nebraska) Housing Authority in cooperation with the Public Hous- son, secretary-treasurer; Leo F. Clinch, attorney; and William R. ing Administration. It was completed in March, 1967; partial occu- Beat, Floyd E. Demaree, and W. W. Bristol, directors. Frank Lindsey pancy was obtained earlier, and the first occupants moved in on Janu- is maintenance man. The office is in the community building and is ary 12. There are 30 modern, attractive apartments, each with three open Monday through Friday, 9 a.m. to 5 p.m. rooms (living room, kitchen, and bedroom), plus a tiled bathroom and RECREATION AND COMMUNITY PROGRAMS adequate storage. These are situated in five brick buildings located south of the city park and within walking distance of the business dis- Recreation centers around the large community room in the com- trict. All apartments are furnished with drapes, electric stove, and a munity building and in the new recreation building northeast of the refrigerator. apartments. The housing authority has received $7,500 from the title The housing project also has the congregate living area, which III program to be used for an areawide recreation and craft program houses an air-conditioned recreation room, community living room for all persons 60 years of age and older. Headquarters for this pro- equipped with kitchen facilities for the use of all residents for social affairs, family gatherings, and entertainment, and the executive di- gram is Park View Plaza. rector's office. The congregate building also has 14 units, consisting of ABOUT BURWELL, NEBR. living-sleeping room combinations with private bath and adequate storage. There are six units with living room, bedroom, bath, and stor- Burwell, the county seat of Garfield County, has much in common age; persons living in these apartments are able to eat in a centralized with other midwestern county seat towns of similar size. It has a mod- dining room, where meals are brought in from the hospital and served ern medicare-approved, 30-bed hospital, and two doctors who serve family style. The daily cost of the meals is: breakfast, 90 cents; lunch, the area. A new 40-bed nursing home is under construction, joining the 85 cents; and dinner, 95 cents. All units are furnished with drapes. hospital on the north. This health unit is one and one-half blocks from There is a master television antenna which is connected to each apart- the housing project. Burwell has a good public library, an efficient ment. volunteer fire department, six churches, a modern swimming pool, a Special features for the elderly include handle-type doorknobs, bath- well-kept park and picnic facilities, and an active Wranglers Club. room grab bars, and an emergency alarm switch in each unit. Burwell is the home of Nebraska's Big Rodeo. ELIGIBILITY B. RANDOM OBSERVATIONS To be eligible to rent an apartment, the applicant must meet the fol- The incomes of tenants in the congregate living area range from lowing requirements: $1,117 to $3,801 a year. Rents, based on 25 percent of adjusted income, (1) Age: One member of the family must be at least 62 years of age. range from $21 to $71. (2) Income limits: Maximum income for one person is $3,500 per Some tenants miss the kitchen but would not be able to cope with it year; for two persons, $4,000 per year. or maintain a balanced diet. The community room has a refrigerator (3) No asset limit. for the use of all congregate tenants. Some keep snacks in their rooms, RENTAL but they are responsible for control of any insects these may attract. Tenants in housekeeping units may dine in the congregate dining The project consists of 10 modified one-bedroom units (smaller), 10 room by notifying the kitchen in advance. The kitchen, in turn, orders one-bedroom units (larger), and two 2-bedroom units. the amounts required from the hospital. The hospital breaks even on the meals. As the costs of food and labor *The description of Park View Plaza with combined congregate and housekeeping units for the elderly and random observations on its experience were contributed by Dorothy rise, SO too does the price of meals. Special diets are provided if VanDiest, executive director of the Burwell (Nebraska) Housing Authority. ordered by the doctor. (58) Tenants seem to enjoy the meals: they are varied and are served in a pleasant atmosphere on good china attractively arranged. 60 For those who are unable to do their own housekeeping but who can afford to pay to have it done, a housekeeping service is available. Pay- ment is by the hour and is handled between the tenant and the house- keeper. For those who qualify (those with an annual income under $1,500), a homemaker service is available through the welfare office. All tenants have their own linens. The laundry is located in the build- ing and tenants are responsible for it. The homemaker helps bathe one tenant who is crippled by arthritis. Tenants help one another in fastening zippers when needed. This is one example of tenants aiding each other. They seem concerned about those who are frail or ill, and run errands for them and visit them. None of the tenants need nursing service. Congregate tenants are not thought of as frail. They are seen as elderly persons needing a friendly hand. When applications are accepted, the person states what type of apartment he or she prefers. Three tenants moved from housekeeping to congregate units when it became apparent that they could no longer cope with the demands of shopping and cooking, etc. Most go to the nursing home of their own accord. Some have had to stay there for an extended period, but if their rent is paid, the apartment is held for them. This has been the case with five tenants. When they are ill and must go to the hospital, most tenants worry about keeping their apart- ments until they are able to return. If a tenant needs a doctor at night, he or she rings the alarm and another tenant telephones the doctor. The doctor, in turn, summons the emergency unit which operates free for all residents of Garfield County. This unit is equipped with short wave radio for contact with the doctor and the hospital and is staffed by volunteer firemen with first aid training. This type of alarm and alert system has been less expensive to operate than one requiring a "live-in" monitor. The emer- gency telephone number is posted on all telephones so that tenants can dial for help from their rooms to a radio dispatcher who can then contact the doctor, the fire department, and the emergency unit. Outside organizations are also involved in the life of the facility. Ladies from the Methodist church bring homemade pies once a month for dinner in the congregate dining room. Other groups hold parties and bingo, and the schools and 4-H clubs provide programs. The Future Homemakers of America have adopted a tenant as a foster grandparent, a reverse on the usual notion of a grandparent adopting a child with special needs. Talking books are provided for those with visual impairments. A local volunteer provides transportation to the local doctor or beauty shop for any elderly person in the city limits. Church services and Bible study are held once a week. Movies are shown once a month. The projector was purchased in 1968 with funds provided under title III of the Older Americans Act. There is also a library in the congregate lobby. Books for it are exchanged with the county library by the same volunteer who provides transportation to the doctor, and so forth. facts about Older Americans 1975 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Office of Human Development Administration on Aging National Clearing House on Aging **** DHEW Publ. No. (OHD) 75-20006 How many older Americans are there? Where do older Americans live in the Proportion of Popul United States? In 1974, one in every 10 persons in the U.S. was 65+ (21.8 million men and women.) In 1974, about half (45.4%) of persons This number is about the same as the total aged 65+ lived in the six most populous States population of the 20 smallest States and the -California, Illinois, New York, Ohio, Penn- District of Columbia. sylvania, Texas-and Florida (the eighth most populous). Each of these States had more than The proportion of the population 65 years one million older persons. The 65+ popula- old and over varied by race and ethnic origin: tion in two States (California and New York) 11% for whites, 7% for blacks, and 4% for will soon reach 2 million. persons of Spanish origin. Eight States had an unusually high propor- Between 1900 and 1974, the percentage of tion of older persons (12% or more) in their the U.S. population aged 65+ more than 12% or more total populations-Florida (15.5%), Arkansas doubled (4.1% in 1900 to 10.3% in 1974) (12.8%), Iowa (12.6%), Missouri, Nebraska, 10% 11.9% while the number increased about sevenfold and Kansas (12.4% each), South Dakota 8% 9.9% (from 3 million to 22 million). (12.3%), and Oklahoma (12.1%). Less than 8% At present death rates, the older population is expected to increase 40% to 31 million by 2000. If the present low birth rate continues, Estimated Population Aged 65+, by State, 1974 these 31 million will be 11.7% of the total Percent Percent Percent Percent population of about 262 million. If the birth Number of Total Rank 1 Increase, Number of Total Rank 1 Increase, rate should increase very significantly, they State (000's) Population 1970-74 State (000's) Population 1970-74 would represent 10.7% of a total population Total 22,023 10.4 9.3 Massachusetts 661 11.4 12t 4.4 of about 287 million. Alabama 365 10.2 24t 12.7 Michigan 798 8.8 39t 6.5 Alaska 8 2.4 55 14.3 Minnesota 432 11.0 17t 6.1 Growth of the Older Population 30.6 Arizona 211 9.8 30t 31.1 Mississippi 246 10.6 21t 11.3 30 in the Twentieth Century Arkansas 264 12.8 2 11.4 Missouri 591 12.4 4t 5.9 California MILLIONS 1,986 9.5 34t 10.8 Montana 73 9.9 25 29 7.4 Colorado 204 8.2 44 9.1 20.0 Nebraska 191 12.4 4t 4.4 20 Connecticut 314 10.2 24t 9.0 Nevada 41 7.2 49 32.3 Delaware 48 8.4 42t 9.1 15 New Hampshire 86 10.6 21t 10.3 District of Columbia 71 9.8 30t 1.4 New Jersey 749 10.2 24t 7.9 10 6.6 Florida 1,267 15.7 1 28.6 New Mexico 86 7.7 47 22.9 5 3.1 Georgia 413 8.5 41 13.2 New York 1,998 11.0 17t 2.4 Hawaii 53 6.3 51 20.5 North Carolina 0 473 8.8 39t 14.8 1900 1930 1970 2000 Idaho 76 9.5 34t 13.4 North Dakota 72 11.3 14 9.1 Illinois The Older Population in the Twentieth Century 1,134 10.2 24t 4.1 Ohio 1,050 9.8 30t 6.1 Indiana 522 9.8 30t 6.1 Oklahoma 328 12.1 Ratio 8 9.7 Year Total Men Women Women/Men lowa 360 12.6 3 3.2 Oregon 251 11.1 15t 11.1 1900 3,080,000 1,555,000 1,525,000 98/100 Kansas 281 12.4 4t 6.0 Pennsylvania 1,348 11.4 12t 6.4 1930 6,634,000 3,325,000 3,309,000 100/100 Kentucky 364 10.8 20 8.3 Rhode Island 111 11.8 9 6.7 1970 19,972,000 8,367,000 11,605,000 139/100 Louisiana 337 9.0 37 10.5 South Carolina 219 7.9 46 15.3 1974 21,815,000 8,966,000 12,849,000 143/100 Maine 122 11.7 10 7.0 South Dakota 84 12.3 7 5.0 2000 30,600,000 12,041,000 18,558,000 154/100 Maryland 333 8.1 45 11.7 Tennessee 429 10.4 23 12.3 tion Aged 65+, 1974 Has life expectancy changed? What are the living arrangements of older persons? A child born in 1900 could expect to live an average of about 47 years; a child born in 1973 About 5% or approximately one million could expect to live 24 years longer-an average older people lived in institutions of all kinds in of 71 years. The major part of the increase OC- 1974. curred because of reduced death rates for chil- Most older persons lived in a family setting. dren and young adults. More people now reach old age, but then do not live much longer than In the noninstitutional population, the num- did their ancestors who reached age 65 in 1900. bers of older men and older women living in a family setting were about the same (7.1 mil- At age 65, life expectancy is 15 years—13 lion men, 7.2 million women), but since there years for men but 17 years for women. As a re- are many more older women than older men sult of this sex difference in life expectancy, (143 per 100), the proportion of older men in which begins at birth, there were 143 older family settings was 83% and of women, 60%. women per 100 older men in 1974 and the disparity continued to grow with age. (Assum- More than one-third of all older persons (6.3 ing that the 1973 death rates do not change in million; 1.4 million men and 4.8 million wom- the future, 80% of female children will live to en) lived alone or with nonrelatives (40% of the age of 65 as compared with only 65% for all older women but only 17% of all older male children.) men). More than 1.2 million older people died in Within the older population the proportion Percent Percent Number of Total Rank¹ Increase, 1972, a rate of 59.2 per 1,000-73 for men living in family settings decreases rapidly with State (000's) Population 1970-74 and 50 for women. The death rate for the advancing age. Texas 1,120 9.3 36 13.4 under-65 group was 4 per 1,000. Utah 88 7.5 48 14.3 Living Arrangements, 1974 Vermont 51 10.9 19 8.5 Three-fifths of all of the deaths of older per- (Noninstitutional Population) Virginia 410 8.4 42t 12.6 sons resulted from heart disease (45%) and WOMEN Washington 354 10.2 24t 10.6 MEN West Virginia 206 11.5 11 6.2 cancer (16%). Wisconsin 505 11.1 15t 7.2 9% Wyoming 32 8.9 38 6.7 What are the costs of health care? 17% 3% American Samoa 1 3.4 53ᵗ 0.0 Guam 2 2.1 56 20.0 In 1973, the Nation spent approximately 80 40% Puerto Rico 198 6.6 50 11.8 billion dollars for personal health care. About Trust Territories 4 80% 3.7 52 15.2 50% Virgin Islands 3 3.4 53t 37.5 28% of this amount was spent for older persons. The per capita health care cost for an older per- son was $1,052, over 2½ times as much as the $384 spent for younger adults. Benefits 1 States are ranked in order of decreasing percentages from government programs such as Medicare (highest percentage is rank 1, lowest is 51) accounted for nearly two-thirds of the health t Tied in ranking. States with identical percentages HEAD OF OTHER FAMILY LIVING ALONE receive identical rank number with following rank expenditures of older persons, as compared with FAMILY MEMBER OR WITH number(s) skipped to allow for number in tie. one quarter for adults under 65. NONRELATIVES What is the marital status of older persons? What is the income situation for About 944 thousand older persons living older persons? * alone or with nonrelatives had incomes under In 1974, most older men (79%) were mar- $1,500 ($29 a week). ried; most older women (52%) were widows. Some are well off. About 1.2 million couples About 16% (3.4 million) of older people There were more than five times as many wid- with 65+ heads had incomes of $10,000 or more in 1973. Some 2 million older couples were below the poverty level in 1973. Approxi- OWS as widowers. had incomes between $5,000 and $10,000. mately 2 million or 60% of these poor were About one-third (36.4%) of the older mar- living alone or with nonrelatives; of these, 1.6 ried men had wives under 65 years of age. Many are not well off. About 655 thousand million were women, mostly widows. Of the In 1971 the States* that participated in the re- couples had incomes under $3,000 ($58 a 23 million poor persons of all ages, 15% were porting program for marriages reported 16,410 week). 65+. brides and 33,056 grooms aged 65+. These were first marriages for about 7% of the women Income Distribution of 6.3 Million Persons and 5% of the men. Most were remarriages of Income Distribution of 5.3 Million older persons who were previously widowed Couples With Heads 65+, 1973 Aged 63+ Living Alone or With Nonrelatives, 1973 (70% of the brides and 67% of the grooms). * A total of 41 States and the District of Columbia. $5,000 OR MORE 18% Distribution of Older Persons $10,000 OR MORE 23% by Marital Status, 1974 MEN WOMEN 82% UNDER $5,000 6.8% 77% UNDER $10,000 8.9% $3,000 TO $5,000 24% 14.4% 38.7% $5,000 TO $10,000 38% 57% UNDER $3,000 78.9% 52.4% $2,000 TO $3,000 29% 39% UNDER $5,000 28% UNDER $2,000 MARRIED WIDOWED OTHER $3,000 TO $5,000 27% $1,500 TO $2,000 13% Distribution of Older Persons by Marital Status, 15% UNDER $1,500 1900 and 1974 12% UNDER $3,000 1974 1900 $1,000 TO $1,500 10% Status Men Women Men Women $1,000 TO $3,000 11% 5% UNDER $1,000 Total 100.0 100.0 100.0 100.0 UNDER $1,000 5% 1% UNDER $1,000 UNDER $1,000 1% Married 78.9 38.7 67.3 34.3 Widowed 14.4 52.4 26.5 59.5 Other * Income data is tabulated by age of head of family or of a lies) or individuals living alone or with nonrelatives to Divorced 2.2 2.6 0.5 0.3 person living alone or with nonrelatives. Data presented avoid factors introduced by presence of family members of Never married 4.6 6.3 5.8 6.0 above represent only couples (2-person husband-wife fami- other ages. Health status and health care utilization How many older persons work? Chronic conditions are more prevalent among More than 2.9 million or 14% of older peo- older persons than younger. In 1973, about ple were in the labor force-either working or 38% of older persons were limited in their ma- actively seeking work-in 1974. jor activity (working or keeping house) due to They make up 3.1% of the U.S. labor force. such conditions, as compared to only 7% for Slightly more than a fifth of the older men younger persons. (1.9 million) and about 8% of the older wom- In 1972, about 18% of the 65+ group had en (1.0 million) are in the labor force. an interference with their mobility due to Only 3.4% or 1 in 30 older people in the chronic conditions-6% had some trouble get- labor force were unemployed. ting around alone, 7% needed a mechanical A large proportion of older men who work aid to get around, and 5% were homebound. are in low-paying agricultural jobs (see chart In 1973, older people had about a 1 in 6 below). chance of being hospitalized during a year, high- The male labor force participation rate has er than for persons under 65 (1 in 10). The decreased steadily from 2 of 3 older men in proportion with more than one hospitalization 1900 to 1 in 5 in 1974; the female rate rose during a year was also greater for older people slightly from 1 in 12 in 1900 to 1 in 10 in (3.8% vs 1.6%). Once in the hospital, older 1972, but dropped to 1 in 12 in 1974. people stayed about 5 days longer than younger patients (12.2 vs 7.2 days). Older Persons in the Labor Force, 1974 MEN WOMEN On the average, older people had one-third PERCENT more physician visits than did persons under 65 IN LABOR FORCE (6.5 vs 4.8 visits) in 1973, with a higher pro- 79.4 45.7 portion of visits occurring within the last 6 22.4 8.2 months. PERCENT UNEMPLOYED Half of the older population had either not 16+ 4.8 6.7 seen a dentist for 5 or more years or had never 65+ 3.3 3.7 visited a dentist. In 1971, dental visits of older PERCENT OF EMPLOYED IN AGRICULTURE persons were much more likely to be for denture 5.5 1.8 work (36% vs 12%) and less likely to be for 19.3 3.3 examinations or teeth cleaning (31% vs 42%) PERCENT OF than for younger persons. EMPLOYED IN SELF-EMPLOYMENT 11.1 4.7 In 1971, older people were twice as likely to 35.8 17.4 wear glasses and 13 times as likely to use a hearing aid. About 92% of persons 65 years old and over wore eyeglasses or contact lenses 80 60 40 20 0 20 40 60 and 5% used hearing aids. PERCENT U.S. GOVERNMENT PRINTING OFFICE 1975 0-579-514 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 Price 25 cents Stock No. 017-062-00092-1

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Aging - General (3)

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id	352356382
sourceUrl	https://catalog.archives.gov/id/352356382
contentType	document
collections	Sarah C. Massengale Files (Ford Administration) Sarah Massengale's Health, Social Security and Welfare Files
subjects	Presidential messages Legislation Social security Crime Old age
iiifBase	https://s3.us-east-1.amazonaws.com/NARAprodstorage/lz/presidential-libraries/ford/grf-0105/643862/352356382.pdf
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url	https://catalog.archives.gov/id/352356382
naId	352356382
coverageEndDate	logicalDate 1976-11-30 month 11 year 1976
coverageStartDate	logicalDate 1974-12-01 month 12 year 1974
levelOfDescription	fileUnit
recordType	description
ocrSource	nara-archive

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