1 40 755 https://www.ssmp.mdocs.skidmore.edu/files/original/c6481aebab3bbdc6cdbad093c22926a6.jpg bb7c69495b78e7c9cbbdb43d24aeaa76 https://www.ssmp.mdocs.skidmore.edu/files/original/9ec4b56d077e8ef019909c791be626b5.jpg 551752e368bc362b59aa66d684de7483 https://www.ssmp.mdocs.skidmore.edu/files/original/63b1b175ea6ec3572af21106863e7175.jpg d5290fad13edf33d7cdb14d8e40616b7 https://www.ssmp.mdocs.skidmore.edu/files/original/aff588986571b8cf3fd63f49cf552578.jpg a170f2d0f66d855e09fdd4906f3a0794 https://www.ssmp.mdocs.skidmore.edu/files/original/636baa66050fc1545e0753213de551d4.jpg 8afb4f280088fe1fef76fed2ab26280c https://www.ssmp.mdocs.skidmore.edu/files/original/bb3d220e304fdeec906fd726bc3d0c6a.jpg a84d80ab316606774a4a6d235feb0864 https://www.ssmp.mdocs.skidmore.edu/files/original/84be871ab13200162ef9a2be275c3b21.jpg 7e04c65621b59caef4ec82b081f6839a https://www.ssmp.mdocs.skidmore.edu/files/original/7b3f51110f6a621f1b095fcd7dead90b.jpg 509b1d0a719160bf9a084a06b413247e https://www.ssmp.mdocs.skidmore.edu/files/original/2bc9e9f5fde3aee897a558acb3ca758f.jpg d6633fb8e9cc7f44b6de7317637eda71 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Historical Photographs of Skidmore College https://www.ssmp.mdocs.skidmore.edu/files/original/cfe0796678b07d5681171f12e53edd93.jpg 5f54e028e1c07e9688aa956e30f4a6a8 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Mattie Saulnier Record Creation Date Day/Month/Year of record creation/edit 5/5/21 URL https://www.saratogaplan.org/explore/public-preserves-trails/zim-smith-trail/ Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Zim Smith Trail Contributor An entity responsible for making contributions to the resource Mattie Saulnier Description An account of the resource Photo of the Zim Smith trail, a public leisure trail which lies where the R & S railroad once was. nature railroad trail https://www.ssmp.mdocs.skidmore.edu/files/original/a33eb136b45b2c33fa2316b54519be5d.tiff 7b3c11590d9c8d9ff779a5c005b9b4e7 https://www.ssmp.mdocs.skidmore.edu/files/original/e93a4ab88bae662b9d81721a9f3982ce.tiff 41c3431a98c8030f4eccc5d729020ee4 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data Postcard Record Contributor Individual who prepared the item and/or edited it. Deirdre Schiff Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. [1907] Date Depicted (Numeric) Date that the information on the item depicts. In many cases, this will be the same date as that in the date field, but there will be exceptions. For example, a historical map drawnin 1890 might show Saratoga Springs as it was in 1820. Or, the information on the map itself might include detailed information that enables us to extrapolate a date, for example, "based on a survey done in 1841." Many State Archives map catalog records refer to this as the "situation date." 1907 Date Published (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the date field that will display. [1907] Date Published (Numeric) Date the item was printed. This will be set as a date field, accommodating only numbers. The field will be able to handle single dates or date ranges. This will not display, but will be indexed and searchable. 1907 Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. This black and white postcard depicts one of the buildings of the Young Women's Industrial Club, which later became Skidmore College. Correspondence is postmarked as Aug. 3, 1907, 5-30 P. out of Schenectady. Address is very unclear, but sent to a Connecticut address. Publisher Publisher of the item, or of the book or atlas in which it appears. [earson-Ullburg Co.]; part of the postcard is cut off, so unable to read full publisher name Place of Publication The city (and if necessary) state or country of publication. Minneapolis Subject - Details This subject field describes the amount of detail in a map. For maps: (or layers) included on the map itself. This field might denote that the map includes information about, for example, Mountains, Railroads, Soundings, Elevation, or Population. These are controlled-vocabulary terms developed locally. The cataloger should be generous in assigning these terms -- even if only one canal is visible on the map, it should receive a "Canals" subject in this layer. Some of these terms are less specific than others and may warrant expansion in the Abstract field. For example, the "Businesses" term might be included here while the Abstract notes that the map shows mills and stores. Multiple terms can be used in this field. Young Women's Industrial Club (Saratoga Springs, N.Y.) Skidmore College (Saratoga Springs, N.Y.) Subject - Geographic Library of Congress subject headings. For maps: for major geographic locations depicted on the map, followed, in nearly every case, by the "Maps" genre subheading. (For example, "Saratoga Springs (N.Y.) -- Maps.") This field will be especially important when the records from this collection are incorporated into larger databases and catalogs. Saratoga Springs (N.Y.) Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Education Record Creation Date Day/Month/Year of record creation/edit 6/19/2014 Repository Name of the repository that holds the original item. Private Collection Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Young Women's Industrial Club, Saratoga Springs, N.Y. 20th century civic life education postcard Skidmore College urban studies women's history Women's Industrial Club https://www.ssmp.mdocs.skidmore.edu/files/original/186440324bbd9f42b839a7b30ec4a396.PDF bc95c50230ce3a409d6f2a67ce01c7d0 PDF Text Text �Additional copies of this report are available free of charge by yriting to State Senator Thomas C. Desmond, Chairman, New York State Joint Legislative Committee on Problems of the Aging, 94 Broadway, Newburgh, N. Y. w �NEW YORK STATE JOINT LEGISLATIVE COMRlITTEE ON PROBLEMS OF THE AGING * Senator Thomas C. Desmoncl, Chairman Assemblyman William M. Stuart, Vice-Chairman Assemblyman Leonard Farbstein, secretary Senator S. Wentworth Horton Senator Thomas F. Campbell Senator Fred G. Moritt Assemblyman Harry J. Tifft Assemblyman John E. Johnson Ex-Officio Members ~ L . ; S A T O R , \ w r r ~ r ~TT. \ J T ~ c , ~ s . ~z Pi.e,sitlc)tl P r o Ten1 or Ill c Ai'c?lnlc TAKER O S \ \ ~ A I. ~ TTwK, ; L ) of f h e d s s e i ~ t b l y ;S ~ s a ~ o a ELMERF. QUINS, JIinot8if!j Leadcr of t11e Serlafc; ASSE~IBLY~\IAS I,EE ~IAILLEII. B. A1lllnjorif,/jLeader of t h e d.sse111b1~j; S S E A I B L Y A ~ A ~ STEISGTTT. I i l l O l ' ~ f ! j A IR\VIS ~ Lcatlcr of flit A,s.sei~tbly;SESATORWALTERJ . ~ I A H O NC h n i,r r ~ z a )of t h e S c ~ r a fCo)~li.rlittec EY ~ ~ 011 F'incrlzcc ; aild ,\SSEAIPI,YI~AS ?~IAI,I,ORP STEI>HI<:SS, ('11nirnln1101 t11(,L - l . s s c r ~ ~ h l ~ j i f Col~lirl tcc o~ TT'n!l.s 0 t 1 ~ 7I l f ~ n n s . n. Committee Staff ,\I,RBRT J . ;\RRAI\IS Tlirecfor J O H X A. RTTSKOTI-SKI Associrrf~Director Consultant: G e o r g ~,\. T a r g c r ; Office Staff: Helei1 FJr~lest,~ ~ i l l i w n l S(2heidlrr. Panliile 31. T. Strickland. Etllia T 7 T e i i t k a ~ant1 Charles C. D e r b y ~~, General Advisers Miss iilatlys F'is!lcr., T)irr(dtol. of ()](I ,\ssistallc.r. SPTY Stat(>S o ~ ' i \~ 1 l f ~ i ' ?n ~ l ~ ~ ~ r t Y0r1i y? 111~llt; Miss ,\lic+r 31. Loolilis, ('o111illuait~- Cons~iltant 011 Sn.yic.es f o r the Xgecl, Ro!:hrster (ioullcil of 8"loc.ial ,\p.encairs ; 31iss (]llip ,I. r\alldall, Consldtant 011 S n v i c r s for the A\gr(d.colllllinllit)- Srr\.ic.~Soc.ic~t\of Torl~. Advisory Committee on Longevity T)I.. ( ' . T\.i\l.tl ( ' I . ; I I I I ~ I ~ O I H. ~ I . I I I ~ ~ ~ I ) - ( ' o ~ r r l i ~ i011e e ('I I $LI l. t t (~e~.iirtl.ii..;, .\Irtlic.;il Sorirty I I E Sr\\. Y111.li ( ~ l l l l t ! . : T)I.. T.oiiis I . I)nl~lill. Sc(.olld \ 7 i ~ ~ ~ - l ~ ~ ~ etint1 d Stati.tic.ia11. 1\Ieti~)l)olitan .;i e~~t T,ife 1nsuranc.r ('om1)an)-: Et1~vw1.d Stirglitz. ('lrief of S t : ~ i fof Snl,u~.l,;~n o i l ~ i t a l .Rc.tl~ebtlil,J1iri.yl:rntl: 111.. ('live 11. 1\11,C'a)-, S('1lool H of ~ I ~ ~ I . ~ ~ (~ o1.11el1ITnivel.qity; ;111(1 I)]., (:eo~,ge I , ; L \ \ ~ I J I I . I I I I , ('11n.11lti11g l ~ ~ y ~ ~ l ~ o l o1111i . .; ~ ( ~ , ~ I I - ~ I I 1'l'~ll)g t I~II~ ll~lllh of tI1e ol(Ie1, l'el~~O11, Advisory Committee on Employment Problems of the Elderly ~ 1\11.. Hal.old .T. C;arnc~. Secretary. S ~ T I Yo1.k S t a t e ( ' o n g 1 . r ~of Indnritrial Organization.;: 1\11,. Harold C . Hitnovel., Sc~.l.etin,y,S e w T o r k Stirte l.'ede~,ation of Lal,or; (01. Allan 1\1. 1)ol)r. 1'1,ehitlcnt of tlle C'on~nrei.ce a n d 11idnit1.y ,\..;oc,iation of Sen- Yo1.l;; .Dl.. Tlieodoiy . I<lnn~pp, Pi.ehidmt, ITiiltl~rol) C l ~ e f l ~ i ~CiO J I I ~ ) ~ ~ ~ ? . : : ( i l Ill.. 1'. ( ' . IT-olz. Ahhistant S u p r ~ . i ~ r t e n d r nInt111~ti.ial t. Relation.;. Eastnran IcIodal; Coii~l~an!-, Rochehter; ;1[1.. (+eol.ge H. I'frif. (+enera1 E1rc.tl.i~ ('olnl~any, Scl~enectacly; 1\11., T,e\vih K . ( : \ \ . ~ I I I I . C'l1airn12111,( ' o ~ l ~ n ~ i t t011 e e 1ndrlst1~i:rl1'1.11l~lrii1~ Rel;~tions.('llwl~ll~er C'OIIIIIICI.(.Ctlie S t a t e of S P J o ~ . k ,a11111\11..S o l o ~ l ~ o : ~ ;tncl of of y~ 1iiir.kin. Resear.c11 I)il.ixctor. 1-nitt~tlTt,xtilc. TT7c11.kel.s L - n i o ~of -411i~i.i(.il. ~ Advisory Committee on Recreation for the Elderly JIi*. S ; I I , ~ I [ , 1\11~(';111llt~~-, A Exe~qitive l ) i ~ ~ c ~ ~ Colony H o i ~ > eIII(,,, toi~. , 1;1~0okly11: 1\11,, H:il,i.y r , i , ~ i ~ ~.(\b , I I I I ~ I I ~ . ~ S i 1\1is.; .\I:II,~IIII 1\111Ilig~1ir, I I [ I ~ I . (I. S Sl)e(,i;~l e l . v i i ~ ef~l l , tilt, A\gc.d, S e w York ( ' i t y IYe1fitl.e Ik1)t11.t111ent: \.~,IJI.. 13on1tx.; foi. t l ~ t.\grd. ('atlloli,. ('ll;rl.itir+ of t h e . \ i ~ c ~ l i t l i ~ ~of~ S c \ev Yo1.1:: 1\11.>.('11irl.Iv.; .i. ~ c ~+ Riegc~1111nir. I)l.ehidelrt of tl~(d \\'illiiinl Hotl.;oll ( ' o ~ ~ ~ n r i ~ ~ ~ i t y Xe\v T o r k ( ' i t y ; a11d 111.. C'lytlc. E. 1\Iur1.:1y. C'ente~.. H ~ ; I I I \ ~ I I I ~ Il < 1 ~ i I ~ 1 of 7 ~ ~ o St~itle111e11t.e w Y I I I , ( ' i t y . S ~ ~I.:L~III,. I.EGISI,ATIVE DOCUMENT (1950) NO. 12 �Introduction By Senator Thomas C. Desmond Chairman, S e w Y o l k State Joint L e f i s l d t i ~ e ( o ~ n n ~ ~ t tonc P r o b l e n ~ uf e ~ F 1 0 ~ 1 1 1nlust be serred, age merits its own the Aging increasing will to clo. As the needs of the elclerly renards. F o r it has served. And is eager to become better understood, coln~rlurlitiesare here and continue serving. there rising to the challenge. 11ldustry itself, conOur Committee, in its studies of the aging, has fnsed as i t is about its relationship to the elderly, found that our older persons do not ask to be served; arbitrarily banning the hiring of olcler persons, spends they l>leatl only to be allowed to serve. They ask for nearly a billion dollars a year for pensions, and a cllailce to serye ill industry, civic work and chari- grants generous privileges to its senior ~vorkers. The table efforts. problems of the aged are complex. Soine of the solu,111tl yet, soviet)- s l l ~ n ~ t s older person out of tions will be inexpensive; others will be costly. B u t the produc.tire. useful life. Somehow i n our national ::-e can, under onr free wterprise system, meet this race fov expansion and wealth, I:-? have overlooked challenge. Our productivity, coinbined with our not 0111~-some fulzdamental humail values b u t also humanity, \\-ill snrinount obstacles. sollie procluctive ralues. F o r with all the tremendous I n this report, the third of our Committee. a wide talent a i d energy that bless our wonderful American range of armament is recomm~n(1ed to conzbnt the yo~ulo,tcri,n e call ill afforcl in terms of dollars a ~ l d trend of the past fifty years toward squeezing illore ccnts to lose the "1;no~:--hown and productive power and more of our older population out of prod~ictive of our 4.5-~111s. ,i.i-plu\, and 63-plus groups. and useful life. To 1 . T\ e (*anill afford, if ;ve wish to expand the purBut thcre are man)- of our aging who look f o r ~ v a r d clia\i~l; l > c ) ~ ~ t ~ 0111' e~o110111y. to Beep our older of r t o rptirenleiit. There are others who cannot work. F o r l~c~rwil, a financidl ghettu of dependency. It i11 these, improred nursing homes, better hospital facilitloesn't 11lal;e srnse. I t doesn't make us strong. I t tics for the chronically ill, adequate housing to meet clvc-\il't llialie for .juhtice. the special needs of older persons. widespread com~nnnity recreatioizal facilities, a social security system The Hidden Disaster that really mal<es oldsters secure, and other such aids, lyc. ilnulan beillps alld ?ffecd- discnssecl ill this report. are urgently needed. A11 explosion, an eartht i ~ e l ~ e n disaster .strikes. nh The Individual's Responsibility quake. or a train accident will throw governmental nlac.hiner)-, comnlunit~-agencies a i d neighbors into T h ~ ie nu doubt that government has a large role b to care for llle ullfortullate rictilns hiell ro play ill this fieid. And yet, while our Committee's a g o ~ l y iaid bare before our r e r y eyes. is B~~~ lf-helz Illilliolls of older persolls face the slow eizclearors are necessarily ancl primarily gearcd to x ~ e r l l l n e l l t a l action, we must emphasize that the death of forced re~irelllellt, xvhel-, milliolls of inclividual lilnst help by developin? his own reqnurces. hidclell elisaster of olcl age on relief rolls. face A11 of us haye within ourselves the capacity to w h ~ l zthouqandq of oldsters are thrust into mental is love and enrich our on-11 lives to the ery end. \Tie all have the hospitals all they plallning for onrunclerstanding. \vhen lllillions of oldsters are consigned reslponsibility for doillg our 0 ~ ~ 1 1 to a lonel- old age, we move a t a painfully slo~v rate. selres, so long as we call. If yo11 work in a plant that has a compulsory retirea grey-haired man, his heacl buried ill That is his arms, cries out, "Yobody cares." IIe might be i n lnent system, for example, it is sheer folly to do nothTour coin in unit^ and probably is. Maybe he neecls ilzg to prepare yourself for the day when you will be only coinpanionship. 3Iaybe he needs a job. Perhaps, retired. I t is sheer folly, realizing t h a t as you age a doctor. I t may be that all he needs is renewed con- yon are subject to deterioration of physical tissues and fidence. B u t h hat ever his problem, we in our neigh- to disabliilp illnesses. not to attempt to prevent chronic borhoods, our communities, states and Nation have ail~ileilts by haring periodic medical examinations, the ~vealth,the energy, the technical skill to see to i t eating nutritious foods, and, i n general, living that our older persons h a r e a chance to make their ~visely. X a n y of the problems volx mill face in the later years can be anticipated. Some of the problater y a r s happy years. Our Committee recognizes a n lrlns of later lifr can be prerented early i n life. And Does nobody care? I I ��TABLE OF CONTENTS P.IGI: Introduction by Senator Thomas C . Desmond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Comnlittee Findings and Recomnlendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The Governor's Views by Governor Thomas E . Dewey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 W h a t Can the Local Colnmunity do for its Elderly? by Miss Alice N . Loomis . . . . . . . . . . . 5-1 W h a t \J7estchester Cor~~munities Doing for their Elderly by Miss Lillian A . Quinn . . . . 58 are lt'hat Syracuse is Doing for its Elderly b ~ Dr . Raymond G . Kuhlen . . . . . . . . . . . . . . . . . . . . . 60 The Seeds of the Aged in Ke\v Pork City by Miss Flora Fox . . . . . . . . . . . . . . . . . . . . . . . . . . 63 New York City's JVork ~ v i t l ithe Elderly by l17illiam Posner . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Soiue Elellleiits of a n d c t i u t ~ P1-ogla111for the Elderly by Miss Ollie A . Bandall . . . . . . . . . . 7 1 - ................ r n Ernploymer~tof our Elderly by Robert C. Goodwin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Labor and its Older Workers by Harry Becker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 How Long do our Workers L a s t ? by Ewan Clague . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87 r e e d for a Citizens' Committee on the Elderly by Miss Ollie A . Randall Business Conditions Today Demand Seasoned Executives by John R . Powelson . . . . . . . . . . . 01 Kew Jobs a t 65 by Senator Thomas C . Desmond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .03 . Public Health and Our Older People by Dr . Leonard A . Scl~eele . . . . . . . . . . . . . . . . . . . . . 08 Medical Care for Prolonged Illness by Dr . E . M . Bluestone . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 . Hospitals and Our Elderly by Dr . JIarcus D . Iiogel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106 . The Physicians' Cnntribiitinn t o a State-\vide Program for the Aged by Dr Frederic D . Zeman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 . The Functions of a Geriatric Clinic by Dr . Robert T . RIonroe . . . . . . . . . . . . . . . . . . . . . . . . . . .114 . JIediczl Aids and Benefits at 40: 60 an11 80 by Dr . C . Ward Cralnpton . . . . . . . . . . . . . . . . . . 118 . The Veterans Akclministration and Geriatrics by Dr . James 3 . Dunn . . . . . . . . . . . . . . . . . . . 121 1 . . En~iron~nental Health and d g i n p Population by ;\I Allen Pond . . . . . . . . . . . . . . . . . . . . . 123 Geriatrics-" Xex3: FY0ntie h . Senator Thoma 5 C. D ~ c n ~ n n d . . l . ; . 128 . Seed There be Death? by Dr . Paul - . Zahl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133 1 . . d Psychiatrist Looks a t the Aging by Dr . G . 11 D a r i d s o n . . . . . . . . . . . . . . . . . . . . . . . . . . .136 Fanlily ('are for the Aged l ~ ) JIiss Hester B . Crutcher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .139 . . you Can't Retire on Your Money Alone by Senator Thomas C Desmond . . . . . . . . . . . . . . . 140 . . State d i d for Recreation Centers by H a r r y Levine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .144 Financing Old Age by Dr . Henry TT7. Steinhaus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 . Trends in Old Age Sssistance by Miss .Jane R I . Hoep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148 Older Person 9 H a r e Special Housing Seeds by Dr . Bertha Kraus . . . . . . . . . . . . . . . . . . . . . . .154 Educational Seeds of the Older Akdultin Rural S ~ \ T k State by Afrs . Eenrietta Rabe . . . 160 Por . Librarians and Our Senior Citizens by Albert J . Abrams . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166 .. Canada and I t s Aged hy Professor John S . Morgan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 ���wants of the elderly. Our Committee has reported on these in previons reports, so we shall not repeat them here. However, it is abundantly clear to our Committee that there are large areas of neglect in our handling of the elderly that need to be brought to the attention of our people and our public officials. Today, in this country, we are: 1. Providing social security that is noble in concept but petty in the pittance which it allows. Not only does the Social Security Act, as presently in force, not provide any real measure of security but in such provisions as that which bans payments to those earning more than $14.99 a month in covered employment, it is anti-social. 2. Spending millions for old age assistance, but hardly a dime, except for work recently undertaken by this Committee, to find out ho~57we can prevent oldsters from needing to apply for assistance. 3. Dumping our oldsters into mental hospitals in many cases because we do not know what to do with them. 4. Kicking men and women out of our shops, factories and governments at age 65 though they are still able to work, need work and want to work. 5 . Refuting to hire men over 45 and women over 35, though our Nation needs more prod.uction to increase oiir staiidarda of !iving. 6. Forcing older persons to retire, though retirement is often a death sentence. 7. Setting up huge public housing projects but barring our older persons. 8. Establishing recreation programs for youngsters but ignoring the recreational needs of our oldsters. 9. Devising miracle treatments of the aged and wonderful new diagnostic aids, while providing few facilities for the oldsters who are chronically ill. 10. Shoving oldsters into nursing homes, boarding homes and old age homes, but failing in many instances to prevent such homes from being turned into dismal death depots for persons waiting release from life, or from being turned into money rackets. And the heartening conclusion reached by our Committee is that it can be done! Xot with any panacea. Not with any "one-shot" pill that cures the disease but kills the patient. Nor can it be achieved over-night. Nor by yielding to pressures of sly promoters of economic artifices seeking political or personal advantage by capitalizing on the fears and needs of our elderly. I t is to the economist, the social worker, the industrial manager, the labor leader, the psychiatrist, the geriatrician, and the adult educator that we must turn for guidance. I n our Committee's efforts to approach the problem scientifically, we have done just that. Social and Economic Changes Our Co~nmittee its two previous reports, "Birthin days Don't Count," and "Never Too Old," has presented an accounting of the tremendous upsurge in the numbers of our elderly and of the spectacular social and ecoizomic changes of the past ;entury which have altered the status of the older person and produced so many heart-breaking difficulties for our elderly. We shall not elaborate on these causative factors, except to point out that the number of persons 65 and over in Sew York State has doubled since 1930, and by 1960 it will have doubled again! Our total population increased 71 per cent in the past 40 years but the increase in older persons has been more than three times as fast, or 258 per cent. I n 1850, life expectancy was 40 years; one hundred years later, it is about 68 years. But it is not alone the impact of numbers that concerns us. The industrial revolution, the change from an agricultural to a factory civilization, and the concomitant movement from farm to city have produced a tremendous change in the living patterns of our older persons. The small city apartments, the trend to smaller families, the mobility of labor, the modern wage-income patterns, and the emphasis on specialization are pressures which have produced an upheaval in the position of older persons in our society. Society did not foresee the impact of these developments and scarcely understands that they lie at the root of many of the social and economic difficulties of our elderly today. With the result that society has been picking up the human wreckage and trying to mend it together with the scotch tape of old age assista11r.e and the adhesive of social security. Areas of Neglect Before attempting to develop a program for the aging. it is necessary to know the basic needs and 6 ��any state. As such wc felt we had a definite responsibility to handle our obligation in a mature, nonpartisan manner. TVe soon found we had to assume some functions not legislative ill a narrou7 sense, such as educating of responsible community leaders, encouraging, prodding and stimulating State and local officials, and while these actirities may not produce legislation, undoubtedly they will bear fruit in better service to our old folks. This Committee has excluded from its official inq u i r k ( a ) the field being covered by the Ostertag Committee on Interstate Cooperation, whose sub-committees are considering the problems of social welfare adnlinistration and financing, including adult institutional care; and ( b ) the field covered by the Mailler Health Preparedness Commission, the Hospital Study Committee, ancl Joint Hospital Surrey and Planlii~ig Commission, which agencies have considered the problems of medical care, hospitalization and chronic illness of the elderly. Our Committee has concentrated its attention largely though not entirely in six main fields: ( a ) eniployment problems of the elderly; ( b ) recreational needs of the elderly; ( c ) health needs of the oldsters; ( d ) community services to the elderly; (e) integration of State programs for the elderly and ( f ) development of a n informed group of medical, labor, industrial, social work, and religious leaders in this State who will be informed in this field and who will be able to provide a continuing medium for advancement of the interests of the elderly apart from any governmental agency. rel pointed out that "to those whose forces are detlining appropriate work shoulcl be given, but not rest." JT7e urge Grandpa to get out of the rocking chair; me want to encourage activity, whether i t be n-ork, social activity-, recreation or any other kind of actirity for older persons. The psychiatrists speak of the "lethal cessation" of actirity, and Dr. Edward J. Steiglitz, renowned geriatrician, emphasizes to our committee that inactivity speeds up the degenerative procpsses. The phantasy of retirement and old age as a period of the Grand Loaf must be erased, for natn~-eeliniinates those ~vhohave relinquished their functional usefulness. Activity is not enough. I t must, in part, a t least be purposeful. The older person must, like all of us, feel that he is doing something that is useful. This feeling of utility becomes especially vital in old ace because oldsters very commonly feel rejected. because they are rejected. TT7e all age differently. The aged have no monopoly on aging; nor youth on youthfulness. Some a t 65 are yo~nlp; some a t 35 are old. TVe age differently mentally and physiologically; and different parts of our body age at different rates. Beyond that, the needs of the aged differ greatly. Thus we must avoid, as much as possible. a broad sweeping treatment of the aging and attempt, as far as possible, the individnalized, personalized, local approach of the case-worker or the modern group techniques of therapy. The closer v e can bring service agencies to the aged. the more effective they ~vill be. Gerontology is in its infancy. TTTeknow little about our old folks. TVe know little about how to care for them. We aren't sure, for example, whether we need ,,,:,,,1 hn:on ,,+l , , C thn nhnr\n:nollxr :11 : a f .n LG61wIIuI llwUrlLulU c ccn~ Basic Principles Guiding Our Committee ters in the State, or many wards or cottages set up in coiinection with our local general hospitals. We We come to you with no panacea or legislative cure- aren't certain as yet whether we should set up settleall for the problems of our oldsters. We carry no ilieilts of old folks or bring them into neighborhoods elixir of youth in our files. with younger people. Our Committee believes that Our Committee is guided by five basic principles : at this stage in our evolntion toward services for older people it would be unwise to freeze into law any 1. A c t i v i t y i s a biologic d u t y . one type of approach or service to older persons. We 2. Oldsters m u s t feel w a n t e d a n d u s e f u l . are only in the planning and experimental phase of 3. A g i n g i s a personal a n d local phenomenon. our development to a more mature handling of our 4. Ulztil w e k n o w far more a b o u t t h e aging t h a n w e oldsters. do, seek a diversity a n d fluidity o f approaches Finally, we are convinced that those of us who are a n d services a n d institutions rather t h a n at- thinking about the elderly of the future would do wel) t e m p t n o w t o freeze i n t o law a single line o f at- to be concerned about child welfare today, for the tack or encourage a silzgle k i n d of institz~tional patterns of adjustment of the individual to hi5 encare. vironment are determined early in life. The crabby, 5. Tlze seeds for a h a p p y old age are best planted crotchety oldster of 76 m7as probably a miserable inan in his 40s, a n irritable youth, and a sniveling, early. brat in knee-pants. The well-adjusted, happy oldWe shall not elaborate in detail on these largely ster of today was probably full of life and pep and self-explanatory guide-post,s. The late Dr. Alexis Car- ambition in his younger days. bllb C-IIIVIIILU113 ���If we add to these costs the payroll tax on employ- setting up in-service training for local welfare workers and employees for the Federal Old Age and Sur- ers. I t has encouraged improved medical care for the vivors Insurance, or the $44,445,538 a year Federal destitute-aged. Too, it operates at Oxford, N. Y., the contribution to old age assistance in this State, or only State operated home. The State Labor Department, through its Bureau of local costs for old age assistance and old age homes, or the burden assumed by private groups in this Research and Statistics, is beginning to compile case State for supporting old age homes and nursing histories of successful employment of older persons, homes, chronic disease hospital wards mainly for the and has initiated a series of studies dealing with older elderly, visiting nurse service for the aged, and many workers. The State Employment Service, under the other such programs, or if we were to include the State Labor Department, has set u p a n experimental extra-long payments to elderly on unemployment in- ~ t n i tin Manhattan to place older persons seeking surance rolls because they cannot obtain work, we gain clerical jobs, and is slowly expanding this valuable some appreciation of the staggering burden already as- type of work to other areas and other types of posisumed by citizens of this State for aid of our elderly. tions. The State Mental Hygiene Department cares for 22,000 persons who are over 65 in its mental hospitals. State Activity Last year it launched an experiment a t Willard State ~ o s ~ i t in lwhich naval bairacks a t nearly Sampson a But this summary of some of the State's financial are being used to determine the practicability of cotobligations in alleviating the plight of the elderly tage care of the harmlessly senile. This department does not present a full picture of the extent to which has placed 827 persons over 60 years of age in foster the State of New York aids its oldsters. homes and is developing its family care program. There are a myriad of State activities directly afThe State Housing Division has set aside some 53 fecting the aging, and we are happy to report that apartments at the Fort Greene Housing Project for coincidentally with the creation of our Committee, older persons, and of course, when older persons live various State departments have stepped up their at the site where slums are demolished for new stnteservices to the elderly, have re-examined their pro- aid public housing projects, they are given priority grams, or have increased the tempo of their researches in renting the new apartments. This division is uninto the needs of the elderly. dertaking an analysis of its research data to sift out -4 64-year old man, disabled by a fracture of both all available facts relating to the living conditions legs, was guided by the vocational rehabilitation unit of the elderly. of the State Education Department. This agency State Health Commissioner Herman E. Hilleboe gnided the man into a profitable rooming house venrecently informed the American Public Health Asture. A '72-year old man, suffering from an affliction sociation that his No. 1 health goal was better care of the legs that barred his return to his former job, for the chronically ill and aged. This represents a \$-as placed through this agency's help as a landscape major shift in emphasis in t h e thinking nf this degardener. partment along lines urged by our Committee. Many The State Education Department, through its of the services rendered by the Health Department Adult Education Bureau, is promoting a variety of from its cancer work to its tuberculosis program dicourses especially for older persons, in old age homes, rectly aid the elderly. day centers, and factories, as well as in schools. The State Retirement Fund in the State DepartPension funds of various charitable and teachers nient of Audit and Control directly affects former groups are supervised by the Insurance Department, State and local employees as well as older workers now which also exercises general supervision over the va- eniployed by the State or local governments. rious insurance companies which sell group retireThere are a host of other State services to the elderment and welfare policies. The State Bank Depart- ly ranging from free fishing licenses granted by the ment similarly supervises banks which are often Conservation Department to oldsters, to bath treatnamed as trustees of various industrial pension funds. ments by the Saratoga Springs Authority especially The Social TITTelfare Department has appointed sup- popular with older persons, and which are free in ervisors to check on nursing and old age homes and sonie instances to persons on old age assistance needis developing standards for these institutions. This ing the therapentic aid of the baths there. department also supervises the grants of old age asOur purpose in recording these activities is to unsistance by local welfare departments. Aiicl TJ-hen clerscore the diverse relationships between a niodern Mr. B., an old age assistance recipient, deems his grant state and its older people. I t also may help the is inadequate, he can appeal to the State Social Wel- reader to understand why our Committee believes fare Department for a hearing. This department is there is need for coordinating State activities. �ANNUAL PARTIAL COST TO THE PEOPLE OF NEW YORK STATE OF CARE FOR OLDSTERS Old Age and Survivors Insurance payroll deduction . . . . . . . . . . . . . . . . . . . .$322.800,0001 Private industrial pension payments. . . 135,000.000' Old age assistance, Federal, state and local payments . . . . . . . . . . . . . . . . . . . 87,600.000 Care of elderly in State ineiital hospitals 20,100,000 Homes for the aged, public espenditnres for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '5,000.000' 1,3003000' Elderly in State prisons, cost of care fol" Assistance to elderly blind. . . . . . . . . . . . 1.000.000" Benefits to elderly veterans and veterans dcpclzdents . . . . . . . . . . . . . . . . . . . . . . . 28,000,000- $601~000.000 Fiscal year 1948-49. No accurate data available for state or S a t i o n on p i i r a t e industrial pension ~ l figure iis 10 per cent of ~ ~ the estzmated national figure for employer-employee contributions to industrial pensions. 3 Fiscal year 1948-49 maintenance cost; does not include ronstruction or depreciation costc of buildings 4 Data relates t o 1946, from K e ~ v Yolk State Department of Social Welfare. Estimate based on ratio of GB.and.oTer ape in prison> t o total prison population a s of J a n u a r y I , 1948; cost ebtimates based on per capita costs in 1946. 6 Based on ratio of persons 65 ancl o ~ e r upstate caseload. in for calendar year 1947. 7Based on ratio of persons 65 and over ieceiving d i s a b i l i t pensions and s u r v i ~ o rdeath claims froill World W a r I and previouq n a r q and eqtimatecl cost in maintenance in veteran. hospitals and homes. 1 2 Community Programs QEe of tho -net lll"oL t : . : - ------ ---- .: 2 ' z A ~ a i ~I. G-I I I ~ j l l n c t - iii ~ U t a r ~ ~ L L L A ~ L S the State toward alleviatiizg the plight of our el~lerly is being made by local private agencies, which are taking the lead in their communities in awakening the people to the need for aiding the oldsters and often in actually operating new services for the aged. state-wide survey inade this past year I?p our Committee shows that old folks are getting more attention than ever before from their home to~vnsLocal activity in the field of the aging i? beginning to boom. Our Coniiliittee has attempted to stiinulate this development, provide n source of information for the local agencies, and channel their efforts into the most productive avenues. Recreation centers for oldsters are being set lip in many communities. Old age homes slowly but stcadily are improving their standards of service. Health, welfare and industrial organizalions are joining to plan community-wide welfare programs for the elderly. A variety of research is being initiated, and new nays for dealing with ailing oldsters arc. beilig 'leTelopecl. T e find that New Tork City and Rochester are foreniozt in advancing the interests of the elderly in our State. Rochester, by virtue of a gift from the local TT70men's Educational and Industrial Union to the llochester Cotulcil of Social ilgencies, has appointed a Conlnl~iiiity Consi~ltaiit on the Aged to s p ~ l ron \eryices of oldsters alld c.oorcliliate ~yorkdealin2 u-ith them. Rochester's social agencies are outstanding in their acl~ancedplanning for the elclerly. This tit>- has hat our Comnlittee believes t o be the olil~t_c,riatric ,,linic in the state, operated by the Baclen stn>er Set. tlenlent House. Rochester's Planning Commi~.jioii lla5 asslglled a staff nlenlber to report on l~ousitlgfor The D~lxirtrnp~it i ~ i a r l ~ 118s thp ~ l d ~ r l y . local TT7plfar~ studies of oldsters on olcl age assistance roll.. Old to age hoines for the first time are being e i i c o u r ~ ~ e c l lift their standards. Recreational projects hax-e alhat ready been set u p for oldsters. Rochester B~IOTV~ it lleecls to do for the elderly, allcl is prepared to clo it, liinited only by available funds. S e w York City, through the leadership of the Xrelfarp Collncil of Ne-7 York alld the Comnlullit~-%erri(.e Society of New Pork, is bringing together public and private institutions, agencies and indi~iclnals dealing with the elderly for a unified attack on old age problenzs. nliss Ollie A. Randall, Consultant oil the A g e d for the latter organization, is a n unofficial S e w york c i t y anlbassador to its elderly people. S e w Tork City's Hospital and IIraltli I l r l ~ ~ r t n ~ e n t s are taking a world-wide lead in studies of deoeneratire diseases which afflict the elderly. The city is also ~ i o n e c r i n g in providing housekeeping ~ e r v i ~ ~ ~ ~ b and LO~LIC e ~ U Ib i ~ k cdi ui6bierb w h u u 1 l t . l ~r e s p v ~ l i lbrzr ro help in their homes rather than in hospital.. S e w Tork City bas the first geriatric unit set up I)\- ally local health departnleiit in the countr~-. Tlir 110spita1 D q a r t m e n t . guided by the able inedical coiuisel of Dr. Ho~vardA. Rusli, is doing iiiiraculons ~rrlrliin rehabilitating the elderly for work. New Pork City's MTelfare Departinent is providing staff p ~ ~ s o n lforr the world rc.non ned Hodion Eiecre~ l ation Center for oldsters in cool>eration n-it11 prirate agencies. Social welfare organizations in various conlnipnities are setting u p special committees for the aged. I n the long r u n these mill prove to be major steps for~varcl,for they will provide the necessary leadership ailcl planning needed for total community programs. Sj-racnse recently established such a committee uncler the leadership of the Onondaga Health Association. The Committee is headed by Dr. Raymond G. I<nhlen, nationally known Syracuse University psychologist specializing i n problems of the aged, who 12 ��already has a large number of research projects under way and is starting to mobilize community support for recreation and adult education programs for the elderly. A presentation of the Syracuse program is detailed elsewhere in this report. Buffalo has set up a special committee on the aged under its Council of Social Agencies, and it is working toward educating trustees and administrators of old age homes toward modern concepts in handling institutionalized elderly. The Committee is also developing craft and recreational programs for oldsters. The Buffalo Fire and Welfare Departments recently joined in surveying old age nursing and boarding homes. The Forty Plus Club of Western New York, with its headquarters in Buffalo, has helped many top notch executives obtain jobs though they were in upper age brackets. I n New Rochelle, Port Chester, White Plains, Ossining, Tarrytown, Yonkers, 39t. Vernon and Tuckahoc, "senior canteens" have been set up largely through the support of the National Council of Jewish Women. Local recreation commissions in Westchester Colmty are being stimulated to think in terms of old people as well as young people. Troy and Yonkers are now considering setting up committees on the aged through their local social welfare agencies. The Community Chest and Planning Council of Utica is launching a study of hospital facilities for the senile in the Utica region. Jarnestown's Recreation Department has organized a "Golden Age Society" to handle recreation for oldsters. At present, it has 341 members, the oldest of whom is 93. The group has picnics, trips, lectures, plays and other entertainment to make life worth living for its members. The club has a special shut-in program for its bedridden members, one of whom has bcc;~i bcd fsr 25 years. : These are but some of the developrncnts in our communities. Others are cited in more detail in other parts of this report. The New York Plan The heart of our proposed plan for New York State is stress upon a local comnlunity approach, an emphasis upon a variety of modes of attack on the problems of the elderly, and a provision for linking private and public agencies in the communities for a united drive to aid our oldsters. I n this, our third report, vie present as definite and concrete a program as can reasonably be achieved at the present time. The program calls for : 1. Teamwork between Federal, State and local governmeats, and between government, industry, labor and citizen groups, 2. A "home-town" approach to the myriad problems of the aging, recognizing that the strength of our country lies in great measure in vitality of our local communities and in the intelligence and public spiritedness of our local community leaders, 3. The preventive approach, which seeks to concentrate on preventing our oldsters from needing to fall back on old age assistance, or from needing hospital facilities, or from needing to be institutionalized in old age homes, by providing job opportunities, health services and adequate housing for older persons. Heretofore most thinking in connection with the aged was centered on trying to ease the woes of the elderly rather than aiming to prevent them. 4. A diversified, multi-pronged attack on the problems af the elderly, rather than a single approach, characteristic of the Beveridge plan in England and the California approach in this country. 5 . Integrating services for the aged with general community services for all citizens whenever possible instead of separating old people from the remainder of the community. The plan calls for establishing : 1. d permanent home-town job-finding service for older persons, with local citizenry joining with the local employment service offices, to conduct an educational campaign designed to encourage the hiring of older worliers. break dov7n artificial age barriers in local plants, furnish counseling service for older persons, and utilize local schools and hospitals for rehal;ifitati=r, ef the elderly jch seeker fc\r xv~rk. 2. h community recreation program in each locality to meet the needs of the elderly. such recreational facilities, to be sponsored by local fraternal, church, civic and welfare organizations and official agencies ; such recreational facilities to be of the day care center type or the clnb type depending on the size and needs of each community, but in all cases emphasizing not merely recreation in a limited play sense, but also opportunity for creative, purposeful activities. The program should not be limited to a particular building or facility, but should spread out to embrace old age homes and nursing homes. 3. Adequate facilities for the chronically ill in each community, as may be recommended by the Joint Hospital Survey and Planning C'onimission, more liberal admission policies of the elderly who are chronically ill by local hos- �6. 7. 8. 9. 10. pitals, provision of home care and housekeepous farm groups, such as the Grange, F'arm ing services for those who often do not need Bureau, Home Bureau, and the Extension Serrexpensive hospital service, and adequate clinice. can provide the central direction and leadical and diagnostic service for the elderly. ershi~ needed. Improved standards of institutional care, in This is a local program that calls for social enginursing homes and old age homes, by licensing, education and supervision, as may be recom- neering that can be launched by our commnnities mended by the Ostertag Joint Legislative Com- without waiting for a beneficent State or Federal mittee on Interstate Cooperation and the State Government to prod, finance, or supervise local et'forts. Some communities are already taking action along Social Welfare Department. these lines as we have indicated in another part of Local adult education opportunities for oldsters, embracing a wide range of courses suit- this report. This multi-purpose drive is practical, already heen able for oldsters, such as hobbies and crafts, because individual segments of it h a ~ e tested in various communities. and also courses dealing with health care after 60, how to adjust to retirement, etc. Such The State's Role courses should be given not only in schools, but wherever convenient for the elderly, in plants, But our Coillniittee believes the State must bear its old age homes, private homes, and civic centers. share of the responsibility. Our communities are A new concept in local health departments already heavily burdened with debt and tax levies. geared to adjusting services to a n aging popu- Our Committee believes that the State has these prilation, with developnlent of health education mary obligations in this field: programs, geriatric clinics wherever possible, A. Provide financial assistance wherever justified. and a shift in emphasis by local voluntary health agencies from the conlmunicable disB. Provide the technical assistance and standards eases to the degenerative diseases. needed to assure uniform, high-level adminisLocal mental hygiene program designed not tration. only for younger persons but also for the midG . Spark its own agencies to a wider appreciation dle aged and oldsters, to block the impact of of the needs of the elderly. senility. D. Provide a central coordinating agency of variFinancial counselling service by the communous departments to give the State program ity's bankers, businessmen and social workers, leadership, direction and coordination. to low and moderate income groups so that the best use may be made of available income by Specifically, our Committee recommends : our elderly and near elderly and so that some may be prevented from needing old age as1. Creation of a special counselling and plareluent sistance. service in the State Enlploynlrnt Serrice, t o aid A program to inform the public regarding the older persons obtain johs. Our Csmmittee beiieads of the eideriy on old age assistance, the lieves every local office of the State Emploj-ment extent to which local welfare departments are Service should have one or more placement exmeeting these needs, and the granting of old perts, depending on the size of the commnnity, age assistance to the needy according to their who is familiar TT-it11 emotional, medical and the needs, based not on a meagre subsistence or ccoi~oinicprobleins of the older persons, who is sustenance level. but on a decent. adequate familiar with local job opportunities for older American standard of living. persons, who is trained in "selling7' older perA local agency in each cominunity composed of sons to industry, and who has the special zeal private and public groups to coordinate the and ability to counsel older workers so that they local old age program, inventory and develop mill have r e n e ~ e dconfidence in their abilities. local resources for the aged, and educate the 2. Creation of a permanent, full-time agency in community to the needs of the older people. the State Labor Department to promote the emThe local councils of social agencies, already in ployment of the aging through education and research designed to break down age barriers in existence, provide a ready-made organizational industry through development of job analysis pattern capable of providing the leadership studies, case histories, etc.. publicity aimed a t urgently needed in urban areas. I n non-urban breaking do-cvn the several myths which retard areas, perhaps existing committees of the State the hiring of older persons, and to collect data Tuberculosis and Public Health Association, of on employment of the elderly which will aid the State Charities Aid Association, and vari- �the employer and employees alike, such as information on pre-retirement counselling policies, private pension plans, etc. 3. Provision of state-aid for recreation centers for the elderly in the same manner it has authorized state-aid for recreation centers for youths. TTe recommend that the Legislature appropriate 10c. of State-aid for each person 60 years of a,O or e over to each community matching this aid dimefor-dime. We believe the State ~villbe buring itself a bargain through such aid, that it will d~crease the ratio of increase of our elderlv in our mental hospitals, and that it will help redtore ~ i t a l i t y our elderly. to 4. Creation of Division of Adult Hygiene and Geriatrics aimed at shifting emphasis in the State Health Department froill comnl~uzicable cliseases to the degenerative diseases which are 11uv the leaclin:: causes of death. 3. The Legislature should provide the Adult Edu- cation Bureau of the State Education Department with the funds necessary to establish a state-wide adult education program aimed a t our older persons, by encouraging localities, industries and labor organizations to organize courses, by training teachers for the special techniqnes needed in motivating older persons and by providing leadership 'to carry out plans already well formulated by this bureau. (3. I11 all state-aided public housing projects, a small percentage of apartments be set aside for older people a t least in proportion to the number of elderly in the community as a whole. 7. permanent State council on the elderly designed to provide the central coordinating machinery needed to provide official leadership i n the field of the aged for the various State departments. 8. Adoption of a law banning discrimination against older persons seeking any State or local NUMBER OF PERSONS AGE 20 T 64 O FOR EACH PERSON AGE 65 AND OVER AGE 1e50- 1900 FROM u s 20 - 64 C E N sus D A T A 195G 2000. FROM ESTIMATES P U B L I S H E D BY B U R E A U O F T H E C E N 5 U 5 '1947 - AGE 65 4 OVER �license, permit, or certificate, or admission to any state-financed, administered or approved course. While our State is admirably free of any such discrimination, we have found that applicants for vocational-industrial teacher training courses set up by the State Education Department are barred if they are over 40 years of age, a policy that blocks able, skilled middle-aged and elderly mechanics, for example, from serving as teachers. lationship and under master-slave relationship, and when he found no real security i n any of these, he sought security in freedom. The baby who wails when it does not receive its Inilk on time is crying out not only with the pangs of hunger but with fear of loss of its security. The baby grown to manhood searches for security through his own labors, through religion, through family relationships, through participation in a free society. Speak to the psychiatrist and he will say: "The man who loses his sense of security is lost. Today mental institutions are jammed because so many people have, State-wide Citizens Committee o n the Elderly for a variety of Eeasons, lost their sense of security." Our Committee recommends that there be estabAnd so the quest of our aged for a modicum of selished in this State a State-wide Citizens Committee curity in their old age lies deep rooted in the physiolon the Elderly. ogy and mentality of man. And if it erupts in modern TITe have already initiated moves leading to the creman as a drive for pensions, or old age insurance, ation of such a group and believe that perhaps one of should it not be viewed as stemming in large measure, our most worthy long-range accomplishments will at least, from the change from a rural economy to an be the impetus given to the establishment of such a urban economy, from an agricultural economy to an group. industrial economy, from a society where families Such a private committee, representing the think- lived in large homes ample for three generation units ing of labor, industry, and farm organizations, and to one of small apartments where two generation units religious. medical, and social welfare groups, can are often cramped. from conditions which often bring bring to bear upon the old age problems in our State, our people to later maturity shunned by an industrial sound. mature intelligence. society and haunted by fears of destitution and a Such a non-official group is needed to review legpauper's grave. islation introduced affecting the elderly, mobilize pubThe financial needs of the elderly are real and lic opinion for sound legislative or administrative ac- urgent. Of 6.3 million nonfarm families with incomes tions affecting the elderly, prod public officials to below $2,000 in 1948, more than one-fourth, or 1.7 greater efforts in behalf of the aged, act as an unoffinlillion, were headed by persons over 65. cial auditor of the State's activities for the elderly. Half of the families headed by persons over 65 had stand as a bulwark against "panacea" pressures incomes below $2,000 a year. which might throw the State into bankruptcy, and A study of old age and survivors insurance recipiserve as a vital link with any national committee set ents indicated that 69 per cent of the nonmarried perup in this field, and aid local councils of social agen- sons ~nc! ccnp!cs living aloiie aud drawing 0881 cies ilz their e E ~ r t ato alleviate the plight of the checks received a total annual income from all sources elderly. of less than $1,000, and practically all of them were This, then, is the New York Plan. I t is not a com- below the $2,000 level. plete. final and definitive plan. But it is believed to The problem is not should we provide a measure of be the best plan that our Committee can propose at security for our aged, but rather: this stage in our social evolution, and with the present limitations on the scope of our Committee's ( a ) how much security can our industrial economy actirities. afford to provide now and in the foreseeable future ; and Man's Quest f o r Security ( b ) how can we channel the drive for security into There is a disposition among some publicists and proper avenues. officials to view the current drive for security for the We have today a 250-billion dollar economy. Some aged as a new trend that stems from a weakening of the moral fibre of our people. economists, more optimistic perhaps than others of This line of reasoning totally ignores the physiolog- their colleagues, believe we shall have a national proical and psychological drives and the socio-economic duction in 1975 of 500 billion dollars. factors which underlie the search for security. How much of this production can we siphon off for Man has always sought security. protection of the aged? This is a problem national, He sought it in the caves. He sought it in nomadic rather than state-wide in scope, and requires a degree tribes which travelled far to find food in abundance. of study that has not been given as yet by anyone in He sought it under the protection of lord-subject re- this country. I I I 1 I I 1 �UNEMPLOYMENT INSURANCE COMPARISON OF CLAIMANTS EXHAUSTING BENEFITS DURING FIRST TWO POSSIBLE WEEKS IN BENEFIT YEAR b State k �1 I I I WHERE OUR OLD FOLKS GET THEIR INCOME Maior Source of Income for People Aged 65 and Over To cushion the economic blows which strike our people in old age, our country has clevelopecl three basic types of financial aid : 1. Contributory old age and survivors insarance; 2. Old age assistance; 3. Industrial pensions. What Security Costs Our Committee estimates that the annual cost of providing old age security in its three niajor forms in this country is approximately 4.7 billion dollars, or 2 per cent of the country's national production. Cost of Old Age Security in the U. S. A. (1950 est.) Cost t o taxpayers of old age assistance.. . . . .$1,380,000,00Q Cost t o employers and employees of old age and survivors insurance. . . . . . . . . . . . . . . . . . . $2,000,000,000 Cost t o employers and employees of prirate . pension systems . . . . . . . . . . . . . . . . . . . . . . . . $1~350,000,000 $4,730,000,000 And are our oldsters obtaining financial security from this nearly fire-billion-dollar-a-year outlay by taxpayers, employers, employees and consumers? The answer is no ! How Much Security Both old age insurance and old age assistance benefits are below a decent living standard. And until recently, the average industrial pension paid little more than the monthly grant to a recipient of old age assistance. There can be little security on $26 a month. Yet that is the average benefit under the old age and survivors insurance system to single workers. And the average benefit to couples under OASI is $11 at a time when the Federal Government itself concedes that a minimum food bill alone for a retired couple costs $45 a month! Old age assistance payments average $45 a month per recipient in this country. And until the recent drive for $100-a-month pensions by unions, private retirement systems paid an average of about $30 a month retirement benefits. Moreover, the OL4SI system, which is supposed to provide for "social security" actually provides insurance benefits for only 1,900,000 elderly, whereas per cent more in average monthly benefits than are those on the OASI rolls! The chaotic condition of our security provisions for thc aged are apparent. The OASI mas intended to do a7Gy with the need for most of the oldsters applying for old age assistance. Yet, as Miss Jane Hoey, Director of the Bureau of Public, Assistance of the F'ederal Security Agency, inf~rmec! csr Committee, due to the inadequacies of the old age insurance program, old age assistance has grown beyond its intended scope and responsibilities. The failure of the old age insurance systenl led to tlie recent $100-a-month pension clrive by nnions, adding another complication to the already sadly entangled old age security system in this country. Oldsters and Economic Protection* Oldsters Receiving Benefits Citizens "Covered" Old age assistance. . . . 2,735,000 2,735.000 OASI ............... 1,900,000 35,500.000 Prirate pensions . . . . . 500,000 11,500,000 * There is considerable duplication in these figures, which are suggestive rather than definitive. OASI The OASI program fails to cover 23,000,000 m-orkers, the self-employed, the honsehold workers, government employees, employees of lion-profit organizations and farmers. �Basic flaws in the old age insurance program, in old age assistance rolls. I n New York State, one out addition to inadequate coverage and inadequate bene- of ten is on OAA. Today, the staggering sum of approximately $87,fits, are : 000,000 a year is being spent by Federal, State and 1. The ban on any recipient of old age insurance local governments within New York State for old earning more than $14.99 a month from any emage assistance. ployer covered by the Social Security Law. 2. Unduly restrictive eligibility requirements for The Cost of Old Age Assistance in New York State, 1949 older workers. Special allowances should be Total % made in establishing eligibility requirements for Federal Bid . . . . . . . . . . . . . . . . . . . . . . 8 4 0 , 4 4 5 , 5 3 8 . w . 46 34 those ~ h were already a t the higher ages when State ,lid . . . . . . . . . . . . . . . . . . . . . . . . .$29,613,023.18* o Local Spending . . . . . . . . . . . . . . . . . . . . $17,524,640.81X' 20 the system began. $87,583,202.31 100 3. Failure to encourage oldsters to continue to * Includes aid for local administrative purposes. work by not allowing pension payments to ac* Approximate. cumulate during period of employment past retirement age. Federal and State aid represents 80 per cent of the 4. Failure to grant dependency benefits to women total cost, v i t h localities contributing the remaining who have accmnulated primary benefits and fail- 20 per cent. ure to start benefits for women a t age 60 instead The number of persons on old age assistance in this of 65. Today more than half of the married State hit a ~ e a k 1941, when 121,578 persons rein nlen a t 65 have wives who are 60, only one in ceived this welfare grant. During V o r l d War 11, 30 h a ~ wives who are 65. This means that nzost the n ~ ~ n i b eon O X h declined, as industry opened its e rs rives on a gates to the elderly. I n the post-war period, the married oldsters must support their n' single pension, IIoreover, women of 60 find it trend has heen upward once more, although the practically inipossihle to obtain jobs. number on O A h ill this State has not yet reached the ar 5. Failure to recognize the change in wage levels p r e - ~ ~ peak. I n November, 1949, OAA recipients iince 1939, by requiring contributions be paid in Sen- Tork State totalled 119,113. S s pointed out earlier, our Committee has not had only up to $3,000 of salary, thereby keeping rethe responsibility of studying old age assistance, for ceipts and benefits below proper levels. it is being reviewed by the Ostertag Joint Legislative Fortunatelj-, as this is written, there is a drive on Coinmittee on Interstate Cooperation. in Congress, to extend the Social Security pru~isions The Social Security Act makes certain requireaffecting the aged. Our Committee hopes that the old lnents manciatory if states are to secure Federal money age and survivors insurance system is developed into for the categorical program of OAA, AB and ADC. a real old age security system or is fundamentally re- The act provides states cannot establish conditions .s t sc thzt the gnal of ~niverqnlcnvernge is attained !i::litin,- residence 2nd citizenship too greatly Asand an adequate benefit obtained. sistance must bc provided equitably and must be paid Our Committee urges, however, that the entire prob- in cash. To this extent these programs have an unlem of integrating old age insurance, old age as- clerlying similarity throughout all the forty-eight sistance, and industrial pensions be thoroughly ex- states in the country. plored by national authorities. However, we should like to note here that the OLIA Our Conlinittee will gladly cooperate with national system in this country is in a very jumbled condition. authorities to the end that a decent old age security Each State has a virtually different assistance plan, sl-stein is established. Our present system has failed, with different eligibility rules and payment standards. and merely to patch i t u p here and there is to store The f o l l o ~ ~ ~ table indicates to some extent the difing up troubles for the years-that lie ahead. ferences in payments and coverage : X Old Age Assistance Old age assistance is bread, butter and bed money. I t affects the elderly quickly, directly and basically. I t provides the means of obtaining a bag of coal for a cold flat, a pair of eye-glasses for a near-sighted old man, or a woolen nightgown for a frail, impoverished x7ido~~*. may help pay for a cancer operation, for a It needed sedative, or for nursing home care. Across the nation. one out of four oldsters is on Old Age Assistance in Selected States yo of Pop. OT er 65 state :$:f',,.$, . :.. :. 3 4 7 , \\7ashington Sew Louisiana .... 8 2 5 5 Average % of oldstels Monthly receiving 0-ih Grant 48 $83 00 31 70.70 b8 66. 8 i 10 52 61 82 47.08 State Per cap it^. Income $1,482 1,643 1,395 1,781 892 The need for developing a sound pattern of aid to the elderly was dramatically highlighted this past �O L D AGE ASSISTANCE RECIPIENTS NEW Y O R K STATE year when California was thrown to the brink of bankrnptcy by a referenclum. subsequently ouerrnlecl by the people themselves, which put 41,000 additional persons on OAA rolls, removed faini1.v responsibility for the elderly, and boosted payn~ents. I n the State of Washington, OAA payments constitute 43 per cent of the entire State budget, although a poll conducted there indicated that 81 per cent of the public is in the dark on how much persons 011 OAA receive. TTTe believe there is similar lack of information anlong our own people. I n order to protect old age assistance recipients, local welfare departments have gone to extremes in keeping their operations in the dark. Occasionally financial data as to total expendi- tures or total case loads are released, generally a ilieaniilgless juii~bleof statistics a t best. Little mention is made of the needs of the elder1)-, and of the needs being met and those unmet. Our people are entitled to know what is being done for their aged neighbors and what their needs are. The local welfare departments will be pleased, our Committee feels, with comm~mity reaction. if they pursue a policy of telling the public of the plight of some of the needy aged, what is being done to help them, and what needs to be done. We believe that in inany cases there will be a11 outpouring of public support, financial and service, beyond that provided for by public budgets. Our Committee suggests that local welfare depart- �ments, while keeping the identity of their 0 . recipi. AA ents confidential, indicate to the press the problems being faced by oldsters in our communities. Our Committee suggests that leading civic leaders, bankers, labor leaders, medical men, be invited by local welfare departments to see from typical case records what the needs of the elderly are, whether they are being met and what can be done to meet them. We urge that local welfare departments examine their public relations programs, if they have such programs, and create them if they do not have them. This should be done not to "build up" the department's prestige but t n increase public understanding of the needs of our oldsters and what is being done to meet them. We believe that our local welfare departments have much to be proud of in the work being done to ease the plight of our elderly, but our communities simply are unaware of what is being done. Despite the fact that OAA is costing the Nation $1,380,000,000 a year, little is known about our old age recipients. Who are they? Are they "every-day" persons, of average intellect and backgrounds, or are they mainly a special "problem" group of persons? TT'liat are the long-range and short-range reasons for those unfortunates needing old age assistance ? Was it mainly a long history of low-wages, which make it impossible to raise a family and at the same time put aside enough money for old age? Was it perhaps a suddell collapse of one's business or health? Do oldsters rush to get on OAA rolls at age 65 or do they prefer to work? And what can the community do to prevent persons from needing old age assistance B Or-have they just lived too longt These fundamental questions, as our Committee noted in our previous report, "Xever Too Old," have not been ansmered. Onr Comnzittee has undertaken, through a study of a sample of representative O d d cases, to ansnrer these questions. This work is nov going on. To present an idea of the human aspects of the OAA cases being handled by local welfare departments, and to indicate some of the salient features of these cases that should be of intercst to our communities, we nish to record here just four cases as prepared by our research staff. The Case of Miss B. her hearing diminishing, she had to go on Home Relief. For 10 years she was on HR, until at age 65, she was shifted to OAA. Xiss B. didn't do too well in elementary school, went to bnsiness school where she studied typing and stenography. Toclay, she lives with her O A d widowed sister in a plain flat. Her sole pleasure seems to be visiting her niece. Case vorker reported "these two women live very quiet hum-drmn lives, seem to be satisfied with it." They hare to use toilet on second floor jointly with other people, do not have provision for getting hot water in rlnantity, so have to heat water on stove. Their flat is not very warm. Recently she fell in her kitchen, chipped her shoalder, lay 20 minutes before help came. During TJTorld JJTar 11, Miss B. at age 63, anemic, deaf, sought x~orl;, together with her virtually sightless sister. "I'll have to be eyes for her while she will have to be ears for me," she said. Wanted job a t local hotel becanse she thought her sister would take the instructions from the supervisor and relay them froin onc factory to another. to her! The!- ~~-e11t Their old iiisurallce company turned them domn'there are plenty of women much more alert than they seeking jobs; even though they may not have insurance esperiellce, they are preferable. " Social worker thought the sisters could i n 1943 not do eight hours hard work, bnt nlight do eight hours at sometliing light. ( Xailz Features 1. Illdicatioll that overlTork caused heart attack that caused her inability to work. 2. .\lthoi~ghonly two years from pension age from a life insurance company she received an allowaiice for only one year. 3. This \yoman tried to get work though anemic, and extremely hard of hearing. 4. hiving lvith her OAA sister has eased each other's burdens, helped fight loneliness, perhaps even helped nutritionally for a person often doesn't like to cook for himself or herself only. 5. Seem to get along satisfactorily witholnt hobby. Co~zcl~csions Miss B., 69-year old spinster, worked for many years 1. Overwork was probably due to caring for inas a supervising typist and stenographer for one of fir111 illother and at same time doing own work, the large insnrance companies, headquartered in New York City. She helped support her svido~vedmother raising question of how far parent-child obligation should be pressed. for many years. Then, vhen two pears from ohtain2. Failure of the employing insurance company to ing a company pension, she was stricken with a lleart vest pension rights in employee resulted in this attack. She had $1,000 in the bank. Her company woman going on OAA after receiving one-year's provided some compensation for a year. allowance and exhausting $1,000 savings. Then, funds exhausted, her heart milling bnt ~ ~ e a k , 22 �3. Health was the factor that led to suzeniployability. 4. Possibility of referring Miss B. to mail order work or envelope addressing for local firms in her own home might have been explored, as she could have during the war apparently done some light work from time to time and was good possibilities need intensive typist. Home~~lork exploration. 5 . Modern retirement plans which permit optional retirement at earlier age than normal will ease plight of some persons in similar situation, who are hit by chronic disabling ailment shortly before reaching retirement age. The Case of Ed the Stable Hand This is the story of an old bachelor who lives rather placidly on his old age assistance allotnient, in a house o~vned his brother. E d grew up skilled in the care by of horses. He finished 8th grade and for the remainder of lnost of his working days worked as a stable hand. TXThelithe depression came, he mas thrown out rk of ~ ~ o for a year before he came on work relief for a short time. Then he got his old job back as stable hand at a country estate. When 1941 came, T e see v him bacli at the welfare office, this time for OBA. He wants vork but can't get it. Living with him in his brother's home is his brother and the latter's children, and his sister, to whom he is closely attached. When she becomes ill, having a foot amputated. he stays honie day after day taking excellent care of her. She dies not long afterward, and he becomes disconsolate. He is no longer interested in seeking work. He becomes rheumatic, and because he is skilled only with horses, he is deemed officially unenzpioyabie. He begins to hmp. Meaiirvhile his brother loses his own store, goes to work in a liquor store, and E d takes care of him when he is ill. Ed's only fun in life is "going ont seeing old cronies on the street." I 1 1947, case worker reports he has only 1 shirt, 2 1 pairs of pants, and 2 pairs of underwear. I n 1948, his niece and her husband move into the house which is converted into two apartments, but he doesn't get along well with her husband, so he stays out as much as he can. He helps with the furnace, cuts grass for a woman across the street for 50c. occasionally, and wants a janitor job. 1. Lack of training for anything except care of horses handicapped this man in search for position. 2. This man is able even a t age 74 to do light v-ork or work that requires no constant standing. 3. This man was narrow visioned throughout his life, perhaps through limited education; range of activities are narrow now. 4. The relative placidity of this case is attributable in part to rather constant, steady living sitnation with his own family. 5 . He never earned enough during his lifetime caring for horses to provide for his old age. 1. Again me see that living with family tended to provide happiness for the oldster. 2. Failure of adjustment with younger generation also is seen. 3. Failure of this man to train for anything expect work with horses handicapped him in later life. 4. Family responsibility, brnther-sister, and brother-brother relationships, are demonstrated. .5. Seed for social sitnation, enabling oldsters to get together, is seen. 6. Psychological aspects of work-desire seen in wish to withdra\vl;'from labor force on death of sister and re-awakening of desire to work, later. 7 , Snrely, society could have found a place for a man skillecl with horses ; surely someone needed this man but the two were not brought together. 8. Xeed for more than one occupational skill indicated. 9. Few of present OAA cases are eligible either for primary or dependency benefits of OASI. The Case of Mrs. 6. Mrs. G., a widow of some 22 years, managed to get along by herself, as a domestic, and probably with some accumulated savings, until her physician told her that her health was too poor to continue working any longer. She was 66 when she gave up her part time work which paid $10 a week and two meals a day. The knowledge that her working days mere over and she ~vonldhave to go on OAA came as quite a shock. Nrs. G's husband had worked for 20 consecintive years for a local gas and light company before his death, but had never qualified for retirement benefits. This OAA recipient has serious high blood pressure, and needs much rest and medical care. She has been very fortunate in finding accommodations at a boarding home with other older women, some of whom are, like herself, on OAA. She has plenty of opportunity for the peace and quiet she needs, and yet does not lack companionship. J f a i n Features 1. Mrs. G., who was not prepared for employment at time of widowhood, did not have sufficient 23 �earning capacity to put money aside for the day when she would not longer be able to work. 2. The four c.hildren of i\lrs. G. were all married and unable to contribute toward her support, although they did give her presents for Christmas, on her birthday, and on Mother's Day, which were apparently sizable enough to help Mrs. G. out some. 3. A t 66 Mrs. G. was working and might have continued working until the time of her death if a physician had not told her to stop. 4. Mrs. G. is skilled in needlecraft, such as crocheting, but i t has remained only a hobby, and means of providing attractive but inexpensive Christmas presents for her children. Conclusions 1. Company pension plans, even though they be meagre, might save many conples or the sinvivor from public assistance. OASI mill help, but i t is too recent to benefit most of our present oldsters. 2. Protection against the heavy expenses of chronic illness so prevalent in old age would help oldsters conserve savings they might have from their working years. 3. Opportunities for homework might enable oldsters with skills to turn hobbies into profit. The Case of Miss A. AIiss d., 83, lives with her 8.5-year-old sister nho is also on OAA. Miss d. worked for years as a domestic, until she could no longer work. A t age 74 ( !) she had to quit and go on OAd. Rheumatism and an infected leg caused her to have to quit work. She lives comfortably with her sister in a threerooni apartment in a good section of town. She aids her sister n~henthe latter is ill, and the sister cares for her hen she is ill. She is remarkably healthy for her age. Her landlord likes the cheerfulness of both sisters, allows them considerable freedom to use his OTT.~I apartment and the sisters regard then~selvesas sort of members of his family, has kept rent low, aided them on various occasions. Mai~zPent lrres 1. Here is a woman who worked till age 74 when she was attacked by rheumatism. 2. Her years of low wages as a domestic precluded any possibility of substantial savings. 3. She and her sister live comfortably and happily together, social worker reports, aiding one an- other when necessary, providing companr- for each other. 4. Amiability has improved their lot by resulting in having their landlord assist them in various ways. 1. OASI doesn't help domestics any. 2. Case suggests possible need for experinlent in attempting to get more OAAers of suitable temperament to live together, to relieve lonzliness, to help each other, etc. 3. Good humor aids throughout life, even inro the late years. Industrial Pensions The p r n h l ~ m of inili~qtrial p~nqinnshas I ~ O I ~ Ito P the fore, as predicted in previous reports of our Committee. Today, more than 11,500,000 Amer~can~vorkers.or nearly one out of every six, from elevator operators to corporation presidents, are piling up pension creclits in retirement funds. We believe that employ~rsand employees are poaring $1.3.50.000.00i) a I \ Q F I ~ , into these pension pools. Our Committee estimated last year that over a quarter of a million men and women are receiving $150,000,000 a year in pension checks from their former em~loyers. I t should be noted that this averages about $56 a month per pensioner. This average monthly pension is probably a little higher this :-ear, as the effects of the $100-a-month pension d r i w by unions go into operation. Industry is pouring enormous sums into pension plans. Marshall Field & Co. allocates $2,000.000 a year irliv its retirement trust. Sheii Oil Co. spends $9,100,000 a year for pension allocations. 1Vhe11 the Gannett Go., Inc. announced early this year it Tyas establishing a pension fund for its employee\. the estimates of employer contributions alone for past services of employees came to $6,000,000. I n the current hubbub over industrial pensions. it may be well to note that the New York State Chamber of Commerce has said : " I t is good basiness as well as good morale for management and workers to cooperate in promoting sound insurance plans to 9rotec.t wage earners against the hazards of old age. " I t nTasindustry, interestingly enough, that initiated pensions, which were in the past often deemed to be "pie in the sky" by labor leaders. And industrial pensions have proven to be good business for inclnstrg because i t steps up morale of employees. liel!)~ recruit a higher type of worker, provides for ortlerly retirement of workers, in addition to providing tax benefits for the company and meeting the company'h moral obligations to its faithful workers. �Our Con~mittee's survey of companies having pension plans indicates that business likes pensions because they are a precise business-like way of handling workers. Organized labor switched from an anti-pension attitude to an aggressive pro-pension stand because Social Security payments proved to be so inadequate, because pay-rises were largely halted in recent months, and because of a rising concern with older workers. To the worker, indnstrial pensions have their advantages and disadvantages. Private pension plans tend to restrict the worker's mobilitp, and tie him down to one company, one community. The plans give him practically no protection if he wishes to quit or is fired even after long service to the company. Furthermore, they generally require such long periods of service to qualify so that as a practical matter only a small percentage of our workers may ever q.;alif:; for the pefisions. On the other hand, so long as Social Security payments are so niggardly, our people will seek to snpplement them by industrial pensions. As Governor Thomas E. Dewey pointed out in his 1950 message to the Legislature : "some of these pension plans are contributory ; others non-contributory ; some are fnnded on a reserve basis and thus baleguarded to some extent against default; others are completely unfunded and unsafeguarded; some are correlated with the national insurance system while others are not." Our Corlinlittee is concerned over six nlam defects of the current retirement systems : supplementary to the social security system, not as a substitute, and must be integrated with it. This whole subject needs further study by liational and state authorities, as well as by industry and labor. Our Comil~itteewill gladly assist i n any such deliberations. Our Committee feels very strongly, however, that while social security is a necessary part of the r3rotection we must afford our older people, it is folly to attack the problems of the elderly as though inerely boosting OASI coverage and payments or increasing old age assistance grants or simply giving everybody who reaches 65 a pension of some sort is the ivhole answer to the problems of our old folks. Social security for the aged is a n important elenlent bnt only one element in a sound program for the aged. UN and the Aged Our couiltry may possibly save itself from making dismal errors made by other countries in dealing with the elderly if we have snfficient information available. The organization best equipped to ro~undup the norld's experience ill dealing with housing for the aged, recreation for the aged, social security. l n ~ n t a l care of the aged, and care of the chronically ill, is the United Nations. I t has the staff, facilities and status to assemble data on a ~vorld-widescale. Our Committee urges that the appropriate office of the United Kations be aathorized to spearhead a drire to bring about better conditions for the elderly of all nations by acting as a central depository of old age data. by exchanging old age information, by assenz1. The plans fail to take into consideration fluct~za- bling world leaders in geriatrics, housiilg for the aged and related fields for the exchange of experiences tions in the cost of living. 2. Inadequate and usuaiiy no government super- and vietvpomts. vision to assure adequacy of the pension systems Employment Problems of the Elderly exist. 3. The plans theinsel~resoperate as a barrier to the Director Robert C. Goodwin of the U. S. Burpan of einploynieilt of the older worker. Enlployment Security informed our Committee that 4. The plans foster conlpulsory retirement on a a survey made by his agency produced fire major finclchronological age basis rather than selective de- ings, all of which, incidentally, are in accord nith activating of older ~i~orkers based on fitness. the findings of our own committee : 5 . The plans fail to provide some retirement pro1. I n labor markets with little unemployment there o k tection for employees who ~ ~ ~ forr many years are substantially fewer jobless among the older for a concern and then leave or are discharged workers as compared with the younger workers ; before retirement age. 2. As eniploynlent increases, employer specifica6. The plans tend to restrict the mobilitp of morktions mith respect to age are tightened and the ers and keep them tied do~vnto one employer. percentage of older workers jobless increases; Industrial pensions probably cannot cover the self3. Older workers, once separated from a job. take employed, the domestics, the farmers, nor can i t longer to find emplop-ment, and if not re-ema~ieyuatelycorer those eillployed in small stores or ployed a t their regular v~ork,are usually do~vnmarginal firnls, thus leaving without protection nzilgraded in skill and pay; lions of our people, in the same manner as does our 4. Discrimination against older worker varies not only mith conditions of the labor market but also OASI system. Industrial pensiolls innst be viewed as 1 5 �Tn Toronto, 1,400 out of 2,200 applicants in the upper age brackets obtained jobs after special counselling, and now receive salaries ranging from $30 a .. j meek to $12,000 a year. The special counselling service for older workers even placed a n 83-pear old! Our C'oinmittee has in its prior reports, "Birth(1a.i-s The Forty Plus Clubs are day after day finding jobs Don't Couiit," and "Sever Too Old," explorrd the for olcler The ~ ~ ~~~l~~~~~~ d trends in employillel1t of the elderly, elllphasized the serrice illcreased placements 68 per cent it iieecl for ntilizing the experience of our older prrsolis laLulched a special drive to obtain jobs for oldsters. in our productive forces, ~ v a r n e dof the nicle-scale Our Coinxnittee mas informed latest available figprejudice against hiring of workers over 43, and ures illdieate that 168,000 persons receiving unelnploytracked down reasons for discrimination against the lllellt in this state are in the 45-vear and clder1:-. Our Committee set forth a reasonable 1x0- ol-er age bracket; that 63,900 persons s,lch grain that the State should undertake, r e r o l ~ i n g insurance are 60 ancl over. Thirty-thre,e per cent of aronild two iliain coilcepts : the women and 44.5 per cent of the men receiving uninsurance are 45 or more1. Provision of special counselling service for older elllplo~mellt -\ stlldy in the Rochester office of the State Eniploy, v v l -*-- u i the s t a t c Emp!=yment Ser:rice, s~ ~cl n inent Service indicated that applicants 40 years old that more oldsters ~ ~ o n be placed in job.. ld re- ailcl orer represent 40 per Cent of all job seekers, but 2. Establishnlellt of a long-range education 1 search progralll ill the State Labor Departlllent only 1 per cent of the job opportullities are filed by desiglled to break clolTll the bias that exists these older workers. Obviously, a special drive must be made in behalf of the older persons. against hiring the aged. When a placement worker, as a t present, has to obOur first proposal provides that the State Indnsrrial tain jobs for all age h p tendq Commissioner shall establish in the State Employ- stalldably to collcentrate on the 18-35 age ment service a special co~ul~selling auld ~lact'lllent l.c-llere success is lllost easily obtained. Enlphasis 011 iervice for the 4.7-yc~arailcl o ~ e job apl)lic.aiit\. r the younger age groups helps build up his ratio The placement service will : of placeinents to applicants, makes his record look better, and enables him to avoid spending longer pe1. dppraise the capabilities of older \Torkers riods trying to place older persons. ing employment ; 2 .Idrise, guide alld direct oldsters tn empln~-l,l~nt JIr. Tyilliam Green. Presidellt of the Anlerican Federation of Labor, inforins us that he favors establishopportunities ; ment of cotznselling and placenient services for older 3. E~~~~~~~~~~ T v o r ~ e r s seek TTorkfor Jyhich older to ~ ~ o r l i e r sAnd we are certain that the CIO and or. they are best suited; ganizecl industry lilcenise will actively join to support 4, ~ ~ i l d self-collfidence of the Lulenaployed the such a 1 1 1 e. ~ ~ oldsters ; Unless our State and local communities make a de5. Survey local job opportuilities for older persons ; 6, ~d~~~~~ and ellcourage illdustrv to hire older terinined, all-out effort to obtain jobs for older persons, costs for olcl age assistance, pensions atid hosworkers. pital care will soar to dangerous heights. Jloreover, d The proposal envisions that a small corps of highly our elclerly may become easy prey to s h r e ~ ~proskilled old age placement experts will be set up to moters seeking to take advantage of their discontent. train and supervise placement officials in local employ- Toclay, discrimination against the elderly in industry n ~ e n service offices and act as consultants in this field. is plunging many oldsters into mental depressioi~ t I t conteinplates that one or more placemeizt ~vorkers ~ ~ h i chastens senility. Our State hospitals are h in the local ofices will be given the special training in jammed with men and TTonien who became senile beplacing older worliers, in dealing with older persons, fore their time. Our proposal represents a new approach to the old and in trying to break clown the resistance of employers to hiring older persons. Once trained, these age problem. Up to the present, government. Fedplacement workers will act as special task forces as- eral, State, and local, has been concentrating 011 the signed to handle the bulk of older applicants for jobs. wrong end of the old age problem. I t has been conThe reconiinendation is based on the snccessfnl ex- cerned almost exclusively with keeping oldsters alive perience of the Canadia~lEmployment Service, the through old age assistance or keeping them out of Forty-Plus Clubs of T e s t e r n New York and Xew harms way in mental hospitals. MTe must now make a York City, and the Federation Employment service shift toward a positive approach. W e must emphasize efforts that ~ v i l prevent persons from needing old age l in New York City. I\-ith occupation. industry and worker characteristics. I n all areas surveyed, there were significant restrictions against older workers. -.7-x. 26 ~ ��5 . New or additional techniques in connselling, classification, employer contacting, publicity, telephone soliciting, etc. which may be effective in helping this group. I n New York City this study will be made in the Queens Industrial Office, the Commercial and Profesqional Office, the Manhattan Needle Trades Office and the Hotel and Service Office, thus covering a crosssection of all occupations and industries with the exception of domestic and farm placement. I n each of the offices in New York City, and as a matter of fact, in each of the cities participating in the study, the sampling will be small because the nunlber of staff all of the cities can assign to this study is very small. Y I n N ~ T lrork City it is expected to include a sampling of approximately 3,000 persons over 4.5 years of age for the experimental group and the same number of sir~lilar persons for the control group. I n the other cities participating in the study, approximately 750 persons will be included in the experimental group and the same number of similar persons in the control group. However, for New York City and for the country as a hole i t is felt by authorities that this sample is sufficient for the purposes of the study. I t is expected that the study will resnlt in considerably greater knowledge about the employment problems of the unemployed older worker and techniques that call be applied in the Public Employment Service to assist him in securing employment than me now know. Our Committee notes with pleasure that in the past year there has been a more enlightened attitude in the State Empioynlent Service regarding the need for and desirability of special service for older workers. TfTe hope this will develop into a full-blown, allout special effort to place our middle aged and elderly workers in jobs. Onr Comnlittee further urges that the State Labor Department, through the State Enlployment Service, prepare suitable literature aimed a t helping p u r older worliers v7ho are seeking jobs. Many of our oldsters who suddenly find themselves out of work have not had the experience of writing for a job, or of being interviewed for a job, perhaps for 20 or more years. They don't know how to proceed on what many of today's youngsters mould consider elementary matters. The older ~vorlcerseeking a job is discouraged; he needs encouragement, direction. Vnti1 such time as counselling and placement serrice is available to our older workers, the State Employment Service should attempt to help the older persons by radio and mass media, pamphlets and broch~~res, newspapers. Homework and the Aged The possibility of directing older persons into honlework strikes our Committee as being a definite possibility for meeting the needs of some elderly men and women who cannot travel to factories or 1 ~ 0 r i iin stores, or who can work only part-time. Social norliers are not as yet fully conscious of hon~emor!~ opportunities in their local communities for providing employment for older persons. Too, the historical bacliground of homework, with its tradition of esploitation of workers, has developed a trend t o l ~ a r d curtailing homework. This whole subject needs further exploration. Today, 8,379 persons in this State have homework permits. About 824, or 10 per cent of these, are 65 or more. Only 59 of the 821 are Homeworkers with Permits under the General Homeworker Order in New York State Spring: 1949 Age Under 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rl 20 and under 3 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877 30 and under 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . .2,133 40 and under 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . .2,179 50 and under 6 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . .1,639 60 and under 70 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,208 . PO and over. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 Oldsters Inc. Our Committee has been thrilled by the ?Iloba~~l< Development Service Co., Inc., of Schenectady. coinposed entirely of men who are over 65 ! This company, engaged in drafting and new product development, will not employ anyone who has not reached retirement age. I t mas organized by men who refused to be shui~ted a q i d p hy inlij.9try7f ~ 0 ~ p 1 1 1 ~ nretirement pnlicy. rjr Today you can see 70-gear olds in the cornpan?- 11andling contracts rolling in from American Loco~notive Co., L~tdlum Steel Co., General Electric Co.. the Atomic Energy Commission, and others. .LA fuller account on this company of oldsters is contained in another section of this report. TJThile the llohasvk Development Service Co. cloes not establish a pattern that ill solve the en~ployment problems of olclsters, it does indicate very rlramatically that (1) at least some older ~ ~ o r k e can sncrs cessfully compete in the industrial market today. ( 2 ) that skills of workers do not suddenly rust away when they reach their 65th birthday, and 13) that at least some oldsters in our local communities can o r ~ a n i z e for production themselves-without goveriiinent help and without special consideration from industry. Anti-discrimination Law Onr Committee is alarmed a t the persistent. senseless barring of older persons from jobs. The help ��Typical "Help Wanted" Advertisements in Daily Newspapers. 30 �to prevent" the employment of any person between the ages of 45 and 65 because of his age. The la^ compels employers to keep age records of their workers. The law authorizes the State Comnzissioner of Labor and Industries to summon before him any eniployer believed not to be complying with the law. After a hearing, if the Commissioner deems the employer has violated the law, he may publicize that fact in any newspaper or newspapers or in any other manner deemed appropriate. If this law gave any hope of helping our oldsters obtain employment, our Committee would recommend its adoption in this State. However, we have been informed by the counsel of the Massachusetts Department of Labor and Indnstries that the department's experience "has been limited to two o r three cases, all many years ago, undoubtedly because of the weakness of the law. I t was not necessary in any case, to publish the name of an offender." From other sources, our Committee learns that the law has been ignored and unenforceable. For example, every company having a pension plan in 3Iassachusetts presumably would be subject to the adverse publicity provided by the law, since pension plan5 undoubtedly "tend to prevent" the employment of older persons. Even if teeth were put in the law, by providing for fines or imprisonment, or both, or by making offenders ineligible for state contracts or other benefits, it vould still be unenforceable since companies can tell an older applicant for a job he is too intelligent for the job, or that the opening has been cancelled or ally of a hundred reasons commonly used by personnel managers. The Massachusetts law has failed. Its adoption in New York State would probablfail also. Our Committee is exploring other possibilities of legislative action to curtail the brutal age discriinination that flourishes. Our Committee is not proposing the older ~vorkers be legislated into jobs. We do wish to see unreasonable barriers to their employment eliminated. We do wish to see men and women hired on the basis of ability rather than arbitrary age specifications. Our Committee believes that the counselling service which it proposed can render enormous effective aid in obtaining jobs for oldsters. Our Committee believes that the State Labor Department can aid by a permanent educational and research campaign. However, we should like to emphasize that here again, our local communities should not wait for State action or depend on State action alone. Each local community can organize home-town campaigns for olcler workers. Through conilcils of social agencies where they exist, through other citizen or official groups in other areas, local factories, stores. and offices can be solicited for jobs for older workers, appraisals can be made of local obstacles in the way of obtaining enzployment for older workers, ancl the full force of home town pressure can be brought against offending concerns which refuse to hire our middle aged and elderly workers. Organized local drives for jobs for the elderly can succeed. Unions and Oldsters Our Committee has launched a pioneering stncly of labor unions in relationship to olcler workers. We hare queried every international union, CIO. AFL, anci independent, in this country. Returns have coiile in gratifying nnmbers, and are now being analyzed. The survey covers age barriers to union membership, age of nnion leaders, union pensions, burial pro~isioizs,union old agc homes, xnion security TL~!~s, compulsory retirement rules, provisions for do~vngrading super-annuated members, ~nedical service pro~ i d e d ,special services and recognition rendered to olcler workers, and a series of questions about attitudes of olcler union members. Obriously, as unions come increasingly to play an iinportant role in the economy, it is essential that me have an understanding of their activities as they relate to the older worker. The rariety of relationships of older workers to unions can be seen from the fact that the Cnited Grotharliood of Carpenters and Joiners of America has maintained an old age home since 1929 at Lakeland, Florida, and that the International Tppographical Union has maintained a home for aged and disabled ni~mhersat Colorado Springs, Co!.. since 1892. Of course, one of the basic ways of assuring our olclsters a place in our labor force, without blocking arenues of promotion or job opportunities for younger people, is to make certain that the Nation needs an expanding labor force; then all ~ v h ocan work and want work will have work, regardless of age. The variety of pension plans involving uniou.; is reflected in the experience of locals of the International Stereotypers and Electrotypers Vnion of North America. Some locals have no pension protection, others are protected by employer sponsored plans not covered in union contracts, still others are under 100 per cent employer financed pensions. Other locals of this union have joint employee-employer pensions financed on 50-50 basis, and still other locals. we find, have some members "pensioned off" by the employers on a handout basis, rather than on an actnarjally sound plan or contractual arrangement, with amounts paid solely at the discretion of the employer. �t r y are communicating with our Committee, asking for information and help in dealing with older workers. A department store makes a special point of employing elderly women as salesladies because they are kind and patient. One company which employs many elderly has no formal retirement system, but grants workers who retire a weekly allowance, a n d regularly sends its infirm elderly ex-employees hot meals from the plant cafeterias. The TTT. and L. E. Gurley Co. of Troy, engineering equipment manufacturers, as reported in "Sever Too Old", employs many old-timers successfully. Over 10 per cent of its workers are 70 years old or more; 20 per cent are over 60. It has, for example, s~zccessfnllytaken a blacksmith retired from the U. S. IITater~rlietArsenal 2s heing too o!C? a ~ re-trailled d him in a short time as a lathe operator. Some firms show amazing consideration for their elderly en~ployees,not only by granting them longer vacations, permitting them to sit a t their work, and exempting them from punching the time clock, but also by permitting them to quit earlier each day, be served first and obtain special diets i n the factory cafeteria, and to use private or freight elevators banned for other workers. One company sends its plant cars to the homes of its retired employees to bring them to weekly social gatherings a t the factory. Others keep oldsters on Industry and the Aged the payroll although they can produce little due to Tl7liilr private enterprise is guilty of erecting unfair chronic illness. Group life insurance, health and hospitalization age barriers which keep vigorous, able oldsters from policies taken out by companies are proving a treworking. American businessmen are engaging in an amazing variety of activities to help our oldsters. inendous economic aid to oldsters who otherwise Thlr hright side of t h old agp pictnre in indi~stryis would be ineligible for insurance coverage. ~ American businessmen are giving generously of generally unknown riot only to the public, but to the their money, time and facilities t o ease the plight rank-and-file of industry itself. A survey our Committee completed shows that of older workers. Industrial management, unfortugratuitous nately, hasn't applied to mass employment policies these beneficial activities range from ~vholly allotilients by the Standard Oil Go. of New Jersey to the lessons learned from numerous isolated examples. its l~easioners who receive under $3,000 a year, to a I t is unfair to condemn industry as a whole for the clonation of recreation hall facilities by Stroock t Co. callous attitude of some companies toward the elderly; v of Sexburgh, one of the leading ~vooleninills of this many concerns are acting humanely toward older country, for a clubhouse for the oldtimers of the com- ~vorkers. Wild charges and indiscriminate abnse of munity. all industry for the unfair practices of some ~villnot American businessmen are not only pouring $1,- be helpful. Our Committee is campaigning vigor350,000.000 a gear into retirement funds for ~vorkers. ously against arbitrary age barriers to employment; bnt alio spend another $1,000.000,000 a year for the but we believe industry is entitled to just credit for its numerous helpful achievements i n the aid of oldFederal old age and survivors social security pool. The Shell Oil Co. has hired a psychologist to advise timers. their older ~vorkersfacing retirement on how bcst to TT'e shall make progress toward fairer treatment of adjust to "retirement shock ". Other companies are older workers seeking employment not by recriminabeginning similar activity. Some concerns have set tions, but by working out various complex problems aside special work for older men and women to suit involved, i n a spirit of mutual understanding, trust their papabilities. Companies throughout the c o ~ ~ i l -and faith. MTenote in some returns already studied that a few unions report no difficulty in obtaining jobs for older members. This is true of the Seafarers International Union of S o r t h America, which through its own hiring halls controls assignment of seamen to work and sends men to jobs solely on the basis of length of time out of work, regardless of age. It is true also of the Internatioiial Union of Journeyman Horseshoers of the r'nited Stat(.> ancl Canada, which reports that older persons are preferred by race tracks because of their es~-rerience. We note that m a n - nnions are giving special recognition to the aged in the form of special dinners, special pins, free lifetime or honorary memberships. etc. The unions seem to indicate that older workers tend to lllalce better nieinbers because of their greater maturity and stability, because they had to work harder to build unions, and because their long experience llai taaght them the need for organization. TxTl?"-.-nn--ln+nA L V ~ ~ L ~ L G L O U , th0i.0iigh i"t3ijoi"t B llru V L L L TT-ill made. be I11 this connection, i t should be noted here that a study by the Division of Research and Statistics of the State Labor Department indicates that when uiiioni hare contracts with employers permitting nnployees to be discharged "for cause", age itself is not dee~~ircl be sufficient cause. tu j, "..--.nT- DLLI YG: �State Civil Service Our Committee made a study which indicates that civil service now offers proportionately more employment opportunities for the aging than private business does. State and local governments are prohibited by law from erecting unreasonable age barriers and from forcing older workers to retire early. A study of 5,050 applications made for our Committee by the State Civil Service Department showed that of the applicants, 695, or more than 13 per cent, had passed their 45th birthday. Almost half of these qualified for appointments in jobs ranging all the way from elevator operator to child psychologist. By contrast with industry's widely prevalent prejudice against employing older workers, the State Civil Service Law declares void any attempt by New York State or its subdivisions to discrimillate because of age against any persons physically and mentally qnalified to compete in a n examination. The State Civil Service Law states (see. 25-a) : "Notwithstanding any provision of l a v to the contrary, except as herein provided, neither the state civil service commission nor any municipal civil service commission shall hereafter prohibit, prevent, disqualify or discriminate against any person who is physically and mentally qualified from competing, participating or registering for a civil service competitive examination or from qualifying for a position in the classified civil service or be penalized in a final rating by reason of his or her age. Any such rule, requirement, resolution, regulation or penalization of such state or municipal commission shall be void. "Nothing herein contained, however, shall prevent surh state or lomicipal canmission from adopting reasonable minimum or maximum age requirements for positions such as policeman, fireman, prison guard, or other positions which require extraordinary physical effort, except where age limits for such positions are already prescribed by law." A similar provision bans discrimination in promotion examinations. The United States Civil Service Commission informed us: "The age of applicants is, of course, not a factor in our examining standards or placement policy in the federal service." Government has heard the plea of the geriatricians, the specialists in aging, that workers be judged by their health and ability, not by the number of their birthdays. Oddly enough, the "over 45" group, which has itself suffered humiliation and frustration in finding employment, expressed the greatest interest in a State examination for Employment Interviewer in the Division of Placement and Unemployment Insurance. Of 180 applicants in this classification 71 qualified for appointment. Other examinations popular with the 45-plus group were assistant accountant, senior engineering aide, general clerk, assistant architect, library assistant, social worker and elevator operator. At the retirement end of the two-way squeeze against the older worker's opportunity for usefnl employment, civil service is again more liberal in its policies. About two-thirds of private companies having pension plans set the compulsory retirement age at 65. The New York State Employees' Retirement System permits a member to retire at age 60, although he may continue to age 70 if he wishes and is physically qualified. After age 70 he may Utill be retained at the request of a department head with approval of the State Civil Service and Pension Commissions. The average age of retirement i n the State service in 1948 x~~as approximately 66, six years above the optional minimum. Still contributing members in the State Retirement System are 993 nlen and women who have reached or passed their 70th birthday, although this number includes some elected officials. The Federal Government also sets its compulsory retirement age at 70, but New York City, most liberal of all in this respect, sets the maximum retirement age at 80 ! Our Committee notes with approval that the State Retirement Fund has speeded up payments of retirement checks and death awards. I t approves of the new system of calling the attention of employees by personal letter two years before they retire and again one year befure they retire of the need for preparing themselves for retirement. Our Committee is glad that the Legislature took the first steps at the 1949 session to remove a legal barrier which blocked State and local pensioners from obtaining part-time jobs with local governments. Our Committee urges that some form of recognition be given to State and local employees who have served faithfully until retirement. Some token of appreciation for loyal service through the years is merited. Our Committee again urges that the desperate plight of many State pensioners be eased and is happy that the Legislature passed in 1949 a proposed constitutional amendment which will need to be voted on again at the 1951 session, authorizing the Legislature to provide for an increase in amount of pensions of State and local retirement systems. Vocational Rehabilitation The term vocational rehabilitation means far more to our Committee than its customarily restricted ap- �plication only to those who have been disabled. Many of our older persons who are fit, but have for one reason or another lost their old skills, or need to learn new skills due to technological advances, or simply need vocational counselling which will make them employable, need vocational rehabilitation. Our Committee has recently received a report from the U. S. Office of Vocational Rehabilitation dealing with rehabilitation of persons 45 years old and over during the 1948 fiscal year. I t indicates that 11,438 persons in this age group, or 1 per cent of all age groups, were rehabilitated. 1 The comparable figure for 1947 was 8,600 persons, 19 per cent of all age groups. I n 1948, the number of persons 65 or over at the time rehabilitation startecl was 882, compared with 654 the previni~.~ >-ear Men constituted over three-quarters of those rehabilitated in the 45-plus age group. Over a third of the 45 and over persons mere dependent on their families or on public or private relief before rehabilitation services m7ere started. About 12 per cent were living on either ~ ~ o r k m e ncompensation or insurance 's bellefits and about 39 per cent were in jobs ~ilhich they ere in danger of losing because of their disabilities. Disabilities lvere largely impaired arms, or legs, amputations, visual and hearing defects. Most of these persons were on the active rolls less than one year before they were placed on jobs. Services rendered them included medical. surgical and psychiatric treatment, appliances and hospitalization, vocational training, training in use of appliances, self-adjustment training. occupational tools and licenses, counselling aiid guidance. This is merely suggestive of what can be done to aid older workers. The small proportion of oldsters receiving the benefits of vocational rehabilitation is indicated by the f olloming table : Persons Receiving Vocational Rehabilitation, by Age, New York State, (1948-49 fiscal year) Total 111 Ages. . . . . . . . . . . . . . . . . . . . . . . . . . . . ..3,012 Age 42-47 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 Age 48-59 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360 Age 60 and o v e r . . . . . . . . . . . . . . . . . . . . . . . . 61 Our Conlinittee believes that vocational rehabilitation of older persons in this State is suborclinated because of a pessiillistic outlook that much cannot be done for oldsters. OLI~ Committee recommends that if a coi~lpreheiisivestudy is made of State rehabilitation services covering all ape groups that it include a determination as to how rehabilitation services can be brought to more of our middle aged and elderly. I f no such survey is planned, our Committee pro- poses to inquire into the rehabilitation of those in upper age groups. Our Committee recommends that the Federal Security Agency make available funds for a special pilot study of the degree to which vocational rehabilitation service can effectively be rendered to persons on old age assistance and old age insurance rolls. The experts on vocational rehabilitation have given little attention in the past to the needs of the elderly because of a pessimistic outlook regarding their possible employment. However, this antiquated viewpoint needs to be eliminated. TVe believe that if competent vocational rehabilitation experts were permitted themselves to examine old age assistance records, for example, to determine which persons might be rehabilitated, and then were to attempt rehabilitation of these individuals, they m~oaldfind a surprising proportion might benefit by their talents. At any rate, such a study vould give us the information regarding vocationai rehabilitation of the elderly that is not now arailable. The Health of Our Elderly I 1 the field of health, the State has reached a turn1 ing point. We must no\t7 shift fro111 traclitional eniphasis upon communicable diseases to degenerative diseases. The need for such a change has been explored in previons reports of our committee. Tuberculosis in 1900 was the leading cause of death ; today, heart disease is Killer No. 1. Pneumonia in 1900 was Killer No. 2 ; today its place has been taken by cancer. Cerebral hemorrhage was seventh ranking killer in 1900; today it is third. However, few health departments in this country have geared themselves to the new trend in diseases. Many such departments are still fighting battles won long ago. Where is the emphasis on heart disease ? We do not find it in any public health department! Examine the public health literature that is available. Booklets, brochures, pamphlets, radio scripts are abundantly available on the feeding of children. Eut you can find rery few leaflets 011 nutrition of the middle-aped aiid elder1)-.l T h e r e is the health department that has set out to eailipaign for periodic conlprehensive health inventories for the middle aged and elderly, so essential to prevention of disease ? Our Coininittee finds : 1. Few of our elderly are given a chance of obtaining guidance in adult hygiene ; emphasis today is 011 curing diseases, not preventing them. 1 The C o m m n n i t ~Service Society of New York, a private welfare organization, recently issued a n excellent pamphlet. ��2. We are in need of better diagnostic and clinical facilities for the elderly so that degenerative ailments can be checked before they have advanced too far. 3. We urgently need expansion of our visiting nurse services and housekeeping and home care services. 4. We lack trained medical personnel to deal ~ ~ i the elderly ; we lack geriatric clinics ; research in geriatrics is m~oefullyinadequate. 5. We need closer check on nursing and convalescent homes. Our Committee is convinced that there should be set in the state a unit On and Geriatrics bring Our aged and the benefits of the latest discoveries in science. Our Committee in "Never Too Old7' has outlined e 10 specific f~nCtl0ns such a unit. But above aii W of believe such a unit will provide the working mechanism for our State Health Department to cope with its No. 1 health problem, the health of our aging POWlation. Our Committee has excluded from its consideration work already covered or being covered by other legislative committees or commissions. I t has therefore not inquired into the problems of the chronically ill or into the question of licensing nursing homes. However, since many persons reading this report will he deeply interested in these two vital phases of the old age problem, our Committee would like to note that the Joint Legislative Committee on Interstate Cooperation, headed by Assemblyman Harold C. Ostertap, has been studying the nursing home sitnation. and that the State Department of Sociai Weifare, with the aid of the Interdepartmental Health Committee, recently studied 1,000 nursing homes upstate and is now planning to develop such a set of standards. Governor Dewey in his 1950 message to the Legislature said: "We shall also have to plan a program for developing more and better facilities, including both nursing and boarding homes and public and private institutions for the aged as well. These efforts will, I am confident, assure to the chronically sick, elderly people, the kind of care, comfort, and safety they should have. ' ' Two recently issued reports by State agencies dealing with the chronically ill were "From Blueprint to Reality," the report of the Joint Hospital Survey and Planning Commission, and "A Pattern for Hospital Care," final report of the New York State Hospital Study, known as the Ginzberg report, made to the Joint Hospital Survey and Planning Commission. "From Blueprint to Reality" estimated that two million persons in New York are suffering from some chronic disease, and that half of these are 45 or more. The report estimated that 23,000 additional chronic hospital beds are needed, half in New York City and the remainder in upstate New York, and reconnnended that such facilities be developed only as units of general hospitals. I t further urged constrnction of five t 150-bed chronic disease centers upstate and provision h for equal facilities in New York City. The Ginzberg study, however, states: "We do not recorninend that general hospitals undertake largescale expansion of facilities to care for chronic patients, but we do recommend improvement in the quality of services provided for them.m Thus, as our own report is being written, the State policy oil this vital and complex problelll is apparently ill a fluid state, that is, no decision has heen made whether or not to create additional beds for the chrollically ill. Both the report of the Joint Hospital survey and Planning Commission and the Ginzberg report should be carefully studied by all persons interested in the problems of older persons, although their main concern is hospital care regardless of the age of the sick. T T list here, without comment, since it is outside Te the province of our committee, the recommendations of the Ginzberg study: "The State should: "1. Subsidize the expansion of services, particnlarlp diagnostic services. to ambulatory patients by making limited grants to hospitals willing to develop adequate programs. "2. Act to improve the quality of the care now being provided in nursing homes and in the infirnlary sections of public and private homes through the establishment of a comprehensive systein of inspections; and to establish minimum standards which must be met if persons on public assistance are to be cared for in these institutions. "3. Seek to raise the level of care currently being provided for individuals with mental diseases or disorders by expanding the facilities of State mental hospitals sufficiently to meet the estimated increase in the nonlber of patients, to beds in obsolete facilities, and to reduce overcrowding. Further, it should raise the salary scale now in effect for psychiatrists and other professional personnel and should expand and improve the training opportunities for all personnel. "4. Develop a comprehensive program for the sound expansion of mental hygiene clinics now being operated by the State and voluntary groups. " 5 . Review the existing rehabilitation pro- 36 �grams now being supervised by the State Departments of Health and Education with the aim of increasing their scope and improving their quality, particularly by integrating the vocational aspects of rehabilitation with more effective employment service and by promoting the specialized training of doctors and other professional personnel in order to exploit fully the potentialities in medical rehabilitation. "6. Act to raise the rate a t which i t reimburses local government for its share of the cost of caring for patients with tuberculosis froin a maximum of $2.50 a day to $3.75. "7. Improve the administrative structure through which i t discharges its responsibilities for hospital care by establishing a State Hos.. pita] Commissier, tc! be ccnccroed ~ 6 t h raijiiig the quality of care, developing sound methods of determining hospital rates, and insuring that the public interest in hospital operation is furthered. " 8 . Devote adequate resources to research in every phase of hospital care, particularly problems connected with the effective care of psychiatric patients and patients suffering froin longterm illness. "9. Promote the expansion of training facilities for all scarce categories of inedical personnel, particularly for psychiatric social workers, physical therapists, and occupational therapists. "Local Government should : "1. Adopt a illore liberal approach toward certifying as public charges older patients who could profit from general hospitalization. "2. Establish rates of payment to private nursing homes and homes for the aged which would enable them to provide a higher level of service in general and a higher level of medical care in particular. "3. Agree to pay reasonable fees to voluntary hospitals that provide good dia,gnostic and therapeutic services to ambulatory patients who are on the public assistance roles. "4. I n New York City, take every possible action to expand and improve the facilities available for the care of patients with tuberculosis, because those presently available are grossly inadequate. " 5 . I n New York City, act in cooperation with the leaders of voluntary hospitals, Blue Cross, and other groups to increase the numbers enrolled in hospital prepayment plans so as to reduce the pressure for admission for free care in the municipal hospitals. "Voluntary Groups should : "1. Improve the quality of hospital care 1e1through stricter control over the work of all 1 1 1 1 bers of the hospital staff, and reduce the costs of hospital care by effective management, which iinplies that boards of trustees must grant adequate powers to their hospital administrators and support them in the exercise of these powers. "2. Recognize their responsibility to make the facilities of voluntary hospitals as available as possible to all competent doctors in the community and not to perinit the hospital to be used for the private advantage of a limited group of individuals. "3. Secure through voluntary efforts some of the requisite funds to experiment in better ways of providing, a t the lowest possible cost, a high level of hospital care, such as the expansion of s e r v i r ~ sfor patients nith !sng-term i!!ncss and for patients who can be treated on a n ambulatory basis. "4. Realize that the continued operation of the voluntary hospital system depends to a very large extent on the expansion of enrollment in hospital prepayment plans that provide adequate coverage for the maximum number of persons. Volnntayy groups should therefore act cooperatively to insure the accomplishment of such a result in the shortest possible time. " 5 . Multiply their efforts to secure a larger amount of charitable contributions to accomplish essential reforms, such as the replacement of obsolete facilities, and exercise prudence in the expenditure of these funds by avoiding the unnecessary expansion of facilities. " 6. Recognize the fact that no hospital can be self-sufficient, and act therefore to improve mechanisms, snch as regional hospital councils, for promoting the coordination and integration of hospitals. The entire hospital system will thus discharge its responsibilities more effectively. "7. Take cognizance of the significant role of government in the provision of hospital care, and realize that a well-functioning and efficient hospital system for the community a t large depends on the cooperation of voluntary and government groups working in the public interest.'' Our Committee has been fortunate in having the benefit of the advice and judgment of Dr. Howard 11. Rusk, who points out : " I t is imperative that full advantage of the techniques of rehabilitation must be taken in the management and care of the aged and chronically ill in the State of New York, not only so that they �can be given the dignity, self-satisfaction and independence which comes from ability to care for one's self, but also in order to reduce the increasing overwhelmingly-high costs of custodial and hospital care. "hIuch of the acute financial plight of both municipal and voluntary, as well as state hospitals, is caused by the increasing numbers of chronically ill and aged persons who enter the hospitals and stay for long periods. The Department of Hospitals in New Pork City are occupied by patients with long term illnesses. The percentage in voluntary hospitals is said to be around 20. I n a survey in Syracuse, i t was found that 84 per cent of 902 successive patients in medical wards Tvere chronically ill. iL I t is agreed that a great many of the c h r ~ n ically ill and aged must have general hospital care initially. Many, however, remain in the hospital purely because of the lack of any place to which they can go if they are discharged. Convalescent or nursing homes are totally inadequate to meet the need, and patients discharged to their homes, where there are no facilities for their care, frcquently must be readmitted to the hospital. "One of the great needs is provision for total treatment of the chronically ill and aged in terms of their total problems, Many such persons cannot be rehabilitated to the extent of emplopability, but a great percentage can be rehabilitated to the point of sufficient self-care so that they are able to live a t home, requiring a minimum of aid from other members of the family. "The Veterans Administration and a few civiliaii hospitals and agencies have shown that a great many chronicaiiy disabied and aged persons can be rehabilitated to the point of self-care and independence in performing the normal activities of everyday living. They have also demonstrated that such programs provide for immense economic savings not only from those patients who are thereby able to live a t home, but in nursing care and other costs for patients, who must continue to live in a n adult institution. However, in most of our civilian hospitals, the patient does not receive the services he needs to achieve this degree of self-sufficiency. Hospitals complain that the chronically ill and aged are responsible for their crowded conditions, but do little to provide their patients with the necessary retraining opportunities that will permit them to leave the hospital. " I n reviewing the study made in New lrorB State on the medical, social and institutional aspects of chronic illness, you will see that al~nost 70 per cent of the 139 hospitals surveyed ac38 cepted chronic patients, but relatively few had specialized departments for their care. The great majority frankly admitted trying to avoid their admission, and in answer to the question 'Do you have satisfactory arrangements for referring individuals who require further care?', of the 118 hospitals replying, 92 said that they did not. They cited insufficient facilities, poor staffs, reluctance of patients to go to county, city or state institutions, and excessive costs. "I feel that primary among the needs of our aged citizens is the opportunity to do something purposeful and constructive. The inajority have worked steadily and industriously in a society that respects only the productive; the ending of ability to do productive work, even though it need not he f s r xateria! gain, is, f e r zest, a traqedy. I t symbolizes the end of independence and parpose in life. I n overlooking purposeful activity, we have neglected to use one of the most valuable tools in the management of the chronically ill and aged. A11 who have gone through an institution have noted the apathy and hopelessness of the resiclcnts. There are always a few. however, x h o are bright and active. They are the patients who have volunteered or been a s s i ~ n e d to tasks within their physical capacities. "Like work for the homebound, the use of work therapy in adult institutions requires not only imagination but close snpervision to prevent exploitation, but i t pays tremendous dividends by providing a purpose in life for the individual. The opportunity to work, and if possible to earn, is necessary therapy if patients are to live in dignity rather than desolation. "Dr. ILlarcns Kogel, Commissioner of Hospitals in New York City, and I have had several tentative meetings preliminary to establishing an activity program a t the Farm Colony in New Pork, and our medical staff a t the Rehabilitation and Physical Medicine Service a t Bellevue Hospital has already completed a medical survey prior to the establishment of such a program. "The problem of providing a n integrated service for the chronically ill and aged is a complex one. I t affects tremendous numbers of persons, numerous diseases and types of disabilities, varying types of medical and semi-medical institutions, and, particularly, all community service agencies. This has been shown particularly well in the excellent studies on chronic disease cond u c t ~ t i the State Department of Health and by the work of the Joint Legislative Committee on the Problems of the Aging. There is one facet of the problem that stands out glaringly at the present time. That is the need in our general �hospitals and adult institutions to provide dynamic training programs which will enable many of the so-called invalids disabled by chronic disease or age to live independently within their own homes. ' ' ~ ~M~~~~~ D. ~~~~l of ~ ~ N~~ York City Hospital Department, whose brilliant efforts to increase the number and quality of facilities to older persons and the chronically ill have made New York City a world leader in this field, has presented to our Committee a basic plan for adapting a general hospital to the increasing number of aged patients. This includes development of a chronic disease wing, small suite of rooms for temporary care of non-custodial psychotics, a dynamic rehabilitation program, an active bonze care program, and expanded services for arilbn:atory patients in its outpatient departmeat. His views are presented elsewhere in this report. Dr. Frederic D. Zemall has inforlxed our Committee that from 75 per cent to 85 per cent of all internal medicine will in the near future deal with care of the elderly. I t is therefore vital that the whole problem of estah]iShing geriatric clinics be explored. The pioneer work of Dr. Robert T. Monroe at the peter Bent Brigham ~ ~ ~ ~ i t ~ elsewhere in this described l , report, indicates what excellent results can be obtained skilled technicians deal diagnosis and rehabilitation of the elderly. We already have a small geriatric clinic in operation by a voluntary of ~ agency in ~ ~ ~ rphe full cooperation ~ the h ~ ~ t State Health Department should be given this clinic SO that it might operate as a controlled experiment in clinical service for the aged. Mcnta! Hygiene Approximately 25 per cent of the persons in our mental hospitals in this State are 65 years old or more. Nearly 21,000 of the 81,500 persons in our State mental hospitals are in this upper age bracket. The cost of maintaining our older persons in State mental hospitals was $956.27 per capita during the 1948-49 fiscal year, or a total cost of $20,081,670! I n previous reports, we have noted that the percentage of first admissions to our State hospitals of persons in the 60-plus age group has more than doubled in the past 20 years. The reasons for this increase are many. Since more persons are living longer, more of us are reaching a period when mental disorders due to aging and physiological changes are likely to appear. An upward trend in the rate of psychoses of old age may also be due to improvements in detecting mental maladjustment. Too, the stepped up pace of living and the tendency of present families to accept less responsibility for their elders, the lack of rooms to care for oldsters, all these have tended to increase the numbBr of elderly in our mental institutions. Many authorities, including our own State Mental Hygiene Commissioner, Frederick MacCurdy, are convinced that a substantial number of elderly are being admitted to mental hospitals who should not be there i ~ ~ i ~ at all. The omm missioner has emphasized that our mental institutions were not built to accommodate any large number of elderly incurable patients. Others ~ o i n t out that the harmlessly senile are often channelled to State hospitals simply because no other facilities are available to them. Cornrnissioner MacCurdy has told Committee that about 93 per cent of the general hospitals in this State will not even keep a patient showing mental symptoms as a patient, although often they nee6 inedieal and nursing care, not care. Dr. Kenneth Keill, director of the Willard State Hospital, has set up at nearby s a m ~ s o nNaval Base a Program for Caring for 1,000 elderly mental patients in the 60-69 age group in Classes have been set up in therapy. A recreational program has been developed. The patients eat cafeteria style, just as though they were ordering meals at an ordinary Cafeteria. Doors are unlocked, a procedure that in the ordinary mental haspita1 would be amazing. Patients are virtually free to Come and go as they please on the premises. This in itself, Dr. Keill has informed us, serves to minimize the problems; and ability to wander ahont during the , daytime permits a using-up of the energy so that when bedtime comes, the patient is ready to sleep without the need of medication. Dr. Keill states that the Sampson Division, in charge of Dr. Guy M. Walters, hopes by studying the physical conditions of this largely uniform group, by making studies of behavior, psychological studies, laboratory investigations of blood, urine and other body excretions, as well as the field of nutrition, to arrive at some conclusions as to the causes and treatment of this increasingly large problem. The large case-load in our mental hospitals is unfortunately shifting emphasis in the Sampson Division from basic, urgently needed research on the care of the elderly mental cases to that of simply providing custodial care. Our Committee urges that full financial support be given by Federal and State governments to the Sampson Division, to the end that there may be developed a sounder, less costly method of caring for the harmlessly senile. Our Committee is happy to report that the State Department of Mental Hygiene published recently a series of leaflets called "Guideposts to Mental Health, " and one of the leaflets dealt with mental hy- 39 ~ �AGE LIMITS FOR ISSUANCE AND CANCELLATION OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS BY INSURANCE COMPANIES LICENSED IN THE STATE OF NEW YORK FEMALE SAME AS MALE. -FEMALE 5 YEARS LESS. 0 FEMALE MORE THAN 5 YEARS LESS ACCIDENT DISABILITY MAXIMUM AGE OF ISSUE LIMIT �giene of older persons. This leaflet represents practically the first piece of health literature dealing with the aged issued by the State, except for those published by our own Committee. Our committee is convinced that the spread of mental hygiene clinics and a broad-scale educational program directed toward helping persons adjust to life's problems are fundamental. We are convinced that a mental hygiene program that starts with children and adolescents and continues through all the age brackets will be able to keep substantial numbers of persons from ever needing old age assistance. Our Committee is convinced that when our local communities adopt broad programs for our aging population, covering job campaigns and counselling, better housing, recreational facilities, adult education, home care services, etc., as proposed by our Committee, the proportion of oldsters needing mental hospital care will be substantially reduced. Our Committee has been very much impressed hy the fact that psvchiatrists in our State mental hospitals have in many instances actually been "geriatricians" since they have dealt largely with older persons over a long period of years. And it seems to us that in all the thinking that has been going on with regard to the elderly the State psychiatrists have not had an opportunity to give the many groups in the community the benefit of their advice and judgment. Our Committee believes it will be helpful if State psychiatrists who have cared for the elderly were to meet with a select group of representatives of social welfare organizations, public and private, for an exchange of views on problems of mutual concern. One problem on which the State psychiatrists can help is in setting up standards so that old age homes, nursing homes, and social workers will know when an elderly person should or should not be referred to a State mental hospital. Since 1933 the State of New York has been placing mental patients in homes other than their own for "foster homes" serve as an opportunity care. ~ h e s e to adjust gradually to the community once more, without disturbing family influences which in some cases were responsible for the mental break clown. aid the elderly person who has been Social assigned to a foster home, and instruct the family caretaker. Miss Hester B. Crutcher, Director of Social l170rk, State Mental Hygiene Department, has informed our Committee that of 1,284 persons placed in foster homes from State mental hospitals. 743 are over 60 years old. While this type of care needs to be used carefully and perhaps offers little hope for making an appreciable dent in the total case-load handled by State mental hospitals, it demonstrates sufficient promise to warrant its expansion to the greatest extent possible. A Our Committee further urges that the Mental Hygiene Department allocate Federal research funds to conduct a study, at the William Hodson Community Center, of the place of a recreational day-care center in a community mental hygiene program. The Hodson Center and others have made a n amazing record. I n six years of operation with a membership of nearly five hundred whose average age is about 74, not a single member of this center has had to apply for admission to a State hospital. Moreover, the crafts taught, the feeling of usefulness engendered, and the social parties held by the group, seem to give the oldsters a reason for living, and a new and happier outlook on life. Libraries and Our Elderly I n another section of this r e ~ o r t .there is a comprehensive analysis of a survei undertaken by our Committee of the relationships of libraries to the elder people in our comiiluliiiies. Summarizing here. we found that libraries are rendering many new services especially helpful to oldtimers, including use of ceiling projectors for the bedridden, book delivery to old age homes, nursing homes, hospitals and the ill confined at home, bookmobiles to reach persons in rural areas, and provision of meeting space for clubs for oldsters. Librarians made a special plea for publication of books in large type for persons with "tired eyes." Some librarians have taken a key role in community planning for the elderly. The provision of state-aid to libraries, as presently proposed by various groups, ~vould enable the libraries to undertake far more work with older persons than is now possible, the librarians point out. Here again our local comolanities have a challe~ge that can be met. The libraries are established to meet the needs of all the community, not just the young. Yet some libraries are operated as though an oldster is an intruder. Libraries can play an important role in a community old age program, not only by merely rnaking available books, but by rendering a host of services ranging from aiding workers to plan for retirement to providing a planned social-educational prtgram geaEed to older persons. u Insuran'ce and the Elderly Our Committee, through the cooperation of the State Department of Insurance, recently surveyed the regulations of 71 insurance companies in New York State t o determine how the practices of these companies affected our older population. We found : 1. Nearly half the companies will not issue a health �AGE LIMITS FOR ISSUANCE AND CANCELLATION OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS BY INSURANCE COMPANIES LICENSED IN THE STATE OF NEW YORK FEMALE SAME AS MALE. -FEMALE 5 YEARS LESS. 0 FEMALE MORE THAN 5 YEARS LESS ACCIDENTAL DEATH AND DISMEMBERMENT RETIREMENT 50 55 60 65 70 M A X I M U M AGE OF ISSUE 75 80 NO LIMIT �AGE LIMITS FOR ISSUANCE AND CANCELLATION OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS BY INSURANCE COMPANIES LICENSED IN THE STATE OF NEW YORK FEMALE SAME AS MALE. FEMALE 5 YEARS LESS. )=]FEMALE MORE THAN 5 YEA.RS LESS 50 55 60 65 LIMITED 70 MAXIMUM AGE OF ISSUE 75 80 POLICIES NO LIMIT �2. 3. 4. 5. insurance policy to anyone over 55; most of the rest set 60 as the top age. More than half the companies refuse to sell hospitalization coverage to persons over 60. Most companies will not sell accident disability policies to those over 65. &xost companies will not write accident and sickness policies for persons above 55. Highest age a t which life insurance is generally sold is 65, but you're lucky to be able to buy it after age 50, due to physical qualifications that must be met. Group health insurance does not exclude persons of any age working in a covered concern. But upon quitting or retiring, a n employee's policy is automatically cancelled. Group life insurance provides a conversion right upon retiring or leaving a firn~, but the premiums a t higher ages are almost prohibitive. we have reason to beiieve that the situation is even darker for the elderly than the survey shows because many insurance companies inipose lower age limits than their written regulations indicate. Our findings demonstrate that the elderly, who need insurance most, cannot now buy it. The 22 per cent of our population who are over 50 years old, and their families, are vitally concerned about the age limits imposed by the insurance concerns. I t is a problem that has been neglected and will become of increasing importance, for the number of our aged is rapidly increasing. Health, hospitalization and accident coverage are suspended just a t the time when such protection is needed most, in old age, when medical care requirements reach a peak, but earning power sinks to a lo^ ebb o r raiiisheh. The survey raises a host of vital cluestions for advocates of both voluntary and compulsory insurance. Does either system intend to provide coverage for the elderly; or ~ i ~ iilt l continue to leave them out in the cold ? If oldsters are to be corered, will insurance costs for younger persons become crushingly high? Is it possible to provide some compromise solution, with private companies either pooling their poorer risks, as in ~vorkmen'scompensation, or receiving a rebate from government for covering older persons? These are issues which must be met. The wiping out of the savings of lo\v-income and middle-income groups by long illnesses thrusts them on old age assistance rolls, into county old age homes and infirmaries, public hospitals and nursing homes, the expenses of all of which are footed by the taxpayers. Thus taxpayers as well as the elderly have a decided stake in this issue. Pertinent figures on practices of insurance companies follow : TT7 TABLE I Age Barriers Erected by Most Insurance Companies l\laximurn 9 g e Type of Policy a t Issuance Accidellt and Sickness.. . . . . . . . . 55 Hospitalization . . . . . . . . . . . . . . . . 60 Accident Disability . . . . . . . . . . . . . 65 Accidental death and disrne~nberment . . . . . . . . . . . . . . . . . . . . . . . GS Limited policies . . . . . . . . . . . . . . . 65 policies life insllrance 4.1 paid u p a t 6 5 . . . . . . . . . . . . . . . . Cancellation Age 60 60 or 65 70 65 65 L i ~ ~ ' i "7".,.;.;.~ ~:,; .,&::~;; : ; : , ~ ; 70 i 0 - TABLE I1 Cancellation Age for Health Insurance - Cancellation Age JJ GO 65 T0 S O ............. ............. ............. Kumher of Companies 1 ............. ............. No linlit ( ? ) . . . . . . . . . . . . . . . . . 34 13 4 i J TABLE I11 Life Insurance Issued by a Typical Company, According t o Age Age % of Kew Insurance 0-40 . . . . . . . . . . . . . . . . . . . . . . . . 50-59 . . . . . . . . . . . . . . . . . . . . . . . . OO-TO . . . . . . . . . . . . . . . . . . . . . . . . 92.45 6.6 i .8S 100.00 TABLE IV Cost of Life Insurance b y Age Age Life Expectancy 2 . . . . 42.1%Fear> 43 . . . . . . . . . 2 5 . 2 1 Annual Premium per $1000 $20.24 39.53 One of the large comlnercial insurance companies states its age limit for joining is 55. There is no age limit for continuing accident insurance, "except for 80 per cent reduction of the death benefit a t age 70; health insurance is reduced 40 per cent at age 60 but may be continued to 65; hospitalization benefits may be continued to age 65. " Onr Committee calls upon insurance companies, the Blue Cross Plan, and the Blue Shield Plan, to initiate experimentally a t first, contracts which will provide wider ser~~ices, particularly in diagnosis, and which will provide our older persons with a n opportunity to insure themsel~~es. Howerer, insurance conlpanies hare a n obligation that goes f a r beyond seeking to develop contracts that will meet the needs of older persons for life, accident, health and hospitalization insurance, although this is tremendonslp important in itself. �AGE LIMITS FOR ISSUANCE AND CANCELLATION OF ACCIDENT AND HEALTH POLICIES ON MALE RISKS BY INSURANCE COMPANIES LICENSED IN THE STATE OF NEW YORK FEMALE SAME AS MALE. E3FEMALE 5 YEARS LESS. 0 FEMALE MORE THAN 5 YEARS LESS HOSPITAL EXPENSE RETIREMENT 55 60 65 70 M A X I M U M AGE OF ISSUE 75 80 NO LIMIT �The insurance companies have an enormous opportunity to provide leadership in a nation-wide campaign directed to our older citizens. The insurance companies have the finances, the know-how and the direct interest so they can effectively reach our older persons with health guidance material so sadly lacking today. The insurance companies have a direct stake in attempting to organize pre-retirement counselling programs in industry, as part of a "packaged" pension plan which they could offer to industry. One of the largest manufacturing concerns in this country, with one of the largest pension systems ever purchased from an insurance company, informed our Committee : "You would think the insurance companies wo~zldget busy and save industry from the ill-will now developing because older workers simply are unprepared for compulsory retirement called for by the pension plans. " Gur Coi11111iiieebelieves that the insurance companies themselves have the responsibility of initiating, with the aid of government, industry and labor, a plan for preventing pension plans from restricting tFe job opportunities of older workers. Today, placement workers from Buffalo to Long Island inform us that i t is practically impossible to place older ~vorliersin companies that have pension plans. The ill m7ill which such a policy brings forth aiainst private enterprise is too powerful to be ignored. Age barriers against employment of older workers must be reduced and in this campaign the insurance companies must play a major role. Too many of our older persons are being thrust onto relief and old age assistance or are having their spirit sag to new lows because pension plans are believed to be keeping then1 from productivity. The help of iiisilraiiee colllpanies is gving to be needed, if this problein is to be solved. Social Workers Our Committee has come to a new understanding of the value of the work being done in our various cbmmunities in this State by trained social workers. There is too wide acceptance by the public of the caricatured concept of the typical social worker as either an under-sexed or over-sexed female college graduate who wears a f u r coat and impossible bonnets and sprinkles polysyllabic impracticalities in her speech as she some~vhathaughtily and arrogantly interviews our impoverished people in their slum dwellings. The joke is in poor taste. Furthermore, the picture is untrue. Nost important, it is serving to deter able young men and women from entering a field of work, which like that of the religious leader and the physician ministers to the urgent needs of our people without thought of selfish motives. Our Committee has found, through its numerous contacts with social welfare groups, both public and private, and through its study of old age assistance cases and how they are handled, that actually our typical, trained social worker is likely to be a hard-working, underpaid expert i n the art of human relations, who is helping oldsters to meet life's problems when they can least help themselves. We have found them bringing comfort, hope, and cheer to older persons, aiding them to obtain needed medical help, helping then1 find a place to live, assisting them in ironing out family difficulties, guiding them to available community facilities, encouraging them to regain their selfconfidence, working out family budgets with them, telephoning employers to see if they can get them jobs, arranging for visiting nurse service, fighting with hospitals to get the= admitted, calming their fears; yes-and in one instance, shoveling coal for an elderly old age assistance client who was ill! The social worker in her direct contact with old persons has an unparalleled opportunity to interpret them and their needs to the community. She has not taken full advantage of her first hand knowledge of the human side of the old age assistance programs to do this. She has considered the recipients' interest and their protection against any form of exploitation, this being her primary responsibility and has not been effective in promoting conlmunity understanding of the group as a whole because of this. T T have found that our social workers combine a Te natural sympathy for the unfortunate together with a practical, realistic view which seeks to protect public funds and understands that the most effective help that can be given is self-understanding and the development of ability to care for one's self. If there be cynical wasters of pubiic funds among our social workers, if there be insolent case workers, they are certainly not typical, and certainly no more numerous among social workers than among the general pablic. Our Committee has been astounded at the comparatively low salaries, the cost of 80 per cent of which is footed by Federal and State governments, being paid to public social workers whose professional training is often at least the equivalent of teachers, whose work often entails large responsibilities for easing the plight of our elderly and for authorizing expenditures of large sums of public money. Such workers are earning as little as $40 a week in some areas of the state, not only less than teachers but less than laborers, and many of them can foresee with considerable degree of accuracy that they themselves will some day be old age assistance recipients beca~xseof the inability to set aside a reasonable cushion of funds for their own old age. Our Committee urges : 1. That salaries of social workers in our communi- �ties be raised to a level commensurate with the training required for the profession and with the responsibilities imposed on them. 2. That the State Social Welfare Department impose a suitable penalty upon any local government which bars social workers from attending professional social work conventions or State inservice training courses. Our Committee believes that the social worker has a key role to play in the New York Plan. The social worker has priine responsibility for awakening the local communities to the needs of the aged, for the social worker knows intimately what they need. We believe that the social worker because of his broad training in dealing with human beings is best equipped to bring the program to fulfillment. Social workers are today hiding their work behind a cloud of ohscurity and anonymity. Our Committee calls upon social workers to publicize the needs of himan beings in their care, for we believe that once the communities truly know the need, they will be generous in supporting the social worker and the destitute. College Courses in Gerontology Our Committee surveyed 486 colleges in this country to determine to what extent our institutions of higher learning have adjusted their curricula to the needs of an aging population. We found that you can now go to college to learn how to grow old successfully, that oldsters are becoming objects of serious study for the first time in the history of higher education, that college students are being taught how to adjust to their elders, how to take better care of oldsters, and how to prepare themselves for later maturity, courses the gamut from penrun sions and social security problems of oldsters to psychological difficulties and recreational needs of the aged. Many colleges are re-appraising their curriculum in terms of giving liberal arts students some understanding of the medical, social, psychological and economic problems of the elderly, helping students learn to prepare for later maturity, not just for postcollege careers, and specialized training of nurses, social workers, medical students, occupational therapists, personnel administrators and psychologists in dealing with the aged. Accidents of the Elderly Our Committee recommends that the State Division of Safety undertake an educational campaign designed to reduce the tremendous number of accidents that befall our older persons. Mrs. G., 72, rises from her bath, slips and breaks her hip, precipitating a general break-down of her physical and mental condition. Mr. B., 69, hobbling along with his cane, and n bit forgetful, comes to an intersection, fails to look up and down the road, starts to cross. He sees a truck bearillg on him, but he can,t move enough to dart out of harm's way; he is struck down. Todav such accidents are common. ~ a l l s ~ a c c o u n t 78 per cent of all home accident for fatalities to older persons in this country,, with burns " musillg per ceni deaths. Deaths by motor vehicles rank second only to falls as the cause of accidental fatalities to older persons. Each ye=, some 5,000 oldsters are hit by cars or are injured tvhile riding in Of the pedestrians are injured Or killed, 30 per cent were crossing between intersections, 15 Per cent were crossing at a n intersection but against a signal, and 22 per cent crossed at an intersection where there was no Our Coiiiinittee is coiiviaced that the annual casualty rate involving older persons can be reduced by adoptioll of a state-wide safety campaign directed at our elderly. The State Division of Safety should, among other things : 1. Stimulate local safety campaigns in our various communities designed to combat the toll taken by accidents to our older folks. Local welfare offices handling old age assistance, district offices handling old age insurance, old age recreation clubs are but some of the agencies that could be used to disseminate information. 2. Encourage wider use of safety equipment and devices in the home, such as grab bars and rails near bathtubs, non-skid rugs, better lighting on stairways. 3. Warn oldsters of the need for special precautions while walking in traffic and use of simple techniques such as mearinc white mufflers or gloves while walking on dark roads. 4'1 �4. Develop anlong architects a n uilderstantiing of the special safety needs of older persons, so t h a t old age homes, nursing homes, and other buildings erected for older persons can be as accident-proof as possible. 3. Encourage rnedical groups to initiate studies of the ph-siological and niental aspects of falls. Adult Education Our Coninlittee in previous reports has iiidicatetl the need for developing a n adult education prograin to cover the needs of older persons. D r . R. J. Pulling, director of the Adult Education Bureau i n the State Education Department, presented to our Coninlittee a stimulating, provocative program f o r adult education for older persons. 'i7e are happy to report that Dr. Pulling's bureau has employed a part-time specialist to encourage localities to develop adlilt ~rliicationprograms for d d c r persons, f o r the older worker seeking to adjust to impending retirement, for the oldster who wants to keep aseful and busy, for the elderly who are miserable because they can find nothing to occupy their time, for the oldster who wants t o l e a r n a hobby or craft. New T o r k State thus steps ont ahead of the rest of the Nation b y initiating a n educational program geared to older persons. Today, courses can be giren i n factories, old age homes, recreation clubs for older persons, as well as i n civic centers, libraries, shops, studies and even i n private living rooms. A report b y the U. S. Office of Education indicated t h a t there were i n 1947-48 only 25 courses for persons past retirement age given i n the entire country a n d said i t was the least widespread type oF ndnlt education. The State Education Commissioner, Francis T. Spaulding, has informed our Committee, "XTe are very much concerned about doing the kind of job that needs to be done i n connection with education for older people. " Our Committee believes : 1. The work of the Adult Education Bureau should be expanded to develop a comprehensive program of adult education for older persons. as outlined in "Birthdays Don't Count, " b y Dr. Pulling. 2. The State Education Department's relationship to older persons extends f a r beyond that of simply adult education. It covers, f o r example, library service to the elderly, vocational rehabilitation, licensing of teachers f o r adult education ~vork,state-aid to recreation centers doing educational work approved b y local boards of education, and &n examination of the entire elemen- tary and secondary school curricula to detrrtnine how youngsters can be prepared to adjust to older persons, frequently a sore-point a t present, and how >-oungsters can be prepared not nierely for a post-school career b u t for a wellro~lndedlife throughout maturity. Therefore, our Cotnillittee urges that the department set u p a n interdepartnlental committee to explore all facets of education i n a n aging popl~lation. 3. The State Edacation Department should allocate funds for research on the educational needs of older persons. T e r y little basic research has been clolle i n this field. 4. Our Comlnittee urges the State Education Departnient to re-examine its own discriminatory policy regarding older persons. Today. a per.. s ~ c!ej.iriiig a licailsa as a teacher of silo13 or a trade subjects is barred from adnlission to qualifying courses of instruction if he is i n n r P t h ~ 40 years old. Jfany able craftsmen, technicians. skilled workers who would make splendid tcachers and who i n their later years might wish to teach are barred b y this regulation. Recreation for Oldsters Recreational clubs for our elderly are mushrooming up all over the State i n heartening numbers. Churches, women's Froups, fraternal organizationq. inclustrial clubs, and local recreation departments are sponsoring recreational facilities f o r oldsters. This is a trend that our Committee is stiii~~llating and IT-ishesto stimulate further. KO community should fail to provide recreational facilities for its elderly. Unfortunate1~-,too many of our localities provide playgrounds for children, tennis courts and baseball fields f o r adolescents a n d young adults, b u t n ~ p l e c t entirely the recreational needs of our elderly. I t is as though suddenly when a man or woman becomes 60 or 63 he or she no longer needs recreation. The day care centers f o r oldsters such as the William Hodson Center i n N e ~ vYork City are proving to be a mental tonic for oldsters. Senescence is apparently retarded b y the activities of these recreational and social centers. which replace the activities of the xi-orking day for the elderly. The record seems to i11dicate that a t Hodson Center, f o r example. the oldsters live 10 years longer than most people in the same age group, and retain their mental stamina longer too. W h y do oldsters like to join these kinds of activity? One says : "It's a retreat for displaced persons ill our society, the elderly". Another says these clubs "put new energy and lore i n your heart." A widow says, "it takes your mind off things, like the loss of a dear one. " ��lack the forlnal eclucation reyniren~ents for academic instruetors. 6. Every local recreation department develop special facilities for oldsters, such as lawn box-ling, checlrers, croquet, horseshoes, etc. 7. That State parks make available similar facilities for oldsters wherever possible and that such facilities be publicized so that more oldsters will take advantage of them. 8. That the State develop a comprehensive recreation program for persons of all age groups, so that special emphasis on one age group, whether youth or the elderly, will be minecessary. Housing for the Elderly in reports, me have caiied attention to the need for providing space in housing projects for our older persons, TITe in the Federal Housing Lam which bars older persons from federally aided housing projects, urged that an analysis of the ~ l l a r l ~ for housing the elderly be ullet dertaken by the State Division of Housing, advocated that cottage-type living arrangements for the elderly as now set u p in certain Florida and N e l ~ Jersey cornmunities be explored, and urged that insurance cornpanics explore the possibilities of investing in housing projects for the elderly. lies We doubt that the anslver to housing the in establishing communities for the elderly alone. our older persons like to be near younger people, prefer not to have to live solely with others of their own age group ; as a whole they want to be part of the whole community, not segregated into old age colonies. Of course there are exceptions, but the exp2rience abroad seems to be that when entire apartment houses were set aside in special areas for older persons, oldsters did not like the arrangement. S~veden, for example, after a number of experiments, is shifting from apartments exclusirelp for the oldsters to ones tvhich contain persons of all age groups. Foreign countries have had considerable experience with housing of the aped, ranging from public hostels provided for by England's National Assistance Law of 1947 to Cologne's housekeeping park apartments for aged per'sons of limited income. The experiences of England, Belgium, Denmark, and other countries need to be sifted, to determine what we can learn to aid us in housing our own elderly. Available figures for this country indicate that most of our elderly live in private homes of their own (68.8 per cent). And there is little doubt but that in most cases the best housing for oldsters is their own home, although this may not always be true especially when they become infirm or senile. About 21.9 per cent live with relatives, which in many cases is satis- 50 factory, enables the oldster to feel useful, solves a n economic situation; but which in other cases may prove unsatisfactory if there are problems of adjustment, undue feeling of dependence, and constant bickering. Over 5 per cent share the home of a nonrelative. Four per cent reside in institutions. The Central Bureau of the Je~vishAged has reported to our Committee: " I n the field of private housing, furnished rooms ancl small apartments are available to older persons b a t they are not adapted to their specific needs. Frequently a n older person lives alone on resourccs which are not adequate for his coinfort and well-beiug. For exaniple, a frequent orcurrence is the dispossession of a lone aged person - from a furnished rooni when he requests or requires extra attention or services from the landlady. JJTe hnTr,, U ~ V n,,,,,.. GDCCU -"--. -.. --1C En:..." ^1;1^." U ~ C L U Jucls-aulll~ltxli ulut.1 1 ~ C L ~ U L I ~ U~('OIIIV fearful and insecure after such experiences." The bureau advocates that the coinniunit~ take responsibility for further stimulation of the public housing authorities and private endeavor toward the bllilding of housing projects with a recognition of the older Persons as a potential and suitable tenant. Today, in York State, there are in state-aided p~lblichousing projects 99 apartlllent units of the One-room type presumably suited for older persons, plus 111 more sllch under construction. These inelude 56 units specially set aside for oldsters a t Fort Greene Houses in Brooklyn, 39 a t Lilliam JTTalcl Houses in Manhattan, 4 ill nfelrose Houses in the Bronx, 100 in the Governor Alfred E. Smith Houses, and l1 in the Farragut in There are, in addition, seventy-one 2-room, bedrool11 units desiglled for two Persons in the Farragut I3ouses, Albany Houses in Brooklyn, and the Flushlng Houses. There are also a total of 772 units, 2room, 1-bedroom, designed for two Persons in our state-aid housing projects. Ho~vever, provisions for housing our elderly in p b lic housing projects still consist almost entirely of the 56 apartments in the Fort Greene projects, plus cuch other apartnients as are provided for elderly slum dwellers whose old apartments were torn do~vnin slunl clearance projects. JTTe are happy to note from the 1950 message to the Legislature by Governor Dewey that "active consideration is being given to the problem of housing the aged, which has been repeatedly recommended by the Joint Legislative Committee on Problems of the Aging." The State Housing Division, we are informed, is sifting all available information on living needs of the elderly. Rochester is making the first really comprehensive study of the housing needs of its older persons. Data which the U. S. Census Bureau plans to compile in 1950 will give us for the first time ic- �mittee greatly by her sympathetic understanding of the plight of many of our elderly. Our Committee was also grieved at the loss of one of its able advisors, Dr. Stephen R. Monteith, of Continuation of Our Committee Nyack, who was Chairman of the Sub-committee to Our Committee believes that it is in the public in- Study Geriatrics of the New York State Medical Soterest that our Committee be continued another year. ciety, and who was giving the medical profession in This recommendation is urged upon us by private the State outstanding leadership in the social aspects social agencies upstate and in New York City, by of geriatrics. medical, industrial, labor and community leaders, as Acknowledgments well as by Governor Dewey in his 1950 message to the Again our Committee must record its obligation to Legislature. the member agencies of the Welfare Council of New The problems of the aging are so vast that to probe Pork for continuing through the year to provide our into them is to attempt to cover most of the major Committee with information, guidance and inspiraproblems of life itself. Our entire economy and our tion. entire problem of human relations are affected by We cannot possibly note here all the individuals the many ramifications of the problems of the elderly. and organizations who aided our efforts, without exOur Committee has made an attack on some of the tellding this report t~ ellcyclopedia proportions. more urgent problems and recommended a broad proTTre are indebted to Parke Davis & Co., Newsweek gram that obviously could not cover all the aspects JIagazine and Standard Oil of New Jersey Inc. for of the problems of the elderly. The Governor has their cooperation in providing free of charge to our asked that we extend our Committee's activities to Committee expensive color plates which would have enable us to join with national authorities in working otherwise been unavailable, to KEA for the use of brilout a basic solution to the problem of economic pro- liant cartoons dealing with the elderly and various tection of the aged. We shall be glad to do so. member agencies of the Welfare Council of New York Our Committee believes that a great deal of work for various photographs. needs to be done with personnel managers, housing We must, however, make special mention of the inexperts, and mental hygiene authorities. Our Comdebtedness of our Committee to the Community Servmittee, if continued, plans to ( a ) keep close check on ice Society of New York and its consultant on the the job counselling experiment mentioned in another aged, Miss Ollie Randall, who has given freely of her section of this report, ( b ) determine from its survey counsel and her wide experience to our Committee. of old age recipients what further local commullities The Committee is also especially appreciative of can do to prevent oldsters from needing old age as- the cooperation given by Miss Gladys Fisher of the sistance, (c) seek to develop with the aid of the State State Social Welfare Department, Dr. Charles A. Insurance Department some sound method of prevent- Pearce, and his research staff in the State Department ing, in a just manner, insurance companies from using of Labor, and Dr. R. J. Pulling of the State Departthe annual renewal clause in health and hospitaliza- ment of Education. tion policies to bar continuation of insurance to To the many colleges and universities, labor unions, elderly policyholders once they become ill, and gen- industrial concerns and councils of social agencies erally to bring the insurance companies to develop which cooperated in furnishing data to our Committheir own programs for the elderly, ( d ) continue to tee, we express our gratitude. We are particularly work with industrial and labor groups to break down grateful to the medical men, such as Dr. C. Ward age barriers in industry, (e) work toward closer liaison Crampton, Dr. Robert T. Monroe, Dr. James M. Dunn, between the State Mental Hygiene Department and Dr. Frederic D. Zeman, and New York City Hosour private old age homes and social welfare agencies, pital Commissioner Marcus D. Kogel for giving our and ( f ) appear before congressional and national Committee the benefit of their advice and judgment, administrative agencies in the field of labor, social in some cases at considerable inconvenience to themsecurity, health, and education, to give them the Seneselves. fit of our findings. Our Committee wishes to thank the various Federal Departments, such as the Veterans AdministraCondolences tion, the U. S. Labor Department, the Social SeOur Committee wishes to express to the family of curity Administration, and the U. S. Public Health our former colleague, Senator Rhoda Fox Graves, who Service for authorizing their key officials to aid our died at age 73, our deepest sympathy i n their loss. Committee by furnishing data and advice. Our deep gratitude goes to the members of our AdSenator Graves was sincerely interested in improving the welfare of our older persons and aided our com- visory Committees and to the various State Commisformation we need to plan a rounded program for housing our older people. �sioners who have provided inforination and guidance, to Mr. Albert J. Abrams, who directed the work of our Committee and drafted this letter of transmittal for our review, and to Mr. John A. Ruskowski, who aided greatly in the preparation of this report and in the work and studies of our Committee. We are also indebted to the many older persons who fnrnished our Committee with invaluable information on their personal problems and thus enabled us to gain an insight into the real and human difficulties which confront so many of our elderly. Nature of This Report Like its predecessors, "Birthdays Don't Count, " and "Never Too Old," this report consists of two basic sections. The first contains this letter of transmittal. The second section consists of various papers and reports prepared for our Committee by some of the Nation's outstanding authorities on problems of the aging, and other analyses which our Committee thought should be brought to the attention of all concerned with the plight of our elderly. NEW YORK STATE JOINT LEGISLATIVE COMMITTEE ON PROBLEMS OF THE AGING Sena.tor T h n m a C. Deso?or.d, Chairman Assemblyman William M, Stuart, Vice-Chairman Assemblyman Leonard Farbstein, Secretary Senator Thomas F. Campbell Senator Fred G. Moritt Senator S, Wentworth Horton Assemblyman Harry J. Tiff t Assemblyman John E.Johnson �The Governor's Views By Governor Thomas E. Dewey (Excerpts f r o m 1950 Nessage to the Legislature) T Housing Although the low rent housing program is primarily intended to accommodate family groups, active consideration is being given to the problem of housing the aged, TI-hichhas been repeatedly recommended b y the Joint Legislative Committee on Problems of the Aging. I n the first project built with State funds, provision was made for one and two room apartlnents suitable for occupancy for aged persons. I n all our State-financed public housing, whether the project is in the planning stage, under constructionor in operation, provisiolls have beell made for slllall size units ~?;ith2 .:ieTT to'iT2rd 2llt?viating the holAsing problems our our older citizens. Nursing Home Care 411 of 11s have a relatire, or friend, or know about someone who is receiring nursing home care or who requires such care. This sitnation constitutes a health problem as well as a n econonzic and social problem to s t a t e Liclmillistration has given extensive lvhich study ancl upon which i t has acted. In recent years there ilas beell a substantial increase in the number of ill, all illcrease t h a t steins from the fact that are living longer and h a r e become a n aging population. M~~~ of our ill clollot hospital nllrsing and other services \Thirh care bllt do are not available in the arerage home. As a result, there has been a tremendous expansion i n the nursing home field. TO learn what kind of care these aged men and women are receiving and to obtain the fundamental facts of this relatively new nursing home econonly, the State Department of Social VTelfare recently made a n intensive survey of nursing homes in upstate New York. (Nursing homes i n New York City are licensed by the New York City Department of Health.) Approximately one thousand homes were were found to one might expect, s,rueyect. be good, bad and indifferent. nIany of them llot be called nursillg homes. They are merely boardA report is noTv being prepared on the ing findings. The responsible owners of these homes, which are proprietary i n nature, want standards to be set, as a protection to the patients and to themselves. The State Department of Social Welfare, with the help of the Interdepartmental Health Council, is now planning to develop such a set of standards. TVe shall also hare to plan a program for developing more and better facilities, including both nursing a n d boarding homes and public and private institutions for the aged as well. These efforts will, I am confident. assure to the chronically sick, elderly people, the kind of care. comfort and safety they should have. HE PROVISIONS for the aged i n this country are today i n a chaotic condition. The national oldage a n d survivors insurance system under the Social Security Act, passed fourteen years ago, as now constituted, is a failure. I t s benefit payments are inadequate. and unless the system is recast fnndamentally, it will continue to fail for another ten to fifteen years to meet the needs of our older people. Jloreover, many ppciple are not even covered by the system. The joint national-state public assistance system was established originally as a stopgap to take care of the lvhO not be brOnght within the scope of old-age and surviuors insurance. Actually it overshaciows the insurance system. I t nnfi T.,r nc y l v v ;?rru ,-'?.. , Luau -1-1 - , auLc -,A allu !n n m n n L,-,GCnu m +hn, ulu-agc ; u n L t I..nn,, a &cL u c u c 1 threatens to become a major fixture in our national life. it does not provicle a permanellt solution to the problem. 1 1 the meanwhile, through the efforts of govern1 mental and industrial employers and more recently of labor unions, pension fullcls for indllstrial and gOVerninental employees have grown considerably i n n~nllberand scope. Some of these are contributory, others non-contributory ; sorne are funded on a reserve basis and thus safeguarded to solne extent against default: others are complete1:- nnfunded and unsafeguarded; sollle are correlated with the national insnrance system while others are not. , ,,, The s t a t e of NelT York, lVithits r a s t allcl illcreasing aged populatioll is vitally collcerlleci the illtro\Tith duction of sollle order into this collfusion of conflicting treads. We are concerned about a sound reorganizatioll of the llational old-age insurance which will meet the l~eecls our population and the populaof tion of other states. lJTe also have a responsibility to correlate our State and mnnicipal retirement plans with the national insurance system ; and, wherever practical, to assist industrial employers and labor unions to develop jointly scnxndly conceived retirement systems. This can not be done withont a inore thorough study of the entire problem than has yet been made. W e mnst find solutions which will stand through time. I recom~nencl, therefore, to your Honorable Bodies that the ,Joint Legislative Committee on the Problems of the Aging be continued and expanded in order to carry forward its excellent work i n this field and to include within its perspective the problems of old-age pensions a n d insurance. This Committee should also be able to make effective presentation of the needs of this State i n the national deliberations on the problenls which may take place during this year. 53 ��While there is a 11-idc variety of fields, discussion of the application of the principle of participation is limited here to recr-ation, health, housing and employment. Recreation is the starting point in most communities; unfortunately, in some it is the limit of the expression of community interest. Recreation for the elderly in all its forms should have the single objective of increasing opportunity to enjoy to the full the leisure of later years. Three guideposts may be of assistance. One, the number of older people with leisure is constantly being increased by those who differ from the average old person in the past. They have better health, they have worked shorter hours, had more vacations, trareled more. They have had more opportunity for varied interests and quite a number have larger pensions. Tvith all the pressure that has been associated with these gains, however, the great need of many is knowing hnlr~to enjoy leisnre, thnt is retraining for leisure. This is a challenge to the ildult Education Section of our public scllools as well as to many other parts of a community. These newly retired and soon to be retired are probably any community's largest reservoir of unused human resources. They hasre ninch to give of time, energy and skill. \lTith their need to learn adjustments, they should br of immense help ill the general thinkins on the place of the older person in our lnodern society. There are no anslTers in the books. TWO,the leis active allcl fori~~erI?bllhT- ~ . i t should be kept fully informed of available cultural resources. This can only be achieved by continuing search and frequent publication. Churches, fraternal organizations, libraries. a r t galleries. museums. ,-itJ, departments, public utilities, and Illany others have extension, social service or public relations departments with rich offerings. A Senior Citizens Calendar, compiled by a committee of lay and professional workers, is of value to any city. Three, there are latellt poTrers ill all but the geauinely senile. The response in new paths may be slow and timid, but the joy of learning even the simplest thing is a creative experience that prolongs and deepens life. One has but to visit the occupational therapy department in a home for the dependent acre6 or chronically ill to realize what skilled leaderslzip can do to arouse and make fruitful the innate desire to learn; or to visit a camp for elderb- 17eople where the Wins of sunburn and mosquito bites may replace those of arthritis and heart attacks. A better understanding of the health needs of an aging population will lead to many changes. It may be necessary for the higher governmental levels to assume greater responsibility for the chronically ill and for the research needed to reduce their number. Certainly the community will improve its immediate services as i t adopts a more constructive attitude toward the treatment of its aged ill. More and better nursing homes are needed wherein illness is not presumed to be a prelude to death. to I n one city, the addition of a ~hysio-therapist the staff of nursing homes, under the direction of a forward-looking County Department of Social Welfare, is hastening the recovery from such misfortunes as fractures and strokes, thereby accelerating the flow of patients from the hospital a t $11 per day, to nursing homes a t $125 monthly, to boarding homes a t $75 monthly and, in fortunate cases, to their own homes. Each step represents a n increase in the independence and happiness of an older person and a decrease in the cost of the care. Preventive and constructive services are ileeded fur both physical and mental health. For example, mnch more is known than practiced i n nutrition of the aged. I n many communities there are from one to a dozen agencies touching this subject. Yet physicians continue to prescribe care for the aged persons suffering mainly from malnutrition. I 1 the prevention of mental illness a community 1 can do much by drawing older people into normal activities. This sounds deceptively simple and the results may seem a t times to be miraculous. An old man in one city. formerly an active respected citizen, was beginning to sit quietly and stare blankly, entirely ~vithdra\~?n apparently ready for a mental and haipital. ~ He was persuaded to become a day visitor j ~ ~ ~ ~ at a home for the aged where he met men of his own age. He entered into their activities and shortly a n alert, old man was searching for a room near the home where a blind acquaintance could live and share with him the home's activities. Perhaps skilled casework and a progressive home for the aged were part of the miracle. I t cannot be said too often that the physical and mental health of our aging population is conditioned by the physical and mental health program for all "geS provided by the local Housing Action Hollqino for the aqecl hol,efullv is passin? from the public conscience and discussion stage to that of definite civic planning and action. Yet does any city kllo\~how much of the living space so sorely needed b5- younger people is in the large apartments and the large houses that are rnearing out old people because there are no small comfortable quarters for them? ICno~~ledge not lacking as to the kind of housing is needed. A few units have been built with extra consicleration for safety and with services available as needed-food. shopping, laundry, housekeeping. �Private investment i n this type of housing is reported to be a sound financial venture. Even without new housing many feeble old people could remain longer i n their own homes or the homes of overburdened families, if only they had supplemented housekeeping, nursing and shopping services. Any hospital can report what the lack of these services is costing the elderly and the taxpayer. One of the next steps i n many communities, and it can be a n immediate step, is the fitting of these services in with those already established. I n a t least one city i n New York State the local planning commission is assnming responsibility for a snrvey of the housing of its elderly residents. From such definite knowledge practical housing plans can be developed. Employment To say t h a t older people experience difficillty i n secnrilig aiirl holding gainfi~J e~r?p!opment is xzlrrely a reaffirmation of the obvious. I n the main, this is clue to conditions largely beyond the control of local industries and local communities. Many questions of general policy are, as yet, unanswered, b u t they are continually arising i n every community. Shonld the terlnination of employment be determined b y chronological age or b y prodnctirity? If based solely on productivity, how will the heads of young families be affected 7 This is a serious and nnsolred problem. Shoulcl the curnmunity offer guidance to the retired person who is contemplating the investment of his life's savings i n a small business? Cannot a business clinie be created for the elderly as f o r other groups? HOTV job finding for the elderly be best can achieved? To what extent will a sheltered workshon contribute to the well-being of those no longer able t o meet the demands of modern business operations? With a better understanding of what can be ahead for each of us there should be fewer tragedies such as that of the university professor who, on retirement, had been greatly honored for his 40 years of service. His wid ox^- startled her associates by saying that the university would be kinder to shoot its retirinc professors t h a n to p u t them on the shelf alive. illso, the local comnl~mitymust explore preparation for retirement. Too frequently the s t u r d y ancl productive worker sadcienly on retirement fincls himself unadjusted to great blocks of free time and snffers from the "bends" by coming too rapidly from the deep waters of a job to the shallows of idleness. The program of preparation for retirement should cover a nliniinum of at least five pears. It is a major personnel operation bj- which the employee is helped to appreciate the eventual freedom from the many years of responsibilities. A t the same time assistance s l i o ~ ~ lbe extended i n the development of interests d which will give zest for living. Here leadership must be given b y the employing organizations with the assistance of other community resources. No single group can do this alone. The grafting of a new and fruitful life is a matter of common concern. Interests should be directed into constructive channels, not only for the benefit of those who are retiring, b u t for the benefit of the community because there is a wealth of untapped skills and abilities which should be used for the community's benefit. One does not lose all his strength the day after retirement. This reservoir of constructive forces should be tapped and the variety and quality are great. A positive approach must be made; the sense of being needed must be fostered; busy work alone will not meet the needs of our aging people. This can be a realistic program. Already two leading industries i n Rochester are attempting to work with such a program which will utilize many of the comm~unity's resources. To develop gradually a durable program for the elderly, including new practices i n employment and recreation, housing a n d health there is needed a n underlying social philosophy. One important method of interpreting this philosophy is the consistent selection and vivid presentation of news which portrays needs and how they are being, or should be met. A n excellent example of this type of reporting was a series of six articles on the various facts of the local program published in the Rochester Democrat a?zd Chrodcle. There is a wealth of material which can be used. showing how sound planning a n d courageous action not only pays i n human happiness, b u t i n the long r u n can save the dollars of the taxpayer a n d contributor. Through planning and interpretation, many of the mistakes t h a t have been made f o r creating unnecessary projects or b y abolishing others of real worth because of the lack of facts, can be avoided. A program cannot advance without community tnlderstanding. Local Action There has been a disposition on the p a r t of many communities to await governmental action, especially on the higher levels, to solve the problems of the aging population. However, i n those communities where responsibility has been assumed, and discussion as well as action has been had, interest and financial support increasingly have been offered b y vohlntary sources. Tl'ithin the past year i n one city a longestablishecl local organization, the '1Vomen's Edncational and Industrial r n i o n , gave a recent legacy to the Council of Social Agencies to carry on a project for the development of a comprehensive program for the aged. A community consultant on services to the �aged has been employed, and a community focus has beell established. To further enrich this effort, the Junior League has given sufficient funds to the council for a series of institutes on the aging population. Keither of these generous gifts-and they may be only the beginning of additional financial support\t70uld have been forthcoming had there not been an organized effort in the community to do something for and with the elderly in their midst. I t is beconling increasingly clear that a successful program is dependent upon the courage and action of local communities in close sympathetic partnerqhip with the state and Federal governments. Each has its important role to play. In New York State, we are beginning to see a consolidation of effort, and there is gradually evolving a program insuring the elderly both protection as needed and continuecl opportunity to share in community life. The recent creation of the New York State Association of Councils of Social Agencies and the proposed unofficial State Council for the Elderly will inevitably act as crystallizing and unifying forces. With the leadership of the inembers of the Joint Legislatiye Committee on Problems of the Aging, the conlmunities in Sew York State can definitely progress in their efforts to meet the needs of our aging population. �* ' I 1 I ' / , I # ' . ' I :, ' ,, , : : I , . , , ' ! , I "i , , , ) " , , , ,$,,, ' 9 I , ' I 1 ' < , I I I ,, I , ' , . ; , ,, , , �both psychological and economic reasons-for gainful employment, a t least part time, for its older clients, some of whom are able to carry part-time jobs and eager for them. Thus far little progress has been made in finding such opportunity. The local offices of the New York State Employment Service are, however, aware of and concerned about employment needs of older people. To the limit of their facilities they offer employment counselling for older people. Westchester's seven private family agencies-catholic Charities and TVestchester Jewish Community Service, county-wide; and five non-sectarian societies in local communities in the south of the county-offer general counselling service to aging men and Ivelen. Westchester Jewish Community Service has a department for services to the aged. The Yonkers Family Service has a staff member whose special responsibility is for its older clients. Visiting Nurse L4ssociations,of which there are 16 in vv estchester, covering the six cities and aii but two of the 18 towns, are providing nursing care a t home to many old people. The TTTestchester Narsing Coimcil (a voluntary federation of these 16 associations) is focussing the attention of its members on their elderly patients and, as mentioned, will have one of its four program meetings on geriatrics this year. TrT Inquiries received at the Information Bureau of the Westchester County Council of Social Agencies are predominantly about care for elderly people; and among these, the most frequent is for nursing home care. Nursing Homes are licensed by our departments of health and the Information Bureau lists only licensed homes. Fuller information is often needed than the license report requires. With the assistance of the Medical Social Work Section of the council, a corps of volunteers visited nursing homes which uniformly welcomed these visits. The volunteers' reports yielded useful data to the Information Bureau; and, as an important by-product, increased interest in the needs of elderly people. There are a number of instances where a bourclinq home, rather than a nzcrsing home, is needed. Though there is interest in many quarters, in the development of boarcii~zghomes for the elderly, as yet few such homes are available. The Council's Section 011 the Needs of the Aging was formed because of the number of inqniries in the Information Bnrean about service for the elderly. This report is largely from that section, of which Mrs. Louis Rose, of Scarsdale, is chairman. ��augnrated, plans should be made to assess their effectiveness i n meeting the existing problems. Only through such research efforts can the most effective programs be planned and revised, and only through a research program can the local experience be made available to other communities in their efforts to meet similar problems. 2. Recreation and Group Activities : Older people, in particular, need activities which will stimulate interests, broaden views, give purposes in living, provide social contacts with others of similar age. Other cities (notably New York City and Cleveland) have reported unusual successful experiences with programs designed especially for the aged. This question should be studied with a view to the development in Syracuse of a broadly oriented program which should include the early establishment of a recreation center for oldsters and the stimnlation of various organiza&ns within the city to develop appropi-iate proerams of group activities for their older members. needs of the old age group might be met. There appears to be need for education a t the adult level which would include special short-term "courses" (perhaps of only a single meeting) designed to meet the demonstrated needs, interests and capacities of various adult age groups. 5. Counseling and Referral: The development of general programs to meet group needs can do much to alleviate the problems of older age groups. However, some agency should be established which would concern itself with the unique needs and problems of the individual. This agency would counsel older adults with respect to their personal problems and marshal1 community resources to meet the needs of particular individuals. Methods of meeting this need for individualizing a broad program and the drawing up of a recommended program for action (possibly a local old age counseling center) is worthy of attention. 6. Public Information and Publicity: A major problem will be the stimalation of general interest in the problems and needs of the older individual as a 3. Work and Economic Security: There seems means of enlisting support for a program designed to little question but what having something to do, 11avmeet these needs. This will entail a carefully planned ing a sense of personal work and usefulness. are fundaeducational and publicity program including appromental considerations in the achievement of a well adpriate publicity in press and radio, the planning of justed old age. Early objectives of efforts in this general educational campaigns (including for examarea might include assessing the adequacy of social ple a possible "conference" or "institute on aging"). security and other old age pension allotn~ents, study a of problems of retirement, the possible establishment 7. Institutional Care : A substantial number of old of a "sheltered workshop" for oldsters. Long range people must be cared for in institutions and homes. thinking and planning may be fruitful with respect Most such homes are crowded and a large backlog of to ways in which industry might better utilize the applicants awaits every vacancy. The special probcapacities of older workers and to ways in which re- lems encountered in the operation of such homes tirement might be handled (perhaps gradzial retire- should be identified, and ways of making the programs ment with a n emphasis upon retiring to something of these institutions no re effective in promoting the rather than from work) so as to foster better adjust- welfare and good adjustment of the residents should ment. Since older workers have been shown to possess be explored. Other possibilities for providing cuscertain desirable qualities to a greater degree than todial care, e.g. in private homes, are worthy of invesyounger workers and are only slightly, if any less, tigation. productive, it appears that some progress might be 8. Nursing and Medical Care : I11 health and other made through an "education" program designed to physical defects characterize the older age group more correct misconceptions. The attention of both labor and management should be directed to such matters. than any other segment of the popnlation. Carc of the chronically ill and the incapacitated present a special community problem. Social study should be 4. Adult Education: I t is becoming increasingly recognized in education circles that the great unfilled directed to these methods by which such care can need in this field involves the adult population. State economically be provided to the best welfare of the aid is already available for adult education programs recipient, to the development of techniques for dealunder the public school program, and the University ing with the geriatric patient, and to the education of College of Syracuse University is geared to serving nurses and others in the care of the older person. the needs of the young adult in the community. Cur- Special inquiry might well be directed toward a surrently these programs serve primarily the needs of the vey of nursing and convalescent homes with a view to young adult and to some lesser extent the middleaged possible bettering and extension of their services. group. Study of the possible further contributions of 9. Housing: Nany communities, particularly these programs might indicate ways in which the large cities, are including in their housing programs A- �the l old age problem" as their primary concern. I have not made a n actual survey of all that is being done by groups other than the committee. (a) Research and Instruction at Syracuse University: Syracuse University was one of the first to establish a course in psychology of adult life (1941) and now in addition to that course conducts regularly a "research seminar in the psychology of maturity and old age." An extensive research program in the psychological and social aspects of aging has been underway for some time and is continuing. ( b ) Adult Education: There are two programs of Points of Actual Progress adult education in the city-one under the auspices The foregoing concerns plans, and that repr~seats of the public school system (supported by State the main efforts to date. Obvionsly, howe~er,plans funds), the other as part of the program of Syracuse lnust be translated into action if the comniuility is to University's 'University College, " a community colbenefit. ~2lthouglithe committee referred to earlier lege. In the pnb!ic szhm! program a cozrsa oii has been in existence only about eight months and psychological problems of adult living (including old wheels are already beginning to show some evidciice age) is being conducted for the first time and a survey =f gettin,- illto lEGtion. And perhaps just as iI1:psr of adult needs in education is planned for next semtant, other things are happening which suggest that ester. various groups are independently interested in the (c) The local Visiting Narses A4ssociationhas long problem and are doing solliething about it. This is as been interested in the problem of aging and is curit should be, because the problem is complex and can reiit1)- conducting an in-service study program debest be met through varied efforts of varied groups. r-oted to geriatric problems. First, what has been the nature of the coilzmittee's ( d ) d very active ~vomen's club (the Onondaga activities since drawing up its plans? Progress has Guild) is devoting most of its attention to promoting been made along three lines : the welfare of the residents in the Onondaga County ( A ) There har been progress in fact-finding. Cen- Home, but is at the same time stimulating interest in sus data have been examined to determine the gross the problenis of aging on the part of a substantial number and the areas within the city whose popula- number of people. tions contain the largest proportion of people dver 60. (e) The local American Pension Club has an active The Council of Social Agencies has made available to recreational program. Participants are members of the committee an analysis of the extent to which the approximately 50 years of age and over. caseload of various welfare agencies is rriade up of ( f ) 12 "Golden Age Club" has recently been estabolder people, and of the types of problems which they lished as a part of the Salvation Army program. present. Plans are now being made for a more inten( g ) A local group work agency, The Huntington sir-e inquiry into the needs of older people who are Club, has activities for all age groups, and is now in not clients of agencies. progress of planning activities for older people. ( B ) Progress is being made toward the establishThese are the activities that have come to the speakment of a recreation center and "sheltered work- er's attention. Some have been operative for several shop." I t is likely that this will be established jn a years. Others have just begun or are in the planning portion of a building recently made available for a stages. sheltered workshop for the handicapped. To representatives of those communities who al( C ) There have been efforts designed to stimulate ready have an active program for the aged and aging local interest in the problems of the aging through this enanleration of activities may seem very insigcontacts with various groups not originally associ- nificant indeed. To those in Syracuse interested in ated with the committee, through appropriate press, the future, they represent heartening signs of an emmdio and television activity, and through the incln- erging program. Even in its beginning the picture sion of a lecture and discnssion of problems of old is characterized by an active and growing interest on age in local "Afeatal Hygiene Institute." the part of varioas groups who are making very difWhat of the activities of other groups? Obviously, ferent, but individually important, contributions almost all x-elfare agencies are concerned with the along the line of their special interests, talents and problem to sonle extent, and some agencies, sucl-1 as facilities. And there is a desirable type of cooperathe local Social Security Office, have some aspect of tion and inter-stimulation. special facilities adapted to the requirements of older people. What the situation is in Syracuse is unknown. Studies should be instituted to inquire into the present housing arrangements of older adults with a view to the preparation of recommendation for possible future construction of public or private housing, and the preparation of reports and recommendations presenting the needs of the older individual, where it seems appropriate to do so, in connection with any pending local or State legislation. �The Needs of the Aged in New York City By M s Flora Fox is Executiee Director, Celztral Bureau for Jewish Aged T HE CEXTRBL BUREAU JEWISH FOR AGED, virby tue of its function and unique position in the chain of conlmuility services for the Jewish aged, has had unasual opportunity to learn about and understand the problems and needs of the Jemish aged. Established in 1945 as a membership organization, the bnrpau's affiliates include the Jewish faliiily- agencies, homes for the aged and chronically ill, hospitals, revreatioli agencies and the Federation of Jenisli Pliilaiithropies of New Pork, froin which the bureau derives the largest proportioil of its financial snpport. The bnrean has become the generallv acceptcd mccliu;;z f o r the er;chaiige of ideas, tile t.1alastion of programs and their implenientatioii where feasible. The bnrean function\ in inany ways : through direct service to individuals and their families, givino. them guidance i11 ~vorking out plans for their care and consnltatioil with coniin~nityagencies on behalf of aged persons; through study of the neecls ailcl problems of the Jewish aged; through consultation on aspects of the care of the aged, both general and specific; through cooperatioil with and participation in the activities of other groups, particularly the Welfare Council of New York City, concerned with the can3 of the aged in the total community; through leadership in the coordination of present services ancl facilities for the Jewish aged now provided in the community-institutional, hospital, familJ s e n ice and recreation ; through leadership in the establishment of new or expanded facilities and services and in the sponsorship and stimulation of member and other agencies. The burean believes that the folloning are the current outstanding needs of the Jewish aged as based on its initial 1916 Survey of the Needs and Facilities for the Care of the J e ~ ~ i s h Agecl in Ne~vTork City whose findings and recoiilmendations have been corroborated and substantiated in supplelizeiitary surveys. and i11 collateral studies and day-to-day experience. Tlic burean wishes to point out that the needs enumerated here are not peculiar to the Jewish aged but are common to all needy aged persons. that a growing number of elderly persons need such care because they cannot be served adequately in their own or in relatives' homes. Particularly noted is the increasing number of chronically ill persons in critical condition who require immediate care outside of their own homes but who have no funds for nursing home care-the only resource immediately available. When persoils can accept public facilities-we have the added problem of Orthodox Jewish persons who are unhappy in a non-Jewish setting-there i s a n 1x1duly long delay in gaining admission to the city homes. If adnlissioii can be arranged to city hospitals for ~llebt: . patients, experience indicates that they ~vill not be kept indefinitely because of the necessity to reserve beds for the acutely ill. Under these circumstances, patients are frequently sent back to unfavorable living arrangements. i\lember institutions, stimulated and encouraged by the bureau, are attempting to help meet this problem. Soine have lnodified building plans to care for additional chronically ill persons rather than for the well agcd. Others, ~ ~ were not planning further expanh o sion, have embarked on fund raising campaigns t o erect facilities for the sick. TVe can look forward, on the basis of the present plans of eight Jewish institutions, to a considerable increase in the number of available beds for the chronically ill. However, they will still serve but a fraction of the numbers of persolis requiring this service. L~ The Mentally Infirm I n this group fall those mentally deteriorated perare characterized by such symptoms as forsons ~ v h o getfulness, garrulousness, talking to one's self, dtvelling in the past, the gradual breaking down of habit patterns, sach as failing to dress properly or maintaining former good table manners, wandering off, getting lost. These persons do not belong in a State hospital but cannot be cared for by institutions for the aged under their present set-LIP. Faced by the lack of proper facilities, the indigent and those whose families cannot care for them find their way to the State niental hospitals. This is a n unhappy situation for the aged ~vhen they are aware of their surroundings and for their families also because of the stigma which is still attached to mental hospitals. I t is also a n expeilsive way of caring for this type of patient. The bureau gave serious thought to its responsibilA The Chronically I11 Aged The bllreau7s 1946 survey revealed a need for additional iiistitutional facilities for the care of the chronically ill aged. Since then, experience has indicated " �admission, preferring the boarding arrangement from which he derived satisfaction and security. There are other persons, however, who, though they have no desire to enter a n institution, still are afraid to remain alone and seek some kind of semi-institutional living arrangement where they mill find independence, privacy and freedom of movement along with a degree of protection. The financial status of many of these people is in the middle and lower income groups-some being on public assistance-so that their ability to pay is a limited one. Thus f a r there are only two projects of this type in the community, the Tompkins Square Houses of the Community Service Society and the Apartment Project of the Home for Aged and Infirm Hebrews which have between them facilities for a total of approximately 130 persons The bureau recommended that the experience of the two projects be studied as to their applicability to other groups in the Jewish commun~tyand that the possibility of expanding the services of other institutions in the same way be ascertained. The Brooklyn Hebrew Home and Hospital, which now serves the chronically ill aged, is formulating plans for such a n apartment project to serve well orthodox aged. itp for the problems posed by the mentally infirm agecl. After due consideration, it was felt that this problem which is in essence universal might better be handled cooperatively with all sectarian and nonsectarian groups through the Welfare Council already actively engaged in formulating plans for obtaining understanding of the problem and the methods for meeting it. Nursing Homes i\Iany of the aged awaiting admission to institntions and many who can continue to remain in the comnlunity outside of a n institution have needed the services of nursing homes for custodial purposes or for temporary convalescent or nursing care during an acute illness. The bureau has seen the establishment of an increasing number of nnrsing homes throughout the metropolitail area. These homes which are independently administered, except for minimum health and 1 .:3-.1:- -----:----.-A,. U L L l l U l I l g leqllll c l l l c l 1 L . D -. ,A I. DGL. U J &LA ~ l l c cpal u 4,-*- +' LIIIGIILU ,g , UI IIUU- pitals and Buildings, have no professional supervision as to physical standards of care, admission requirements, personnel qualifications or facilities. Essentially operated for profit, they present varying degrees of standards of care and have charges for the serrice which often bear little relation to the care provided and the ability to pap. With few excaptions the clients of the bnrean can only afford a minimu~n rate. The bureau belieres that a sound nursing home program should be set u p with adequate superrision, standards and services a t a rate that is flexible to meet the various economic groups who need this service. The bureau has taken part with other health and welfare agencies of the Mrelfare Council in eneonraging the Department of Hospitals to develop a prograill in this area of service which will more realistically meet the demand. Public Housing The bureau, as part of other community groups in the Welfare Council. recognized that practically no public housing had been erected to meet the specific needs of older persons. I n the private field of housing, furnished rooms and sillall apartinents are available to older persons but they are not adapted to their specific needs. Frequently, a n older person lives alone on resources which are not adequate for his comfort and well-being. For example, a frequent occurrence is the dispossess of a lone aged person from a furnished room when he requests or requires extra attention or services from Boarding Arrangements the landlady. \Ire hare seen many self-sufficient older Many elderly persons no longer have their 0 ~ ~ 1 1 persons become fearful and insecure after such experifamily ties and greatly prefer living in a family home ences. Many of these people seek admission to a home, to living alone or in a n institution. I n this kitid of though with proper and suitable living arrangements set-up, their need for personal attention, supervision they could remain in the community. and guidance is fulfilled along with their need to conThe bureau has advocated that the community, protinue to be part of the community. They may require fessional and lay, take responsibility for further stimvaq-ing degrees of physical care, companionship and ulation of the public housing authorities and private family life. The bureau advocated that this type of endeavor toward the building of housing projects service be explored and studied as to its potentialities. with a recognition of the older person as a potential The Jewish Community Services of Queens-Naqsau, and suitable tenant. The bureau has participated in stimulated by its membership in the bureau, under- conferences with the Ne~v York City Housing Authortook to set up such a program through its Private ity along these lines. Residence Plan. Under this pilot project, 35 persons Medical Care have to date found this way of living a very meaningThere are very limited medical facilities for conservful one. I n a few instances, where the client mas on the waiting list of a home for the aged, he deferred ing and improving the health of the aged person liv4 �ing in the comiillulit~-. Clinical facilities are frecluent1)- inaccessible ancl just as frecluently are not atlapted t o iilret the specific needs of the older person. For those not able to attend clinics, there is a serious lack of provision for home medical care if they are ~ m a b l e pay for private service or are not under the to care of agencies nhich provide illedical attentiol~in the home. Some people i n this group may be able to obtain occ.asiona1 and ofttimes enlergellcy nledical care but cannot plan for any continnity which niay be nieclically reconlrilellded to insure their iliasinluin fnnctioning in the c o m r n ~ ~ ~ l l t y . Tlic b n r e a l ~ therefore believes that present faciiities should be ?xpanded and. if required, nexv facilities be developetl to furnish nc.essaq- medical care in cliilics nncl in the IIoilles of aged persons adapted to their particular needs. Homemaker Service There arc very limited resources fo1*visitiao homeinalcers in general ancl their a\-ailability to the aged is restricted b y the individual policies of the agencies providing this type of serrice, since thej- dre not specifically geared to the needs of the aging. P a r ticular limitatioiis are found i n the restrictions on length of time the homenia1;er may remain i n a home, as the aged need long-term service-sometimes over a i ~ period of n~oiiths n r i e of tlic long waiting periods for admission to institntions. The bnrean aclrocatetl that honlenlalier service be expanded a n d adapted to the special needs of the aged individual with recognitioll of the necessity for flexibility i n type, length and cost of service. I n line with this thinliii~g, bnrcau i n JSarch 1948 initiated the a Home Care Prograin to be sponsorecl jointly with the Home for Aged a n d Infirm Hebren s and the ervish Family Service. A n important feature of this plan to maintain elderly people i n their o ~ v nhoines is the homemaker service. The clients for the project are selected b y the Social Service Department of the h o ~ n eand renlaili under their qnperrision. ,411 s r r r ices and facilities of the hoine are arailable to the clients. They feel secure because the home hah guaranteed to them t h a t they v i l l be transferred to the iilstitution ~vheiithey can 110 longer reillail1 safely in their own hoines even ~ ~ i honieniaker serviw. The t h ,Je~\-ish Family Service with a long experience i n adiniiiistering homemaker service provides homemaliers 15-ho are especially geared to the needs of the aped. S o t only is this a n effectire and satisfying way of extending service to elderly people b u t i t is also a less costly method of care than irlstitutionalization. I n addition, it helps to reserve beds in homes for the agrtl for t l i o ~ h o nc'ed them the inost n~ Visiting Nurse Service IIorne nnrsing care is available i n all the boroughs to indiriduals in all economic levels without diserinlination as to age, color and religion. IIowever, the nnrsing service is most usually set u p for short-term or a time-limited nursing need of people and only i n special instances are the established nursing services now able to offer intiefinite care. l\lany of our aged fall into the latter group and cannot depend on this service ~ v i t hany real sense of security. The bureau has advocated that the visiting nurse service be expaneled to provitle long-tinie service according to t l l ~ iieeds of the aped inclividnal. Recreation -he bureau recognizes that the aoed, like all people, 1 ileecl activity ancl association ~ v i t hother persons of si~nil~r interests 2nd age. Fi-eyc~eniiyprobiems occur i n faillilies with older persons because the latter feel bored and neglected. The TTTilliarn Hodsoil Center, the first recreatioll project for the aged ill Xew Tork City, denzonstrated the value of group activities in restoring and buililing u p a n aged person's confidence and desire to continue being active. The coiiimnaity, alerted b y this example, has made considerable progress i n establishing more recreation centers for older persons as p a r t of a11 expanding pro,0 ram. These programs a t this time are limited to thaw who are able to reach the centers, b u t make no provision for those who are holueboul~dbecause of illness or inclement weather. The bureau has recommended that there be a n espansion of the present recreation program and the d~velopmentof a home recreation program for those patients who are only semi-amhalatory as indicated above, or who are permanently or temporarily confined. 111 this connection, the bureau together with the Jewish TTTelfareBoard is instituting a progralll to enlist the interest a n d assistance of Jewish community centers and "lT's" in making their facilities and technical sliills available to elderly persons. Adult Education The bureau has recognized the value of the various activities IT-hich fall within the scope of adult edncation as aids i n helping people to accept, adjust to. a ~ l d find satisfaction i n their latter years. F o r some iiidividnals classes, lectures, discussion groups are more satisf!-ing t h a n the handicrafts, for example. These activities can be a n important adjunct to, or pari of, the programs of recreatio~lcenters and iiistitntioas for the aged. The bureau has participated i n discnssions on this ��persons will live with private families on foster home basis. Three year experimental program administered by the Home for Aged and Infirm Hebrews, providing home medical care for 125 aged persons to continue living at home. Three-year continuation of the homemaker service demonstration program as mentioned earlier in the Home Care Project. A new nursing home in Queens or Westchester to serve at least 50 persons. What the State Can Do The bureau has itself undertaken and stimulated the development of various services in the community for the care of the Jewish aged, knowing full well that these services would meet but a small fraction of the total needs. I t engaged in these activities to dcm~nstratcthe ralidity of certain services, in the hope that not only private agencies would follow suit but that the public agencies would be enco~lrag.edto set up similar projects on the needed larger scale. The bureau believes that the State can give assistance in many ways, in the following areas: 1. The chronically ill-by helping in the estahlishment of more beds for those who cannot be cared for at home and the further development of home care under hospital supervision for those sicked aged who can remain at home with the aid of such services as visitng physicians, nurses, homemakers and occupational therapists. The mentally infirm-through the provision of more appropriate care for them than is now available. Nursing homes-by the establishment of public nursing home services and by enabling public and private agencies to make joint financial arrangements allowing for subsidies. This would permit flexibility in creating a total community plan. Boarding homes-by making possible their expansion through the availability of more funds to enable public assistance recipients to pay higher rates. Public housing-by encouraging the const~uction of more units especially adapted to older persons. Medical care-by promoting better understanding of the diseases which seem to predominate in the latter years, and by taking steps to off- set the genera!!j: accepted belief that little o r nothing can be done about them; by the establishment of better clinic facilities for older people and by fostering greater understandillg of the older patient on the part of hospital staffs. Homemaker service-by making possible the expansion of this service in public hospitals and public welfare programs. Recreation and adult education-by making available increased funds for expansion. E m p l o y m e n t b y lending administrative support to the educational program of the Joint Legislative Committee on Problems of the Aging-and its sizccessor, with employers and employees. . ��I TJTelfare. The Welfare Council \\as active in the legislative area by helping to pass and later to draft ainencl~ n e n t s the original Old Age ,lssistance legislation. to The council developed a statellleiit of miniinlull standards for homes for the aced ~ ~ h i became a inode1 for ch use throughout the country. Through constant rerisions, it has hacl n ide natioiial a n d internatioilal use. This important statelllellt had the effect not only of raising standards of existing homes for the agecl, but served as a basis for the developinent of nely institutions. The c o ~ ~ n cn l i orlced relentlessly for the eml~loymrizt of trained social T orliers aild otlier personnel i n hoines I for the agecl. I t arranged for a course i11 "llental Hygiene for the Xged" for lay a n d professional workers. I t ~vorkeclclosely with the New York State ancl city x m s i n g Aiit!;crities ill ail effort to illat<e spyrial provision for older persons i n pnblic housing projects. As a result of this collaboration, 50 apartilients were in planned ancl l~~ovicled the E'ort Greene Houiiug Project i n Brooklyn for elclerly persons. As f a r as is l i n o ~ ~no, siiliilar public facilities for the elderly exist n elsewhere i n the U~litetlStates. This is a real tribute Welfare Council of New York City to the public officials resl~onsiblef o r this cl~velopment. ,111~clesc~iptionof what Kern l'orli City is doii~g for I n the area of recreation for the older person, the the elderly must take into consideration the activities TJTelfare Cou~lcil n-a\ among the firit to recognize the of the Welfare Council-the agency which has rnajor I I P for S L I C ~prograins ancl has given help and gnid~ responsibility for city-wide planning and coordina- ance to public and private agencies alike. I n addition, tion. I n the Welfare Council, social agencies h a r e the ~ o u n c i h a i sir1c.e 1947 sl~onsorcd annual hobby l ail fonnd a common meeting ground for the discussion i l 1 o ~ ~ persons oyer 60. The t h i r d annual IIobby for and stndy of the problen~s older people ancl, i n i~ianj- Show i n 1949 had 834 individual participants and was of instances, the council has served as a catalytic agent seen by more than 15,000 persons. This project has i n facilitating the inlpleinelltation of prograins by hacl the effect of pnil~tingdramatically to the recreathese agencies. Altllongh not essentially a n operating tion needs of older persons. agency itself, the council has, everthe he less, initiated These and man)- other accomplishments have had a projects later taken orer by others. Represented i n definite bearing on c ~ ~ ~ rdevelopn~e~its prograins ent in its membership are sectarian as well as non-sectarian for the aged i n New YorB City. agencies-private and public agencies alike-all worlring together for the general elfar are of the community. Four Areas of Concentration The Welfare Council can thus point with pride to its record of accomplishn~ent i n behalf of agecl of A t the present time, New York City is concentratNew Yorlr City. F o r almost 23 years it has. through ing its efforts on four major areas of interest: housits sections, conlmittees and conference groups on the ing, employment, chronic illness and recreation. TTTelfareof the Agecl, proricled leadership and initia- With respect to housing, it is worth noting that the t i r e i n helping to focus the attention of the lay and building plans of many homes for the aged are now professional community 011 the older persons i n our coming to fruition. I t is expected that within the midst. coming year approximately 500 additional beds will The Welfare Council TTas among the first orgaiziza- have been provided in institutions for the aged. I n tions to establish a n Inforillation Burean for the Xged addition, this year will probably see the expansion of as an aid to aged persons seeking inforinatioli abont the apartment project idea. This, as you know, facilities. I t established a reporting system to inforin makes it possible for older people to live in the member agencies of racancies, admissions, rejections. privacy of institution sponsored apartments. An and duplicate applications. This reporting systenz interesting experiment in foster homes for the aged TTas later taken over by the State Department of Social is likewise going on. This has demonstrated the feasbecoine rather cnstolilary, i n this conlplex society i n which IT-e live, to speak with glooin about the inany bocial proble~nbthat face r i i anel the difficulties that stand i n the way of their solution. The problenls of the elclerly are indeed no exception to this rale. That the elderly are fast becoming our number one social problein is all too clear to infornled persons everywhere. Perhaps fewer persons are aware of the difficulties inherent i n the resolution of those problems. I t would be only fair to say though that even i n this regard the past few years have seexi a crescendo of activitj--at least in the social welfare a n d medical fields-in behalf of the older person and real efforts have been made to recognize aiicl cope with many aspects of the situation. TJTithout wishing to minimize the seriousness of the problems facing t h e elderljr nnr tn lJnderesti::::,tc the tasks lying ahead, I should like, if I may, to d e ~ i a t e some.cvhat from the accepted rule and present a picture of creatire activity ancl acco~nplishmenti11 behalf of the aged. T HAL �ibility of keeping those older persons who do not want institutional placement in the community. Similarly, there has been a n expansion of home care projects f o r older persons by hospitals, homes for the aged and family welfare agencies. I n providing home medical care, the services of visiting nurses and homemakers, these agencies have made it possible for older persons t o remain in their own homes much longer than was previously possible. This has proved valid not only psychologically but has been found to involve less cost and expense to agencies. Although housing facilities are of immense importance to older persons, there is perhaps nothing which contributes more to their dignity and self-respect than employment through which they can contribute to their own maintenance and needs. Educating prospective employers and the community a t large to the ad---. vallLdgcs 01 eiiiploy-iilg all older pelsoii is a struggle which is no less New York's than other communities'. This is a n area that one group or even many highminded groups cannot, in and of themselves, tackle. I t is a problem that requires the concentrated coordinated, and cooperative efforts of the private social agency, government, industry, labor, and other community agencies, for solution. I t is our feeling that in this sphere the State, through its established facilities, can play a role of real leadership. I t must be recognized, however, that serving the older person in employment requires special skills and special training. I t is our feeling that once specially trained staff is made available, they can function and give help to older persons through the existing employment and placement facilities of the State. The care of the chronically ill is receiving attention on niany fronts. Chronic illness is a scourge which affects persons of all ages. The Welfare Council's concern with the need for special care for this group of our population was instrumental in the setting up of new facilities for them. The council's Nursing Home Study, completed in 1947, recommended the development of visiting housekeeper service and other types of home care, which could help remove many of the chronically ill from hospitals where they hardly belonged and merely added to the congestion of N. Y. City's hospitals. This study has been looked to for guidance in the development of new rules and regulations for supervising and licensing nursing homes in this city. At the present time, Welfare Council is engaged in studying one aspect of the problem of the chronically ill. This study is concentrating on the chronically ill now living in homes for the aged which have no hospital facilities. I t is our hope that this may result in the setting u p of standards for the care of these patients in homes for the aged. L- Xuch thinking is going on in New York City in extending recreational and leisure time activities for the older person. The need for such programs has been long established, and the Welfare Council has worked closely with both public and private agencies having such programs. There is still, however, much confusion as to the objectives of such a program. To many older persons, these activities must become a substitute for the lack of employment opportunities. To others, these programs are ways of filling the need for companionship. The definition of objectives is the only way to determine the types of programs to set up as well as the settings in which the programs are to operate. There is a growing realization that programs for older persons must beconie part of the group work program of the community as a whole. This means that community centers-if they are to serve the total community-must provide for the needs of older persms in the same TTaythey rnVnrLV vide for the youth and young adults. A Welfare C o ~ ~ n cCommittee on Recreation for the Aged is now il working actively on many of these problems. Need for Community Action I n pointing up these major areas of activity for the older person, we, of the Welfare Council, believe that the time has come when a concentration of effort on the part of itself and social agencies alone is no longer adequate. The impact of problems which the community is facing in relation to the older citizen is such that it reqnires the attention of the whole community. The Welfare Conncil is a coordinating agency for social agencies and as such has its finger on the pulse of the community. Social agencies themselves, however, cannot substitute for the "grass roots" activities which local groups and lay councils can initiate and achieve. We therefore wish to submit for serious consideration the need for organizing neighborhood, city-wide and state-wide councils for the elderly. These groups can serve as the catalytic agents in bringing to the attention of civic groups and governmental agencies the needs of the aged and stimulate activity by and for them as groups and as individuals. To a large extent, the Joint Legislative Committee on Problems of the Aging has been very effective in this regard. I t is important, however, to plan a continuing and long range program which the committee has so ably begun. Looking Ahead I n reviewing the past and present programs for the aged, we cannot help but look to the future. As time goes on there will undoubtedly be a n increase in the number and types of programs. I t is quite likely that as communities begin to feel the impact of �the numbers of older citizens and the need to do sible for us to know better what type of facility to something about the resultant problems, many set up. With respect to housing facilities for older persons, projects will be embarked upon. One would indeed be hard put to deprecate these projects or to disparage the same principle must hold true. It is fairly the high-mindedness which may impel the communi- generally agreed today that the community must conties to implement them. We should like to submit sider varied types of facilities for older persons: the proposition that if we are to serve our older institutions, apartments, foster homes, etc. Before, citizens intelligently, the essential question we must howerer, we embark on these programs, we must first face is not "What type or how many projects is it know how older persons can be cared for in these necessary to set up" but rather, How are these facilities. A knowledge of the how will often make it projects to operate in order for the older person and possible for us to revise our estimate of what to do. We recognize fully that all that has been done thus the community to derive most therefrom. The implications of this question are many. Basically it means far for the older citizen has only scratched the surthat once we have become aware of the existence of face. There is real need for continued creative thinkthe need, we must analyze and evaluate existing facili- ing in this area. Needless to say the Joint Legislative ties as well as current thinking in order to know how Committee with which Welfare Council has mainbest to meet these needs. To say that older persens tained close liaison has cootributed imnieiisely to require recreational activities and that programs are our better understanding of the older person. I n looking toward the future we must evaluate therefore necessary is a statement of the need. I n considering the implementation of this, we will need also the past and the present and it can truly be said to know how recreational programs can help older that in relation to its elderly New York has been in persons. A knowledge of this how vill make it pos- the vanguard. �Some Elements of an Action Program for the Elderly By Miss Ollie A. Randall C ' o ~ t s u l l a t t l O I L l l i c A g e d . ( ' o t ~ if n z i ~ t i l )~ 9 r i ~ i 1Soc,ic2t!l o f 1-c i r . 1-o1.k ~ .c T of the increasing number of elderlj- citizens are very intimately bouncl u p nit11 the interests of the whole state-wide commnnity and only by a very careful assessnlent of those interesrs and Tyays of safeguarding them can we be assured of the essential balance in tlle State'\ program for group., of all ages As olle exalnilles the almost startlillg olle is il~ll?l-essecl the f a c t that xeTy by yor1< State \yitl1 its lllillioll alld illore oldsters-6S years of age and eyerllas approximately 10 per cent of the total natiollal population of persollr of this age proup, allcl NeTT yorl< City about 5 per cent, These figures are roupll, but they are accurate ellongll to give us all pause, ecpecially since the ratio of older persolls is groTTiuo to well huge proportiolls and the ratio of persons 1; >-ears of age all(1 under is clecreasillg at a similarly alarining rate. I ~ EISTERESTS very important thing is being accon~plished-tllat at least both enlplo>-ers and equally, if not inore i111portant, enlployees are beginning to be conscious that they must examilze ~i-hathappens i n placement and einpioynlent and in firing in the iight of new i i u o ~ ~ i edge, neTy experience, and new social demancls. l'hiu i c t h ~ right kind of ediication, ~ i i di\ w r y ~ tiil~ely. TTThile action is s l o ~ iin coming, there is a beginning ~ ~ h i c h encouraging. N e ~ v Tork State is illax not be actively iilterestecl ill \\--hat it (!WS illdirectly and incidentally for citizens of other- states, b ~ it~is tpossible to report that everywlkere one travels aiicl this subject is under cliscussion, there is 3 note in the voices of persolls froill other of genuine l7arts of the country as they comment, "Rnt uqetloll't haye a Joint C~nimi~sioil-Ton in Senr Tork State are wa) O L I ~ in the lead!" ~~~~~~~~~~~e Need for Leadership New York State This liillcl of leadership is 1110st ~ i t a at tliiz tiilic, for l Those of us n h o h a ~ ~ e older people one of o w inade keep a focus clirectly upon ullr agillii allcl lllajor collcerllr for a nuniber of years are T7ery proud citizens to be snl-e that Ti-hat is clolle for tllrlll is alld grzlttif~ll that Nert Toll< s t a t e has aheaciy recog- llot ollly ill their interests but that it does 110~sil>lllliiized this situation, and its serionsness, in a illllliber talleonsly jeopardize the illterests of the rest of tile of nays, but in none nllich is haying such ~i-iclc-ipread collllllnllity~ lire callllot afforc-a repetitioll of Caliresponse as that of tlie a p p o i n t n ~ ~ u t the Joint Leo- forlzia, TTTashillgtol1 State, llor of Coloraclo, ~ ~ 1 1 ~tlle e of 1islatiye Corlllllittre 011 Prohleni5 of the - ~ ~ i n 1 1 ~ 1 olclsters, acllllittedlv nitll cllarlatall or self illtere5tetl ~ p the ,2ged under the able chairnlallrlzip of Sellator Des- lea(ieri, deliberately tool; matters i n their on11 hands, 111olld. The approa1.h of this Comillittee to the task of -ith clevastatillp results. stuclyiiig the multiplicity of problenls of older ppople are al>t to see tllPir lleecls ill tct.~lisof haq, it seems to us, beell nlost constructive sill('e they l,~~lle~-, ,hicll essential1:- the!- ma!- be. but nlu1.11they have up-to-date directecl their efforts prilllarily toward are certailllr llot ill their IIon ervr, to lllost discoyering the facts as to the employment of older of US lyllo hare n-orl;ed n i t h alld for tllelll for a l ~ n m people in the state, and to finding ways and illrani of her ,-ears there llas collie a conrictioll tllat \Titll keepil~gperson., still able t o work,in spite of their xelv lTorl;'s yery sorullcl age assiitallc.e ~ v ~ g , - , lasl n chroaologic.al ape, in the n n m b ~ r sof the g ~ r i n f n l l ~ - foundation. tllrre call be yery l,ositiIr ~,c.\l~lt\ a ill eml~loyed. ~~ltimatel>reclncing the amounts spent fc11 this proThis is not simple. since v e are still sadcllrti -\-it11 gram if efforts are directed towarrl satisfl\-in2 iolllcJ attitncles and prejudice\ abont older 17roplp R C to of t h e l r i t a i i p i h l ~ ~ hut ~rlually vital i ~ c r ~ l \ p ~ a k i n g h their ability to perforin. which h a ~ e little to clo n i t h as a citizen froill S e ~ y TorB City I nlight say that I either the present (lay abilities of older people, or with have hope that the State Depart~lleiltof Social X e l the kinds of deinallds nhich are act~zallynlade npo11 fare's stnd>-of the iieecls of people on public assistance 1 1 ~ (I them today. These still need to be changed. Bnt onc may be llelpfnl in this TI7? ~ s p r ~ i a I ~ P Pit\ ~.o<lllt\ 72 . �8 4 >,, , ' ,! , . , / 2 , ' I 4 , I ) , ,t'.l~.," , / , I ,I , ', , , I \ ' i f , ,. ,,,,, ,'." ' I , , , , I , ,' 111 ,:, -1 'I,$ , , ( ''1 I I 5 I I I ' ( ' ,l;tl 1 , . $ :, , I 1, ',, ! . r ~ t : . !' ' ' 0 ,I , 1 , ' , < , l , ~' ( I I i ' I. 8 ' , ,'!,,I I l l %3 !v'i,l , ,!', %'ll.>l ' I ' , i I 1, , I t I ! , , . I , ' ' < # \ ~ ' ! ~,> V;$,b 1, / , ..,a#! ' , , I I , , , < ! ; ; + t t ' d , / , ! ( " ~ , ice,' i. , t q , ,;,(,I,, \ . 1 , I , I .._ I ' . ' ~ , , , S # l . , , a , 8 , I 1, ' V , , , . ( ' I ) ' , ' 8 I , % Ij �Adult Education long before they will constitute an even larger proportion of the total low income group, and that will be May I add a word on adult education. I n this long before the life of the newly built honsing is over. service, and in the administration's effort to inlprove The 1950 census schedules are being designed to get the library services in the State, me see a very useful information on living arrangements, income, and ally in our efforts to maintain for a longer period family status. Some of the facts gathered in several healthier and more contented mental and emotional pilot studies are already available and should be attitudes on the part of older adults. If the staff can helpful. Rochester is through its own planning com- be made available, along the very imaginative and mission making a n analysis of these needs and possi- practical lines being developed by Dr. R. J. Pulling bilities. I am no economist, or city planner, but this and the State Department of Education, and local suggestion seems to make sense from the point of view boards of edncation can be persuaded to avail themof both in the light of the estimates of the experts! selves of what the state offers, we are assured of more Comnlissioner Stichman has already publicly eu- and better leisure-time activities which can minimize pressed his interest in the housing needs of older peo- the discontent and unhappiness induced by idleness ple at a hearing of the Desmoncl Committee (1947), and uselessness. With leisure time a commodity enand of late in the press and over the radio in IOTT rent joyed by more and more of us as working hours be~ public housing. I t woilld hp ~xtremelygratifying if come shorter, t h hahit of using it wisely and constructively should bring good results if younger and interests could find endorsement by the adthese t ~ v o ministration and support in local communities so that middle aged adults are encouraged through the use accommodations couid be Included which would be of these facilities. suitable for older people and smaller families. It is A11 of us hope that in 1950 the Joint Legislative my personal belief that eventually this mould mean Committee on Problen~sof the Aging and Aged will more satisfactory lives for the people themselves. but be continued, and definite plans toward a State group that it mould mean fewer persons having to be admit- of citizens to succeed it when and if i t is discontinued ted to homes for the aged and to mental hospitals. ~vill made. be �Need for a Citizens' Committee on the Elderly By Miss Ollie A. Randall Consultant o n t h e A g e d , C o m m u n i t y Service Society of New P o r k L L O ~ D GEORGE once wrote that "how we treat our old people is the crucial test of our national quality." Coming nearer home, in both time and space, one of our own local statesmen, Dr. Louis I. Dublin, speaking at the 1947 annual public hearing of the New York State Joint Legislative Committee on Problems of the Aging, pointed out that "we should see to it that a group of public spirited citizens in the community is especially concerned about (them)older geople. " Certainly the existence of the New Pork State Joint Legislative Committee on Problems of the Aging is evidence of our attempts to improve the quality of state responsibility and of the value of an organized group of citizens who will conscientiously and intelligently address their efforts to the problems faced by older people, which consequently are faced by the community as a whole. That it has had official status is another fortuitous circumstance. The stirrinp public interest-the actual collection of data-the distribution of those data to ever-growing numbers of persons concerned but not informed about the problems of aging and aged people-all serve a social purpose, the importance and validity of which can 110 longer be questioned. The legislative committee has its own peculiar place in our State program, which is to some extent prescribed and circumscribed by legislatix7e statllte. I I should therefore like to put it to ~ L that one of the problems which we as citizens who are not members of the government in any official capacity must solve is how we are going to capitalize on work which this committee has done, and is still doing ; and how to continue in force, as well as to direct, the activity which has been initiated and the momentum of it. Today, when we go to discuss the special needs of older people-whether those needs have to do with financial support, employment. recreation, hospital care, education, and especially the social services-we are met with the statement that old folks are jnst people and must be treated just as are other people in the community. This is a fundamental human and social fact-and no one would quarrel with the situation were that fact the guiding principle today. Then there would be no necessity for committees, commissions or councils, about which we are talking. The fact of the matter is that old people are not being so treated. Let us not fool ourselves about 75 that, nor let us evade issues by lip service to what becomes a wearisome, meaningless platitude. Old people in growing numbers are dislocated persons in almost any family or community, and equal opportunity to participate in family and community life is denied them in many instances on the mere basis of their chronological age. - - Consideration of them in relation to any one of the needs!istcd above is .-----ll--" usually aullul~luLlcU"-- ZYt: ----""-'---U y "- age of the individual, and the availability of what the community has to offer a citizen is determined by his age. \mile age is permitted to act negatively as a barrier, we are on the other hand told it is not sound to plan positively f o r older people on this basis, this in spite of the fact that what is done for children and adolescents is geared to their special needs, which have been isolated and studied i n all instances experienced by the persons providing the service. We have not yet reached that stage of development in our provisions for older people. Basic Knowledge Lacking Few of us-although years are being added unto many more of us daily-have actually experienced old age when we are trying to help a n old person make his plans; what old people i n our midst slzould have is only now being studied, and rather spottily at that. Our resources-or rather our lack of themand our prejudiced opinions-really determine what we think about the old person, rather than real knowledge about the individual himself. Therefore it is my personal conviction that we still must have in the community-at the local, state and national levels-citizens whose appointed task it is to keep a watchful eye upon the interests of older citizens -upon what is being learned that can alleviate their present unenviable status, and to see what action is necessary. ~t a City Council meeting in a nearby state there sat two members of that council who saw eye to eye neither in matters of politics nor of One member was in the habit of coming to meetings somewhat obviously under the influence of liquor, much to the disapproval and disgust of his opponent. After a rather disturbing experience at one session, in which the intoxicated gentleman behaved in his usual undignified manner, his opponent deliberately �paused ailcl pointedly saicl. "Mr. Mayor. T e have all v been hearing recently a great deal about Alcoholics Anonymous. But must we also be burdened with Alcoholics Conspicuous ? " MThatI am trying to indicate here is that alcoholics, either as individuals or as members of a group, do not become "anonymous" until after a period of rather 11 conspicuous" difficulty, and that by the same token as that. we cannot expect a constructive or desirable Old Age Anonymous-or even Synon>7inons-~vitl the rest of society, until after a period in which there has been sufficient focus of attention and emphasis sp sharpened that there is, for a period of time, an Old Age Conspicuous. TTe are, I believe, in that stage of social development iio~v,in the hope that through our planning, old people can before too long a time becoille socially normal in that they are again naturai and integral members of their con~inunities. T~ acliieve illat degree of ~ .---.-.- ~ the)U L L~ L ~ C F s11ould be able to call not only upon specially interested citizens, but upon those who coinbine this interest wit11 a responsibility for inaking that interest count in terins of desirable conlinunity action. For the next few years a t least we must then hare within gouernnzenfal units those ~vho ill make it their business to know how they call improve the statns of older people. TTe shall in addition require this group of "l~ilblic. spirited " citizens in eonjunction with each c i ic xmit ~ of government coiitinnoi~slj- inventory and appraise to ~ r h a ti s being done, what ulore should be done, ant1 stimnlate the necessary action n herever action is called for. For instance, thc 3Iavor of the City of New Yorl; has rerentiy appointed a >fayor's Advisory Coninlittee for the Aged, with a charge which covers the rcsponsibilitj- of advising on the whole broad scope of wrvices ~vliichthe older citizens of this great city reclnire. omy. There is nothing in the suggestion that there is a statewide committee which would jeopardize the application and operation of that principle. In fact it would encourage the adaptation of services to the individuality of the local situation. I t should homever also act to stimulate the right kind of local action -and to help in coordinated planning so as to prevent some of the ilecessary duplication in experimentation and effort which is taking place-those motions which are being wasted when every motion should be made to count. co~uicil the elderly is proposed for Sew Pork for State in a bill introduced during the 1949 State legislative session, copy of which is to be fonnd in "Never Too Old." This provides for an official council, with tlirect participation by members of the administrative ----I IzL- ~ O L QA,.,. ~ Guvclluucut. This has rcs! virtze and LL IL 2 i ~ d ~ e nlay have a place in our pattern of State organizatiolz, but I should still like to see a group of citizens, given official status either by independent organization or on a conlnlission basis or by appointment by the Governor, as being possibly more effective because of the free wheeling nature of their organization. Since the interest of so large a group of votins citizens is at stake, these s h o ~ ~ be continuonslv viewed ld objectively by persons who have a sympathy for and luiiderstanding of older people. Hen-ever, they must similarly be so viewed that the present imbalance in social prorisions, weighed as it is in favor of the young, is not continupcl by an eclnally dangerous overweighting in favor of older people. --7n---Am California's Sad Experience Sonleolie in Washington facetiously suggested recaently that perhaps what we should or ought to do on a national basis is to buy the State of California and use i t for a retreat for all older people with their $100 pensions. This IT-ouldbe no inore fantastic than National Organization the recent situation in which that State was in effect sold out for the benefit of the old folks i11 the po~julaSiin~~ltaneonsly there is being considered the organ- tioii at the expense of the younger people, ancl ereii izatioii of a iiational group ~ ~ h i c h hopefull.\- have at the expense of many of the civic institutions ~vhich will not o11i:- the sanle fnnctioiz aiid an ere11 inore active are essential to maintain a decent level of livinq for one for the Sation as a TI-hole.so as to avoid in the the very oldsters demanding the financial support fnturc the sporailic and uilclirected programs no~v vhich was wrecking the State's economy. This exyeribeing undertaken ~vithont reference to ~ v h a t is al- eilce c n n "liappen here "-by "here," I mean We~v read:- B n o ~ ~ or available. For these t n o rra\ons york State or alnlost anywhere else in the United ii alone, eve11 if we were not alreatly conriilcetl of the States, either right now or in the near futurr. Perneieiiit>- of a state-wide coiilnlittee of citizens. it haps this horrible exanlple of charlatan leadership jn ~vould appear to be logical that there be snch a group California has served a very salutary purpose. TJ-e to scrvc as the natural channel betveeii the local >till learn painfully by v a y of ~ v h a tCommissioner groups in villages, tonns, cities aiid counties, and to Rnth Taylor calls "the obvious7' if not actually by the national group. v a y of the very "coi~spicuous." New York State has One of the inost prized principles of our ilational almoqt ro~ighly10 per cent of the total number of aiid state gorernlnent is that of state and local antoll- legally aged people in the country-and h'ev Yorl; , , �City has allnost 3 per cent of them. V h i l e our progranis are generally quite sound, it is within the realm of credibility ancl of possibility that in some sections of the State dissatisfaction could easily lend itself to making people receptive to this dogmatic picture of a personal utopia in old age. It is for all of us to renleinber that no utopian plan, established at the of the rest of society, or out of step with contemporary social life of the community, has ever survived-nor should it. But citizens' groups can undertake to inforni and educate all of us that an olcl person's utopia can and shonlcl a c t l ~ a l l ybe-for each of us-that of having an equal opportunity with others to be persons and personalities i n our o\t-n rights in society, with our fair and earned share of what the community offers. The need for a citizens' col~liiiitteei n the interests of older people lies priniarily in the necessity for a n independent, socially informed group in the comniunity to : 1. Supplement and conlplenient the work of legislative commissions snch as the Joint Legislatire ConiInittee on Problems of the Aging, and of adriiiaistrative councils such as that enclorsed by this Committee proposed in the 1949 legislatire session; 2. To assist in coorclinating the work of private ancl rolnntary groups or agencies, so that there may be objective evaluation of resources, services, and the gaps in these ; 3. To educate the community a t each level of governilient as to neecls and progress in meeting these; 4. To stiniulate the right kind of intelligent leadership ; and 3. To pronlote the Biild of action which will improre the stanclarcl of nell-being of the total coin~nunity, nhether that be local, state or national. �$ : 6 , I , ( l i t I , , , , ( . ' , > I , ^ ' I > , , I ,,,, ,) 1 1 ) , ! 8 , ' I I , I ' �lislznients-all of which was conducive to the enzploylneilt of older workers. The enlploynient service of 1940 was confronted ~vitlzcjnite a different set of considerations. A declining birth rate, a n increase in the life span, and cessation of inlinigration all helped our the ~ i r t n a l Kation to get older. Our median age in 1940 had reached 29.0. Those 63 years and over represented 6.8 per cent of the population but only 43.4 per cent of these workers were in the labor force and 13 per cent of thein were unemployed. About half had been jobles, for a t least a year. I n periods of large-scale uiiemploynzeiit, the olcler workers are by far the hardest hit group. 3Iaizpo~~er shortages, resulting from World War 11, suddeizl>-opened the door to the older worker. I t is estimated that in April 1945, 2,600,000 more I\-nrkprc, aged 4.5 and over were employed than would have been expected from long-term prewar trends. After the war, nzillions left the work force. Among the men. however, the big decline occurred in the younger groups, particilarlp those under 20. I t is significant that the labor force contracted less among the older workers. Even today, the older worker is holdinq his o~~n. According to the Bnreau of the Census, 4.5 per cent of the labor force of those 55 to 64 years were unemployed in October 1949. The corresponding figure for thobe 63 years and over is 3.8. This compares f a r n r a h l - n i t h the 5.7 unemployment rate for all ages. Despite this present status and despite the recent spurt in the Nation's birth rate, there is reason to believe that basic trends will reassert themselves and the problem now latent will again becoilze acute. Results of Recent Study The Bureau of Employment Security and the affiliated State employment security agencies are in a n excellent position to study the job problems of the older v-orker. One of the more significant studies recently undertalien was a n analysis of the experience of older jobseekers in six communities selected from different parts of the country and representing varying conditions in respect to the extent of uiienzployment. I n a sense, the six communities may be considered as reflecting unemployment conditions under different phases of our business cycle. The citiesDallai. Birmingham. Denver, Rochester, Toledo, and Portland. Oregon-represented labor market conditions that ranged from very tight labor supply to substantial labor surplus. The qurvey reaffirmed conclusions previously arrived at and uncovered some new findings. 1. The study revealed that in the labor markets with little unemployment, there are substantially less jobless among the older workers as compared 79 with the younger. I n five out of six areas, the proportion of workers 45 years and older registered with the eniployment services was less than their percentage in total work force. This was especially true in Dallas, a tight labor supply area. Here, older workers accounted for about 36 per cent of the area's labor force and yet only 21 per cent of those registered for work. Portland, on the other hand, with a large labor surplus, was strikingly different. Workers 45 years and oTer represented 37 per cent of the total n-orli force but were 43 per cent of those registered. 2. As employment increases, employer specifications with respect to age are tightened and the per cent of older workers among the jobless increases. 3. I n both tight and loose labor markets, older workers, once separated from the job, take longer t o And employment. If not re-employed at their regular work, they are usually downgraded in skill and pay. I n all six areas studied, oIder workers sought jobs longer than did the younger workers. I11 Birmingham. for example, 26 per cent of the T\ orlrers iuiider 45 years reniaiiied in the active files for ~ o over t ~ iiionths while older workers for the same period accounted for sonic 35 per cent. Other evidelice of longer unemplo-meat is available from u n e ~ n ~ l o y ment insurance experience. I n Rochester, insured workers who used u p all of their benefit rights in 26 consecntive weeks of uneniploynient iiicludecl larger p r u l ~ o r t i u nuf the older workers. ~ 4. Older worker discrimination varies not only with the condition of the labor market but also with occupation, industry, and worker characteristics. I t was found that (I) low age limits mere set on l u l l 4iilled jobs that required strength; ( 2 ) there were fen restrictions in the low-paid and undesirable service occupations; ( 3 ) restrictions were not too rigid in skilled occupations requiring long training periocls; ( 4 ) the)- were, however, quite rigid in white collar jobs. 5 . In all six areas, there were significant restrictions against older workers. For example, 31 per cent of all job orders received in Portland specified an age liinit of under 45 years. This was the area with the greatest labor surplus. I n Dallas, and Denver, discrimination was less severe but still significant. Age liillitations in both cities were found on about 33 per cent of all job orders. I n Birmingham, 79 per cent of the orders vere restricted but much of that n a s due to the great physical reqnirein~~nts of llea~jindustry. Common Fallacies Th? reasons for discrilnination against the olcler worker are mail)- but, in the main, are based upon 111istakennotions. �I. "Hiring older workers will increase my workmen's compensation rate." is a frequent objection. To this the Association of Casnalty and Surety Companies replied : "Let this be ~u~derstood-there is 110 provision in workmen's coillpensation insurance policies or rates that penalizes an enlployer for hiring a handicapped worker. There appears to be much inisillformation on this point. Therefore, to erase any misunderstanding, these are the facts. Workmen's compensation rates are determined by two factors : (1) Relative hazards in the conipany 's work and ( 2 ) its accident experience. The formnla for determining the preniiunz rates makes no consideration for the type of personnel involved. . . . The insurance contract, therefore, says nothiilg in-iplied or direct about the pliybical condition of the worker that the insured nlay hire. " 11. "Older workers are more likely to become injured on the job," is another favorite standby. Yet, in the study on "Absenteeism and Injury Expt3rience of Older TvITorkers," prepared by the Bureau of Labor Statistics, Mr. BIax D. Kossoris found in a study of work conditions of about 17,000 workers in a variety of 109 illanufacturing industries that the only disadvantage of the older worker is that their disabilities last longer once they are injared. Bnt on the whole, they are likely to be absent less frequently and less likely to be injured than the younger worker. 1 1 "Older workers are less profitable." Why in1. vest in training oldsters who won't be aronnd much longeru-these comments overlook stndies that indicate that older workers are more experienced, have less outside distraction, arc more conscientions, and often are as productive as younger workers. Undoubtedly, old age weakens ability on those jobs requiring energy and speed. But even on such jobs, the decline from age 50 to 75 is slight and varies with the occupation. As for an investment in training, there is more than one case on record where the so-called older worker outlived his younger detractor. IV. Pension plans are a favorite jnstification for personnel policies that bar older workers. I n view of the current widespread trend to adopt pension plans through collective bargaining, this is rapidly becoming a serious consideration. I t is, however, possible to adjust pension plan formulas so that the hiring of older workers does not create an undue burden upon employers. The extension of collective bargaining agreements to the extent that they affect seniority provisions have been a major factor in protecting job rights of older workers. V. "You can't teach a n old dog new tricks," or sometimes it is more euphoniously stated as fear that E the older worker may carry over old work habits i11stead of responding to the ways of the new establishment. Stated either way, it misrepresents the case. Proposed Program What to do ? A program for the older workr.r n ~ ~ ~ s t point in two directions : ( a ) Toward the elderly vho want to retire, a!id ( b ) Toward those who wish to remain in the labor market. At the present time the older worker has no real choice since pensions are generally much too lorn to permit retirement regardless of inclination. For those vho wish to retire, the obvious lieecl is for extension of coverage and liberalizatioil of Old Age and Survivors Insurance, old age assistance, aiid other forms of categorical relief in which older workers participate. Jloreover, payments under such programs should be adjusted to changes iii thv cost uf living. However, there is a great deal of evidence inrlicating that many workers wish to remain in the labor force beyond the '(legal old age" so-called oil 65. This was evidenced, for example, by the reluctance of those older workers who came into the labor marl<et dnring the mar to leave when hostilities were over. hloreover, we are told by the medical profession that such participation is good for them. A rnarlred increase in deaths among workers soon after they retire has been noted. The economists add that it is good for society too, since it increases the productive nnits in the community and permits a higher standard of living. One particnlar concern is with that part of the program which facilititates the continued participation of older workers in productive employment. The basic approach to the problem must be a local one. That is not to say that the Federal and State Governments have no role. On the contrary, there are such vital activities of the Federal Government as vocational rehabilitation, public health programs, accident prevention, adult education and training, job clinics for older workers, etc. TTe do not propose to attempt to legislate older workers into jobs. I t may, however, be advisable to remove those legislative barriers which make it difficult for older workers to remain employed. A case in point would be the ban prohibiting Social Security pension payments to accumulate tiuring periods of employment past retirement age. There is also much that the state and private agencies can and have been doing. The activities of this Committee are perhaps one of the best examples of that. The major program must be individual aiid personalized. This requires a thorough knowledge of �was follo~ved careful presenby personal q~ualifications tation of his best features to selected employers. ~l total of 933 such employers were given the telel)l~oae sales talk on behalf of specific older applic~ants. Most placenlents were made in sillall compailies where there were no pension plans. It was fonncl that older ~vorlcersneeded individual selling as long as there is employer resistance. It was also evident that a sales presentation placed upon the concept of an age handicap does not get resi~lts. The success of this experiment in spotlighting specific problenls and snggesting solntions has enc80uraged the X e v Tork State Einploynleiit Servic+eto extend tlie project to the Qneens Inclnstrial office, the Manhattan clerical and professional office and the domestic, and household office. The l~ossibility of cond~2.ctingsilllilar experiments in Ri~.ffa10is also hejng consiclered. Anj- agency like the Employment Service ~ h i l e can do much, swims upstreal11 until it there is more recogilitioii of the problem by employers and positire action to ren~oveartificial barriers. Another illustration of positive prograillming for the older n-orker was reported by the Emploj-meiit Job Counselling for Older Workers Service in Iliami, Florida. Here, sereral retclrans As mas reported to your Committee last year, the ~ h had h e u responsible front office jobs i11 the hotel o New York State Employment Service recognized the industry found that they could no longer secure this special problems of the older worker and has rerisecl type of work. The problem of these olcler ~vorkers its counseling program accordingly. Personnel en- was discussecl with the Hotel Associati011 ancl a coopgaged in interviewing, counseling and job solicitatioll erative program set in motion. A training prnpranl on behalf of older workers mere given special training. Tvas instituted covering such jobs as transcript mritThese changes were the result of a n experiment ers, auditors. food control and other jobs in the Eotel which involved setting u p a small unit at the N. T. industry that conlde utilize the kizowledpe a~iclskills City commercial office to deal exclusively with tlle these olcler workers had acqnired through tlle years. placeineilt of clerical jobseekers 50 years of age ancl Jobs were the11 solicited for each of these 17eterans in older. the occupation for svhich they had been training. No Between November 1947 and November 1945, a longer were these older people compelled to say to total of 1,120 referrals were made to employer inter- employment managers, "I am 49 years old-and have views. Of those interviewed, 305 or 27 per cent were been for Illany years." placed in jobs. The usual experience in clerical reAny program, no matter how well coliceived. rmis ferrals is 40 per cent. A check made three months the risk of being scuttled during the period of largelater of the 25 workers showed that 18 lvere still scale unemployment. Older workers have a very speemployed. cial interest i11 maintaining the economy at high emA majority of openings secured for the older verb- ployment levels. Unless we are able to do this, the ers were obtained by persistent telephone solicitation. rejoinder to "Life begins at 40" will invariably be Complete analysis of the applicant's experiences and "Do you call that living?'" the local labor market inclndiilg illformation on the size, nature and job requirements of employer!: as ~vell full knov-ledge of the job history and abilities as of the older job applicants. The local offices of the Employment Service have, through its employer relations program. been condncting a campaign to promote the hiring of olcler workers and other special groups by educating the employers to the usefnlness of these ~vorl<ers. have TT-e attempted to point out to employers the implications of inlproved medical scieilce on longevity, ant1 the higher levels of physical abilities of the older ~ o r l i ers. TTe have tried to get einployers away fro111 connting birthdays and to have them think in terms of occupational or physiological age. Through its job analysis program, the Employment Service is in a positior, to u;zdertal<c jGb c:l,-ineering projec:s that will show the types of jobs best suited for the elderly. Through its couilseling ailcl selective placenlent techaiques, the Employment Service has been reilderiilg personalized s e n ice to the older workers. ��Wilson. President of General Motors Corporation, i n Detroit on November 15,1949 : "If the present security pensions were adequate when the law was passed, they are inadequate They do reflect the change in the purchasing Of the security pensions were not increased as wages and collections were incI-eased. It would seem I-easonable with the minimum wages increased from seventyfive cents per hour to pensions in about the same proportion." Changing Conditions TThy are workers so concerned about security today? The need for security has grown out of the economic and social changes accompanying this country's development from a pioneer agricultural community to the greatest industriai nation on earth. The need does not arise because individual workers are deficient or inadequate or less self-reliant than workers of an earlier time. I n 1775 when the founders of our American government talked of the Rights of Man-the Rights to Life, Liberty and the Pursuit of Happiness-they thought that the right to own property provided sufficient economic protection for the individual. At that time most Americans were self-employed on farms, or owned the tools needed to earn their living. Today, more than three out of four persons in the United States are employees. As workers have moved from farms to factories they have grown away from self-sufficiency. A lay-off at the factory, or a period of illness can exhaust a worker's savings very quickly, yet he must continue to buy food and to pay for shelter if he is to continue to live. The problem of security is complicated by the growing numbers and proportion of the aged i n our population. I 1 1900 only 4.1 per cent of the 76 million per1 sons living in the United States mere 65 years of age or olcler. I 1 1950 niore t h a n 1 million people will be 1 1 oTer 6.5. This will be 7.7 per cent of the total population. By 1980, i t is estimated that 22 million, or 12 per cent of the population, will be older than 65. There are several reasons for this increase i n the older population. TVe are producing fen-er children, and we have restricted immigration. Then, too, Ameri'aiis are living longer because of better medical care anc1 public health measures and because of higher living standards. American life insurance companies i n the early nineteenth century assumed, on the basis of experience, t h a t the expected life of females at birth would be 18.1 years, and that of males 14.2 years. By 1900 life expectancy at birth had risen to almost 50 years, a n d by 1940 to 62 gears. More recent estimates place life expectancy a t 67 years. Although there are more and more people i n the older age groups employers generally are not Tvilling to hire older workers. Furthermore, new inventions and deielopments continue to make many occupations obsolete. The older worker may not get a chance to learn a nelv job even when he would be able to do so. And there are not as many job opportunities for older people in alld cities as there are on farms. During the peak of \Tartime employment, only onethird of the men and ,Tomen 65 years of age and over were gainfully occupied. Today, not more than one out of every four aged persons are working for a living. Thns, there is a critical problem of old age dependency. Savings for Old Age Few, if any, workers' families are able to save siirl'lcieiii iiioiiey oniof ciii;i;eiii eai;i-diigs to iiisiiiie themselves a modest standard of living after retirement-even though these savings may be supplemented by Old Age and Survivors Insurance benefits. Similarly, few individuals, acting alone, can budget for protection against major medical and hospital expense. The Detroit auto worker, for example, has an average monthly income of about $260, if he 1 works 1 months out of 12. I t costs a family of four in Detroit over $280 a month to maintain a "modest standard of living." This budget includes an allowance of $8 to $10 a month for hospital and medical care, but it requires about $20 more each month than the average monthly income received. Thus there is no margin a t all for saving. Yet the worker v h o wants to receive a n income of $100 a month beginning a t age 60 and who buys a n annuity a t age 30, for example, mould have to make payments of about $36 per month for 360 consecutive months. This would mean a total savings of approximately $13,000 s ~ h i c h of course, ont of the question is, for industrial workers. Inadequacy of OASI Our present social security systein is completely inadequate to meet the needs of working people for protection when they are "too old to work and too young to die", when they are ill, and when they a r e unemployed. The old age retirement benefits, f o r example, fall f a r below the niinimum relief budgets i n our cities and towns. The Federal Old Age and Survivors Insurance benefit for a worker and wife, both oyer 65, averaged $42.39 a month i n Michigan i n 1949. B u t an elderly couple living i n Detroit needed abont $143 a month for a modest standard of living. �Torkers should iiot have to look to poor relief and provided income maintenance benefits as a matter of to charity as their principal floor of security when right instead of falling back on charity programs as they are unable to work. Yet this is, in fact, the case. our basis floor of protectioii for a n aging population. For the country as a whole, in June, 1948-a period of high level employment-there were 216 persons receivUAW-CIO Program ing public assistance for every 1,000 persons over 65. To give adequate protection to workers against the E r e n in Michigan, where indnstrialization perinits economic hazards of age, incapacity (both temporary broader coI7erageuiider the Federal insurance system and permanent) and death, the UAW-CIO is seekthan ill illally other states, more than 20 per cent of ing expansion of the governmental social security the persoils over 63 were dependent on public relief programs-both in amounts and in coverage-and for security in their olcl age. This cloes iiot include is asking for a comprehensive and integrated system those additional persons receiving poor relief and of benefits in the programs established under collecprivate charity. These persons are ~ ~ i t h o u t other tive bargaining. These benefits are : (1) pensions resources because savings and property were liqllifor people who are too old to work or who become dated before they subjected theillselves to the indigdisabled and cannot continue to work; (2) medical nity of the "means test." care programs which lift from the worker and his famiiy the existing ecsnomtc barriers to necessary Insecurity Hastens Aging hospital and medical care; (3) rehabilitation services to help the disabled worker return t8n gainful Tile i-ASS--CIO has extensive data on tile problenl employment; (4) payments to maintain family inof the aged and infirm ~ ~ o r l r e r meeting living in come during the illness of the wage earner; and (5) expenses after leaving employment. Huildreds of survivor's benefits when the wage earner dies precase stories have been obtained which show the grad- maturely. ual destructioil of personality when the worker These benefits shoulcl be atlecluate for their purpose realizes that he cannot 1~7orlrany longer, exhausts his o r the)- should not be atlopted. I t is better to start resources, faces the p ~ ~ b l irelief office, becon~esill c ~ ~ i ft eh~ ~ and adequate benefits than to spread the er and struggles uiito death with the problem of how to inoney available for protection too thinly and fail to provide himself with the barest essentials of life. I n provide real security for any of the coininoii hazards the abstract these facts do not have the same nlealling of life. Benefits niicler collective bargaining programs as they do when T T know the iizdivicluals affected ~ should be sufficient to sustain the worker and his The social service department at the UAW-CIO faniilp on a lnodest standarc1 of l i ~ i n g . They shonlcl nieclical clinic in Detroit has recordecl illany stories not be so l o ~ v that supplementation bp public relief is rs this pattern of from indiviclnal ~ ~ o r l r e which sho~v necessary. The floor of protection provided by governlost morale ancl human m s t e . During the 1980's lneiit programs must be considered in establishing the ~vorkers exhaasted all of their resources either because anlount of the benefits under IT-orliers' security collecthey nere mlei~~pluyed because ~ r ~ e ~ ~ luf e r s ur b their tive bargaining programs. But the necessity for addifamilies were unemployed. With the full-employtional relief payments must be avoided. nient years cluring the war the older workers, particnsecurity programs under collective The ~vo~lcers' larly, attempted to save. Nany made down-payments bargaining are intendecl to provide bellefits suppleon homes and paid accuinulated debts. Illness struck. inentary to the go\-ernmelit floor of protection. They as i t often does especially with older people, savings are particularly necessary in industrial ant1 hizh cost disappeared, homes were lost, and finally public poor of living areas. Programs under collective bargainino. relief n as applied for. I 1 other instances, premature 1 are also adapted to meet the needs of particular groups superannuation occurred becanse of the anxiety of of ~vorkersand to proride a flexibility not possible workers who were approaching the time when they nnder government programs. This flexibility in the feared they would no longer be able to work. Over collective bargaining programs makes it possible to half of the inore than 1,000 workers seen each month establish denionstrations and pilot planr which can a t the T'ATV-CIO clinic have illnesses which the provide experience for expansion ancl extension of doctors qay have been caused or made worse by basic much needed public programs. This is particularly feelincs of insccnrity. &Inch of this insecurity is true in the field of medical and hospital care. ~vhere related to fear of hat will happen to the 117orlcer and porernment experience with prepaid care is still very his family when he can 110 longer worl;. limited. A "means test" program should not be the answer There a r e three important principles around which to the economic needs of the worker when he is "too old to work ailc1 too younp to die." Charity is not collective bargaining programs for workers' security the denloeratic answer to this need. I t is time that we are being developed. These are: (1) universal cov- �erage-that is, every worker covered by the collective bargaining agreement as well as his immediate family must be given the protection provided by the program ; (2) employer-financing-that is, employer payments sufficient to meet the cost of the program; and (3) joint union-management administration of the employee-benefit fund. Universal Coverage Is Basic Why is universal coverage essential? Vhen a retirenzent inconle program is won through collective bargaining it is in lieu of other alternatire economic gains and is won on behalf of all workers. Therefore, every must be covered. To worker in the bargaining ~ m i t restrict coverage to certain classes of ~ ~ o r k e ris s nelther jnstlfied nor feasible. Restrictions 011 coverage in pension plans have been developed largely because of the employer's desire to reduce the cost of the plan. Restrictions in pension plans ontside of collective bargaining have tended to exclncle older workers, to provicle for a waiting period. or to establish earnings qualifications. 9 program under collecti~ebargaining is intended to accomplish protection for all the workers. To exclude the older workers delays the effectiveness of the program and fails completely to meet the imnlediate probleill. The rerlairement of a waiting period before a worker may participate has no ralidity for plans dereloped through c,vllectire bargaining. I-l?cler these plans workers earn old age security during their working life as a part of their compensation. Hence they should receive credit from their first day of service, and a waiting period is inequitable. Similarly, an earnings qualification is not justified in a retirenlellt program established through collective bargaining. TTTorkers in the lower wage brackets need a pension plan even more than the higher wage group : it is nlore difficult for the 1015-er income groups to save. Furthermore, corerage of all ~ ~ o r k e has the pracrs tical a d ~ a n t a g eof contributing to the stability and actuarial soundness of the program and permitting many econonlies in administration. The Employer Should Pay Employer-financing is probably the most debated and the least understood of these principles. There are a nnmber of reasons why employers should finance the security programs set up nnder collective bargaining. I n the first place, it is the only practical and effectire to secure coverage for all the workers in the gronp. Contributory plans in indnstry have failed to enroll all employees. Inclusion of all members of a group is essential to an effective program of security protection. The employer-payments agreed to in collective bargaining are not gratuitous payments. They are not soinething for nothing. The basis for the employerpayment is that a worker, by the performance of his job, earns a retirement income and other social security protection as a deferred part of his earnings. Funds for worker security programs come from industry irrespective of whether they are paid directly to provide benefits or whether they are deducted from employer-payments to employees and then used to provide benefits. I t makes no economic difference whether the employer makes the payments directly or whether they pass through the hands of employees-if employer payroll deductions can he considered to pass through the hands of employees! The employer allocates fnnds for the repair and replacement of his machines as a cost of doing business. The repair and replacement of his "human machines" is no less a legitilllate responsibility of industry. The Federal tax regulations recognize employer-payments for retirement and health security pro,crams as an ordinary and necessary expense " of doing business and allov the employer full declnctibilitp for such payments. On the other hand, nionies technically paid to the worlrcr and then declnctecl from his wages by his , employer are taxable to the I\-orker. 4 dollar paid by the employer to the worker and then "checked-off" for benefits results in only 84 cents available for workers' security benefits. This means that with employee-financing, or the payroll check-off method of financing, the employer must pay almost $1.20 in nages tv proclnce une clollar which is available for vorkers' security. ( ( Joint Union-Company Administration Joint unio11-lllanagelllent adnzinistration of the employee-benefit fund is essential. I t is through this joint administration that the programs can be adapted to meet the needs of particular groups of ~vorkers and can be kept flexible. I t is not practicable to work out all the details of pension and medical care programs in collective bargaining. After agreement has been reached on the broad policy provisions of a program, responsibility for developing it should be delegated to a joint boarcl of trastees 'ivho can, in addition, review the program periodically and arrange for modifications whirh may be necessary fro111 time to time. TT70rkers are the group most clirectly concerned with the proper functioning of the program. and here they have an effective voice in its administration, a better program results. �Flexible Retirement Age There is a fourth principle which is important-a flexible retirement age. Workers security programs should permit workers to retire a t the point at which they become superannuated. Workers should not be required to retire a t a fixed age. The proper point for retirement differs for each individual and the reasons for retirement likewise vary from individual to individual. Therefore there should be sufficient flexibility with respect to retirement age to permit each worker to retire on an individually determined basis. This means that retirement should be permitted throughout the span of years in which workers most frequently become superannuated. medical care. When he cannot work for reasons of sickness or accident his family living expenses can be met, even though on a somewhat reduced basis. And when he is unable to do his usual job for reasons of accident or sickness, rehabilitation serrices will be available to help him back on his feet. All of these things mean that the worker will be more secure about his future. His savings will not be exhausted with a single illness. Homes can be bought with a knowledge that illness in the family will not mean a loss of equity. Necessary medical care and hospitalization will not be delayed for economic reasons. This adds up to an increased sense of wellbeing and increased self-confidence on the part of the worker-a happier and more secure worker. A flexible retirement age is needed because superThe advanta,ges of workers secnrity prngams to aiinuatioii is oiily in part related to the individuai's industry areas great as the advantages to the chronological age. The onset of disqualification beworker. Companies which have put health and welcause of old age and infirmity is also a fi~nction the of original equipment of the individual, of the effects of fare plans into effect have reported that improved environmental factors, and of the appearance of labor relations and public relations have resulted, chronic conditions. A worker may become super- productivity has increased, and absenteeism and labor turnover have decreased. annuated before 65 as well as after 65. Age 65 has been most often adopted as the retirement age because Worker security programs mean as much to the it has been thought that persons tend to outlive their community as they do to the worker and to industry. usefulness on the job at about this age. Age 65 has They mean fewer persons on public relief and charity been generally accepted as the average age for retire- programs. They mean a healthier community because ment of salaried or office workers. the people of which it is composed are happier and If it is desirable to permit retirement for sedentary more secure. workers at 65 it follo~vs that persons engaged in physiSuch programs mean inore assurance for workers cal work should be permitted to retire somewhat who want to make commitments for such long-time earlier, if they so desire. There is considerable sup- purchases as homes. They mean fewer uncollected port for age 60, or even an earlier age, as the point at accounts for merchants. As the President's Steel Inwhich retirement nlay be permitted. For some individ- dustry Board stated, in its report: uals, however, superannuation may not occur until "The inauguration and operation of insurance some years after 65. This variation between individand pension programs will make a considerable uals as to when superannuation takes place is recogcontribution to the attainment of the economic nized in Labor's thinking about retirement age. Individual Security Means Community Security Workers' security programs have value not only for the worker, but for industry and for the community. The worker need no longer fear the economic hazards of age, incapacity, and death. He can look forward to a decent retirement income when he is too old to work. He will have insurance against death or total and permanent disability. He need no longer fear the unpredictable and unbudgetable cost of hospital and stability so necessary a t this time. With the knowledge that the economic hazards of life will be at least partially met, workers will be more apt to help sustain consumption spending at a high stable level." The UATV-CIO believes that the sooner we face the problem of providing an adequate workers' security program, the easier it is to solve. Each year of postponement of security programs is costly for the workers. for industry, and for the community. �How Long Do Our Workers Last? B y Ewan Clague Commissioner of Labor S t a t i s t i c s , U . 8.Department of Labor T of working life of American workers is a highly important field of inquiry for those concerned with the economic and social problems of older workers in our modern economy. For, by comparing the ages at which worlcers cease gainful activity with their total life expectancy, we have a significant measure of the magnitude of the problem of old-age dependency as it affects the individual worker. i n order to 111akeavailable basic data 011 tilib aspect of manpower utilization, the Bureau of Labor Statistics has taken the actuarial techniques of the conventional life insurance tables and adapted them to the measurement of working life. These tables show the ages at which men enter the labor force, the ages at which they stop working either because of death or retirement, and the average number of years of working life remaining to them, at given ages. These materials will be published, in detail, in a fortheoming bureau study. I shall refer briefly here to a few of our major findings. HE LESGTH Under 1940 conditions of mortality and of labor force participation, the average male worker aged 20 could expect to remain in the labor force-either working or seeking work-for an additional 41.3 years, or t o age 61. However, he could expect to live f o r an additional 46.8 years, or until age 67. So, on the average, he could anticipate a gap of 5% years between his working life and his total life span. mortality and retirement prevailed throughout the life history of a generation of workers. They are not forecasts and do not attempt to predict, for example, the conditions a young man will in fact be exposed to in the course of the next four or five decades. By comparing the pattern of working life of 1940 with that prevailing in other periods, mre can however gain valuable insight into the factors underlying the growth of the present problem of old-age dependency. d cerltury ago, or even more recently in our history, there was very little difference between a man's working life span and his total life span. Life expectancy was short and only a small proportion of the population survived until ages which are now considered conventional for retirement. Moreover, mre were predominantly an agrarian economy. As an independent farmer or craftsman, the older worker was often in a position to continue in an active, productive role until the very end. For most workers, there was no ,harp break in employment, but rather a tapering off. Retirement, as we know it today, was the exception rather than the rule. Changes in Work-Life Pattern T,et us consider the work-life pattern of men in 1900, since comparable data for prior periods are not readily available. At the beginning of the century. the 20-year-old white man had an average life expectancy of 42.2 years, or about 5 years shorter than his counterpart in 1940. His working life expectancy of 39.4 I would like to stress two things about these fi;~ u r e s . years was, however, only 2 years less than in 1940. First, they are averages. They include men who "die On the average, therefore, he could expect slightly i n the saddle," as well as men who are exposed to pro- under 3 years outside of the labor force, as compared tracted periods of retirement, after they have stopped with 5% years in 1940. working. Under 1940 conditions, about half of all From this simple comparison we can diagnose two men workers could in fact expect to continue working of the basic elements in the long-term economic probuntil death or fatal illness. For the remainder, the lem of the aged. On the one hand, the advances of period of retirement was much greater than the aver- medical science enabled a growing proportion of the age. If we assume the life expectancy of retired men population to survive into old age. On the other a t any age to be the same as for all men at that age, hand, employment opportunities did not keep pace the average life span in retirement for men retiring at with this increase in the aged population. There mas age 60 or later was approximately 1 years. 1 a steady shift from agriculture and the small hsndiSecondly, as in the case of the standard life insur- craft trades to large-scale urban industry, with its ance tables, the estimates of working life simply emphasis on speed, its rigid work schedules and its describe what would happen if an existing pattern of dilution of skills. The older worker was no longer �Old Age Dependency Increases able to slow down gradually 011 the job, but at some stage-often at some fixed chronological age such as I t is clear from these comparisons that we are 65-he was forced to ~nake conlplete break +tl i ema ployment. As a result, there was a long-term down- faced with a major and growing problem of old-age trend in the average age of retirement and a ~viden- dependency, even under relatively favorable assumptions. However, if we fall short of our full employing gap in the period of old-age dependency. This basic problem was, moreover, intensified by ment goals and if we fail to provide adequate work the great depression of the thirties. The burden of opportunities to those older men and women who unemployment fell heavily on the older workers, who want to and are able to work, the problem will be -once laid off-fonnd it increasingly difficult to se- greatly magnified. cure reemployment. By 1940, after a decadz of severe unemployment, there were nlany older ~ ~ o r k e r s , There will be nlo~ultingpressures fur an expansion in their fifties and sixties, who were still able to ~ o r l of old-age benefits and growing demands for a pro~ and willing to work, but who, after prolonged uuem- pressire broadening of the eligibility conditions. The ployment, had given up the search. increased span of enforced idleness in old age will But with wartime lnobilization and postwar pros- place a heavy finallcia1 burden not alone on the aped perity caa::, ainple e;.idence that many of these older themselves, but on those in the labor force who mill be workers were in fact capable of productive employ- contributing to their support, either directly as indiment. Large ilunlbers re-entered the wartime labor vidi~alq,or h y i l l ~ r p ~ ~lpyip~ their ~ l ~ r r e n t p r l on wrnforce while others postpoiled their retirement. This ings. pattern moreover has continued into the postwar There is, howerer, nothing inevitable about Ihese period, so that substantially greater numbers of older long-term trends. I believe that legislators, T T ~ O are workers are now in the working force than ~vonldbe in a position to deteriniiie public policy, can do a expected fro111 prewar trends. great deal, in coiijunction with labor and manageThese rhanges have had a pronounced effect on the meat, in promoting employment opportunities for the pattern of working life. As a result of fnrtller ad- older ~vor1;ersalicl extending their working life span. ranees in nledical science and the general improveAs a guide to coilstructive action, me shall, of nlelit of living standards. the 20-year old inale ~ v o r k e ~ . course. ncccl nlu~liInore cletailecl illformation than I under 1947 conclitions, could expect to live an addi- have tlins far presented. The public health specialist tional 48.2 years, a gain of alillost 1% years over has a~ailabledetailed statistics on the incidence of 1940. At the same time, his average ~vork life espectdisease and the causes of death, to guide him in formancy also increased by 1y2years, to 42.8 years, largel- ulating an effectix-e health program. I n similar fashdue to the increased proportions of older men, in their ion, v e illust k1101v iiinch more abont the types of late fifties and sixties, ~7110vere found in the postx-orkers who are at present inost vulnerable to premawar labor force. Thus, in contrast t o the lonq-term ture and involuntary retirement, abont their occntrend, there has been 110 further ~ ~ i d e n i i in the reig pation and industry and their geographical location. tirement gap dnring the curreilt decade. TYe also need direct infornlatioli as to the specific These conlparisons suggest alternatire patterns for causes of their withdrawal from gainful activity. future trends in the work life span. resumption of ,It present this area is still largely unexplorrd from prewar trends. on the one hand, would mean a rapid a statistical rie~17point. midelling of the period of dependency and mould correspondingly add to the ecoilomic burden of old-age The City vs. Oldsters dependency. Under this assumptioii, the gap between total life expectancy and ~vorkinglife exnectancy will widen to allnost 10 years in 1975, as com0 1 the basis of our present k a o ~ ~ ~ l e d g the Amer1 of e pared to 514 years i11 1947 and less than 3 years in ican labor market and of coiiditiolls in various occu1900. On the other hand, if we can nlaiiitain the cur- pations, it is possible, however, to focus on certain rent patteyn of labor force participation, the increase broad sectors of the labor force, where the problem in life expectancy v-ill be acldecl mainly to tht period is likely to be most severe. First, we know that the of productive life. Even under these coiiditions, there TI-orking-lifespan is shorter for the city worker than ~vill,however, still be an increase of about 134 years for the farmer. Secondly, in the nonagricultural secin the average period of retirement, due siinply to the tor of the ecoiion~y, the period of retirement is likely fact that under the improved nlortality coliditioiis to be longer for the wage or salaried employee than projectecl for 1975, a larger proportion of young Inen for the inan ~vorking his own account, as a businesson are likely to survive to retirement age. nlan or an illdependent professional. �I n this broad area of nonagricnltural einplopment there are wide differences, too, in the severity of the employment problem of older workers. There are many employees of mature age, in execntive, silpervisory and professional positions, whose experience and judgment render them increasingly usefui to their firm. However, in the great mass of industrial and clerical jobs, mhich bulk so large in our modern econoiny, the opposite is more freqnently the case. For many of these workers, the major threat to a full well-rounded working career is the gap between the individual's occzcpational working life and his total potential working life. The most obvious illustration is in the case of those jobs which involve very high physical requirements. Professional athletes o r airline pilots or other men engaged in hazardous or strenuous activities are required to be in perfect or near-perfect physical condition. At some stage, and well hefore the end of their nnr~nal, vorking life, men in these jobs-even though a select group, to begin with-are compelled to shift to a less exacting tyne of work. The sitaation of airline pilots, though extreme, map hrrve to point up the problems which may be enc~onnteredunder these circumstances. Airline pilots as a. group are predominantly young nlen-both because of the very stringent physical qualifications they must meet mlder the Civil Air Regulations ancl because of the very recent growth of the occupation. Thus, since 1940, the nnillber of pilots employed by the scheduled airlines has tripled. Although there have, of course, been individnal problems of superannuation for pilots, there has not as yet been a izrasq problem. But vithin the coming decade or two, a large proportion of the present pilots ill be in their forties and fifties; clearly many of them will no longer be able to meet the current physical standards. llTT'here will they go? The types of gronnd jobs on the airlines for which they may qualify or which thev are likely to consider suitable are necessarily limited. Retirement also is not the solution for them. The only alternative for many will be a completely new occu1)ational orientation. ~ c h Less spectacnlar, but of n ~ ~ wider significance, is the situation of many other ~ ~ ~ o r kwho find that as ers they grow older and slow down, they can no longer meet the pace of modern industry, although they may still be capable of gainful employmeizt. If they retain their jobs with their employer, this problernthough still a real one-nzay be dealt ~vith a quiet, in unobtrusive fashion. I n many industries, seniority gi~rs the older xorker a substantial measure of security. And, apart from this form of protection. man:- employers have adopted policies to shift their older employees to lighter, less exacting duties. Stranded in Middle Life However, in our dynamic economy, there is the ever-present danger that these workers may get stranded in the middle of their working life. Periodic business recessions, or simply the normal turnover of business establishments, may cast them in the role of a jobseeker. Technological or style changes illax- depress their industries or render their skills obsolete. Shifts in consumer demand and the changing pattern of industrial locatioil may also have the same effect. Once the man past his forties is forced into the labor market, his problem of adjustment may prove to be a difficnlt one. Many employers are reluctant to hire older workers, unless they have some special qualifications. The -\.cry seniority rules which protect hi111on the job work to his disadvantage when he is on the outside. And the prospect of "starting all over again," to a man of mature years and responsibilities, is i;ot a very appealiilg one. What can T e do about this dilemma of the older v worker? I will not presume here to attempt to spell ont any detailed solution. From this brief review it is v apparent that T e are dealing with a highly complex problem. I t is a problem that me are approaching with all too meager factual resources, although the Sew york State Joint Legislative Conlmittee on Problems of the Aging has performed an ontstailclillg service in t h i s respect, in assenlblillg and evaluatilzg the available data. I t is, inoreover, a problem vhich is growing in dimensions each year, and which will command the combined resources of the Federal and State and local governments, of labor and management, and of n1an)- community groups, if it is to be clealt with effectively. I n cullclubion, I IT-oulcl, o ~ ~ e v elike to refer to one h r, general course of actioil which merits your conhideration. You are all familiar ~ ~ i the general theme of t h "physical fitness." Institutions such as life irrsnrance companies, particularly, have a strong ancl obvious interest in promoting in~provedhealth standards, proper diet, adequate exercise and other hygienic measures ~vhichwill have the effect of extending the average life expectancy. The colnmaility at larpe has an interest, too, in extellcling the period of working life. To this end, we should inaugurate a program of "vocational fitness," designed particularly to meet the needs of middle-aged workers. We must first, of course, determine what particular types of jobs are adapted to their background and abilities, by careful studies of the job requirements, the conditions of entry, the productivity of older workers on these jobs and other pertinent information. We must, at the same time, improve our technical know-how in testing and counselling older workers. �T i t h this type of information, we may be in a position to conduct a n effective campaign to encourage mature workers to undertake adult education and vocational retraining programs. Preferably, these programs should be conducted, not when the worker is out of work, but when he is still on the job. I n order to be effective, these programs must obtain the whole- hearted cooperation of labor a n d management groups and must be p a r t of a broader campaign to expand employment opportunities for the older worker. All this may seem like a n ambitious project, b u t if it succeeds i n extending the period of productive life f o r even a fraction of our labor force, it will prove to be a sonnd investment. �Business Conditions Today Demand Seasoned Executives By John R. Powelson President, F o r t y P l u s Club of AT. Y., I ~ L c . T HE EXECUTIVE, over 40, seeking employment is often ruled ont of competition withont even a hearing under today's employment practices. The following alleged reasons are those most frequt.iitlj given : 1. C'onipany pension and group insurance plans. !?. C'ompany traditional policy of employing only >-ounger men. 3. Reluctance, based on fear by young company rxecutives, to e~nployolder men. 4. Company fixed policy of promotions of esecatires from within. To arm the executive, over 40, against such hiring procrdnres, the idea of the Forty Plus Club was born. Afore than 10 years of successful operation have proved that these employment problems a n d prejudice\ (.an be overcome. Since 1938 Forty Plus Clubs hare been organized coast-to-coast, including such cities a5 New York, Boston, Buffalo, Philadelphia, Cleveland, Detroit, Chicago, Los Angeles and S a n Francisco. Typical of the overall operation, is the Forty Plus Clnb of N e v York, Inc., which maintains headquarters a t 250 West 57th St., New York City. Founded i n 1939 the objectives of this non-profit organization are to secure executive employment for members by their own cooperative efforts; to offer members encouragement. inspiration a n d assistance ; a n d to create i n the minds of prospective employers a realization of the value of mature experience, seasoned judgment a n d trained business knowledge. To function efficiently the club maintains five committees : 1. The Admissions Committee-which screens a n d investigates applicants. carefully 2. The Marketing Committee-which keeps u p constant liaison with industry and business b y means of personal calls and printed matter. 3. The Placement Committee-which recommends members for job openings, a n d arranges per- sonal interviews a t the request of the potential employer. 4. The Public Relations Committee-which prepares press releases. radio scripts. paid advertising, trade paper press copy, a n d supplies speakers for Chambers of Commerce, Trade ~ s s o c i a t i o n sand Service Ciubs. 5. The Resume Committee-which helps members prepare resumes of business experience. The F o r t y Plus Club has strict membership requirements which act equally for its own protection a s pr ell as that of the employer. To qualify a member ~ n n s tbe a n American citizen, 40 years old or over, show a satisfactory e d ~ ~ c a t i o n a l record, have demonstrated execntive ability, and have earned a minimum of $5,000 yearly. As a result of this strict screening, only 8 per cent of the applicants are accepted. Experience shows that most of the club's members a r e undergoing temporary unemployment not through a n y basic faults of their own, b u t rather through the inevitable industrial readjustments following a national emergency, mergers a n d combinations of circumstances beyond the individual's control. The club realizes that the American economy-vast, successful a n d envied by all nations-represents in the last analysis the sum total of the know-how, energy and creative genius of all elements of the population. America today is taking positive political action i n the matter of conservation of natural resources; water, forests, oil and soil. Failure by government a n d business and industry t o conserve equally important human values, to gainfully employ the hard-won experience, the seasoned judgment, the ingrained habit-of-work. as possessed and best exemplified by the over-40 executive age group, only serves to subtract from the maximum productive effort which is the American goal. As evidence of the success i n this direction of the club's efforts, it is interesting to note that since its formation i n New York, more t h a n 1700 have been �placed i n executive jobs. Employment records reveal moreover, that virtually no labor turnover has been created by the hiring of Forty Plus members, which in itself is a t once a tribute to and justification for the strict admittance standards in force. The seasoned employee appreciates and holds his job. The Forty Plus Clab of New YorB, Inc.. invites the cooperation of Federal, State and local goverilment agencies. The enlightened employer can profitably ntilize the club's services by passing along to the Placement Committee executive job specifications as they develop, thereby extending to the club's membership a n opportunity to compete for such positions. The club cannot emphasize too strongly or too often the time tested fact that there is "no substitute for experience. " ���It needed a n "uptown" man with no industrial connections. Encouraged with their initial progress, but still beset with serious obstacles, Hamkins and his men placed their ideas and their headaches before handsome, aggressive, and fortyish Kilgore AiacFarlane, president of the Schenectady Savings Bank, an uptowner known for his business acumen. "You fcllo~vs are doing a grand thing," MacFarlane told his visitors. "Count me in to help in any way I can. Incidentally, we have some unused space here in our bank building. If I talk this over with the Board of Directors and tell them your story, maybe yon can locate here. " 31acFarlane agreed to serve as treasurer of the nebulous company, which now incorporated niider the name of AIohaw-k Development Service. The rest of the roster of officials and employees so~iiderllike a "Who's Who in Engineering and Drafting." Hawkins became president. Stearns mas made secretary " 2 E -.-.* L--- L1 --- -I . Sniish assumed tile title of vice-president and chief engineer. Among the employees were 70-year old Ellery Steadwell, who was responsible for the design of 60-inch searchlights. d. Roy Fonlder, a 69-year old graduate of Rrown University who had been supervisor of drafting at the American Locomotive Company, and a group of other oldsters as faniiliar in engineering as the slide rule. - : ment Service was drawing its employees from the retired ranks of only one company, and that thp same company had already offered some contracts? The men of MDS had the answers ready: General Electric had a surplus of work which its own employees couldn't handle. The men in the new company were familiar with General Electric products. They could do a good job from the very beginning, without extensive training, and without delay. True, most of the original work was coming from one company, but Mohawk Development Service was free to take, and indeed was anxious to get, work from ~vlierever it might come. Labor was soon satisfied that the new company was not a "branch" of General Electric, and that it v-as serving a useful purpose by preventing the rustinc of skills, and probably adding years to the useful lives nf older men mhc! manted to work. MDS weat alieacl with the blessings of organized labor. Started on Little Capital The corporation was launched with a capital of only $2,000. That isn't e n o ~ ~ g h buy a new autoto mobile, even a low-priced one these days. But it paid the relit for a while. I t bought pencils and stationery. I t paid for drafting boards, paper, drawing ink. Tsquares, desks and filing cabinets. Fronz there on the oldsters pitched in themselves, smung ha~~imers, pushed planes and saws, and out of Labor Satisfied rough boards constructed needed work tables. They Things were looking brighter for the infant con- clesigned their own lighting equipment. There was cern. Maybe too bright. Rumors were rife that AIDS no thought of the arthritis, stiff joints, and wrinkled, had come under the ~vatchfal eye of organized labor. tired hands which supposedly make the elderly unfit Members of the Draftsmen's Union at General Elec- for any kind of physical effort. These oldsters. samtric demanded to know what this n e v venture was all ing boards, sliillfully putting the pieces together, about. From the soot-covered, dingy building in the helping to construct a modern workshop by their own congested railroad area, which houses Local 301 of the sweat and toil were unmindful, in their enthusiasm, of United Electrical Workers, there was an omino~zs.un- the common picture of the elderly, tired, weak and to miserable. easy silence. The men of MDS waited anxio11sl~see if the axe ~vouldfall. Finally the attitude of I n March. 1948, not many months after a bold, new labor began to cr>-stallize. idea stirred in the imaginative mind of the old "Col"We're not opposed to the employment of older onel", the doors of MDS were wide open for business. workers, " explained Local Business Agent Leo Jan- Six old-timers rolled up their sleeves. I n a long. low drean, reteran uf inany a tongh labor scrap. "011 room, where floating lanips flooded tables stickinq u p the contrary, ne're all for it. Bnt this could be a in rows like tank traps, they quietly took their places move by some of the corporations we have contracts and went to work. They turned out designs and bluewith to get aroand the retirement rule." prints for turbines, turbo-generators, diesel engines There was a campaign underway to pet Schenec- and large motors. No "E's" for excellence were tady's big plants to liberalize their pension proriqions. sought by the oldsters. The many favorable comullents Labor officials didn't intend to have these industrial from satisfied customers, the new contracts that came giants arguing that more and better pension pianc, rolling in from American Locomotive, L ~ ~ d l uSteel, m were unnecessary because they had found a way to the Oil Institute of New York, and a host of othrr take care of their older employees by letting them concerns, mere the only citations the oldsters wanted. work for themselves as long as they wanted to. Why ,Is orders piled up more pensioners were taken off the li mas it, labor wanted to know, that M o h a ~ ~Derelop- shelf. �,it the eilcl of its first year 1\Ioha\~l;Develonl~zellt preserving our 01~11esteem and confidence. \Te are harder ancl better than we ever ciid before, Service had 1 6 employees. The nuinber zoomed ~ ~ o r l i i n g throng11 1949; and President Ha~vkinsis looking for because we lmow we just can't fail ancl still hold our ll other fields in ~ ~ l l i cto siphon nlachinists and eugi- heads up. It's a inatter of proving to ourselves, as neers, de-activated by private industry solely because \Tell as to others, that we aren't old or useleis. lTTe're coing to ihon everybod?- that ne're f a r fro111 washed of the nulilber of birthdays they have seen. 3IDS has been cleared for worlr on government con- up." tracts connec.ted wit11 the defense program. I 1 fact it 1 has taken coiltracts from the Atomic Energy ComLow Absenteeism Rate nlission. Grasping the sturdy, prison-like bars which Eniploj ees at JIohan k Development Service n orli of coyer th? long, iiarrov w i n d o ~ ~ s the Schenectad:Savincs Bank. H a ~ k i i i s once remarked, "TTe couliln't on a n hourly basis. Since they are all in the upper be ljrtter 1,repared to protect any lcind of secret age brackets it was anticipated that some of them might be laic1 u p occasionally, and unable to work niaterial.. ' JIIIS. like many other companies, has erected rigid because of illness. One enlployee was ont for five age barriers. You might be the best drafts~nanor months. The conlpany paid him nothing for this engineer in the world, but yon clon't itancl a chance time, but when he was able to come back he resumed here lulless yon can prove that >-ou're over 63. and his olcl job. However, this case of prolonged illness is once retired by prirate industry. Present employees nnusual in the brief history of RIDS. The absentee s tllai ille illell art: aciually o u t lass iilarl r a l ~ g ein age I^rom 66 ro 74. Tile? i ~ a \ e guud ill- ~ e c u l d l ~ u \ i s a coille They are happy, because they are contribl~tis~c they mere before they were pensioned by their orsoliietliing to society, and, above all, because they have iginal einployers. "A11 our men put together," laughs, "couldn't Beep a doctor in a cha11i.e to prove that older 11-orkers can l?roduce President Ha~vlcins l?rofitahl!-. They are paid the same hourly ratec as aspirin. or a hospital in ether." pre\ail at General Electric for conlparable \~-orli. Today, MDS is a bustling, profitable concern. It The>- can utilize their skills, and the:- are not subject offers to industry services in the fields of engineering to anotlier compulsor>- retireinent age rule. There and drafting, and consultants on any electrical or are no time clocks at JSDS, for noize is needed. TT7heiz snechanical l?roblenis. As General Jlanager Stearns r o ~ \ sof bright lights are fliclrc3rl on, ancl the rnstle explains. "TTndertal;ings such as ours (,an be planned of drav in2 j,al)er heralds the begin~iing of a ~ P T T to supplement, not necessarily to compete with, local ~ ~ o 1 . k ?-on can be sure that it's nerer later than inclustries. Setting up a reservoir of skilled older da\-. illell to serve as a stand-pipe to take on peak loads of 8 ,310 -i.\r. Tlie olcl-timers took a lot of good-natured ribbing existing industrieh helps them to stabilize their pay~ ~ l l ethry v e n t back to ~ ~ o ragain. Their J-olunper, rolls, lninin~izes frequent hiring and firing. and il l; fornier iello~y-workersat General Electric and Arner- heightens their eiilployees' sense of security in their icali T,ocornotive greeted thein ~ i ~ i t"Ncllo, Tom. Jobs. We do not fear competition if it comes. MDS h Hon are things at the old age ho111e2" or "AIaking an- is not a charitable organization. We have ansnrother t r y at it. Gill? Why don't yon old duffers ad- passecl efficiency to sell. I n our field we are satisfied that we have the best skills, lninds and experience niit 7011 thro~ughancl take it easy ? " 're It niight hare been jnst such barbs which helped that inoney can buy. " The books of ;\IDS have collsistelltly shown jet black t h e coinpa~i)~ sncceed, for the oldsters inade u p their to i~iindsthat they simply couldn't afford to fail. Snc- instead of red. E l n p l q ees have been well paid, and hare even been given sizeable bonuses a t Chribtnlas cesq became a matter of personal. self-esteem Typical of tlir rnil)lo~-eesat 31DS is 68-year old time. Charles Spinnler. an able, retired G. E. Engineer, Hawkins' only complaint is that government tax no~v "un-retired". He hacl been on the shelf for two policies are hard on neli- companies like his. Iiotes years u h e n lle \\-as contacted by the Hawliins, Stearns. on gross income and undistributed profits are so heavy Sinith teani. Does he feel that the older Inen are cap- that the accuinnlation of capital for expansion is next able of doing as good a job now as they did hen they to impossible. He ~vould like to diversify the type of were n i t h G. E . or Alco1 Here's his answer: "These ~ ~ o rbeing done. F o r instailce, H a ~ ~ B i n s dreamlr is lnen are better no^^ than before they reached retire- ing of the day when >IDS will be able to open a mament age. They still have their skills. There's no chine shop, and hire some of the skilled, pensioned fooling around on the job here. Every man knows machinists ill Schenectady. I n fact he is already his nork and goes right at it. TT'e still take a lot of looking around for a spot to locate the nlachine shop. liidclinp from our young friencls at other p!ants. nloney to do this. A But it will take co~~siderable 7T'e're confrontecl with a challenge. Tt 's a matter of machine shop is quite different fro111 a draftsmen's �oEce. d more elaborate and expensive plant mill be necessary. And machines cost money, far more than tracing paper, thumb tacks and drawing boards. The head nlan at AIDS figures that about $25,000 will be needed before the company can expand into other kinds of work. But to a small, young lamb in the industrial jungle $25,000 is more than just pin money. Nevertheless, the man who has already performed a modern busines miracle on a shoestring is confident that his dreanis will be realized. Supposing that Hawkins can eventually hire 15 or 20 "superannuated" machinists to make niodels of new products, or to take other special development work. Perhaps the total number of MDS personnel vill reach several hundreds. The possibilities are great. If older men can form their oxn profitable bnsiness corporation in Schenectady, why can't the same be done by other groups of oldsters in Detroit, New Pork City, Chicago, Boston, or Pittsburgh. or xxhere~erynn fin? men with skills ? A hundred elderly employees here and another hundred there can, in the aggregate. number many thousands. Dr. Roger I. Lee of Boston, former president of the American Medical Association, warns us that "Death conies a t retirement." One of America's leading experts on aging, Dr. Edward J. Stieglitz, informs me, "Premature retirement while still vigorous, ambitious and anxious to serve can be a major disease." The eminent physiologist, Dr. Anton J. Carlson, says, "We are contributing to biologic parasitism and degeneration of huinan society as well as wasting valuable resources by keeping in idleness older workers able to perforin useful service. Work is a biologic and social duty as long as we can carry on." Laurence A. Hawkins and his associates have found a ~ v a yto do something that these experts on aging have been advocating for years. Their imaginative and financially successful attack on premature retirement aiid widespread prej~tdicesagainst hiring the elderly iiirty set the pattern w k i ~ h mill nat only keep illany off public old age assistance rolls, but which 11-ill provide satisfying work, make men live longer, aiid give society the benefit of an untapped reservoir of mature judgment and unequalled skills. �Public Health and Our Older People By Dr. Leonard A. Scheele S u ~ . g e o t G e l z e ~ a lof the U ~ l i t e d S t a t e s ~ T HERE is no question that the iiicreasiiig proportion of older people today presents the Nation with its forelnost problein in the conservation of hllnlan resources. Public health is only oiie facet of the very broad problem this Joint Legislative Con~mitteeon Probleiils of the Aging Committee is considering. B u t I hope i t will not, be thought mean to subordinate the iinportance of other aspects of the problem -$hen 1 say that public health is the Be>-, if not the definite solutioii to the total probleiil of aging. I an1 sure that 1115- colleagues froni the Social Security Administration. the Bureau of Labor Statistics. the Veterans Administration, the hospitals, and other related fields 1x31 agree t h a t plan., for the emplo>-ment, welfare services, housing, recreation, nledical and hospital care for older people depend primarily upon the health status of the group. Of equal importance i n our joint considerations is what public hpalth does-or could do-to improve the health of all adults. The effect of the aging of the population on public health. and vice versa, has been describecl many times. Reports of the Bureau of the CP~SLIS show that the proportion of persons 4.5 years of age and over. rose from 18 per cent i n 1900 to 27 per cent i n 1910. I t is estimated that these age groups at present account for 29 per cent, and that b y the year 2000, 40 per cent of the population will be 45 years of age or over. One in every five persons is in the middle ape group-45 to 64 years; fifty years froin now, that ratio will be one i n four. 1-aiices made b y public health and niedical service5 i n reducing the mortality aillong children and yonlig people. There is oiie fact associated with the aging provess, howerer, that is a rlarion call to public health. The aging of the population is reflected i11 mortality stah tistics ~ ~ i at greater proportion of total death< now oc~curriiiga t the older ages. Xearly 80 per cent (78 per celitj of all deaths occiiiriilg at tile prewlir tiilie i n the I'nited States are among persons 45 years of a" and orer. The increase in the proportion of deaths a~lzong olcler people has accelerated dnring the past S years. O Iii 1920. only 50 per cent of all deaths occurred i11 the 1 3 and older ape groups. B y f a r the largest iiicreases have occurred ill the definitely old age brackets. T h e r e a s i n 1920, persons 65 years of ace or older accounted for only 29 per cent of the deaths, today practically half of the S a t i o n ' s mortality occurs anlong our older people. Public Health a Practical Science Public health is not only a humanitarian science; it is a practical science. The philosophy and practice of public health are to attack the causes which produce the highest proportion of deaths and disability i n the population. As i n the past, mortality statistics are the most accurate indices available to us for determining o a r major problems both as to cause? of death and disability and as to the specific population groups exposed. Today, those data tell us that most of our problems are the chronic a n d degenerative disAge Shifts eases, and t h a t mortality froin these and other causes These shifts i n the ape coniposition of the po]>l~la- is concentrated i n the older age groups. This is the tion have been brought about largely b y major de- challenge to all agencies aiiil groups concerned with creases i n mortality ainong children and yonng adults the well-being of our older people. since 1900. The clecline i11 the birth rate ( u p to about About 45 years ago, public health ~vorkerhheard 10 years ago) aiid restrictioiis on inlmigration have another such challenge. The Bureau of the Census also contributed to the trend. i n 1904 publishecl a report on the mortality and vital Some students of denlography have been concerned statistics recorded i n the 1900 census. I t zho~ved lest the proportion of aged persons impose a severe that more than 30 per cent of all deaths occurred burden upon the economy of the Nation, a n d par- among childre11 luicler five years of age. Childhood ticularly upon the young adults in the proclnciiig a g ~ and youth-fro111 birth to 23 years-then bore ahont groups. Froin the p ~ t b l i chealth point of view, how- the same burden of lilortality t h a t our older people ever, the aging of the population, i n itself, is riot a n now bear. &!toreover, the principal causes of death alarm signal. On the contrary, i t testifies to ad- in these groups were infectioi~s diseases. �The answer to that challenge is ~v'itten in the his- in the older age groups. That trend is already aptory of public health. The major causes of mortality parent. About 95 per cent of the heart deaths a t were attached vigorous1:- in the succeeding years. present occur at ages 45 and over, as compared with Control of infectious diseases, nlaternal and child 84 per cent thirty years ago. health care, improved sanitation aiid nutrition, comI t has been estimated that by 1980, even vith no bined with advances in the inedical treatment of many increase in the death rates for heart disease in the diseases, have brought about a striking reduction in older age groups the total death rate from heart disthe general death rate and in the mortality from eases would be about 452 per 100,000 population, as c.ompared with the present rate of about 321 per 100,numerous specific causes. 000. On such a basis, heart ailments would then be reI t is not possible to select a single year in ~ ~ h i c h the impact of scientific advances "begins" to be re- sponsible for about one-third of all deaths in the flected in our mortality data. To bring the accelerat- United States. The situation with respect to cancer sonlenhat reing trend into closer perspective, however, let us consenlbles that of heart diseases. The cancer death rate, sider the past thirty years. all ages, has increased from 83 per 100,000 population in 1920 to about 133 at the present time. Except in Death Rates by Age infancy, the ape-specific rates have risen in all age groups. with the major increases among persons 65 The general death rate in the riiited States has devears of age and o17er. clined from 1.300 per 100.000 population, 1920. to Aithough there has been soiiie decline in death rates that period about at the present time, age, ~ a s c n l a r diseases of the brain has become the the death rates for nephritis, pneumonia and infln- b ~ 7 third leading cause of death in the United States. All enza, aiid tuberculosis have declined markedly in all age groups. Howerer, the decline has not been so but a yery few deaths occur a t ages 45 years and over. rapid in the age groups orer 43 as it has been st, the The rlrcline in the cleath rate fro111 diabetes mellitus all ages, is due priiicipallj- to reductions i11 the younger younger ages. The death rates for accidents, except motor vehicle age groups. The rates from this cause increased confatalities, have declined in all age groups among per- stantly at ages 33 to 74 between 1920 and 1940. P a r t sons 75 years or older. The reductions anlong infants of the increasing cleath rate i11 the older apes may be under one year and anlong persons 6.5 to 74 vears, attributed to the prolongation of life of the ynung diabetic through the use of insulin. however, are relatively slight. - The rates from motor vehicle accidents have increased among all age groups except among chiltlreii of school age, 5-14 years. The proportion of deaths from this canse among older people, however, has not increased substantially. The mortality experience due to heart disease, cancer, blood vessel lesions of the brain, and diabetes ~nellitus, illustrate niost forcibly the growing problem of degenerative diseases anlong the older age groups. -15 years and onward. Since 1920, the death rate from heart diseases, all ages, has more than doubled. But in all age groups under 25 years, the rates have been anlazinglv reduced. The rate of decline has been fairly constant since 1925 for the age groups 1-24. I n the sanie period, the death rates from heart disease have illcreased in every age group froin 35 years and orer, but niost markedly a t ages 55 and onward. Because large numbers of persons are survivinq to advanced ages, we can assume that the death rate fro111 heart diseases for the total population ill continue to rise. As the infections diseases, such as ineasles, scarlet fever, rhelxniatic fever, and syphilis, cotne more and more under control, we may also expect a greater concentration of heart disease deaths 99 Killers and Cripplers I an1 well aware that these data do not present the still larger problem of disabling illness among our older people. Thr conditioiis I hare mentioned not only kill-they niake iiiralids of niillions. But we are all aware that illany of the major crippling tiiseases do not at the sanie time produce high death rates. Arthritis, rheumatism, high blood pressure, other nletabolic di\eases, nlental and n e r ~ o n s ailnients, for example, are resl~oizsiblefor a large proportion of the disabilities that keep older people fro111 leading a normal, productire life. That older peopIe can be productive, has been proved over and over again. More than one-fourth of the 16 niillion women employed daring World War 1 n-ere orer 45 years of age. The namber of older 1 nien working during the war was even greater. If we are to deal effectively with our aging population. howerer, T e must plan to conserve and emv plo:- the productire capacities of our older people to a f a r greater extent than in the war years. And we ~iiust plan to do so continzlously a n d not as a n expedient in emergencies. Work and a respected place in �society are as essential to healthful living as food and numerous voluntary agencies and private foundations shelter. If the longer life which modern technology have greatly augmented research in the chronic dishas fashioned for us is to be worth living, we must eases and physical medicine, through aid to the Natry to make it healthier, happier, and more productive. tion's institutions and individual scientists. From This objective points up my earlier statement that this expansion of scientific study, we can expect rapid public health is the key to the solution of our prob- advances in one or more phases of chronic disease lems. Building on the experience of our health agen- control. HOW, then, shall x e begin to apply widely the existcies, both official and voluntary, we must rapidly develop effective methods for combating the chronic ing knowledge of chronic diseases? How prepare for diseases which are concentrated among older people. fnture advances ? Control of many of the chronic diseases is a pracWe must at the same time learn how to restore to their highest possible levels of health, the millions of tical goal. The public health concept is to build a men and women who are already disabled by disease long range program upon prevention, early diagnosis, or premature "old age." These goals can be attained adequate and continued treatment, and rehabilitation. As in the great calnpaigns against syphilis and if all gronps who hare anything to contribute join together, with firm purpose to solve the inany specific tnherculosis, we can go out into the highways and byivays and search for the undiseoverecl cases among and dif'ficult problems inherent in such a task. The task undonbtedly is formidable. I t will draw the supposedly healthy people. We can not only upon practically all fields of n~eclical and pnblic health search for the frank cases of disease, but for the con. . sciences. It reac:i <Leep:y ille scieilcea. d i t i ~ n s that prcdisposc t~ chran:c :!!ncss o r that are its precursors. Research Needed Mass Screening The Public Health Service, in cooperation with The f~uldainental solution, of course, will come from scientific research. At present, m7e have scant State and local health departments, is already experi1ino~vledg.e the causes of some of the major chronic menting with methods to extend mass case finding of diseases, such as arteriosclerosis, hypertension, arth- techniques for several chronic ailments. I n about 30 ritis, cancer, coronary occlusion, mental diseases, and minutes, an individual passing through a "screening" so on. We lnust eventually learn the causes. I n the line can be given a chest X-ray; blood tests; urine meantilile our abilities to control the course of these analysis; blood pressure determination; measurement conditions in the patient, and even to reduce their in- of height and weight; and tests of vision and hearing. The resuIts of such combined case-finding procidence in the general population, are much greater than is often realized. There are reasons for real grams indicate that if 1,000 apparently well adults are given the battery of tests, over 900 instances of optimism. The most recent drastic proof of progress is the dis- chronic disease or defect would be found. Tuberculosis, other diseases of the lungs, syphilis, covery that hormonal compounds, such as cortisone and ACTH, may be effective in the treatment of diabetes, anemia, high blood pressure, obesity, and arthritis. Even more promising is the fact that these defects of vision and hearing can thus be "screened7' and other steroids provide new research tools for the out for diagnosis and corrective treatment. Many investigation of many of the most baffling chronic individuals will have multiple symptoms, especially maladies. Our ignorance today may disappear in the in the older age groups. Chronic diseases occur singly, over long periods of light of new knowledge tomorrow. Recalling progress in other chronic diseases, we find time, usually without obvious signals to the patient. additional grounds for optimum. Malaria, one of the Epidemic diseases strike swiftly, affecting large groups most devastating chronic infections, has almost dis- in short order. No community can or would ignore an appeared from the United States. Syphilis and tub- epidemic. The multiple screening plan would serve ercnlosis-two other chronic infections-are being to arouse both families and communities to active rapidly reduced to a relatively low rank as causes of concern for the prevalence and threat of undetected, death and disability. The control of syphilis eventu- untreated chronic disease. ally will show, even in the older age groups, substantial reductions in syphilitic heart disease and psychoWatch That Fat ! ses due to syphilis. Recent improvements in treatment now make it possible to control undulant fever as a On the preventing side, early treatment can greatly reduce the disability due to chronic disease and can chronic disease. I n the past two years, the Federal Government, prevent premature death. One of the immediate �values of public health activity in this field would be the control of obesity. The relation of obesity to heart disease, hypertension, and other chronic diseases is well known. The death rate among persons 55 years of age and over, who are 40 per cent over weight, is 65 per cent higher than among people in the same age groups who are of normal v~eight. Such data support the need for developing an obesity control program. I t is f a r more difficult for an obese person to maintain normal weight, once he has achieved it, than to bring his weight down to normal. Medical supervision may be needed for long periods. The Public Health Service is supporting joint projects in obesity control, 136th the New Pork City Health Department and the Boston, Mass., Dispensary. I n the latter, experiments are being conducted to determine whether psychological factors that adversely influence weight contr~! can bc overcome by grcnp therapy. Many new and improved tests are being developed. Mass case-finding tests for heart disease and cancer will be added in the foreseeable future. If, in the meantime, our multiple screening methods are organized and operated to smooth functioning, we mill be in a position to detect and place under treatment many more adults ~vho need preventive services, treatment, and rehabilitation. Rehabilitation Rehabilitation-the fourth basis of chronic disease control-is of equal importance with the other three. All services designed to care for the chronically ill and aged will contribute in some degree to improvements in their health status. The advantages of a rehabilitation program to restore physical and mental functions are so obvious, however, that the provision of facilities and services for this purpose cannot be omitted from any sound plan for older people. Rehabilitation services can be integrated with a chronic disease control program, despite the ariat ti on in organizations concerned. The citizens of every community possess qualities of leadership needed to plan and establish a system of integrated haspital, medical, public health, and rehabilitative services. We only need to find better ways of organizing and administering ont services. Recent amendments to the National Hospital Survey and Construction Act make it possible for the Public Health Service to aid State and local governments, public and private non-profit institutions in stitdies and demonstrations leading to coordinated systems of hospital care. Such research will involve the integration of large teaching hospitals, regional and small community hospitals. I t mill involve, in many instances, the relation of nnrsing and convalescent homes, out-patient services, housekeeping, visiting nurse, and niedical social services to hospital care. Community Services Needed I n no other field is there greater need for coordiThe quality of medical and hospital care for the nation of facilities and services than in programs for chronically ill and for the aged can be improved most the better health of older people. Public health workrapidly by organizing our existing community serv- ers, social welfare agencies, hospital administrators ices effectively, even while we are trying to build the the country over are increasingly aware of the need additional facilities which we need. The home care for action. Such official groups as this joint legislaproject developed by Doctor Blnestone a t Montefiore tive committee illustrate the widening public interest Hospital in New York is destined to be emulated in and the deepening public conceri~. The problems are many parts of the country. The oatstanding charac- both perplexing and vast. I am confident that if the teristics of this program are the planning and team- persons all concerned ~ ~ i solving the problem of t h work which assure the patient continuous super~~isionaging will work together with firm purpose and selfand expert care, without the often fatal break be- lessness, keeping the interest of the individual patient tween hospital service and discharge to the home or uppermost, xx7e qhall work out effective methods for to a nursing or boarding institntion. ensuring better health to our older people. �Medical Care for Prolonged Illnesses By Dr. E. M. Bluestone Director, Xontefiore Hospital for Chronic Disease, S e t c York C i t y T agents are involved in any discussion of the ecollomics of medical care for prolonged illness: ( a ) the patient, ( b ) philanthropy and (c) government. I n the voluntary. non-profit hospitals of this country the income from all patient sources toward the cost of their niailltenance last year TTas 89 per cent. The relatire burden of cost for their care on philanthropy and governlnent was, there1 fore, 1 per cent. I t is only necessary to add that if philanthropy does not make good its share, it is clear that government must be invoked and no one has the right to coniplaill hen, in circlulnstances like these, governlnent does step in to help dependent peqple who cannot help themselves or get volunteers to help them. What I am stating here applies to any hospital, or any type of medical care, which the sick, the nearsick or the recently sick may require. However. as me transfer these observations from the so-called "acute" general hospital to the "chronic" hospital, in a n age when snch artificial and demoralizing distinctinns are still being made as a nlatter of actual practice, we cannot help noting that the contrib~ltion the patient of toward his care is progressively reduced with the continuance of his illness. Patient snffering froni prolongecl illness, known too often as "chronic" patients in the hopeless and incurable conllotation of the term, become involved eventually in a vicious circle from ~\-hichthe philanthropist, with or without the help of the taxpayer, must provide a n escape. Poverty and prolonged illness pnrs~ueeach other relelltlessly where society does step in to break the circle. I 1 the only voluntary general hospital of its kind 1 in America devoted to the scientific care of prolonged illness, namely Montefiore Hospital in Neb- York City, the total contribution of all of its patients t o ~ r a r d their care, on a comparable basis, is 24 per cent. I n this hospital ward patients, as part of the total patient group, contribute only 6 per cent toward their maintenance. The bnrden that must be borne by philanthropy and government, with patients suffering from prolonged illness, becomes hearier as the patient's financial reserves disappear. This financial problem is before us more pressingly than ever, in view of the sheer numbers of people suffering from prolonged illness and, in particular, the relation of snch illness to the aging process. There are worse things in this world than dying young, or dying suddenly. TITe are learning painfully that there is such a tragic thing as dying on your feet, in a wheelchair, on a stretcher, or in bed, over long period of time. T e should therefore be as much concernecl with the discomfort and inh happiness as we are with pain and v i t h the prevention of death. Prolonged illness is more characteristic of age than of youth, though by no means limited to age. The reason for this is that the human body, as it wears out dild as it ricyiliies a siiccessiuii of iiieclical epiyodes through life, becomes progressively less resistant to the ravages of illness. V e are getting considerable help these days through the ~ronderfnlcontributions of scientific medicine, but the net effect of thtlse contributions is to prolong life in terms of years. The proclucative medical scientist has been placing in the eager hands of the social worker golden opportunities for joint effort in the exercise of a relatirely n e x specialty, known as social niedicine or human ei.ology, which has for its ultimate objective the happiness of the aped as well as of all others who can benefit from its ministrations. I t is to this specialty that philanthropy ancl government must look i n a joint effort to solve the problelil created by age and by depcndelice generally. I ~ R E Evital Acute and Chronic Cases These thoughts lead rile to complain about the clifference betveen acnte and chronic or, what is inore to the point, between the urgent ancl the non-urgent in collilnnnity-reaction to varying pressures. I t is no^^ clear to any student of medicine and the social sciences, that the distinction still being made, to the detriment of the patient suffering from prolonced illness, b e b e e n " acnte " and " chronic ", is a survival of the pre-scientific era. The response to urgency has thus f a r governed the charitable heart, but I snbmit that the acid test of charity, in its most philanthropic sense, is the response vhich it makes to less urgent situations-to the unvoiced appeal of the patient snfferer from prolonged illness. Response to urgency is coinpelli~ig and relatively satisfactory. As long as the feeling of mutual aid prevails among men we mill be able to connt fully ancl heavily on i t in acnte sitnations. But IT-e have come into an era of longer life. and of relativelj- longer periods of illness which may 102 �lead to social dependence. MTe hare also come into an era of greater availability of medical a n d social mays ancl means of dealing with them a n d the soolzer w-e plan for the less urgent, the better. The threat of imminent death, and the presence of agonizing signs and synlptoms, will revoke a n immediate response i n almost every case. TTe must now accept a cardinal principle of prerentive medicine coupled with a carclinal principle of social medicine. under vhich every effort mnst be made not only to prerent illness but, if we are snccessful i n these efforts, to prerent death, chronicity, complications, sequelae, relapses, and social dependence. How is this to be achiered; what is the cost of achievement, and hat are its benefits? social workers, and the rehabilitationists workin? i n the medical field, are leading the way. How long can the "acute" general hospital limit its magnificent facilities to those alone who enjoy the benefit of a snap diagnosis, as well as a snap diagnosis of a shortterm illness i n the admitting room ? The Plight of the "Chronics" Let me state the case this way. There are three major reasons why a n "acute" general hospital transfers patients suffering from non-acute illnesses to other institutions. The first is the progressive loss of interest in such patients b y the niedical staff. This is dne to the fact that these patients are considrrecl to be unprodnctive and therefore undesirable. The reHow long can we continue the unjust, inequitable sult is that the administration of the hospital is under and often indecent distribution of medical facilities pressure to get such patients oat, regardless of the which characterize our time? The acute general fact that there is no better facility i n the world for hospital has a t r y 2t the eo:~ditis:~. If it wwecds their care at a tiiiie i ~ h e i itheir iieed for a hubpita1 through its own efforts, with or without the help of bed continues. This lack of clinical currency 3s well Kature, well and good but, if the condition does not as the lack of financial currency can, however, be comrespond quickly to treatment. the patient lilnst look 1,ensated for b y ( a ) financial subsidies to doctors to to his safety ancl his comfort elsewhere. Bnt ~ r h e r e make n p their losses from private practice ; ( b ) labordoes one find a medical facility which is the eclnal of atory facilities for the stimulation of scientific talent the general hospital? I t is not eiiongh to point with and scientific interest i n the problems of prolonged pricle to the achievements of the nioclern general hos- illness, and for the recrnitliieiit of aclditional doctors pital and to say, which is relatire1:- true, that it is the with selectire interests i n the various aspects of pror e r y best resource of civilization for the pravtict- of longed illness; and ( c ) classrooms and conference scientific medicine. TVhj- does it limit its b e n r f i t ~so roonls to stiiiiulate the teaching. Every becl in erery hospital, no matter where i t is severely? W h a t about the non-acute-that vast segnlent of suffering humanit>- which is less rocal, still located or by whom occupied, is potentially a teaching needing a hospital bed and equally deserriiig of the bed and l,otentially a research bed. The first reason for the transfer out of the "acnte" best that scientific medicine afforcls. The clinical and social problems confronting the "acute " general hos- general hospital of a non-acute patient will disappear pital are relatively siiiiple and more quicklj- dealt as the planner proceeds to apply these remedies and with. They are inore dramatic for the philanthropist integrates functional and structural facilities for the and inore spectacular for the clinician. H o ~ w r e r .i t coinbinecl benefit of both stages of illness. The second reason for the transfer of a patient is the patient suffering from prolonged illness with a difficnlt, stnbborn, and often colnplicatecl clinical con- safferiiig foni proloiigecl illness out of a n "acute ) ' dition which gives a slow response, if any. to treat- general hospital i n his progressively rneager financial ment, that renlains a n eternal challenge to t h r mail contribution ton-ard his care. E n t this reason for transfer too call be satisfactorilj- met by a subsidy to of science, to philanthropy ancl to gorernment. S one seems to differ, i n principle, in the conten- the hospital froin one source or another. What thc o tion that neither age nor duration of illness shonld patient cannot coiltribute himself t o ~ i a r dthe cost of stay the hand of the plailner in the field of mrciical his care lrl~lstobrionslp be contributed either by philcare yet, i n practice, all b u t the acutely sick are out- a n t h r o p - and/or government. Once the nledical siders as f a r as the saperb facilities of the modern needs of this lrind of patient are established he shonld general hospital are concerned. Looli into your non- be assigned to whaterer facility can do him the most acnte medical facilities, ancl the exceptions nhich good regardless of his financial ability. The third reason for transfer is the greater relative prore the rule, and you will agree that we nlnst seek new, inore equitable and inore decent mays of dealing need of the available becl in the " a c i ~ t e " general hoqn-ith humanity's problein of medical clisability. The pita1 b y the acutely sick patient. If the s n l ~ p l pof science of nledicine must share the wealth in such a beds is not equal to the demand tlien o b ~ i o n s l ythe n a y that those people nil1 benefit from it who nee6 it. most urgent must be dealt with i11 the order of their for this is the essence of medical philanthropy. The nrgenq-, bnt this reason for transfer must disappear �where supply can be made to meet the demand. Instead of establishing the additional required bed a t a distance from the prime diagnostic and therapeutic facilities of the general hospital, it should be established within the hospital compound. This can indeed be done much more inexpensively within the general hospital, since it avoids the expense of duplication and the handicap of distance to all concerned, unless, the hospital can continue to furnish the required medical care to the patient in his own home. We shall still face the danger of neglect of the chronic sick in the presence of the acute, because of the transfer of interest, sympathy and attention from the former to the latter, bnt this will in the end disappear. There is far more danger of neglect with the rustication of the non-acute patient at a distance from the best of medical caro dt a time when he may need it most. Medical Crumbs Besides, the tenacity and stubbornness of prolonged illness must be matched eqnally by tenacity and stubbornness in the medical and social scientists who are, in turn, supported by philanthropy and government. This can only be accomplished if the patient is kept before their eyes and not transferred to a spot where he can gaze at the landscape while waiting for medical crumbs to be thrown in his direction. These remarks are limited to the patient suffering from acute illness as well as to the patient suffering from prolonged illness. I t is of the greatest importance not to confuse either of these with ( a ) the convalescent type of patient or ( b ) the so-called custodial type. The convalescent patient is safely on the road to recovery from a n acute or chronic illness and may or may not need the continued use of a hospital bed. The custodial type has made only a partial recovery and is left with a burnt-out disease, an irreversible scar or a residual handicap, which may or may not require a hospital bed, but for social reasons sometimes requires some kind of institutional care. I t will readily be seen that the aged patient falls into one or the other of these four categories: acute, chronic, convalescent or custodial. IIe is, besides, an unattractive problem in preventive medicine and in social medicine. I t is a mistake to thing of his illnesses as coming under the single heading of any such social specialty as geriatrics. Whatever his illness, it belongs to the specialist who has been trained to deal with it. The geriatrician can only hope to be a casefinder, a coordinator and a general practitioner to the aged, as the doctor often is to the young. New Criteria for Hospitals Let us now bring these thoughts together, developed largely in a great hospital laboratory for the study of social medicine, and see the program for nledical care as a whole. Until such time as we are able to build in accordance with this blueprint, we can at least elaborate a functional coordination which will lead by planned steps to the ultimate achievement of the program. To begin with, distinctions between acute and chronic should disappear and a new criterion for the admission of a patient to the general hospital should be recognized and implemented, namely the need for a hospital bed. Regardless of other consideration, this need for a hospital bed should control admitting policy. A patient who needs a hospital bed for the care of his condition, acute or chronic, should get it in one location, the general hospital. Broadly speaking, these needs are ( a ) a period of close observation in the highly concentrated diagnostic and therapeutic atmosphere of the general hospital, where medicine is practiced intensively and scientifically on a group basis; ( b ) what is popularly known in the hospital as a "workup"; (c) some form of service like a major surgical operation; and ( d ) some form of treatment which can only be administered on the hospital premises, like deep radiotherapy. These are the four major criteria for admission to hospital beds. The poverty of the patient, or the desire of the doctor for the concentration of his patients in one area for his personal convenience, are in themselves invalid criteria for hospitalization and represent a very expensive for111 of care which can in fact be avoided. When the patient does not need a hospital bed for his particular condition, or when he no longer needs a hospital bed. the same quality of care must be offered by the hospital to him in his o\vn home, or in a substitute for his home-an intermediate type of institntion, preferably though not necessarily on hospital gronncls. Transit of Patients Let us see how the factor of urgency applies in such a combined and integrated intra-mural and extra" mural setup where the hospital radiates scientific care directly to the patient if he is indigent. or in cooperation with his doctor if he is not. TTTith the disappearance of the solid wall of the hospital, figuratively speakinp, and the appearance in its place of a combined stationarj- arid mobile service, by which most of the scientific facilities are centralized intramurally, the factor of urgency can be related by a simple formula to the factor of distance. The greater the urgency of the patient's condition, the less the distance between him and the central facilities of the hospital. The less thc urgency of his condition. the greater the distance. To illnstrate, the patient who is exsanguinated, or in shock, must remain within the hospital operating room till the urgency of his condition is at least partially relieved. With progressive �relief he can be renlovecl ( a ) to a recovery roonz alongside ( b ) to a room on the sanie flour ( c ) to a room on a floor above or below ( d ) to a room in a pavilion alongside ( e ) across the street and, finally ( f ) to his own home, or to a substitute for his home. 1Iospital care acconipanies him in every case, reducing its intensity to meet the requirements of lnedical necessity. Hospital quality is guaranteed to the patient at all times. IIe is as much a hospital patient in his home as his former neighbor who remained on the hospital IT-ards. The same social and scientific hierarchy stands guard over him, under the protecting wings of the hospital, ancl there is a free exchange of intra-mural and extra-mural patients on a priority basis. I n a teaching hospital, the teaching inaterial and the opportunity for teaching thus provided in a combiiiect program, are priceless. I n a hospital fortunate enough to do scientific research, the patient is under observation and controi under this co~nbined plan for a period of time which is limited only by death. Such a complete, comprehensive and continuous plan of medical care has no equals aiid no competitors in a ilemocratic society. The hospital and its out-patient department representing the intra-mural services, and the home and the substitute for the home representing the extra-mnral services, employed for the benefit of the indigent, the insured groups and those who can afford care on a n individual fee basis, can do away wiih the inequities and the indecencies nhich are still being tolerated. I n no other Tvap can the taxpayer. philanthropist, medical man of science aiid social worker generally serve the sick and the near-sick to better advantage. Select your patient. or the clinical condition from which he is sufferin?, ancl the dqctor ~vorkingin collaboration with the social worlrer can find for him in this combined plan of inedical care the place he needs most. And let me remind ~ O L Iat this point that when the problem of prolonged illness will be solved we shall know that we have solved alniozt all of the problems of medical care. We shall doubtless find that T e need less bed, withv in hospital buildings than we thought we needed hen we were engaged in expansive and expensive postwar planning only a few years ago, aiid also that T e v need more trained personnel, combined with more have. scientific facilities, in the hospitals that we i i o ~ r ~ TTTe need niore financial subsidies, more teachin? and more scientific investigation in modernized buildings which. until structural anification can be ~vorlitidout, should have the benefit of functional unification. On the other hand, the housing expert should take illto account the incontrovertible fact that better housingmeans less of a burden on the comlnunitp for hospitalization. We have oversold the hospital to the public. Fortunately the way back is inexpensive. TTith a cost of two dollars per cubic foot of hospital construction, and with the present-day requirement of 10,000 cubic feet to serve every hospital bed, the capital investment is rapidly becoming unbearable when the facility is used indiscriminately. Jforeover, the cost of n~ainteiiance has risen to unbearable heights on behalf of too many people who do not require such costly facilities. I n circumstances like these we must look t o the inexpensive bed in the home of the patient and use it to his best advantage. F a r more important, however, than the prevailing high costs of medical care is the opportunity which extra-mural hospital service radiating into the patient's home affords for the individualization of care on a personal basis. The maintenance of the identity of the patient, his privacy, his self-respect, his freedom of movement unhampered by demanding neighbors who are strangers to each other iii i:le :iospital aild liiS pi-eseilce iii ille loosoill of his fanlily in the natural environment of his home, improve his conlfort and speed his recovery. The patient has, indeed, the pleasant illusion that the hospital exists for him alone and that i t stands ready. as it indeed does, to serve him under all circumstances. Let me remind you that, with the best intentions in the world, the hospital, knowing the patient an average of only eight and a half days and applying a mechanical routine in his care, cannot help adding insult to injury. I t should not be offered as a resource unless there is no better method of dealing with the patient's problem. Home Care Cost Lower With an experience of almost three years in the field of comprehensive home care under hospital auspices, we found the cost of such care to our hospital, on a comparative basis, to be approximately one-fourth of the cost of ward care. Moreover, we have approximately one-fourth of the cost of ward care. Moreover, we have found that patients are more comfortable in their homes and we confidently expect to prove by statistics that they get well quicker at home because of the added factor of personal comfort which dominates the mental attitude of the patient and his family. I t is our hope that hospitals generally will adopt the criteria for admission ~ ~ h i I h c have outlined here, and distribute patients in warcls, in out-patient clepartments, in the homes of these patients and in suhstitutes for these homes, under the protecting wings of these hobpitals, to the e i ~ d that every mah. no matter what his age or how long the duration of his illness. will find readily available to him the exact facility ~ ~ h i c h requires to restore him to health. he �Hospitals and Our Elderly By Commissioner Marcus D. Koegel Commissioner of Hospitals, Y e w Y o r k C i t j H are places for the congregate care of the sick whether the illness be acate or chronic, and the victiin of disease young or old. EIomever, the two extre~nesof ages are often forced upon hospitals even thongh no disease is present. The hospitalization of the well baby, because society has failed to provide a lnore suitable shelter for the infailt or of the elderly, and for no better reason, con~titutes the inlposition upon our hospitals of a great burden aside from the potential and actual damage to the iiitiiiiate assoiiiiioceiit reeipieilts of uur cliai-iiS, bp ciation with disease ancl disability. r The problem of the child, h o ~ ~ e r eis, a minor one compared to the g r o ~ ~ ~ problem of the aged. I n ing dealing with this situation we mnst develop solme fundanlental concepts. One of these is that general hospital facilities should be used for the elderly requiri~ig active treatment of either a n acute or chronic illness and that some other type of acco~nlnodationis needed for the infirm aged, the physically handicapped aged or for the oldsters who are well and homeless. OSPITALS We can shout this principle from the rooftops but as long as those Other types Of accommodations are not Of patients unsuited for active care continues to tie up haspita1 beds and services. o u r adult general hospital population has undergone a shift in age distribution in the direction of the older age groups. This is not unexpected TT-hen one considers the increase in the percentage distribution of the elderly in the general population of Kern Y ork City. The 1948 population estimate assumes n total . of one-half a nlillion people (541.678) 65 years of age and over which is more than double what it TTas in 1930. Older people get sick more often and stay sick for longer periods. As Professor Ginzberg so aptly puts it, by lengthening the average span of life we hare "traded a lessened inortality in the earlier years for a n increased morbidity in the aged." Glamour Cases Our general hospitals do not take kindly to the elderly sick. They have been geared to the dramatic illness, the crisis, the hectic flush, the high fever. Our whole philosophy is one of youth and glamour and plenty. The aged patient brings apathy, garrulousness, irreversible danlage and incontinence. None of this is pleasant. Our reorientation inust begin in the schools of medicine and ill the schools of nursing and me must find som~ illeans to a ~ ~ a k e the present schools of l~ursing iz and we niust find some means to awaken the present generation of practitioners to a greater interest and a more dynainic approach to the problems of the aged blCli. An important reason for the disinclination of the general hospital to treat the oldster is that there is often the strong possibility that the bed will be tied np indefi~iitelj-. Delays are frequent in discharging elderly people after they have received the maximum benefit from hospitalization. Often there is un~villingiiess 011 the part of the patient to exchange the of sheltered e~lvirolinle~it the hospital for the discoinforts of a hoine long since preempted of affectioil or warmth. Then there is the resistance on the part of the family to the return of the aged one to the fanlily hearth. In a city such as onrs with restricted accomnlodations and every cubic foot of space worth filial derotioll at a low, the burits ,eight ill gold den of care of the aged at hollle lllay become intolerable. 1 There is one segment of the elderly sick whose reception in our general hospitals is downright hostile. I have reference to the senilepsychotic, ~h~~~is no hiding place for this unfortunate individual and irrespective of the physical condition, he is summarily relegated to a facility for the care of the insane, M~~~ mental conditions of the aged are transitory but the disturbance must be brief indeed if the patient is to escape the stigma of commitment to a state institution, I do not propose that the municipality assume the responsibility for the patients with personality disiiitegrations and psychoses which have every appearance of being permanent. We must however develop a more coillpassionate approach to the short-lived episode of confusioli ancl disorientation so often a conconlitant of niedical and surgical ailments in the elderly. 106 �riers which render access to clinic services a nightinare to the disabled and infirm. Above all, the bustle and the hurry and the attitude of clisinterest and irritation will have to be replaced and the elderly patient made to feel that he is ~vantedaiid that the hospital services are there to benefit him. Five-Point Program What rearrangelllent is necessary so that the general hospital may adapt itself to provide properly aiid economically for the steadily increasing number of aged patients ? 1. I t should develop a chronic disease wing or unit where the aged patients can be transferred as soon as the acute episode of the illness is over and prior to transfer to home care or discharge to home, to a nursing home or custodial institution. The close relationship of such a ~vingto the general hospital will make readily available all of the hospital services aiid good care can be furnished the patient at a cost ninch below that in the acute section of the hospital. 2. I t should provide a sinall suite of sound-proof rooms and ancillary facilities for the temporary care of the non-cl~stodia! psychetic. 3. The general hospital must organize a dynamic prograin of rehabilitation which in the aged will be geared to develop in the patient the ability to meet the daily demands of living aiid to restore hini to the greatest degree of usefulness and self -sufficiency. Idleness and inactivity encourage deterioration aiid a breaking dow11 of inorale; therefore, if planned activities and iilterests are available, mental and physical deterioration is less progressive. I t is well for these patients to know that while they are ill there is a definite plan for their rehabilitation-a program of activities, which will within their area of accoiliplishi~leiits. help them to re-establish the normal pattern of living and restore feelings of confidence and self -respect. 4. An active home care prograin must be established. The exteiisioil of hospital care into the home is no longer in the experimental stage or on a demonstratioil basis. The highly snccessful program of the Departinelit of Hospitals ancl the splendid pioneering efforts of the JZontefiore Hospital in Ken- York have established home care as a necessary tool i11 any system of coniprehensive hospital care. 5 . The general hospital inust strengthen its serrices for the care of the ainbulatory patient and make it possible for the ambulant aged to receive prompt attention aiid good care in its Out1 patient Department. I 1 order to insure the inaximunl utilization of outpatient services i t may be necessary to derelop a voluntary motor corps for the transport of the elderly to and from their homes. Thought d l hare to be given to the elimiiiatioii of the architectural bar- TfThatever the initial outlay for these changes, the end results ill reflect great savings. The bottlenecks which tie up actire hospital beds with inactive patients, the liiental ancl physical deterioration of the neglected elderly patient-all these will cease. Reorganization Only Part of Answer Uiifortunatelj-, however, the problerti of llospitals and the elderlp is not solved with the reorganization and niodificatioii of the services in general hospitals. rn-;l--- LL- -.-r:-.-c ~ u u a L ~ L Cpalilcllli j --.-.. z c .---I,,, U V C L ud lllantlh .-, ,I-.,,+ up - ., +, , , ., aulluhli I ~ J C L~ ~ . l l l i of the population of Nen- 5Prk City. By 1960 he is expected to account for 9 per cent of the total population and by 1980 for over 1 per cent. 1 To supplement the chronic disease service of a general hospital we still need in a city such as ours a hospital of the type of the Bird S. Coler &Temorial Hospital. This 2,000 becl facility n o v going up a t the north end of Welfare Islalid mill provide the outlet for the chronic clisease units of the general hospitals. I t will take the betlridden chronically ill and aged patieiits, the handicappecl and the infirm for whom other arrangements cannot be made. This will be by no ineaiis considered the end of the line, for the most active rehabilitation program d l be developed. Care nil1 be individualized aiid every effort will be made to get the patients out of bed-to take care of themselves aiid restore self-confidence and some measure of indepeadence. Affiliation of the hospital with a medical school will assure a continuation of professional interest aiid the availability of eren the most highly specialized iliedical services. Experience has taught us that it is uiir~ise isolate a hospital of this type geographic all^ to from the professional skills that are required to serv1 ice it. I 1 fact. the closer this type of hospital is to a general hospital the better for all concerned becanse it is then possible to integrate the services with a general hospital and to arrange for the rotation of the house aiid resident staffs through this unit. To maintain the interest of the professional staffs it is iinperative to provide incentives in the ;'orin of research facilities. This not oiily attracts good inen to the hospital but pays valuable dividends far out of all proportion to the sinall investment in space and equipment. At the Bircl S. Coler Neinorial Hospital we not only failed to do this but we were lax in �planning adequate X-ray and laboratory services. These deficiencies will be remedied. Actually it was no one's fault. Onr thinking hadn't crystallized to the point where we were sufficiently sure of ourselves. We know now that the apathetic era of care for the chronically ill belongs to a bygone day and that we have now entered a new age when the most hopeless patient is approached in the spirit of hopefulness and with an enthusiasm and zeal that transcends all difficulties. I n a city the size of ours there is room for still another type of hospital in which the elderly make a p a considerable proportion of its population. I have reference to a research center in chronic diseases of the type of the Goldwater Memorial Hospital. This was planned as the laboratory where selected patiepts and selected diseases would be studied so that some light could be shed on the aging process and the long term illnesses that plague our people. Here new techniques would be developed in treatment and specialists and technical personnel mould be trained to take care and take their place on the staffs of other hospitals to practice and teach what they have learned. Unfortnnately the numbers of chronically ill, aged and infirm grew rapidly to such large proportions that in no time they choked the adult services of our general hospitals and flowed over and inundated all of our hoines and units designed for their care, iner cluding the G o l d ~ ~ a tll'lemorial Hospital. As a consequence, the research activities of the Goldwater l'lemorial are limited and this great hospital will not be able to fully carry out its purpose until our construction and modernization program has been considerably advanced. I 1 spite of all handicaps, however, the Goldwater 1 Jleniorial Hospital has made many significant and fundamental contributions. Full justice cannot be done to the subject of hospitals and the elderly without some discussion of the special needs of the aged and what specifications are required in the hospital environment to meet those needs. Special Environment Factors The aged require a familiar, pleasant and homelike environment with more than the usual physical comforts, protection from accidents, and special psychological and emotional support. Physical comfort inclades such items as warmth, good lighting, an adequate place for personal possessions, easily accessible toilet and bathroom facilities, privacy (small units), quiet (soundproof 'areas), comfortable furniture, suitable clothing and shoes in good repair, between meal snacks if and when desired, a magnifying glass and hundreds of other little things which make for comfort and which are of paramount importance to the elderly. Protection from accidents is particularly important in this group as older bones are more brittle, older eyes are less keen and the recuperative powers of older bodies are less responsive. Protection from accidents implies attention to well-lighted stairways and corridors, stnrdy railings in good repair, ramps where possible instead of stairs, stairs free from impediments, non-skid floors, rubber mats in the bathroom for use in the bottom of the tub to prevent slipping, thermostatically controlled ~vater,plumbing in good repair, hand rails and elevated rests in bath tubs to eliminate the possibility of slipping and to make getting in and out of the tnbe less taxing, electrical eqnipment in good repair, wires completely insulated and sturdy plugs and switches conreniently placed to eliminate the need for searching for them i11 the dark, low beds for the ambulatory patient to prevent falls. Furniture in the patient unit should not be too hard and not too soft, not too high and not too low. I t should be anchored, as the elderly patient is apt to lean against beds, tables and chairs and lose his balance. Armchairs should be provided. TVherlchairs should be equipped with special foot pedals. hfechanical devices facilitate lifting heavy, helpless patients from their beds and prevent injury to workers. Beds equipped with protective sides prevent falls from bed. Doors sufficiently wide to admit wheelchairs permit easy transportation of patients. Furniture should not be moved after the older person retires so that if he awakens during the night he will not be unfamiliar with the arrangement. Night lights eliminate the confusion caused by darkness. All of these are means of protecting the elderly against injury. The older person must be encouraged to give thought and attention to items of personal hygiene. Good planning of the bathroom and toilet facilities will help the oldster take better care of his personal needs. Bathrooms should be equipped with movable shower sprays and the cubicles should be sufficiently wide to permit the entrance of wheelchairs. I do not know the solution to the bathtub situation except to eliminate bathtubs. However, we need bathtubs at the appropriate height for the ambulatory patient; at stretcher height for bed patients; low tubs for arthritics so that they can step into them without danger and portable tubs for patients who cannot be transported to the bathroom. Some day somebody will actually take the bull by the horns and eliminate all bathtubs. The toilet stalls must be wide enough for wheel- �chairs and hand rails must be provided so that the patient can support himself. Commode-like toilet seats are necessary. Call bells should be provided in all areas, and patients taught their fnnction. Wash basins and mirrors should be placed a t a convenient height to enable wheelchair patients to use them comfortably. Feeding the Elderly Patient The elderly patient offers a challenge to the dietitian who has adranced to the point where she is ready to revise the old concepts and discard the practice of lilniting their diet to the bread, tea and applesauce regime which has been too long a common and widespread procedare. I t is essential that the nutritional elements of a n a d e q ~ a t ediet Fe s~ppliec! generens amounts, and in in a form which can be masticated and digested by the elderly person. We in the Department of Hospitals have in recent years accepted this challenge and completely revised the feeding program in the units devoted to the care of this group. The menus were greatly expanded to insure a higher nutritional value, a greater variety of foods mras provided, and the preparation of many foodstuffs elaborated. Specific food increases included a greater allowance of milk, ice cream and other dairy products, more citrus fruit in a form suitable for the aged, a wider variety of frozen and fresh fruits and vegettables, larger allowances of meat, poultry aud fish and a wider selection of desserts and food adjuncts. The size of the portions were somewhat reduced in order to allow for the patient's capacity. Too much emphasis cannot be placed on the improvement of the food's appearance, the adjustment of tableware and catlery to the handling abilities of the elderly person, and the decor of the dining area. Certain structural arrangements must be made for feeding areas-gently sloping ramps leading into the dining rooms, or small dining roonis close to the patient's bed location, wide aisles between tables and specially sturdy construction of chairs and tables. Table service is usually the wisest choice for elderly people, but where the psychological aspect of self-help is important, partial cafeteria service can be effective therapy. I n hospitals where the stay of the chronically ill or the elderly is prolonged and the number to be cared for is great, beauty shops must be provided for the ladies and barber shops for the men. The ladies also need readily accessible to them a place to wash intimate personal things. There is a great need among the elderly patients for recreational and social activities and they should be given the opportunity for religious observance. I have carefully steered clear in this presentation of the public home for the aged ancl the nursing home. Both these facilities are essential elements in a program for the elderly. The large nursing home in fact often approaches closer to the hospital and our public homes frequently become filled with sick aged who overflow their infirmaries and should be in hospitals; oii the other hand the chronic disease seivice of a Feiiera1 hospital or the chronic disease hospitals have illany patients who reqaire only shelter and affection. The nursing honles can stand considerable improvement in the quality of care they render and this is an area in which we hope to exert some inflneiice in the future. 7JT,'\'e Tery anxious to develop a type of asare sociatioil ~vhicli will perinit us to transfer to the nursing honie from the hospital patients suitable for home care but who do not have a proper home. Today our home care prograill is limited to patients where the home environment is suitable for the extramural care. The hospital care of the aged is merely one facet of a large problem. A major effort of the community should be to keep the aged a t home as long as they can be kept there with comfort and safety. Serious thought should be given to~vards the provision of dwelling units and commul~ity services designed especially to make the same possible and ererp assistance should be rendered to simplify the extension of hospital care into the honie when this becomes necessary. We will never have enough hospital beds for the aged sick or public homes for the homeless aged if the individ~lal permits himself to be easily swayed to surrender to the community the very personal responsibility w~hichis his for the care of the aged and infirm. No public home can ever take the place of the family hearth and no hospital bed can ever compete for comfort and security with the bed in one's o m home. �The Physicians ' Contribution to a State-wide Program for the Aged By Dr. Frederic D. Zeman Chief of Xeroice of the Home for Aged and Ilafivm Ilcbrezr~s,S e i o 1-ork C i t y T I3h WORI) "geriatrics" is an extremely useful \lord, gathering into a very short space a number of varying concepts. But the word geriatrics should not be interpreted to mean that the care of the aged is neces\arily a meclical specialty, for actual!:,- al! the medical specialties \%it11 e2ice:)rion of tilt: pediatrics and obstetrics have to clo with olcl people in one way or another. Furthermore, it must be realized that these problems are increasing so rapidly that v e inay reasonably expect that the care of the aged is going to. in a very short time, comprise 7.5 or 85 per cent of v h a t we call internal medicine. I t is, therefore, worth while today to discuss what the phj-sician's responsibility is in relation to these problenls and to point out the many ways physicians come into the picture, and, fartherniore, to point out something as to what physicians have been doing in this State and throughout the Nation. Abont two years ago I spoke before the Annual Conference of the New York State Conference of Social Welfare a t Buffalo on a state-wide program for the aged and the chronically ill. ,It that time 1 drew up as much for my own information as for the information of my audience a cliagrani which indicates the set-np or the possible set-up of a state-wide program. Socio-Medi'cal Aspects Now. I have been very fortnnate in m y own training. I was taken in a t a very early age by a very remarkable group of social workers associated with the Welfare Council of New York City. LInd,through their efforts and through their continued queries, I was led to go further into the social aspects of these problems than many of my colleagues, and so thereafter I began to be confronted with t ~ concepts. o One is the general principle of the Welfare Council as a coordinating agency for all of the activities in a community, and, secondly. the principle of a central control bureau for the care of a particular group in the community. I was helpful a few years ago in setting up such a bureau for the care of the Je117ish aged in New York City, and this bureau has been functioning niost successfully under the direction of Miss Flora Fox for a periocl of pears, now, and it serves as a central office where old people in need of assistance can not only find information bnt can be examined, their f~ulctionalcapacities can be deter~~lir~eci, advice can be given to thein on the basis and of a careful meclical and social service study. Now. as chart indicatesj yon xx-ill find n n thp tnpnlost level the Legislature of the State, nleaning the Cllovernor, the Senate and the Llssembly-all the elected representatives of the people-and, i n association with thein on this highest level I have placed the State I3ealth Department, the State Departinent of Social Welfare, the State Department of Mental Hygiene and the State AIedical Society. These groups would sencl, according to my plan, delegates to a State Counc.il for the Aged and the Chronically Ill, and the State C'omlcil ~vo.tlldwork in each community through a Local Council or Welfare Conncil for the Aged or Chronologically Ill. l'ou mill be interested to see how many agencies in each community ~vouldnaturally share in the work of the local XTelfare Council. You will find that immediately involved are the hospital service-social service departments, private social m-elfare agencies, the Red Cross, the Visiting Nurses Associations. the County Medical Society, and the city or county health departments, the city or county public ~velfaredepartments, and mental hygiene agencies. That is a very large and diverse group, and each one is particularly interested in certain aspects of the care of the aged, and each one has a definite and important caontribution to make. Therefore, their co-nrdination, the integration of their activities, is something wc must try, as citizens, to accomplish. These agencies, working together, would then set up a Central Bnrean, and that 1170uld have a medical and social service staff, and operate out-patient departments. They would also operate recreational agencies for the aged, which have been so successfully designed in this city by the Department of Pnblic Welfare under the leadership of h l r . Harry hevine. Sheltered workshops wonld also be one of their functions, but I want yon to realize particularly the other agencies that uronld be involved : the general hospitals, �AN INTEGRATED PLAN FOR THE CdRE OF THE CBBONICALLY S I C K AND AGED I N NEW YORK S T A T E BY FREDERIC D ZEMAN. M.D. . I STATE LEGISLATURE SENATE ASSEMBLY 1 I I I STATE DEPT. OF HEALTH 1 I STATE DEPT. OF S O W WELFARE ,----I I L---- STATE MEBICAL -----' 1 L STATE COUNCIL FOR AGED AND CHRONICALLY S I C K I STATE DEPT. OF MENTAL HYGIENE r----- I I VISITING NURSE CITY OR COUNm FORAGEDAND CHROhlCALLY SICK ASSOCIATION MEDICAL SOCIETY HEALTH DEPTS. w HOSPITAL SOCIAL PRIVATE SOCIAL SFASVICE DEPTS. WELFARE AGENCIES - MEDICAL STAFF j j I I ---..- w n v...r h i -.--- ) . ~ I nl ---. I OVC- 1 . WELFARE DEPT. I r '----T-----' - MENTAL HYGIENE AGkXCIES I - . ) RECREATIONAL SHELTERED WORKSIIOPS AGENCIES FOR AGED GLVk.RAL POSPITALS r-,,-----u----- L ---,I I STATE HOSPITALS -I b I----1----' ,----, A,,--CAEP PRIVATE U PUBLIC I LWIVLRSTY MEDICAL SCHOOL STATE HOML STATE GLKONTOLOGl RFS-CHLALI. I I ' ! I I I E R SPECIAL HOUSING F O R A G E D AND CIUlONICALLF ILL L,--------- public and private. As Dr. Monroe pointed out, the general care in the hospitals has steadily increased. Two Inen on the staff of Bellevue not long ago wrote a n extremely interesting article under the title of, "The Patients Are Older and Stay Longer." Then, coupled with that, yon have the private homes for the aged, the state hospitals for the mentally sick, the state hospitals for chronic illnesses, and the university medical schools. Then it would be necessary to include a State Gerontology Research Laboratory as 1 ~ 1 1 special housing for the aged and chronically as ill. SOII-,you see, many of these agencies are already as in existence. It would be necessary to create certain neli- ones, such as the State Gerontology Research Laboratory. The state hospitals for chronic illness. I believe, may be on the way. They have been highly recommended by the Health Preparedness Conl~nission of this state. . PRIVATE HOMES FORTHEAGED - STATE HOSPITALS FOR MENTALLY SICK I I 1 1 Note: Existing agencies are indicated by solid lines. Proposed agencies are indicated by dotted lines. The home care program is something we should give a great deal of attention to. It is actually the future hope for the-care of the aged. We have set up such a bureau in the Central Bureau for Jewish Aged, and in cooperation with the Jewish Family Service, particularly through their home-maker's service, and under our home care or extramural program, as we prefer to call it, we provide for old people in their own homes, visiting physicians, visiting nurses, visiting houseworkers or homemakers, and we hope, in time, to supply visiting occupational therapists and visiting volunteer visitors. The number of old people is increasing so rapidly that institutional care is no longer possible, even if i t were desirable. I t certainly is not desirable except for people who are chronically ill in one way o r another. Our whole effort must be to extend this home care program. But I want to say, however construc- �tive theoretically this home program is, it presents certain defects from the standpoint of the mental attitude of the prospective client. We have found from experience when old people come to us asking adniission to the home they only do so after they have spent long hours of soul searching, long hours of study and discussion with the family, and when they have finally made np their minds they want to go into an institution they will not be pnt off with a substitnte program. I t is, therefore, necessary that we educate the public in the ways of the home program, and one of the ways ~ v edo that is to assure our home care clients when the time comes they need institutional care they will have a first priority on the services of the institution. Attitude of Physicians pitals to operate on patients over 80-and to \)perate on them successfully. And the two most important things that contribute to that are improved anti-operative and post-operative care, and improved anaesthesia, and the use of anti-biotics and the abundant use of penicillin and plasma. The physician's responsibility is in his institutioiial work, in his work in the general hospitals, in the hospitals for chronic diseases, and in the homes for the aged, too. The homes for the aged, as presently constituted, form a great area for the practicing young physician to earn his reputation. They contain material which is, for the most part, untoached for the physician with an iilvestigative turn of mind, and which will afford him the opportunity of doing ~vork of real value. Now, the physician in iiidnsti-y has a respoiisibiiity to old people because it is up to the physician to decide what a man's functional capacity really is because, as this Committee has so widely publicized, birthdays don't really count-it is what a man can do really counts-his functional capacity-and it does not parallel the number of years yon have spent upon this earth, as we all know. The physician has a great responsibility for education. At the Home for the Aged and Infirm Hebrews we are conducting a course for graduate physicians and have, for the past five years and, with my colleagues, we give about 18 hours each semester, under the auspices of the College of Physicians and Surgeons, given partly at the home and partly at the Mt. Sinai Hospital, in the care of the aged. The registration is gradually increasing-although I must say the biggest registration we had was in the first two years after the war, when men could take the course under the G.I. Bill of Rights. I n addition, we have at the home an affiliation with the Division of Nursing Education of Teachers College, Columbia University. I think it is greatly to the credit of the educators that they realize that the work later on of the nurses is going to be largely working with the older people. We started off two years ago with a one week course for those people studying for higher degrees of nursing in Teachers College. That work has been extended to a two-week course, one week of which is devoted to work in our occupational therapy department and the second week to taking care of old people. I n addition, we now have student nurses sent down just briefly for a'visit from the St. Luke's Hospital and Presbyterian Hospital. Which shows that these teachers of even undergraduate nurses appreciate the significance of the problem. I want to point out particularly that the physicians of this state and the physicians of the Nation are deeply and profonndly interested in and aware of these problems. I have had the same experience that Dr. Monroe has had with colleagues who seem to think that they can still practice on what they learned in medical school about old people, and who seem to think there is nothing more that they can learn, even today. I have also had the experience of being treated with rather poorly concealed contempt and condescension by some of my colleagues who can't understand how I can possibly be interested in old people. Actually these men are missing ont on one of the great experiences in a physician's life if they have never had the opportunity of taking care of old people. Whereas the younger person expects everything as a matter of course, the old person is so used to being pushed around by his family, and so forth, than when he meets a physician who brings to him the understanding that Dr. Monroe does, for instance, he is put a little off balance and he doesn't know just how to take it, and his gratitude is something that is really touching and puts the physician distinctly on his mettle and makes him think that this is a human being for whom he must put forth his very best efforts. As Dr. Monroe pointed ont, today me are able to do most important things for people medically. The control of infections of old age by antibiotics has changed the picture completely. The death rate from penumonia has dropped spectacularly. A fatality from disease like erysipelas is almost unheard of nowadays, and it is possible to treat infections of the genitourinary tract and infections of the peritoneal carity with the greatest success. There was a time not so long ago that a surgeon who would operate on a Research Needed patient 70 years or over would have been looked at askance by his colleagues-as one who had an itching The need for research does not need to be emphascalpel. Today it is a common practice in your hos- sized or enlarged upon. We have gone a long way but �there are still many basic, fundamental problems to be explored. The research in this department must be forthcoming in order for us to make further progress. And that brings me to the responsibility of the physician as a member of the district professional societies-as a member of the county, state and national organizations. These organizations are also doing their part. The American Medical Association has co-operated with the American Public Health Association and two other national organizations in setting up the Committee on the Care of the Chronically Ill, which is about to start functioning under the leadership of Dr. Alorton Levin, late of the New York State Department of Health and the Executive Secretary of the Health Preparedness Commission. The New York State Society has a Study Committee on Geriatrics and the New York County Medical Society has a Snb-Committee on Geriatrics, headed by Dr. C. Ward Crampton. So that I think you will realize that these problems of the aged require intense and hearty co-operation between physicians and the social workers and the nursing profession for the proper functioning of any kind of set-up that is devised for their solution. I think it is interesting to realize that the very first group in the field met at a meeting of the New York Academy of Medicine in 1928, and at that meeting some of the noted authorities from this country and from England spoke and really gave us the first impetus to the scientific study of the problems of the aging in this country, svhich culminated some 1 or 12 years later in the publica1 tion of the work of Dr. Cowdry "Problems of the Aging," which has gone into a second edition and is just about to go into a third edition, and which actually forms the Bible and reference hook of physicians working in this field. �The Functions of a Geriatric Clinic By Dr. Robert T. Monroe Peter Belzt Brigham Hospital, Boston, Massachusetts 0 is the time of life when persistent diseases occur most frequently, and when scars of accidents and disease, and deficits of all sorts, steadily accumulate. No one, in fact, can live beyond middle life without showing some evidence of the ravages of time. And so, old people are the big problem in our hospitals and other institutions. I n the Peter Bent Brigham Hospital, with which I am connected, one in every three medical service aclmissions is over 61 years of age. This hospital does not take children under 12, and the proportion of old people in general hospitals probably is less, but it is not likely that they are under one in five. A survey of the almshouses of Massachusetts four years ago showed that two-thirds of the occnpants were over 65 years of age, and two-thirds of them were bed Or semi-bed patients. I would guess that age-composition of our nursing homes is equally weighted in favor of old people. Yet old people malie up less than 10 per cent of our population. Old people need their full share of hospital facilities. They respond as favorably to the anlazillg antibiotics as their younger neighbors. Surgical procedures are now about as safe for them, also, and they need no longer be denied curative or palliative operations because of age. A very great im~roven1elltin the quality and the duration of life is available to them. But I do not believe that they need as large a percentage of our general hospital facilities as they now preempt. I t is obvious that many sick old people go to hospitals for minor troubles because they have nowhere else to go. This is a waste of both money and space. For hospital study and care are the most expensive form of medical service, and in many areas there are too few beds to permit them to be occupied without regard to a priority of needs. When we have hospitals for chronic diseases, and wards for the same purpose in general hospitals, they will be used very largely by old people. I n them we can take excellent care of patients with complications of diabetes mellitus, others with persistent heart or kidney failure, and those with fractures and arthritis. They can be our best resource to study the means for rehabilitating patients with paralysis and inadequate circulation. But, again, we mnst guard against their becoming repositories for terminal care. I t is unlikely that we shall ever have so many beds for chronic LD AGE disease that we can tolerate indefinite residence in them. N~zrsinghomes enter the pictnre here. Some will be for custodial care of patients who have been demonstrated unable to improve on active treatment. Other homes mill be for the advancement of convalescence to the point where families can take over. Still others may be for minor acute illnesses, such as grippe and sprains, in patients, especially old ones, whose resources at hoine need such supplementation. If enough of these nursing homes are administered and staffed by local general hospitals, the quality of their care will raise the standards of all above their present deplorable level. Geriatric Clinics Needed This con~pletes list of buildings that seen1 to be the needed to provide for all types of medical care, Yet one needs little acquaintance ~vithold people to see that there must be one more facility. That is a clinir set especially for them-geriatrics clinic, if you wish, ~t is the purpose of this paper to describe its functions, and it is based upon 10 experience in one. TYe are Tvell axvare of the value of heart clinics, cancer clinics, Tvell-baby clillics, gnidante clinics. and Illany others. I beliere that geriatric clinics will become as useful time. in The functions of a geriatric clinic are three, in general. I n the first place, it fosters the maximum physical fitness in old age. The disabilities of old people require only occasional bed care. Most of the time the patients are able to be up and aboat. and it is at this level, in these intervals of relati~elylittle trouble, that much can be done to promote health and stave off the recurrences. TT7hen a patient has recovered from heart failure or a coronary artery occlusion. he needs to be seen frequently if he is to regain confidence in living and to learn what he can do and what he cannot do. His heart disease is not cured in the sense that his heart loses all traces of trouble, but in the great majority of instances that heart can give a satisfactory acco~mtof itself for a very long time. Most old people have high blood pressure ; they, too, need to report frequently to learn that it is not dangerous or disabling. JIost old people have pain that suggests arthritis and all of them can be sho~vnto hare the degenerative changes that are called hypertropic arthritis. Yet the correction of postural and 114 �other mechanical stresses. and constant instruction in the need for exercise &nd physical play, relieve most of them. Physicaltherapy is helpful but not often necessary; it cannot take the place of teaching old people how to regain comfort and the exhilaration of active normal living. Patients with peptic ulcer need frequent consultation, to be sure that they eat normally and regularly, and to catch the significance of symptoms that might mean activity of the nlcer or other indigestion. The diabetic needs regular review of his diet, his insulin dose, and his general status. The old man who has had a stroke does better if he is coached to restore function in paralyzed muscles or to develop substitute function in others, and to face the future without undue fear of other strokes. ?Ilp esperien1.e has been that these, and other chronic cliseases. can be kept from progressing, or can be kept at tolerable levels, and patients can be maintained in independent living outside of hospital sitaations to a surprising degree, by reguiar visirs to a geriatric clinic. The difficulties of seeing. hearing anc1 111os7ing about. which we assume must come with pears, lnakes other old people, withont obvious disease, relax their grasp upon objectire living. They, too. perform better TT-ith witable mechanical contrivances and with the will to play that coines from ability to plan. This is the liioclern meaning of Juvenal's phrase "JIens sana in corpvre sano," a sound inind resides in a sonncl body. The second function of a geriatric clinic i~ t o offer general guidance to old people. Probably few of us enter upon old age with delight. The general custom is to shudder as we come into each decade, starting ~vith age of 30, and to have well developed fears by the the age of 60 that we are losing or soon will lose mental competence. We picture the farther reaches of age as a twilight darkening into night. But the facts are not as bad as fancy. A recent statistical survey of 8,000 men and TI-omenover 61 years of ape. ~ h were studied on the medical service of illy hoso pital over a period of 30 years, revealed that only 2 per cent were senile, 1 2 to 15 per cent more had arteriosclerotic psychoses, and about 10 per cent had temporary psychoses in relation to serious bodily disease. Most of the rest of these individnals, around 70 per cent, were normal mentally or depressed by their circumstances. The reactive depression, then, looms as the big hazard to normal functioning in old age. The loss of a spouse, the loss of family or friends, the loss of a way of life. the loss of a job and econonlic inclependence; the necessity for resort to charity, lack of resources to express a n aptitude or make new attachments to life, preoccupation with pain or difficult breathing, inadequate care in illness, inadequate contact with surroundings due to poor eyes and ears, are a few of the causes. Malnutrition, whether from disease. from poverty, from faulty habits, or loss of appetite due to sadness or lack of incentives to eat, adds - to the clepression. The vicious circle is made to spin faster by sympathetic friends and physicians who take old people a t their face value and say, "At your age, what can you expect?" Empathy and Sympathy The geriatrician knows that empathy is better than sympathy. He has the difficult task of looking through both ends of a telescope a t once. He focuses as sharply as he can upon the mental or physical disease of his old client, and he does all that is possible to improve i t ; and he uses a wide-angle lens upon the total circumstances of the person n7ho has the disease. He kno~t-sthat satisfactory adjustmrnt to persistent disabilities and deficits map be attained only after the patient's general health is attended to or after life has again come to have value and interest for him. Happy degrees of recovery are possible eT-ely age, ULLL '1"- I---' ----.-I,.,. L ~a~ t; to be obtajiied LLLC UW,L L C S U l~ among persons in early old age. Here is a field of preventive medicine that is, currently, practically untilled. KO geriatrician can do i t all alone. Hib clinic innst provide hiin ~ ~ i many resources or he must t h hare access to them. I n or near the geriatric clinic there must be a physician who can assess the capacity and the mental \tatus of an old person accurately without bias. Only thus will nlistakrq he aroirlerl which arise from acceptance of his impracticable day-dreams or from dismay with his present situation. I n other words, harm can be done by untutored uplift as me11 as by a fainthearted spirit. One who dares to advise a n old person iiiust know the facts and abide by them. Next, the clinic must have access to means for re-education. So~needucation can be directed tovard new jobs, to the development of hobbies and handcrafts. Adult rducation courses in public schools and as private ventnres are available for a few; they will have to be directed more particularly to old people if they are to fulfill their needs. Old people need general education also. TI-e must reinenlber that education is a drawing out process, an unfolding that can be made t o continue as long as life lasts. I t is most effective in association ~15thothers. Public library lectures have been shown to be useful i11 Cleveland. 1 hope, erentnally, that regular classroom work can be instituted for old people who wish replenishment and reactivation of their minds. The geriatric clinic must have a n agency that can place old people in jobs. Normal old people mish to ~i-orli, be useful, to be independent as long as posto sible. Those who do not, have a psychological or physical impediment worthy of correction. Present difficulties in finding employment for old people demand solution. For denial of work means sentencing an old person to charity and its psychological trauma "--A - - A �or to existence on savings and pensions with isolation from active society. The clinic must concern itself with the living situations of old people. I t must find quarters for them where they can have harmonious contacts with others, where they can be assisted to maintain independent homes by making housekeeping and shopping easy. I t must see to it that optional diets are possible and that appetite is stimulated by sociability. These are difficult goals to meet, and lead us to plan for special housing facilities for old people. The clinic, in its program for rehabilitation, mast also seek to provide social association for those who have lost family and friends. Therefore it is interested in the formation of clubs in churches, schools and other neighborhood locations; it tries to find opportunities for physical play on public playgrounds and perks, 2nd in scjuare dances and bowling alleys; and it hopes to promote reasonable vacations in the country or on the seashore. These are the tools for general guidance. All these activities are slanted toward the poor because there are so many of them. I t must be recognized, hoverer, that the independent and wealthy are equally in need of rehabilitation and the means to procure it. And it cannot be emphasized too often that our attention should be directed primarily tom-ard preventing and repairing the breaks which produce physical and personal deterioration in old age. The third function of the geriatric clinic is research and teaching. The field of research is broad, as already shown. I t involves studies along social, psychological, educational, occupational, recreational and financial lines. I n the more narrov field of medicine, the clinic must collect statistics on the incidence of diseases and disabilities of all kinds in old age, and discover important interrelationships. They are profuse and valuable in pediatrics. I t must produce a new medical history form, because the old patient's past experience with accidents and operations and disease mean much in his current standing, and because his family relationships, occupation, education, social resources, living arrangements, food habits and daily schedules show what he is. I t takes an hour to produce a good history on middle aged patients. I t takes four or more interviews of an hour each to produce one on an old patient. I t is time veil spent; it is, indeed, indispensable if the patient is to receive intelligent care. I n the physical examination, the clinic needs to study the significance of such items as changes in body weight, changes in blood pressure, variations in vital capacity, the sensitivity of the carotid sinus, the status of the peripheral circulation, and the integrity of the main nerve pathways in addition to the usual complete survey. I n the laboratory, the clinic wishes to obtain data that will help to identify aileinia and diabetes early, and by X-ray films to pick up any form of pulmonary tubercnlosis. Therapeutically, the clinic can study proper methods of caring for minor illnesses and for persistent disease and disabilities, and it can learn what happens over a long period of time to old people who are supported in their illnesses and their total situations. At present our textbooks contain little information and much nzisinformatioii on these points. Pharmacologically, the clinic studies the differences caused by age in dosages of drugs and in the selection of sedatives and analgesics. All of these projects are planted most fruitfully in research and teaching institutions. They have the resonrces in equipment and workers, and they have the drire and the critical capacity which the geriatric clinic: needs to share. I 1 them the geriatricians can 1 secure opportunities to supervise the care of old patients on t h e hospitr! v:zrds tzs YC!! as i the outi i door department, and in them medical students, house officers, nurses, social workers, physiotherapists, dieticians and others can come to understand old people. But chronic disease does not attract ten1porar.v researchers, 1~110vish short problems, and old people are so coillplex and individual that they usually overwhelm beginners in medicine. I have not been able to produce a single disciple so far. Discounting personal inadequacies, I blame this failure on the youth of medical students and the fact that I do not yet have the clinic services in full operation. When me do, I have confidence that me can employ the services of st~tdents all sorts for short periods and make the of experience an exciting ancl useful one to them. But since there are many old people in every locality, it seems proper to suggest that geriatric clinics be established in every general hospital that has clinics. They should also be placed in community health centers, and, when me get them, in old age housing projects and old age centers. The more of them there are. the more adequate xvill be our real knowledge of the problems of aging, and the more we can claim that there is a science and art called geriatrics. Staffing the Clinic As to personnel, the geriatric clinic needs, first of all, a physician ~villingto study chronic diseases and the wide-ranging influences that bear upon old age. Without him, there is no clinic. He ought not to be hard to find, now that we are beginning to realize the functions of the clinic. The second indispensable member of the clinic is the social service worker. She knows much more of the human side of old people than doctors do, and she can unlock the community resources that are available. The other members �of the team can be borrowed on part time from the etical and complicated, and that it presupposes a nonhospital or parent organization. They are a clinic existent faith in the value of old age and a degree of secretary, a laboratory technician, a dietician, physio- cooperation from old people that is doubtful. I agree therapist and psychologist. A nurse is necessary if only that these ideas are not yet demonstrated in opmuch treatment is done or if supervision is extended eration. I contend that they are sound, that the to the homes of the patients. faith in age can be evoked in most of us, and that old My friends object to all this saying that they are people will respond when they find the understanding more geriatricians than I am because they can take guides. I t is hard work, for it must be with individcare of more old people than I do, and that there are uals, and not with large groups; and it does not also many oldsters that we must rely upon the general ways succeed. But it is satisfying work, and the qualpractitioner to do the job. Granted. But this as- ity will improve. Finally, it is objected that the sumes that there are enough general practitioners, clinic is very expensive. I t need not be so at first. that they are alert to the problems of age, and vigor- Even with all the workers and resources that have ous in their attack upon them. The general practi- been mentioned, the annual expenses vould be met. tioner learns his pediatrics from child specialists and in terms of community cost, by the rescue of no more clinics for children. We must produce clinics and than a score of old people from charity and their resspecialists that can supply him with a comparable toration to economic independence. Then the claims body of information on patients at thc other end of of Robert Bro~vning'sRabbi Ben Ezra will not seem life. I t is also objected that all this is highly theor- absurd. I COPR. 1949 BY NEA SERVICE. INC. T. M. REG. U. S. PAT. OFF. '3 "It isn't age that's causing your trouble-why, even I' get a crick in my back when fall sets in!" �Medical Aids and Benefits at 40, 60 and 80 By Dr. C. Ward Crampton Chairman, Subcommittee on Geriatrics, Vedical Society of New Y o r k County T HERE are aids, benefits, advantages and blessings which medicine can bring to men at the age of 40, 60 and 80 who have been given only the ordinary treatment for obvious disease. The treatment of disease in the elderly is receiving increasing attention. The provision of aids, benefits and life enrichment is not. TTTepropose, therefore, that every community should establish a clinic primarily to develop a service for these higher degrws of health and vigor for the elderly. I n this field much more can be done than is generally supposed. mTe are wasting money; Jve are losing years of happiness and service. Hospital beds and wheelchairs Can be a and Old can be to his feet a'ert, cooperative and eager. This and more has been done for many individuals and groups in hospitals alld homes. I t call be done agaill and agaill When people know the facts, and are prepared to give the time and make the effort. How can this be Let us examine the facts. At the age 60 a is a record of his past years. He shows accumulated damages, defects, tissue poisoning, stagnation and starvation with half-cured illnesses and infections-evil things. These are the results not of time but of hazards that occur in the passage of time. Our eneilly is not age, it is damage. It is not chronological age but anatomical, physiological, pathological and psychological damage. any age, 40, 60 or 80, these accumulated burdens, defects and deteriorations by thorough can, in large part, be discovered alld identified. This examination takes much time, skill, experience and devotion. rphe evils thus disclosed call be partly rellloved or neutralized. ~h~ man is thus alld re~ may h freshed. ~ l t h this ~ ~ look like rejuvenation, it is not, for nothing will restore youth. ~~~t it does take away removable burdens incidental to aging. me may call this rehabilitation or Tve may coin a term ' ' de-aging. ' ' The examination takes several visits. I n introduces the de-aging procedures. These, in turn, continue to develop into a continuing program of inedical watchfulness, care, coaching and pre-trouble maintenance throughout life. Thus, there are three service. : (1) Examination ( 2 ) De-aging ( 3 ) Medical Care and Guidance. The examination has been developed and reported. I t is brought up to date in the Jannary 1950 issue of The Jozirnal of Geriatrics. At this time we shall present in brief the seven essentials of deaging, outline the cure and security program and suggest a basic plan for the Geriatric Clinic designed to give all three services. Now, the essentials of deaging ~\-hich ;lare already proven themselves in practice: 1. Attack Infections: These can be foulld locally in teeth, tonsils, sinuses, g a l bladders, prostate and tubes. ~lldiscoverableillfec.tiolls may be by the sedimentatioll test, leucocytosis with a blood shift to the left, blood complement fixation, pulse speed, as an elenlent ill constitutional diseases-arthriti,, iritis, lleuritis and lnyositis often endured as "just agillg. > > These infections call be attacked locally when found and attacked froin the rear by anti-biotics. antigens, selective chenlical agents and supported by other deefforts. A single of attack is alJTays illconlplete. ~~ono-diagnosis lllono-treatment are and 'leficient. ~ ~ is ,visdonl and modern science apl i ~ ~ plied. illness has as mally roots as a tree and health has as many branches. 2. Nutrition: There are both dangers to be avoicled and pri~~ileges be gained by diet. Protein, calto c i ~ ~and iron are conzlnonly sub-optimum and fats m excess. This topic was fully presented to the nleetinp of the Joint Committee on K ~ ~ t r i t i o n December 1947. I t in was widely noted and utilized, most recently in Nz~tritionReview VII, 10, October 1949 where examination and techniques are presented. While diet is important, digestion, processing, transformation and ~~tilization food by body cells are far more of important and more often neglected. All of these essential life processes nlay be found disordered and all may be ordered to advantage. 3. Vitamins: Selected vitamins taken in quantities far in excess of dietary needs map be used as 118 �medicines and as cures, aids, benefits and blessiiigs. B1 may rescue a n old person from mental stagnation. B12 has a special service in an anemia and the oil solubles, A, D and E may dcmonstrate results in tissue improrenrent. Shrunken subcutaneous tissue of the clawlike hands of the aged sometimes seem to be changed most happily. Further reports await clinical trial, lilore exact measurement of benefits and accumulation of data by the years. This urges more research. 4. Remove Stagnation: Life is action. Stagnation probably liills more people than fatigue. Bed rest has its dangers. Bed exercise mill help rehabilitation. I 1 our geriatrics examination every organ should be 1 tested for hidden sabotage. For example, colonic delay of a week is possible for one mith daily evacuation. This is damaging, discoverable and correctable. Body condition depends upon inter-organic teamwork. ~l fine hard-working heart can be ruined by a lazy !iwr a c : ! an harassed kidney ~viiich in turn are helplessly damaged by poor nutrition badly guided by a negligent mind. I t might often be written "he died of a heart attack caused by uncliagnosed mental anemia. ' ' and it pays to be sick. Where there is no vision of interest, action, service and personal worth he will slo~vlyperish. P e t the last five years may be the finest of all life. An effort may be made to take a man from qmbbing in the refuse of existence and bring him to the Land of Beulah. content mith life and eager for his next estate. This is a challenge to physician, psychotherapeutist, family, nurse, social worker aird spiritual guicle. The physician call do inuch. The body can be nlacle to help the nlind ancl the inind taught to help the body, for the body ailcl the mind are a t the mercy of each other. Early as ell as late psycho-aging can be iiiuch prevented and corrected by the use of techniques in the anatomical, psychological and pathological cle-aging referred to a b o ~ e . Thiainil~rchloride alone may lift the burden of despair, defeat ant1 clulliless but accoinpanied by such things as prostatic massage, physiotherapy, calcium, iron and needlin: of painful trigger points in crippled llluscles may with teamr~orkand psychotherapy open n e ~ vailti hright horizons with all the later years. This is an outline of the sevell facztors of c2e-dging. Much has been done but it will readily be seen that lliach nlore needs to be done. Nev lmethodh to be explored, present plans further tested, inrpror~xl, discarcled or extended and given wider application. This is work for every community under state aid and gnidance. De-aging introduces the third geriatric service as follon-s: 5. Endocrines: The endocrine glancls give a good exainple of a team of specialists working together as in football. The efficiency of each gland and their interdepartnlental teamx-orB should be assayed as an "endocrine efficiency formula" written for each person. A single hormone. even the male sex hornlone is less and less used alonr. The male and female gland extracts, prescribed together with pituitary, adrenal 1. Life-Long Geriatric Service: The program of or thyroid (depencling upon the pensonal endocrine cle-aging coiitiliues and develops into life-long service formula) is an example of the direction of proaress. of niedical IT-atchfnlness, care, protection, prevention, One physician reports from the use of balanced hor- benefits, blessings, cure and security. This is like the mones "improvement in well-being, strength, enclurwatches his athletes service of an athletic coach ~ v h o ance, initiative, energy, sleep and sex with IPS\ headand keeps them in best condition for the race of life. aches, nervousness, arthritis pains and tensions.'' I n The medical coach has the great advantage of the short, less evil, more good in life. The t e a n i ~ ~ o r l < principle in endocrine therapy is, in turn. only one full recorcl of the cle-aging service aird the examination and the life recorcl upon which it is based. He part of the seven-fold program of de-aging. knows ~vhattroubles have been conquered or halfand 6. Structure: The years bring fatigues and dam- conq~~erecl tend to crop up again. IIe k n o ~ ~ - s ages to the body structure. The head is bowed. the tendencies and weaknesses as well as sourcdei of back is bent, ribs and chest cramped, joints stiffen. strength aird tested vays of cures and repair. The This is ailatonlical aging. Much of this is preventable "trainee" may pet adrice at ally time by telephone and correctable. It is thrilling to see a man five years and save a call. Ile will colne in to be re-checked on in bed, get up and walk, dress himself and go back to the actual condition of his heart, circulation, blood work. Rusk, Deaver aird Trevor Ilon-ell and others pressure, nutrition, digestion, cholesterol, blood sugar have done this. This is strnctarable rehabilitation, or nitrogens, capillaries ancl reins, joints, nerv'es, exailatoniical de-aging. I t releases hospital beds and ercise and diet. IIe will be iirspectecl for any possible sares hospital bills. I t re-makes lives. I t call be done. bigns of ollconliilg chronic disease, deterioration or breakdon-11. 7. Psychological Techniques in De-Aging: Yon The service is p r e r e n t i ~ e constructive. curative and , cannot get a man out of bed if he wants to stay there life-sustaining and life enriching. �will be made covering four of the seven days. A urinalysis made immediately after this four day food This is the ideal. It has been done. It can be done and test record gives f a r better information than can better and better. This program of medical service, be obtained by the customary methods. care, cure and security and benefits should be exThe second visit sizes u p the whole man, his whole tended to all. How should this be accomplished? life. We write down a diagnosis, efficiency jndexes Each community should give its own anslyer for itself of each organ, and each system, lay out a pronrarn in the establishment of a Three Service Geriatric Serv- for rehabilitation and de-aging. ice Station. The following may serve as a guiding A fall written report is given to the examinee to plan. take to his own physician or to go to one or nzore special clinics for treatment and further diagnosis if The Geriatric Clinic and De-Aging Station necessary. A most important feature is this complete record in writing which is furnished to the examinee The clinic should be established in connection \Tit11 for him to take anywhere to any doctor, a t any tirne a standard hospital. This clinic should be manned by for the rest of his life, a Basic Record. physicians of experience over 50 or 60 years of age, The basic record iclea has made soine headway in preferably over 70. They may even be called hack the last 40 years, The New York State Medical Sofrom retirement or old age homes and they will render ciety approved the plan 10 years ago and recently rea great service. affirmed its opinion. Iii advaiice of tile opeicig of these i!inies it may l n e Geriatric Station wiii work n-ith aii lnedicai be suggested that the State Department of Health social and educational services in the community. I t call upon the several communities to nominate phy- will give its services in clinics, hospitals, homes and sicians to take charge and direct the clinics. They institutions. may be brought far a refresher course to Albany, The clinic, in addition to examination, de-aging and New k'ork and Buffalo and put through the Geriatric service, .cvill have a special division for record and Exa~ilination and De-Aging Service themselves. This research; men of 40 years or under will offer themwill give them an intimate esperience with the mork- selves as guinea pigs. They will be examined thoring of the plan. They will benefit themselves and be- oughly (the vhole man, the whole life.) A record come good examples. Nothing could be better than will be filed. They will be re-examined anilually as personal demonstration. This is a further develop- long as they live. Our purpose is to gather data on ment of the reciprocal examination plan of the Com- the hitherto unknown processes of aging and the hidmittee on Longevity of the Class of the College of den beginnings of chronic disease. Physicians and Surgeons of 1900, of vhich the writer This plan v a s announced two years ago and has is a member. been generally approved. The University of JIinneThe clinic may be open once a week, for example sota and the Maj-o Clinic have already independently Wednesday morning from nine to twelve. The ex- begun work in this direction and others have the amination mill be made on appointment and will con- matter under consideration. sist of three visits of one hour each. The first visit We now suggest that each city and county in the will be devoted largely to interview, thorough history State call a council of medical, social and civic leadand consultation. The man will be giren time to tell ers to start these stations a t the earliest opportunity. all his tronbles. The usual niedical examination will We recommend the development of a Bureau of be given with special geriatric tests ; stress tests will Geriatrics at Albany consisting of the several eombe given on each organ. inissioners of health, welfare, education and other The next risit will he at the end of seven days. services with representatives of the medical, social, This week's interval is used to great advantage. A civic, economic, industrial and educational orgaaizaco~npleterec.orcl will b~ made of four days' diet, rest, tions of the State. Let them organize, guide and suswork, smoke. drink, et cetera in detail and in writ- tain Geriatric Stations based on the plans outlined in^. A conlplete history q~~estionnaire the medical above but developed, improved and applied by the of combined ~ ~ i s d o m , experience and devotion of all cont? pe will also be filled ont. Tests of the kiclnej-s and intestinal tract efficiclncy cerned. Community Approach -7 �The Veterans Administration and Geriatrics By Dr. James M. Dunn Chief o f Physical Medicine, Rehabilitation Division, Departmeltt of Jfedicine and Surgevay of t h e United States Veterans Administration Assistant M medicine and the modern standard of guiding spirit of the household a housewife, and he living have raised the life expectancy of man was very promptly told they were not housetvives but to a new high level. This trend is continu- they were homemakers, and that is a career. ing. I t has resulted in an intensification of all the Women in careers outside of their omin homes preproblems that concern the aging whether they are sent similar problems. MTomenwhose sole career tensick or well. ters in the home usually continue in their life uocaIf one spends the first 20 to 25 years of his life in tion until they attain their full expectancy. They preparing himself to assume the responsibilities of tend to slow down gradually and naturally. Perhaps his vocation and is required to cease those activities this is one reason why the life expectancy of women at some arbitrariiy determined age, it may be readiiy is generally longer than that of men. seen that the productive years of his life are markedly I t would seem that aging men and career women limited. have the inherent right to continue in gainful. pleasThroughout the history of the United States, the ant and constructive occupations as long as they live, rights of the individual and his co-equal responsibil- provided they are physically and mentally able to ity to his fellow-citizen and to his government are do so. Such occupations may ~vellbe avocational. traditional. Does one become less of an indiridual One who has been able to acquire a competence should when he reaches a given birthday? Must he be de- be free to pursue the activities of his choice. EIo\vclared obsolete? Is it necessary for him to become a ever, he too should pursue a regular and productive occupation if he so chooses. Many aging people are burden to other people? happy when they are able to earn the means, over and I t has been said that the average individual uses about 15 per cent of his potential physical and men- above whatever pension they have earned heretofore, tal abilities. I t appears that there should be ample to live in their own homes; it seems that they shonld scope for one to contribute to his own support aiid to be afforded the satisfaction of doing so. The aging who are not mentally and physically fit continue to make his contribution to his community within the 85 per cent not ordinarily used, provided are entitled to the best medical care through hospitals, rehabilitation centers and out-patient services. he is mentally and physically able to do so. The normal individual wants to mork so that he Treat Aged as Individuals may support himself and his dependents and make his contribution to his community. Within the I had been a physician engaged in private practice foreseeable future, roughly one-half of the popula- up to the end of TVorld War 1 , and I kno\v the 1 tion of the United States will reach retirement accord- philosophy of the physician. He is out to earn his ing to present retirement procedure. I t is estimated way through life by creating as much happiness as he that 40 per cent will be 45 years old or older by goes along as he is capable of doing. The cornerstone 1980. Present economic trends seem to indicate that of his ethical conduct is always and ever that vhich relatively few people will be able to acquire enough concerns the welfare of the patient. I say that here means to support themselves adequately dnring a because I feel that each of the different partial ~ o l u lengthened expectancy after retirement. Conse- tions that me have to the problems of the aginr has a quently, the working half of the population mill be limited value. I couldn't take exception to one saddled with an intolerable burden through taxation of them. But rre must not forget that the catalpor o t h e r ~ ~ i sunless a solution is found to the economic tic agent that goes on in the crucible coiitaininc all e, problems of the aging. That is the thing me have to those different ideas and forces will only make the think of in going into this entire question of the ag- correct physiological reaction if the catalyst is coring population. rect-and that catalyst is the moral side-the attitude Now as to women in careers outside of their homes, of people who give that particular service. I t is not I attended a meeting down in Washington the other eiiourrh to have a courageous plan about hospital day where somebody made the mistake of calling the construction; you have to have the human element. ODERK �Those people who are aging; there are no two alike age of the veterans entitled to hospital, domiciliary in the world. They are individuals. and out-patients care will place them definitely No matter how good a n operating plant, no matter among the aging segment of the general population. how good a nledical care plant is or how good the soThe Veterans Adininistration is studying this probcial services are, in their application they are no betlem with the greatest of interest, in order to meet its ter than the people who handle them. That nieans obligation and in order to make its contribution to the you, and i t means me. Ton have to hare that cornertotal problem incidental to the aging population. On stone of ethics. the other hand, the findings of the New Yorlr State I t seems that the pension systems in vogue among Joint Legislative Committee on Problems of the Agthe industries of the country, voluntary insurance iIlg assist in pointing to a to system, the possibility of developing crafts charactersome of the veterans' problems relative to its segistic of local commnnities, the constructive work belnent of the aging population. ing done by the United States Public Health Service, TTTetry to get the nlan back on the job or have him the activities of the Veterans Administration, the transferred to another job if the job he has is such various State hospital systems, the private hospitals that he can't go back to it. We are trying to solve in the various comm~ulities,and olcl age and retirepart of the problem before i t happens with the ment systems-should all be studied with a r i ~ m o t younger group of our veteran patients, and I may approaching the integrated solution of the problems say that we are having a fair degree of success. of the aging. Considerir,g thc intrinsic hniiiaii values, siicl~ tile as ~v e must have a n integrated program. love of home ~ v i t h its family association and its conall The Teterans Administration is vitally concerned notation for the future of the state, i t is imperative with the problems of the aging. I n 19-10, 20 years that we pause before we embark upon an expailsive after the first World War, there were approximately and costly plan of constructing public iizstitutions to 16,000 members in the domiciliary homes of the Vethouse the prowing aging segment of our population, as erans Administration. The total number of veterans a sltbstitate for the traditional home, ~vhich, after all, approxiwas approximately 4,000,000. There are 11or.ris the fo~~nclation our way of life. of inately 18,.500,000 veterans. I t is estimated that there The aged worker is not a psychiatric case or an will be required approximately 75,000 domiciliary orthopedic caw or a geriatric case; he is a man or homes 20 years hence, provided the same legal basis for eligibility exists then as exists now. There are at n-oman with individuality and dignity and rights ancl duties, and i t is our business to see to i t that we do not present 112,000 becis in Veterans Admiriistration blame our industrial people because they can't conhospitals. tinne a man when he is no longer able to continue a Despite the fact that 75 per cent of the patients job that he has been doing all his life in the physical presently receiving hospital treatment are veterans field. B a t we hare a challenge to see if he cannot be of World War 11, the average age of the veteran transferred to a job less strenuous mentally or phypatient is 55 years. Twenty years hence the average sically, where he can continue orki king efficiently. TTT �Environmental Health and Aging Population " By M. Allen Pond, F.A.P.H.A. r'llzef, Division of Engineering Resources, Public Health Service-Federal Security Age~tcy, washing to,^, D. C . Health in an Aging Population Tt is onr purpose here to examine some of the health problems associated with a n aging population and to speculate on the significance of the physical environment i n relation thereto. As a by-product, i t may be possible to hazard a prediction as t o the role of the engineer i n chronic disease prevention and control. The subject is so complex and intangible that discussion of it must appear discursive, a n d no obvious point of departure suggests itself. A s a baseline, i t is iml3ortant to recognize that the objectives i n environlnental health are (1) to establish physical barriers to prerent the spread of disease, a n d ( 2 ) to provide snrronndings that will help maintain vital resistance and pronlote positive health and a sense of well-being. The engineer is concerned primarily with inanimate lnatter and directs his attention not to people but to the physic*al enviroaineiit i n and with ~vhiclz they lnust lire. HP is equipped to prerent b u t not to cnre. The keys to snccesifnl public health practice are to be foniitl in the lu?derstancling of the etiological and 'picleiiiiological characteristics of diseases of commnnit!--wide importance. F o r instance, it was impossible to derelop effectire enr-ironmental health programs until there n-as reasonably precise knon-ledge about the causes and inocle of spread of typhoid fever, the d5-s~nteries. yellow fever, malaria, ancl cholera, to name a few communicable diseases that h a w been controlled by sanitation measures. There is an analogy between our position a t present relatire to the prerention of chronic disease and the sitnation that existed before the germ theory of disease was enrulc*iated. Then. blood-letting ant1 bed rest m-ere aclrocated but used only affer the illness appearecl. Now i n our chronic disease programs early diagnosis is eniphasized. Yet, i n general, treatment for most of the organic diseases is largely p a l l i a t i ~ e ancl destinecl to postpone rather t h a n prel-ent death from the diagnosed cause of illness. Until more light is shed on the cause or mechanism of those diseases most frequently attaclring older " Presented a t a Joint Session of the Epide~niology,Food adults. efficiency i n preventive programs xi11 be diffiancl Nutrition, Health Officers, and Statistics Sections of the American Public Health Association a t the Seventy-seventh cult. Environmental health measures, if they are to Annual Meeting in New Tork, S. S., October 2 i , 1949. Re- play any role i n chronic disease control, must either printed frorn -4nlelican Journal of Public Health, J a n i ~ a r y , await the accumulation of essential knowledge, or 1950. C i n the age con~positionof a population is al~vays resul t of the simultaneons action of the complex factors. F o r example, during the past half-rentnry, when the sharpest recorded changes i n life expectancy and arerage age a t death occurred, the American people h a r e enjoyed progressively hipher standards of living and better nutrition. They have become better educated. Transportation has imp r o ~ r d . The nation has becolme more urbanized. Bcirancrs in the medical sciences have made possible the p r e ~ r n t i o nof sollie diseases, the cnre of others, and better management of most. Xot the least important factor has been the establishment of enrironmental barriers against the spread of disease. On the debit side of the ledger there hare been two n-orld wars. Increased niechanization of the factory and home have increased accident hazards. S e w anc1 ;leadly materials hare been discovered ant1 come into wide use. The tempo of l i f ~ both urban an(1 , n ~ r a l has increased. . K e hare had, then, a rariety of forc(.5-mostly belieficial-working npon the population. The net result has been that the average ~unitin the popnlatioll has been made to lire longer. H o ~ v e r e r ,as the arerage l(.iipth of life has been extendetl, so too has the time over which the individual is exposed to the favorable and unfavorable conditions that influence his h ~ n c tion and deve1opment.l I t so happens that the principal recognized I i a ~ a r d s .to health i n the early p a r t of life are primarily exogellons. nhile those t h a t are significant in later life seem to be largely endogenous. This may explain in part IT-2iy the engineer, b y establishing e a ~ i r o n m e n t a lbarriers against the spread of comm~uiicabledi\e:-lse, ha\ contl*ibuted directly to increased longevity. It suppests, also, t h a t the physical eiirironnzent ins!- not be a direct etiological factor i n organic disease. Rowerer. as F r a n k points out, the problem of aging is 11ot 1)urely a biological one, but has large cznltural, social a n d psychological implications.' HAKGE �they may be directed at raising the standard of living with the knowledge that such activities usually benefit the public health. I n spite of this generally pessimistic note about the present role of environmental health workers in the attack on health problems associated with the aging population, it is possible to comment positively, or a t least to discuss hopefully, certain aspects of the subject. Environmental Cancer-For example, in the field of cancer prevention there are certain definite signs that environmental controls may be expected to be useful. Even though there remains a vast ignorance as to the carcinogenic properties of the environment, there is an increasing literature on environmental cancer, almost all of which is industrial in origin."^ the use of known cancer producing materials becomes more widespread and as more becomes known abont the carcinogenic spectrum, it is likely that greater attention will be paid to non-indnstrial environments. Of the few recognized carcinogens occurring in the natural environment, solar radiation and radium are among the best established. I t is the artificial environment of our industrial society that has created more serious carcinogenic potentialities. Soot and certain waste products from the fractionation and distillation of coal and petroleum, as well as the wastes from the smelting and processing of certain metals may produce cancer. Fully 90 per cent of the knom-n environmental carcinogens never existed in dangerous concentrations until industrial processes brought workers into constant and close contact with them.4 I t is indulging in pure speculation to attempt to prophesy the role that the engineer may play in cancer control. Industrial hygiene engineers already are concerning themselves with the protection of ers against excessive exposure to kno~vncarcinogens. I t may be too early to train large numbers of engineers in cancer control, but there should be no delay in interesting a t least a few in this field. Heart Disease-Undoubtedly the potential death toll from diseases of the heart and circulatory system has been reduced by communicable disease control and treatment of recognized heart ailments. Engineering control of health hazards associated with environmental defects has helped prevent the spread of infections known to be precursors of heart disease. For practical purposes, however, little has been done to develop a physical environment in which those with heart afflictions may be protected against unnecessary additional cardiac damage. Glickman and his coworkers, reporting on the effects of sudden environmental temperatnre changes on cardiac patients, note few differences between the response of those with cardiac ailments and those in the control gr0up.j They conclude that the differences may as well have been related to the aging process. These observations may be used to illustrate an administrative problem. From the engineering standpoint it is interesting that there were differences; but until their practical significance is assessed, there is little reason to reconsider air conditioning, ventilation or heating standards. I n other words, the mere revelation of hitherto unknown facts cannot without interpretation be used as a basis for changing standards or practices. I t is impossible to resist a temptation to draw an analogy between an important engineering research finding a qnarter of a century ago and the role of the physical environment in heart disease. Talbot demo ~ i s t ~ a t e d relatively ~iiilil. that streshes applied reyeatedly caused failure in railroad rails resistant to much greater stresses applied a few times or continuo~sly.~ Is it fair to assume that the stresses inherent in frequent, literally thousands of stair ascents inay ultimately produce cardiac failure in persons with mild or unrecognized heart disease ? Mental Health-The potential of the physical environment to produce niental health problems remains to be defined. Certain characteristics of dwellings and orkin king places are known to cause tensions, but there is insufficient epidemiological evidence upon which to base activities aimed at controlling environmental hazards to mental health. I t is likely that the physical environment per se seldom produces mental illness, although jt may serve as a contributory factor by increasing the hazard of breakdown in persons on the threshold of mental illness. Studies of the livability of low-rent dwellings have shown that inadeqnate storage space and unsatisfactory room layouts, among other factors, make housekeeping difficult and u n p l e a ~ a n t . ~ we accept the If premise that longe~itg implies more prolonged exposure to the continuing hazards of living, such harassments as these may be especially significant for older people. Recommendations for the design of housing for elderly persons take these points into a c c o ~ n t . ~ - l l However, research is needed to substantiate or refute the group judgments underlying such recommendations. Housing-A thorough knowledge of popnlation statistics is basic for the planning of housing.ll Designers and builders of houses have not yet shown that they appreciate that changes in the age composition of the population are paralleled by changes in family composition and size. At both ends of the adult span �of life, single-person families are more numerous than are insecure, experience in London, England, and in the age group from 25 to 64. Except in large cities, Donora, Pa., during the late fall of 1948 focuses attenlittle has been done to provide housing for one- and tion on the potential hazard presented by smog (i.e., a two-person families, particularly for those in the twi- combination of smoke and fog). light years of life. Even in the best planned modern Acute mass disasters from atmospheric pollntion housing developments attention is rarely paid to de- are spectacular events because of the resulting numsign for elderly tenants. ber of deaths and disabled persons encountered. HowThere is wide agreement among students of the sub- ever, such catastrophes occur rather infrequently and ject that housing for elderly people needs special con- result from unusually massive exposures. I 1 point of 1 sideration as to location, design, and e q ~ i p m e n t . ~ - l l fact, they are of lesser importance than more wideI n general, all new housing projects should contain spread and less obvious injuries to health occasioned provisions for persons of all age groups, and the able- by the prolonged action of lower concentrations of bodied elderly should be housed with the rest of the atmospheric impurities on larger popnlation groups.13 community. Nevertheless, TVhipple many years ago pointecl out Older persons are ordinarily housed more safely in that epidemics in the ultimate may serve as life savers. single-story ~ u l i t s than in d ~ e l l i n g s containing stairs. The London and Donora incidents may well become I t is not so widely realized that special attention the incentives to basic ~ ~ o in k r this field. should be paid to provision for warmth, layout for I n London, deaths from all causes during the ~veek efficient and easy housekeepiiig, and accident preven- of the widely publicized intense fog of Kovember, tion. It is desirable as t~ provide ccmmnna! facili i948, rose sharply in comparison with previous weeks !C ties and easy access to such neighborhood facilities as and with the same ~ ~ e ink previous years.14 Death e stores, churches, theaters, and public transportation. rates from bronchitis and pneumonia were more than Furthermore. the question of elastic design ( i.e., pro- doable those for the same causes during each of sevvision for easy modification of dwelling size to take eral preceding weeks. Possibly the niost significant care of changing family needs) has hardly been ex- public health aspect of this particular London fog is plored. revealed by analysis of the age grouping of fatal cases I f housiilg plays any role in determining the health of bronchitis and pneumonia. For both diseases, the status of a community, it is obviously related to the greatest excesses in mortality rates occurred among health of old persons and the infirm. persons 45 years of agc and older, the peak being in Accidents-Death rates from accidents traclition- the age group 6,i and over. Among persons under 45, ally have been highest in the age group 65 and over. there were no significant differences between either I n 1947 the accidental death rate for persons in this the crude or the respiratory disease death rates for age group was 286.8 per 100,000, of vhich fatal falls preceding weeks and those for the foggy week. At Donora, all of the fatalities which were attribaccounted for 59 per cent and motor vehicle mishaps represented 17 per cent.12 The accidental death rate utable to the smog incident occurred among persons for persons 45 to 64 years old was 68.5 per 100,000. over 52, the mean average and median ages being 65.15 The number of permanent disabilities produced by The Public Health Service investigation of the situaaccidents is significantly larger than the number of tion revealed also that there was a significantly higher incidence of serious cases aillong persons in the older deaths. More than 3 out of 4 fatal home accidents among age groups. Similar crises had occnrred previously persons 65 years of age or older are caused by falls, in the community, probably being associated with adand in 1947 accounted for more than 15,000 deaths. verse atniospheric conditions. An interesting sideThese accidents occurred in various parts of the house, liglit of the inquiry was the revelation that there appeared to be a positive correlation between the severalthough the bedroom was the most frequent site. The causes of accidents are manifold. I n older per- ity of the affliction and certain aspects of housing sons especially, physical deficiencies and poor ,judg- qnality. ment are frequently cited as contributory causes. Roth and Smenson, in an unpublished study of the However. structural or mechanical defects that pre- irritant aspects of atmospheric pollution, point out dispose to accidents should not be overlooked by the that irritation appears to increase with age and that health official concerned with accident prevention. I n susceptibilities vary widely and are greatest for perthe design, construction, and maintenance of shelter sons mrhose eyes or nasal passages are inflamed.ls I n for the aged and infirm, special attention should be their reference to the implications of age, they show given to the elimination of accident hazards. that college students require a concentration of about Atmospheric Pollution-Although the epidemio- four times the strength of the irritant (e.g., formaldelogical bases for a large scale attack on air pollution hyde vapor) needed to produce equivalent irritation in �persons over 50. Furthermore, susceptibility appears to increase with age even in older persons. As a result of these isolated experiences, is i t fair to assume that older people are especially susceptible to the hazards of atnlospheric pollution ? I s it likely that older persons, who may have less efficient or more worn out respiratory or circnlatory systeins than J-ounger members of the community, \Then exposed to abnormal atmospheric conditions may be seriously einbarrassed ? What specific air pollutailts are inost significant in producing excess nlorbidity and mortality ! Answers to questions such as these will be important in plaiziling and operating community-wide projects for the control of air pollution, and will also play a role in increasing life expectancy. Care of the Chronically Ill-The increase in recognized chronic disease has created a need to plan for and provide a variety of facilities for care of the chronically ill. Therein lies a fertile field for engiileeriizg study and progress in the design, construction, equipment, and inaintenance of hospitals, infirmaries, ilursing homes, and outpatient centers. Hope recently has outlined soine of the cnvironmental sanitation problems in the national hospital survey and construction program.li As he points out, it is one of the few activities in which the engineer is identified with the care and treatnlent of the ill and infirm. With rare exceptions, there is little evicl~nce that sanitary engineers involved in hospital design, construction, and maintenance hare concerned themselves yet with mnch beyond their traditional interest in water supply, plumbing, and waste disposal. I n the field of radiation therapy alone, there appears to be abundant need for pablic health engineering skill in the design and maintenance of treatineilt roolns and equipment. Furthermore, increased use of radioactive materials in medical research and patient care mill pose a variety of new probleins in radiation protection and hospital waste disposal. Even casnal observation of relatively nzoderiz plants for the care of the chronically ill reTeals the need for substantial extension of knowledge concerning the thermal enrironnzent, i l l ~ ~ ~ n i n a t i o n , noise. alld materials of construction as they relate to elderly persons and the infirm. Standarcls are based insecurely on group judgment supported largely by linzited phvsiological research on young, healthy adults. In spite of the inherent difficulties of carrying out controlled laboratory studies on persons past nliclclle age, serious consideration should be given to necessary physiological and psychological research on elderly persons. TVithout the basic data which can be obtained only through such research, it is unlikely that there will be significant improveinents in the physical standards for shelter for the aged and infirm. Discussion I t is clear that planning ail eiivironnlental health program for the aging population i s not only conlplex but a t present must be based largely on speculation. Intuitively we are led to believe that the physical environnlent will nltimately be deinonstrated to be significant in the etiology of organic disease. Factual bases for such a n assunlption are inadequate. The inlmediate problem, from the engineer's standpoint, seeins to be one of gathering and analyzing data coilcerning the relationships between the environnlent and the health of older people. Little is l c n o ~ ~ n the physiological and psychological responof ses of the aged and chronically diseased to sharp changes in t h environment. Thg inlplications of micro-changes are virtually ~ulknown. 1 1spite of the lack of factual bases for action. \01111d 1 jnclgment dictates that the solution of health prohlenls alllong the aging populatloll will involve preventive as ell as curative measures, and that the preventive prograin will iilclude environnlental controls as nell as iinproveineiits in personal h>-giene. Preserit l i l l o ~ l edge supports the belief that the physical en\ irnnment contributes to the causes of cancer and accidpnts; further, it points up a relationship betneen environinent and the course of nzental illness and of ,diseases of the heart and circulatory- s:-stem. I s it lulres\onable to expect that lrno~\-ledgeto be gainrtl in the future will bear out these facts? This discussion ~ ~ o n be inconiplete withui~tmenld tion of the public health significance of the continuing application of basic sanitation measures. Although inany of the diseases normall:- resulting from at1 insanitary enrironn~enthave been brought under control, eternal vigilance will be necessary to preserve the be gains already made. I t ~ r o n l d patently absnrcl not to inaintain existing barriers against enviroizlnental llazards to health. lleasnres to prevent the spread of enteric and insect- and roclent-borne diseases are as iniportant for the aged as for the young. For this reason alone, health apelzcies niust promote ~videspreacl application of existing sanitation knowledge to prevent preventable diseases. Such action will raise the standard of living and bring measurable health henefits to all segnients of the population. I t has already- been mentioned that increased longevity also increases the period of time during which the human orgailisnl may be exposed to environmental hazards. Despite the success which has attended engineering efforts to improve and protect water, mill<.and food supplies, and to control disease-carrying insects and rodents, there remain a large number of unsolved sanitation problems. Food-borne disease seems to be on the increase." New probleins are appearing in �water s ~ p p l y . ' ~ The radiological health field is in its infancy, and the surface has only been scratched in the hygiene of housing.1° There is acute need to realign official and voluntary forces to strengthen sanitation activities throughout the Nation. Serious personnel shortages exist, and many existing sanitation workers are inadequately trained. Most are poorly paid. There are literally thousands of conflicting ordinances, codes, and regulations in effect which serve to impede uniform and coordinated action. Although progress is being made, sanitation activities continue too frequently to be carried on as isolated programs comparatively insnlated fro111 other conzponents of the public health effort. F o r all these reasons it is encouraging to note that plans are being laid by the National Sanitatioiz Fonndation, in cooperation with nunlerous official and voluntary agencies, to launch a nationrvide sanitation program. For the first time on a broad scale, attenL ~ U L L i b b e i q g i eil i v i l ~ e ~ de\ e i o p ~ l l e ~of c~ininunizy li interests in all aspects of enrironnlental health, with1 . out which progress in the future n-ill be painfully slow. I t has been comparatively easy to a p p l - a few successful control measures to protect water and niilk supplies. or to eliminate insect- or rodent-breeding places. I t is more difficult to control widespreacl hazards that resnlt from human frailties. As we enter into the era when chronic disease becomes a major public health problem, i t is likely to be oficial vital that everyone-not just the ~ ~ a t e r w o r k s or milk-plant operator or restaurateur-be concerned with enr-ironmental barriers against disease. The whole realill of sanitation practice in all likelihood will change dramaticallp during the nest quarter century. d safe and healthful eiirironinent is n o and~ ~ will become increasingl>- inlportant to the aging population. I t is important, therefore, that sanitation persoiinel be prepared to assume new responsibilities and (leal with new problenls. Pltblic interest is likely to promote professionai awaiiening. ,I nation-wide sanitation program will stilnnlate both. References 1 Boorle. R. B., and Ciocco, -1. Cardiometric Studies on Children. I . Stethograpl~icPatterns of Heart Souilds Observed in 1,482 Children. Jfilbaizk V e m . Ftind Quart., 17 : 323 ( O c t . ) , 1939. 2 Frank, L. K. Foreword to Problems o f Aging by E. V . Con-tlrey. Baltinioi e : ST-illiams & ST'ilkins, 1939. 3 Hueper, TT. C. Environu~entaland Occupational Cancer. Suppl. 209. P u b . H e n l t l ~Rep., 1948. 4 Hueper, IS7. C. Environmental Cancer. Bethesda: Natl. Canver Inst., 1949, 19 pp. 5 Glicknlan, S . , Inouye, T., Keeton, R. W., Callen, I . R., Hick, F. K., and Fahnestock, RI. K. Physiologic Adjustments of Normal Subjects and Cardiac Patients to Sudden Change in Environment. Presented a t 55th Annual Meeting of American Society of Heating and Ventilating Engineers, Chicago, Jan., 1949. Preprinted from A.S.H.T.E. Journal Section, Heating, Piping and Air Conditioning. 6 Talbot, A. N. Progress Reports Sos. 1-5 of Comniittee on S t ~ e s s e s Railroad Track. Proc. A m . R y . E n g . Assn. Vols. in 19, 21, 24, 26, 31. 1918, -20, -23, -25, -29. 7 Livability Problems of 1,000 Families. Fed. Public Housing Auth., Washington, Bull. 28. Oct. 1, 1945. 8 -4non. Old People's W e l f a r e . The Katl. Council of Social Service, Inc. London, 1947, 72 pp Q Anon T h e Care and T r e a t m e n t o f t h e E l d e r l y and Infirm. British &led. Sssn. London, 1947, 28 pp. 10 Matthe~vs, Olire. Housing f o r Old and Single People. Inst. of Housing, Inc. Birmingham, 1938, 15 pp. of Cornrnzl?zily Planning it1 1 ( 1 111s 11 Lansing, C. F. S t ~ c d i c s of t h e S p a n of Life. Nea York City Housing -4uth 1'337, 43 PP. 1 2 d c ~ l d e l Faclo. ~t 1949 Ed. S a t l . Safety Council. Chicago, 96 PP. 13 Editorial. I n d u s t r ~ a lPollution of Human Enr ironment. J.A.M.=l., 140: 1342 (-lug. 27 1 , 1040. I4Logan, ITT. P. D. Fog and RIortality. Lancet. 256:7S ( J a n . 8 ) , 1949. 1 Scl~renk.H . H , Heimann, H., Clayton, G. D., Gafafer, : TT'. &I., and TTealer, H. S i r Pollution in Donora, Pennsylvania. P u b . Healtlt B u l l . 306. TS7ashington, 1949, 173 pp. 16 R o t l ~ H . P., and Smenson, E . A. Pl~ysiologicalStudies of , I r r i t a n t Sspects of At~nosphericPollution. Univ. of Southern Calif. Scllool of Rled., Los Sngeles (Oct. l 5 ) , 1947, 48 pp. (unpublished). 17 Hope, 11. C. The Hospital Survey a n d Construction Program : E n ~ i r o n m e n t a l S a n ~ t a t i o n . A.J.P.H., 39 :893 ( J u l y ) , 1949. 18 S u ~ n ~ n a rof Disease Outbreaks from Water. Milk and y Milk Products, Other Foods and Undetermined Vehicles. Div. of hanitation, P . H . 8 , Rlar., 1949. 1 9 Bolts, I. H. Water-Borne Diseases. A.J.P.H., 39:974 ( A u g . ) , 1949. 2 0 Johnson, R. J. The Housing -4ct of 1949 and Health Department Progran-s. P u b . H e a l t h Rep., Vol. 64, Xo. 43 (Oct. 2 8 ) , 1049. �Geriatrics-A New Frontier By Senator Thomas C. Desmond Chairman, New Y o r k State Joint Legislative Committee on Pt-oblems of the S g i l l g T HE TOWNSPEOPLE in a small, New England community had gathered once again to honor their oldest neighbor and friend, Jim Barroughs. As they pressed around him to offer their good wishes on this, his 96th birthday, the question came up as it had so many times before : "Jim, what's the secret of your long life and good health? ' " Jim paused and thought for a moment. "You know," he said, "every year you've asked n ~ ethat I've probably told you something different. This year I I'rr? y = s the tmth. The rcQs=n ' y c Evcd geing to tell so long is because I never died." Jim Burroughs' explanation mas much more reasonable than the hundreds of longevity secrets offered by the elderly. These range from sleeping late mornings and smoking a pipe after lunch to rising early and shunning tobacco. Scientists scoff a t the suggestion that any of these countless schemes offered by the oldsters as the keys to longevity have any real value. They tell us that our hope lies not in an elixir of youth, not in any stay-young-and-be-happy prescription, but in the work of a new breed of scientists called geriatricians. You will be hearing more and more i11 years to come about geriatrics. It is a new branch of medicine which aims not merely to stretch out the years of life but to make them brimful of vigor. Geriatrics (the word is derived from two Greek words, geras, meaning old age, and iatrikos-e-on, belonging to medicine) is the medical aspect of aging. Just as the pediatrician specializes in the health of children, the geriatrician specializes in the health and well-being of the elderly. "The aim of geriatrics,'' says Dr. C. Ward Crampton, Chairman of the Geriatric Committee of the New York City Health Department, "is to retard, modify, defeat, postpone, and neutralize the progressive deterioration and disabilities associated with aging." A t Cornell and Columbia Universities, in Indiana and Illinois, i n Baltimore and Boston, researchers are intensifying their efforts to f i d the answer to the ageold question, "What makes people grow old ? " Medical societies are beginning to set up geriatric committees. A Geriatric Bureau has been established in New York City's Health Department. Medical spe- 'Reprinted from June, 1950, issue of Today's Health. cialists have organized the American Geriatrics Society. The American Pharmaceutical 3Iannfacturers' Association, in cooperation with the American Medical Association, has launched a fonndation to study degenerative diseases. Homes for the aged and chronically ill are adding clinics for the olclsters. Activity in the medical field of aging is booming like stocks i11 a bull market. Why the accelerated interest ? With startling rapidity the population structure of our Nation is changing toward an ever-increasing pronnpt:nvr ~f the elderly. If prastr~li trends continue, by 1980 some 40.4 per cent of the population will be 43 years of age or more. One of our top scientists has estimated that 30 per cent of persons who have reached 65 owe their survival to advances in public health and medicine since they were born. Once people died young. Now they have an even chance to live to be happy oldsters. We are a t a turning point in medical research. From now on the emphasis will be on chronir illness and degenerative diseases. Public health agencies have largely subdued the infectious diseases and plagues. Only 50 years ago the greatest killers were tuberculosis and pneumonia. Today these diseases have been pushed down to relative unimportance. Rearing their heads defiantly instead are heart disease, cancer, and cerebral bemorrhage. These are among the chief cripplers of the oldsters. While we have given people bonus years of life, not much has been done to make these years vigorous, and free of fear of the merciless onslaughts of time. Unless something is done to prevent it, one-half of the children born this year will ultimately die of degenerative diseases of the circulatory system and kidneys. The Age Fighters rYLbLvLL A small band of geriatricians, armed with the conriction that many of our middle-aged people are being consigned to old age long before their time, are searching for clues which might lead to longer and better living. Theories on what causes trouble in later years are numerous. Some geriatricians believe that it is the failure of the various systems of organs to work together properly; others suspect that clumping of cells �alternatives: you can shut your eyes to disagreeable facts and hope to escape them (which you can't), or you can anticipate the problems of age while your mind is still vigorous and make plans to meet them. If you have elderly parents or relatives, chances are that yon have already seen or soon will see insidious, degenerative diseases of the mind and body at work. Old age is peculiarly the field of chronic disease, which causes a million deaths annually. Virtually every family feels its tragic, lingering sting. Geriatricians tell us that to avoid niany of the pitfalls of the later years of life we should cushion ourselves early against the shock of old age. Don't make the mistake of Mrs. Emily Camp, a 60 year old vidow, who carefully camouflaged her snow-white hair with jet-black dyes, hid her wrinkles under layers of makeup, and wore the gay-colored, youthful clothes of a Hollywood starlet. She tried to look and act forty, and almost had herself believing that she was. One day while she was standing in a crowded bus, however, llrs. Camp received a light tap on the shoulder from a pink-cheeked teen-ager who had politely risen to offer her a seat. Nrs. Camp forced a smile and nodded appreciatively, but she slid down heavily as though she had experienced her first taste of death. She had never faced the fact that she was growing elderly, and that others could see it. I n industry each year thousands of older workers, untrained and unprepared for retirement, are turned out to become burdens on their offspring and sink into stupor and inactivity. Industry brands them "too old," and it comes as a crushing blow. Dr. Theodore G. Klumpp, noted scientist and business executive, declares that "Any biological organism that has been accustomed to a set routine for 40 or 50 years can't suddenly be shaken from its orbit without untoward consequences. " The age-fighters tell us that leisure without useful activity can be a trap. You can't retire from life, but you can retire to new interests: that small business you wanted to start; the book you always thought of writing; the summer camp you planned at the lake; the flower garden you pictured in your back yard. Your third and fourth and fifth decades are not too soon to cultivate the hobbies and activities that will serve you a lifetime. Retirement should be welcomed as the beginning of a new career; Prepare in Youth for A* it should not be dreaded as the end of life. The present hope of geriatrics is not just to tack The time to prepare for age is in youth. Your 30th birthday is not too soon to decide whether at 60 you on to your twilight of life a few more years to be enwill be as young and vigorous as the man of 40, or dured in senility and chronic illness. The chief aim whether you will present the common picture of the is to conserve your vigor, brain and skills so that you average man of 80, old, weak, and miserable. YOU can maintain your active participation in society. Dr. Nathan W. Shock, who is heading the Geriatric must seek and earn health as your years advance; it Unit of the United States Public Health Service a t will not be thrust upon you. The only hope you have of avoiding old age is to die Baltimore City Hospitals, says: "We are not interyoung. If you expect to continue living, you have two ested in finding ways to allow people to live longer in the blood vessels may be the cause of decline in the aging; still others regard chemical processes and nutritive factors as the fields of study promising the greatest rewards. 111-supported in their important work and toiling in relative obscurity, the age-fighters are hammering at different fronts, but driving toward a common goal: more life in more years of life. The key to perpetual youth may never be found, but in their quest the researchers expect to turn up the answers to many puzzlers: Why does the heart weaken after middle age? Why do arteries harden and joints become knotted and stiff? Why does the hairline recede and the waistline bulge? I n short, what can be done to p ~ z t the dreaded period of the off Great Decline ? Geriatricians already confidently predict that by 1960 life expectancy will cli~llbto 70 years, and they see no reason why man's life span cannot be boosted eveiltilaiiy to i O O years. They point out that a dog is fully grown at two and has a life expectancy of 12 years; a cat at 2% years is fully grown and has a life expectancy of 10 years; a t four a horse is fully grown and has a life expectancy of 25. Accordingly, if man is physically mature a t 25, he should have a normal life span of 150 years. The Russian scientist, Alexander A. Bogomolets, developed ACS (antireticular cytotoxic serum) which he thought might prolong human life to a century and a half. Groups in Texas and California have taken up the study of ACS, and are investigating intensively its potential benefits. At Cornell University Professor Clive M. McCay has been conducting a series of brilliant experiments with dogs and white rats which offer startling new clues for prolonged vitality. He has found that life can be extended and youthful characteristics maintained by control of a single factor : food. The geriatricians will be the first to tell you, however, that you are wishing for the moon if you expect to have the elixir of youth handed to you on a silver platter. On the other hand, we are assured that on the basis of what is now known, we can not only extend the average life 10 more years, but insert the extra decade in the prime of life. I �than they already do. TTTliat we are interested in is finding ways to help thein to live out their normal life spans as vigorous, useful citizens. " A t Welfare Island, where New York City's taxpayers have put up the money to build a hospital and to defray the operating costs of laboratories for the purpose of studying chronic diseases, Dr. J. Murray Steele, who is in charge of the work, expresses a similar view. "The philosophy of the project," Dr. Steele explains, "is not priinarily to increase the life span of the aged individual, but to increase his 'span of health', so his last years mill be spent in 'reasonable comfort and happiness', and he will not becoine a burden to the eomn~unity. " Geriatrics applies to every year of life, for every year has its effect on the succeeding ones. But it is ufteil aruuilcl the age uf furty that the signs of ~.iear and tear during life begin to become readily detectable. Forty is certainlv not "old age7'. I t is merely the beginning of senescence, the nornial process of aging. The two most critical decades for yon fro111 the medical viewpoint are the years betveen 40 and 60, n-hen x~arningsignals are beginning to appear, but 1vhile there is still enough "youth" left with IT-hich to work. Mrs. George Fiske, an alert, iiitelligeiit housewil'e of 40, startled the niembers of her bridge clnb by announcing that she had rnade an appointinent for her first comprehensive health examination in preparation for her later years. "I-Iave you gone out of pour mind ? " chuckled her friends. "Why there's obviously nothing wrong with you. TTThydon't you enjoy life. You're just looking for tronble. " That's precisely what Mrs. Fiske intended. She was looking for trouble, trying to ferret it out before i t could do much damage. 17' The apparently healthy, ' L y o ~ t h f ~ geriatric patient like Mrs. Fiske is the age-fighter's delight, but, unfortunately, as rare as a string of lakes in a desert. If you wait until you have been floored by heart trouble, arthritis or some other insidious degenerative disorder, you have waited too long. Dr. Edward J. Stieglitz. pioneer age fighter. and Chief of Staff of Suburban Hospital in Bethesda, i\laryland, tells us that the subtle, stealthy signs of depreciation are seldoni obvious. They don't junip up a t you and ring a bell. IIigh blood pressure may exist for 20 or 30 years before i t moves in for the kill. Long before diabetes becomes crippling there is a period in 11-hich the victim's ability to utilize sugar is but nioderatelg impaired. Nost of the patients ~vhocome to the clinician in later life are looking for a cure after the damage has been done. They gambled on being among the lucky few whom nature does not treat harshly; and they lost. People do not age at the same rate or in the saiiie way. Even in the same person organs deteriorate a t different rates. We are told that a 60 year old inan may have a 70 year old heart, 50 year old kidneys, a 40 year old liver; and he niay be trying to live like a 30 year old. Another specialist in aging compares the later years of life to a foot race. If the stop signal were suddenly given, every participant ~ ~ o u l d be a t a different point. Then too, we are told that there are many kinc?s of aging : anatomical, physiological, psychological. biological, hereditary and statistical. Probably the least iinportant of these is your age measured mercly by the number of birthdays you have had. The geriatrician will take yon a t 40 or 60 or SO. and he ~villdo the best with which he has to work. I n every case he emphasizes that the treatment must be individualized. He has to know medicine. but he ~ilust also know the man. The basic step in "de-aging " is the conlplete health examination, sometimes called the 'health inrentoq-." The geriatrician wants to know what your condition is and how it got that way. He wants to ' measure" your health. for he knows that health is only relative. He wants to knom- something about your forebears, for a 60 year old nian whose parents died a t 40 is potentially f a r different from a 60 year old ~vhose parents and ancestors averaged 90 at death. He is interested in the accidents and the illnesses of your youth, for they niay have left scars which crop n p again in maturity. I-Ie ~vantsto kno~7ab:>nt the stresses you have undergone, mental and physical, during any period of life. He wants to know something about your daily routine and habits: what you eat, how well J-ou sleep, what narcotics or stimulants yon use, and how often. Chances are your personal medical history is sketchy and inaccnrate, and that i t is incomplete is certain. i Health Report Doctors hare long advocated the health report card or ' 'health passport " which n ould be a birth-todeath sumnlary of your physical condition and backgronnd, so that any physician who treats you will have a t his disposal co~nprehensive knowledge of :-our medical biography. Medical societies in various states have already proposed that state health departments establish for each person born a continning health record. to be issued ~ v i t hthe birth certificate and used b- the in! dividual throughout life. No law compels yon to do so, b u t the medical men tell us that you will have a great head start over the familiar geriatric cripplers if you will keep a complete �health and medical record -ourself as accurately and He has founcl that I-rgnlar exclrcise ancl play (sllch as faithfully as yon can. as simple games and dancing to restore the sense of As one age-fighter has said, "XTe seldoni see any- tiilliilg and coordillationl hare beneficial effects on thing but the XPZ of life. Equally important to us patients v i t h high blood pressure, hypertensive heart are the ABC's, through Q and R and S. With the disease, arthritis, tremors, and hemiplegia. "Here," blank spaces filled in, the doctor could prolong life, says Dr. JIonroe, "is a field of rehabilitation as exease suffering, and occasionally even snatch his patient citing and rewarding as that with war casualties. " from a menacing doom." Dr. llonroe's observations have been further verily Fortunately, the disabilities of aging come s l o ~ ~ ~ fiecl a t the I-Iodsoa Coinnlunity Center in New Pork and in varying degrees, so that there is an opportunity City, where outings, games, meetings and crafts are for the patient to adjust himself to then1 if he wishes. provided for oldsters. The expected average life span The greatest dangers to watch for as you grow old of the old folks ~vho find conzpanionship a t the Center are nlalnutrition and physical and mental unfitness, and participate in its recreational programs has heen which are present to some degree in almost every per- extended 10 years. From an age group in whicli menson over 60 years of age. They are a t the core of tal clisturbances ancl senility take a huge toll, there many of the degenerative disabilities of later years, has not been a single case of a referral to a nlental inand they often begin in youth and middle life. stitution of a n oldster at the Hodson Center! Dr. Joseph T. Freeman, of Doctor's Hospital, PhilThe nzan ~vho keeps up his associatioils as he prows adelphia, reconlmends a diet for the aging that is older, retains I n interest ir, ii-hat is guiiiu U I I about "relatively high in protein, average in carbohydrate, him, ancl develops hobbies and nseful activities to and 1 0 in fat." ~ ~ take up his idle time will remain young, no matter ~vhite hair. his Dr. Crampton tells 11s more specifically how a 60- 110~~year-old should nloclify his eating habits compared Obviously, the hallclful of geriatricians in the connv i t h a 30-year-old. He indicates that compared with try cannot take care of a vast army of ole1 tiruers recomnlellcled standard requirements for the y o u u e r nhose needs range from mere sympathetic understandperson, the sexagenarian should consuine : 10 per cent ing to treatment of severe heart disease. But yon ean more protein. Titamin E, calcinnl, iron, and phos- looli for help to any ph)-sician T T T ~ O geriatric-li~inded. is phorus; 13 per cent more iocline; ancl fro111 20 per The point to remember is that the usual health excent to 23 per cent more Vitalllin A, thiamin, niacin. a~zzinationtoday is for the purpose of detecting any riboflavin, folic acid, T'itamins C ancl D ; ancl 20 per ailnlelits you might have. The kind of "anti-aging," cent to 23 per cent less fats and carbohydrates. pre-ilisease examination you rnust seek is one of progThe sigllificant conclusions of the hunger-fi~liters nostic value; one that will not only measnre your and age-fighters on diet for the elderly can be slummed health, bnt help you to k11o~vwhat i t will be fire or 10 or 15 years from no~v. If you are a n avid tennis enup in these five niajor points: thusiast a t 30, you want to know what pitfalls to 1. Shed unhealthy, excess f a t and hold your belt- a~~oicl, hat to do so that you will still be playing a line down. good game 10 years hence. If yo~l'rea top bowler 2. Drink your tea and coffee if yon like it, but in your league a t 40 you don't want to be sitting on don't neglect milk. If you have given i t up go the sidelines at 45. S o niatter ho~vold you are. you back to it. Get a pint to a quart a day. want to free yourself of anxiety over premature dis3. Forget the toast and tea fad of Grandmother's ability and prolonged invalidism i n the years to day. Get a n optimum diet, rich in vitamins and co111e. proteins. Through "strew tests," the geriatrician can give 4. Have your weight checked periodically. Ask )-on sonie indication of what your future health status your doctor to plan a diet to fit your individual night be. He does this by placing upon the organs a needs if necessary, and obtain his recommendaload corresponding to the wear and stress they mill tions on vitamin and mineral supplements. undergo in another decade or two. Conllnonly iused 5. Don't spare the fruits and fruit juices, and stress tests are reaction of blood pressure to cold don ' t spurn leafy vegetables as being ' 'weeds water n rist submersion ; the electrocardiogram before They will help you keep in trim. and after measured step climbing; a n d the compariA t his geriatric clinic in Boston, one of the first such son of the horizontal and standing blood pressnfe. clinics in the world. Dr. Robert T. Monroe has found I n this lvay he can fin~lweak spots in your body. that nluch that passes for senility turns out to be Following analysis of your detailed and searching merely physical or mental unfitness. This is true of "history," a careful examination of your body, and much feebleness, frailty, unsteadiness, awkwardness, a frank discllssion of your anxieties, emotional conflicts, and adjustments, the geriatrician can give you undue fatigue. and shortness of breath. ". �guidance in nutrition, exercise, recreation, posture, mental outlook, and proper environment to suit gour condition. If he finds that your heart is weak or gour liver is bad, his method is one of support. He tries to build up all the other organs to their full efficiency to buoy up the stragglers; to reduce the load they have to carry. He can gauge your limit, and say "Keep within your limit and you will be safe." . Yon acquire confidence after your health inventory, for now you know what you are, and what you can and should not do. You have been relieved of many of the bugaboos of age. You go out to face a brighter world with a spring in your step and a smile on your face. You go back for periodic check-ups, and thus keep your health and vigor at or near their maximum. Just as in youth you insure gourself for economic security in later years, you have insured yourself for physical and mental security. Geriatrics promises less but delivers more than the quick cure-alls and youth-restorers we read about and hear about so often. The frontiers of knowledge in geriatrics are constantly being extended, and further dramatic advances are inevitable. There is no route to earthly immortality, but there is a road to a longer and happier life if you will keep looking ahead, and seek the proper guidance along the way. �Need There Be Death? By Dr. P a u l A. Zahl Associate Director of t h e H a s k i n s Laboratories, S e w Pork City his emergence from total animalisin into a state of high subjectivity, man has suddenly (that is, within the last 5,000 years) turned the tables on nature. No longer do species and evolutionary considerations compel his activities; the psychological growth of the individual in relation to his fellows is the keynote (still unrecognized by many) of the Coming World. How eminently frustrating, then, when thoughtful man-ever obsessed by the will to live-knows that he has but a few decades of creative existence before he must succumb to evolution's most uncharitable and sardonic ruling. Bat must he yield forever to nature's disinterest in individual survival ? Is it an absolute cyclicity with which men go down into extinction every generation, to be replaced by a new crop of germ-cell bearing tyros? Well, there is still the reasonable hope that if scientific aspiration and technological progress can be prevented from withering in the dust of crumbling social institutions, then individual wisdom and experience may some day be permitted to gather cumulative strength, instead of ebbing back to zero with each aged generation. . . . When our neolithic ancestors buried weapons and travel accouterments with their dead, they were premising an existence beyond the grave. I n the millennia after those dawn days, the human creature came to see himself as a dual entity composed of mortal body and immortal soul; the phenomenon of human life was even construed by some as a spiritual test trip between two eternities. I n beliefs ranging from nirvanaistic foreverness to complete corporeal resurrection, we have never ceased hoping, dreaming, praying that death is not the end. Hence, when the biologist ponders the mysteries of life's transcience, he is acting in the tradition of all men. 'ITH Biological Questions Only a few years ago the biologist would have defined death as an irreversible cessation of metabolic activity. But today, far more than the philosopher, he has had to revise his conception of mortality. Cannot the viruses, dried to a state of zero metabolism, be preserved indefinitely, thereby virtually negating death? Do not experiments in which microbes are frozen into suspended animation, to be revitalized at 1 Reprinted from The American Rcholar, spring issue, 1949. mill, change our ideas of biological time, and the meaning of death? I n order to reveal the basis and extent of these emendations, it is relevant perhaps to begin with an inspection of life and death among man's evolutionary forebears. 'The first inhabitants of our planet were not subject to death. As single cells, they grew until reaching a k e d size limit, then divided in two, leaving no parent-and no corpse. I n the course of evolutionary time, organisms came to consist of many cells, the vast majority of whichrelegated to subserve supportive and nutritive functions-were shorn of their original capacity to reproduce the whole organism. Further division of labor occurred; and as millions of years rolled on, the cellular constituency of advancing organisms became highly diverse and astronomically large. There were tissues which served to digest food for the entire organism; others specialized to deliver nutriment to every cranny of the body; still others assigned for integration and courier detail, for locomotion, excretion, protection. But ever secluded and sheltered within each organism were the precious germinal cells, waiting but to pass on the species, ere the body died. Motivation for the epical developments which comprise what we know as organic evolution, lay in the fact that multicellular animals had long since abandoned sunlight as the source of primary energy, and so were impelled to sharpen their efficiency in the capture and devouring of their evolutionary collaterals. The whole "aim" and "purpose" of the outer body was to nurture and protect its wards-the reproductive cells-and to deposit them, when ripe, for fusion with those of the opposite sex. I n life's two-billion year reaction chain, no value was assigned to post-reproductive maintenance of the individual organism. The diversity and survival-fitness.of evolving species were enhanced by this generation-to-generation scheme, this life-death-life-death pattern, since in the mixing of mutated genes during fertilization, offspring differing froin either parent were produced. Only those individuals whose constitutions enabled them to cope with endless geological and environmental shifts on the la net. survived to pass their valuable new gene coibinations into the main stream of the species' germ plasm. Thus, survival of the evolving species, not of the single being, �was the preelnineilt goal of aninlal evolution. The institution of death arose as a result of this null value placed on the individual once it had passed on the fanlilv torch. Senescence and death are by no means universal biological phenomena; they are but the price paid for high specialization and for an advanced evolutionary position. Perennial organisms, for example, are in fact not subject to senescence, and never wear down to natural expiration. This condition prevails, presumably, because the body tissues of snch organisms have not been specialized to the point where they have wholly lost their reproductive capacity. A single mangrove spront may spread to a continuous net oyer many square miles of brackish swampland. its indefinite increase being limited only by colnpeting vegetation or other environmental restrictions. Perennialism applies, in addition, not only to snch notable examples of non-aging as the giant sequoias, but to the teeming bacteria, f l ~ n g i and algae; a ~ a!:;= to d many of the lower multicellular animals which grow and bud very much like plants. Among organislns of this class, life can be stopped (as it is most often) only by accident, attack by preying organis~ns,or severe environmental adversity. The life-span of those higher organisins whose body cells have lost their species-reproduction capacity, always begins with the activation of a prerio~lsly dormant egg cell, and continues from birth to death in a series of intergrading growth stages. No known consciousness of self exists in the embryo, which is parasitic on the mother (as in mammals), or dependent on a store of yolk which the mother has provided for embryo nourishment (as in the egg-laying forms). Birth is usually associated with a release from this dependency, although in many animals, especially the mammals, a post-partnriency relationship persists for a considerable time. Life's course after birth includes a progressive selfawareness, varying widely from species to species, and ostensibly reaching its highest expression in man. Concomitant with this "subjective" development, the organism becomes sexually mature, and sets out to repeat the life-cycle pattern of its parent-predecessors, employing perhaps half its total lifetime in reproductive activities aimed at species perpetuation. The body then progresses ~vithoutchoice through tissne degeneration into death. Gene-determined Life Span The span allotted from birth to the onset of senescence of the body super-structure is gene-determined, and subject to wide species variation. A tiny animal called the rotifer completes its entire cycle within a few days, during this period having passed on its undying germ cells. The mouse does not age and die until one to two years have elapsed; some reptiles live to exceed a hundred and fifty years; and the elephant's longevity is proverbial. Noreover, there is no apparent relationship between the size of an organism and its life expectancy. A man is qmaller than a cow, yet lives much longer. The parrot's normal span may approach the human three-score-andten. Of course not all, indeed very few ssuch deathdestined indiricluals realize their full life-potential, which for most mammals is calculated to be about six times the period from birth to maturity. The nature of the colllpetitire biological milieu is such that mishap, nutritional cleficiency, or invasion b>- p r ~ d a t o r y inicrobes usually terminates life long before true old age has set in. I n man, these factors hare been considerably minimized, making the "sere ancl yellow leaf" stage all the more conspicuous. Perhaps half of civilized man's total personal activities-accident aroiclance, food consnmption, rest, hygiene, ;nedical therapy, etc.-are aimed at deferriiig cleaii~. The non-perennial organism which ages and finally dies when the life-potential has dissipated itself, nlay well be conlpared to a clock which stops ticking once the spring tension fails. But spring tension alone does not cleternline the life-span, for the rate of a clock's ticking obviously fixes the speed at which its spring energy is spent. This applies analogously to the organism. Since the speecl of "ticking" within the body is broadly conditioned by the temperature at which it occurs, thermal changes may alter the life-span. Fruit flies maintained from birth at 30 degrees centigrade go into senescence within 21 days; at 10 degrees centigrade they do not succumb to old age and natural death until almost 200 days have elapsed. Moreover, temperature affects not only the length of the life-cycle; it changes markedly the organism's subjectire sense of time. Insects, for example, when fed at a set hour each day become conditioned and will anticipate feeding by arriving punctually at the trough. If the temperature of the environment is raisecl, they come too early; if lowered, too late. Immediately one wonders why the Eskimo and, say, the desert Bedouin do not show high discrepancy in their time senses, or indeed why the former does not vastly outlive the latter. The ansver is clearly that niammals possess an efficient internal regulating system which, irrespective of external temperature, maintains the inside fires burning at a constant rate. Insects, again, lacking themostats-like all other animals, except mammals and birds-tend to adopt the temperature of the air around them. It is interesting to note that when something goes wrong with the human thermostat, as in fever, the time sense is completely upset, and events race crazily. We have said that the rate of metabolic "ticking" deter~ninesthe length of time during which a given �life-potential is expended, and that this rate is to a determined tension within every iildividual of every considerable degree fixed by the temperature at ~ ~ h i c h non-perennial species. The tortoise drives ahead for the body chemistry functions. Improving on the ex- more than a century; the human being for three-scoreperinlent with the fruit flies, could we not reduce the years-and-ten; the rotifer for only eight days. Is i t internal temperature of higher animals to a point not possible to identify the factors that preordain the where the life-span could be increased indefinite1)-, or shortness of individual existence, and perhaps to cona t least suspended? Happily or unhappily, this is trol them? not possible a t the present state of the biological art. This question, asked so early in the Atomic Era, still The delicately balanced organ and tissue relation- seems unfortunately to connote fantasy. Obviously, ships within the mammalian body are such that a we cannot yet supply a complete or eren a satisfactory drop in internal temperature of only a few degrees is answer. On the other hand, we may infer from the quickly fatal. absence of inevitable death among the lower orpanBut among the non-mammalian species some sug- isms that there is nothing in the fundamental nature gestire experiments have been performed-spectac~~- of protoplasm that demands a ~vearing-out. A man is larly successful among very 10~x7 species, disappointing protoplasm ; a sequoia is protoplasm. One has a anlong creatures even as high as the insects. Thc re- death-terminated life-cycle; the other does not. X search and interpretation of Basile Luyet explains man is a inamnial; so is a mouse. P e t one lives thirty i~-hp. If protoplasm is frozen by ordinary means, times longer than the other. therr cl~veIoptiny water crystals vhich, sharp and Many crude attempts have been made to probe the angular. cause irreparable damage to fragile strnr- h_nr?:an aspects of such gersntic enigmas. Thc clixir tural arrangements within the cell. 0 1 the other of life has prayerfully been sought i n glandular ther1 hand, if freezing is accomplished so rapidly and to apy, connectire tissue extract treatment, reduction of so 10x1- a temperature that ice crystals do not have a bacterial toxins within the body, nutritional n1anip~1chance to form, protoplasm assumes a v i t r e o ~ ~or lation, and so on-bnt vainly, for such gropings have s non-crystalline condition. been basecl on the shaky premise that senility is due to This vitreous state is achieved by rapid immersion the break-up of a single tissue or physiological sysof the nlaterial into liquid nitrogen (195 decrees be- tem. Cnrrent physiological intelligence indicates that low zero centigrade) or some similar lev-temperature true aging derives not from the wearing-out of a single fluid. Essential to the procedure is that the transition body unit, but rather from a n over-all deterioration from normal temperature to that of vitrification be in- genetically intrinsic to the physiological organization stantaneous; and that in thawing, the change be of each species. expect a inore fruitful approach to the equally rapid. Present techniques do not allon- such One ~1-0uld lightning thermal shifts in any but microscopic or- problem of man's mortality to lie in a further quest ganisms, undoubtedly because of the longer time re- for fundamental knowledge of the nature of organ quirecl for heat transference in large masses of cellu- and system relationships within the body, and of the lar material. Thus, only the viruses, bacteria, pro- subtle genetic means by which they are inflaenced. tozoa. and some of the smallest multicellular animals Modern gerontologists are just beginning to look jnto have been successfully vitrified, and thereby trans- such aspects of biochemistry as molecular degradation muted into a state of passive immortality. The plat- and sy&hesis, membrane permeability, energy, exform ciemonstrator who re-vivifies a " frozen ,, fish change, dynamics of gene determinism-to list then1 would find wit11 a little dissection that only the outer all would constitute the outline of a physiology textscales were actually frozen. book. I t does not require a seer's perception to realOf profound significance is the possibility of vitri- ize that this class of phenomena will have to be elucifying spermatozoa, and perhaps even ova, for per- dated f a r more fully before effective thonght can be petual storage. This has actually been accomplished devoted to the challenge of obviating that deep-seated i11 the case of spermatozoa, although the technique is rusting which leads so inexorably to senescence and not developed to the point where it has practical ap- death. Perhaps in this inaugural age of science, man plication. VTe may expect that in the not too distant will begin to supplant his traditional b a t fading future, vitrified sperm banks will be employed in dream of life-after-death with a new and vigorous aninla1 husbandry. The implications of their use in search for biological, and so psychological, immortalhuman enthenics are breathtaking. . . . ity. To those who wonld worry about the staggering implications of literal inimortality, may one add. in The Coiled Spring genuflection, that there will be time enough to deal Xore directly cogent than thermal manipulation to ~ ~ i that greatest of all challenges: the patterning of t h the problems of aging and death is the plausibility of values, motivations and reproductive mores in a sosomeho\v altering the spring which lies coiled t~ a pre- ciet>- \I-hoqr citizens are assured perpetual life. �A Psychiatrist Looks at the Aging By Dr. G . M . Davidson Jfa~zllattaihS t a t e Hospital, W a r d ' s Islaizd, S e w I o f k N to say that a long life without health is not only an iildividual b a t a national tragedy. Therefore, no effort is too costly to remedy the situation. The probleiil of aging is very complex, has many aspects and issues inclusive of the psychiatric. My presentation is limited to an approach of basic evaluation of the aging process. To begin with, I would like to point out certain fallacies of thought ~vhichin my opinion handicsp progress. Due to our traditional materialistic education we are looking for a cause and effect relationship in any problem we may be interested in. This attitude, however, has proven inadequate in its application toward problems pertaining to human nature. I n fact, biology has definitely established that what may be considered "the cause" of a condition is often not the cause a t all, and that causes are multiple. To illustrate, there is a n organic brain disease known as Korsakoff disease of which a most characteristic sign is a certain type of amnesia. The latter was always considered due to the pathology of the brain of such subjects. However, I was able to show that amnesia could be lifted in some cases by means of sodium amytal and that in such instances i t was possible to ascertain that amnesia is essentially psychogenetic in origin; the organic implication belonging to other factors in the problem as a whole. EEDLESS Alice i n Wonderland Another difficulty in our approach toward problems related to manifestation of human nature is our ignorance regarding the body-mind relationship. We are still under the spell of the "old" dualism, which makes, to quote von Hornbostel, "sound and sight, inner and outer, body and sonl, God and the world to fall apart." Perhaps the difficulty will be best illustrated if I should quote to you from Alice in Wonderland. As you recall, Alice was very much annoyed with the sudden vanishing and reappearing cat, and asked him to stop the practice. The cat complied vanishing this time slowly beginning with the tail and ending v i t h the grin which remained for some time after the rest mere gone. "TVell I have often seen a cat without a grin," thought Alice, "but a grin without a cat; i t is the most cnrious thing I ever saw in all my life." However, it is not only Alice that might be surprised by such a phenomenon. Ifany eclucated people inclucling sollie nleclical illen still identify the mind with the brain and cannot "see" the mind without the brain. I n other worcls they insist that the grin and the cat can be only seen together. The latter "logic" is definitely not logical clinically. For instance we know from experiment that a risual iniage may ontlast the stiniulus that provoked the image; we know that mental gron-th continues after physical growth ceases; CI: kaow that a mental reaction which may be ushered in by a physical cause niay continue after the physical cause subsides. I t should, therefore, be the anibition of the psychiatrist to be able to reach ultimately coiirlusioiis of physical changes in the organisms on the basiq of psychological symptoms. This falls in line with the experience of Alice in JTTonderland. If so. hon- can we scientifically o ~ ~ t l i n e quoted allegory Yl the I t is this may: We identify the individual in space and time as the "total personality" which ~neansto regard him as a whole inclusive of his past and his environment. The total personality is composed of a multitude of parts which are trained by experience to work in harmony for the benefit of the totality. Depending upon the harmony and unity achieved and the compensatory ability for incurred damages, there may be all degrees of functioning up to a point of maximuni efficiency. Disharmony or unrepaired damage may result in clun~sinessin its mind-expression, failure in more pronounced states, and disaster in severe expression. I n search to measure the totality in action I applied Sherrington's view on the coordinated neurological mechanism which he called the final common path. My studies have convincecl me that there is a common final path of the total personality which T identified with affectivity (according to a standard dictionary affectivity means to aspire; to aim; bent of niiiid; uqed synonynionsly with emotionality). I t is in hari~ionywith the view that the mental and the physical are separate of one and the same, the totality, n hich may be measured by different is methods. A f f e c t i ~ i t ~ - regarded as the evolntioiiary outcome of the original irritability of the cell which in t u r n may be identified as the "mental component" of the cell. Affectivity is the measure of the bodily power to absorb and reflect stimuli. This approach suggests that the release of personality disorders is caused b- Inany factors among which I distinguish: : �tially of the same origin. I mean to say that certain mental nlanifestations associated with involution of 1. Factors belonging to the evolution and integrathe individual (change of life), can be observed in the tion of the total personality and expressed in disorder agitated and depressed type of senile psychosis known of the total affectivity and its constituents (such as as agitated depression, as well as those similar sympsocial, sexual, etc. impulses), a disorder which is contoms which occur in agitated depression a t any age, sidered in t n r n the biological background of what is and differ only in their strength of expression, which kno~vn " inental conflict ;' ' as is due essentially to the psychology and physiology of 2. Factors belonging to the maintenance of equilibthe respective age. For instance, the emotional state rium and rooted in the system of defense of the total of inrolutiollal melancholia, in addition to the aspect personalit!- (physically-impairment of homeostasis ; of anxiety, has a n admixture of remorse and nostalgia. mentally-impairment of mechanism, such as the The nuclear motive of these nlental states is the fear inechanism of repression, compensation, etc.) ; and of death and of the anknown (in so many instances 3. Precipitating and aggravating factors (emothe fear of life), which in turn is the result of other tional, tran~llatic,etc.) which overcharge our capacity psychodynanlics of the total personality. This may to react. or participate in dissolution of the total perbe applied also to other mental states with due consonality. sideration to the individuality of the case. With the foregoing in mind and with emphasis on If this view is correct then there is hope that the the fact that psychopathology may give clues of C ~ R T ~ ~ill Sthe organisn~~ tried to isolate certain P T individual may be spared these incapacitating sta.tes. phenoillena which could be applicable in a longitudinal way, to manifestations of aging. Now conles the I t has been established that in the mentioned neuroses question. lJThat do v7e mean by aging and when does and psychoses, the subjects are of a certain make-up aging begin? I n answer, some see aging as begin- which is marked by traits of oversensitivity, scrupuning TT ith conception and terminating in death, which losity, overorderliness, stinginess, etc. The traits are considered as "reaction formations" due to faulty view, while correct in a philosophical sense, is incorearly socialization, and thus may be avoided by proper rect clinically since it confuses a t some phases of life growth with decline. Another opinion is that aging education. Cerebral Arteriosclerosis begins some time about middle age. This is also incorrect for the reason that chronological age does not Another point that 1 mould like to discuss is the coincide with the physiological and the psychological of cerebral arteriosclerosis which we encounage. lllld 1~11e11 does middle age set i n ? That is an- tel- in persons of advanced age. TVe do not know other question. 1 mould think that aging is a pl~ase exactly ~ v h a t cerebral arteriosclerosis is due to. But in the life process of the individual which starts some Ive do know that the process is selective. I t used to time after maturity (according to a standard diction- be said that a man is as old as his arteries. This is ary. maturity is a process brought about by conlple- not quite true; ho~vever,it may be said that arter-0tion and dereloplllent for anJTfnnction appropriate to sclerosis niay be related among other things, to the its kind). Aiccorclingto my investigation aging begins individual's ability to disperse cholesterol. This a t about the end of the third and the beginning of the 1~7011ldrefer to hormonal and dietary factors, as well fourth clecade of the life of the individaal and is as to the fnllction of the reticuloendothelial system manifestecl by a set of psychological phenomena. I t is (belongs to the system of defense of the personality). a t this time that the individual may cast a glance Diagllosis of cerebral arteriosclerosis is often diffiinto the future and the unknown. He develops inse- cult unless there are pronounced focal symptoms, and curity to which he reacts with an anxiety state; the utller urganic L.oi~ditioi~s excluded. IIomever, the are idea of death may cross his mind with all the disquiet diagnosis of early cerebral arteriosclerosis may be that it ma!- cause. Other sympton~s may follow. made on mental lines. A particular irritability and The lllcntioned phenomena inay be mild in their ex- emotioiial instability may be an early sign. These emopression or inore serere, depending upon the original tional states are undoubtedly an unconscious reaction emotional coi~stellationof the inclividual. to his failures due to aging. Depressive states may For those rvho are very concrete in their attitude, be rooted in inrolntional changes which may go on io or for those ~ ~ l are bnrdened with problem of cause in the same period. *4cute vascular conditions may and effect relationship, the foregoing conclusion and be suspected froln the nlanifestations of acute disthe f o l l o ~ ~ l ndiscussion will be difficult to accept, turbailces in orientation and memory. The more g IIo~verer. f a r as I am concerned, I believe that the severe distnrbances of menlory or language are due to as mentioned synptoms and the similar ones which ma:impairment of the synlbolic formulation of thought. be ohsrr~-ed nliddle life or adranced age are ebsen- xhic.11 has an einotional as well as neurological aspect. at Factors in Personality Disorders 137 �As f a r as cerebral arteriosclerotic delnentias are concerned, we have no adequate tests to measure them. to I n some respects they are sin~ilar other dementias, such as senile ones, which me shall discuss presently. Generally speaking, studies of the brains of cerebral arteriosclerosis subjects do not prodnce definite evidence to account for the clinical manifestations. I believe that the studies on the subject do not reveal any factors which could be considered solely due to aging. It refers rather to factors working upon the life process in general. Therefore, one may hope also here that better knowledge of the nature of arteriosclerosis will help in prevention of the dificalties ~vhicharise from this acquired condition. the brain and clinical phenomena. Therefore, one may assume, a t the present state of our knowledge, that there are no specific causes for the process of aging. The causes are multiple. It is the people themselves, their mode of life with all the traumatic influences that are responsible f o r the pathological states of the aging. The release of the conditioil being in harmony with the outlined three groups of factors responsible for the release of a n y personality disorder, as discussed. Conclusions I n suinming up I would like to emphasize the f01lowing psychiatric observation : Senility 1. We are ill-prepared in meeting oar aging. I n I want to discuss briefly still another point which is a pathological appendix of aging, and which is spoken of 2s senility. The lattcr in its height of expression is knox~n senile psychosis. I have already as mentioiled one type of such psychosis, the agitated and depressed type. There are other types, such a s : the paranoid type, the confused type, the type of simple deterioration, etc. Approaches from the angle of the final conlmoil path we identify the situation \Tith dissolutioll of affectivity (interestingly the French psychologist Ribot studying at the t u r n of the century the senile states and emphasiziiiq the loss of memory discussed ~ e r y ably the progressive changes in emotionality). I n examining the varions types of senile psychoses we come to the conclusions that the respective type of reactioi~is rooted in the potentialities of the personality of the individual. F o r iiistailce a person with a poor system of defense will sho~v simple deterioration. A well equipped person will develop trends which in t u r n may help him to be better preserved. I n the confused states we a a y have a toxic factor, etc. Regarding intelligence in the senile cases I wish to repeat that we hare 110 adequate tests to measure it. It is to be noted that intelligence seeins to improve after treatment of the snbject with vitamins B and C. Concerning memory, I like to say that a loss of the latter may occur at any time during life. I t ought to be noted that memory is only important as a n instruinent of adjnstment. To function properly there must be integration of new with old memories. This integration is weakened in the aged for the reason of dissol~ltion of emotionality. I t is the ell~otioi~al which is essenlink tial for integration of new with old memories (co111pare with our "loss" of 11lenlory for infantile :xperiences). Studies of senile brains do not produce satisfactory evidence to explain the clinical manifestations. I n fact, there is no correlatioll bet~veenthe filldil~rrsof 138 2. 3. 4. 5. fact IT-€ meet aging grudgingly and react to its perception with anxiety which is a n alarl~i sigilal of the systeni of defense, and i n prono~ulced instances with morbidity. Sorlnal aging is marked by a clecliile in fnnction which is taken care of by the systenl of defense of the personality-in both its physical and niental aspects-as seen fronz measureiilent of biological time and inental manifestations. TII pathological aging there is all abnormal ~veakening of the system of defense, which reaches its height of expression in dissolution of affectivity, coiiditions ~vhich require most urgent study. (The workings of i t is seen ia the ~ a r i o u stypes of senile psychoses with all its 11 negative ' ' compensations.) The system of defense of the p e r s o l ~ a l i tlllay ~ be vulnerable on inore than one score. There lnay be hereditary and coi~stitutional factors responsible, yet unkno\vn. We do know. however, that infectious, traumatic and emotioilal factors play a n important role. Therefore one nlay conclude that proper education, proper application of physical and mental hygiene guided by a sound philosophy of life which shall proricle the individual with social, economic, sexual and eniotional security will help him and soviety to aroid the calamities of aging as observed in our times. Finally it must br pointed out that the road of of achievement of ilormal aging for all is a long ancl tlzorii,~-one. Our knonletlge of the problenl ii ~ ~ 1meager. The time is short and - y only a rigorous research progra~ll ins>- help. For researvh two ~ l r m r n t s needed: idpac and are financial backing. Fortunately there is abundance of both in this country. Therefore, we may look with confidence i n the fntnre. But n e have to go to work right away. �Family Carefor the Aged By Miss Hester B. Crutcher Direct01 of Social W o r k , New Y o r k State .$fental Hygiene Depcc~.tnzent S 1933 the State of Kew York has developed a program of placing patients in homes other than their own for care. This method of care is used for the patient for whom it will have definite therapeutic value. I n this instance, the family care home serves somewhat the same purpose as a convalescent home might for patients who had been treated in a general hospital. This offers the patient the opportunity of making his community adjustment gradualiy and without the pressure he would feel from his o~1~n family to work or to assume other responsibilities which he may not feel eqnal to doing. I n the family care home the social worker from the hospital encourages the patient to do what he feels able to do and gradually to assume the respoiisibilities of community life. The family caretakers are given instructions as to what the patients7 needs are and how these needs should be met. They give him support and encouragement so that he will make progress and yet not feel that any pressure is put upon him to assume the responsibilities he carried before his illness. Therapeutic family care has been used for elderly patients as it is felt that with this support they can find a niche for themselves in the community and eventually make a permanent adjustment with the help of old age assistance or other coinmunity agencies interested in helping the aged. Foster family care is also used for patients, many of whom are aged, who have profited all they can from hospital-treatment but who do not need the varions highly specialized services of the hospital. Those patients are often confused, forgetful and unable to take adequate care of themselves but they are not dangerous to themselves or others. They need the carefnl supervision of the hospital social service and the protection offered by an understanding family. With this they can enjoy varying degrees of freedox in IKCE community living and they are much happier than they are in the institution. Family care in the State of New York has developed s l o ~ ~ l y . During the war the securing of families interested in this project was difficult because in many families both husband and wife worked or perhaps they opened their homes to daughters and children whose husbands were in service-thus they had no space for patients. Since the war the housing shortage has continued to hinder the development of this program. TfTe shonld also mention the fact that the shortage of both psychiatric and social service staff during the war mas an added factor preventing the developnient of family care. I n spite of this relatively slow developnlent it has been shown that with adequate psychiatric social service supervision, and adequate medical personnel to select patients, that family care offers a valuable source of exit from our institutions which can be increasingly used both for the benefit of the patient and the community. We feel that the development of family care might be one may of decreasing the necessity for new bnildings; we know that it is less expensive than hospital care and that the satisfaction to the individuals who enjoy the benefit of family care is something that cannot be measured. At the present time there are 2,000 patients placed i11 foster homes by the institutions of the department. Of the 1,284 placed by various State hospitals, 743 are over 60 years of age and 84 of the State school patients are over 60. Incidentally, in this group of patients past 60 there are 27 men and 36 women ~ ~ h o are past 80 years of age. From the above figures it will be noted that already the State has used family care quite extensively for elderly patients. TTTebelieve that foster home care for elderly patients is a resource which has shown its valne and which should be more extensively developed. ��Dr. Theodore G. Klumpp, president of the Winthrop Chemical Co., says, "Any biological organism that has been accustomed to a set routine for 40 or 50 years can't suddenly be shaken from its orbit without untoward consequences. Dr. Lydia G. Giberson of the Iietropolitan Life Insurance Company speaks of the "lethal" cessation of activity. Famed physiologist A. J. Carlson of the University I Psychiatrists warn that idle retirement is likely to aggravate our personality defects, to evoke deep irritations, and make us childish and petulant to such an extent as to transform a fine citizen into a liability. Retirement unwisely planned tends to bring forth weaknesses of childhood that have been consciously or unconsciously repressed through an active life. The mental experts find that the man who wishes to COPR. 1950 BY NEA SERVICE, INC. T. M. REG. U. S. PAT. OFF. "Thirty-nine days until I h'ave,to retire! ward t o this all these years-till of Chicago and the late Dr. Alexis Carrel, one of the greatest scientists of our era, have both warned against the "rocking chair" phantasy. "When me are in idle retirement," says Dr. Carlson, "I\-e are contributing to biological parasitism and degeneration of human society as well as wasting valuable human resources. " Dr. Carrel pointed out that leisure is even more dangerous for the old then for the young, that inaction impoverishes the content of time. "To those vhose forces are declining appropriate work should be given, but not rest," he advised. 1 I've looked fornow!" "rest' ' or "live the life of Reilly " is either ii~~lulgiiig in a phantasy or is simply running alyay from life, due to past failures, inadequately rewarded. Our mental hospitals are flooded with elderly who are not insane but simply confused, harmlessly childish or depressed, senile largely because they permitted their minds to rust away. The Best Rule to Follow Science therefore calls for vie\$-ing retire~nentin a Ilely light, in which it must be : �( a ) fitted to the individual's needs, ( b ) in which activity must not cease, ant1 ( c ) in ~ ~ h i c h innst be coizceivecl llot as a it 1' clrawing back," but rather as a neJT tnri1 in life's road, filled with new challenges, nev- opportanities. Successful retirement is one of the most difficult achievements of a lifetime, as hard as the clinlb to the top in business or finance or law. I t recluires careful thought. Too many persons begin in their 30s and 10s to invest in annuities or to build u p invest~nents for retirement, but neglect until the clay they retire planning hat they are going to do with their retire~ n e n t-ears. Illlo~vyourself a t least 10 years, if possible, to develop and test your plan. When Should You Retire? Siiice some of n< are old at 45, Ti-hile oeileral are !-oL,ng at 80, rule can be given as to when we should retire. Since one's chronological age is uiiimportant coinpared - \ ~ i t h Don't Stop-Slow Down one's physiological or inental age, S e w Tol-!i State I-Iealth Conimissioner Hernlaii E. Hilleboe says. "a Llbo\e all, clon't stop working until other ilitrrests fixed age for retirement is absard." The best rule to follo~vis to retire when >-on can nrp ready to absorb ancl keep alive your niental rnerafford to, want to, or have to, clue to inability to con- ji~es. This sloning dox~iiprocess may consist of rastinue, and then be certain >-ou don't merel:~ yegetate lug off the number of hours you nork at t h e ofice, taking longer or illore frequent vacatiolls; grdd~tal1)but retire to something. sliiftiiig respvilslbilities to younger as5ociates; or cutii ting c l o ~ ~on activities that drain >-onr eiiergles, qnch Examples of S~~ccessful Retirement as busiiless travelling. saleq p r n ~ c r t i o av:or!:, 51:i:crriT,-e ca:: !eai.ii iiiiicl~I ' ~ ~ Ithose who hare retired sion of personnel. This slow-down will also enable II successfully. When Dr. F r a n k P. Graves, former OIL to give yonr program a pre-rctirenieiit trinl. S e w york State Commissioner of Eclucation, i~otecl The core of snccessful retireillent is useful avtirity. educator ancl holder of 40 honorary degrees, retlreil. But n h a t constitutes " u s e f ~ ~ l a c t i ~ i t y Again. the " I he clecided to go back to school and become a lawyer. ai1snt.r c1el)rucls on the individual. retired sales solnething he had always wanted to be. 11 his 80s, iiianager found that operating a small gift shop was 1 D r . Graves found a new, satisfying career. Mr. Ber- l~seful. pleasurable, and kept him snfficiently ac2ti~-e to nard Baruch has found in retirenlent a buy-, rital. suit his needs. Another retired "big bnsiness" execurich career advising goverilinellts and stimnlatiiig tive organized a small ~ ~ o o d w o r k i n g plant in his oarmuch needed health research. F r ~ e rof administrative age to produce hand carved trays that sell successfully i details and responsibilities, three of General Electric by mail. This iilaii had always been an organizer and Company's top scientists, Drs. Willis R. TVhitney. 82 ; reveled in hif ability to x~eld together a snlall organiIrving Langmuir, 67; and TTTilliam I). Coolidge, iG. lation that makes a profit without much effort on his all officially "retired" from the company, have re- part. third "retiree" when advised a t age 82 by turned to their laboratories to find new challenses and his phr-sician to "take things easy," inovecl his real satisfactions in working, perhaps a t a more l e i s u y e l ~ estate bnsiness from his office to his home, where hc pace than previously, in the new fields of radar, tele- still x~orksat i t part-time. These nlen are all still vision and atonlic energy. Note that all these Inen are productive and the years sit lightly on their shoi~lders. useful and needed. Synthesizing the findings of science with :he perAnd Get a Hobby-Horse sonal experiences of the sl~ccessfully retired, there are five basic principles for making retirement a golden LLll of us, to grow old gracefully, need to clevelopera of satisfaction and happiness : as early as we can-interests outside of bnsiness. Age 1. Start planning the izon-fiscal aspects of retire- is no excuse. Dr. Noland D. C. Lewis. noted psj-chiament when you initiate your fiscal progranl for trist. points out that a illan of 65 can learn more easily retirement. Begin in your 30s and 40s to work than a boy of 12. If you don't like to play golf, skip it. If you despise gardening, avoid it. But keep an on your plan. 2. Don't stop working abruptly; slow d o ~ yradu- open mind a b o ~ l thobbies. I n retirement yon need ~n leisure time activity to supplement your useful work. ally. Many a businessinan who sneered a t such activities activity the core of your retirenient 3. Make ~csefzil as painting, photography, writing, sculptaring or plans. 4. Develop now an interest outside your business or carving has found such hobbies a "blue chip" investprofession that you can ride as a hobby when ment for contentment i n retirement. I n many communities you will find handicraft schools or Y.M.C.A. you retire. 5 . Devote p a r t of your retirement to civic or char- hobby clubs where businessmen are preparing for their retirement. itable service. �One of the basic emotional needs for snccessful retirenlent is to feel needed. And certainly one field in which our senior citizens-men and women-are needed is that of civic and charitable work in every comnlunity. Many of our philanthropic ancl ed~lcational organizations are staffed by well-meaning amateur administrators; they need help in modernizing their work, they need counsel. Some agencies need investment counsel; others need aid in giving financial counselling to families in tronble. Many need help in soliciting funds from industry and financial organizations. Our health associations, family welfare agencies, local groups combatting jnvenile delinquency, the Red Cross, the Boy Scouts of America, and church organizations, urgently need part-time volunteer aid that our retired executives and professional people can give. XTe need more businessinen of ability on onr boards of education, on our hospital boards of ~ireCiol.,, 7) V U 1-~ --. ~ i i e h ~ ~ Kwith groups ill be e n o r ~ o u s l y r e ~ ~ a r d i n absorbing and useful. I t will give zest to g, your retirement years. Selling the American System 1Iany of our bnsinessmen earn their livelihood selling products, services or ideas. I n retirement they can use their talents to render a patriotic service of utmost importance by "selling " the people of their respective communities on the illnerican system and the achievements of American initiative; on the role of capital in producing new standards of living ; and on the simple economic facts of American life. Many retired American businessmen will find this role of 'salesman emeritus" to be enormously satisfying and challenging. And it is a job that needs to be done. Underl5-ing the activity program for retirement years there must be a solid bedrock of financial security. This is needed to make the retirement program feasible, to erase the possibility of financial stress and to p r o ~ i d e emotional stability that stems from the an knowledge that the later years are provided for. One who is not a financial expert should consult one of the host of experienced fiscal advisers, such as trnst officers, who are skilled i11 portfolio planning for retirement. The stakes are too high to depend on amateur counsel, tips from well-meaning friends, or intilition. Retirement call he an era of achievement a s well as calm, of usefulness as well as restfulness, TI-hiehvill keep one youthful in spirit. If you would avoid the boredom of unplanned retirement, the restlessness of useless activity in your later years, the dulling of mental powers in idle leisure, start now to avoid the hazards of the mental "bends" that come with sudden, unplanned retirement. ( L e t m e grow lovely, growing old, S o marly fine t h i f i g s do. Laces and i v o r y a n d gold A n d s i l k s need n o t be n e w . A n d t h e r e i s healing in old t ~ e e s , Old trees a g l a m o u r h o l d ; W h y may n o t I , a s u;ell as these, G r o w loaely, growing old? Autlior Unknn\~-11 �State Aid for Recreation Centers B y Harry Levine Administrator, Special Services f o r the Aged, N e w York C i t y Departrneltt of Tfelfare I SHOULD like to pay tribute to the splenclid achievements of the Desniond Committee. Ti1 the very brief period in which it has functioned, it has made a most important contribution to the field of old age. Through its published material and its ability to reach the community it is making the leaders in many fields and the community, itself, aware of the problem and the possibilities of a concrete practical program. I t is making a lasting rontrib~ztionto the 16 millioll Americans past 60. Since time immemorial, man has counted longevity amongst he blessings, particularly ~vheii few achieved it. Now that we have achieved the three score and ten years for the many, those who have achieved it doubt it's blessing and with good reason. There are, however, some blessings. Today, the man of 60 or 65 is a much different person from the man of 60 or 65 of the 1800's or 1900's. He is a much younger person. He is much healthier, stronger and more dynamic. When the average life expectancy mas 35 in 1800, a person of 40 was comparatively old; when we achieved an average life expectancy of 45 in 1900, a person of 50 mas a comparatively old person. Now that n7e live to almost 70, a person of 40 or 50 is comparatively young. I n a shorter lifetime, he worked as many hours as he now does in a longer lifetime. He works under conditions much more favorably to his health in terms of sanitation, heat, light and transportation. I n the past, if he managed to reach 65 he mas a tired old person. Today, a 65 year old person has an interest in and a zest for living, a need to be active and to participate-and why not, for at 55 he has a life expectancy of close to 20 years; at 60, at least 16 years; at 65, 13 years. Even at 70, he still expects to live for 10 more years. If you add 5 or 10 years of unemployment, that is the lot of many people. Before they reach 60 or 65, you have another lifetime to account for. Actually that lifetime cannot be accounted for. I t is generally masted. I t makes little contribution to the family and to the commanity and much less to the older person. I t is difficult to accept the fact that the lifetime of millions of people in the United States is wasted, but what is even more difficult to accept is that from these ~nillions-with little to do, with no positive interest, unwanted, feeling themselves a burden-deterioration and illness becomes their daily es- perience aiicl for many, many thousands mental hospitals beco~nean unnecessary and undeserved inhnman and bitter ending. I just had occasion to check the figures of BrooB1)-11 State Hospital. As of October 1, 1949, they had 1.165 men and women patients over 60, 71 were 85 to 89, 28 were 90 to 94, 3 were 95 to 99 and 1 ~ 5 - a ~ el-cn over 100. I t is difficult to contemplate that an indi~idnal :nay enter at the age of 60 and lire for -10 years in a mental hospital. Kings County has 7.800 patients who are past 60 and they send n i n ? . ~t h t a ~ 100 patients a week over 60 to other State hospitals. The Manhattan State Hospital advises that of their 4,000 patients, 1.971 are over 60 years of age. Tllere are 153 on convalescent statns. Dr. Travis writes that it is amongst the latter group that people shonltl a ~ a i l themselves of oar day center activities. I an1 \-ery deeply concerned mith the 153 convalescent patit.nts, but I an1 even more concerned with the people i ~ ~ h o may get into mental hospitals-particularly n he11 nre are advised that 75 per cent of those already in mental hospitals could have remained in the conlnlunity mith a little help, and even now, most of then1 clo not belong there. O'ld age homes care for approsilllately 1per cent of our older people. I am interested in the more than 90 per cent. The lack of infornlatioii and lack of understanding of our older people not only makes possible the fact that over 60 per cent of all new admissions to mental hospitals in Xew Porl; State are people over 60, but it makes possible the consipni1:ent of most of our older people to oar economic, social and cultural scrap heap. When a man or woman stops working in his or her occupation; when there is no longer a falnily to raise; when an older person must learn to live alone after the death of a lifetime partner ; unless there is a place where the^- are needed, where they could continue to make a co~ltribution;where they could continae to be active, they begin to lose their feelings of adeqnacy and ~vorthwhileness. Time begin5 to hang heavy on their persons and their personalities, particularly during the morlring hours b e t ~ ~ e 9 n A.M. r :00 to 3 :00 P.M., when everyone else around them is occnpied and funcrtiuning. I believe it is then that deterioration sets in and illness becomes confused mith age and eventually part of it. There mnst be a place in the conlmunity for the older person--a pla .e that �can lnaintain a feeling of usefulness and adequacy and belonging for the conntless nunibers who need it and want it. Day Centers Needed When we begin to analyze what really can be done for the older person, not in the near future, but now, we feel more and more that the development of a well planned integrated system of day centers for older people is one of the realistic practical programs that can be developed today. When Dr. Charles Kidd analyzed the problem, he pointed out that a smaller population of older vorkers will be in the labor force in 1960 than in 1948, despite the recognition that there will be a tremendous increase in the number of older people. There is a steady marked decline of older people in the labor force. For cxample, in 1890, 70 per cent of men 65 and over were in the labor force. By 1940, this figure declined to 42 per cent and will decline to 36 per cent by 1950; and by 1960, he predicts it may be as low as 30 per cent. I t becomes even more apparent when Dr. Ewan Clagne points out that aniong persons 65 to 74 one-half are not affected by chronic disability and impairment. Only 5 out of every 100 persons were classified as invalids, and there is a growing difference between ability to work, work itself and the life span. The day center can be a substitute for the loss of the work day; the day center can be instrumental in prolonging the period of usefulness; it can extend the feeling of acceptance and belonging in the older person; it can give meaning to the latter part of life by developing a dynamic program for the older person. I t is generally accepted that each individual ages at his own speed or pace and in the same individual different fanctions age at different rates. I t is, tlierefore, the content age rather than the birthilav or chronological age that becomes important in working with older people. We hope that in these day centers medical findings will be utilized to help the older per- son to a realization of the remaining strengths available to him and to plan for its utilization. We also are aware that people have many areas of competency that a busy work life has not permitted of development. mTe hope, through a testing process, to uncover these areas and combine those areas of competency with the strengths remaining to the individual. The day center program has for its objectives: 1. The promoting of the social and emotional adjustment of the older person through activity. 2. To make possible for the older person the maximum use of the capacities least impaired and of capacities least used. 3. To promote community usefulness by having the older person fit to participate in voluntary programs in the community. With a case work, group work and personal eounthe older person csn maintain a period of well being for a much longer time than is presently the case. We believe, through the various activities developed a t the centers, that it is possible: rrn11:nm --,,nnm urjlllug pLvsrccnr, 1. To lessen the need for mental hospitals. We haven't had a single admission to a mental hospital from our centers in the six years o i its existence. 2. To lessen the need for clinics and general hospitals. Our people stop going to clinics after a period at the center. 3. To cut the period of illness from a matter of years to a matter of months. Their illness is usually of short duration-a matter of weeks or at most months. I do hope that the committee will see fit to recomlneiid the appropriation of a t least one million dollars to extend this program throughout the State. I believe the appropriatioll d l , in turn, save many millioiis for the taxpayers in the State. OUR NEW OLDSTERS "Noting the interest you are taking in the conditions of the 'oldsters,' of which I shall soon, b e a member, I am writing to you for information." Letter to Senator Desmond from 80-year old Mr. W . H. Singer, of Olean, New York, Jan. 29, 1950, inqniring whether he can take a job without impairing his old age assistailce benefits. �Financing Old Age B y Dr. Henry W . Steinhaus Research Assistant t o the President o f the Eyuitable Life l s s u r a v r e Society S 60 years ago, on June 22, 1889, to be specific, the first Social Insurance Pension System in the world became law in Germany. Dnring these 60 years the extension of life has intensified the problem of lirelihood after retirement but no satisfactory basis has been developed for financing old age pensions on a national scale. There are two principal methods of financing a national pension system. One involves a pay-as-yougo system under which pensions are paid out of current revenues. The other involves complete funding under which capital is accumnlated during the working years of a generation, sufficient to pay pensions after retirement without additional financing. Between these two extremes are various other methods under which some reserves are accumulated to pay part of the pensions but ultimately requiring subsidies. OJIE Pay-as-you-go vs. Funded System The original Social Security Act of 1935 employed the method of funding. When the act was amended in 1939, a pay-as-you-go systeni was substituted, modified somewhat by a small contingency reserve. However, this reserve actually rose to $12 billion dne to the inflation of wages on which contributions are based, and it looks as if the pay-as-you-go system had turned itself into a funded system under which the scheduled tax rates would be entirely sufficient to maintain the present structure of benefits. If inflationary developments of the relatively mild character of the last few years are sufficient to turn one type of funding into the other, there would seem to exist most serious objections to the adoption of a fnlly fnnded system. Nevertheless, H. R. 6000 again has proposed funding of pensions. Reserves would accumulate which would reach even without any further inflationary development nearly $100 billion over the next 30-40 years. There is obviously no guaranty under either system of financing that the old age pensions will accomplish what they were supposed to do, namely, to establish at least a minimum of financial security for our aging population. Current pensions average $25 monthly, and while they may be raised to a n average of some $44 next year, there is obviously no guaranty that the purchasing power of these $44 will be maintained. If our deficit spending and easy money policy continues, the chances are that the purchasing power of the pensions will steadily decline and that adjustments in benefits will always lag by several years. At the same time payrolls and contributions would be higher than anticipated. I n 1935, opponents of the funded system compared the proposed $47 billion reserve to our then national debt of some $30 billions and wondered what the Government would use for investments. This objection was taken care of quite neatly, and even a $100 billion reserre could apparently be handled. However, in order to create this reserve, we must withdraw from current income billions of dollars annually. These withdrawals would be in addition to any required by supplementary private pensions. Since the Government has the taxing power, it could always pay the promised pensions, Congress willing, whether or not the reserves existed. Private pensions, holyever, have obviously no security behind them except the funds already deposited. If the pension movement spreads and nlillions of our citizens obtain a supplementary pension guaranteed to provide $100 a month including Social Insurance pensions, the annual charge would be prohibitive. On a funded basis it costs about 6 per cent of payroll to provide private pensions to sapplenient those proposed under H.R. 6000, or $6 billion annually for a $100 billion payroll. This amount added to the taxes proposed for the Social Iiisnrance pension represents a sizable proportion of our national capacity to save. The withdrawal of funds of such magnitude would probably cause a decline in consumption, because price rises necessitated by increased employer costs will cause deferment of spending by a population whose income is also reduced by direct contributions for Federal and private pensions. If the Government attempts to replace this deficiency by additional deficit spending, an inflationary cycle would be set in motion and deflate the purchasing power of the pensions. We cannot increase our standard of living by printing money and distributing it. I think the public understands this by now. We cannot create old age security by putting away current earnings without actually reducing our standard of living accordingly. This the public does not understand yet. I n either �case, the economy will adjust itself autolnatically by inflation. Attempts to provide artificially more financial security than there is have perhaps the pleasant illusion of a chain letter that benefits the first few recipients of income, but the outcome is a rude awakening of those who expect a benefit later on. Three Point Programs It is not conceivable that there would be a single answer to all these problems, but there are a few things that can be done. First of all, we must attempt to stabilize the span of retired life by encouraging deferment of retirement. Fortunately, the generations living under the favorable health conditions of today appear to bring into their old age an improved vitality. This improvement in vitality may permit a deferment of retirement for those able to maintain employment. Secoiicl, the Federal Government should abstain entirely from withdrawing purchasing pover by means of payroll taxation for the purpose of bnilding up additional old age reserves. The reserve of $12 billion b,~-itself would be sufficient to pay the pensions proposed under H.R. 6000 for the next six years. 11-ithont requiring additional contributions. If payroll taxes are held at low levels, a greater number of individuals mill be able to provide a competence for their old age, and thereby minimize the national problem. Third, we should explore non-monetary financing of old age security. Up to this point we only reviewed the problem of providing a pension payable in cash, and it was the accumulation of money of declining purchasing power which caused all the difficulties. One of the biggest items on the budget for the aged is the cost of living quarters. Only too often exorbitant rents eat up much of the money grants and leave little for comfort. Ownership of living quarters effectively provides an inflation-proof roof over the head. The European pattern of living of the aged has emerged as centered aronnd living quarters, either in large settlements or in individual homes and apartments of income-prod~~cing types. There are many problems involved in furthering non-monetary financing of old age. An equitable method must be found to transfer ownership from generation to generation. The taxation of such dwellings must be handled in such a way as to avoid undue burdens on both the aged and the community. There are other items in the budget of the aged which may lend themselves to non-monetary storage. I n my opinion, the greatest hope for old age security lies in our success in exploring and activating nonmonetary methods of financing old age security. �Trends in Old Age Assistance By Miss Jane M. Hoey Director, B.ui.erru of Public .Issista~lce, Cltited s t a t e s Social S e c u v i t ~ -4dtninistration A s AN introduction to the subject of trends in old age assistance perhaps it would be desirable to state some basic assumptions underlying the need for and cbjective of an old age assistance program. Man is a nation's greatest asset, whatever his agenot just when he is young-and whatever his race, nationality, religion, physical or mental capacity, personality, or social or economic status. The family, whatever its composition or age of its members, is the basic nnit of our civilization and needs to be developed and preserved whatever the cost. There is no substitute for the family nor for the care and affection which most members of a family give to each other. The Kation has an obligation to man, always to respect his dignity, his integrity, and rights as a human being, and to help him develop all his capacities to be productive, and to support himself and his dependents, and to contribute materially, culturally and spiritually to his own growth and developinent for the benefit of society. The Nation, through its various governmental units and private agencies, has an obligation to make possible normal family life through such measures as will protect health and develop wholesome surroundings in which man can live ; to establish and maintain a decent standard of living; to provide such services as education, health, and welfare as are necessary to promote public welfare; and to encourage private institutions and agencies in giving services which are helpful to man and families as these services are needed and desired. I t is because of our failure to live up to our theoretical assumptions in practice, and because of the facts of change in our population and the varying needs of groups such as the aging, that m7e must reconsider our plans, our attitudes, and our programs. When the Social Security Act was passed in 1935 it mas in the middle of a depression and millions of workers of all age groups were unemployed. There was a generally accepted idea at that time that older workers should retire and thus leave jobs available for younger workers. During the long period of the depression, large numbers of older workers who were unemployed used up their savings and other resources and at 65 were almost coinpletely destitute. Therefore, a long-range plan for meeting need caused by certain common standards, uneniployment snd old age, was developed under the Social Security Act. Provision was made for unemployment insurance, State administered, and old age insurance, later changed to old age and survivors' insurance, a Federal plan financed through contributions of employees and employers. However, no provision under the Social Security Act was made for large numbers of workers, chiefly those in agriculture and domestic servants. Also there mere many who were then aged and in need and who could never be covered by the insurance programs. So for this latter group the Social Secnrity Act provided grants-in-aid to states to help them pire more adequate financial aid and other services to their needy aged living in their own homes or in private institutions or boarding homes. Because this needy group was so numerous and because it took so long for persons to qualify under the old age insurance program, many persons, aged and others, assumed that the only program for care of the aged with which the Federal and State governments were concerned was old age assistance. For this reason and because for a long time there have been individuals and groups advocating "pensions for the aged," some state legislatures have tried through the old age assistance program to guarantee a minimum income to the needy aged and have liberally interpreted need. Because old age insurance benefits are inadequate to meet the average need, many beneficiaries of old age insurance are also eligible for supplementary old age assistance, and 10 per cent are in receipt of it. H.R. 6000 If changes in the Social Secnrity Act, such as are proposed in H.R. 6000 are enacted, this inag change drastically the trend in old age assistance in the future. I t may also change community attitudes toward the need for a flat pension. A11 Old Age and Snrvirors Insurance program for all employed persons and ~vith benefits adequate in amount to meet average need, supplemented by an old age assistance program for the needy aged, \vould seem to be a desirable objectire toward which we have made real progress, but which needs extension and strengthening as indicated by present congressional action. Old age assistance is a program of financial aid and other services to men and women who are at least 65 years old and who do not have enough income and re- �sources to secure the necessities of life-food, shelter, clothing, medical care, etc. The program mas intended to supplement insufficient incomes of individual people; and to supplemeilt other plans and programs that provide income after 65. These programs have not been developed as anticipated, and old age assistance has grown beyond its intended scope and responsibilities. To understand past trends and to plan for the properly limited function of old age assistance in the futnre we must look, in passing, at some other pertinent developments in the United States. As most of our programs and plans for old age security are oriented toward age 65, that age has become unfortunately synonymous with old, retired, disabled, and sometimes useless. Unless community attitudes alla our programs are redirected tolT,ard a worker's ability to maintain himself as long as he is able and to do so, many of our citizens over be sentenced to a life of inactivity. ?;o avoid 65 this sentence, must overcome these confusing and misleading concepts and attitudes they reflect. We must assert our conviction that people over 65, like those of 20 and 40, have the right and the responsibility to use fully their capacities for work, play and participation in community affairs. For ethical, social and economic reasons me cannot afford to retire workers automatically on their sixty-fifth birthday. Although ITe should modify Our fisatioll O age 65 n as the benchmark for retirement. me must keep in mind that the rate of people who reach that age is growing more rapidly than the population as a whole. I n 1880, persons 65 and over constitnted 3.4 per cent of the population; in 1940, 5.7 per cent; in 1960, 9.2 per cent; in 1975, 11.3 per cent. I n 1948 there were 1 million persons 65 and over; in 1960 there will be 1 15 millions. not get along without the older worker, if it is to be an expanding economy of the type they forecast. The majority of retired workers are not likely to maintain themselves from savings of their own. One example may be enough to show this: I n November 1949, it cost a family of four in Detroit $280 a month to maintain itself at a inodest standard of living. Two hundred sixty dollars per month is the average wage of the Detroit automobile worker, if he works 1 out of 12 months. Thirty-six 1 dollars is the monthly premium for a private annuity that assures him an income at the age of 60 of $100 if he starts buying it at the age of 30 and pays for 360 months. This is, of course, impossible for most factory and farm workers.= Private pension plans are estimated to cover about four million workers, many of whom are also elltitled to Old Age and survivors Insurance benefits. The essefitia! pnrposc of thcse plans is to remove those x:orkers from the employment who are past a age, usually 65. Union welfare funds TTere established as early as 1867, hen the Brotherhood of Locomotive Engineers benefit plan. Their developed a death and recent expansion due in part to the lack is of provision for sickness and disability insurance under Old Age and Survivors Insurance. Today these union plans according to Harry Becker of the T?nited States Automobile ITTorkers, protect nearly four million workers, aboLztfive times the number in 1945. Old Age and Survivors Insurance, in 1935, when the Social Security Act was passed, was expected to be the major source of economic security for the retired worker. Because of the program's limited coverage aiid inadequate benefits, this intent of Congress has been realized only in part. Out of 57,000,000 ~vorkers in civilian employment in June 1949, some 22,000.000 Resources of the Older Worker were in jobs that provided no credits under the Old We are all too familiar with the truth of the state- Age and Snrvivors Insurance program. The number ment that e m p l o y m e n t opportzcnities of older workers of beneficiaries aged 65 and older was then about deteriorate. I t has been confirmed recently by a study 1,800,000 ; the number had almost tripled since 1945, of the United States Employment Service conducted but TTas still 836,000 fewer than the number of old age in six areas in the spring of 1949 at the height of the assistance recipients, now 2.6 million in June 1949. recent recession. I n a period of declining employ- The average monthly old age insurance benefit was ment, marginal workers and particnlarly men over 45 about $26. and women over 35 are among the first to be laid off. If H. R. 6000 beconzes law, its liberalizations for This is especially true of unskilled workers. Uizem- Old Age and Survivors Insurance ~.vouldbe felt ployed men over 45 and women over 35 take longer gradually i n old age assistance, as the program mathan those in younger age groups to find nem employ- tures; but we could not look to a n immediate realignment. If not re-employed in their former regular oc- ment of responsibilities between the programs. cupation, they are nearly always required to accept As previonsly indicated, the vigorous efforts of the employment at lower skill and pay levels. Such em1 Summarized ploynlent policies are hardly in line with the unequi- under Collective from "Supplementary Security Programs Velfare vocal statement of economists that our economy can- November 1949, Vol. 7, Number 11, p. 208. 149 �so-callecl penston nzouen~ents make it haxardnas to predict that the future ~villassign to Old Age and Survivors Insurance its major role and to old age assistance its ininor place anlong Social Security programs. I n fact, these movements are a direct threat to Old Age and Survivors Insurance. They esert strong political pressure to expancl old age assistance into a non-contributory pension program for all persons aged 6.5 ancl older, their cost to be met frum current taxation. The success of these efforts is obvious in Louisiana, TJTashington, California, and Colorado. as is their impact on goveriinlental expenses and taxation. For instance, Louisiana in 1949 has the highest per capita state tax revenue in the country, $85.59 as compared with $79.7.5 in TT'ashington, $72.47 in California, ancl $70.60 in Colorado.' The rise and fall of the movemcnt in California may not be a n omen of future developments. IIowever, California's experience illustrates what happens when old a ~e as: sistance is proilzotecl with little consideration? of the require~nentsof other needy people in the State or of the other type^ of public services nhich need financing, such as edncation and health. Through these efforts has been created an inlbalance in program planning and adequate consideration to all interests has not been given in some states. On the other hand, these pension nlovements have made positive contriattention to the needs of the butions by d r a ~ ~ i n g agecl ancl hecuril~g more adeyaate assistance in a number of states, and by strengtheniiig the convictioii throughout the country that old age assistance comes to people as a right and not as a gratuity. Grants-in-aid for Old Age Assistance S s a ~ ~ of clecentralizing operation and in order a y to leave v i t h the states full responsibility for aclministration of old age assistance and other public assistance aiicl service programs, the Federal Gorernment established under the Social Security Act grantsin-aid to the states. The coilclitio~isfor state receipt of such funds are stated in the act, including the maxim~~m amounts of Federal fniids available to niatch state f ~ ~ i l d s I n the fiscal year of 1950 the . will expend over one billion dolFederal Govern~nent lars for public assistance to 4% niillion needy persons and the state governments will spend aboat an equal amonnt. For old age assistance the Federal share in 1950 will be about $850.000,000. As of October 1949, the nnnlber of recipients is about 2,700,000. The imbalance in provisio~isas betmen prograins under the Social Security Act can best be illustrated 2 State tax collections i n 1949 e r c l u s i ~ eof unemployment insurance tax. Bureau of the Census. by the amounts granted to states under the Social Security Act since the beginning of these programs in February 1936 through October 1949. The total amount in r o ~ ~ i lfig~lresfor public health service d grants, the three programs under the Children's Bureau-crippled children, maternal and child health, and child xvelfare services: the administration of employment security; and the three pablic assistance programs-old age assistance, aid to dependent children, and aid to the blincl- as seven billion rlollars, al~nost fire billion of 11-hich ~ ~ efort old age assistance n and one billion for aid to dependent children. The Federal agency matches state fuiicls up to certain m a x i ~ i ~ ~and sthe higher income states generally ~m malie higher appropriations. Ti1 the Nation as a ~ ~ h o l old age assistanre proc, grams have cle~elopedgradually ~OTT-ard nlore adequate pay~nentsand coverage, toward more equitable treatnlent of inilividuals, and more efficient operation. Ole1 age assistance laws have existed in the United States since 1913, ~vhen the first one, later fonnd 1 1 11 constitutional. ITas passed in Slaska. llontana followed in 1923, Nevada and XTisconsin in 1925. By 1935. there were 32 states that had enactecl legislation and paid old age assistance under these laws. Ten of these states began payinents only in 1934 in anticipation of the Social Security Act. Recipient Rates and Amounts of Assistance I n December 1935, 42 states had snbmittecl plans for the administration of old age assistance to the Social Security Board. All states and territories had an approved plan by Deceiilber 1938. Since then the number of recipients has grown from 1,779,232 to 2,700,000 in October 1949. Almost one out of every four persons, aged 65 or over, is now on the old age assistance rolls. The number of beneficiaries of this progranz is greater than in any other public pro;nram except those for veterans. I n October 1949 the average assistance payment was $44.37 as compared with $29.75 in July 1945. This average paylnent today buys only 1 per cent more consumer goods and serv1 ices than in 1945. The cost to the Federal Governlnent has more than doubled since 1945. Assistance recipient rates and amounts of assistance still vary widely among the states. I n June 1949, 810 out of 1,000 aged persons were on the assistance rolls in Louisiana, 601 in Oklahoma, 103 in New York, 66 in Sew Jersey, and 109 in Pennsylvania. In June 1949, the average nlonthly payment in California was $70.35 and Mississippi $18.80. I n New lrork i t was $52.74. This range between average payments is obrionsly mnch greater than the range between the cost of living in these states. If we want to appxeciate what the individual payment may mean to indi- �vidual men and Tvoiilen who iiiust live on it, we cannot think only in terms of national averages. Perhaps the most significant derelopment in the shifting pattern of state recipient rates has been that of the development of a rather clear-cut relationship oetween the per capita income of the states and the proportion of aged persons on assistance. States with a low per capita income have now, in g~neral,the high recipient rates. This situation is quite different from the situation in 1940. I n that year, Xevada and New York, states with a high per capita income, had recipient rates of 334 and 128 per 1,000 aged 63 end older; and L4rl<aiisas and 17lississippi, states with a very low per capita income, had rates of 185 and 193; today the figures are respectively 220 and 103 for Nevada and New York, and 403 and 480 for Arkansas and 1Clississippi. I n eight states, most of which rank low in per capita income, more than 400 per 1,000 are receiviag aid. Five states, four of which rank high in per capita incollie, had a rate below 100 per 1,000. If we relate this pattern to the pattern of distribution of old age and insurance benefits, it becomes clear that in the agricnltnral states the old age assistance program carries an extra burden of needy persons out of proportion to that of industrial states. Eleven (except TITest Virginia) of the tx~elvestates (3lississippi, Arkansas, South Carolina, Alabama, Iientucliy, Sortli Carolina, Tennessee, Georgia, Louisiana, Oklahoma, S e w 34exico. T17est Trirginia) that had the lo~vestper capita income in 1945 rank high in the relative number of old age assistance recipients and low in the proportion receiving Old Age and Snrvivors Insurance benefits in June 1949. I n that month, 14 states had more beneficiaries of Old Age and Survivors Insurance than recipients of old age assistance. Sine of these states, largely industrial, had per capita incomes above the national average in 1946-1948. The 14 states are Connecticut. Delaware, District of Columbia, Indiana, Maine, Xlaryland, i\lassachusetts, New Hampshire, New Jersey, New Pork, Oregon, Pennsylvania, Rhode Island, Virginia. Increased Federal financial participation has been an important factor in enabling states to raise assistance payments. Following the enactment of the 1948 amendments, lnost states reported increases in average payments. JIaizy of these resulted from raising the money a m o ~ ~ nassigned to individual items in the state's asts sistance standards, from adding iteins to the standards, or from raising maximums. Froin June 1948 to Jane 1949 the average increase was $5 or more in 15 states, and froin $4 to $4.99 in eight states. Among the states that increased pay~ilents by smaller amounts, the largest single group included those in mhich state funds were inadequate and cuts in payiiients to recipients would have been made had there been no additional Federal funds. Some of the states with smaller increases also added relatively large numbers of recipients to their assitsance rolls. I n New York State, recipients benefited from the 1948 amendments by an average moiithly increase of $3.30. Since the New Pork provisions for financing the program require that the localities meet 20 per cent of the total payments, the localities had to appropriate additional fands to meet their share of the increase since assistance rolls have continued to expand. Smervices De:ermining Eligibility From statistical case records v e know that the ways by which assistance is provided is improving in many places. Applicants receive aid with less delay. I 1 1 1946, for instance, only 31 states made the first, payment less than a month after the receipt of :he request for aid. I n 1948, 39 states managed to do so. This administrative progress, although only two or three ~veeks, may see111 a very long waiting periocl to the needy applicant. liore and more recipients are left free to spend their assistance payment according to their own choice and judgment as required ill the Social Sec~zrityAct. I n our review of state practice for 1947-48, mhich was limited to one or a few counties in each state, serious qnestions were raised in four states only about a violation of the requirement that assistance be paid withont direetioiz on the speading by the agency. Hen-ever, practices mhich do not restrict oatright the recipient's use of the money. but are not in accord with the principle of unrestricted cash payments, are unfortunately still found in several states. I t is difficult for some workers to draw the fine line between coanseling on appropriate uses for money and instr~~ctions how to spend it. The opon portunity for a hearing before the state agency is available to dissatisfied claimants in all states. The promptness and ease with which this opportunity is given varies considerably. TTThileaverage assistance payments still differ widely among the states, distinct progress has been rnade within a good many states tovard the equitable deterinination according to uniform state-wide standards of assistance. Medical Care TTThile the public assistance program is primarily concerned with money for maintenance when medical care is not available from other sources, it must be provided by the assistance agency. The provision of inedical care or of nloiiey for its purchase has steadily increased. I n 1 states maximnlns on assistance pay1 nients may be exceeded for that purpose. I n Louisiana it may be raised to $90 for that purpose ; in Montana it may be increased to $90 for nursing care, and �to $100 for hospitalization. I n addition to amounts made available to recipients to pay for medical care, most agencies-among them New York-that provide such care, pay vendors directly for some medical services. Such vendor payments are most likely to be made when large bills for hospitalization or other expensive treatment are incurred. Four states meet the entire cost of medical care through vendor payments. Federal financial participation is not available for the expense of vendor payments and for expenses that exceed the Federal maximum. Under H. R. 6000 vendor payments may be made but the maximum on individual payments for old age assistance is $50 per month for assistance and medical care. This would be entirely inadequate. Providing $6 per month on the average for each old age assistance recipient would be a much more adequate amount. Other Services Throughout the country, many public assistance workers give additional services, such as counseling to and referrals of claimants to other social agencies. These services are so closely integrated with the workers' activities in determining eligibility that their statistical enumeration and identification in case records is not often feasible. TVe can identify those services that are provided by special staffs, such as homemaker services, as given in New York City, through which people are helped to stay in their own homes when their ability to manage them is failing. I n several states (Illinois, Texas, and Michigan) state and local staffs develop ways of making sheltered care available to aged recipients. I n many large and small communities and probably in all states, top administrative staffs cooperate in commodity planning for health and welfare services. Legislative Trends Trends toward liberalization and expansion of the assistance programs continued in legislation enacted in 1949, a year when nearly all legislatures mere in session. The trend, generally, was toward increasing the amount of assistance paid to needy people and to making more needy people eligible for aid by repealinq restrictive conditions of eligibility. Little iegislation was enacted which restricted the scope of the assistance programs. This is interesting because many legislatnres had preriously appointed committees to study the operation of the public welfare department specifically, or as part of a larger study of state government. One reason given was to see whether the assistance rolls could be reduced. I n previous legislative sessions there have always been some areas of public assistance administration in some states that have suffered set-backs, although legislation as a whole was constructive. I n 1947, legislation affecting the responsibility of relatives to support their kin, and the recovery from estates of recipients for assistance granted, restricted the states' programs in some instances. These same areas were singled out for attention in 1949. Some Liberalizations For instance: I n 1949 eleven states amended their laws with reference to minimums and maximums 011 old age assistance payments. Eight states raised the maximum, two established or changed the minimum ; Connecticut deleted its maximum altogether. Five states liberalized residence provisions, including one that repealed the residence requirement. Some repealed the clauses requiring the recovery of assistance granted from the estate or resources of a recipient. Arizona modi6cd its citizenship rcquireme~t and tempered the provision that made acceptance of employment a condition of eligibility. Massachusetts provided an additional item in its assistance standards, namely, $4 for leisure time activities, and the state is to reimbnrse the locality for this amo:mt of money in full, notwithstanding any other provisions concerning reimbursement. Eight states passed legislation affecting persons in institutions or needing institutional care. This reflects the continued interest of legislatures in this area and the discussions in Congress that considered a relaxation of provisions in titles I and X which prohibit Federal financial participation in payments to inmates of public institutions. Restrictive Legislation The outstanding concern of legislatures with the problem of dependency arising from desertion of parents is also noticeable in provisions affecting adult children who refuse to support their parents. Seven states this year enacted statutes providing for interstate cooperation in obtaining support from cleserting relatives. Several other states passed other provisions to strengthen the responsibility of public agencies to secure support from relatives. If property was transferred for other than fair consideration within a specified period, this was made a bar to eligibility in several states. The right to recover from resources of recipients of assistance paid was written into some laws, as well as penalties for any fraudulent action i n connection with the receipt of assistance. Miscellaneous Provisions There was also considerable activity in providing for changes in state organizational patterns in some 1 2 �A basic minimum guaranteed to workers through their own and their employers' contributions ~ - o n l d maintain in this country the mobility of labor, a right which is important for us to maintain. If these developments come to pass, both programs can assume their respective major and minor functions in a comprehensive plan of the American community for its older citizens. Conclusion Such a plan should be based on the following facts : The increasing interest i n and understanding of Chronological age per se does not establish a barrier the problems of an aging population hopefully make to continued economic self-maintenance, employment, themselves felt in many ways. An Old Age and Sur- rehabilitation, or to physical and mental health. Alvivors Insurance program expanded to cover all em- though disabling conditions accompany the aging ployed persons, including agricultural workers, would process in many cases, aging itself must not be treated in the not too distant future reverse the trends toward as a disability. The community as a whole depvnds an expanding old age assistance program, and restrict increasingly on the contribution of aging persons, and the latter to the function of meeting the needs of a they must be urged to participate in planniny and relatively small number of needy people who for some working with the younger people. Although it inay exceptional reason are not entitled to Old Age and be necessary to do so for an interim period, we are Surs-ivoi-s Inj.iira;zce bcncfits or fizd t h e n imdeql~..ate. not interested in setting up special welfare services for The social insurances should be the basic form of the aged, but we are interested in establishing for all security against need when people cannot work and people who want them social and cono~nicresoilrces, support themselves. built up in balance n-ithin onr total rc.onorny. states, and in others for a modification in the division of fiscal responsibilities between state and counties. Some of the latter should prove to be of considerable help to those counties that have found it hard, if not impossible, to raise their share of money for assistance expenditures. �Older Persons Have Special Housing Needs * By Hertha Icraus l s s o c i a t e Pl.ofesso~.of Social Ecorzomy, 13r!j,~Vnrcl. College A expandiilg literature on the aging population agrees substantiall>- on the facts pre. sented in the box on this page. Where and holv clo these people live now? Case stnclies and experience have shown that living i n their own home, even with insufficient care, is preferred b y nzost elderly people. There is infinite reluctancr to move into institutions, or to share the home of near relatives, unless forced b y dire economic need, serious physical incapacity, or utter lack of suitable housiizg. I n a S e w lTork City study of more tho- +L-,.% A L - - L I I L ~ . C - L L I U L L ~ i~iquiriesconcerning aged, 87.5 ~ ~ I ~ per cent related to living arrangements-x~here, how, with ~\-hom lire ! to I t may be assumed that within the census gronp of 24 per cent, living with children or close relatives. many aged vould have preferred independent homes if available. Increasinglj-, in the wake of a changing cultnre pattern of family life, this arrangement is also the preferred choice of the younger family. r r b a n and apartment living, simplified houselrecpin~,and fewer children have co~nbinecl reduce the usefulness to of the resident grandparent within the family cycle of the younger generation, except for emergencies. RAPIDLY b u a i l Needs of Chronically I11 The need for more adequate care for the chronically ill, including more adequate housing, has been studied widely in recent years. Occasionally i t has been dranzatized when serious incapacity affects a comparatively small group whose tragic handicap is war-related. for instance in the case of the paraplegics. Legislation enacted in 1948 (HR 4211) has authorized the T'eterans Lkdminirtration to pay 50 per cent of the cost (not exceecliilg $10,000) of a suitable housii~pnnit for any veteran entitled to compensation for perman~nt and total service-connected disability "due to spinal cord disease or i n j n r p with paralysis of the legs and lower p a r t of the hotlj-." Eligible reterans may obtain model plans and \:~ecificationsof suitable h o w ing units without cost. The paraplegics' plight is a n extreme illustration of the plight of a n infinitely larger and steadi1)- ill 1-easing group of the population, ~ r h i c h ,despite coiisiclerable handicap, nlay live * Reprinted f r o m ,Tournal of Hol~sing. ,Tail. 1950. and desire to live i n their o ~ v n homes-not i n institutions and connnercial nnrsing hoilzes-if suitable homes can be fonncl with adequate equipment and a chance for houselreepiiig ancl attendant care as needed. I t is well lmoxvn that a snbstantial p a r t of the chronically disabled group are identical with the aged pop~~lation; others are s o m e ~ ~ h a t younger. I 1 the 1 case of disabled children and adolescents, suitable arrangements invol~yethe entire family home to which these young people belong. They do not, i n the main, represent a peculiar ho~lsing problem. I t is among the middle aged and elderly living alone, or with a spouse or close relatire (possibly am-ap from home for most of the day as the inain wage earner) that a demancl f o r adapted living arrangements has arisen that requires attention. They 'epresent a substantial gronp. I n 1933, Mary C. J a r r e t t f o ~ u l d h a t many chronic t patients i n hospitals and in their own hoines need only attendant care b u t actually receive hospital and skilled nursing care. at high cost, because more snitable facilities are lacking. I 1 turn, they deprive oth1 ers of urgently needeel qualified hospital service, of which there was and remains a serious shortage. Man:- patients must be kept in hospitals beyond the point of need for hospitalization; a t the time of possible discharge, t h e - and their relatives, assisted b y case workers, are frustrated b y the utter lack of provisions saitable for living within personal limitations. Plans for additional hospitals for the chronically ill, for public, voluntary, and corizinercial nnrsing homes -all urgently needed in most comni~u~ities-vill only meet a snlall fraction of the problem, vhich in the ~iiaiilre~luiresthe facilities of family homes, not of institntional care. Mentally I11 Realistic. attention should also be given to the very frequent in[ ident of failing nlental powers among the aging. According to expert opinion. our orercro~vdecl nleiltal institutions today a r e forcecl to house large n n n i b ~ r s elderlj- patients v h o do ?lot require of the treatment facilities nor the type of cllstodial care provided in them. 111 planning for il~velling11nits suitable in clesipn for the handicaly~ed,it should be remembered that the freq11e17r'~- chronic disahlil~gillness is considof �tion. The reqnirements are identical, although slightly different i n degree, not in character of need. The tr-ansition from full to impaired capacity may be slow and hardly noticcable; i t may also be suddcn. It nlust be I n the )-ear 1900-3 ~iiillion assunzecl that the majority of all aged personh suffer I n the yel11. 1!)4(i-10.5 n ~ i l froni one or several iiiil~airments,whether actually linn I 1 the :-car 1973-17 1 t o 20 cliagnosecl as such or not. Dwelling nnits planned million ( c j t i i ~ ~ a t ' ) for the aged and suitable for them i n design and sup1Sar1,iages ~ v i t h 110th m a n plemental facilities shonld not be reserved rigidly for and wife sul.\-irinp have 30people of a specified chronolopical age. They should yea1 average span. also be available, as ail iniportaizt comn~unity resource, Last child of above c.onple rn:tl.l.ie., on the avei.age, a t for those of younger age group\ who recjllire tllr qame end of 1 8 year.: of caoi~ple'~ provisions because of actual disability. Of all permt~l.~.ird life-iravinp oncsons suffering froill invalidity, 50 per cent are i11 the fonrtll of conl)le'h 111a1.ried life ah t\vo-l)erstll~ famil)-. age gronps over 33 ; their integration shoultl not offer Of nlthn (is alltl over. ti4 ]lei. a serions probleni. ~'cllt a1.c lliitrrietl \\.it11 s p o u ~ t ~ I n developing different patterns for senior d ~ ~ e l l l)~.e*e~lt-orily34 per cent of n-oil lei^ in s;1111e age pronl). ings, special attention should also be paid to the problem of the aging fariner ready to retire hut with Average ~vife 11~11ally li\-e1 :3 yeii1.s :!ftcr l ~ i l ~ l ? ~ n ~ l ' s ,1",>, t, gw. T t h", h n n , , n',t;,,"t,rl th"t " h , , . , t 12 de:tth. per cent of all farm operators-orer 800,000-are now 4rel.ttge I111slinnt1,in fainily iv11ere \vife (lies pren,;tin this ape group; a t the same tiine there is considertlirrly, htll.vi\-ei six years. able cle~nandfor farms by y o ~ u l gfan~iliesea;:er for inrlependent operation. Tn addition to so~mclopporA l ~ o u t 50 per cent of men continue in painful ernploytunities for reinvestment after selling his farm, the rncnt beyond age of 65; elderly farmer and his wife want a snitable and comahout 8 per caeilt of women. A t age of 75, percentages fortable dwelling near familiar snrronndings, perdrop t o 1'7 and 2. haps i n a suburban clnster a r o ~ u l dthe county seat. I n Llecemher I R X i , of 10.5 The;- nmay also become interested i n busy and conmillion persons 03 and over. 3.G e~nployed (including genial colnmunities in a inore favorable climate, delib900,000 n-ives of earners ) erately planned for lneeting the increasingly ~ffective 3.9 million benefited from demantl of senior honseholders. social insnrance, oltl age as- FACTS ON OLDER PERSONS IN POPULATION OF THE UNITED STATES* KITJSBER OF P E R S O S S (i.i AS11 OVER I I 1 1 ~ &IA4RR1A(;ES I ~ i 1 . LIFE SPAS 1 1 1 i I i I I S C OJIE ,A , ILW sistance, in.titutiona1 etc. p l u L b L" , . A A " Iru.3 u c L r r C,L.I.IWCCLL brrub U l J l l C L , care. Of 2.5 million hushand-\vife families, where head ti5 a n d over, 9.1 per cent had incomes less t h a n $500; 28 5 per cent, $300-931500; 20.3 per cent, $1500-$2500. I n 1946, old ape and s u r x ivors benefits averaged $25.80 per month, per pers o n ; g r a n t s from old ape assistance, $35.31. Experience to Date I n this country, the developnient of non-inititutional housing for aged has not yet gone beyond a few nnits, ralnable as illustrative samples and pioneering rentures. TTntil very recently, the housino needs of the aged were considered only in peneral, as part of every cross section of the population, none of which should be overlooked. F o r the last 10 years, h o ~ v v e r , there has been growing recognition of a xidespread. serions, and utterly tulnzet need of very considerable HOUSISG / P r i v a t e l ~ o m e sof their own scope. Ti1 early postwar Congressional hearings on 1 -(i8.8 per cent (allnut half of tlle~n, one- a n d two-per the housing bill that became law last year. the represon households ) sentative of the Anzerican Public Welfare L2ssoeiation Shared Iiorne of relati1 r21.9 per cent testified that the honsing need of the aged is anlong Shared home of non-relatirc the lnost serious. The l ~ o n s i n z p l a t f o r n ~ of the -over 5 per cent dnzerica~i Associatioli of Social TT'orkers also demands I n institutions-4 per cent special attention to w c h honsing. Local housing anthorities. too, a r e beginning to pay erably greater among Ion-inconle groups than among solne attention to the need. a widespread policy, the illore conifortable. ilzost pltblic honsing projects h a r e excluded elderly Housing for those seriously handicapped bg- phys- people liring alone. ere11 couples. i n order to rive ical or mental disabilities should be seen as a n jnte- preference to families with children. 1 noticeable ex1 gral p a r t of a housing 1)roprani for a n aging popi~la- cdeption is the K ~ T 1-orlc Citv ITo~lsing,rXutl~oritp. T �Their Fort Greene Houses, built with State fnnds, includes apartments built for the aged. Another unique public housing project for the aged is a small colony, Roosevelt Park, Millville, New Jersey-a development of 18 bungalows. The State of Washington has been the first to encourage cooperative housing for small groups of elderly people, as a design for living pecnliarly suitable for those of independent spirit and eager for congenial associations combined with low-cost living. Each project is sponsored locally by some civic association. Units of older persons have been helped to set up cooperative households in dwellings adapted for this purpose. Most of the residents are recipients of old age assistance grants, with the Washington State Department of Public Assistance encouraging the venture, but not financing it. Starting in New York City, but later moved to Newark, New Jersey, a similiar cooperative housing project m7as deveioped for aged, mostly refugees from central Europe. The Cooperative Residence Club, Inc., has established a unit for approximately 55 residents (also an additional summer unit in New England), financed and operated as a nonprofit cooperative association. Among the best known humanitarian developments are two New York City apartment houses for aged, providing sheltered living-Tompkins Square House, containing 60 units of one or two rooms, operated by the Community Service Society of New York, and a n expanding apartment project operated since 1939 by the Home for Aged Infirm Hebrews. Finally, two small "villages for aged, developed under private auspices, may be mentioned-the colony of the Motion Picture Country House Association in San Fernando Valley, California and the new venture of The Loyal Order of Moose, developing the fraternity's City of the Aged at Moosehaven (near Jacksonville), Florida, expected to become at some time also a research center for gerontology. Experience Abroad Foreign countries have paid considerably more attention to the peculiar housing needs of the aged, living on restricted means, although the provisions are not yet adequate in any country. Municipal housing projects with simple housekeeping facilities for aged women have been a conlinon resource in many European countries since the middle ages. A modern version of the same plan was developed in Cologne, Germany, in 1926 when the city established a unit of 800 housekeeping apartments for aged individuals and couples of limited income, grouped around a park. Rentals included nursing and housekeeping aid, also complete laundry service for all tenants. England, Denmark, Sweden, and Holland, among others, have developed extensive dwelling units for aged as part of their public housing programs. England has for many years allocated 1per cent of public housing to the aged. I n that country, the report of the Survey Committee on the Problems of Aging, sponsored by the Nuffield Foundation, which has made a nationwide study covering numerous aspects of needs and services, suggests "as the most intelligent guess" that a minimum of 5 per cent dwelling units specifically suited to the needs of the aged should be available throughout Britain. The report emphasizes that meeting this figure will require a qnota of building and remodeling in most areas substantially beyond the 5 per cent average. England's National Assistance Law of 1947 also includes definite provisions for the expansion of senior housing facilities, in the main in the form of public hostels. All plans reflect a realistic appreciation of their needs and the very sound observation that larger housing units, scattered through the communities, will become available for families with children when aged iiidividnals and couples will be offered new small units designed for them. Building these small units will obvioi~sly be less expensive than the development of a n equivalent number of dwellings for growing families, which often must include new school projects. I n addition to expanding non-institutional ho~zsing, Great Britain is also engaged in building small pnblic homes, allowing for a maximum of freedoin and privacy despite institutional management. Iroluntary agencies are also encouraged and assisted to contribute within the next few years a sizable number of small hostels for aged residents. Among a wide range of Swedish projects, homes for L < pensioners" and the Flower Courts of the Flower Foundation have become well known as representing an enlightened social housing policy. I n 1938, the International Federation for Housing and Town Planning studied the various housing projects for aged in 13 different countries and published a summary of interesting information on senior housing in Belgium, Denmark, France, Germany, Great Britain, Holland, Italy, Latvia, Norway, Roumania, Sweden, S~vitzerland, United States. Next Steps I t is of great importance that the housing market should begin to respond with definite plans to the housiiig demand of a 10 million, plus, population group of adults, steadily increasing in actual numbers and in proportion to the total population. Community planning for most of their needed facilities has barely begun. Clusters of senior dwellings-remodeled older 11011s- �ing or newly built-must soon form an integral part of all public and private housing developments, to be scattered over many different neighborhoods and to be offered on every price level. Such units may be developed in cottage and bungalow courts, as part of multiple dwellings and mixed with apartments of other sizes, or as solid wings of apartment houses. They may expand to entire suburban neighborhoods or even individual communities, especially in southern climates. Architects and builders should also be encouraged to give increasing attention to a pattern for which we may assume effective demand. Single family dwellings could be planned with the attachment of small housekeeping units with a separate entrance, offering considerable privacy. Such combination units would hare the following advantages. They may be part of a wise and practical retirement plan: the housekeeping annex may serve as an income-producing unit, or as a suitable home for adnlt children, single or married, while the senior family will live in the larger home during the expansive part of the family cycle. On retirement, the senior family, or .cvidowed parent, niay move into the annex, now using the main house as an income-producing unit. Such combination would provide some economic security developed over a period of years. I t would add to emotional security by continuing family and neighborhood contacts despite advancing years and shrinking income. I t would give access to esseiitial housekeeping and nursing aid, as necessary, to be provided by the younger family in the niain dwelling, presumably close relatives. I t would allow nzutnal aidto flow both ways, for instance during periods of illness or absence of the younger family when grandparent aid may again become important. At the same time residents in the honsekeeping annex would not affect the family pattern of either the younger or the older family unit and woulci not force two or three generations into a common rhythm, thus protecting the privacy and living arrangements of each group. Design Good design for all types of units, in single and mnltiple dwellings, remodeled and new, will be essential. I t should be worked out jointly by architects, homemakers, physicians, social workers, and nurses. American studies of such design should cover the best layout and eqnipment for individual units, within the limits of economic planning, and the equally important layout and equipment for essential group facilities (service centers) that must supplement individual units. Some of the design developed abroad may be found very suggestive indeed, since it aims at widely identical, common human needs. Good design for a housing program for the aged must be guided by the following essential requirements. I t must provide an adequate number of snlall dwellings suitable for one to two persons, a t low and middle price levels. All dwellings must be easy to manage and require only a minimum of housekeeping effort. They must also be carefully freed from common hazards likely to injure persons of slowed reactions, impaired vision and hearing, and decreasing mobility. A certain proportion-possibly 20 per cent-must be planned specifically for persons actually incapacitated, so as to accommodate the seriously infirm, including those of the middle aged group. Their design must be adapted to the needs of individuals who may require help in bathing, toileting, dressing; who may have to grope their way or may be tied to wheel w! chairs. Such c~nditions i! affect thc mzasnrements of individual rooms, doors, stairm7ays, elevators, ramps, porches. Good design will reduce the exceedingly high home accident rate among elderly people; the elderly die from accidents that younger people survive easily. A special study of fatal accidents of the 65 and over group in New York State in 1947 has shown that four out of five home accident fatalities were caused by falls. Burns and poisonous gases ranked second and third as the greatest killers. Inadequate housing often proves disastrous when advancing age brings weaker vision and hearing, and poorer coordination. Group Services Finally, senior dwellings must be planned in clusters large enough to allow for the economic development of group services by which each individual unit may be reached as needed and which must be seen as an essential supplement of each unit. Group services will center on housekeeping, attendant, and nursing aid. There must also be recreational facilities, provided in- and out-of-doors, suitable in layout and program for seniors of mature interests and limited mobility. The physical base for such group services must be included in the basic design of each housing development but their operation should not necessarily be a function of the landlord. Group services may be sponsored by nonprofit agencies, b y churches, by cooperative associations, by public or private community agencies. For the middle and higher income levels, some of the facilities may be managed commercially, in the form of service occupations. A typical service center for senior dwellings would ���Educational Needs of the Older Adult in Rural New York State S u p e ~ v i s o r Education , f o i Ilie By Mrs. Henrietta Rabe d y i r ~ y Bureau o f Adult Educatio?~, , A7ew Y o r k State Educatzon Department The following paper is a field r q o r t made to Dr. R. J. Pulling, Chief of the Bureau of Adult Education of the New York State Education Department. Our Committee believes this report uncovers attitudes and has educational implications of utmost importance in the development of programs for older persons living in rural areas. HI^ report is based on a study of eight widely urban population. One out of every twenty persons 1 scattered villages in New York State having a population of 2500 or less. I n contrast to the city, vhere public and private agencies are a chief source of information on the older adult, getting the picture rural-wise necessitated speaking with individuals such as the principal of the central district school; the librarian; directors of homes for the aged, both public and private; the local historian; clergymen; officers of local clubs and organizations, including the Grange and the New York State Farm Bureau Federation; as well as to shopkeepers. particularly those shops where people are inclined to "visit." Typical of such shops are the feed store, the barbershop, the drugstore, the garage, and the tavern. No study of this type would be complete without getting the point of view of the older person himself. Therefore, a number of older persons were interviewed in each of the villages studied. I n making this study no attempt was made to get a comprehensive picture of the total needs of the older persoil on such problems as employment, health or housing. Education assumes these needs to be necessary concerns of other agencies. However, some consideration had to be given to economic and social factors, because of their direct relationship to needs that can be served through education. The value of this study is not as it relates directly to the communities studied, but rather as it relates to the larger picture rural-wise. I n order to serve this larger purpose, consideration also was given to certain population characteristics of rural Xew york State. sume pertinent population ~ h of Rural New York State ~ 1. The older adult makes up a larger proportion of the r ~ l r a farm and rural non-farm regions than of the l in urban areas is in the older bracket (45 and over), but in farm regions the ratio is one out of ten. 2. The rural non-farming population includes the highest percentage of widows in New York State. Many such ~vidows come from urban centers as well as from farms, concentrating in villages and non-farm residences. 3. One of the significant changes in the population of New York State in the past decade is in the number of persons living in rural areas who do not farm. This has resulted in part from the fact that many folks, on retirement, return to a rural community, where, in many cases, they lived earlier in life. Economic Status of the Older Adult Figures are not available to contrast the proportionate number of dependent adults i n rural farming and rural non-farming regions with those in urban regions. The following facts are significant, however, IT-ith respect to the rural scene: (1)the home farmer in most cases continues to operate his farm beyond the usual age of retirement ; ( 2 ) the farm laborer in normal times finds his employment dependent upon physiological capacity rather than chronological age ; and ( 3 ) the non-farming group, including the manual laborer, the skilled craftsman, the store worker, etc., seems to be less discriminated against than city workers because of age. Few farmers today give up their farms after reaching the customary retirement age. When the farmer finds himself less able to operate his place, he continues to ~ maintain it as his homestead and either rents ~ ~ ~ ~ ~ ~ i the farm out on shares, permits a married child to o ~ e r a t e or cuts his farming down to a minimum. it, - I n normal times the farmlaborer in his fifties and sixties who is known in the community does not find ~ i �I -5-10 "These beautiful May days don't appeal to me as much as they did on'ce-can't play hooky from anything!" COPR. 1949 BY NEA SERVICE, INC. T. M. REG. U. S. PAT. OFF. �Club activities such as the above looin very large that his age is a bar to en~ployment. I n the case of the aged single farin worker, it is not uncommon for in the social life of rural da-ellers. The average adult hiin to be employed for room, board, and a little belongs to a t least one organization in addition to spending money in return for working conditions church affiliation. The Central District School is which are commensurate with his physical capacity, another center of activity for many adults. With respect to family relationships, even in rural namely, lighter ~vork,a slo~verpace, and short worklife, there seems to be a consistent pattern of prefering hours. Nost villages have a nunlber of inore or less retired ence on the part of aged parents to live apart froni people, but the illen frequently find odd jobs avail- their married children. Only out of necessity does able locally. There seems to be a ready willingness the parent give up his home to live with a inarried on the part of local merchants to give work to older child. I t was repeatedly stated by school principals, men when they are considered a part of the commu- by clergymen, as well as by individuals, that even in nity. Another explanation for this is that the older the rural conimunity, the strong family tie of the person generally is willing to accept a lower wage past has undergone a change. than the younger worker in the conimunity who, for the nlost part, comn~utes to the nearest city for Prevailing Attitudes of Rural Dwellers employment. Conlparatively few aged people in rural ~ g i o n are s The expressions of rural dwellers axid those closely to be found in hoines for the aged. County welfare conceriiecl ~ v i t h rural issues not only help to point up departments make it a practice, wherever possible, to existing needs but give some indication of the obpiace appiicants in boarding homes. I 1 the communi- stacles in the way of initiating a program of ecluca1 ties stndied, abont 90 per cent of the residents of the tion in the interest of the older adult. For this reacount>- homes are men, niostly w i t h o ~ ~ t fanzilies. who son some characteristic expressions are being included are considered difficnlt to place in boarding homes. in this report. A large percentage of these nlen listed their former occnpation as manual and farm laborer. 1. The question "How do older people in the comS o atteinpt was made, for purpose of this study, to munity spend their time?" brought forth such of get a break-clo~~-11 the number of people receiving responses as : old age assistance in the different communities. lloviProtesta~ztwziwisfer: l 1 Our most active church inemever, there may be some value in giving this picture bers are the older people-particularly the older for at least one of the communities. I 1 a village having a population of about two thou- omen. ' ' 1 Librarian: "A lot of older men and vomen come to sand there are 33 people 65 years of age and over who are receiving olcl age assistance. This figure inclndes the library regularly, not always to read, but as an21 people who are in nursing homes, 1 in boarding other place to go, and to chat." 1 homes, 1 6 who maintain their own homes, and 5 who Sclzool priflcipal: live v i t h relatives. ( A ) "They remain active in their clubs. TTTehave abont thirty clubs in this town, including civic, chvrch Social Status of the Older Adult aiid fraternal groups. Many of the officers of the The older person i11 rural regions continues in the clnbs are old folks." nlainstream of community activities along with other (B) "About twenty per cent of the adults attendage groups, ofttinies maintaining positions of leader- ing our evening classes are fifty years of age and ship. For example, in the coinnlunities studiecl the orer. " board of trustees of the library axid the school board (C'i " T J O ~ S of older people attend our sl7ecial pro11-ere cornposecl largely of inen aiid women in their granis here i11 school, eren the basketball ganles." 1 seventies and eighties. I 1 one community the presiDirector, private ltome for the aged: " 1 1 ladies 01dent of the school board is a nian seventy-six years of enjoy sewing, reading, and bridge playing. On Sunage. I n another, the president of the board of direc- clay most of them go to one church or another. Soiile tors of the library is ninety years of age. of thein are active i11 the TT70inan's Club." I 1 church groups as well as in such organizations as 1 Diracctor, colinfy 11o111e for the ugecl: "Xothinc. You the Grange, the 3Iasons, Odcl Fellows. Eastern Star, eonldii 't get those people interested in anything. ' ' Rebekah, Garden Club, and Historical Society, the offiGcirage ozt,ler: "A few of the men conle around rrgcers are largely from the older nleinber yronp. The ularly. They like to sit around ancl play cards." ' Ho~neBureau aiid farin cooperatives, with thti r \TOTavern owner: "They come in every day for a glass men's auxiliaries, are other groups in which many or two of beer and sit around.'' older people participate. �Retired railroad worker: "I listen to the radio a lot. At night I visit at my neighbor's and watch the television. " Retired school teacher: "I read a lot and belong to the Garden Club and Historical Society. We have a study group in the Garden Club." Fornzer city dweller: "I do all sorts of odd jobs around town. A man's got to keep busy." Farmer, age secenty: "There are plenty of chores for an old farmer. And I belong to the Masons and Grange. Rarely miss a meeting. " 2. In an attempt to discover the existing social pattern for "talking things over" in the rural community, the question was asked, "What has taken the place of the 'cracker-barrel' discussion groups?" Protestant mir~ister:"Sothing-unless perhaps the meeting room at the fire-house. No matter when you go by, you'll find a few men sitting around there talking things over. ' ' Sclzool principal: "My guess is that the radio has taken its place, but that doen't allow them to express themselves, nor does it have the same social value." T o u q n Historialz: "With automobiles, they're able to get around more to club meetings. " Medical doctor, age 7 4 : "People don't talk politics over as mnch as they used to." Catholic priest: "The railroad shack (gate house) is a meeting place for a number of the older men i11 the village. Once in a while I join them." 3. In answer to the question, "Do you feel that there is a need for educational activities designed especially for the older person?" the following were typical responses : Catholic priest: "I think it would be a very good thing to provide such activities for the older folks, and certainly well worth trying. I approve of the idea whole-heartedly. " Director of Y o u t h Center: ( ' I don't see why the older folks couldn't use the center same as the voung folks do. We could give them space here if the school were to furnish leaders for their activities. They certainly could use the place before the kids get there. That would make i t a real community center. " Librarian: " I t would be easy to form a discussion group from among those older folks who come to the library." W e l f a r e oficer: "Our recipients of old age assistance who live i11 boarding homes are old and I do not believe they are interested in outside activities. Those living in their own homes have home duties and are not people that would be interested in any sort of activities. ' President-Gardeqz Club: "Yes, I do. I know it ~ ~ o u be a good thing for people like the co~xplenext ld door. They keep entirely to themselves. He has a heart condition, and when he goes, she'll be lost." Oficer-iTew Y o r k State Grange: ( A ) "The farmer is conservative and doesn't take quickly to new ideas such as that, but I believe that once he is sold on its value, he'll go in for it mholeheartedly. " ( B ) "Because of mechanization, even the older farmer is able to get his work done and still have time for other things. " P r o t e s t a d Minister : ( A ) "Yes, I do, not only for those that are able to get around but for the home-bound. Many of my older church members are finding i t difficult to get out, and I know how important it is for them to keep up contacts with the outside." (B) "It isn't only the old folks that need help, it's youth too, I plan to devote a series of sermon$ on the need for re-evaluating our attitude toward old age and on the 'Fourth Commandment '. " j School principal: ( A ) "Possibly, but it would be difficult to reach some of the older people who probably need it most. Many old folks are reluctant to start nev7 things." ( B ) "If we did have special programs for the older folks here i11 the central school it ~vouldbe all right for those in the village, but how about those outside gf the village where transportatioii wonld be a problem ? " Implications for Education (C) "If they're interested in such activities, why don't niore of them attend our evening classes now?" I n a s m ~ ~ c h many rural dwellers continue to work as Officer-Ll'ew Y o r k AStcifeFarnz Bzirenu: "JTTith the beyond the custonlary age of retirement, it mould seem growing interest of the adults in the activities of the that there is less need for recreation centers, as such, of central district school in my own community, I would or for additional c l ~ ~ b s the "Golden Age" variety be inclined to think that the older aclnlts wonld re- such as seem necessary i11 large conimunities. Severtheless, there are certain conditions that spond to a program planned for them. As I qee it, they do have real needs that could be served by the coulcl be i~llproved for the older adult through the school. I wish there was solne way that the school provision of activities which are not commonly availcould help the older person ~ h finds it necessary to able in a small community. Such activities could o sappleinent his income, which is a serious problem reasonably be provided by the public school through its adult education program, and would bring benefit for inany v 7 i d o ~and spinsters. " ~s �not only to the individual, but to the larger social group. A description of such activities comprises the balance of this report. 1. The older adult needs to be kept flexible in his thinking and up-to-date with respect to technological and social change. ( F ) Pornling n e w concepts of sz~ccessfzrl lilting Working for satisfactions in later life in contrast to working for money ( G ) Agencies serving t h e aged Public health facilities, mental hygiene clinics, visiting nurses, recreation centers, employment centers. nursing and old age homes. The rural comm~~iiity very much influenced by is These and similar topics could be built around sepaits large proportion of older men and women who con- rate short-unit courses consisting of lectures ancl distinue to function either as leaders in civic organiza- cussioil groups. F o r such to be most effective, the intions and fraternal clubs or as members of such dividual must have a chance to discuss his on-n pergroups. As such, they either have a direct influence sonal problems. Courses of this type would not only on others or are themselves subject to influence with have value for the older person but for the middle respect to their attitudes, their thinking, and their aged person who is giving thought to successful revoting. Our aging population will very significantly tirement and old age. have a n effect upon the Nation politically and economically ; and i d local matters the increasLg propor3. The older adult needs to feel useful. tion of older men and women will have a direct, hearThe desire to be useful and have social approval is is , ing on \biletiler the coiiir~~iiiitj. t~ bc : static er a present throughout all of normal life. The increased dynamic one. I t is, therefore, of utmost importance that the older leisure that comes with a diminution of the activities person be kept infornied and helped to understand of earlier life should make i t possible for a person to social issues and community problems. If this is not attain new goals which bring added satisfaction to the done, the older person who tends to be fixed in his incli~idualand enrichment to the community. Yet thinking, translating the present through the past, many older men and women find themselves with little might be resistant to change, even if i t means social to do and think about because earlier in life they improvement. There is also the danger that this large lacked the time or the opportunity to develop vital unit of our population might be used politically for interests and skills other than that of their job. This selfish purposes. Therefore, i t is to the best interest is a particularly serious problem for many widowed of thc individual as well as the community for the ancl unmarried women. Pastimes of a purely recreational nature. or cusolder person to be exposed to ideas that are different from his own and to the changes that are continually tom-made fun, although an important aspect of livoccurring in the social and political structure of the ing, will not over a long period of time be a satisfactory substitute for productive activity. The solntion, ~~orld. ,'is a solution to this need the public school can rather, lies in the acquisition of skills that have inorganize "olcl timer" discussion groups on a ~ ~ i d herent possibilities for creative expression, g r o ~ ~ t h , e variety of topics, including issues of local, national, and self-development and that can contribute something of ralue to the social group. The 1~711olegamut and world concern. of the arts and crafts as well as the pure ancl applied 2. The older adult needs accurate information sciences offer rich interests for all age groups ; but the about and help in adjusting to the changes of aging. added hours of leisure as life advances permits the To better understand what is involved ill the process older person to develop special skills in these areas, of aging-the liinitations that come with age as well to read and plan, and to develop judgment and selfas the plus values-the older adult needs to become criticism. From the point of view of the community, creative informed on such matters as the following: activity such as the above means raising the cultural ( A ) Pi?zancial problevns of older people Social security, old age assistance, employment op- level and adding a valuable local resource. Imagine any village enlivened by periodic a r t and craft exportunities for older workers, self-employment hibits, or having recurring musical activities per( B ) Physiological aspects of aging formed by choral groups, string quartets, and small Health education courses orchestras ! Think of the value to the community in ( C ) Psychological aspects o f aging having a group of men and women who are studying Preventive mental hygiene local conservation needs with respect to water, soil, ( D ) Nutritional needs ( E ) Acljztstwzefits in fanzily and other social rela- timber, wildlife, and other resources; or who are rendering a service to the field of professional science tionships through the collection and recording of data on the Grandparent education, living with other adults �distribution and life histories of local animal and plant life ! Other than the personal satisfactions which creative activity affords, ofttimes it offers an opportunity for self-employment, and thus its value is increased, for some older men and women are seeking ways of supplementing their financial resources. Many a person has been able to find for himself a new source of income through creative interests-the painter; the textile designer; the lampshade decorator ; the designer of greeting cards; the craftsman who makes jewelry, wood sculpture, pottery, metalwork, leather goods; the weaver; the woodworker who builds models of all sorts or who makes toys, furniture, and novelty items; the photographer; the animal fancier; the gardener who grows a new or special quality fruit, vegetable or flower. The public school has the facilities and the personnel to provide training in a wide variety of creative activities that will do much to make up t h e last period of life one of activity and usefulness. The typical arts, crafts, and science courses offered in the evening adult education program may not be the ansv-er. To be most effective, a program planned for the older adult might have to include a greater variety of subjects to fit many different interests, given at a time that corresponds with the older person's habits, and offered at a place suited to his convenience, with the n-orlr geared to his slower pace. Therefore, the public school seems to be the logical center in the rural community for making available to the older person opportunities for meeting and mixing with others whom they otherwise might not have a chance to meet. Through activities within the school the individual will be thrown in contact with people of like as well as different interests. This is a good social experience for the individual, and in addition, such exposure could very well result in a choice of new activities which might become an important part of his own living. Thus the public school, in becoming a center of activity for the older men and women of the community, would help them to keep mentally pliable and alert, which is good mental hygiene, and in addition would provide concomitant social skills, important to many older people. Summary All of the activities suggested above and others of value can easily be defined as good adult eclncation and are possible of attainment i n any community which is large enough to maintain a public school. These activities could be made available within the school itself as well as to study groups that might be formed within such local organizations as the Grange, the Garden Club, Historical Society, Woman's Clubs, and church groups. A program such as this could be 4. Many older adults need opportunities for devel- supported jointly by the community and state-aid. oping social skills and finding new social relationThe needs of the older person, as contained in this ships. report, are not to be interpreted as applying excluA problem common to many older people, regardless sively to the residents of a small community. Defiof where they live, is that of loneliness, some causes of nitely not! The need to feel useful, the need for social which are mobility of married children, retirement, relationships are not needs of the aged alone any more and loss of spouse and friends. This, again, is a great so than the need to be mentally agile and up-to-date concern of many widowed persons; and according to on social change are needs of only rural dwellers. statistics, 43 per cent of the married women of this Such needs are common to all adults, varying only in country are widowed at age 65. The problem is also scope and satisfied in different ways a t different stages a serious one for many elderly couples who have of lifetime. Our problem is to attempt to isolate the needs of moved to a rural community upon retirement. Lacking roots in the community the newcomer frequently the older adult that can be helped through learning does not possess the social skills and the know-how of actirities ; to evaluate such needs within the framemaking new social relationships. work of the small community; and to recommend ways The public school in providing programs for older in which the public school can function in this area of adults will also help them develop social skills. The service to the total community. These recommendaschool is present in all communities, it is familiar to tions are based on the premise that the need for educaall and is accepted by all. By tradition it is accus- tion is continuous throughout life and that it is the tomed to working with people of all types and hack- responsibility of public adult education to provide grounds. I t has facilities and equipment which fre- opportunities for such education wherever and for quently are not present elsewhere in the community. whomever the need exists. �Librarians and Our Senior Citizens By Albert J. Abrams Director, New Y o r k S t a t e Joint Legislative Committee on Problems of t h e Aging w HAT should be the relationship of a library to the elderly of the community? T u T a spe7 T ht cial services do our libraries render to oar elclerly? What types of books and magazines do the elderly prefer ? Interest in these questions is high aniong both gerontologists and librarians. The gerontologist is concerned with fitting the library into its proper niche in a n over-all program for the elderly. The librarian is affected for if libraries are to be dynamic, vital agencies they must keep pace with shifting community needs, and serve the elclerly as effectually as they serve other groups in the pop~ilation. The deinographic factors ~vliichimpel an examination of the role of our libraries in serving the elclerly are these : 1. A spectacular increase in the number of our elderly, mounting from 1,100,000 i11 1870 for 65-plus age group to nearly 12,000,000 in 1950. 2. The tremendous increase in the span of life, fronl roughly 45 in 1900 to 67 in 1948. 3. The fact that at age 65, the average person has a life expectancy of 1 2 years. 4. TThile the proportion of elclerly i11 our comniunities is inounting sharply, the proporti011 will vary considerably according to types ancl locations of collzn~unities. The socio-economic factors which call for librarians to examine their services to the elderly are these: 1. An amazing growth of retirement programs, now covering 10,500,000 TI-orkers. 2. The prevalence in iildustry of coinpulsory retirement a t age 65 for men, age 60 for women. 3. Age barriers which prevent men 40 ancl over and woinen 35 and over from obtaining jobs. 4. Better educational backgrouilcl of the "ne~v" old compared with the elderly of prior decades. These trends add up to this : more and more of our elderly who are making up a larger proportion of our popalation hare and will have more and niore time for reading. To gain a n insight into the work being done and the work that should be done by libraries for our elderly, State Senator Thomas C. Desnlond, Chairman of the New York State Joint Legislative Conl- mittee on Problems of the Aging, queried 150 librarians responsible for conllllullitp librarjes ranging from a one-room rural library a t Haiiles Falls to the nlamlnoth New XPork City Public Library system. Their answers clisclose that by and large our librarians are aTYare of the challenge that the increasing number of our elclerly presents to our libraries, are alert to the opportunities that exist for helping our oldsters, ancl are eager to be of service to our senior citizens. The rnain llanclicap in serving the elderly appears to be not a deficit of zeal or will, but a deficit of finances to expand library services. The Library and Other Community Agencies The library is but one cominunity agency capable of being geared to the needs of the elclerly. The library must join with the schools. the recreation centers, and the "60-plus" clubs, for example, to meet the needs of the senior citizen for cultural, leisuretime activities. I n some communities, the libraries will set the pace for other agencies; in others, it will for good reasons play a role niinor to other agencies. T7uTrhether the library is leader or follower, it is important that the library staff join with other groups in planning community programs for the elderly. The Desinond survey showed that the Rochester Public Library is in close contact with the Rochester Council of Social Agencies which is formulating a comprehensive program for the aged, and with neighborhood groups organized by the Coancil. I n this way, both the council and the library are enabled to move forward together to serve the elderly. The Brooklyn Public Library works intimately with the Brooklyn Council for Social Planning and its Superintelldent of Branch Libraries serves as a member of the Committee on Services to the Aging. Such close vorking relationships enable the library to keep in touch with new developlnents which n ~ a yaffect the library, to share in serving the elderly most effectively, and give other agencies the benefit of the library's experience with the elderly. - Relationship of the Library to the Elderly Just as a philosophy of life or at the very least an attitude toward life enables one to adjust best to the daily vicissitudes of living, libraries need to �adopt some goal or rationale in attempting to serve the conlnlunity and the various segmeiits of the community. The Desmond survey indicates that librarians have an nnderstanding of the difficulties of the aged, and the variability among them, needed to chart a sympathetic program for them. Growing old is a peculiar thing," says Librariaii Helen A. Stratton of the Binghamton Public Library, "Its worst tragedy is that most elderly persons feel young and think young, but have not the outward appearance or quickness of youth. I t does not hurt to be labelled a 'teen-ager' bat it does hnrt to be con. tinually reminded that one is old." The Acting Secretary of the City Library of Poughkeepsie, Miss Bniy Ver Kooy, points out that the "aged of the futnre hare had a different past froni the aged of the present," and then asks, "TJ7ill their interests be the same as the interests of the aged of today? Have they not actively participated in a different world throughout their working liues?" The need for making distinctions in various age groups even among the elderly is noted by lfiss Lucy E. Francher of Swan Library, Albion, who says: "there seems to be a great difference between the 60-75-year-olds and those approaching 80. The first group can do considerable solid reading and are capable of following time-consuming interesting hobbies. The latter seem too feeble in physique and sometimes mentally to do more than read the lightest fiction and sometimes not even that. TYhatever constructive work done should be for the 60-75 age group." However, librarians should not fall into a very common trap by confusing chronological age with physiological or mental age. The geriatricians emphasize that chronological age is of little significance, that some people are young at 80, others are old at 45; some at 7 5 have the heart, arteries, and alertness of a man of 35, others at 50 have a physiological and mental age of 80. The gerontologist eager to see the elderly served may receive a temporary slight jolt when he awakens to the fact that libraries are created to serve all aye groups, and that as librarians point out, it is dedicated to the entire community, not to ally particular segment. Librarian Alice H. Smith of the Arcade, N. Y., Free Library, bluntly says, " I n my opinion, the elderly should be treated by the library exactly as the younger borrowers are treated." Director Isabel D. Clark of the White Plains Public Library informed the Desmond Snrvey: "The relationship of a library to the elderly of the community should be much the same as to all other groups, namely, to provide wholesome recreation and lifelong education to every citizen who needs it. Because a larger proportion of the elderly and the very young find it impossible to go <I their library it is important that nieans be provided to reach these people where they live." Mrs. Marie B. Higgins, librarian of the Rennselaer Public Library, points out that the "important services a community library can offer elderly people are easy accessibility, absence of stairs, comfortable reading facilities, good lighting, and an adequate book selection, all items which in library service are needed by the public as a whole." Sylvia C. Hilton, Librarian at the Scarsdale Public Library, comments, "I note a growing consciousness among libraries, churches and cities to the old as a different and separate group. I n our library, if we had the space or facilities, we wonld answer any need for group activities with the emphasis on the interests, such as hobbies, rather than on age." Esther Johnston, Chief of the Circnlation Department of the New \rTork Public Library, says, "the library best serves the older man or xoinan when it does not strive to set hi111 or her apart from the younger inembers of the community." The "equal treatment" concept received support from Librarian Sarah Cor~vinof the Newburgh Public Library ~ ~ states, "the relationship of the library h o to the elderly of a coinmunitp should be just about what it is to any of its borrowers: ready and willing to help wherever possible, but without emphasis on the oldster part. " Alice IJ. Jewett, Chief Librarian of the lIount Vernon Public Library, elaborates on this viewpoint: "The relationship shonld be the same as to any other group in the community, a recognition of the existence of such a group, a conscious effort to snpply their needs, and such special services as seem to be justified in view of the services provided by other local agencies.'' Some librarians think their major contribution to the elderly can be "courtesy and comfort. " Binhamton's Librarian, Helen A. Stratton, says, "In a library the elderly should be greeted cordially, helped to a certain extent (not too much) . . . and they must never be hurried." Mrs. Estelle Harrower, of the Amsterdam Free Library, says the library should be a place for the elderly to rest and relax as well as to take a book. The relationship of the library to the elderly will depend largely on the librarian's concept of the total role of the library. If vieved as sinlply a place ~vhere a variety of books are available free of charge, the library mill tend to be static, restricted; if viewed as an agency for bringing knowledge and enjoyment to all the people of the community, the library will be dynamic, its services varied. The gerontologist in his zeal to provide services to meet the needs of the elderly must keep a reign on his enthusiasm, for the library is dedicated to all the community, not to one segment. The library, on the other hand, in its �efforts to "play fair" with all groups must conscientiously seek to establish the needs of the elderly, and it determine ~ q h a t should do in jnstice to all to meet those needs. Segregated Book Shelves Opposed The Desnlond Survey elicited the practically unanimous opinion of librarians against setting up special book shelves for the elderly. Thus Director F. L. Gates of the Syracuse Public Library says, "we do not approve of calling special attention in the library to these people on account of their age." Librarian Sara Corwin of Newburgh reports that at one time she did provide special shelves for oldsters but it was not successful, for the elderly do not ~ v a n t "to be considered different.'' 31rs. Stephen Leechner of the Croton Free Library summed up the viewpoint of the librarians when she advised, "inany people of 60 would be rather insulted o r a n n n y ~ c lto he considered i a the c!dcr!y gronp." To which Librarian Helen 11. JIacDonough of the Baldwin Public Library adcis, "no one likes to be singled out as 'olci'. For example, books on handicrafts and other home activities useful to retired persons as well as others are easily available in all libraries. They do not need to be especially grouped for the elderly. Such a grouping ~vouldbe resented by some." Librarian Anne F. Hammersley of the Hamburg Free Library says, "our library does not feel any of the readers are 'old.' TLTe may take more care to find out what they want and to help them individually, but that is all." Most gerontologists would probably agree with the librarians that segregation of the elderly in the library would not only be resented by the elderly but ~vould tend to further isolate the oldsters physically and psychologically from the total population and thereby be harmfal. However, it should be pointed out firmly that this does not mean no special effort should be made to serve the elderly. I t does not mean for example that clubs and hobbies for the elderly should not be encouraged in the library. I t does not mean that shut-in service for the elderly who are ill should not be provided. I t simply means that shelves specially set aside for old folks are unwise, and that insofar as practical services should be based on function rather than age. Thus we see no reason why libraries cannot have special shelves for books on "Fun in Retirement. '' Reading Preferences Supporting the argument against special book shelves for the elderly is the conclusion of librarians, as reported to the Desmond survey, that our senior citizens have as wide a reading taste as many of our younger people. Librarian Francis R. St. John of the Brooklyn Public Library reports, "reading of older people cannot be typed. Their reading tastes stem from their backgrounds." Miss Thelma R. King of the Steele Memorial Library, Elmira, says, "By and large they keep the same reading interests they always had. " At the Floyd hIemorial Library, Greenport, Librarian Gladys K. Pemberton finds the "reading interest of people over sixty does not vary any noticeable extent from that of a person ten or twenty years younger. The usual reading interest of middle life carries over to the later years. Miss Helen Ludlosv, of the Thrall Library in Jliddleto~vn,says: "it is almost impossible to generalize about the reading tastes and habits of this group. Older people tend to read much the same kinds of books as they did in younger days. ' ' Pointing out that for many the years bet~veen60 and 70 are "the reading years." Librarian Jlary TJ. McCabe, Corning Public Library, says many of these senior citizens have their own reading lists saved through the years, and that there are more older people with a fine appreciation of books than we sometimes realize. Despite the agreement that the reading tastes of the elderly (the Desinond survey used 60 years and over as the dividing line because some arbitrary figure had to be used) could not be typed, the librarians surprising uniformity in report nonetheless s h o ~ ~ ~ e d that women over 60 like best light stories with happy endings, with a inininlum of profanity or sex or realism. This was as true for elderly women who live in the cities as for those living in suburban and rural areas. Other types ranking high on Grandma's "hit parade" of books are mysteries, light humorous nonfiction, religious fiction, and early 20th century light novels by authors like Grace Livingston Hill Lutz and Mary '\Taller. The books serve, the librarians reported, to take the elderly back to their youth, to escape life problems or simply to "pass time." The elderly male rates westerns as tops, with the "whodunits" a close second. The older male likes books with plenty of action. As one librarian emphasized they prefer a minimum of "gooey romance," and will not be found dead with a novel by Faith Baldwin. A substantial number of libraries indicated that the size of type frequently is the deciding factor i n determininc whether an older person will read a particular booi. I n fact, some attributed the popularity of ~vesternsamong the elderly males to the fact that these books often had uncrowded pages of clear type. One interesting fact elicited by the Desmond survey was that -books such as "Peace of Mind" apparently �is not as popular with the 60-plus age group as with the 40-50 age class. No reason was given for this preference. There was a noticeable absence of statistical data on reading habits of the elderly. However, the librarians seemed to be in general agreement that newspapers are preferred to inagazines by the senior citizens, and that the "Reader's Digest," "Life, " "Time," "Saturday Evening Post," "Colliers, " "Ladies Home Journal" and "Women's Home Companion" were favorites among the magazines. Some librarians, such as Niss Ludlo~vof Middletown reported "oldsters do not make much use of the magazine racks. " Many librarians reported they have what is known to them as a n "old timers' morning club" consisting of elclerly who come in to read the daily nempapers. clnh~ for Oldsters Several librarians indicated their familiarity with the "Live Long and Like I t " club for oldsters sponsored by the Cleveland, Ohio, Public Library, and some expressed the desire to form similar groups. Thus Mrs. Elizabeth F . Kelly of the Freeport Memorial Library says, "For the past year I have been giving considerable thought to what this library can do for the elclerly people. I ~vould like very much to form a n organization for them." I n some coliimunities, such clubs are already in operatioil sponsored by ch~~rches, Junior League organizations, recreation commissions and other local agencies. Librarian Lucy E . Francher, Swan Library, Albion, reports she has given up the idea of forming a 69-plus club becanse "all the oldsters we know of belong to church groups, fraternal organizations, D. A. R. or a study club." I t is clear that whether "Golden Ape" clabs should be organized at all or whether the library or some other group should sponsor "Golden Age" clubs should depend on local conditions. A t Mount Vernon, a recreation center for the elderly has been set up on library property in a n old house adjacent to the library itself, by the Nonnt Vernon Chapter of the National Council of Je~vish Women. Some libraries which may not sponsor or organize such clubs may help by proviciinc meeting space; others may have no meeting room facilities. Thus in the one-room library at Hailies Falls. it is inlpos~ible to provide quarters for old4ters clubs. Others, such as the library at Icingston, reports, through Tlibrarian Mary A. Schaeffer, that it is situated in the center of the city which spreads over a very large area, niaking it difficult for many of the oldsters to use it Even some big city libraries, such as those in Rochester, report they do not have room or facilities for inviting oldsters clubs to meet there. At \TTatertolvn, Librarian Helen M. Talbert notes that meeting roollis of the library are open to all groups in the city, and points out that many c l u ~ women are in the 60-plus age bracket and make use of the meeting rooms. Elmira and Rome, N. Y., both report they have meeting rooms, but that no group of olcler persons has taken advantage of them. The Corinth Free Library expects to have meeting rooms available in the new building to be erected in the near future. At Freeport Library, a group of older women meet in the library's High School Room two hours a week and discuss L41~~erican English literature. Interand estingly enough this group started with a leader, but when the leader became ill, the oldsters TT-ere obtaining so liiuch enjoyment from it that they have carried 011 by themselves. a t the Pour Home Public Library-,a t Johnson City, club rooms are usecl by the Townsend Club and the industrially affiliated Endicott-Johnson Thirty Pear Club. The Rochester and New York Public Libraries cooperate with old age groups by sending out lecturers, book reuiexvers, and motion pictures to them. The New York Public Library sends through its branches cartons of books to recreation centers for the elderly. At stated periods the books are returned to the branches and a new collection jssued. The Brooklyn Public Library, on the other hand, which has an active and varied program dealing with the elderly, prefers to bring recreation clubs for the oldsters into the lihrary for discussions of books of interest to them. Also, Elenlentary English Classes of the Adult Division of the Board of Education, composed mainly of older persons who have been in this country for many years, visit the libraries. Shut-In Service Shut-in service by libraries ranges from delivery of books to the honsebonnd and the hospitalized to that of vroviding ceiling projectors for "Gooh on the Ceiling." I t may involve operation of a "Bookmobile" or consist sinip1~-of s ~ l e c t i n zappropriate hooks for the ill to be picked u p by friends or relatiyes. The importance of shnt-in service can be seen from the fact that according to a national snrsTeyone out of six persons at any given time is afflicted by chronic disease. Since the elderlr are especiallr hard hit by chronic, degenerative diseases, shnt-in service is particularly helpful to the older age groups. Librarian? may gain a new insipht into the ability �of oldsters to gain benefits from reading, from the fact that a t a state mental hospital a library of books has been set aside for the senile psychotics! Even these unfortunates, harmless but suffering from melancholia, forgetful and perhaps at times confused, confined to a state institution, find comfort and relaxation in books! We mention this merely to emphasize the need for not under-rating the capacity for our elderly to enjoy books. The Desmond survey found that the TJ7estern Union Telegraph Company a t one time provided a n inexpensive delivery service for persons desiring books but this was discontinued. On the other hand, a t New Rochelle, Library s Director Josephine H. E d ~ v a ~ dreports that its shut-in service circulated during the 1948 calendar year 8,784 volunles. This consisted of monthly deliveries of carefully selected titles to people unable to conie to the library or ~ h have no one to send o for their books. This library, iiiterestiagly enough, plans to cooperate ivith i l ~ e local Tisiting Kurse Association which is launchiiig an actire program for the elderly, and lye can visualize in the future the visiting izurses brillging library books to the confined or directing the library to those T T ~ O though confined need library serrices. The Cornell Library Association a t Ithaca reports it could probably arrange pickup ancl clelivery to bedridden patients through friends of the library "if the need n-ere inclicat~d. " UnfortiLuiately, the lack of personnel is handicapping shut-in service. The Fnlton Public Library had to discontinue it because they "had no one to deliver the books." Miss Helen H . JIacDonough of the Baldwin Public Library says the deliver;\- service be to bedridden oldsters ~vould desirable "if our staff were large enough to handle it." Mrs. I. D. Clark, director of the TT7hite P!ains Library, expands the concept of shut-in service significantly by pointing out that "mature and kindly voluiiteers who coulcl clelirer carefully selected books to house-bound folks and take time to talk with them or interest them in a hobby could add iinmeasurably to the happiness and contentnleizt of this group of citizens. Such a plan mould probably keep an appreciable number of possible inmates out of hospitals and institutions for the mentally disturbed." It is probable that no large staff is needed to handle a shut-in service szipervised by the library but adnzinistered by local civic or women's clubs, who urould arrange for pickups aiid delivery service of books. Nurses and doctors wonld in many instances be glad to cooperate by encouraging bedridden oldsters to use the shut-in service. Bookmobile service is approved by many libraries, if funds are available. I n New York City older people who do not live near any branch library use the service provided by the bookmobiles. And a t little Haines Falls, Librarian E r a Zistel reports their bookmobile "makes the rounds during the summer; in the winter we provide no service, due to lack of funds." I n Nount Vernon, bookmobile service was withdrawn, but was missed so keenly by two homes for old ladies at outlying sections of the city that arrangelnents have been made to send them a carton of about 40 books each month, partly of the library's choosing but largely the selection of the women themselves, reports Chief Librarian Alice L. Jewett. Which brings us logically to the service rendered by libraries to the nlany elderly who are in olcl age homes, hospitals, nursing homes, boarding homes, and similar institutions. The geriatricians advise that as time goes on the variety of facilities for caring for oldsters will increase, so in seeking to reach the elderly, libraries will need to keep alert. The Buffalo Public Library, reports Librarian diexaiider Galt, conducts a branch library for patieiits a t the 3Ieyer Memorial Hospital, a county any institution. but has 110 services i n connection ~ v i t h of the other hospitals. Air. Galt says, "for many years we have hoped to have similar services in the other hospitals, but have never had the money to take care of this work ; the same is true of old people's hoilles. ' ' A t Elmira, the library in cooperation with the Junior League provides books for two hospitals aiid one convalescent home. Throng11 the Exteilsion Division of the Rochester Public Library, books are sent to the Presbyterian Home, the Rochester Friendly Home, the Church Home, aiid the St. John's Home for the Aged. The Syracnse P~zblicLibrary serves hospitals, nursing honles and homes for the aged. The Henlpstead Library provides books for the elderly a t the Sassau County Poor House. The New York Public Library cooperates with the United Hospitals Associations in furnishing books to hospitals. Librarian Lucy E. Fancher of Swan Library, Albion, cites some of the headaches involved in shut-in service. She discussed with a Brownie leader the possibility of having her girls take books and return them for old people in convalescent homes. The proposal was viewed favorably. Then JIiss Fancher communicated with the convalescent homes. One owner objected that it would be too mnch trouble to keep track of books. A t another home, she r a n into the fact that some of the elderly had cataracts which prevented their reading; others kept busy with other activities, ranging from crocheting to conducting an extensive correspondence; still others simply were not interested. Hou-erer, a t a third home she found a desire expressed for the service. But by this time, the Brownies had already been assigned to another activity. �As nursing and convalescent homes come under stricter supervision and their standards become higher, librarians will find that the directors of such institutions will come increasingly to ~velconle the service of the libraries. At Port Jervis, Librarian Leona Edith Dugan tried sending books to the local hospital but the nurses felt they were too bnsy to collect and return them to the library and since none of the library staff had a car the service mas discontinued. On the other hand, the library at Rome, N. Y., s~iccessfully operates a regular pickup service at the Oneida Connty Home. ~t is not enough merely to offer such a service, to issue a statement to the press or post a bulletin in the library or even to send an announcement to the various institutions and homes. The service offer must be carried into the homes and institutions by the librarialls, by llurses, doctors and relatives. ~f the library be!ievcs there is a real for tilib type of delivery sersrice in the comlllLlnity, it lllust sell the idea to the community. snlall collllllullities especially, the added work of initiating alld supervisillg this would be slight, if the aid of civic and fraterllal groups lvere enlisted to furllish transportation, and pickup service, i\lallJ- fraternal groups have perlllallellt mittees to visit their sick, and these perhaps could be enlisted to bring ~ ~ i them not 0111)- flowers and t h goocl cheer, bnt also books. Because so many of our elderly are imnlobilized tlirongll falls or chronic illness, the use of ceiling projectors became an iillportant factor in enabling them to read, in providing them an opportanity to pass the time pleasurably. The Great Neck Library provides such projector service. The Hempstead P ~ ~ b l Library reports that its ceiling projectors and ic microfilms are enthusiastically received bj- the elderly, stating that "patients in their 80's whether at home or in an institution hare enjoyed reading our 'Books on the Ceiling.' " At Glorersville, the library and Lions Club jointly operate the ceiling projector service, with the club infornling the library as to persons entitled to use the machine, delivering and returning the machine, and the library responsible for record keeping and maintenance of the projector. Miscellaneous Services d miscellaneous number of library services available to all age groups are of especial interest to the elderly. Hobby exhibits often held their attention and interest. The Great Books Discussion groups and Book Review meetings frequently are a source of enjoyment to older people. Some libraries attempt to help oldsters who have difficulty reading by having a recording machine for them, or conducting record concerts, Some librarians make a special effort to obtain books for ('tired eyes. " I n some communities, the most practical service that could be rendered the elderly, the librarians say, would be to put the adult reading rooms on the ground floor, where the elderly could get to them without arduous climbing of steps. Conclusions Like Chief Librarian Francis R. St. John of the Brooklyn Public Library, "we feel that the elderly constitute a very important group in the conllll~nity As and one which has been rather Desmond says, l L L i b r a r i a n s must face the fact that our people are living longer, are remaining V ~ ~ O ~ O U S alert longer, and are having increased alld and !eisX'c time." 0 LLL ' ~ coa~il~uiiitiea state rrlust at the same time appreciate the fact that if library services are to be expanded to meet the needs of the elderly, fillallcia1 assistallce mill be meded. From the experiences and opinions of the librarians as expressed to the Desrnond snrrey, u e clrax these fundamental conclusions, as basic precepts which might well gorern libraries in serving the elderly of their 1. Libraries are dcdicatecl to serve all the community. Therefore. it should examine the composition needs of the community and its patrons, and attempt to serve all in just proportion. 2. Coinnlnnities differ not only in the proportion of their elderly but also in the educational backgrounds of their elderly. Therefore services of libraries to the olclsters would vary from community to commanity as local needs dictate. 3. The library should join 'irith other colllrnunity agencies in planning local programs for the elderly. The services the library renders to the oldsters should depend i n part on the extent and character of services provided by other local agencies, to prevent unnecessary overlapping ancl duplication ancl omissions. 4. Library programs for the elderly need frequent auditing and review, for a program designed for the oldsters of 1950 may be outmoded by 1955. The library should keep pace ~viththe changing backgrounds and needs of the elderly. 5. Librarians, educators, and other qualified authorities agree that education, which begins at our entrance into this world (if not sooner), should not end until we make our final exit. Thus the adult education programs of our comnlunities should be geared not only to the young and to the middleaged but also to our oldsters. 171 �(b) bringing the library to the elderly by: 6. Segregated book shelves for the elderly are (1) providing delivery service with the aid unwise; activities should be set up on a of volunteer groups, if possible, to the functional rather than a chronological age basis, bedridden a t home, or those unable to whenever possible. However, clubs for oldsters get to the library. and hobby shows for oldsters serve an import(2) providing book service for public and ant function of bringing groups of elderly private hospitals, old age homes, nurstogether, enlarging their social scope, revitaling and convalescent homes, and izing lives allowed to become shriveled up and recreation clubs for elderly. narrow. ( 3 ) arranging for lectures, book reviews, 7. Libraries can best serve the elderly b y : and movies by library staff at meeting ( a ) bringing the elderly into the library by rooms of old age clubs. (1) making the library a hospitable, (4) providing "books on ceiling" projector pleasant place to visit, with the library service for the bedbound. staff prepared to be especially kind and patient with oldsters who may be Librarians have an opportunity in many comhard of hearing, inattentive, demand- munities to lead the way to better community undering, etc. becanse of peculiarities of the standing of the needs and abilities of the elderly, to aging process. demonstrate that many of our elderly are capable of ( 2 ) organizing and directing clubs for contributing a great deal to society, and to smash oldsters if none exist in the community. the common concept of the library as only a place ( 3 ) providing, if available, meeting space where books are borrowed. for clnbs for the elderly. Let n s remember that you can judge the cultural (4) arranging for "Great Books" discus- level of a community by the care and attention it sion groups, Book Reviews, talks, and gives its elderly. movies in the library, if facilities are I t may take some patience and tolerance in dealing available. with some of our elderly; but then, these qualities are (5) make available radio and recording needed in dealing with some librarians, young or rooms for those hose sight is impaired. old, for we are all humans. However, few services ( 6 ) encourage hobby showings for the of the librarian will yield such tremendous satisfaction as those arising from the knowledge that they elderly. ( 7 ) keep needs of elderly in mind ~ ~ r h e nare giving our neglected elderly new hope, nev vistas, ordering books. and new happiness, in their last years. �Canada And Its Aged By Professor John S. Morgan Associate Professor of Social W o r k , University of Torouto T HE GOVERNMENT Canada has just appointed of a special Committee of members of the Senate and the House of Commons to study the needs of the aged. This is symptomatic. The pressure of events is compelling the Canadian people to re-assess the provisions now made in Canada for its older citizens. This increased concern however, is due to a number of factors, some of which are typical of the situation in the United States, and some of which are peculiar to the Canadian scene. As in the United States, the number of older citizens nv,,n,,vt;nno+nl~ + A the whole popiikiiioa has been rising during the first half of this century. For example in 1921 the age group over 60 represented 75.1 per 1000 ; in 1931 it was 83.9 ; in 1941 it was 102.1 per 1000;l and there is no doubt that the Census for 1951 will show a further substantial increase. Furthermore, as reported in a recent article prepared by the Bank of Nova Scotia,' the numbers in the upper half of the "working-age" group are also rising. "Even with no further reduction in mortality rates, the number of persons in Canada aged 45-64 will increase from about 2% millions in 1949 to some 3% millions in 1971, and they \Till then make up perhaps 40 Per cent of those in the most active years of \Torking life (20 to 64) as against 33% Per cent at present." So that, although the age structure of the Canadian nation is relatively that of a "youllg nation" as compared with all the Testern European nations and is ~ e r h a p s little "younger " than that of the United a arrived hen the gro1l7ing States, the time has 1 1 0 ~ numbers of older citizens has become a matter of serious concern to the people of Canada. .L,IA,b,l, bu Over-Emphasis on Youth In Canada, as in the United States, the patterns of employment accepted by both labor and management have tended to put an overemphasis on youth. Since so much of Canadian industry until very recent years has been primary industry of a heavy type-such as logging, lumbering, mining, agricnlt~~re-the emphasis 011 comparative youth and physical strength has been even greater than in the United States. Employers in Canada have accepted without serious thought all 1 The Canada Y e a r Book 1048-$9. Ottawa: T h e Kings Printer, 1949. 2 Young and Old: T h e Changing Age Pattern. The Bank o f Nora Scotia RIonthly Bulletin, February, 1950. of the myths about the difficulty of employing older workers which have been so thoroughly exposed by the New York State Joint Legislative Committee on Problems of the Aging in its two reports. There is, therefore, the same need in Canada as in the United States for research into the work capacities of older workers, and the same urgent need for public education on the necessity to revise accepted but now outdated employment practice^.^ The developing services of the National Employment Service in providing special counselling services for older workers has aiready been reported at length in Never Too Old and needs no elaboration here. I t is being extended to the larger Employment Offices in the industrial parts of Canada. Unlike the United States of America, Canada has 110 Social Security Act and no coherent set of plans or provisions for meeting the basic economic needs of dependent citizens. The main reason for this lies i n the field of political science. Canada is a federal country but responsibility for health and welfare has been adjudged to lie with the Pros~inces, that whenso ever a question of economic security legislation arises, Canada runs into a confused political discussion about jurisdictions in which the needs of people tend to get lost in the heat of the battle for Provincial rights. The last occasion on which an attempt was made to improve the system of economic assistance to aged persons was in 1945 when a Dominion-Provincial Conference was called to consider among other things a re-alignment of responsibilities for health and welfare b e t ~ ~ e e n the Federal and Provincial legislatures. This Conference got involved in a fruitless discussion of powers of taxation and was abandoned before the proposals concerning the needs of the aged were seriously considered. The main provision for economic aid to the aged in Canada is made in the Old Age Pensions Acts. The first Act was passed in 1927 when the Dominion Governmeilt was authorized to pay one-half of the net cost of pensions up to a maximum of $20 a month to British subjects of 70 years of age and over whose had resided income did not exceed $365 a year, in canada for 20 Sears ill the province in which 3 See "Unemployment Among Older W o r k e r s 1945-49". The Canadian Labour Gazette, Kovenlber, 1949. Ottawa: T h e Kings Printer, 1949. 173 �application was made for five years or inore. The Provincial Qovernnients then passed Provincial Acts (British Columbia in 1927 being the first and the Pro\,ince of Quebec i n 1936 being the last, excluding Kewfounclland which passed appropriate legislation set i n 1949 upon Confecleration) ~vhich u p the adininistration and establisbecl these non-contributory means-test pensions within the nliiiinla laid domn i n 1 the Dolninion Act of 1927. 1 1soine Provinces, a share of the half not coniiiig froin federal funds was paid by municipalities, but this practice was soon cliscontinned. This meagre provision has been extended and liberalized on several occasions. I n 1931 the Federal Gorerninent's share Tvas raised to 75 per cent of net peii5ions, i n l9:S'i bliud persons becalne eligible for. pensions a t age 40 ; i n 1943 the maximum pensioii was raised to $25 a nionth ; i n 1944 the maximum perniitted illconle was raised to $423. h rriajor revision took ilk 1947, "I-----l d : i l i-:g Lhe L U I I L I.~4L I U I I U G c t L n ,,,n,,mc ---. A : IIUc lll L test, inchtding the blind a t age 21, and raising the maxini~unnionthl- rate of pension to $30. I n 1949 t h e niaxiniiull rate to which a 75 per cent Fecleral contribution can be clainled was raised to $40 a month. paicl supplenleiital Since 1942 some provinces h a ~ e a l l o ~ ~ a n c e from provincial revenues ; these hare s variecl in anlounts ancl froin tinie to tinie, the present situation being that only three Provinces ancl the Ynl<on territory are paying snppleiilental allox~ances. Excluding any provincial snpplements, the position i n March 1950, then, is that Old ,4ge Pensions are payable to persons aged 70 or over n h e n the annual income, inclltdiilg pension is not more than $600 for a single person or $1.080 for a married person, or C LLIL IllLuLru $1,200 for a person married to a blind person. Administration is the responsibility of the various Provinces, Federal supervision being confined to audit of the accounts. With the exception of medical care prorisions i n some Provinces, there is little or no service to pensioners. From the inception of the first Old Age Peilsioii Act i n 1927 to Septenlber 30, 1949, the Federal Government had spent $585,696,316.93. The annual cost of these pensions has been rising steadily, and will be substantially increased b y the 1949 increase of maxiniunz pension rate to $40 a iilontli. I t is this steadily rising charge on the budget nhich has influenced the Government to re-examine the whole situation. The need for better prorision can be even inore clearly seen froni the follo~vingtable. Since the Canadian Oltl Age Peizsioiz is only giren after a fairly stringent nieans test, it is clear that nearly half of all Canadians o v r 70 years of age hare bcc:: l~nab!e to p r o ~ i d e for t h ~ i r nlcl age and hy f a r the greater nuniber of these have so little income that they clnalifj- for the full pension. Medical Care provisions are available to old age pensioners under the Provincial administrations i n Alberta, British Cohunibia and Ontario, Sasl~atche~van, Nora Scotia. The typical arrangement is for the Provincial Governmelit to nlake a n agreement ~ ~ i t h the pro^-incial Medical Association or the College of P h y s i c i a i ~ancl Surgeons, that recipients of old age ~ pensions ma>- receil-e office care froni their own physicians, with a liiilited list of permitted nledicines, tll~ acllliinistratioii of the schrnle being i n the hands of the niedical society, which pays the phpicians froni a f u n d provided by the Province on a per capita per Statistical Summary a s a t September 30, 1949 Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia 15,777 27,085 16,139 15,935 4,559 19,287 12,189 20,458 12,918 7,438 4,215 (max. $30 month) 6,590 -- I. Number offOld Age Pensioners'. . . . . . . . . 2. Number in receipt of h.Iaximum Old Age Pensionz.. .......................... 3,'Percentage of pensioners3 to population 70 years of age or over. . . . . . . . . . . . . . . 47.81 43.90 46.24 70.82 36.19 56.73 Ontario Prince Edward Island Quebec Saskatchevan Sorth TTTest Territories Yukon 80,731 2,853 66,674 16,230 19 83 65,304 1,085 52,876 11,384 19 75 10.38 25.30 - 1. ru'umber of Old Age Pensioners1. . . . . . . . . 2. Number in receipt of Maximum Old Age Pensionz.. . . . . . . . . . .. . . . .. . . . . . . . .. 3. Percentage of pensioners3 to population 70 years of age or over.. . . . . . . . . . . . . . 35.27 46.02 52.79 47.18 NOTES. 1 and 3 from the Quarterly return Old Age Pensions and Blind Pensions in Canada as at September 30th, 1949, published by the Old Age Pensions Division, Department of National Health and Welfare, Ottawa, 19-19. Percentages based on estimated population as at June lst, 1948, except Newfoundland, Yukon and Northwest Territories based on 1941 Census. 2 from a return furnished in the House of Commons, Nov. 3rd, 1949. (Report Col. 1394) All cases not reviewed under 1949 changes in pension rates. 174 �day basis f o r each recipient of pelision on the Provin- self-sustaining basis now that the capital cost has been cial records. Hospital care, except i n Saskatchewan found. The family welfare agency i n Montreal has and British Columbia, falls uiider the provisions f o r converted a legacy into the Belvedere Apartments for the care of iildige~itsi n the Public Hospitals Acts of older citizens in the center of the city. The developmost, if not all of the Provinces. Saskatchewan a n d ment of well-established private agencies vhich have British Colun~biahave contributory hospital insur- created homes for older people, such as the Sunset ance programs for the whole population of the Lodge of the Salvation Army has beell the subject of Province. There has been little supervision of the special attention i n the city of Toronto. These are kind of inedical care given, and little or no research only exainples of a number of experiments and extenor actioii i n the rapidly developing nledical science of sions of existing services 1~2iicha r e being developed to meet the growing need of places where a n old pergeriatrics. The care of tlie aged i n other ways than b y ineans son or a n old couple call seek and find adequate shelter in of pensions is inore fragriientary and varies froin ~ ~ i t h their very nlodest means; b u t the supply falls Proviilce to Province and municipality to municipal- f a r short of the need. Large numbers of older people, ity. It is very difficult to get at the real facts of the especially i11 tlie indnstrial towns a n d cities, still live situation f o r the facts are hidden and little research i n conditions of squalid discoaifort. Here and there i n Canada there a r e experiinents i n has been done. I t has been suggested that for some of those uiidcr 70 )-ears of age, the 17nemploymelit recreation for older people and recreation agencies are Insurance F u n d is being used for economic support giving this iiiatter soine b a t not enough attention. although the recipient ancl the Unemp101-ment Insur- The activities of the Gordon H o l ~ s e Settlement i : ~ ance Coinniissioii are riel1 aware that the recipient is TTanconver provide one exanlple of a well planned only "able ancl willing to work" as a polite fiction to progranilne of recreation activities f o r its older memkeep him nitliin the s t a t u t o r ~ -recjuirenients of the bers. The Sccond Mile Club of Toronto, supportecl by Unemploynieiit Insnrance Act. The hosl~itals a n d the city council as well as by the Comlnuility Chest of nleiital hospitals of eyer>-Province contain large ntuil- tlie city, is a n experinlent i n the development of a bers of elderly people v h o are classed as chronically club for older people, i n which they can not only get ill or nlentally ill, but hose real iieed is geriatric care recreational activities but develop a new social life for themselves. Service clubs i n a number of cities are and rehabilitation. The long tradition of municipal responsibility in- beginning to interest thenlselves i n the needs of the herited from the old English Poor Law reaches into aged. These are all beginnings, b u t they are few i n sonie of the Canadian Provinces niore than others. proportion to the neecl. Thns in most Canadian Prorinces there are still niluliicCanada Starts Old Age Work ipal ho~nes(or "poor houses") which shelter a limnber of elderly people who are there because their Caliacla is just beginning on the long task of proparishes or nlunicipalities of residence call find iio viding for its aged. Many plans are being aired. niore suitable form of care for them. I n Quebec The Senate-Conlmoiis joint committee will be asked to Province. with the long standing tradition of the consider various proposals for better economic a i d ; Rolnaii Catholic Charch, there are man>-old people i n contributory insurance will be proposed, on the patreligious institutions, which receive support from the tern of Old Age and Survirors Insurance in the Province under the Quebec Public Charities Act. I'iiitecl States or the Retirement Allo~i~ances the of Ontario has recently illade a valiant effort to eiicour- British National Insurance A c t : universal no-means age the conversion of the old municipal homes i n the test allowances (or "birthday pensions for all") of P~oT-iiice into niore adequate homes for the aged, a n d the kind recently suggested b y Mr. d l t o n Linton, in its recent Ilonles for the Aged Act has offered s ~ t b - testifying on Bill H.R. 6000 before the Senate Comstaiitial finailcia1 assistance to lnunicipalities to b ~ ~ i l c lmittee on Finance, i n the United States will be proiiev and inore modern homes for the aged. These posed: the needs of older citizens i n terms of jobs. provisions ancl those of the other Proviiices care for housing, medical care, ancl social services (such as some of the aged who cannot, mostly for reasons of those now prorided under the British National Assistphysical or mental health, be cared for i n their o\iTn ance Act) will be presented. There is much good-will, homes. some anxiety, and not a little confnsion. ConstituThe need for better housing for older people is tional problems, financial and adnlinistratire difficnlbeginning to receive some attention in Canada. Here ties, political proniises and counter proposal lie ahead. and there experiments are being tried which hare The stndies of the Nen Yorlr State Joint Legidatire much prornise for the futnre. A block of flats for Conlnlittee on Problems of the Aging cannot b ~ l be a t olcler people has been built in Bnrlington, Ontario, by valuable aid to careful e s a m i ~ ~ a t i oof the facts and ll and is expected to operate on a hol~efnllyto the beginnil~gsof n-ise solutions. the Canadian I~egion, '5 �APPENDIX RECOMMENDED LEGISLATION STATE O F NEW YORK No. 743 Int. 734 IN SENATE January 23, 1950 Introduced by Mr. DESMOND-read twice and ordered printed, and when printed to be committed to the Committee on Finance AN ACT TO create a counselling service for older workers i n the labor department, and making an appropriation therefor T h e People of t h e S t a t e of N e w Y o r k , represented in Senate a n d A s s e m b l y , do enact as follows: E s ~ ~ a n - a ~ 1 0 ~ - 1 \ I a t t inr italics is new; matter in brackets [ ] is old law t o be omitted. e Section 1. Article twenty-four of the labor lam ancl section eight hundred fifty to eight hundred fifty-five, both inclusive, comprising such article, as last renumbered by chapter three hundred seventy-seven of the laws of nineteen hundred forty-five, is hereby renumbered article twenty-five and sections nine hundred to nine hundred five, respectively, arid such lam is hereby amended by inserting therein a new article, to be article twenty-four-A, to read as follows : ARTICLE 24-A COUNSELLING SERVICE OLDER FOR WORKERS $ 825. The industrial comnlissioner shall establish in the New York state employ~ilentservice a coun- selling service for older workers. Such counselling service shall appraise the capabilities of the older workers, advise, guide and direct older workers to ei~ip!oyment opportunities, encourage older workers to seek the work for which they are best suited, and give them confidence in their abilities and perform such other functions as the industrial commissioner shall deem desirable to counsel older workers successfully. $ 2. The sum of fifty thousand dollars ($50,000), or so much thereof as may be necessary, is hereby appropriated to the state department of labor for the purposes of this act. The moneys appropriated by this act shall be payable from the state treasury on the audit and warrant of the comptroller on vouchers certified or approved in the manner provided by law. S 3. This act shall take effect immediately. �STATE OF NEW YORK Chapter 598, Laws of 1950 3rd Rdg. 388 Nos. 162 9, 3354 Int. 1536 February 8, 1950 Introduced by Mr. DESMOND-read twice and ordered printed, and when printed to be committed to the Committee on Internal Affairs-reported favorably from said committee, committed to the Committee of the Whole, ordered to a third reading, passed Senate and Assembly but not delivered to Governor, vote reconsidered, restored to third reading, amended and ordered reprinted retaining its place in the order of third reading AN ACT To amend the town law, in relation to the regulation of private sanatoriums, convalescent homes, homes for aged or indigent persons, day nurseries, hospitals, rest homes, and buildings used for similar purposes T h e People of the State of N e w Y o r k , represented in Senate and Assembly, d o enact as follows: EXPLAXATIOR Matter in italics is new; matter in brackets [ ] is old law to be omitted. - Section 1. Paragraph numbered twenty of section convalescent homes, homes for aged or irzdigent perone hundred thirty of the town law, as amended by sons, d a y nurseries, hospitals, rest homes or any chapter three hundred thirty-eight of the laws of building or part of a building used f o r similar purnineteen hundred thirty-nine and renumbered by poses, containing a total number of beds, cots or simichapter one hundred twenty-six of the laws of nine- lar equipment providing sleeping accommodations for teen hundred forty-four, is hereby amended to read more than five persons; specifying the type of construction, the manner of their running and operation as follows : 20. Hotels, inns, boarding houses, etc. Regulating and prescribing regulations assuring proper sanitahotels, inns, boarding houses, rooming houses, lodging tion Land], cleanliness and fire protection. $ 2. This act shall take effect immediately. houses, associations, clubs or any building or part of a building used in the business of renting rooms, This bill was adopted by the Legislature, and is now Chapter individual or several, and also private sanatoriums, 598 of Laws of 1950. �STATE OF NEW YORK No. 2286 Int. 2109 IN SENATE February 21, 1950 Introduced by X r . DESMOND-read twice and ordered printed, and when printed to be committed to the Committee on Civil Service and Pensions AN ACT To amend the civil service law, in relation to the suspension of pensions T h e People of t h e S t a t e o f *?JewY o r k , represelzted in Senate and Assembly, do enact as follows: E X P L A ~ A T I O Matter in italics is new; matter in brackets [ ] is old law t o be omitted. X- Section 1. Section thirty-two of the civil service law, as added by chapter seventy-eight of the laws of nineteen hundred thirty-tivo, is hereb>- amended to read as follows: 8 32. When pension [and annuity] suspended. 1. If any person subsequent to his retirement from the civil service of the state, or of any municipal corporation or political subdivision of the state shall accept any office, position or employment on and after July first, nineteen hundred thirty-two to which any salary or emolument is attached in the civil service of the state or of any municipal corporation or political subdivision of the state, except the office of inspector of election, jury duty, poll clerk or ballot clerk under the election law, or except the office of notary pnblic or commissioner of deeds, or an elective public office, any pension Lor annuity] awarded or allotted to him upon retirement, and payable by the state, by such municipal corporation or political subdivision, or out of any fund established by or pursuant to law, shall be suspended during such service or e~nploymentand while such person is receiving any salary or emolument therefor except reimbursemeilt l u r traveiing expenses. 2. T h e provisions of tlzis section shall be sz~spencled, u n t i l J u l y first, wineteen hundred fifty-two, to t h e extent lzecessavy t o permit a retired m e m b e r t o continue as such a n d t o e a r n not t o exceed seven hzcndred fifty dollars per calendar year as conzpensation i n a n y positioqt in government service or public service, provided: ( a ) H i s retirenzent allowance, conzplttecl zuithout optional modification, does not eaceed fifteen hunclred dollars per year, a n d ( 6 ) H e d u l y execzctes and files w i t h Itis r e t i r e ~ n e n t systenz. a statenlent that he elects t o have t h e provisions of this szcbdi~:isiona p p l y t o ltinz. A n y statement executed and filed pursuant t o this subdivision nzay b e w i t h d r a w n b y a retired nzenzber a t a n y t i m e b y a statenzent similarly execzcted and filed. $ 2. This act shall take effect immediately. �STATE O F NEW YORK Int. 2112 No. 2289 IN SENATE February 21, 1950 Introduced by Mr. DESNOND-read twice and ordered printed, and when printed to be committed to the Committee on Finance AN ACT To amend the labor law, in relation to creating an office on employment of older workers, defining its powers and duties and making an appropriation therefor T h e People of t h e S t a t e of ATew Y o r k , represenfed i.n Senate a n d Assenzbly, clo enact as follozi)~: EXPLASATIOK-3Iatter in italics is new; matter in brackets [ Section 1. Article twenty-four of the labor law and sections eight hundred fifty to eight hundred fifty-five, both inclusive, comprising such article, as last renumbered by chapter three hundred seventy-seven of the laws of nineteen hundred forty-five, is hereby renunlbered article twenty-five aiid sections nine hundred to nine hundred five, respectively, and such law is hereby amended by inserting therein a new article, to be article twenty-four, to read as follows : ARTICLE 24 OFFICEFOR E~IPLOP>IEXT T H E OLDER OF l l r Section 825. State office for employment of the older workers. 826. General purposes and duties. 827. Director. 828. Duties of director. $ 825. State office for employment of older workers. The industrial conlmissioner shall establish an office for the employment of older workers, composed of three representatives, each from employer and employee organizations, respectively, arid one representative of the general public, who shall be the chairman. They, by a majority vote, may designate one of its members, other than the chairman, as a vice-chairman to act in the absence or inability of the chairman. Each member shall be appointed for a term of three years and shall hold office until his successor shall be appointed a a d has qualified. Vacallcies shall be filled by appointment by the commissioner for the unexpired term. The members of the council shall receive no compensation but shall be reimbursed for transportation and other expenses actually and necessarily 1 is old law t o be omitted. incurred in the performance of their duties under this article. 8 826. General purposes and duties. The office shall : a. attack age barriers to employment through research and education. b. launch a s~zstained drive to encourage employers to hire elderly workers. c. compile for industry a list of jobs for vhich the elderly have been fonnd particularly suitable. d, conduct studies on utilization of aging nlaapower in industry. in ~ ~ with the ~ e. ~ cooperation ~ ~ homework bnrean develop a sound program for expanding work of oldsters a t home. f . help in developiiig retaining facilities for the aging. g. encourage creation of sheltered workshops. h. develop pamphlet on colnmnnity uses of retired workers. i. help prepare workers for retirement. $ 827. Director. The industrial comniissioner shall appoint a director who shall be technically trained with adequate administrative experience in personnel and social welfare work and who shall receive a salary to be fixed by the office within the amounts made available by appropriation. The director shall serve at the pleasure of the industrial commissioner. 5 828. Duties of director. The director shall: ( a ) be the administrative head of the office; ( b ) appoint and remove from time to time, in accordance with law and any applicable rules of the state civil service commission, such employees and technical experts as he may deem necessary for the efficient administration of the work of the office. The compensation of such �employees and technical experts shall be fixed by the director within the amounts made available by appropriation; (c) investigate and report from time to time upon the facilities and services which are needed or which may be needed to promote the interest,^ of aging and elderly workers of the state and make such recommendations as may prove beneficial and useful in carrying out the provisions of this article ; (d) advise and cooperate with employer and employee organizations on matters relating to the rehabilitation and employment of aging and elderly workers; and (e) perform such other duties as may be necessary to carry out the provisions of this article. § 2. The sum of fifty thousand dollars ($50,000), or so much thereof as may be necessary, is hereby appropriated out of any moneys in the state treasury not otherwise appropriated and remaining to the credit of the state purposes fund in the general fund and made immediately available for use by the office for older workers, including expenses of maintenance and operation and personal service of employees, in carrying out the provisions of article twenty-four of the labor law as added by this article, Such money shall be paid out of the state treasury on the certificate of the industrial commissioner after audit by and upon the warrant of the comptroller as provided by law. § 3. This act shall take effect immediately. �STATE O F NEW YORK No. 2290 IN SENATE February 21, 1950 Introduced by 31r. DESMOSD-read twice and ordered printed, and hen printed to be conliilitted to the Committee on Finance AN ACT To amend the public health law, in relation to instituting and developing an adult hygiene and geriatrics division in the department of health and making an appropriation therefor The People of t h e S t a t e o f *ITewY o r k , represe~ztedin Senate amcl Assenzbly, do ertact as follows: E X P L A R A T I O N - - & I ~ ~ italics is new; matter in brackets [ ] is old law t o be omitted. in ~ ~ ~ Section 1. The public health !: is hereby aiiieiided a? by inserting therein a new article, to be article twenty-three-A, to read as follows : ARTICLE 23-A AND GERIATRICS ADULTHYGIENE Section 460. Adult hygiene and geriatrics. 461. Purpose and functions. 462. Po~versand duties. § 460. Adult hygiene and geriatrics. The state departlnent of health shall establish an adult hygiene and geriatrics program, designed to improve and protect the health and vitality of middle'aged and elderly citizens of the state. $ 461. Purpose and functions. The department, at the discretion of the commission, shall: 1. Plan the change in emphasis on public health work from commnnicable diseases to degenerative diseases and chronic illnesses. 2. Develop a program for integrating all public health department activities, ranging from cancer control division, public health nurses, district health 0%cers, health education division on the utilization of geriatric techniques. 3. Develop a program for periodic comprehensive health inventories, for the middle aged and elderly. 4. Plan and promote a health education program for the elderly. 5. Set up a "pilot" old age clinic at a general hospital. 6. Develop plans for expanding the facilities of chronic illness centers to iilclnde old age clinics. 7 . Explore possibilities of reducing cost and improving care of the chrol~ically through use of nonill institutional facilities. 8. Develop, carry out and stimulate laboratory, clinical and statistical research on health problems of older people, as may be recommended by the state niedical society or other agencies. 9. Carry on a program of professional education and training of medical students, phpsicja~is,ancl nurses in the prevention, medical. and nursing care of diseases of older people. § 462. Powers and duties. The commissioner shall have the power and it shall be his duty to employ such assistants and personnel, within the amount of the appropriation, as is necessary to carry out the provisions of this article. 8 2. The sun1 of fifty thousand dollars ($50.000), or so much thereof as may be necessary, is hereby appropriated out of any nioneys in the state treasury not other~vise appropriated and remaining to the credit of the state purposes fund i n the general fund and niade immediately available for use by the state department of health, including expenses of maintenance and operation and personal services of employees, in carrying out the provisions of article twenty-three-A of the public health law as added by this article. Such money shall be paid out of the state treasury on the certificate of the commissioner of health after audit by and upon the warrant nf the comptroller as provided by law. 3. This act shall take effect imlnediatelp. �STATE OF NEW PORK No. 2291 I N SENATE Int. 2114 February 21, 1950 Introduced by Mr. DESMOND-read twice and ordered printed, and when printed to be committed to the Committee on Finance AN ACT TO amend the executive law, in relation to creating a state council on the elderly; defining its func. tions, powers and duties and providing for the appointment and term of office of its members, and making an appropriation therefor The People of the State of Xew York, represented in Senate and Assenzbly, do enact as follows: E X P L A K - ~ T I O X in~italics ~ ~ new; matter in brackets [ ] is old law t o be omitted. - ~ ~ ~ is ~ ~ Section 1. Article fifteen of the executive law, and sections two hundred and two hundred one comprising such article, as last renumbered by chapter seven hundred sixty-three of the l a ~ m nineteen hundred of forty-five, is hereby renunlbered article sixteen and sections t ~ hundred fifty and two hundred fifty-one, o respectirely, and such lav- is hereby amended by inserting therein a ne1v article, to be article fifteen, to read as f o l l o ~ :~ s Section 200. C o ~ ~ n ccreated ; employees ; utilization il of departmental personnel ancl assistance. 201. Definitions. 202. Parposes and dnties of coancil. 203. Director. 204. Duties of director. 205. Grants. $ 200. Council created; employees; utilization of departmental personnel and assistance. 1. A state conncil on the eldery is hereby created to consist of nine members to be appointed by the governor, alnong which there shall be a representative appointed from each of the following: department of education, department of labor, department of social welfare. department of health, and division of housing. Three members shall be appointed for a term to expire January fifteenth, nineteen hnndred fifty-two, and two members for terms to expire on January fifteenth, nineteen hundred fifty-three, two members whose terms shall expire on January fifteenth, nineteen hundred fifty-four and two members whose terms shall expire on January fifteenth, nineteen hun- dred fifty-five, and their successors shall be appointed for a tern1 of four years. Vacancies for causas other than expiration of terms shall be filled for the remainder of the unexpired term. The governor shall designate one of the members to serve as chairman of the conncil. The inembers of the council shall be allowed their actnal and necessary expenses incurred in the perforinance of their duties nilder this act, but shall receire no coiiipensation for services rendered pursuant to this act. 2. The council niay employ and at pleasure rpmove such officers and emp10~-ees. and such expert and clerical assistants as it deems necessary and may fix their coinpensatioil within the amounts made available by appropriatiozl therefor. 3. To effectuate the purposes of this act any departinent, division, board, bureau, commission or agency of the state or any political subdivisioll may provide such facilities, illcludillg personnel, assistance and data, as mill enable the conncil properly to carry ont its activities and effectuate its purposes hereunder. 201. Definitions. As used in this act. 1. "Council" shall mean the state conncil on the eldcrly created by this act. 2. "Director" shall mean the director of council to be appointed nncler the provisions of this act. § 202. Purposes and duties of council. The council shall : ( a ) Encourage the coordination of the work of various state departments and agencies dealing with the elderly. ( b ) Interpret the needs of the elderly to the vari011s state departinents and to the public. (c) Stimulate research on problelns of the aging. ( d ) Enconrage organization of old age committees in each local community. �(e) Spear-head a state program for the elderly, giving it leadership, direction and support. ( f ) Report annually on facilities, progress and activities of public agencies dealing with the elderly. § 203. Director. The council shall appoint a director who shall be responsible to the council, and who shall receive a salary to be determined by the commission. The director shall serve at the pleasure of the commission. § 204. Duties of director. The director shall ( a ) Appoint and supervise and direct all officers, agents and employees necessary to carry out the provisions of this act. ( b ) Study and report to the council upon the facilities and services for the elderly which are needed or which exist within the state and by consultation with the authorities in charge. (c) Assist in the correlation and development of programs for the elderly, provided that surveys of the recreation facilities and programs of local agencies shall be made only upmi their request. ( d ) advise and cooperate with and encourage comnluriity recreation agencies interested in the use of or the development of recreation facilities and programs for the elderly. (e) Advise the adnlinistrative officers of all state agencies authorized by law to perform services for the elderly of regular meetings of the comnlission altd of snch special meetings as map consider matters relating to their specific responsibilities, and inrite snch officers to attend and participate in deliberations of the conlmission ~vithoutthe authority to rote. ( f ) Encourage and render assistance in the promotion of training programs for volunteer and professional personnel dealing with the elderly in cooperation with other agencies, organizations and institutions, and may encourage the establishment of standards for recreational personnel. (g) Assist any department, commission, board, agency and officers of the state in rendering services for the elderly in conformity with their respective authorized powers and duties and encourage and assist in the correlation of state and local activities for the elderly. ( h ) Perform such other duties as may be prescribecl by law. § 205. Grants. The commission, with the approval of the governor, may accept as agent of the state any gift of funds for the purposes of this act. 5 2. The sarn of fifty thousand dollars ($50,000), or so much thereof as may be necessary, is hereby appropriated out of any n~oneys the state treasury not in otherwise appropriated and remaining to the credit of the state purposes fund in the general fund and made inllnediately available for use of the state council on the elderly created by this article, including expenses of maintenance and operation of the council, and for personal service of employees, in carrying out the provisiolls of this article. Such moneys shall be paid out of the state treasury on the certificate of the chairnlan of the council after audit by and upon the warrant of the comptroller in the manner provided by law. 3. This act shall take effect immediately. a �STATE OF NEW YORK Nos. 2293, 3054 Int. 2116 I N SENATE February 21, 1950 Introduced by Mr. DESMOND-read Committee on Judiciary-committee mitted to said committee twice and ordered printed, and when printed to be committed to the discharged, bill amended, ordered reprinted as amended and recom- AN ACT To amend the civil rights law, in relation to providing that applications for licenses, certificates or permits from the state may not be denied because of maximum age limits T h e People of t h e S t a t e of N e w Y o r k , represented in S e n a f e and Assembly, d o enact us fo1lolc.s: E~PLAKATIONMatter in italics is new; matter in brackets [ ] is old law t o be omitted. Section 1. The civil rights lam is hereby a m ~ n d e d by inserting therein a n e v section, to be section seventy-three, to read as follows : § 73. N o application b y a person wlzo i s in all other respects qzialified for a n y license, certificate or permit issued b y t h e state or a n y departnzent, conznlission, authority or a g e n c ~ jthereof, or b y a n y municipality, shaii b e denied becalcse such psrsoii is ovir slzy specified age. Nothing lzerein contained, lzowever, slzall prevent tlze state board of social welfare f r o m adopting reasonable age reqzcirenzelzts f o r licenses, certificates or pernzits for foster nzothers in charge of i n f a n t s and children. 8 2. This act shall take effect immediately. �STATE OF NEW YORK No. 2294 Int. 2117 IN SENATE February 21, 1950 Introduced by Mr. DESMOND-read twice and ordered printed, and when printed to be committed to the Committee on Taxation AN ACT To amend the tax law, in relation to allowing contributions made or amounts paid by employees to pension trusts or retirement plans maintained by their employers T h e People of t h e S t a t e of N e w Y o r k , represented in. S e n a t e a n d A s s e m b l y , d o enact as follows: EXPLARATION Matter in italics is new; matter in brackets [ ] is old law to be omitted. - Section 1. Section three hundred sixty of the tax law is hereby amended by adding thereto a new subdivision, to be subdivision nineteen, to read as follows : 19. Contributions m a d e or amozcnts paid, zuithheld or incurred b y t h e t a x p a y e r d u r i n g t h e taxable year w i t h respect t o a n y pension t r u s t or retirenleqzt plan mccinticiiieci b y t h e taxpayer's employer in a n a m o u n t n o t exceeding in t h e aggregate, five hzlndred dollars. § 2. This act shall take effect immediately and shall be applicable to returns for any taxable year beginning on or after January first, nineteen hundred fiftyone. �STATE OF NEW YORK Int. 2096 Nos. 2273, 3091 I N SENATE February 21, 1950 Introduced by 39r. CA39PBELL-read twice and ordered printed, and when printed to be committed to the Committee on Finance-committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT To amend the social welfare law, in relation to adult recreation and making an appropriation therefor T h e People of the State of Xew Y o r k , represeqzted in Senate and Assentbly do enact as follows: EXPLAYATION-Matter in italics is n e v : m a t t e r i n brackets [ I is old law t o be omitted. the vocational rehabilitation of the elderly, and give new zest to their live^. I t is the purpose of this bill to encourage establishment of recreational programs for the elderly which mill promote ( a ) the social and emotional adjustment ARTICLE 10-A of the older person by making it possible for him to FOR RECREATION THE ELDERLY and create an environment that is find com~anionshin favorable to continuing growth and give him a sense Section 481. Declaration of intent. 482. Adult recreation council created; func- of personal stability and security, ( b ) the rehabilitation of the personal efficiency of the older individual tions, powers and duties. 483. Powers of cities with respect to recrea- by making it possible for him to make maximum use of his time and of capacities least impaired, and (c) tion for the elderly. community usefulness by creating a feeling of ade483-a. Adult recreation projects; approval. quacy and acconiplishnlent through activity. 483-b. State aid. 8 482. Adult recreation council created; functions, 483-c. Withholding state aid. powers and duties. There is hereby created in the 483-d. Grants. state department of social ~velfare n adult recreation a § 481. Declaration of intent. Recreation is a basic council to consist of five members to be appointed by human need. The state of New York has already the state commissioner of social elfar are, including the authorized a program of state-aid for recreational director of adult education of the department of edufacilities for youth. Ho~vever,the recreational needs cation, ex officio. The council shall have power to of our senior citizens have not as yet been met. Many organize, elect a rhairnlan and secretary, adopt, of our older persons, shunted aside by industry, lead- promulgate and make effective, plans, rules and ing lonely lives in what should be golden pears, room- orders with respect to the furnishing of recreation in t h ing in dreary boarding houses or crov7dedin ~ ~ irela- school buildings and properties or elsewhere for tives, feeling un~vantedand insecure, and plagued by adults over sixty years of age. boredom, are in urgent need of recreational facilities $ 483. Po~versof cities with respect to recreation for the preservation of their mental and physical for the elderly. 1. Each city of the state is hereby health. authorized to furnish and foster recreational activiThe tremendous increase in the number of our ties for adults over sixty years of age, as may be elderly, the longer life span now vouchsafed our authorized by the council, and to receive and expend people, the huge burden on our state and citizens of moneys from the state, the federal government or persons on old age assistance rolls, the mounting private individuals, corporations or associations for costs, for care of the chronically ill, and for wards for furnishing such recreation in accordance with plans, the senile in our mental institutions, together with rules or orders of the council. the real loss to our economy entailed by loss of the 2. The furnishing of such recreation is hereby production of which many of our elderly are capable, declared to be a proper municipal purpose for which are but some of the factors that cry out for establish- the moneys of such city may be raised and expended. 3. The chief executive of a city may appoint a recment of a recreational program for the elderly. There is ample evidence that a recreational program can reation for elderly committee to advise and assist in retard some of the characteristics of senility, encourage the provision of such recreation and facilities therefor. Section 1. The social welfare law is hereby amended by inserting therein a new articie to be article tea-a, to read as follows : �5 483-a. Adult recreation projects; approval. 1. Any city desiring to establish a recreation project for the elderly may apply to the council for its approval of its plans. The application shall be in accordance with rules, plans and orders pronlulgated by the council, shall be in writing and shall specify the nature of the project in such detail as the council shall require. 2. No application for the approval of plans for a recreation project for the elderly shall be considered which has not been first approved by the governing body of the municipality making application. 3. The council may approve or disapprove the proposed project as filed or if its modifications are consented to by the applicant, approve the same with such modifications. 4. The approval of any proposed project by the council shall authorize the municipality to establish, operate and maintain the recreation project, and shall be entitled to state aid as hereinafter set forth; provided, however, the council may at any time subsequently withdraw its approval or require changes in a plan or program previously approved. 3 483-b. State aid. 1. Each city operating or maintaining a recreation project hereunder shall submit to the council quarterly estimates of anticipated expenditures for operation and maintenance of the recreation project, including also rental of buildings, purchase of equipment and administrative expense, not less than thirty days before the first days of the months of s p r i l , July, October and January, in such form and containing such information as the council may require. At the end of each quarter each city shall subinit to the council, i11 such form as the council map require, a verified acrounting of the .f;.nancial operations of such project during such quarter together with a claim for reimbursement of one-half of such amount as herein provided. 2. The council shall thereupon certify to the comptroller for payment by the state of one-half of the entire amount of such expenditures as approved by the council; provided, ho~vever,that the ainount of state aid shall not exceed the sum of one dollar for each ten persons over sixty pears of age, residing in the municipality, as shown by the last preceding federal census, nor in any event more than one-half the anlouiit of such local expenditures for such project. 3. For the purpose of reimbursement hy the state, adniinistrative expenses shall include compensation for personal services paid by a nlunicipality to any employee, for the purpose of administering the benefits provided by this act. 5 483-c. Withholding state aid. The council may authorize or require the comptroller to withhold the payment of state aid to any municipality in the event that such municipality alters or discontinues, without the approval of the council, the operation of a recreation plan approved by the council, or fails to adopt or change a plan as recommended by the council, or fails to comply with rules or regulations established by the regents. 5 483-d. Grants. The council, with the approval of the commissioner, may accept as agent of the state any gift or grant for any of the purposes of this article, and any moneys so received may be expended foYany of the purposes of this act in the same manner as other state moneys appropriated for the purposes of such adult recreation. 5 2. The sum of fifty thousand dollars ($30,000), or so much thereof as may be necessary, is hereby appropriated to the social welfare department out of any moneys in the state treasury in the general fund to the credit cf the state purposes fund not otherwise appropriated, and made immediately available for the purposes of this article, including approved paynient, of state aid, and, to the extent of not over ten thousand dollars thereof, for expenses of maintenance and operation of the department and personal services of employees, in carrying out the provisions of this act, Such moneys shall be paid out of the state treasury on the certificate of the commissioner after audit by and upon the varrant of the comptroller. $ 3. This act shall take effect August first, nineteen hundred fifty. �STATE O F NEW YOR'K No. 2173 Int. 2022 IN SENATE February 20, 1950 Introduced by Mr. HORTON-read twice and order printed, and when printed to be committed to the Committee on Finance AN ACT To amend the education law, in relation to providing for adult education for older persons, and making an appropriation therefor T h e People of the State o f N e w P o r k represented in Senate and Assembly, d o enact as follows: EXPLANATION-Matter i n italics is n e w ; m a t t e r i n brackets [ Section 1. The education law is hereby amended by insertir~g tilereill a rlaw section, t o be sauiioii forty-six hundred fifty, to read as follows : § 4650. Adzilt education for middle-aged a n d elderly persons. T h e education department slzall stinttilate t h e developnlent of adult edzication for middle-aged b and elderly persons. S u c h program shall i?zcl~lcle, u t n o t be limited to, pre-retirement cozcnselling, classes in healtlz edzication for older persons, education for leisure t i m e i n retirement and classes in c r a f t s or other suitable acticifies or subjects o f interest t o older persons. Tlze clepnrfnzcnf shall t r n i n teaclzers iqz the nzofivation and instrzlction o f older persons. I is old l a w t o be omitted. § 2. The sum of fifty thousand dollars ($50,000), oi; SO inuch ilieieuf as inay be iiecessary, is hereby appropriated to the education department out of any moneys in the state treasury in the general fund to the credit of the state purposes fund not otherwise appropriated, for the purpose of carryin? out the provisions of this section. Such funds shall be payable on the audit and warrant of the comptroller on vouchers certified or approved by the comniissioner of education, in the manner prorided by lan-. 8 3. This act shall take effect immediately. �INDEX Abrams, Albert J., inside front cover, 52; article by, 166-172 Accidents, among elderly, 47, typical cases, 47, suggestions in preventing, 47; number of, 80, 99, 125; protection from, 108; increase in hazards, 123; causes of, 125, 157 ACS (antireticular cytotoxic s e r u m ) , 129 ACTH, 9, 100 Activity, purposeful, 8 Adult education, 15, 16; in factories, old age homes, recreation clubs, etc., 48; courses in country, 48, 61, 62, 65; suggestions for state action regarding, 67, 74; need for in rural areas, 160-165 Adult hygiene and geriatrics, proposed division of, 16, 36 Advisory Committee on t h e Aged, N e v York City, 10, 76 Age barriers, 15, 29, 51 Aged, emotional and psychological needs of, 7, cost of homes for, 12; (see also elderly) Aging, mental and physiological, 8, h'ational Committee on the, 10; State Wide Committee on the, 10; kinds of, 130; (see also elderly) American Public Health Association, 11 American Public Welfdre Association, 135 Arteriosclerosis, cerebral, 137, 138 Arthritis, 9, treatment of. 100, 114 Assistance, public, 53, 84 Atmospheric pollution, 125 Austin, dsse~riblymanBernard, inside front cover Banking Department, Kern 'ork State, 11 Barkin, Solomon, inside front cover Baruch. Bernard. 9 , 140. 142 : Basic rkcord, 120 Becker, Harry, article by, 82-86; 149 "Bi~tl~daus Don't Count," 2, 6, 26, 48, 52 Birth rate, U. S., 83 Blind, elderly, 12 Bluestone, Dr. E . X., 101, article by. 102-105 Blue Cross, 44 Blue Shield, 44 Boarding homes, 6 ; suggestionq for state action regarding, 67 Bogomolets, Dr. dlexander A., 129 Bookmobile service, 170 Bortz, Dr. Edward L., quoted, 78 Bronchitis, 125 Buffalo, city of, 14 Bureau of Adult Education, S e w York State, 16, 48, 160 California, State of, old age assistance experience in, 76 Campbell, Senator Thomas F., inside front cover, 52, proposed legislation by, 186-187 Canada, aged in, 173-175 Canadian Employment Service, 26 Cancer, deaths from, 99, environmental, 124 Cancer clinics, 10 Carcinogens, 124 Carlson, Dr. Anton J . , statement on retirement by, 97, 141 Carrel, Dr. dlexis, 8, 141 Census, 1950, 74 Central Bureau for t h e Jewish Aged., 50. 63. 111 , , Cerebral arteriosclerosis, 137, 138' Child welfare, importance of, 8 Chronically ill, 1, 13. 36, 53, 63, suggestions for State action regarding, 67: in X e ~ vYork Citv, 69: mass screening of, - . 1: : cark of. 102-105. 126 : housi& needs of. 154 0 ~ i t i z e L scommittee on 'the ~ l d e r l iroposal fbr, 17, need for, ~, 75-77; functions of, 77 Civil service, 33 Clague, Commissioner Ewan, article by, 87-90; 145 Clinics, cancer and tumor, 10 Clinics, geriatric, 12, 15, 36, 65, 114-117, persolinel needed, 116 Cohn, Adolph J., 9 Coler Memorial Hospital, 107 Collective bargaining, 82 Colleges, gerontology courses in, 47 Conimunicable diseases, 123, 128 Communities, role of in aging, 2, 12, 1 3 ( c h a r t ) , 14; providing recreation, 48-50 ; possibilities for action, 54-57 ; need for action, 70; place in health work, 101; geriatrics clinics in, 118, 120 Conimunity Service Society of New York, 12, 51, 64, 72, 75 Connective tissues, degeneration of, 9 Conservation Department, Kew York State, 11 Coolidge, Dr. William D., 142 Cortisone, 9, 100 Cost of living. 26, 149 Councils of Social Agencies, Association of, New York State, 57 Counseling services, financial, 13, 15; employment, 15-16, 26, 51, 173, personal problems, 61, 164 Coxry, Dr. E. V., 113 Lrampton, Dr. C. Ward, inside front cover, 51, 113, article by, 118-120, quoted, 128, recommendations on nutritional needs, 121 ~riicher, Miss Hester B., 41, article by, 139 Custodial care, 64 Davidson, Dr. G. >I., article by, 136-138 Day Centers, need for, 145, objectives of, 145 Deaths, Chief causes of, 34, 98-99 Degenerative ailments, 36, deaths and disabilities from, 99, 128 Dependency, old age, 88 Depression, mental, 115 Derby, Charles C., inside front co\er Desmond, Senator Thomas C., inside front cover; introduction by, 1-2; 52, 72, 74, article by, 93-97, article by, 128-132, article by, 140-143; 141, 3urvey of libraries by, 166, 168, 171, proposed legislation by, 176-185 Dewey, Governor Thonlas E., 25, 36, 50, 51; statements by from 1950 message t o legislature, 53, 73 Diabetes mellitus, deaths from, 99, hospital treatment for, 114 Discrimination, 16-17, 26, 28, 79, 91 Drugs, new discoveries in. 9 Dublin, Dr. Louis I, inside front corer, quoted, 75 Dunn, Dr. James &I., 61, article by, 121-122 Economic security, 61 Education Department, Yew York State vocational rehabilitation unit, 11; Adult Education Bureau, 11, 13, 48, 74, 160 Elderlj, number of, 6, 16, 72, 98, 155, 173; needs of, 6 ; areas of neglect regarding, 6 ; hopeful outlook for, 9; cost of care, 12; health of, 34; accidents of, 47; housing of, 50, 154-159; nutrition of, 55, 131; employment of, 56; group activities of, 61; council for 76; productive capacities of, 99; hospitalization of, 102-105, 106-109; mental health of, 136-138; family care for, 139; economic status of, 160-162; social status of, 162; in Canada, 173-176 Emotional problems, elderly, 10, 137 Employees, number of, 83; security program for, 85 Employment, problems of, 2, 6, 29, 51, 56, 6 6 ; suggestions for State action regarding, 67; in New Yorlr City, 69; article on, 78-81; common fallacies in, 79; reasons given for age barriers in, 91, chart, 155 Employment Security, United States Bureau of, 25, 27, 78; recent studies by, 79 �Eii~pIoymentService, S e w Tork State, 15, 59, 81 Endocrines. 119 Environmental health, 123-12i, references on, 127 Ernest, Helen, inside front cover Exercise, 131 Family care, of elderly, 139 Family welfare agencies, 10 Farbstein, A4sseiii1~lyman Leonard, inside front corer, 52 Federal Honsing Law, reconlrnended change in, 50 Federal Security Agency, Bureau of Public Assistance, 19, 34 Federation Employnlent Service, 26 Federation of Jem-ish Philanthropies, plane for aged of, 66 Financial couriseling, 13, 13 Financial needs of elderly, 17 Fisher, Miss Gladys, inside front cover, 51 F o r t Greene Housing Project. 11, 69, 156 F o r t y P l u s Club of New Tork, 26, 91 F o r t y Plus Club of n.estern Nexv Tork, 14, 26 Foster homes, 10, 11. 41, (i9 Fox, Niss Flora. article hq-, 03-67; 110 li'reeman, Dr. Josellli T., 131 Galno, Harold J . , inside front coxer Geliatric Clinics, 12, 15, 36, 65, 114-117, perxoiinel neecled, 116 Geiiatrics, lo, Rochester Clinic, 12, 36, 59, 61, 64, 110; "de-aging", ebsentials of, 118-119; 128-132 Gerontology, 7, 8, 47 Giberson, Dr. Lydia G., 141 Ginzberg Report (See alko S e ~ i rYolk State Hospital s t u d y ) , 36-37, 106 Gold\vater 3Iemorial H o - l ~ ~ t a 1US l, Good~vin, I r . Robert C., 2.5, 2 i , article by, 78-81 J Government, role of in aging, 1, 2 Graves, Dr. Frank P., 1-12 Graves, Senator Rhoda Fox, 51 Green, TT7illiam, 26 Graq-s insurance, 44, 51 Guiley, 1. and L. E. Company, 32 % ' Gxvyn, Lenis R., inside front coler H . R. 4244, 154 H. R. 6000, 146, 147-148, 152, 175 Elizabeth, inside front cover Hanniford. A%sceinljlv\x-ornan Hanover. Harold C..'inside front cover Hawkin;, Dr. Laurence d., 93, 96, 97 Health, of elderly, 34, 5.5, 98-101, 123-127, i n ~ e n t o r y ,130 Healtli Department. S e w York State, 11 Heart diseases, deiths from, 99, hospital treatment for, 114, environmental factors in. 124 Heck, A%sseniblymanOs\vald D., inside front corer Hilleboe, Coinniiaaioner Herrnan E., 11, quoted, 142 Hobbies, importai~ceof, 131, 142 Hodson Community Center, 12, 41, 48, 65, 131 Hoey, JIiss J a n e 11. article by, 148-153 Hoine accidents, ( g r a p h ) 17, tq-pica1 cases, 47, suggestions for preventing, 47 Home c:il,e, 9, 13, 36, 102-10.5, 107, 111 Homernnker herviceq, 63, 111; suggestions for State action regarding. B i Honie~x-orlc, 28 Horton, Senator S. TTTent\\-orth, inside front co\.er, .i2, propohed legislation by, 188 Hospital facilities, 1, 8, 102-105, 106-109, 114 Hospitals, mental. 6 Hoorer, Ex-president Herbert. 9 Hormoneq, 119 Hullsing. 1 , 2, 6. 16; esl~erinlentsi n foreign countriea, 50; Statc-aide11units for rlderl>-. 30; statement by Governor on, .53; im1)ortnnce of in c~oiriinuiiities, 55, 02; private and lnlblic, 64, 73; ~ugpestionsfor State action regarding, 67; in New York C'it>-. 69; 155-136. planning of, 121-125; needs of clderly, 134-139: t~)ji.oad, 1st;; design for, 157 Housing Division, S e w York State, 11, 50 Illnesses, Chronic, deatlis fiom, 09 Immigration. 83, 98 Inactivity, effects of, 8 Incomes, 17, 19 ( c h a r t ) , 155 ( c h a r t ) Industrial pensions, 12, 19, extent of, 24, 82, 146 Industrial revolution, effects of, 6 Industry, age bias in, 1 ; benefits t o older ~ ~ o r k e r 32 s, Infections, treatment of, 118 Infectious diseases: deaths from, 99 Information, public, concerning elderly, 61 Instability, emotional, 137 Intitutional care, 61, 63 Iilsurance, 41, age limits, (graphs) 40, 42, 43, 45; group health and life, 41, hralth ancl hospitalization, 51 Fe~x,Torl; State, 11 Insurance Drpartr?~ent, Ini~urance, imemploynieut, 11, 18 ( g r a p h ) , 26 Janlebto~~-n. City of, 14 Je\\.isli Aged, Central Bureau of, 50, 63 Jewish Pliilantllroljies, Fecleration of, plans for aged, 66 Jewi4l TTomen, Sational Council of, 14, 58 Joll-counhelling, 51, 81 Jo~J-fintling service, 14 <Jolinson, ~%ssemblymaii John E., inqide frolit cover, 52 \Joint Hobl~italS l n . ~ e y and Planning Colmnission: 8: 14, 36 Joint Legislative Coniiriittee on Interstate Cool?c,l.ation, 8, 15, 20. 36 > J o i n t Legislative Coinmittce oil Problenis of tlie Affing: inside f rant coyer ; Findings and Recomrrie~idationsof, -5-52 ; Govregarding, 33; leadership of, 57, ernor's recoriirr~e~ldatioi~s 6fij 67; i d ; $0. 71. 74, 75, 77, 89, 98, 122, 144, 166, 173, 175, recommended legislation of, 176-158 -~ Keill, Dr. Kenneth. 39 Kidcl, Dr. Charles. 14.5 Kidnej diseases, llospital treatment for, 114 Iilunlpl~,Dr. Theocloie G., inside front colcr, quoted, 129, 141 Icogel, Dr. A1a1c.113D., 38, 39, Sl, article by, 106-100 K o s o r i ~ Alas D., 80 , Kraus, Piofe.so1 Hertha, article by, 154-150 Kuhlen, Dr. Raymond G., 12, article br, 60-62 Labor Department, Kexv York State, Bureau of Research and Stati\tics. 11 ; State Emploq-rnent Service, 11 Labor force, U. S., 78-79, 87; in world \Tar 11, 88, changes in, 145 - -- Labor Statistics, Buieau of, U. S., SO, 87, 98 Laboi union-, 31, 33; i n iclation t o oldel ~x-o~ker-. 82-86. nelfare fnncls of, 149 L a n g n i u i ~ ,Dr. Irx inp, 142 L a n t o n , Dr. Geo~ge, inside front corer Lee, Dr. Roger I, statement on retirement, 97 Legislation, recon~mencled,176-188 Lenrislature, Kelv York State. 33. 36. 110 ~ e k i n e~ a i : r y , , inside front cbvei, 110, article by, 144-145 Lewis, Dr. Xolancl D. C., 142 Libraries, in relation to elderly, 41, 166-172, Adult recreation in, 48 Licenses. qualifications for, 48 Life expectancy, 6, 78, 83, 87, 123, 129, 144, 135 Living \tmidards, 123, 121 Loomis, 3Iiss Alice ;\I., insicltl f i ont co\ el., article by, 54-57 llacCurday, Dr. Fiederick, 39 JIacFai lane. Icilgore, 95 AIach, Connie, 9 AIalioneq-, Senator Walter J . , inide f i o ~ I 1.1 el ~ t JIailler, Asbc~nl~ly Lee B., in.ide f i ont cox el. 8 inan 1\Iaillcr Co~nmission (See Ken roll; State Healtli Pieparednebs Comn~icsion , 8 ) JIalnutrition. cauieq ,\nil reiultr of, 113 \Ianllattan i t a t e Hospital. 136, 144 Jlarriagei, 13.7 Mass screening, 100 1Ia.-achn.ett> L a n , age disciiniination in eniplo>~nent, 31 29, AIcCaullc) . ;\Ii\, ':II a ;\I inside front en-\er JIcCay, Dl. Cll\e 31. Inside fiont corer, 120 Medical care, 64 (bee also geiiatlics) ; sugpe-tions for State action legarcling, 67 JIedical examinations, 1 3Iedical schools, geriatrics in. 10 . �Medicine, advances in, 9, 87. 121, 128 RIental hospitals, S e w Tork State, patients in and cost of, 10. 11. 12 > Mental hygiene, 13, 15, 39 Xental Hygiene Department, New Yo11i State, 11, 51, 139 Mental wroblems, elderlr. 10. 13. 63: sureeations for State action regarding, 67; enuses of, 113; en>ironmental factors in, 124; housing in, 154 Merrit, Joseph, 5)hletabolism, 133 Jloha~vkDerelopinent Service Company, 28, 98-97 Monroe, Dr. Rubcrt T., 39, 31, 111: 112, article by, 114-117, clinical ol~servationsof. 131 llonteiiore Hobpilal, honle care project at, 101; care of prolonged illness at, 102-105 Nontietl~,Dr. Steplien li., 51 JIorpan, Professor John S., article by, 173-175 Moritt. Senator Fred G., inhide front corer, 52 hlortality rates, 87, '38, 11y age, 99 Illoae, Graridm:r. 0 Motor reliicle accaiclents, tleatl~sfrom, 99 31ulligaii, Nibs Marion G., inside front cover JI~rray, Clyde E., inside front cover - 2 -- -- S;~tion;tl Assistance Law of 1947, Great Britain, 50 S;ltion:~lCommittee on the Aging, 10 Sational Council of J e ~ v i s hTT70nien: 14. 58 Kational E ~ n p l o y ~ n cSerrice, Canada, I i:! ~lt Sational Hospital Survey and Constructicm Act, 101 Sat,io?lal Saniti~tionFoundation, plans of, 127 Sational Social Welfare Assembly, 10 Seeds of elderly. financial, 17 "Sez;er Too Old," 2, 6, 22> 26, 32: 36, 52, Tfi, 173 Sc\vhnryli, Citj- uf. 49 S e w Tork City, *idvibory Committee on tlie l ~ c c l in. 10, 12; needs of aged in, 63-67; work n-ith elderly, ~ 8 - 7 1 population ; changes in, 106; I~ospitalsin, 106-101) Xetv York City Healtli Department, 12, 128 Kern Pork City Hospital Department, 12, 38, 39, 64, 106 Sclv Tork City \T7elfare Department, 12 X e v Pork Plan, 14-17, 47 New York State, older persons iu, 10; activities for older ~ ~ c o p l 1I, ; obligations toward older people, 15 e Se\v Tork St,ate Association of Councils of Social Sgencies, 37 New york State Clin~liber Commerce, quote from on pensions, of 24 Xe~v Tork State Education Department, 48, 74 S e w York S t a t e Health Departmei~t,11 S e w Tork S t a t e Banking Department, 11 New Pork State Civil Serrice La\\-, 33 New york State Conservation Department, 11 Xew Tork State Education Department, 11, 160 New Pork State Health Preparedness Commission, 8, 111, 113 New Pork State Hospital Study (see also Ginzherg Report), 36-37 Ke~v York S t a t e Housing Division, 11, 50 New york S t a t e Insurance Department, 11 S e w l*ork State ,Joint Legislative Committee on Problems of tlie Aging; i~isitle front corer; Finclings and Reco~iimenclations of, 5-52: C+orer~~or's reconlrnentlations regarding, 53; leadersl.~ipof, 57. 60, 67, 72; 7O, 71, 74, 75, i i , 89, 98, 122, 144. 166, 173: 173 ; reconimentled legislation of, 176-188 New yorli State Labor Department. Bureau of Reaearch and Statistics, 11, 32; S t a t e Enlploynient Perrice, 11, 15, 26, 27, 28 Sc\x- Ydrk S t a t e 33, 36, 110 S e n Tork State 3Ient;tl Hygiene D e p a r t l i ~ m t , 11, 39, 139 Sen- York State Retirement Fund, 11 S e n - Tork Xtate Safety Division, eclucational campaigl~of, 47 S e n - lWorli State Social TTelfare Department, 11, 12, 15, 36, 1 7 ; survey of nursitlp home-: b ~ 33. 69, 72 , S e w Tork State IToma~i'sRelief Corps Home, 11 S u r s i n g honies, 1, 6, 10, 13: 38; statement 1 ~ yGovernor oil. 5 3 ; standards for, 53, (il, 64; suggestions for State action regarding, 67; functions of, 109, 114 S u r s i n g service, visiting, 11, 65 Kutrition, 55, 100, 118, 123, 131 Obesity, 101 O'Dwyer, JIayor \\7illiam, 10, 76 Old age assistance. 6. navinents in S e w Tork State. 10. 12. 2 0 ; L ~ e d e r acontribu<ioA toxx~ard,11, 12, 20, 150; local costs l for, 11, 12, 13, 20; 19; number on, 20, 21 ( g r a p h ) ; typical cases. 22-24; l j r e l n ~ t i o nof need for, 51; liberalization of, 80 ; trends in, 148-1.53 ; recipient rate, and amounts under, 150-161 ; senices determining eligibility under, 151. medical care uncler, 131, other services under, 152, legislative trends i n , 159 --- - - - Old age homes, 6, 10; local costs for, 11, 12, 13; adult education in, 48, 51, 69, nurnber in, 144 Old Age Pensions Acts, Caiiada, 173 Old Age arid Survivors Insurance, 11, 12, 19; flan-s in program, 20, 25, .5:3; liberalization of, 80; inadequacy of, 83; benefits under, 83; extension of, 148, 149, 153; ftuicl assets of, 158; contributory feature of, l i 3 Onondaga Health S s s o c i a t i o ~ ~ , 60 12, Operative techniques, 0 Orertag Committee (See Joint Legislatire Committee on Interstate Cooperation) 8: lS, 20, 36 Paral;v*is, treatnient of, 114 Pearce, 1)r. Charlc-. B., 31 Peiisioni, 1, 10. 12, 19, 24. 33, 80, 82, 122, 146-147, 149, Cana(la, 173 I'erronality disorcle~s,137 Peter Bent Rrigl~aiiiHospital, 114 Phrsical t h e r 8L., ~ .115 .n l'liysic.ians, role of in program for aping, 110-113, 116 l'i~euinonia, 125 l'ollution, atmospheric, 125 Ponil, 11. Allen. article h\.. 123-127 Pope, Co1. Allan ,\I..insiile front corer P o p ~ ~ l a t i o n , S., increase in, 6, age clinnges in, 83, 10G, 149, U. 173, characteristics in Ken- Porli State: 160 Po61ier~TVilliam, article by, 68-71 I'on-elson, ,John R.. article b:-> 91-92 Prihons, cost of care of elderly in. 12 Psychiatry, and elder1:-, 136-138, 141 in Psychology, t e c h n i q ~ ~ e s "cle aging", 119 Psychosis, senilr, 135 Public assistance, 53, 84 : Public Iiealtli, 1. S., 08-101, 123-127, 129 Public Health Service, U. S., 51: 125 Public housing, 6; suggestions for State action regarding, 67 P n l ~ l i cinformation, on elderly, 61 Publicity, conceniing elderly, 61 Pulling, Dr. K. J., 48, 51, 74, 160 Quinn, Senator Elmer F., inqide front cover Quinn, Miss Lillian A., article by, 58-59 liabe, Mrs. Henrietta, article by, 160-16.5 Rac1i;rtion theraav. 126 Randall, l l i + dilie A. inside front cover, 12, 51, article by, is%; article bv, 75-77 Iiecommeiidetl legiyslation, 176-185 Recreation, community, 1, 6, 13, 45-50: 54, 61: clubs, 10, 12, 48; Adnlt edncation in, 48; Stare aid for, 16, 49, 144-145; ill S e \ r York City, 63; suggestions for S t a t e action regarding, 67 ; i11 S e w Tork Pit>-, 69 Reliabilitation, ~c;catioiial, 33, persons receiving i11 New York State, 34: physical and n ~ e n t a l ,101, 114, l l B j 118 l i E l S (Reticulo-endothelial i m ~ n u n esera) 9 Ilc>earcli jn aging, ineecl for, 100, 112 s, Retirement. 1, 6. 8, s y ~ t e ~ i idefects in, 23; state and n~unicipal plans, 5:3; ~ ) ~ P I ) R I . R ~ ~ O I ~ 56, (jl, 129, 142; coverage, 82; for. Aexil)ilit?- in age ~ ) f 86; projections for future, 88; article , on, 140-14:3 Retirement Fund, Sex?- Tork State, 11 Jiiegclman, Mr.. ( ' l ~ a r l e s A4., illride front COT-er liocliehtcr, S e w York, actirities in aging, 12; Council of Pocinl A4gencics, 12, 166, 11oi1si11gin, 30; industries in, 56; fillancia1 snpport for, 57; census study in, 74 Rochester De?nocrat c01d C h r o ~ ~ i e l e , article on local program in, .56 191 1 " �Rose, Mrs. Louis, 59 R u r a l areas, education needs of older people in, 160-165 Rusk, Dr. Houlard A., rehabilitation work of, 9, 12, 37, 119 Ruskowski, John A., inside front cover, 52 Safety Division, New P o r k State, educational campaign of, 47 Sanitation, 123 Saratoga Springs Authority, New York State, 11 Savings, for old age, 83, 149 Scheele, Dr. Leonard A., article by, 98-101 Scheidler, William M., inside front cover Second Mile Club, Toronto, Canada, 175 Security, 17, 61 Senescence, effect of recreation on, 48 Senile, cottage care of, 11, psychotic, 106 Senility, 138 Seniority, 89 ~heltereh Workshops, 2, 61 Shock. Dr. Kathan W.. auoted. 129-130 Shut-& service, librar~~,'169 ' Smith, Arthur R., 93, 95 Social Security, 1, 6, 10, 20, 53, 80, 82, 83, Act of 1935, 146, 148. 150 Social Security Administration, U. S., 51, 98, 148 Social Welfare Department, New York State, 11, 12, 15, 36, 47; survey of nursing homes by, 53, 69, 72 Social work, schools of, 10 Social workers, 46, 47, 116, American -Association of, 15.5 Spaulding, Dr. Francis T., 48 S t a t e Charities Aid Association, 15 S t a t e Wide Committee on t h e Aging, 10 Stearns, Ray, 93, 95 Steele, Dr. J. Murray, quoted, 130 Steingut, -Issemblyman Irwin, inside front cover Steinhaus, Dr. Henry W., article by, 146-147 Stephens, Assemblyman D. Mallory, inside front cover Stichman, Commissioner Herman T., 73, 74 Stieglitz, Dr. Edward J., inside front cover, 8, statement on retirement by, 97, statement on degetieratire clisorders by, 130, 140 Stress tests, 120, 131 Strickland, Pauline T., inside front cover Stuart, Assemblyman ST'illiam M., inside front cover, 52 Sweden, housing experiments in, 50 Syphilis, 100 Syracuse, city of, 14, activities for elderly in, 60-62; University research and instruction at, 62 Tax revenues, state, 150 Therapy, physical, 115, radiation, 120 Tifft, Assembl~manHarr) J., inside front cover, 32 Tompkins Square House.;. 04, 156 Toscanini, Arturo, 9 Tremors, muscular, 9 Troy, city of, 14 Tuberculosis and Public Health Association, 15 Tunlor clinics. 10 Unemployment, effects of, 84, 88 Unemployment insurance, 11, 18, ( g r a p h ) , 26, 148 United dutomobile Workers of America (C. I. O . ) , 82-86; ~ r o g r a m 84 of, United Nations, 25 United States Bureau of Employment Security, 25, 27 United States Civil Service Commission, 33 United States Public Health Service, 51, 100, 101, 122, 125 United States Social Security Administration, 51 United States Veterans Administration, 51, 121-122, 164 Utica, city of, 14 Vascular diseases, deaths from, 99; signs cf, 13; Veterans Administration. U. S.. 51. 98. 154 Veterans, benefits t o elderly, 12, '1211122, dependents of, 12, number of, 122 Visiting nurse service, 11, 36, 59, 62, 65 , . . . vitamins, 118-119, 131 Vocational Rehabilitation, 33, persons receiving in New York State, 34 Walters, Dr. Guy 3f., 39 Weidkam. Edna. inside front cover Welfare agencies, family, 10 Welfare Council of Kew York City, 12, 51, 63, 64, 69, 110; hobby show of, 69 Westchester County, New York, activities for elderly in, 14, 58-59 Wl~itney, Dr. Willis R., 142 TT7icks, Senator S r t h u r H., inside front cover Willard State Hospital, 11 Wilson, C. E., excerpt from speech by, 83 Wolz, P . C., insicle front cover StTomen's Educational and Industrial Union, 12, 56 Work-life pattern, changes in, 87 JTorkshops, sheltered, 2 TTToman's Relief Corps Home, Kew York S t a t e (Oxford, K. Y.) 11 -- Working life span, U. S., 87-90; variations in by occupations, 89 Workmen's Compensation, 80 Yaeger, George A., inside front cover Yonkers, city of, 14 Zahl, Dr. P a u l d., article by, 133-135 Zen~an, Dr. Frederic D., 30, 51, article by, 110-113 ��r GOVERNOR APPOINTS STATE C O U N C I L O N THE A G I N G OF CITIZEN'S COMMITTEE NEW YORK STATE P L A N FOR THE A C I N G Guide Public Officiolr-Aid in Developing Public-Private Agency Teamwotk State Aid fw Nan-merit SheLared Work Shop � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Language A language of the resource eng Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Adult and Senior Center of Saratoga Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document Table of Contents <br />Some concepts basic to an understanding of electricity and electronics (pages 3–16) Robert Stollberg Version of Record online: 22 AUG 2006 | DOI: 10.1002/sce.3730350102 A<br /><br />Scientific inquiry for science teachers (pages 17–39) Richard H. Lampkin Version of Record online: 22 AUG 2006 | DOI: 10.1002/sce.3730350103 <br /><br />Harvest of the sea (pages 39–41) William Gardner Version of Record online: 22 AUG 2006 | DOI: 10.1002/sce.3730350104 <br /><br />Developing skills in the use of current materials: A problem in teacher-education (pages 41–43) B. Frank Gillette Version of Record online: 22 AUG 2006 | DOI: 10.1002/sce.3730350105 <br /><br />The new and the old in science teaching (pages 43–54) R. Will Burnett Version of Record online: 22 AUG 2006 | DOI: 10.1002/sce.3730350106<br /><br />Click here to view <a href="http://onlinelibrary.wiley.com/doi/10.1002/sce.v35:1/issuetoc" title="Table of Contents">online</a>. Creator - Organization Company, government agency, or other organization responsible for creating the item (the publisher should not be listed again here unless the same organization had a role other than that of publisher in sponsoring or creating the map). New York (State). Legislature. Joint Committee on the Problems of the Aging. Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Civic Life Record Contributor Individual who prepared the item and/or edited it. J. Dym Record Creation Date Day/Month/Year of record creation/edit 19/05/2017 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Young at Any Age Date A point or period of time associated with an event in the lifecycle of the resource 1951 Publisher An entity responsible for making the resource available New York State Language A language of the resource eng Creator An entity primarily responsible for making the resource New York (State). Legislature. Joint Committee on the Problems of the Aging. Desmond, Thomas C. https://www.ssmp.mdocs.skidmore.edu/files/original/e12c2355a174344f6b8661d06c8d7d27.jpg 14111798d033d825cce4bd8525c56072 https://www.ssmp.mdocs.skidmore.edu/files/original/bceb0d66bec40f0977099bddcd04c84e.png d54b56ada90218c3c28c2af06148cf82 https://www.ssmp.mdocs.skidmore.edu/files/original/b962f2678130494957de40a6df5d4ccb.png 6157b6aa72538ac3ed275cc44cc09f3d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mapping Saratoga Springs Date A point or period of time associated with an event in the lifecycle of the resource 1700- Map Cartographic document Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. 1934 Date Depicted (Numeric) Date that the information on the item depicts. In many cases, this will be the same date as that in the date field, but there will be exceptions. For example, a historical map drawnin 1890 might show Saratoga Springs as it was in 1820. Or, the information on the map itself might include detailed information that enables us to extrapolate a date, for example, "based on a survey done in 1841." Many State Archives map catalog records refer to this as the "situation date." 1934 Date Published (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the date field that will display. 1934 Date Published (Numeric) Date the item was printed. This will be set as a date field, accommodating only numbers. The field will be able to handle single dates or date ranges. This will not display, but will be indexed and searchable. 1934 Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. This map shows the Yaddo estate and gardens in a map drawn by Philip Reisman (1904-1992) during his 1934 residency there. The spots marked on the map legend as North Farm and North Farm Studio indicate roughly where Exit 14 is now located. Philip Reisman’s sketch map of Yaddo captures a personal take on outdoor setting for members of this artist’s colony on the former country estate of Spencer and Katrina Trask. Whether thinking, writing, making music or strolling, the artists in residence at Yaddo in the 1930s roamed a park-like setting and lodged in studios recently converted from a model farm’s barns and stalls. Today as in Reisman's day, the mansion and Italianate rose garden welcome visitors. But in the late 1950s, North Farm and North Farm Studio were cleared for I-87 (the Northway), and its Exit 14. Yaddo leases the 150 acres that are now across the highway to Saratoga National Golf Course. Five new live-work studios will be built this year along four ARTIFICIAL? lakes — named after the four Trask children. <br /><br />For more details on Yaddo and the Trask family, see the New York Public Library's f<a title="NYPL, MSS 4795, Yaddo" href="http://archives.nypl.org/mss/4795">inding aid to the archive</a>. Scope Tiered geographical location (for example: United States, New York State, Saratoga County, Saratoga Springs, Congress Park). This field is here for two reasons: first, to present, at its narrowest level, the scope of the entire item (in other words, not every place name has to be listed here). Second, this field will allow for accurate and helpful narrowing and broadening of geographic searches. Property Type For Maps: This subject field describes the purpose of the map. This is a controlled-vocabulary field using terms developed for this project. It is important to note that Map Theme and Map Type are not hierarchical, thus it is possible to have the two fields overlap or even duplicate each other. In determining the purpose of the map, the cataloger should consider the publisher, and, (if known) original use of the map. For example, a map that shows a wide variety of information might be a candidate for General in the map_type field, however, if it was prepared by the state geologist and contains, in addition to everything else, substantial information about the geology and topography of the state, it would be classified as a Geological map. Multiple terms can be used in this field. Property maps Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Property and Development Publisher Publisher of the item, or of the book or atlas in which it appears. Manuscript map, Yaddo. Record Contributor Individual who prepared the item and/or edited it. Jordana Dym Record Creation Date Day/Month/Year of record creation/edit 12/6/2014 3/29/2015 Place of Publication The city (and if necessary) state or country of publication. [Saratoga Springs, N.Y.] Physical Dimensions The actual physical size of the original image 24 3/4 x 27 1/2 in. URL Obituary, Philip Reisman, <a title="Philip Reisman Obituary, New York Times, 1992" href="http://www.nytimes.com/1992/06/19/arts/philip-reisman-87-artist-who-offered-views-of-new-york.html">New York Times, June 19, 1992</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Yaddo Date A point or period of time associated with an event in the lifecycle of the resource 1934 Language A language of the resource eng Creator An entity primarily responsible for making the resource Reisman, Phillip Medium The material or physical carrier of the resource. paper Spatial Coverage Spatial characteristics of the resource. Yaddo Estate Temporal Coverage Temporal characteristics of the resource. 1934 Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. <a title="Contacts, Yaddo" href="http://www.yaddo.org/yaddo/contacts.shtml">The Corporation of Yaddo</a> Rights Holder A person or organization owning or managing rights over the resource. The Corporation of Yaddo, map https://www.ssmp.mdocs.skidmore.edu/files/original/4a4905c7f525dae0825be62ab20af4ae.jpg 3d22703422bc2b67e6ad9bf97fc96598 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Record Contributor Individual who prepared the item and/or edited it. Jillian Seigel Record Creation Date Day/Month/Year of record creation/edit 43270 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Work starts on Spring Run Trail Date A point or period of time associated with an event in the lifecycle of the resource 4/5/10 Creator An entity primarily responsible for making the resource Donges, Patrick H. Source A related resource from which the described resource is derived The Saratogian Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Saratoga Springs Subject The topic of the resource Transportation Description An account of the resource A multi-use path to connect Northway and Congress Park Format The file format, physical medium, or dimensions of the resource text EnvironmentalJustice SaratogaSprings transportation https://www.ssmp.mdocs.skidmore.edu/files/original/421d0f71e9d8e1921937db322974c858.jpg 7593a859ebf2cb3effceabca3d7efa37 Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Brookside Museum Record Creation Date Day/Month/Year of record creation/edit 1991 Publisher Publisher of the item, or of the book or atlas in which it appears. Brookside Museum Subject - Geographic Library of Congress subject headings. For maps: for major geographic locations depicted on the map, followed, in nearly every case, by the "Maps" genre subheading. (For example, "Saratoga Springs (N.Y.) -- Maps.") This field will be especially important when the records from this collection are incorporated into larger databases and catalogs. Ballston Spa, NY Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Work Horses Harvesting Ice https://www.ssmp.mdocs.skidmore.edu/files/original/27ff129a075d148f70ef055434d382e0.png 434c4b4e9f97cf6ff1b0abef7f75f546 https://www.ssmp.mdocs.skidmore.edu/files/original/2e8944acdb917b8480164a1c527b5aff.mov 670e82b3fd30ef7cf338033c5b3376d7 https://www.ssmp.mdocs.skidmore.edu/files/original/39213105a3cc20e432c479f3d26810a4.png 9011c29331efa63a0c6a27e910d3bdfb https://www.ssmp.mdocs.skidmore.edu/files/original/9d5d2ab21dd8d9cea213ff11a03d5d55.png f196f9a4be9995248ab640d44048a28e https://www.ssmp.mdocs.skidmore.edu/files/original/e11779ddbf288eecf948beea3b74aa03.png fa2b0313360f79f23499956303f53078 https://www.ssmp.mdocs.skidmore.edu/files/original/6e0eb354b218f2c0830e24c1db3bf6a4.png 99a9e63034a957174781d43997c45988 https://www.ssmp.mdocs.skidmore.edu/files/original/42b7b4024779d03be3a10ced6e574caf.png d5728f90b620b072e5607b045223f0d2 https://www.ssmp.mdocs.skidmore.edu/files/original/45f4690aa200ba4dd25878052bfdcb7c.png 355e0e8cb84f1e3268bdfa3b27555161 https://www.ssmp.mdocs.skidmore.edu/files/original/e23f8988b01923b46aaf24184266e04f.png f29acc2ed73337d9448946ae88875421 https://www.ssmp.mdocs.skidmore.edu/files/original/ac5919a9fd6470399f0ff0de0a61ab4e.jpg c687d198c3da0702249cd5bb60675d98 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Latinx Oral History A resource containing historical information obtained in interviews with persons having firsthand knowledge. Interviewer The person(s) performing the interview Ashley Polanco Interviewee The person(s) being interviewed Juliana Boucher, Samantha García, Jonnea Herman, Isabel Rojas, Alison Ungaro Letellier, Aaron Schneider Record Contributor Individual who prepared the item and/or edited it. Ashley Polanco Record Creation Date Day/Month/Year of record creation/edit 04/26/2016 Location The location of the interview Skidmore College, Saratoga Springs NY Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource When People See me: Skidmore Latinx Student Interviews Creator An entity primarily responsible for making the resource Ashley Polanco Date A point or period of time associated with an event in the lifecycle of the resource 03/23/2016 - 03/24/2016 Language A language of the resource English Description An account of the resource Latinx students from Skidmore College engaged in a conversation with Ashley Polanco and Alyssa Morales of Raices about race within Latinx communities. They share their experiences of how others perceive their identities. Dominican family Latinos Latinx Mexican oral history Puerto Rican race Skidmore College student https://www.ssmp.mdocs.skidmore.edu/files/original/5391745d7c83ab3caf70086ec3600f62.JPG c535add9808ad2fcba8b45be3e1dc37a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Record Contributor Individual who prepared the item and/or edited it. Jillian Seigel Record Creation Date Day/Month/Year of record creation/edit 43270 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource West side to get group home Date A point or period of time associated with an event in the lifecycle of the resource 2/6/91 Creator An entity primarily responsible for making the resource Stevens, Rik Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Saratoga Springs Subject The topic of the resource Urban Renewal Description An account of the resource 6 people to move into a group home; some neighbors welcome to the idea, some not Format The file format, physical medium, or dimensions of the resource text EnvironmentalJustice SaratogaSprings UrbanRenewal https://www.ssmp.mdocs.skidmore.edu/files/original/6112e5e6b41a602ff370f2137877b1b9.jpg e08141dbc65099720ea89604cb9b9d29 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Harry T. Burleigh 150th Commemoration Date A point or period of time associated with an event in the lifecycle of the resource 2016 Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. J. Dym Record Creation Date Day/Month/Year of record creation/edit 28/11/2016 Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Recreation Repository Name of the repository that holds the original item. The Saratoga Springs History Museum (Saratoga Springs, N.Y.) Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Wesley Smiley trainer, former steeplechase jockey horse Graham of Geniva Date A point or period of time associated with an event in the lifecycle of the resource ca. 1920 Is Part Of A related resource in which the described resource is physically or logically included. George S. Bolster Photograph Collection Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Saratoga Springs History Museum Rights Holder A person or organization owning or managing rights over the resource. Saratoga Springs History Museum. Please do not republish or post on the internet without acquiring permission from the SSHM. https://www.ssmp.mdocs.skidmore.edu/files/original/e1be9cc7e3e9b0bfebf2a9bb94db6b9d.jpg c81a177b2f98b3f701fc5b06468d812a Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Mattie Saulnier Record Creation Date Day/Month/Year of record creation/edit 6/5/21 URL https://www.saratogacountyny.gov/saratoga-county-clerk/the-way-we-were/the-way-we-were-town-of-waterford/ Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Waterford flood Date A point or period of time associated with an event in the lifecycle of the resource 1936 https://www.ssmp.mdocs.skidmore.edu/files/original/7958d462d132e56b797db394a2cd1b13.jpg 893a69a6dacbe731a6f8e7bdec9617ab Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Mattie Saulnier Record Creation Date Day/Month/Year of record creation/edit 6/5/21 URL https://www.structuremag.org/?p=1541 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Waterford Bridge Fire Date A point or period of time associated with an event in the lifecycle of the resource 1909 https://www.ssmp.mdocs.skidmore.edu/files/original/efd246f2ba1ad822dc1d997602f3e9c9.jpg 5b32dc92d80b6c7a382bd1ffb3bb6e43 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mapping Saratoga Springs Date A point or period of time associated with an event in the lifecycle of the resource 1700- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data paper Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. This abstract of a title for a home sale in 1958 includes all abstracts going back to the original ownership of the land by the Ritchie family of Saratoga Springs. This document is interesting for a couple of reasons. First, albeit indirectly, this abstract tells a map story. Many titles and mortgage documents identify property based on original plats—property maps filed with the County Clerk in Ballston Spa. This page from a title for a house on Ritchie Place and Lake Avenue identifies the plot from two maps. The first is an 1881 survey conducted by L<a title="Cramer map of Jumel Estate" href="http://ssmp.skidmore.edu/items/show/93">ouis H. Cramer of the estate owned by Mme. Jumel</a>. The second identifies the property as Lot 3 owned by James Ritchie, per <a title="Mott map of Ritchie Property (1923)" href="http://ssmp.skidmore.edu/items/show/198">a map filed by city engineer Samuel J. Mott on April 16, 1923, with the County Clerk</a>. <br /><br />But this title, perhaps, offers more interesting insights not from the map, but from sales restrictions. Between 1931-1944, sale of this property prohibited workshops, factories or gasoline stations, hinting at resistance to certain activities near downtown. But it is the comment that “said premises shall not be sold, leased or otherwise disposed of to any other than white people “that perhaps most asks us to look with new eyes at the era’s city maps. Repository Name of the repository that holds the original item. Private Collection Subject - Name Names of individuals associated with the item. Last name first. For Maps: People represented on the map itself. In nearly every case, this field will be used when people are pictured on the map (several maps in this project are decorated with photographs or engravings in the margins). Use authorized versions of the name from the Library of Congress Name Authority File where possible. Mott, Samuel J. Ritchie Jumel Cramer, Louis H. Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Property and Development Demographics Record Contributor Individual who prepared the item and/or edited it. J. Dym Record Creation Date Day/Month/Year of record creation/edit 4/8/2015 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Warranty Deed, No. 11, Bernard J. and Emily S. Donovan to John J. and Rose M. King, August 19/20, 1944 Date A point or period of time associated with an event in the lifecycle of the resource 1944 Is Part Of A related resource in which the described resource is physically or logically included. Abstract of Title of Robert L. Nicholas and Marilou S. Nichols https://www.ssmp.mdocs.skidmore.edu/files/original/2ec4b56ecf1097bf4d0adccb03c7392e.jpg 320742e1841de5b007ddcfa97c3bdc95 https://www.ssmp.mdocs.skidmore.edu/files/original/43322c723f560453b02ee50b2bd8a0ae.jpg a19922e7f1ebe1698112c306a33c6cb8 https://www.ssmp.mdocs.skidmore.edu/files/original/278be2a64715bdd5fa3c0122a049aac4.jpg 8f75205050c25eb1618f61dde718d856 https://www.ssmp.mdocs.skidmore.edu/files/original/0ae94aa139eee3b2afe04c3fd6c681ec.JPG e2383ecd19337cae37cc933dcbcb227e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Melt Date A point or period of time associated with an event in the lifecycle of the resource 2/18 Creator An entity primarily responsible for making the resource Nicole Barry Medium The material or physical carrier of the resource. Photograph https://www.ssmp.mdocs.skidmore.edu/files/original/7e64121a89d747e64b42c5f7cd1da168.JPG f2f218d7562f38101ab6f872f1e2bb22 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Exploration Through the Eye of the Wanderer Date A point or period of time associated with an event in the lifecycle of the resource 2018 Creator An entity primarily responsible for making the resource Barry, Nicole Format The file format, physical medium, or dimensions of the resource Photography Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Barry, Nicole Record Creation Date Day/Month/Year of record creation/edit 19/4/2018 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Warming of the Globe Date A point or period of time associated with an event in the lifecycle of the resource 2018 Creator An entity primarily responsible for making the resource Barry, Nicole Is Format Of A related resource that is substantially the same as the described resource, but in another format. Photograph Barry Global Warming MDOCS nature Pond Principles of Documentary Skidmore College Spring 2018 This Place https://www.ssmp.mdocs.skidmore.edu/files/original/ea6fb22a0f02ce41970810673dec18a9.jpg 5a0142cd7794589318817f282a5abac9 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Record Contributor Individual who prepared the item and/or edited it. Jillian Seigel Record Creation Date Day/Month/Year of record creation/edit 43270 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Walking, biking, to Spa park studied Date A point or period of time associated with an event in the lifecycle of the resource 6/17/10 Creator An entity primarily responsible for making the resource Coleman, Lee Source A related resource from which the described resource is derived The Daily Gazette Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Saratoga Springs Subject The topic of the resource Transportation Description An account of the resource A new study of the Route 50 corridor near the Saratoga Spa State Park recommends $1.5 million in improvements to pedestrian and bicycle access to the park and nearby city trails. Format The file format, physical medium, or dimensions of the resource text EnvironmentalJustice SaratogaSprings transportation https://www.ssmp.mdocs.skidmore.edu/files/original/8849ef0156ff3f66083e1935ae0fffff.png 744cfdb674a11197dd1a2bf29d1babeb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data color photograph Record Creation Date Day/Month/Year of record creation/edit 5/6/2021 Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. 2020s Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. Spa - Gideon Putnam Hotel - Roosevelt Baths Spa URL https://www.gideonputnam.com/roosevelt-baths-and-spa Record Contributor Individual who prepared the item and/or edited it. Miles Herman Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Waiting area at the Roosevelt Baths and Spa, Gideon Putnam Hotel Date A point or period of time associated with an event in the lifecycle of the resource 2021 Is Part Of A related resource in which the described resource is physically or logically included. Gideon Putnam Hotel Source A related resource from which the described resource is derived https://www.gideonputnam.com/roosevelt-baths-and-spa/salon-services Description An account of the resource A waiting area at the Roosevelt Baths & Spa, Gideon Putnam Hotel. The Roosevelt Bathhouse is the only original bathhouse left from when Saratoga became a center for water treatments in the 1930s, thanks fo Dr. Simon Baruch and President Franklin Roosevelt. Creator An entity primarily responsible for making the resource Gideon Putnam Hotel https://www.ssmp.mdocs.skidmore.edu/files/original/1cf2fc16d8b0ab753de3a5508cd4e832.png 595cdfc38b9f75fae4970eeec4bbbd68 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Will Kertzmann Record Creation Date Day/Month/Year of record creation/edit 5/5/2021 Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. September 2020 URL https://poststar.com/news/local/rivers-and-saratoga-casinos-reopen/article_6ec6b551-7554-569f-baff-7ccd795f2b7d.html Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Visitors to Saratoga Casino doing temperature checks, summer 2020 Date A point or period of time associated with an event in the lifecycle of the resource 2020 Source A related resource from which the described resource is derived "Rivers and Saratoga Casinos Reopen," Post-Star Staff Report, September 9, 2020. Creator An entity primarily responsible for making the resource March, Jenn Abstract A summary of the resource. A photo of guests at the Saratoga Casino in the summer of 2020, doing temperature checks by scanning their wrists Publisher An entity responsible for making the resource available The Post Star Language A language of the resource eng gambling saratoga casino Saratoga Springs https://www.ssmp.mdocs.skidmore.edu/files/original/a199583afe1dc40e0d270298ae9238f8.jpg 890b0a50fc0773225ab1b11b20b1c016 https://www.ssmp.mdocs.skidmore.edu/files/original/14e1b16a54f7327f60a323f61670246d.jpg 6d2f4a7b8bac7a0432926ecce459d882 https://www.ssmp.mdocs.skidmore.edu/files/original/fd675ad782f32a17a388aff48489397d.png 1456afd273c710e00af89c81d38d500e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mapping Saratoga Springs Date A point or period of time associated with an event in the lifecycle of the resource 1700- Map Cartographic document Creator - Organization Company, government agency, or other organization responsible for creating the item (the publisher should not be listed again here unless the same organization had a role other than that of publisher in sponsoring or creating the map). Saratoga Springs Chamber of Commerce Publisher Publisher of the item, or of the book or atlas in which it appears. Saratoga Springs Chamber of Commerce Place of Publication The city (and if necessary) state or country of publication. Saratoga Springs, N.Y. Repository Name of the repository that holds the original item. Geography and Map Division, Library of Congress Date Published (Numeric) Date the item was printed. This will be set as a date field, accommodating only numbers. The field will be able to handle single dates or date ranges. This will not display, but will be indexed and searchable. 1950 Date Published (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the date field that will display. ca. 1950s Date Depicted (Numeric) Date that the information on the item depicts. In many cases, this will be the same date as that in the date field, but there will be exceptions. For example, a historical map drawnin 1890 might show Saratoga Springs as it was in 1820. Or, the information on the map itself might include detailed information that enables us to extrapolate a date, for example, "based on a survey done in 1841." Many State Archives map catalog records refer to this as the "situation date." 1950 Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. ca. 1950s Caption This field will include transcriptions of text that appears on or around the item, at the discretion of the cataloger. It should include relevant bibliographic information that is not given in the title, for example, "Top of map: 'EXAMPLE NEEDED' Publisher and printer information might also be included in this field: "EXAMPLE NEEDED.'" Note that the location of the printed text is given in the field itself and that the caption information is always included in quotes. "Bottom of map: 'For information on hotels, guest houses, and restaurants: Write for Chamber of Commerce List or Ask at Information Center' and 'Bus service provides easy access to all parts of the city.'" Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. This color pictorial map is a fold-out brochure created by the Saratoga Springs Chamber of Commerce to serve tourists. Recto: The brochure titled "Visit Saratoga Springs: King of Resorts, Queen of Spas" promises "Recreation and Relaxation" in Saratoga. The top panels of the brochure detail some of the summer highlights of Saratoga Springs (eg. Saratoga Lake, horse racing, golf courses, spas, and historic sites). There is an inset map that details the modes of transport to access Saratoga Springs (by motor, rail, or air). The bottom half of the brochure outlines winter attractions in Saratoga (eg. skating, Skidmore College Winter Carnival, bowling etc.) as well as year-round activities (eg. ice fishing, baths, concerts, and dining). Black and white drawings accompany each activity/site outlined in the brochure. Verso: This side of the brochure includes a colored map as well as a list of "points of interest." The map focuses on downtown Saratoga Springs and offers an outline of streets (not drawn to scale) and modes of transport to and from the city. Larger than life-size drawings depict iconography of Saratoga Springs (eg. golf course, race horses, colonial solider from the Battle of Saratoga 1777, boating on Saratoga Lake, and mineral springs). The points of interest key (that uses numbers to mark important sites) offer brief explanations of the attractions/activities of Saratoga during the summer as well as offer information about the public or private accessibility of the attraction. Type For Maps: This subject field describes the purpose of the map. This is a controlled-vocabulary field using terms developed for this project. It is important to note that Map Theme and Map Type are not hierarchical, thus it is possible to have the two fields overlap or even duplicate each other. In determining the purpose of the map, the cataloger should consider the publisher, and, (if known) original use of the map. For example, a map that shows a wide variety of information might be a candidate for General in the map_type field, however, if it was prepared by the state geologist and contains, in addition to everything else, substantial information about the geology and topography of the state, it would be classified as a Geological map. Multiple terms can be used in this field. Pictorial maps Tourist maps Color maps Subject - Details This subject field describes the amount of detail in a map. For maps: (or layers) included on the map itself. This field might denote that the map includes information about, for example, Mountains, Railroads, Soundings, Elevation, or Population. These are controlled-vocabulary terms developed locally. The cataloger should be generous in assigning these terms -- even if only one canal is visible on the map, it should receive a "Canals" subject in this layer. Some of these terms are less specific than others and may warrant expansion in the Abstract field. For example, the "Businesses" term might be included here while the Abstract notes that the map shows mills and stores. Multiple terms can be used in this field. Bathing Beach (Saratoga Springs, N.Y.) Boston and Maine Railroad Canfield Casino (Saratoga Springs, N.Y.) Congress Park (Saratoga Springs, N.Y.) Convention Hall (Saratoga Springs, N.Y.) Delaware and Hudson Railroad Corporation Grand Union Hotel (Saratoga Springs, N.Y.) Iconography--mineral springs Iconography--race track Iconography--horse McGregor Golf Club (Saratoga Springs, N.Y.) Petrified Gardens (Saratoga Springs, N.Y.) Saratoga Battlefield (Saratoga Springs, N.Y.) Saratoga Golf Club (Saratoga Springs, N.Y.) Saratoga National Historical Park (N.Y.) Saratoga Springs (N.Y.)--Broadway Saratoga Springs Public Schools (Saratoga Springs, N.Y.) Skidmore College Yaddo (Saratoga Springs, N.Y.) Transportation--airport Transportation--railroad Transportation--highways N.Y.S. Forest Nursery (Saratoga Springs, N.Y.) (formerly Tree Nursery) Saratoga Springs Chamber of Commerce Saratoga Racing Association Inniscarra (Chauncey Olcott Cottage) (Saratoga Springs, N.Y.) Ash Grove Farms (Saratoga Springs, N.Y.) U.S. Government Fur Animal Experimental Station (Saratoga Springs, N.Y.) Saratoga Spa State Park (N.Y.) Geyser Park (Saratoga Springs, N.Y.) Saratoga Springs Public Library (Saratoga Springs, N.Y.) Lincoln Baths (Saratoga Springs, N.Y.) Recreation Washington Baths (Saratoga Springs, N.Y.) Broadway Drink Hall (Saratoga Springs, N.Y.) Post office (Saratoga Springs, N.Y.) Congress Theatre (Saratoga Springs, N.Y.) Iroquois Indians Scope Tiered geographical location (for example: United States, New York State, Saratoga County, Saratoga Springs, Congress Park). This field is here for two reasons: first, to present, at its narrowest level, the scope of the entire item (in other words, not every place name has to be listed here). Second, this field will allow for accurate and helpful narrowing and broadening of geographic searches. City Record Contributor Individual who prepared the item and/or edited it. Deirdre. Schiff Allie Smith Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Travel and Tourism Recreation Transportation Subject - Geographic Library of Congress subject headings. For maps: for major geographic locations depicted on the map, followed, in nearly every case, by the "Maps" genre subheading. (For example, "Saratoga Springs (N.Y.) -- Maps.") This field will be especially important when the records from this collection are incorporated into larger databases and catalogs. Hathorn Spring (Saratoga Springs, N.Y.) High Rock Spring (Saratoga Springs, N.Y.) Lake Lonely (N.Y. : Lake) Loughberry Lake (N.Y. : Lake) Saratoga County (N.Y.) Saratoga Lake (N.Y. : Lake) Saratoga Springs (N.Y.) Record Creation Date Day/Month/Year of record creation/edit 6/1/2014 3/21/2015 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Visit Saratoga Springs, King of Resorts, Queen of Spas Date A point or period of time associated with an event in the lifecycle of the resource 1950s Publisher An entity responsible for making the resource available Saratoga Springs Chamber of Commerce Language A language of the resource english Creator An entity primarily responsible for making the resource Saratoga Springs Chamber of Commerce business color map nature parks race tracl railroads recreation schools transportation https://www.ssmp.mdocs.skidmore.edu/files/original/064ef5a849db340b5edc115696987bdf.jpg 15dced24532f4fac8ed9e5b174bf63f7 Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Mattie Saulnier Record Creation Date Day/Month/Year of record creation/edit 6/5/21 Repository Name of the repository that holds the original item. Brookside Museum, Saratoga County Historical Society (Ballston Spa, N.Y.) URL https://brookside.pastperfectonline.com/photo/083E3933-2FDB-4591-81A6-342722498536 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Vischer's Ferry Description An account of the resource Hand-operated rope ferry across the Mohawk River at Vischer Ferry; background Niska Isle. Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Brookside Museum https://www.ssmp.mdocs.skidmore.edu/files/original/4c60ad283de3420b99ae850cd578b925.jpg c5dc885f291ae9be00b0983599f24238 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Adult and Senior Center of Saratoga Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Creation Date Day/Month/Year of record creation/edit 5/12/17 Record Contributor Individual who prepared the item and/or edited it. Phoebe Radcliffe Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context 1980-60YearsYoung-ValentinesParty Title A name given to the resource Valentine's Party Date A point or period of time associated with an event in the lifecycle of the resource 198x Description An account of the resource A photograph from a Valentine's Day party at the Center Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Adult and Senior Center of Saratoga Language A language of the resource English Format The file format, physical medium, or dimensions of the resource Photograph events Holidays Saratoga Springs Senior Center https://www.ssmp.mdocs.skidmore.edu/files/original/9bbfda8ea17be775e07af5cd07d3a853.pdf 57c42d447d97018af58acee9e7df8db5 PDF Text Text ����������������� https://www.ssmp.mdocs.skidmore.edu/files/original/177c864a91d7d980782b864ae395f380.jpg b623a655fc6632eebe1538c98411fba1 https://www.ssmp.mdocs.skidmore.edu/files/original/73da690f412f57c9e58e8cb097d3d612.jpg ddd9ec71d91ed0de48fac042caf2f4d6 https://www.ssmp.mdocs.skidmore.edu/files/original/18f5b8bdab4b46f8da67d25b56022d2a.jpg f616b163bd18a38cf066d3a465405f5e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mapping Saratoga Springs Date A point or period of time associated with an event in the lifecycle of the resource 1700- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data Pamphlet Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. The 1960s in Saratoga Springs was marked by a need for change to combat years of previous decline. Saratoga Springs fell into a period of decline after World War II and urban renewal was the clear response to update the city’s reputation. The Federal Housing Act of 1949 set a standard for American cities to be beautiful and aesthetically pleasing. As cities across the country at this time were seen as centers of urban decay, an economic boom generated the funds for rebuilding. Federal subsidies allowed local governments to invest in urban renewal projects and in turn local governments receive money for public infrastructure. A pamphlet created in 1965, “Urban Renewal in Saratoga Springs,” proposed to citizens that “beautiful” and “new houses” were needed in a core area downtown, off Broadway. The Agency distributed 1,000 copies to property owners to provide basic knowledge of “urban renewal.” The main objective as described in a March 24, 1965 article by the Saratogian, was “to provide the plasma to inject the incentive for private investors to revitalize both residential and commercial segments of the heart of the city. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Creator - Individual Name of the person or people responsible for creating the item. Smith, Benjamin L., Consulting Engineer DeLisle, Kenneth R., Planning Consultant Subject - Details This subject field describes the amount of detail in a map. For maps: (or layers) included on the map itself. This field might denote that the map includes information about, for example, Mountains, Railroads, Soundings, Elevation, or Population. These are controlled-vocabulary terms developed locally. The cataloger should be generous in assigning these terms -- even if only one canal is visible on the map, it should receive a "Canals" subject in this layer. Some of these terms are less specific than others and may warrant expansion in the Abstract field. For example, the "Businesses" term might be included here while the Abstract notes that the map shows mills and stores. Multiple terms can be used in this field. Urban renewal Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Property and Development Record Contributor Individual who prepared the item and/or edited it. D. Schiff Record Creation Date Day/Month/Year of record creation/edit 4/6/15 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Urban Renewal in Saratoga Springs: A Glance at the Present...A Glimpse of the Future... Date A point or period of time associated with an event in the lifecycle of the resource 1965 Creator An entity primarily responsible for making the resource Smith, Benjamin L., Consulting Engineer DeLisle, Kenneth R., Planning Consultant https://www.ssmp.mdocs.skidmore.edu/files/original/8a228f5735baa0597591ec68d03bf7ea.JPG 2312516be101a002d36cb497265e4e4e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Record Contributor Individual who prepared the item and/or edited it. Jillian Seigel Record Creation Date Day/Month/Year of record creation/edit 43270 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource URA Private Housing Project Date A point or period of time associated with an event in the lifecycle of the resource 25296 Creator An entity primarily responsible for making the resource N/A Source A related resource from which the described resource is derived The Saratogian Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Saratoga Springs Subject The topic of the resource Urban Renewal Description An account of the resource 66-unit middle-income apartment complex to be completed by December of 1969. The Urban Renewal Agency put forth theses plans to create three building with 22 apartments each; expected rent from $160-$190/month. Format The file format, physical medium, or dimensions of the resource text EnvironmentalJustice SaratogaSprings UrbanRenewal https://www.ssmp.mdocs.skidmore.edu/files/original/74ebe408549e45036621172bb0a7c1aa.jpg 5767ac8aa4f61a934f84c5656473319a https://www.ssmp.mdocs.skidmore.edu/files/original/68eb8b2dc25cb18a5faa185c1509a389.jpg 1143f130627b166a92f0d1c432c3d3c7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mapping Saratoga Springs Date A point or period of time associated with an event in the lifecycle of the resource 1700- Map Cartographic document Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Scope Tiered geographical location (for example: United States, New York State, Saratoga County, Saratoga Springs, Congress Park). This field is here for two reasons: first, to present, at its narrowest level, the scope of the entire item (in other words, not every place name has to be listed here). Second, this field will allow for accurate and helpful narrowing and broadening of geographic searches. Other Type For Maps: This subject field describes the purpose of the map. This is a controlled-vocabulary field using terms developed for this project. It is important to note that Map Theme and Map Type are not hierarchical, thus it is possible to have the two fields overlap or even duplicate each other. In determining the purpose of the map, the cataloger should consider the publisher, and, (if known) original use of the map. For example, a map that shows a wide variety of information might be a candidate for General in the map_type field, however, if it was prepared by the state geologist and contains, in addition to everything else, substantial information about the geology and topography of the state, it would be classified as a Geological map. Multiple terms can be used in this field. Road maps Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Transportation Travel and Tourism Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource United States Hotel Date A point or period of time associated with an event in the lifecycle of the resource ca. 1903 Description An account of the resource A business card for the hotel highlighting its modernity and advertising its symphony offerings on front, with a map of routes from Albany to Saratoga springs on the back. Language A language of the resource eng map https://www.ssmp.mdocs.skidmore.edu/files/original/40f273d9f84a94e8baf1b87758d279f9.jpg 01b1cfdc38d4760b0f2f6eda604e2739 Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Publisher Publisher of the item, or of the book or atlas in which it appears. Brookside Museum Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Union Bag Paper Mill Publisher An entity responsible for making the resource available Brookside Museum https://www.ssmp.mdocs.skidmore.edu/files/original/57606e4417883bfc4e657ce9eb57b14d.jpeg 91e84558c39197cbb5e6b8b673d58581 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mapping Saratoga Springs Date A point or period of time associated with an event in the lifecycle of the resource 1700- Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data photo Record Contributor Individual who prepared the item and/or edited it. Jordana Dym Record Creation Date Day/Month/Year of record creation/edit 2/8/2015 Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. ca. 1950 Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Uniformed Man reading Road Atlas Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Krystle Nowhitney Hernandez Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Julio Cesar Castro García Title A name given to the resource Un Minuto para Mí/A Minute for Myself Alternative Title An alternative name for the resource. The distinction between titles and alternative titles is application-specific. Julio Cesar Castro García_2017_2.jpg Date A point or period of time associated with an event in the lifecycle of the resource 2017 Subject The topic of the resource Belmont Park, Elmont, NY, USA Description An account of the resource Caminando voy con mi conciencia, tratando de convencerme que el mundo no gira en torno a mí. Caminando voy dejando atrás lo malo que me ha pasado en la vida y pensando en lo bueno que está por venir; Algo bueno está esperando para todos. Walking, I go with my conscience, trying to convince myself that the world does not revolve around me. Walking, I leave behind the bad that has happened to me in life while thinking about the good that is to come; something good awaits us all. License A legal document giving official permission to do something with the resource. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Format The file format, physical medium, or dimensions of the resource Digital Photograph, JPEG art bilingual Estamos Aqui immigration Latinx race track Saratoga Race Course Spanish https://www.ssmp.mdocs.skidmore.edu/files/original/f9c1ade34b9644da831d0b14169bafd7.jpg 81469c43480a8cbabd9925f437966369 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Mattie Saulnier Record Creation Date Day/Month/Year of record creation/edit 6/5/21 URL http://bridgehunter.com/ny/albany/4033181/ Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Twin Bridges Today Date A point or period of time associated with an event in the lifecycle of the resource 2009 Publisher An entity responsible for making the resource available Doug Kerr https://www.ssmp.mdocs.skidmore.edu/files/original/0a63b127b1eda1839175e00af58603d0.jpg af8635f223dc07fd6fc758c5dd59df67 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Mattie Saulnier Record Creation Date Day/Month/Year of record creation/edit 6/5/21 URL https://www.saratogian.com/news/bridging-history-long-lost-photos-depict-kosciuszko-span-construction/article_3bab8b74-2be5-5361-bf26-24e29de63ea2.html Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Twin Bridges Being Built Date A point or period of time associated with an event in the lifecycle of the resource 1950s https://www.ssmp.mdocs.skidmore.edu/files/original/1685b2ab59a33ebc2575127d49ad4fac.jpg c280811e88af8a49645265e751d3b8d6 https://www.ssmp.mdocs.skidmore.edu/files/original/8d7fd432c66e053e5d175165ccd16274.jpg db26941334b5414c8ba3dc1efc2034b7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Harry T. Burleigh 150th Commemoration Date A point or period of time associated with an event in the lifecycle of the resource 2016 Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Repository Name of the repository that holds the original item. Internet Archive (archive.org) Library of Congress URL <a title="Twelve Years a Slave" href="https://archive.org/details/twelveyearsslave00nort">https://archive.org/details/twelveyearsslave00nort</a> Record Contributor Individual who prepared the item and/or edited it. J. Dym Record Creation Date Day/Month/Year of record creation/edit 22/11/2016 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Twelve years a slave. Narrative of Solomon Northup, a citizen of New-York, kidnapped in Washington city in 1841, and rescued in 1853, from a cotton plantation near the Red River in Louisiana Date A point or period of time associated with an event in the lifecycle of the resource 1859 Publisher An entity responsible for making the resource available C.M. Saxton Language A language of the resource eng Contributor An entity responsible for making contributions to the resource Northup, Solumon Type The nature or genre of the resource book Subject The topic of the resource Northup, Solomon, -- 1808-1863? Slaves -- United States -- Biography. African Americans -- Biography. Saratoga Springs (N.Y). -- History Identifier An unambiguous reference to the resource within a given context 001Burleigh https://www.ssmp.mdocs.skidmore.edu/files/original/58ff9dabcc06c970417df80e12f3f6fe.jpg 18170f333bd4e8abeab0d060313a35c4 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Mattie Saulnier Record Creation Date Day/Month/Year of record creation/edit 5/5/21 Repository Name of the repository that holds the original item. Brookside Museum, Saratoga County Historical Society (Ballston Spa, N.Y.) URL https://brookside.pastperfectonline.com/photo/4B48EAB1-E907-4DBD-A26A-480349047529 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Trolly Car Interior Contributor An entity responsible for making contributions to the resource Mattie Saulnier Description An account of the resource Interior view of a trolley car a seated man is within. Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Brookside Museum railroad transportation trolly https://www.ssmp.mdocs.skidmore.edu/files/original/3b4526fe5a239e5c84128553328c5f3c.pdf 7aa49e877fab6eb1e13135f02f2cce45 PDF Text Text ����������� Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data paper Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. A pamphlet advertising the destinations and attractions along a Hudson-Mohawk Trolley Route. Covers Schenectady, Ballston Spa, Saratoga Springs. Has photographs of key locations and descriptions of tourist attractions, including the Saratoga Battlefield. Price list of trolley fares and stops at the rear of the brochure. On the title page " Once the country of Indian Trails now the Land of Trolleys) and " Among the Foothills of the Adirondacks." Centerfold is a map of the trolley route. Includes inset maps of Lake George. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Creator - Organization Company, government agency, or other organization responsible for creating the item (the publisher should not be listed again here unless the same organization had a role other than that of publisher in sponsoring or creating the map). Schenectady Railway Company Subject - Details This subject field describes the amount of detail in a map. For maps: (or layers) included on the map itself. This field might denote that the map includes information about, for example, Mountains, Railroads, Soundings, Elevation, or Population. These are controlled-vocabulary terms developed locally. The cataloger should be generous in assigning these terms -- even if only one canal is visible on the map, it should receive a "Canals" subject in this layer. Some of these terms are less specific than others and may warrant expansion in the Abstract field. For example, the "Businesses" term might be included here while the Abstract notes that the map shows mills and stores. Multiple terms can be used in this field. Transportation Trolley Subject - Geographic Library of Congress subject headings. For maps: for major geographic locations depicted on the map, followed, in nearly every case, by the "Maps" genre subheading. (For example, "Saratoga Springs (N.Y.) -- Maps.") This field will be especially important when the records from this collection are incorporated into larger databases and catalogs. Hudson Valley Mohawk Valley Adirondacks Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Transportation Record Contributor Individual who prepared the item and/or edited it. Jordana Dym Record Creation Date Day/Month/Year of record creation/edit 11/25/2014 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Trolley Trips, Hudson-Mohawk Valleys, Schenectady Railway Company Language A language of the resource English https://www.ssmp.mdocs.skidmore.edu/files/original/161209c9ac45e077e58f2a670d5623e8.jpg de45bf0f5a9257d33f0631fd5400b8b2 https://www.ssmp.mdocs.skidmore.edu/files/original/bd58e0a43f0c0c9bc0ea1b9df23ef4f3.png cc5efe8b9d3e82f3389a1912b5040c2d https://www.ssmp.mdocs.skidmore.edu/files/original/38db43bbf4da78c9028c3580f807ad65.png 64d95b85206051f6b0ffc21dd2c3d66b https://www.ssmp.mdocs.skidmore.edu/files/original/cd6759695d215d34f916c91562a025bd.png 4cbcb5a41378f66053a724ccd482ca74 https://www.ssmp.mdocs.skidmore.edu/files/original/d77398b886b920bdf4c76d629a4cb8fe.png 6fc9ee2010b4b7e5dce59e51761d7ec9 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Mapping Saratoga Springs Date A point or period of time associated with an event in the lifecycle of the resource 1700- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data book Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. The 1915 edition of a series includes maps and stops located in a specific regions providing a guide for visitors in towns and cities. Visitors to Saratoga are led to the hotels, springs and Woodlawn Park. Subject - Details This subject field describes the amount of detail in a map. For maps: (or layers) included on the map itself. This field might denote that the map includes information about, for example, Mountains, Railroads, Soundings, Elevation, or Population. These are controlled-vocabulary terms developed locally. The cataloger should be generous in assigning these terms -- even if only one canal is visible on the map, it should receive a "Canals" subject in this layer. Some of these terms are less specific than others and may warrant expansion in the Abstract field. For example, the "Businesses" term might be included here while the Abstract notes that the map shows mills and stores. Multiple terms can be used in this field. transportation electric railroad Delaware and Hudson Railroad Corporation (D &H, R.R.) Boston and Maine Railroad (B&M Railroad) Subject - Geographic Library of Congress subject headings. For maps: for major geographic locations depicted on the map, followed, in nearly every case, by the "Maps" genre subheading. (For example, "Saratoga Springs (N.Y.) -- Maps.") This field will be especially important when the records from this collection are incorporated into larger databases and catalogs. Hudson River Valley (N.Y. and N.J.)--History New England Saratoga Battlefield (Saratoga Springs, N.Y.) Saratoga Lake (N.Y. : Lake) Ballston Spa (N.Y.) Champlain Canal (N.Y.) Hudson River (N.Y.) Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Travel and Tourism Transportation URL Available on <a title="1915 Trolley Guide" href="https://archive.org/details/trolleytripsthro01hart" target="_blank">archive.org </a>(along with other editions). Record Contributor Individual who prepared the item and/or edited it. Jordana Dym Elana Scaglia Record Creation Date Day/Month/Year of record creation/edit 8/17/2014 3/9/2015 Repository Name of the repository that holds the original item. Library of Congress Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Trolley Trips through New England and Hudson River Valley, America's Playground Date A point or period of time associated with an event in the lifecycle of the resource 1915 Publisher An entity responsible for making the resource available The Hartford Press Language A language of the resource English Hudson River Valley transportation trolley https://www.ssmp.mdocs.skidmore.edu/files/original/65cbbc7ab0c36a4430a736fd50795277.jpg b69184d94d7a857870aa1b3391be709b Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Record Contributor Individual who prepared the item and/or edited it. Brookside Museum Record Creation Date Day/Month/Year of record creation/edit 2004 Publisher Publisher of the item, or of the book or atlas in which it appears. Brookside Museum Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Tree Alongside Erie Canal https://www.ssmp.mdocs.skidmore.edu/files/original/3287ba991b83780eab0f8e9f7134f470.jpg 99e06006be5d626178b035f51baea8d5 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Record Contributor Individual who prepared the item and/or edited it. Jillian Seigel Record Creation Date Day/Month/Year of record creation/edit 43270 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Trailways Alters Route Of Buses for Saratoga Date A point or period of time associated with an event in the lifecycle of the resource ND Subject The topic of the resource Transportation Description An account of the resource Adirondack Trailways has rerouted its buses from Hamilton Street to Broadway, in response to a warning by the public safety department that the use of Hamilton Street is illegal. Format The file format, physical medium, or dimensions of the resource text EnvironmentalJustice SaratogaSprings transportation https://www.ssmp.mdocs.skidmore.edu/files/original/95208d7121a2a8d3dfe0ebae97ef625d.jpg 71025962f808a2cb276c509791912820 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Record Contributor Individual who prepared the item and/or edited it. Jillian Seigel Record Creation Date Day/Month/Year of record creation/edit 43270 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Trail project on path to reality Date A point or period of time associated with an event in the lifecycle of the resource 12/18/05 Creator An entity primarily responsible for making the resource Cooper, Robin K. Source A related resource from which the described resource is derived The Daily Gazette Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Saratoga Springs Subject The topic of the resource Transportation Description An account of the resource Outgoing administration eyes key land deals...Now, less than two weeks before a new mayoral administration steps into City Hall, the outgoing mayor and city attorney are on track to complete three key land deals to amek the Spring Run Trail a reality. Format The file format, physical medium, or dimensions of the resource text EnvironmentalJustice SaratogaSprings transportation https://www.ssmp.mdocs.skidmore.edu/files/original/5735d730d9e1b63f0046ed303d422f41.jpg 4e147f9b6e4428b9d25096a3adef2c47 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga Springs History Date A point or period of time associated with an event in the lifecycle of the resource 1706- Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Repository Name of the repository that holds the original item. Saratoga Room, Saratoga Springs Public Library Record Contributor Individual who prepared the item and/or edited it. Jillian Seigel Record Creation Date Day/Month/Year of record creation/edit 43270 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Touring on the Trolley Date A point or period of time associated with an event in the lifecycle of the resource 7/30/03 Creator An entity primarily responsible for making the resource McCord, Jason Source A related resource from which the described resource is derived The Post Star Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Saratoga Springs Subject The topic of the resource Transportation Description An account of the resource Hour of Saratoga sightseeing only costs $1 and is popular with the tourists Format The file format, physical medium, or dimensions of the resource text EnvironmentalJustice SaratogaSprings transportation https://www.ssmp.mdocs.skidmore.edu/files/original/28cf80e214a317dd71d563bd8c9cc3b6.jpeg 603b8221a46d43862d9f4330958b3b08 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. 1844 Publisher Publisher of the item, or of the book or atlas in which it appears. Saratoga Springs : B. Huling URL Internet Archive, <a href="https://archive.org/details/2541031R.nlm.nih.gov/page/n4/mode/1up">https://archive.org/details/2541031R.nlm.nih.gov/page/n4/mode/1up</a> Repository Name of the repository that holds the original item. Internet Archive (archive.org) Creator - Individual Name of the person or people responsible for creating the item. Allen, R.L. Record Contributor Individual who prepared the item and/or edited it. Isabelle Jaber Record Creation Date Day/Month/Year of record creation/edit 07/05/2021 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Title Page Date A point or period of time associated with an event in the lifecycle of the resource 1844 Creator An entity primarily responsible for making the resource R.L. Allen Abstract A summary of the resource. Title page of R.L. Allen's "A Historical, Chemical, and Therapeutical Analysis of the Principle Mineral Waters of Saratoga. Springs" Date Created Date of creation of the resource. 05/07/2021 Publisher An entity responsible for making the resource available B. Huling (Saratoga Springs); W.H. Graham (New York) Language A language of the resource English Source A related resource from which the described resource is derived A Historical, Chemical, and Therapeutical Analysis of the Principle Mineral Waters of Saratoga. Springs Description An account of the resource A treatise on the Saratoga Springs mineral waters by an MD. health resorts medicine mineral waters https://www.ssmp.mdocs.skidmore.edu/files/original/7b6c14b10a4151d7423093e224087e98.jpg ea647fc95c4ab680474019723aff8c7d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Adult and Senior Center of Saratoga Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Record Creation Date Day/Month/Year of record creation/edit 5/12/17 Record Contributor Individual who prepared the item and/or edited it. Phoebe Radcliffe Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Identifier An unambiguous reference to the resource within a given context 197x-60YearsYoung-ThenNow Title A name given to the resource Then and Now Date A point or period of time associated with an event in the lifecycle of the resource 197x Description An account of the resource A side-by-side of 162 Circular and 5 Williams Provenance A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource. Adult and Senior Center of Saratoga Language A language of the resource English Format The file format, physical medium, or dimensions of the resource Newspaper 162 circular 5 Williams construction Saratoga Springs Senior Center https://www.ssmp.mdocs.skidmore.edu/files/original/b6f9e98022f76761b6b972281675e56e.tiff e096fcd3de659ca3c512d480819a0d24 https://www.ssmp.mdocs.skidmore.edu/files/original/89044e6e832aba0e7d7baa5f5152bbcc.tiff aa0b842964f74535bde1045c7bf5e150 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Skidmore College History Date A point or period of time associated with an event in the lifecycle of the resource 1911- Still Image A static visual representation. Examples include paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type Text to images of textual materials. Original Format The type of object, such as painting, sculpture, paper, photo, and additional data Postcard Record Contributor Individual who prepared the item and/or edited it. Deirdre Schiff Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. [1950s] Date Depicted (Numeric) Date that the information on the item depicts. In many cases, this will be the same date as that in the date field, but there will be exceptions. For example, a historical map drawnin 1890 might show Saratoga Springs as it was in 1820. Or, the information on the map itself might include detailed information that enables us to extrapolate a date, for example, "based on a survey done in 1841." Many State Archives map catalog records refer to this as the "situation date." 1950 Date Published (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the date field that will display. [1950s] Date Published (Numeric) Date the item was printed. This will be set as a date field, accommodating only numbers. The field will be able to handle single dates or date ranges. This will not display, but will be indexed and searchable. 1950 Abstract (& Historical Note) Natural language description of the map itself, providing a general summary of the map and noting significant features. This is the place to introduce keywords and proper names that might be of interest to researchers, but do not warrant a separate subject heading of their own. Inset maps should also be described here, with their full titles given. Whenever historical or explanatory information is available, it should be included here as well. This includes information about items or events that are larger than just the map itself; for example, information about cartographers, a description of the map's historical significance (for example, "This is the first printed map of Saratoga Springs"), notes on the laws leading to a map's creation, descriptions of changes in state or county lines, information about the organization that created the map, how often maps were updated, and information about the map's creation and publication. Many State Archives maps have historical information in the catalog record -- that should be captured in this field. This black and white photograph postcard depicts The Surrey-Williamson Inn, an event and alumni house at Skidmore College. Correspondence side blank. Subject - Details This subject field describes the amount of detail in a map. For maps: (or layers) included on the map itself. This field might denote that the map includes information about, for example, Mountains, Railroads, Soundings, Elevation, or Population. These are controlled-vocabulary terms developed locally. The cataloger should be generous in assigning these terms -- even if only one canal is visible on the map, it should receive a "Canals" subject in this layer. Some of these terms are less specific than others and may warrant expansion in the Abstract field. For example, the "Businesses" term might be included here while the Abstract notes that the map shows mills and stores. Multiple terms can be used in this field. Skidmore College (Saratoga Springs, N.Y.) Subject - Geographic Library of Congress subject headings. For maps: for major geographic locations depicted on the map, followed, in nearly every case, by the "Maps" genre subheading. (For example, "Saratoga Springs (N.Y.) -- Maps.") This field will be especially important when the records from this collection are incorporated into larger databases and catalogs. Saratoga Springs (N.Y.) Theme For browsing purposes, we are borrowing and adapting themes from the Library of Congress's American Memory project. Property and Development Record Creation Date Day/Month/Year of record creation/edit 6/19/2014 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Surrey, 950 North Broadway, Saratoga Springs, New York postcard Skidmore College Surrey https://www.ssmp.mdocs.skidmore.edu/files/original/eedbead97dd39adb4267c37ef02d2d43.jpeg 9e6d80a5365d248ed431ffbbc8bcc94d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Saratoga County Map Cartographic document Date Depicted (Display) Text version of the date field -- can handle non-numeric characters (ca. 1850s, [1844]). This is the content date field that will display. 1777 Record Contributor Individual who prepared the item and/or edited it. Zack Kouli Record Creation Date Day/Month/Year of record creation/edit 9 May 2021 URL Hosted at the Schenectady Digital History Archive, <a href="http://www.schenectadyhistory.org/resources/mvgw/maps/saratoga-oriskany_campaign_map-300.jpg">http://www.schenectadyhistory.org/resources/mvgw/maps/saratoga-oriskany_campaign_map-300.jpg</a> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Saratoga Orikansky Campaign, 1777 Description An account of the resource Map which shows how many of the forts, battles, and movements of revolutionary war activity in Saratoga County were along the water. Date A point or period of time associated with an event in the lifecycle of the resource 1925 Is Part Of A related resource in which the described resource is physically or logically included. Nelson Greene, ed. History<em> of the Mohawk Valley: Gateway to the West 1614-1925 </em>(Chicago: The S. J. Clarke Publishing Company, 1925). Publisher An entity responsible for making the resource available The S. J. Clarke Publishing Company Language A language of the resource eng Contributor An entity responsible for making contributions to the resource Greene, Nelson