STATEMENT OF GEN. JOHN F. MCMAHON, COMMANDER IN CHIEF, VOLUNTEERS OF AMERICA

Senator MCNAMARA. Next on the list today is the Volunteers of America, General McMahon.

General, we are glad to hear from you at this time.

I see you have a very short statement. If you want to proceed to present it in that manner that you have drawn up here, or do you want to submit for the record and summarize it; whatever you like. General MCMAHON. I will go through the statement if you don't mind, Senator.

Senator MCNAMARA. All right.

General MCMAHON. I realize that coming at the eighth day, I believe, of these hearings, there is little that could be said on this subject that probably has not already been said by others who have appeared before you. However, we would like to add a few underscores and an exclamation point or two on the points that have been raised by others and by our own organization in correspondence with you and particularly in our letter, I believe, of April 30.

In this prepared statement we state:

For more than 60 years the Volunteers of America has devoted a substantial part of its welfare services to the needs of the aging. For the first three decades of that period, our organization, like every other, was guilty of superficial thinking in our approach to serving those needs it can be summed up as a "let's do something nice for the old folks" philosophy.

Thirty years ago we saw our error and started to do something about it. We established the first of what has since become a nationwide network of what we call our Sunset Clubs-organizations of older people set up within the framework of Volunteers of America service programs. Today, those clubs enable us to reach out to the aging of the community, determine their specific, individual needs and then do our best to meet them.

We still "do something nice" for the aging-social and recreational programs, for example-but we try to do more than that. Through our welfare services we provide material aid, counseling, and guidance in personal problems, camp vacations, and housing and care in homes for the aging. Through our salvage program we provide employment opportunities for some oldsters, job-retraining and job-finding help. Through our mission churches we offer opportunities for nondenominational worship to those aged people who may have drifted away from God, and in a recent survey in Long Beach, it was somewhat startling to note that more than 50 percent of the old people surveyed attended church much less frequently than they had 10 years before, and the percentage was still higher in the lowest income group. This is something I think that religious agencies and church groups need to work on.

If you are impressed by this recital of services, I am pleased. But you shouldn't be. We and other organizations that do similar work are scratching the surface when it comes to meeting the needs, some apparent and some hidden, of our older Americans.

The bitter truth is that society, not only in our country but throughout the world, treats the senior citizen in what amounts to the same way Eskimo tribes once treated their oldsters. When we assume,

usually incorrectly, that the aged person has outlived his usefulness, all too often we turn him out onto the tundra of neglect. There he dies, alone and forgotten.

For thousands of our people, old age means the lonely furnished room, the skimpy meals in a cut-price cafeteria, the steady deterioration of body because of inadequate medical services, and-worst of all-the steady deterioration of spirit in the face of the cold, unyielding fact that nobody cares. This is startlingly true to us when we are working in a Sunset Club, for instance, located on the Bowery in New York. You would be surprised how many old folks live in an area of that kind just because of the low rent possibility and the need to stretch the meager funds they have to cover all of their basic needs. Even under the best of circumstances, where there is money and family available to the older person, many of them suffer from psychic neglect. Ours is a youth-oriented society-"old" is often synonymous with "uselessness."

What can be done about it? By voluntary agencies such as ours, very little more than what is being done now-with one important exception that I will deal with a little further on. The problems are already too vast for private agency resources, and, as the committee is aware, they are getting bigger at an incredible rate because of the increased lifespan of our people. The number of people over 65 has more than quadrupled in this century, with most of the increase coming in the last 20 years. That number, and the rate of increase, is still rising sharply, and will continue to do so as medical science further prolongs life.

Thus new approaches to meeting the problems of the aging must be found. These problems, generally, are the same as those faced by any age group-housing, food, clothing, and medical care, and social, recreational, and economic opportunities. But because of the special character of the older age group, three of these problems are particularly acute: medical care, housing, and economic opportunity, and there is where I would like to place some triple underscores and some exclamation points.

Social security provides at least minimal food and clothing, and private agencies offer increasingly more inclusive social and recreational programs.

It is the feeling of many of us in the field of work for the aging that some form of Federal, State or local financial aid or some combination of two or all three must be made available to older people needing medical care. It should be provided on the basis of actual individual need-perhaps as supplementary to social security payments and it need not take the form of so-called socialized medicine. It could operate in much the same way that persent private medical and hospital insurance does, thus maintaining our traditional doctor-patient relationships, but with public agencies acting as the insurer, just as the Social Security Administration is the insurer in our present public pension system.

I am aware of the difficulty of setting up such a program, but the fact that it will be difficult does not mean that we can continue to permit our senior citizens to suffer from pain and disease, as many of them do now. Only in larger communities are free or low-cost clinic facilities generally available to those who cannot pay for medical care, and while the American medical profession has given and

continues to give most generously of its time and talent to aid the indigent at minimal cost or at no cost at all, our older people deserve better of us than to be forced to seek charity, no matter how freely given, when they are sick.

It is also appalling to see through our Sunset Club program contacts how many of these old folks are taken in by quack cures and spend what little resources they have, buying cures for cancer and things of that nature which they can ill afford to do because they do not have the resources to pay for proper medical services.

To meet the problem of housing, too, public assistance is needed. The day of the large American household, where there was always room for a grandparent or two, and, just as important, a genuine need for the household services older people could contribute these days are gone. Indeed, we never had such households in the number that, looking rosily at the past, we now recall.

Nor are homes for the aged the answer, except in specific instances where some degree of custodial care is required. Today's older person is often too young, too filled with vitality, to be planted in a rocking chair and isolated from the community.

I feel that in our present public housing programs, special provisions should be made for a certain number of units reserved for the use of older people. It is here that I refer again to the exception mentioned earlier the voluntary agency such as ours can plan and build pilot projects for housing older people, and from them the public housing agency can learn the lessons that will save money and prevent mistakes when a large-scale public housing program for senior citizens is begun.

The Volunteers of America is now planning such a pilot project in Detroit, working with the Department of Gerontology of the University of Michigan. We face many problems in this venture ranging from design to financing, but we feel that these can all be solved. If we are right, we will bring our facilities to the attention of the Congress one day for whatever value it may possess as a field experiment. Plainly, we and other voluntary agencies could not, even if we devoted all our resources to it, solve the problem of housing the aged. There are simply too many of our older Americans who are badly housed.

Lastly, public aid is needed in solving what I feel is the most difficult of all problems involving older people-and it is one that the representative of the National Federation of Women's Clubs just mentioned the provision of economic opportunity or, more plainly, a chance to work. I say it is the most difficult because it requires a change of attitude on the part of nearly every one of us, and attitudes are hard to change.

Today, comparatively few men and women in their sixties and even later in life are ready for the economic ash heap. They can work profitably, both for themselves and for their employers. But too few of us are sufficiently convinced of this fact to act upon it. This lack of conviction is no one's fault; it simply stems from the fact that the way we feel about age has not begun to catch up with the new facts about age and aging.

Medical science has not prolonged life so much as it has inserted additional years into the lifespan. Americans remain vigorous and competent for far longer than they did only a few decades ago. Their

vigor and their competence must be put to use, both for the sake of older people themselves and for the sake of our economy. Only if they are given the opportunity to produce can older people continue to function as consumers, for financial assistance can offer only minimal incomes and the vast majority of private pension programs provide incomes only slightly above the minimal level.

Frankly, I do not have a solution for this problem, though I am convinced that it lies, in part at least, somewhere in the area of reeducation—not only of business and labor, which are directly concerned with questions of employment, but of all of us. The whole climate of opinion about the economic aspects of age and aging must be changed.

Here is where research is so badly needed, for a solution must be found. That research must be encouraged by the public agency, both with financial aid and strong leadership, for even those of us who ordinarily engage in such research are behind the parade when it comes to awareness of how pressing the problem of providing economic opportunity for older people is today.

Senator MCNAMARA. Thanks very much, General. I am sure your statement is appreciated by the committee and will be very helpful. We know that your organization works in an area that is largely neglected by many of the organizations that have testified here.

When you speak, as you do on page 2 of your statement, of the thousands of aged who live in lonely, furnished rooms, with skimpy meals in cut-price cafeterias, we know that you speak with authority because you work so much with these people.

Do you find many instances where the people that you are referring to in this category have any insurance at all?

General MCMAHON. Very little, if any.

Senator MCNAMARA. Almost no health insurance?

General MCMAHON. That is right.

This might be an answer to that question. This past weekend I had an opportunity to visit with a group of Sunset Club members from our Staten Island Club who were at one of our summer camps at Tottenville, State Island, for a weekend outing, and I took this informal opportunity to raise the questions with this group of about 60 people ranging in age from 58 to 92.

I said, "If you were going to be before the committee and make a statement on the problems of the aged, and aging, what would you like to say?" And almost in chorus the women in the group raised the health issue. They were concerned about the fact that if they had to choose between some food in the budget or something of that nature and going to the doctor with an ache or a pain, they would put off going to the doctor. Well, of course the medical field realizes that these are the warning signs of nature that there is something more serious that should be attended to and if they had the encouragement or the incentive to go to a doctor by feeling that they were not going to have to deprive themselves otherwise they would go to the doctor while there was a chance to keep them in good health and not after they had become so chronically ill that there was not much that could be done for them.

And the men in the group almost in chorus said, "A chance to continue to work," which of course is the thing that we have been underscoring in our statement to your committee.

Senator MCNAMARA. We find many of these people, I am sure, to be under 65, too.

General MCMAHON. Yes, sir.

Senator MCNAMARA. In this category.

General MCMAHON. Yes, sir.

Our club normally serves from 60 upward and many of them have been retired by industrial organizations or business or industry.

Senator MCNAMARA. Yesterday we had some testimony from the organizations that you mentioned in your report here as being cooperative, the American Medical Association. You indicated that they give most generously of their time and aid to indigent people. They recommend strongly that the Federal Government do not enter into this field until every effort has been made through the family and through local units of government to help solve the problem.

Do you think the time has come when there is a need for the Federal Government to enter this area?

General MCMAHON. My view would be that the day has arrived when we must do something. If it can be done through existing plans, fine, I am for it, but if it cannot be done and very rapidly, I believe it is time for our public agencies to step in and provide some kind of medical protection for this older age group.

If I could personalize this a bit, I have a mother who is 76 and she has had hospital insurance for 15 or 18 years, or longer, when the plans were first being established. She has never had 1 day of benefits that she required from this insurance. But does that prevent her from worrying now at her age? Of course not because she knows if she becomes ill it is not going to be a 21-day period in a hospital or a 28-day period in the hospital, but it may be 6 months; but her protection, although she has never had any call upon the benefits of this plan, is still going to cease when it reaches that point.

So there is the area where it is going to be most difficult, in my opinion to work this problem out on the private plan basis.

Senator MCNAMARA. You mention a pilot project. What type will this be, a hotel type, or a village type or what?

General MCMAHON. I am glad you asked me that. Being in Michigan, you should know about this, and you probably do, Senator. This plan is to construct a multiple-housing unit of unique construction with every room having a southern exposure, individual rooms for the old person or the old couple; but included in the plan is a medical research facility so that the staff from the department of gerontology of the University of Michigan, in cooperation with our organization, can maintain a research program there where they have this group of old people in relatively good health where they can observe them in their day-by-day living and have periodic checkups and maybe discover the answers to the cause of some of the ills that we just attribute to old age.

Senator MCNAMARA. Thanks very much, General. I assure you we appreciate your testimony very much, General McMahon.

General MCMAHON. Thank you for the opportunity of being here. Senator MCNAMARA. All right, sir.