Mr. SIDNEY SPECTOR, THE DALLAS HOME FOR JEWISH AGED, Dallas, Tex., August 7, 1959. Staff Director, Subcommittee on Problems of the Aged and Aging, DEAR SIDNEY: Thank you for your kind letter of August 4. It pleases me to have your comments on our new association and to note that you recognize the significance of the development. I am enclosing a statement which will attempt to reply to the points that you have asked about and which may be included in the proceedings of the hearings. With regard to appearance before your subcommittee, either I or any of our officers will be glad to appear and to cooperate in any form that we can upon your invitation. I am certain that I am speaking for Jack Gold and Dr. Sol Geld, my cochairmen. If you feel that the enclosed material is not sufficient for your purposes, please feel free to call upon me. Sincerely yours, HERBERT SHORE, Executive Director. STATEMENT OF NATIONAL ASSOCIATION OF VOLUNTARY JEWISH INSTITUTIONS (A) Present programs: (1) To provide a means for nationwide communication with and representation from the institutional field of the care of the aged. (2) To foster and promote recognition of the role of institutions serving the aging and aged, especially their contribution toward the welfare of the aging and aged. (3) To work with other organizations representing institutional care of the aging and aged. (4) To facilitate exchange and distribution of information and experience to all institutions for aged in the United States and Canada. (5) To establish a forum for advancement of knowledge of the field through the means of workshops, meetings, studies, and discussions among practitioners and lay leadership. (6) To work toward the objective of establishing a national organization to be broadly representative of institutions caring for the aging and aged. (B) The association will actively participate in a session on "Toward a Definition of a Modern Home for the Aged" which will be held during the annual meeting of the Gerontological Society in Detroit, November 12, 13, and 14, 1959. It is hoped that at this session steps will be taken toward the creation of a national association of homes for the aged, that will be representative of all national, religious, State, etc., nonprofit groups. (C) The specific problem as we see it is that unfortunately there exists considerable misunderstanding as a result of semantics and that when certain terms are used, these evoke in the mind's eye of an individual a particular frame of reference. Consequently, by using a term such as "home for aged," one individual conceives of it as a facility for ambulatory, another as a facility for indigent, a third as a facility offering no nursing services, and yet another as a facility offering comprehensive care and the most modern social and medical services possible. At the National Conference on Nursing Homes and Homes for Aged sponsored by the Public Health Service in February of 1958, it became clear that the voluntary, nonprofit home which had for more than a century in this country pioneered programs of care for the aged, became completely misunderstood and submerged by the highly organized proprietary nursing homes. Even the definitions prepared for the "Guide for State Surveys" and presented at the National Leadership Training Institute at Ann Arbor in 1959 perpetuated this misunderstanding. Consequently, our organization is attempting to develop a suitable working definition which can set the modern institution into its proper context. copies of such a definition are enclosed. Our organization believes that for those older people who are required to live in a home for aged for a variety of rea sons, these facilities should be the best and most highly organized and devel oped, comprehensive facilities that the community offers. Two (D) Our association supports and endorses the highest possible standards of service and, as such, works with all voluntary groups, local community groups, and all State and Federal agencies responsible for creating licensure standards. We feel that it is our responsibility to continually demonstrate and experiment with new programs and services, to encourage and report research so that knowl edge gained from such programing can be shared and taken over by public and other programs to the end that the older person receives the best possible care, TOWARD A DEFINITION OF A MODERN HOME FOR THE AGED The modern home for the aged is a comprehensive care facility serving as A group living arrangement in a protective environment (for "well" aged, long-term chronically ill, senile, and rehabilitative aged). A skilled quasi-hospital (with medical, psychiatric, nursing, dietary, occupational and physical therapy, and all preventive, curative treatment, and social services). A social agency providing casework, group work, adult education, recreation, and day care services for nonresidents. A rehabilitation, training, and research center. A spiritual facility (with a well-rounded religious program). A diagnostic center (for study and evaluation of older people and their adjustment). These multiple functions, services, and programs to achieve satisfying, wellrounded opportunities for older people, meeting their social, emotional, physical, and spiritual needs. HERBERT SHORE, Dallas Home for Jewish Aged. TOWARD A DEFINITION OF A HOME FOR THE AGED (By Dr. Solomon Geld, executive director, Daughters of Miriam Home and Infirmary for the Aged, Clifton, N.J.) FOREWORD On the eve of formation of a national association of Jewish homes for the aged and its hopeful amalgamation with other denominations toward an American associaiton of homes for the aged, the quest for a definition is understandable though not of primary import in terms of current functions of the homes and future goals. Their heterogeneous character, which is rooted in the variety of motives o ftheir founding fathers, in the various modes of living of their respective populace, and in the difference of specific needs-will continue. Nevertheless, in view of the prevalent misconception about homes for the aged-even among groups directly concerned with the broad subject of aging-a discussion leading toward an acceptable definition may be valuable as an orientation point for the general public and as a scale to be used for the homes to assess their own specific weight of present and future functions. Public relationswise we are prompted by a lack of adequate recognition of our homes on the national scene. Among ourselves we are motivated by the continuous change of pace of our homes. In fact, the outstanding constant factor of our programs is their continuous change in adaptations to changing needs. Art Waldman of Philadelphia fame, with whom I discussed this, came out with a very sophisticated reasoning which he expresses as follows: "It is difficult to define a metamorphosis. It is easy enough to describe a tadpole and easy enough to describe a frog, but when the animal is changing it becomes very difficult by way of definition, particularly so since the animal we are talking about is taking on a new form which I think will not be definable until such time as structural changes are set. We now only have a Bikini-like garment which covers very little but suggests a lot." THE PAST The past development of our homes as well as their current multiple functions are amply described in the two papers of Morris Zelditch, one entitled "Historical Perspective on the Care of the Jewish Aged," delivered 2 years ago at the national conference; the other, "The Home for the Aged", delivered in April of 1957 at the New England regional conference of the council. The reading of both of them is respectfully recommended to all of us who wish to develop the healthy habit of holding up a mirror for the purpose of self-study and improvement. 47461-59- -22 THE PRESENT On the basis of extensive reading of publications emanating from homes for the aged and from national coordinating bodies and as the result of discussion with some 60-odd administrators of homes in various sizes, character, and religious denominations within the Metropolitan New York area, I offer the following definition of a home for the aged, with the plea that it be understood dynamically with the implication that the object of our snapshot has been constantly moving before, during, and after we have taken it: "In the current constellation of interests, services and communal care of the aged, a home for the aged is a voluntary permanent, (1) usually sectarian community (2) of predominantly elderly men and/or women, (3) sponsored, planned (4) and supervised by either governmental, (5) and/or fraternal, (6) and/or (7) religious bodies, acknowledged as a nonprofit social enterprise and designed especially but not exclusively (8) as a protective environment within a circumscribed single or multiple (9) physical setting, for that segment of our elderly population whose declining years (10), accompanied frequently by physical, mental, economic and social deprivations, postulates an adequate philanthropic service subsidy, the size, variety, and quality of which ranges from a minimum of food and shelter plus rudimentary social program given exclusively to those within its walls (11), to the widest network of professional social and medical services given in cooperation with related health and welfare agencies (12) to both its resident population and, tangentially, in various degrees to the aged population of its surrounding community (13)." GLOSSARY (1) Permanency of residence is distinguished from the generally transitory character of boarding and nursing homes and from hospitalization, notwithstanding the fact that some aged leave a home and some stay permanently in boarding homes. The whole battery of service facilities and programs revolves around this principle of permanency which is the outstanding feature of a home for the aged. (2) A community of the aged implies a continuous process of social interaction among the residents themselves, among the residents and staff, in the daily routine of living together, a process which is fostered and strengthened by the home's variety of special programs purported to give the aged social status. A home for the aged with anonymity or isolation of residents, which is frequently found in boarding and nursing homes, is functionally a contradiction in terms. (3) Age limitation is still a primary factor although some homes with quasimedical facilities find it necessary to admit patients with prolonged illness in their forties because a lack of other communal resources. (4) Planning with a client and his family by lay and/or professional people prior to placement is another demarcation line separating the home from commercial nursing homes, hospitals and boarding homes, where placement can be effected by means of a single contact between client and/or his physician and the admissions office or proprietor. (5) E.g., county welfare homes. (6) E.g., Masonic home, homes for retired ministers, firemen, Landsmanschaften, etc. (7) A nonprofit home for the aged, though under fraternal or religious sponsorship and overall responsibility, has, as a rule, a silent partner in the local, State, and Federal Government by virtue of the latter's authority to license and approve it by means of its direct capital of indirect budgetary participation and by granting to them tax-exempt status. (8) There are homes, particularly small ones of 10 to 15 residents, under Protestant sponsorship which in terms of functions are resident clubs of the well aged exclusively. I know a Presbyterian minister who is the executive secretary of nine such homes scattered in a wide geographical area in Pennsylvania. (9) E.g., the central house and its extension facilities, apartment projects, residence clubs. (10) "Declining years" is an admittedly ambiguous term which is purposely being used to emphasize the heterogeneous attitudes of the homes concerning their desirable aged clientele. (11) See note (8). (12) Case work, group work, hospitals, city and county welfare boards, etc. (13) By surrounding community we mean either the total population of a town or county of the neighborhood of the home in a large city. THE FUTURE The growth of the number of the aged, which resulted in greater public recognition that they have, as of right, a functional place in American society and as such should be active as long as possible, suggests the prognosis that there will be a gradual curtailment of intake of the well aged into homes for the aged. Those among the aged who have a degree of self-sufficiency will be able to function in the community with the aid and support of extramural services if, and when, necessary. With the reduced intake of the well aged, the home will become predominantly a "therapeutic community" (a term used recently by Dr. Alvin Goldfarb, of the New York State Mental Hygiene Commission), "a geriatric medical center" (as projected by Dr. Gittleman of the Brooklyn Hebrew Home and Hospital for the Aged) or "an intermediate medical facility" with strong hospital ties (as defined by Drs. Manuel Rodstein and Frederick D. Zeman in a soon to be published paper, "Utilization of General Hospitals for the Population of a Modern Home for the Aged”). When that happens some features of the present operations may gradually dissolve, such as permanency of residence, sectarian sponsorship and clientele, geographical, age and sex limitations. Conversely, the medical service facilities, personnel, and program will grow and with them the minimum size of the home to justify economically the variety of costly services in relation to average daily bed occupancy and the number of patient days during the year. In the development of the home from a predominantly social to a predominantly medical and therapeutic community, the homes under Jewish auspices are setting a remarkable pace. THE NAME In view of the transition from singular to multiple functions, some homes have changed, others have advocated the change of name "Home for the Aged." Thus we have the Jewish Center for the Aged in Atlantic City; the team of Felder and Wiseman, administrators of the Menorah Home and Hospital for the Aged, recommended to their board a year ago a change to Menorah Geriatric Center, motivating that recommendation by the fact that they encompass with the agency a variety of intramural and extramural service to the aged. Personally, I have no definite opinion on the desirability of changing the name. The function of a home is such that no name having three words can fully encompass it. The name is a public-relations tool for the general public for the purposes of easy identification and remembrance. The Drexel Home, the Newark House, the Kingsbridge House are just as good, if not better, than the terminology which includes the word "aged" (as you know, in Israel the homes are called parents' homes, corresponding to children's homes). The use of the term "hospital" in conjunction with the term "home" is not always honest. I am inclined to think that the name is not important. By way of illustration, the word "pontifex," from which the English pontiff is derived, meant originally bridgemaker. It has come a long way from the early days of Rome's founding fathers to its present meaning. Similarly, I think in time people will learn to identify a home under any name with its actual function. First and foremost is the function, the meaning, the work-then comes the title. That is, after all, the purpose of our discussion toward the definition of a home for the aged. JUNE 1, 1959. STATEMENT OF CHESTER D. SwOPE, D.O., AMERICAN OSTEOPATHIC ASSOCIATION The American Osteopathic Association, as representative of a health profession legalized and practiced in all the States, is manifestly interested in the efforts of this subcommittee to alleviate the problems of the aged and aging, particularly those bearing on health maintenance. We welcome the invitation of the chairman to be of assistance. Several years ago the association set up the American Osteopathic Academy of Geriatrics to make special studies and to organize study groups to interest the members of the osteopathic profession in the subject of geriatrics and to keep them abreast of developments. A number of State laws require refresher courses for osteopathic licensees, and these sessions afford additional opportunity for considerations of current developments. In addition, the organized profession actively participates in conferences on aging at the National and State and local levels. Four hundred and nine hospitals are staffed by physicians and surgeons of the osteopathic school of medicine. In these, as in other hospitals, the percentage of occupancy by patients 60 years of age or older has greatly increased. More diagnostic centers and rehabilitation units could and should be set up with the assistance of Hill-Burton funds to relieve these institutions of persons who can be cared for in their homes. More institutions for the aged and chronically ill should affiliate with general hospitals to obtain the services of well-trained medical and related personnel. Prepaid health insurance plans for the aged should be encouraged. In 1956, by way of the Social Security Amendments of 1956, Congress expressly encouraged the States to purchase coverage from medical insurance plans for the benefit of their public assistance recipients, but Colorado was the only State that did so. A number of private carriers are now offering health insurance to the Financial support is needed from Federal and State Governments, private foundations, and individuals for basic research on aging. aged. During 1957-58 Federal grants to the States for old-age assistance totaled more than $1 billion. The previous year, the amount approximated $1 billion. Much of that could be devoted to research on aging and training of research personnel if employers, public and private, were educated against indiscriminate compulsory retirement. In 1953 it was estimated that the Nation was losing $3.8 billion a year by not using the productivity of older workers. Furthermore, nonworkers suffer far more bed-disabling days than do those usually working. The number of bed-disabling days per person for males aged 65 and over during the period July 1957-June 1958 was 6.3 for those usually working and 20.6 for those not working. For females aged 65 and over for the same period per person for those usually working the number of bed-disability days was 5.1, for those keeping house the number was 12.6, and for the others the number was 36. The More funds should be made available for applied research in geriatrics. osteopathic schools of medicine, in common with the other medical schools, are participating in the research and training programs of the National Institutes of Health in such fields as cancer, cardiovascular diseases, arthritis and metabolic diseases, neurological diseases and mental health, which may be said to bear a primary relation to aging. Lectures and clinical courses are given in the care of the aged, under the subject of gerontology, and kindred subjects throughout the curricula in our colleges. The American Osteopathic Association will continue to work with private organizations and Government agencies for the advancement of the health care and welfare of the aged. We will be pleased to be of any further assistance to this Senate Subcommittee on Problems of the Aged and Aging. NATIONAL CATHOLIC WELFARE CONFERENCE, Hon. PAT MCNAMARA, U.S. Senate, Washington, D.C. DEAR SENATOR MCNAMARA: I am pleased to send you herewith a statement submitted by Msgr. Raymond J. Gallagher on behalf of the National Catholic Welfare Conference in response to your invitation of July 17, 1959. Sincerely yours, PAUL F. TANNER, General Secretary. STATEMENT OF MSGR. RAYMOND J. GALLAGHER, NATIONAL CATHOLIC WELFARE CONFERENCE The growing concern of the Nation for the problems of the aging is a very encouraging phenomenon. Like many social problems of broad application, more has been said in surprise and amazement at the size of the problem than has been said in constructive programs. The Catholic welfare services in the United States have been active in the field of the aging for many generations and are pleased with the prospect of wider national attention to the challenge which the aging population presents to us. We are pleased to submit the following statements regarding the broad activity of the Catholic Church in the |