There should be encouragement of special facilities for the chronically ill, developed in relation to appropriate medical and hospital resources. There is need for improvement of standards for institutional care and work with State and municipal agencies in their development and enforcement. Standards for facilities for the aged should be developed for use of home builders, both public and private. Standards are needed also for the operation of multiple housing developments, including guides on personnel requirements and the integrated community services needed. Further study and experimentation are important in the matter of retirement policies and preparation for retirement. Normal and stimulating social relationships and a sense of participation in community life should be maintained through adapting present programs of the public schools, the churches, leisure time agencies and other groups to the interests and needs of older people and, in certain instances, through development of special centers geared specifically to their social and psychological needs. Development of further counseling, guidance, and guardianship programs for older people is important. There is necessity for innovation and creativity plus a coordinate approach to devise new ways to meet problems in this field with their many facets. In this relatively new field of service, it is difficult to secure adequate financing from either tax or voluntary sources to develop the basic and sound community services needed to help older people to lead independent and satisfying lives. A broad program of interpretation and education for the general public concerning the increasing aged population and indicating needs and resources to meet needs would increase community understanding and undergird sound development and support for adequate services. (d) Relative responsibilities of governmental and voluntary groups in meeting specific problems as outlined An examination of the areas of responsibility covered by governmental and voluntary agencies indicates certain trends or principles which are generally common to most States and communities. Mass services, where the need is apparent for large numbers of people in a community, services which have widespread public acceptance and those calling for the expenditure of vast sums of money tend inevitably to become the responsibility of Government. Services geared to the needs of special groups, those involving intimate personal relationships, requiring a highly individualized and flexible approach to local situations, and those activities having considerable citizen interest where opportunities for volunteer participation in the program are greatest have remained the responsibility of the voluntary agencies. In general, the role of the Federal Government seems appropriately to be in the broad area of income maintenance through OASDI and old age assistance. It would be desirable for public welfare services to give increased emphasis to counseling and personal services. Further attention needs to be given to ways of stimulating public and private housing adapted to the needs of older people. There is great need for leadership by Government in realistic planning to meet the health needs of the increased aging population. The Federal Government has an important responsibility in the stimulation and setting of standards, along with financial participation in many State and local programs. However, such standards should permit flexibility in application by local communities. Community welfare councils can be helpful in adapting national standards to local conditions. Governmental agencies, as well as voluntary organizations should be encouraged to participate in community planning and to cooperate with other groups interested in services in this field. We are pleased to have this opportunity to present information on the conditions and needs of the aging based on our experience with local welfare councils as background for the Subcommittee on Problems of the Aged and Aging. Possibly a summary of our point of view could be continued emphasis, in line with the general trend in community planning today, on the fact that the vast majority of older people are not so much in need of care as in need of help in caring for themselves. This can be an important goal for all services. We appreciate the thoughtful approach and the methods of study being used by the subcommittee in an effort to gain the best knowledge and objective facts in preparation for their report to the Senate. NATIONAL REHABILITATION ASSOCIATION, Washington, D.C., August 6, 1959. Senator PATRICK V. MCNAMARA, Chairman, Subcommittee on Problems of the Aged and Aging of the Senate Committee on Labor Public Welfare, Senate Office Building, Washington, D.C. MY DEAR MR. MCNAMARA: In accordance with your recent invitation to the National Rehabilitation Association to file a statement with your Subcommittee on Problems of the Aged and Aging, please note the attached statement. On behalf of the National Rehabilitation Association, I want to thank you for giving us this opportunity. Please contact us if there is any way in which you believe we can be of help or service. With best wishes, I am, E. B. WHITTEN, Executive Director. STATEMENT OF E. B. WHITTEN, EXECUTIVE DIRECTOR, NATIONAL REHABILITATION ASSOCIATION The National Rehabilitation Association is a voluntary nonprofit corporation organized in 1925 and in continuous existence since that time. Its principal objective is to do what it can to see that every physically or mentally handicapped person in this country, without regard to age or nature and extent of disability, is given an opportunity to achieve the maximum degree of independence and usefulness of which he is capable. It publishes the Journal of Rehabilitation, a magazine addressed to professional workers in rehabilitation. It has been the sponsor of much of the rehabilitation legislation now on the statute books, including Public Law 565, the Vocational Rehabilitation Act of 1954. The interest of the National Rehabilitation Association in the problems of the aged and aging is an outgrowth of the practical problems met by rehabilitation workers in attempting to rehabilitate the handicapped. An ever increas ing percentage of the individuals applying for rehabilitation services to public and voluntary agencies are individuals in the middle and upper age brackets. For instance, the number of individuals rehabilitated in the State-Federal vocational rehabilitation program in 1958 was 74,317. Thirty-one percent of these individuals were over 45 years of age. In 1945 only 18 percent were over 45 years of age. The State rehabilitation agencies are also feeling acutely the influx of referrals from the Social Security Administration of individuals making application for disability benefits under that program. The average age of individuals so referred is 58. At the same time, rehabilitation centers and sheltered workshops are being asked to serve increasing numbers of handicapped individuals in the upper age brackets. As related to vocational rehabilitation, service to increasing numbers of older people presents a problem, since there is definite resistance to the employment of older people in most occupations. We fear that many older handicapped individuals who could profit substantially from rehabilitation services are being denied services, because there does not appear to be any justifiable vocational objective when the individual makes application for service. The problem of securing an adequate and comprehensive evaluation of the rehabilitation potentials of older people is also more difficult than in providing the same service for younger individuals. We might say at this time that we conceive of the problems of older individuals as not being, necessarily, separate and distinct from the problems of people who are not so old. These problems are, however, felt more acutely and they may arise more often. We work on the basis that the best way to help older individuals meet their needs is through existing programs aimed to improve the general health and well-being of our citizens, although this philosophy does not necessarily preclude special projects or programs aimed at assisting older people. The National Rehabilitation Association is the sponsor of S. 772, by Lister Hill, of Alabama, which would provide Federal assistance to States to help them improve their programs for the evaluation of the rehabilitation potential of severely handicapped people, establish programs of rehabilitation for severely handicapped individuals who may not be considered employable at the time they make application for service, and assist in the establishment of rehabilitation workshops and other rehabilitation facilities which will contribute to the rehabilitation of these severely disabled groups. The passage of this legislation will, we believe, contribute substantially toward helping improve rehabilitation services for older disabled individuals. In the first place, it will enable States to go all out in an effort to evaluate the rehabilitation potential of these individuals. In the second place, by removing the employability factor as a criterion for accepting individuals for service, it will enable the State agencies to provide valuable rehabilitation services to such individuals. In many instances, we feel that the provision of these services will result in vocational rehabilitation, although this may not have been considered feasible in the beginning. Although Federal vocational rehabilitation laws do not at the present time preclude acceptance of individuals for rehabilitation services on account of age, in actual practice many States, either by law or regulation, do refuse to accept older people, particularly those over 65 years of age. Generally speaking, such individuals may be considered unemployable, since they frequently have been retired from employment and because opportunities for new employment may be very few. It is difficult for States to break through the custom of arbitrary limitation of services on account of age, particularly, as long as their programs are strictly vocational rehabilitation programs. We think careful consideration should be given to whether or not Congress should appropriate sums of money to the State rehabilitation agencies, to be used in special projects designed to rehabilitate the older individual. It probably should be provided that no one project could last over a certain specified period of years. It is felt that if the States have financial encouragement to begin special projects for the rehabilitation of these older people, they will absorb such activities ́into their regular programs after a reasonable length of time. We do not believe that any changes in existing law would be required in order to make such funds available, although an amendment to the law would, no doubt, place additional emphasis upon the will of the Congress that additional efforts be made to rehabilitate this particular group. The National Rehabilitation Association is also concerned for the proper housing of older individuals, including the handicapped. It is particularly important that business places and other public buildings be so constructed as to make possible the easy entry of individuals who may be handicapped. At the present time, work is being done with the American Standards Association to try to see that such standards include construction designs that will facilitate the well-being of handicapped individuals. The committee can help by calling attention to this need in its report. Hon. PAT MCNAMARA, THE AMERICAN OPTOMETRIC ASSOCIATION, INC., U.S. Senate, Washington, D.C. DEAR SENATOR MCNAMARA: Your release of August 20 concerning your work to date and the committee report of your past activities just reached me. May I congratulate you on the thoroughness with which you are investigating the problems of the aged and aging. I particularly like your idea of interviewing "the elder citizens and giving them the opportunity to express their views. You might be interested in an incident which occurred at the National ship Training Institute for the White House Conference on Aging which held at the University of Michigan in June. The main part of this progra as you know was conducted by the Department of Health, Education, and Wel fare and was largely for training local and national leaders in various aspects of the field of aging and the part that they can play in the forthcoming White House conference. A fine little old lady of approximately 80 sat through the first day of this meeting from 9 a.m. to about 9 at night and was present at one of our final discussion groups in the evening. After listening to our discussion that evening for about an hour, she finally rose to her feet and madethis remark, "I am not quite sure what all of this study of aging is about, but I am convinced that it is no place for an older person." With this she picked up her gloves and purse and left. Your previous request to supply you with material from our national organization reached my office during my absence. I'm now pleased to supply you with the following information. The American Optometric Association recognized the importance of this age group several years ago. I am enclosing a copy of material taken from the Handbook of National Organizations concerning their plans, programs, and services in the field of aging. This is the June 1959 edition published by the U.S. Department of Health, Education, and Welfare. This contains much material which might be of value to you concerning vision care services which are available for the older age group. One of the first evidences of aging occurs to many people through their vision. This becomes apparent when they realize for the first time that "their eyes are all right, but their arms are not long enough." As optometrists, it falls our lot to explain this development as one of the natural aspects of aging. There are, of course, many other changes which take place in the vision with age. As you know, our national organization is devoted entirely to vision care, and if we may be of any assistance in supplying information or data to you for your investigation, please call on us at any time. The enclosed material which very briefly lists our present program and plans will give you some idea of the scope of our activities in this field. Sincerely, RALPH E. WICK, O.D. PREPARED STATEMENT OF RALPH E. WICK, O.D., AMERICAN OPTOMETRIC Membership and affiliates: 50 State affiliates; 10,000 members. Present programs: A national committee has recently been organized. Its title is "Vision Care of the Aging." Its functions are to investigate and report changes in vision caused by the aging process; to disseminate information to and stimulation of State committees of State optometric associations on this subject to promote attendance at national and regional conferences on aging; to consult with national agencies on the subject; to develop curriculum in schools and colleges of optometry on specific programs dealing with the aging; to prepare printed material such as a textbook, "Vision Care for the Aging,' which is to be ready approximately in September 1959; and to expand use of aids for the partially sighted. A second committee entitled the "Social and Health Care Trends Committee" is responsible for: Research and statistical studies on the economics of vision care of the aging; establishment of a national nonprofit prepayment facility for group vision care to include the aging group; serving as consultant and adviser to governmental and voluntary agencies concerned with prepayment or tax-supported plans for vision care of the aging; and collaboration with other professions and establishment of health care services for voluntary groups or tax-supported programs. At the State level, State optometric associations have committees on vision care of the aging to consult, negotiate, and serve State welfare agencies providing tax supported vision care to the aging; plan vision services for homes for improve 335 was eader unu de facilities for care of the aged requiring subnormal vision 1, committees work directly with older age groups in pre'k with local welfare agencies in serving old age assistance hers receiving general public health indigent care; and exblind pensions. [anual on the Vision Care of the Aging," to create a better awareness of the problems connected with servicing the vision needs of the aged. A speaker's kit to explain the need for and handling of vision services for the aged. A booklet entitled, "Getting Used to Bifocals," listing important rules for wearing bifocals with comfort. A reprint from "Senior Citizen" on vision care for the mature person. Plans: Increased public relations concerning the importance of vision care for the aging; the design of guides for the organization of optometric services to provide better vision care for the aged; surveys of the vision needs of the aging population; research to develop new aids for the partially sighted among the aged; and solution of some of the financial problems connected with vision services for the aged group. A book entitled "Vision Care for the Aging" by Monroe Hirsch, O.D., and Ralph E. Wick, O.D., guides for the visual rehabilitation of the aged person. Scope and methods of participation: Through distribution of printed materials on vision care of the aging; research personnel as speakers on the subject of vision needs and care of the aging; and furnishing consultants or members of an advisory committee or as general participants at these meetings. |