manpower pool from which future service workers and research workers will come. Similarly, if all the emphasis is on current service, we will not increase the body of knowledge by which future service will be improved. Manpower needs must be anticipated, for they cannot be met overnight. The diversity of knowledge and skills required to implement a sound national program for the aging requires lengthy periods of training. The abilities of the scientists, practitioners, and technicians who seek solutions to the problems of aging and who apply the solutions are one of our most valuable resources. We believe that attention should be given now to determining the present and future needs for scientific and professional persons qualified to contribute to a national program for the aged and aging. During the past several years, one member of our association, Dr. George W. Albee, has studied in great detail the manpower trends in the field of mental illness and health. In his recent monograph, "Mental Health Manpower Trends," prepared for the Joint Commission on Mental Illness and Health, Dr. Albee states: "The lengthy educational preparation of professional personnel in the field of mental illness and mental health makes pessimistic the prospect that their number can be increased sufficiently to meet social needs." Such severe manpower problems in an already established and to some extent overlapping field suggest that it is absolutely essential to give immediate attention to manpower needs in the field of aging and that, even as such attention is given, the Nation will, in the years ahead, experience difficulties in providing the skills and talents which the field of aging deserves. Since the manpower needs require high levels of skills and knowledge, much of the training involved will be the responsibility of the Nation's universities. Graduate training programs leading to specialization in the field should be encouraged. Such programs will be necessary in the several disciplines which now contribute to research and services. Recently, doctoral training programs in psychology with the psychology of aging as an area of concentration have been established in a few universities. These programs involve an expansion of the present graduate program in psychology and, in some instances, are being undertaken with the support of the National Institute of Mental Health. University funds are generally too limited to provide additions of staff with specialized interests; long-range training grants would permit the establishment of training programs to meet present and anticipated needs for specialists in the field of aging. As yet, neither this association nor its division on maturity and old age have evaluated the potential needs for psychologists in the several areas of research and services relevant to aging. Such a manpower study is one of the contributions this association might make. A coordinated series of such studies by this and other scientific and professional associations could supply very useful information for national planning to meet manpower needs. CONCLUSIONS A resource of increasing importance in this Nation is its older people. The degree to which they continue their responsibilities as citizens, their activities as family members and earners of a livelihood, and their adjustments in pursuing a satisfying way of life is of major significance to all age levels in society. It has important implications for a democracy dedicated to the principle of the dignity of the individual. The achievement of a longer period of healthy functioning is an objective to which psychologists can make useful contributions. Progress may be expected to encounter practical problems of increasing magnitude due to the probable changes in age composition of the population and will require greater knowledge and understanding of the process of aging. The American Psychological Association and its individual members have, for a long time, been interested in the problems of the aged and aging and have been active both in the research and service aspects of the field. This interest and activity has been increasing markedly during recent years. The association wishes to be as helpful as possible in the development of this important area of national concern; it appreciates the present opportunity to state its interests to the Senate Subcommittee on Problems of the Aged and Aging and offers its services to the subcommittee as may be needed. Mr. SIDNEY SPECTOR, THE DALLAS HOME FOR JEWISH AGED, 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 asA 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 improve ment. 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. |