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We have also taught some individuals on therapeutic diets, as requested by the physician.
In considering what needs to be done, the licensing regulations should include more definite nutrition requirements and food service standards. The licensing agency would then follow and interpret these regulations.
The State health agencies should be encouraged to step up participation in work with the aged.
In some instances it might be well to increase professional staff. There are only nine States who have a nutritionist now who works full time with the aged or chronically ill. A further study of nutritional requirements of the aged should be encouraged and referred to the proper laboratories and organization.
At the present time, we know that the older person requires fewer calories but for all other food nutrients were are accepting the standards for other adults. Research probably should be done in this area.
A simple uniform accounting system with the accompanying forms for nursing homes might give a basis for comparison of home to home. This would assist in part as a basis for rate structure in a given community. The menu should be available for review to compare with purchase of food.
A simple kit could be developed by our association with the nursing homes, which would give nutritional standards and foods needed to attain them. A simple menu system, simple purchasing information, accounting procedures, sources of standardized recipes, and instructions for the routine diets which may be served in most nursing homes. Homemakers and retired professional workers could be offered refresher courses to prepare them to participate more effectively in communities on programs, or committees, and as consultants in nutrition and food service. This is something which probably could be a State or Federal supported program.
In some industrial organizations where they have had preretirement lectures, nutrition lectures have been given and were well received.
This point was not in our statement which was submitted to you, but it should be emphasized, that nutrition is for everyone, not only for the aged. We would like to see a program in which we would publicize good nutrition for everyone, whether it is the aged person living alone, or in an institution, or in the family which included the aged person. There are many programs which give misinformation or which perpetuate food fads. It would seem that radio or television could be encouraged to carry programs giving correct nutrition information in a stimulating and authoritative manner on a continuing basis.
Recently, the Department of Agriculture revised "Food Guide for Older Folks." I do not know just how much publicity it has received but this guide is one reference which should be publicized.
I thank you very much, Senator McNamara, for the privilege of making the statement.
Senator MCNAMARA. Thank you. Your information and suggestions and recommendations are surely very pertinent and the subcommittee will give them consideration.
Thank you for your contribution.
Mrs. LARSSON. Thank you.
(The statement referred to above follows:)
STATEMENT FROM THE AMERICAN DIETETIC ASSOCIATION, CHICAGO, ILL.
The American Dietetic Association is an educational, scientific organization of about 14,000 professionally qualified dietitians and nutritionists. Approximately 47 percent of the members are engaged in hospital dietetics and 4 percent are nutritionists. Thus 51 percent of the membership have potential to give service to the aged. Members of the national organization are also members of the 52 affiliated State dietetic associations. There are about 135 local dietetic associations.
(a) A summary description of your interest and work in the field of aging The members of the association are interested in maintaining and improving the nutrition of the aged and aging. The services rendered to this segment of the population are concerned with nutrition and related areas.
Members as individuals and as members take part in planned association activities participating in giving service to the aged in the following ways: (1) Counseling and teaching individual senior citizens, in their homes and in institutions, the importance and need of eating good food. Interpreting therapeutic diets as prescribed by the physician.
(2) Teaching groups of the aged about nutrition. Senior citizen centers, community centers, golden age groups and special meetings afford these opportunities.
(3) Evaluating the nutritional adequacy of food served in homes for the aged. This was a national project of the association in 1949. A followup of this study was conducted and published in 1957 in the Journal of the American Dietetic Association.
(4) Giving assistance to the personnel in homes for the aged and nursing homes. Consultation service has been given to these institutions. Administrators and cooks have been instructed in ways to improve food service.
(5) Developing and publishing a booklet entitled "Eating Is Fun-For Older People, Too" was done as a national project. The booklet has assisted the homes for the aged and the nursing homes materially because of the basic and elementary principles it contained concerning food service. Eleven thousand copies have been sold. Publishing and distributing a leaflet entitled "Forget Birthdays." Approximately 95,000 copies have been distributed.
(6) Participating in home care and rehabilitation programs and assisting in the development of programs similar to "meals on wheels."
(7) Publishing in the Journal of the American Dietetic Association much of the original research that has been done in the area of nutrition of the aged. (b) Some analytical evaluation of your activities with an indication of additional responsibilities you might logically undertake
In the participation of the activities listed above, we have established the need for nutrition services in the medical care programs as well as the community programs for the aged.
Further services could be rendered by employment of part-time or shared dietitians by institutions providing care to the aged in a given community.
Further development of ways and means to feed the aged who are unable to do so themselves because of physical restrictions or financial limitations is needed. Programs such as Meals on Wheels have great potentialities. It has been suggested that group feeding similar to the school-lunch program could be considered. It seems highly probable that the present school-lunch facilities could be used as a basis for this service.
Further committee and project work could be undertaken to determine food habits of the aged and this information used as a basis for community action. A survey of activities by members would assist in an evaluation of kinds of assistance now being given and would point the way to other areas in which dietitians and nutritionists could work.
The association could more pointedly indicate the responsibility each member has to contribute to community programs for the aged. Perhaps more emphasis could be given to the nutrition of the aged in programs at local and State association levels.
(c) The specific problems of aging as you see them out of your own organizational experience
(1) Less interest in food is shown by persons living alone.
(2) Many aged individuals live alone in one room with limited facilities for cooking.
(3) Many aged individuals cannot or do not know how to get the best return for their food dollar. Additional problem is that of shopping.
(4) Lack of understanding and interpretation of therapeutic diets prescribed by physicians.
(5) Institutions for the aged frequently do not feed their patients and residents food that will meet the recommended nutrition standards of the Food and Nurition Board of the National Research Council.
(6) Institutions frequently serve the evening meal so early that patients and residents are often hungry before the next meal.
(7) Institutions are restricted in their purchase of food because of limited funds.
(8) Nutrition is not always included in programs for the aging inasmuch as this area is not represented on the planning program.
(d) The relative responsibilities of voluntary groups, local committees, the States and Federal Government in meeting these specific problems as you have outlined them
In almost every community where voluntary groups are found there will be professionally qualified dietitians and nutritionists who will be helpful in planning programs for the aged. Their particular contribution and participation will be in nutrition education programs for the older population such as talks, demonstrations, and counseling of diet upon referral by physicians. Nursing homes and homes for the aged would be encouraged to improve nutrition and food service if the State licensing agency would incorporate improved standards in this area in licensing legislation and if they would enforce and interpret these standards in granting licensing.
Nursing home associations could be encouraged to employ a nutritionist or dietitian who would give counseling and consultation service to the homes belonging to the association.
The tate and Federal Governments by supporting and participating in giving refresher programs to homemakers and retired professionally qualified dietitians thus better preparing them to participate more effectively in their own communities, as part time, shared and consultants in nutrition and food service to the aged in his home or institution.
It would seem reasonable for the State and Federal Governments to stimulate activity to extend or increase the consultation service to groups providing nutrition service to the aged.
The nutrition services in State health agencies should be encouraged to develop and to step up their participation in working with the aged.
Senator MCNAMARA. Now from the Friendly Seniors and Unitarian Church, Mrs. Helen Duey Hoffman.
Mrs. Hoffman, since it is rather late and we have gone well past the time when we should adjourn, I am going to ask you this question: Would you like to proceed briefly or would you rather come back at another time when we can give you more time?
STATEMENT OF MRS. HELEN DUEY HOFFMAN, THE FRIENDLY SENIORS OF ALL SOULS CHURCH (UNITARIAN)
Mrs. HOFFMAN. I have already made a statement which is here on the table.
Senator MCNAMARA. You have a prepared statement. We will make your statement part of the record.
(The statement referred to follows:)
PREPARED STATEMENT OF HELEN DUEY HOFFMAN, THE FRIENDLY SENIORS OF ALL SOULS CHURCH (UNITARIAN)
The men and women who call themselves the Friendly Seniors meet every Tuesday in the year for lunch and a planned program, including current events, a speaker, music, announcements, movies, discussion of books, social and civic problems, and card games. The hours are 12 noon to 4 p.m. Rain or shine, an average of 45 from a membership of over 100 attend these interesting meetings. Race and religion are no bar to membership.
This story, taken from the record, tells how, when, and why they organized themselves. About half of them are Unitarians. The others are from various religious groups: Protestant, Jewish, Catholic, or none at all. Politics and religion, as such, are not discussed.
The current problems group, otherwise known as the adult education group of All Souls Church (Unitarian), which meets at 9:45 a.m. Sundays, decided to use the whole month of April 1952 to discuss the challenge of an aging population. Subjects and speakers were as follows:
(1) Housing: Helen Duey Hoffman.
(2) Health: Dr. Joseph Mountain, U.S. Public Health (State Services Director).
(3) Employment: Ewan Clague, Commissioner of Labor Statistics, Department of Labor.
(4) Challenge of an Aging Population: Clark Tibbets, Chairman on Aging, Social Security Board.
There were over 100 men and women attending. There seemed to be three groups: 20 to 30 years of age, who seemed much concerned about parents or older relatives; 30 to 45 years of age, who seemed much concerned about their present jobs and their future retirement; and the 45 to 90 group, vho asked few questions of the speakers, although they seemed concerned about their problems.
In December 1952 the board of trustees authorized and directed that a committee of five persons be appointed to explore the feasibility of setting up an agency for the utilization of the skills and experiences of older people.
It was pointed out that the use of these would benefit society and at the same time give satisfaction and recognition to older people. Also, that this is a problem of wide community importance and that it might be possible for us to demonstrate some of the steps needed to meet the situation.
The committee named by the board consisted of Lloyd Luther, Helen Duey Hoffman, Commodore Frederick Dillon, Walter G. Smith, and Marian Halsey. The committee elected Commodore Dillon as chairman and Marian Halsey as secretary.
To carry out the assignment, the committee wished to know (1) who the persons are who desire to have their skills and experiences made use of, with or without compensation; (2) who are the possible employers within or outside the church, willing to hire older people on a full- or part-time basis; and (3) what special projects could be developed.
Employers were invited to get in touch with a member of the committee. Senior members, interested in employment of some kind, were asked to fill out a questionnaire and to arrange for an interview.
The committee recognized that useful employment is a morale as well as financial problem; and is national in scope.
The projects was described as not a
charity, not a Goodwill Industry, and not a recreation project for older people. That is left to the District of Columbia Recreation Department.
The 30 or more free recreation programs cover music, lectures, concerts, drama, public speaking, singing, dancing, etc.
Announcements of the project were made in the church publications and to the 14 organizations within the church.
The committee recognized the problems in general, but not in particular. One must be over 65 years of age to understand the problem. To understand what it means to be over 65, one must be that age. To know pain, one must feel pain. However, they did lay the groundwork for a project which could in time deepen their insight into the challenge of an aging population. In many respects, the committee seemed to have a broader outlook than that of any other group locally or nationally in the year 1953.
The recommendation was as follows: A senior council with a social worker at its head who had a knowledge of the psychology of older people, with ability to arouse incentive, where possible, in these people, and to encourage a receptive attitude toward the efforts of the agency. Emphasis was placed on adjusting older people to their environment where possible.
Ways and means for paying the full-time social worker was important. The senior council could not run itself without a skilled worker. If such could be provided, the senior council would then function along these lines:
(2) Cooperation with existing agencies engaged in similar or related work-U.S. Employment Service; District of Columbia Recreation Departmen; Goodwill Industries; etc.
(3) Investigation and arrangement of employment with special attention to cases furnished herewith.
(4) Find employers and arrange meeting prospective employees; personnel work.
(5) Establish a repository for up-to-date information on all forms of retirement-Government and private:
A. Old-age pension.
B. Social security benefits.
C. Workers' compensation, etc.
The committee soon found that interest was keen, advice was plentiful, and suggestions were many. Out of all this came the following problems of people retired or at leisure as expressed to members of the committee:
(1) Housing.-Older people are not acceptable in most apartment houses. The reasons given seem to be that older people are considered a nuisance and a risk. They are at home all day, are lonely, have illnesses, want and need attention. Rooms to rent are usually in big old houses with hazards of stairs, lighting, and fire escapes. Rents are too high and steadily increasing. Young people are preferred. Almost no older persons wants to buy a house, and those who have purchased one have found it unwise.
(2) Health services.—Insurance companies have ways of canceling hospital, surgical, and medical insurance policies even after 20 or 30 years of payments; sometimes this is done when the policyholder reaches 60. Usually it is done at 65 years of age. Many companies will not accept people over 40. Doctor bills and medicines are steadily going up and eat deeply into savings. Nursing homes are so expensive, $300 a month up. Anything below that cost would not be sanitary or well run. Managers prefer bed patients, not those who are ambulatory. They can be better controlled. People chronically ill cannot afford to go to hospitals, and do not want to do so, since they are not usually emergency cases. There are almost no infirmaries for the chronically ill. An infirmary bed costs less than half the cost of a hospital bed. Church and fraternal homes will not take bed patients. As it is, they have long waiting lists. All property must be turned over to them.
(3) Incomes.-Pensions, social security, annuities.-Three-fifths of the nearly 16 million over 65 have under $1,000 a year to live on. Very few have enough to maintain their former standard of living; hence, difficulty of adjustment to environment. Since the continuously rising cost of living affects the dollar so seriously, food and shelter costs take most of the income. Clothing, shoes, recreation, carfares, amusements, church contributions-all these are becoming less and less possible. About three-fifths of the older people are no longer part of the so-called buying public. Most older people get little or no medical care; hence, chronic illness prevails.
The careful planning of 20 or 30 years ago for the day of retirement has failed of its purpose, since the dollar is now worth only 50 cents. Until a more stable economy prevails history will repeat itself.
(4) Loneliness.-Cut down from a longtime standard of living to a mere existence, cut off from associates in office or industry, unwelcome after a while at