Against this rather grim picture of the nursing-home situation in the United States, there are these facts: More skilled nursing homes are becoming available, and Government help is increasing.

Nursing-home care is one of the medical services for which the Federal Government shares expenses with States under the public assistance programs-medical assistance for the aged and old-age assistance. Under MAA, more than $177 million was spent in 1962 for nursinghome care, and, under OAA, nursing-home payments represented more than one-third of the $390 million total spent.

In addition, Federal assistance in building nursing homes is available through four separate Federal agencies. Through the Department of Health, Education, and Welfare, grants are available to public and nonprofit organizations. Mortgage insurance for construction or rehabilitation of proprietory nursing homes is provided by the Federal Housing Administration. The Small Business Administration makes commercial loans for building or expanding homes. And the Area Redevelopment Agency also can make loans for privately operated nursing homes in redevelopment areas.

But, summed up, the services and home arrangements for disabled older Americans are too few and, in many cases, too poor in quality. This will be changing because of a new awareness of their needs by leaders in Federal, State, and local governments and in private organizations.

Chart 10

PERCENT OF POPULATION AGED 65 AND OVER IN THE UNITED STATES, 1961

ESTIMATED PERCENT INCREASE IN NUMBER OF PERSONS AGED 65 AND OVER IN U.S., 1960-70

A Short Look Back, A Long Look Ahead

The simple recognition that a problem exists is the first step toward its solution.

The problems of the Older American-documented in the preceding pages have come dangerously close to making him a second-class citizen. But recognition of the problems and their danger has prompted substantial action to solve them.

For in the past few years, the gap between how the Older American lives and the democratic goal of an independent life has been closed somewhat. Although all levels of government, private and public organizations, employers, unions, and many individuals have made their contributions, the role of the Federal Government has been particularly significant.

Some of the dimensions of this have been cited earlier, and others can be found in the appendix. But several major strides should be spotlighted.

During the 1963 fiscal year, the Federal Government will spend or administer $17 billion for the nearly 18 million older Americans over 65 and will also provide special tax savings of $775 million.

Much of the money-more than $13 billion-will come from Federal trust funds in payments for social security, railroad retirement, and civil service retirement.

General tax money will supplement these social insurance payments. It will be used to provide public assistance payments to the very needy; it will provide money for medical care for many with very low incomes; it will assist in making adequate housing possible; it will support needed social services for the aged and will make possible special programs for education, rehabilitation, and increasing employment opportunities.

These figures represent astonishing improvements for older people in the past 10 years. A fine example is the great rise in the number receiving social security checks, largely because of the expansion of the program.

Ten years ago only 3.5 million older Americans and their dependents were collecting monthly payments. Today, 12.7 million collect such payments-almost 4 times the total in January 1953.

Part of this growth results from the changes made in the past 2 years. One change, for example, lowered from 65 to 62 the age of eligibility for men to collect payment. Already more than 700,000 men have received payments as a result of this change, and eventually, about 30 percent of all men betwen 62 and 65 are expected to take advantage of it.

Another development is the increase in the amount the Public Health Service is spending on research on what happens to people as they grow older.

Just 10 years ago, only $100,000 was spent for such research. In 1963, the amount earmarked for such research is $15 million, and much

White House Conference on Aging

Legislation

larger sums are being invested in research on chronic diseases-particularly heart disease and cancer-that particularly afflict the aging. Or consider the Government's effort to increase housing specifically built for older people. Ten years ago, no program existed. During 1962, more than $550 million was committed for Federal "Housing for the elderly" programs, in the form of loans, mortgage guarantees, and long-term public housing contributions contracts.

A good benchmark for measuring what has been done recently is the progress made toward easing the difficulties of older people since the White House Conference on Aging in January 1961.

From this Conference came a detailed report charting national goals and efforts to be undertaken if, in fact, our Nation is to make possible for its older people a high degree of independence.

The progress has been impressive. Eighty percent of the Conference recommendations for specific Federal action have been carried out either wholly or to a substantial degree.

Here are some of the major improvements made since the Conference by the Federal Government in benefits and services for older Americans:

• The social security law was revised in June 1961. As a result, benefits were raised $900 million a year and more than 3.3 million people received increased payments or started collecting payments for the first time. The changes made it possible for men to draw retirement payments at 62; raised the payments of widows, widowers, and dependent parents by 10 percent; increased from $33 to $40 the minimum payments a retired worker, an aged widow, or a disabled worker could receive each month; made it easier for some older people to qualify for payments; and permitted those drawing payments to earn more without seriously affecting their social security.

The Community Health Services and Facilities Act was passed in October 1961. It authorized new programs for out-of-hospital community services for the chronically ill and aged and increased Federal grants for nursing-home construction, health-research facilities, and experimental hospital and medical-care facilities. All but two States have such programs underway.

• Changes in public assistance programs in 1962 substantially increased the Federal funds for old-age assistance, reemphasized restorative services to return individuals to self-support and self-care, and provided encouragement for employment by permitting States to allow an old-age assistance recipient to keep up to $30 of his first $50 of monthly earnings without corresponding reductions in his public assistance payments.

• The Housing Act of 1961 provided for the rapid expansion of housing for the elderly through public housing, direct loans, and FHA mortgage insurance. Commitments for housing units for older people in 1961 and 1962 were more than 111⁄2 times the number in the preceding 5 years.

• The Senior Citizen Housing Act of 1962 set up low-interest, long-term loans and loan insurance to enable rural residents

Gerontology Branch, PHS

Fice of Aging

Hospital Insurance

over 62 on farms and in small towns to obtain or rent new homes or modernize old ones.

• The programs of medical research on aging are expanding at the new Institute of Child Health and Human Development, which was set up last year in the National Institutes of Health. • Other new legislation added safeguards on the buying of drugs, boosted railroad retirement and veterans' benefits, helped protect private pension funds against abuse, and increased recreational opportunities for all.

• Free food available to those on welfare and to other low-income people has been increased in both quantity and quality.

• A new Gerontology Branch in the Chronic Disease Division of the Public Health Service has been set up. It is the first operating program dealing exclusively with health needs of the older citizen and giving emphasis to rehabilitation programs that reduce or eliminate the disabling effects of chronic diseases, such as stroke, arthritis, cancer, and heart diseases, which cannot yet be prevented.

• A new Office of Aging has been established in the Department of Health, Education, and Welfare, to assist in coordinating the many and diverse program in aging that are administered in various parts of the Department. It is anticipated that this Office will also play a major role in the administration of the proposed Senior Citizens Community Planning and Services Act of 1962.

In spite of these investments to correct the inequities faced by our older people, much more remains to be done. Their numbers are large, and their needs are great.

As the facts surrounding their health problems show, the primary need of older Americans is a basic plan of hospital insurance. President Kennedy explained the need this way in his special message to the Congress:

A proud and resourceful Nation can no longer ask its older people to live in constant fear of a serious illness for which adequate funds are not available. We owe them the right of dignity in sickness as well as in health. We can achieve this by adding health insurance-primarily hospitalization insurance-to our successful social security system.

The President's plan would extend the social security system to include hospital insurance which would cover almost everyone 65 or older and which would pay, for each spell of illness:

1. The costs of up to 90 days of inpatient hospital services, with the patient paying $10 a day for the first 9 days or at least $20; or for those people who so choose the costs of up to 180 days with the patient paying the first 22 days of average costs; or all costs for up to 45 days of hospital care.

2. All costs of up to 180 days of care in skilled nursing-home facilities affiliated with hospitals after transfer of the patient from a hospital.

3. All costs above the first $20 for hospital outpatient diagnostic service.