cine and hygiene which particularly pertain to older people. Nutritionists of city departments offer group counseling on nutritional needs and food preparation. The center membership is frequently invited to be guests at public and private places of interest and entertainment; for the first time, many of the older people are using the community facilities which they helped to build.

VII. Membership

Participants in the program come from various sources: By direct invitation, by announcements, by posters, and by advance notices published in the local newspapers. Cooperating agencies such as hospitals, schools, libraries, churches, the social-security board and the public welfare agency itself can make the new service known to the older people they serve. Local club groups and fraternal organizations are invited to refer their own members or parents and grandparents of their members to the day center. In communities where it is possible to canvas from door to door, as in a housing project, volunteers can extend personal invitations.

At the formal opening to which potential members and representatives of community organizations have been invited, volunteers can bridge the feelings of loneliness by the creation of an atmosphere of friendliness and warmth, introducing people to each other and showing them through the facilities which will be theirs to use and enjoy. After brief announcements to explain the purpose of the center, the days and hours it will be open, and the activities which it offers, the serving of refreshments will set a party tone to the gathering. A musical program which can start community singing and dancing is a helpful device.

A guest register will provide a mailing list for later invitations to the more reticent or fearful older person, and there should be arrangements for the registration of those who wish to join the center at once.

The opening day usually brings the smallest part of the total membership, for the largest single source of new participants is by word of mouth-by invitation from an active member to a neighbor, a friend, or to the stranger who sits beside him in a bus.

CONCLUSION

The value to the community of the day center for older people is implicit in the degree to which the day center program promotes the preservation of personality and mental health. Since the major emphasis is prevention, the group activities are geared to arrest and to prevent the deterioration that comes from the older person's feelings of insecurity and rejection. He is given opportunity for activities which make possible a sense of adequacy and accomplishment. In a community that provides acceptance, companionship, and warmth there is fulfillment.

In evaluating the day center program, many positive changes are observed in the individual member. He moves from his isolation into a community. He has a place to go each day-a reason to dress and prepare himself for association with other people. He has a place to go-a reason for going. He has something to do something which interests him and which he does at his own pace. No longer isolated, he is physically active and mentally stimulated. He has the opportunity for the continuation or renewal of meaningful social relation

ships. He learns to approach reality situations, accepting and adjusting to his aging in a setting with his contemporaries which promotes change and growth.

Isolation can extend even to the older person living within a family group. Too often, the parent or grandparent demands and competes for an excess of attention and affection. Through the center, he becomes an active part of the fabric of the community, using his daytime hours effectively and with satisfaction. He has a new source of emotional gratification and spares himself rejection by the family which resents the demands of emotional dependence. As he becomes less demanding, his family more readily gives him affection and relationship.

As the senior citizen becomes a healthier personality through his integration in the life of the center, he contributes to the well-being of the total community. With purpose, with direction, with activity in his life, there is no longer the pattern of inertia that produces physical and emotional deterioration. There is a lessened need for institutional care. The rate of admission of center members to institutions is considerably lower than the rate for the same age group in the general community. This is true not only for mental hospitals, but also for general hospitals, homes for the aged, and nursing homes. The center member becomes a community member and is less anxious to withdraw to a completely protected dependent environment. Community funds are better spent for a preventive program than for the costly construction and maintenance of additional homes and hospitals.

A study of clinic attendance by a group of the members for a period before and after joining a center disclosed the fact that from the time of membership there was a 50- to 70-percent reduction in the total number of clinic visits. It was also found that the extent to which these clinic visits were reduced for any particular individual closely correspond to the extent to which he has become involved in the activities of the center. In fact, it is sometimes necessary to prod the members to attend clinics if they become overabsorbed in center life.

The clinic habitue who sought companionship in the waiting room at the hospital now found it at the center. The attention he demanded from clinic workers and medical staff has gained in a greater degree from his accomplishments at the center. There was no longer the total preoccupation with ills, real and imagined. With a membership which was such a large percentage of cardiac and circulatory disorders and special dietary requirements, the day center provides health and nutrition education and suggests habits of living that will promote the physical well-being of the members. Those members who do have real disabilities can still use remaining strengths constructively in a day center setting.

In a democratic society, public agencies are concerned with the total well-being of all individuals, and they have recognized that physical maintenance alone is insufficient. This broad concept of public welfare has been extended to all, with the single exception of older persons. An ever-increasing segment of the population, they remain a deprived group. The problem has grown to the extent that it is part of every community, so large in scope that public agency participation is necessary. The acceptance of this responsibility holds promise for broad social and economic gains.

18. NEW DIRECTIONS IN PUBLIC WELFARE SERVICES FOR THE AGING 1

Elizabeth Breckenridge

How is public welfare going to adjust to the demands of an aging population? What lies ahead? Can we trace in embryo the shape of the future, the programs for older people that will require more and more attention from us in the years ahead?

To a considerable extent, it appears that we can. The following comments attempt to forecast the future evolution of public welfare in meeting the needs of this increasing sector of the American population. As might be expected, some new directions are more definite than others, and alternative patterns of action lie ahead of us as possible solutions for some of the emerging problems.

Note that this exercise in crystal gazing is an individual rather than a group effort. By way of extenuation, however, that individual has assiduously attended most of the major meetings linking public welfare and aging during the last 9 years, and has earnestly tried to digest and reconcile the verbal and written pronouncements on this topic that have been issued in recent years. Insofar as she has succeeded, what follows is a synthesis of opinion. Nevertheless, caveat emptor, for each has his bias.

This pamphlet is the final report in the American Public Welfare Association's series telling of ways public welfare agencies have created additional services for older people. Following the introductory statement on The Range of Public Welfare Services to Older People, seven specific "how to do it" articles told how new programs had been planned and operated by public welfare agencies. Subjects included help to patients discharged from mental hospitals, recreational and activity programs, the stimulation and use of a wide variety of resources in the community, homemaker and friendly visiting services, and planned improvement in the use of institutional care.

DISPARITY BETWEEN THEORY AND PRACTICE

Even this short review of the contents of the series suggests that public welfare has definitely increased its methods of dealing with the problems of the dependent aged. This is true. Nevertheless, the actual task of assembling these reports showed how much remains to be done. In other words, the association was unable to find examples of fully developed public welfare programs providing some of the services which the American Public Welfare Association Committee on Aging had recommended for inclusion in the series.

There is a serious disparity between the broad concept of public welfare for the aging that we talk about in conferences and committee

1 Source: American Public Welfare Association pamphlet, ninth in a series of reports from Public Welfare Department on How Public Welfare Serves Aging People.

meetings and the services we are in fact providing in our local offices. This disparity between theory and practice has two aspects.

EXTENSION OF TESTED PROGRAMS

First, the programs which were described in these pamphlets have not been duplicated as widely as they should be. They are still exceptional programs rather than standard operations. Even in most large metropolitan areas, this is the situation, not to mention the semiurban and rural sections of the country. In the latter, it has often been found that these kinds of programs are practically unknown, and that community leaders are not even aware of their potentials for alleviating distress among the aged.

At first glance, this is discouraging, but there is reason for optimism too. All the services presented in these pamphlets had what might be called a forced birth-forced because the needs of the aged were too serious, too obvious, too widespread to be ignored any longer; therefore, the public welfare agencies were compelled to create new ways of meeting urgent demands for service. Furthermore, these particular programs have been tested by time and experience. They get results. They have proved their efficiency in terms both of budget and of therapy. They are no longer a matter of hypothesis. We know they work.

We know also, from a battery of local surveys, that the needs toward which the new service programs are aimed are prevalent in varying degrees all across the American continent. Every substantial geographic area has old people who are lonesome, frightened, frail in mind and body?

Given the good will and intelligence of our lay leaders and public administrators, it is no risk to prophesy that public welfare in the near future will rapidly establish these services within its regular framework.

This developument will be facilitated by the fact that we now have specific instructions as to how these services can be started and carried on. Of course, there will be local modifications, dependent on the extent of need and the availability of other resources.

Here, then, is one new direction in public welfare services for the aging: the growth of recreation and activity programs; improved after-care services for older persons released from State mental hospitals; extension of homemakers and volunteer visitors for the aged; more constructive relationships with agencies providing sheltered care; and more significant participation in developing community resources for the aging.

ADDING NEW PROGRAMS

The disparity between theory and practice in this field, however, has a second aspect, which was also clearly revealed in searching for material for these pamphlets. This is the apparent absence of certain programs which are widely discussed and assumed to be worthwhile, notably employment and rehabilitation services for older people.

It is perhaps noteworthy that the first group of programs we have been discussing might in general be called palliative, that is, they make a bad situation better, usually without actually restoring the old

persons to independent living in the community. If they are practical at all, programs of employment and rehabilitation are more definitely remedial, dynamic, and constructive.

Are such programs within the scope of public welfare in the future! More and more, leaders in public welfare and in work with the aging appear to believe that they are. Since the depression years, administrators of general relief agencies have effectively administered or made use of employment and rehabilitation services for younger clients. Similar programs have been conducted by public welfare agencies for the blind, the disabled and for recipients of aid to dependent children. Therefore, with reference to the propriety of conducting these programs, there is ample precedent. The question is whether or not the results will justify the effort and expense.

As we said, evidence as to this is lacking from programs actually operated directly by public welfare agencies, because so far no such programs exist on a substantial, organized basis. This is particularly true of employment; rehabilitation service for older persons is being purchased by a few public assistance agencies on a limited scale, from hospitals, clinics, and the rare county institutions capable of providing this kind of care.

EMPLOYMENT

Let us look first at employment. Most people, including welfare administrators, manifest little hope of accomplishing much in getting jobs for people over 65. This is also the attitude of most public employment services. If work possibilities are considered at all, it is in terms of part-time occupation or sheltered workshops. Even though we have been haunted by thousands of potholders, rugs, belts and weird little lumps called "ceramics," we will grant that workshops and part-time occupations have their rightful place in the overall scheme and deserve a larger place. But is it realistic to think this is as far as welfare can and will go in promoting employment for the elderly? Should the worker in old age assistance continue to neglect the possibilities of work for his clients? Must the older individual's desire to feel useful be satisfied only through volunteer, civic, or family activities?

Facts contradict this. Facts also indicate that public welfare is going to have a role to play in expanding employment opportunities for the aging, either through stimulation of other agencies (such as State employment services), or through operating guidance, training and placement services within the public welfare organization. What facts support this point of view?

First, there are many indications that a large number of people over 65 continue to be capable workers and, furthermore, want to keep on working. The average age of applicants for OASI benefits is more than 3 years greater than 65. Industry surveys report satisfactory job performance. Doctors tell us we are aging physically at a decreasing rate. Finally, any announcement of job opportunities for those over 65 is greeted by a flood of applicants.

Second, special guidance and placement services for older workers, whenever they are established, have inevitably reported a good ratio

The Place of Rehabilitation in the Public Welfare Program: A Statement of Polley. Public Welfare, April 1955.