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STATE PROGRAMS FOR THE AGING

A REVIEW OF THE PROBLEM AND RECENT ACTION IN THE STATES

(December 1956, The Council of State Governments, 1313 East 60th Street, Chicago, 37, Ill.)

STATE PROGRAMS FOR THE AGING

Facing every State legislature in 1957 will be urgent requests to meet the economic, health, and social needs of our older citizens. Within each State the magnitude and quality of these needs will be different; programs and services accordingly will be designed with local conditions in mind. But the universality of the problem indicates that common guides for action may be helpful for adaptation to special practices and traditions.

WHAT'S THE PROBLEM

The basic, hard core of the problem is one of population. In 1900 there were only 3 million people 65 years of age and over. Today there are over 14 million and in 10 years-which is only the day after tomorrow we can expect around 20 million.

This is not only an increase in absolute numbers, but also in the proportion of the total population. The rate of increase of older people has been twice that of the population as a whole. In 1900 those 65 and over constituted 4.1 percent of the population. By 1950 the proportion had doubled to 8.1 percent and is still continuing to rise. Another basic element is that of life expectancy. In 1900 the average male child could expect to live to 46; by 1952 he could expect to live to 66-20 years more. The female baby in 1900 could look forward to 48 years of life; in 1952 to 72 years-24 more years.

What makes these basic facts a problem? It is primarily because we, as a nation, have shifted rapidly from a rural to an urban, industrial society without taking into account the accompanying problems of the aging. The average older person and his family have lost the security and self-sufficiency of life in the rural community. His savings are subject to the ravages of inflation; his family and friends live with difficulty on the margins of their income. He increasingly depends on the organization which employed him, on government, his union, other institutions and agencies for social and economic support.

What does all this mean for us as citizens, as taxpayers, as productive members of the economy?

It means that less than half of our citizens 65 and over are employed and that the Nation is losing $3.8 billion a year by not utilizing their productivity, according to the estimate of a distinguished economist. It means an annual expenditure today of more than $1.5 billion in old-age assistance payments for 2,700,000 people over 65.

It means a national outlay of almost $4 billion this year to more than 8 million beneficiaries of OASI and conservative estimates of around $20 billion annually are in prospect just a generation from now.

It means that the burden of support for older persons and for children will fall in the next 25 years upon an increasingly smaller proportion of the population-namely, those persons of young, working age, 21-44. In the next 25 years, those 45 and over will increase 40

percent; those 20 and under 50 percent; but the rest 21 to 44 will increase only 20 percent and the squeeze is on them.

It means an unbalanced population in the older years with a high proportion of single, older persons-either unmarried or widowed or divorced. The figures are 31 percent of the men, and 62 percent of the women. And increasingly it is the women who comprise our aging population.

It's a problem of unemployment

Most older persons want to work and do continue working as long as they are physically fit and can find employment. But the employment opportunities begin to fade and the shock of compulsory retirement because of age alone strikes; the available jobs go to younger persons; skills and trades become obsolete.

In 1890, 68 percent of those 65 and over were gainfully employed. By 1950 the proportion had declined to 43 percent and is expected to go down further to 35 percent, or even less, in the next 25 years.

Even in good times many older workers lose their jobs and have trouble getting new ones. They tend to remain unemployed longer and exhaust their unemployment compensation benefits sooner. The odds are against them-even when able, willing, anxious to work. It's a problem of income

The major concern of most older people as they approach retirement is how to maintain an independent, American standard of living on a sharply reduced income. A recent study of 1951 incomes showed that for married couples, where the head of the family was 65 or over and for other persons 65 and over, the income situation including the value of their housing was as follows:

Almost one-third of all aged families in 1954 had no liquid assets at all and 50 percent had less than $500; 69 percent, less than $2,000. Many are forced to depend on children for support, but the great majority now have to look to Government for pensions and assistance. Unless our economy can expand sufficiently to absorb the productive potential of our older citizens, they can only press upon government for the essential incomes to secure: Nourishing food, decent housing. clothing, medical services, opportunities for social life, recreation and education.

Thus the problem is one of a great majority of older citizens engag ing in a difficult-sometimes impossible-struggle to try to make ends meet as they maintain health and self-respect. Too often, however, dependency, worry, and deterioration become the destiny of many aging persons who have contributed a lifetime of production to the amazing growth of the American economy.

It's a problem of housing

All studies indicate that the housing available to large numbers of older people is unsatisfactory from the point of view of their safety and health, and their emotional and social needs. Older persons are at a disadvantage in renting or purchasing homes, because of special

risks due to their advancing age and reduced income. Thus, the hous ing of most older persons is more dilapidated, more in need of repair. than the average; less suitably designed for their needs. The problem is compounded by the fact that 31 percent of the men and 62 percent of the women 65 and over are either single, widowed, or divorced and provision for them is limited.

Of the 35,000 accidental deaths in homes in the United States in 1948, 52 percent were due to falls and 85 percent of these deaths from falls in the home occurred among persons 65 and over.

A larger percentage of the income of older persons has to go for rent than is true for the population as a whole. As a consequence, many" older persons find themselves relegated to rooming houses or substandard apartments in cheap-rent districts.

Yet, maintaining an independent home-close to family and friends-is a primary objective of sound social policy for our older people.

It's a problem of physical health

At present older people suffer disproportionately from chronic illness. Persons 65 and over constitute 8.2 percent of the population, but 39.6 percent of those disabled for 3 months or more. Approximately one-half of all persons over the age of 65 have some chronic, disease or physical impairment. Patients 65 and over in all hospitals: were more than double their proportion of the total population.

In addition, it is just at this time of life-when prolonged medical care is before them-that our older persons are least able financially to bear the costs. Any acute illness is a drain upon income, but a chronic illness such as cancer, arthritis, heart disease, rheumatism may drag on for years and wipe out the resources of an entire family.

In too many cases maintenance of good physical health is hampered by lack of knowledge of nutrition, by inadequate care in hospitals and nursing homes, by failure or inability to use preventive measures.

Rehabilitation services have performed seeming miracles in restoring "hopelessly" invalided aged to social and physical usefulness. However, these are only now beginning to be extended to older people. It's a problem of mental health

Loneliness, rejection, lack of usefulness, and insecurity become the lot of hundreds of thousands of older persons who have had pride and enjoyment in their work. They thus lose interest in the future and present and tend to escape into memories of a happier past; or else. they may substitute fantasy for reality.

Mental deterioration thus becomes a distinct possibility for the iso-: lated older person without a truly useful role in society. From 1904 to 1950 total population in the United States doubled; the number 65 and over increased about 4 times; but the number of first admissions 65: and over to mental hospitals multiplied approximately 9 times.

One patient out of every three in our mental hospitals is over 60 and one of every four 65 and over. Thus while people 65 and over: constituted 8.2 percent of the population, they made up 25 percent of the mental hospital population. One authoritative estimate concluded that it would not be surprising, if in 10 years 50 percent of the hospital population will consist of senile and arteriosclerotic patients.

Our mental hospitals today are overcrowded and personnel shortages tragically severe. We need a heavy investment in research and