Out of much experimentation has come another type of housing for the aging, including veterans, which attempts to bridge the gap between the kind that separates the aging from others into specialized institutions, apartments or retirement communities of their own on the one hand and their maintenance within their accustomed family residence on the other. This is currently called "proximate housing." For the most part, the already established enterprises of this type have been sponsored by religious or retired worker organizations, with some promotion by local housing authorities. In this latter type of housing, groups of dwelling units of various types in urban areas are built and reserved for occupancy by older people. These houses or apartments usually are designed with special features to meet the general needs of the aging and are rented or leased on a long-term basis. The argument is made for them that they offer independence of living among contemporaries but at the same time permit reasonable proximity to old friends and to relatives in the younger generations and to community shopping facilities. Along this same line, in the case of facilities provided by local housing authorities an outstanding example is presented by the Cedar Apartments in Cleveland. Sponsored by the housing authority, this development has a policy of providing multi-story apartment projects for low income families in the vicinity of major existing health care institutions and stores. On an experimental basis, in addition to covering the usual communal social services, one of its new projects will include a professionally staffed diagnostic center and facility for temporary medical care where immediate and urgent medical needs of the older residents may be met. Still another approach to the provision of appropriate housing for the aging of interest to aging veterans is "dispersed housing. Under this plan, individual dwelling units (detached houses and apartments) for older people are interspersed with dwelling units designed for rental or sale to other age groups. While offered as a special plan, it appears that this has developed more or less accidentally and its merits then recognized in projects where a large proportion of houses were incidentally sold to retired people and desired modifications then made presumably by the buyers. This gave rise to new residental communities in which many middle-aged and older people are dispersed among younger families as is usually the case in older communities. These projects will all be under study as time goes on to offer, on the basis of experience, some guidance for further development of housing for the aging veteran still capable of living in individual or family housing. Chapter VII INSURANCE OF THE AGING VETERAN PURPOSE OF THE PROGRAM CURRENT GOVERNMENT INSURANCE The Federal Government insurance program for veterans arose out of the general sense of obligation to its citizens called to special hazardous wartime service which disrupts their normal economic support arrangements for themselves and their dependents. The unpredictability of the time, duration, nature and extent of these disruptions, which preclude major reliance on probabilities based on past experience, has hampered or prevented full assumption of this function by normal private insur ance sources. From the standpoint of the aging male veteran, this insurance is primarily useful as a means of providing economic maintenance for a wife who survives him and to assure a continuance of some income to him in case of partial or total disability affecting his employment. It also gives him basic economic support when income is no longer received from full or partial employment or investment sources, and when it is not adequately provided by public or private pensions. It is the basic function of such insurance to stand in ready reserve and be called into action whenever the above conditions arise. These develop and intensify at an accelerated rate with advancing age, making the insurance-based contributions to economic support of most vital importance to veterans on reaching and progressing within the 65 years of age and over group. CURRENT GOVERNMENT INSURANCE STATUS While not all of the World War I veterans are now in the 65 and over age group, within another five years 99 percent will have reached or passed the entering age and hence will be included. The following account of the Government insurance status of World War I veterans can, therefore, be taken as representative of the status of veterans in the 65 and over aging classification. Some of this group and some veterans of peacetime service between July 1921 and October 1940 hold United States Government Life Insurance (hereafter referred to as USGLI), some important provisions of which are not afforded by National Service Life Insurance (NSLI), which was available to servicemen and some veterans between October 1940 and April 1951.* The features of USGLI insurance of primary interest from the standpoint of income or economic support of aging veterans are the disability and loan provisions. Under this insurance, permanently and totally disabled veterans qualify for disability payments at a rate of $5.75 per thousand dollars up to the $10,000 insurance maximum. In mid-1960 there were about 16 thousand veterans receiving such payments. In 1928 a disability rider was offered for an additional premium charge to provide an additional monthly payment of $5.75 per $1,000 face value for total disability if incurred before reaching the age 65 and lasting more than four months. In mid1960, about 20 thousand veterans had such a rider on their insurance policies. The total contribution to veterans' incomes under USGLI contracts is estimated at $111 million in 1960, including disability benefits, cash surrenders, matured endowments and dividends. The USGLI policy is a sustaining asset also, and the aging veteran who does not already have a full outstanding loan on it can borrow up to 94 percent of the face value. He can also decide, if insurance protection of a wife or other survivor is not of more importance, to supplement his income by collecting the cash value for his own use at any rate desired. The major economic implications and importance of these developments under the changing conditions of the future are considered in the following chapter. *For a summary review of these programs see "Government Life Insurance Programs for Veterans and Servicemen," Annual Report, 1959, Veterans Administration. Chapter VIII LOOKING TO THE FUTURE THE EXPANDING AGING VETERAN POPULATION ADVANCES IN TECHNOLOGY PREVENTIVE MEASURES PURCHASING POWER PROTECTION THE COST OF MEDICAL CARE INCENTIVES TO SELF-SUPPORT The preceding account of the recent and current economic status of the veteran population aged 65 and over has indicated a great many ways in which economic developments have affected the group's living standards and arrangements, and the major ways in which the size and the age class composition of the group itself, as well as the individual situations of its members, are constantly undergoing change. At a time when national attention is being increasingly claimed by those 65 years of age and over in the population, the portion of the male members of the group who are veterans has been rapidly expanding and they will in another 25 to 30 years account for half of the total. While the aging population itself has been expanding and the veteran proportion of this increasing group rising, there have been important economic developments which greatly modify the kind and level of living that can be provided. To the extent that the effect of such developments on the aging veteran population can be foreseen, the necessary arrangements to carry out national policy with reference to economic maintenance can be currently planned and legislatively and administratively provided for. To assist in coping with developments that cannot be so adequately foreseen, further attention might be devoted to maintaining current programs and facilities on as flexible and readily alterable basis as is consistent with reasonably efficient current operations. The following summary reviews some major areas of concern on the above scores. ADVANCES IN TECHNOLOGY Note was made in Chapter II of the fact that technological advances have been increasing the capabilities of the national economy in supplying a greater volume and better quality and variety of goods and services, as well as reducing the labor and other requirements per unit of production. Also that this is a vital factor in the increase in the standard of living and usually results in lowering unit prices or increasing payments of income to individuals. The suggestion was made that some program of periodic review in the future be considered to assure proper participation in the benefits from such advances by the aging veterans dependent in large part on relatively fixed types of income such as pensions and compensation payments. Technological advances in another area of special concern to the aging veteran population are in the field of medical science and the technology of physical and psychological treatment and the facilities to provide it. These along with more widespread medical care have been contributing to increasing the economically active life span. This has been accompanied by the maintenance of physical work capabilities longer and by reduction in the time required for hospitalization and intensive care per episode of illness of the population. These latter developments have been of special significance to the aging, who are subject to special health disabilities in addition to those of the adult population below age 65. Developments leading to further reduction in hospital stay and recovery time per illness, the growth of care techniques and facilities short of complete hospitalization requirements, and newer diagnostic procedures and medicaments facilitating treatment in the home are all contributing to the creation of new conditions of health care in the future. These developments free more of the time of existing suppliers of professional service so that they can each serve more individuals. They also have this effect on the use of facilities such as hospital beds. This technological efficiency improvement will help somewhat in meeting the expanding demand but it seems unlikely under present prospects to keep pace in view of the rapidity of the growth of the aging veteran population and the increase in hospital length of stay with advancing age. Extensive special investigation and study will be required to obtain some more precise information as a basis for future guidance and closer appraisal of the influence of these developments on planning for the various professional services and care facilities. PREVENTIVE MEASURES Technological and other advances have provided a basis for increasing attention to the preventive approach to health and economic problems of special concern to the aging population. This involves the identification and modification of such developing situations at as early a stage as possible rather than waiting for some indirect administratively determined event, |