June 10, 1970
Page 19108
PROBLEMS OF AGING IN RURAL AREAS
Mr. MUSKIE. Mr. President, on June 2, the Special Committee on Aging continued its exploration of the problems of older Americans in rural areas. Among the witnesses we were privileged to hear was Dr. Roger S. Leach, field program coordinator for the cooperative extension service at the University of Maine.
Dr. Leach described a nutrition education program in Maine which has had great impact on the senior citizens employed as nutrition aides and their communities. Dr. Leach also pointed up most articulately the difficulties faced by the elderly poor whose problems are often not visible to the communities in which they live.
I ask unanimous consent that his remarks and my statement at the hearing be printed in the RECORD.
There being no objection, the items were ordered to be printed in the RECORD, as follows:
MAINE'S SENIOR SERVICE CORPS NUTRITION AIDE PROGRAM
(Statement of Dr. Roger S. Leach)
Maine is known to both residents and nonresidents as "Vacationland". Few people realize that Maine is the northernmost state in Appalachia and approximately 23 % of its nearly one million people live on incomes that fit the poverty guidelines. Currently approximately 75,000 people are participating in the donated commodities or food stamp programs.
The Maine Cooperative Extension Service initiated a Nutrition Aide Program in November of 1968 as part of a nationwide effort in nutrition education. This initial effort has now been expanded to include twelve of our sixteen counties in one of these three separately funded nutrition aide projects: (1) The Expanded Nutrition Education Program, funded from the U.S. Department of Agriculture, (2) The Volunteer Nutrition Aide Program, supported by a grant from Title I of the Higher Education Act, and (3) The Senior Corps Nutrition Aide Project, contracted with the State Office of Economic Opportunity and funded through the National Council on Aging.
The Expanded Nutrition Education Program administered by the Federal Extension Service provides supporting materials for both professional staff and aides in all of our nutrition education projects as well as direct funding for the employment, training, and supervision of 50 to 60 nutrition aides.
The volunteer nutrition aide program, "Mobilizing Volunteers for Personal and Community Growth", is a one- or two-year demonstration project (depending on availability of funds) with an objective of recruiting, training, and supporting 150 volunteers over a two-year period. This project is based on these assumptions: that (1) there are people in every community who have time and a need to do something useful for others, (2) communities should be given encouragement to solve their own problems, and (3) we cannot obtain sufficient funding to employ enough aides to work with all low income families.
The Senior Service Corps Nutrition Aide Project was funded in January of 1970. Thirty half-time aides were employed by the end of February. All were 55 years of age or older and met the OEO poverty guidelines.
The basic approach for all of our projects has been the same. Before aides are employed in any county, local and state level, Extension staff members meet with representatives from all agencies working with low income families in the area. Outreach workers, child and family services, public health nurses, Maine Employment Security Commission, Diocesan Bureau of Human Relations, Farmers Home Administration, and others are represented. An attempt is made to reach an understanding whereby all agencies feel that this aide program will compliment their individual activities. If such an agreement cannot be reached, we will not initiate a program in that county. With our limited resources, we cannot afford to waste energy competing with other agencies. The most desirable arrangement seems to be an interagency committee on recruiting, training, supervision, and evaluation, for the aide program.
Direct supervision is provided by Extension professional staff. The local professional staff also conducts the training of the aides with assistance from the State Nutrition Specialist. Initial orientation and training of one or two weeks is followed by weekly half-day sessions throughout the duration of the project.
Training includes:
1. Getting acquainted with each other;
2. Getting acquainted with the job ahead;
3. Learning to be a helper;
4. How to prepare meals using simple, low-cost recipes;
5. How to plan and prepare well-balanced meals;
6. How to shop for food;
7. How to store food;
8. The value and use of food stamp and donated food programs;
9. An understanding of basic nutrition; and
10. How to become better managers of all resources.
Although this project has been in operation for only a few months, it is obvious that it has become extremely meaningful to the recipients, the aides and the communities. The meaning is captured in these reports from our field staff and aides.
Zelma reported that the selectmen said there were visible changes in the recipients of donated foods in his community. He meant that the recipients coming in to the food distribution center have a new facial expression, "they look pleased; they know that they will no longer be looked down on like dogs, but, in fact, are viewed as ladies". This change has come about because of the Nutrition Aides. The recipients know that when they go to their monthly food distribution they will have friends there, the Nutrition Aides.
Lucille has been visiting older people in her area and realizes that she cannot visit them often enough, so she has asked a number of neighbors if they might consider visiting these people. Lucille is excited about the fact that several of the neighbors are visiting the older people and that it is truly beneficial, both to the older adult as well as the visitor. It is sort of a neighbor to neighbor approach.
Mary in her contacts with people receiving donated foods learned that some people were not using corn syrup and she has suggested a modification of the corn syrup using a maple flavoring extract so that it tastes just like "maple syrup". Mary also reported that one of the persons she provided with this corn syrup recipe has passed it on to a coparticipant of donated foods. This helpful information is being recycled among the recipients. In addition, Doris, another Nutrition Aide, picked this information up from Mary and is passing it around to her recipients.
Mary reported that a woman receiving donated commodities said to her, "Officials look down on me, but you made me feel welcome and treated me like a person".
Dorothy, one of four of York County's Nutrition Aides who attended a week's training in certification of people to receive donated foods, said that the selectmen in two communities let her certify people with whom she comes in contact. Her work is good in the eyes of the selectmen.
Mary reported that the Nutrition Aide program to her was like a breath of spring. She feels a new spirit and is living now. She feels better, and looks forward to the next day. Stated simply she said, "I feel needed".
Laurette says because of her work as a Nutrition Aide she does not have time to think about herself and her problems – there are just too many other people to help. The Nutrition Aide program has been good for her morale.
Mary says, "I look forward to Fridays when all the Nutrition Aides and staff get together; I really can't wait for Fridays". She likes the fellowship, the relationships and the "schooling". She feels treated like a person with value.
Elin, a young 74-year-odd Nutrition Aide, reported with a smile on her face;."Conrad, I may have wrinkles on the outside, but I.don't have a one on the inside!" She looked just like a young girl, full of life and radiance.
Mara, another Nutrition Aide, summarized the program from the vantage point of someone deeply involved. She says:
"We find such situations as a young widow so numbed by grief that even her impending motherhood cannot give her a will to live – or a very elderly man who has lived all alone all winter on nothing but potatoes, because he thought that there was no one he could ask for help, no one who cared. We may hear of a family of eleven children, all under working age, whose home burned with all its possessions.
"We may find elderly people too feeble or crippled to get out to do errands, or too apathetic through loneliness to even prepare their own meals. We have found people who cannot eat properly because they need dentures, or cannot see without glasses they cannot afford – people imprisoned through lack of a crutch or wheelchair. We hear of sudden illness, accident, job loss, discouragement, defeat. These things are our job. Not to BUY a crutch, or COOK a meal, but to help people regain their own initiative, and restore their pride by helping them to help themselves.
"Our role is to stimulate their interest, to provide information, to lead and guide the needy into the situations where their own effort will again sustain them. Whether the need is financial or physical – intellectual or spiritual, we must train ourselves to observe, in every circumstance, the loophole through which each individual may escape his predicament with his pride and his personal integrity intact. This program also offers employment to older adults. I think one of the basic precepts on which this program was founded is to restore to the aging their birthright of participation. In any age group, pride in accomplishment is more than a reward. It is a spur to further accomplishment.
"We hope we will see this program expanded from our small group to embrace every senior citizen who dares to hope his usefulness and productivity cannot be finished.
"The Elder Statesman's role in service to his country is well recognized. The Elder Citizen, too, has invaluable contributions to make to society through his accumulation of knowledge and experience.
"A unifying force such as this program can offer these older citizens many more rewarding years of service, from which our entire culture may reap incalculable benefits."
Senator MUSKIE. Thank you, Dr. Leach, for your excellent statement. How many counties does the program cover?
Dr. LEACH. We have York County, Androscoggin County and northern Aroostock.
Senator MUSKIE. Rather well distributed over the state?
Dr. LEACH. Yes.
Senator MUSKIE. How many low-income families are you now assisting with the program?
Dr. LEACH. At the last report, we were working directly with 431, I believe, but that was about a month ago and, of course, it was just getting started.
Senator MUsKIE. The latest figure I have is that you have about 830.
Dr. LEACH. That may be correct. I think that may be what has happened within the last month, because the project has been expanding quite rapidly.
Senator MUSKIE. The statement which you put in the record indicated that many older citizens are reluctant to use the food stamp and commodity distribution programs. I wonder if you would touch upon the reasons why so many of our older citizens do not now use the available programs.
Dr. LEACH. I think one of the main reasons is that we are dealing with two different types of people. I think someone made the statement we are dealing with the poor who have grown old and the old who have grown poor.
Now the old who have grown poor just don't think in terms of taking what they call welfare; they are too proud. They need someone to go out and establish a personal relationship with them, become a friend, and then take them by the hand and say, "It is all right, this is a program that is for you," and take them in and get them certified.
I think this type of an approach is the only way we are going to reach these types of people.
Senator MUSKIE. Do you think it has the most value with respect to the second group; that is, the older poor?
Dr. LEACH. No, I think it is of equal value to the poor who have grown old. I think they are somewhat more receptive to a program of this type, but they have still got to go ask for something in order to reap the benefits.
Senator MUSKIE. Is the accessability of these programs a limiting factor?
Dr. LEACH. You mean location?
Senator MUSKIE. Yes.
Dr. LEACH. I think very definitely. We have been finding people who would like to have been certified, but the roads were impassable or they could not get out to the certification center.
It does take transportation. I feel very strongly – in fact, we feel in all of our Nutrition Aide Programs that one very valuable element in building a bridge between the low-income and higher income people in the community is to try to involve them in providing things like transportation, building an organization. We find very frequently that the average citizen in our community does not understand the problems of the elderly, the problems of the poor.
We find this a very good way to get them acquainted with the problems, and, after all, they are the ones who are going to have quite an influence on what happens.
Senator MUSKIE. Have all Maine communities been receptive to these programs? What is the situation now, more receptive? Is the absence of the program in a community or county a limiting factor?
Dr. LEACH. I have been directly involved with communities, in fact, my own community. I live in Orono and the first statement made was that there were no poor in Orono, or, at the most, perhaps 20. But I think it is kind of pathetic.
People don't really understand, they don't know the situation. I think that one of the problems we have is lack of education. We must build the bridge, as I indicated before, between the haves and the have-nots, so that they understand the situation and do something about it.
Senator MUSKIE. In other words, what you are saying is that the poverty of a lot of people, whether it comes to them in old age or is the condition in which they have lived all their lives, is not visible to their community.
Dr. LEACH. Absolutely right.
Senator MUsKIE. Is this because of reticence or insensitivity on the part of the community? What is the reason?
Dr. LEACH. I think we consciously have to bring people together; it won't happen by itself. We drive by these homes and we don't realize that somebody lives there or the problems he might have – perhaps it is insensitivity, blindness or just lack of awareness.
Senator MUSKIE. So that even in a state with small communities like Maine there is a lack of communication.
Dr. LEACH. Very definitely.
Senator MUSKIE. I think our largest city now is 88,000, but even so we have that problem.
Do you find that the most rural persons eligible for food assistance programs would prefer food stamps or commodity distribution programs, or is there any distinction?
Dr. LEACH. I really can't answer that question. Since they have not had the opportunity, they really don't know what the choices are. I think some of them have said they would rather have the food stamp program, but of course for us the donated food does provide an opportunity, a link where we can get in and at least share recipes. It provides some way of establishing that relationship which is very important.
Senator MUSKIE. The dietary help you mentioned in the 10 points involved in the training – how to prepare meals, for example, using simple low-cost recipes. This would seem to me to be a valuable service to provide. Have you had any reactions to that yet? Is such assistance given to all the people in these programs?
Dr. LEACH. There again it varies with the individual. For some it is very helpful, for others we have not reached the point where we can work on dietary habits. It takes quite a while to establish a relationship where you can even suggest that they might need to improve their diets.
This project has been of such short duration that we really have not gotten too far into the nutritional aspects.
The needs are there and over time we will be able to deal with them.
Senator MUSKIE. This next question I have probably is not answerable in light of the program's short experience, but I would like to put it any way.
Those elderly that you contacted in your program, what percentage have nutritional deficiencies?
Dr. LEACH. I anticipated that question, but I cannot really answer it.
Senator MUSKIE. Did you have any impression that there are a sizable number who have nutritional deficiencies?
Dr. LEACH. Yes, there are and it is awfully hard to put your finger on the real problem. Sometimes these people – as one of the aged referred to – are quite apathetic. They don't eat well and then because they don't eat well, they don't get a proper diet and feel more apathetic.
It is a kind of a cycle and you cannot put your finger on any one thing and say that is it, is the problem. But I think very definitely a high percentage of our elderly people do not have an adequate diet and, therefore, they cannot feel well.
Senator MUSKIE. I suppose that you have a special problem with the aged individual who lives by himself and lacks incentives to prepare his own meals.
Dr. LEACH. Yes.
Senator MUSKIE Is that in your program?
Dr. LEACH. Well, just visiting with some of these individual older people provides some kind of an incentive for them. The aide may try to encourage them to try a new recipe or just to check with them and say, "What did you have for breakfast this morning?"
Once they establish a relationship with them, the rest follows. You don't do that on the first visit.
Senator MUSKIE. One final question: Again you may not have the experience yet to answer it, but I will ask you. At the White House Conference on Food Nutrition and Health last December, one of the major recommendations was this:
All housing programs for the elderly, regardless of the method of financing or sponsorship,
should include meal services with proper nutrition.
What would be your reaction to that?
Dr. LEACH. That is quite a blanket statement to respond to.
Senator MUSKIE. Yes; it is.
Dr. LEACH. I think it is a very desirable thing. I am sure that for many people this would be very valuable. I also feel that we want to be careful that we don't take away from those who have ability, the opportunity to be creative and prepare their own meals. This is a creative thing for women preparing the meals and something for them to look forward to. It keeps their mind active.
I don't think you can make an inclusive statement.
Senator MUSKIE. What I was driving at in the question is that your kind of program, your kind of service thus provides for their additional needs.
Dr. LEACH. Yes. Recently, suggestions have been made that that in-school lunch program facilities be used to provide a meal a day for some of our senior citizens. I think this would be a very valuable program. I think they are moving in this direction at the present time – not the school lunch necessarily – but using other facilities they have there.
Senator MUSKIE. I would like to congratulate you, Dr. Leach, on this program. Our people in Maine are not very communicative by nature which I suspect has resulted in the neglect, through lack of exposure, of a lot of the problems that we ought to deal with.
I want to congratulate you.
Dr. LEACH. Thank you, sir.
I want to add one more thing. When you were asking me about communication – why people didn't understand the problems of the low income – I think that I would only be fair to say that we have a very strong feeling in Maine which is very deeply ingrained that anyone who really has any ambition will get out in his own way.
It is very uncomfortable to confront people on this issue, but they do have to be confronted. I am convinced of that. They have to be shown that the people who need these programs are not lazy, that really there are serious problems which cause them to be the way they are.
Senator MUSKIE. Thank you.
STATEMENT OF SENATOR EDMUND S. MUSKIE Mr. Chairman, the hearing today is timely and appropriate because the 7 million older Americans in rural areas have too often been overlooked or ignored.
They are probably among our most "forgotten Americans."
They are forgotten because their retirement income needs are not met by social security or old age assistance.
Their nutritional needs, although aided by the food stamp and commodities distribution programs, are largely unmet because of gaps in these programs and woefully inadequate funding.
In fact, our 20 million older Americans probably constitute the most uniformly malnourished segment of our population.
The depths and extremes of this "hunger crisis" are most acute among the elderly in rural areas.
Many are hungry or malnourished simply because they are too poor to buy enough food.
In far too many instances, they are confronted with the choice of buying food or necessary prescription drugs to maintain their health. And, too often, both needs suffer irreparably.
When food assistance programs are available, other problems present formidable obstacles.
Lack of adequate transportation can impose an almost impossible barrier for those who must travel great distances to receive free food at distribution points.
Of the 118,000 senior citizens in Maine, for example, only 40,000 have drivers licenses, leaving almost 80,000 with no immediate access to transportation.
Failing health can make it difficult to walk to the local welfare office to apply for food stamps or stand in long lines to receive food stamps in banks. It may also be impossible for senior citizens to walk to market to purchase food or carry heavy packages to their homes.
Fortunately, some steps are being taken to ease the nutrition crisis of the senior citizen in rural areas of America.
One such undertaking is the senior service corps nutrition aide program which is described in detail this morning by Dr. Roger Leach. Outstanding accomplishments have been achieved by this program.
For example, one nutrition aide located an elderly man who had been living on potatoes, apples and beans for an entire winter. After several calls, the malnourished older man agreed to apply for donated commodities. He is now gainfully employed after being jobless for several years.
In another senior service corps program in Maine, aides have been assigned to community action agencies in nine "Hunger Counties" designated by the citizens board of inquiry into hunger and malnutrition. They have worked as helpers in surplus food certification and distribution, resulting in the certification of 38,000 persons for surplus foods in areas which previously had no program.
In Presque Isle, Maine, alone, 5½ tons of badly needed surplus foods were distributed in one month.
Other outstanding senior citizen projects in Maine are currently being funded under titles III and V of the Older Americans Act. Grants to 21 community organizations have resulted in 80 community centers for senior citizens in both urban and rural areas.
The community centers have helped senior citizens find new careers as well as meaningful volunteer opportunities.
The senior feeding program in the Waterville Center provides balanced meals for about 300 people once a day, five days a week. In Portland, two senior centers provide meals along with other services to older persons.
We need to expand such nutrition programs to rural areas where they are so badly needed.
The problems of senior citizens in Maine are symptomatic of those besetting the elderly throughout the United States. They have been forgotten in the past, and they will continue to be overlooked in the future unless major policy changes are made now.
In the area of nutrition, we must ask pressing questions:
Why do so many senior citizens lack adequate food? And how many are slowly starving that we have not yet discovered?
What is a realistic expenditure to ensure that each senior citizen has a nutritious diet? How can we make our present food assistance programs more responsive to need? In the wealthiest Nation
in the world, with a gross national product approaching $1 trillion, it is unconscionable to delay in finding the answers.