Survey of Health Needs of Older Citizens and Their Potentials in Home Health Work

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UCH PUBLIC attention recently has M been drawn to the medical care needs of older citizens in the UJnited States. The total number of patients confined to their homes by chronic disease in 1959-61 was estimated by the National Health Survey to be 915,000. Of this number, 584,000 were in the older segments of the population. For a number of reasons the major focus of attention has been on ways of paying for the treatment of elderly patients in hospitals or other institutions. The potentialities of organized home health services for providing care in the homes of older citizens have not been fully and imaginatively explored. Visiting nurse services, homemaker services, organized home care programs, and a variety of services can augment physician care in the home. However, even though physicians' home visits are becoming less frequent, home care programs have been slow to develop, and the use of visiting nurse services has not been proportional to the growth in the number of chronically ill-aged in our communities. One possibility for remedying the situation would be to recruit and train older persons willing to serve in the promotion of good health and morale among the elderly. In this article, we describe the efforts of a local health department in discovering, in conjunction with community agencies, the health needs of older citizens living in the community and the potential manpower contribution of this group. In 1960 the Newton (Mass.) Health Department and the Newton Community Council established a home care and geriatric program in this suburb of Boston (1). The primary purpose of this program wa,s to plan and coordinate the delivery of health and supportive services to the patient and his family in the home. The identification of the Newton Health Department as a locus of concern for the provision of services to the chronically ill at home gave rise to opportunities for exploring other problems of older citizens who live at home. Among the requests received for service, which the home care program attempted to satisfy, the commonest was for nonprofessional assistance. The most readily available source of manpower for such services was generally an older woman living at home, usually a widow or a mother with adult children, with time on her hands, looking for employment which would use her talents and satisfy her need to feel useful. These were, however, merely the impressions of the professional workers in the health department's program and needed verification. Accordingly, a study was planned to answer the following questions. 1. How many older people at home needed nonprofessional health care? 2. What kinds of services did they need ? Dr. Phillips is director, division of chronic disease, Massachusetts Department of Public Health, and lecturer on public health practice at the Harvard School of Public Health. Dr. Lambert is assistant professor of social research, the Florence Heller Graduate School for Advanced Studies, Brandeis University, Waltham, Mass. Copies of the interview schedule used in the survey described in this paper may be requested from Dr. Lambert.