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Overcrowding, under staffing, and under financing are three of the important issues related to public facilities, but there are others. One of these is obsolete architecture and design. Maintenance may have been so poor that lavatory and toilet facilities may be nonfunctioning, food preparation cannot be carried out in the desired sanitary fashion, and climate control may be so unequal to the task as to leave buildings either too hot or too cold.

Many Americans have the impression that poor residential facilities are something inevitable which must be endured, along with other evils of our times. Not so! One can visit several European countries, especially in Scandinavia, to find imaginative and unusual programs of care. Along with others, I have been impressed on my visits there to find many residential facilities which were located close to population centers. In Copenhagen I visited a residential facility (Children's Hospital at Vangede) which is in a suburban setting served by the city's rapid transit system. Many of these facilities have no more than 150 to 200 residents, and some are no larger than a large household. Staff-to-resident ratios are frequently 1:1, and the care provided is exemplary. In addition, the physical surroundings are pleasant, abounding in bright colors. Fixtures and furnishings are attractively designed and not the clumsy institutional or prison industry furniture often found in this country. Everything is meant to be attractive and to have appeal to those who must reside in such a facility.

The problems of our overcrowded institutions can only be solved by giving simultaneous attention to community resources. It has been pointed out on many occasions that the galaxie of services needed should include diagnostic centers, special education, day care, vocational training, sheltered workshops, residential schools, group living homes, etc. I would maintain that residential facilities will not be what we want them to be unless simultaneous efforts are made to rectify the situation in both the institution and the community.

As one major effort towards accomplishing the desired objectives, massive re-education is required. There is nothing to be gained by hiding the fact that our residential facilities are in a deplorable state, their buildings crumbling, the staff overworked, underpaid and often undertrained, and the programs providing only minimal care and habilitation. Each state must develop a greater public education effort to bring to the attention of the citizens this blot on our escutcheon. It should be our wish and intent to try to rehabilitate residents to the community, rather than to segregate them. This reorientation in thinking will require considerable effort as public officials, administrators of institutions, professional workers, and the lay public all come to understand that the handicapped and the retarded do not need to be moved aside, but rather should be a part of the ongoing community process.

Group homes, nursing homes, and respite centers which provide short-term residence in an effort to help families and to meet temporary needs should all be part of the services available in the community. Even severely retarded individuals with extensive physical handicaps can be handled in the community. Great Britain some years ago pioneered with the idea that the physically handicapped, as well as the person with other handicapping conditions, can and should be maintained in the community; but to do this, the concept was developed that even the most severe form of handicapping condition requiring prolonged nursing care could be cared for in the community as part of a regular pediatric unit. Such services need not be separated, segregated and removed from society (Pediatric Society of the South East Metropolitan Region, 1962).

One might ask the question. Should not all such persons be maintained in the community? Why should they be removed? Should not society's aim be to try to help when mental retardation or physical handicap has occurred? One does not say to the parent of a child with leukemia that the child should be "put away," although everyone knows that the child will ultimately die, and understands the human tragedy which has occurred. Rather, all forces are mobilized to help and to sustain the child in the community even though he may need periodic hospitalizations. Surely the same approach should be used for the mentally retarded and the physically disabled.

In the easing of understaffing, two programs are worthy of note. The Foster Grandparent Program (under which the government pays retired citizens to engage in one-to-one work with retarded persons for a few hours a week) has been successful in helping to cope with the manpower problem. It meets the needs not only of handicapped persons but also of the elderly who are looking for a constructive role in our society where they can be of help and assistance and not be thought of as misfits, relegated to a shelf. The SWEAT (Student Work Experience and Training) program has been another successful device in attracting people, in this case youths, to mental retardation. Under this federally supported program, high school and college students are paid a stipend for working during a summer in a facility or service for the retarded. In many such programs conducted across the country the students have received didactic instruction along with the work experience. SWEAT has been one of the most imaginative as well as economical and apparently successful projects attracting young people to careers in this field. But much more is needed, and much greater effort will be required if the manpower problem is to be solved.