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Throughout the Scandinavian countries, I have been greatly impressed by the numbers of young, eager, well-informed men and women one finds working with the retarded. At a school for cerebral palsied children in Gothenburg, Sweden, I had the opportunity of visiting one of the most delightful places to be seen anywhere. This happened to be a residential facility where things are so well developed that one could find a child who was ill (from some other cause) being read to rather than being left alone, as is so frequently the case in our country. A training program in Denmark for primary workers in mental retardation (equivalent to our attendants) is of considerable interest. The program is half theoretical and half practical. The students, many of them akin to school dropouts in this country, are recruited for such training, subsidized during it, and thereafter provided with good situations in which to work. A similar program has been in existence in at least one area in England.

While the turnover is fairly great among the young people in Scandinavia who are trained in these programs, there is another sidelight to all of this. Most of these young people will go on to be parents themselves, and having learned something about the handicapped as well as something about child development, they will be more understanding of the handicapped and also will be in a better position to manage their own families. At any rate, it can be noted that these ingenious training programs have come close to solving the personnel problem. This idea should be studied carefully by all of our states to see what can be adapted to the American scene.

In thinking about solutions for residential care, one certainly must give thought to architecture and size. Dr. Gunnar Dybwad has written much about the architectural barriers in residential facilities. He and others would point out that if existing buildings are to be modified in order to relieve overcrowding, a loss in bed space is inevitable. On the basis of 10 to 15 years of experience, the Scandinavian countries, again leaders in the remodeling of existing buildings, have pointed out that it is absolutely necessary to plan on reducing the number of beds by half in order to bring many old buildings up to modern standards.

The desirability of having large facilities of 1,000 or more is still controversial. Many of our facilities are of this size, or larger, and some more are now being constructed. The evidence is not convincing as to why large residential facilities need be built. The argument often runs that large facilities cost less to operate. I would suggest that this point has not been proved. Currently, the President's Committee on Mental Retardation is in the process of having a study conducted concerning what is known about costs of running large versus small facilities. There is preliminary evidence to suggest that small facilities of 150 to 250 can be constructed and operated at no more than the cost now being utilized in the larger residential facility, and perhaps even at less cost. It is even possible that the hostel concept of placing small groups of retardates into existing rented, leased, and purchased homes and facilities (rather than newly constructed ones) will prove the most economical alternative for many retardates needing residential care. Existing facilities are often cheaper than new construction, and rentals and leases preserve the flexibility of locating and using facilities as needed -- a flexibility that is drastically reduced in new purpose-built construction. Cost analysis can be deceptive, however, if one is not comparing like commodities. The study will, I believe, shed some important light on the entire matter of cost accounting in the operation of these various facilities.

An additional point to be made about the size of an institution certainly relates to one's sense of human values. In today's world, where many of us become numbers on an IBM card, we feel great reluctance to bid farewell to the concept of a more individualistic approach to human services. Increasingly, people express preference for return to small units and systems, whether in a university, a city, or a residential facility. These human values must not be permitted to be overshadowed by too much architectural efficiency and the engineering consideration of locating buildings at the point closest to the steam plant. Surely we have seen the problems of regimentation so as to be ever on guard in all sectors lest we increase or even perpetuate this problem.

I have not written much about which one can be happy. Individuals and groups concerned with the handicapped and retarded should make every effort to join hands with each other to see what can be done to improve this deplorable situation. I would suggest that the reorientation of the community will be the crucial factor. Facilities close to where people live should be the watchword. At the same time, we must attend to the condition of our existing facilities, to improving the pay scale, to reducing the number of residents, and to restructuring the mission of residential facilities in ways which will return residents to the community.