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lives a burden to themselves and to others have, by surgical skill and special forms of education, been restored wholly or partially to the ranks of the self-supporting and useful members of the community. This REHABILITATION of the dependent and defective members of the community, whether their misfortune is due to war or other causes, is the chief aim of the treatment given them by the community at the present time.
RESPONSIBILITY OF EACH COMMUNITY
It is an accepted principle that each community should, so far as possible, care for its own unfortunates, and the effectiveness with which it is done varies. But everywhere it has taken a long time to change from the old policy of mere RELIEF to the new policy of REHABILITATION (see above).
THE LOCAL ALMSHOUSE AND ITS DEFECTS
In New England and in a few other states the town, or township, is the unit for administering "poor relief," but elsewhere it is the county. The "almshouse," or "poor farm," or "county infirmary" is the usual local institution for this purpose. Unfortunately it has been, as a rule, badly managed. Men and women, old people and children, healthy and diseased, blind and crippled, moral and immoral, even the insane, have been housed together, often mingling with one another with little restriction. The evils of such a system are apparent.
Moreover, the policy of the typical almshouse has been merely to give shelter and food and clothing to those who appeal for it, rather than to remedy the causes of dependency or to restore the unfortunate to a basis of self-support and usefulness. Medical treatment is of course given, but the means do not exist to give special expert treatment to particular classes of defectives. Little educational opportunity worthy of the name is afforded. While able-bodied inmates usually have some work to do, it is seldom of a character to train for self-support or to create habits of industry.
To provide this special treatment requires elaborate equipment and expert service, which cost a great deal of money, more than most counties or towns feel that they can afford. Communities must come to realize that they cannot afford to neglect their unfortunate members, no matter what it costs to care for them. But the cost need not be so great as it seems. A great deal of money is now WASTED on almshouses without adequate results. This can largely be remedied by insisting upon more expert supervision in such institutions, and by a system of regular inspection by expert state officers. Greater care should be exercised with respect to those who are admitted to the institutions. Only the deserving should be allowed to live on the public funds. It is not uncommon for some classes of shiftless people to make a practice of seeking shelter in the almshouse during the winter, where they live in comparative comfort and idleness at the public expense, only to leave in the spring for a life of aimless indolence, imposing as beggars upon kind-hearted people.
PURPOSE OF STATE INSTITUTIONS
Moreover, the county almshouse should be only a temporary place of detention for many of the people who now are kept there permanently. Those who need special treatment or training should be passed on as quickly as possible to special institutions that are equipped to care for them. Since most local communities could not well afford to maintain such special institutions for the comparatively few who would need them, the state should maintain enough of them at central points to provide for the needs of all local communities.
The states do maintain such institutions--hospitals and sanitariums for various types of mental disease, homes for orphans and for the aged, and for persons with incurable diseases, asylums and schools for the blind and the deaf-and-dumb, industrial schools for boys and girls. The problem of the state is, first, to develop such institutions to the highest possible degree of efficiency for the REHABILITATION of their patients or inmates, and, second, to secure effective cooperation on the part of local authorities and institutions in transferring those, and only those, who are entitled to state assistance.
COOPERATION FOR "OUTDOOR" RELIEF
When dependents are cared for in institutions, it is called INDOOR RELIEF; when they are cared for outside of institutions, in their homes, it is called OUTDOOR RELIEF. Outdoor relief requires community organization and cooperation and expert leadership quite as much as indoor relief. The lack of these has often resulted in great harm both to the community and to the needy person. Promiscuous giving of charity by well-intentioned persons often results in giving to the undeserving as well as to the deserving. There are lazy and shiftless individuals who find it easier to live on charity than by honest work, and whose lack of self- respect permits them to do so. Sometimes they do so by fraudulent methods. Giving to such persons encourages pauperism and fraud instead of curing it. Kind-hearted people often say that they would rather be cheated occasionally by dishonest applicants for charity than to fail to help the really needy by too great caution. The answer to this is that by proper community organization and cooperation the needy will be found with much greater certainty, the fraudulent will be detected, and the aid given to those who should have it will be much more effective. The citizen who turns an applicant for aid over to an effective organization in a great majority of cases performs a much greater service both to the applicant and to the community than by attempting to give aid directly. A few pennies or a few dollars given even to a worthy applicant may not reach the root of the trouble at all, and may be the innocent cause of perpetuating the trouble.
Many voluntary organizations exist for charitable and philanthropic purposes. The church has always been one of the chief agencies to care for the poor and unfortunate; but there are many others, especially in our large cities. Sometimes they maintain hospitals and other institutions for the treatment of those who need indoor relief. They have done a great deal of good. But they are subject to the same difficulties that individuals encounter in dealing wisely with particular cases. They have often devoted themselves too exclusively to giving temporary relief instead of seeking to cure causes and to rehabilitate the unfortunate. They are frequently deceived by impostors. Seldom do they have expert investigators to follow up individual cases and to prescribe the most effective remedy. They frequently duplicate one another's work in a wasteful manner.
This lack of team work has been in large measure remedied, especially in city communities, by the establishment of CHARITY ORGANIZATION SOCIETIES. Such societies do not as a rule give direct relief, but act as a "clearing house" for existing charitable agencies in the community. That is, they organize the effort of the various existing agencies. They have a corps of trained investigators who look into each case reported by any individual or charitable agency in the community, make a careful record of it, and prescribe the proper treatment. The case is usually turned over to one of the existing agencies that is properly equipped to handle it. Philanthropic persons may turn to the charity organization society for advice as to purposes for which money is most needed. The aim of charity organization is to remedy causes of dependency and to restore dependents to a self- sustaining basis so far as that is possible.
GOVERNMENTAL ORGANIZATION FOR POOR RELIEF
Charity organization societies are wholly voluntary organizations; and there is need for such voluntary cooperation to care for the community's unfortunate and to root out the causes of dependency. Such organizations should, however, work in cooperation with governmental agencies. There are state boards of charities which usually have supervision over the various state institutions for dependents and defectives. Every large city government has its department of charities, sometimes combined with the department of health. The "overseer of the poor" is one of the oldest of town officers. The care of dependents and defectives in small, or rural, communities has, however, been very poorly organized.
RELATION BETWEEN STATE AND LOCAL ORGANIZATION
An effective attack upon the public welfare problems of a state is twofold: (1) by a state welfare board and state welfare institutions, and (2) by town and county welfare boards and institutions... .
Public welfare work calls for a state board of public welfare, statewide in authority ... and for state institutions that are large enough to care for the delinquents, the dependents, the defectives, and the neglected who cannot be better cared for by local authority and institutions. ...
But, on the other hand, it calls for county boards of public welfare with county-wide authority and trained executive secretaries. ... Many of our ills bulk up so big that they can be successfully attacked only in detail by local interest, local effort, and local institutions. Tuberculosis and poverty are capital instances of social problems that are beyond the possibilities of state institutions, and that necessarily wait upon organized county efforts of effective sort. ... We do not know the deaf, the blind, the feeble-minded, the epileptic, the crippled, and the neglected or wayward boys and girls--their number, their names, and their residences in any county of the state ... because there is at present no local organization charged with the responsibility of accounting for such unfortunates. ...
[Footnote: E. C. Branson, "County responsibility for public welfare," in the North Carolina Club YEAR BOOK, 1917-1918, pp. 161, 162 (University of North Carolina, Chapel Hill, N. C.).]
CAUSES OF DEPENDENCY MUST BE REMOVED
There will doubtless always be some dependent and defective members of the community for whom the community must care. Their number, however, may be greatly reduced by creating conditions that will remove their causes. It has been reported from many
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