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In the past there has been a tendency to dwell on the potentials of the higher grade retarded and their increasing move towards greater independence, while no progress or improvement was foreseen with what has been so sadly misnamed as "the custodial cases." One recent author even suggested that an increase in the number of older more severely retarded should lead to a reduction in psychological personnel.

It would be my contention that experience both in Europe and in some places in this country justifies the expectation that we can effect substantial improvements in the performance of the older mentally retarded all across the board, from the present crib case to the trusted institution worker operating with considerable independence, to the older retardate in the community sheltered workshop.

Independence, this goal of human existence, comes in a broad spectrum and may mean for the most severely retarded no more than the painstakingly acquired ability to raise one's hand to bring food to the mouth, and for the more advanced individual the privilege of moving about freely in the community. In between these two poles there lies a multitude of opportunity for us to enrich the life of the older mental retardate, and to support his natural tendency to seek gratification, however limited, of his desire toward greater independence.

In the institution this should mean discontinuation of the present degrading mass housing, and a continuous offering beyond school age of stimulating activities, opportunities for self-expression, and at least a measure of respect for one's privacy and individuality.

An assumption is often made that one should automatically consider the older retardate as an "infirm" person in need of close medical supervision and nursing care. While this undoubtedly is true for some of these individuals, it is emphatically not true for others, and hence strikingly different patterns for institutional buildings, institutional programs, and institutional personnel must be developed as we will set about accommodating the increasing number of older residents.

As a matter of fact, the question may well be raised as to what extent it would be preferable to accommodate those older retardates who have no particular health problems, in a specialized setting closer to their home community, and in a far more informal fashion than is in general provided by our large, all-purpose establishments.

I have dwelt in such detail on these aspects of institutional care because it seems to me that notwithstanding the splendid and rapid advances we have made in our communities in affording the mentally retarded an opportunity to live happily if not productively, and notwithstanding the fine work of a few outstanding residential facilities, overwhelmingly the public image of the more severely retarded is that drab, depressing picture which largely confronts us as we travel from state to state visiting institutions for the mentally retarded -- and which Dr. Seager has so strikingly characterized in his just cited article in "Mental Hospitals."

Yet to eliminate the institution is by no means the answer. On the contrary. It is quite apparent that much of the progress we should hope for in the coming decades for the older retardate will be enhanced by many new uses of residential care and treatment.

When recently the statement was made that "our present knowledge points in one direction: toward programs based on the maximum inclusion of the mentally retarded within the community, rather than as in the past, programs based on the maximum isolation of the retarded from the community," this does not contradict residential care; it merely envisions smaller, community-related, easily accessible, open facilities such as are already actually under discussion in several of our States.

Some of these facilities may, in fact, not be more than boarding houses with room for six to ten retarded adults; others may combine overnight care with daytime programs attended by other retarded adults living with their families. Obviously there will be different degrees of care and supervision. Many of the older people are quite capable of "being on their own," traveling about, while others need a more confining, protective care.

There will be need for facilities providing full time nursing care, and others where emotionally disturbed or mentally ill patients receive psychiatric attention. No doubt many of the adult retardates who can adjust to programs in sheltered workshops or protected employment in the community, eventually may seek the haven of a less demanding environment such as a residential group care facility can provide.

However, the assumption of several writers that the lengthening life span of the retarded will merely result in a tremendous increase of debile, senile patients for whom nursing care is required, would not seem to be a compelling conclusion. Certainly the radical changes in the health of the retarded during the last few years are a product of improved physical and mental hygiene.