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When we look at decreased mortality rates specifically, we may well emphasize the beneficial results of antibiotics. But when we look at the general health status of the retarded, such factors as improved dietary management, vastly increased opportunities for outdoor activities, and the satisfaction of being allowed to be constructively occupied, no matter at how simple a task, would seem to assume at least equal significance.

This then raises an important question. Granted that the life span of the retarded is increasing, how much of an increase must we expect? Specifically, must we expect senile debility at 50, or even 40 years of age, in a large number of those who are now adjusting well in community programs? Or can we presume that there is no reason why these individuals cannot remain in good health for far longer periods?

It stands to reason that we need very badly the answer to these questions in plotting our long range programs. The difference may mean hundreds of millions of dollars in institutional construction and maintenance costs.

Time does not permit further discussion of residential care, but I would want to list three examples of promising new developments:

In one State, an institution has working arrangements with a community sheltered workshop quite a distance away, for the placement and training of a group of older residents. There is, of course, room for a great deal more of such cooperative planning.

In at least two other States plans have been completed for hiring, as attendants, former residents who have qualified by training and will enjoy the privileges of State employees. This will vastly influence the general status of other residents.

Finally, a State institution located close to a city in another State, has eliminated all visiting restrictions and encourages family members to participate in the actual care of the patient or resident, a move designed to "loosen up" the heavy and debilitating burden of institutional routine.

In 1957 the New York State Inter-departmental Health Resources Board published a study by Dr. Gerhart Saenger entitled: "The Adjustment of Severely Retarded Adults in the Community." Without doubt this study will remain one of the benchmarks in the field of mental retardation. In following up the life history of a large number of mental retardates over a considerable number of years, the study furnished definitive proof that the then common belief that the more severely retarded would sooner or later be sent to an institution was quite fallacious. To the contrary, the community adjustment of the older group in this study, men and women in their 30's and 40's, was distinctly more favorable than that of the younger group.

What must be kept in mind is that the group here studied was a sample from all those who had attended New York City Board of Education classes for trainable children since 1929, during a period when there were practically no community services set up for the mentally retarded.

Without indulging in wishful speculation, it would seem safe to say that if such good results obtain without support of agencies, it is fair to assume that with the development of such specialized agency resources, far better results can be expected.

Adjustment of the retarded in the community is largely dependent on three factors: a satisfactory domicile, suitable work or other activity, and a recreational program.

While in all three areas provisions in most communities are woefully inadequate, there is at least a fairly clear understanding of what is needed in the vocational or work area. Work training centers in preparation for employment in the open labor market, sheltered workshops for long term or terminal protected employment, selective job placement, have all been well developed in recent years, and we shall hear tomorrow some leading experts report to us on these subjects.

Experience of recent years suggests that a far greater percentage of the more severely retarded is capable of sustained productivity in a work situation than had ever been thought feasible. From my observation of some of the sheltered workshops in this country and in Holland, I would venture to say that we have not yet really established how limited in intelligence an individual may be and still be capable of such productive effort.

Of necessity this will have to remain a matter of conjecture for quite some time, since it is safe to say that retardates who are ready for vocational training or job placement now or in the next several years are a product of an unenlightened period in the field of mental retardation. One can well hope that improved home training and improved school programs will produce better training prospects.

These statements should by no means imply that, with but few exceptions, retarded adults regardless of the severity of their handicap can be productive workers. Rather, we have learned that their handicap is not adequately described solely in terms of intelligence rating, and that success and failure in vocational training or sheltered workshop is, to a considerable extent, determined by the adequacy of the retardate's general personality, and in particular, his social adaptability.