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Of equal urgency and unrelated to any one specific plan or proposal is the need to raise to an acceptable minimum level the salaries if those to whom we entrust the major share of the rehabilitation, raining, and care of the mentally retarded. The disgraceful conditions in our institutions for the mentally retarded, so forcefully pointed up by the President's Committee on Mental Retardation (1967), are related to the disgraceful salary level for basic care personnel. In one state, it was lower than that paid to exterminators of vermin; in another, lower than that of a disemboweler of chickens; and in a bird, lower than that of an attendant of a public toilet. There is no escape from the fact that in some states the necessary appropriations to correct these inequities which are such a blot on our nation's record will constitute a definite burden on the public treasury. That is the price of decades of neglect!

In order to establish a rationale for public expenditures in the field of mental retardation, not only to the average citizen but to many public officials and legislators, our financial accounting should be linked to social accounting. The cost-benefit scheme proposed in the chapter by Wolfensberger should provide the necessary frame of references. Admittedly our tools for such social accounting of fiscal expenditures in the field of human welfare are quite inadequate as yet, but nothing else is as likely to speed improvement in many states.

New Avenues of Financing. One important feature of several of the new programs suggested by the various contributors to this volume is that they open up new avenues for the financing of services for the mentally retarded. For example, regionalization and dispersal make it possible to combine local and state funds to provide the matching money required under federal law for certain federal monies, some of which may not have been directed specifically to the mental retardation field.

In states where the county has to pay for part of the costs of care for its residents in a state institution, this money could be applied to various kinds of community services, residential as well as nonresidential, with or without state subsidy. Indeed, the shifting from residential care in a state institution to community-based care in the retarded person's own home or in a small community facility opens the way for a variety of federal financing, primarily under various provisions of social security and public assistance programs. Admittedly, there is at the moment a great deal of confusion as to which circumstances may be applied to which provisions (the quotation from the letter of the New York State Department of Social Welfare appearing elsewhere in this chapter illustrated such an instance of confusion), and, admittedly, some of the federal and state agencies involved are not very eager to extend these provisions to the mentally retarded. However, pressure from the local, state, and national associations for the mentally retarded and from interested citizen groups will, in time, enlist cooperation from state governments and local governmental units once these recognize the fiscal advantages, and this should lead to early clarification.

Desirable as it is to gain a greatly broadened financial base for mental retardation programming, it is necessary to caution against what has already happened in several states where unscrupulous administrators have exploited or misapplied provisions of new amendments to the Social Security Act. Thus, there have been moves to shift the residential burden of the state to the federal government by wholesale transfer of mentally retarded individuals into facilities inadequately regulated and unsuitable for them, since they were designed and maintained for persons with a different problem constellation. Here is a good instance where social accounting should negate the fiscal reasoning. Joseph T. Weingold (1968), executive director of the New York State Association for Retarded Children, characterizes such a procedure aptly as "using the mentally retarded in the state school as the anvil in which to hammer medicaid funds from the federal government."

Certainly states should make every effort, and indeed have an obligation towards their citizens, to use all available funding sources in appropriate fashion, and censure is due to states negligent in that regard. But considerable significance must be attached to the phrase "in appropriate fashion," and certainly appropriateness must relate itself to the interests and welfare of the mentally retarded person and his family.

Finally, the conflict between principle and realism brought forth by the application of the principle of normalization to the area of financing must be recognized. On the one hand, it is desirable that to the maximum feasible extent payments for services for the mentally retarded come from the same source as those for corresponding services for the population at large, while on the other hand, long experience has shown that in any general non-earmarked distribution of funds the retarded are likely to be left out or at least disadvantaged. Temporary earmarking until the service is clearly integrated into the activity pattern of the agency may be one solution.