DEPENDENT ADULTS As there are children who from orphanage or other cause cannot be cared for in their own homes, so there are also adults who, through advanced age or physical in capacity arising from some other cause, cannot support themselves, and for whom there are no relatives or friends ready to offer maintenance and shelter. In the chapter on the social consequences implied in the acceptance of a normal standard of living, it was pointed out that hospitals for the sick have not yet reached their full natural de velopment, and that we may expect that many for whom as yet no provision has been made, will be received as patients at the expense either of the taxpayer or of private philanthropy. Whichever bears the burden, it is essential that those who can pay for treatment and maintenance shall do so, either on the present ordinary plan of fees for care actually received, or by an insurance system of regular payments by the month or quarter, in return for which care is given when needed. Many of those who now become public charges could readily meet the actual expense involved if it could thus be distributed, and there are many who would prefer thus to keep free from obligations to others. This applies, however, to out patient dispensary treatment, to secure which patients call in person at dispensaries, and to treatment given from such institutions to patients who are cared for at home.
Somewhat more completely dependent are those who become patients within the hospital, because they have not homes in which they can be properly cared for, or because from the nature of the illness hospital care is deemed advisable. For the majority of these, also, care 127 in the hospital is only a form of relief, for the family separation is but temporary and the purpose is the easiest possible restoration to ordinary home life. The incurable, or those suffering from chronic disease involving a long period of institutional care ; isolated individuals, who although not seriously ill are, on account of physical in capacity, not quite able to earn their own living ; and the less efficient members of classes variously afflicted, such as the blind, the crippled, and the epileptic, form a series of dependent groups for whom provision must be made.
To some extent private endowments and even societies relying upon annual contributions have supplied institu tions to meet these needs. There is, however, plainly apparent a tendency for private philanthropy to withdraw from this field, and to occupy itself rather with those who are more easily reclaimable, and with preventive tasks of which the aim is to lessen the number who become de pendent upon others. This tendency is one which may wisely be encouraged. Institutional care for those who cannot be cured, for those who can look for release from their infirmities and afflictions only in death, is certainly a most appropriate task for the state. It is true that if the state neglects it, it will be performed in some fashion by private charity, but it is admitted that the amounts likely to be invested by private philanthropy in con structive social work and also in relief will not be suffi cient to support all of those who, whether by their own fault or that of others—or without fault on the part of any — are dependent, and at the same time provide genu ine relief in its more accurate sense for those who, through effective relief, may be removed from the ranks of the social debtors. A division of work is therefore essential, and if the arguments presented against public out-door relief are valid, the division lies along the line of institu tional care from the public treasury, and relief at home from private sources. This does not mean that private philanthropy should be debarred from creating institu tions, especially since the donor may not be disposed to expend in more fruitful tasks amounts which he is ready to give for the relief of the aged, or those who are suffer ing from special types of infirmity. In the field of ex perimental relief for those who have been thought to be incurable, private philanthropy is amply justified. The voluntary transfer, however, of expenditure from relief of those for whom there is no outlook except the possibility of greater comfort, to the relief of those who can be helped effectively, is in the direction of progress, and there should be no hesitation to fill this gap by more liberal appropriations from the public treasury.