The association which I represent is devoted to improving the standards among the private-nursing homes in the State. It is estimated in our State, by the association that I represent, that 1,000 additional beds are needed. I believe that is below estimates given to your committee in other forms at other times. The commissioner of welfare in our State pays for a large percentage of the patients occupying the homes operated by the Connecticut Private Hospital Association. This figure varies, but it is slightly below 50 percent. In the State of Connecticut the privately operated nursing homes are not without their problems, and therefore it is the suggestion of the Connecticut Private Hospital Association that the bill before the Senate be amended so that the sum being appropriaetd for the building of nonprofit nursing homes on a matching basis between the States will be changed so that the same sum of money will be appropriated and allocated to the Small Business Administration to be loaned on a secured basis in accordance with sound business principles to private operators for the construction of privately owned nursing homes, this money to be repaid over a suggested 20-year period. There is a known need in the State of Connecticut for additional nursing-home care to supply bed room for an estimated 1,000 additional patients. There is no question but what the need for additional privatenursing homes exists. In Connecticut private nursing home operators are faced with great difficulty in financing and expanding for the reason that savings banks and building and loan associations and other lenders consider them undesirable loans for the reason that the buildings are all devoted to a special, single purpose, and in the event of financial difficulty would not be readily salable in the event that they came into the ownership of said properties; and further, that because of the lack of sufficient capital by persons qualified to operate such type of nursing homes, the market for such homes is limited and the means to construct them is very limited, and it is in this respect that this legislation could be of assistance. While this is not in the prepared statement, gentlemen, may it be suggested the officers later suggested to me that I convey the message to the committee that possibly, instead of a direct appropriation, a guaranteed type of loan of the FHA variety might be suggested to you gentlemen. The Connecticut Private Hospital Association having considered the matter, feels that when all factors are taken into consideration, such as the outlay for land, buildings, equipment, et cetera, that they can care for the aged and infirm and others who need nursing home care at a cost lower than any publicly operated institution; and they believe, further, that they can give a higher quality of care, because if a patient is not satisfied, the patient may move from one home to another freely. In other words, competition among the homes themselves will tend to keep a high quality of service, whereas in the institutions, nonprofit and publicly operated, usually the patient will be required to stay in a given institution based upon his geographical location regardless of whether or not some other institution provided care better suited and adapted to the particular patient. In conclusion the Connecticut Private Hospital Association wants to go on record as supporting generally the position of the American Association of Nursing Homes, of which it is a member, which it understands will appear tomorrow to state its position. On behalf of the officers, directors, and members of the private hospital association, I want to thank you for being given the opportunity of appearing before your committee to state the position of this association on this bill. Senator PURTELL. Thank you, Mr. Parmelee. May I ask here, Have you had a chance to study H. R. 8149, which, of course, has passed the House ? The reason for my inquiry is because of the language there, which I think will interest you very much, and your association. May I read from page 15, the 16th line: The term "nursing home" means a facility for the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care, but who require skilled nursing care and related medical services (1) which is operated in connection with a hospital, or (2) in which such nursing care and medical services are prescribed by, or are performed under the general direction of, persons licensed to practice medicine or surgery in the State. Now, actually there are many of the facilities that you talk about that will not meet this definition; isn't that correct? Mr. PARMALEE. That is correct. Senator PURTELL. Let's review it again. Mr. PARMALEE. There are two such facilities in the State at this time. Senator PURTELL. This takes in those which are operated in connection with the hospital or in which nursing care and medical services are prescribed by or are performed under the general direction of persons licensed to practice medicine and surgery in the State. I think that tightens it up quite a bit, doesn't it? Mr. PARMELEE. Well, that is correct. Senator PURTELL. The thing you worry about is this competition with private enterprise, and you have a right to worry about it from the way you operate in the State, in the State of Connecticut, but they have very high standards there, have they not, as compared to the other States in the operation of this particular type of hospital? Mr. PARMELEE. That is so, and, as a matter of fact, in one of our leading newspapers, as you know, the Hartford Courant, appeared quite a complimentary article on the operation of these nursing homes. Senator PURTELL. I would say one of the leading papers of the country. Mr. PARMELEE. Yes, sir. Senator PURTELL. I think the Hartford Courant is one of the leading papers of the country, and I read the article and I know what high standards the State prescribes and makes you subscribe to in the operation of these hospitals. Now, what you are worried about and concerned with is this: Here you have done a pretty good job up there. How many beds have you got now? Mr. PARMELEE. 4,500. Senator PURTELL. How many? Mr. PARMELEE. 4,500. Senator PURTELL. 4,500 beds, and you have set up rather rigid standards as to the operation of those. Mr. PARMELEE. Yes, sir. Senator PURTELL. And you must be licensed as a type of hospital; is that correct? Mr. PARMELEE. That is correct. Senator PURTELL. Under State supervision? Mr. PARMELEE. That is correct. Senator PURTELL. And that supervision, I might say, is rigid, too; isn't it? Mr. PARMELEE. It is very rigid, and justly so. Senator PURTELL. What you are worried about is the investment you have made, with the acknowledgment on the part of the State that your operations must be of the highest type, because you have State patients, have you not, referred to you by hospitals in many instances; is that correct? Mr. PARMELEE. That is correct. Senator PURTELL. And where hospitals are filled, is it correct the State sends you patients who would have otherwise gone to the general hospitals? Mr. PARMELEE. Well, usually that is in reverse. general hospital first and back to the nursing home. Senator PURTELL. Yes. They go to the Aren't there cases-I am thinking of Middlesex County particularly-I have been informed, anyway, that you have had cases there where the hospital was filled and it was felt your accommodations met the needs, anyway, of cases which would ordinarily go to the general hospital? Mr. PARMELEE. I think those cases are rare, Senator. Senator PURTELL. I think they are rare, but, anyway- Senator PURTELL. It was an acknowledgment of the fact that your standards were high enough in the operation of those hospitals, at least in that vicinity, for the State to recognize that it was serving the need of a general hospital in the cases referred to it; is that correct? Mr. PARMELEE. That is correct. Senator PURTELL. I am not trying to put words into your mouth. I am trying to develop something that I had been informed in Connecticut, anyway, was true. What you object to, then, is having set this high standard of operation there, acknowledged by the very fact of the State use of the facility, you find now the Federal Government offering to set up in competition with you like facilities through the use of Federal funds? That is what you are objecting to, is it not? Mr. PARMELEE. They are worried, first, that they do not wish to be eliminated, and, second, they do not believe in this particular part of your proposed program that expansion by public, nonprofit institutions is justified in our area. We can't speak for the rest of the country. Senator PURTELL. You feel you can take care of the expansion if some funds through some other agency were made available to you on a loan basis for expanding; is that what your thought is? Mr. PARMELEE. I think they may be taken care of regardless, possibly. Senator PURTELL. Thank you. Senator Hill has some questions. Senator HILL. You say they may be taken care of regardless? Senator HILL. They may possibly. Mr. PARMELEE. You see, this type of loan is not a popular loan among our Connecticut banking people. Senator HILL. Anyway, you have a good system, we will say, of nursing homes. According to my information, you have one of the best certainly in the United States. Isn't that true? Mr. PARMELEE. That is what we claim, sir, and I believe that it has been so stated by disinterested persons. Senator HILL. Then the question would come: You have that system. Certain funds were earmarked solely and only for the construction of nursing homes. Your State might not be interested in using its share of funds so earmarked for nursing homes; is that correct? Mr. PARMELEE. Well, that is a possible truth, but there are certain officials in our State that we understand think otherwise and who would like to build some experimental institutions along this line. Senator HILL. I see, but there might be a question there as to whether or not your State would use or take advantage of its full share of Federal funds; is that right? Mr. PARMELEE. That is correct. Senator HILL. If the earmarking, then, was too rigid, there wasn't any flexibility there, any opportunity for interchange of funds, you might well then lose your share; is that right? Mr. PARMELEE. Yes, which should not be done to the good State of Connecticut. Senator HILL. Then you would go along, I take it, pretty strongly with Mr. Bugbee and Dr. Ferrell that these funds ought to be interchangeable; is that right? Mr. PARMELEE. I certainly would endorse it. Senator HILL. So that Connecticut might get its rightful share, just as I would seek at any time that Alabama might get its rightful share is that correct? Mr. PARMELEE. We will endorse that, Senator. Senator HILL. All right. Mr. PARMELEE. I may say, as a private citizen, the larger part of this bill I am heartily in favor of. Senator HILL. Thank you. Senator PURTELL. Thank you, Mr. Parmelee. We will stand in recess until 10 o'clock tomorrow morning in this room, at which time the first witness will be Dr. Howard A. Rusk of New York University, Bellevue Medical Center. (Whereupon, at 12:33 p. m., the subcommittee recessed until 10 a. m. Friday, March 19, 1954.) PRESIDENT'S HEALTH RECOMMENDATIONS AND RELATED MEASURES FRIDAY, MARCH 19, 1954 UNITED STATES SENATE, COMMITTEE ON LABOR AND PUBLIC WELFARE, SUBCOMMITTEE ON HEALTH, The subcommittee met at 10:05 a. m., pursuant to recess, in room P-63 of the Capitol, Senator William A. Purtell (chairman of the subcommittee) presiding. Present: Senators Purtell (chairman of the subcommittee), Goldwater, Cooper, Hill, and Lehman. Also present: Melvin W. Sneed and William G. Reidy, professional staff members. Senator PURTELL. The hearing will come to order. Our first witness this morning is Dr. Howard A. Rusk, one of our very eminent men in the profession, and we are very happy to have you with us this morning, Doctor, to help us in our deliberations. Is it your intention to read this statement in complete detail-it isn't long or do you have a longer statement, or do you wish to have this statement in the record and perhaps talk extemporaneously in addition to it? Dr. RUSK. I would prefer, Mr. Chairman, if I may, to have this statement in the record and talk extemporaneously and informally. Senator PURTELL. It will be so ordered. Dr. RUSK. Thank you. Senator PURTELL. Go right ahead, Doctor. STATEMENT OF DR. HOWARD A. RUSK, PROFESSOR AND CHAIRMAN, DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION, NEW YORK UNIVERSITY COLLEGE OF MEDICINE, CHIEF, PHYSICAL MEDICINE AND REHABILITATION SERVICE, BELLEVUE HOSPITAL, NEW YORK CITY, AND DIRECTOR, THE INSTITUTE OF PHYSICAL MEDICINE AND REHABILITATION, NEW YORK UNIVERSITY-BELLEVUE MEDICAL CENTER Dr. RUSK. I practiced internal medicine in St. Louis for 15 years before the war, and it fell my lot to establish the convalescent and rehabilitation program in the Army Air Forces during my service career. After this service, I couldn't go back to internal medicine as I had known it, because I saw what could be done for severely disabled people with an adequate program. So, I went to New York, where |