The article goes on to say: "Longer stays in the hospital mean additional beds and increased cost of hospitalization," he said referring to Dr. Seckinger. "It means, therefore, that before there can be a decrease in annual appropriations for tuberculosis we will need, especially in the District of Columbia, to provide additional beds for hospitalizing the patients who need treatment now. Until those patients in the infectious stage are isolated in hospitals the dangers to the public health remain." Mr. Chairman, I ask to put that in the record at the end of the testimony. Senator GOLDWATER. Without objection, it may be so included in the record. Senator HILL. When he speaks about that infectious danger, he means everybody in this room, everybody in the District of Columbia is subject to a danger from the infection; isn't that right, Doctor? Dr. RODGER. That's right. Senator GOLDWATER. Senator, may I ask Senator HILL. Yes. Senator GOLDWATER. That is a little bit confusing. He states with the improved techniques in handling tuberculosis the patient is required to stay in the hospital longer. Senator HILL. Longer; that is right. I imagine he means by that-the doctor should answer the question, not me; I am only a layman-that if you want recovery, if you want to get rid of this disease today, using your improved techniques, you stay in the hospital longer, but you have a better chance, I suppose, of what you might call recovery and getting rid of the disease. Is that right, Doctor? Dr. RODGER. I think it is. I am no authority on tuberculosis. Dr. RODGER. But the terminal cases last longer, too. Senator HILL. Of course, I recall, and I am sure Senator Goldwater does, in the old days when we had to send these patients to Arizona and similar places, and that meant when they went most of them had to stay there. In fact, if they didn't stay, they were taking a pretty big, calculated risk. Isn't that true? Senator GOLDWATER. It was a little confusing. That is the reason I asked, because he states with the improved techniques the patient is required to stay in the hospital longer. Senator HILL. I am not a doctor, but I would certainly make that deduction. Dr. RODGER. That is right. Senator HILL. The idea being if you are going to get rid of tuberculosis, if you are going to take advantage of these new techniques to get well, you have to stay in bed and, as far as staying in a hospital is concerned, you have to stay longer today than you did in 1947; is that right, doctor? Dr. RODGER. That is right. Senator HILL. I think we might put that article in the record, not in the record with the doctor's remarks, but at the end of the testimony. Senator GOLDWATER. Would you mind, Senator, if we asked Dr. Cronin if he could explain that statement? It is still confusing to me. Senator HILL. No; go ahead. Senator GOLDWATER. Doctor, do you have anything to say that might shed a little light on that statement? Dr. CRONIN. I don't know. I read Dr. Seckinger's statement, Senator Goldwater, and in the statement it is noted that the total number of beds they need for tuberculosis is 1,175. The District of Columbia currently has a total of 1,065 beds for tuberculosis, of which 940 are acceptable. They have 125 beds which are not acceptable under the Hill-Burton Act, which usually means the institution is non-fire-resistant, and so on, or other reasons. The District of Columbia needs, on the basis of the formula in the Hill-Burton Act, which is the 212 beds per average annual death over a sample 5-year period, 1939 to 1944, and the subsequent 5 years, 235 more beds for tuberculosis. Senator HILL. You mean today? Dr. CRONIN. Today. Senator HILL. They need 235 additional beds for tuberculosis patients alone? Dr. CRONIN. That's right, to adequately care for the anticipated number of TB cases ahead. Now, as far as Dr. Rodger's statement that the terminal cases stay longer, that is because of the advances of modern medicine antibiotics, and so on. They get peneumonia and the antibiotics help the pneumonia to be defeated, so to speak, and we can keep people alive longer, even with tuberculosis. The newer drugs in tuberculosis, of course, haven't been in existence long enough to have a final say on them. Many people do well in getting newer drugs and are permitted to be treated outside the hospital. In some instances there are certain resistances built by the tuberculoses bacilli to these drugs, and in those instances those patients frequently come back to the hospital for care. Although I am not an authority on tuberculosis, as a physician in public health work, I don't think the whole story is here yet on these newer drugs or on the total care of tuberculosis. It is a picture which is changing from time to time, and it may change geographically. There are certain areas of the country that lend themselves to tuberculosis sometimes more than others. Senator HILL. Doctor, may I ask you a question? Dr. CRONIN. Yes. Senator HILL. Is the whole story here on any field of medicine? Dr. CRONIN. There is no whole story. We are in a state of flux, Senator. Senator GOLDWATER. Have you any other questions, Senator Hill! Senator HILL. When we got off on the subject of tuberculosis, I was talking about your amendment here, and you answered a question to the effect you didn't want these things frozen so tight, that you wanted an interchange as between the funds; isn't that right, Doctor? Dr. RODGER. That's right; between the four categories of this bill. Senator HILL. Yes. Dr. RODGER. We weren't suggesting going outside of that. Senator HILL. I understand. You want them more left at the State level? Dr. RODGER. That's right. As I see it, from our State level, the Hill-Burton aspect, we would have quite a job with our rigid categories making anything really work out to the best efficiency for the State of Michigan. Senator HILL. You think whatever success the program has attained up to date has been due in large measure because we have left the administration and the determinations at the State level? Dr. RODGER. I am very sure of that, Senator. Senator HILL. You are sure of that. In other words, don't you think there is nothing more important to preserve about the program, as we move forward, than leaving your authority and your determination at the State level? Dr. RODGER. That's right. Senator HILL. You agree with that, do you? Dr. RODGER. Very much so. Senator HILL. Very much so. That is all. Thank you. Senator GOLDWATER. Thank you very much, Doctor. (The newspaper article referred to previously by Senator Hill is as follows:) [From the Washington Post and Times-Herald, March 19, 1954] SECKINGER CALLS TB WORST DISEASE HERE Tuberculosis control in Washington is costing $20 million annually in private and public funds yet tuberculosis remains the District's "worst communicable disease," District Health Director Daniel L. Seckinger declared yesterday. Dr. Seckinger spoke at the opening of a 2-day conference at the Department of Health Education, and Welfare, where tuberculosis authorities from Maryland, Virginia, and the District gathered to discuss prevention, treatment, and rehabilitation of patients with tuberculosis. Dr. Seckinger observed that with improved techniques of treatment, the average hospital stay for tuberculosis has increased from 390 days in 1947 to 439 days in 1952. "Longer stays in the hospital mean additional beds and increased cost of hospitalization," he said. "It means, therefore, that before there can be a decrease in annual appropriations for tuberculosis we will need, especially in the District of Columbia, to provide additional beds for hospitalizing the patients who need treatment now. Until those patients in the infectious stage are isolated in hospitals the dangers to the public health remain." Dr. Seckinger called for more integrated planning among agencies working to control tuberculosis plus greater cooperation among the tuberculosis patient, the family, and community agencies interested in their welfare to wipe out the disease. Dr. A. L. Chapman, regional medical director for the United States Public Health Service, observed the "end of tuberculosis as a major threat to community health is in sight" but depends upon continuous supervision of the patient from the time of detection until final rehabilitation. This, in turn, he said, de pends on how well all persons serving the patient work together. "There are times when the patient with tuberculosis is segmented by administrative procedures within the community," he continued. "Found by one group, treated by another, and followed up after discharge from the sanatorium by another group, there always is the danger that a patient will become merely a trisected statistic, and completely lose his identity as a human being." Both Dr. Daniel L. Finucane, superintendent of Glenn Dale Hospital and Dr. Leon H. Hetherington, chief of Maryland State Health Department's Bureau of Tuberculosis, emphasized the need for helping the patient to solve the emotional and financial problems attendant to his illness. Dr. Finucane suggested the need for adequate public assistance grants for families of tuberculosis victims and a special fund to care for patients' personal needs to aid the recovery process. The conference continues with workshops through tomorrow afternoon. Senator GOLDWATER. The committee will now hear Mr. Clebern S. Edwards, the president of the American Association of Nursing Homes. Mr. Edwards. STATEMENT OF CLEBERN S. EDWARDS, PRESIDENT, AMERICAN ASSOCIATION OF NURSING HOMES Mr. EDWARDS. Mr. Chairman, Mr. Robert F. Muse will present the testimony for the American Association of Nursing Homes, but with your permission I would like to introduce the following people, who are here to assist you in your determinations. Senator GOLDWATER. We will be very glad to have them. Mr. EDWARDS. Mr. George Mustin, of Memphis, Tenn., secretary of the American Association of Nursing Homes. Mr. Frank C. Bateman, of Springfield, Ohio, executive director of the American Association of Nursing Homes. Mrs. Houner Hoffman, first vice president of the Indiana Association of Nursing Homes. Mrs. Goldie Rogers, president of the Maryland Association of Nursing Homes. And Mrs. Lucia Forde Murphy, of Spokane, Wash., representing the Inland Empire Association of Licensed Nursing Homes, with headquarters in Spokane, Wash. Senator GOLDWATER. This is a great pleasure to have you folks with us this morning. Thank you very much for coming here. Mr. Muse, you may proceed in your own way. STATEMENT OF ROBERT F. MUSE, REPRESENTATIVE AGENT OF THE AMERICAN ASSOCIATION OF NURSING HOMES Mr. MUSE. Thank you, Mr. Chairman. Mr. Chairman and gentlemen of the committee, the American Association of Nursing Homes, with membership and affiliation in 31 States of the Union, is unalterably opposed to that phase of Senate bill 2758 that gratuitously encourages Federal competition with privately operated, proprietary nursing homes. For over two decades, an estimated 20,000 nursing homes operating and serving in every county in the United States have been caring for the aged and chronically ill without aid or favor from State or Federal governments. We are fearful that this bill, S. 2758, exceeds the fondest hopes and dreams of those advocates who have espoused the cause that only the Government can best serve the needs of our public-health program. This bill, therefore, has come as a shock to the medical and hospital professions and has been an especial shock to the overwhelming part of our population dedicated as it is to the philosophy of private initiative and private enterprise. Our opposition to this bill stems fundamentally from two simple precepts: The first is a definition and a philosophy of the nursing home, its growth and its need to the communities of America. Secondly, the cruel and ill-considered policy of fostering Federal grants for the purpose of competing with nursing homes, without first, or at least concurrently, allowing this private industry and profession the opportunity to fulfill whatever may be lacking in the public-health program of America in those areas served by nursing homes; and thirdly, and rather parenthetically, I should like to take a moment to point out how bewildered we are to know the reason why this administration, dedicated as it is to the encouragement of private enterprise, would so arbitrarily cut a swath across one of the growing professions in these United States, and under the facade of doing good through so-called nonprofit nursing homes, is drifting toward socialism in the medical field at an unprecedented pace. What then, Mr. Chairman and gentlemen, is a nursing home? The longevity of our population, the chronic illnesses defined and controlled by our medical professions have been the necessary forces for the growth and maturity of the nursing home. For the past 23 years they have served the communities of America with neighborly understanding. These homes are small, compact, friendly units caring for people afflicted with some of the most dreaded diseases known to medical science and treating them with a sympathy and understanding that cannot be attained in large chronic institutions. Thousands of nurses and other lay people have dedicated their time, their energies, and their fortunes in the development and promotion of nursing homes throughout the United States. They have located them where they are needed, in the community, not in the outlying districts where county and State institutions are always located. The nursing home, so often defined as an annex to the hospital facility, in the matter of public health, has made its service available to the people where it is needed, so that an afflicted or aged person is able to be within easy communication of friends and relatives; and, as if by design in this atomic age, these semihospital facilities, though dispersed and decentralized as small, efficient units, are serving the needs of our aged and those chronically ill, with understanding and unity of purpose. We are not, however, unaware that much criticism, of late, has been leveled at the title "nursing home." We are not unaware, too, that nursing homes have suffered bad public relations because irresponsible people, contrary to law and what is right, have housed, harbored, and attempted to serve people who are indigent and others without the sanction and approval of any licensing authority, State or Federal. Mr. Chairman and gentlemen, lest your minds be clouded by this recent outburst of adverse public relations, let it be known that these unlicensed facilities are not nursing homes; they are as unlawful as bootleggers or any other criminal working without the confine of the law and are properly held in disdain by the public, you, the public's representatives, and nursing home administrators alike. The genuine nursing home, that institution in whose behalf we are appearing as a national association, is not an unlicensed and irrespon |