sible unit; rather, it is licensed under strict laws of the various States and subjected to rules and regulations of the properly designated State agencies.

The licensing laws, however, have been slow in coming into exist

ence.

This national association has urged that every State have a licens ing law and a set of rules and regulations for the conduct of nursing homes.

We are happy to report that every State but one, North Carolina, in the Union now has a law licensing nursing homes and defining what the code of conduct in a nursing home must be.

As I say, we not only relish this very recent turn of events toward unfair State licensing laws, but we have been instrumental in promoting it.

At this point, Mr. Chairman, I should like to read into the record a statement by Mr. George Mustin, secretary of the American Association of Nursing Homes, in an address in Cleveland, Ohio, recently referring to the nursing home profession's need for uniform laws and standards. Mr. Mustin said, and I quote:

State laws governing nursing homes range from poor to acceptable. In at least one State the licensing application does not list as a requirement any knowledge of nursing or of nursing homes.

The number of square feet in bedrooms ranges from 50 per patient, which is too low, to 2 patients per room, regardless of its size. We believe the minimum should be 70 square feet per bedroom for homes now in operation, 80 square feet for homes subsequently initially licensed.

One State designates the kinds of food by weight each patient is to receive. There are other laws which might better be amended, and there is need for additional legislation to improve existing laws.

The laws governing building codes range from few requirements to those more rigid than the legal yardsticks by which older hospitals in some areas are evaluated.

Standards, too, vary as much as laws, and should be re-examined in line with health and safety requirements, taking into consideration the sensible day-by-day nursing home operating procedures.

I read this, Mr. Chairman and gentlemen, to point out at this time. that we are not here for selfish reasons; rather, we are here in what we consider to be the public interest and the public good.

Being a licensee of the State, the nursing home must keep strict and accurate records concerning the medical treatment and nursing care of its patients in a system of charting and recording that is very comparable to the charting and recording required in hospitals.

The home must cater to dietary problems and tend the most intimate needs of unfortunate patients oftentimes completely bedridden; it must maintain a staff of professional nurses and provide facilities for comfort and care 24 hours per day, 7 days per week.

The nursing home administrator, employing on an average of 10 personnel, must be responsible for all those incidental things demanded of any employer-insurance, welfare benefits, vacation pay, social security, workmen's compensation, and so forth.

At this point I should like to read into the record a survey of 23 typical nursing homes in the city of Minneapolis.

Senator GOLDWATER. Mr. Muse, if you would care to submit that, it can be inserted in the record without your reading it, if you want to avoid reading it. You have that privilege.

Mr. MUSE. Thank you, Mr. Chairman. It is very short and I would like to read this into the record.

There are 23 nursing homes with 552 patients employing 229 people. In 1 year these 23 nursing homes had a payroll of $391,865, and for food alone they spent $221,468.

Twenty-one of these institutions paid $42,596 in real estate and personal property taxes, and over the past 3 years the 23 homes have spent in capital improvements in their properties $191,748.

These are homes, Mr. Chairman, that have been taken at randon to show the consciousness on the part of the nursing home administrator in working toward a solution to some of the problems that are facing all of us.

The home must conform to the rules and regulations of the various State agencies of public health and public safety and from time to time the physical structure of the building must be altered at great expense in order to keep up to the requirements demanded by public safety.

Most importantly, the nursing home administrator in charity and kindness must constantly cope with problems made testy by the aged inhabitants of the home and be ready to satisfy not only the whims of the patient but oftentimes unreasonable demands of the relatives.

Who are the patients being administered to in nursing homes? To answer this, I am submitting a typical census marked "A" and ask that it be extended upon the record for your consideration. Senator GOLDWATER. Without objection, it will be received. (The exhibit referred to is as follows:)

EXHIBIT A.-NURSING HOME CENSUS SURVEY OF A TYPICAL MASSACHUSETTS NURSING HOME

1. Note range of age among patients.

2. Note the modest amount being paid for the nursing home facility and professional care.

3. Note the amount of professional attention each of these patients requires. 4. This home is typical of homes throughout the United States that are licensed under the laws of the various States.

POPE NURSING HOME, CENSUS FOR JANUARY 1, 1954

1. Age 90; single; female; 4-bedroom; $30; public assistance: Came from nieces July 1950. Suffers from partial blindness, convalescing from a dislocated shoulder, has general arthritis, and is slightly senile. Originally on house diet, now on fat-free diet. Meat is cut. Lacks partial use of arm. Needs assistance in dressing, hair, etc. Four prescriptions daily.

2. Age 85; single; male; 2-bedroom; $49; private: Admitted April 1950 from hospital. Suffers from general ananasaraca and chronic myocarditis. Must be lifted from bed to chair. House diet, poor appetite, must be prompted to eat. For past year suffering from kidney condition. Not dressed. Six prescriptions. 3. Age 78; female; widow; private room; $35; public assistance: Admitted February 1952 from boarding home. Suffers from arthritis in left knee; unable to walk because of this condition. On high-protein diet. Able to dress herself. Does not get along with people. Three prescriptions and injections.

4. Age 94; female; widow; 3-bedroom; $35; public assistance: Admitted February 1952 from hospital. Had fracture of pelvis-arterialesotic, anemic, arthritis, and general arterialeroses. Has had hemorrhagic cystitis. Foley catheter for short periods. Lifted from bed to chair, now able to bear some weight on hip. House diet, food cut. Received public aid. Eight prescriptions, plus liver injections. Not dressed.

5. Age 70; single; male, semiprivate; $35; private: Admitted August 1951 from hospital. Suffers from arterialeroses and hypertension. Low-salt diet; able to feed and dress himself. Three prescriptions.

6. Age 90; single; female; 3-bedroom; $35; public assistance: Admitted September 1952 from boarding home. Coronary sclerous, peripheral arterialeroses and hypertension. Low-salt light diet (no rich food, gross sweets, highly seasoned, or food that has a tendency to form gas.) Was able to be out bed at first. Suffers frequent coronary attacks, now a bed patient. Has four prescriptions.

7. Age 88: female; widow; 3-bedroom; $30; public assistance: Admitted De cember 1950 from hospital. Had fractured hip. Mild senile. Now able to walk. Nurses dress her. Low-salt diet, food cut. Restricted fluids. Incon

tinent.

8. Age 79; female; widow; 4-bedroom, $60; private: Admitted December 1951 from own home. Cerebral hemorrhage. Was able to be up and dressed at first. Now completely bedridden. Unable to feed self. Is incontinent. Senile, so that it is necessary to use bedside on her bed. Five prescriptions. 9. Age 88; female; widow; 4-bed room; $35; public assistance: Admitted January 1951 from another nursing home. Has areriosclerosis, heart disease, hypertension, generalized arteriosclerosis (including cerebral), old cerebral thrombosis, right side involved 1949. Completely bedridden. In past 2 years has a number of slight cerebral thromboses. Right side now completely paralyzed. Has only partial speech. Low-salt diet, is fed majority of meals. Five prescriptions and injections.

10. Age 71; female; widow; 4-bed room; $60; private: Admitted July 1947 from own home. Diabetes mellitus, generalized arteriosclerosis, chronic nephritis, hypertrophic arthritis. When patient was first admitted she had numerous diabetic sores, especially on her head. These are now completely healed. At first able to get from bed to a chair and care for herself to some degree. Now completely blind, completely bedridden, unable to do anything for herself, growing steadily worse. Diabetic diet, will not chew food; must be made semi-solid or put through a blendor. It is necessary to test for sugar three times a day (because of patient's eating habits) to determine insulin dosage. Incontinent. Five prescriptions and injections.

11. Age 88; female, single; 4-bed room; $60; private: Admitted October 1950 from hospital. Arteriosclerosis, hypertensive heart disease. Able to be dressed when she was first admitted. Had part of breast removed 1951 (not malignant). Now confined to bed, must be fed. Patient seems to have a constriction in throat and will only swallow soft solids or liquids. Four prescriptions.

12. Age 80; female; single; 4-bed room; $30; public assistance: Admitted 1935 from home. Myxodema, moderate anemia, secondary arteriosclerosis. Low mentally, always needed supervision. Now incontinent. House diet. High iron and protein. Did not receive public the first 10 years. Nurses help dress. One prescription.

13. Age 78; male; single; private room; $60; private: Admitted 1948 from home. Chronic cardiovascular disease. Cerebral scleroses. Is like every old man of 90. Must be lifted from bed to chair. Is fed. Is incontinent. Is very uncooperative on feeding. Has just a pneumonia. Two prescriptions. 14. Age 82; female; widow; 3-bed room; $35; public assistance: Admitted 1947, from son's home. Slightly senile, anemia, fracture of right hip. Confined to bed. Incontinent, totaly incapable of caring for self in any way. Must be fed, semi-solid diet. Three prescriptions.

15. Age 74; female; widow: 3-bed room; $30; private: Admitted September 1950 from boarding home. Severe arthritis, knees completely stiff now. Is lifted from bed to chair. Suffers a great deal of pain and is depressed and cries for long periods. High-protein diet. Given injections weekly by doctor. Not dressed.

16. Age 69; female; widow; semi-private; $30; public assistance: Admitted November 1951 from hospital suffering from contusions of left knee from a fall. Ulcers on right leg that never heal. House diet. Partially cares for self. Dress self.

17. Age 76; female; single; 4-bedroom; $30; public assistance: Arterialeroses, senility, admitted 1945 from nursing home. At that time was up and dressed, able to care for self, but slightly forgetful. For past 2 years strictly bedridden, incontinent, is fed liquids only, all muscles have constricted, unable to move any part of body. Had own money for about 4 years. Now on OAA. Has not spoken for 2 years. Takes long time to get necessary food and liquid into her. One prescription.

18. Age 87; female; widow; 3-bedroom; $32.50; public assistance: Admitted from home in 1950. Hypertensive cardiovascular. Has Foley catheter at

all times. Has been on a low-fat diet, sippy diet, 2-hour feeding, bland diet, low-salt diet and now semihouse diet. Past year has been receiving aid. Kidney condition requires daily irrigation of catheter. Two prescriptions.

19. Age 74; female, single; 4-bedroom; $35; public assistance: Admitted from hospital in 1947 after a resection of cancer of the colon. On low-roughage diet. Up and around and able to care for self. Patient hemorrhaged from bleeding peptic ulcer. Was operated on for subtotal gastromectomy in January 1952. Six meals bland diet daily. Patient has arthritis of knees but has recovered and is ambulatory. Also suffers from cardiac decompensation.

20. Age 79; female; widow; semiprivate; $40; private: Admitted from home in February 1951. General arterialeroses. Taken from bed to chair daily. Incontinent. House diet, food must be cut. Speaks little English. Is not dressed. 21. Age 64: female; widow; private room; $30; public assistance: Admitted from home in 1946. Hyperthyroid disease. Hypertension, arthritis of feet. Able to care for self to some extent. Mentally keen and cooperative. Dresses self. Five prescriptions.

22. Age 86; female; widow; 3-bedroom; $35; public assistance: Admitted 1951 from home, suffering from mild arterialeroses with cerebral involvement which has gradually become much worse. Incontinent. Shows loss of strength in general. Colitis. Food cut up. Now a great nursing problem. Three prescriptions.

23. Age 70; female; single; 4-bedroom; $35; public assistance: Admitted from hospital 1947. Cerebral hemorrage right hemiplegis, arterialeroses. Cannot speak, completely paralyzed on right side, bedridden, but is able to feed herself and make her wants known. Patient cried for first year. Fussy about food and will not eat straight house diet. Two prescriptions.

24. Age 92: female; widow; private; $35; public assistance: Admitted from hospital in 1948 with fracture of left shoulder. Has poor circulation of legs and for past year has had number of ulcers on legs. Patient is deaf and determined in her ways. Able to care for self some. Nurses assist dressing. Three prescriptions.

Mr. MUSE. After you have studied this census, it may come as a surprise to you that these patients, running the terrible gamut of disease and afflictions, are being adequately cared for in nursing homes and, to the extent that they are being cared for, leave the hospitals free to administer the acute problems in our health program. It may come as a surprise, too, that the care is being given for the small weekly amounts that are indicated by the census, contrary to the well-known high cost of hospital care.

I would ask you to observe, contrary to other information given to this committee, that the overwhelming number of these patients are indigents who are being supported in whole or in part with public funds, and what you have noted about this census is typical of nursing homes throughout the country.

It should not come as a surprise that the nursing home administrators, in view of the work they have been doing in behalf of the indigents of our country, are, therefore, a little bit fearful of the implications of this particular measure before you.

Gentlemen, no longer can we be polite in our reference to the dogooders and the misguided zealots who constantly harangue about the problem, and say that the cure for the afflictions of our aged population is the establishment of so-called nonprofit nursing homes.

Please bear in mind that the cost of construction, operation and maintenance of a nonprofit nursing home is not 1 penny less than the cost of construction and maintenance of a private nursing home. In fact, in most instances, the cost of operation, because we are not dealing with public funds, will be considerably less in a private nursing home; but we know as a fact, Mr. Chairman and gentlemen, that the cost of operating in the private nursing homes, despite the fact that

these private nursing homes must pay real-estate and personal taxes, is considerably less than the cost of operating a so-called public medical institution and we are assured that, because of the compactness of the nursing home, the patient is allowed more intimate attention than he would receive in the systemized type of care that is given in most State and county chronic hospitals.

Yes, gentlemen, we are fearful that there is a tendency on the part of the Federal Government to infiltrate the field of private nursing homes. Our fear is best summed up in the words of Oren Harris, the distinguished Congressman from Arkansas, when he addressed the House of Representatives on March 9, 1954. I quote:

Now, as to nursing homes. We are getting into the field of nursing homes. This is the only controversial feature of the bill. It is the new feature of the program. The people operating nursing homes throughout the country are fearful that this will put the Government or the localities, nonprofit institutions and associations, in competition with them. Frankly, if private nursing homes can provide the need, I would much rather see the program expanded by them. There is some justification for their fear. Private enterprise cannot compete with a Government program and exist.

At that time Mr. Oren Harris was speaking on II. R. 8149. Before the House of Representatives' companion bill reached the floor of the House for debate, our organization appeared before Representative Wolverton's committee and after consultation with nursinghome representatives from 22 States, who convened in Washington, we expressed before that committee our sense of fear and bewilderment about the propositions contained in that bill that will lead the Federal Government into the nursing-home field.

We did not appear before that committee, nor are we appearing before your honorable committee, through selfish motivation. The proposition that we make is a simple one. The nursing homes have taken care of the aged and chronically ill, either by necessity or design, for the past two decades without once calling upon the Government for aid.

All that we asked of Representative Wolverton's committee, and all that we ask of this committee, is that the Congress of the United States treat the nursing home with fairness and consideration, both in the interest of maintaining private enterprise in this phase of our public-health program, and guaranteeing thereby better health and better service to our general public. What we offer as an alternative to that phase of the bill that would make $10 million available in the form of Federal grants for this year is a policy of sound commonsense. There is no magic in the Federal dollar. The Federal dollar can purchase no more than any other dollar-it can be stretched no farther. If money is going to be made available to anyone, it ought first to be made available to that industry that has struggled against all odds to care for the acute problems that this bill attempts to correct.

The entire proposition as it relates to nursing homes, however, in view of the survey made by Secretary Oveta Culp Hobby, is unwise, unsound, and unrealistic.

The Secretary's committee report indicates that the per unit cost of construction for nursing homes is a maximum of $8,000 per bed. This amount was testified to before the committee and before Representative Wolverton's committee. The fact is, the per bed cost of construction for first-class nursing homes will not exceed $2,000 per unit.