In that regard, Mr. Chairman, I should like to submit for the record a bid that was given to Mr. George T. Mustin by Polk W. Agee, architect, registered architect, in Memphis, Tenn., wherein the cost per bed unit would be approximately $1,600 for first-class construction in a homelike atmosphere. Senator GOLDWATER. That will be received and entered in the record at this point. (The bid referred to is as follows:) Mr. GEORGE T. MUSTIN, Mustin Nursing Home, Memphis, Tenn. MEMPHIS, TENN., December 17, 1953. DEAR MR. MUSTIN: As per your request, here is a list of the low bidders on the nursing home which you propose to construct at 642 Semmes Street, Memphis: General construction, Annaratone Construction Co., 590 Loeb St., Memphis $62, 475 Plumbing, Fischer Heating & Plumbing Co., 367 Adams Ave., Memphis 11, 191 Total_ 7,600 7, 226 88, 492 In my opinion these firms are thoroughly reliable and capable of completing their contracts in a satisfactory manner. Very truly yours, POLK W. AGEE, Architect. Senator HILL. That would be built in Memphis, Tenn.? I suggest that if the survey about this most important matter of construction cost has proven to be the subject of speculation, and to raise doubts as to the actual cost of nursing-home construction, then we can reasonably raise doubts about other phases of the nursinghome program as they have been investigated and reported upon by this committee of Health, Education, and Welfare. Mr. Chairman, we are not here in the position of favor seekers. However, we can give you this assurance: If the money for the construction of modern nursing homes were to be made available to present licensed nursing-home administrators and to others contemplating this type of professional community service, the law of supply and demand would cause those homes to be distributed where they are most needed and consequently would become self-amortizing. I would suggest to you that if the amount of money contemplated being given to nonprofit institutions, under the bill before you, were made available in my State of Massachusetts, in a very short time there would be a minor building boom in the building-trades and hospitalsupplies industries; but under the proposed bill here before you moneys will not be made immediately available. There is some illogic about this bill, for, on the one hand, you would appropriate $60 million of taxpayers' money for the construction of nursing homes, and in the same bill indicate that you are willing to spend $2 million to make a survey apparently for the purpose of determining whether or not the $60 million must necessarily be spent. It seems to us, you are putting the cart before the horse. However, if this bill does nothing more than point out the lack of adequate financing that has been facing the nursing home administrator for the past quarter century, then much will have been accomplished, for as you may be aware banks are ill-disposed to give mortgage money for single-purpose buildings, be those buildings motels, hospitals, theaters, or nursing homes. Consequently, the nursing home adminitrators have been put to much cost because of high rates of interest in order to meet the expenses incidental to equipping, staffing, and maintaining their nursing homes. We feel, in keeping with the most recent pronouncements of President Eisenhower, that had this administration in surveying the needs for chronic illness looked to the Small Business Administration for the solutions, that approach would be in keeping with the philosophy of this administration, and if through the small business this administration would make available liberal loans to licensed nursing homes throughout the country, as it has done with other small-business enterprises, the problems, at least as respect first-class buildings and equipment, would be solved almost immediately; and at the same time this administration would be keeping faith with its pledge to encourage the growth of small business and return the business professions of the country to the free-enterprise system. Lest we be carried away with the need for new buildings and modern equipment, I would have you consider an equally important aspect of the entire problem as it was emphasized by Representative Frances Bolton on March 9, 1954, before the House of Representatives when she spoke in favor of Representative Wolverton's bill but raised this most important question, and I quote: As I reported to the House in my survey of the health care situation in America on February 25, there is unquestionably an acute shortage of nurses in this Nation. In many areas of the country whole hospital wards are being closed because there are no nurses to staff them. Just how do we propose to staff these additional facilities to be constructed under the hospital survey and construction program? Representative Bolton, by this statement, has pointed out the practical effects of bringing the nursing-home service to the community and not asking the patient to leave the community to go to the institutional type facility, for the nursing home may draw upon many thousand skilled nurses who for one reason or another are not able to travel from their home to the metropolitan centers and serve in hospitals, but are available for part-time work in nursing homes. The American Association of Nursing Homes, Mr. Chairman, is equally concerned with all the problems and their solutions for nursing our aged and chronically ill, more concerned probably than anyone or any other group in the United States, for this indeed is our profession and business. We have fought vigorously through the years for high ethical standards. We deplore the renegade who would abuse the privilege of serving our elder citizens and particularly our chronically ill. We are ever vigilant to expose them and in this matter we have always sought the help of public health authorities. This philosophy and outlook about our profession was made known to Representative Wolverton's committee and to members of his committee. At the time we appeared before the Committee on Interstate and Foreign Commerce, we were assured by the committee chairman that H. R. 7700, a bill that makes available long-term mortgage loans to clinical and health facilities, will be modified and amended so as to include within its scope guaranteed long-term loans at low rates of interest to licensed nursing homes throughout the United States. Representative Wolverton reaffirmed his desire in this matter when in reply to a question by Representative Cretella on March 9, 1954, before the House of Representatives, he said, and I quote: I might say there is other legislation to follow that could prove beneficial to private nursing homes in the event the committee reported it favorably and it is adopted by the House. I refer you to H. R. 7700. Conclusively, we are asking that this committee recommend that S. 2758 be amended by striking therefrom the line in subsection 4 of section 651, "$10 million for grants for the construction of nonprofit nursing homes" and to strike from S. 2758 any other reference of grants for the construction of nonprofit nursing homes. And we ask that H. R. 7700 and its companion bill, if there is one before the Senate, be amended to make available long-term loans to private nursing homes for the period of 1 year. If this is done, we can guarantee to you, Mr. Chairman and gentlemen, that by initiative and sound business principles usually practiced by proprietary institutions there will indeed be a minor boom in the nursing-home profession, for we can build more cheaply and we have a greater ability because we are decentralized for procuring professional nursing help, together with the fact that we will immediately build homes where we know they are needed and will not have to wait for a survey to tell us about our own business. We can promise that with the FHA type of guaranteed loan for nursing homes we can make available facilities for the treatment of chronic illness heretofore undreamed of in these United States, both in quality and quantity; and we can pledge this to the American people: That we will keep abreast of the growing needs of our aging population rendering to them kindly and humane service at the community level. Remember this above all, Mr. Chairman: That if we fail it is always within your power to introduce this phase of the bill in any succeeding year; but the proof that we ought to succeed in our pledge is in the accomplishments of Mr. Henry Kaiser, who was willing to underwrite the successful prepayment health plan now bearing his name. This plan could not enjoy its present success unless he and others were willing to underwrite and guarantee to the banks the repayment of loans for clinical and hospital facilities. Mr. Kaiser proved that hospitals properly operated, and clinics efficiently run, can give the best service the American way, the proprietary way, which is the self-liquidating way, so that it is a burden to no one and a profit to all. Neither our professional industry nor the people served by it need any coddling from Government. It needs nothing but your warm hand of friendship in the form of Government-guaranteed loans, the repayment for which we will be responsible, and a manifest act of faith on the part of our Government that our professional industry is capable of serving the needs attendant upon the aging population of our era. Mr. Chairman, I should like, too, to extend upon the record some remarks made by Mr. George T. Mustin on page 6 of the Journal of the American Association of Nursing Homes, March 1954. 46293-54-pt. 1—13 Senator GOLDWATER. Without objection, they will be received. (The remarks referred to are as follows:) FROM THE SECRETARY'S DESK From time to time it is suggested in some quarters that the general hospital is the proper agency for the care of the chronically ill patient holding that the doctor on his daily rounds can keep closer watch on the patient than through any other method, and that the hospital is properly equipped, in the event of sudden illness. We disagree completely with this thought, firm in the belief that the average chronic patient does not require daily medical examination, and as for the availability of specialized equipment, any patient requiring such has passed from the chronic to the acute stage and probably needs to be hospitalized anyway. But that is not to say they should live in a hospital so they will be quickly available in the event of sudden illness. The Chronic Illness newsletter of December 1953, published by the Commission on Chronic Illness, quotes from a publication of the United States Public Health Service as follows: Although "the country now has in its nursing homes considerably more beds for the care of long-term chronic patients than has been generally recognized *** relatively few of these beds are in facilities which meet accepted standards." This is followed by a statement not in quotes: It is further indicated that increased popularity has been given to the opinion that patients having chronic diseases should be cared for in general hospitals or facilities associated with general hospitals. The chief criticism leveled against nursing homes is our lack of functional housing. The matter of housing is most important and has certainly engaged the attention of every nursing home administrator. All of us would rather have a proper building for our patients, but, alas, we have no Hill-Burton money, and for the vast majority of us there are no funds available from religious, fraternal, or philanthropic organizations. No; our homes are what we have made them, and the improvements we have been able to accomplish are what we as individuals and as association members have been able to carve out with our hands, heads, and hearts. Just for a moment give thought to what our hospitals would be without funds from city, county, State, or Federal Governments; without funds from religious and fraternal groups, or without aid from philanthropists. Do you suppose there would be those imposing edifices of steel and stone as now grace our land? You know the answer. Nursing homes could be housed as well if construction loans, not grants, were made available on high-percentage, long-term, low interest rates. These loans could be made available to nursing homes individually, based on their experience and record of operation. And since we have been caring for the chronic patient for many years, we feel it is our right to have an opportunity to improve this important phase of patient care. We have not touched on a most important part of our work, the field of daily service to our patients, not in itself associated with medicine, but rather with a kind of homespun psychology; the task of causing the infirm, the chronically ill, and the aged feel wanted, needed, and still a part of the scheme of things. This kind of treatment is not to be found in general hospitals, but it is vitally needed to fashion happiness for those in our hands. It is a cardinal reason why the private nursing home will continue and prosper. We have not touched on our nursing services to patients, since that is the first requisite of any nursing home. Many of our homes are operated by physicians, registered nurses, and licensed practical nurses, and those which have not had professional training, have received theirs in the school of experience sufficiently to satisfy the licensing and inspection authorities. We are proud of the level of our care, although we do strive continually to better it, and our advances in this respect have been steady. We know our patients must receive experienced nursing care, and also that kind of personal attention which brings contentment to declining years. No; let the hospital keep to its field, where it has its hands full in the constant employment of its specialized knowledge and skill. Let us keep to our field where our hearts as well as our hands contribute to the contentment and care of our charges. Let those who would have better patient housing help to obtain it. It will be interesting to see if our critics are more concerned with the chronically ill or the furtherance of pet theories. GEORGE T. MUSTIN, Secretary. Mr. MUSE. I should like to ask of you, Mr. Chairman, if it would be possible to extend upon the record the written testimony from State presidents that will be forwarded to your attention within the next 14 days, testimony that bears upon the problem in 31 different States in the union, as these States are affiliated with the American Association of Nursing Homes. Senator GOLDWATER. That will depend upon the size of the testimony. We wouldn't like to say we will receive it and print it if it will occupy 2,000 pages, say. If it it a normal amount of testimony, we will certainly receive it and print it. Mr. MUSE. We feel, Mr. Chairman, in that respect, we can have the testimony confined to three average pages. Senator GOLDWATER. That can be received and printed in the record. (The letters referred to follow :) Hon. WILLIAM A. PURTELL, TEXAS NURSING HOME OPERATORS ASSOCIATION, Houston 2, Tex., March 30, 1954. Senate of the United States, Washington, D. C. DEAR SIR: I am reliably informed that at present the subcommittee of which you are chairman has at present under consideration S. 2758, which deals with the subsidizing by our Government at an added burden to the already overburdened taxpayer of nonprofit nursing homes and other related institutions. This proposal which is now before you is to be the Senate version of House proposal (7341) which was in my estimation and the estimation of other nursinghome operators passed by that great body in very unsuitable form. Referring to the above, there are approximately one-half million nursing home beds available in the United States. We have never been surveyed as to this fact, but one is gladly urged and welcomed at this time. These beds are all licensed and taxpaying (Federal, county, and State). We, and I am sure you will agree, want to operate as free citizens and pay our taxes to the Government instead of standing outside the White House begging and lobbying for a handout. The approval by the Senate of the United States of this legislation in its present form is only the opening wedge of the forcing upon the people and overburdened taxpayer of socialized medicine. I employ approximately 15 people, and they are all taxpayers as am I. I will repeat, I am 100 percent opposed to socializing the nursing homes in any form, and socializing is what it amounts to when the operator has to look to the Government for money on which to operate. Sincerely, Mrs. LELA HORTON, First Vice President. COLUMBUS, OHIO, April 3, 1954. Mr. MELVIN SNEED, Professional Staff, Senate Committee on Labor and Public Welfare, Capitol Building, Washington, D. C. DEAR MR. SNEED: There is enclosed the statement of the Ohio Association of Nursing Homes regarding Senate bill S. 2758. It will be appreciated if you will present this to the subcommittee considering this bill at their next meeting thereon. Very truly yours, THOMAS W. LANE. COMMENTS RE S. 2758 BY OHIO ASSOCIATION OF NURSING HOMES The Ohio Association of Nursing Homes wishes first to express its appreciation for this committee's courtesy in extending this unusual opportunity to the association to present its views regarding this pending legislation. This very act indicates a degree of interest in the problems of care of the aged which has heretofore been lacking. |