The Ohio association believes that there is no need for governmental subsidy of nursing homes in order to insure adequate care of the aged and chronically ill, believing firmly that time, continuation of efforts already commended by those in the field, and governmental encouragement by other means will accomplish the result desired in a better fashion. In order that the committee may compare the situation in Ohio with that existing in other States, certain basic factual information is herein set forth. (NOTE. Unless otherwise indicated, the information listed has been secured from the Ohio Conference on Problems of the Aging, sponsored by the Ohio State University and Ohio Citizens Council for Health and Welfare.) In 1952 there were 759,000 persons over the age of 65, or 1 for every 11 persons in the State of Ohio. The majority of these persons lived in family households. In 1953, 30 percent of all persons over the age of 65 were receiving income from employment, either as a wage earner or the wife of a wage earner; 36 percent were receiving old-age and survivors benefits; and 7 percent were sustained by other retirement programs. Over 65 percent of the patient population of county homes in Ohio are over 65. The number of patients over the age of 65 in our mental institutions increased 40 percent during the last 6 years, although the total population in such institutions increased only 15 percent during the same period of time. In 1953, 20 percent of the patient population in these institutions were over 65. In 1950, 18,500 men, or 5.6 percent of the over-65-age group, and 18,020 women, or 4.7 percent of the over-65-age group, were in institutions, hotels, or other types of domiciles caring for more than 5 lodgers. As of March 9, 1954, there were in Ohio 572 licensed commercial nursing homes having 8,240 beds for aged and chronically ill. There were on the same date 95 philanthropic homes having 5,160 beds for the same purpose. It is the opinion of the licensing agency, the Division of Social Administration of the Ohio Department of Welfare, that there is no substantial shortage of nursing homes in the State but that additional homes which could or would accept patients at minimal rates could well be established. Those counties in the State with the lower proportion of older persons are the more populous counties. For example, although the State average of persons 65 and over is 8.9 percent, the following highly populated counties are below such average: There are more women in the over-65 age group than men, and this trend is increasing. For example, in 1950 there were 89 men for 100 women. In 1975 projection indicates that there will be 75 men for 100 women. It must be remembered, of course, that for many old age brings with it physical infirmities and mental deterioration. Those who are able to care for themselves usually do not go into homes for the aged; therefore, the majority of residents of such homes are incapacitated in one way or another in addition to the debilities of their age. Many are disabled by arthritis, diabetes, paralysis, cardiac and nervous disorders. There are many with impaired eyesight and hearing. The minds of some are not as active as they once were, and their memory and perception have been effected. A considerable percentage are senile. A recent survey by the Ohio Citizens Council for Health and Welfare of 48 homes for aged Ohioans revealed that, of the total of 3,963 residents therein, 738, or 19 percent, had disabilities sufficient to confine them to bed. The remainder were able to be up for varied periods of time, although some could not leave their rooms or particular floor on which they lived. This same survey revealed a variety of accommodations and services offered, a brief summation of which may be of interest to this committee. All of the 48 homes used 1 or more living rooms or dining rooms or some other space for the leisure time activities of their residents. Twenty-five had solariums. Fifteen had chapels or auditoriums. Six had recreation rooms. There were 8 libraries and 11 workshops. Tools and equipment for all types of handicraft were some times evident, as were tailor shops, shoeshops, and barbershops operated by the residents. Such rehabilitative equipment as sewing machines, weaving looms, wood-carving equipment, power saws, and brushes and paints were discovered. All of the 48 homes had some of the following equipment for more leisurely activity: Musical instruments, radios, television sets, recording machines, and movie projectors. Daily newspapers are almost invariably furnished to the residents. Religious services are high on the list of activities of the residents of the homes of the aged, both as to frequency and popularity. Gardening or farmwork was done by the residents in 28 out of the 48 homes, but relatively few residents participated therein. Much of the information already given supports, we believe, our contention that encouragement of expansion of commercial nursing homes by means other than governmental subsidy would better answer the need of our aged and ill population and at the same time avoid additional expenditures of Government funds which could not be recovered. It is important to remember, of course, that such a program, if inaugurated, would carry out the expressed intent of the present administration to promote the growth and expansion of private enterprise and that the resultant increase of activity among that group would reflect in increased tax revenue. On the other hand, the present provision of S. 2758 providing for outright grants to nonprofit nursing homes would not in itself provide a satisfactory solution to the existing problems and would obviously witness the expenditure of a considerable amount of funds with no expectation of any tax return thereon. One of the facts set forth in the early part of this statement showed that the more populous counties have the lower proportion of older persons. Experience has shown that the majority of nonprofit homes tend to be established in these communities. Commercial nursing homes, however, are widespread throughout the State, being present in communities of every size and need. It is believed in this respect that there is a distinct advantage to the residents whose mental attitude and morale is of extreme importance to their comfort to be able to remain in their own community among familiar surroundings and acquaintances. These commercial nursing homes employ local help, which is generally more obtainable than an institution which must secure some of its employees from other locations. Another important factor previously mentioned was the higher proportion of women than men in the over-65 age group. Again, experience has shown that women in particular prefer the smaller, more sociable, homelike privately operated homes to the generally larger, institution-type nonprofit nursing home. The private nursing homes have been pioneers in the care of the aged and chronically ill and have consistently attempted to expand and enhance the quality of the services rendered to their residents as well as making continual efforts to improve their own standards of care. Nothing contained herein should in any way be construed as derogatory of the philanthropic nonprofit nursing homes. We realize the need for such institutions in addition to the commercial nursing homes and public institutions. As a matter of fact, there has recently been formed an interorganization relations committee of the three State organizations representing the public, philanthropic, and commercial nursing homes. At his specific request there has also been formed an advisory committee to the State director of the department of public welfare composed of representatives of each of the three mentioned organizations. It has been discovered, however, that no one type of nursing home can adequately supply the answers to the varied problems of caring for the aged. We feel, therefore, that the presently proposed legislation is discriminatory and fails to adequately gage the true needs of our senior citizens. We wish to record our unalterable opposition to any such legislation which will tend to preempt a field of primary concern to local governments, adversely effect individual initiative, and discriminate against private enterprise. We advocate a program whereby nursing homes in all classifications may be encouraged in their endeavors to provide better care for the aged and chronically ill on an equal basis by governmental assistance other than outright subsidy. Such action will, we feel certain, enable those engaged in this field of endeavor to keep pace with the needed expansion which will be required in the future to properly care for the ever-increasing ranks of the aged. Respectfully submitted. ESLIE SHARPE, President, Ohio Association of Nursing Homes. › KENTUCKY ASSOCIATION OF NURSING HOMES, SENATE COMMITTEE ON LABOR AND PUBLIC WELFARE, Capitol Building, Washington, D. C. SIRS AS president of the Kentucky Association of Nursing Homes, which association represents a majority of the licensed nursing homes within the Commonwealth of Kentucky, I am protesting against the inclusion of nursing homes in the provisions of H. R. 8149 and Senate bill, S. 2758, for the following reasons: 1. The nursing-home operators of this State fear that this would set a bad precedent and open a door for an expanded and greatly accelerated program of unfair competition on the part of the Government to the private-enterprise operators of nursing homes. They have seen the system of hospitals operated by the Veterans' Administration expand since 1926 from 26,000 beds to present plans for some 130,000 beds offering service to about 40 percent of the entire adult male population of our country, with the possibility of still greater future expansion. Private hospitals are greatly concerned about this, and nursing-home operators on their part feel that they should take warning from this and other programs of Government spending that tend toward the socialization of medical facilities and private enterprise. Such a program as is initiated in these recently introduced bills could eventually destroy the proprietary nursing homes profession in this country. 2. Nursing-home operators believe that these bills were conceived as a result of misinformation. The original bill, H. R. 7341, was conceived with the idea that there were only about 9,000 nursing homes in this country, whereas figures compiled by the nursing homes associations throughout the country indicate that 20,000 would be a more accurate estimate of the number. The administration did not realize how large a number of nursing homes were already in operation. Nor did they take into consideration the large number of such patients as are now being cared for in State, county, municipal, church, fraternal, and veterans' institutions, and in the general hospitals throughout the country. Apparently they did not know that some of the newer hospitals, especially in rural areas, are maintaining their present bed capacities at present occupancy levels only by taking care of a considerable number of patients that are in reality nursinghome patients. They made no survey to ascertain how many nursing-home beds are already vacant in such areas. Yet they estimated that only a small percentage of the needs are presently being met. Nor did they consult with any of the nursing homes associations to ascertain whether all present and future needs for improvement and expansion might be met through long-term loans without outright grants. If this had been done in a sincere manner, nursing homes would never have been included in the provisions of these bills. 3. Large centralized nursing homes such as would result from this proposed plan would be needlessly expensive to build. It was estimated by the sponsors of this proposal that it would cost $8,500 per bed to build and equip nursing homes, whereas proprietary nursing homes meeting all State licensing requirements can be built on a 1-floor plan according to local community needs at about one-third the cost anticipated by the sponsors of this legislation. 4. Large centralized nursing homes of this type are not conducive to the proper care of nursing-home patients. They become too professional to provide the home atmosphere which has made the nursing-homes profession what it has become today. They lack that human touch and personal relationship between worker and patient that means so much toward making old people happily contented, as we find in the majority of licensed and approved nursing homes throughout this Nation. They rob the residents of the companionship of their friends and relatives because these find it difficult to make frequent trips to visit a more distant centralized nursing home. Our present nursing homes are built around the community which they serve. Centralized nursing homes would mean that nurses and workers generally trained to care for acute and short-term patients would be assigned to the care of nursing-home patientsa task for which they are untrained and which demands a different type of care from that of general-hospital patients. 5. It would encourage public-nursing homes, and it is generally known that satisfactory operation of public institutions for long-term cases is extremely difficult. Care in such institutions has not compared favorably to that found in properly regulated licensed nursing homes, and few public institutions are operated on the standards required of private institutions. 6. Government-sponsored publicly owned nursing homes would tend to remove responsibility for the care of such patients from the relatives and local communities and shoulder it upon the Federal and State governmental units. A large percentage of the public feels that, if an institution is publicly owned, individuals should not have to pay for the service it renders. This would result in an ever-increasing tax burden and a further drift toward socialized medical care. 7. Whether paid by public funds or not, care in such nursing homes would actually cost more than in proprietary nursing homes, especially when cost of maintenance, replacement, cost of operation, and loss of taxable income to the Government are all taken into consideration. Even in nonprofit hospitals care may cost more than in proprietary hospitals when such things as contributions, subsidies, endowments, tax exemptions, and so forth, are all considered. 8. Large institutions for the care of long-term patients on a self-supporting basis have proved unprofitable financially, with the result that they have in some cases been discontinued and in others transformed into general hospitals or have undergone modifications as to their original purposes. 9. This Nation has rejected socialized medicine. Yet, when a large group of citizens are encouraged to look to the Federal Government to provide care for all their disabilities, they are being led one step closer to socialized medicine. No private enterprise can long compete with a Government-subsidized enterprise in the same field of operation. Private and proprietary nursing homes could not successfully compete with public-nursing homes. In this proposal the Government is alining itself against private enterprise. The elimination of private enterprise in the nursing-home profession could conceivably bring one step nearer the elimination of private enterprise in the medical profession. A continually expanding Federal aid program for all types of care could lead eventually to the federalization of all hospital and medical care. 10. There is a fear on the part of many nursing-home operators that factors other than the best interests of our chronic and aged population may influence the location and construction of public-nursing homes. Some of them have felt that already a few politicians have used old-age-assistance raises as a tool for the advancement of their own personal ambitions by leaving old people under the impression that politics had something to do with such increases. These operators fear that the provisions of this legislation might be used for political purposes on a local level. In the foregoing, I have endeavored to summarize, without burdening anyone with statistics, some of the principal reasons why the members of the Kentucky Association of Nursing Homes are opposed to having nursing homes of any kind included in the provisions of H. R. 8149 and Senate bill S. 2758. They feel that money for construction of nursing homes by outright grant should not be undertaken until all other legitimate efforts have been made to meet the needs, and they feel that long-term, low-interest, Government-insured loans to proprietary and nonprofit nursing homes alike, without partiality, by including both nonprofit and proprietary nursing homes in the provisions of a bill such as H. R. 7700, would fully solve any problems of the present or future in connection with the need for nursing-home beds. They feel that an attempt should at least be made first along this line before any legislation is passed to provide outright grants for public and nonprofit nursing homes. They also feel that if more public funds for the care of the indigent who are in need of hospitalization or nursing-home care were provided to meet the cost of such care, the number of nursing homes of a high quality would greatly increase, and that this would make it easier to finance such construction from regular financial circles. Even if the proposed legislation should be enacted, this increase for the care of indigents will naturally follow in time, so why should not we "put first things first" and leave the enactment of such legislation as is proposed in H. R. 8149 and S. 2758 only as a last resort, should all other more reasonable methods prove to be inadequate. Respectfully, IRA O. WALLACE, President. Re. S. 2758 Mr. MELVIN SNEED, WISCONSIN ASSOCIATION OF NURSING HOME OPERATORS, Professional Staff, Senate Committee on Labor and Public Welfare, Capitol Building, Washington, D. C. DEAR MR. SNEED: On behalf of 357 nursing homes within the State of Wisconsin, the Wisconsin Association of Nursing Home Operators assert their position against the above bill S. 2758 that has been introduced for legislation. In our State more than 12,000 older citizens, excluding many in mental and general hospitals, are receiving some type of institutional care. Almost two-thirds of them are in our nursing homes. It is therefore understandable that the nursing home operator is playing an important role to assist this new generation to become rart of our social and cultural life. The nursing home strives to maintain a home atmosphere that is nonexistent in large institutions but at the same time render physical care that he is unable to get in his own home. You, no doubt have been subjected to discussion against this bill, such as free enterprise, return of internal problems and responsibilities to States, and deactivation of Government competition with private industry. All these are logical reasons that should be given due consideration. However, we should not lose sight of the purpose of this bill. It is not presumptuous to say the purpose is for the benefit of our older citizens. Therefore, it would not only be logical but also proper to have the older person decide who will be his custodian at large. Too often we are prone to solve the older persons' problem without consulting them for advice and opinion. Let us weigh their thoughts as we meditate over this bill : Grandma and grandpa wonder what constitutes a nonprofit organization? Will it carry a stigma of charitable significance? Will it represent a public institution? What is there to prevent a city or county to set up its own nonprofit organization? Would it not then be city or county operation? Experience has informed them that the public institution or poor farm, though gradually making its departure, are still, in memory or in fact, a stigma to society. In small and large cities they continue operation as the "catch-all" for community problems. Regardless of age, derelicts, alcoholics, and various types of undesirables are admitted. This type of institution is a convenient method, or the least line of resistance, for the court to clear its calendar. Unfortunately these same institutions are "bursting at its seams" with older citizens. Is this the penalty for old age to be cast in with community outcasts? In a sense, our interpretation of S. 2758 is a backward step in the field of gerontology. It is an encouragement to the rebirth of poor farms. Granted, it is an encouragement for communities to accept the aging problem as a community problem, but what prevents a nonprofit organization from converting to a commercial institution? The hesitancy of the average citizen to accept responsibility for its aged, and lack of qualified personnel interested in this field of work, has been a discouragement for direct community participation. In conclusion, may we stress. "what the older citizens desire" should be the guidepost for any decision in this field of welfare. Respectfully submitted. ALBERT G. INCANI, Vice President. Mr. MELVIN SNEED, MISSISSIPPI STATE ASSOCIATION OF NURSING HOMES, Professional Staff, Senate, Senate Committee on Labor and Public Welfare, Capitol Building, Washington, D. C. March 30, 1954. DEAR MR. SNEED: First, the members of the Mississippi State Association of Nursing Homes would like to thank you for this opportunity to give our views concerning Senate bill S. 2758. Our State association is opposed to Senate bill S. 2758. The most important one thing to be considered whenever we think in turns of nursing homes is the welfare of the aged and chronically ill found in these homes. Whenever a man or woman |