Proprietary nursing homes have performed their services for many years, and without Federal aid. We represent an established, tax-paying industry, with an investment in this State of some 6 millions of dollars. Under the circumstances, we have performed a valuable and essential service, and with the proper support and cooperation, could improve this service to meet the requirements of the most exacting critic. Where there is criticism of the nursing home, it is generally based on charges of low standards, and of improper housing. While we do not feel there is any justice in a charge of low standards in Tennessee, we do feel they could be raised, provided the licensing and operating standards of the State could be revised, more personnel provided for inspection, and laws presently on the books enforced more strictly. Briefly, in order to have good standards, there must be laws requiring those standards, frequent inspection to see the law is complied with, and rigid enforcement of laws requiring licensure as a prerequisite to operate. The argument used in connection with the companion bill in the House (H. R. 8149) that the bill should be passed because of the lack of uniformly high standards has no basis in fact because the proposed measure merely relates to the construction of nursing homes, and has no reference or influence upon the standards of operation. That is wholly within the field of State legislation, inspec tion and enforcement. As for the criticism concerning our housing, we would like to build modern plants, but it is most difficult to negotiate financing through usual channels, since lending firms take the position that ours is a specialized field, and that construction would be for a one-purpose building. Therefore, their offering, if at all, is usually limited to 50 percent of cost. Just how many fine hospitals would we have today if they had to be constructed under similar circumstances? One point upon which those sponsoring S. 2758 do not dwell is the impact upon the present nursing home standards, if this proposed measure were to become law. The resulting construction of nonprofit homes would, in our opinion, inevitably relegate the proprietary nursing homes to domiciliary institutions, and thus lower the standards of our homes. Nursing homes, as we now know them, would cease to exist, and their present level of care, which has risen slowly with the years through individual and collective effort, would descend into the dark ages of poor standards, because of our inability to compete with federally fostered institutions. There are alternatives to S. 2578 which would provide some measure of assistance in the four categories, with lesser effect upon our proprietary homes. Since the inception of the Hill Burton Act, there have been construction within its framework in all four categories. If the act were amended to provide construction under the auspices of hospitals, but not necessarily physically connected thereto, then the substance of S. 2578 would be realized. However, in the case of nursing homes, such hospital sponsored construction should be only for the hospital's convalescent cases, and not for the chronically ill. This would be right and proper, and would relieve the present shortage of hospital beds. The other alternative would be to appropriate sums for a survey to cover a period of 2 years, and at the same time, pass legislation providing Government or Government-insured loans to proprietary homes. We feel that in 2 years we could make such progress toward modern housing that it would be clearly seen there was no necessity for offering grants to nonprofit institutions. Gentlemen, before passing upon this proposed legislation, weigh the doubtful benefit to be obtained for our aged ill citizens against the certain devastating effect upon the established proprietary home. Give us an opportunity, through Government support to continue our services, and to improve them. With help, we can and will render the very finest service. Sincerely, GEORGE T. MUSTIN, President. Mr. MELVIN SNEED, INTERMOUNTAIN ASSOCIATION OF NURSING HOMES, Professional Staff, Senate Committee on Labor and Public Welfare, Capitol Building, Washington, D. C. DEAR MR. SNEED: This is to inform your committee on the views of the Intermountain Association of Nursing Homes in Utah concerning Senate bill 2758. In the State of Utah, propriety homes have operated 25 years without aid of city, county, State or Federal funds. We feel that this bill will deny us our inamiable right as a free people to enter or continue free enterprise. The inamiable right of a free people as indigents to choose the home in which they shall be cared for. This right which was given to us by our forefathers and our sons are still fighting to preserve, will be taken from us. In order to give the very best of personalized care in our private homes, we have contacted every available organization and individual who is primarily concerned with the care and treatment of the indigent as an individual. Dr. George A. Spendlove, director of Utah State Department of Health; Bishop Joseph L. Writhlin, head of the presiding bishop's office, Church of Jesus Christ of Latter Day Saints; H. C. Shoemaker, commissioner of State public welfare; a group of leading physicians and hospitals recommended propriety operated nursing homes, because of the excellent care being given the patient and the splendid progress and expansion in meeting the growing need in the nursing care of the chronically ill. This has been done by propriety operated homes over a period of years without any expense to the taxpayer. Adiel F. Stewart, chairman of the Salt Lake County Commission, made the assertion that it cost $12, or more per day to keep a patient in the infirmary maintained by the State. Private enterprise is giving the care for $3.34 per day in this State; a difference to the taxpayer of $8.66 per patient. We as taxpayers alone certainly are interested in the fact that these figures bare out our contention that propriety homes can and should be allowed to operate without competition from the Government. It is a well known fact that propriety operated homes do operate at less expense and give much better care to the indigent. At present, in the State of Utah, we have to our knowledge three nonprofit nursing homes which we have visited. One administrator asserted that it is impossible for them to care for an indigent at the present rate of pay. Nonprofit homes do not accept difficult nursing care patients. We are presenting figures we feel you will be interested in. In the year of 1939 there were 36 homes and no licensing laws. Today there are 70 licensed homes. Nursing homes were first regulated under the 1947 hospital act. Licenses were being issued by the State health and welfare departments. In 1951, Utah was the first State in the Union to pass legislation formulated by nursing home administrators for the purpose of governing nursing homes, making it possible for city, county, State health and sanitation inspections. The administrators licensing agent is under the office of business regulation. In 1953, Utah administrators passed legislation to remove nursing home licensing from the hospital act of 1947, placing it under the State department of public health. All future administrators are required to pass a written test before securing business administrators appointed by the governor. Under this law the governor appointed a governing council consistig of five represetatives. Two of whom are nursing home administrators with more than 5 years experience. This council is to form and approve all rules and standards regulating nursing homes. Because of this law, nursing home administrators were placed on a professional basis. We feel the Government could best serve the chronically ill by increasing their individual grant, thus giving the propriety administrators the opportunity to expand as needed. The total bed capacity is 1,560 with homes having vacancies at this time. Of this number approximately 500 are indigents. There are recreational facilities for the entertainment of those able to enjoy it. There has always been a rehabilitation program in effect in propriety nursing homes. Yours truly, NAOMI BROOKS, President. LOUISIANA ASSOCIATION OF LICENSED NURSING HOMES, Hon. MELVIN SNEED, Professional Staff, Senate Committee on Labor and Public Welfare, Capitol Building, Washington, D. C. DEAR SIR: Attached hereto is a statement of facts and statistics as concerns the State of Louisiana and reasons why the Louisiana Association of Licensed Nursing Homes feels that it should oppose certain phases and features of Senate bill S. 2758. It is also felt that the suggestions incorporated could be of infinite more benefit in solving a perplexing problem. We are appreciative of the committee's generosity in allowing our organization to submit such a brief for their consideration. Respectfully, Mrs. EDITH THOMPSON, President. ARGUMENT AGAINST CREATION OF NONPROFIT NURSING AND CONVALESCENT HOME FACILITIES The following pertinent facts and statistics are submitted for consideration, if effective care of the aged, infirm, and chronically ill is to be achieved in Louisiana with the least amount of Fe leral funds expended: 1. Louisiana has at the present time 12 Hill-Burton hospitals. The percentage of occupancy on an average during the past 12 months has run 65 to 70 percent full. 2. In both nonprofit and profit hospitals and private homes the total occupancy has been approvimately only 85 percent. 3. Ninety-eight percent of the Louisiana Welfare Department's patients have been placed in private nursing homes, rather than nonprofit homes. Reason: Nonprofit homes and hospitals refuse to take welfare patients for the fee allowable. 4. The provision to provide Federal funds for the creation of nonprofit nursing and convalescent home facilities will completely and irrevocably eliminate a phase of "free enterprise," and such funds will serve only to duplicate (at unnecessary expense) existing facilities which are more than adequate. 5. Such a provision as contemplated in Senate bill S. 2758 will cost both the Federal and State Governments large amounts of revenue in taxes collected. from private nursing homes. 6. No revenue in the form of Federal and State taxes will be available from tax-free nonprofit hospitals and nursing homes. In conclusion, from an economic standpoint it would appear that an amendment to Senate bill S-2758, eliminating the providing of Federal funds for the creation of nonprofit nursing and convalescent homes and substituting a provision enabling private nursing homes to secure long term, low interest rate loans for purposes of remodeling existing facilities and the building of new homes when needed, would be of greater benefit to the public welfare. Both from a tax standpoint and the forestalling of unnecessary expense plus the aid and comfort to private enterprise, it is respectfully suggested that the above points of argument be given careful and detailed consideration. MISSOURI ASSOCIATION OF LICENSED NURSING HOMES, MARCH 29, 1954. Mr. MELVIN SNEED, Capitol Building, Washington, D. C. GENTLEMEN OF THE COMMITTEE: The Missouri Association of Licensed Nursing Homes, being an affiliate member State of the American Association of Nursing Homes, herewith wishes to protest the portion of Senate bill S-2758; the provision to provide Federal funds for the creation of nonprofit nursing homes. There are 320 licensed nursing homes in the State of Missouri with 9,560 beds, as of March 15, 1954. With these facilities we have been caring for the aged and indigent in this State for many years without any assistance of funds from the State, county, city, or Federal Government in any amount of funds above the grant of $55 maximum payment of the old-age assistance grant in this State. There is no shortage of chronic beds in this State and no need for nonprofit nursing homes unless those nonprofit nursing homes would be obligated to take only the indigent and the $55 a month bed-patient. It is of course obvious that in this day and age, that an elderly person can barely get food and shelter for $55 a month, let alone food, shelter, nursing care, physician, medicines, and laundry-all for $55 a month-which is expected of the nursing home in this State. We feel that if the nonprofit nursing home would care for the aged and indigent in this class of patient, then that would be a wonderful way of caring for our aged and indigent, but when nonprofit homes hide under the guise of "nonprofit" and take paying patients at $100, $150 and more, per month, then they are no more nonprofit than we private enterprise nursing homes are, especially so when we are caring for the indigent of the State for $55 per month. So we are violently against this sort of socialized medicine, and the discrimination against private enterprise by our President and Congress, if such a bill is passed; a definite threat to private enterprise and to the proprietory nursing home who has been doing this job for so many years. All we are asking for is a fair deal. When the Missouri association, along with 29 other State associations, appeared before the Interstate and Foreign Commerce Committee, through our representative of the American Association of Nursing Homes, in hearings on H. R. 7341 (which was replaced by H. R. 8149), Mr. Wolverton went on record at the hearing to say that he would amend his bill H. R. 7700 to include private enterprise nursing homes in the bill which provides long-term low-interest, guaranteed loans to small business. This would be a step in the right direction. If the tremendous amount of money called for in Senate bill 2758 was put into such a bill as H. R. 7700 appears to be, if amended, and made available to profit and nonprofit alike, we feel that the private nursing homes would improve tremendously, and immediately upon loans being made available to them, and there would be no need for the expenditure of granting money for creation of nonprofit nursing homes. The department of health, education, and welfare has made the statement that there is a great need for nursing homes because there are only some 9,000 in the United States. This statement is not quite true for in the 30 States that belong to the American Association we have approximately 20,000 nursing homes, not counting those of the other 18 States. Many of us have spent our lives in this field of caring for the aged in nursing homes, and we have thousands of dollars invested in our businesses. We feel that we have been doing a public service for years and aiding the national economy at the same time with our taxes and by providing employement for thousands of people. We have a real and human interest in the older folks we take care of in our homes. We try to make it a home and not an "institution." Truly our homes are "a home in which to live; something to do; and someone to care." Thank you for the courtesy offered each State, through our American Association of Nursing Homes, and we sincerely hope and pray that you will give due consideration to the facts presented by each State in this matter. Yours respectfully, DONN C. BENNETT, President. KANSAS ASSOCIATION OF LICENSED NURSING HOMES, INC., SUBCOMMITTEE ON LABOR AND PUBLIC WELFARE, United States Senate, Washington, D. C. GENTLEMEN: We feel it pertinent to establish for the committee the authority with which we make the statements to follow in this report. First, membership in this association is open to all licensed nursing homes in the State of Kansas, profit or nonprofit. Therefore it is not composed of a selected group who might be subject to certain prejudices or feelings of bias. Secondly, the statistics quoted in this report have been obtained directly from the Kansas State Department of Social Welfare, which is the agency in this State charged with the direct responsibility of licensing such homes. (Technically we are licensed as "boarding homes for adults," but we prefer to call ourselves "nursing homes," since the provision of nursing service is our primary functions.) Further, the department of social welfare has authorized us to make certain statements herein, and will verify them if they are contacted by your committee. 46293-54-pt. 1-14 The primary purpose of this report is to establish the fact that private enterprise has and will continue to provide sufficient and adequate facilities for the nursing care of the chronically ill and infirm of the State of Kansas, and that there is no necessity for the subsidization of nonprofit homes by the Federal Government through grants for construction of such homes. In fact, we feel it quite unfair to take the tax money paid by the nursing homes of the Nation, give it to nonprofit homes which will be in direct competition with the privately owned nursing home, then have no opportunity to gather taxes from the newly established nonprofit homes. We feel that this is somewhat like killing the goose that lays the golden eggs. On February 28, 1953, there were 365 homes in the State of Kansas providing beds for 3,987 patients. On the same date, 1954, there were 444 homes with 5,460 beds. This represents an increase of 21.6 percent in number of homes and an increase of 36.9 percent in number of beds during this past year alone. During this period there was a lesser increase in number of persons needing our service than increase in beds provided, indicating that private enterprise is anticipating and meeting the needs as they occur. On the basis of the above statements we feel that we, the proprietary homes of the State, have adequately provided for the needs of the chronically ill in this State. At the rate of increase shown in the past year alone, it is certain that we can continue to do so. As for the opinion of the licensing agency with reference to the necessity for beds, may we quote Mrs. Loudell Frazier, supervisor, adult boarding home program, division of public assistance, State department of social welfare, 801 Harrison, Topeka, Kans., who states, "I hesitate to state that there is a need for more beds in boarding homes in Kansas. I do not feel that Kansas has reached the saturation point in this regard, where the number of patients exceeds the number of beds available." We wish to further point out that the 5,460 beds in the State of Kansas represent approximately $5% million in investment. This amount of property represents a considerable return to the Government at various levels in taxes, both property and income. In addition the cost per bed is about one-eighth of the amount per bed estimated by Mrs. Hobby in her testimony before the House Committee on Interstate and Foreign Commerce which has previously considered the companion bill to the one your committee has under consideration. Further, the rates presently paid to proprietary homes for the care of the chronically ill who are receiving welfare assistance is equal to or less than that estimated in testimony submitted to this same House committee previously. If Mrs. Hobby's figure of $8,000 per bed for new construction is correct, it would require over $43,500,000 to replace the existing nursing-home beds in Kansas alone. This does not take into consideration any increase over present needs; and, according to all surveys available, such increase will occur at a geometrically progressive rate. We feel that this action providing such grants to nonprofit homes is based upon need as indicated by figures, percentages, and estimates that are definitely in error. We think, rather than provide funds for such homes when no one knows definitely how badly they are needed, that a survey should predeed the establishment of such grants. For example, Mrs. Hobby, when appearing before the above-mentioned House committee, used the figure "9,000" with reference to the number of nursing homes in the Nation, whereas even the 1950 census indicates over 11,000. When the State officials of our various States are not positive of the exact needs, the lack of information on the Federal level must of necessity be even more extensive. The process of taking a survey first, then basing additional legislation upon the results of the survey, seems to us a more logical procedure than to propose grants and include a sum in the bill for a survey to be made to determine the need for the grants. We are certain that once these grants have been authorized some agency will find a means of expending the funds. Therefore, we feel that the Federal sponsorship of nonprofit nursing homes will merely be an additional load upon the taxpayer, that it will use the taxes of the privately owned home to establish nonprofit homes in direct competition with it, that it will provide no service at a lesser rate to the public, that it will provide no service that is at present needed. Further, the cost of construction at governmentally estimated rates would be substantially in excess of the present cost, which is borne entirely by private industry, at no cost to the Government. As to the adequacy of care in the presently existing homes, may we point out that our State officials have informed us that there has been an approximate 75-percent improvement in nursing-home standards since the formation of our |