marvelous world again. And then, too, this is a great thing for the children, of course, but even greater, it seemed to me, for those people who suddenly found that they were needed and wanted, and that they could communicate and could aid those who needed the services that could be rendered.

We must not put them aside unneeded and unwanted. Simply to take care of their physical needs is a travesty and one reason we have fallen into it is the thing Dr. White talked about, the failure to plan for a whole life, to plan what we are going to do.

A person gets all wrapped up in his business or profession or farming or whatever he does, and suddenly he comes to age 65, or whatever time he decides to retire, and there he is, cut off from what he was doing before and he has not anything to go on to, and he cannot go fishing forever.

It would be fine for a couple of weeks to go fishing, but not having anything to demand his attention and his input and his worth, and this is what I think Dr. White so knowledgeably and eloquently told you is the reason you see senility in elderly people. More often they just withdraw into themselves, they do not feel needed, and consequently, reality begins to escape them.

I certainly cannot improve on what Dr. White said, and I am very appreciative of your appearance here, and your very fine discussion, Dr. White.

I am a little concerned about the time aspect. I know some of you want to ask Dr. White some questions. The luncheon will be ready at 1. I might ask, Dr. Walter, would you like to go ahead now, and we will ask you to save your questions for Dr. White, and then you can ask questions of either gentleman this afternoon. Dr. Walter is the director of Medical Care Services of the Utah State Department of Social Services, Division of Health, and is going to talk about health problems of the elderly.

Dr. Walter?

STATEMENT OF DR. BRUCE WALTER, DIRECTOR OF MEDICAL CARE SERVICES, UTAH STATE DEPARTMENT OF SOCIAL SERVICES, DIVISION OF HEALTH

Dr. WALTER. Thank you, Senator Moss.

Dr. Selman, what I will probably do is give my presentation in two parts, the forepart at this time, and then after lunch, I will show the difference between Medicaid and Medicare, so that the members of the group will understand these two programs, especially when I have the backup of the Social Security Administration assist me.

This particular portion of my remarks concerns a number of problems that I presently see in the recent governmental medical system. and I would like to bring out a number of these things which may elicit some questions from you after lunch.

First of all. I have a major concern in one particular area. This is called the Medicare deductible. The deductible now has reached, to my knowledge, the level of $84 before you can participate in the A part of Medicare.

This deductible, I believe, has probably reached the level of being

a deterrent for care, and probably now is blocking the care that some people should seek, and unfortunately, they may seek care somewhat too late. I am advocating, therefore, that the present deductible system be done away with, in new legislation. Since it is probably necessary to find a mild deterrent, a specific charge for hospitalization, for example, could be levied on each first, second, or third day, and then a level of amount of coinsurance or that 20 percent or 10 percent or some other figure could be levied continually thereafter.

This, of course, could be reduced to a lower figure. The deductible, especially on the amount that now exists at the present time, should be eliminated. This would also reduce the present administrative problem.

The second problem is in the area of catastrophic illness. We see problems where one member of the family develops a very major illness. The other member of the family who may be healthy, but sees the family finances depleted at a tremendous rate, or perhaps eventually depleted entirely, and they finally find themselves on welfare. What I am advocating is a full investigation of the catastrophic area, and protection of the family finances, where the illness is bona fide, legitimate, major, and where the family finances in no way can finance the continued chronic care that is necessitated by major illness.

HIGH COST OF CUSTODIAL CARE

Next is a companion concern. This is the level of custodial care. Senator Moss also stated that Medicare does not take care of people in custodial categories.

In this particular situation, we run into the same type of problem that I mentioned previously. We have extremely high costs, even if the patient does not require a high level of nursing home care, the cost is prohibitive.

IVe also find that families have to contribute to the care of one of the family members or grandparents. We find after a period of time that a great deal of resentment is built up by the family, directed to the family member. They have to contribute to the continued care of one of the family members. We all know that in yesteryears, we all used to take care of our family members, especially if we lived on the farm, where it was quite easier.

However, that type of culture has dwindled and many of our people do not live in family farm situations anymore. It is very, very difficult for families to care for them and have to pay out of their wages, especially in our present day, to take care of people for time immemorial.

Another area that I would like to also mention is the area of physical examinations. The physical examination on a routine basis is now not a covered benefit under Medicare. This is the routine type of screening, the checkup, so to speak. This was eliminated in the original bill for a very good reason. This can be overdone and expensive, so what I am asking here is that there be provisions in the new law that physical examination programs under innovative programs can be funded or assisted so that this type of exam can be performed without major expense to the beneficiary.

In Prosser, Wash., the administrator of a hospital and the physi

cians got together and developed a system. They found there was time during the hospital day that was quiet. There was time when the laboratory and the X-ray room was quiet, so they developed a screening system where the senior citizen paid $6 for the whole year.

For this $6, the senior citizen received a physical examination, a blood exam, a urine exam, a chest X-ray, a hearing examination, and a number of other evaluations.

There was an eye exam as well. These were performed throughout the year, at the hospital, performed by the physicians, and the trained personnel in the hospital, and at slack times when they were not overly busy. The examinations were performed by appointment, organized, and as you might guess, it has been successful.

It is my hope that these innovations could be supported, so that this type of innovative program could be developed many places.

Next is the area of homemaker services. Homemaker services, as you know, is not a benefit under Medicare or Medicaid. However, it is my general feeling that if properly controlled, and properly administered, that homemaker services could be of benefit of medical programs, therefore, by allowing many more people to remain in their homes and enjoy their surroundings when they are infirm. I believe that with this kind of administration, especially through the established home health agencies, that this type of program could be successful. I am hopeful under proper guidelines, that these kinds of programs could be supported in new legislation.

IMPROVING HEALTH ACTIVITIES

I am also hopeful that home health activities can be improved, and rather than just skilled nursing type services, that they be extended to people who are perhaps not in need of skilled services entirely, but could have lesser needs, and could be supplied with these needs.

I am also hopeful that occupational health activities, which are presently a benefit of the program could be pushed.

Presently, much of our problem is in the area of occupational health which asserts rehabilitation and retraining, could be expanded.

At the present time, we have very few people trained in occupational health, which has been one of the major deterrents of why this benefit has not been widespread.

I know in Price there is an interest in securing funding under certain Federal programs. Funding is unavailable primarily because the expertise in writing the complex grants simply was not here, and I am hopeful that there can be a system developed so that Federal grants, grantmanship can be brought into the outlying areas, or if it cannot be brought in, that there be some simplification of grantwriting so that rural areas and outlying areas can benefit from grants as well as the major metropolitan areas.

We also have a number of problems which we relate to the Federal Government. Some of you probably do not know some of the problems that State administrators go through; however, some of you are experiencing difficulties in going through and getting and applying for benefits, which is somewhat similar.

Essentially, State administrators have much of the same type of difficulty, and I might say sometimes much greater than this.

We are hopeful there will be in the new legislation some stipulations on timely response by Federal administrators so that there can be decisions made, more timely than we are now getting them in the medical field, in the construction field, and in the environmental impact studies field. The latter has been a major problem area.

We are also concerned that now we are going into a period where undoubtedly we will experience greater Federal programs. I hope there will be stipulations in the law that personnel who are in major decisionmaking areas have specific qualifications, education, and experience related to the programs they administer. In many of our areas, we find people making decisions and are in jobs that they neither have the experience nor the education to properly perform the duties.

When this happens, there are delays, difficulties, unhappiness, and defensiveness on the part of these Federal employees. I hope that if it takes more money to employ qualified people for these administrative positions, especially in national health insurance, that perhaps that certain Federal requirements on salaries may be waived for certain positions.

DENIAL-OF-SERVICE AREA

I am also concerned about another area, and this is called the denialof service area. In many of our programs, we have denial of service. Some of these are administrative, and many we have heard today are part of the design of the law.

This is realistic because there has to be some constraint on finances. However, sometimes there are denials where perhaps they are not in the design of the law.

One of these areas is inhalation therapy, one of which is of some importance in this particular region, because it is useful for people who have lung disease.

This particular benefit was restricted about a year or two after the Medicare program began, primarily because of overuse, and probably some misuse.

It is my belief, however, that this benefit could be returned with proper controls so that people such as the people in this region could receive these benefits.

Now, these are just some of the points I wish to make. I believe they are pertinent perhaps to your particular area.

This concludes the first of my discussion, and if there are any questions, I would be glad to answer them.

Thank you.

Senator Moss. Thank you very much, Dr. Walter, for that presentation, and as Dr. Walter announced, he does have additional information to present after the luncheon which will include some slides and pictures. This undoubtedly will be very informative, and help clear up some of the questions on Medicare and Medicaid which are confusing to many people.

Now, I think this is about as good a time as any to take a luncheon break. I noticed we have some additional visitors that have come in, one very distinguished visitor, Mr. Holbrook. I am glad you came, and Betty is with you also. Mr. Holbrook is an attorney in Salt Lake City.

We are glad you came to listen; today we have been having a very interesting hearing, and should you achieve your goal, this is one of the problems that will be with you in the Senate.

I think the morning has been very productive, and I am grateful to all of you who participated on the panel, and to Dr. Walter and Dr. White, who are sitting here now, and have functioned essentially as a panel. Both are well versed in the problems that surround aging people, as far as health is concerned, and it has certainly been informative

to me.

I want to say that I think it is of the greatest importance to have gatherings of this sort.

I want to compliment all of you who have come today. You have been here before, no doubt, for the other meetings, the seminar, and you have given us careful attention: you have asked very good questions, and I hope over the luncheon break you will think of other questions that will shed more light on the problems that plague you and your neighbors. Perhaps together we can try to do better in our society: dealing with the aging process and with those who become older. We have only begun, the job is incomplete. Dr. Selman, perhaps you could announce details of where we go for our luncheon.

Dr. SELMAN. Senator, may I ask my question before we go, because if I am doing housekeeping, I may not get back.

I want to ask Dr. White a question. As director of Community Services and Community Education on this campus, we are wondering now-in your presentation, you talked about mental health, spiritual as well as the physical, and we have Meals-on-Wheels, we have Medicare and Medicaid and all of that, but we cannot get a program going through the legislature wherever it is needed, and maybe Mr. Holbrook could answer it better than anyone, where we could allow the elderly to come into our classes, even though they may not have all of the chairs full, to come in without any charge for tuition, because it is set that we have to charge so much.

Now, maybe someone can tell us how we can work on that. This is one of the things that came up yesterday in our session.

Senator Moss. Thank you very much. We will recess, and it looks as though we ought to be able to get back here about 1:30. We will start as soon as you are back.

[Whereupon, the subcommittee was in recess at 12:50 p.m.]

AFTER RECESS

Dr. SELMAN. Senator Moss has asked to be excused. He is opening a thrift store in Helper for the Community ACTION people, and has other obligations, and so Val Halamandaris will be presiding over the rest of the hearing.

Mr. HALAMANDARIS [presiding]. Thank you very much. I want to say that it is a real pleasure for me to be back home here at the College of Eastern Utah, to see so many old friends and to make new ones. When I was in school here I ran for office. I had developed such a large head from being president of the high school that my friends decided that it was time that I be put in my place. They did that very successfully, by electing the other fellow. Thereafter, I went to Washington, D.C., and I found that was an even more humbling experience.