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As the title of the hearing suggests, we on the Committee on Aging are concerned about problems which elderly persons encounter when they stand in need of medical or health maintenance attention.

The Subcommittee on Health of the Elderly, which is conducting these hearings and on which I serve as ranking Republican member, has already dealt with many such problems.

MEDICARE COVERAGE INADEQUATE

We know, for example, that Medicare-valuable and essential as it is covers only a little over 40 percent of all health care costs of the elderly. Averages can be misleading, of course. Medicare serves many older Americans very well, and it prevents financial disaster when illness strikes. But it has many holes in its protection, and we are exploring these holes very closely. This kind of inspection is very much needed, particularly when there is so much talk about establishing a national health insurance program for all age groups.

One of the biggest gaps in Medicare today-as our earlier hearings have shown-is its failure to encourage greater use of home health care to help those who don't really need to be in institutions. I have sponsored legislation which would help to correct this situation, and I am looking forward to the testimony which I know will be given on this subject later today.

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I am also concerned by reports-in the press and elsewhere-about problems arising from the transfer of patients from State hospitals to boarding homes. Later today, I will be hearing about the situation in Las Vegas and Santa Fe where, as in many other cities, boarding homes have been established to meet this new demand.

But we're interested not only in problems but in solutions and in proposed solutions to the problems.

We're interested in getting the facts and then using those facts to insure that Congress does its part in building a better health care system for older Americans.

We in Congress, of course, can do only part of the job. What is really needed to solve the problems are imaginative, hard-working people working in their own communities to make things better.

We're about to hear from some of those people today, and as one who knows from firsthand experience just how much they and others contribute to this particular community, I am proud to be here, and I am anxious, too, for their testimony.

Now, let me, in my own way if I can, explain some of the problems that have arisen. There are more people in the region that we are covering involved in the problems of our senior citizens than we could invite here as witnesses, many more than we can hear today as wit

nesses.

There are many more involved in my own community, in their own community, in their own way, in trying to solve the problems of our elderly.

I hope you understand that we could not, in about 3 hours in Albuquerque and 2 hours in Santa Fe, invite everyone that is actively involved in this problem to come, to attend, and be a witness.

1 See appendix 1, p. 1113.

If I did not hold these hearings today-on this very difficult weekend, when many people would prefer to have the extended vacationI do not think we could have held them for 3 or 4 months. This factfinding in Congress itself is a continuing process, and for those who wonder when will we do this in another community, when will we hear the problems that we did not arrange to hear today, I can only assure you that either formally or informally, throughout my stay, and so long as I am on the Special Committee on Aging, we will try to go to different parts of the State and formally or informally hear the other problems that you want to discuss.

Now, I also know that many of you would like, when the questions come up, to speak in Spanish. You may do that. We welcome it. You know I understand it, but we also have David Vargas from Congressman Manuel Lujan's office, who will be the official interpreter for the record, so that your questions, your comments, if they happen to be in Spanish, will be properly stated for the record, exactly as you have stated them to us.

It is not possible to go through 3 hours in both Spanish and English. We could not get it done. We asked around and most people agreed that we should proceed in English, but those who want to speak in Spanish, we welcome it, and we will have it interpreted; and if the audience needs to understand it, we will state it for them.

For the witnesses, I think you already know we are behind schedule some 20 minutes. You have been asked to keep your remarks within a given time frame. Please try to do that, and try to understand it is not that we are trying to limit you, but rather we are trying to be fair to all of the witnesses we want to hear today.

I think some of you who are witnesses know that a lot of hard work goes into preparing for a hearing. We are very, very fortunate. First, I am fortunate to be on the Special Committee on Aging. We have some of the staff people here helping us. I want to introduce them to you. They work for the U.S. Senate and not for me, but they are here to serve me in my capacity of trying to help the committee understand what the problems are.

On my right is Bill Oriol, who is the staff director of the Senate Special Committee on Aging. On my left is John Guy Miller, the minority staff director of the committee. And then next to Bill is Caroleen Silver from my office; many of you who are corresponding, writing, or calling have previously gotten to know her over the longdistance telephone and through the mails. I thought you ought to meet her in person. I might say to all of you that she is indeed pleased with what she found in terms of your responsiveness. I hope you who are working for New Mexico find her to be equally responsive, as she has told me you have been.

Then we have Patricia Oriol, chief clerk, from the Senate committee. This proceeding is being reported in its entirety. It will be made a part of the special committee's record; and eventually, as we proceed with legislation, portions of it will be used to justify either changes in legislation or suggested administrative changes.

I will violate my own rules and tell you two other things, because I do not want to forget them later.

BOARDING HOME PROBLEMS

First of all, there has been a great deal said in the papers about the boarding home problem.' I am aware of them, and I hope nobody thinks that Senator Domenici came to town to be some kind of a critic, that he has some kind of magic wand.

Quite to the contrary, we all know there is a problem.

The State of New Mexico has a role, and we are not here to criticize; we are here to help. The State of New Mexico recognizes the problem. They may without help be able to solve it; they may not.

The purpose of this hearing is to see that board-and-room facilities for our elderly are as good as we can possibly afford; and where legislation is needed, we hope these hearings will help.

We are prodding, pushing, shoving, coercing, even rethinking ways to help solve the problems. We hope our hearings will contribute somewhat to that.

We are going to proceed now with the witnesses.

Mr. ORIOL. Yes.

Senator DOMENICI. We do have two guests that certainly play a vital role in giving us the facts. We have Leroy Smith, president of the New Mexico Health Care Facilities Association; where is Mr. Smith? We thank you for coming. Mr. Smith will make his statement later on. The Health Care Facilities Association has worked with nursing home care.

And then we have Dr. Robert J. Miller-will you stand up, Dr. Miller-we may have time to hear from Dr. Miller. He is from Truth or Consequences. He is with the American Optometric Association. He is the head of that group. They are interested in the Committee on Aging.

Doctor, we thank you for coming from Truth or Consequences. We hope to hear from you if time permits.

First, we are going to hear from a panel. On this panel are John Segura, Albuquerque; Mrs. Selma Clever, community relations aide, Albuquerque; Mrs. Cora Cooper, Albuquerque; and Mrs. Reyes Abeita, outreach worker, Isleta Community Action program.

John, I think we have agreed you are going to go first, is that correct?

This is Mr. John Segura. John, if you would start, then we will go right to Mrs. Clever.

Mr. SEGURA. All right. I think, as most of you know, we are here on transportation needs for the elderly people.

Senator DOMENICI. John, maybe I could ask one question, and if it is going to be answered in your general statement, wait until then. I am wondering if you have any special problem in persuading elderly persons to participate in the nutrition programs. If you do, do you have any ideas of how we can overcome these problems? It is kind of difficult to get them to participate, is it not?

Mr. SEGURA. No; the greatest problem I have encountered in contacting the people is that they have no means or way of commuting to places where the sites are.

1 See appendix 1. p. 1113. 2 See statement. p. 1109.

Senator DOMENICI. All right. You proceed with your statement, John.

STATEMENT OF JOHN SEGURA, ALBUQUERQUE, N. MEX.

Mr. SEGURA. As most of you know, the elderly people from the south, and that reaches all the way from here down to Isleta, and beyond that point, most of them are from Latin descendants; some of them are indigent, and some are white, but age has no color barrier, and it has no restriction of where you live. This is one of the reasons why at the meal sites now, we have not had as many as we would like to have, because these people live out in an area from, you might say, from North Fort or South Fort all the way to Isleta, and beyond that.

Most of the people, if I spoke to them and asked them to stand, would have a problem, and some of those folks do have automobiles, but others do not have automobiles, and they have to be transported. This being the main cost, than you would see that these people, some of them have not been out of their homes for quite a while.

Some of them are 80, 74, 65, and so on. Some of them have what you might call an ailment, rheumatism, arthritis, and as forth, and these are the problems that hinder them from coming to the various sites for their meals.

Now, not only is that the problem, but there are many other problems that we could talk about for the whole day, and just speak about the many needs they have, just speak about one, would be to deprive the other one from coming into light, but I am not going to speak about all of these. My companions will also speak in those fields.

TRANSPORTATION SHORTAGE ACUTE

I would like to say that some of those folks, unfortunately, could not make it here today, because they could not be brought. That is how bad and acute our transportation is for the elderly people.

For the younger generation, I do have something, and I think that you should always be attentive to those that are older. But I would ask at this time, please help us, that these folks may come and be helped, that they may be able to participate, and then be renovated, and become a part of that field which once was their society, and help you with the many probelms, and with their many experiences in life. I know that you would probably say, "What have they contributed that we might be able to help them?"

If you look about in the State of New Mexico, for these older people, it was a time of trial, and it also was a struggle to come about to this end, but they have kept this State what you call "The Land of Enchantment."

They have come so far that they have already entrusted their work unto the younger generations, so you look about, and you see them. I do not want you to think of those that are old as past, but as a champion of a few days that have passed by, who gave you this land that you have.

It is for this reason that I think that these people who are not able now to perform in the full capacity should be helped by you, and by

our Nation. I wonder all the time, is it possible for us to forget our elderly people. Could you forget your grandfather, could you forget your father, could you forget yourself, because you will be right in the same boat we are in now. So this is one of the things that I would suggest, give us help, that we might help these people.

Give us aid that might let them live the days they have just with the hope you have given them.

Let them have the life which you will have in the days to come. Perhaps, I am one of the fellows that speaks too much, but to the far right, you will see a gentleman over there, a few days ago he could barely walk, but the transportation that has been available, and the food given to him, has made it possible for him to stand, it has made it possible for him to be counted back into a society that he was a part of, so I would like to say, do what you can to save these people.

If not then, maybe we will pass, and you will come to light of the picture later on. But as for now, as the chairman has stated before, he is here with his companions to try to find out. I would say this is the time to start acting, so that part of New Mexico, and part of the rest of the world might know that our Nation still cares for the elderly.

Senator DOMENICI. John, let me ask you this: I heard you describe the situation, and you are telling us that transportation, whether it be to meals, or medical type of services, is a very serious problem for the senior citizens. Is that correct?

Mr. SEGURA. Right. The main thing, that needs, let me spell it out a little bit for you. The needs would probably be income, but that is just a minor problem.

The next one would probably be negligence, Medicare, and hospitalization, transportation; but this would probably be one of the minor things you would encounter in the older people today. But you would find that the greatest problem is transportation.

He cannot get to the places where he wants to go. He cannot go to where he would wish to go, simply because he does not have a way and means to get there. If he does, he has to have someone who is kindhearted, or who wishes to help.

Would this answer your question?

Senator DOMENICI. Yes, John. I have a series of photographs from the South Valley senior citizens in front of me taken by photographer Maria Costa. These are photographs of a van with a gentleman, very old, somewhat lacking in capacity to walk. He is being helped down from this panel truck, and I see somebody helping him. They are leading him to the van, this other gentleman. He has a cane.

I assume this describes the function of the senior citizens center in helping this older gentleman get some place where his needs are supposed to be satisfied-food or health services. Am I correct that this is one of the things that you do?

Mr. SEGURA. Yes, of course. As you see there, we only have one bus. Senator DOMENICI. And that bus is actually operated by that senior center?

Mr. SEGURA. By a group of them, yes.

Senator DOMENICI. Now, how did we get the bus, and where did we get the money to pay for the bus?

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