the various health disciplines. In addition, the physical and psychological problems of the elderly are in many ways unique as are the problems of other ages and groups such as the addictions. As such, care for the elderly requires specialized trained staff.

To complement any changes in alternative living/care facilities and the skills of daily living centers, funding of a well trained geriatric physical and psychological care team to assist with finding the elderly, applying preventative techniques to the well elderly and preretirees, providing direct service, and providing consultation to families and ancillary agencies would provide somewhat of a comprehensive care system.

In regard to health care of the elderly in general, I would recommend the committee invite various associations within States, for example, nursing, social work, psychology, medicine, psychiatry, occupational-physical-speech therapies, and the like, to develop a transdiscipline committee within each State. Functions of such a committee could be, for example:

To review the health resources of the State and make recommendations as appropriate to, for example, the State commission on aging, various health planning councils, State health agencies, and the like. To review educational/training programs of the various health disciplines regarding orienting students to providing services to the elderly once members of their professions and to encourage students regarding specialization in geriatric care.

To review existing programs or to recommend a program for preventive health care as separate from or as specialized within-that is, through coordination-existing, but often separate, health programs. To review such situations, conditions, or services that indirectly relate to or have an effect on the physical and mental well being of the elderly, for example, boarding and nursing homes, pharmacies, and the like.

To stimulate an interest in providing care to the elderly on the part of professionals within their own disciplines; to attempt an understanding of disinterest in providing service care; and where indicated to recommend, plan or develop education/training for professionals who have, in general, not received such in their professional preparation.

I would suggest that consideration of reimbursement, that is, per diem, mileage, and clerical assistance, as well as some official State sanction, would facilitate such committee work.

I wish to thank you for the opportunity to testify in behalf of Los Vecinos. In closing, although I've never heard an elder person state it, one feels it expressed in the suicide rate, one feels it sometimes when projecting what it will be like when one is old, you think you see it in their eyes sometimes, that is paraphrasing Patrick Henry, "Give me life or give me death.”

Senator DOMENICI. Thank you very much. Doctor, let me say that perhaps your statement is a bit technical for some, but there is a real need for people back in Washington who understand the relationship of the profession that deals with the area you have discussed, and how those professionals view the work-especially from one who has been

working at it, as you have indicated, 52 years. We appreciate your statement, and it is one of the best we have had in the technical area that you have spoken to.

There is a genuine concern in Congress about many problems you have discussed. There is an effort being made to establish geriatric type centers. There is a broad base of consideration around the country. It has been very difficult to get them adequately funded. You proba bly know that last year the Appropriations Committee deleted such centers totally. Furthermore, it was on the floor of the Senate that money for somewhere between four and five of the contemplated broad-based centers under the geriatric center bill were put back in.

We have been inquiring regularly as to HEW's refinement of the process of establishing where they are going to be, and what discipline will be in them. We can report that they have not come up with a conclusive set of regulations and decisions.

The medical schools have been working with us; we have been trying to figure out whether we have a chance for one of those. We are not sure of that, but I want you to know that we have taken an active part in communicating with HEW about it.

We know it is inadequate, but if we can get the four or five started, some of the ideas you have expressed will be in some and not in others, but hopefully in due time it will form a network across the country, and we will learn more about the responsibility.

I also appreciate your candor about boardinghouse problems, because you are trying to look at it from the standpoint of where we have put everyone. You are not saying anyone is all or totally right. We cannot expect boarding homes to be nursing homes, if we do not have the amount of money to spend for them. We cannot expect them to take care of patients at the rate elderly people are able to afford, but we have to come up with some answers.

We greatly appreciate your analysis in that regard. We do hope that you try to develop something, and we can continue on with your vast experience.

SMALLER HOMES CONDUCIVE TO INTIMATE CARE

There is concern for the homes that would have less than three patients. I for one do not want to be part of pushing that kind out of the business, because it would seem to me, based on testimony, the more intimate the relationship of care is even if it is not always family-the better thrust we are making as far as the national policy. On the other hand, if they are exempt from something that is good, how do we make sure that those that are in a home for only two are also getting the benefits you describe.

Thank you very much.

Our next witness is Mrs. Josie Candelaria, health planner, Mid Rio Grande Health Planning Council, Albuquerque.

Let me ask a couple of questions about your testimony so we will all understand. As I understand it, Mrs. Candelaria, you have a closed circuit television program that indicates what you have found. It would be a half hour, but that you have tried to cut it down to 10 minutes.

Mrs. CANDELARIA. Yes. You can cut us off at any time, and I will explain the reason for doing this.

Senator DOMENICI. All right. Let us together try to figure out how this would best work out.

Mrs. CANDELARIA. We would especially like for you to see it.

Senator DOMENICI. Perhaps I had better go down there and look this way, so that we can all be looking at the video tape.

[Whereupon, the video tape was shown and transcribed as follows:]

Mrs. CANDELARIA. I will begin by expressing my appreciation to Bob McCarthy and Della Mirabal, Mountain View Satellite Sustained Contact Team. Della, for her assistance in contacting and scheduling the people to be interviewed. Bob, for allowing and securing the video tape, both manpower and equipment.

Mr. Williams, could you tell us perhaps a little bit about yourself, how long you have lived here?

Mr. WILLIAMs. In Albuquerque?

Mrs. CANDELARIA. Right here, perhaps.

Mr. WILLIAMS. Since 1928 in Albuquerque, about 20 years.

Mrs. CANDELARIA. I see. How long have you been confined to a wheelchair or to rephrase it, how long has it been since you have been able to walk?

Mr. WILLIAMS. I went on crutches in 1951, and then a trip to the hospital, and I think I was confined to a wheelchair, and during that period, I would say about 1963-1965, 1967.

Mrs. CANDELARIA. Would you elaborate as to the type of illness that confined you to a wheelchair and later on, I saw you walking around on crutches, so I know you had not let that get you down.

Mr. WILLIAMS. We have never really known all of the facts. The doctors have never been able to really figure it out, what I have. It is the hip joint, in the pocket, which causes the leg to become shorter.

Mrs. CANDELARIA. How long have you had this condition now?

Mr. WILLIAMS. Since 1966.

Mrs. CANDELARIA, 1966?

Mr. WILLIAMS. Yes.

Mrs. CANDELARIA. Are you covered by Medicare?

Mr. WILLIAMS. Yes.

Mrs. CANDELARIA. And you find that Medicare is adequate?

Mr. WILLIAMS. Well, I do not use it as much as I should. It has been very inconvenient because I do not travel, and I have not had much luck in handling Medicare through the telephone.

Mrs. CANDELARIA. I would be interested to hear from you, the way you really feel about Medicare, as we were discussing it earlier.

Mr. WILLIAMS. Well, Medicare is the thing that we have to have. Social Security was raised, and so was Medicare costs, so one balanced the other. Actually, we do not get anywhere. We just stand in one place and work like a treadmill. One price goes up, and the other price goes up to meet it.

Mrs. CANDELARIA. Have you had any kind of assistance from outside the home, any kind of home health care?

Mr. WILLIAMS. Yes, I have the visiting nurses, the first year and a half or so, I think, after I came out of the hospital.

Mrs. CANDELARIA. For about a year and a half. Did you find the type of health care that they provided to be adequate?

Mr. WILLIAMS. Yes, the girls were very efficient that we had.

Mrs. CANDELARIA. Perhaps the question then, the other question should be directed to Mrs. Williams. I am sure that it was a very traumatic time for you, and you welcomed the kind of assistance that was rendered to you.

Mrs. WILLIAMS. Yes, indeed. It was very helpful for me.

Mrs. CANDELARIA. How many days a week did you receive any kind of assistance with your husband?

Mrs. WILLIAMS. One day.

Mrs. CANDELARIA. One day a week?

Mrs. WILLIAMS. Yes.

Mrs. CANDELARIA. Did you find that adequate?

Mrs. WILLIAMS. Yes.

41-055-75- --3

Mrs. CANDELARIA. Earlier you discussed the fact that you were far more fortunate than other people that perhaps did not know about many of the resources available. Will you elaborate on it?

Mr. WILLIAMS. In what respect?

Mrs. CANDELARIA. You said you were able to get around, and you did not let the idea of being in a wheelchair get you down, and you were able to do things for yourself, and a little garden you have out there kind of attests that you were able to get around.

Mr. WILLIAMS. Well, that is one of the things you had to learn to do to live, is do what you have to do with, and make use of it, and so it serves two purposes, it keeps you busy, it keeps your mind occupied, and it keeps your joints, in my particular case, in workable condition, I might say.

Mrs. CANDELARIA. You had experience with Medicare and again with home health care. If there was anything that you were able to do, or any kind of advice or opinion that you were able to give, what would they be, what kind of suggestion would you have for the improvement of those kinds of services for those people?

Mr. WILLIAMS. Well, I do not know too much about their present set-up, or the things they were trying to do, even at that time.

Now, when I first came out of the hospital, I was fitted with a leg brace, and Easter Seals helped out on that considerably.

What Medicare did not take care of, Easter Seal picked up the tab, and the thing I objected to on that was that the people, the man who made the brace and the handling of it was apparently trying to get rich off of one brace.

Mrs. CANDELARIA. You mean you had to pay for the brace?

Mr. WILLIAMS. Well, in the end he billed me, for I think $180, and above what the brace is supposed to have cost, and one of the visiting nurses here who had quite a bit of experience around in such things, picked that up, and we took it back to him, and that is the last I ever heard of it.

After he had billed me about three or four times, I did not even realize really that it was a bill. I thought it was just a copy of some procedure report that he had to make out and send to Medicare and to other officials.

Mrs. CANDELARIA. You were on Social Security at that time, and I suppose you are still on Social Security?

Mr. WILLIAMS. Yes.

Mrs. CANDELARIA. Was that adequate to take care of all your medical expenses? Mr. WILLIAMS. No, it never is. I do not know anybody that had enough Social Security to fully take care of just their everyday needs, much less hospital and doctor bills. Doctor bills have gone clear out of sight, and as you know, hospitals have gone clear out of sight, and they are what Medicare and Social Security will take care of.

Mrs. CANDELARIA. Are you under Medicare care now?

Mr. WILLIAMS. Yes, the doctors in the medical centers are my doctors, and they keep in contact with me, and I have a kidney infection, and that gets taken care of. They just look after the infection in my kidneys, and they have to be watched very carefully, and I have taken just about all of the medication, which is very expensive, that is known to the medical profession, and he keeps changing from time to time, for instance, I have some here that the price of the medication was $60 for 40 pills.

Mrs. CANDELARIA. That is quite expensive.

Mr. WILLIAMS. And how are you going to make Medicare and Social Security meet those things?

Mrs. WILLIAMS. I do not know how anybody could believe that they would charge that much.

Mrs. CANDELARIA. Your telling us about it helps. It might start the ball rolling in the right direction to alleviate some of the conditions that exist. Della, would you like to say something at this point?

Mrs. MIRABAL. I was going to ask Mr. Williams, do you feel that you are well informed, and that you knew where to get all of the services that you required?

Mr. WILLIAMS. No, I never was.

Mrs. CANDELARIA. Do you feel that it would be helpful to the people, who say they are not getting any services at all, if the people were informed where to get the services?

Mr. WILLIAMS. Yes, and another thing that would be helpful would be for a depot or some center where unneeded equipment such as wheelchairs and. walkers and trapeze from the beds over their heads to help them to turn over and move in bed, a lot of people have more trouble than you imagine, and I am one of them, but I have all of those things due to the fact my son was a welder, and I will show you those pretty soon.

The things that I have, that other people do not have made available tothem, and if we had the center where those unneeded things could be collected, and then given to the people who do need them, that would be one of the things that would help a lot.

Mrs. CANDELARIA. You suggest that those things be given to the people without cost?

Mr. WILLIAMS. That is right. It would be strictly on a donation basis, people who do not need them anymore. Now, there are people who, for instance, they have hospital beds and things like that in their homes, and they are no longer needed. Well, a lot of times those go to the garage, storage, or thrown away, instead of getting to the proper places where they are actually available for somebody to use that needs them.

Mrs. CANDELARIA. Thank you, again, Mr. and Mrs. Williams. This is Fred Walters. He has a different kind of problem; would you care to tell us a little bit about your illness, and the number of years you have been ill?

Mr. WALTERS. Well, I have been ill with emphysema going on 8 years, and it is gradually getting a little worse. As long as I behave myself, I can get along pretty good, and I do not try to overdo and overwork.

Mrs. CANDELARIA, You are under Medicare and medication?

Mr. WALTERS. I sure am, taking three at a time of medicines.

Mrs. CANDELARIA. Are you covered by Medicare?

Mr. WALTERS. Yes.

Mrs. CANDELARIA. Do you find this is adequate?

Mr. WALTERS. No, not entirely adequate. We have a little insurance that we have had for several years. In fact, we have had the hospital policy, I imagine, since I have had the darn thing for 35 years.

Mrs. CANDELARIA. I see.

Mr. WALTERS. It does not pay much anymore. It is kind of outdated, but it helps.

Mrs. CANDELARIA. I see. Well, about 7 years ago, I met you under different kinds of conditions. At that time, you were bedridden, and you needed different kind of assistance than what you need today. Were there agencies available to assist you and to help in caring for you at home with your illness?

Mr. WALTERS. None whatsoever, except my wife, and that is what we do need, I think, out here in this district, is some home nursing care of some kind, so that he could help people. I do not claim to know what it is about, how to go about doing it, but one thing we do need out here is that. We are supposed to have it, but you never see the people around.

Mrs. CANDELARIA. You were never referred, your doctor never referred anyone to you to assist your wife with the care, home health care type things? Mr. WALTERS. Not a bit, no, never, no.

Mrs. CANDELARIA. In your opinion, was the care something that you could have used, or was your wife able to take care of you adequately?

Mr. WALTERS. At that time, we needed help, because I was almost helpless, at that time. I would have to stop several times just to walk across the room, and I could not do nothing, not a thing. She had to do all of the work, inside and outside, and we have a pretty large lot up there, too large, and for one person to take care of, that is a lot of work.

Mrs. CANDELARIA. Plus caring for a sick person.

Mr. WALTERS. That is another thing. I think we need somebody. Now, I cannot afford to pay wages, the going wages for stuff, but I know there are people that do things cheaper, like painting the eaves on the house,and stuff like that, around the edges of the house, and it needs it bad, and I just cannot afford to have it done, but I know there is people out that set up in some community, where some older person, I do not care how long it would take them, to give me a flat price.

Mrs. CANDELARIA. So there are all kinds of needs by not only the elderly, but those not able to function because of some illness.