BARRIERS TO HEALTH CARE FOR OLDER AMERICANS SATURDAY, MAY 25, 1974 U.S. SENATE, SUBCOMMITTEE ON HEALTH OF THE ELDERLY OF THE Santa Fe, N. Mex. The committee met, pursuant to notice, at 2 p.m., in the city council chamber, city hall, Hon. Pete V. Domenici, presiding. Present: Senator Domenici. Also present: William E. Oriol, staff director; John Guy Miller, minority staff director; Patricia G. Oriol, chief clerk; Caroleen Silver, legislative assistant to Senator Domenici; and Pamela Klepec, research assistant. OPENING STATEMENT BY SENATOR PETE V. DOMENICI, PRESIDING Senator DOMENICI. The subcommittee will come to order. I would like to thank everyone for coming to this hearing of the Special Committee on Aging. I would like to give this audience an historical note. I have checked, and found that today's hearings are the first ones ever conducted by the Senate Special Committee on Aging in New Mexico, and I am proud to be here to instigate it. I would like to thank everyone for coming this Saturday afternoon for a proceeding which will necessarily deal with very serious problems and very earnest attempts to do something about those problems. Our subject is "Barriers to Health Care for Older Americans." We will keep a written record of all that took place in Albuquerque this morning and what will take place here in Santa Fe this afternoon. The facts we obtain here will thus become part of the published proceedings of previous hearings conducted in Washington and in four States, as well. 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. 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 ex ploring them 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 Î am looking forward to the testimony which I know will be given on this subject later today. I am also concerned by reports-in the press and elsewhere-about problems arising from the transfer of patients from State hospitals to boardinghomes. Later today, I will be hearing about the situation in Las Vegas and Santa Fe, where, as in many other cities, boardinghomes have been established to meet this new demand. But we are interested not only in problems but in solutions-and in proposed solutions. 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. I would like to inform you that if you desire a printed copy of the transcript, please fill out a form at the back of the room, and we will see that you get a copy after it is printed. Our first panel of witnesses this afternoon is headed by Anthony T. Arroyos, director, Santa Fe City and County Senior Citizens Program; he is accompanied by Mrs. Lucy Narvaiz, Outreach worker, Santa Fe County Senior Center, Remijio Lovato, chairman, advisory board, Santa Fe County Senior Center, Mrs. Matilda Solis, Santa Fe citizen. Mrs. Crucita Ortiz, Santa Fe County Senior Center, and Mrs. Charla B. Scott, Sante Fe citizen. Mr. Arroyos, you and your panel members are welcome to this subcommittee. You may proceed in any way you wish. STATEMENT OF ANTHONY T. ARROYOS, DIRECTOR, SANTA FE CITY AND COUNTY SENIOR CITIZENS PROGRAM Mr. ARROYOS. Thank you very much, Mr. Chairman. I would like to welcome you to the city of Santa Fe, and I hope that whatever transpires today is fruitful, because we are all highly concerned about the senior citizen programs in Santa Fe and other northern parts of New Mexico, and I certainly hope that it all comes out like it is supposed to. What I would like to do is just give you a history of our programs that is very brief. We started, basically, in the last part of 1969. We started the four basic projects that at the time was felt were good projects, and they are still with us. At that time we had four staff members and a limited budget, and they were sharing their funds with the title III of the Older Americans Act. In 1973, it took a turn about, in that the county officials and city officials signed a joint powers of agreement. It brought the program into a comfortable situation, where you could expand the program on a countywide basis, and in doing that, the funding went up, and now we have 21 projects, 17 staff members in the program, 8 civic organizations, 43 business establishments, and the budget being proposed is that the city of Santa Fe is picking up $96.000 of the budget as compared to $36,000 of title III, so it has regressed quite a bit in the last year. There was some foresight on that, and we would like to not be completely dependent on Federal funds, but rather start moving in the direction of easing out as well as we could under the circumstances. SENIOR CITIZENS' PROGRAM I want to give you some statistics on what we were doing, and I would like to give you statistics as to our senior citizens' program. We feel if it is comprehensive, it attracts more participation. First of all, we have 2,890 registered members, and recreational, cultural, and social activities. We offer 249 different activities; we have had as many as 468 volunteers, participants in activities in the year's time is 15,000; transportation, 18,000; Meals-on-Wheels, 5,600; meals are served to 408 participants. Meals are served at five meal sites for 17,490; outreach is 521; escort services, 1,802; shopping assistance, 151; legal counseling, 89; consumer counseling, 480; HEW counseling, 1,347; home visits, 42; prescriptions issued, 4,928, of which 41 drugstores participated. We have a committee made up of druggists, doctors, and so forth. We provided home maintenance for 52 individuals in our food for the elderly project. We have been able to help 255 individuals. In home health care, we have helped 150 individuals. In our information and referral, we printed 31,500 newsletters, and in our telephone reassurance, we have contacted 3,600. In our 10-percent discount program, 2,890 participate, with 43 businesses participating. I would like to make a brief statement on health for those not able to attend, which we are here for, simply because the others testifying today would like to express their feelings from the practical experience point of view. This statement is reiterating the other statements that Mr. Oriol already has, as we see it here. Our elderly in Santa Fe County and northern New Mexico face many barriers in supportive, preventive, and rehabilitative health care. These barriers include lack of health services, facilities, transportation, along with eligibility requirements, poverty incomes and accountability at all levels. Facts point out that even with Medicaid. Medicare, and State health and social services, there still is a gap in providing assistance to the elderly poor. In Santa Fe County rural areas alone, there are approximately 4,000 persons classified as medically indigent people not eligible for any form of assistance from the local, State, and Federal Government. When doctors, health care centers, clinics, hospitals, and long-term facilities do become available, they are quickly overloaded due to the great demand of citizenry. Due to poverty, immobility, isolation, and transportation difficulties, the blind, handicapped, and shut-in elderly are denied the right of primary health care. In our day-to-day contact with the elderly, we run into senior citizens who have not seen a doctor in years. Not because they don't need one, but because of the health barriers stated here. Finally, nursing and boardinghomes in northern New Mexico provide inadequate health care for their clients as has been shown by studies on nursing and boardinghome conditions. Proper monitoring and accountability is not enforced by either the Federal or State government. The Federal and State governments have to increase their participation in financing programs which will lift the barriers currently facing the elderly desperately in need of supportive, preventive, and rehabilitative health care. PHARMACEUTICAL PROGRAM I would like to describe very briefly the pharmaceutical program which we feel is having a big impact in Santa Fe, and on which we have had a lot of inquiries. Basically, the project is to offer purchasing of drugs to senior citizens who are not on any assistance whatsoever, but they need help with their drug purchases, and this is for those with acute or emergency conditions. Chronic conditions requiring maintenance medication will also be considered, as the budget allows. Only nonassistance persons will be recipients. Exceptions are stated in the guidelines, but may include persons receiving Social Security benefits subject to the guidelines. Basically, that is the description. The other health project description was based on a request to the city council for revenue sharing funds. The intent of the project was to go out into the community and seek out these people that have not been seen by doctors in years. Its purpose is to provide the handicapped that are isolated, the opportunity for minor physical checkups on a regular basis at their homes. Thank you. Senator DOMENICI. Is that last one a new program? Mr. ARROYOS. Yes, it is, Senator, we started it in February, the latter part of February, early March. Senator DOMENICI. So the person in charge will have had just a few months of experience, but will tell us something about the program? Mr. ARROYOS. Yes, she is a witness here, and she has seen 150 beneficiaries and she has held some clinics throughout the county and in Santa Fe, and she can expand on that. Senator DOMENICI. Before we go to the next witness, let me ask you a couple of questions. If a senior citizen in Santa Fe is trying to find out what is available at any particular time, let us say next week in Santa Fe, and perhaps the individual is beginning to wonder about some kind of need, is there one specific place that she can go in Santa Fe to get information about available programs-broadbased, and then, specifically, those that concern themselves with health? Mr. ARROYOS. The feeling we would like to have is that in coming into our center, they can get just about any information they need. Should we not have it, on Social Security, or on taxes, we will provide the transportation to the place where they can get the answers on anything. We will be with them until we satisfy them as best we possibly can to provide them with information. Senator DOMENICI. Assume that the particular person I am referring to got very sick and was home, and a son or daughter or relative came into the house, and was trying to find out as quickly as possible what is available to senior citizens in this community. They were going to use the typical way to find out, the phone book, the Chamber of Commerce, some social agency. How would you propose to let them know that you are available as the principal source? How do you list yourself, and where do you give this information? Mr. ARROYOS. The listing, first of all in the telephone directory, that is No. 1. No. 2, the Santa Fe Legal Women Voters put out a booklet called "Santa Fe" and the description of our program is in it. The Community News also has a description of our program, and it has a short description. All senior citizens carry a membership card should they have to contact us, and it has the phone number, and so forth, on this. If they are looking for a specific thing, I think information is pretty well scattered out. We have a program every morning over the air, where we inform them of what we are doing. Every Wednesday, we take different projects announced as we go along, and we have them often on the air. We have another radio station that gives spot announcements. We do two or three television shows on a monthly basis, and the press release by the media is accepted very well in Santa Fe. We seem to be in the paper almost every day. So this type of dissemination, as well as outreach workers out in the field, and nurses out in the field. Drivers are also out there all the time, and they are answering questions. Senator DOMENICI. One last question, with reference to your city government and your county government. Each has headquarters at city hall courthouse, in terms of their normal operation as a government unit. Now, is the senior program of Santa Fe considered to be part of the service that the city and county has for citizens? Is there something with some part of city hall itself, within its management role. that attributes to the city a role in senior citizens' problems? Mr. ARROYOS. Mr. Chairman, when they signed their joint powers of agreement, the county agreed the city would be grantee. When the city took over and after we got the program squared away to their liking, they then made it a department of the city of Santa Fe. This has greatly helped in fuel allocations, and in licensing, bonds, in all of these other things to assure you have a sound program, so it really has helped, and we have come a long way in the last year. Senator DOMENICI. So the city of Santa Fe has a department which concerns itself with the problems of senior citizens. Mr. ARROYOs. That is correct. Senator DOMENICI. Would you introduce the next witness on the panel? Mr. ARROYOs. We will start with Mrs. Crucita Ortiz. Senator DOMENICI. Fine. We are delighted to have you with us. 41-757-75 |