For a period of 2 years as a community aide I did friendly visiting and shopping for over 300 people. I have done the following for these people: found cleaning women, had prescriptions filled, cashed welfare checks to pay rent, taken people to the clinic, visited people in the hospital. All these services were needed because the people had no relations, no one to turn to when they needed help, and by the way they still need help.

Thank you so much. [Applause.]

Senator SMATHERS. All right.

Miss CARTER. This is Bernardo Negron who is a VISTA worker at the Hudson Guild.

Senator SMATHERS. All right, sir. You go right ahead.

STATEMENT BY MR. NEGRON

Mr. NEGRON. Senator Smathers, ladies, and gentlemen, I am a Puerto Rican by birth and a VISTA worker at the Hudson Guild-Fulton Center. I am 68 years old and have been attached to the Hudson GuildFulton Center for the past 2 years. I have worked closely with medicare alert. Miss Carter has submitted a copy of the medicaid literature for the committee to see. It is impossible to understand, and as a result we must explain the program, on a person-to-person basis and we must help the people fill out their applications. This is very time consuming, and we are not able to reach all of the people eligible for medicaid.

I have taken many people to the hospital for clinic visits and we have had to wait all day for treatment. As you are aware, clinic waiting rooms are very ugly and uncomfortable places. There is a lack of concern about people's feelings, and sometimes they are treated very roughly because they are very poor and sometimes cannot speak English well. Many times elderly people are not treated because of the number of people waiting for treatment, and they are told to come back the next day. So they spend day after day in clinic waiting

rooms.

Angel Lopez, a crippled man, age 73, lived alone in a public housing project. One morning I took him to the clinic and I could not stay because of other visits and agreed to come back later that day to pick him up. In the afternoon I received a telephone call to come and pick him up because nothing could be done for him. A few days later I took him to another hospital where they hospitalized him until I could make arrangements for him to be admitted to the Sailor's Snug Harbor Home for the rest of his life.

As you can see, gentlemen, there is a great need for improved health services for older people. In my own case I have not been able to get medicaid because I have a $3,000 savings account in a bank. I have not been able to get medicare because I went to a hospital and there I had some treatment not covered by medicare and I got a bill for $162 but I was glad because I was under Blue Cross and Blue Shield who took care of that and paid.

I thank you ever so much for this opportunity that you have given me. My recommendation before I leave is that any treatment received by any patient ought to be signed by this patient because we have cases

where patients have been sent a bill for things they have not used. I have a case of a lady who was sent a bill for 3 pints of blood and she never saw any blood in that hospital. We ought to have the patient sign the bill before it is paid.

Thank you ever so much. [Applause.]

Senator SMATHERS. All right. Miss Patricia Carter, director of consumer education project.

STATEMENT BY MISS CARTER

Miss CARTER. Thank you very much.

The Hudson Guild's consumer education project sponsored by the New York State Office for the Aging has been vitally concerned about the best use of the health dollar. We have found that consumer education is very different from our original conception of it and we have had to get into many other areas. For example, we cooperated in a Medicaid Alert campaign for this purpose. We found that older people negatively associated medicaid with welfare and that many would not take advantage of the program for this reason. The major fears were that their bank accounts and insurance would be taken away and that this program would be as demoralizing and stigmatizing as is public assistance. It was necessary to work on a person to person basis to explain and assure people of the program's validity.

As Mr. Negron mentioned, the literature is unreadable and this added to our job.

The list of participating doctors and services distributed by welfare was inadequate. Several people were asked to leave doctors' offices when they presented their medicaid card. The word about this quickly spread throughout the Fulton Center and further complicated the situation. We finally had to call up doctors and services individually to find out if they would accept medicaid patients and at what times. We found that some doctors didn't want poor people cluttering up their offices at times when wealthier patients were there, and they admitted this to us.

The cost of maintenance drugs is prohibitive to a person who is not on medicaid. Some of our people have not been accepted for medicaid simply because of a few hundred dollars and it is these people on the borderline who are so drastically affected by high drug costs. We have started a cooperative arrangement with the drug plan and have been saving amounts from 69 cents to $5 on prescription costs.

As you know, most doctors do not apply for medicare, the patient does this. The redtape being what it is, older people must wait from several weeks to several months before they are reimbursed. This amount can be substantial and what does a person living on a minimum income do?

Persons on medicaid who have not been reimbursed for the $3 medicare cost also have a problem. A woman came to me about this saying that the $3 would mean a lot to her. It would mean $61 a month rather than $58.

You already have been told about the lack of concern at hospital clinics. One of our members has discovered a lump on her neck. Of course, her first thought is cancer. She has been waiting 5 weeks for a

diagnosis. She has gone to the clinic, been examined and given another appointment. Can you imagine what turmoil she is going through?

Since hospital beds are scarce, patients are sent home as quickly as possible. Who then is responsible for caring for them? A 75-year-old woman was hit by a car and sent home the same night. She cannot walk well and is bruised. Who is to take her to the clinic? Who is to prepare her food? Who is to check on her occasionally?

A number of people have been found dead or unconscious in their rooms both in roominghouses and the public housing projects. Some have been found with the telephone in their hand. Who is responsible for them?

Also, gentlemen, do not confine health interests to hospital and doctor care. It is not to a man's best health interest when he has a heart condition and must walk up six flights of stairs because there is not enough adequate housing, and it is not to a person's best health interest when there is not enough money to eat well.

I would like to close by telling you about one of our members. Mr. Joffee was going to have an operation. One day he came into the Center crying. He was holding a note from his doctor to "Admitting." The note described the operation and noted that Mr. Joffee was a "very poor risk." He had a heart condition. I will never forget the last time that I saw him. He knew so emphatically that he was going to die. After all, his doctor said so. He had a heart attack during surgery and was sent to a nursing home to recover. He had another heart attack and died. Was the note influential in his death. Who can say? But what does a man feel going into surgery knowing that he is expected to die?

Thank you. [Applause.]

Mr. ORIOL. The other witnesses have described the long waiting at clinics for attention now. A few years ago at the Center you had a health maintenance project, did you not?

Miss CARTER. Yes; we did.

Mr. ORIOL. And that project managed to keep people out of clinics, didn't it?

Miss CARTER. It was worked in cooperation with the St. Vincent's Hospital and it did save a lot of time because many of the cases were sort of screened through this health maintenance clinic and very simple things could be done there.

Mr. ORIOL. You had almost a neighborhood approach?

Miss CARTER. That is right.

Mr. ORIOL. And the reason it was successful in your area, especially successful, as I understand, you did have a high concentration of elderly and you still do.

Miss CARTER. Yes. It was located in a public housing project and 500 old people live there alone.

Mr. ORIOL. So it is a very simple matter for them to come to their health maintenance center. What has happened to that program?

Miss CARTER. That program was closed before I started at the guild which was about a year ago and nothing has been done since then. Mr. ORIOL. As a result people who formerly went to the health maintenance center are now waiting in the clinics.

Miss CARTER. That is right. One of the advantages of such a clinic, for example, one lady who has very poor eyesight clipped her toenails

and got an infection. She had to go to the hospital and wait all day to get this fixed. It was such a little bit of care that a health maintenance clinic could clip her toenails for her. This sort of small thing, we could save a lot of time.

Mr. ORIOL. For the record I just would like to note that we have asked Mr. Carpenter, the director of your center, to submit a statement on that program and what has happened because it no longer exists.10

There is a representative of the Queens Bridge health maintenance project here today. That project has managed to keep going with help from various sources, but I understand that the director there is very concerned that there, too, they may have to stop operation.

Miss CARTER. I understand so.

Mr. ORIOL. I noted that in Dr. Brown's testimony this morning his reference to the fact that he did not believe that neighborhood centers need be established solely to help the elderly but it would seem from your experience that under certain circumstances this kind of program might be helpful.

Miss CARTER. It would seem that the elderly need so much little kinds of care-explanations of diets, help to find proper drugstores, clipping of toenails, this kind of thing, that really does not need to be the concern of a large metropolitan hospital.

Mr. ORIOL. That statement will be in the record and we will forward a copy of it to Dr. Brown for his comment, with the Chair's permission.

Senator SMATHERS. Yes.

Mr. ORIOL. Another question I wanted to ask, what is the advice given by social workers and others in New York City to elderly applicants for medicaid who have a small nest egg and are fearful that they may not be able to keep that nest egg if they are enrolled in medicaid?

FEAR OF LOSING "NEST EGG"

Miss CARTER. In our center we have almost had to do it on a "you do me a favor" basis. We promise them that they are not going to have their nest eggs taken away, and if "you do me a favor you will apply. All you will get is refused, if you are not eligible."

Mr. ORIOL. So the fear of losing a nest egg is a big problem?
Miss CARTER. Tremendous.

Mr. ORIOL. One other thing. You were very kind in sending me the official literature of the city of New York to people who want medicaid and you wrote in certain questions about what does this mean and what does that mean. I don't have the answer, I didn't understand it any more than you did. Again with the chairman's permission, perhaps we could forward those questions to the proper officials and ask them about some of these things.11

Miss CARTER. I think that would be a good idea.

Mr. ORIOL. Thank you.

Senator SMATHERS. Thank you very much.

(The chairman addressed the following questions to Miss Carter in a letter subsequent to the hearings:)

10 Additional discussion of health maintenance programs on p. 543.

11 See letter by Commissioner Ginsberg, p. 572.

1. I believe that our record would be incomplete if we did not have a brief description of the Consumers Demonstration Project conducted by you with funds from the Administration on Aging. May we have a paragraph or two?

2. How can such consumer information projects be coordinated with other services such as visits to elderly isolates, Project FIND, and home health services? 3. Your vigorous criticisms of informational literature distributed on Medicaid lead me to wonder whether you have recommendations for improving such literature. Would you, for example, be in favor of the Social Security Administration's establishing an advisory board of specialists from the communications media to help review such publications and send their recommendations to state and city agencies that distribute literature?

(The following reply was received:)

Answer 1. The Hudson Guild's Consumer Education Project is supported with the New York State Office for the Aging under the Older American's Act of 1965. Consumer education can be defined as helping people to use financial resources to effectively achieve family goals. However, consumer education as it relates to the older persons involves a complex network of physical, social and financial problems. Two basic principles of consumer education are (1) to do for one's self rather than purchase services and (2) to look and shop around before buying. Elderly persons with aching bones, heart conditions, and minds which are not as clear as in previous years often find the efforts needed to save a few pennies just more than they can invest.

The alternatives usually available in decision making are not open to the elderly person. And the pitifully inadequate income coming from Social Security or combined Social Security and public assistance does not give the older person a dollar that can stretch. Thus, we have approached the program by attempting to deal with the major areas of an older person's life which can cause him financial or physical problems and emotional strain. We felt it necessary to create a broad base of security in these areas in which the people can depend, then they will be more receptive to involving themselves in programs outside the scope of their immediate needs.

Our program has (1) demonstrated a need for adequate food programs; (2) cooperated in a Medicaid Alert; (3) developed a Drug Plan; (4) attempted to involve older people in Social Action; (5) initiated an information program with Welfare; (6) held a city wide conference on consumer problems of older people; and (7) began testing various educational techniques. Our next year will be focused on social action and the development of a family security program. Reports of the project can be obtained by writing to Hudson Guild, 119 Ninth Avenue, New York, N.Y. 10009

Answer 2. As we discovered at the Hudson Guild, a consumer information project covers food, clothing, health, cost of services, family security; as well as Welfare and Social Security grants. It also involves group work, case work and community organization. Thus, an effective consumer information project associated with visits to elderly isolates; Project FIND; and home health services programs would necessitate a strong coordination of direct service agency programs and business to insure that needs of older people are considered in program development; that existing programs and projected programs are not duplicated and that information flows freely. This plan, of course, assumes that agencies would commit themselves to giving up a bit of their autonomy for the good of the whole. In some respects, this is what Dr. Cherkasky talked about in relation to hospital services.

As a necessary part of this, it would be important to include at the neighborhood level a consumer specialist who would funnel this program from the planning level to the older people and return information regarding needs back up the line.

The consumer specialist could; (1) test the effectiveness of educational material and new educational techniques; (2) serve as a central neighborhood source of general consumer information because she would have at her fingertips the results of the central planning body's efforts; (3) work with staff at the neighborhood level to develop and implement consumer programs, to fill the local need.* Again, this is similar to what rural extension has been doing on a general level.

*For example: If the older people have not been receiving their entitled grants from Welfare, the consumer specialist could in cooperation with the central planning committee implement a program with the local Department of Welfare to bring older people up to standard.