Answer 3. I vigorously criticized Medicaid literature because that was what we were discussing. I would also vigorously criticize Social Security literature, federal pamphlets and so forth. It seems to me that great and valuable lessons could be learned from advertising firms; how to get an idea across and how to interest people in buying a new product or changing a brand. They also are able to gear their advertising to the interests and levels of people who will provide the market.

Yes, I certainly would be in favor of the establishment of a communications advisory board to review publications and make recommendations. But I would not confine it to Social Security but would expand the program to include all government informationals which are intended to be read by the general older public.

I would caution, however, about the danger of becoming bogged down in reviews of the recommendations and re-reviews. There must be a real committment on the part of the agencies to implement and test the suggestions. STATEMENTS BY MISS HELEN M. HARRIS, EXECUTIVE DIRECTOR, UNITED NEIGHBORHOOD HOUSES OF NEW YORK; MRS. EDNA YOUNGBLOOD, MEMBER, WILLIAM HODSON COMMUNITY CENTER; LEON FRAITER, MEMBER REDSHIELD DAY CENTER, MANHATTAN; MRS. SUSAN KINOY, PROJECT DIRECTOR, PROMOTING HOME HEALTH AND SOCIAL SERVICES TO NEW YORK'S AGING, COMMUNITY COUNCIL OF GREATER NEW YORK; AND WALTER NEWBURGHER, PRESIDENT, CONGRESS OF SENIOR CITIZENS

Senator SMATHERS. Our next group of witnesses, Mrs. Edna Youngblood, of the Hodson Community Center; Mr. Leon Fraiter, member of the Redshield Day Center, Manhattan; Mr. Walter Newburgher, president, Congress of Senior Citizens: Mrs. Susan Kinoy, project director, Promoting Home Health and Social Services to New York's Aging; and Miss Helen M. Harris, executive director, United Neighborhood Houses.

Our first witness will be Miss Harris.

STATEMENT OF MISS HARRIS

Miss HARRIS. Thank you. My name is Helen M. Harris and I am the executive director of United Neighborhood Houses of New York, the federation of some 60 settlements and neighborhood centers located in the least advantaged areas of the city. These are old neighborhoods with a sizable population of elderly people. More than half of our member settlements run programs for the elderly and are acutely aware of their problems and needs.

Their No. 1 problem, and I don't have to say that to this group, outside of food and shelter is medical services-their availability, their accessibility, and above all, their cost.

When medicare became a reality and medicaid a possibility, it seemed as though the No. 1 problem was about to be licked, and all of us who had been working for health insurance these several decades rejoiced along with our elderly neighbors. But it turned out to be not quite so simple as we and they expected. Medicare, part B, had to be explained and sold before a deadline. Language was often a problem and a great deal of interpretation was necessary, mostly on a 1-to-1 basis, to get across to people just what they were entitled to and what they had to do to receive the benefits of the programs.

We particularly rejoiced when New York State passed its liberal, far-seeing medicaid program, designed to break the back of that dreaded specter "medical indigence." Now we hear that Congress is prepared to strike a mortal blow at our New York State program by mandating lower income ceilings. This would make ineligible thousands of persons who for nearly a year now have been receiving health services under medicaid. To force a retrogression to "indigency" instead of "medical indigency" would be shortsighted, indeed. We urge the committee to prevent such action in the Congress and permit the more advanced States to set their own standards. To do otherwise would be to stifle a constructive, preventive health program before it could get off the ground and be fully tested.

For those on welfare, medicare and medicaid brought almost instant benefits. And in the beginning doctors, dentists, and druggists went along with the program in most neighborhoods. People reported quicker, more kindly, reception and service, even in hospital clinics. Dentures and eyeglasses came unbelievably fast for some who had waited months for them. To choose one's own doctor and be treated with respect like any paying patient enhanced one's innate dignity.

But for those who had managed to stay off of welfare there were problems. Literature about the program was confusing and hard to understand. Application forms were long, complicated, and too demanding. Producing the last eight wage stubs, bank balances, insurance policies, and savings accounts was often so difficult many an elderly person threw up his hands and refused to complete the application. And for those who did complete it, 3 and 4 months might elapse before they received their card, and then they were faced with the hated words "department of welfare" on all the forms and the identification card. This business of being identified with the department of welfare has been a stumbling block for many and a reason that many refused it.

The greatest problem medicaid presents for many elderly persons not on welfare, who desperately need the program, is the matter of their savings. Many have worked in "uncovered" jobs all their working lives, been able to save a little and steadfastly refused to accept relief even though in their so-called golden years their social security payments may be as little as $35 a month. Almost all the elderly in our settlement neighborhoods live on unbelievably small incomes. They live in wretched houses, pay very low rent, and cannot afford to move to public housing because the rents are higher there.

Yet many of these have little more savings than medicaid allows. Some count on their savings to eke out their low incomes. Some are afraid to use any, against the day of greater need. Many refuse to reveal the amount as it was said here before for fear it will be taken away from them. All resent this intrusion into their privacy. They are the proud, independent elderly for whom the thought of a major illness that could wipe out their savings is a constant worry. These are the truly "medically indigent" for whom medicaid was designed.

These, too, are the people who are unable to pay the new $11 clinic fee our city hospitals have imposed, where before no fee was charged, and have stopped going for regular checkups. When in dire need they go to a private doctor and pay him $7 or $8 a visit. Unfortunately, as

has also been said here today, the doctors, too, are raising their fees and the elderly who for whatever reason refuse or are ineligible for medicaid are in a tight squeeze.

PART B PREMIUM CAUSES PROBLEMS

For the same reason, the thought of an increase in the part B fee from $3 to $4.50 a month has caused real consternation.12 When you haven't got enough to live on anyway, even $1.50 a month would mean less carfare or food or some other necessity. In a number of our settlements, the elderly have raised the question of the $50 deductible in medicare. "Couldn't it be lowered?" they say, "or eliminated altogether?"

Another great difficulty-increasing, unfortunately-which again you heard today is the shortage of doctors and dentists who will accept medicaid patients. In the beginning, as we said earlier, many more doctors participated in the program. However, the long delays in receiving payment from the city and the extra and time-consuming paperwork involved in filling out forms have caused many doctors to refuse medicaid patients. At one settlement in East Harlem, the LaGuardia House, the director reports that the only way they can get one doctor to accept their patients is for the settlement staff to agree to do the paperwork for him. Those doctors who remain in the program are often overworked, their offices overcrowded, and find themselves unable to give as much time as they would like to each patient.

The same is true of dentists. It is increasingly difficult to get dental care and where 6 months ago many persons were delighted with their new dentures and their "family" dentist, today there are more complaints of inferior quality of treatment and dentures. This is not universally true, of course, depending on the particular neighborhood and dentist, but true enough to be brought to your attention.

As for service in hospital clinics, there is tremendous variation from hospital to hospital in New York City. Some older persons report excellent diagnoses and treatment, others try to avoid certain hospitals except in an emergency because examinations are superficial, waiting time from 2 to 4 hours. The waiting continues to be long in even the best hospitals.

Are the elderly generally less satisfied with health services available to them or more satisfied? Interestingly, in our settlements fewer report being less satisfied in spite of their complaints. The majority are more satisfied though some of these feel the service falls far short of their expectations.

United Neighborhood Houses has made every effort to find out from the participants themselves-both the givers and the receivers of services-what their experience has been, how they feel about it and what are the major problems. We conducted a hearing last April called "Witness for Medicaid" before Members of Congress and city and State health and welfare officials that gave us some of the answers. Settlement neighbors, most of whom happened to be on welfare, spoke movingly of the wonderful benefits they were receiving. But all of the problems just described were brought out, too, by hospital officials, a

12 Pursuant to his authority periodically to set new rates for medicare pt. B premiums, HEW Secretary Gardner on Dec. 30, 1967, increased the premium from $3 to $4 per month, effective Apr. 1, 1968.

dentist, a druggist and settlement workers who were engaged in trying to sign people up. I commend this brochure to you if you have not seen it which contains the words of the witnesses taken from the transcript.

Just this past week we have surveyed the field again, getting answers from the elderly themselves and from staff workers, to the questions your committee sent to us.

In spite of the obvious drawbacks and roadblocks and the inevitable mistakes in starting so enormous a program, "Witness for Medicaid" and our recent survey convince us that a new day has dawned in providing health services to the elderly that will brighten as the problems discussed here are solved. Medicare and medicaid, no matter what the problems they present now, are fine first steps in what must inevitably come in our country, the recognition that good health is everyone's birthright and health services everyone's right-regardless of ability to pay. We are years behind other countries in our commitment to health as a broad social policy. I hope the words of those most in need may help to hasten the day.

Thank you. [Applause.]

Senator SMATHERS. Thank you, Miss Harris. We are going to make the brochure a part of the record at the conclusion of your statements.13 (The chairman addressed the following questions to Miss Harris in a letter written subsequent to the hearings:)

1. Do you plan to submit excerpts from the letters received by your member neighborhood houses, or will your statement stand as a summary of the letters received as a result of the Subcommittee inquiry?

2. May we have more specific information on the complaints of inferior quality of dentistry and dentures? Is it your feeling that the advent of Medicaid has caused a lowering of dental standards generally throughout the city?

3. The Subcommittee has received some information about the work of volunteer elderly health visitors in the Henry Street Settlement House area. May we have additional details on the program, the importance of such services, and the relationship to the Gouverneur clinic?

(The following reply was received:)

I am sending you, as you requested, the following:

1. The transcript of my testimony which needed no editing.

2. A report on Services For The Elderly By The Elderly from Henry Street Settlement.1

3. Two copies each of five letters, which we received from our settlements, that are typical of the comments received from a total of 19 houses.' With regard to your question concerning dental services, as I stated in my testimony the situation is quite varied throughout the city. Some of our houses report a lowering of standards and great difficulty in finding dentists who will accept Medicaid patients. Others have found in their neighborhoods that dental care has greatly improved. It all depends on the social point of view of the dentist and also his ability to wait a long period of time for payment.

I am also enclosing two copies of the memorandum we sent out hastily to our houses with your list of questions. Since many of them replied without restating the questions, I thought you might need this memorandum. I do hope you will find our material a help to you.

We are most grateful to you for your persistence in bringing the facts with regard to Medicare and Medicaid before the United States Senate. If I can be of service in any way, please let me know.

Senator SMATHERS. Our next witness is Mrs. Edna Youngblood, member of the Hodson Center group.

Mrs. Youngblood.

18 See p. 510.

1 In committee files.

2 See app. 1, p. 527.

STATEMENT OF MRS. YOUNGBLOOD

Mrs. YOUNGBLOOD. As stated, I am Edna Youngblood, a member of this wonderful Hodson Center. I want to greet all of our distinguished guests and thank you for bringing this hearing to us.

I say from the beginning this is Hodson Center's medical needs. We all know that both medicare and medicaid have been a help to a great many of us senior citizens. It has given us a degree of better medical health and a longer life but it has made us wait and wait for our refunds and expenses of over $50 allowed to us. I know of several cases where our senior citizens have sought admission and were sent from one place to another so many times, going to different hospitals and different distances, have spent bus fare in vain and then waited for months before talking to the right person who in turn promises results but then more waiting.

We here at Hodson need a representative of medicare for all of our senior citizen day centers to talk to and explain to us even if it is on a limited basis. What is needed is some help for those on medicare and medicaid who are unable to shop or carry packages due to disability to even go to laundromats. This would keep them living as they wish to in dignity and cleanliness.

Medicare also limits us senior citizens, due to small lifetime savings, from getting dental services, good chiropody services-which means care of our feet-to help us go back and forth to places-and glasses, as a lot of us really need. These three services are very important to us as senior citizens at this time of life.

Our doctor fees have increased from $5 to $7 to $10. This keeps some from getting medical attention while waiting for refunds of former bills. Doctors are very hard to get at night and more so over weekends when a lot of illness occurs. We know our doctors are human, they need vacations, they need time with their families, but this is the career they chose and took an oath to care for the sick.

Our doctors don't want to visit in some neighborhoods. Would it be possible that our doctors could call the local police and ask for protection in making these calls?

Our visiting committee who I must say are doing a great service for our center describe conditions in some nursing homes as one of neglect and that many of the older people don't want to accept this sort of care and therefore delayed their recovery.

Drugs are getting so expensive, yet some unions are offering discounts and there are some discount houses but this means we have to travel and in most cases we are not able to do this. Could not a set price be put on certain drugs prescribed by our doctors? Is it possible for our doctors to have a cost price list at their office to help relieve us of this terrible expense?

Medicaid does cover so many of the services we senior citizens really need such as dental, foot care and glasses and sometimes special braces and shoes and drugs. Could not those on medicare be extended these services on the doctor's special orders? This would give us a desire to live a more useful and healthful life at a time when we can really enjoy it in dignity and cleanliness and encourage us to indulge in hobbies and to encourage others to help us at our day centers.