Page images
PDF
EPUB

COSTS AND DELIVERY OF HEALTH SERVICES

TO OLDER AMERICANS

WEDNESDAY, OCTOBER 16, 1968

U.S. SENATE,

SUBCOMMITTEE ON HEALTH OF THE ELDERLY

OF THE SPECIAL COMMITTEE ON AGING,

Los Angeles, Calif.

The subcommittee met, pursuant to recess, at 10:30 a.m., in the assembly room, Old State Office Building, 217 West First Street, Los Angeles, Calif., Senator Harrison A. Williams, Jr. (chairman of the committee) presiding.

Present: Senators Williams and Randolph of West Virginia.

Also present: William E. Oriol, staff director; John Guy Miller, minority staff director; Shalon Ralph, professional staff member.

OPENING STATEMENT BY THE CHAIRMAN

Senator WILLIAMS. The hearing will come to order. With this hearing, the Subcommittee on Health of the Elderly of the U.S. Senate Special Committee on Aging continues its study of the costs and delivery of health services to the elderly.

With this hearing, the Subcommittee on Health of the Elderly of the U.S. Senate Special Committee on Aging continues its study of the costs and delivery of health services to the elderly.

Testimony taken at two previous hearings has made several major points clear about the quality and availability of health care for older Americans.

First, there can be no doubt that medicare is already having tremendous impact. On July 1, when medicare was 2 years old, President Johnson reported that 20 million Americans of age 65 and over-10 percent of the Nation's population-were covered by the program.

More than $8 billion had been paid for expenses incurred in 10.6 million hospital stays and 45 million medical bills. Well over a million persons had received care after their stay in the hospital, in nursing homes or when home health care is available-right in their own bedrooms.

Another million and a half persons had received hospital outpatient diagnostic services.

Judged strictly in terms of statistics, the medicare program certainly has produced results. But it is impossible to measure the amount of dignity and security it has provided to the elderly, as well as the assurance it has brought to younger families whose parents need no

longer live in dread of financial disaster because of extended hospital treatment or major medical costs.

But even if medicare has already proved itself to be a blessing, it should not be regarded as a cure-all for all that may be wrong with our health care services today.

Medicare, after all, merely provides the wherewithal to pay for certain health care expenses. It may have some effect in improving the quality of such care, but it can't be held responsible for long-standing deficiencies or failures in the organization of health care.

At its field hearing in New York City, for example, the subcommittee took testimony in a part of the Bronx where there is only one doctor for every 10,000 people. Twenty or 30 years ago there were five times as many doctors and only about half the number residents. We learned that much the same was true in some parts of St. Louis, too. And of course it is the elderly-with a high rate of chronic illness-who live in large numbers in the central city neighborhoods. They suffer severely from shortages of trained medical personnel. Much the same is true in many rural areas; we're not dealing with just a city problem.

HOW TO ATTAIN HIGH QUALITY FOR ALL?

We have to ask ourselves: How are we going to organize health services so that high-quality care is available to all?

Another subject that received a considerable amount of attention at the first two hearings was the medicaid, or the title 19 program, as it is so often called. Congress intended that this program should help take away some of the welfare taint that overshadows the care given to low-income people. Congress declared that there was a large group in need of help, the so-called medically indigent who earn enough to take care of themselves, except when they are hit hard by high medical bills. Medicaid, of course, applies to all age groups, but it is important to many elderly people, especially when medicare benefits run out.

The subcommittee has found considerable confusion and concern about some aspects of the medicaid program. Some elderly people believe that their hard-earned nest eggs are placed in danger when they sign up. Others regard it as a welfare program, with a welfare stigma.

Within recent weeks, Congress has-I am afraid-contributed to the uncertainty by proposing major cutbacks, even after many States have made extensive plans for putting medicaid to work for their residents. One of the major reasons for calling this hearing in California was to get firsthand information about your medicaid program-or MediCal as it is called.

As I understand it, there was some fear 8 or 9 months ago that this program would produce a deficit.

Then it turned out that you had a surplus.

And now there are new State laws that permit cutbacks when costs reach a certain level.

What are the effects of the Medi-Cal program on the provision of health services for the elderly in California? We will look for some answers to that question today.

The first two hearings have also yielded much informative discussion about the need for prevention or early detection of chronic illness.

One of the hospital directors interviewed during preparations for this hearing was asked how to keep hospital costs down, especially those hospital costs supported by medicare. His answer was prompt. He said we should try to keep as many people as possible out of hospitals. One way to do that is to promote health maintenance programs, including regular disease detection screening. As things stand now, however, we focus Federal funds and attention on the obviously ill person, while withholding the funds and concern needed for actions that will prevent such illness.

HEALTH CARE IN THE HOME

Another way to keep people out of hospitals is to provide the means to give health care to people in their own homes. I personally know of people who are in hospitals only because there was no one, not even family, who could give them their daily meals and a few essential services.

We'll look to our witnesses today for a few good ideas about home health care, too.

In fact, we expect to receive many good ideas here today. California has many problems; but it also has many people who care about solving those problems. We've found over the years that many far-reaching innovations have originated in this State, and there is no reason to believe that this is no longer true.

To close, I would like to thank Senator George Smathers, who conducted the first two of the hearings on this subject as chairman of the Health Subcommittee, for taking us so far along in our study. I know that he had hoped to be here today but I have agreed to conduct the hearing in his place in order to advance our work in this area.

We will move on to our first witnesses after a statement from one of our most eloquent and distinguished Senators, Senator Jennings Randolph of West Virginia.

Senator RANDOLPH. Mr. Chairman, I have no desire to speak this morning. I think it is important that we proceed with the hearing.

I thank you very much. I am delighted to be here to join with all those present who want to make this program here today one of one

purpose.

Thank you very much.

Senator WILLIAMS. Our first witnesses will be Miss Elsa Carrow, administrative assistant to Mayor Yorty, and Mrs. A. M. G. Russell, chairman of the California Commission on Aging.

Now, these girls know what they are doing here. They are already in place. Who goes first?

Miss CARROW. I am the chairman. Shall I go ahead?
Senator WILLIAMS. For the record, Miss Carrow.

STATEMENT OF MISS ELSA CARROW, ADMINISTRATIVE ASSISTANT
TO MAYOR YORTY, MAYOR OF LOS ANGELES, CALIF.

Miss CARROW. Honorable Chairman and members, I am pleased to welcome your committee to the city of Los Angeles on behalf of our mayor, Sam Yorty.

A previous commitment prevents Mayor Yorty from welcoming you personally today. He asked me, as his coordinator for senior citizen activities, to bring you his personal greetings.

And further, he wished me to express his deep concern about the subject of your inquiry, the costs and delivery of health services to older Americans.

Los Angeles historically has been a mecca for the elderly and retired, who seek sunshine, comfort, and ease of living in their later years. Approximately 10 percent of our city's population is aged 65 and over that is, some 300,000 senior citizens.

Senator WILLIAMS. Would you just repeat that?

Miss CARROW. Yes. Approximately 10 percent of our city's population is aged 65 or over-that is, some 300,000 citizens.

Senator WILLIAMS. That is just the city of Los Angeles?
Miss CARROW. That's right.

This important segment of our population comprises a community with few geographical limits but with special needs that must be met by special services from both government and private enterprise.

From the earliest days of his administration Mayor Yorty has taken active interest in the challenges and conditions encountered by our senior citizens. One of his first official acts was to form the Mayor's Committee on Senior Citizens Affairs.

Composed of outstanding persons in fields of endeavor identified with senior citizens, the committee explores and recommends improvements in such areas as recreation, transportation, housing, employment, and health.

Not all of these areas are within the province of the city health services for one is the concern of county, State, and Federal Government.

Even though health care is outside his jurisdiction, Mayor Yorty believes adequate medical care is a primary concern and a right to be enjoyed by all senior citizens. For that reason he has sponsored medicare and its California State counterpart, Medi-Cal.

He has urged a full measure of attention to the health needs of our senior citizens.

The path of medical assistance for the elderly has not been smooth, as you will hear from other speakers today. That is one reason why we welcome your hearing here in Los Angeles.

We believe, as Shakespeare wrote, "To lose thy youth in peace, and to achieve the silver livery of advised age," is one of the rights of all. We hope and trust that the outcome of your hearings here and across the Nation will make that right a reality for all Americans.

Thank you.

Senator WILLIAMS. I would like to have you repeat that Shakespearean quote again.

Miss CARROW. Thank you.

"To lose thy youth in peace, and to achieve the silver livery of advised age, " is one of the rights of man.

Senator WILLIAMS. Bill Oriol said, "I wish I had said that." Thank you, Miss Carrow.

Miss CARROW. Thank you.

Senator RANDOLPH. Longfellow said it another way. He said "For age is opportunity no less than youth itself, though in another dress," since we are talking about poetry.

Senator WILLIAMS. Thank you very much.

Mrs. Russell, from the California Commission on Aging.
You are chairman, as I understand it?

STATEMENT OF MRS. A. M. G. RUSSELL, CHAIRMAN, CALIFORNIA COMMISSION ON AGING

Mrs. RUSSELL. Senator Williams and Senator Randolph, and gentlemen, I am Mrs. A. M. G. Russell, chairman of the California Commission on Aging, and on behalf of myself, of Mr. Charles W. Skoien, Jr., executive director of the California Commission on Aging, and of Mr. Carel Mulder, director of health care services of the State of California, and as representative of Governor Reagan today, we welcome you to the State, a State with a senior population of nearly 2 million, approximately 10 percent of our national senior population. Senator WILLIAMS. I will say we are going to be a little less than formal here. I don't know what your full name is. I have it A. M. G. Mrs. RUSSELL. I'm Bonny Russell.

Senator WILLIAMS. They call you Bonny?

Mrs. RUSSELL. That's right.

Because of the importance of this hearing today, and those you have had in the past in Washington and in New York, I would like to provide you with a little bit of background regarding activities that relate to the delivery of health care services in California.

It is the role of the California Commission on Aging to advise and counsel, and cooperate with all governmental and private agencies that are serving the senior Californians.

It is the job and responsibility of the commission to work as enablers in the provision of health services.

It is our sincere belief that in order to render quality health services it is vital that the responsibility not be vested in any one agency or organization-but, must be shared by all. This means that our national society must work together to create an adequate health program for all.

It has been our privilege in California to see our senior Californians give of their time, their talent, and energy-and most of all, their experience to the local community not only for their own personal benefit, but for the benefit of the health and welfare of each of their communities.

Also, through many innovative and creative ideas, California is developing many new ways to serve the elderly through preventive

means.

For example, there are two senior Californian regional education centers, one in San Jose and one in Los Angeles; centers funded through the Older Americans Act with programs which bring the local community and the local college or university together to provide a comprehensive senior program.

Through this effort, in the field of health we will be providing daily meals, nutrition program health lectures, training of health leaders, and-most of all-a public education program showing the community the need for adequate health planning.

Other aspects of this program will be a 7-day-a-week multipurpose program, a training center for college and university students, a community outreach program utilizing the senior Californians in the community on a paid basis, and an extensive training program for administrators of nursing homes, board and care homes, homes for aged; administrators in the fields of housing, employment, religion, educa

« PreviousContinue »