improvement of employment conditions is essential to improvement of patient care in nursing homes. The American Nurses' Association recommends that in all instances a registered professional nurse carry the responsibility for nursing care in the nursing home. In many instances in the nursing home, the patient's physician does not provide the degree of medical supervision that would be provided for the patient in the hospital. The registered professional nurse dischrges her responsibilities in partnership with the physician. In this respect, the American Nurses' Association agrees with certain statements made in 1958 by the American Hospital Association "Listing Requirements for Inpatient Care Institutions Other Than Hospitals," as follows: "There shall be a duly licensed physician or physicians who shall advise on medical administrative problems, review the institution's plan for patient care, and handle emergencies if the patient's personal physician is unavailable. "Each patient shall be under the care of a duly licensed physician, and shall be seen by a physician as the need indicates. "There shall be a medical record maintained for each patient, which shall include at least (a) the medical history, (b) report of physical examination, (c) diagnosis, (d) physician's orders, (e) progress note (medical and nursing), (f) medications and treatments given." STANDARDS OF NURSING CARE IN NURSING HOMES 1. Skilled nursing care (including its preventive, curative, and rehabilitative aspects) is a necessity in a nursing home. Therefore, the nursing home should provide direct (preferably on the premises 24 hours a day) supervision of nursing care by a registered professional nurse. 2. The registered professional nurse in charge should preferably have had training beyond her basic nursing education in care of the aged and chronically ill, inpatient rehabilitation, and in management and leadership. 3. There should be a registered professional nurse or a licensed practical nurse on duty at all times. The number and type of nursing personnel on duty should depend upon the number and condition of the patient population. 4. The registered professional nurse, who is responsible for the kind and quality of nursing care, has an obligation to protect the public by not delegating to a person less qualified any service which requires the professional competence of a nurse. However, certain aspects of the daily patient care may involve or be delegated to other personnel. 5. The registered professional nurse in charge should participate in the planning and budgeting for nursing personnel, equipment, and facilities. 6. The registered professional nurse in charge should have responsibility for the selection, orientation, supervision, evaluation, and employee-development of professional and allied nursing personnel; this responsibility to be discharged in comformity with the functions, standards, and qualifications for practice as established by the American Nurses' Association. 7. The registered professional nurse in charge should coordinate and conduct the total nursing program. This would involve interpretation of medical orders and provision for restoration of the patient to his optimum physical, mental and emotional, and social potential. 8. The registered professional nurse in charge should participate in the screening of prospective patients in terms of kinds of care available in the institution. 9. There should be a nursing care plan established for each patient. In the development of the nursing care plan it is necessary to have a written statement by the physician regarding the nature of the illness, the condition of the patient, and the treatment prescribed. 10. There should be a nursing record for each patient. The registered professional nurse should be responsible for the accuracy of the reporting and recording of the patient's symptoms, reactions, and progress. 11. The registered professional nurse in charge should make rounds with the physician and confer with him concerning the patient's nursing needs. 12. The policies relating to the control of prescribed medicines and treatments should be in writing, defining frequency of medical review, and the recording and renewal of orders. These policies should have the approval of the consulting physician or responsible medical group. 13. All medical orders should be in writing and signed by the physician. 14. There should be written nursing policy and procedure manuals which are kept in line with currently approved nursing practices. 15. There should be written personnel policies, job descriptions, plans for orientation for new staff, and provision for inservice education. Employment standards should be consistent with those recommended by the State nurses associations. 16. The nursing staff should be provided opportunity to attend professional organization and other educational meetings. 17. The registered professional nurse in charge should be responsible for defining the activities of volunteer workers as related to patient care and in guiding the volunteers in carrying out their activities. RELATED STATEMENTS ANA Statements of Functions, Standards, and Qualifications for Practice. ANA Code for Professional Nurses. PREPARED STATEMENT OF R. O. BECKMAN, EXECUTIVE DIRECTOR, SENIOR SERVICE FOUNDATION OF MIAMI, FLA. The courtesy of your committee in asking for a few comments about the adequacy of programs for our retired population, in relation to congressional proposals for the establishment of the U.S. Office of Aging is genuinely appreciated. My brief observations are based on 9 years of contact with such problems, as a newspaper columnist, consultant, participant in State and National conferences, and firsthand observer of senior activities programs from coast to coast. The announcement of this hearing asked the question: Are present programs for the aging meeting the need? Despite the tremendous stepping-up of interest on the part of the public and among the professions, discussion has not yet been replaced by action: the answer is therefore an emphatic "No." Comprehensive action will not come overnight, in spite of voluble demands from a minority of retirees sorely in need of an improved economic, health, and leisure status. It will result from the development of public understanding of what it means to grow older and to spend the second half of life in pursuits other than earning a living. This involves education, a slow process at best. Not only does the younger generation need to understand that old age is a normal part of the lifespan that can be serviceable to them and the economy, but the old folks themselves need an opportunity to learn about the potential of their later maturity. The senior population is presently at the crossroad without a legible roadmap. One road leads to sunny heights; the other to a quagmire. If the surplus older generation of an overpopulated world is not allowed to prove its mettle but is turned into a fungus that saps the national economy, who can say that it may not be exterminated? In China concentration camps are said to be already set up with chemical vats into which the aged are dropped to furnish fertilizer for the rice crop. The Eskimos used to set useless oldsters on floating cakes of ice. Fortunately the American goal toward which we are making headway is to provide a brave new climate in which to grow older. An education program to give personal and social meaning to the individual throughout his total life span is definitely on its way. In the coming decades we will no longer be saying: "Poets weep, and make us weep, at young lives cut short while old age stumbles blindly along its meaningless pathway." Adult education about and for application in later maturity is making headway, but slowly. It has already convinced perhaps 1 in 10 of older persons that an active mind is the best antidote for boredom and frustration in the later years. Grandparents that participate in classes, workshops, discussion groups or self-study, are setting themselves apart from others content to coast into a vegetable existence. They continue alert, refusing to go to seed. They are less troubled than many younger folks over the apparent meaningless of life. Older persons resent competition from younger ones in the schoolroom atmosphere; greater success is achieved when they are brought together in special interest groups rather than classes. These may not be staged on school premises. More or less formal training in avocations or hobbycraft are of greatest appeal. The libraries play an important role. Discussions on preparation for retirement are expanding; colleges are interesting themselves in this field. Formal education programs do not meet with general approval from older persons. Few school boards have enrolled any considerable number of retired persons. It appears that only about half a million over age 60 is thus registered. School authorities the country over are unable to supply authentic data regarding such enrollment. Formal or informal education for young and older persons will help them with the problems they face later on. They will understand the changes that come with age, develop more wholesome attitudes, extend their interests and skills through continued mental growth. Training of this kind will prevent the older person from heading down a bumpy detour marked "Retirement" to meet with a blowout-and no spare tire. A fast changing nuclear world now concedes that responsibility for an avalanche of older persons cannot be left entirely to the individual, his famly, his community or the State government, though each has a primary share of accountability. The Federal Government should continue to explore the problems of old age and provide major leadership for action. It must provide technical assistance and grants-in-aid to stimulate local services. The most logical step to this end is a U.S. Office of Older Persons to serve as a central coordinating clearinghouse, not only for the wide range of Federal activities, but for the guidance of local community effort. Already existent is the fledgling special staff on aging in the Department of Health, Education, and Welfare which, more than any other medium, has provided national leadership in its field. It could be given a statutory basis, more independent leadership, and "line item” appropriations as proposed in some bills presented to the Congress. Most of these bills, including one introduced by Representative Cramer of Florida in 1957, and even a recent one by Senator McNamara, appear to have one administrative shortcoming. Desirable as are their objectives, they do not specifically clarify the responsibiilty and authority of the proposed coordinating agency, thereby opening up the prospect of duplicate effort, manpower, and expense among the Bureau and other Federal departments. Overlapping, confusion, inefficiency and boondoggling could result. Appropriate legislation could, however, clearly earmark the function of the new office as functional rather than operational. Projects relating to the aging and undertaken by Federal agencies and the bureaus of the Department of House, Education and Welfare could be cleared and evaluated by the Bureau of Older Persons. Together with an advisory Federal Commission on Aging it would then furnish consulting services in implementing them. It should be authorized to pass on proposed grants-in-aid projects or services, but would assume no operating function aside from inspection and supervision of demonstration projects in recreation or other fields not specifically within the province of other departments or bureaus. Throughout the functioning of such a Federal office the emphasis can be laid on providing older persons a chance to do things for themselves and their communities, rather than having things done for them. The senior citizen wants recognition and opportunity rather than alms from a paternal government. Hon. CLEVELAND M. BAILEY, WASHINGTON, D.C., April 12, 1962. Chairman, General Subcommittee on Education, U.S. House of Representatives, Washington, D.C. DEAR MR. BAILEY: I regret that because of health I cannot at this time undertake to testify at hearings on proposed legislation to establish a Federal agency for the aging-hearings to be held on April 17, 18, and 19. The organization in which I am particularly interested, the American Association of Retired Persons, will be most ably represented by our executive director, Mr. William C. Fitch. We are in the process of developing a National Capital chapter of the AARP, but are not now in a position to name someone from our organization to appear at these hearings; that is, we have not had time to explore the details of the proposed legislation and to arrive at any conclusions as to the merits of the various bills. Personally, I feel very strongly that an independent, nonpartisan Commission on Aging is long overdue. The special staff on aging of HEW does notable work, but their viewpoint is understandably that of the very aged, ailing, and needy people of the welfare system. The millions and millions of us, also of the over-age-62 classification, who, through thrift, self-denial, and careful investments acquired a competence for our retirement years, are increasingly finding ourselves lumped with the welfare groups and even the President recently spoke of the "16 million aged, all in need of medical assistance." A rather rash statement when one considers that his own parents are of the "aged" classification, but hardly in need of any dole from the taxpayers for medical care. A Commission on Aging, devoted to the interests of all persons over age 62, which could assist in preretirement program development, and also give full consideration to the sensible utilization of the skills, abilities, knowledge, dependability, and effectiveness of the retired citizens, could give immeasurable assistance not only to the retired persons, but also to the community, the State, and the Nation. I shall follow with much interest the information developed through the hearings before your subcommittee. There is nothing quite like a good congressional hearing to bring out all sides of a controversial question. Thank you for your invitation. Perhaps at some later date I shall be in a position to contribute in the manner you suggest. Very truly, GERTRUDE LEACH. FEBRUARY 12, 1962. Hon. CLEVELAND BAILEY, Chairman, General Subcommittee on Education, DEAR MR. CHAIRMAN: Early in June I mailed you a brochure outlining an eightpoint national program for senior citizens, developed by Mr. Joseph B. Shank and me, approved by the St. Louis chapter of the Golden Age & Senior Citizens Clubs of the U.S.A., Inc., for presentation to the national organization at their annual convention held June 14-17, 1961, in Chicago, Ill., and accepted as their national program by the delegates. There were over 1,200 delegates from 42 States attending the convention, representing over 100,000 members, with very large chapters in many cities-to name a few: St. Louis, New Orleans, Albuquerque, Kansas City, Detroit, Evansville, Milwaukee, Altoona, Panama City, St. Petersburg, Atlanta, Palm Springs, Los Angeles, etc. I especially would like to bring to your attention point VIII in the brochure enclosed, "Federal Commission on Aging": "Last, but not least, we propose early passage of legislation to provide for the establishment of a Federal Commission on Aging. This Commission will be bipartisan and directly responsible to the Congress and the President. It will serve as a sounding board to assist the Government to apply new techniques for new problems of the senior citizens as they develop. Aging is a problem of immediate concern to everyone. Everyone has relatives or friends who are faced with the grave problems of their retirement years. We have much knowledge on what is needed. It is time now to work out acceptable answers to the problems." It is our opinion and we recommend highly that a Federal Commission on Aging be set up bipartisan or nonpartisan; but not in the office of HEW but responsible to the President and the Congress jointly. Health, Education, and Welfare office has only the welfare viewpoint, and all of its activities are aimed in that direction. Many of those who are in the aging classification are not in need of the ministrations of a gigantic Federal welfare bureau. What we need is an independent commission to which we can turn for information, assistance, and advise, and which we can inform, assist, and advise reciprocally, and which will not be dedicated solely to welfare and the needs of the indigent, very aged, and the ill. The Golden Age & Senior Citizens Clubs of the U.S.A., Inc., is an incorporated organization with years of successful growth and recognized standing in each respective city and is expanding so that the general membership will total over 4 million by 1965 and is not an organization of feeble, aged indigents, but of people 50-plus who are examining preretirement as well as retirement problems. Speaking in behalf of the Golden Age & Senior Citizens Clubs of the U.S.A., Inc., I hope that you will take this recommendation into consideration in your plan to set up a Federal Commission on Aging. Knowing of your deep interest in the aged, I am sure that you will be deeply concerned regarding a proper office for proper administration. Warmest personal regards. Very sincerely yours, ANTHONY SALAMONE, Director, Adult Education; Chairman, Advisory Council, Golden Age & Senior Citizens Clubs of U.S.A., Inc. STATEMENT BY THE FLORIDA PODIATRY ASSOCIATION, PRESENTED BY HARVEY M. KOPELMAN, D.S.C., ST. PETERSBURG, FLA., RE FEDERAL COMMISSION ON AGED AND AGING Gentlemen, first let me commend you for not bypassing this tremendous responsibility we owe to our older people, and for accepting the challenge to seek out and find ways to help our senior citizens. H.R. 10014 sets forth a 10-point declaration of its objectives. The American Podiatry Association and the Florida Podiatry Association whom I represent, concur heartily with all these objectives and feel that we, as an important part of the medical team, can and will support these objectives to the fullest of our abilities. Specifically in the area of point No. 3 in the 10-point declaration, which states: "To afford our senior citizens the best possible physical and mental health which medical science can make available through preventive care, treatment, and rehabilitation, available without regard to economic status"; specifically in this area are we best trained to offer our skills and support. Permit me to give you a background on podiatry which may be a new term to some members of this audience. From the aspect of education: Our men are required to have 2 years of premedical training at an accredited college, then 4 years of medical and poditary training at one of our professional colleges. A year of postgraduate work is required by some States, and heartily recommended by all. We are licensed in all 50 States. We are considered physicians of the feet, and treat problems we see medically, surgically, and orthopedically. Twenty years ago organized medicine recognized that podiatry satisfied a gap in medical care that the [medical] professioon has failed to fill. More recently and more specifically, McBane advised doctors of medicine interested in geriatrics that podiatrists-chiropodists should be available in inpatient and outpatient departments in every general hospital, and especially in departments treating diabetic, orthopedic, dermatologic, and rheumatic patients. He also pointed out that there would be an increasing demand for podiatry services as geriatric work continued to develop. Dr. Elaine P. Ralli, Bellevue Hospital, New York, says "Podiatry is an extremely important aspect of outpatient care. I know of no service which gives greater relief to the patient." This aspect of relief is a vital one because if our elders are restricted because their feet won't function properly, they suffer a deleterious effect on their general physical and mental well being. An even more important phase of our patient care is exemplified in the comments of Dr. Anthony Sindoni, chief of the metabolic services, Philadelphia General Hospital. “*** a noticeable reduction in the number of amputations since the establishment of the podiatry department 20 years ago." We are reducing the number of limb and life losses, especially in patients with diabetes and circulatory problems, the bulk of whom are in the over 65 category. Older people must be able to move about. If poor foot health makes them homebound, very significant medical, social, economic, and psychological disadvantages ensue. These individuals become family and public charges with deleterious impact on the family and society at large. But more important, these older people cannot utilize all of their "skills and interests, and find social contacts which will make the gift of added years of life a period of reward and satisfaction and avoid unnecessary social costs of premature deterioration and disability." The feet of our senior citizens are an area of primary need. Not only for the outpatient mentioned above, but for the inpatient in the public hospital, the resident of nursing homes, and institutions for senile patients. They must have foot care, because most are unable to help themselves, and with proper help, they are able to walk where they could not, and we all know the importance of daily routine exercise to elderly patients. Where they are bedridden due to foot problems, we get them on their feet faster, insuring a |