The CHAIRMAN. Thank you. The chair recognizes Mr. Schuette.

STATEMENT OF REPRESENTATIVE BILL SCHUETTE

Mr. SCHUETTE. Thank you, Mr. Chairman. I want to thank the witnesses and the guests and also this opportunity for me to express my personal interest and support of home health care services. As the representative of a very rural area, the 10th district of Michigan, I have had the opportunity to speak with many Medicare beneficiaries, health care providers, and senior advocate groups on the matter of home health care.

I cannot emphasize enough the importance of these services to homebound elderly in my district. Whether the individual receives direct home care services or the friend or relative who cares for the homebound receives advice and suggestions, it is one of utmost importance that all communities across the country continue to work with HHS and HCFA officials to assure quality care for our elderly.

Recently, I chaired a joint hearing between the Select Committee on Aging and the Task Force on the Rural Elderly in Houghton Lake, MI, to address the issue of whether we were meeting the health care needs of Michigan's rural elderly. From the testimony given by Medicare beneficiaries, case workers, health care providers, and, may I add, including a representative from Michigan home health care in Traverse City, MI, as well as hospital administrators and senior spokespersons from area agencies on aging, I can assure you that there is much work to be done not only in my district, the 10th district in Michigan, but I am sure in many other Members' districts as well.

Home health care is a fiscally sound practice for both the Federal Government and the patient alike. In addition, it enables people to remain independent, which many experts asserts improves the person's mental and physical state of being. Home health care is a unique and viable alternative to institutionalization and one that should be supported and proved to assure continued quality care. Mr. Chairman, I commend you for holding this hearing, and I look forward to the testimony and statements of our witnesses. The CHAIRMAN. Thank you.

Mr. SCHUETTE. Thank you, Mr. Chairman.

The CHAIRMAN. The chair recognizes Mr. Henry.

STATEMENT OF REPRESENTATIVE PAUL B. HENRY

Mr. HENRY. Thank you, Mr. Chairman. Very much in passing, because I have a conference committee to which I must excuse myself shortly, and I apologize to our guests for that. I simply point out that each comment that we have received thus far has referred primarily to the Medicare/Medicaid systems, and obviously the issue of availability, affordability transcends well beyond.

Two meetings ago, if I am not mistaken, we had a witness here by the name of Ms. Connie Fisher from my district who also dwelled on this issue, and I am pleased to say that finally her problems have been resolved. In this case, it involved a commercial carrier and the willingness of a commercial carrier to fund and take care of the home care insurance coverage. So the issue here is not

just coverage and availability and quality in Medicare/Medicaid, but also the private sector as well.

Thank you, Mr. Chairman.

The CHAIRMAN. Mr. Jeffords.

STATEMENT OF REPRESENTATIVE JAMES M. JEFFORDS

Mr. JEFFORDS. Mr. Chairman, I ask unanimous consent my entire statement be made a matter of the record.

The CHAIRMAN. Without objection, it will be ordered. [The prepared statement of Mr. Jeffords follows:]

PREPARED STATEMENT OF HON. JAMES M. JEFFORDS

Mr. Chairman, I would like to brifly outline my support of today's review of the Medicare home health care program and the quality of home health care in general. With the enactment of the Medicare diagnostic related group (DRG) reimbursement system for hosptials and the resulting reduction in the length of hospital stays, more and more seniors are turning to home health care agencies to meet their health care needs after leaving the hosptial. I think the increasing rates of home health utilization since 1983 reflect this trend.

A growing need for both sophisticated health care and traditionally "social" services have been identified in our communities and home health care agencies have moved to meet these needs. In Vermont, our home health agencies have responded admirably to the increasing demand for services. Judging from my correspondence with these agencies in the last few months, however, Health Care Financing Administration regulations coupled with Medicare reimbursement reductions have not made this an easy task.

I applaud the efforts of the American Bar Association in identifying problem areas in home health care delivery and quality in their "black box" report being released today. As we in Congress work to ensure that quality care is provided by home health agencies, I hope we will incorporate solutions to the problems now hindering home health agencies and work to avoid unnecessary administrative burdens.

I would like to commend Chairman Roybal for holding his timely hearing and look forward to today's testimony.

Mr. JEFFORDS. I'll be very brief.

In Vermont our home health agencies have responded admirably to the increasing demand required of them, but from my correspondence with them, I realize that they are having great difficulty trying to abide by the regulations of the health care financing administration and the Medicare reimbursement reductions, so I am hopeful that the witnesses will give us an answer to these questions, and hopefully this committee can make some suggestions which will alleviate these problems. I thank the chairman.

The CHAIRMAN. Thank you. The chair recognizes Mr. Regula.

STATEMENT OF REPRESENTATIVE RALPH REGULA

Mr. REGULA. Thank you, Mr. Chairman. I ask unanimous consent to put my statement in the record.

The CHAIRMAN. Without objection.

[The prepared statement of Mr. Regula follows:]

PREPARED STATEMENT OF REPRESENTATIVE RALPH REGULA

Mr. Chairman, I would commend you for your active interest in the issue of home health care. I share your conviction of it's importance in the overall health care plan of our nation, and particularly as it relates to catastrophic and long-term care.

Today we are confronted with a lapse of direction in the basic health policies of our nation which pulls productive citizens into poverty and degrades our nation's elderly. According to a study by the National Center for Health Services Research nearly 16 million Americans, or one family in five, incur catastrophic medical costs each year. The report stated that 7.5 million persons had out-of-pocket expenses of more than 10 percent of their annual income each year. Of this total one-third had incomes below the poverty line and were over the age of 65.

These figures do little in explaining the emotional and physical trauma experienced by the victims of chronic illness. Home care is an integral part of the overall treatment of such conditions. It can offer financial and emotional relief from the institutional costs generated by catastrophic and long-term care. Of the approximately six and one-half million senile or disabled persons who need full-time custodial care some five million are currently cared for in the home. This dimension of care must be preserved and encouraged as a cost-effective and patient-oriented element of chronic

disease treatment.

I read with encouragement the results of a survey conducted by Forecasting International which cited enthusiasm for home care. It was found that 85 percent of the population favor insurance plans that encourage the care of chronically ill at home. Even more encouraging was the statistic that home care is preferred by 72 percent of the American public over nursing homes. This awareness and preference for home care has begun to solidify into public policy.

The number of certified home health agencies grew form 1,275 to 5,447 between 1966 and 1985. Since 1982, alone, these agencies have increased by 55 percent. From 1974 to 1980, Medicare expenditures have nearly tripled

from $772 million in 1980 to $2 billion in 1985 and are expected to rise to $4 billion by 1990.

Despite this interest there is a need for more comprehensive information regarding the quality of care given in the home. Reporting requirements under both Medicare, and most State laws, focus on reimbursement abuses rather than quality of care. Efforts must be taken to ensure adequate information is available to document the impact and effectiveness of home care in treating certain chronic conditions. Furthermore, as this industry continues to grow we must ensure minimum standards of quality through adequate legislative and regulatory authority.

The testimony to be provided by the highly acclaimed panel of witnesses before us will most certainly provide an insight into the problem and how to serve the best interests of the aged.

I have joined with other Members of this committee in introducing legislation which we feel goes toward addressing this issue in regards to catastrophic and long-term care. Our distinguished Chairman has also offered a proposal for dealing with the matter. I am confident that we can work together in a bipartisan spirit to find an answer to this great need of our nation's elderly.

Mr. REGULA. I commend you for having it. I think it is an important topic. Seventy-two percent of the American people have indicated that they would prefer home health care. I think we are challenged to find an effective way to provide these services, and I yield back.

The CHAIRMAN. Thank you, Mr. Regula. Mrs. Meyers.

STATEMENT OF REPRESENTATIVE JAN MEYERS

Mrs. MEYERS. Mr. Chairman, thank you very much.

As a Kansas Senator, I introduced a bill last year in the Kansas Senate that would license home health agencies. We placed the responsibility with the State department of health and environment to set standards and to be responsible for enforcement. Of course, the reasons for this legislation are primarily two: One, the fact that because of DRG's, people are leaving hospitals sooner, and second, because of the title 19 waiver we have people seeking alternatives to nursing homes.

Kansas does have this kind of waiver, and it is very important that we have good home health care. It is particularly important for older people because frequently they are not only ill, but they are very isolated. It is therefore important that we know what kind of people are going into their homes and whether they are qualified to do. What they say they are qualified to do.

States can play a very strong role in this, Mr. Chairman, but I am very happy to revisit this area to see what we can be doing at the Federal level in this regard. I might mention, Mr. Chairman, that I am having a hearing August 9 in my district in the greater Kansas City area with the Mid-State coalition on aging, which is a group of about a dozen agencies in the central part of the country. We will be discussing health care for the elderly, and I am very pleased that we are having this hearing today as a prelude to that hearing.

The CHAIRMAN. Thank you, Mrs. Meyers. The chair recognizes Mr. Wortley.

STATEMENT OF REPRESENTATIVE GEORGE C. WORTLEY

Mr. WORTLEY. Chairman Roybal, I join my colleagues in saluting you for conducting this hearing on the quality of home health care. Home care is the oldest form of care, yet so little is known about what truly goes on between the aid or nurse and the patient. Patients spend thousands of dollars annually for this one on one personal care. Many do receive the loving attention that they so greatly deserve, but there are cases where patients are abused or an aid never shows up, although a fee continues to be collected.

This past February, I held a hearing in my home district of Syracuse, NY, on home health care. The outcome was very positive. Countless constituents told me how much more comfortable mom or dad was staying at home and how much better the children felt about being able to keep the parent at home with some outside assistance.

After all, we are a family oriented society, and it only makes sense whenever possible to try to offer the comforts of home to those who comforted us in our growing years. Yet, Mr. Chairman, the picture isn't always this rosy. In these days of budget cutting