My husband could not be expected to help me since he was for many years the sole support of his own mother who was widowed early in life. There was one time when we were both paying for bills for his mother as well as paying for medical expenses and support of both my parents.

My father-in-law at present is living in his own home with his wife. He is 62 and is suffering from Parkinson's disease. It is being arrested at the present time. This illness has been costing us $35 a day for hospital care. We had a $750 bill for an operation and this was only half the amount of the original fee. There is a very small insurance coverage but this doesn't help much. He had to mortgage all his property and finally social service in the hospital came in to try to straighten out the bill. I have had to help a good deal myself. We paid $2,000 over a period of 3 weeks and this depleted all my cash savings and caused a lot of friction between my brother-in-law and my husband. My father-in-law will not be able to work again and we don't know what kind of arrangements we can make now.

My mother-in-law, 82, suffers from an illness for which there is no cure. She is just growing older. Naturally the problems and the expenses increase with time. Physically her condition is excellent, but mentally it is not. She cannot be left alone, not even at nights. All her life she has lived moderately and has saved her money. The money that she and her husband saved was invested in a home and until recently she lived on her own income. Now her home has been sold but even with this money she cannot live on her income. She has two sons, one in New York. She is in California and is not willing to leave there. The son in California has three teenage children and she feels his home is too strenuous for her. If she did live with him it would be necessary to have complete nursing care around the clock. Naturally her sons want her to have the best possible care. For a limited time they could make out with expenditures but eventually all money will be exhausted. At present this problem causes a great deal of anxiety for the whole family because it's going to mean debts for many, many years for her sons. Her nursing home care has been costing about $5,000 over a period of 8 to 9 months because of the cost of nursing around the clock.

My 86-year-old father is in a hospital now with a diagnosis of arterial sclerosis and cerebral thrombosis. The cost of care per month now is from $800 to $1,000. Social security amounts to about $15. My father also has another pension of about $100 a month. He has no other insurance. He has had to deplete his cash savings and has had to borrow money. He has spent close to $5,000 during a period of 10 years because of a heart condition. His present illness is not included in this. The financial situation has been complicated by the fact that my mother died in 1957 after a cardiac condition of more than 20 years. Medical expenses for her were about $1,000 or more a year for a 20-year period. Because the cost of hospital and medical insurance would have been prohibitive, our family did not carry insurance of any kind for our parents. At various times we were able to save for emergencies, but then it has all gone for payment of medical expenses. These were paid by myself and an unmarried sister. We have another sister but she has had major medical expenses of her own following an accident and has been unable to help financially. We have had the custodial care of our parents and most of the financial responsibility. We have tried to hold on to a modest home in which my unmarried sister and I have invested but this is heavily mortgaged. The physical and emotional drain has been considerable over the years. Trying to carry a full-time job and home responsibility and cover custodial care in a chronic illness does produce irritability and the load has been very heavy. We don't know what the future will bring.

My 94-year-old father has enjoyed excellent health until recently. Now he is falling down often and recently with results that sent him into,shock requiring round-the-clock nursing at $36 a day. Sketchy inquiries to date have indicated that unless he becomes ambulatory he will be unable to find a home either private or public. He will be unable to afford practical nursing for very long and

a home must be found for him. The doctor will not send him to the hospital unless he breaks a bone or has some definite illness. He says that the patient requires constant nursing and the hospital would just send him home in a day or two and then he would need round-the-clock nursing while there. We have a homemaker service in our State but the laws prevent the service from taking care of bed patients. They're allowed only to serve the family of a walking patient.

About 3 years ago my husband's brother was stricken with a heart ailment following a serious operation. He had tried to get his brother into the Blue Cross but there were so many delays that death overcame him before anything was accomplished. Then we were faced with medical and hospital bills and funeral expenses. This finished off our savings and meant taking loans on life insurance, et cetera. We are still paying for it 3 years later, and we have two children preparing for college. I do not have all the bills in my hand and my husband is reluctant to discuss figures with me. It's his family and he is sensitive about it. All I know is that our savings are gone and we have loans to pay.

I, too, have two elderly parents in their middle seventies. They are in good health now but are carefully husbanding their savings so that in the event of prolonged illness of either one they won't have to be a burden to their children. The specter of illness haunts them and the high cost of private insurance makes it difficult for them to buy it. We dare not offer to pay premiums because of their sensitivity. Elderly people have peculiar notions that make them sensitive. But we, their children, are haunted by what might happen if they ever felt they were becoming a burden to us. We also have an elderly aunt whose husband died 5 years ago. The husband's prolonged illness before his death and the all-continuing need for medical care has fast depleted savings. She has no children to turn to. We, her remaining relatives, will need to care for her, too.

My mother, aged 74, is in a home for the aged. She has a small pension of about $50 a month. Her nursing home care costs $210 per month. I have helped to finance, for mother used up her savings, cashed in her insurance and liquidated other assets. The total cost over 6 years has been $10,000. We tried to get public assistance but could not get it.

I realize that there are many people who will consider that the sacrifice implicit in these accounts is a part of the Christian obligation and even more the Judaic injunction to "honor thy father and mother." But it does not seem to us that this ethic in a country as well off as our own should require the sacrifice of the interests of one's children to those of their grandparents or that social measures to spread the heavy costs of old age over a lifetime are any less ethical than those that depend upon family sacrifice.

Again there are others who say that the community should help those families where real need exists through old-age assistance, especially as liberalized last year by the Kerr-Mills amendment. We in the YWCA have long recognized the role of public assistance in meeting acute needs when they occur. But in most States this will not solve the problem of these families whose problems I have just described. For most State welfare laws require children to contribute to the support of their aged parents and require that the latter exhaust virtually all their own resources before they become eligible for assistance.

For example, in my own State of New York which has passed a fairly liberal medical assistance for the aged program under the Kerr-Mills amendment the same standards of relative's responsibility apply as in all other assistance. Moreover, an aged person must dispose of all but $900 of his life's savings to become eligible for aid.

These requirements may not prevent older persons who are absolutely impoverished from applying for help but they bear heavily on these conscientious middle-income families I am describing here. They simply will not ask their aged parents to give up the lifetime savings, however small, that represent the difference between selfrespecting old age and the embarrassments of public dependency. The symbolic and psychological value attached to these assets are a very real limitation on the relief which such families can expect under the Kerr-Mills approach to medical need.

Our studies lead us to believe that the medical needs of older people can in the long run only be adequately met through a combination of measures both public and voluntary. Social insurance can prevent need by assuring minimum benefits to the great majority through the pooled savings of their own lifetime contributions to the social security fund. Voluntary and commercial policies can provide supplementary benefits to those who can qualify and afford their premiums. Public assistance, including medical assistance for the aged, can provide on an individual basis for those whose needs are still not fully met.

With such a range of social benefits to carry the major economic costs families would be freed from their present overwhelming burdens of anxiety and financial outlay to fulfill their rightful role of giving social, moral, and affectional support to parents in their old age. We believe that this is a high measure of Christian justice and the most practical way to respect and honor our parents in the modern world.

Thank you, Mr. Chairman, for allowing us this precious last few minutes.

I wonder if we might have the privilege of hearing a brief comment from Miss Wickenden, who, as we have stated, is our technical assistant, and who looks at the YWCA with a slightly more objective eye than I do.

The CHAIRMAN. We will be glad to hear from you, Miss Wickenden. Miss WICKENDEN. As you know, I have served for many years as a welfare consultant to different organizations, and I think I am correct that the YWCA was the first organization to point out that this problem of medical care for the aged was really a two-generational problem.

I think one point that has not been always clearly brought out, as I have listened to the testimony today, is the fact that assistance, and particularly the Kerr-Mills provisions, useful and important as they are, do not help this problem because most States require that the children support before the old person establishes eligibility. And that means that the means test-and I have no objection to the means test in certain kinds of situations-the means test is applied not only to the old person, who is asking for assistance, but also to his children and their families. And the same kind of investigation has to be made of the middle generation as is made of the older generation.

And that, I think, makes it a very real limitation, except in those cases where you have extraordinary need, and therefore people are asking for a degree of assistance that cannot be supplied by insurance. The CHAIRMAN. Thank you both for coming to the committee. We appreciate your statement very much.

Mr. Curtis?

Mr. CURTIS. Mr. Chairman, first I want to thank these ladies for providing these examples.

I have gone over them rather quickly, it is true, but, you know, the interesting thing in almost all of them is that the King bill would not help them at all. And that is the point.

Take one of them, that is a clear one. He is 62 and suffering from Parkinson's disease. The King bill will not help him.

The only ones that I can identify that it would help, of course, are those who are on social security insurance. And there is only one that clearly indicates that.

Now, here is another very interesting thing, in the one on page 6, at the bottom.

The specter of illness hauts them and the high cost of private insurance makes it difficult for them to buy it. We dare not offer to pay premiums because of their sensitivity.

It is very difficult for me to accept such a thing, on the part of children taking out insurance, health insurance, for their older relatives.

The testimony before the committee reveals that the variety and kinds of health insurance that now are available to older people have been increasing very rapidly in recent years, and I am very happy to note that the insurance companies are directing their advertisements to the children of older people.

It does two things. One, from the standpoint of the older person, and two, from the standpoint of the children who stand to inherit from their parents, particularly when frozen assets are involved. It frankly is a good economic investment as well as a very humane and understanding one.

These cases illustrate the reason we need some specific cases: I would like to have some examples of people who the King bill would cover. It is very, very interesting that the cases that usually are cited are those of people who are being taken care of now.

So I am completely convinced that this talk about people not having the care is not true, and it is simply voicing more than con be proved. I think these are real problems that you are bringing to us. Do not misunderstand me.

Mrs. PERSINGER. May I make a comment?

We did not specifically try to find out whether people were speaking about social security pensions, or we were not addressing ourselves to that problem. We were addressing ourselves to the need, which we were trying to establish.

Mr. CURTIS. Yes, but you are talking about the King bill. That is what your testimony is on.

We are all concerned about the need. And I think most people will agree there is a need in this area. But what we are trying to find out is what mechanisms are meeting or will meet it. And that is the very point I am making, that the King bill will do nothing for most of these people.

Mrs. PERSINGER. We recognize that. But it is partly a matter of generation. As we all know, more and more people are on social security. And some of these people are so old that they would have retired, 20 years ago, before social security was even established. So

we did not feel that we could specify only the ones who were on social security.

Mr. CURTIS. I was not asking that. I am just interested in the caseload that you show that you have taken at random; because if what I think is happening, the rival insurance companies are moving rapidly into this area; we are not going to have people over 65 to the extent we have had who do not have health insurance.

The figures were very impressive in 1938. Only 8 percent of our whole population had health insurance. By 1946, that figure had jumped to 42 percent. And today, in 1960, it is around 73 percent. And there is a similar vast percentage increase of people over 65 who are getting some form of health insurance.

And not only is there this kind of progress in the quantity coverage, but the quality of policy is improving. In other words, some of these policies have been minimal. That is why I think we must direct our attention to what the problems are today, and whether this legislation about which you come here to testify is going to do any real good in meeting the problem, or whether we do not have to attack it in another way.

Miss WICKENDEN. I think, if I could supplement, these cases simply do not reveal whether the person is already on social security or not. That simply is not stated. However, the problem remains the same whether they are or are not for those that are coming along. And unless the new policies are infinitely more adequate than the old, I think the last survey that was made showed that only a quarter of the people who had insurance coverage in their old age had even a half of their bills paid. So the mere numbers with policies really does not in itself indicate the extent to which protection is available.

Mr. CURTIS. No; we would have to get into quality. And we have been doing that, too. And the answer here is that the policies are infinitely more adequate than they have been, and the progress is considerable.

Now, these cases do state income. So that when they do not mention social security, I think we are right in assuming there is no social security income. But they do state where their funds come from. Miss WICKENDEN. I think many people think that their social insurance benefit is part of their income.

Mr. CURTIS. NO; I am talking about your case studies as you have presented them. One of them says: "Social security amounts to about $15"-which is a strange figure. That is the one on page 5. The others say how much there is. I remember one spoke of private pension plans. So there is an item relating to income in here, and we may assume that social security benefits would be included if they were on social security.

I think it is important to understand what the problem is and to do so we need to get some more of these case histories. This committee has been sadly lacking in them, and I want to thank you for bringing these cases to our attention. I think if it would not put too much burden on you, to supplement the cases, it would be extremely helpful. The CHAIRMAN. Mr. King?

Mr. KING. I do not want you to feel disturbed because you may have cited a case that did not come within the provisions of H.R. 4222 in the event it is enacted, because a good deal of the testimony we have heard, here, now, going into our second week, by those who are op