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COMMITTEES AND CHAIRMEN

COORDINATOR OF COMMITTEES:

Richard G. Fowler, 3586 Tilden Ave., Los Angeles 34, California.

STANDING COMMITTEES:

Awards: George V. Devins, 3011 Lombardy Ave., Roanoke, Va.

Chapters: Frank S. Deyoe, 87 Elm Street, Saxonville, Mass.

Constitution: Harlan G. Wood, 1786 Laurelhurst Dr., Salt Lake City, Utah.
Education: Ivan W. Swisher, Ed.D., 401 El Medio Ave., Pacific Palisades.
California.

Membership: Bernard H. Weber, 7631 Willis Ave., Van Nuys, Calif.

Nominating: Carl B. Peterson, 4728 N. Virginia, Chicago 25, Illinois.
Professional Standards: Arthur Landy, 1437 Deniston Ave., Pittsburgh 17,
Pennsylvania.

Public Relations: David Ser, 43-01 - 46th St., Long Island City 4, N. Y.
Scholarship: Carl H. Alsberg, 9158 McLennan Ave., Sepulveda, Calif.

ADMINISTRATIVE COMMITTEES:

Advertising: John J. Marquette, 66 Stone Ave., Ossining, N. Y.
Bibliographical: Frances R. Bascom, Ph.D., 1643 Spruce, Boulder, Colo.
Committee on Committees: Daniel Bennett, 97 Highland St., Brockton, Mass.
Exhibits: Bernard H. Weber, 7631 Willis Ave., Van Nuys, Calif.
Legislative: George W. Jones, 6205 Glyndon Lane, Richmond 25, Va.

Liaison: John J. Arena, Jr., 5037 Rapido, Houston 21, Texas.

Placement: Julian Vogel, Chief CT, VA Hospital, Waco, Texas.

Position Standards: Zane E. Grimm, 1924 Great Highway, San Francisco,

California.

Research: Oscar H. Ciner, Ed.D., 81-08 Little Neck Parkway, Floral Park,
New York.

Salaries: Everett C. Converse, Route 4, Box 76, Sherwood, Oregon.

ANNUAL CONFERENCE:

Indiana University Medical School, Indianapolis, Ind. (July 10-15, 1961) General Chairman: Paul E. Roland, 1481 W. 10th St., Indianapolis, Ind. APMR Representative: Worth J. Randall, 4987 Ellis Ave., Dayton 15, Ohio.

Mr. KING. Fine.

Any questions of Dr. McCrary?

We thank you for bringing to us the views you have expressed. Dr. Rubin?

Dr. Rubin, if you will identify yourself for the record, we will recognize you for the 5 minutes that we seem to have allotted to you, sir.

STATEMENT OF DR. ABE RUBIN, SECRETARY AND EDITOR, AMERICAN PODIATRY ASSOCIATION

Dr. RUBIN. Thank you, sir. Mr. Chairman and members of the Committee on Ways and Means of the House of Representatives, I am Dr. Abe Rubin, secretary and editor of the American Podiatry Association (known from 1912 to 1958 as the National Association of Chiropodists). I speak for our professional association, consisting of 52 constituent State societies, on behalf of our patients, 40 percent (or more) of whom are over 60 years or age. We therefore are very much aware that our older people are very much concerned with their ability to provide for their necessary medical care in their retirement. The members of our association offer their support to programs which will meet this need, but the association is not prepared to suggest the forms such programs should take.

In the past, we have frequently failed to advise legislators-and administrators of the importance of foot care as a significant part of total health care, and especially service by the podiatrist in this regard. Appended to this statement are: (1) Two sheets of abstracts from conference publications and report of the 1961 White House Conference on Aging; (2) reprint of an editorial by Walter C. Alvarez, M.D., editor of Geriatrics, from the May 1961 issue of that publication. These illustrate the general recognition of the need and value of professional foot care for the aged.

I would respectfully request that these be included as a part of the record, so that I need not read them.

Mr. KING. Without objection, they may be included. (The material referred to is as follows:)

[From Geriatrics, May 1961]

THE VALUE OF FOOT CARE TO THE AGED

(Walter C. Alvarez, M.D.)

In the past, I have commented on the great benefits that old persons can get from expert foot care. They need such care more than do the young. Obviously, they need it when they are suffering from narrowing of the leg arteries, particularly when they have diabetes. Many persons in these situations can be kept from getting gangrene of a foot or a leg by the care of a good podiatrist. As Dr. Edward L. Tarara of the Mayo Clinic recently noted, there is great danger of infection in the poorly nourished tissues of the feet of the aged. Any bruise, abrasion, or cut should occasion alarm.

Often because of the comparative insensitivity of the tissues of the aged, the old person does not become properly concerned when something starts to go wrong with his feet. As a result, gangrene may develop.

Some time ago, when I visited a large and well-run home, I was much interested to hear that the best-loved man in the place was the podiatrist, who added so much to the comfort of the old people. By keeping their feet in good condition, he enabled them to get about.

A we physicians all know, poorly chosen shoes have caused most of the trouble with the feet of civilized men.

Because, until just a few years ago, women kept trying to wear shoes too small for them, many today are suffering from bunions and corns. Today, it is good to see that most girls wear soft heelless shoes.

The December 1960 number of the Journal of the American Podiatry Association contains a symposium on the care of the feet of the aged. Besides the articles by Dr. Tarara and others, there is one by Dr. Leo N. Liss of San Francisco who tells of the fine Laguna Honda Old Peoples' Home which houses some 1,600 patients. Forty percent of them are able to be up and about. Some time ago, a podiatry clinic was organized to take care of the feet of these old people, and in 1955, four podiatric externs were given room, board, and laundry at the home, in return for their giving 10 hours a week each for the care of the patients. The results have been most satisfying, and in 1959, 3,239 patients were taken care of. With the good foot care, patients who might otherwise become or remain bedridden are kept ambulatory. And this is important because in 1950, the cost of a bedridden patient was $4.03 a day, while that of an ambulatory patient was only $1.78 a day. Obviously, the wise administrator of a home for the aged will see to it that his people's feet are given proper care.

WHITE HOUSE CONFERENCE OF AGING, JANUARY 9-12, 1961

ABSTRACTS FROM CONFERENCE PUBLICATIONS AND REPORTS

"FOOT CARE

"Older people must be able to move about. There is no question that the feet are a danger point for the aged. To neglect or mistreat them can result in serious setbacks. Hospitals, nursing homes, etc., have found that prophylactic foot care for their aged patients helps to contribute to the well-being of the whole person. Podiatry has known and shown that many patients, with precisely made and fitted footgear and appliances and devices to redistribute weight stresses, will seem to have feet that are almost new. Our geriatric patient, once moving about with pain-free feet, is more easily motivated for total rehabilitation."-From "Background Paper on Health and Medical Care," prepared under direction of Planning Committee, Health and Medical Care, April 1960; pages 48-49.

AN EXAMPLE OF MANY STATE REPORTS

"34. It is recommended that nursing homes and geriatric clinics be made aware of the availability of qualified podiatry services in all major cities in Georgia; that podiatry representatives be included with dentistry, medicine, hospital and nursing home administration, and public health representatives in planning for the total health of the older citizens."-From "Report of Recommendations for Georgia," prepared by the Governor's Commission on Aging; August 1960, Atlanta, Ga.

"The institutionalized or home care patient, once moving about with painfree feet is more easily motivated for total rehabilitation-85 percent of older people have foot problems. Since the doctor of podiatry (chiropody) is the only person devoting his professional services solely to the foot and although he does devote considerable professional time to older people, it is necessary for him to devote more time and recruit fellow podiatrists to such service. He should engage in research. Develop improved and more economical foot wear and more specific pharmaceuticals for the foot. He should develop educational foot care programs for the older person."-From "Role and Training of Professional Personnel," group VI, section 10; B. Health Services, Podiatry. "*** 4. Scope and Methods of Participation: At the national level our Committee on Aging is stimulating, guiding and assisting State and local committees. The American Podiatry Association is providing consultation in the development of the White House Conference on Aging program through the consultant in podiatry. At the State and local levels committees and individuals are participating in State and city conferences on aging and public education programs for senior citizen groups."-From Handbook of National Organizations," Department of Health, Education, and Welfare.

While no blueprint can be offered at this stage of deliberation, the need for diagnostic facilities, day care centers, mental hygiene out-patient and home services, 'half-way houses,' regional rehabilitation centers as well as

new self-care and other services in hospitals has been stressed. Within these structures as well as in independent practice the resources of the dental, optometric and podiatric professions should be afforded the elderly."-From "Recommendations, Governor's Conference on Aging," State of California.

Dr. RUBIN. In addition to the significant medical and sociopsychological contributions of podiatric care, appreciable economic advantages accrue from keeping the individual ambulatory through professional foot care. In the December 1960, issue of the Journal of the American Podiatry Association, Leo N. Liss, D.S.C., in his paper "Twenty-Two Years of Podogeriatrics," states that:

The number of patients treated in the clinics had an effect in reducing the number of patients that had to be cared for in the hospital wards.

The writer was reporting on his 22 years of experience as podiatrist for a home and hospital for the aged. He also points out that in his institution, in June 1959, inpatient hospital care costs were $8.50 per day per patient, and cost per ambulatory patient was $3.58 per day.

SUGGESTED AMENDMENTS

I would like to suggest, therefore, that in your considerations section 1603 of H.R. 4222 be amended as follows; (a) on page 7, line 11, by adding the word "podiatry" after "physiatry" and before "or"; and (b) on page 8, line 11, after "Patient", place a comma and add "including podiatry service," before "as."

I should also like to call your attention to the fact that because pertinent legislation only very infrequently includes the term "podiatry or podiatrists," administrators very often fail to recognize such service, although not excluded by the language of legislation. For example, in the administration of the Federal Employees Health Benefits Act, Federal employees' claims for covered service performed by a podiatrist were, in many instances, denied. Only recently have the terms "doctor," "physician," or "surgeon" been redefined in insurance contracts to include the "podiatrist" for covered foot conditions.

We believe the above suggestions are very much in the public interest and merit your serious consideration.

AN ALTERNATIVE HEALTH BENEFIT PROPOSAL FOR OLDER PEOPLE

As a private individual, I should like to make some personal observations and comments about the different types of health benefits legislative proposals for our older people. Some have been characterized as "skimpy," "doesn't cover enough people," "pauperization," "no provision for revenue to cover cost"; others have been characterized as "first step to socialized medicine," "intrusion of Government into doctor-patient relationship," "not enough benefits," "will cost too much," "will be abused," "not a voluntary program."

It would seem to me that a voluntary health insurance program to which social security retirees could subscribe could be evolved. Onehalf the premium would be deducted from the monthly social security payment, with the other half coming from special social security funds obtained by increasing the present assessment. Plans analogous to those available to Federal employees should be able to be developed. Benefits could be of service or indemnity type with adequate and reasonable ceilings for annual benefits, and perhaps include coinsur

ance and deductible features. Also, private and public plans now in operation which provide for health insurance for the employee when he retires from the active work force could be included as an optional plan. This would offer encouragement to the further development of such plans.

This method can cover the needs of most older people. For those not covered and for the small number who would exhaust their annual benefits and be unable to finance additional care, their needs could be supplemented through the present Kerr-Mills State programs. This combination of voluntary health insurance and the Kerr-Mills State plans should fill the obvious need in the American tradition.

Thank you for the opportunity to appear before you and it would please me to be of service to you by attempting to answer your questions.

The CHAIRMAN. Dr. Rubin, we thank you, sir, for bringing to the committee the views that you have expressed.

Are there any questions of Dr. Rubin?

We thank you, sir.

Mr. Davis?

Mr. Davis, will you identify yourself, sir, by giving us your name, address, and the capacity in which you appear?

STATEMENT OF JOHN EISELE DAVIS, Sc. D., EXECUTIVE DIRECTOR OF THE ASSOCIATION FOR PHYSICAL AND MENTAL REHABILITATION

Dr. DAVIS. My name is John Eisele Davis, Sc. D. My position is executive director of the Association for Physical and Mental Rehabilitation, and I am appearing here today for the president of our association, Mr. Richard Fowler, as its representative before this committee. Realizing the complexity of the problems involved in this legislation and the many groups interested in these proceedings, our association is most appreciative of this opportunity to express its viewpoint and specific recommendation in cooperation with the sincere efforts of this committee to fulfill some of the urgent needs for the care and rehabilitation of the aged in this country.

Along with the following formal statement is appended a brochure explaining the discipline of corrective therapy as a paramedical specialization. I am confident that a perusal of the functions, educational and clinical requirements, professional objectives, certification standards and membership of its medical advisory board including leading physicians will assure you as to the high professional competence of corrective therapists as essential members of the modern medical rehabilitation team. I might add that the nucleus of this group was recruited from Dr. Howard Rusk's World War II, Air Force, Reconditioning Unit, and was referred to by him as "the cream of the crop."

It is our conviction that a new culture in a rushed, stimulating industrialized world calls for a higher level of physical activity for our aging and aged population. Society is becoming dissatisfied with the degenerative passivity of older persons sitting in a chair and adding to the monotony and decline of their advancing years. As a result of working with the aged extensively our therapists are becoming in

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