HOMEMAKERS VERSUS VOLUNTARY AGENCIES, FOR HOME HEALTH AIDE SERVICES-Continued

At best, a general cost comparison between proprietary and non-profit health care services is difficult. The reason being, costs fluctuate across the country and therefore it's almost impossible to get a fix on a national cost average.

From a number of investigatory sources, the general consensus is that HOMEMAKERS UPJOHN (or similar proprietary organizations) can provide services at a lower cost per case than a non-profit agency. Plain and simple, this is due to the common structure of proprietary companies which allows them to offer a variety of health care levels. This, as opposed to a fixed rate for registered nurse services, for example.

Perhaps, the question then becomes one of providing the required level of care, rather than the cost for over-care ... (sending an R.N. to cover a case where an L.P.N., Nurse Aide, Home Health Aide, etc., could easily provide the services required.)

Another indicator is that non-profit agencies are grossly over-burdened, their case loads unrealistic and therefore their time is limited. Because of this, their time also becomes very expensive, and while the inherent costs are not always assumed by the patient, it nevertheless becomes the burden of the taxpayer. More important, their timetable often permits only the essentials of patient care (i.e., R.N. care).

Considering the magnitude of health care services requirements nationwide, the need for proprietary companies, as well as not-for-profits, becomes very obrious. We collectively are filling a very critical need for home and health care services. We can offer professional health care specialists on short notice when they are needed, for as long as they are needed. Because of the broad range of health care levels, the costs for service can, in most cases, be reduced substantially. Again, side benefits of this program are the resourceful tapping of

what could be a dormant labor pool and the successful training and upgrading of thousands of people now contributing to society as a whole and at a time when more people require our kind of help.

Home Health Care

TYPES OF SERVICES PROVIDED

(R.N.'s, L.P./V.N.'s, Nurse Aides, Orderlies, Home Health Aides, Therapists.) Typical among home health care cases is the terminal cancer patient. The HOMEMAKERS UPJOHN specialist assigned to that case-be it a licensed nurse, or health aide, etc.-must be prepared not only to attend to health needs required (within her range of skills), but also provide for the emotional support of the family and handle any emergency situations.

Home Management

(Visiting Home Managers, Live-in Companions, Housekeepers, Substitute Mothers.)

Some of our home management cases quite often come from a social welfare agency. And in more cases than not, it is a situation where they are unprepared to deal with the case and will assign it to HOMEMAKERS UPJOHN on a "prove yourself" basis. One such case in our records involved a murder-suicide, leaving four teen-age children the responsibility of a welfare agency. Three of the four children involved were school dropouts. One was an alcoholic, another was promiscuous and the other two were on drugs. HOMEMAKERS UPJOHN assigned a Visiting Home Manager to the case and she performed her job to the letter, even though she took a great deal of abuse in the early stages. With these odds, she Still managed to hold the family together as a unit, put the children back in school, provide emotional support for them, rehabilitate them to fit our society and, in short, performed the impossible.

Staff Relief

(Hospitals, Nursing Homes, Extended Care Facilities, Other Health Care Institutions, Doctors' Offices and Clinics.)

Most hospitals in the United States are not staffed to 100% capacity. If they are operating at 80% staff capacity, there is a 20% need for R.N.'s, L.P./V.N.'s, nurse aides, orderlies, etc., in emergency situations, vacations, sick leave.

One case history in our files clearly indicates the need for a professional, qualified relief staff.

A serious fire in Boston injured several firemen. Because of the drain on the regular nursing staff at the area hospital, a private duty nurse could not be found to be with a severely injured fireman, HOMEMAKERS UPJOHN was in a position to not only immediately supply a private duty nurse, but keep one on duty around the clock for as long as a private duty nurse was needed on the case. This was a direct request from the Fire Department involved. Much like their calling, they recognized the need for emergency back-up assistance. This not only indicates the flexibility of HOMEMAKERS UPJOHN in providing important health care service in an emergency situation but also the immediate availablity of a qualified private duty nurse for a long term assignment.

TYPES OF SERVICES PROVIDED

CES (Claimant Evaluation Service) for the Insurance Industry

(R.N. Evaluators provide Health Care Counseling for Insurance Companies to provide Rehabilitation Projections.)

Miscellaneous

(Rehabilitation, Retardation Care, Private Duty Nursing, Hospital Sitters.) In Florida, 400 mentally retarded children are back in their homes, because HOMEMAKERS UPJOHN is providing help to care and to train both the child and parent in the home to deal with their situation.

Lucille Smith (East Orange, N.J.) spent many working hours on the case for which she was awarded the Green Cross-but she also spent many of her own hours helping the troubled family. Both parents were drug addicted. An older sister who is a deaf mute lived with them. The children, ages two through 15, had various problems ranging from diabetes, heart condition, mild retardation and deafness to asthma. Lucille helped the family move from a cramped apartment to their own house. She painted rooms herself, then canvassed various agencies and people to equip the home. "She is teaching the children pride, discipline and the

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idea that they do not have to accept their ghetto-like conditions," said Bill Wooddell and George Hutchinson, owners. "The Green Cross pin has to be earned, and she has earned it." Lucille was also honored with a "Homemaker of the Year" award by the Division of Youth and Family Services, State of New Jersey.

"FROM AUTHORITATIVE STUDIES OF EXPERTS ON THE NEED FOR HOME HEALTH

CARE"

A study made at St. Luke's Hospital Medical Center in New York City reported a comparison of stroke patients who received home care with a matched group without home care. The report revealed that the group receiving home care had shorter hospital stays, greatly reduced overall costs, fewer readmissions for recurring strokes, and fewer deaths. The people receiving home care had shorter hospital stays, with an average of ten days less. A dramatic decrease in overall costs was noted, with an average expense of $3,450.00 for home care patients vs. $8,300.00 for the comparison group.

Mr. Peter VanCampan, Employee Benefits Specialist for the Eastman Kodak Company, reports that home health care coverage is an integral part of Kodak's basic health plan. Under it, an employee is covered up to 90 days of home health care per year. Their records show an average reduction in hospital stays of 21 days per patient. Kodak's consequent net savings in health care costs represent approximately $160,000 per year.

In an example closer to home, The Upjohn Group Health Insurance Program includes post hospital home health care. An early report on this program by the insurance company indicated a $152.00 per case cost savings by using home health care in lieu of continuing hospitalization. Upjohn's own group health benefit department reports that the actual cost savings per case was $270.00 rather than the $152.00 used by the insurance company. More recent information reveals that the average today is a $318.00 savings per case. This, just reported by Upjohn's insurance company.

The experience of Blue Cross of greater Philadelphia in the eight years from 1962 to 1970 showed that the use of intensive level home care resulted in an average of 12.9 days saved per case, an average saving of $330.00 per case. Similarly, Blue Cross of Michigan found that during the period from 1963 to 1972 the provision of combination of intensive and intermediate level home care resulted in an average savings of days that range from 18.5 to 10.2 days per case. Dollar savings per case ranged from $519.00 to $917.00 per case.

The obvious underlying application of these, and other statistics, clearly indicates a lower cost per case through decreased length of hospital stay, a decrease in admissions through maintaining patients at the health level that reduces the need to be admitted and by proper adjustments within the health care capital structure, a lower total cost to the community.

Mr. ROSTENKOWSKI. Dr. Rusalem.

STATEMENT OF DR. HERBERT RUSALEM

Dr. RUSALEM. Mr. Chairman, and members of the committee, I am Herbert Rusalem; I am a member of the faculty of Columbia University and a specialist in counseling the elderly.

I represent the 39,000 members of the American Personnel and Guidance Association, and the 1,500 members of the American Rehabilitation Counseling Association. Both of these organizations are dedicated to the task of helping people to achieve the highest level of functioning possible through guidance and counseling and rehabilitation methods.

On behalf of these organizations I want to thank the subcommittee and its chairman for giving us an opportunity to present testimony on

H.R. 4772.

We strongly endorse the entire bill and because of our special interest and qualifications we want to especially speak on behalf of sections 1835 and 1861, both of which provide for greater participation in home health care of paraprofessional and professional workers who have counseling skills.

As I read H.R. 4772, it seems as though the House is acting against the warehousing of older persons in private homes and institutions for survival purposes.

Unfortunately, the more than 20 million older Americans who live in our society are coping with massive problems of inadequate housing, low income, poor nutrition, loneliness, health deficits, and social rejection.

Although some of these problems relate to the decline in physical capacities and old age, most are the result of a callous and unreasonable view of elderly persons in America as second-class citizens who merit only the most elemental life sustaining services and even these are grudgingly made available to them.

Sound research in our field confirms that many of the losses experienced by aged persons and much of senescence itself is tributable not so much to the consequences of the aging process as to the status which aging persons have in America and the extensive prejudice that is shown against them. I feel that the proposed measure is a bright spot in American social action for older Americans because it provides specifically for guidance counseling and rehabilitation of aging persons on home care.

When illness is superimposed on advancing age the effects can be highly traumatic to the individual. Already having suffered tragic consequences of withdrawal of others from their lives and having experienced disengagement and isolation in their communities, many older persons are emotionally vulnerable to other disappointments and losses. When on top of all this illness strikes confining the elderly person to his home or immediate neighborhood, the debilitation process is accelerated. The consequences, the adoption of a dependent life style that renders the individual an unnecessary burden on his family, his community, and his government.

And I say unnecessary because repeated demonstration projects clearly indicate that helplessness and dependency among these aging people can be prevented or reversed enabling the once limited older person to take useful roles in society.

One demonstration project at Federation Employment and Guidance Service in New York City found that unemployed home-bound persons 65 years of age and over and some in their 80's and 90's could be helped to develop new careers and become wage earners again. The programmatic research project on the rehabilitation of home-bound persons. found that older persons on home care confined to their homes can be taught not only to care for themselves but to make and implement important vocational and life decisions for themselves that keep them in the mainstream of their community despite home care status.

The PATH program, personal aides to the homebound, sponsored by Federation of the Handicapped, rescued hundreds of persons on home care and converted them into useful citizens who are now serving other older and handicapped persons throughout the New York metropolitan

area.

I would like to indicate in the most direct terms possible, that many of the symptoms that we associate with senility are symptoms we engender in older persons by reason of our neglect and ostracism. Just as we cultivate senility by present social policies, so can we prevent and counteract senility by more enlightened policies.

We believe that one of the keys to this situation is counseling. Most older persons just give up in the face of repeated rebuffs and reversals because no one cares very much about them. Virtually all of this, of all their customary relationships with others, are built on others' assumption of their helplessness. In many ways we infantalize our older fellow citizens imposing upon them a belief that they are incapable of meeting daily life demands of living and functioning autonomously. After spending years in this subordinate position it is no wonder that older people begin to believe the worst about themselves. and become as dependent as others mistakenly believe them to be.

The central contribution that counselers can make to the lives of these individuals is to offer them a relationship based upon mutual respect, a recognition that they can fend for themselves in many ways, and a belief that rehabilitation into a more self-directed status is possible.

This approach to the older person has not been sufficiently carried out by direct health care providers whose preoccupation is with offering requisite health diagnosis and treatment at the least possible cost of time and money.

Harried physicians, nurses, therapists, and others have neither the opportunities nor the skills to convey to the home care patient a firm commitment to his possibilities for an improved social status and the ways through which a fuller, richer life can be realized despite his home care situation.

On the other hand, professional and paraprofessional counselors trained in the use of a human relationship to help others see this goal as their primary focus; they have the abilities required to persuade the older person that he or she still counts and that there is much to live for.

As a person grows older it becomes easy for hims to lose sight of his purpose for living, when each successive depressing day confirms the desperateness and hopelessness of his situation, driving the individual into further and further retreat.

On the other hand, a skilled counselor enters the world of the home care patient with another attitude, saying in effect, "I believe in you and I believe that you can be more than you are now."

That is what many home care patients have been waiting to hear and consequently it is not surprising how many of them rush to grasp the hand that is offered them. The counselor becomes temporarily a reason. for wanting to go on living and for trying to raise one's functioning level. Through the counselor, the older person begins to perceive new and more constructive possibilities for himself and accordingly widens his horizons.

In time, he or she learns to do without the counselor and goes on his or her own way to develop a far more functional place in the community for him or herself.

No material benefits, direct health care, housing, nutrition, or activities can substitute for a counseling relationship. Although all of the foregoing are vital, they tend to sustain the person on his current level. But counseling and rehabilitation help to give the home care patient. a vision of how things could be better and in cooperation with other services works with the patient to realize his potential and make this vision come true.