Representative PRYOR. Isn't it true at the present time the Federal Government, the American taxpayer, is subsidizing the nursing home industry to the tune of almost $2 billion a year and that if the taxpayer does this, don't you think in turn the nursing home owner has some obligation to do likewise? Mr. RODMAN. Well, very definitely. Obviously we have a publicprivate relationship here between a private industry and the Government who is buying services. This is not unique in the American economy. There are some things that make this different from a defense industry or some other service being sold to the Government. We are dealing with aged, ill human beings, and there are other factors. The only thing that we feel is unfair, and we face this at the State level-most of my activities are at the State legislature-people say so many millions of dollars are being spent in nursing homes this past year or this institution took $300,000 in State money. Such figures have no significance until you relate them to patient days and services provided. Now when we had this type of discussion with our State legislature we said, "Yes, but divide the number of patient days provided to the State by this amount and you will see that where the State was paying $80 to $90 a day to keep a State-aided patient in a hospital, they are paying $10 to $12 a day for nursing home care. If they could transfer patients to a convalescent home or State-aided nursing home where they were paying a maximum of $13.50, the State could save millions. Maybe for want of a few cents to a dollar a day they were spending three times as much because they were not making it possible for decent nursing home beds to participate in State programs. It means nothing to talk of millions without applying it to something. Obviously we have a responsibility, but what is the Government getting for its money? I mean there is more to it than just taking the dollar figure. I assume you appreciate this. Representative PRYOR. You are not one that believes just because we put more and more money into the nursing home industry that we get better and better care? Are you making that statement? Mr. RODMAN. No; not necessarily, but what I did say is that too often in the past substandard nursing homes have existed because the State was the customer, that no private family would put a parent in this type of institution. Now who is at fault, the State for perpetuating poor care because they would not pay a better rate or some entrepreneur who provides a service at the price the State was willing to pay? It is a very tough situation. All we are saying is that if you want to indict substandard care, as did the speaker, very eloquently, from Minnesota, if in fact those conditions exist, then you should ask of Minnesota or any other State (1) why are your regulations so lax that these institutions are not closed down and (2) why do you not have a State reimbursement rate that will let you put patients in a decent type of institution and close the others down? The State shares our responsibility in this area. Representative PRYOR. Thank you, Mr. Rodman. Senator Moss. Thank you, Congressman. ! We do thank you gentlemen for coming to appear before us today. We are glad to hear from the Health Facilities Association of Maryland. We have been conducting hearings, in this committee, into nursing home problems all across the country and inevitably we focus on the problems, the difficulties that arise, and maybe we sometimes give the impression that there is nothing positive in this field of nursing home care. I would say nothing could be further from the truth. In the matter of the 4 or 5 years which we have been functioning on this committee we have noticed a tremendous gain. We notice that the standards have been raised, and I want the record to show and the knowledge to be general that there is an improvement and many, many of our nursing homes are doing a very outstanding job. Of course that does not mean we can overlook the cases where we have lapses of inadequate care and improper treatment, and we must focus on those areas because we must find the way to raise the standard. I think your co'loquy with the Congressman was a very good one in which you said, "Is the State at fault by perpetuating inadequate care in failing to pay an adequate rate, or is it the fault by not enforcing standards and forcing those homes out of business who do not give adequate care, or is there a failure of inspection and supervision which is never an excuse," I think, for abuse of patients and anybody will agree to that. So we have a very difficult problem with which to deal and the Federal Government is deeply involved because a great amount of the funds come from the Federal Government. We are likely to make this problem much more severe with section 225 in the bill that is now before the Congress for consideration and which I have spoken against so frequently. We hope from these hearings to be able to write a report to the Congress on the conditions of nursing homes and the requirements that will reveal the factual situation and persuade the Congress to take what action is needed on the Federal level. Your testimony will certainly be helpful to us. Now the hearings are going to be continued until the first day of October; if it is possible, we will have the hearing even sooner. We of course have not heard yet from Mr. Gould, an important factor in this hearing from which many of these facts can be gleaned, and perhaps other witnesses. At that time also the report of the State will be complete and we will have the benefit of that which is not completely before us now. I think we have at least exposed the problem and realized that, if anything, we,must find out the facts before we can write an adequate report in this case. We thank you gentlemen for your participation and all who have appeared as witnesses. Mr. RODMAN. Thank you. Senator Moss. We thank also the many interested people who have stayed through the hearings this morning. We are now in recess then until the first of October or at the call of the Chair. (Whereupon, at 2:52 p.m., the subcommittee recessed, to reconvene, at the call of the Chair.) APPENDIX 1 BALTIMORE CITY HEALTH Department, Memorandum to: Dr. Robert E. Farber. Subject: Water supply investigation-the Gould Convalesarium salmonella outbreak. On August 3, 1970 a survey of the plumbing system for cross connections was made of the Gould Convalesarium, 6116 Belair Road, and 15 water samples and one ice sample from an ice machine were collected for bacteriologic analyses. In addition 4 water samples were collected from properties in the vicinity of 6116 Belair Road. A second series of 18 water samples and one ice sample were collected on August 5, 1970. Nine samples from properties in the vicinity of 6116 Belair Road were also collected on August 5, 1970. The laboratory results of the bacteriologic analyses is attached and disclosed the absence of coliform bacteria in all samples. No chlorine residual was found at any of the outlets except for one sample at 6101 Belair Road on August 5, 1970. During the investigation it was reported that the water was shut off for 8 hours prior to the outbreak. The Bureau of Utilities Operation was requested to check their records for any interruption to water service in the vicinity of 6116. Mr. T. E. Rutley, Utilities Maintenance Division, Bureau of Utilities Operation, informed us that a careful check of their maintenance records and the questioning of their personnel disclosed no interruption to water service in the area of the Gould Convalesarium prior to the outbreak. In addition when water samples were collected on 8/3 and 8/5 the person interviewed at each location in the vicinity of the Gould Convalesarium was questioned as to whether there had been any interruption to water service in the area. In each instance they reported no interruption to water service. With regard to plumbing work performed at the Gould home, Reed and Reed, Mechanical Contractors, 2641 E. Monument Street, replaced a service sink in the basement of 6116 Belair Road on July 27, 1970. The hot and cold water supplies to the existing service sink had individual control valves so that there was no interruption to water service in the building when the new service sink was installed. The Gould Convalesarium at 6116 Belair Road receives its water from an old 6-inch cast-iron main on the west side of Belair Road. The west side of Belair Road is the eastern boundary of the Eastern 3rd Zone of service. Across the street on the east side of Belair Road is Eastern 2nd Zone of service and there is a 20-inch main serving the properties on the east side of Belair Road. The Eastern 3rd Zone of service is supplied by Guilford Pumping Station taking suction from Guilford Reservoir which receives its supply from the Ashburton Filtration Plant by gravity. The water from Ashburton Reservoir flowing into Guilford Reservoir is treated, filtered and chlorinated and all water leaving Guilford Reservoir is rechlorinated by an automatic chlorinating station. I am attaching a memorandum from Mr. W. J. Koterwas, Water Division, Bureau of Engineering, giving the chlorine residuals for the month of July. The chlorine residuals for July averaged better than 0.7 ppm. The most likely route, size of mains and distances for water to reach 6116 Belair Road would be as follows: Via of a 36" main east on Cold Spring Lane 1200' to York Road The total distance from Guilford Pumping Station would be approximately 6.6 miles. Because of the grid system there could be some minor variations in the route of water at times but even these variations would be off of the Northern Parkway main south and east before it reaches Belair Road. The small size main on Belair Road and the long distance from the point of chlorination accounts for the lack of chlorine residual in this area. A check of our records since 1966 indicates low or no chlorine residuals in our sampling area D4B with the bacteriologic results being negative for coliform bacteria except for one positive sample which was negative on resampling. WATER SAMPLE RESULTS-THE GOULD CONVALESARIUM SALMONELLA INVESTIGATION |