There are three groups of citizens today, the care of whom has been largely neglected by society. They are the defective children, the mentally ill, and those of old age who have not the means to take care of themselves or even register complaints to their relatives or to proper authorities.

Certainly, I do not know much about the specific incident of salmonella outbreak. But I raise the question, why do we not require of nursing home personnel the same kind of tests required of employees in the general hospital. Even the tests given in the hospital are not enough; but at least we do have some testing of food handlers for TB, syphilis and intestinal infestations. We require cultures to make sure that they are not carriers. I have seen a number of cases of amoebic dysentery. They are quite often found around the harbors of the world; generally, there are no clinical symptoms but the disease can be transmitted if the infected individual handles food.

The whole problem in the United States, as I see it, seems to be that we have allowed the care of the elderly to become a very profitable business and we allow virtually anyone to run a nursing home, regardless of any technical or medical experience. Some of these businessmen are interested only in making money. I know one who has managed to build seven or nine nursing homes in a very short time. It is interesting to me that we say that nursing home care is very expensive and on the other hand that there are people making millions from operating these facilities. Something is wrong there. Where is the money going? As my colleague said, it is not enough to inspect the buildings and to look at fire safety requirements. We must inspect inside these institutions and look at the quality of care. In most cases, I suspect the records of inspectors are just filled out as a formality in qualification for Medicare payments.

I had the privilege and the misfortune to bring my mother to this country when she was 90 years old. I say misfortune because my mother became very ill and needed nursing services around the clock. She needed more care than I could give her and my friends suggested I place her in a nursing home. They told me that, in America, nursing homes are luxurious institutions and could give my mother much better care than I could give her myself.

I decided to put her into a nursing home in Hyattsville. Unfortunately, 36 hours later I took my mother out again with a broken hip. It is fundamental medicine to take precautions that old people are not subjected to diarrhea or falling. Those are the two things that will kill older people quickly.

At the Baltimore home it is clear the food handlers had not been tested nor had the food caterers who prepared the food. Other homes have impressive stainless steel kitchens, I assume to impress building inspectors. Why can't they prepare the food and special diets on the premises? Why does the unitarian value have to be twice seduced so that the caterer will make some money out of it and also the nursing home?

These expensive enterprises, nursing homes, do not favor nor serve the elderly.

In the Hyattsville home, I found that my mother had not been placed in a private room as I asked but she was in a double room in which

there had been added a third bed. There were also three chairs and three wheelchairs and three patients in this room. The supervisor explained this by saying that they wanted my mother in with another lady who spoke Greek. This other Greek lady told me of the neglect and improper activities in the nursing home, and that only two high school girls had been assigned to this floor at night. How can two young girls take care of 60 old ladies all at the same time? I know nursing homes have difficulty finding personnel; this is a big problem. But older people are humans-they are not animals or livestock.

I think my colleague had an excellent idea when he suggested subsidizing a family to care for the elderly in their own homes. After my bad experience, that is what I was forced to do-take care of my mother at home and at tremendous expense.

In the 2 weeks when I was with mother at the Suburban Hospital. which has a small orthopedic surgical service, I noted that there were 18 women from nursing homes with broken hips in the hospital at the same time. The chief nurse told me sarcastically that there is always an "epidemic" of broken hips in nursing homes. Sometime later I heard that the nursing home association was lobbying for a bill which would have made broken hips a natural hazard in nursing homes, so that nursing home operators or their insurers would not have to pay families or patients in the event of a hip fracture.

When I heard this my stomach turned inside out because broken hips are not a natural hazard in a nursing home or any place. They are an indication of neglect of proper care. At that time I was not in a position to speak out because of my employment. Because my mother suffered from a broken hip they might have suggested that I was biased. At any rate, neither the nursing home nor the insurance carrier ever paid any of the $25,000 expenses of my mother.

After I took my mother out of the nursing home, God bless her soul, I have slept better, consciously today I am peaceful. But the irreparable damage had already been done; because, it was necessary for my mother to undergo a 3-hour operation, which caused her some mental deterioration. When a person is above 60 and goes through general anesthesia the mental capacity is never the same again. My mother was uncontrollable, confused, and lost. I had once again to look for a nursing home.

This time I was more fortunate, I took her to the Citizens Home in Harve de Grace and I can tell you that this is an excellent facility. They have deep respect for nurses there. They gave my mother much care but, even this home, did not have the personnel it needed. Having had previous bad experiences, I stayed with my mother all night and hired two persons to be with her during the day.

During this period I was able to observe firsthand the kind of practices that have been discussed with you here today. Even in this good nursing home, medical care is practiced by telephone. I watched, three times a day, the preparation of a big tray with a large number of tranquilizers on it-thorazine, darvon, and others going into the mouths of patients by the clock. I saw trays of food coming out of patients' rooms unconsumed-3 times a day. The food was not consumed because patients with high doses of tranquilizers suffer loss of appetite. Prolonged use of some of these drugs can have a very

harsh effect on the patient. In prescribing drugs special precautions must be taken for children and those of old age. If you follow the commands of the PDR you are given instructions to reduce the initial dosage of drugs to the lowest optimal dose. In the nursing home I saw patients continuing to receive the initial dosage-no one bothered to reduce it to the minimum beneficial dosage.

Physicians, in my experience, never visited their patients. If you'll bear with me a little more of my experience with my mother. I am a physician myself, I had money enough to hire the best practitioner. I hired a very famous doctor, in fact, he has been promoted to chief of staff of an important and very large hospital. But I can tell you that I had to scream like hell to get him to come down to see my mother after 15 days.

You can imagine my frustration, and it was made even worse by the fact that I was practicing at the Pierpoint VA Hospital, and yet I could not prescribe any drugs for my mother across the bridge in Harve de Grace. I suggest, if I had all this trouble getting a fellow physician to visit a nursing home patient, that families would have much greater trouble.

While I am on the subject of Veterans' hospitals it is too bad that no one talks about them any more. Sure, there was an uproar for awhile, but the public has a short memory. We have veterans who have been neglected for years-progress notes are written as a matter of routine and, many times, they cover up mistakes or items which should come to the attention of others.

In one instance, I remember a patient who came two or three times to the hospital and no one came up with the correct diagnosis—as a result the patient died of a tumor of the brain. When a sputem test is required to test for TB-the patients are given a saliva test instead. Mental patients, old and young alike, require gastric washing but VA hospital authorities say it is too time consuming.

In some of our VA hospitals we have old men with active TB alongside with younger veterans and then there are the syphilitics. I discovered people who had had syphilis since the first World War-who have been left in the VA hospital to vegetate, without revising their condition for years. They have been stored in the hospital.

It seems our health facilities from nursing homes to hospitals leave much to be desired.

Back to nursing homes, I can tell you I couldn't take very good care of my mother not even with the able help of the nursing staff and the other personnel I hired. The practice of geriatric medicine is difficult. But this is no excuse to allow the patients to be tranquilized right into oblivion.

At the Harve de Grace nursing home I saw a patient, in the room right next to my mother, dying with heavy jaundice from the long usage of high doses of tranquilizers. And no one took the care to decrease the dose to the minimum needed by the patient. The patient was dying a slow death for weeks, but the dosage was high since her admittance.

The death certificate, like the others that have been talked about today, was by long distance telephone. As my colleague before me.

said, "Death is the last of the painful consequences, it sulks in nursing homes."

But the care and inspection must be done by dedicated, trained, and scientific people. I served the Greek Government 20 years, sir, and I inspected the hospitals which had been connected with, something that you call over here, Social Security. I had the power to open the door and enter, even at 4 a.m. in the morning, to go in the rooms and see how the patients were doing-by day or by night. It caused me to make some enemies of my personal friends-but it was worth it! As you know, over here the business of nursing homes has grown like mushrooms. Because of this kind of business they make profit from very sick and very old people. Mainly they draw their gain from the uncontrolled storage of human beings for life!

To my way of thinking, the outbreak of salmonella in Baltimore. was inexcusable. Everyone realizes that the bacteria is carried in filth and that unclean conditions or contamination in the preparation of food can lead to this kind of epidemic. If nursing homes cannot remedy these bad conditions, then perhaps we must accept the treatment of the elderly in their own homes. In other countries older people stay at home, they are much happier and live longer. At least they die in their own environment from legitimate causes and not from fractures or food poisoning.

We must make some great improvements and particularly with regard to the children, the mental patients, and the older Americansthe segment of society that cannot protect themselves. They have been overlooked too long and exploited lately. I am glad, Senator Moss, that you have undertaken this important work. There is much that you can do. I ask you to continue your investigations of nursing homes and then to look at mental institutions and facilities for children.

Senator Moss. Thank you very much, Dr. Nicholson, for your confirmation of what has been said by the other doctors that we have had: you underscore for us the fact that we ought to, wherever possible, have our older folks at home, but where it is necessary for them to be in a nursing home that they must then have adequate attention and inspection, and that there is no excuse for not having adequate inspection.

Dr. NICHOLSON. Senator we have many fine doctors in America, but America today is a little bit like Nazi Germany-everything for youth. We are neglecting a valuable asset in our senior citizens. Why don't we ask retired physicians to help us with our institutional care? Let them serve as inspectors or as administrators of these facilities. They have much experience that they could bring to their work— experience must be acquired through the years, it cannot be bought. We must not allow the day to come when all work connected with health and welfare becomes a profession or a business; it is also a mission, a God given privilege, and it must be practiced as such. Senator Moss. Thank you very much. We appreciate having you come to testify before us.

Our final witness will be Mr. Mitchell Gould, executive director, the Gould Convalesarium, Baltimore, Md.

Mr. Gould.

STATEMENT OF MITCHELL GOULD, EXECUTIVE DIRECTOR, THE GOULD CONVALESARIUM, BALTIMORE, MD., ACCOMPANIED BY ARNOLD WEINER, ATTORNEY

Mr. GOULD. This is Mr. Arnold Weiner, my attorney.

Senator Moss. You may proceed, sir.

Mr. GOULD. Mr. Chairman, I join the many who have commended your committee for its effort on behalf of our aging and infirm. I am here today to add whatever I can to your fund of knowledge about the tragedy which struck our nursing home in July of this year.

As you are probably aware, I have cooperated fully with all interested agencies at every level of government to the end that effective preventative measures might avoid, if possible, a repetition of the sorrow which we experienced. I appear here at your invitation and not pursuant to any subpena or other legal compulsion.

I was born in 1919 and I have lived in Baltimore for most of my adult life. In 1939 I was employed by the U.S. Secret Service and I was stationed in Baltimore, Md., and Charlotte, N.C., with occasional tours of duty at the White House in Washington. I was also employed by the Office for Emergency Management as a special agent and, in addition, a special agent with the Federal Works Agency.

In 1945, following my discharge from the Armed Forces, I attended the Johns Hopkins University in Baltimore. I received a bachelor's degree, as well as a master's degree, in speech therapy. I have also taken courses in special studies at the University of California at Berkeley and at the Teachers College in Milwaukee, Wis. I attended the first semiannual course for nursing home administrators at George Washington University. I have taken most of the annual courses in relevant subjects which have been offered by the Maryland Department of Health, including courses in diet therapy and occupational therapy.

My own career in the administration of nursing homes has followed closely the history of this profession. Shortly after the war, when the demand for new construction was greatly in excess of the ability to build, most nursing homes were opened in structures which had originally been designed for other purposes.

The need for beds for the care of the elderly became acute and, as a consequence, private homes, former hospitals and former schools were frequently converted to nursing homes.

Within the next 15 years, however, funds and supplies for new construction became more readily available, and simultaneously, the standards for public buildings were raised. As a consequence, nursing homes, as other buildings used for public purposes, turned to new structures designed specifically for their special requirements.

In the early 1950's I opened a nursing home in Howard County, Md., in a stone mansion which had been utilized for many years as an exclusive girls' school. This home was licensed and approved for 68 patients. In spite of efforts at remodeling and repairing, however, the rise in the standards for public buildings made it impossible for this structure to meet the new requirements.

As a consequence, and when our lease expired at the end of the 3year period, this home was closed in August 1957. I also had a similar

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