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U.S. GOVERNMENT PRINTING OFFICE

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WASHINGTON : 1976

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SENATE SPECIAL COMMITTEE ON AGING

FRANK CHURCH, Idaho, Chairman
HARRISON A. WILLIAMS, JR., New Jersey HIRAM L. FONG, Hawaii
JENNINGS RANDOLPH, West Virginia CLIFFORD P. HANSEN, Wyoming
EDMUND S. MUSKIE, Maine

EDWARD W. BROOKE, Massachusetts
FRANK E. MOSS, Utah

CHARLES H. PERCY, Illinois EDWARD M. KENNEDY, Massachusetts ROBERT T. STAFFORD, Vermont WALTER F. MONDALE, Minnesota

J. GLENN BEALL, JR., Maryland VANCE HARTKE, Indiana

PETE V. DOMENICI, New Mexico CLAIBORNE PELL, Rhode Island

BILL BROCK, Tennessee
THOMAS F. EAGLETON, Missouri

DEWEY F. BARTLETT, Oklahoma
JOHN V. TUNNEY, California
LAWTON CHILES, Florida
DICK CLARK, Iowa
JOHN A. DURKIN, New Hampshire

SUBCOMMITTEE ON LONG-TERM CARE

FRANK E. MOSS, Utah, Chairman
HARRISON A. WILLIAMS, Jr., New Jersey CHARLES H. PERCY, Illinois
FRANK CHURCH, Idaho

HIRAM L. FONG, Hawaii
EDMUND S. MUSKIE, Maine

EDWARD W. BROOKE, Massachusetts EDWARD M. KENNEDY, Massachusetts J. GLENN BEALL, JR., Maryland CLAIBORNE PELL, Rhode Island

PETE V. DOMENICI, New Mexico THOMAS F. EAGLETON, Missouri

BILL BROCK, Tennessee
JOHN V. TUNNEY, California

DEWEY F. BARTLETT, Oklahoma
WALTER F. MONDALE, Minnesota
LAWTON CHILES, Florida
DICK CLARK, Iowa

HOUSE SELECT COMMITTEE ON AGING

WM. J. RANDALL, Missouri, Chairman CLAUDE PEPPER, Florida

BOB WILSON, California SPARK M. MATSUNAGA, Hawaii

WILLIAM C. WAMPLER, Virginia EDWARD R. ROYBAL, California

JOHN PAUL HAMMERSCHMIDT, Arkansas FRED B. ROONEY, Pennsylvania

H. JOHN HEINZ III, Pennsylvania MARIO BIAGGI, New York

WILLIAM S. COHEN, Maine WALTER FLOWERS, Alabama

RONALD A. SARASIN, Connecticut IKE F. ANDREWS, North Carolina

WILLIAM F. WALSH, New York JOHN L. BURTON. California

CHARLES E. GRASSLEY, Iowa EDWARD P. BHRV, Rhode Island

THEODORE M. (TED) RISENHOOVER, MICHAEL 1. BLOUIN, Iowa

Oklahoma
DON BONKER, Washington

GILBERT GUDE, Maryland
THOMAS J. DOWNEY, New York
JAMES J. FLORIO, New Jersey
HAROLD E. FORD, Tennessee
WILLIAM J. HUGHES, New Jersey
MARILYN LLOYD, Tennessee
JIM SANTINI, Nevada

SUBCOMMITTEE ON HEALTH AND LONG-TERM CARE

CLAUDE PEPPER, Florida, Chairman IKE F. ANDREWS. North Carolina

H. JOHN HEINZ III. Penpsylvania
EDWARD P. BEARD, Rhode Island

WILLIAM S. COHEN, Maine
JAMES J. FLORIO, New Jersey
MARILYN LLOYD, Tennessee

CONTENTS

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Statement by Senator Frank E. Moss...

Statement by Representative Claude Pepper.

Statement by Representative H. John Heinz III.

Statement by Senator Bill Brock..

Statement by Representative Wm. J. Randall..

Statement by Senator Charles H. Percy--

CHRONOLOGICAL LIST OF WITNESSES

Martin, Hon. John B., consultant, National Retired Teachers Association/

American Association of Retired Persons..

Koch, Hon. Edward I., Representative from the 18th District of New York.

Etzioni, Dr. Amitai, professor of sociology, Columbia University, and

director, Center for Policy Research

Hawes, Gerald A., audit manager, office of the auditor general, Sacramento,

Calif.

Warner, Dr. George, special assistant, Health Facilities, Economics, and

Preventive Health Services, New York State Health Department,

Albany, N.Y.----

Weikel, Dr. Keith, Commissioner, Medical Services Administration, De-

partment of Health, Education, and Welfare; accompanied by Peter

Franklin, Special Assistant to the Secretary; Dr. Claire Ryder, Director,

Division of Policy Development, Office of Nursing Home Affairs; and

Gerald Sheinbach, Assistant Bureau Director, Division of State Opera-

tions, Bureau of Health Insurance, Social Security Administration --

Wilsmann, Edward J., president, Upjohn Homemakers Home and Health

Care Services, Inc., Kalamazoo, Mich..

Brown, Richard P., executive vice president, Unihealth Services Corp.,

New Orleans, La--

Smith, John B., legislative counsel, medical personnel, Personnel Pool of

America, Inc., Fort Lauderdale, Fla.

Winston, Þr. Eilen, National Council for Homemaker-Home Health Aide

Services, New York, N.Y..

Tigar, Nancy, assistant director, Council of Home Health Agencies and

Community Health Services, National League for Nursing-

Reese, Eva M., R.N., executive director, Visiting Nurse Service of New

York,

Rawlinson, Helen L., director of Home Care, Blue Cross of Greater

Philadelphia---

Starr, Janet E., executive director, Coalition for Home Health Services

in New York State

Pfau, Mary Ann, coordinator of ambulatory and home care nursing

services, nursing services department, American Nurses' Association.---

Hall, Hadley D., executive director, San Francisco Home Health Services.-

Semmel, Herbert, Center for Law and Social Policy; accompanied by Ru-

dolph' Danstedt, assistant to the president, National Council of Senior

Citizens, Washington, D.C...

Byrne, John, MHA, president, National Association of Home Health

Agencies, and executive director, Visiting Nursing Association of St.

Louis, Mo.; accompanied by Don Trautman, chairman, Legislative

Committee, National Association of Home Health Agencies...

Prendergast, James Terence, legislative counsel for Staff Builders, New

York, NY

Keeley, Fred, Home-Kare, Inc., Campbell, Calif.

(III)

43 395ST

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APPENDIXES
Appendix 1. Communications between Senator Frank E. Moss, Repre-
sentative Claude Pepper, and David Mathews, Secretary, Department
of Health, Education, and Welfare:
Item 1. Letter from Senator Frank E. Moss, chairman, Senate Sub-

committee on Long-Term Care, and Representative Claude L.
Pepper, chairman, House Subcommittee on Health and Long-Term
Care; to David Mathews, Secretary, HEW, dated December 12, Pago
1975.

165 Item 2. Letter and enclosure from Senator Frank E. Moss and Repre

sentative Claude L. Pepper; to David Mathews, Secretary, HEW-- 166 Item 3. Letter from John A. Svahn, Acting Administrator, Social and

Rehabilitation Service, HEW; to Senator Frank E. Moss, dated
October 16, 1975.

176 Appendix 2. Report by the Office of the Auditor General of California entitled "A Management Review of the Homemaker-Chore Services

Program,” dated June 11, 1975; submitted by Gerald A. Hawes--- 177 Appendix 3. Proposed medical assistance program regulations (home health services) by the Department of Health, Education, and Welfare, Social

and Rehabilitation Service; from the Federal Register, August 21, 1975. 198 Appendix 4. Statements from individuals and organizations:

Item 1. Statement of Arthur S. Flemming, Commissioner on Aging,

Department of Health, Education, and Welfare, before the Sub-
committee on Health and Long-Term Care of the House Select
Committee on Aging, November 19, 1975.

207 Item 2. Statement of Peter Franklin, special assistant to the Secretary,

Department of Health, Education, and Welfare, before the Sub-
committee on Health and Long-Term Care of the House Select
Committee on Aging, November 19, 1975..

209 Item 3. Statement and attachments of the National Association of

Home Health Agencies, Portland, Oreg.; submitted by John Byrne,
president..

215 Item 4. Statement and attachment of Edward J. Wilsmann, president,

Homemakers Home and Health Care Services, Kalamazoo, Mich.. 226 Appendix 5. Letters from individuals and organizations:

Item 1. Letter and enclosures from Richard P. Brown, executive vice

president, Unihealth Services Corp., New Orleans, La.; to Val J.
Halamandaris, associate counsel, Senate Committee on Aging, dated
November 4, 1975---

239 Item 2. Letter from Lawrence N. Fuchs, secretary, Homemaker-Home

Health Aide Association of New York State, Inc.; to David
Mathews, Secretary, HEW, dated September 18, 1975---

242 Item 3. Létter and enclosures from Cyril F. Brickfield, counsel,

NRTA/AARP; to Senator Frank E. Moss, dated September 24,
1975; submitted by John B. Martin.-

243 Item 4. Letter from Hon. Patricia Schroeder, Representative in

Congress from the First District of Colorado; to John A. Svahn,
Administrator, Social and Rehabilitation Service, HEW, dated
September 29, 1975.-.

252 Item 5. Letter and enclosure from Maxine A. Thomas, R.N., executive

director, Salt Lake Community Nursing Service (Utah); to Senator
Frank É. Moss, dated October 1, 1975..

253 Item 6. Letter and enclosures from Florence Moore, executive director,

National Council for Homemaker-Home Health Aide Services, Inc.,
New York; to John A. Svahn, Acting Administrator, Social and
Rehabilitation Service, HEW, dated October 3, 1975; submitted by
Dr. Ellen Winston---

254 Item 7. Letter from Eva M. Reese, executive director, Visiting Nurse

Service of New York; to the Administrator, Social and Rehabilita-
tion Service, HEW, dated October 6, 1975.--

257 Item 8. Letter from Florence Moore, executive director, National

Council for Homemaker-Home Health Aide Services, Inc., New

York; to Senator Frank E. Moss, dated October 29, 1975--- 258
Item 9. Letter from Constance Holleran, deputy executive director,

American Nurses' Association, Inc., Kansas City, Mo.; to Senator
Frank E. Moss, dated November 3, 1975.-

259 Pogo 260

263

Appendix 6. Additional material submitted for the record:

Item 1. Position paper entitled "Public Management of Health and

Home Care for the Aged and Disabled,” submitted by Amitai

Etzioni, director, Center for Policy Research, Columbia University. Item 2. Initial policy

statement on supplementary services, adopted
by the Board of Directors, National Council for Homemakers-
Home Health Aide Services, Inc., May 4, 1974; submitted by Dr.

Ellen Winston..
Item 3. Revised draft of a bill to provide for homemaker-home health

aide services to all individuals and families in need of such care;
submitted by the National Council for Homemaker-Home Health

Aide Services, Inc.-
Item 4. Proposed regulations for Federal certification of unlicensed

proprietary home health agencies; from the Congressional Record,

October 8, 1975, submitted by Herbert Semmel..
Appendix 7. HÉW audit on three agencies offering homemaker chore

services; released to the press on May 18, 1976:
Item 1. Letter from Richard Ballard, branch manager, HEW Audit

Agency, San Francisco, Calif.; to Mario Obledo, secretary, Health
and Welfare Agency, State of California; submitting proposed HEW

Audit Agency report..
Item 2. Newspaper article from the Sacramento Bee, May 18, 1976.-.

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