Mr. O'HARA. Thank you.

Mr. ELLSWORTH. Are there any clubs that give you any personal assistance? I am not talking necessarily about financial assistance, but a person in your position getting sick, even if there is plenty of medical help available, might have trouble locating it.

Mrs. CooLE. I belong to one of them.

Mr. ELLSWORTH. You do?

Mrs. COOLE. Yes, here in the city.

Mr. ELLSWORTH. Do they assist you in any way with the problems that arise?

Mrs. CooLE. I do not know whether they know about them or not. Mr. ELLSWORTH. The reason I asked, in some of the cities the senior citizens clubs have activities that go into the home. For example, in Cleveland they have a program of "Meals on Wheels." So if you get sick for a short period or even a long period they will bring meals to you, the cost depending upon your income, in which case yours would be very low.

I just wondered if there are any of these activities in Wheeling. Mrs. COOLE. If so, I know nothing about it. I rather think not. Mr. ELLSWORTH. Thank you.

Mr. O'HARA. Thank you very much.

Chairman BAILEY. Thank you very much, Mrs. Coole.

Mr. Bernard Smith, head of the State bureau of public assistance, has just come into the room. He has to catch a plane pretty early, and if he is available now to testify we would be glad to have him come forward.

Will you be seated and identify yourself to the reporter and proceed with your testimony?

STATEMENT OF W. BERNARD SMITH, HEAD OF WEST VIRGINIA PUBLIC ASSISTANCE DEPARTMENT

Mr. SMITH. I am W. Bernard Smith, State Welfare, appearing here at the request and recommendation of Governor Barron to give the administration's viewpoint upon the problems here under consideration before this committee.

I have, gentlemen, a prepared statement. I do not have copies at this time but can have them prepared and submitted for the record, if you would desire.

Chairman BAILEY. Without objection that will be arranged.

Mr. SMITH. West Virginia is extremely interested in the problems of its aged citizens. We must admit that we face an extremely difficult task in solving these problems since from our total population of 1,860,421 persons, 172,000 of these are above the age of 65.

This problem is compounded by the fact that a large percentage of these elderly citizens have extremely low annual incomes.

For example, 96,772 persons in the State of West Virginia over the age of 65 have incomes annually of less than $1,000.

Persons numbering 121,559 have incomes of less than $1,500 per

annum.

This progresses to the annual income of $3,000 per year, which is 148,723 persons.

Of this total 17,705 persons are in need to the extent that they must exist on old-age assistance grants. These persons comprise 31 percent of the States total welfare caseload.

This caseload has steadily declined from its peak of 26,722 in January of 1953 to its present total. This is, of course, due to the fact of increased social security participation.

This State last year expended $7,746,798 in both State and Federal funds for old-age assistance. We must, however, point out that the average monthly award was only $34.04.

I think we can all readily see that this is certainly inadequate to sustain even the barest minimum requirements.

This State, however, has long recognized the need for medical services to these persons and has for many years provided medical services. to its old-age recipients through its general medical program.

West Virginia is also providing medical care to the aged to nonrecipients of old-age assistance which is presently serving 19,382 persons.

On both of these beneficial medical programs the State restricted by resources can only provide for emergency services. We must also point out that this figure of 19,382 persons are those actually receiving services during this period of time.

It does not consider the persons we know eligible, but who have not seen the necessity for the services at this time.

We have a potential eligibility in West Virginia based on financial eligibilities of 104,000 elderly citizens who could, at any time, be eligible for our medical assistance program.

Chairman BAILEY. Might the Chair ask how many of them you are processing now?

Mr. SMITH. There are 19,382 that have been receiving services. At the point when we were taking advance registration, whether they were receiving services or not, there were 30,000 persons over the age of 65 which had registered for the monthly assistance program. Chairman BAILEY. Now you say that the eligibility list would exceed 100,000?

Mr. SMITH. The potential would be 104,000.
Mrs. HANSEN. May I ask a question?

What does your State consider as the emergency type program? Mr. SMITH. The extreme emergency is the situation that you need actual emergency treatment at the present time. We have a few chronic situations which we do care for. But they are minimal. Mrs. HANSEN. Is it largely surgery, or is it medical care, or what? Mr. SMITH. The greatest expense we incurred is hospitalization and hospital treatment.

Mrs. HANSEN. What is the average cost to the State of West Virginia per person, per day, for hospital care?

Mr. SMITH. That is hard to estimate.

Mrs. HANSEN. Can you give us an average?

Mr. SMITH. I can give you an average of the cost of treatment per person, which is $67.50 per case in West Virginia. This would include an average of all medical care.

Hospital payment is based upon a cost statement provided by the hospital. It runs as much as from $19 to $41 per day.

Chairman BAILEY. You may proceed with the rest of your formal statement.

Mr. SMITH. Thank you, Mr. Chairman.

What we feel from our immediate needs.

These persons immediately need comprehensive medical service benefits which not only include emergency treatment but also care for chronic conditions so prevalent with elderly citizens. It would also be most beneficial to provide a system of preventive care which, while costly at the outset, would in my opinion, save funds in the future and provide these citizens with happier and more useful latter years.

We fully recognize that all of these necessary services could presently be provided. This, however, is extremely difficult for West Virginia in view of its high percentage of elderly citizens and their low annual income.

In addition to the unfortunate economic burden there are additional roadblocks for adequate care in West Virginia. Even if funds were available there is a shocking lack of adequate hospital and nursing home facilities available for such care.

We, ourselves, have been partially responsible for this deficiency. We have not provided adequate payments to hospitals and especially nursing homes for patients placed there by our department of welfare. This we are presently attempting to correct by establishing a graduated scale of payment based upon facilities and care available in an effort to offer the proper incentive to construct and expand these necessary facilities.

In the consideration of any program for aging it is our feeling that assistance should be available without requiring these citizens to reduce themselves or their children to paupers. We deem it extremely essential to the proper psychological development of elderly persons to allow them to retain some resources which they will be able to call their own. We all know that even the smallest amount held in the sock, so to speak, for a rainy day gives peace of mind. This we find is essential to our elder citizens.

While support of parents should always be encouraged when it does not burden the children to the point of causing mental anguish to them and to their elderly parents fearing this dependency, we must recognize that today's society requires far more demands upon families. They must provide education for their children and meet the demands of our complex society. We must recognize, too, that in many instances the financial burden of an elderly parent can detract from our future generation, the grandchildren of today's elderly. However, the most important aspect of this problem can only be solved by individuals of our local communities. The elderly person must receive every opportunity to participate in all phases of community life to insure that they retain their sense of belonging and being useful. This, only the individuals of a community can accomplish.

Further, in consideration of specific inquiry made by the committee, that regarding the creation of a coordinating agency, it would be necessary to determine the purpose of such an agency, it is the consensus of this State that if such a coordinating agency is for the purpose of studying the overall problems of our elderly citizens for the purpose of presenting a comprehensive program to the Congress, it may be beneficial. However, it is the unanimous con

sensus of all agency heads having direct relationships with Federal agencies that if such a coordinating agency is solely for the purpose of operating to aid the States in their contacts with the various Federal agencies, such a department would not be helpful. It is the feeling that it would establish only more redtape which would hinder the Federal-State agency relationships.

We would prefer, as an alternative in the field of aged, to point out that several Federal agencies and committees have responsibilities in this field.

We would feel it would be much more beneficial to study and to propose that all such responsibility be placed within the supervision of one Federal agency, from which we could obtain this information and assistance.

We strongly feel that this would expedite the solution of this problem in a far better means than such a coordinating agency.

Mrs. HANSEN. I would like to ask a question.

Going back to your statement on the caseload falling from 31 percent to 26 percent, have the costs gone down at the same time, or have the appropriations remained steady or gone up?

Mr. SMITH. The job develops from this situation. You are referring to MAA, I take it.

Mrs. HANSEN. You said the old age assistance program.

Mr. SMITH. The old age assistance has dropped from the 26,000 to the present caseload of 17,000. This has been the result of increased participation in social security.

Mrs. HANSEN. My question was, has the old age assistance appropriation decreased by the same amount, a comparative amount? Mr. SMITH. No.

Mrs. HANSEN. Has it remained stable or has the legislature found it necessary to increase funds at each biannual session?

Mr. SMITH. I would have to explain State budgetary processes. Int our budget all categorical grants are included in grants of appropriation, which covers all categories of assistance. We extend from that in all different categories.

Appropriations would have very little effect. While it decreases, another category will rise.

Mrs. HANSEN. Did you not separate in your categories so you are able to tell whether the increase in caseloads is equated by a decreasing cost load? That is what I am after.

Mr. SMITH. Yes.

Mrs. HANSEN. Is the cost of the State of West Virginia going down?

Mr. SMITH. The cost to the State of West Virginia is going down but we are also maintaining the same average payment to individuals. We are going to have to face the problem of increasing payment on old age assistance to meet the rising cost of living today. We have not faced this problem at this time but it is certainly upon us now. Mrs. HANSEN. Will it just be cost of living?

Mr. SMITH. Yes.

Mrs. HANSEN. Do you have for your State department of public welfare or assistance a State council and then community council or county council to participate in programing for various groups such as old age assistance groups and the aid to dependent children, and so on?

Mr. SMITH. As far as the aging is concerned, we have the Governor's Commission on the Aging. We have as a local alternative the county council, which in West Virginia serves both as administrative and advisory.

Mrs. HANSEN. Are they working on, let us say, programs of education, recreation, housing, and those fields that are related?

Mr. SMITH. Yes, ma'am. We have been working on these for sometime. But another problem in West Virginia is the adequate housing facilities. It is a difficult problem. Many various agencies are working in this area.

Mrs. HANSEN. I take it there is a vast lack of low-cost housing for the lower bracket income groups?

Mr. SMITH. Yes, ma'am.

Mrs. HANSEN. Is there any particular reason why it is existing in West Virginia?

Mr. SMITH. I would hesitate to say.

Mr. O'HARA. Recently I read a report, I believe, in the New York Times with regard to the operation under the Kerr-Mills program. The report spoke of certain difficulties the State was experiencing under the Kerr-Mills program, having to do, I believe, with the fees to be paid to doctors in hospitals for the care of persons eligible for Kerr-Mills assistance.

Is that program administered in West Virginia by your agency? Mr. SMITH. Yes, sir.

Mr. O'HARA. Could you give us a little information with regard to the operation of Kerr-Mills in West Virginia?

Mr. SMITH. I would first like to state that I feel that was not the basic problem that resulted. There are many problems.

First, let me point out that in any welfare agency, one of the overpressing problems in administering Kerr-Mills is a problem that such a program is foreign to the training of the employees and staff of any welfare agency.

Our staff, recruited through civil service, has been trained in the social work field. It is very difficult to acclimate them to the administration of a medical program of the magnitude of the Kerr-Mills program in West Virginia."

Another problem which resulted was the avalanche of pending and back authorizations for medical care.

On December 1 of this year we imposed an emergency program for a 2-month period to allow us to pick up our overloading burden of past authorizations, which at that time were outstanding, was close to $2 million in our bills. When we accumulated these we were able to reduce some fees by reducing the amount of time allowed for hospital stay. This was cut from 30 days to 12 days of hospital stay under the Kerr-Mills program here.

The medical fees have been restored and are to be reconsidered on the 17th of this month. We will obtain our exact expenditures at that time.

It will be necessary to point out that at the height of the MAA program in West Virginia, we were spending close to a million dollars a month. The estimations that had been presented to the legislature when this program was accepted at a special session were that the cost per patient load might be $5 per case. This was based about