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TRENDS IN LONG-TERM CARE

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HEARINGS

BEFORE THE

SUBCOMMITTEE ON LONG-TERM CARE

OF THE

SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE

NINETY-FIRST CONGRESS

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WASHINGTON: 1970

For sale by the Superintendent of Documents, U.S. Government Printing Office
Washington, D.C. 20402 - Price 60 cents

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Part 2. Trends in Long-Term Care, St. Petersburg, Florida, January 9, 1970
Part 3. Trends in Long-Term Care, Hartford, Conn., January 15, 1970
Part 4. Trends in Long-Term Care, Washington, D.C., February 9 & 10, 1970
Part 5. Trends in Long-Term Care, San Francisco, Calif., February 12, 1970
Part 6. Trends in Long-Term Care, Salt Lake City, Utah, February 13, 1970

CONTENTS

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Exhibit A. Washington Report on Medicine and Health, dated January 27, 1969_ _

Item 2. Material submitted by William R. Hutton, executive director,
National Council of Senior Citizens..

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Exhibit B. News article from the Washington Daily News, dated
February 14, 1969.

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Exhibit C. News article from the Washington Post, dated February 16, 1969

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Exhibit D. Resolution on nursing home standards of the National
Council of Seniors Citizens

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Exhibit E. Letter to Mary Switzer from William Hutton, re draft
regulations for standards for payment for skilled nursing home
care under title XIX of the Social Security Act__

Item 3. Material Submitted by Mary E. Shaughnessy, member, American
Nurses' Association.

Exhibit A. Letter expressing objections of American Nurses'
Association to interim policies and requirements pertaining to
standards for payment for skilled nursing home care.
Item 4. Material submitted by Rev. John Mason, director of services to
aging, American Lutheran Church........

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Exhibit D. Position of the American Lutheran Church on delivery of health service to elderly people__

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Exhibit A. Statistics of 95 homes, December 31, 1968.
Exhibit B. Five-Year comparison-American Lutheran Church
national program expense-Average per resident per day cost__
Exhibit C. American Lutheran Church National average staff hours
per bed per month...

TRENDS IN LONG-TERM CARE

WEDNESDAY, JULY 30, 1969

U.S. SENATE,

SUBCOMMITTEE ON LONG-TERM CARE,
SPECIAL COMMITTEE ON AGING,
Washington, D.C.

The subcommittee met at 10:15 a.m., pursuant to call, in room 3110, New Senate Office Building, Senator Frank E. Moss (chairman of the subcommittee) presiding.

Present: Senators Moss, Miller, and Fannin.

Committee staff members present: William Oriol, staff director; John Guy Miller, minority staff director; and Margaret M. Fink, assistant clerk.

Senator Moss. The subcommittee will come to order.

I am pleased to see so many here which indicates interest in this subject that we have to discuss this morning. I am grateful for your

presence.

OPENING STATEMENT OF THE CHAIRMAN

I had expected to begin these hearings on "Trends in Long-Term Care" later in the year, but it has become obvious that this subcommittee cannot ignore a current crisis while considering future trends.

That crisis is the recently issued interim regulations describing the standards for skilled nursing homes under medicaid issued by the Department of Health, Education, and Welfare.

The new regulations provide that, by July 1, 1970, licensed practical nurses in charge of nursing activities on all shifts must be qualified by graduation from a State-approved school of practical nursing or have background equivalent to such training.

But until then, nurses in charge on other than the day shift may be licensed practical nurses "waivered" by a State licensing agency. HEW's recent announcement also notes that the newly published standards match those in the handbook of public assistance administration that regulated services until January 1 of this year, with the exception of the waiver granted for the employment of nurses who are not qualified by formal training.

We are left, therefore, with regulations that say, in effect, that a single, untrained practical nurse on duty in a home with 200 or 300 patients or more constitutes "properly supervised nursing services" on the afternoon and night shifts.

It is also questionable whether the provision for what HEW calls background equivalent to such training will in fact provide properly (1)

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