41-304 し TRENDS IN LONG-TERM CARE 91-2 HEARINGS BEFORE THE SUBCOMMITTEE ON LONG-TERM CARE OF THE SPECIAL COMMITTEE ON AGING NINETY-FIRST CONGRESS WASHINGTON: 1970 For sale by the Superintendent of Documents, U.S. Government Printing Office Part 2. Trends in Long-Term Care, St. Petersburg, Florida, January 9, 1970 CONTENTS Page 1 CHRONOLOGICAL LIST OF WITNESSES Laughlin, Thomas, Deputy Commissioner, Medical Services Administra- tion, U.S. Department of Health, Education, and Welfare--- Hunt, Joseph, Commissioner,__Rehabilitation Services Administration, U.S. Department of Health, Education, and Welfare- Brinkley, Sterling B., M.D., chief medical officer, Rehabilitation Services Administration, U.S. Department of Health, Education, and Welfare.. Martin, Hon. John B., Jr., Commissioner, Administration on Aging-- De Preaux, Paul, president, Connecticut Association of Nonprofit Homes Hutton, William R., executive director, National Council of Senior Citizens- Salmon, Pierre, M.D., American Medical Association_.. Harrison, Bernard P., director, department of legislation, American Shaughnessy, Miss Mary E., RN, M.S., member, ANA Commission on Eggers, Rev. William T., president, American Association of Homes for the Mason, Rev. John, director of services to aging, American Lutheran Church, Minneapolis, Minn., chairman, Committee on Title XIX. Baird, Mrs. Eleanor, vice president, region I, American Nursing Home Schluter, A. L., national chairman, Skilled Nursing Home Conference. Bonin, Garland, commissioner of the Louisiana State Department of Martin, Rose G., National Association for Practical Nurse Education and Item 1. Material submitted by Paul De Preaux, president, Connecticut Association of Nonprofit Homes and Hospitals for the Aged_____ Exhibit A. Public Health Code of Connecticut: Regulations gov- erning the operation and maintenance of chronic and convales- Exhibit C. Connecticut State Department of Health, Division of Exhibit A. Washington Report on Medicine and Health, dated January 27, 1969_ _ Item 2. Material submitted by William R. Hutton, executive director, Page 135 135 Exhibit B. News article from the Washington Daily News, dated 137 Exhibit C. News article from the Washington Post, dated February 16, 1969 137 Exhibit D. Resolution on nursing home standards of the National 138 Exhibit E. Letter to Mary Switzer from William Hutton, re draft Item 3. Material Submitted by Mary E. Shaughnessy, member, American Exhibit A. Letter expressing objections of American Nurses' 139 141 141 142 142 143 143 Exhibit D. Position of the American Lutheran Church on delivery of health service to elderly people__ 144 Exhibit A. Statistics of 95 homes, December 31, 1968. TRENDS IN LONG-TERM CARE WEDNESDAY, JULY 30, 1969 U.S. SENATE, SUBCOMMITTEE ON LONG-TERM CARE, 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) |