It was over 6 years in the planning and 3 years in its construction. It represents an advance in hospitalization compatible with the renascent city of Pittsburgh which aims also to be the medical center of the world. Hospital-Building No. 1 NOW, LET'S GO ON OUR TOUR Here on the ground floor of the hospital building, note the glassed-in lobby and the open loggia beyond. This hospital building has eight floors consisting of: First floor-administration offices; Second, third, and fourth floors-typical patient floors; Sixth floor-admission floor; Seventh floor-isolation, private or semiprivate rooms; Eighth floor-lab, surgery, X-ray, living quarters for internes, chaplains, etc. Our tour, as it begins, proceeds to the left past the elevators and down the long corridor for visitors to other sections of the hospital. Checkerboard corridor in building No. 2 Turn to the right at the end of this corridor and enter the recreational core, proceeding down the checkerboard corridor, so called because of the pattern of clear and opaque glass. If we pause here for a moment, we can observe to our right a view of the hospital that shows the many types of materials that went into the construction— aluminum, brick, steel, terra cotta, slate, glass, concrete, and stone. To our left is one of the two smaller courts with colored terrazzo walks, benches for patients, and growing plants. Convalescent sections—buildings No. 8 and No. 4 Ahead is building No. 3 where we will visit a convalescent section (building No. 4 is a replica of it). The convalescent floors are identical to the typical patient floors in the eighth-floor hospital building where our tour began. Patient capacity in the hospital building is 532. Each half floor of the convalescent sections, like typical patient floors of the hospital, has four 5-bed rooms, each with lavatory facilities. Also, two 2-bed rooms with lavatories between them. Then, as we proceed down the hall, there are linen rooms and bath facilities and nurses' station. From this station, the nurses can oversee patients in their quarters and also watch over the staircase exits. Beyond the nurses' station is the ward. This ward has six 4-bed cubicles for a total of 24 patients and is the largest patient area in any part of the hospital. Throughout the hospital, there are 21 different room colors and 9 different furniture colors. On any one floor, each room of the hosiptal is of different color scheme. Adjoining the ward is a solarium. Half of each solarium will be devoted to tables and workbench areas where patients can engage in sewing, leather work, rugmaking, etc., either as part of therapeutic treatment or as a hobby. The other half of the solarium will be for television parlors. Each half floor in the convalescent and hospital patients' floors has 48 patientsor 96 to a floor. In this building, patient capacity is 288. Convalescent patients are those not requiring intense hospital care, but too ill to be placed in ambulatory facilities. Eye, dental offices, auditorium lobby in building No. 2 We go down the stairs here to the lower floor of this building, passing under the checkerboard corridor, and turn right. Here we find the eye examining rooms, the dental offices, the barbershop and beauty parlor. There are other dental and eye offices on the sixth floor of the main hospital building and these services also are available to patients at bedside. The auditorium lobby is beyond. Laundry and kitchen in lower levels of building No. 2 Those who wish may descend two flights here to see the laundry on basement level C. With a capacity of over 15,000 pounds a day, this is larger than any commercial laundry in the county. Areas also are set aside here for pressing and sewing. On level B is the kitchen. Here you'll see the modern equipment of the bakeshop, the use of stainless steel, walk-in refrigerators and freezers. Over 3,000 meals can be prepared here at a serving; and as many as 10,000 persons per day can be fed by the kitchen in the event of a major disaster. Returning to level A of building No. 2 again, we turn right past the auditorium lobby, then into the mushroom corridor. Straight ahead we get a good view of the new hospital's main outdoor court. The terrazzo areas, the shrubs, grass, trees, and colorful benches of aluminum frames make this an attractive area in any season of the year. See how the eye is relieved from the monotony of usual institutional surroundings by the varied use of building materials and color. Patients who would otherwise have to be confined to wards for their own safety will have freedom to use this supervised enclosure. Infirmary building No. 7, west section Now we proceed to our left to the nurses' station of an infirmary section of the hospital. This section also is duplicated across the large central court. Together, they accommodate 980 who are ambulatory patients requiring medical care and nursing supervision. Notice the graded staircase on your right. This is for use of those patients who travel daily to the dining room. The units of this infirmary section project into the attractive central court as you will notice on the photo' accompanying this tour outline. Although the units are not altogether identical, they are quite similar in layout. The unit we are visiting, for instance, contains a ward with four 6-bed cubicles. There is adjoining a 12-bed and a 2-bed room. Patients in each section easily can identify their section by the different colors of the ceramic tile walls. Each unit in the infirmary section has its own solarium and porch. You will notice, perhaps, that this ward is different from the typical ward of the hospital and convalescent sections where there are 4-bed cubicles. Here there are 6-bed cubicles. The reason for this is that there is less need for privacy in the infirmary section since ward areas are used only for sleeping. Other areas are provided for sitting and recreation. Let's turn back now to view another of the hospital's two smaller courts. This is called the mirror lake court and has a pool and fountain designed in the style of downtown Pittsburgh's Mellon Park. See the open sundecks and porches that overlook the court where patients on wheelchairs or litters can enjoy the outdoors in good weather. Observe, also, the variety of architectural forms that can be seen from here the pyramid of the church, the rectangular hospital building, the dome of the auditorium. This could be a favororite spot of camera fans. We proceed to the left now, then turn right past the patients' dining room. This dining room overlooks both the mirror lake court and the large central court. It can serve over 900 people, cafeteria style, in two sittings. Auditorium-building No. 5 Passing the kitchen, we enter the auditorium. The auditorium seats 750. It is designed so that patients in wheelchairs or on litters also can find room here to see the movies, attend the lectures or dramatic presentations. Interesting about the auditorium is the fact that most patients able to attend need not use stairs for they can enter the auditorium on three different levels. We'll walk up to the balcony level and, leaving the auditorium, walk through the patient's library. A library is very important to long-term patients and we are hopeful that this will become a branch of the Carnegie Library. Interdenominational church-building No. 6 Crossing the corridor, we enter the church. Unique about the church, apart from its design, is the three-denominational revolving altar for Protestant, Catholic and Hebrew faiths. Another interesting feature is the lighting which falls through the stained-glass windows at the entrance, and at the opposite end, upon the altar. The church accommodates 250 and will have an organ. Like the auditorium, the church is designed for use by wheelchair and litter patients as well as ambulatory patients. Administration in building No. 1 Leaving the church, we'll return to the main hospital building lobby via the long corridor that parallels the visitors' corridor. Here are the hospital administration offices. The offices on the right are for investigators, social service personnel, purchasing, revenue, and other administration work. On the left are 1 Not reproduced. physicians' offices, staff lounge, library, and conference rooms. The furniture of the offices is two-toned to carry out the theme of multi-color throughout the hospital. OUR TOUR IS ENDED NOW We of the institution district hope you have enjoyed your visit to the new hospital and that you will tell others about it. The people of Allegheny County should know what is provided for those who are sick, and very often aged, who cannot pay for prolonged private hospital care. This hospital, merely because it is beautiful, is not an extravagance. It has been economically engineered by imaginative people to give new life to our older county residents and others who need medical assistance. PREPARED STATEMENT BY MR. G. B. TRINKAUS, MANAGER, GROUP Department, AETNA LIFE INSURANCE CO. INTRODUCTION As a representative of the insurance industry located in southwestern Pennsylvania for more than 25 years, and particularly as a representative of a company writing group insurance I have been aware that many of us in the industry here have followed closely the hearings of the subcommittee which have been held in Washington and other places. We have been impressed by the wealth of statistical information and opinions furnished to you. The expert testimony shows clearly that the problems of the aged are complex, encompassing not only health care and health insurance but also adequate income, housing, employment, adjustment in living habits, and other problems. It is to be expected that not all of the statistics and testimony would be in complete agreement. Predictions of things to come many years in the future is hazardous even if there were a complete agreement on the situation today. Nevertheless, the discussions stimulated by your hearings will be beneficial to all of us. The purpose of my filing this statement with your committee today is to discuss the work of the insurance companies and their representatives in western Pennsylvania in trying to meet some of the problems of the aged and aging, and to point out some of the things that have been done and are being done to meet this problem both nationally and locally. My purpose is also to again call to your attention some of the statements that have been previously filed with the committee in other appearances before it. We in the insurance industry provide an important service to a vast number of people in meeting a multitude of their personal security needs. As has been previously stated before your subcommittee, not all older people are subject to the same forces-they have different needs, desires, family connections and other assets. Hence, any service designed to meet these needs must be a flexible one. This kind of flexibility is provided through the development of a wide portfolio of both group and individual policies. These policies provide income for retirement, death benefits, income replacement during periods of disability and insurance against the costs of health care. Many of these coverages are available for both the head of the household and dependent members of his family. Since health care benefits for the aged have received the most attention in recent years, I shall discuss this coverage first and shall follow these by comments on life insurance benefits, pension benefits, and efforts by the insurance industry in the areas under your consideration. I shall not attempt to discuss specific programs that had been effected by my own and other insurance companies, as these have been outlined to you in previous discussions. HEALTH CARE INSURANCE At your Washington hearings you heard testimony by Mr. Follmann with respect to the role of voluntary health insurance in financing health care for the aged. It is obvious from his testimony that the insurance industry is well over the threshold of providing health care coverage for the older citizens, whose needs for coverage are even greater than those of the younger people. There is every reason to believe that the considerable expansion of health care coverage for older people which we have seen in the last 5 years will continue in the future provided Government does not discourage such continued efforts by the industry. For quite some time the group insurance writing companies have had an interest in the continuation of group insurance coverage for retired lives, and during the past few years many group policyowners have amended their group contracts to continue some health care insurance for employees and their dependents after retirement. The level of benefits provided, cover a wide range. In some cases the full benefits available to active employees are continued after retirement. In other cases, because of cost, the benefits are limited by using lifetime maximums or similar devices. Individual hospital, medical, and surgical contracts are now available at the older ages and the nonmedical conversion of group hospital-medical and surgical insurance at termination of employment or retirement is now an established and growing practice. Since Mr. Follmann in his testimony before your subcommittee in Washington described the seven principal methods being employed by insurance companies to provide protection for the aged against the costs of medical care, I shall not repeat them He also reviewed the recommendations made to its member companies by the Health Insurance Association of America in December 1958. In general, these recommendations urged the insurance industry to continue to expand both group and individual health care coverages at the older ages as rapidly as possible consistent with sound underwriting. These recommendations show that the insurance industry is well aware of the problems of the aged and its responsibility in this area and is taking increasing and effective action. THE FUNCTIONS OF LIFE INSURANCE While much of the discussion of the insurance needs of the aged has been directed toward the need for health care coverage, very little mention has been made of life insurance and pension benefits which are certainly an integral part of the overall financial protection enjoyed by aged and aging people. Your committee is well aware of the billions of life insurance in force under individual and group forms. Most of this insurance will provide financial security in later years for widows and other dependent members of the family of the deceased worker whether death occurs before or after retirement. In addition, life insurance and pension plans frequently provide an income upon the insured's disability. I wish again to call the attention of the committee to the flexible provisions of life insurance policies under their optional methods of settlements, and their cash and loan values, as well as the waiver of premium provision which releases income for other needs during disability. Certainly any evaluation of the financial needs and assets of our aged must be made with proper recognition of the extent of life insurance coverage. EMPLOYER PENSION PLANS Your committee is completely aware of the enormous growth of voluntary pension and retirement plans and the continuous effort to bring the benefits of these plans through business and industry to an ever increasing number of people by the insurance companies, by banks, and through trustees of selfadministered plans. In my experience the activity of the insurance companies in this field has never been more active than at present, and I am sure the same applies to other efforts in the same direction. From what I have been able to learn there are few, if any, sections in the country where there has been more activity in this connection than in southwestern Pennsylvania, and I am sure that any study you made of this matter would verify this statement. REFERENCES In preparing this statement for the committee I have, of course, referred to the many documents that have been previously placed in your hands and I feel that it would be appropos to refer to those which have most impressed me and which I recommend for your future consideration. The statement made by Mr. J. F. Follmann, Jr., director of the Health Association of America, information research division, made before your committee on June 1959, and appearing from pages 211 to 223 in the record of these hearings. The statement made on October 13 and 14 by Mr. Edward A. Green, vice president and group actuary, John Hancock Mutual Life Insurance Co., and a fellow of the Society of Actuaries, with especial reference to his items (1), (2), and (3), under his summary. CONCLUSION It is my conviction that the insurance company representatives in southwestern Pennsylvania are deeply interested in, and keenly aware of, the problems of the aged and aging and are proud of the great progress in this direction now being made by the insurance industry. On behalf of the insurance industry I appreciate your allowing me to submit this paper to your committee. PREPARED STATEMENT OF AMERICAN SERVICE INSTITUTE OF ALLEGHENY COUNTY, PITTSBURGH, Pa. TESTIMONY RE IMPACT OF CULTURAL FACTORS ON FOREIGN-BORN AGED The American Service Institute is a Community Chest-United Fund agency which serves the community by assisting individuals of foreign birth or foreign parentage in their efforts to adjust to the American way of life and to become participating members in the community. Because of the deep-rooted, permeating influence that foreign culture plays in the individual's adjustment and integration into the community and the significant numbers of foreign stock in Allegheny County, we believe it is important to bring to the attention of this committee the special needs of the foreign-born aged. Of a total population of 1,515,237 in 1950, 9.6 are foreign born and 27.5 percent have parents of foreign birth. In the standard metropolitan area which includes Pittsburgh and Allegheny County, 58.4 percent of the white population 60 years of age and over in 1950 were foreign stock. Professional workers who have direct contact with immigrants and American citizens of more recent origin know through experience that the influence of culture is a tenacious one which is not abolished by a "magic melting pot" process. Although needs of the aging are basically the same, cultural differences tend to enhance the normal human problems of the foreign born. The foreign born who have not become integrated into the American culture have the problem of being socially isolated when faced with the prospect of old age whether it be spent in a public institution or in the outside community. Often unable to communicate in English, the individual is separated from the companionship and fellowship so vital to his mental, emotional and physical well-being. He feels no "sense of belonging" because he has little in common with the social groups that are not part of his ethnic culture. Frequently, foreign-born aged prefer to exist in poor housing facilities at the lowest subsistence level in order to retain other satisfactions, such as the ability to communicate in the language that is most familiar; satisfying social outlets; ethnic identity, the freedom to eat what he likes and according to his own eating habits; to worship in the church or synagogue where he feels comfortable and "belongs"; to pursue the leisure time activities that bring him the greatest pleasures and satisfactions. Experience has shown there are frequent instances of resistance to public institutions by foreign-born ill or aged because of these culturally conditioned attitudes. While the language barrier is a significant factor, diet also plays an important role in how the individual adjusts to a different environment. People want the foods to which they are accustomed and which are prepared according to the ways of the ethnic group with which the individual identifies. Foreignborn patients in hospitals have been known to reject foods that are "American" in taste and character, preferring to deprive themselves of nutritional needs rather than eat foods which are not palatable to them. It is to meet such specific needs as these that nationality organizations, through their beneficial fraternities, have established their own institutions for the aged which they support and maintain themselves. These organizations, in their programs for the aged, provide the manifold props of common language, cultural and ethnic identification, familiar diet, and social interests. According to a Pittsburgh bicentennial workshop committee of doctors and social workers exploring the application of mental health principles to the rehabilitation of the aging, nationality organizations "helped ward off the older person's breakdown in identity vis-a-vis his family and community as these latter failed him in the characteristic way of our culture." 1 For here the aged immigrant 1 Report of Bicentennial Workshop No. 1: "How Can Mental Health Principles Be Applied to Rehabilitation of the Aging?" Jan. 22, 1959. Pittsburgh, Pa. |