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to $16 and now it has gone up to $21 plus. We can't afford to pay that. I brought her to the hospital for open heart surgery and could not afford the cost of a nursing home. I understood that Medicare would pay 80 percent of the cost of the nurse visiting every day and Medicare did pay 80 percent of this care; but, I could not afford the cost of the nurse visiting every day so I dropped the visits from every day to 4 days a week. Now, it is 1 day a week. I have been taking care of my wife myself. My request is that Medicare should pay 100 percent of the cost for a visiting nurse. I am required to pay for all of her medication and it is impossible to do this and pay 20 percent of the cost of the visiting

nurse. Senator PELL. Thank you very much. We will come back to the questions in a moment but I would like to get all the evidence and the examples of the problems that I am sure that everybody in this room has been exposed to and knows about. I want to get them in the record and then we will talk about them. Mrs. Chauvin, would you give us your statement.

STATEMENT OF IRENE CHAUVIN, WOONSOCKET Mrs. CHAUVIN. My name is Mrs. Irene Chauvin, Woonsocket, R.I. Senator Pell, I want to tell you about an experience my mother had under the Medicare program.

My mother was taken from Fogerty Hospital to Grandview Nursing Home, April 20, 1971. This was to be covered under Medicare. On May 19, 1971, I received a letter from the board at the nursing home that she was off Medicare. On May 19, my doctor told me—when I phoned him—that she was covered by Medicare. The nursing home still maintained that she was not covered. Then, in the meantime, I was told that she was back on Medicare. I also received a call on June 3 that she was not covered; and was then informed on June 4 that she was again covered. I still don't know who is going to pay the bill for the period from the 20th of May until the 3d of June. I have been unable to determine why these changes keep on occurring and Mrs. McDermott at the nursing home said she was unable to understand or explain the problem herself.

Senator PELL. Thank you very much.

Now, Mr. Peters, returning to your testimony and the illness of your wife, what was the total cost would you say of your wife's sickness? ?

Mr. PETERS. Well, you mean the cost of the operation?
Senator PELL. The operation, the medical costs and so forth?
Mr. PETERS. For the operation, $1,000.
Senator PELL. How much?

Mr. PETERS. One thousand dollars, and almost another $1,000 for the hospital.

Senator PELL. About $2,000 in all ?
Mr. PETERS. Right.

Senator PELL. Am I correct in saying that Medicare the way it is presently written and Blue Cross covered most of these costs?

Mr. PETERS. Yes, Senator.
Senator PELL. What would you say, about 90 percent of the cost?
Mr. PETERS. They covered everything.
Senator PELL. So far?

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Mr. PETERS. Yes.

Senator PELL. What you are really saying is that despite this coverage you are now faced with an economic burden in the future?

Mr. PETERS. It is the medicine, it costs a lot of money.
Senator PELL. And the visits for the nursing care?

Mr. PETERS. That is right. The nurse was coming to the house for 100 days and that was paid; but after 90 days I have to pay $3 a dayshe was coming four times a week—and I couldn't afford it. Now she is coming only

once a week and I have to do the work myself. Senator PELL. What you are saying then would be that the cost of the visiting nurse and the medicines should be covered by Medicare?

Mr. PETERS. Yes.

PRESENT PROPOSALS AN IMPOSSIBLE HARDSHIP

Senator PELL. It is not one of the problems that we face ere. We always put the emphasis on looking after the pers

looking after the person who is sick in the hospital and not enough on follow-through afterwards. Now, in this regard, the present proposals out in the Ways and Means Committee of the House of Representatives could reduce and narrow the benefits that people will be getting in your case and that would be an impossible hardship I think.

Mr. PETERS. A box of pills cost almost $19 and I get 200 pills in a box, and I think she has to take about eight of those pills a day.

Senator PELL. And there is no help from Medicare for that?
Mr. PETERS. No help whatsoever.
Senator PELL. Not five cents ?
Mr. PETERS. No.

Senator PELL. How much does it cost you for the visiting nurse to come?

Mr. PETERS. Well, $3.

Senator PELL. Is that out of your pocket or does Medicare take that?

Mr. PETERS. No, it is out of my pocket. Medicare pays for the rest, 80 percent.

Senator PELL. Right. Thank you very much for these facts. I think it is amazing that the community as a whole is not aware of this. I am very glad that you have been willing to share your experience.

Nr. PETERS. My wife is a sick woman, Senator.
Senator PELL. I fully realize that.
Mr. PETERS. Very sick.

Senator PELL. I apologize for probing into your personal life but it is only by personal examples

Mr. PETERS. It is all right.
Senator PELL (continuing).

That we can get at the problems. Now, as I understand it, Mr. Farley, let me put it this way. How many days was your wife in the hospital when she was sick?

Mr. FARLEY. I couldn't say exactly the date. I would say about a week.

Senator PELL. About 2 weeks or a week!

Mr. FARLEY. Over a week and then the doctor advised me that she would get stronger if we transferred out to the nursing home in Lincoln.

.

Senator PELL. Of the time that she was in the hospital, how much did you pay out of your own pocket?

Mr. FARLEY. I paid $71.70. I have the bill here.
Senator PELL. About 3 or 4 days that you had to pay for?
Mr. FARLEY. They charged me $629.15 and Blue Cross paid $570.65.
Senator PELL. Right.

Mr. FARLEY. Then they added to this $58.50 as she was in a private room, and I had to pay the hospital $71.50. I have the check to prove it here.

Senator PELL. Your thought was that she was eligible-since you were eligible for 100 days nursing home care—when you took your wife out and she was in the nursing home. That you wouldn't have to pay anything more; isn't that correct?

Mr. FARLEY. Well, the nurse up there was very nice with me and she advised me that she had a letter

Senator PELL. Could you speak a little closer to the microphone so that all the people can hear you.

Mr. FARLEY. She advised me if I paid in advance—instead of paying $23—I would pay $20 a day; so I sent her a check for the nursing

a home for $140. My wife came out of there—from my knowledge on Wednesday. I thought I had a little refund coming to me but I didn't get any refund as yet. The way they told me, I had no refund coming so I didn't make my fight about it.

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RETROACTIVE COSTS FOR NURSING HOME CARE Senator PELL. My understanding is that you were told retroactively that she would have to pay $140 for the nursing home care which you thought would be covered; isn't that correct?

Mr. FARLEY. The 7 days would be covered; but, instead of paying $23 I paid $20 and she came out of there on Wednesday.

Senator Pell. Then the problem from your point of view was that you did not know all the facts and found yourself with a bill of $140; is that correct?

Mr. FARLEY. I have a small paper here that I took with me. It is marked here $20, paid in advance; 7 days, $140, Tuesday, March 9. Here is the check for the $140.

Senator Pell. Right. Thank you, but to digest your testimony so that all of your friends here understand it, the problem as I understand it is that you were retroactively told you owed the Government $140; is that not correct?

Mr. FARLEY. I don't owe them—I paid them.

Senator PELL. That is right, but you were retroactively charged to pay the nursing home $140 that you did not expect you would have to pay under Medicare? Mr. FARLEY. For the 7 days.

7 Senator PELL. That is correct.

Mr. FARLEY. My wife came out of there, to my knowledge, on Wednesday.

Senator PELL. So this idea of reducing the benefits of the nursing home care would make your situation even more acute or worse, wouldn't that be correct?

Mr. FARLEY. Yes.

Senator Pell. Thank you.

Mrs. Chauvin, going back to your testimony. You as the daughter of an older person faced the problem that many of our middle age citizens today face. As I understand it, after your mother was sent to the nursing home, Social Security told her that the cost would not be covered once she was there and you appealed that decision. Is that the situation now?

Mrs. CHAUVIN. That is right. She was under Medicare from the 20th of April to the 19th of May—when Mrs. McDermott told me that she was off Medicare. Then I contacted my doctor and he told me that she was on Medicare. That is why this has been pending—not paying the 15 days—as Mrs. McDermott didn't know where we stand; she was on-and-off and off-and-on again. I don't know who is suppose to pay that bill.

Senator PELL. Could your mother be cared for in any other place than a nursing home or a hospital! Could you take care of her at

? home?

Mrs. CHAUVIN. I cannot. It takes two to put her back in bed-my mother is practically blind. We have tried to find a nursing home, and Mrs. McDermott has tried, and we can't find a place.

Senator PELL. Now, if Medicare does not pick up the tab and if your appeal is denied; what will that mean that you will have to pay? What will be the cost to you?

Mrs. CHAUVIN. That will be $32 a day.
Senator PELL. How many days?
Mrs. CHAUVIN. For 15 days.

RUSSIAN ROULETTE WITH BANKRUPTCY

Senator PELL. About $500-$480. What this example shows is that the effort to cut back on Medicare cost by reducing the coverage of the patient in a nursing home will cause hardship. What they should be doing, in general, is to try to pick up the cost of the old people's care—but with the minimal service possible, so that if you don't have a hospital you can go to a nursing home. Rather than reducing the days in the nursing home, it seems to me that the Government should increase them. What you are doing here is sort of playing Russian roulette; with the result of your bankruptcy if this is not resolved eventually.

I would hope that perhaps one little good thing will come of this hearing; because my purpose here is to listen, and to hear the problems, and to educate myself. But, out of this process of education may come the hot light of publicity that can cause a quicker determination of your appeal. I would wish you success in that determination.

Mrs. CHAUVIN. Thank you, Senator Pell.

Senator PELL. And I have real regrets if it does not work and I bleed for you

and I understand the problems. I thank the three of you and would ask that our next panel, which is concerned with Medicare Delivery Problems, come forward.

I thank Mr. Peters, Mr. Farley, and Mrs. Chauvin very much.

Now, Mrs. McDermott is the administrator of the Grandview Nursing Home and Miss Anna Gray is the director of social services at the Woonsocket Hospital and Miss Mabel Huggins is the executive director of the Visiting Nurse Service of Woonsocket and I would ask that they come forward.

Before you get started I think I ought to read into the record the proposed cutbacks in Medicare and Medicaid which are presently being considered in the House of Representatives. This is for the record but I think it would be of interest to everyone and especially the older citizens who are here.

FIVE CUTBACKS IN MEDICARE AND MEDICAID

The House Ways and Means Committee ordered reported on May 17, 1971, a comprehensive Social Security Welfare Reform Bill. Some provisions of this bill would result in cutbacks in Medicare and Medicaid coverage.

These cutbacks are five in number.

In Medicare there are two: One would increase the deductible under Part B of Medicare from $50 to $60-an increase of 20 percent. The other cutback would be to charge older citizens who are in the hospital $7.50 a day for hospitalization between the 31st and the 60th day. This would be an increase of some $225 in doctor bills for the older citizens.

For Medicaid the proposals are as follows: One, States would be permitted to eliminate or reduce the scope and extent of health care services presently optional under Medicaid-such as dental care, eyeglasses, and outpatient prescription drugs. In this regard I would offer a great compliment to Rhode Island for leading the States in human determination and the administration of the Medicaid legislation. The second cutback would be that the Federal matching funds for Medicaid would be reduced by one-third after 60 days in a general or tuberculosis hospital; 60 days in a skilled nursing home, unless the State establishes an effective utilization review program; or 90 days in a mental hospital. Under the third proposal medically indigent patients under Medicaid could be subject to a premium charge based on income. Moreover, States would be authorized to make the medically indigent subject to copayment provisions which would not be based on income. In addition, States would be permitted to establish costsharing arrangements for categorically needy recipients—the aged, blind, and disabled—but only for services not required to be provided under the State program.

These proposals are under discussion and one of the purposes of this hearing is in a small way to exert pressure to make sure that these reductions do not take place frankly and in this regard we are very lucky to have the witnesses before us now who tie directly with the previous panel. We started out with a panel of those who are covered by Medicare and now we have a panel of people who are very knowledgeable, very humane, and very concerned with delivering the Medicare services that should be delivered. We had Mrs. Chauvin with the problem she was facing in getting her appeal acted on so that her mother can stay in the Grandview Nursing Home and we have Mrs. McDermott with us who is the administrator there who did the best she could to help her and is sort of caught in the middle of this situation.

I would ask Mrs. McDermott to start out as the immediate witness.

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