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Miss Huggins. There are approximately 180 visiting nurses in Rhode Island.

Senator Pell. Very roughly!

Miss Huggins. There are 11 agencies and probably anywhere from one to 50 nurses. Well, in the Providence District there are probably 50 nurses.

Senator PELL. Is it your own experience that the well being of the patient is improved by being able to remain at home, as opposed to going to the hospital or nursing home. What is your own view?

Miss HUGGINS. I think there are emotional and social problems also that affect a person when they are ill. It is not just an illness that has a name. There are so many different factors that not only affect the person who is ill, but the entire family, and if a person can remain at home with the family I think that it helps to solve a lot of these problems that they have.

Senator PELL. How many visiting nurses are there in Woonsocket?
Miss HUGGINS. I have 15.
Senator Pell. You feel that is enough to do the job or not?
Miss HUGGINS. No, it is not.

Senator PELL. How many, do you think, would be needed if all the medical care at home was given that should be given?

Miss HUGGINS. Well, for instance, of our visits in 1970, over 50 percent of these visits were to people 65 and over.

Senator PELL. Let me get that again. Over half of the visits were to people over 65 ?

Miss Huggins. Right; 43 percent of these were Medicare patients.

Senator PELL. Do you feel that this many patients who could use your services now are not getting it themselves because you don't have enough nurses to do it?

Miss Huggins. Well, I think that if Medicare coverage were better we could hire the nurses. But, as Mr. Peters pointed out, we reduced our visits to his wife simply because his plan B visits are running out. So, in order to give him—or give her—some guidance and health care, we have reduced the visits from five a week to four a week. Now it is once a week, so that they still will be able to see her, and yet she's not really receiving the care that she needs. We are not seeing her as often as we would like to.

Senator PELL. This is why we are relating these panels to each other because Mr. Peters' case is one that is in very real application here. If you could go as often as you would like 6 days a week or 5 days a week, would you say there is any other way that these expenses could be picked up, any other agency that could pick them up?

COSTS ARE HIGHER THAX PAYMENTS

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Miss HUGGINS. We are, ourselves, a nonprofit organization. We receive our moneys from Medicare, from Medicaid. Sometimes a Medicare patient can go from Medicare and receive Medicaid; but, in return, this program reimburses $8 a visit whereas our fee--and this is actual cost under cost analysis is $13.75, so we are taking a loss here. There are other agencies too that we receive moneys from. We are also a united fund

agency.

Senator PELL. Your average visit costs you an average of $13.75?
Miss Huggins. Right.
Senator PELL. Are your nurses RN's or practicals?
Miss HUGGINS. I have three practical nurses and all the rest are RN's.

Senator PELL. Thank you very much for the directness and the openness of your testimony. I think we should be moving on to the next panel.

Thank you very much, Mrs. McDermott, Miss Gray, and Miss Huggins.

Senator PELL. Now, the third panel. We will have them introduce themselves and make their statements.

Mr. Roy. Yes, sir, my name is Joseph Roy and I am a member of the Senior Opportunities and Services.

Senator PELL. Thank you very much. The first witness will be Mr. Duarte who is the head of the local OEO program and a very articulate witness indeed. What I was hoping he would do was to direct his testimony as much as possible to the question of nutrition food health.

STATEMENT OF AMBROSE DUARTE, EXECUTIVE DIRECTOR,

SOCIAL PROGRESS ACTION CORP.

Mr. DUARTE. Senator Pell, Mayor Lussier, Representative Skiffington; I certainly couldn't afford to miss this opportunity to make our point known in regard to many of the problems of our senior citizens here in the city of Woonsocket.

Sometime last summer the agency was very fortunate in receiving some $19,000 for Senior Opportunities and Services.*

Now, in any event, we started a program because we were aware that many of our senior citizens of Woonsocket had poor nutritional habits, and that many of them were living alone. As a result of their living alone, and isolated from the rest of society, their eating habits began to deteriorate to the point where they were practically not eating at all. We have heard the common phrase, tea-and-toast diet, and this is not just a common phrase—it is a reality. Through our efforts in talking to the senior citizens in the city of Woonsocket, we found out from them that they were very much interested in a nutritional meal being provided for them at least on a weekly basis. The agency started a program such as this. Presently we have approximately 850 members participating in our program. We cater to 250 citizens weekly.

Besides the nutritional effort that we have provided for them, we have also created a friendly social atmosphere which brings our senior citizens together; and allows them, for the first time, an opportunity to make their views known. We have found in surveys—that we have conducted in the past—that we have not uncovered the type of information that is prevalent with the many problems of our senior citizens today. This type of information is presently coming forward. We are finding, over and over again, there are many problems—not only of health and nutrition, but many, many more.

*See appendix 1, item 2, p. 194.

64–350 0-71-pt. 2-4

Our program could be expanded many times over. As a result of what has been happening with the program, we firmly believe that we can provide the feeding program-perhaps twice or three times a week. But; unfortunately, like every other agency, because of our times, problems of funding are always in existence. Presently the Senior Opportunity program is in jeopardy, and is not being refunded for another year. I think this has brought a great deal of dismay and heartache to our senior citizens. We have had an opportunity to remove from them the loneliness, the isolation, the feeling of being rejected from society in general. As a result of this, many of the health conditions which we have heard this morning are due to some of these causes and conditions of our senior citizens. They are alone, they want to be needed and they need to be wanted. This is one of the most important things that we are finding here in the city of Woonsocket.

I could probably go on and talk about some of the many problems. But I would rather confine my remarks to what this hearing is consisting of today. We have discovered that many of our senior citizens, if they eat one good nutritional meal a week they are doing excellent. A lot of them are not prepared to make a meal for themselves because, in fact, they are living alone. They have no desire to prepare meals for themselves. A great many of them came from large families, originally, and are only used to preparing large meals. If we have to talk about preventive care, one of the most important aspects of preventive care in regards to senior citizens is the maintenance of the common nutritional diet that is so important to their livelihood and wellbeing. Unless we have this type of effort in existence, I think we are going to see the chronic illnesses. I think we are going to see many of the health problems and the problems of delivery of services to our senior citizens. I think the problem of nutrition is very closely associated with health—and the health aspects that we have heard todayand, above and beyond that, I think it is rather important that we see to it that our senior citizens be at least provided with some of the nutritional services and nutritional benefits on a day-to-day basis. I would like to see our program expanded only for the benefit of our senior citizens. Thank you.

Senator PELL. Thank you for a very articulate statement, Mr. Duarte.

Now, coming to Mrs. Doss.

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STATEMENT OF REBECCA DOSS,* DIRECTOR, OFFICE OF SENIOR

OPPORTUNITIES AND SERVICES, WOONSOCKET

Mrs. Doss. Yes, thank you. I think the only thing I can really add to Mr. Duarte's statement is that all services through the Senior Opportunity and Services program are provided absolutely free of charge. There is no charge whatsoever. Thank you.

Senator PELL. Mr. Roy?

*See appendix 1, item 3, p. 196.

STATEMENT OF JOSEPH ROY, WOONSOCKET

Mr. Roy. I want to thank you very much for all you have done in the past, Senator, and I know that you are not going to let us fall by the wayside. Now, I, as you know, am a senior citizen and I have been in Woonsocket for 45 years. I know all about Woonsocket, and was born in Woonsocket-left it for a while—and I have been here now for the last 45 years. Now, getting the elderly together for amusement is very important, and this program, I believe, is one of the few in the State and probably goes a lot further than that. We put it in motion with Mr. Duarte's office—that was Social Progress Action Corp. which is known as SPAC—and when they formed it they invited me to take part, and I certainly would not refuse. I did all I could and so did they. I think we have done a real nice job. Our people—when we told them, the last couple of weeks, that we probably could not be funded—almost fell down in their seats. It hurt very, very much. We told them that they were going to have an opportunity, when we heard you were coming down. I know that you are going to go to bat and pinch hit for us, and I know you are going to hit a homerun for us.

Senator PELL. I don't know about that.

Mr. Roy. Now, I want to talk about our Gay 90's Dinner Club first. I think that was a mainstay of the program and it was decided that we were going to sign applications and get members to come to our dinner meeting. We never knew whether it was going to grow or not, but it grew and grew and is still going. The people are in love with the Gay 90's club, and we have more than 850 members at this time. I know if this club falls, it is going to hurt. This dinner club meeting gives the elderly a chance to meet old friends. Every week someone comes up and tells me that they met some people here that they hadn't met for years. That makes them very happy, and also they make some new friends, and they become pals, and they go out together, and they invite each other to their homes, and they are very very happy to meet those fine people. Now, Mr. Duartě was saying that a lot of people don't have one good meal a week. We don't do that either, because we give one a week; but, there are four groups and they have to wait 4 weeks before they have another one. We don't have the funds necessary to double it up so they would have at least two a week. Those are the same meetings with all kinds of people and, I would say, all kinds of groups that come to our meeting. They speak on different problems and projects and what have you.

We also have doctors, nurses, priests and ministers, and everybody there, and it makes a whole nice day. We give them movie picturesand all that—and when the day is over, people hate to leave. So, all-in-all, I think this is a real fine program and all those that know about it would not want to see it fall.

Now, about the Senior Opportunity and Services that is something else again. People want to know about this, and want to know about that, or they need a ride here or a ride there. For example: to go to the doctor, the hospital or whatever, to a store for shopping and we do all that. All of us keep busy and, I must say, Mrs. Doss is one that works. She doesn't care how many hours it takes; she wants to make sure that the program is well taken care of, and that everybody is happy. She never leaves anyone without an answer, and if she doesn't have an answer to something she is going to go out and find it; and make sure that the answer is turned over to the party that asked the question. This makes all of those people happy. Even, myself, I have taken a lot of people here and there; because, as you know, taxis cost a lot of money and their checks are not too high. If they go to the doctor, to and from that would be twice the amount. So we do this for them and we don't care what they ask, they are going to be taken care of.

I think there is no one in our group that wouldn't come up and tell you that they think it is the greatest thing that has ever happened to Woonsocket. Thank you very much.

Senator PELL. Thank you very much for your testimony.

18 PERSONS OVER 45 DIED OF MALNUTRITION

I am particularly interested in this problem of nutrition. I served for some time on the Senate Special Committee on Hunger and moved from that to the Special Committee on Aging, which is why I am up here now. I was struck, in the course of that, with the problems of malnutrition of our very older citizens. I realize that when inflation, and the taxes and the rent is due-or the utilities—you tighten up on the belt and it is taken out of food. In one 3-year period in our own State, my recollection is, 18 people died of malnutrition; and, every one of those who died of it was over 45 years of age. I remember those statistics. I also remember the fact that many of the advertisements you see on television for dog food and cat food is not only for dogs and cats, but older citizens use this food.

I realize that the problem of food is a much more real one than we are aware. In this connection—incidentally in the OEO grant that you are working under—I am not sure if you are aware of the fact that the Meals on Wheels portion of the program is funded.

Mr. Roy. We have Meals on Wheels better than 20 per week, at this time.

Senator PELL. I am talking to Mr. Duarte here. Are you aware of the fact that that portion of it is OK?

Mr. DUARTE. No: I didn't.

Senator PELL. We checked on it, on the telephone, and the Meals on Wheels portion—we have received assurance—will be funded. There is no assurance for the other portion of the program,

and we will do our best. But, as you know, the general tendency in this administration is to cutback many of these human investment programs. At least one of the wonderful programs that you are working on here will go on; and it is news that I am delighted to bring, especially. Some pleasant Monday morning news for a change.

Now, what do you think, Mr. Duarte, that we should do to encourage or help along with these nutrition programs? What would you say you would like to see us do in Washington?

Mr. DUARTE. I think, Senator, through our investigation, meetings and dealings, and talking to people we have heard from them some of their needs in this particular area. There is a vast majority of them

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