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and ask questions-whether it is Mrs. Slater or Mr. Williamson or whoever they say "we haven't got any money. They are cutting back." The Senator just told you that they are making these cutbacks. Then they say, "Why don't you write to your Senators, write to your Congressmen?" Don't forget there are a lot of Senators and a lot of Congressmen in this country. How many of you do that? I would like to read something. Incidentally, I have been sitting here and listening to all these speakers. I am sure there is a lot of truth, but get this. I happen to be on the Governor's advisory board; I am not a politician-I represent the old folks, that is, all you people. I want to read this because this was something that we talked about-and may I do so? Senator PELL. Certainly.

Mr. CORNETT. It says here:

The elderly are urged to protest the cut in funds. Rhode Island senior citizens are urged to write to the State Advisory Committee on Aging and to write their congressional delegation in protesting the administration's cut in Federal funds for programs for the elderly under the Older Americans Act.

In the letter that was sent to senior citizen organizations throughout the State:

Robert S. Berg-the chairman of the United States Bureau of the Budgetstates there is an allocation of $29.5 million for all programs under the Older American Act for the coming fiscal year; despite the fact that the Congress authorized $105 million for these programs.

I have those here, too.

Mr. Berg noted that the allocation for the community grant in Rhode Island as being reduced by $44,000 for the fiscal year-beginning July 1 of this year. Such programs as senior centers, Meals on Wheels and the transportation project, and there would be severe financial problems if this cut were allowed to stand, it was noted. The reduction would also preclude the funding of any new programs in Rhode Island under the Community Grant provisions of the Older American Act. We feel you should be made aware that the Bureau of the Budget has appropriated lesser amounts than Congress wants made available to older people, the letter stated. We would suggest-it continues-that each of you write individual letters to your congressional delegates and to Mr. William E. Oriol, Staff Director of the Senate Committee on Aging.

Senator PELL. Yes, Mr. Oriol is right here, and I would like to have him stand up and take a bow.


Mr. CORNETT. I am telling them what Congress has authorized for programs for the elderly and what should be appropriated by the Bureau of the Budget. Now, I have a list here am I boring you people? Well, listen, this is why you haven't got any money. Just as the Senator said about the cutbacks, and the people that sat at the table there said they haven't got the money to do what they want to do this is the reason, I don't make these figures. We feel where this letter was sent out to the different units-that you should know this. We feel that you should be made aware of the financial programs affecting the older people. These are in progress in Congress right now. Here are the amounts authorized by Congress; and, note that the Bureau of the Budget appropriated lesser amounts than Congress wants made for all our people. So don't blame the Congressmen, and don't blame the Senators, because this is the meat right here. The congressional authorization-and these are the ones that we are talking


about here the community grants and State agencies; the Congress authorized $30 million, and the Bureau of Budget's allocation brought it down to $5.45 million. I can go on, but I don't want to bore you much. In closing, here, the final analysis of the whole thing—in the figures compiled-is that the Congress authorization for the elderly was $105 million; and the Bureau of the Budget, the total allocation was cut down to $29.5 million. That is why the State of Rhode Island is working on a budget that is now $44,000 less than in the past. I thank you very much.

Senator PELL. This testimony was particularly helpful because it shows the difference between what is authorized and what is appropriated or spent. We in the Congress authorize, or develop ceilings on the amounts of money that we think should be spent; but, then less money is spent or released in the end. What is needed is a new approach in Government where more money will be spent on what we call the human environment program-the health, the elderly, education-and less money to be spent on defense and space. Will our next witness identify himself?


Mr. RICHARDS. My name is Arthur Richards and I am the general president of 10 different clubs in Woonsocket with a membership, a total membership, of about 3,000 people.

Now, I was happy to hear about the Gay 90's club because I had a dinner, one time, there as a guest. They are doing wonderfully well, but I understand the Gay 90's-if you are making too much money you cannot go ahead and have a meal there. Now, I wonder if it could be arranged that people like myself who live alone, and that cannot prepare meals the way you should, and don't get too much of a pension either-if we could go ahead and pay part of the dinner. Say, for instance, that we pay two-thirds of the dinner; pay that out of our pockets, and we would get one good meal a week. This way the Government could finance the rest. I think that would help those that cannot belong to the Gay 90's club. They could go ahead and have one good meal a week, and it couldn't cost us as much as going to a restaurant which costs around $2 to $3 for a meal. Thank you.

Senator PELL. Thank you very much for the suggestion. It may involve a change in legislation but we will examine it and see what can be done. I would add that I made an error earlier when I said the Meals on Wheels was definitely approved. I have been informed by a subsequent phone conversation that the program is still being considered. We are pushing on one side and the course of the economy is on the other. We were a bit premature. The next witness?


Mr. DURAND. I am Mrs. Alexina Durand, of the Senior Citizens. I want to speak about the cabs which have meters. When I have to shop at a store, or something, just the one way costs me $1.25 and when I return it is the same thing-and that comes to almost $3, and nothing to show for it. Then another thing, we have given a bill to Repre

sentative Skiffington on the utilities to try to reduce what we are paying on the phone and electricity. We haven't had any answer from him, yet, so I was hoping that could be worked out. Also, in regards to the seniors on their pension, it would also be a big help in reducing and helping out towards the other expenses they have to meet with. So you know that would be a big help if it can be worked out.

Thank you.

Senator PELL. On the Federal level we are working on some bills*I have cosponsored three-which would reduce transportation costs on those means of transportation on which some of the funding is Federal. Those would be airline or federally regulated railroads; but, when you come to taxicabs I am afraid the Federal Government is not going to do this. Perhaps Representative Skiffington would like to reply.

Mr. SKIFFINGTON. Senator, and people here today, I did introduce a bill to reduce fares on buses, and utilities, and the bill is still in the committee of the House of Representatives and like everything else this morning, when you get down to the real cold hard facts the answer is money. As the gentleman said here that's the problem-getting the money to finance these programs. As you all know we have a financial crisis in the State of Rhode Island which is not any different than any other State and not any different from the Federal Government and we are always trying to do our best for senior citizens and anyone else that needs help.

Senator PELL. Anyone else in the audience that would like to say something at this time?


Mrs. HERVE. I was listening today, unfortunately it is all one side and I appreciate what you have been doing for all of these places. I am still a taxpayer at 75 and every year they jack the taxes instead of giving us a reduction-you know-especially at my age. I am not the only one. I have never been on relief, never had a nickel for relief nor asked for it, but why should we be taxed, you know, at full price? They raise the tax every year, and they jump up the evaluation besides. Another thing about the State tax, you know, this week-or last Saturday-I got a bill and I went down for my State tax. I have a few dollars in the bank. I explained to the woman down there in the office in Woonsocket and asked if I had to pay that. She said, "Well, I don't know, you fill it in and we will let you know about it." Now, Saturday I got a bill for it plus 25 percent-which they will never get from me, because I already filed it. If they want the rest of the money they will get it. I won't be penalized, no. I don't care who hears it, anybody from the State House I don't care.

We got 10 percent for the Medicare, that is only the Medicare of 10 percent for the old age and the very same day they raised our fee for the Medicare, is that right? After that I pay a Blue Cross-and I bet a lot of these people pay Blue Cross besides. It used to be $11 for 3 months and now I get a bill for $21. That is what we got for the 10 percent more.

*See appendix 2, p. 202.

Thank you.

Senator PELL. Thank you very much. I am afraid that you confirmed the fact that there are two things sure in life, death and taxes. Our last witness; would you identify yourself?


Mrs. BEAUDOIN. I am Mrs. Harriet Beaudoin. I got a raise in my pension and they give us Old Age Assistance of $7. In Massachusetts they are getting $10, how is that? They raised our pension and Old Age Assistance to give us $7 in Old Age Assistance; but, in Massachusetts they are getting $10. How is it they are getting $10 and we are being cut to $7?

Senator PELL. These are differences in the State regulations, and I am not familiar with them myself. I would think that Mrs. Slater might be able to help us. Well, she has left. Doctor Mulvey? Ďr. MULVEY. The State regulations.

Senator PELL. This is a Federal hearing and I am afraid that we can't help you in this at all.

Mrs. BEAUDOIN. Thank you very much.

Senator PELL. I want to thank each of you, as we bring this meeting to a close. Now, you have seen these blue sheets of paper and if any of you have any suggestions or ideas write them out on the piece of paper and mail them to me.* I think this was an interesting and instructive meeting. We had witnesses from one community, Woonsocket, talking about the problems as they affect the group-one group of people—and that is the elderly. The record will provide many insights to Congress as they consider changes that need to be made.

Today we have also heard some new suggestions on amendments to H.R. 1. These suggestions indicate that Medicare should be expanded and not contracted. There should be less restrictions on nursing home care, greater use of home care services, and there should be more nursing homes throughout the country. Moreover, it seems that the hearing has shown that Washington will do better to do more listening and less issuing of regulations.

The subcommittee is in recess, subject to the call of the Chair. (Whereupon, at 12:30 p.m., the subcommittee was recessed, to reconvene at the call of the Chair.)

*See appendix 3, p. 219.


Appendix 1



The Rhode Island Home Health Agencies wish to take this opportunity to share with you some of our concerns over the plight of the patients over age 65 who were led to believe that Medicare would solve most of their health problems and who now find out-of-hospital service to be severely limited. Rhode Island is fortunate in that there is complete coverage of all areas of the State by Home Health Services.

When the Federal Medicare legislation was being drafted, the Visiting Nurse Services, certified under Medicare as Home Health agencies, were considered an important resource in keeping costs down because, according to experts, health maintenance care and prevention at home would be considerably less expensive care than care in a hospital or extended care facility. Yet the conditions for participation which govern reimbursement set up a barrier to the use of home health services, limiting what might become an important health resource. Since the patient must be certified as needing skilled nursing care on an intermittent basis or physical or speech therapy in order to qualify for home health benefits under Parts A and B, the definition of skilled nursing care and the interpretation thereof becomes a most important matter for Home Health Agencies providing services to Medicare patients.

In August 1969 the U.S. Department of Health, Education and Welfare's Social Security Administration's Bureau of Health Insurance issued Intermediary Letter No. 395 on the subject of "Skilled Nursing Care Provided as a Home Health Benefit". This letter contained a definition of skilled nursing care which became a matter of grave concern to Home Health Agencies.

It appeared that the Home Health Agencies and Federal Medicare Intermediaries had not interpreted the definition of skilled nursing care uniformly throughout the country,

In an effort to assist Rhode Island Home Health Agencies in determining acceptable levels of care, a subject in which Social Security has shown much concern, the Rhode Island Blue Cross, Federal Medicare Intermediary, prepared a brochure entitled "Level of Care Guidelines" in early October 1969.

As the definition's interpretation still was not uniform among the Rhode Island Home Health Agencies, it was felt that the Rhode Island State Nurses' Association's official definition of Professional Nursing should replace the present Medicare Program's definition of skilled nursing care.

The Rhode Island State Nurses' Association's official definition is as follows: "Professional Nursing is a health service to individuals and Groups, which is based on principles derived from the biological, physical, and social sciences. It utilizes the skills in observation, communication, and interpersonal relationships. It contributes to the maintenance and promotion of health, and to the provision of physical and emotional care, comfort, and support to the people with a variety of health needs, by: health teaching, and supervision of patients and families; teaching, supervising, directing, and participating with all members of the nursing team in identifying patients' nursing needs, developing and implementing appropriate nursing plans; collaborating with other health professionals in providing comprehensive

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