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ELLA TALL, CRANSTON DEAR SENATOR PELL: I am writing as a concerned citizen. My request is that you work for (a) an amendment to Medicare to permit home health agencies to obtain reimbursement for home visits of nutritionists and (b) a revision in the Medicare regulations to set forth minimum qualifications for nutritionists and dietitians employed by home health agencies.

Secondly, concerning the food stamp program, I hope that you will work to have the 92d Congress reconsider the amendments made in January on the food stamp act of 1964 (HR 18582). I object to the reduction of maximums set for eligibility for food stamps because it especially hurts senior citizens. And, as a nutritionist, I strongly object to the future elimination of the food stamp program.


I am writing you as a member of the American Dietetic Association and a concerned dietitian to urge you to consider (1) an amendment to Medicare to permit home health agencies to obtain reimbursement for home visits of nutritionists and (2) a revision in Medicare regulations to set forth minimum qualifications for nutritionists and dietitians employed by home health agencies.

I am certain you are aware of the importance of nutrition in health programs; it is also most urgent that nutrition consultants carry the proper qualifications. Our association has, in the past, urged the Secretary of HEW to recognize the urgency of this problem. Since home visits made by dietitians and nutritionists employed by health agencies are not reimbursable under Medicare, the optimum utilization of nutrition personnel is hampered.

I respectfully request that you give this matter your immediate attention since nutrition should be recognized as basic to health and as an integral part of preventive medicine.

RHODE ISLAND ASSOCIATION OF FACILITIES FOR AGED, East PROVIDENCE The Rhode Island Association of Facilities for Aged is a voluntary organization of not-for-profit extended care facilities, skilled nursing homes, convalescent homes, rest homes, retirement residences and feeding programs for the aged. We are organizations of church, state, and voluntary groups.

All of us are concerned with care for the aged, from medical through supportive. We are an independent organization, not affiliated as a local chapter with any national organization.

The undersigned Administrators of these facilities extend to you our sincere congratulations on your appointment to the Senate Committee on Aging. We are pleased. We also are ready to demonstrate our supportive responsibilities to you by offering our experiences, judgments, or whatever we can do in this regard, both for existing programs or any that may be under consideration in which notfor-profit facilities for the aged are, or could be, involved.

As Administrators employed by governing Boards, we speak here only as individuals who stand to personally profit nothing from expansion of federal programs for the aging. Nor are we seeking additional clients, for not-for-profit facilities normally operate at capacity with an unfulfilled need still remaining. But as concerned citizens and professionals in the care-for-the-aging field, we consider it our duty to advise you of our firm beliefs regarding present programs, or programs under consideration, as follows:

1. We endorse the principles of Medicare as originally set, but fluctuating administrative interpretations as to what is "covered care" have created great confusion on the part of prospective beneficiaries and service providers. Firm guiding rules still do not exist. The program was instituted before it was administratively ready, and failure to provide precise information to eligible beneficiaries has resulted in financial hardship for the aged, because many cancelled existing insurance on the belief that all hospital and nursing home care would be covered.

2. We believe the public assistance program needs re-evaluation and revision. Presently, reimbursement rates do not cover costs in most if not all of the Rhode Island nursing facilities. The not-for-profit facilities must seek charitable contributions, raise rates for the full paying patients or use endowment funds to meet the difference between actual costs and reimbursement rates. Providers of service should be reimbursed on governmentally sponsored patients, at cost, by the sponsor.

3. We are opposed at this time to the so-called “Universal Medical Care Program”, since neither facilities nor personnel are available to make it work.

4. We do, however, endorse the “Catastrophic Illness” principle, rega lless of the age of the beneficiary, if the program specifically defines what care will be covered prior to implementation.

5. Provision for long term chronic care must, at long last, enter the care for the aged scope of coverage.

6. We do not endorse any one of the twelve or so proposals, now under legislative consideration, to revise or supersede the Medicare and/or the Medicaid programs. Rather, we believe the best elements of the plans will be amalgamated by the appropriate legislative committees. We take no stand on the reimbursement mechanism (governmental vs non-governmental insurance companies) but feel any program must be geared so that providers of service are assured of cost recovery.

7. We recognize that the area of critical bed shortage, at least in Rhode Island, is in the Intermediate Care category. Skilled nursing beds could be vacated if adequate intermediate care beds were available to which some patients could be transferred. We feel that a federal grant program for construction of intermediate care beds, perhaps an extension of the HillBurton program, should be considered, so that this category of critically needed beds, locally, could be made adequate.

8. We recommend that the following be used as evaluation principles for any revisions of present programs or new programs:

a. Are physical facilities and trained personnel available to meet the program needs.

b. Have the specifics of coverage been furnished to prospective beneficiaries and service providers in advance of implementation.

c. Is there assurance that providers will recover the costs of furnishing services.

d. Has sufficient time been allowed to develop administrative details

before the scheduled date for program implementation. Our organization does not meet formally during the summer months but will resume its monthly meeting schedule in September. We meet at 2:00 P.M. on the third Thursday of each month at one of the member facilities. It would be our pleasure if you could be with us at one of our fall meetings, should your schedule permit. We do stand ready at any time you desire to have a representative group meet with you in this regard on any visit back to your native State. Our interests are objective our concern is for the aged American in need of help. Respectfully and sincerely,

ALBERT V. LEES, President and Administrator, United Methodist Retirement Center.

(Mrs.) MYRTLE WITHAM, Treasurer and Superintendent, Bethany Home of Rhode Island.

(Mrs.) BEVERLIE WOULFE, Vice President and Director, Scandinavian Home for the Aged.

(Mrs.) CLARICE MASON, Secretary and Superintendent, Elizabeth Higginson Weeden Home. Joseph N. Brown, Director, Nursing Home Administrators Institute, U.R.I.

Richard J. Holden, Administrator, Hallworth House, 66 Benefit St., Providence, R.I.

Oscar K. Swanson, Adm., St. Elizabeth Home, Providence, R.I.
Hope E. Parkin, O.E.S. Home of R.I
JoAnn Allison, Exec. Director, Bannister House, Providence, R.I.
Sr. Estelle Lamathe, Hospice St. Antoine, N. Smithfield.
Joyce L. LaRocque, Asst. Adm. Scalabrini Villa, N. Kingston.
Rev. Carl M. Helgerom, Admin., Home for the Aged in Providence_02907.
Rosemary B. O'Neil, Mgr. Bradford House, Providence, R.I. 02903.
Mininova E. King, R.N., Hattie Ide Chaffee Home, Riverside, R.I.

JEANNE G. DUBE, WOONSOCKET I wish to express my own viewpoint on how Rhode Island Medicaid for the aged has proven a blessing to my elderly parents.

My father who has fairly good health has been caring for mother who is an invalid. These two people are very close and dread the day they may be separated.

Without the care of the Woonsocket Visiting Nurses who come in three times a week to bathe mother and check for any change in condition and then report anything unusual to her physician, they could not remain together. Needless to say their financial position could not allow these services nor, may God forbid, an expensive nursing home which would mean uprooting their many years of togetherness and cause much anxiety to both of them. Rhode Island Medicaid has met many of their needs-also all medication and physician care when his services were required. Dad has some glaucoma and this also is tended to.

When two people who have spent a lifetime together and try so hard to hold on to each other as long as possible, can society allow medicaid to be discontinued or curtail its many services? This happens to be my parents' case, how about all the other needy people with different situations?

Figures for Visiting Nurses' Visit, July 1970-May 31, 1971 Medicare paid approximate---

$2, 085. 65 R.I. Medicaid approximate----

1, 628. 50

457. 15


JEANNE G. DUBE (For Davies and Laura Girouard).

LAURA MORIN, WOONSOCKET With the high cost of living each senior should receive $100.00 monthly. I had to quit work when I was only 65 years old on account of illness, bad to wait 6 yrs. before I could collect, so I don't receive much monthly, so I believe we should have at least $100.00 monthly. I also would have ask that something be done for transportation, markets are in the outskirts of the city, and Doctor's office also far off so, it cost a couple dollars to go to the office, and $8.00 for a visit. $10.00 out of your check just for that is quite expensive. No transportation for pleasure is too expensive, so the old folks must stay close in. Thanking you for trying to help us.

MARJORIE BERRY, WOONSOCKET Please look into Coverage for the elderly not covered by any present bill. Example: If you were born before Dec. 31st, 1896 you were covered even if neither you or your husband ever had Social Security Cards. However, I know there must be many people here in Rhode Island like my own Mother who was born 9 days too late. January 9, 1897. She is entitled to nothing. I don't think this is at all fair.

Thank you, Respectfully.
P.S. Thank you for coming and showing an interest in Woonsocket.

MRS. EDWIN JEDRZYIC, West WARWICK I believe your hypothesis that society (e.g. children of aged parents) is unwilling to care for aged parents is untrue and unsupported. I believe you base your line of reasoning on false assumptions. For example, our social is an urban one. In 1900, we were rural Nation. In fact, 70% of the population lived on farms, etc. The reverse, in 1970, is now true. Over 70% of our population live in urban areas. Urban life-size of home, economics, etc.—does not support the idea of the extended family as we knew it in our developing younger years. If you apprise yourself of current sociological and economic studies you might change your conclusion. All segments of society are affected by this change. Nursing home care does not imply-inhuman care.

However, I promote the idea that maybe our society, in general, continues to place more value on those that can become productive and self-reliant and less on those who are dependent on others for the maintenance of their life and We should consider the total life of an individual and not only certain aspects of his life at a given time and under certain circumstances. I believe that Panel II revealed that this is now the tragedy of the aged-ill.

BIENTA MCELREANY, R.N., WOONSOCKET There should be "socialized medicine" for all over 60. We can't question the need nor conscientiously turn our backs on people who can't help themselves because of age and/or disease. It's unbelievable that this problem exists in the affluent U.S.A.

Foster homes for the aged should be pushed—they like a home atmosphere, and only a small number of those in the nursing homes are ill enough to need this care.

VNS Home visits from the hospital would help keep people out of the nursing homes.

The State should run or closely watch nursing homes as they often exploit the elderly, and Medicaid, and the people aren't happy there.


The 200 members of the Morin Heights Senior Association present their suggestions to be included in the new Medicare and Medicaid, bill-allowances should include financial help for the following:

1. Eye Glasses.
2. Dental, extractions and plates (new teeth).

3. Hearing Aids. We are resident of Low Income Project, R.I. 3—1, Morin Heights, Woonsocket, Rhode Island.

PATRICIA K. ADAMS, R.D., WARWICK I am writing because I, like many other Rhode Island dietitians and nutritionists, am concerned that nutrition has not been given adequate recognition in such major health programs as Medicare and Medicaid. I would like to request (a) an amendment to Medicare to permit home health agencies to obtain reimbursement for home visits of nutritionists and (b) a revision in the Medicare regulations to set forth minimum qualifications for nutritionists and dietitians employed by home health agencies.

The reason for this request is that home visits by nutritionists employed by health agencies are not reimbursable expenses under Medicare, whereas home visits by nurses and physical therapists are reimbursable expenses, Where there is a complicated dietary problem, a home visit by the nutritionist will not only greatly benefit the patient, but can also serve as a teaching demonstration to the nurse or home health aide.

I hope you will help nutrition gain recognitions a basic component of preventive medicine by introducing the necessary legislation in the Senate.

Another cause which I feel is most worthy of support is the expansion of lowcost meal programs to the aging as proposed by H.R. 5520 (Representative Pepper) or S. 1163 (Senator Kennedy).

Thank you for the consideration of these matters and for your sincere interest and support in the past regarding concern for better nutrition for all Americans.

RACHEL JONES, R.D., CRANSTON As a trained public health nutritionist, I am very aware of the need in our State for teaching our community members how to make wise food choices.

Often, the people who need this service most are those who are home-bound. Unfortunately, neither in Rhode Island nor any other state are home visits by a nutritionist or dietitian reimbursable under Medicare.

I know how strongly you believe in preventive medicine and hope you will be able to influence Congress to enact needed revisions for an amendment to Medicare that will permit home health agencies to obtain reimbursement for home visits for qualified nutritionists. Services of nurses and physical therapists are reimbursible. However, these people cannot give the detailed and intense instruction that a well-qualified nutritionist would be able to supply.

It would also be of great benefit to our citizens if Medicare regulations are revised to include minimum qualifications for nutritionists and dietitians employed by home health agencies.



More than a year ago, the American Dietetic Association wrote the Secretary of Health, Education and Welfare urging adequate recognition to the importance of nutrition to health in such major health programs as Medicare and Medicaid. The Association further urged that the qualifications and duties of nutrition consultants be included in the regulations of home health agencies.

Since the Department has failed to respond to the request for the American Dietetic Association, I am personally appealing to you as Senator to urge the Congress that nutrition be recognized as basic to health and as a component of preventive medicine.

I am requesting (a) an amendment to Medicare to permit home health agencies to obtain reimbursement for home visits of nutritionists and (b) a revision in the Medicare regulations to set forth minimum qualifications for nutritionists and dietitians employed by home health agencies.

I appreciate your consideration and time that will be given to this important issue.



I respectfully request that you consider the following proposals by the American Dietetic Association.

(1) An amendment to Medicare to permit home health agencies to obtain reimbursement for home visits of dietitians and nutritionists and

(2) a revision in the Medicare regulations to set forth minimum qualifications for nutritionists and dietitians employed by home health agences. As a registered dietitian working as a nutrition consultant for the Providence District Nursing Association I can see the benefit of such legislation. At present home visits by nurses and physical therapists are a reimburable expene under Medicare. Optimum utilization of nutrition personnel is restricted because home visits are not reimbursable.

A home health agency is designed to provide continuity of care in line with the patient's need. However, very often we come to a dead end because not enough importance is placed on nutrition and diet therapy. Medicare encourages hospitalization by depriving its recipients of adequate home care.

The trend towards shorter periods of hospitalization increases the demands of a home health agency. A dietitian or nutritionist must have the knowledge and skills required to provide interaction with the physician, nurse, social worker and other health personnel to adequately provide for the patient and his family in the home. Minimum qualifications for a dietitian or nutritionist working in a home health agency are therefore essential.

Thank you for your interest.

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