Old age is a dark threat to many people. I do not believe there are actually many opportunities for them to earn money once they have retired. People who are well, who are doing a good job and who could for a very few years get a bonus in social security deserve a break. There won't be too many of them. Forced retirement on a low income with no hope is the last thing that anybody wants. If an elderly person can supplement his income after retirement, then I say God bless him and let him have whatever he can earn without deductions. The time is short at best.

Thank you for bringing to your office as Senator such great qualities and for spending so much of your time in the public interest. I want you to know that I think you have proved to be one of the most conscientious and devoted Senators that our State has ever had.

Very Sincerely yours,

(Miss) DORIS E. JOHNSON, Librarian.

ITEM 2. LETTER FROM ARISTIDE B. MORSILLI, JOHNSTOWN, R.I. DEAR SENATOR: I am writing this letter to you with the hope that in the not too distant future this problem will be a thing of the past.

In mid June of this year, my wife was rushed to R.I. Hospital for a condition which cannot be treated. After several weeks of tests, I was notified of the results of the tests and was told she would have to be hospitalized in order for her to be medicated so that she will not lapse into a deep sleep as she did when stricken. As of today she no longer talks, hardly recognizes anyone and is confined to bed. This is the result of premature brain damage which I am told sometimes happens to young people. Doctors cannot account for the condition, nor do they know of any treatment. As my wife is only 62 years old, she does not qualify for any aid program. This condition began when she was 58 and she was hospitalized in 1968 and was examined again in Oct. 1970 at the Lahey Clinic, Boston.

When discharged from R.I. Hospital, the Social Service Dept., of the Hospital assisted me in placing her in a nursing home for which I am paying $196.00 weekly for her care. Now you can well appreciate that at these rates, I cannot survive very long financially as my weekly salary certainly does not amount to what I am paying for her care. Consequently what lifetime savings we made together will not last very long.

It seems to me that a country as great as ours should have a program whereby no such thing should occur. I think it is about time for our government to be concerned with our own problems and let the rest of the world contribute a bigger share to their own problems. The time has come to spend more on our citizens' health and well being instead of all that money being spent for unnecessary killing and subsidizing of other countries.

No doubt, there are many cases like mine and I am not trying to be looked upon as a special case, but I am hoping that some program will eventually be introduced to give our people security and care throughout their days. This, of course, can only come about by your efforts and the efforts of others in your position. I hope we will soon have the best health programs in the entire world.

Sincerely yours,

Copy to Senator Claiborne Pell.

ARISTIDE B. MORSILLI.

ITEM 3. LETTER TO SENATOR PELL FROM ANTHONY J. AGOSTINELLI, EXECUTIVE DIRECTOR, THE URBAN COALITION OF RHODE ISLAND September 21, 1971.

DEAR SENATOR PELL: We respectfully request that the attached reports of our Health Task Force become parts of the Senate subcommittee's records which received testimony on health in Rhode Island yesterday. Thank you for your interest. Sincerely,

Attachments.

ANTHONY J. AGOSTINELLI,

Executive Director.

THE REPORT OF THE TASK FORCE ON HEALTH

Dr. CHARLES J. MCDONALD, Chairman. The Health Task Force of the Urban Coalition of Rhode Island was organized to provide health leadership in the community. It was organized to address itself forthrightly to important health issues. We consider our main role to be that of a supporter, critic and coordinator for the various providers of services and the consumer.

The first organization meeting of the Health Task Force of the Urban Coalition of Rhode Island was held on February 5, 1970, at the Providence Public Library. Attendance of provider groups was exceptionally good, however, there was very limited attendance on the part of the "consumer" group or inner city poor. Therefore, the original intent of the meeting was abandoned and it was decided to hold another organizational meeting in an area of greater accessibility to at least one segment of the inner city poor. The second organizational meeting was held on February 25, 1970, at the Opportunities Industrialization Center Building. At that meeting the process of electing four members from the Task Force's general membership to the Working Committee was carried out.

Keeping in mind the charge of the Urban Coalition of Rhode Island, a set of ten goals were outlined for the Health Task Force. Some were considered immediate, others were considered future goals. All were considered attainable. They were as follows:

1. To reaffirm our belief in, and restate our endorsement of the Neighborhood Health Center concept as a vital force in the delivery of health services to the urban poor.

2. To seek ways and means of extending the health center concept into other communities.

3. To broaden and strengthen the association of the existing health centers with the community hospitals.

4. To increase the moral and financial commitment of the State Departments of Social Welfare and the State Department of Health to the Neighborhood Health Centers.

5. To pursue the concept of group practice in the urban areas of Rhode Island where physicians are not now available. The groups may or may not be directly aligned with the existing or future health centers.

6. Anticipating difficulty with Item 5, we turned to an additional goal. To pursue the use of physician's assistants or semi-physicians in the areas of concern. We would thus reduce the need for physicians in these areas, and in all probability reduce the cost of delivering health services.

7. To study and make recommendations regarding health manpower. We recognize that the Coalition has appointed a Task Force on Manpower. However, it was the consensus of the Health Task Force that we, as a group of health professionals, i.e. physicians, nurses and administrators, and consumers having an intense interest in the future of, the expansion of, and the betterment of the health care system, were best suited to pursue this particular task.

8. To improve Dental Health Services to the urban poor.

9. To consider how best to improve public education in matters of health, and delivery of health services.

10. To consider approaches to the vital matter of improving nutrition in the inner city. We cannot improve health without improving nutrition. With these goals in mind, the Working Committee of the Health Task Force held its first meeting on March 11, 1970. In attendance at that meeting and in weekly meetings thereafter were members of the Executive Committee and Board of Directors of the Coalition, the four community representatives, and representatives chosen by the Chairman from the following organizations-Blue CrossBlue Shield, State Department's of Health and Social Welfare, Progress for Providence Health Centers, the Hospital Association of Rhode Island, and the Directors of the Miriam, Rhode Island, and Roger Williams Hospitals. I wish to add, that on occasion, representatives from the Neighborhood Advisory Boards of Progress for Providence, and the Rhode Island Fair Welfare Organization attended as observers.

The Working Committee, after appraising the enormity of its goals, elected to pursue immediately the solutions to those that were either immediately attainable or were attainable with minor changes in our present system. To that end the following Subcommittees were formed.

64-350-72-pt. 3- -10

1. Health Center Financing, Immediate and Future, Father Francis J. Guidance, Chairman.

2. Group Practice and Insurance, Albert Brennan, Chairman.

3. Health Education, Dr. Joseph E. Cannon, Chairman.

4. Health Manpower and Employment, Jack R. Fecteau.

5. Physicians Assistants, Dr. Arnold Porter.

6. Dental Health, Dr. Joseph Yacovone.

The report and recommendations of these subcommittees are on file in the UCRI office. They will be summarized below.

Prior to summarizing the subcommittee reports, I would like to allay a fear that has been expressed by members of our Working Committee and members of the Task Force-at-large. That in attempting to focus on too many issues, our efforts are diluted, thus, our accomplishments will reflect this dilution. It is argued that the Neighborhood Health Centers should be the main focus of all our attention. The solution of its problems would lead to the solution of our Health Care problems. I agree fully with this premise. Therefore, let me point out how the conclusions of our subcommittees, in most instances, relate to the delivery of Health Care via the Neighborhood Health Centers.

The Subcommittee on Group Practice and Insurance in a very thorough assessment of the situation has made the following recommendations-that we accept the premise that proper Health Care is "obligatory" in much the same sense that in education it is the obligation of the State to provide educational facilities and of the individual to utilize those facilites. In the matter of health care, the medical professionals must provide and the consumers must seek. The "third party" or administrative agent must supply the financial and administrative "bridge" between the two. The subcommittee concluded that the four basic disciplines necessary for proper health care, preventive, diagnostic, curative and rehabilitative are available but not accessible to poor people. There is a need to pull down the "barriers of inaccessibility" between the "seekers of services" and the "providers of services"-barriers that range from geographical to psychological, from intellectual aloofness to ingrained apathy, from haughtiness to condescension-but most of all, from high cost to low or non-existent incomes. Fundamental to accessibility of the four disciplines, particularly for the disadvantaged is the concept of the "Neighborhood Health Center". We support the theme of binding the nine existing centers together through a single Corporate entity having administrative and financial jurisdiction over each, without relinquishing the totality of autonomy of the individual centers.

Group Practice, in combination with Neighborhood Health Centers, would evolve into comprehensive community health facilities that would mobilize and organize all the skills of a community in such a way as to make use of people and equipment in providing all health services to a neighborhood within a city. Each of the centers should have a multi-specialty professional staff that would include the disciplines necessary to provide comprehensive medical care to the community.

Vital to the delivery of proper Health Care via Neighborhood Health Centers is an alliance with, and reliance upon hospitals.

The key element to the success or failure of the concept of Neighborhood Health Centers is the stabilization of income. They cannot operate without assurance that enough dollars will be made available on a timely basis in an orderly business-like manner. We suggest that income stabilization would best be met through capitation, i.e. that each of the Center's registrants pay, or have paid on his behalf, a preset annual fee that would cover the total cost of his care. The payment source of the capitation fee would be through reshaping or redirecting programs already in effect, both government and private. I might add here that meaningful discussions have been held with sponsors of the Rhode Island Group Health Association regarding participation in such programs.

The subcommittee concludes with the following statement. "It is also assumed that the 'disadvantaged' do not own exclusive rights to the lack of accessibility of proper Health Care, giving rise to the very real possibility of Neighborhood Health Centers acceptance of other than the traditional 'disadvantaged'."

The Subcommittee on Financing of the Health Centers report is summarized as follows. Procedures for the incorporation of the Health Centers, within the guidelines set by the office of Economic Opportunity, are completed. The Corporation has been supplied with additional OEO working and planning funds that when added to funds from other sources are sufficient to carry the Health

Centers an additional year. It is anticipated that money will be available from federal sources for prolonged operation of the Centers once new proposals have been submitted.

Additional sources of federal funds include the HEW and Model Cities Projects. Additional sources of State funds include the State Department of Social Welfare whose contribution to the Health Centers should be increased to meet the actual costs of the care of patients whose health service costs are the responsibility of the Social Welfare Department. Perhaps a system of capitation as suggested by the Group Practice and Insurance Subcommittee is the most feasible method for this department to pay its share of the patient costs.

Local sources of funds which of necessity must be private include the Dexter Fund, and the United Fund. Partial private funding will eventually be necessary when Federal funds have "dried up". Planning for such an occurrence must be made now.

Other local funding sources include the Hospitals, primarily, the Miriam, Roger Williams, Rhode Island, and St. Josephs. Direct financial assistance may not be feasible. However, assistance in terms of management manpower, cooperative training programs, items of equipment, etc., are entirely feasible.

The Subcommittee on Health Manpower and Employment stresses the need for augmentation on the principle of "upward mobility". It is ludicrous for this nation to have shortages of “health manpower" both professional and nonprofessional, and high unemployment rates among the inner city poor. The greatest problem appears to be the inability of a worker to enter the health employment field and be allowed to grow financially and professionally. He is stopped by licensure practices, professional mores, personnel policies and attitudes of peer groups within an individual hospital or health organization.

The subcommittee intends to combine forces with the ad hoc Health, Manpower and Education Committee of the Hospital Association of Rhode Island and the Governor's Task Force on Health Manpower to pursue a concept of "opening up" the health field to the disadvantaged through accelerated efforts in training, education and motivation along with altering the attitudes and traditional barriers without lowering the quality of performance.

This subcommittee intends to work with the Neighborhood Health Centers to upgrade training programs and accelerate the "upward mobility" of its trainees. The Dental Health Subcommittee is calling for the initiation of a comprehensive dental health program for the poor of Rhode Island. This program should include dental care, preventive dental measures and health education. New methods of delivering dental care are to be explored, evaluated and initiated.

The Health Education Subcommittee has pointed out the lack of available manpower in the State of Rhode Island to initiate a meaningful program of health education. The Urban Coalition should strongly endorse the recent actions of the State Board of Education in appointing a committee to develop a comprehensive Health Education Curriculum for our Elementary and Secondary Schools. The Coalition should support a concerted effort on the part of our state-supported colleges and university to develop programs for the training of Health Educators. We must have Health Educators to teach within the guidelines set by our new health curriculum.

The Urban Coalition should join the Medical Society and other interested groups in endorsing a unified health education program rather than piecemeal programs as now exist. We must urge each community throughout Rhode Island to demand that health education programs be introduced in each school.

The Subcommittee also feels strongly that the concept of "peer group" education be strongly endorsed. This type of educational program works ideally through the Neighborhood Health Center. Center nurses and aides from teams to seek out neighborhood people and inform them regarding health practices and available health resources.

We must also consider as an important facet of health education, the correction of the attitudes of health professionals, semi-professionals and non-professionals, toward the "poor" consumer and vice versa. Far too often, the attitude of these groups is cited by the poor consumer as one of the prime causes of his lack of utilization of available health services.

The Subcommittee on Physicians Assistants has not had sufficient time to formulate its thinking. The Chairman of this subcommittee was selected in absentia and has only recently been able to begin the formulation of his task and the members of his subcommittee.

Before closing, I would like to express my sincere appreciation to the membersof the Task Force, and especially the Working Committee, for their initial efforts to bring together a workable and effective program for the delivery of health care for the urban poor of Rhode Island.

I hope that they will continue to work just as hard in the ensuing months to bring our proposals to fruition. Because, after all, we have only made proposals, we must now stop the dialogue and proceed on a course of action. Our goals, we must remember, are those which are immediately attainable.

[Attachment.]

To: Dr. Charles J. McDonald, Chairman of the Health Task Force.

From: Charlotte J. Montiero, Community Liaison for Health Services and Programs.

Subject: Progress Report for Health Task Force of the Urban Coalition of Rhode Island, Inc.

I. NEIGHBORHOOD HEALTH CENTER CORPORATION OF PROVIDENCE

The Community Liaison for Health Services and Programs has been participating as a member of the "planning team" of the Health Center Corporation in developing the Comprehensive Health Care package to be submitted to OEO in Washington, D. C., in late February. The planning team is composed, of course, from the staff of the Neighborhood Health Centers' administration under the direction of Mr. Michael Gerhardt, Planning Director of the Health Corporation. Various organizations (agencies) are represented on the planning team: the Department of Social Welfare, the Health Department, the Regional Medical Program, Progress for Providence, Miriam and Rhode Island Hospitals, and Blue-Cross-Blue-Shield. Several representatives from other agencies have been given the task of preparing various sections of the proposal. A copy of the assignments for the draft proposal is included in this report.

The Comprehensive Health Care package will provide a capitation scheme for the nine (9) de-centralized health centers. The capitation scheme is presently being prepared and will be considered by the Department of Social Welfare and Blue-Cross-Blue-Shield. Before such a plan is submitted to Washington, it must also be approved by an ad hoc planning review committee of the Neighborhood Health Centers' Corporation Board. Vital statistics concerning the capitation scheme will be made available at a later date.

II. NEWPORT VISITING NURSES' ASSOCIATION

The Visiting Nurses' Association of Newport indicated in November that they wanted to explore the possibility of expanding their child health conferences into Family Health Care Centers, for the local civilian hospital offers no outpatient service other than the emergency room. The only ambulatory services offered are given by private physicians or at clinics operated by the Visiting Nurses' Association. The Visiting Nurses' Association presently provides a generalized public health program for Newport and three adjacent towns, serving a population of 77,093 people. Statistics provided by the State Department of Health and community surveys show a great need for the following services: OB-GYN, Pediatrics, Family Planning, Chronic Disease Screening, Speech and Hearing Clinics, Nutrition, Internist.

The Visiting Nurses' Association selected several persons from various health agencies and their board to serve on a planning committee. The planning committee selected as their consultants Miss Lynn Cowger, Regional Medical Program, Mrs. Irene McGovern, Visiting Nurses' Association, and the Community Liaison for Health Services and Programs. We are initially preparing a proposal for a centralized Family Health Care Center to be located in the Visiting Nurses' Association's facility. The Visiting Nurses' Association is located in a high-rise building for the elderly with 7,500 square feet of office and clinic space. This building is also located in the "heart" of the largest "prime" target area. There is a strong possibility that the Regional Medical Program will make available $20,000 seed money for planning. We are exploring funding possibilities at present and propose to have the proposal for the comprehensive Family Health Care Center completed by early March.