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to the convalescent home nearby. We did. We encountered the faces of about twenty-five persons there. The experience has haunted me ever since. It was ghastly. From not one-neither the female nor the male persons present-could I draw a smile. They reacted like expired persons-figures in a mortuary-who somehow were still not dead but waiting to die. An attendant brusquely asked us who we wanted to see. When we told her, “No one in particular," she seemed disappointed; this was too inexact; it meant that we could not be routed to a specific place so that we would be removed from the premises as quickly as possible and in a stereotyped manner. Oh, what a travesty on time our presence meant!

This type of thing is a reflection on all of us. It is barbaric. It is uncivilized. One is young, one is middle-aged and one is old. At the third stage one is put into what is commonly called a nursing or convalescent home to die.

Almost everyone at some point in his or her lifetime has entered a hospital. When you do this you say to yourself "I don't like the looks of this building, I don't like the smell of a hospital and I hope I can get out of here as quickly as possible." If you go in for a serious operation, you know it will be two or three weeks. If it is a relatively minor matter, you know it will be a matter of a few days. Whatever the time element, your mind is focused on getting well again and getting out.

Unfortunately, the deposit of your person at the doorstep of a convalescent home has a far different connotation.

Psychologically, when you enter a hospital you are a whole person going in and you hope to be a whole person coming out.

For older persons going into a convalescent or nursing home, psychologically, you go in knowing that this is the end of the line-you are to be there until you die.

This is horribly inhumane, and not in keeping with the humane thinking of society today.

Ninety per cent of the present nursing homes would have it so. It is economically more feasible to admit a patient, figure out the arrangement for payment and keep that person in bed or in a semi-invalid condition until the expirant breathes his last. Then, a bed opens up and another patient can be admitted. It need not be so. The knowledge of medicine today has advanced to such a degree that two thirds of the persons entering nursing homes could be returned to their own homes if application of this knowledge could practically be put to use and these patients had a home to which they could return. I have seen demonstration projects that prove this out. For instance, a public health nurse in Detroit, if my memory serves me correctly, picked out five stroke cases in as many nursing homes and set out to teach the staff how to treat stroke cases. Three out of the five were returned to their own homes, one expired and one remained in the nursing home.

The profit motive in nursing homes has made a mockery out of the intent of such places.

I strongly advocate that all nursing homes be publicly owned and administered. This is, of course, a general statement that should in no way take away the rights of existence for non-profit homes. Many of these are engaged in highly meritorious service.

But the present arrangement in which most persons are treated in non-profit hospitals where the professional impetus is to make people well regardless of cost while at the next stage most people are taken to for-profit nursing homes where the incentive is to take care of people at the lowest possible cost to the nursing home operator is senseless.

It is hardly in keeping with our times.

The Well-Being Project was not created to keep persons out of nursing homes. But it has substantially served this purpose.

It was created to do a direct service job for older persons. The federal grant came under the heading of health but it is a well-known fact that health is only many problems that face older persons. I have already pointed out the one of the psychological factor. Finances, lack of communication and loneliness -particularly loneliness-are probably more important components of the total picture.

The Metropolitan Detroit Committee on Aging sponsored a number of in depth studies on the question of what are the needs of older persons. These go back to the late 1950's and early 60's. In Detroit's largest public housing project,

Herman Gardens, we studied the wants of close to 1,000 older persons, possibly more. Was it health? Was it something else that caused them worry? We found out. It was a multiplicity of problems. With a social worker, Lois Pettit, I participated in in dept studies of older persons living in hotels, in rooming houses, in private homes. Stories on all of these subjects, including a story on a public health clinic at Herman Gardens, are available.

We found out.

What to do next?

The Well-Being Project with a highly skilled social worker and a registered nurse with public health training, working as a team, without rigid controls at the neighborhood level was the answer. We did not want these teams to make intricate detailed reports. Either you give service or get reports.

The program is not one hundred per cent perfect. As these workers become better established in their communities the time spent on aggressive visitation in their neighbor hoods decreased. These are highly dedicated workers. In another type of service one might recommend bringing in a new team-always with the intent of putting on the muscle to visit more people in their homes. But when you deal with old people change is a factor you can do without.

If not too many social scientists get involved, the Well-Being. Project, not easily defined because it deals with human beings in the best method to cope with human beings, offers a formula, or a principle, if you will, that should be duplicated on a broader scale throughout the Detroit area and applied in every community throughout the country.

While I am on the subject of aging I would like to take this opportunity to make a couple of other points.

On the question of insurance I have had a devilish time trying to figure out how to get the protection through Medicare and two private insurance policies for my own eighty-five-year-old mother-in-law. My wife nags me because she says as an expert I should have all the answers. I have developed a fair understanding of what I am doing. I have appealed to other experts, such as Bill Fitch in Washington, and they in turn indicate that the problem is so involved they don't have all the answers. God pity the old person who does not have someone helping him.

Recently, at a hospital in Detroit I overheard an older person tell the snippy clerk dressed in a nurse's uniform at the desk, "The hell with all this stuff. So, I'll pay my bill and let it go at that."

Most doctors and most hospitals don't give a damn how the patient makes out with respect to his own pocketbook. All they are concerned with is the responsibility incumbent upon them. The doctor treats. The hospital wants payment for its services. How the patient is reimbursed is the patient's business. And I'm afraid that nine out of ten older persons do not have the knowledge to pierce through all of the red tape to get what he or she is entitled to.

All laws such as Medicare should be simplified. And doctors, hospitals and nursing homes that do not subscribe to the system in full, including the task of processing the claims of their patients, should be stricken from the approved list.

All of this in addition to the requirements concerned with high standards of

care.

The government should take into consideration the need for keeping older persons except those chonically ill-in their own homes. My mother-in-law and I fight like cats and dogs. But she is a part of our family life. She takes part in taking care of her great grandchildren. She has duties and chores. And as much as she gripes at age 85 she also laughs and gets great satisfaction out of being part of life. Furthermore, she is never told that she may be taken to a nursing home. She has a home.

I regret that I could not participate in your hearing in person. I was informed that your meager expense allowance permits coverage for only one person per project. I have had close to forty years in newspaper. work, first in Chicago and then Detroit. I was with the Detroit Free Press for 26 years-for about the last 15 as a reporter in the social sciences covering mental health, the aging and the handicapped-and I left there about Feb. 1.

One of the reasons is that I came to the conclusion the "big," monopolistic press is not interested in doing a real job of serving people. The communications field is dominated by the motives of big business. I felt I could build up a weekly newspaper to the point of economic and professional status so that the real pur

pose of a newspaper could be preserved: to give top quality news to its readers and serve its community. When that goal is reached I can then, again, become a spokesman for those who cannot speak for themselves on a wider basis. For the time being it was not economically possible for me to be there-although my heart is entirely with what you are doing.

Maybe, sometime, the rules can be changed to the extent that you can have the privilege of hearing from persons who may have something to offer, whether they are on a payroll or not and whether they can afford to pay their expenses to appear or not.

I am completely dedicated to the spirit of the Well-Being Project. It has a purpose. To me, keeping people from the despicable prospect of being victims of a nursing home is enough.

Sincerely yours,

83-481 0-67-pt. 1-21

WARREN STROMBERG.

APPENDIX 3

A REPORT TO THE PRESIDENT ON MEDICAL CARE PRICES BY THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE FEBRUARY 1967

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Last August, you asked me to study the reasons behind the rapid rise in the price of medical care and to offer recommendations for moderating the rise. In response to your request, I am transmitting herewith a Report on Medical Care Prices. The Report was prepared by Assistant Secretary William Gorham of this Department with the assistance and advice of the Department of Labor and the Council of Economic Advisers.

Medical prices have been rising for many years at a rate substantially in excess of the rise in the general price level. Like other prices, medical care prices accelerated in 1966. The Bureau of Labor Statistics Index of Medical Care Prices rose 6.6 per cent in 1966. Hospital room rates rose even more precipitously.

The Report attributes these price rises to the pressure of the rising demand for medical services, the relatively slow growth in the supply of physicians, rising wage costs in hospitals without commensurate increases in productivity, and the increasing complexity of medical care provided to the patient.

The Report holds out little hope for an early end to medical price
increases. Growing population and rising incomes, as well as the
public commitment to assure adequate medical care for all citizens,
will continue to put upward pressure on medical prices.

Nevertheless, steps can be taken to moderate the rise in medical prices by using medical resources more efficiently. To this end, the Report recommends:

1. The establishment of a National Center for Health
Services Research and Development to discover and
disseminate new ways of delivering health care
efficiently.

2. The encouragement of the group practice of medicine.

3.

Strong Federal support for State and area-wide planning
for the efficient use of health resources.

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