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2. Pertinent information regarding employees shall be on file in the home and available for inspection and shall

include name in full, maiden name if any, address, Social Security number and previous experience, if any. 3. A complete and accurate report of all accidents occurring to residents shall be submitted by the licensee to the

Department. This report shall include:
a. Date, time and circumstances involved in the accident
b. Attending physician's name
c. Attending physician's report and treatment prescribed
d. Condition of resident

e. Name of person in charge at time of accident, and names of witnesses, if any. 4. Arrangements shall be made with responsible persons or agencies when indicated for the provision and mainten

ance of the following resident necessities:
a. Proper clothing, night attire and foot wear, legibly marked and for seasonal wear.
b. Eye examinations and eyeglasses
c. Ear examinations and hearing aids
d. Dental care and dentures

e. Prosthetic devices and braces 5. Arrangements shall be made with the Division of the Blind of the Massachusetts Department of Education for

the provision of recreational and occupational therapy for blind residents and for residents with impaired

vision. 6. All personnel shall be strictly supervised as to cleanliness of person and clothing. Food handlers shall

wear caps or hair nets, and shall be suitably clothed. Facilities shall be provided for the storage of street

clothing for non-resident personnel when employed. 7. To report immediately by telephone giving complete and accurate details to the Department the occurrence

of epidemic disease and poisoning, including food poisoning. On weekends or holidays call State House,

Capitol Police. This verbal report is to be confirmed in writing within 24 hours. 8. To report as soon as possible in writing all fires involving residents, personnel or property. 9. Instruct all personnel as to their duties in case of fire or other emergencies. A first-aid kit shall be provided. 10. To encourage residents' punctual attendance at clinics when such appointments have been made. 11. To submit an annual report. This form, which shall be furnished by the Department, is to be filled out for

the calendar year, January 1 through December 31, and returned in duplicate not later than January 15 of each

year.
12. To provide adequate facilities for storage of the following.

a. Towels and washcloths.
b. Clothing during all seasons of the year, personal effects and valuables,

c. Beds, bed springs, mattresses, bed pillons and blankets when not in use. 13. Beds, bedsprings, mattresses, bed pillows and bed rubbers shall be properly disinfected as indicated and

following the discharge, transfer or death of a resident. Adequate equipment shall be provided for said dis

infection. 14. All equipment used for the administration of medications and treatments shall be properly cleaned and steril

ized after each usage. 15. To arrange for the religious benefits for residents of all denominations, if desired. 16. To check and identify residents' medications and personal belongings at time of transfer of ownership of the

home. 17. A complete narcotic and sedative count shall be made by the licensee and the new owner at time of transfer of

ownership. This count shall be recorded in the Narcotic and Sedative Book, and shall be signed by the

licensee and the new owner. 18. Pets a. Pets shall not be allowed in any of the following areas:

(1) Kitchens and areas used for preparation, serving or storing of food

(2) Laundries b. No commercial breeding of pets shall be allowed in the home.

SECTION III

REHABILITATION

A. OCCUPATIONAL THERAPY 1. Homes contemplating the establishment of an occupational therapy unit shall submit to the Director, Division

of Hospital Facilities, Massachusetts Department of Public Health, in duplicate, the following information:

home,

a. Name and address of the home
b. Date license was issued and number of beds
c. Name address and qualifications of the reg stered occupational therapist to be employed

d. A floor plan of tie home identifying the proposed location of the unit to be used for occupational therapy 2. The unit, wien provided, shall be well I ghted, ventilated and heated, and shall be separate and apart from

rooms used for resident facilities. There shall be a bell or signal system to summon aid in an emergency. 3. A prescription for resident participation is occupational therapy shall be recorded, da.ed and signed in the

Doctor's Order Book by the attending phys'cian. Th s prescription shall state specifically all details regarding

the type of occupational therapy prescribed. 4. A record shall be kept of the physical progress made by the resident and is reactions to the occupational

therapy prescribed. This shall be incorporated in the resident's individual record. 5. The occupational therapy program shall be supervised by a registered occupat onal therapist.

6. All storage and unit facilities shall be maintained in a sanitary manne and kept in good repair. B. RECREATIONAL THERAPY 1. Homes contemplating an organized recreational therapy unit shall submit to the Department a floor plan of the

iden:ifying the . pecific area to be used. The Department reserves the right to disapprove the location of the unit wien indicated. 2. This unit s iall be well lighted, ventilated, heated and equipped wit a bell or signal system to summon aid

in an emergency. C. PHYSICAL THERAPY 1. No home shall be permitted to establish a physical therapy unit for treating residents without the approval

of the Director of the Division of Hospital Facilities, Department of Public Health.
2. The request for such approval shall be written in duplicate, signed by the licensee, and shall include.

a. Name and address of home
b. Date license was issued, and number of beds
c. Name and address of licensee
d. Name, address and qualifications of the registered physical therapist who will administer physical therapy.
e. A floor plan of the home, identifying the specific areas to be used for administering physical therapy

and/or for the storage of the equipment. The Department reserves the right to disapprove the location. 3. This unit shall be well lighted, ventilated and heated, and hand washing facilities shall be separate and

a part from rooms used for resident occupancy or other resident facilities. 4. This unit shall be used exclusively for the administration of physical therapy treatments to residents. 5. Equipment used for physical therapy shall be approved by the American Medical Association. 6. All physical therapy equipment shall be serviced at least annually by a qualified person. No repairs shall

be made except by a qualified person.
7. The following basic equipment shall be provided for the physical therapy unit.

a. Treatment table and footstool; chairs
b. Adequate linen supply
c. Supply closets
d. Sanitary waste containers
e. Hamper for soiled linen
f. Disposable towels
g. Curtains or cubicles to assure privacy
h. Desk or table and chair for clerical use

i. Hand bell or signal system to summon aid in an emergency 8. A prescription for the administration of physical therapy shall be recorded, dated and signed by the presci"

ing physician in the Doctor's Order Book. This prescription shall state specifically the type of treatment to be

given, frequency, duration and all details regarding the treatment. 9. The physical therapist shall record, date and sign all pertinent data pertaining to the treatment. This shall

be incorporated in the resident's record. 10. No resident shall be un attended while receiving physical therapy treatments. 11. Physical therapy shall be administered by qualified persons:

a. A physician registered to practice medicine in Massachusetts, or

b. A physical therapist currently registered in Massachusetts. 12. All equipment and facilities shall be maintained in a sanitary, safe condition and kept in good repair. 13. All plumbing and electrical installations required for the administration of physical therapy shall be inspected

and approved by the appropriate local or state authorities.

Senator SMITH. How many new nursing homes would you say have been licensed in Massachusetts this year?

Dr. RUBENSTEIN. I do not have that figure, but I would imagine that it is somewhere between ten or a dozen new ones. The reason for the increase in new nursing homes is that the regulations have been changed so that now it is no longer possible to convert a two-story frame dwelling, residence type of building, into a nursing home. Now, in Massachusetts we will only license new facilities built for the purpose of nursing home operation. That has been in existence since January.

Senator SMITH. That was January this year? Dr. RUBENSTEIN. January 1961. We just completed our first year of experience with that new law.

Senator SMITH. During the last several months, Doctor, I have had occasion to visit some of these new nursing homes in the Commonwealth and I have been greatly impressed by the great improvement and the wonderful strides that have been taken in this field.

Dr. RUBENSTEIN. Thank you, Senator. Senator SMITH. What would you say, Doctor, was the need for new additional nursing homes right now in Massachusetts ?

Dr. RUBENSTEIN. As a matter of fact, I am just in the process of evaluating our experience this year with respect to the number of new beds being added in new homes and to compare that figure with the number of nursing home beds which have been added in previous years to see just what the difference is. My impression is that we are perhaps adding newer and more beds under the new program than we did under the old for the simple reason that many of the nursing homes in the past were smaller; 6, 7, 8, 10, 12, 15 beds. The new ones tend to be in the vicinity of 50 to 60 beds. So one new nursing home would represent perhaps three, four, or five old ones in number of beds.

Senator Smith. Of course, here in Massachusetts, I am sure you are all aware of it, the number of people 65 years of age or over has increased a great deal in the last 10 years.

Dr. RUBENSTEIN. Yes.

Senator Smith. Since 1950 I think our regular population figures show an increase of slightly under 10 percent while those over 65 years of age in Massachusetts has increased 22 percent. I am sure that this will point up a greater need for additional nursing homes here in Massachusetts.

Dr. RUBENSTEIN. Yes; we are all growing older fast.

Senator SMITH. That seems to be the case. It is interesting to note right now Massachusetts has more people in this category than the State of Florida, and we here are inclined to think of Florida as the great retirement State. Dr. RUBENSTEIN.

21,000 people in nursing homes. Senator SMITH. What was that figure?

Dr. RUBENSTEIN. 21,000 nursing home beds in Massachusetts at the present time. I believe one of the reasons for this is the fact that our welfare department has been aware of this and has set a regular quota which tends to be a little higher than in most other States.

Senator Smith. Doctor, last week we had hearings in the State of Connecticut, and I was wondering: Do we have different standards for acceptable beds? Does that vary from State to State?

Dr. RUBENSTEIN. Yes; I believe that there are differences. We have simply taken the definition set by the Public Health Service for unacceptability. In other words, if it is a frame structure, we consider this unacceptable because this is the definition set by the Public Health Service. We might have done this, but we could have done it another way. We might have said that any nursing home which complied with our local and State regulation would be acceptable, but this would be just fooling ourselves, and we have taken the realistic approach that we will call them as we see them.

Senator Smith. You certainly are to be congratulated in taking just this approach, Doctor. Let me just say at this time that I appreciate the wonderful work that you have done in your department and we look forward here in Massachusetts to continued advances in this field and hope that we will always be leaders throughout the Nation.

Thank you very much, Dr. Rubenstein. Dr. RUBENSTEIN. Thank you, Senator. Senator Smith. Once more I find it necessary to deviate from our scheduled list of appearances of witnesses. I would like to call Dr. Neville Booth who is representing the Massachusetts Dental Society.

STATEMENT OF DR. NEVILLE BOOTH, MASSACHUSETTS DENTAL

SOCIETY

Dr. Booth. Mr. Chairman and members of the committee, I am Dr. Neville Booth. I represent Dr. Francis C. Bates, president of the Massachusetts Dental Society.

As a practicing dentist specializing in oral surgery with teaching appointments in Massachusetts and as a consultant to a number of hospitals, I have many occasions to come in contact with nursing homes and their patients. My remarks reflect personal observations and the activities of the State dental society.

The problem: The dental care for the homebound and aged is a neglected area in public health. There is no formal

formal program within the dental society at the present time to aid these unfortunate citizens.

The residents of nursing homes present the following types of dental problems:

(1) Poor oral hygiene. This is due to either a lack of adequate nursing care or self-cleanliness. It is doubtful whether the

personnel employed in nursing homes are adequately trained in methods of accepted oral hygiene.

(2) The geriatric patient shows degenerative changes in the teeth, the gums, and other oral structures which require care and treatment. These changes superimposed along with poor oral hygiene lead to infections which can be more serious than bed sores.

(3) Most persons in the category under consideration are partially edentate. In many instances they have inadequate and/or ill-fitting dentures or lack entirely the replacement for missing dental structures.

(4) Few nursing homes adapt their dietary program to the needs of patients with the above-mentioned conditions. The nutritional requirement of these people is of paramount importance, both from maintenance of reasonably good health and the cor

rection of deficiencies and disease. Members of the dental profession render services to patients either at the nursing home or at the office. It is, however, primarily an emergency service consisting of the extraction of diseased teeth and the repair of dentures. Treatment in nursing homes can be very difficult due to inadequate equipment and other local factors.

In most instances the services are rendered by a local dentist on the request of the home. Few, if any, nursing homes have dentists or dental consultants on their staff.

I would like to digress, Senator, to compliment the program which has recently been introduced in the city of Brookline which is almost a pilot study. Remedial

programs: Massachusetts has long been a pioneer in matters of dental education and dental health. The Massachusetts Dental Society is vitally concerned with the dental health of the citizens of the Commonwealth. The problem of the dental needs of the chronically ill and aged was given particular attention last year following the attendance by the president, Dr. Philip H. White, at the White House Conference on Aging. His programs have been continued and expanded under the direction of the present administration.

The Council on Dental Health under the chairmanship of Dr. James H. Dunning, former dean of the Harvard School of Dental Medicine and a recognized authority in public health dentistry, has initiated action. A committee to study the dental care for the chronically ill and aged has been actively working with the Director of the Massachusetts Federation of Nursing Homes to conduct the survey of the more than 700 nursing homes recognized by the federation. This survey will seek to obtain definite information on the dental health, the dental needs and the availability of professional assistance as they now relate to the patients involved.

The cooperation of the Massachusetts Dental Hygienist Association has been solicited for the development of a training program which would provide instruction in dental health and prophylactic therapy for the patients in the nursing homes. Such a program would require closer cooperation between directors of nursing homes and the dental society than now exists.

The State department of public health through its division of hospitals established about 1 year ago a commission for a study of accreditation for nursing homes. Consultants were invited from all related fields. It is my privilege to represent the Massachusetts Dental Society on this commission. At the present time the School of Nursing at Boston College is developing a program to study the various phases of this broad program. It is evident to me that the contribution of the dental profession to this commission will be of vital importance in the final analysis.

I would assure this committee that the Massachusetts Dental Society is not only very much aware of the problems of dental health and nursing homes but is taking active steps to survey the situation.

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