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some amplification for it will reveal to you one aspect of the problem that concerns you and that is the kind of people who are administrators of nursing homes in Massachusetts and in New England. At least those with whom we have come in contact, which may now run to some 125, we wish to indicate to you their desire to establish higher standards and to become a profession.

Now the important thing to bear in mind is that they came to the university, and they came to the university as other fields of endeavor have come to us, for their continuing education. I have reference to schoolteachers, superintendents of schools, engineers, pharmacists, and the like. As I said, not just a mere handful are involved nor is it merely a gesture on their part intended as a public relations gimmick, and in a moment it will become clear why I so say.

These folks in this first year of the program have spent of their own money as much as $500 each by way of tuition fees and the like. They have invested a considerable amount of their time. As they come to the initial undertaking it means spending 4 days in our conference center. In other words, they have to be away from their place of business from 4 to 5 days. In addition, when they then attend the subsequent seminars, some of them travel as much as 200 miles in 1 day. It would mean leaving their home as early as 6 o'clock in the morning to come to the conference center and spend an entire day, not leaving until 5 and then traveling back to their place of residence. The nearest that anybody is to the conference center is about 40 miles.

Now what is the program? I am not going to take the time except to say that we require them to undertake this workshop and then the seminars. They are not merely concerned with skills and techniques but understandings because we endeavor to understand who is the elderly citizen, how can we cooperate with them, and the like. I wish time permitted me to go into detail as to the content; it just does not permit

it. I would like to say at this time that among those who are on our staff are Dr. Rubenstein and Mr. Connelly whom you heard this morning

Now the major effort is in cooperation with the Massachusetts nursing homes and with the American Nursing Home Association. Initially we started on the State level. We are now working with the entire New England area. As Dr. Rubenstein told you this morning, we concluded the third workshop just yesterday afternoon which began Monday morning.

Now let me give to you one indication among others that I think will be important to you. We endeavor to evaluate everything we do. When we undertook the seminars that were conducted this past spring—and if I have not stated before I would like to say so now, we began the program just a year ago. It was in November of 1960 when we held our first workshop at the Endover Inn but which we now hold at our own conference center. We made a stipulation that we would like to undertake to evaluate what we are doing. Senator SMITH. Could you finish

up

in one moment? Mr. HURWITZ. Yes, sir. They gave us the grant of $500 for that evaluation which we have just received.

I will conclude with this and then I will be able to submit, if you desire, the report we made of our first year's activity. I would sike you to know that the Special Committee on Aging was most cooperative and has been furnishing us with the material for all of our training programs.

Thank you very much.

Senator SMITH. Thank you, Mr. Hurwitz. We will be glad to have your full statement and the reports you mention to be included in the record.

(The prepared statement of Mr. Hurwitz follows:)

PREPARED STATEMENT OF FRANCIS L. HURWITZ

Mr. Smith and members of the subcommittee, my name is Francis L. Hurwitz, residing at 14 Egmont Street, Brookline, Mass. I am associate professor of adult education, and director of special programs in the Center for Continuing Education of Northeastern University, Boston, Mass.

I felt it incumbent upon myself to submit for your consideration some aspects of the continuing education program the Department of Special Programs of Northeastern University has been developing for nursing home administrators in the New England area. I believe the committee should be aware of this educational activity on the part of a growing number of nursing home administrators. It seems to me that it imparts a trend that should be taken into cognizance, the development of more effective administrators that I feel will improve the quality of nursing home care. Also, I was in attendance in this morning's session and heard the presentations that were made, several having included reference to the educational activity in nursing home administration being conducted by Northeastern University. I have reference to the statements of Dr. A. Daniel Rubenstein, director of hospital facilities of the Massachusetts Department of Public Health ; Mr. Patrick A. Tompkins, commissioner of the Massachusetts Department of Public Welfare; and Mr. Edward F. Connelly, executive director and general counsel of the Massachusetts Federation of Nursing Homes.

These references to the educational pursuits of nursing home administrators are undoubtedly considered by you important activities for what they indicate. However, it seems to me there should be amplification of what is involved in the Northeastern program. By so doing, I believe it will reveal the kind of people who have the administrative roles; also, to indicate the desire on the part of the administrators who are participating in the program to overcome their inadequacies in order to meet more effectively the demands of a changing role, as well as an attempt to establish high professional standards.

I should like to emphasize that not just a mere handful of administrators have been involved. I should like also to emphasize that their involvement in the educational program has not been just a mere gesture, nor is it intended by them as a public relations gimmick. As of this date, 137 nursing home administrators have participated in 11 training offerings; 3 having been workshops in nursing administration, each of which was a 4-day-living-in experience, the most recent of which concluded yesterday afternoon; and 8 were seminars in management principles, each having been 10 weekly 3-hour sessions, concerned with such areas as organization and administration, interpersonnel relations, financial operations of the nursing home, and mental health of the aged.

Further, I should like to have the committee have an awareness that these administrators have been obliged to spend a considerable amount of time and money in this educational effort. Quite a few have spent up to $500, and a number have traveled as much as 100 to 200 miles each day of their attendance at the seminars.

Initially, the offerings were undertaken in cooperation with the Massachusetts Federation of Nursing Homes, and involved administrators of Massachusetts facilities. However, as the program developed, our offerings were made on a regional basis in cooperation with the American Nursing Home Association, involving the six New England States.

As I have already stated, we designed the educational program to have the participants approach their studies through workshops and seminars. While the focus is on the administrator's role in the nursing home, we do know that the way in which a nursing home organization functions has a direct impact on the care of the patients.

I thought it would make my statement more meaningful if I appended a reprint of a report of our first year's activity, authorized by my colleague, Dr. Reuben J. Margolin, and myself, which originally appeared in the September 1961 issue of Nursing Homes, the publication of the American Nursing Home Association. I also thought it might be helpful to you if I made available the program of the workshop in nursing home administration which was held this week, November 27 through 30, at the University's conference center, Henderson House.

I would like to take this opportunity to express our appreciation for the cooperation we have received from the Special Committee on Aging of the U.S. Senate in furnishing us materials, especially for the workshops.

Finally, I wish to inform the committee that indicative of the seriousness with which these administrators approach their desire for continuing education, the Massachusetts Federation of Nursing Homes, at our request, gave us a modest grant of $500, though of great significance in its intent, to evaluate the seminars. The study has just been completed and will be published soon, and I shall be pleased to furnish copies of the findings as soon as they are available. It is our desire to test and evaluate at all times our offerings, in order that we may fulfill most effectivley our responsibilty in the educational program we are developing for the administrator of the nursing home. The continuing educational opportunities for nursing home administrators should be encouraged. One of the best ways, I submit, is by aiding and supporting the educational institutions, making available educational opportunities for nursing home administrators.

[Reprinted from Nursing Homes, September 1961 issue]

A UNIVERSITY REPORT ON ADMINISTRATOR PROGRAM BY FRANCIS L. HURWITZ,

B.B.A., LL.B. AND REUBEN J. MARGOLIN, ED. D. Northeastern University has been engaged, through its department of special programs of the center for continuing education, in developing a training program for nursing home administrators since the late summer of 1960. It is the first institution of higher learning to engage in such a pioneering venture. This, of course, makes for the excitation that comes from frontiersmanship; and which simultaneously engenders the sense of grave responsibility whenever the educator dares to venture forth into uncharted territory.

The initial request for a training program came from a courageous nursing home administrator who had been attending, along with three other nursing home administrators, workshop for nurses at a local hospital just south of Boston, Mass. The four administrators felt that similar training programs specifically geared toward the problems of the nursing home would be of great value. Shortly after Labor Day, 1960, the Education Committee of the Massachusetts Federation of Nursing Homes met with Northeastern University's Department of Special Programs. During several meetings in September there was an intensive exploration of needs as seen on three levels: those of the administrators, those of the nursing homes, and those of the community ; together with the setting of objectives to be gained. The approach was one of programing in adult education.

WHAT IS ADULT EDUCATION ? What then should be our conception of adult education? Our society is dominated by a tremendous amount of change. The important fact, however, is the rapid acceleration of change. For the first time in the long history of man the knowledge and personal equipment we acquired in youth will not function adequately in our mature years. Until this present older generation, an individual could live his entire life and be able to have the formal education of his youth still valid and serve him. The only change needed was that of youthhood. The time span of social revolution now is a generation; whereas, formerly, several generations were required. We are the first generation doomed to obsolescence unless we accept and adapt to change throughout life. From the professions and industry comes loudly the cry “study or perish.”

Adults demand education that serves their recognized needs. They desire a learning experience that helps them solve their immediate life's problems. Since they are in a position to demand suitable learning experience, adults usually insist on the following conditions: Adults desire to set their own prognoses, and so want to take out of each learning situation that knowledge and those skills and attitudes which fit their recognized needs. To the extent to which

1 Director, special programs, Northeastern University, Boston; and associate professor of social science, Department of Special Programs.

adults have the opportunity to share in defining their problems, is the degree to which they are freemen, and the direct relationship will be behavioral change. Adults want educational experience that will help them master life, not merely subject matter. They want to draw upon organized knowledge as a resource that gives more meaning to their experience. Adults want their learning to be useful in the immediate or foreseeable future. Adults want to be actively involved in the learning process. Finally, adults demand competent leaders who have a thorough knowledge of a special field and the ability to relate that field to the purposes of the learner.

ADULT BRINGS LEARNING

The adult brings to learning situations a tremendous range of stored learnings. The teacher should capitalize on the possibilities of transfer from the stored knowledge and skills of the adult. Some are negative attitudes, including the memories of childhood which make the adult learner bring to the school old feelings of insecurity. So the adult educator has the responsibility of trying to give the learner a sense of security and mastery without any feeling of shame or inadequacy.

There should be the understanding, by the adult educator, of differences in environment, culturally and technologically; the differences in behavior patterns because of subgroup affiliations. Further, an awareness that adults by their education and their experiences, may have ideas, tendencies, attitudes, and interests which interfere with their modification of older learnings and acquisition of new adjustments.

Our explorations with the education committee were carried out in the light of these basic principles of adult education. We saw that the nursing home was occupying a position of ever-increasing importance in our medical and social communities. The rapid growth of the nursing home requires a careful analysis of its current status and the formulation of effective management methods. Therefore, we felt that we should focus on the administrator's role, and not patient care. However, it is important to recognize that the efficient administrator does affect patient care, and not just peripherally.

As the initial project in our training program, we undertook to conduct a residential workshop in nursing home administration in cooperation with the Massachusetts Federation of Nursing Homes. We had two basic objectives: (1) Analytical discussion of the community image of the nursing home, with recommended procedures for future action; and (2) the development of sound management policies and practices for effective care of patients and for profitable operation. The workshop was designed to serve the needs of top-level administrative personnel responsible for policy and operation; primarily, the ownermanager.

WORKSHOP HELD

The workshop was held at the Andover Inn, on the campus of Phillips Andover Academy, Andover, Mass., from Monday evening, November 28, through Thursday afternoon, December 1, 1960, and involved 31 nursing home administrators. Concentration on the initial sessions through Tuesday night was on management principles in the organizational setting, with a concern for recruitment, training, and supervision of personnel. There was then a consideration of the interaction and behavior patterns in a social system; the relationship of staff to outsiders; and how patient care is affected. The nursing home was then related to the general community as well as to the medical community and how the community could be improved.

We endeavored to involve maximally the participants, and we did this by maximizing the opportunity for audience participation. Each participant was given a take-home notebook which included prepared outlines of all staff presentations, supplementary selected materials, bibliographies, and relevant articles. The staff numbered 11, involving, in addition to the writers, 5 members of the Northeastern faculty, as well as the director of hospital facilities, Massachusetts Department of Public Health, superintendent, Boston City Hospital, the director, Medical Care Studies Unit, Beth Israel Hospital, Boston, and the executive director, Massachusetts Federation of Nursing Homes."

2 Dr. A. Daniel Rubenstein. 3 Dr. John F. Conlin. 4 Mr. Jerry Solon. 5 Edward F. Connelly, Esq.

Through daily evaluation followed up with a postworkshop evaluation, we learned that additional training was desired. Also, we obtained clues for a more effective design for subsequent workshops.

Immediately following the workshop two steps were taken. We met with the director of hospital facilities, Massachusetts Department of Public Health, to explore the broad areas and the limitations of our training program from the perspective of the department of public health. Since the initial venture last November, we felt it important to consult constantly with the director of hospital facilities in all of our planning and programing.

ANOTHER MEETING

After this meeting we met again with the education committee of the federation and went through the same process of exploring how we might best further the continuing education of the nursing home administrators. From these deliberations it was determined to go into depth in some of the areas explored at the Andover workshop namely, administration and interpersonal relations. We also discussed with the education committee a more comprehensive evaluation of the seminars. On our proposal the Massachusetts Federation of Nursing Homes made a grant to the university in the amount of $500 for the evaluation of the seminars. A modest sum, but it was important as an expression of purpose. A competent social scientist from Boston Univerity was engaged to conduct the evaluation. The purpose, as we saw it was twofold : to determine the impact of the seminars upon those nursing home administrators who enrolled, and secondly to obtain some idea of the administrator's self-image of an ideal nursing home administrator's role. A report on this evaluation will be the subject of another paper.

The design of the seminars contemplated a maximum of 25 participants, to run 3 hours each session for a period of 10 weeks, beginning March 15, 1961. While the offering was in cooperation with the Massachusetts Federation of Nursing Homes, at the request of the director of hospital facilities, the seminars were opened to administrators of nursing homes not affiliated with the federation. The response was phenomenal. We were required to hold second sections of each seminar on the following day, permitting 27 in each of the seminars in administration, and admitting 26 to the seminars in interpersonal relations.

Some 85 percent of those who participated enrolled for the two seminars. In each instance those who took a single seminar did so solely because of time pressure. Almost one-third were unaffiliated with the federation. However, a number of these have since become members of the federation. Almost all of the administrators were from nursing homes located in the eastern part of the State. Because a number of administrators were unable to attend the seminars, due to lack of space, the request was made of us to undertake a program in the western part of the State, especially for nursing homes there. In our meetings with the education committee, our recommendations for a residential experience as the initiating experience was accepted. The design developed contained modification of the Andover experience, principally on the basis of the postworkshop valuation by those participants. For the second workshop in nursing home administration, the Lord Jeffrey Inn on the campus of Amherst College in Amherst, Mass., was selected. The workshop was held June 5 through 8, 1961, with 21 in attendance.

SOME MODIFICATIONS

The Amherst workshop design had these modifications. Sessions were held in the mornings and afternoons. In the evenings the workshop population was divided into two small discussion groups, each led by one of the authors. Though intended for the exploration of pertinent problems revealed in the day's presentations, the participants had the opportunity to build their own agenda. We found this modification a valuable contribution to the learning experience of the participants.

A new area was included : that of financial control and budgeting. And in addition to community relations, the areas covered included organization and administration, interpersonal and human relations, as well as the relation of the nursing home to the medical community. At some of the sessions we used the devices of the reaction panel and the buzz groups. At the conclusion of the evening small group session, the participants were given evaluation sheets to fill out. Again, the participants were given a take-home notebook with

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