Letters from-Continued 1961. Ringham, E. B., president, Senior Citizens Council of Minneapolis, to Thielen, Isabel Speer, St. Michael, Minn., to Senator Long, dated Page 764 763 765 Watson, Wayne E., secretary-treasurer, Minnesota Retired State Employees Association, St. Paul, Minn., to Senator Long, dated Weinberg, Mrs. B. L., president Adath Social Club, South Branch 759 Weinke, Klara K., Minneapolis, to the committee, dated December 4, 1961 769 Report entitled, "Fire Safety in Homes for the Aged," prepared and sub- mitted for Cyrus E. Magnusson, State fire marshal and commissioner of insurance, by Eugene L. Weber, assistant commissioner of insurance and fire investigation supervisor. Survey entitled, "As Senior Citizens See Themselves-A Survey of Aging 709 NURSING HOMES MONDAY, DECEMBER 4, 1961 U.S. SENATE, SUBCOMMITTEE ON NURSING HOMES, Minneapolis, Minn. The subcommittee met at 9:30 a.m., in the ballroom, Coffman Memorial Union Building, University of Minnesota, Senator Edward V. Long presiding. Senator LONG. The subcommittee will come to order. It is a sincere pleasure for me to welcome all of you here this morning to this subcommittee hearing of the Senate Committee on Aging. The Special Committee on Aging was established last February by a Senate resolution which called for a year of study and information gathering on the full range of problems of our older citizens. The resolution also charges us with making reports of our findings and recommendations to the Congress next year. To do this job the committee has scheduled more than 30 hearings in all parts of the country this fall. These subcommittee hearings are inquiring into four subject areas: Retirement income maintenance, housing for the elderly, nursing home care, and Federal and State activities in the field of aging. When these hearings are completed, the committee will have an extensive collection of up-to-date information on the problems of the aging and the aged. The record of testimony and discussion will be studied by the committee members and the staff, and will form the basis for our reports and recommendation to the Congress. The hearing this morning is on the subject of nursing homes. We will hear from governmental officials concerned with nursing homes services, representatives of nursing homes, and from other experts who have special knowledge of problems in this field. As you well understand, we are limited for time, as our committee can only be here today. This afternoon will be a town hall system of meeting for our elderly citizens where the citizens themselves, who are more interested in the problems of the aging than anyone else, will be here to discuss their problems with the committee. The witnesses this morning have submitted written statements to the committee. We must of necessity, as you understand, limit our discussion somewhat for each witness. We want to give everyone proper time but we just don't have enough time during the day to go at length with every witness. We have asked the witnesses to submit statements, which they have done. We will ask the witnesses not to read their statements when they are making their presentations, but if they could speak informally for just a few minutes from them and perhaps then make themselves available for questions and discussion from that time on. The first witness this morning is Dr. Robert N. Barr, who is the secretary and executive officer of the Minnesota Department of Health. Dr. Barr, if you are in the audience, we will appreciate it if you will come around. STATEMENT OF DR. ROBERT N. BARR, SECRETARY AND EXECUTIVE OFFICER OF THE MINNESOTA DEPARTMENT OF HEALTH FOR MINNEAPOLIS Dr. BARR. Senator Long and members of the committee, the State board of health is the official agency in Minnesota which administers the Hill-Burton program. It also licenses all hospitals and related facilities, including nursing homes, homes for the aged, boarding and care homes, and licenses hotels, lodging houses, camps, and resorts, et cetera. There are two exceptions. The foster homes which care for not more than two older people who are relatively well and do not need nursing care, operate under a permit from the local county welfare board. Some 20 nursing homes that are owned and operated by the county welfare board, are licensed by the Minnesota Department of Welfare using the standards of the Minnesota Department of Health and include 6 that are conversions of the small tuberculosis sanitoriums in the State. I have available for the committee a packet of informational data on nursing homes and boarding care homes in Minnesota which indicates the number of beds, the quality of beds in the various categories of hospitals, and related facilities in Minnesota. It includes the facilities and beds that have been built in Minnesota during the past 12 years. I also have a statement made by myself as a representative of the department of health relative to nursing homes and a fact sheet which summarizes the development of nursing homes in Minnesota. Both are available to the audience. I believe there are one or two points that should be emphasized to the committee, Senator. One is that almost 70 percent of the nursing homes and homes for the aged beds under construction in Minnesota are being built by nonprofit and public organizations. This includes construction by local governments, community hospitals, church, and other nonprofit organizations. Some 60 percent of all long-term-care beds at the present time are actually owned and operated by these groups. Private enterprise, provides in Minnesota a smaller segment. This is rather unusual. As in most States private enterprise owns and operates for profit the vast majority of the nursing home beds. There has been a tremendous upsurge in the construction of nursing homes and homes for the aged in Minnesota. Some 2,224 beds were completed or are under construction as of November of this year and there are some 6,000 beds or more in the planning stages. Our experiences indicated that about 30 to 50 percent of those in the planning stages go ahead to completion. As a result, there is a critical need in every area in Minnesota for a very careful study of needs so that we do not get overbuilding in one area and underbuilding in another. The community services bill passed by the Congress during its last session I believe is one of its finest pieces of health legislation. It may, in the future, rank next to the Hill-Burton legislation in this field of health legislation. I am sure it will do a great deal in developing out-of-hospital facilities and services in the community, particularly in the forms of home nursing, homemaker services, and other kinds of community services to help people stay in their own home. I think that eventually, nursing homes and homes for the aged are going to be provided by nonprofit organizations, as have hospitals in this and most States. I should add that the department does not exclude good private enterprise in Minnesota. This occurs for one reason only, namely that the present levels of pay that are provided by welfare in this State or in other States are such that if the individual nursing home provides all the services that the patient needs, the private operator would lose his shirt in the operation of the nursing home. So we have problems: One is the cost of the operation and the provisions of and the paying for needed services; another is the provision of good facilities and services for all who need such. This creates also a very severe shortage of trained personnel, particularly nursing, in spite of the fact that Minnesota has a rather remarkable program for training nurses. We train them for other States. Last year Minnesota nurse training schools graduated 1,053 registered nurses and 466 licensed practical nurses. A shortage of nurses still exists and women who have been nurses, are being reactivated in order to provide services in our hospitals, nursing homes and other facilities. We must also be more realistic in the future and recognize that: (1) When we spend a dollar for nursing home care, home care, and homemaker service, we should get a dollar's worth of service. On the other hand, we must be willing to spend the necessary dollars in nursing home care and rehabilitation, to assure quality services. Many rehabilitation services have been developed in this State. Complete rehabilitation centers are located in Minneapolis, St. Paul, Rochester, and the university. About 120 other facilities which provide some rehabilitation are located throughout the State. About 20 nursing homes in Minnesota are units of acute general hospitals. Here some of the most intensive nursing care is being provided. We are probably approximating the total need for nursing home beds in Minnesota. If this proves to be true, then we must improve the quality of services that are given in all of these institutions, hosiptals, nursing homes, rehabilitation centers, homes for the aged, and so forth, in order to make certain that these people who need services can be placed in the kind of facility that provides their needed services. This means integration of all activities to provide better service for the aged. Senator LONG. I have a question I would like to ask you, but first, I recognize the great progress that the State of Minnesota has made. That's one reason that our committee wanted to be here and take testimony here to give the advantage to other States and our committee that can be gained from the experience that you have had here. You mentioned in your statement and in your remarks a moment ago that a large percentage of your beds, 65 or 70 percent, that have been added since 1950 were nonprofit and Federal and you indicated that was a trend and I understood you think that in the course of time that privately owned nursing homes of that type will be passé. Dr. BARR. I think so. Senator, years ago we had the same trend in hospitals and gradually the hospitals became nonprofit because of the recognition that the provision of hospital services is a public responsibility and should not be placed on a single individual or group of individuals. Nonprofit organizations being tax exempt, et cetera, have real advantages. If a third of the nursing home beds eventually become units of hospitals, again, these will be nonprofit because all hospitals in Minnesota are nonprofiit. Private enterprise has stepped in and filled a gap that was left by society which did not recognize its responsibility in the earlier years. Senator LONG. Doctor, you indicate there would be a need of 1,600 beds per year in your statement until 1970. Are you optimistic that you will be able to achieve that growth? It is a double-barreled question. Do you think you will be able to achieve it, too, at the present levels of the Hill-Burton funds that you now have available? Dr. BARR. Very little of the construction in nursing homes has come from Hill-Burton, even though we have transferred chronic hospital and diagnostic treatment funds to nursing homes construction. Only three or four projects could be assisted each year. Under exhibit 7 in the tabulation provided is listed the nursing homes, et cetera, built each year from 1950 to November 1, 1961, and indicates those which received Hill-Burton aid. On page 8 it will be noted that 1,482 beds were completed in 1960, 1,453 beds were completed and 2,202 additional beds were under construction as of November 1, 1961. We have also reported that more than 6,000 beds are in the planning stages as of today. It is very likely that Minnesota may reach its goal before the 10-year period is up. There is one other figure which will be of interest, 840 nursing home beds in Minnesota were reclassified or closed during the period January 1, 1960, to October 31, 1961. This, I think, in part, is the result of competition and the providing higher quality service. Senator LONG. I am not sure you covered this in your prepared statement or in your remarks, but can you tell me the number of square feet per bed and the average cost per square foot in nursing homes that are now being constructed? Dr. BARR. The State standard is the same as appendix A of the Federal act. It is, single room, 100 square feet; room for two persons, 80 square feet per bed; and room for three or more persons, 70 square feet per bed. The cost per square foot is a very difficult thing to determine and is not included in the tabulations submitted. It is also quite variable. For example, there is a very splendid infirmary completed by the Wilder Charities, in St. Paul. It has 141 beds. Sixty beds are reserved for welfare patients. It is part of a complex which will have 500 beds which will also provide housing for the aged in the form of utility, 1-bedroom and 2-bedroom apartments, a dormitory kind of housing for the aged, and a day care center where you can leave grandpa off in the morning and pick him up at night. It has both rehabilitation services and medical direction. The infirmary per diem costs are now pegged between $812 and $10 a day, depending upon the kinds of service needed. Obviously, the foundation is underwriting part of the cost and is not charging off any of |