Nursing Homes

The subcommittee met at 10 a.m., in Clara Thompson Hall of Music, Drury College, Springfield, Mo., Senator Long presiding. Also present: Hon. Durward G. Hall, Representative, Seventh District of Missouri.

Committee staff present: Frank C. Frantz and Edith Robins, professional staff members; and John Guy Miller, minority counsel. Senator LONG. The committee will come to order.

I am delighted to be here in Springfield this morning to open this hearing of the Senate Committee on the Aging. I had some difficulty in getting here. We had a hearing in St. Joseph yesterday, and I think they had six or seven inches of snow there yesterday afternoon and last evening. It was very bad weather, but in spite of that we had excellent attendance at both the morning and afternoon sessions. I was unable to fly. My pilot and plane are tied up in St. Joseph. They are going to come down here after me today. We had to drive over some very bad roads into Kansas City last night, and then took the Florida Special down here from Kansas City last night, arriving here at 4 o'clock this morning.

We are particularly delighted that Congressman Hall from our Seventh District can be in attendance this morning. The Congressman is one of my good friends in Washington and I am delighted to be here with him today.

I am glad to welcome all of you here this morning to this hearing of the Senate Special Committee on Aging. I welcome you here to join with us in heeding the prayer of the psalmist who said: "Cast me not off in the time of old age, forsake me not when my strength faileth."

Today, rejection or abandonment need not be the lot of our elders. Failing strength can be restored and preserved. Our doctors are finding the ways to do this. We must find the ways to assure that these are used to minimize the infirmities of old age.

Our hearing here this morning is on the subject of nursing homes. The nursing home has an increasingly important role to play in the whole complex of medical and related services to older people. It is through this kind of institution that much of the new knowledge in geriatrics and restorative medicine can be made to benefit many of the people of advanced years who suffer from long-term or chronic illnesses.

Nursing homes are just beginning, in recent years, to come to grips with this new role, moving away from a tradition of minimal, custo

dial care and of isolation from the pattern of medical and social services of the community. In doing so they are taking on new activities and new responsibilities.

State health and welfare agencies throughout the country are giving increased attention to licensing and regulation, both from the standpoint of physical hazards and the provision of professional and paramedical services in nursing homes. Some States, including Missouri, have developed positive and constructive programs of consultation and training for nursing home operators and staff to assist them in expanding and improving patient services.

Our mission here, and in other cities where we have had hearings on the subject of nursing homes, is a constructive one. We are not conducting investigations of nursing homes. We hope to obtain information about the need for nursing home facilities and services and how adequately these needs are being met. We are interested in hearing about the plans and programs of both State authorities and the nursing homes themselves to expand and improve services, and hearing any suggestions that may be forthcoming as to how Federal programs can assist them toward their objectives.

This morning we will hear from our State Division of Health, from witnesses who are working directly in the nursing home field, and from others whose work brings them in contact with nursing home problems in this State. We know that Missouri has some of the most modern legislation to be found in this field, and I mentioned earlier the constructive approach which our Health Department is taking in its implementation. I expect that there will be much brought out here this morning which will be of interest to other States in connection with their efforts in this field.

Although much progress has been made, certainly we would all agree that much remains to be done. The problems which must be solved before nursing homes can fulfill their proper role in the main stream of community medical and health resources are deserving of careful study and our most diligent efforts.

I would be very glad if Congressman Hall would care to make a statement at this time.

STATEMENT OF HON. DURWARD G. HALL, A CONGRESSMAN FROM THE STATE OF MISSOURI

Congressman HALL. Thank you, Senator Long and members of the staff and members of the Senate Committee on Aging.

We certainly want to welcome you to the Seventh Congressional District of southwest Missouri and we have arranged fine weather for your committee, regardless of your troubles that may be impinging on the benefits that you had since the adjournment. We think this brisk weather will give you snap and vim and vigor and vitality as we people of the Ozarks ourselves have it.

I am glad that your committee is covering all of the State of Missouri and we think there is an expression down here that particularly fits this. You are covering us like the morning dew covers the Ozarks, and you and your committee are welcome. Senator Long, I want you to know that the people whom you hear today will be forthright and candid and they will believe everything they say, and I would like to present them to you as some of the finest people on this earth.

I would like, if I may, in addition to welcoming the committee and presenting the people of the southwest corner of the State and others who will appear before you today, to have your permission to insert a statement into the hearings at this time, and in addition, Mr. Chairman, if I may, that portion of the Congressional Record pertaining to a discussion I had on the floor of the House of Representatives, a copy of which I will submit herewith, under the topic of "Operation Survival," and a final insertion at such place the Senate Committee should deem advisable in the hearings on the subject of medical care deductions for our elder citizens presented in the House of Representatives on Tuesday, June 20.

Senator LONG. Such will be made a part of our permanent record. Congressman HALL. Mr. Chairman:

We in southwest Missouri are pleased that the Senate Special Committee on Aging has seen fit to hold hearings on the subject of nursing homes in this part of our State, because we believe that the challenge of improving the environment for older citizens is a deserving cause.

We are proud of the progress that has been made in southwest Missouri toward meeting these problems, but I believe there are other steps that can be taken to enable men and women over 65 to derive the greatest satisfaction out of their retirement years.

I believe personally there are two basic problems to which attention needs to be given. One is the fact that many older persons do not have general health conditions that require constant hospitalization over a long period of time, or else they have indeed secured their own futures.

Where family housing, which should always be prime consideration, is unavailable, these people generally prefer the type of environment and surroundings which can be provided by nursing homes. Such homes which are properly constructed and staffed can provide an atmosphere which suits the demands and needs of daily living. At the same time, precious hospital beds which might otherwise be occupied without real need are made available to those for whom the need for round-the-clock medical care is truly necessary.

Then, too, Mr. Chairman, the cost of nursing home care is considerably less, as much as a third to a fifth of the cost of hospital care. The other side of the coin is one which is faced by young and old alike, but which becomes far more pronounced during the later years when earning capacity is reduced. That is the problem of sufficient income to meet basic needs.

I should like to offer my comments to this committee on both questions, taken in their proper perspective. As a doctor, I am well aware of the fact that many older citizens whose conditions did not warrant hospitalization have sometimes had to enter hospitals because of the lack of nursing home facilities.

It is no exaggeration to say that great strides have been made in recent years in Missouri toward closing this gap between available and needed facilities.

Since the disastrous nursing home fire at Warrenton several years ago, with which we are all familiar, Mr. Chairman, new licensing codes have been adopted in Missouri which give greater assurances of safety and comfort and the proper outlook to older citizens who reside in nursing homes.

Today, the problem in southwest Missouri is not so much one of quality as it is one of quantity.

The Congressional District Data Book, published by the Bureau of the Census, reveals that there are 56,000 persons over age 65 living in Missouri's Seventh Congressional District. This will be increased slightly with the four counties that have been added. That is a higher percentage of persons over 65 than live in any other Congressional District in the entire State. To a degree, this attests to the success of the various retirement programs conducted by chambers of commerce, the Ozark Playground Association, and other organizations which seek to attract people to live and invest here in their retirement years.

This does not imply that one of every person 55 to 60 need or cannot afford medical care or housing, but with a larger proportional population over 65 we have an added responsibility of providing needed facilities in the nursing home field. I know the committee will recognize that considerable progress has been made by local government toward providing proper and adequate facilities for those with limited

economic means.

Right here in Springfield the Sunshine Acres and the Grand Acres Nursing Homes are outstanding examples of what can be accomplished at the local level. Operated by a nonprofit board, with the aid of the county government, Grand Acres has provided a model example of how good facilities can be provided for those in greatest need at the lowest possible cost to the taxpayer, and with the help available from the State, from their individual savings or from social security, thus preserving the individual's pride and moral obligation.

These acres were constructed by the county administration after careful exploration with many other agencies, then they are leased to a nonprofit board at minimum expense, Mr. Chairman. This method permits persons on public welfare to receive their assistance checks, which are in turn endorsed over to the nonprofit board which operates the home, a procedure which could not be followed if the home were operated by the county in which case such assistance checks could not legally be forthcoming. Since the board is not concerned with construction costs, but only with operating expenses, costs are virtually self-liquidating.

I believe the Grand and Sunshine Acres experience could well serve as a model to other communities throughout the Nation, and I hope the committee will consider such a recommendation in its final report.

Of course Grand Acres were built for a special need. It is generally recognized that the great bulk of nursing home facilities must be provided by the proprietary nursing homes. At the outset let me say that I believe that these people are to be commended on their accomplishments in this field in southwest Missouri. Throughout our district there are many such licensed homes taking care of hundreds of our elderly citizens. I have been in them, I have had patients in most of them.

Recently legislation was enacted which should be of considerable help. An important feature of the new law was the provision of mortgage guarantees under FHA for the construction of proprietary nursing homes. Together with the liberalization of Small Business Administration regulations for nursing home loans, and the provision

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Books

Nursing Homes, Volumes 4-6