but requires constant improvement to fulfill its total function. It's interesting to note that 25 years ago critics of the Social Security Act stated it was unsound economically and that it was the first step toward socialism in this country. But the majority of our Representatives did not agree with their view and President Roosevelt signed it into law August 14, 1935. At present, 9 out of every 10 working people are covered by the protection of the Social Security Act. It's economically sound and accepted as a way of life-former critics now agree it's a good thing. We find a growing ground swell of public opinion for medical care-health benefits-nursing home care for the aged through a social security-railroad retirement plan, that would spread the cost over our working years and would not be dependent on State legislation or the taking of pauper's oath. The American Public Health Association backs the social security approach to finance health care without a means test and so passed a resolution at their recent convention in Detroit. This APHA includes as members some doctors, nurses, technicians, and specialists. We, as representatives of the millions of working people, contend, as the wealthiest nation in the world, the lawmakers of the United States should take the necessary steps to solve this problem-through the King-Anderson bill. Mindful that it is not our desire to disrupt the traditional concept of the doctor-patient relationship, in this country, nor the established American practice for the doctors qualifying themselves through our licensing procedure, as we believe patient's free choice of his doctor should be protected. Summarizing the facts: Our population is aging. The aging have low incomes and few savings. Private insurance is inadequate to meet the great social problem involved. These facts and statistics have been recorded many times and no matter how you look at them or add them up, they come to the same answer. It is an answer that has already been accepted in many countries less able than we. I have given you the desire of the overwhelming majority of the members of Springfield organized labor, and our State and National labor organizations as well, in urging Congress enact the House bill, H.R. 4222, and adopt in this country the humane principle of medical care, nursing home care, for our aged under social security-railroad retirement. We know your committee is interested in people generally and we in labor are urging our members to let you know how they feel regarding this problem. We feel that in the interest of good government it is necessary for all citizens to make their wants and needs known directly to you, so you don't have to take my word for it nor the doctors' word for it, but the people themselves. Out of my contact with the hundreds of elderly people and hundreds of members who are helping take care of aging parents and relatives, I feel confident that their needs will prove to be as I have described them here to you. Senator LONG. Mr. Wheatley, thank you very much for a very fine report, and I am so sorry we are running short of time. But I do appreciate it very much and your statement will be a part of the record and will be carefully considered by the staff and the committee. (The prepared statement of Gorden E. Wheatley follows:) PREPARED STATEMENT OF GORDON E. WHEATLEY NURSING HOMES AND CARE OF THE AGED My name is Gordon Wheatley. I am general chairman of Railroad District 18, International Association of Machinists, and deeply appreciate the opportunity to give labor's views before this committee which is a demonstration of true democracy at work across our land on a vital problem affecting so very many people today. My occupation brings me in contact with many retired people, members of labor organizations, and others. Also many people who are approaching the age of 65, and we have come to consider the problem of nursing home care for the aged as indeed one of our foremost questions because the cost of medical care is most important to this aging group. And it's understood that proper nursing homes can be used when hospital care is not mandatory. According to a booklet of the U.S. Department, Health, Education, and Welfare, our nursing homes should be capable of providing skilled nursing home care and related medical services. And the services offered should be under general direction of a person licensed to practice medicine. The long-term hos-pital patients could easily be moved to nursing homes when hospital services are no longer required. Let's look at what a subcommittee of the U.S. Senate found when it went into nursing homes in Boston, Pittsburgh, San Francisco, Miami, and Grand Rapids. These homes contained 450,000 beds, in various types of institutions, classified loosely as nursing homes. Only half of them provided skilled nursing services and of this half with the nursing service, just half of these met the Hill-Burton standards for safety (fire), sanitation, and design. Three out of five had no registered or professional nurses, one out of three had not even a practical nurse. Found 3 men, 2 in wheel chairs, in narrow foyer entrance, and stale odor seeping from under doors, place dirty, and 17 elderly patients lived there, cared for by practical nurses. These elderly patients paid $150 to $200 per month for room and board, with medical bills and drugs extra. In most States overcrowding was found. In one of two rooms on the first floor of a two-story frame house-five elderly patients lay in beds, separated by such small aisles that hardly enough walking space remained. This was only allowable it was explained-account of high ceilinged rooms. This home was clean but rates were $250 to $350 per month. In many homes the patients were bedfast and some lay dozing while others stared at ceiling. In one dark cubicle of this home lived a couple, wife 83 sat on the only wooden chair, husband 99 lay silently on the bed; and upstairs a 79-year-old crippled arthritic man sat fully dressed on his bed reading a Bible. His only visitors, he told the committee, were his sons who came on Sunday and the welfare department doctor who comes once a month. In a nursing home filled to its 45-bed capacity there was a full-time registered nurse in charge, room was clean and had fresh atmosphere. As of the first of this year, the Hill-Burton hospital and medical facilities survey of nursing homes in Missouri showed a serious need. With a total of 15,136 nursing home beds, 43 percent or 6,518 of them are rated unacceptable based on our State basis of fire and health hazards. Missouri has only 1 acceptable nursing home bed for every 58 persons over 65 years of age. The growth of the aged population in the United States today has led to increased concern about this problem. Between 1950-60 Missouri's population 65 and over increased 24 percent while the total State population only increased 9 percent. Those over 85 increased 54 percent in just 10 years. Our State has over half million aged persons and the U.S. census shows 161⁄2 million Americans have now passed 65 and will increase one-third million a year and by 1965 we can expect 22 million in the United States. More grandchildren today know their grandparents and are concerned about them than ever before in history, because of our increased length of life. At the beginning of 1961, 60.5 percent of all over 65, in Missouri, were receiving social security payments. Average was $71.34 a month, but over 37 percent of these received less than $60 per month. In July 1961, 112,943 aged people in Missouri needed some help from old-age assistance program. Such help in the form of payments to doctors, hospitals for medical care averaged $1.42 for the month. Missouri's old-age program, in cooperation with the Government, is limited to recipients of old-age assistance. This problem of our senior citizens, paying for nursing home service, medical care, will increase and concern more families, over a longer period of time, as we go on-unless we take steps in the right direction to solve it. Statistics now show that elderly people, even with their limited means, spend more after age 65-yes, twice as much-for medical care, nursing care, than those under 65. It's common knowledge that as people grow older their need for nursing home care and medical care grows greater. The health information shows that in 1957-58 men and women over 65 spent an average $177 annually for medical care, while those under 65 only averaged $86 annually. And remember this is what was actually spent, not what should have been spent. There are no figures to measure how many millions of our retired citizens do not seek or get the medical care they need simply because they cannot afford it. The facts show the vast majority over 65 cannot afford the medical and nursing home care they need because they have reached the time in life when their incomes are severely reduced. Of the 15.3 million individuals 65 and over who are not in institutions, in 1959, 55 percent had annual incomes less than $1,000. Another 23 percent had incomes from $1,000 to $2,000. In other words, only 13 percent of all people in the country 65 and over had over $3,000 per year incomes. This is indeed very significant, because the Bureau of Labor Statistics show that a retired couple needs an annual income ranging from $2,390 in Houston, Tex., to $3,112 in Chicago, Ill., just to maintain a modest but adequate standard of living-if they had no unusual medical or nursing home care. Therefore, when we compare the actual incomes of the aged with the Bureau of Labor budgets, it becomes convincingly clear that a large majority of our retired population simply cannot afford to pay for medical care, nursing home care, with the incomes they have. Some might say, why not private insurance? Because private insurance has never met the problem and never will with its built-in limitations. Congressman Dingell, Michigan, testified last year that only 40 percent of all Americans over 65 have any form of health insurance at all. The Secretary of Health, Education, and Welfare admits that some of the coverage is inadequate. From the experience of some of our members, we know it's downright deceptive. Many policies are cancellable at option of company and this comes to pass after about the first time the first spell of sickness occurs. As we have seen, the elderly are the least healthy group in our population and until this problem got a lot of publicity it was practically impossible to obtain noncancellable health and accident policy for people over 65. The McNamara committee found that of people who had insurance before 65. but did not keep it up-31 percent could not afford it-20 percent had group. plans that could not be converted at retirement and 13 percent had been canceled by insurance companies. Private insurance by its very nature will always. be inadequate to meet needs of people over 65. We cannot in good conscience sweep this problem under the rug for millions of our elderly citizens, that have worked a lifetime building our Nation and who. during their twilight years deserve to live with dignity and self respect, not subjected to a means test, charity, nor the grudging aid of relatives. And not forced to use up their meager savings or wasting their small incomes on high priced insurance, often useless, or turning to children or the pauper's oath. It's evident most elderly people do not have the income to pay for nursing home or medical care. Some say that's true-but why not use their savings? We do. not believe it's right for a country as wealthy as ours and as industrially advanced, to require citizens, who have contributed to the Nation's wealth with a lifetime of labor to take a means test-to qualify for token medical-nursing home care in their old age. As a matter of fact, many of these old people are close to the bare edge of subsistence already as most retired people have little or no savings. Federal Reserve Board, in 1959 survey, showed that 8 million families, in which the head was 65 or over, 29 percent had no liquid assets--17 percent from $1 to $500 in reserve, and 21 percent from $500 to $2,000. Actually, 67 percent, or total of 5,630,000 families had savings of less than $2,000. Now anyone who has had experience with illness, prolonged, or spent a few days. in a hospital knows how fast $500 or $1,000 can be absorbed by medical bills. So any of these 5,630,000 families could be quickly wiped out. Therefore it's not right we require any American to sacrifice his home, his car, his savings, and his pride because he needs medical-nursing home care. Not when we know how to.. spread the risk through a sound system of social insurance under which all will benefit and none need to suffer. What's the answer? It lies in a program that spreads the cost of high risk oldage insurance over the entire working life of the insured: it's social securityrailroad retirement plans. It's a medical, nursing home care plan that continues with us into retirement and does not end when we quit work. It's an answer that has already been accepted by many other civilized and industrialized countries of the world. Medical care has been brought within reach of workers in England, France, West Germany, Switzerland, Scandinavia, and Italy through the principle of social insurance. Some others, such as India, Japan, Greece, with resources far below ours, have gone much farther than we have in the United States, to remove the risks of sickness and accidents through such principle. In fact, we are the only major industrial nation in the world that does not do so. The social security-railroad retirement system was started over 20 years ago and has done much to bring dignity to elderly Americans, but requires constant improvement to fulfill its total function. It's interesting to note that 25 years ago critics of the Social Security Act stated it was unsound economically and that it was the first step toward socialism in this country. But the majority of our Representatives did not agree with their view and President Roosevelt signed it into law August 14, 1935. At present, 9 out of every 10 working people are covered by the protection of the Social Security Act. It's economically sound and accepted as a way of life-former critics now agree it's a good thing. We find a growing ground swell of public opinion for medical care-health benefits-nursing home care for the aged through a social security-railroad retirement plan, that would spread the cost over our working years and would not be dependent on State legislation or the taking of pauper's oath. The American Public Health Association backs the social security approach to finance health care without a means test and so passed a resolution at their recent convention in Detroit. This APHA includes as members some doctors, nurses, technicians and specialists. We, as representatives of the millions of working people, contend, as the wealthiest Nation in the world, the lawmakers of the United States should take the necessary steps to solve this problem-through the King-Anderson bill. Mindful that it is not our desire to disrupt the traditional concept of the doctorpatient relationship, in this country, nor the established American practice for the doctors qualifying themselves through our licensing procedure, as we believe patient's free choice of his doctor should be protected. Summarizing the facts: Our population in aging. The aging have low incomes and few savings. Private insurance is inadequate to meet the great social problem involved. These facts and statistics have been recorded many times and no matter how you look at them or add them up they come to the same answer. It's an answer that has already been accepted in many countries, less able than we. I've given you the desire of the overwhelming majority of members of Springfield organized labor, and our State and National labor organization as well, in urging Congress enact the House bill H.R. 4222, and adopt in this country the humane principle of medical care, nursing home care, for our aged under social security-railroad retirement. We know your committee is interested in people generally and we in labor are urging our members to let you know how they feel regarding this problem. We feel that in the interest of good government, it's necessary for all citizens to make their wants and needs known directly to you-so you won't have to take my word for it-nor the doctors' word for it- but the people themselves. Out of my contact with the hundreds of elderly people and hundreds of members who are helping take care of aging parents and relatives, I feel confident that their needs will prove to be as I've described them here. Senator LONG. Mr. Ralph Longston, administrator, Grand Acres and Sunshine Acres Nursing Homes, Springfield. STATEMENT OF RALPH LONGSTON, ADMINISTRATOR, GRAND ACRES a board of civic-minded businessmen who receive no pay and then the buildings are leased from the county and it is operated as a nonprofit organization, and we make an attempt to take care of all the people we possibly can. Now, at Sunshine Acres we have a total of 140 beds set up; at Grand Acres we have a total of 86 beds. That gives us a total of 226 beds that we have right here in the limits of Springfield to where we take care of the residents of Greene County. The source of income for our patients, the biggest majority of them, are the old age assistance recipients. We have permanent total disability, we have a few on railroad retirement, we have social security and then we have a few that do pay privately. Now, these people, originally the majority of them were people that did own property and they were on the old age assistance program, but they could be gone from their property only 2 years and then that has to be sold and the income from the property go to the care of the people. Now, that is the type, mostly, that we do care for, the ones that cannot afford to go into the private nursing homes. Now, the needs for additional beds, that we do need, because it is, ever an increasing demand. We try to take care of what we possibly can. We have to more or less try to take care of the ones that need it the worst, and we can always use extra beds, believe me on that, we can. Now, we have a unique situation here in the Springfield area between Sunshine and Grand Acres Nursing Homes and with the Hanley Hospital. Now, the Hanley Hospital is the city hospital. We take people that are in the lower income bracket, say, one of them should happen to have a stroke or a heart attack where he requires oxygen or anything like that, why, we take these individuals, we send them into the Hanley Hospital, who, in turn, will give them the needed medical care, the emergency medical care that they do need and as soon as they can be released then they do come back to our homes. We have taken people from Hanley Hospital and we certainly do try to take care of them, so we have a beautiful working agreement, which, if more areas would try to work under our conditions, I believe that we would have much, much better medical care in the State of Missouri. Now, patient costs, I have heard a lot of discussion on that. We at Sunshine and Grand Acres Nursing Homes do receive the surplus food commodities, everything it buys wholesale, and the county does underwrite us, but now on our patient costs, we cannot operate any less than $3 per patient per day, and that is just the bare minimum cost, believe me. That is for the food, the drugs, and the nursing care. That excludes our utilities or any replacements of windows or anything like that, and so you see that we have to have at least $90 per month per patient. Out of this, it all depends on the individual type of patients you do have, some of them require much more care than what the others do, and on those patients we do charge up to $150 a month, and that will more or less help us to defray the cost of the people that $65 is the maximum of what they do receive. Now, we do a little bit of physical therapy. We are trying our best. When Grand Acres was built we had a room set aside, it is pretty cluttered right now and we don't have all the equipment we want, |