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Dr. BOURKE. Rather than to have a multiplicity of units, we have set up 50-bed units, and we encourage their working with the larger medical teaching centers.

Senator HILL. I want to refer to the letter I referred to earlier from our hospital planning division head. I stated at the time I had not had an opportunity to read this letter, and I will have to be frank and say I haven't yet read the letter because I wanted to hear the testimony of the witnesses, but I do note one thing-another thing here, too--and that is this: It says:

H. R. 8149

that was the companion bill, of course, in the House

does not require the facilities constructed thereunder to be operated in accordance with the State-adopted standards except in those States which have a licensure act covering such facilities.

We feel operation in accordance with the State standards is most essential in the proper operation of the facility and in the protection of such standards afforded. This is particularly true in the case of nursing homes and chronic disease hospitals.

Do you agree on that?

Dr. BOURKE. Some of the States, I know, are working with the nursing-home problem. We had it under study in New York State through the welfare department the past several years. It is something more than facilities. It is an analysis of what the quality of care is and how much attitude toward rehabilitating these people occurs in that type of setting.

Senator HILL. Of course, without being critical, and I certainly don't want to draw any indictment here, and particularly I do not want to draw any indictment against the home people, I know many of these chronic hospitals and nursing homes are doing a wonderful job for the finances they have. You have to always bear that in mind what you can do with what you have.

Isn't that right?

Dr. BOURKE. That is right.

Senator HILL. But the truth is one reason we need more chronic hospitals and nursing homes is that the standards in some, to say the least, are pretty low, and I say they are low because, and I am sure this is true in large measure, of the lack of finances.

Isn't that true?

Dr. BOURKE. Yes; I think so.

Senator HILL. But surely your State standards ought to apply. You agree on that, don't you?

Dr. BOURKE. I think anything should be done that will prevent the isolation of these institutions from the focal point of medical service.

Senator HILL. I was interested, too, Doctor, in your testimony that you agreed with Mr. Bugbee of the American Hospital Association in stating that these funds ought to be interchangeable because, as you suggested, one State might have a pressing or compelling need for one type of facility or might be able to go forward with the construction of that type and some other State might have another type of facility it was able to go forward with or had the compelling need


Dr. BOURKE. We have constructed diagnostic centers as part of our medical teaching centers under the basic program.

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Senator HILL. Under the basic program?

Dr. BOURKE. Yes, sir.

Senator HILL. And you would have these funds interchangeable? Dr. BOURKE, Yes, sir.

Senator HILL. You would hold fast, would you not, in any amendments of this act, I think this is important, to the basic conceptand there wasn't anyone who hammered this more than our good friend, Senator Taft-the basic concept of the administration and the authority in this act being at the State level rather than at the Washington level; is that right?

Dr. BOURKE. I think that has been one of the basic facts of the success of the program, Senator Hill.

Senator HILL. Thank you, Doctor.
Senator PURTELL. Thank you, Doctor.

If there are no more questions, our next witness will be Mr. Richard C. Parmelee, attorney for the Connecticut Private Hospital Association.

I welcome you here, Mr. Parmelee. I know that you have got some testimony that is going to be very interesting to this committee.


Mr. PARMELEE. Thank you, Mr. Chairman.

Gentlemen, I am here, as you know, on behalf of the Connecticut Private Hospital Association, and having been seated here this morning listening to the distinguished doctors who preceded me I am quite humble at this moment. However, on their behalf, and reading from a statement which was prepared at their request, and largely by them, I wish to state that the Connecticut Private Hospital Association is opposed to Senate bill number S. 2758 in principle, for the primary reason that it proposes to substitute nonprofit organizations to conduct nursing homes in place of private enterprise and placing such public institutions in competition with the estimated 20,000 nursing homes which for 20 years or more have cared for the indigent, the aged, and the chronically ill without aid or favor from either county, State, or Federal Governments.

The next four paragraphs, gentlemen, in fairness to your committee, have been lifted from a statement made before the House committee at an earlier time, but I have been directed to call them to your attention because it so heartily represents the thinking of my Connecticut people.

A nursing home is an institution unique to the American scene. Like many of the great prepayment health plans, these homes have grown and matured out of sheer necessity. They have served the communities of America with neighborly understanding. It came as a shock to virtually every privately owned nursing home when President Eisenhower in his address to the Nation suggested that the Federal Government through this bill, H. R. 7341, should survey the need for federally-sponsored nursing homes.

For the past 20 years, 20,000 nursing-home operators have spent their time, their energies, and their fortunes in the development and promotion of nursing homes throughout the entire United States. These nursing homes are small, compact, friendly units caring for

persons afflicted with some of the most dreaded diseases of our time with the sympathy and understanding that cannot be attained in larger, chronic institutions.

The nursing-home operator locates the nursing home where it is needed. He employs local help, local nurses who would in many instances, because of family obligations, be unavailable to travel to more centralized chronic institutions. There is hardly a community in the United States without 2 or 3 nursing homes, thereby giving the families of the chronically ill and aged a variety and freedom of choice.

The nursing home is two things: It is a profession and it is an industry. It is licensed under the laws of the various States; it must keep accurate records as to the medical treatment and nursing care of its patients. It must be prepared to solve an untold number of dietary problems; it must tend to the needs of patients who are completely bedridden; it must provide the facilities for comfort and care 24 hours a day, 7 days a week; it must conform to the rules and regula tions of the various State departments of public safety, rules, and regulations that vary from time to time and are costly items in the maintenance of a nursing home.

In Connecticut, the private nursing home or convalescent hospital is conducted by individuals and privately owned corporations on high standards and subject to regulation by the public welfare council, offices of the commissioner of health, and the fire marshal of the State.

The homes are located in various parts of the State in suburban and rural areas and most of them are well managed and in keeping with high standards in all respects.

The patients are cared for in a homelike atmosphere and the average population of the individual home is such that the patient who in many cases must spend all or a larger part of his life in such place feels more at home and at ease than in any large publicly operated hospital or institution.

May I say at this point, gentlemen, and I think Senator Purtell is well aware of it, Dr. Stanley Osborne, our commissioner of health, has seen to it standards of health have been maintained, and more recently Dr. Margaret C. DuBoise has been employed there and is in charge of all hospitals in our State, and she has taken great and particular care to see to it in the nursing homes all State laws and regulations promulgated under the State laws are rigidly enforced and carried out.

Also, with respect to the fire hazard, which I know gives concern to your committee for certain other areas of this country, be it said now that under the able leadership of our former State police commissioner, who was lost to us, Mr. Hickey, who, in effect, was our fire marshal, some very rigid and very high standards of fire protection have been provided for in these nursing homes throughout our entire State, and they are still in force, and the effect of his able leadership on the fire protection in this sort of institution will be felt for all time.

In our State the management of these nursing homes in most cases consists of a husband and wife, who add to the homelike atmosphere.

In Connecticut at the present time there are 4,800 beds in licensed nursing homes, and there are 187 separately operated institutions. Not all of them are members of this association.

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The association which I represent is devoted to improving the standards among the private-nursing homes in the State.

It is estimated in our State, by the association that I represent, that 1,000 additional beds are needed.

I believe that is below estimates given to your committee in other forms at other times.

The commissioner of welfare in our State pays for a large percentage of the patients occupying the homes operated by the Connecticut Private Hospital Association. This figure varies, but it is slightly below 50 percent.

In the State of Connecticut the privately operated nursing homes are not without their problems, and therefore it is the suggestion of the Connecticut Private Hospital Association that the bill before the Senate be amended so that the sum being appropriaetd for the building of nonprofit nursing homes on a matching basis between the States will be changed so that the same sum of money will be appropriated and allocated to the Small Business Administration to be loaned on a secured basis in accordance with sound business principles to private operators for the construction of privately owned nursing homes, this money to be repaid over a suggested 20-year period.

There is a known need in the State of Connecticut for additional nursing-home care to supply bed room for an estimated 1,000 additional patients.

There is no question but what the need for additional privatenursing homes exists.

In Connecticut private nursing home operators are faced with great difficulty in financing and expanding for the reason that savings banks and building and loan associations and other lenders consider them undesirable loans for the reason that the buildings are all devoted to a special, single purpose, and in the event of financial difficulty would not be readily salable in the event that they came into the ownership of said properties; and further, that because of the lack of sufficient capital by persons qualified to operate such type of nursing homes, the market for such homes is limited and the means to construct them is very limited, and it is in this respect that this legislation could be of assistance.

While this is not in the prepared statement, gentlemen, may it be suggested the officers later suggested to me that I convey the message to the committee that possibly, instead of a direct appropriation, a guaranteed type of loan of the FHA variety might be suggested to you gentlemen.

The Connecticut Private Hospital Association having considered the matter, feels that when all factors are taken into consideration, such as the outlay for land, buildings, equipment, et cetera, that they can care for the aged and infirm and others who need nursing home care at a cost lower than any publicly operated institution; and they believe, further, that they can give a higher quality of care, because if a patient is not satisfied, the patient may move from one home to another freely. In other words, competition among the homes themselves will tend to keep a high quality of service, whereas in the institutions, nonprofit and publicly operated, usually the patient will be required to stay in a given institution based upon his geographical

location regardless of whether or not some other institution provided care better suited and adapted to the particular patient.

In conclusion the Connecticut Private Hospital Association wants to go on record as supporting generally the position of the American Association of Nursing Homes, of which it is a member, which it understands will appear tomorrow to state its position.

On behalf of the officers, directors, and members of the private hospital association, I want to thank you for being given the opportunity of appearing before your committee to state the position of this association on this bill.

Senator PURTELL. Thank you, Mr. Parmelee.

May I ask here, Have you had a chance to study H. R. 8149, which, of course, has passed the House?

The reason for my inquiry is because of the language there, which I think will interest you very much, and your association. May I read from page 15, the 16th line:

The term "nursing home" means a facility for the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care, but who require skilled nursing care and related medical services—

(1) which is operated in connection with a hospital, or

(2) in which such nursing care and medical services are prescribed by, or are performed under the general direction of, persons licensed to practice medicine or surgery in the State.

Now, actually there are many of the facilities that you talk about that will not meet this definition; isn't that correct?

Mr. PARMALEE. That is correct.

Senator PURTELL. Let's review it again.

Mr. PARMALEE. There are two such facilities in the State at this time. Senator PURTELL. This takes in those which are operated in connection with the hospital or in which nursing care and medical services are prescribed by or are performed under the general direction of persons licensed to practice medicine and surgery in the State.

I think that tightens it up quite a bit, doesn't it?
Mr. PARMELEE. Well, that is correct.

Senator PURTELL. The thing you worry about is this competition with private enterprise, and you have a right to worry about it from the way you operate in the State, in the State of Connecticut, but they have very high standards there, have they not, as compared to the other States in the operation of this particular type of hospital?

Mr. PARMELEE. That is so, and, as a matter of fact, in one of our leading newspapers, as you know, the Hartford Courant, appeared quite a complimentary article on the operation of these nursing homes. Senator PURTELL. I would say one of the leading papers of the country.

Mr. PARMELEE. Yes, sir.

Senator PURTELL. I think the Hartford Courant is one of the leading papers of the country, and I read the article and I know what high standards the State prescribes and makes you subscribe to in the operation of these hospitals.

Now, what you are worried about and concerned with is this: Here you have done a pretty good job up there.

How many beds have you got now?

Mr. PARMELEE. 4,500.

Senator PURTELL. How many?

Mr. PARMELEE. 4,500.

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