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Dr. RODGER. That's right.

As I see it, from our State level, the Hill-Burton aspect, we would have quite a job with our rigid categories making anything really work out to the best efficiency for the State of Michigan.

Senator HILL. You think whatever success the program has attained up to date has been due in large measure because we have left the administration and the determinations at the State level? Dr. RODGER. I am very sure of that, Senator.

Senator HILL. You are sure of that.

In other words, don't you think there is nothing more important to preserve about the program, as we move forward, than leaving your authority and your determination at the State level?

Dr. RODGER. That's right.

Senator HILL. You agree with that, do you?

Dr. RODGER. Very much so.

Senator HILL. Very much so.

That is all. Thank you.

Senator GOLDWATER. Thank you very much, Doctor.

Dr. RODGER. Thank you.

(The newspaper article referred to previously by Senator Hill is as follows:)

[From the Washington Post and Times-Herald, March 19, 1954]


Tuberculosis control in Washington is costing $20 million annually in private and public funds yet tuberculosis remains the District's "worst communicable disease," District Health Director Daniel L. Seckinger declared yesterday.

Dr. Seckinger spoke at the opening of a 2-day conference at the Department of Health Education, and Welfare, where tuberculosis authorities from Maryland, Virginia, and the District gathered to discuss prevention, treatment, and rehabilitation of patients with tuberculosis.

Dr. Seckinger observed that with improved techniques of treatment, the average hospital stay for tuberculosis has increased from 390 days in 1947 to 439 days in 1952.

"Longer stays in the hospital mean additional beds and increased cost of hospitalization," he said. "It means, therefore, that before there can be a decrease in annual appropriations for tuberculosis we will need, especially in the District of Columbia, to provide additional beds for hospitalizing the patients who need treatment now. Until those patients in the infectious stage are isolated in hospitals the dangers to the public health remain."

Dr. Seckinger called for more integrated planning among agencies working to control tuberculosis plus greater cooperation among the tuberculosis patient, the family, and community agencies interested in their welfare to wipe out the disease.

Dr. A. L. Chapman, regional medical director for the United States Public Health Service, observed the "end of tuberculosis as a major threat to community health is in sight" but depends upon continuous supervision of the patient from the time of detection until final rehabilitation. This, in turn, he said, depends on how well all persons serving the patient work together.

"There are times when the patient with tuberculosis is segmented by administrative procedures within the community," he continued. "Found by one group, treated by another, and followed up after discharge from the sanatorium by another group, there always is the danger that a patient will become merely a trisected statistic, and completely lose his identity as a human being."

Both Dr. Daniel L. Finucane, superintendent of Glenn Dale Hospital and Dr. Leon H. Hetherington, chief of Maryland State Health Department's Bureau of Tuberculosis, emphasized the need for helping the patient to solve the emotional and financial problems attendant to his illness.

Dr. Finucane suggested the need for adequate public assistance grants for families of tuberculosis victims and a special fund to care for patients' personal needs to aid the recovery process.

The conference continues with workshops through tomorrow afternoon. Senator GOLDWATER. The committee will now hear Mr. Clebern S. Edwards, the president of the American Association of Nursing Homes.

Mr. Edwards.


Mr. EDWARDS. Mr. Chairman, Mr. Robert F. Muse will present the testimony for the American Association of Nursing Homes, but with your permission I would like to introduce the following people, who are here to assist you in your determinations.

Senator GOLDWATER. We will be very glad to have them.

Mr. EDWARDS. Mr. George Mustin, of Memphis, Tenn., secretary of the American Association of Nursing Homes.

Mr. Frank C. Bateman, of Springfield, Ohio, executive director of the American Association of Nursing Homes.

Mrs. Houner Hoffman, first vice president of the Indiana Association of Nursing Homes.

Mrs. Goldie Rogers, president of the Maryland Association of Nursing Homes.

And Mrs. Lucia Forde Murphy, of Spokane, Wash., representing the Inland Empire Association of Licensed Nursing Homes, with headquarters in Spokane, Wash.

Senator GOLDWATER. This is a great pleasure to have you folks with us this morning. Thank you very much for coming here. Mr. Muse, you may proceed in your own way.


Mr. MUSE. Thank you, Mr. Chairman.

Mr. Chairman and gentlemen of the committee, the American Association of Nursing Homes, with membership and affiliation in 31 States of the Union, is unalterably opposed to that phase of Senate bill 2758 that gratuitously encourages Federal competition with pri vately operated, proprietary nursing homes.

For over two decades, an estimated 20,000 nursing homes operating and serving in every county in the United States have been caring for the aged and chronically ill without aid or favor from State or Federal governments.

We are fearful that this bill, S. 2758, exceeds the fondest hopes and dreams of those advocates who have espoused the cause that only the Government can best serve the needs of our public-health program.

This bill, therefore, has come as a shock to the medical and hospital professions and has been an especial shock to the overwhelming part of our population dedicated as it is to the philosophy of private initiative and private enterprise.

Our opposition to this bill stems fundamentally from two simple precepts: The first is a definition and a philosophy of the nursing

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home, its growth and its need to the communities of America. Secondly, the cruel and ill-considered policy of fostering Federal grants for the purpose of competing with nursing homes, without first, or at least concurrently, allowing this private industry and profession the opportunity to fulfill whatever may be lacking in the public-health program of America in those areas served by nursing homes; and thirdly, and rather parenthetically, I should like to take a moment to point out how bewildered we are to know the reason why this administration, dedicated as it is to the encouragement of private enterprise, would so arbitrarily cut a swath across one of the growing professions in these United States, and under the facade of doing good through so-called nonprofit nursing homes, is drifting toward socialism in the medical field at an unprecedented pace.

What then, Mr. Chairman and gentlemen, is a nursing home?
It is an institution unique to the American scene.

The longevity of our population, the chronic illnesses defined and controlled by our medical professions have been the necessary forces for the growth and maturity of the nursing home. For the past 23 years they have served the communities of America with neighborly understanding.

These homes are small, compact, friendly units caring for people afflicted with some of the most dreaded diseases known to medical science and treating them with a sympathy and understanding that cannot be attained in large chronic institutions.

Thousands of nurses and other lay people have dedicated their time, their energies, and their fortunes in the development and promotion of nursing homes throughout the United States. They have located them where they are needed, in the community, not in the outlying districts where county and State institutions are always located.

The nursing home, so often defined as an annex to the hospital facility, in the matter of public health, has made its service available to the people where it is needed, so that an afflicted or aged person is able to be within easy communication of friends and relatives; and, as if by design in this atomic age, these semihospital facilities, though dispersed and decentralized as small, efficient units, are serving the needs of our aged and those chronically ill, with understanding and unity of purpose.

We are not, however, unaware that much criticism, of late, has been leveled at the title "nursing home." We are not unaware, too, that nursing homes have suffered bad public relations because irresponsible people, contrary to law and what is right, have housed, harbored, and attempted to serve people who are indigent and others without the sanction and approval of any licensing authority, State or


Mr. Chairman and gentlemen, lest your minds be clouded by this recent outburst of adverse public relations, let it be known that these unlicensed facilities are not nursing homes; they are as unlawful as bootleggers or any other criminal working without the confine of the law and are properly held in disdain by the public, you, the public's representatives, and nursing home administrators alike.

The genuine nursing home, that institution in whose behalf we are appearing as a national association, is not an unlicensed and irrespon

sible unit; rather, it is licensed under strict laws of the various States and subjected to rules and regulations of the properly designated State agencies.

The licensing laws, however, have been slow in coming into exist


This national association has urged that every State have a licens ing law and a set of rules and regulations for the conduct of nursing homes.

We are happy to report that every State but one, North Carolina, in the Union now has a law licensing nursing homes and defining what the code of conduct in a nursing home must be.

As I say, we not only relish this very recent turn of events toward unfair State licensing laws, but we have been instrumental in promoting it.

At this point. Mr. Chairman, I should like to read into the record a statement by Mr. George Mustin, secretary of the American Association of Nursing Homes, in an address in Cleveland, Ohio, recently referring to the nursing home profession's need for uniform laws and standards. Mr. Mustin said, and I quote:

State laws governing nursing homes range from poor to acceptable. In at least one State the licensing application does not list as a requirement any knowledge of nursing or of nursing homes.

The number of square feet in bedrooms ranges from 50 per patient, which is too low, to 2 patients per room, regardless of its size. We believe the minimum should be 70 square feet per bedroom for homes now in operation, 80 square feet for homes subsequently initially licensed.

One State designates the kinds of food by weight each patient is to receive. There are other laws which might better be amended, and there is need for additional legislation to improve existing laws.

The laws governing building codes range from few requirements to those more rigid than the legal yardsticks by which older hospitals in some areas are evaluated.

Standards, too. vary as much as laws, and should be re-examined in line with health and safety requirements, taking into consideration the sensible day-by-day nursing home operating procedures,

I read this, Mr. Chairman and gentlemen, to point out at this time that we are not here for selfish reasons; rather, we are here in what we consider to be the public interest and the public good.

Being a licensee of the State, the nursing home must keep strict and accurate records concerning the medical treatment and nursing care of its patients in a system of charting and recording that is very comparable to the charting and recording required in hospitals.

The home must cater to dietary problems and tend the most intimate needs of unfortunate patients oftentimes completely bedridden; it must maintain a staff of professional nurses and provide facilities for comfort and care 24 hours per day, 7 days per week.

The nursing home administrator, employing on an average of 10 personnel, must be responsible for all those incidental things demanded of any employer-insurance, welfare benefits, vacation pay, social security, workmen's compensation, and so forth.

At this point I should like to read into the record a survey of 23 typical nursing homes in the city of Minneapolis.

Senator GOLDWATER. Mr. Muse, if you would care to submit that, it can be inserted in the record without your reading it, if you want to avoid reading it. You have that privilege.

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Mr. MUSE. Thank you, Mr. Chairman. It is very short and I would like to read this into the record.

There are 23 nursing homes with 552 patients employing 229 people. In 1 year these 23 nursing homes had a payroll of $391,865, and for food alone they spent $221,468.

Twenty-one of these institutions paid $42,596 in real estate and personal property taxes, and over the past 3 years the 23 homes have spent in capital improvements in their properties $191,748.

These are homes, Mr. Chairman, that have been taken at randon to show the consciousness on the part of the nursing home administrator in working toward a solution to some of the problems that are facing all of us.

The home must conform to the rules and regulations of the various State agencies of public health and public safety and from time to time the physical structure of the building must be altered at great expense in order to keep up to the requirements demanded by public safety.

Most importantly, the nursing home administrator in charity and kindness must constantly cope with problems made testy by the aged inhabitants of the home and be ready to satisfy not only the whims of the patient but oftentimes unreasonable demands of the relatives.

Who are the patients being administered to in nursing homes? To answer this, I am submitting a typical census marked “A” and ask that it be extended upon the record for your consideration. Senator GOLDWATER. Without objection, it will be received. (The exhibit referred to is as follows:)


1. Note range of age among patients.

2. Note the modest amount being paid for the nursing home facility and professional care.

3. Note the amount of professional attention each of these patients requires.

4. This home is typical of homes throughout the United States that are licensed under the laws of the various States.


1. Age 90; single; female; 4-bedroom: $30; public assistance: Came from nieces July 1950. Suffers from partial blindness, convalescing from a dislocated shoulder, has general arthritis, and is slightly senile. Originally on house diet, now on fat-free diet. Meat is cut. Lacks partial use of arm. Needs assistance in dressing, hair, etc. Four prescriptions daily.

2. Age 85; single; male; 2-bedroom; $49; private: Admitted April 1950 from hospital. Suffers from general ananasaraca and chronic myocarditis. Must be lifted from bed to chair. House diet, poor appetite, must be prompted to eat. For past year suffering from kidney condition. Not dressed. Six prescriptions.

3. Age 78; female; widow; private room; $35; public assistance: Admitted
February 1952 from boarding home. Suffers from arthritis in left knee; unable
to walk because of this condition. On high-protein diet. Able to dress herself.
Does not get along with people. Three prescriptions and injections.

4. Age 94; female; widow; 3-bedroom: $35; public assistance: Admitted
February 1952 from hospital. Had fracture of pelvis-arterialesotic, anemic,
arthritis, and general arterialeroses. Has had hemorrhagic cystitis. Foley
catheter for short periods.
Lifted from bed to chair, now able to bear some
weight on hip. House diet, food cut. Received public aid. Eight prescriptions,
plus liver injections. Not dressed.

5. Age 70; single: male, semiprivate: $35; private: Admitted August 1951
from hospital. Suffers from arterialeroses and hypertension. Low-salt diet;
able to feed and dress himself. Three prescriptions.

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