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KENTUCKY A9sOCIATION OF NURSING HOMES,

New Castle, Ky. SENATE COMMITTEE ON LABOR AND PUBLIC WELFARE,

Capitol Building, IVashington, D. C. Sirs: As president of the Kentucky Association of Nursing Homes, which association represents a majority of the licensed nursing homes within the Commonwealth of Kentucky, I am protesting against the inclusion of nursing homes in the provisions of H. R. 8149 and Senate bill, S. 2758, for the following reasons:

1. The nursing-home operators of this State fear that this would set a bad precedent and open a door for an expanded and greatly accelerated program of unfair competition on the part of the Government to the private-enterprise operators of nursing homes. They have seen the system of hospitals operated by the Veterans' Administration expand since 1926 from 26,000 beds to present plans for some 130,000 beds offering service to about 40 percent of the entire adult male population of our country, with the possibility of still greater future expansion. Private hospitals are greatly concerned about this, and nursing-home operators on their part feel that they should take warning from this and other programs of Government spending that tend toward the socialization of medical facilities and private enterprise. Such a program as is initiated in these recently introduced bills could eventually destroy the proprietary nursing homes profession in this country.

2. Nursing-home operators believe that these bills were conceived as a result of misinformation. The original bill, H. R. 7341, was conceived with the idea that there were only about 9,000 nursing homes in this country, whereas figures compiled by the nursing homes associations throughout the country indicate that 20,000 would be a more accurate estimate of the number. The administration did not realize how large a number of nursing homes were already in operation. Nor did they take into consideration the large number of such patients as are now being cared for in State, county, municipal, chureh, fraternal, and veterans' institutions, and in the general hospitals throughout the country. Apparently they did not know that some of the newer hospitals, especially in rural areas, are maintaining their present bed capacities at present occupancy levels only by taking care of a considerable number of patients that are in reality nursinghome patients. They made no survey to ascertain how many nursing home beds are already vacant in such areas. Yet they estimated that only a small percentage of the needs are presently being met. Nor did they consult with any of the nursing homes associations to ascertain whether all present and future needs for improvement and expansion might be met through long-term loans without outright grants. If this had been done in a sincere manner, nursing homes would never have been included in the provisions of these bills,

3. Large centralized nursing homes such as would result from this proposed plan would be needlessly expensive to build. It was estimated by the sponsors of this proposal that it would cost $8,500 per bed to build and equip nursing homes, whereas proprietary nursing homes meeting all State licensing require ments can be built on a 1-floor plan according to local community needs at about one-third the cost anticipated by the sponsors of this legislation.

4. Large centralized nursing homes of this type are not conducive to the proper care of nursing home patients. They become too professional to provide the home atmosphere which has made the nursing homes profession what it has become today. They lack that human touch and personal relationship between worker and patient that means so much toward making old people happily contented, as we find in the majority of licensed and approved nursing homes throughout this Nation. They rob the residents of the companionship of their friends and relatives because these find it difficult to make frequent trips to visit a more distant centralized nursing home. Our present nursing homes are built around the community which they serve. Centralized nursing homes would mean that nurses and workers generally trained to care for acute and short-term patients would be assigned to the care of nursing home patients a task for which they are untrained and which demands a different type of care from that of general-hospital patients.

5. It would encourage public-nursing homes, and it is generally known that satisfactory operation of public institutions for long-term cases is extremely difficult. Care in such institutions has not compared favorably to that found in properly regulated licensed nursing homes, and few public institutions are operated on the standards required of private institutions.

6. Government-sponsored publicly owned nursing homes would tend to remove responsibility for the care of such patients from the relatives and local communities and shoulder it upon the Federal and State governmental units. A large percentage of the public feels that, if an institution is publicly owned, individuals should not have to pay for the service it renders. This would result in an ever-increasing tax burden and a further drift toward socialized medical care.

7. Whether paid by public funds or not, care in such nursing homes would actually cost more than in proprietary nursing homes, especially when cost of maintenance, replacement, cost of operation, and loss of taxable income to the Government are all taken into consideration. Even in nonprofit hospitals care may cost more than in proprietary hospitals when such things as contributions, subsidies, endowments, tax exemptions, and so forth, are all considered.

8. Large institutions for the care of long-term patients on a self-supporting basis have proved unprofitable financially, with the result that they have in some cases been discontinued and in others transformed into general hospitals or have undergone modifications as to their original purposes.

9. This Nation has rejected socialized medicine. Yet, when a large group of citizens are encouraged to look to the Federal Government to provide care for all their disabilities, they are being led one step closer to socialized medicine. No private enterprise can long compete with a Government-subsidized enterprise in the same field of operation. Private and proprietary nursing homes could not successfully compete with public-nursing homes. In this proposal the Government is alining itself against private enterprise. The elimination of private enterprise in the nursing home profession could conceivably bring one step Dearer the elimination of private enterprise in the medical profession. A continually expanding Federal aid program for all types of care could lead eventually to the federalization of all hospital and medical care.

10. There is a fear on the part of many nursing-home operators that factors other than the best interests of our chronic and aged population may influence the location and construction of public-nursing homes. Some of them have felt that already a few politicians have used old-age-assistance raises as a tool for the advancement of their own personal ambitions by leaving old people under the impression that politics had something to do with such increases. These operators fear that the provisions of this legislation might be used for political purposes on a local level.

In the foregoing, I have endeavored to summarize, without burdening anyone with statistics, some of the principal reasons why the members of the Kentucky Association of Nursing Homes are opposed to having nursing homes of any kind incirded in the provisions of H. R. 8149 and Senate bill S. 2758.

They feel that money for construction of nursing homes by outright grant
should not be undertaken until all other legitimate efforts have been made to
meet the needs, and they feel that long-term, low-interest, Government-insured
loans to proprietary and nonprofit nursing homes alike, without partiality, by
inc'ading both nonprofit and proprietary nursing homes in the provisions of a
bill such as H. R. 7700, would fully solve any problems of the present or future in
connection with the need for nursing home beds. They feel that an attempt
should at least be made first along this line before any legislation is passed
to provide outright grants for public and nonprofit nursing homes.

They also feel that if more public funds for the care of the indigent who are
in need of hospitalization or nursing home care were provided to meet the cost
of such care, the number of nursing homes of a high quality would greatly
increase, and that this would make it easier to finance such construction from
regular financial circles. Even if the proposed legislation should be enacted,
this increase for the care of indigents will naturally follow in time, so why
should not we "put first things first” and leave the enactment of such legisla-
tion as is proposed in H. R. 8149 and S. 2758 only as a last resort, should all
other more reasonable methods prove to be inadequate.
Respectfully,

IRA O. WALLACE, President.

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WISCONSIN ASSOCIATION OF NURSING HOME OPERATORS,

Eau Claire, Wis., March 28, 1954.
Re. S. 2758
Mr. MELVIN SNEED,
Professional Staff, Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, D. C.
DEAR MR. SNEED; On behalf of 357 nursing homes within the State of Wiscon-
sin, the Wisconsin Association of Nursing Home Operators assert their position
against the above bill S. 2758 that has been introduced for legislation.

In our State more than 12,000 older citizens, excluding many in mental and general hospitals, are receiving some type of institutional care. Almost two-thirds of them are in our nursing homes. It is therefore understandable that the nursing home operator is playing an important role to assist this new generation to become part of our social and cultural life. The nursing home strives to maintain a home atmosphere that is nonexistent in large institutions but at the same time render physical care that he is unable to get in his own home.

You, no doubt have been subjected to discussion against this bill, such as free enterprise, return of internal problems and responsibilities to States, and deac. tivation of Government competition with private industry. All these are logical reasons that should be given due consideration.

llowever, we should not lose sight of the purpose of this bill. It is not presumptuous to say the purpose is for the benefit of our older citizens. Therefore, it would not only be logical but also proper to have the older person decide who will be his custodian at large. Too often we are prone to solve the older persons' problem without consulting them for advice and opinion. Let us weigh their thoughts as we meditate over this bill:

Granumn and grandpa wonder what constitutes a nonprofit organization? Will it carry a stigma of charitable significance? Will it represent a public institution?

What is there to prerent a city or county to set up its own nonprofit organization? Would it not then be city or county operation? Experience has informed them that the public institution or poor farm, though gradually making its departure, are still, in memory or in fact, a stigma to society. In small and large cities they continue operation as the "catch-all” for community problems. Regardless of age, derelicts, alcoholics, and various types of undesirables are admitted. This type of institution is a convenient method, or the least line of resistance, for the court to clear its calendar. Unfortunately these same institutions are “bursting at its seams" with oliler citizens. Is this the penalty for old age to be cast in with community outcasts?

In a sense, our interpretation of S. 2758 is a backward step in the field of gerontology. It is an encouragement to the rebirth of poor farms. Granted, it is an encouragement for communities to accept the aging problem as & courmunity problem, but what prevents a nonprofit organization from converting to a commercial institution? The hesitancy of the average citizen to accept responsibility for its aged, and lack of qualified personnel interested in this field of work, has been a discouragement for direct community participation.

In conclusion, may we stress. "what the older citizens desire" should be the guidepost for any decision in this field of welfare. Respectfully submitted.

ALBERT G. INCANI, Vice President.

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MISSISSIPPI STATE ASSOCIATION OF NURSING HOMES,

March 30, 1955.
Mr. MELVIN SNEED,
Professional Staff, Senate,
Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, D. C.
DEAR Mr. SNEED: First, the members of the Mississippi State Association of
Nursing Homes would like to thank you for this opportunity to give our views
concerning Senate bill S. 2758.

Our State association is opposed to Senate bill S. 2758. The most important one thing to be considered whenever we think in turns of nursing homes is the welfare of the aged and chronically ill found in these homes. Whenever a man or woman

is placed in a nursing home, the first thing their loved ones think about is: "Is my mother or father going to be happy in that home?" In order to make an elderly person happy when you take them from their own home to a nursing home is to make their period of adjustment a pleasant and speedy one. Elderly people cannot stand much changes. In order to accomplish this, you must have a kind and sympathetic nursing staff who are stable. A person could never get the personal and individual attention in a State institution as they receive in a private nursing home. A good nursing home does not have the large turnover in personnel as that found in State institutions. This alone is an important factor in the welfare of the patients. The nursing home must always thrive to make it known to the patients that they are not just put away in a home and not wanted.

Elderly people are very much like children inasmuch as they get sick quickly and if neglected, their ailment can become serious in a short time. Only a closely supervised nursing home can give the type of care so necessary in caring for the aged and chronically ill. A tiny blister, the size of a pea, can if neglected turn into a vicious bed sore. So very often you find personnel in the large institutions who try to get by with doing the least possible work. A private nursing home is run by a responsible administrator, who is constantly watching over his patients to see that they get the necessary nursing care.

It is true that we have an inadequate number of nursing homes throughout the country but we sincerely believe the answer to this problem lies in the passing of H. R. 7700. Bill H. R. 7700 will allow administrators of private nursing homes to make a reasonable loan to build new nursing homes or remodel their present building thus giving more and better nursing home facilities.

The passing of Senate bill (S. 2758) would mean socialized nursing care, one step ahead of socialized medicine. We all are aware of the danger of socializing any form of profession, especially the care of elderly people. It is our belief that we should always try to preserve the freedom of free enterprise. It was this belief of democracy that made mine and millions others who went into service an easier task to perform.

It would be wise to visit the patients in proprietary nursing homes and those in State institutions and get firsthand information as to how these people feel about their surroundings. I feel sure that you will find those in private nursing homes much happier than those found in State institutions. We think that it would be worth the try to permit the proprietary nursing homes to take care of the aged and chronically ill by allowing them to make reasonable long, term loans to build more facilities. Please give the private nursing home administrators an opportunity to do the job themselves. Sincerely yours,

HARRY D. HELMAN, President.

THE MINNESOTA ASSOCIATION OF NURSING HOMES,

Minneapolis, Minn., March 30, 1954. SESATE SUBCOMMITTEE ON LABOR AND PUBLIC WELFARE, Capitol Building, Washington, D. C.

(Attention: Mr. Melvin Sneed, Professional Staff.) GENTLEMEN: The Minnesota Association of Licensed Nursing Homes wishes to record its protest in opposition to those portions of Senate bill S. 2758 and House bill 8149 providing for appropriation of Federal funds for the construction of public nonprofit nursing homes on the following grounds: 1. The privately owned and operated licensed nursing homes have adequately filled the need for the care of chronically ill and convalescent patients in our State,

Nursing homes are not to be confused with the many church and charitable bomes whose patients or guests are almost 100 percent ambulatory and not in need of nursing care or medical supervision. The need for nursing and medical care for the aged and infirm during the past decade has been met by the private pursing homes who furnished the only proper care available when the only alternative was the old-fashioned county poorhouse. The privately owned homes have expanded their existing facilities as rapidly as the need for these services arose, and, in addition, have added 84 new privately operated homes during the period from 1947 to 1950 in our State alone.

We feel that, as an important segment of the system of private enterprise in our country, we will continue to adequately meet any need for our facilities as this need arises.

Amplifying the above statement regarding the importance of our position in the field of private enterprise, we wish to call your attention to the accompany. ing statistics on attached exhibit which give an accurate picture of the financial activities of the private nursing homes in the State of Minnesota.

2. Privately owned and operated licensed nursing homes are better suited for giving nursing home care than large institutional type homes.

The average size of a private nursing home is between 20 and 30 beds. Some are considerably smaller, having as few as 9 beds, and some as many as 50 beds. This type of operation can be carried on in a reconverted mansion or smaller new home which does not require the expensive facilities associated with a hospital. Also, from this type of home, a convalescent or chronically ill person is allowed to choose the one in which he or she wishes to reside; the care is much more intimate and personal; and the transition from residence with their own families to a nursing home is much less sharp.

Nursing homes must be distinguished from convalescent hospitals in that the term "hospital" honestly implies the need and usage of many highly technical types of equipment similarly employed in the regular hospitals. This technical equipment is not necessary in the ordinary nursing home. Patients and their families have repeatedly expressed their happiness and contentment in the home like atmosphere found in the private nursing homes as compared to the institutional atmosphere inescapable in the large publicly run institutions.

The Government sponsored or financed institution usually is a large institu. tion involving hundreds of beds and necessitating a large initial investment. This type of institution pays no taxes, and their histories of operation show them to be costly and I real added burden to all taxpayers.

Costs of patient care in private nursing homes are strictly regulated by our State, county, and city agencies. These agencies regularly inspect our homes to insure adequate facilities for the proper care of patients. This results in a balance between services rendered and the amounts paid therefor which would not be possible in the State or county homes.

Government sponsored nursing homes violate the principle that the aged should have the right to choose the home in which they are to be placed, by making them wards of the county or State and forcing them to be subjected to institutional care, such as existed in the old type of poor farms now generally abandoned.

Government sponsored homes would be the beginning of socialized medicine for persons over 65 years of age receiving old-age assistance. It means that the care of the convalescent and chronically ill of our aged population would become subiect to political pressures, rather than remaining part of the free enterprise system of our country. It means a highly increased tax burden to pay for the cost of constructing Government sponsored nursing homes.

3. Government financed nursing homes would destroy large investments in private nursing homes made in response to growing need for nursing home care and put Government in direct competition with private enterprise,

They necessarily involve large single institutions that discourage private investment, and would revive the old poor farm system for the care of the aged, which the social security law was intended to eliminate. Private nursing homes have expanded private employment, made use of many old properties, and have paid large sums in taxes to the State and Federal Governments, all of which would be seriously affected by this bill.

4. We feel that the reasonable solution to this problem is the insuring by the Federal Government of reasonably long term low interest loans to the private nursing homes to aid and encourage them to still better meet any future need for expansion as conditions might dictate and save our Government the millions of expense now being considered in these bills which cannot help but add to the country's and taxpayers' financial burdens. Very truly yours,

ALVIN COSTELLO, President.
C. S. BOYCE, Secretary.
MILTON S. DAVIS, Treasurer.

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