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Annual extent of operations of private nursing homes in Minnesota

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716 $923, 658. 54 $720, 175.48 $131, 921.91 $90, 839.85 133, 427.81 3161, 216.10

Rural Minnesota. 1,885
Minreapolis-St.
Paul......

1,218

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Total...

3, 103 1, 202 1,789,680.61 1,210,725.40 211, 882. 69 182, 707.52

62, 551.68

302, 500. 66

NOTE.-The conservative estimate of the value of the investment in private nursing homes in the State of Minnesota woull be at least $6 million. Many homes have installed, and are installing, strinkler systems in the interest of eliminating fire hazards, which as a single item are averaging between $6,000 to $10.000 per home. The figures for the metropolitan area of Minneapolis-St. Paul are separate from the rest of the State because of differences in costs between city and rural areas. We believe these figures to be very conservative, and, if they err, they do so on the low side.

THE GEORGIA ASSOCIATION OF NURSING HOMES,

April 1, 1954.
Mr. MELVIN SNEED, Professional Staff,
Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, D. C.
DEAR SIR: We, the private nursing homes of Georgia, speaking through the
Georgia Association of Nursing Homes, respectfully voice our objections to the
Gorernment appropriating $50 million for nonprofit nursing homes for the aged
as provided in pending bills, S. 2758, H. R. 8149, and for grounds say:

In the State of Georgia we have 84 homes licensed by the State Hospital Services Division of the State Board of Health with a total bed capacity of 2,686 patients and with prospects of other nursing homes being built through private enterprise. Each of these nursing homes represent an investment of from $15.000 to $30,000. In addition, they are staffed with medical practitioners and purses who, for the most part, own the establishments, or the majority interests therein.

Should the Federal Government pass Senate bill S. 2758, H. R. 814), unfair competition, that of subsidized governmental nursing homes against the unsubsidized ones, would immediately result, probably forcing the 8t privatelyfinanced nursing homes out of business because of the larger, more modern facilities arailable only through subsidy of the taxpayers.

The nursing homes occupy a more important place in the community in that it is a bridge between those patients who are not able to enter hospitals for financial reasons but are able to afford the lesser expenses involved in the nursing homes.

The greatest need of private enterprise in this field would be to obtain long-
term, low-interest loans from the Federal Government that would help each
home raise its standards by adding extra beds, more doctors and nurses, and more
modern equipment.
Another need of the private nursing homes which might be provided by the
Gorernment without undue cost to the taxpayer would be closer laboratory
cooperation provided between the private nursing homes with United States
Public Health laboratories. Likewise, making available to private nursing
homes surplus armed services equipment such as hospital beds, laboratory and
hospital equipment, and other equipment which is no longer needed for military
purposes, would be of untold benefit. This latter type of aid would assist the
bilirsing homes and the public immeasurably and would enlarge the base of
service the private nursing homes are presently rendering their communities.

If desired, a representative of this office would be pleased to appear before
an appropriate committee considering these bills or supplemental information
will gladly be furnished upon request.
Yours very truly,

John L. McCALLUM, President.

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TEXAS NURSING HOME OPERATORS ASSOCIATION,

Beaumont, Tex., March 28, 1954. Mr. MELVIN SNEED, Professional Staff, Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, D. C. DEAR SIR: Please refer to Senate bill 2758, which is the Senate version of House Resolution 8149, a bill to amend the hospital survey and construction provision of the Public Health Service Act. I would like for the members of the Senate subcommittee to consider the following facts as they study this legislation,

The Public Health Service Act that is to be amended did not include nursing homes. This act was not intended to subsidize nonprofit organizations to compete with private enterprise. Hospitals were originally organized by groups of religious people as nonprofit institutions. Nursing homes were originally organized by small-business people, engaged in free and private enterprise. Nursing homes hare remained in the category of private enterprise. Hospitals are, predominantly, nonprofit organizations. Therefore, nursing homes should not be included in this bill.

The term "nonprofit organizations" is very broad. The bill does not specify that the organization must have been chartered to care for the sick and helpless. It does not specify that the nonprofit organization must be a part of the nonprofit hospital organization. Again the original intent of the bill to be amended has been forgotten.

The figures presented to the Committee on Interstate and Foreign Commerce, February 4, did not include the commercial nursing home beds. Until a proper survey is made, including the beds in licensed nursing homes in the United States, no person or group should be willing to ask for legislation appropriating such an enormous amount of money. How can a need be determined without these beds being counted? How can the people engaged in private enterprise survive and compete with Government grants for which they must help provide the money? Every State in the Union now has a licensing agency for nursing homes. This agency has the figures covering their State. Why should $2 million be spent to make a survey that can be made by the licensing agency of each State? They have inspectors and representatives employed and in most cases have the figures available.

On the 24 and 25 of this month I held an open State meeting for nursing home operators of Texas. Over 75 operators attended this meeting. Every section of the State was represented. Open discussion brought out time after time that there is no shortage of facilities for the chronically ill in Texas.

The director of the Texas State Department of Health, Dr. George W. Cox, has stated repeatedly that we have no shortage of facilities in Texas. We definitely need to do some remodeling and it would be very good if we could replace some of our homes with new construction. We would like very much to have funds made available on long-term 2- to 3-percent interest loans. The commercial loan companies will not loan money at this low rate and if we are able to obtain such loans the money would need to be appropirated by legislation for this purpose. Would it not be better to make these funds available to experienced people on a loan basis than it would be to grant it to inexperienced nonprofit organizations that do not pay taxes and who would not be required to pay it back?

The people who have invested their money and spent many years of their life in this humanitarian work were completely ignored when this bill was written. At the same time Senate bill 27.58 will legislate them out of business. This bill discourages private enterprise: it discourages small-business people. You know, and I know, that the very foundation of the American way of life is private enterprise and that the phenomenal growth of our country is the results of fair and clean competition: the competition resulting from people starting in small businesses, investing their own money and labor. surviving and growing as they improved the service they had to offer or the article they had to sell. Should our legislators permit the passage of a bill that would tend to destroy the American way of life?

There is not a professional group of people in America who have given as much in return for the dollars they have received as the nursing home people have given. They started in most instances, with a small amount of money. a desire to serve suffering humanity, and two hands that were accustomed to hard work. They have reinvested their profit and many of them hare modern, well-staffed homes; some are still striving for better physical plants and have not reached their goal.

I bumbly ask that you conscientiously study Senate bill 2758 and I pray that you, too, will see the injustice of this legislation. Yours very truly,

MBS. OSCAR YELLOTT, President.

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LICENSED NURSING HOMES ASSOCIATION OF NEW JERSEY, INC.,

Elizabeth 4, N. J., Murch 27, 1954. Hon. ALEXANDER SMITH, United States Senate,

Washington, D. C. DEAR SENATOR SMITH: The Licensed Nursing Homes Association of New Jerseg is opposed to S. 2758 principally for the reasou that the bill, as it now stands, completely ignores private enterprise and attewpts to build federally sponsored Dursing bomes in direct competition with the estimated 120 proprietary nursing homes that have pioneered the movement in caring for the indigent, ayed, and chronically ill in New Jersey for the past 20 years without aid or favor by the county, State, or Federal Government.

Nursing-home operators have spent their time, energies, and fortunes to develop and promote nursing homes throughout our State. Some may have fallen by the wayside, but, nevertheless, the greater majority have shown that private enterprise can provide for a social service that our statesmen and leaders have forsaken for so long a time. Now apparently, in their anxiety to establish reforms, the administration casts violently and shockingly aside all basic principles of private enterprise, the very foundations which we all cherish, tight, aud work for,

In New Jersey, there are approximately 120 nursing homes with an average value of $50,000 per home. We employ nurses, cooks, maids, bandymen, and pay substantial sums of money in salaries and taxes. The gross volume of busiDess in New Jersey alone is over $10 million per year, distributed to craftsmen, Carpenters, plumbers, food suppliers, and so forth.

And now, with one grand swoop, privately owned nursing homes will find it impossible to compete with the nonprofit bomes, because S. 2758 encourages the creation of the nonprofit group to form and take over, by unfair competition, that which private enterprise has created by arduous efforts throughout the past years.

We do not condemn the basic principle of the bill but do condemn the utter disregard for the proprietary nursing home. All we request is that the ad. ministration encourage private enterprise in the nursing field as it eucourages Donprofit groups, and that long-term, low-mortgage loans be made available to the nursing home operators.

In closing, we should like to reply to your survey which indicates a shortage of pursing home beds. Nursing home operators in the many communities throughout New Jersey always had vacancies, and they have them now. In some communities, a shortage of beds may exist only for indigent patients, and that is because of the inadequate grant the governmental agencies will allow for room, board, nursing care, and services. A reevaluation of operating costs and allowa ances for the maintennace of welfare patients, would be informative and reflect well upon those of us who, in our limited way, have provided nursing care and services to indigents at a loss.

Your survey also indicates that it is less costly to build and operate public or nonprofit nursing homes than hospitals, but it should also state that private enterprise can build and operate for less than either. Respectfully yours,

Lewis Gasi, President,

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TENNESSEE STATE ASSOCIATION OF NURSING HOMES,

March 27, 1954. Mr. MELVIS SNEED, Professional staff, Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, D. C. DEAR MR. SNEED: In conenction with hearings on S. 2758, March 19, 1954, the Tennessee State Association of Sursing Homes wishes to enter the following into the committee hearing record.

Te oppose that portion of S. 2758 which would make available grants for the construction of nonprofit nursing homes for the reasons hereinafter stated.

Proprietary nursing homes have performed their services for many years, and without Federal aid. We represent an established, tax-paying industry, with an investment in this State of some 6 millions of dollars. Under the circumstances, we have performed a valuable and essential service, and with the proper support and cooperation, could improve this service to meet the requirements of the most exacting critic.

Where there is criticism of the nursing home, it is generally based on charges of low standards, and of improper housing.

While we do not feel there is any justice in a charge of low standards in Tennessee, we do feel they could be raised, provided the licensing and operating standards of the State could be revised, more personnel provided for inspection, and laws presently on the books enforced more strictly. Briefly, in order to have good standards, there must be laws requiring those standards, frequent inspection to see the law is complied with, and rigid enforcement of laws requiring licensure as a prerequisite to operate.

The argument used in connection with the companion bill in the House (H. R. 8149) that the bill should be passed because of the lack of uniformly high standards has no basis in fact because the proposed measure merely relates to the construction of nursing homes, and has no reference or influence upon the standards of operation. That is wholly within the field of State legislation, inspec. tion and enforcement.

As for the criticism concerning our housing, we would like to build modern plants, but it is most difficult to negotiate financing through usual channels, since lending firms take the position that ours is a specialized field, and that construction would be for a one-purpose building. Therefore, their offering, if at all, is usually limited to 50 percent of cost. Just how many fine hospitals would we have today if they had to be constructed under similar circumstances?

One point upon which those sponsoring S. 2758 do not dwell is the impact upon the present nursing home standards, if this proposed measure were to become law. The resulting construetion of nonprofit homes would, in our opinion, inevitably relegate the proprietary nursing homes to domiciliary institutions, and thus lower the standards of our homes. Nursing hoines, as we now know them, would cease to exist, and their present level of care, which has risen slowly with the years through individual and collective effort, would descend into the dark ages of poor standards, because of our inability to compete with federally fostered institutions.

There are alternatives to S. 2578 which would provide some measure of assistance in the four categories, with lesser effect upon our proprietary homes.

Since the inception of the Hill Burton Act, there have been construction within its framework in all four categories. If the act were amended to provide construction under the auspices of hospitals, but not necessarily physically conpected thereto, then the substance of S. 2378 would be realized. However, in the case of nursing homes, such hospital sponsored construction should be only for the hospital's convalescent cases, and not for the chronically ill. This would be right and proper, and would relieve the present shortage of hospital beds.

The other alternative would be to appropriate sums for a survey to cover a period of 2 years, and at the same time, pass legislation providing Government or Gorernment-insured loans to proprietary homes. We feel that in 2 years we could make such progress toward modern housing that it would be clearly seen there was no necessity for offering grants to nonprofit institutions.

Gentlemen, before passing upon this proposed legislation, weigh the donbtful benefit to be obtained for our aged ill citizens against the certain devastating effect upon the established proprietary home.

Give us an opportunity, through Government support to continue our services, and to improre them. With help, we can and will render the very finest service. Sincerely,

GEORGE T. MUSTIN, President.

INTERMOUNTAIN ASSOCIATION OF NURSING HOMES,

Salt Lake City, Utah, March 26, 1954.
Mr. MELVIN SNEED,
Professional Staff, Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, D. C.
DEAR MR. SNEED: This is to inform your committee on the views of the Inter-
mountain Association of Nursing Homes in Utah concerning Senate bill 2758.

In the State of Utah, propriety homes have operated 25 years without aid of city, county, State or Federal funds.

We feel that this bill will deny us our inamiable right as a free people to enter or continue free enterprise. The inamiable right of a free people as indigents to choose the home in which they shall be cared for. This right which was given to us by our forefathers and our sons are still fighting to preserve, will be taken from us.

In order to give the very best of personalized care in our private homes, we have contacted every available organization and individual who is primarily concerned with the care and treatment of the indigent as an individual.

Dr. George A. Spendlove, director of Utah State Department of Health; Bishop Joseph L. Writhlin, head of the presiding bishop's office, Church of Jesus Christ of Latter Day Saints; H. C. Shoemaker, commissioner of State public welfare; a group of leading physicians and hospitals recommended propriety operated nursing homes, because of the excellent care being given the patient and the splendid progress and expansion in meeting the growing need in the nursing care of the chronically ill. This has been done by propriety operated homes over a period of years without any expense to the taxpayer.

Adiel F. Stewart, chairman of the Salt Lake County Commission, made the assertion that it cost $12, or more per day to keep a patient in the infirmary maintained by the State. Private enterprise is giving the care for $3.34 per day in this State: a difference to the taxpayer of $8.66 per patient. We as taxpayers alone certainly are interested in the fact that these figures bare out our contention that propriety homes can and should be allowed to operate without competition from the Government. It is a well known fact that propriety operated homes do operate at less expense and give much better care to the indigent.

At present, in the State of Utah, we have to our knowledge three nonprofit nursing homes which we hare visited. One administrator asserted that it is impossible for them to care for an indigent at the present rate of pay. Nonprofit homes do not accept difficult nursing care patients. We are presenting figures we feel you will be interested in.

In the year of 1939 there were 36 homes and no licensing laws. Today there are 70 licensed homes.

Nursing homes were first regulated under the 1947 hospital act. Licenses were being issued by the State health and welfare departments.

In 1951, Utah was the first State in the Union to pass legislation formulated by nursing home administrators for the purpose of governing nursing homes, making it possible for city, county, State health and sanitation inspections. The administrators licensing agent is under the office of business regulation. In 1953, Utah administrators passed legislation to remove nursing home licensing from the hospital act of 1947, placing it under the State department of public health. All future administrators are required to pass a written test before securing business administrators appointed by the governor.

Under this law the governor appointed a governing council consistig of five
represetatives. Two of whom are nursing home administrators with more than
5 years experience. This council is to form and approve all rules and standards
regulating nursing homes. Because of this law, nursing home administrators
were placed on a professional basis.

We feel the Government could best serve the chronically ill by increasing their
individual grant, thus giving the propriety administrators the opportunity to
expand as needed.
The total bed capacity is 1,560 with homes having vacancies at this time. Of
this number approximately 500 are indigents.

There are recreational facilities for the entertainment of those able to enjoy
it
. There has always been a rehabilitation program in effect in propriety nursing
homes.
Yours truly,

NAOMI BROOKS, President.
JEAN SINCLAIB, Vice President,

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