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LOUISIANA ASSOCIATION OF LICENSED NURSING Homes,

Lake Charles, La., March 29, 1954. Hon. MELVIN SNEED, Professional Staff, Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, N. C. DEAR SIR: Attached hereto is a statement of facts and statistics as concerns the State of Louisiana and reasons why the Louisiana Association of Licensed Nursing Homes feels that it should oppose certain phases and features of Senate bill S. 2758.

It is also felt that the suggestions incorporated could be of infinite more benefit in solving a perplexing problem.

We are appreciative of the committee's generosity in allowing our organization to submit such a brief for their consideration. Respectfully,

Mrs. Edith THOMPSON, President. ARGUMENT AGAINST CREATION OF NONPROFIT NURSING AND CONVALESCENT

HOME FACILITIES The following pertinent facts and statistics are submitted for consideration, if effective care of the aged, infirm, and chronically ill is to be achieved in Louisiana with the least amount of Feleral funds expended :

1. Louisiana has at the present time 12 Hill-Burton hospitals. The percentage of occupancy on an average during the past 12 months has run 65 to 70 percent full.

2. In both nonprofit and profit hospitals and private homes the total occupancy has bein appro’imately only 85 percent.

3. Ninety-eight percent of the Louisiana Welfare Department's patients have been placed in private nursing homes, rather than nonprofit homes. Reason: Nonprofit homes and hospitals refuse to take welfare patients for the fee allowable.

4. The provision to provide Federal funds for the creation of nonprofit nursing and convalescent home facilities will completely and irrevocably eliminate a phase of "free enterprise," and such funds will serve only to duplicate (at unnecessary expense) existing facilities which are more than adequate.

5. Such a provision as contemplated in Senate bill S. 2758 will cost both the Feieral and State Governments large amounts of revenue in taxes collected from private nursing homes.

6. No revenue in the form of Federal and State taxes will be available from tax-free nonprofit hospitals an) nursing homes.

In conclusion, from an economic standpoint it would appear that an amendment to Senate bill S-2758, eliminating the providing of Federal funds for the creation of nonprofit nursing and convalescent homes and substituting a provision enabling private nursing homes to secure long term, low interest rate loans for purposes of remodeling existing facilities and the building of new homes when needed, would be of greater benefit to the public welfare.

Both from a tax standpoint and the forestalling of unnecessary expense plus the aid and comfort to private enterprise, it is respectfully suggested that the above points of argument be given careful and detailed consideration.

MISSOURI ASSOCIATION OF LICENSED NURSING HOMES,

MARCH 29, 1954. Mr. MELVIN SNEED, Professor Stafi, Senate Committee, Labor and Public Welfare,

Capitol Building, Washington, D. C. GENTLEMEN OF THE COMMITTEE: The Missouri Association of Licensed Nursing Homes, being an affiliate member State of the American Association of Nursing Homes, herewith wishes to protest the portion of Senate bill S-2758; the provision to provide Federal funds for the creation of nonprofit nursing homes.

There are 320 licensed nursing homes in the State of Missouri with 9,560 beds, as of March 15, 1954. With these facilities we have been caring for the aged and indigent in this State for many years without any assistance of funds from the State, county, city, or Federal Government in any amount of funds above the grant of $.35 maximum payment of the old-age assistance grant in this State.

There is no shortage of chronic beds in this State and no need for nonprofit nursing homes unless those nonprofit nursing homes would be obligated to take only the indigent and the $55 a month bed-patient. It is of course obvious that in this day and age, that an elderly person can barely get food and shelter for $55 a month, let alone food, shelter, nursing care, physician, medicines, and laundry-all for $55 a month-which is expected of the nursing home in this State.

We feel that if the nonprofit nursing home would care for the aged and indigent in this class of patient, then that would be a wonderful way of caring for our aged and indigent, but when nonprofit homes hide under the guise of “nonprofit" and take paying patients at $100, $150 and more, per month, then they are no more nonprofit than we private enterprise nursing homes are, especially so when we are caring for the indigent of the State for $55 per month.

So we are violently against this sort of socialized medicine, and the discrimi. nation against private enterprise by our President and Congress, if such a bill is passed; a definite threat to private enterprise and to the proprietory nursing home who has been doing this job for so many years.

All we are asking for is a fair deal. When the Missouri association, along with 29 other State associations, appeared before the Interstate and Foreign Commerce Committee, through our representative of the American Association of Nursing Homes, in hearings on H. R. 7341 (which was replaced by H. R. 8149), Mr. Wolverton went on record at the hearing to say that he would amend his bill H. R. 7700 to include private enterprise nursing homes in the bill which provides long-term low-interest, guaranteed loans to small business.

This would be a step in the richt direction. If the tremendous amount of money called for in Senate bill 2758 was put into such a bill as H. R. 7700 appears to be, if amended, and made available to profit and nonprofit alike, we feel that the private nursing homes would improve tremendously, and immediately upon loans being made available to them, and there would be no need for the expenditure of granting money for creation of nonprofit nursing homes.

The department of health, education, and welfare has made the statement that there is a great need for nursing homes because there are only some 9,000 in the United States. This statement is not quite true for in the 30 States that belong to the American Association we have approximately 20,000 nursing homes, not counting those of the other 18 States.

Many of us have spent our lives in this field of caring for the aged in nursing homes, and we have thousands of dollars invested in our businesses. We feel that we have been doing a public service for years and aiding the national economy at the same time with our taxes and by providing employement for thousands of people.

We have a real and human interest in the older folks we take care of in our bomes. We try to make it a home and not an “institution.” Truly our homes are "a home in which to live; something to do; and someone to care." Thank you for the courtesy offered each State, through our American Association of Nursing Homes, and we sincerely hope and pray that you will give due consideration to the facts presented by each State in this matter. Yours respectfully,

Donn C. BENNETT, President.

KANSAS ASSOCIATION OF LICENSED NURSING HOMES, Inc.,

March 28, 1954. SUBCOMMITTEE ON LABOR AND PUBLIC WELFARE, United States Senate,

Washington, D. C. GENTLEMEN : We feel it pertinent to establish for the committee the authority with which we make the statements to follow in this report. First, membership in this association is open to all licensed nursing homes in the State of Kansas, profit or nonprofit. Therefore it is not composed of a selected group who might be subject to certain prejudices or feelings of bias. Secondly, the statistics quoted in this report have been obtained directly from the Kansas State Department of Social Welfare, which is the agency in this State charged with the direct responsibility of licensing such homes. (Techdically we are licensed as "boarding homes for adults,” but we prefer to call ourselves “nursing homes," since the provision of nursing service is our primary functions.) Further, the department of social welfare bas authorized us to make certain statements herein, and will verify them if they are contacted by your committee.

46293_54pt. 114

The primary purpose of this report is to establish the fact that private enterprise has and will continue to provide sufficient and adequate facilities for the nursing care of the chronically ill and infirm of the State of Kansas, and that there is no necessity for the subsidization of nonprofit homes by the Federal Government through grants for construction of such homes. In fact, we feel it quite unfair to take the tax money paid by the nursing homes of the Nation, give it to nonprofit homes which will be in direct competition with the privately owned nursing home, then have no opportunity to gather taxes from the newly established nonprofit homes. We feel that this is somewhat like killing the goose that lays the golden eggs.

On February 28, 1953, there were 365 homes in the State of Kansas providing beds for 3,987 patients. On the same date, 1954, there were 444 homes with 5,460 beds. This represents an increase of 21.6 percent in number of homes and an increase of 36.9 percent in number of beds during this past year alone. Dur. ing this period there was a lesser increase in number of persons needing our service than increase in beds provided, indicating that private enterprise is anticipating and meeting the needs as they occur.

On the basis of the above statements we feel that we, the proprietary homes of the State, have adequately provided for the needs of the chronically ill in this State. At the rate of increase shown in the past year alone, it is certain that we can continue to do so. As for the opinion of the licensing agency with reference to the necessity for beds, may we quote Mrs. Loudell Frazier, supervisor, adult boarding home program, division of public assistance, State department of social welfare, 801 Harrison, Topeka, Kans., who states, “I hesitate to state that there is a need for more beds in boarding homes in Kansas. I do not feel that Kansas has reached the saturation point in this regard, where the number of patients exceeds the number of beds available."

We wish to further point out that the 5,460 beds in the State of Kansas represent approximately $51%, million in investment. This amount of property repre sents a considerable return to the Government at various levels in taxes, both property and income. In addition the cost per bed is about one-eighth of the amount per bed estimated by Mrs. Hobby in her testimony before the House Committee on Interstate and Foreign Commerce which has previously considered the companion bill to the one your committee has under consideration. Further, the rates presently paid to proprietary homes for the care of the chronically ill who are receiving welfare assistance is equal to or less than that estimated in testimony submitted to this same House committee previously.

If Mrs. Hobby's figure of $8,000 per bed for new construction is correct, it would require over $13,500,000 to replace the existing nursing-home beds in Kansas alone. This does not take into consideration any increase over present needs; and, according to all surveys available, such increase will occur at a geometrically progressive rate.

We feel that this action providing such grants to nonprofit homes is based upon need as indicated by figures, percentages, and estimates that are definitely in error. We think, rather than provide funds for such homes when no one knows definitely how badly they are needed, that a survey should predeed the establishment of such grants. For example, Mrs. Hobby, when appearing before the above-mentioned House committee, used the figure “9,000" with reference to the number of nursing homes in the Nation, whereas even the 1950 census indicates over 11,000. When the State officials of our various States are not positive of the exact needs, the lack of information on the Federal level must of necessity be even more extensive. The process of taking a survey first, then basing additional legislation upon the results of the survey, seems to us a more logical procedure tban to propose grants and include a sum in the bill for a survey to be made to determine the neell for the grants. We are certain that once these grants have been authorized some agency will find a means of expending the funds.

Therefore, we feel that the Federal sponsorship of nonprofit nursing homes will merely be an additional load upon the taxpayer, that it will use the taxes of the privately owned home to establish nonprofit homes in direct competition with it, that it will provide no service at a lesser rate to the public, that it will provide no service that is at present needed. Further, the cost of construction at governmentally estimated rates would be substantially in excess of the pres. ent cost, which is borne entirely by private industry, at no cost to the Govern. ment.

As to the adequacy of care in the presently existing homes, may we point out that our State officials have informed us that there has been an approximate 75-percent improvement in nursing home standards since the formation of our

association and its subsequent participation in drafting of regulations, selfimprovement programs, etc. Since the association represents virtually all prirate establishments, this is a further indication of the better results obtained when private industry functions with rather than under Government.

The proprietary operators of Kansas, through their association, have, since the formation of the association 3 years ago, conducted 4 training institutes for operators; developed and distributed the first correspondence course in nursingbome operation in the Nation; established Nursing Home Day, declared each Fear by the Governor of Kansas to acquaint the public with the nursing home, its service to the community, the community's need for these services, and to make such operation respected and appreciated; and inspired many reforms in administration and operation of nursing homes and nursing home laws in Kansas.

We feel that the passage of this bill will have a definitely destructive effect upon the self-improvement programs presently engaged in by private operators because the incentive to improve standards of care and expand facilities will have been removed. The reason is simply that the private operator will feel the futility of such further effort on his part, realizing that it will be only a matter of time until the nonprofit homes engulf the field. Since legislative wheels grind slowly and it will take a period of time to establish these proposed nonprofit homes, there will occur a considerable number of years durins which facilities will definitely not meet the need because of failure of private industry to expand, since it anticipates extinction in the field. In Kansas alone, eren on a grant basis, Congress could not appropriate enough funds to replace and expand, to meet needs, the beds presently provided by private enterprise when the private operator abandons the field in the face of forthcoming federally subsidized competition.

We hope the foregoing material will be of assistance to you in your delibera. tions. Please feel free to call upon us for any information or assistance we may be able to provide. Respectfully submitted.

ESTELLE C. BIFFER, President. Senator Hill. Is the gentleman through? Senator GOLDWATER. Are you through? Mr. Mose. I am through.

Senator Hill. In that connection, Mr. Chairman, Mr. Edmund F. Jacobs, executive secretary of the Washington Association of Licensed Nursing Homes, was in to see me a few days ago, and I know that he Tas also seeking to see the chairman of the subcommittee, Senator Purtell. I don't know whether he saw Senator Purtell or not, but I know he was seeking to see Senator Purtell, and I suggested to him that he might send me a wire or a letter expressing his views. I have that wire here, together with several other wires on this very subject of the nursing homes, which I would like to put in the record at this point.

Senator GOLDWATER. They will be received. (The telegrams referred to are as follows:)

PUYALLUP, WASH., March 18, 1954. Senator LISTER Hill,

Labor and Public Welfare Committee, Washington, D. C.: Am setting forth herewith results of recent survey of nursing home facilities, State of Washington, per your oral request on my recent visit your office. Of 8.197 beds licensed by Washington State, 5,126 belong to association, presently 559 association beds empty: 1,681 additional association beds under construction or awaiting approval of plans. Figure does not include potential new entrants into field. Forty-eight-bed fireproof modern State-approved convalescent class 1 bome recently opened at cost of $2,200 per bed. Nineteen patients transferred directly from general hospital, Kitsap County, to this new home where care given at cost of $6 per day. We find no need for additional nursing home beds in our State that cannot be met by our industry. We feel Senate bill 2738 is definite threat to private industry.

EDMUND F. JACOBS, Erecutive Secretary, Washington Association of Licensed Nursing Homes.

SEATTLE, Wash., March 18, 1954.
Senator LISTER HILL,

Labor and Public Welfare, Washington, D. C.:
Senate bill 2758, we feel, is detrimental to private industry. A survey in
Washington State shows approximately 800 to 1,000 available beds today for the
convalescent and chronically ill and senile patients in licensed nursing homes.

ETHEL MAY HILL, R. N..

Hill Convalescence

SEATTLE, WASH., March 19, 1954.
Senator LISTER HILL,
Labor and Public Welfare,

Capitol Building, Washington, D. O.
Senate bill 2758 lets be fair to private enterprise. We all ready have vacant
beds in our licensed nursing home.

Mrs. JOHN C. HEWITT.

SEATTLE, Wagh., March 19, 1954.
Senator LISTER HILL,
Labor and Public Welfare,

Capitol Building, Washington, D. C.
Senate bill 2758 due to adequate space in licensed nursing homes in the State
of Washington I feel this bill should be vetoed.

NORMA SHANE,
Sunset Manor Sanitarium.

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SEATTLE, WASH., March 19, 1954. Senator LISTER HILL:

I am definitely opposed to Senate bill 2758 subsidizing State resthomes, a glorified name for back to the poor farm speaking for State of Washington, statistics show hundreds of vacant beds, no shortage of space. If this is a genuine do good appropriation why not divert these millions to improving penal institutions where the need is desperate. Privately owned nursing homes are doing a good job at less expense to the taxpayer. If the resthome patients voted on this bill the answer would be "No." The resthome owner pays for their own buildings at no expense to the taxpayer. This bill has not received the time for statistical investigation it needs and the general public knows nothing of its significance. If the taxpayer is to get any relief from the burden he is now carrying such expenditure as this bill proposes will not find favor when the real facts are disclosed. Your earnest consideration is requested.

VICTORIA GARDNER,
Member, King County Nursing Home Association.

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SPOKANE, WASH., March 17, 1954. LUCIA Ford MURPHY,

llotel Shoreham: Review Colfax, Wash., February 27. Hillcrest may be replaced with a new $165,000 50-bed nursing home within the next 10 months. County commissioners met with State officials in Seattle last week and learned that the county may legally rebuild Hillcrest with assurance that the State will use its facilities and underwrite operating expenses. Chairman Bell pointed out that Dr. Kabl, acting State director, suggested Whitman County raze the old structure and build a new 50-bed nursing home at a cost of $165,000, the commissioners would operate it on a separate fund set aside for this purpose. Plans and estimate for the building construction will be discussed by commissioners March 8, when Phillip Austin head of State planning section visits the present Hillcrest site, a possibility of the county obtaining Federal money to aid in the construction lies in the faith of a $10 million appropriation now, Bell exclaimed.

The money would be given to the county on a 50-50 basis under the HillBurton Act. If we decide definitely to go ahead with the construction the money will have to be budgeted this July and become available next January. He explained that the construction would not require any special tax levies since

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