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POSITIVE INCENTIVES TO BE MORE EFFICIENT AND COST CONSCIOUS IN THE PROVISION OF CARE. THIS IS AN ACTION THAT HAS BEEN BADLY NEEDED FOR

YEARS, BUT HAS BEEN IGNORED AND OVERLOOKED BECAUSE IT WAS TOO

DIFFICULT AN ISSUE TO CONFRONT AND NOT ESPECIALLY POLITICALLY

ATTRACTIVE.

TO THE EXTENT THAT THIS PORTENDS FUTURE CHANGES THAT MAY BE UNDER CONSIDERATION, I AM TRULY ENCOURAGED.

I AM PARTICULARLY CONCERNED, HOWEVER, THAT THE NEEDS OF ALL OUR

OLDER AMERICANS BE GIVEN THE THOROUGH AND PROPER CONS I DERATION IN

THE COUNCILS IN WASHINGTON THAT THEY RIGHTFULLY DESERVE.

THESE

PEOPLE, IN THE TWILIGHT OF THEIR YEARS, THE AMERICANS WHO ARE RESPONSIBLE FOR THE GROWTH AND DEVELOPMENT OF THIS GREAT NATION ARE

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EVERYTHING THEY HAVE WORKED A LIFETIME ACHIEVING; THAT IS A HAPPY

AND COMFORTABLE RETIREMENT.

I FIND IT DISMAYING THAT MEDICARE, THE

HEALTH CARE PROGRAM FOR THE AGED, SPENDS LESS THAN ONE-HALF OF A

BILLION DOLLARS ON

INSTITUTIONAL LONG TERM CARE,

WHEREAS THE

MEDICAID PROGRAM, A PROGRAM FOR THE INDIGENT, SPENDS MANY BILLION OF DOLLARS FOR THE SAME TYPE OF CARE. I FIND THERE ARE OTHER

INEQUITIES THAT FROM MY PERSPECTIVE SEEM TO HAVE LITTLE RATIONALE

OR JUSTIFICATION. WHY, FOR EXAMPLE, MUST A PERSON BE HOSPITALIZED

BEFORE THEY ARE ELIGIBLE FOR NURSING HOME BENEFITS UNDER THE

MEDICARE PROGRAM? WHY, ARE THE MEDICARE BENEFITS FOR THOSE GENUINELY IN NEED OF NURSING HOME CARE SO RESTRICTIVE AND LIMITED? WHY IS IT OUR OLDER AMERICANS CANNOT BE SAFEGUARDED AGAINST

CATASTROPHIC HEALTH CARE COSTS?

| CANNOT BELIEVE THAT A COUNTRY

THAT IS CAPABLE OF PUTTING A MAN ON THE MOON IN TEN SHORT YEARS

CANNOT REDIRECT THAT SAME CALI BER OF BRAIN POWER TOWARD DEVELOPING

A HEALTH CARE SYSTEM THAT WILL PROVIDE QUALITY HEALTH CARE AT A

PRICE THAT ALL CAN AFFORD.

THE FACT THAT THIS ISSUE IS FINALLY

BEING CONFRONTED HEAD ON AND NOT BEING AVOIDED OR SIDE-STEPPED IS A

REFRESHING CHANGE TO OBSERVE.

HIDING OR PRETENDING THAT A PROBLEM

DOES NOT EXIST WHILE THE HORROR STORIES CONTINUE TO MOUNT FOR MANY

MILLIONS OF AMERICANS YIELDS US AS A NATION NOTHING BUT DELAYED

ANGUISH AN PAIN. I HAVE NO CONCRETE PROPOSALS FOR CHANGING OR IMPROVING THE MEDICARE PROGRAM, BUT I DO WANT TO REAFFIRM MY STRONG

CONVICTIONS THAT THIS TOPIC BE GIVEN THE HIGHEST PRIORITY IN WASHINGTON. WHEN I READ OF THE FINANCIAL CRISIS THREATENING THE MEDICARE TRUST FUND, I AM PARTICULARLY ALARMED. THERE MUST BE A BETTER WAY. CONGRESSMEN, I, AS A MAYOR, LOOK TO MEN LIKE YOU AND YOUR COLLEAGUES IN WASHINGTON TO COME UP WITH CREATIVE AND VIABLE SOLUTIONS. I THINK WE HAVE MADE A STEP IN THAT DIRECTION WITH THE RECENT PASSAGE OF THE SOCIAL SECURITY AMENDMENTS AND THE HOSPITAL REIMBURSEMENT REFORM CHANGES THEY EMBODIED. CERTAINLY, THIS

REPRESENTS A CREATIVE, INNOVATIVE AND FARSIGHTED EFFORT.

I URGE

THAT THIS EFFORT BE CONTINUED AND EXPANDED TO ADDRESS THE CONCERNS

OF AMERICA'S ELDERLY.

Yes, I BELIEVE WE HAVE A COMMITMENT TO

AMERICA'S OLDER CITIZENS AND THE SAME NATION THAT PUT A MAN ON THE

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THIS IS NOT A PARTISAN ISSUE AND SHOULD NOT BECOME AN ARENA FOR PARTISAN POLITICS. I DO NOT SPEAK AS A REPUBLICAN OR DEMOCRAT, BUT

RATHER AS A CONCERNED ELECTED LOCAL OFFICIAL AND IF MY MESSAGE TO

WASHINGTON IS ANYTHING,

IT IS THAT AMERICA DOES CARE FOR

ITS

ELDERLY AND THAT WE ARE LOOKING TO YOU AND YOUR COLLEAGUES IN THE

CONGRESS FOR CREATIVE AND INNOVATIVE SOLUTIONS. 1, FOR MY PART, AND I AM SURE THAT I SPEAK FOR VIRTUALLY ALL THE MAYORS AND GOVERNORS OF AMERICA, STAND READY TO DO OUR SHARE TO ASSIST YOU IN

THIS NOBLE EFFORT IN WHATEVER WAY WE CAN.

I APPRECIATE YOU GIVING ME THIS OPPORTUNITY TO SUBMIT TESTIMONY BEFORE YOUR COMMITTEE AND I COMMEND YOU ON SHOWING THE FORTITUDE TO

TACKLE THIS MOST DIFFICULT AND TROUBLESOME OF HEALTH POLICY ISSUES.

I LOOK FORWARD TO FOLLOWING YOUR PROGRESS IN THIS VITAL AREA.

THANK YOU.

NEW JERSEY GERONTOLOGICAL SOCIETY

The Medicare program, the federally funded health insurance program for elderly persons 65 and older, which is run by the U. S. Health Care Financing Administration (HCFA) is facing serious fiscal crisis. With increases which average annually 19%, health care costs have skyrocketed over the past 5 years. The fiscal solvency of Medicare must be maintained so that access to high quality health care can be assured the fast growing elderly population, This burgeoning growth, particularly in the over 75 population, has caused a resultant shift from acute to chronic conditions. 80% of the 65+ population have one or more chronic conditions with 18% of the non institutionalized elderly so severely impaired as to require assistance in daily living. The U. S. has a health care syster hat has been addressing acute care rather than chronic care. Congress must act to redesign the benefits in order to provide long term solutions for Medicare.

Tome health care should be a part of the health care delivery system because it provides:

1) A less costly method of providing post-hospital care - older
people take much longer than young to recooperate from illness.

2) Often a more cost effective method of long term care especially when only 1 or 2 services is needed by the patient which would prevent institutionalization,

3) Assurance of care for those returning home from acute cáre.
Studies attest to the strong personal preference of persons to
remain at home with support of family and friends within
familiar routine.

Health funding should be included in considerations for health maintenance and health monitoring programs so that people are encouraged to take responsibility for their own health. The emergency room all to often becomes the substitute for any kind of regular routine or preventive medical care. What results is the "revolving door syndrome" 3-4 days in the hospital - home with no support system in place - then back into the hospital after 3-4 distressing days at home. Union County Visiting Nurse and Health Services has provided an eight year demonstration program of health education and monitoring in senior citizen housing. There has been a definite reduction in hospital recitivism and institutionalization as a result of this program,

The number of single older women in the aged population with reduced financial assets is a burden on social and health programs. However, it is unfair to expect this elderly population to assume the major proportion of the skyrocketing rise in health care costs. The reforms must be divided in a fair and equitable way between the caregivers (hospitals and physicians) and the clients. We must not lose sight of the criginal goal of the program "To provide needed health service of good quality to all Americans 65 or over."

If any of the members of the Gerontological Society of N. J. wish to give testimony or make a statement concerning the proposed changes in Medicare they are urged to do so before April 27, 1983. Congressman Rinaldo is keeping the hearings open up until that time and is anxious to have as much input as possible. The address is:

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PRINCETON SENIOR RESOURCE CENTER

I wish to thank Congressman Rinaldo for providing an alternative opportunity for those of us who attended the hearing of the House Select Committee on Aging held in Princeton, New Jersey on March 2nd. Unfortunately, a crowded agenda prevented many of us who provide direct services to the elderly from testifying. I would like to make a few comments concerning the proposed Medicare reform.

For the past 9 years I have served as Director of the Princeton Senior Resource Center which is located in the center of public housing for the elderly. This has afforded me a unique opportunity to see first hand some of the current problems which we must address in our Medicare system. In a population of 74+ we see at least (our housing is 17 years old) 80% of our residents have Chronic disabilities. Their needs are not being met by Medicare because Medicare is an acute care system. Congress must act to redesign the benefits in order to provide long term solutions for Medicare.

Home health care should be a part of the health care deliver system because it provides:

1) A less costly method of providing post-hospital care
older people take much longer than young to recooperate
from illness.

2) Often a more cost effective method of long term care
especially when only 1 or 2 services is needed by the
patient which would prevent institutionalization.
3) Assurance of care for those returning home from acute

Studies attest to the strong personal preference
of persons to remain at home with support of family and
friends within familiar routine.

care.

Our residents follow the pattern of what is called the "revolving door" syndrome - which is totally cost ineffective in the long run. An example in point - a 72 year old male resident (Mr. B) with no family had been hospitalized for an operation in September and had had several hospitalizations since then. He was not showing much improvement and again was hospitalized in February. After being discharged in February and trying to exist without proper home care he fell ill again and was rushed to the emergency room on Friday March 4th. However, was sent home at noontime. He had no homemaker coming in and our agency was contacted on Saturday AM (when our office is closed) as he was unable to cope by himself. We managed to find someone for Saturday but Sunday he was left on his own and unable to manage and required another trip to the emergency room at noon he was sent home again that same day. Late Monday AM he was back in the hospital for the third time. He has now been in an intensive care facility for two weeks, where he is not expected to recover.

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