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6. Age 90; single; female; 3-bedroom; $35; public assistance: Admitted September 1952 from boarding home. Coronary sclerous, peripheral arterialeroses and hypertension. Low-salt light diet (no rich food, gross sweets, highly seasoned, or food that has a tendency to form gas.) Was able to be out bed at first. Suffers frequent coronary attacks, now a bed patient. Has four prescriptions.

7. Age 88: female; widow; 3-bedroom; $30; public assistance: Admitted December 1950 from hospital. Had fractured hip. Mild senile. Now able to walk. Nurses dress her. Low-salt diet, food cut. Restricted fluids. Incon

tinent.

8. Age 79; female; widow; 4-bedroom, $60; private: Admitted December 1951 from own home. Cerebral hemorrhage. Was able to be up and dressed at first. Now completely bedridden. Unable to feed self. Is incontinent. Senile, so that it is necessary to use bedside on her bed. Five prescriptions.

9. Age 88; female; widow; 4-bed room; $35; public assistance: Admitted January 1951 from another nursing home. Has areriosclerosis, heart disease, hypertension, generalized arteriosclerosis (including cerebral), old cerebral thrombosis, right side involved 1949. Completely bedridden. In past 2 years has a number of slight cerebral thromboses. Right side now completely paralyzed. Has only partial speech. Low-salt diet, is fed majority of meals. Five prescriptions and injections.

10. Age 71; female; widow; 4-bed room; $60; private: Admitted July 1947 from own home. Diabetes mellitus, generalized arteriosclerosis, chronic nephritis, hypertrophic arthritis. When patient was first admitted she had numerous diabetic sores, especially on her head. These are now completely healed. At first able to get from bed to a chair and care for herself to some degree. Now completely blind, completely bedridden, unable to do anything for herself, growing steadily worse. Diabetic diet, will not chew food; must be made semi-solid or put through a blendor. It is necessary to test for sugar three times a day (because of patient's eating habits) to determine insulin dosage. Incontinent. Five prescriptions and injections.

11. Age 88; female, single; 4-bed room; $60; private: Admitted October 1950 from hospital. Arteriosclerosis, hypertensive heart disease. Able to be dressed when she was first admitted. Had part of breast removed 1951 (not malignant). Now confined to bed, must be fed. Patient seems to have a constriction in throat and will only swallow soft solids or liquids. Four prescriptions.

12. Age 80; female; single; 4-bed room; $30; public assistance: Admitted 1935 from home. Myxodema, moderate anemia, secondary arteriosclerosis. Low mentally, always needed supervision. Now incontinent. House diet. High íron and protein. Did not receive public the first 10 years. Nurses help dress. One prescription.

13. Age 78; male; single; private room; $60; private: Admitted 1948 from home. Chronic cardiovascular disease. Cerebral scleroses. Is like every old man of 90. Must be lifted from bed to chair. Is fed. Is incontinent. Is very uncooperative on feeding. Has just a pneumonia. Two prescriptions.

14. Age 82; female; widow: 3-bed room; $35; public assistance: Admitted 1947, from son's home. Slightly senile, anemia, fracture of right hip. Confined to bed. Incontinent, totaly incapable of caring for self in any way. Must be fed, semi-solid diet. Three prescriptions.

15. Age 74; female; widow: 3-bed room; $30; private: Admitted September 1959 from boarding home. Severe arthritis, knees completely stiff now. Is lifted from bed to chair. Suffers a great deal of pain and is depressed and cries for long periods. High-protein diet. Given injections weekly by doctor. Not dressed.

16. Age 69; female; widow; semi-private; $30; public assistance: Admitted November 1951 from hospital suffering from contusions of left knee from a fall. Ulcers on right leg that never heal. House diet. Partially cares for self. Dress self.

17. Age 76: female; single; 4-bedroom; $30; public assistance: Arterialeroses, senility, admitted 1945 from nursing home. At that time was up and dressed, able to care for self, but slightly forgetful. For past 2 years strictly bedridden, incontinent, is fed liquids only, all muscles have constricted, unable to move any part of body. Had own money for about 4 years. Now on OAA. Has not spoken for 2 years. Takes long time to get necessary food and liquid into her. One prescription.

18. Age 87; female; widow: 3-bedroom; $32.50; public assistance: Admitted from home in 1950. Hypertensive cardiovascular. Has Foley catheter at

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all times. Has been on a low-fat diet, sippy diet, 2-hour feeding, bland diet, low-salt diet and now semihouse diet. Past year has been receiving aid. Kidney condition requires daily irrigation of catheter. Two prescriptions.

19. Age 74; female, single; 4-bedroom; $35; public assistance: Admitted from hospital in 1947 after a resection of cancer of the colon. On low-roughage diet. Up and around and able to care for self. Patient hemorrhaged from bleeding peptic ulcer. Was operated on for subtotal gastromectomy in January 1952. Six meals bland diet daily. Patient has arthritis of knees but has recovered and is ambulatory. Also suffers from cardiac decompensation.

20. Age 79; female; widow; semiprivate; $40; private: Admitted from home in February 1951. General arterialeroses. Taken from bed to chair daily. Incontinent. House diet, food must be cut. Speaks little English. Is not dressed. 21. Age 64: female; widow; private room; $30; public assistance: Admitted from home in 1946. Hyperthyroid disease. Hypertension, arthritis of feet. Able to care for self to some extent. Mentally keen and cooperative. Dresses self. Five prescriptions.

22. Age 86; female; widow; 3-bedroom; $35; public assistance: Admitted 1951 from home, suffering from mild arterialeroses with cerebral involvement which has gradually become much worse. Incontinent. Shows loss of strength in general. Colitis. Food cut up. Now a great nursing problem. Three prescriptions.

23. Age 70; female; single; 4-bedroom; $35; public assistance: Admitted from hospital 1947. Cerebral hemorrage right hemiplegis, arterialeroses. Cannot speak, completely paralyzed on right side, bedridden, but is able to feed herself and make her wants known. Patient cried for first year. Fussy about food and will not eat straight house diet. Two prescriptions.

24. Age 92: female; widow; private; $35; public assistance: Admitted from hospital in 1948 with fracture of left shoulder. Has poor circulation of legs and for past year has had number of ulcers on legs. Patient is deaf and determined in her ways. Able to care for self some. Nurses assist dressing. Three prescriptions.

Mr. MUSE. After you have studied this census, it may come as a surprise to you that these patients, running the terrible gamut of disease and afflictions, are being adequately cared for in nursing homes and, to the extent that they are being cared for, leave the hospitals free to administer the acute problems in our health program.

It may come as a surprise, too, that the care is being given for the small weekly amounts that are indicated by the census, contrary to the well-known high cost of hospital care.

I would ask you to observe, contrary to other information given to this committee, that the overwhelming number of these patients are indigents who are being supported in whole or in part with public funds, and what you have noted about this census is typical of nursing homes throughout the country.

It should not come as a surprise that the nursing home administrators, in view of the work they have been doing in behalf of the indigents of our country, are, therefore, a little bit fearful of the implications of this particular measure before you.

Gentlemen, no longer can we be polite in our reference to the dogooders and the misguided zealots who constantly harangue about the problem and say that the cure for the afflictions of our aged population is the establishment of so-called nonprofit nursing homes.

Please bear in mind that the cost of construction, operation and maintenance of a nonprofit nursing home is not 1 penny less than the cost of construction and maintenance of a private nursing home. In fact, in most instances, the cost of operation, because we are not dealing with public funds, will be considerably less in a private nursing home: but we know as a fact, Mr. Chairman and gentlemen, that the cost of operating in the private nursing homes, despite the fact that

these private nursing homes must pay real-estate and personal taxes, is considerably less than the cost of operating a so-called public medical institution and we are assured that, because of the compactness of the nursing home, the patient is allowed more intimate attention than he would receive in the systemized type of care that is given in most State and county chronic hospitals.

Yes, gentlemen, we are fearful that there is a tendency on the part of the Federal Government to infiltrate the field of private nursing homes. Our fear is best summed up in the words of Oren Harris, the distinguished Congressman from Arkansas, when he addressed the House of Representatives on March 9, 1954. I quote:

Now, as to nursing homes. We are getting into the field of nursing homes. This is the only controversial feature of the bill. It is the new feature of the program. The people operating nursing homes throughout the country are fearful that this will put the Government or the localities, nonprofit institutions and associations, in competition with them. Frankly, if private nursing homes can provide the need, I would much rather see the program expanded by them. There is some justification for their fear. Private enterprise cannot compete with a Government program and exist.

At that time Mr. Oren Harris was speaking on H. R. 8149.

Before the House of Representatives' companion bill reached the floor of the House for debate, our organization appeared before Representative Wolverton's committee and after consultation with nursinghome representatives from 22 States, who convened in Washington, we expressed before that committee our sense of fear and bewilderment about the propositions contained in that bill that will lead the Federal Government into the nursing-home field.

We did not appear before that committee, nor are we appearing before your honorable committee, through selfish motivation. The proposition that we make is a simple one. The nursing homes have taken care of the aged and chronically ill, either by necessity or design, for the past two decades without once calling upon the Government for aid.

All that we asked of Representative Wolverton's committee, and all that we ask of this committee, is that the Congress of the United States treat the nursing home with fairness and consideration, both in the interest of maintaining private enterprise in this phase of our public-health program, and guaranteeing thereby better health and better service to our general public. What we offer as an alternative to that phase of the bill that would make $10 million available in the form of Federal grants for this year is a policy of sound commonsense. There is no magic in the Federal dollar. The Federal dollar can purchase no more than any other dollar-it can be stretched no farther.

If money is going to be made available to anyone, it ought first to be made available to that industry that has struggled against all odds to care for the acute problems that this bill attempts to correct.

The entire proposition as it relates to nursing homes, however, in view of the survey made by Secretary Oveta Culp Hobby, is unwise, unsound, and unrealistic.

The Secretary's committee report indicates that the per unit cost of construction for nursing homes is a maximum of $8,000 per bed. This amount was testified to before the committee and before Representative Wolverton's committee. The fact is, the per bed cost of construction for first-class nursing homes will not exceed $2,000 per unit.

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In that regard, Mr. Chairman, I should like to submit for the record a bid that was given to Mr. George T. Mustin by Polk W. Agee, architect, registered architect, in Memphis, Tenn., wherein the cost per bed unit would be approximately $1,600 for first-class construction in a homelike atmosphere.

Senator GOLDWATER. That will be received and entered in the record at this point.

(The bid referred to is as follows:)

Mr. GEORGE T. MUSTIN,

Mustin Nursing Home,

MEMPHIS, TENN., December 17, 1953.

Memphis, Tenn.

DEAR MR. MUSTIN: As per your request, here is a list of the low bidders on
the nursing home which you propose to construct at 642 Semmes Street, Memphis:
General construction, Annaratone Construction Co., 590 Loeb St.,
Memphis.

Plumbing, Fischer Heating & Plumbing Co., 367 Adams Ave., Memphis__
Heating, Ideal Heating Co., 1252 Madison Ave., Memphis_‒‒‒
Wiring, Dawkins Electric Co., 26 North 2d St., Memphis_‒‒‒‒

$62, 475 11, 191 7,600

7,226

Total

88,492

In my opinion these firms are thoroughly reliable and capable of completing their contracts in a satisfactory manner.

Very truly yours,

POLK W. AGEE, Architect.

Senator HILL. That would be built in Memphis, Tenn.?
Mr. MUSE. In Memphis, Tenn., yes, sir.

I suggest that if the survey about this most important matter of construction cost has proven to be the subject of speculation, and to raise doubts as to the actual cost of nursing-home construction, then we can reasonably raise doubts about other phases of the nursinghome program as they have been investigated and reported upon by this committee of Health, Education, and Welfare.

Mr. Chairman, we are not here in the position of favor seekers. However, we can give you this assurance: If the money for the construction of modern nursing homes were to be made available to present licensed nursing-home administrators and to others contemplating this type of professional community service, the law of supply and demand would cause those homes to be distributed where they are most needed and consequently would become self-amortizing.

I would suggest to you that if the amount of money contemplated being given to nonprofit institutions, under the bill before you, were made available in my State of Massachusetts, in a very short time there would be a minor building boom in the building-trades and hospitalsupplies industries; but under the proposed bill here before you moneys will not be made immediately available.

There is some illogic about this bill, for, on the one hand, you would appropriate $60 million of taxpayers' money for the construction of nursing homes, and in the same bill indicate that you are willing to spend $2 million to make a survey apparently for the purpose of determining whether or not the $60 million must necessarily be spent.

It seems to us, you are putting the cart before the horse. However, if this bill does nothing more than point out the lack of adequate financing that has been facing the nursing home administrator for the past quarter century, then much will have been accomplished, for as

you may be aware banks are ill-disposed to give mortgage money for single-purpose buildings, be those buildings motels, hospitals, theaters, or nursing homes. Consequently, the nursing home adminitrators. have been put to much cost because of high rates of interest in order to meet the expenses incidental to equipping, staffing, and maintaining their nursing homes.

We feel, in keeping with the most recent pronouncements of President Eisenhower, that had this administration in surveying the needs for chronic illness looked to the Small Business Administration for the solutions, that approach would be in keeping with the philosophy of this administration, and if through the small business this administration would make available liberal loans to licensed nursing homes throughout the country, as it has done with other small-business enterprises, the problems, at least as respect first-class buildings and equipment, would be solved almost immediately; and at the same time this administration would be keeping faith with its pledge to encourage the growth of small business and return the business professions of the country to the free-enterprise system.

Lest we be carried away with the need for new buildings and modern equipment, I would have you consider an equally important aspect of the entire problem as it was emphasized by Representative Frances Bolton on March 9, 1954, before the House of Representatives when she spoke in favor of Representative Wolverton's bill but raised this most important question, and I quote:

As I reported to the House in my survey of the health care situation in America on February 25, there is unquestionably an acute shortage of nurses in this Nation. In many areas of the country whole hospital wards are bring closed because there are no nurses to staff them,

Just bow do we propose to staff these additional facilities to be constructed under the hospital survey and construction program?

Representative Bolton, by this statement, has pointed out the prac. tical effects of bringing the nursing home service to the community and not asking the patient to leave the community to go to the insti. tutional type facility, for the nursing home may draw upon many thousand skilled nurses who for one reason or another are not able to travel from their home to the metropolitan centers and serve in hospitals, but are available for part-time work in nursing homes,

The American Association of Nursing Homes, Mr. Chairman, is equally concerned with all the problems and their solutions for nursing our aged and chronically ill, more concerned probably than anyone or any other group in the United States, for this indeed is our profession and business,

We have fought vigorously through the years for high ethical standards. We deplore the renegade who would abuse the privilege of serving our elder citizens and particularly our chronically ill. We are ever vigilant to expose them and in this matter we have always sought the help of public health authorities.

This philosophy and outlook about our profession was made known to Representative Wolverton's committee and to members of his committee.

At the time we appeared before the Committee on Interstate and Foreign Commerce, we were assured by the committee chairman that H. R. 7700), a bill that makes available long-term mortgage loans to clinical and health facilities, will be modified and amended so as to

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