include within its scope guaranteed long-term loans at low rates of interest to licensed nursing homes throughout the United States. Representative Wolverton reaffirmed his desire in this matter when in reply to a question by Representative Cretella on March 9, 1954, before the House of Representatives, he said, and I quote:

I might say there is other legislation to follow that could prove beneficial to private nursing homes in the event the committee reported it favorably and It is adopted by the House. I refer you to H. R. 7700.

Conclusively, we are asking that this committee recommend that $.2758 be amended by striking therefrom the line in subsection 4 of section 651, "$10 million for grants for the construction of nonprofit tursing homes" and to strike from S. 2758 any other reference of grants for the construction of nonprofit nursing homes.

And we ask that H. R. 7700 and its companion bill, if there is one before the Senate, be amended to make available long-term loans to private nursing homes for the period of 1 year.

If this is done, we can guarantee to you, Mr. Chairman and gentlemen, that by initiative and sound business principles usually practced by proprietary institutions there will indeed be a minor boom in the nursing-home profession, for we can build more cheaply and we have a greater ability because we are decentralized for procuring professional nursing help, together with the fact that we will immediately build homes where we know they are needed and will not have to wait for a survey to tell us about our own business.

We can promise that with the FHA type of guaranteed loan for nursing homes we can make available facilities for the treatment of chronic illness heretofore undreamed of in these United States, both in quality and quantity; and we can pledge this to the American people: That we will keep abreast of the growing needs of our aging population rendering to them kindly and humane service at the community level.

Remember this above all, Mr. Chairman: That if we fail it is always within your power to introduce this phase of the bill in any succeeding year; but the proof that we ought to succeed in our pledge is in the accomplishments of Mr. Henry Kaiser, who was willing to underwrite the successful prepayment health plan now bearing his Lame. This plan could not enjoy its present success unless he and others were willing to underwrite and guarantee to the banks the repayment of loans for clinical and hospital facilities.

Mr. Kaiser proved that hospitals properly operated, and clinics eficiently run, can give the best service the American way, the proprietary way, which is the self-liquidating way, so that it is a burden. to no one and a profit to all.

Neither our professional industry nor the people served by it need any coddling from Government. It needs nothing but your warm hand of friendship in the form of Government-guaranteed loans, the repayment for which we will be responsible, and a manifest act of faith on the part of our Government that our professional industry is capable of serving the needs attendant upon the aging population

of our era.

Mr. Chairman, I should like, too, to extend upon the record some remarks made by Mr. George T. Mustin on page 6 of the Journal of the American Association of Nursing Homes, March 1954.

46293-54-pt. 1-13

Senator GOLDWATER. Without objection, they will be received. (The remarks referred to are as follows:)

FROM THE SECRETARY'S DESK

From time to time it is suggested in some quarters that the general hospital is the proper agency for the care of the chronically ill patient holding that the doctor on his daily rounds can keep closer watch on the patient than through any other method, and that the hospital is properly equipped, in the event of sudden illness. We disagree completely with this thought, firm in the belief that the average chronic patient does not require daily medical examination, and as for the availability of specialized equipment, any patient requiring such has passed from the chronic to the acute stage and probably needs to be hospitalized anyway. But that is not to say they should live in a hospital so they will be quickly available in the event of sudden illness.

The Chronic Illness newsletter of December 1953, published by the Commission on Chronic Illness, quotes from a publication of the United States Public Health Service as follows: Although "the country now has in its nursing homes considerably more beds for the care of long-term chronic patients than has been generally recognized *** relatively few of these beds are in facilities which meet accepted standards." This is followed by a statement not in quotes: It is further indicated that increased popularity has been given to the opinion that patients having chronic diseases should be cared for in general hospitals or facilities associated with general hospitals.

The chief criticism leveled against nursing homes is our lack of functional housing. The matter of housing is most important and has certainly engaged the attention of every nursing home administrator. All of us would rather have a proper building for our patients, but, alas, we have no Hill-Burton money, and for the vast majority of us there are no funds available from religious, fraternal, or philanthropic organizations. No; our homes are what we have made them, and the improvements we have been able to accomplish are what we as individuals and as association members have been able to carve out with our hands, heads, and hearts.

Just for a moment give thought to what our hospitals would be without funds from city, county, State, or Federal Governments; without funds from religious and fraternal groups, or without aid from philanthropists. Do you suppose there would be those imposing edifices of steel and stone as now grace our land? You know the answer.

Nursing homes could be housed as well if construction loans, not grants, were made available on high-percentage, long-term, low interest rates. These loans could be made available to nursing homes individually, based on their experience and record of operation. And since we have been caring for the chronic patient for many years, we feel it is our right to have an opportunity to improve this important phase of patient care.

We have not touched on a most important part of our work, the field of daily service to our patients, not in itself associated with medicine, but rather with a kind of homespun psychology; the task of causing the infirm, the chronically ill, and the aged feel wanted, needed, and still a part of the scheme of things. This kind of treatment is not to be found in general hospitals, but it is vitally needed to fashion happiness for those in our hands. It is a cardinal reason why the private nursing home will continue and prosper.

We have not touched on our nursing services to patients, since that is the first requisite of any nursing home. Many of our homes are operated by physicians, registered nurses, and licensed practical nurses, and those which have not had professional training, have received theirs in the school of experience sufficiently to satisfy the licensing and inspection authorities. We are proud of the level of our care, although we do strive continually to better it, and our advances in this respect have been steady. We know our patients must receive experienced nursing care, and also that kind of personal attention which brings contentment to declining years.

No; let the hospital keep to its field, where it has its hands full in the constant employment of its specialized knowledge and skill. Let us keep to our field where our hearts as well as our hands contribute to the contentment and care of our charges.

Let those who would have better patient housing help to obtain it. It will be interesting to see if our critics are more concerned with the chronically ill or the furtherance of pet theories. GEORGE T. MUSTIN, Secretary.

Mr. MUSE. I should like to ask of you, Mr. Chairman, if it would be possible to extend upon the record the written testimony from State presidents that will be forwarded to your attention within the next 14 days, testimony that bears upon the problem in 31 different States in the union, as these States are affiliated with the American Association of Nursing Homes.

Senator GOLDWATER. That will depend upon the size of the testimony. We wouldn't like to say we will receive it and print it if it will occupy 2,000 pages, say. If it it a normal amount of testimony, we will certainly receive it and print it.

Mr. MUSE. We feel, Mr. Chairman, in that respect, we can have the testimony confined to three average pages.

Senator GOLDWATER. That can be received and printed in the record.

(The letters referred to follow :)

Hon. WILLIAM A. PURTELL,

United States Senator,

TEXAS NURSING HOME OPERATORS ASSOCIATION,

Houston 2, Tex., March 30, 1954.

Senate of the United States, Washington, D. C.

DEAR SIR: I am reliably informed that at present the subcommittee of which you are chairman has at present under consideration S. 2758, which deals with the subsidizing by our Government at an added burden to the already overburdened taxpayer of nonprofit nursing homes and other related institutions. This proposal which is now before you is to be the Senate version of House proposal (7341) which was in my estimation and the estimation of other nursinghome operators passed by that great body in very unsuitable form.

Referring to the above, there are approximately one-half million nursing home beds available in the United States. We have never been surveyed as to this fact, but one is gladly urged and welcomed at this time. These beds are all licensed and taxpaying (Federal, county, and State). We, and I am sure you will agree, want to operate as free citizens and pay our taxes to the Government instead of standing outside the White House begging and lobbying for a handout. The approval by the Senate of the United States of this legislation in its present form is only the opening wedge of the forcing upon the people and overburdened taxpayer of socialized medicine. I employ approximately 15 people, and they are all taxpayers as am I.

I will repeat, I am 100 percent opposed to socializing the nursing homes in any form, and socializing is what it amounts to when the operator has to look to the Government for money on which to operate.

Sincerely,

Mrs. LELA HORTON, First Vice President.

COLUMBUS, OHIO, April 3, 1954.

Mr. MELVIN SNEED,

Professional Staff. Senate Committee on Labor and Public Welfare,

Capitol Building, Washington, D. C.

DEAR MR. SNEED: There is enclosed the statement of the Ohio Association of Nursing Homes regarding Senate bill S. 2758. It will be appreciated if you will present this to the subcommittee considering this bill at their next meeting thereon.

Very truly yours,

THOMAS W. LANE.

COMMENTS RE S. 2758 BY OHIO ASSOCIATION OF NURSING HOMES

The Ohio Association of Nursing Homes wishes first to express its appreciation for this committee's courtesy in extending this unusual opportunity to the association to present its views regarding this pending legislation. This very act indicates a degree of interest in the problems of care of the aged which has heretofore been lacking.

The Ohio association believes that there is no need for governmental subsidy of nursing homes in order to insure adequate care of the aged and chronically ill, believing firmly that time, continuation of efforts already commended by those in the field, and governmental encouragement by other means will accom plish the result desired in a better fashion.

In order that the committee may compare the situation in Ohio with that existing in other States, certain basic factual information is herein set forth. (NOTE.-Unless otherwise indicated, the information listed has been secured from the Ohio Conference on Problems of the Aging, sponsored by the Ohio State University and Ohio Citizens Council for Health and Welfare.)

In 1952 there were 759,000 persons over the age of 65, or 1 for every 11 persons in the State of Ohio. The majority of these persons lived in family households. In 1953, 30 percent of all persons over the age of 65 were receiving income from employment, either as a wage earner or the wife of a wage earner; 36 percent were receiving old-age and survivors benefits; and 7 percent were sustained by other retirement programs. Over 65 percent of the patient population of county homes in Ohio are over 65. The number of patients over the age of 65 in our mental institutions increased 40 percent during the last 6 years, although the total population in such institutions increased only 15 percent during the same period of time. In 1953, 20 percent of the patient population in these institutions were over 65. In 1950, 18,500 men, or 5.6 percent of the over-65-age group, and 18,020 women, or 4.7 percent of the over-65-age group, were in institutions, hotels, or other types of domiciles caring for more than 5 lodgers. As of March 9, 1954, there were in Ohio 572 licensed commercial nursing homes having 8,240 beds for aged and chronically ill. There were on the same date 95 philanthropic homes having 5,160 beds for the same purpose. It is the opinion of the licensing agency, the Division of Social Administration of the Ohio Department of Welfare, that there is no substantial shortage of nursing homes in the State but that additional homes which could or would accept patients at minimal rates could well be established. Those counties in the State with the lower proportion of older persons are the more populous counties. For example, although the State average of persons 65 and over is 8.9 percent, the following highly populated counties are below such average:

Cuyahoga

Butler.

Greene

Franklin.

Jefferson

Lake

Lorain.

Mahoning.

Percent

7.7

7.3

7.0

8.4

7.9

7.3

7.8

7.7

7.3

7.5

6.6

Montgomery

Trumbull -

Summit

There are more women in the over-65 age group than men, and this trend is increasing. For example, in 1950 there were 89 men for 100 women. In 1975 projection indicates that there will be 75 men for 100 women.

It must be remembered, of course, that for many old age brings with it physical infirmities and mental deterioration. Those who are able to care for themselves usually do not go into homes for the aged; therefore, the majority of residents of such homes are incapacitated in one way or another in addition to the debilities of their age. Many are disabled by arthritis, diabetes, paraly sis, cardiac and nervous disorders. There are many with impaired eyesight and hearing. The minds of some are not as active as they once were, and their memory and perception have been effected. A considerable percentage are senile. A recent survey by the Ohio Citizens Council for Health and Welfare of 48 homes for aged Ohioans revealed that, of the total of 3,963 residents therein, 738, or 19 percent, had disabilities sufficient to confine them to bed. The remainder were able to be up for varied periods of time, although some could not leave their rooms or particular floor on which they lived.

This same survey revealed a variety of accommodations and services offered, a brief summation of which may be of interest to this committee. All of the 48 homes used 1 or more living rooms or dining rooms or some other space for the leisure time activities of their residents. Twenty-five had solariums. Fifteen had chapels or auditoriums. Six had recreation rooms. There were 8 libraries and 11 workshops. Tools and equipment for all types of handicraft were some

times evident, as were tailor shops, shoeshops, and barbershops operated by the residents. Such rehabilitative equipment as sewing machines, weaving looms, wood-carving equipment, power saws, and brushes and paints were discovered. All of the 48 homes had some of the following equipment for more leisurely activity: Musical instruments, radios, television sets, recording machines, and movie projectors. Daily newspapers are almost invariably furnished to the residents. Religious services are high on the list of activities of the residents of the homes of the aged, both as to frequency and popularity. Gardening or farmwork was done by the residents in 28 out of the 48 homes, but relatively few residents participated therein.

Much of the information already given supports, we believe, our contention that encouragement of expansion of commercial nursing homes by means other than governmental subsidy would better answer the need of our aged and ill population and at the same time avoid additional expenditures of Government funds which could not be recovered. It is important to remember, of course, that such a program, if inaugurated, would carry out the expressed intent of the present administration to promote the growth and expansion of private enterprise and that the resultant increase of activity among that group would reflect in increased tax revenue. On the other hand, the present provision of S. 2758 providing for outright grants to nonprofit nursing homes would not in itself provide a satisfactory solution to the existing problems and would obviously witness the expenditure of a considerable amount of funds with no expectation of any tax return thereon.

One of the facts set forth in the early part of this statement showed that the more populous counties have the lower proportion of older persons. Experience has shown that the majority of nonprofit homes tend to be established in these communities. Commercial nursing homes, however, are widespread throughout the State, being present in communities of every size and need. It is believed in this respect that there is a distinct advantage to the residents whose mental attitude and morale is of extreme importance to their comfort to be able to remain in their own community among familiar surroundings and acquaintances. These commercial nursing homes employ local help, which is generally more obtainable than an institution which must secure some of its employees from other locations. Another important factor previously mentioned was the higher proportion of women than men in the over-65 age group. Again, experience has shown that women in particular prefer the smaller, more sociable, homelike privately operated homes to the generally larger, institution-type nonprofit nursing home.

The private nursing homes have been pioneers in the care of the aged and chronically ill and have consistently attempted to expand and enhance the quality of the services rendered to their residents as well as making continual efforts to improve their own standards of care.

Nothing contained herein should in any way be construed as derogatory of the philanthropic nonprofit nursing homes. We realize the need for such institutions in addition to the commercial nursing homes and public institutions. As a matter of fact, there has recently been formed an interorganization relations committee of the three State organizations representing the public, philanthropic, and commercial nursing homes. At his specific request there has also been formed an advisory committee to the State director of the department of public welfare composed of representatives of each of the three mentioned organizations. It has been discovered, however, that no one type of nursing home can adequately supply the answers to the varied problems of caring for the aged. We feel, therefore, that the presently proposed legislation is discriminatory and fails to adequately gage the true needs of our senior citizens.

We wish to record our unalterable opposition to any such legislation which will tend to preempt a field of primary concern to local governments, adversely effect individual initiative, and discriminate against private enterprise. We advocate a program whereby nursing homes in all classifications may be encouraged in their endeavors to provide better care for the aged and chronically ill on an equal basis by governmental assistance other than outright subsidy. Such action will, we feel certain, enable those engaged in this field of endeavor to keep pace with the needed expansion which will be required in the future to properly care for the ever-increasing ranks of the aged. Respectfully submitted.

ESLIE SHARPE,

President, Ohio Association of Nursing Homes.