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actuates organizations, labor organizations and industries and others who want to do something for the health of their people, this incurs a very ready acceptance, and I am strongly of the opinion that, with the adoption of legislation of this kind and as it becomes effective, those who may have thought they had good reason for opposing it will realize with the experience of time how shortsighted they were in their opposition.

Now, doctor, or Mr. Kaiser, you have brought with you Dr. Garfield and several other witnesses. What is your desire with respect to their being heard? It will be necessary to adjourn now until 2 o'clock if you wish that they shall each one be heard. If you desire that they shall introduce statements into the record that can be done. I leave it to you people to determine just what you wish to do.

Dr. GARFIELD. Mr. Chairman, most of the things I wanted to say have been brought out in this questioning period. I believe I was the only witness.

The CHAIRMAN. I know by my conversation with you people before the hearing started this morning that there is a fund of information that you could give if the committee had found it convenient to be here this afternoon. There are several happenings that are drawing some of the members away from Washington today that precludes us having as large an attendance here as the importance of the subject is entitled to have. I want to do just whatever you folks want to do.

Mr. KAISER. I think we can submit any statements that we have to make, Mr. Chairman. The committee is not here to question, so they can ask questions and we can answer those by statements.

The CHAIRMAN. If you have in mind questions that have been raised where you feel that there is information in detail that could be offered to support the statements that you have already made, feel free to revise and extend your remarks, and we will also consider the statements that I have.

Mr. KAISER. Thank you.

Mr. HESELTON. In connection with those statements that you will furnish, are they available now in typed form?

Mr. KAISER. No.
Dr. GARFIELD. No. We will have to submit them.

The CHAIRMAN. I am assuming, on the basis of the questions that wero asked and information that has been sought by some members of the committee, that those who have accompanied Mr. Kaiser here today have had that intimate knowledge with those problems that enables them to give the detailed information that would answer the questions that have been raised.

Mr. KAISER. We know what you are thinking about. We will work up something

The CHAIRMAN. Then the committee will not find it necessary to meet this afternoon at 2 o'clock.

Thank you, Mr. Kaiser.
Mr. KAISER. Thank you, Mr. Chairman.

(Whereupon, at 12:20 p. m., the committee was recessed, subject to the call of the chairman.)

PUBLIC HEALTH SERVICE ACT

(Mortgage Loan Insurance)

FRIDAY, MAY 7, 1954

HOUSE OF REPRESENTATIVES,
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The committee met, pursuant to adjournment, at 11 a. m., in room 1334, New House Office Building, Hon. Charles A. Wolverton (chairman) presiding.

The CHAIRMAN. The committee will come to order.

Gentlemen, the next subject that we take up today is H. R. 7700, and we have two witnesses to be heard. One is Mrs. Minnie Hood Hopkins, chairman of the legislative committee, National Association of Registered Nursing Homes, and Miss Zuzié Siegal, president of that organization, whom I understand is present this morning.

We also have Mrs. Evelyn G. Stone, chairman of the standards committee, Missouri Association of Licensed Nursing Homes, St. Louis, Mo.

Mrs. HOPKINS. Miss Siegal will give the testimony for the Nursing Home Association.

The CHAIRMAN. In other words, Miss Siegal will speak for your organization.

Very well, Miss Siegal, we will be glad to hear from you. STATEMENTS OF MISS ZUZIE SIEGAL, PRESIDENT, NATIONAL ASSO

CIATION OF REGISTERED NURSING HOMES; MRS. MINNIE HOOD HOPKINS, RICHMOND, VA., CHAIRMAN, LEGISLATIVE COMMITTEE, NATIONAL ASSOCIATION OF REGISTERED NURSING HOMES; MELVIN A. CASE, SYRACUSE, N. Y., FIRST VICE PRESIDENT, NATIONAL ASSOCIATION OF REGISTERED NURSING HOMES; AND ARNOLD H. RICKLER, BUFFALO, N. Y., LEGAL COUNSEL TO THE NATIONAL ASSOCIATION OF REGISTERED NURSING HOMES

Miss SIEGAL. Mr. Chairman and members of the committee, my name is Zuzie Siegal, and I am the president of the National Association of Registered Nursing Homes. Our association consists of memberships in 33 States. The members are operators of nursing homes throughout the Nation and they are the type of people who provide a perfect cross-section of thinking and ability in the care of chronically ill, convalescent, and infirm patients. They represent, in total, many hundred of years of practical experience, which, as we must all admit, is something that this field particularly requires.

The National Association of Registered Nursing Homes is the oldest organization of its kind in the United States. It is a nonprofit association composed of nursing and convalescent home owners and operators pledged to the improvement of standards and ethics. The officers, all of whom own or operate one or more institutions, serve the association without compensation of any kind. Many of the members of this association have 30 or 40 years' experience and are well qualified both by education and service to speak on the problems of caring for the aged, convalescent, infirm and chronic patient.

In my opinion, and I am certain I express the views of all the members of the association, no group truly interested in the care of the sick could possibly oppose any bill which is intended to enhance the program of medical care. It must be obvious, therefore, that we favor bill H. R. 7700 in its intent. However, we respectfully submit that in developing the intent of this legislation we must not overlook those who are going to carry out this intent.

In our opinion, there are several serious omissions in this bill and there are a number of thoughts not fully expressed. It is to these omissions and thoughts that we should like to direct your attention.

However, before discussing our suggestions, may we submit to you a few statistics, which our study of the testimony on H. R. 7341 shows to have been neglected. During the hearings on H. R. 7341 it has been testified that there are 20,000 nursing homes in the United States. Assuming for this discussion the figure of 20,000 nursing homes, it is important to note the following: the average capital investment per nursing home is conservatively set at $60,000. The total estimated investment, therefore, is $1,200 million. The average nursing home has a bed capacity of 25, providing therefore an approximate total of 500,000 beds. For the care of its guests under present standards, each nursing home employs, roughly speaking, 1 person for every 3 patients, or, in round numbers, a total of 170,000 persons. The average weekly salary of such employees is about $50, or about $8,500,000 weekly. The sum total of these figures cannot help but impress you with the fact that we who address you on H. R. 7700 today represent a large financial stake in the American economy.

We suggest that the most serious omission in bill H. R. 7700 is the failure to mention the proprietary nursing home. This is of serious concern to us because it very definitely excludes this large group of pioneers in the field of nursing home care from benefits which are provided for those who have followed. It is a generally recognized fact in the field of medical care that the private agencies have always led and that the so-called nonprofit governmental agencies have usually followed.

May we point out to you at this time that the terminology used in H. R. 7700, as well as in previous bills with regard to voluntary agencies, requires a little clarification.

Voluntary agencies may and do care for the sick. In this group of sick are included those who are able to pay

their own way totally, those who pay their way partially, and those who require total assistance from public and private agencies. In return for the designation of "voluntary” these agencies are given many benefits, among them tax exemptions, the right to go to the community for soliciting of funds, and, of course, a sizable sum of money from tax funds.

Wherein we ask does this voluntary group differ from the ignored proprietary group, ignored in spite of the fact that they carry out and prove the basic fundamental tenet in this country, namely, free enterprise and private initiative. This principle is expanded on page 2, line 10 of the bill, and I quote:

Solutions to the people's health needs can and should be attained through free enterprise and private initiative.

Let us at no time lose sight of this all-important fundamental of our political and economic life.

Just as do the voluntary institutions, we, the proprietary nursing homes in this country admit people who are able to pay their way, people who can only partially pay their way, and people for whom private and governmental agencies have assumed responsibility.

The unhappy difference is that we have no tax exemptions, no right of fund solicitation, and no recourse to tax funds in charitable institution budgets. Ours, therefore, is a very, very difficult role. We are a recognized member of the medical care team in the total overall medical care program, locally, statewide and nationally, yet for some reason, which we choose to believe is purely oversight, no mention is made in this bill H. R. 7700 of the proprietary nursing home.

We hope that you will bear with us if we recall to this committee's mind testimony on bill H. R. 7341. In the testimony to which we refer the question was asked by one of the committee whether the nursing homes fear competition, or whether they fear the higher standards which would be set by the allocation of money to voluntary institutions only.

We wish to call to your attention the fact that nursing home operation is a profession and not a business. We wish further to call to your attention that it is not competition we object to, but unfair competition.

Our position on the medical care team has a parallel. This parallel is that we, in a sense, are much like the physician who practices his profession without fear that any other physician's standards are any higher, but who objects strenuously to unethical competition on the part of his fellow physicians.

We ask no special favors, but neither do we expect that assistance generously given to others will be dispensed so as to miss our capable and experienced hands.

When, therefore, bill H. R. 7700 provides for mortgage insurance on loans which may be made by private banks for the purpose of improving the medical care in any community, who can say that any recognized member of the medical care team should not benefit from such legislation?

The nursing homes, because of their pioneering status, have had to take a tremendous amount of criticism. They have taken it, and they have steadily progressed. As you probably know, there was a time when public agencies came to our then infant association for advice and guidance in the preparation of standards for nursing homes.

Have all of us forgotten the horrors of the old almshouse? Even the very earliest of proprietary nursing homes represented an unquestioned improvement over the poorhouse.

We merely ask now that through the inclusion of proprietary nursing homes in the benefits provided in bill H.R. 7700 you make it possible for us to improve further the facilities which we originated and

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