therein, to broaden the program to include proprietary as well as nonproprietary nursing homes, be given consideration by the Committee. The American Nursing Home Association organized in July, 1968, a National Volunteer Service Program which is being developed and implemented by our nursing home members across the country at the local level. At the present time, approximately 1,172 homes have joined the program. This program is geared and oriented to the individual nursing home. It is not tied to any public or nonprofit agency or organization, except that it is being fostered and encouraged by our Association, which is a nonprofit organization. For the information of the Committee, we would like to submit some background papers on our Volunteer Service Program, including the rules which must be observed in establishing such a program.* We would like to point out especially that the volunteers participating in this program do not displace any paid personnel. They serve to complement the permanent staff which is similar to the intent of the proposed legislation. The American Nursing Home Association feels that its Volunteer Service Program is an all important effort to provide supplemental services to patients in need of institutional care. In this connection, we would like to say that our Association shares the concern you expressed, Mr. Chairman, in your opening remarks about the "serious shortages of trained personnel in aging and related fields." The Commissioner on Aging, Mr. John B. Martin, in his testimony, reiterated this concern about the shortage of personnel when he reported on the findings of the Surveys and Research Corporation contained in their study entitled, "The Demand for Personnel and Training in the Field of Aging." The point to be made here is that there is a shortage of personnel and the volunteer service program using "the elderly to help the elderly" can achieve a meritorious goal. Mr. Chairman, we respectfully request that your Committee give consideration to the views of ANHA as outlined in the accompanying enclosures, before any final action is taken on the legislation. We would appreciate this letter and the enclosures being made a part of the official printed record of hearings on this legislation. Sincerely, ALFRED S. ERCOLANO, Executive Director. EXHIBIT 1 STATEMENT OF EDWARD WALKER, PRESIDENT, AMERICAN NURSING HOME ASSOCIATION Mr. Chairman and Members of this distinguished and important Committee: My name is Edward Walker. My place of residence is Miami, Oklahoma. I appear here this morning as a representative of the American Nursing Home Association of which I am the President. The American Nursing Home Association is a non-profit organization serving the Nation's long-term care facilities and their patients through educational and research services. It represents in excess of 7,800 facilities with almost 400,000 beds in 49 of the 50 states. It counts among its members both proprietary and non-proprietary instiutions. In truth, it has more nonproprietary members than does the association which limits its membership to non-proprietary facilities. The Assocation is proud of the role it has played, since its inception in 1949, in raising standards for both facilities and patient care across this Nation. As late as 1950, only five states had licensing laws regulating nursing homes while today every state has such laws. The American Nursing Home Association played a considerable role in bringing this about. The Association is equally proud of the role it is playing in the Medicare and Medicaid programs under the Social Security Act. Approximately 70% of the extended care facilities certified under Medicare are members of ANHA. These 70% of Medicare ECF's provide 72% of Medicare's ECF beds. Mr. Chairman, ANHA is proud and grateful that you have invited us to appear here to testify concerning S. 276. Let me say immediately that the American Nursing Home Association, with no hesitancy and with complete enthusiasm, endorses the concept, principles, and provisions of S. 276. *Retained in committee files. The passage of Public Law 89-73, better known as the Older Americans Act, was a shining landmark in the history of social legislation in the United States. The provisions embodied in S. 276 would enhance and embellish that Act. You, as well as Senator Harrison Williams and the other distinguished Senators sponsoring this bill, are to be commended for having done so in the 89th Congress and for doing so, hopefully with success, in this Congress. The actions envisioned in and by an Older Americans Community Service Program are things that need doing and ought already to have been done. Philosophers have defined a complete and primary truth, that is, an axiomatic truth, as being one where all of the subject is all of the predicate. The concept, embodied in S. 276, namely, that of older Americans continuing to assist the Nation as well as other older Americans, most emphatically meets this definition. Hence, it is difficult to comprehend any opposition to its enactment. The ANHA, therefore, not only endorses it, but offers whatever assistance you may call upon us for, both to its enactment and to its implementation. Mr. Chairman, we have read the history of this bill and that of its predecessor S. 2877; we have read the testimony of the hearings in the Second Session of the 89th Congress; and, we have read the comments of Senator Williams when he introduced S. 276 on January 12th of this year. Let me say only that we subscribe to all the positive statements thereto and that, for sake of brevity, we will not emphasize the obvious by re-stating the real need for an Older Americans Community Service Program. We will, however, make one suggestion, which we hope can add to the program, and, therefore, be added to the bill. We suggest that the singularly successful Foster Grandparent Plan be adapted to the needs of the elderly in our Nation's nursing homes. We offer no technical details as to how this should be done, that is, whether is should be, as is the Foster Grandparent Plan, a joint program utilizing both the Office of Economic Opportunity and the Administration on Aging; or whether it should be lodged wholly in the one and not the other; or even whether it should be an entirely separate program from the Foster Grandparent Plan. This we leave to those most competent to judge and so determine. What we offer is an idea which we think is in harmony with the underlying concept and principles contained in S. 276, namely, the return to gainful and meaningful activity on the part of able older Americans within a program serving other but incapacitated older Americans; and, in that way, serving the community. In short, let America be served by having the elderly help the elderly. It is our thought that, perhaps, none could do it so well since older people are usually more comfortable in the presence of other older people. There is a problem, however, and not to examine it would be a disservice to you. The problem is as follows: whereas 85% of the Nation's nursing homes are proprietary facilities, Section 603 provides on page 4, lines 6 and 8, that such services will be performed. . . . either (A) on publicly owned and operated facilities or projects, or (B) on local projects sponsored by private nonprofit organizations. ..." It is our hope that this problem can be resolved in such manner that, under the provisions of the Older Americans Act, service programs to patients similar to those of the Foster Grandparent Plan may be permitted to take place in all long-term care facilities, both proprietary as well as non-proprietary. To do otherwise is to severely limit the program. We see no conflict in permitting these programs to take place in all long-term care facilities since the program envisions a direct service not to the facilitity but to the patient therein. This is poignantly underscored when it is realized that there are more public assistance patients in proprietary facilities than there are such patients in non-proprietary facilities. Mr. Chairman, may I impose upon the Committee, at this point, to describe the nursing home and the role it played in medical-care and health-care? I do so with the purpose that it may serve this Committee in its deliberations. Probably no other segment of the health-care field has undergone as rapid or as dramatic a change as has the nursing home in this past decade. Nursing homes have moved from converted dwellings into modern new facilities specifically designed to provide skilled nursing care in an environment as closely related to that of the traditional family home as institutional architecture can achieve. While the early years of nursing homes were primiraly devoted to custodial care and personal care; today nursing homes have become medical-care and health-care facilities and, as such, are deemed an integral component of the spectrum of medical-care and health-care. Nursing homes, in fact, are playing an ever-increasing role in the health care community across the length and breadth of this land. Not only do they provide skilled nursing care, but they also provide the social environment and home-like comforts which are so necessary to the well-being of the geriatric patient. They serve, too, as convalescent centers—as half-way houses for persons of all ages on the road back from acute hospitalization to their own homes and their own community life. This is the growing role of the skilled nursing home of today and it is the one that is drastically changing the profile of the nursing home. In the concept of care which today prevails, the hospital is the acute care facility and, as such, is oriented to the physician; whereas, the nursing home is a long-term care facility, and as such, is oriented to the nurse. Thus, Mr. Chairman, to permit the provisions of Section 603 to block or restrict the program which the American Nursing Home Association is today suggesting, would be to prevent the hundreds of thousands of elderly patients in a large portion of our Nation's best facilities from receiving the personal and personalized services that could be derived from the Corps of Senior Citizens which is envisioned by S. 276 and, thus, deny both to the older American, who is a patient, and to the older American, who is a capable and willing performer of such service, the benefits to be derived therefrom. Mr. Chairman, I want to make it patently clear that we realize that the workers within the Foster Grandparent Plan do not take the place of staff. We are in no way suggesting that they should do otherwise in a similar program for the elderly patients in nursing homes. Staff has its functions; workers in a Service Corps have theirs, and, although the twain may occasionally meet, they can never merge, I know this is clear to the Committee; I want the Committee to know that this is also clear to ANHA. What we have here in mind is what Senator Williams had in mind when he said in a news release: "Anyone who has visited a nursing home even the better ones-knows that a little attention or conversation can go a long way...". Some of the services that can be performed by the Service Corps are as follows: accompany the patient, who, although ambulatory, needs a watchful eye, on trips to visit parks, museums, attend the ball game, to browse in stores and shops or even to shop for the small purchases their meager resources permit, but in which the patient delights for a host of reasons... to read to those who eyesight has dimmed . to discuss with those who still feel the need to solve the world's problemsmore important just to listen. Mr. Chairman, the staff and volunteers apparently do these things in our facilities. However, the action we are suggesting would enable this to take place with greater frequency and with even more personal attachment. All this with a concomitant gain to the Senior Corps member performing the service. In conclusion, then, let me emphasize again that it is the older American, both the patient as receiver and the Service Corps worker as doer, who is being directly benefitted and not the facility-the facility, of course, is indirectly benefitted in that its patients are receiving attention over and beyond that given by the staff. We hope that you can resolve the problem we have noted here today. We know that you will if you deem it proper and of merit. Mr. Chairman, I close by thanking you again for having us here today. I reiterate that, with or without acceptance of the American Nursing Home Association's suggested action, I and its members endorse S. 276 and stand ready to help in any way that you ask. Thank you again. COMMUNITY COUNCIL OF GREATER NEW YORK, New York, N. Y., June 18, 1969. DEAR SENATOR KENNEDY: Near the time of adjournment of the 90th Congress, the Citizens' Committee on Aging of the Community Council of Greater New York wrote to you and several of your colleagues, expressing our concern over the failure of the Older Americans Act Amendment of 1968 to be released from Committee in the Senate during that session. Your office and those of your colleagues were unanimous in responding that you would give this matter your attention and favorable consideration in the 91st Congress. In connection with the current hearings held by your Committee on two Senate Bills dealing with this subject we would like to place our Committee on record in support of H.R. 11235, which passed the House of Representatives on Monday, June 16. We understand that this measure is to be transmitted to the Senate. From our study of the House bill, it appears to be a more complete bill than either of the Senate bills currently before your Committee. We particularly call your attention to the specified increased appropriations called for in Titles III, IV and V, and to the inclusion of volunteer programs in Title VI. Because of the pending expiration of authorization under the Older Americans Act of 1965, it is of the utmost importance that the Congress pass and send to the President a bill with the appropriate authorizations for extension of the Act. Inasmuch as the House has already acted upon H.R. 11235, we urge that your Sub-Committee and the full Committee on Labor and Public Welfars report this bill favorably as soon as possible in order that the Senate might be able to act upon it prior to the close of the Federal fiscal year on June 30. Our Committee is available for any additional support of this legislation which may be needed or desirable. Sincerely, JERRY A. SHRODER, Executive Secretary, Citizens' Committee on Aging. NATIONAL ASSOCIATION OF RETIRED CIVIL EMPLOYEES, WASHINGTON, D.C. Mr. Chairman and Members of the Committee, I am Othie G. Burk, Vice President of the National Association of Retired Civil Employees, generally called NARCE. This organization has been in continuous operation since February of 1921 seeking to improve the conditions and welfare of our members. We now have more than 136,000 members and have chapters in every State of the Union, and in Puerto Rico, the Canal Zone, and the Philippines. I want to thank you, Mr. Chairman, for giving me this opportunity to present this statement in behalf of our members and to speak in behalf of the other hundreds of retired Federal Workers, many of whom cannot afford even our meager annual dues. I know you realize that much remains to be done or you would not be interested in extending the Older Americans Act of 1965. I will not burden you with a discussion of all ten objectives set forth in that Act, but do want to mention a few of them. 1. The first stated objective was an adequate income in retirement. We constantly read that more than forty percent of Older Americans exist on incomes below the poverty level. I submit to you Gentlemen, the plight of the Older Retired Federal Worker is much worse than that. The latest figures pubIlished by the Civil Service Commission are as of July 1, 1967. In Table A-9 of that report we find that more than forty eight percent (48%) of the 580,771 employee annuitants received less than $200 per month and most of them had families. More than sixty three percent (63%) received less than $250 per month or $3000 per year, and more than seventy four (74%) received less than $3600 per year. It is even worse for the survivor annuitants of Retired or Deceased Federal Workers. From that same table we find, of the 250,293 survivor annuitants more than sixty seven percent (67%) receive less than $100 per month or $1200 per year. More than eighty three percent (83%) receive below $1800 per year, and more than ninety two percent (92%) receive below $2400 per year. Many of the widows in this group have children to care for, since it includes survivors of deceased employees who had not retired. Mr. Chairman, it seems this Government needs to put its own house in order while it urges other segments of the economy to care for the Aged and Aging. It would seem far less expensive to provide more reasonable retirement income to retired workers rather than to set up agencies to care for them. 2. The second stated objective was to provide the best physical and mental health which science can make available and without regard to economic status. Mr. Chairman and Members of the Committee, our President, Mr. Walters and I are much concerned and disturbed by the letters that come to our office. Many of them say to us-"We have three or four prescriptions on our table and do not have the money to pay for them". Add to that the fact that most of our retired Federal Workers have been unable to qualify for Social Security and therefore cannot have part A or hospitalization under Medicare, and you can begin to see the extent of the problem. 3. The third objective deals with housing and again we find there are problems. Many of our members write to tell us they have sacrificed all their lives to pay for a home in which they could spend their declining years. Now the taxes have become so high they cannot afford to keep those homes on their meager incomes. This is a sad state of affairs. 4. The eighth objective would provide efficient community services which provide social assistance in a coordinated manner and which are readily available when needed. We find very few communities provide such assistance to the retired Federal Worker. In too many cases all forms of public assistance is denied simply because they receive a Government annuity. And our people still have a measure of pride they say we DO NOT WANT CHARITY: WE WANT JUSTICE. 5. The sixth stated objective of the Act is closely allied to the first and the eighth objectives. It would provide Retirement in health, honor, dignity-after years of contribution to the economy. Mr. Chairman, unless we can reach objectives one, two and three of this Act, we will never be able to meet this objective. I firmly believe if the Federal Government would set the example and provide these stated objectives for their former employees, you would find Industry and the Private Sector treading right on your heels. 6. The tenth stated objective of the Act is to allow freedom, independence, and the free exercise of individual initiative in planning and managing their own lives. It is obvious that present conditions do not allow us to reach that objective. In a hearing before Senator Williams and his subcommittee on April 29, 1969, Dr. Shepard stated "The belief that older persons need less money is a myth. If they have $10,000 they spend every penny of it; if they have $3500 they manage to exist somehow." Mr. Chairman and Members of the Committee, we know that many hearings have been held, studies have been conducted, projects have been initiated, statistics have been compiled. This is only the start and it has taken the past three years to do even this little bit. And even this so-called little bit has been an enormous undertaking. I am sure you are all familiar with the steps of problem solving. We should now have defined the problem, we have stated our objectives, we have established many of the facts. We plead for a continuation of this Older Americans Act in hopes that we will now begin to apply some of the information to the solution of this problem. It would be shameful and wasteful to have come so far without the chance to carry this to a successful conclusion. I pledge to you the assistance of this Association in any way we may to help solve this problem. We know it seems to be getting worse rather than better. We know there is no simple solution but an adequate income would be a major help. We know that time alone will not solve the problem, and we are willing to help at all times. OTHIE G. BURK, Vice President. NATIONAL COUNCIL OF JEWISH WOMEN, New York, N.Y., June 24, 1969. DEAR SENATOR KENNEDY: In response to your letter of June 13, 1969, I am pleased to submit for the record of the hearings the enclosed statement on behalf of the National Council of Jewish Women in support of the extension of the Older Americans Act. We deeply appreciate your recognition of our interest in this legislation, and we are greatly pleased that our pioneering effort to provide opportunities for volunteer service to older Americans will, hopefully become a Federal program when final action on the pending amendments is completed. Sincerely yours, [Enclosure] Miss HANNAH STEIN, STATEMENT IN SUPPORT OF THE EXTENSION OF THE OLDER AMERICANS ACT OF 1965 The National Council of Jewish Women, an organization established in 1893, with a membership of over 100,000 in local units throughout the United States, has throughout its history pioneered in programs designed to get at the root of problems which afflict the elderly. In 1946, it initiated the golden age clubs to prove that loneliness among the aged and retired, is an unnecessary evil. As other needs became apparent through our local and national studies, it added direct services, such as "meals on wheels", special employment projects, friendly visiting and education programs. During the past twenty years we have con |