that the work has spread in California, and possibly shows some leadership for the rest of the country.

Mr. KAISER. Well, we have to work at it. And you will have to do something about this right away. Just as soon as the doctors have this available it will all smooth out.

I have here a history of what happened to FHA when they first started. You ought to see what the Congressmen said about FHA when it first started. And look what it has accomplished.

Mr. PELLY. I would be glad to get some of those remarks some time that I can use in the House.

Mr. KAISER. We will see that you get them.

The CHAIRMAN. Have you finished?

Mr. YOUNGER. Yes.

The CHAIRMAN. I was just about to say that while this may be a pioneer effort so far as the practice of medicine is concerned, the principle that is the basis of this bill has been so frequently recognized by the Government in other activities that it removes all point to the argument that because it is a pioneer that, therefore, it is not entitled to consideration. I believe we are going to have to stop and think that this is the same policy that was put into effect with the National Housing Act, the veterans' housing, the military housing-that is, title VIII of the National Housing Act-the farm tenant purchase loans, the Federal ship mortgage insurance, and others that I could go on and refer to. And, as has been so well said, if you look at the origin of this and the dire predictions that were made as to the adoption of such a policy when the National Housing Act was taken up, it seems now almost ridiculous in the face of its success, not only in supplying the need but from the standpoint of lack of loss by our Government. And again, as a matter of fact, it had the effect naturally of encouraging the private enterprise.

Here we are in a situation where there is need of medical services. Nobody can deny that, whether it is in a rural community or whether it is in a city. Now what you will do to meet that need depends upon the particular community and what they are willing to do to take care of the need that they must acknowledge. So that when you say "What will be done in a rural community?" it just depends on what the individuals in that community feel should be done to meet the particular need that they have. The rural communities have formed granges and all sorts of organizations, cooperative efforts of one kind and another, to carry on that which they felt was a need in their particular locality. They will do the same thing with reference to this. It cannot be otherwise in my opinion.

There is nothing I could say, however, at this time that would add to what has already been said by you, Mr. Kaiser. The statement that you have given is as complete a statement and with as justifiable reasons as I have heard given before a committee in support of any piece of legislation. It appeals to me greatly and would appeal to the average citizen who was interested solely and entirely in promoting the health of our people.

Of course, if you permit selfish interest to enter into the consideration of legislation, then I can readily understand how some might be opposed to it. But looking at it in the broad light such as has actuated you, such as actuates members of this committee and such as

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 were 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.)

1

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 Zuzie 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 ASSOCIATION 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.