Letters and reports from staff members in our neighborhood centers all over the country show a clear unmet need for helping to finance a part of the health requirements of older men and women living in the neighborhoods we serve. Since their founding, the settlement and neighborhood centers have been bringing their firsthand experiences in industrial neighborhoods to our lawmakers. Sometimes it is to city hall that they turn, sometimes to the State capitol, and sometimes to the Congress of the United States. Steadily throughout the years they have been asked for their firsthand experiences which have come from their close observation and close association with people in our poorest neighborhoods. In April 1930 the National Federation of Settlements was asked by Senator Wagner and Senator Robert La Follette, to bring the results of their studies of unemployment to testify before a Senate committee. Later in 1934, I served on the Advisory Council to the President's Committee on Economic Security and at that time it was hoped that our people's health needs would be a part of the comprehensive social security program, which included employment insurance, old-age insurance, child and maternal health service, accident compensation. Unfortunately, the opposition to health needs through social security was strong enough to keep health out of the social security coverage. Before the Housing Act was passed, we took our part many times in presenting to the Congress the desperate need for decent housing in our slums. Throughout these years and the years to follow, we have continued to bring to the public and to the Congress, the chaotic, wasteful, and cruel lack of health services for low-income people in our country. In 1938, we made possible a study In of the British experience, "Health Insurance With Medical Care," so that there would be a better understanding than was to be found current at the time. 1946, we presented to a congressional committee the findings of a National Federation of Settlements study on "Medical Care in Settlement Neighborhoods." In June 1949, we again brought our experience to bear before a Subcommittee on Health of the U.S. Senate on Labor and Public Welfare, in support of S. 1679, the national health bill. A report issued in 1951 of the Henry Street Settlement's study of the health needs of 553 families living on the Lower East Side of New York, was included in "Building America's Health," a report to President Truman by a commission on the health needs of the Nation. Again, in 1952, we brought the need for health care for the dependents of servicemen before the U.S. Senate Banking and Currency Committee. In July 1961, we testified in favor of H.R. 4222, the Health Insurance Benefits Act of 1961, which dealt only with care for the aged. Throughout these years we have seen a fabric of security slowly being built to protect those of our lowest income neighbors. But the least progress is always in the field of health. We realize the power of the opposition but at the same time we see our neighbors still unsuccessfully struggling to meet the costs of catastrophic illness, inevitable sickness among children, the cost of the day-byday emergencies, which, too often, take savings or food money. We see sickness rob the wage earner and his family of their independence. Older members of our community have increased in proportion to the population. Medical science keeps people alive longer, but there is still insufficient provision for these added years to be borne with security. The fear of sickness and its costs is ever present in the minds and hearts of the aging who cannot afford to be ill. The Hospital Insurance Act of 1963 only helps bear some of the burden of hospitalization and nursing care. But what is most important to the older people whom this bill is meant to protect, is that it comes to them as a right through their own payments to social security. There is no humiliating means test to add to the burdens of sickness and old age and the sense of comfort that at least this amount of care is theirs if they need it. Miss HELEN HALL. Our formal resolution, the weight of our past experience with unsatisfactory health services in industrial neighborhoods, and the current suffering which settlement personnel see daily in all sections of the country, compels us to urge passage of H.R. 3920, Hospital Insurance Act of 1963. We know this one hill will not solve the entire problem, but it can be seen as another step toward provision of humane and dignified help so badly needed by the elderly members of our society. GLADYS DUPPSTADT, Secretary for Social Education and Action. ILLUSTRATIONS OF NEED Lack of provision for medical needs of the elderly, and the inadequacy of the existing systems of partialized services is shown in several case stories gathered from settlement personnel. From Texas comes the story of several settlement neighbors: "Mr. R. is an elderly gentleman who is almost blind and paralyzed. Staff from the settlement help him to get to the charity clinic when he is ill. Не is extremely poor and needy, but quite proud. He still walks around practically dragging one foot. He is not eligible for old-age assistance. He lives on a social security $37 monthly check. He pays rent and buys groceries. If Mr. R. paid for doctor's services and medicines he would be evicted and starve and would still owe money. * * * * "Mrs. G. lives alone and has been trying to become a citizen for quite a long time. She studies at our agency. She lives on a $35 monthly check that she gets from the welfare. She used to work but has aged and can no longer find employment. The last time I asked her, she still had not been able to save the $30 that citizenship will cost her. Thirty dollars would be practically a whole month's income for her. She has solved her medical problems by using her religion. She is a Roman Catholic, but has availed herself of Pentecostal and Christian Science tenets. She has been able to dodge medical expenses when she is ill. Both Mr. R. and Mrs. G. would be better off in our United Fund Agency, The Hearth, for elderly people. However, there is no room there and they cannot accept any charity patients. Their fee there is well over $200 per month and the price goes up to something like $250. Neither of these people could ever hope to gain a place in the nursing home, and will probably one day wake up dead. There are a few private nursing homes here and I can imagine that their fees must be $300 and more a month. "There are many people in our city who can no longer work and must depend upon charity of one kind or another. Same, if they worked enough under social security, can get a little help there. If they are not citizens, they cannot get old age assistance, of course. "Even when getting free treatment from doctors (this also includes children) quite often they are asked to fill certain medical prescriptions. They cannot afford them and don't get them. They simply stay sick longer." From northern Ohio comes the story of an elderly couple in the neighborhood. The wife suffered a fractured wrist and mental disorder at 81 years of age. The local president of the AFL-CIO sought to find help for payment of their medical bills for the fractured wrist. Mr. L. is deaf and stated that he would not be interested in a hearing aid. Mr. and Mrs. L. live alone in their six-room house. Her mental condition makes it impossible for them to consider roomers. However, the husband is able to manage her. Mr. L. worked at the local shipyards from 1898 until 1944, when he retired. Their combined social security is $123 per month, and is their only source of income. The home was purchased 47 years ago. It has been covered with imitation brick and needs repairs, but is clear of debt. The tax valuation in 1961 was $3,800. The L's have no life or hospital insurance, but have $1,100 in the bank for funeral expenses. When Mrs. L. broke her wrist they incurred the following bills: doctor $110, hospital $62.50, X-ray $32, totaling $204.50. Mr. L. withdrew $55 out of the bank to pay toward the hospital, but still owes $149.50. Need for assistance with medical expenses for the elderly poor is not being adequately met through a combination of public assistance provisions and voluntary efforts. Often the sick person dies because of redtape among the various agencies not having time enough to be worked out and cleared. This is what happened to the Howards in New York, in 1963, as told from the records of one neighborhood center: The assistant director writes: "On April 9, Mr. and Mrs. Howard came to the office by appointment arranged by our neighborhood worker. Mr. and Mrs. Howard are an elderly couple apparently living on social security benefits of $158.50 per month. He is a fine looking man, rather handsome in his old age, with the look about him of an old band musician. He is thin, rather stooped, and it obviously took a great deal of effort for him to get to my office. They seem to have sufficient money for their current management from their social security benefits. However, Mr. Howard has a serious heart condition, and he is in need of constant medical attention. In April, he was in the hospital for his heart condition for about 2 months, and at that time, the department of welfare helped them with his hospital expenses. He must go to the doctor weekly and is on medication, probably digitalis, which is expensive. "Initially, I had the impression that the department of welfare could provide these people with assistance with their medical needs. After considerable telephoning, I was finally able to speak to a supervisor in the medical unit. She explained to me that the Howards did receive assistance on April 16. He returned to the welfare center when he was in medical need. For their current expenses, she thought that they should be referred to intake at the nearer neighborhood welfare center. She suggested that I send them there. Consequently, on this date, May 9, I wrote a referral letter to the department of welfare, which is included in the record. About 2 weeks later, I saw Mrs. Howard again, and she explained to me that the welfare department had not been able to help her. Apparently, she felt that there was nothing she could do, and she was quite disturbed about this and said that she would just have to see what she could do in order to manage to continue to have Mr. Howard go to his doctor. I again called welfare, spoke to the intake worker, who told me that they could not help these people because they had a budget deficit. I attempted to give my opinion about their need for medical attention, but could not get any change made. "I told Mrs. Howard that there was nothing further that I could do and that I hoped she would get in touch with me if things got really bad. "On June 18, Mr. Howard died of a heart condition. This I learned when 1 visited Mrs. Howard on the 16th of July in her home. The purpose of this visit, which was quite sad, with Mrs. Howard crying a good deal, was the effort on her part to work out provisions for her belongings and to draw up a will. She told me that she had received some death benefits for Mr. Howard, which covered his burial, cemetery, and a stone to mark his grave. She went on to tell me of her great loneliness and the fact that she had no one to turn to and that she would like to have a will to be able to arrange for her own burial. She had paid for this in part already. I arranged for Mr. R., attorney of neighborhood conservation, to draw up a will for her." These stories of misery and despair, which attend old age, can be multiplied in every neighborhood where we serve. STATEMENT OF CHESTER C. SHORE ON BEHALF OF AMERICAN VETERANS COMMITTEE (AVC) DEALING WITH HEALTH INSURANCE PROPOSALS Mr. Chairman and members of the committee, this statement is presented on behalf of the American Veterans Committee (AVC), an organization of veterans of both World Wars and the Korean conflict. At our last national convention in New York, May 30-June 2, 1963, the following resolution was adopted: "The high cost of medical services and medicines continues to cause a lack of proper medical care among the less favored sections of our people, especially among the elderly. While health insurance plans have closed part of the gap, their coverage is far from comprehensive, especially as to doctors' services outside the hospital, medicines, and health appliances. Moreover, their rising cost makes them prohibitive to the less fortunate among our people, and the refusal of many insurance companies and plans to renew coverage for the elderly, when it expires, renders them of limited avail to many in this group, who need their coverage most. "From its inception AVC has recognized the importance of the problem and has urged the adoption of legislation to provide comprehensive medical care for all or at least a public health insurance scheme with broad coverage, which would attain the same end. AVC has also endorsed more limited plans to cover only those who are over 65 years of age and which would provide only a more limited coverage. "AVC again now calls on the administration to fight for, and on Congress to enact, legislation setting up a comprehensive medical care program for all through social security, with collateral arrangements for those not covered under social security." AVC notes that this committee is considering three principal bills which would set up a means for payment for medical services out of social security to persons 65 or over; namely, H.R. 3920, H.R. 4029, and H.R. 6782. It is not our purpose in this statement to underwrite a preference for any one of these three bills, but we generally support the principles set forth in such legislation. The committee will note from the statement of our resolution that our organization is convinced of the necessity of legislation that would provide comprehensive medical care for all. The poor state of the health of our citizens is sharply reflected by the large number of draftees who are rejected from military service for medical reasons. In addition to the concern as human beings that we all must feel for our fellow citizens who cannot provide themselves with adequate health and medical care, we would point out also that the strength of our Nation is critically related to the health of our citizens. H.R. 3920, H.R. 4029, H.R. 6782 are supported by our organization because they are an important step in meeting the medical needs of those who are frequently less able to do so, the elderly. But, as an ultimate goal we urge consideration of legislation that would provide broad coverage to all, not only those over 65. AVC notes that this committee is also considering legislation that would ease the medical care burden of the elderly through tax credits or deductions, and other means. It is our belief that the best and most comprehensive method is through the social security system as set forth in H.R. 3920, H.R. 4029, and 6782. We do not believe that the other methods proposed should be a substitute for H.R. 3920, H.R. 4029, and H.R. 6782. In his state of the Union message President Johnson called for a war on poverty, which still exists for all too many American citizens. This war we must wage. One campaign in the war is medicare, meeting in part, as it does the health needs of many of our poor through the method of self insurance. Approval of the medicare legislation thus contributes to the Nation's war on poverty. Lastly, AVC notes with dismay our concern that this legislation has been pending for a long period of time without any action taken on the floor of Congress. We, therefore, urge speedy consideration. Respectfully yours, CHESTER C. SHORE, Chairman, Legislative Committee. NATIONAL ASSOCIATION OF JEWISH HOMES FOR THE AGED, Hon. LEO H. IRWIN, Bronx, N.Y., January 8, 1964. Chief Counsel, Committee on Ways and Means, DEAR SIR: We are enclosing herewith the statement of the National Association of Jewish Homes for the Aged on behalf of the King-Anderson bill. As per instructions, we have enclosed in one package, clearly marked, 53 copies for the members of the committee and the interested staff. In addition, in the second package, we have enclosed 50 copies for distribution to the press. Trusting that these are in order and with many thanks to you for your cooperation, I am, Cordially yours, HERBERT A. SELTZER, Chairman, Committee on Legislation. STATEMENT OF NATIONAL ASSOCIATION OF JEWISH HOMES FOR THE AGED ON BEHALF OF THE KING-ANDERSON BILL BY JACOB G. GOLD, PRESIDENT, AND HERBERT A. SELTZER, CHAIRMAN, COMMITTEE ON LEGISLATION The National Association of Jewish Homes for the Aged, representing over 95 percent of the voluntary nonprofit Jewish homes in the country, with a present bed capacity of over 16,000, supports the King-Anderson bill. We feel the assist ance it proposes to render is in response to a real and pressing need. Although a number of the member institutions of this association have achieved local licensure of their infirmary or hospital divisions, with some even fully accredited as hospitals by the joint commission on accreditation of hospitals, the majority of the other homes generally provide medical and nursing care of high standard under various State regulations. The King-Anderson bill makes it a prerequisite that skilled nursing facilities be affiliated with a hospital in order to qualify. We feel this provision will create real hardships. Not all predecessor bills made this requirement, but did sharply intend that not custodial care but posthospital skilled nursing care was to be compensated. This care to be given in a facility at much lower cost than in a general hospital. It is our opinion that just such a standard should obtain now because the supervision by health authorities and the administrator of the dispensing agency can be depended upon to approve nursing facilities with the necessary competency to engage in this important work. In view of the present relatively insignificant number of hospital-affiliated, long-term facilities, such as homes for the aged, it would be more of a hindrance than a help to establish that requirement in the King-Anderson bill. In some States there are no such affiliations at all, thus patients would be penalized. Hospital affiliation usually leads to hospital control. With such affiliation, the burden upon the hospital would be aggravated and thus the hospital would probably not be anxious for such a joinder. On the other hand, those who establish and support homes would be loath to have their rights and autonomy preempted. Hospitals, understandably, are primarily concerned with the care of the acutely ill patient, and as a rule are not too anxious to utilize their limited beds for the aged, the chronically ill, or the long-term patient. In some States the regulations for homes for the aged have been written in such a way as to inhibit hospital administrators from attempting any involvement with the licensing authorities. We believe that the foremost objective of the King-Anderson bill is to provide payment for hospital and other long-term skilled nursing care, to meet the needs of the ill aged. There is no warranty that affiliation with a hospital is a better method for achieving this objective, than to authenticate the right of a well-run, licensed, or approved home for aged to care for a posthospital, long-term patient. The board of directors of such homes are community-minded, responsible people and will not work adversely to the aims set forth. To exclude homes for the aged which are not hospital affiliated from the KingAnderson bill by legislation, would cut off a broad field of service to the aged by institutions possessing high levels of quality and experience. We urge your consideration of these principles during your deliberations. We urge the removing of the requirement for hospital affiliation of ancillary facilities. Hon. WILBUR D. MILLS, NATIONAL COUNCIL OF JEWISH WOMEN, Chairman, House Ways and Means Committee, MY DEAR MR. MILLS: We would appreciate your inclusion of the enclosed statement in support of legislation for medical care benefits under social security in the record of hearings of your committee on this question. Please note that this statement supplements the joint testimony submitted before the commitee by Miss Elizabeth Wickenden on November 20, 1963, in behalf of a group of organizations including the National Council of Jewish Women. Sincerely yours, PEARL L. WILLEN, |