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qualify under the licensing laws for nursing homes; now under the nursing practice acts.
Nursing is the largest and most complex profession, and its services are vital to the prevention and treatment of disease and injury in any age group. Our special concern for the problems of the aged is manifest in all that is done to improve nursing service for the public.
In addition to its own programs and activities, the ANA works with other organizations and with Government agencies when opportunities arise for joint effort in the health care of the aged.
On behalf of the American Nurses' Association, I would like to thank the committee for this opportunity to appear and present our views on this subject.
The American Nurses' Association will be pleased to assist this committee in any way possible.
And I will try to answer any questions that you have.
You mention on page 2 a very serious situation in many so-called nursing homes. Do you have any quick description of what a nursing home should consist of by way of facilities and staff?
Miss THOMPSON. It would depend a great deal on how they are classified, whether they are to give purely custodial care to the person who has no place to live and needs someone to look at their physical and nutritional needs, or whether this home is established to give the kind of care which we would call skilled care.
There are, I believe, 15 States that have now some very limited description of the kinds of persons who should be working or the qualifications of the persons who should be working in these homes. A great deal needs to be done in clarifying the types of homes and deciding the qualities of the personnel that should be employed in order to carry out the functions of that home.
Senator McNAMARA. We agree it is hard to generalize.
Senator McNAMARA. Senator Clark, have you any comments or questions?
Senator CLARK. No questions.
Senator RANDOLPH. No, Mr. Chairman, except to compliment Miss Thompson on her realization that those in the nursing profession are alert, qualified, and most cognizant of the problem of the need for improved nursing qualifications.
I think you have quite a challenge and I know you will help us in this special field.
Miss THOMPSON. We will do our best.
Senator McNAMARA. Thanks very much. Your testimony has been very helpful.
Miss THOMPSON. Thank you.
STATEMENT OF RT. REV. MSGR. JOHN O'GRADY, SECRETARY,
NATIONAL CONFERENCE OF CATHOLIC CHARITIES
Senator McNAMARA. Now, our last witness today is from the National Conference of Catholic Charities, Msgr. John O'Grady.
Monsignor O'Grady, we are sorry that the hour is so late. I see that you have a comparatively short statement and we will ask you to proceed in your own manner.
Monsignor O'Grady. Thank you.
Senator McNAMARA. And your prepared statement will be made a part of the record at this point.
(The prepared statement of Monsignor O'Grady follows:) PREPARED STATEMENT OF Rt. Rev. MSGR. JOHN O'GRADY, SECRETARY, NATIONAL
CONFERENCE OF CATHOLIC CHARITIES I have many hopes for this Subcommittee on the Aged under the very able leadership of Senator Pat McNamara. I am sure that Senator McNamara will want to explore as fully as possible all the available information in regard to the aged, and that he will not be satisfied with a restatement of the platitudes to which we have been so accustomed for the past 10 years. Some years ago Mr. Oscar Ewing, who was then Administrator of the Federal Security Agency, called a conference on the aged. During the sessions of this conference a number of us who had been interested in the aged for many years decided that we would try to find out all the limitations of our information in regard to them. We decided that we would bore in on all the committees of the conference with the basic purpose of having them face the same questions that we were trying to face. The net result was that we caused a good deal of confusion in the committees. As they approach the end of their sessions they were not too sure as to what they should recommend. It was clear to us that Mr. Ewing's associates had already decided what they were going to recommend. As a final result, Mr. Ewing's recommendations which were published in the press were entirely at variance with the reports of the different committees.
For many years I have been faced with the same dilemma that confronted Oscar Ewing and his staff. I think it is a dilemma that is confronting all of us today. We have in the welfare field a very large number of people who have long since reached the conclusion that they know all that is to be known about the aged. I have often wondered why they have taken such a simple, naive attitude. When we understand their position and their day-to-day experience we can readily see why they reach the conclusion that the aged, for the most part, need to be led by the hand, that they have practically no independence, no family life, no savings, very little homeownership. I had been hoping that this was a passing stage. I therefore decided that I would give a large part of the energy and resources that are available to me to firsthand studies of the aged. It did not take long to discover that the problems presented were by no means easy. My first real awakening was in our “Study of Older People in the Family, the Parish, and the Neighborhood" in St. Louis. It was clear to me and to the members of my staff and my consultants, that such a study called for careful preparation. It called for an educational program in the community. It called for a great deal of leadership on the part of the clergy of our church. As a part of our educational program we worked with the clergy of our church in the preparation of material that they should use for publicity purposes. Before we got very far in our study it became clear that our educational preparation had done much to pave the way for us.
Our most experience convinced us that in our St. Louis study we had minimized the difficulties of this type of research. One of the significant things that we found in St. Louis was the lack of any real resistance to giving the information we requested. I am not saying that there was not some resistance, but it was very limited. In preparing for our Milwaukee study, in spite of good leadership in the parish, of a pastor who is a remarkable person and has the support of his people, we found resistance in about 20 percent of the families that we approached. I think this illustrates one of the greatest difficulties we encounter in undertaking real research in the families of the aged. In the St. Louis study the family would keep on asking, “Well what is this for? What use are you going to make of this information?" One should remember in this connection that when you take a whole community, when you take all the families, even the families of one church, you have very independent people, people with strong family life.
One of the handicaps that has stood out in all our studies is the fact that they were done under the auspices of a welfare organization. This in many instances brought an immediate reaction. This was particularly true of our study in the fruit belt of Buffalo. "We are not on the welfare,” they would say. “Isn't this Just for families on the welfare? We contribute to Catholic charities. Why, then, should we have to answer all these questions of yours?" I believe that this would be one of the obstacles that any governmental organization would face in undertaking research on the aged. It is very clear that the aged do draw distinction between what they would call “the welfare" and what they would call social security. Social security, they will tell you, is different. It is something for which you have paid. They believe it is in harmony with their dignity, but they never like the idea of being on the welfare.
The basic question that has confronted us more and more in our studies of the aged is the character of their family relationships. In all the welfare studies of the aged there has been a great deal of emphasis on the breakdown of family life. I have always had a question as to how far this was in accordance with the facts. Now I am fully convinced that it is not in accordance with the facts. Our studies have brought out more and more the great strengths of family life. This is a matter on which we have very little research. One can count on the fingers of one hand the number of people who are conducting basic research on the family life of the aged. The family life of the aged has been our basic concern in our Milwaukee study. What I know of the material so far encourages me in believing that there is a great deal of evidence in this study which points to the great strengths of family life. This is an area in which we need more and more study, but we do not have as yet many people who are qualified to undertake such research. It is relatively easy to secure funds for basic research on the family life of the aged, but it is very difficult to find the personnel.
In our own studies one got the impression that the aged did not want to lean too heavily on their families. They wanted to preserve their own independence; they wanted to do things for themselves. They did not want to be too dependent on anyone, including Government. It is too bad that we do not have more research on the effect of the administration, and the relatively loose administration, of old-age assistance in certain States on the family life and morale of the aged. I know this is a very delicate question, but it is one that must be confronted.
Another point that stands out in our studies is the extent to which the aged have been able to develop their own programs. Invariably they wanted to continue in some useful, constructive work, and they did not want to depend on the employment services to find work for them.
Our studies of the aged have pointed also to the basic importance of community self-help in meeting their problems. I have worked with this approach in many other areas. I have seen some of the finest examples of community self-help in the program of the Community Service Organization in California. This organization has given the young Mexicans a new point of view in regard to their own very great potentials. It has not set them apart in new ghettos. It has brought them together with all citizens in various communities in the State. I have experimented with the same approach in Lackawanna, N.Y., and presently in western Montana. I have experimented with it in the new State of Ghana in West Africa. This point of view, I am sure, will be developed more and more in dealing with all our problems in the American community. It is my hope that this subcommittee may emphasize this point of view in dealing with the problems of the aged.
Monsignor O’GRADY. It is a pleasure for me to have an opportunity of appearing before this very able subcommittee.
I have worked before with some of the members of this committee on housing and other things, and, of course, I have worked closely with Senator Clark in this field.
Now, I am reminded of a situation that developed in this city a few years ago when Mr. Oscar Ewing, who was then head of the general security agency, called a meeting of people who were supposed to discuss problems of the aging.
Some of us, who were more or less recalcitrant individuals I suppose, thought that we would get together and study among ourselves how little we knew about the aging, how limited our information really was. We tried to bore into the various committees to try to get them to follow the same approval but we found that the committees had already decided what they were going to report, and they were going to report exactly on the information that was handed to them by the National Government.
Some of us kept on complaining about that, but anyhow the reports, as they had been written in the Department ahead of time, got out into the press, and our statement got very little publicity.
Now, I am sure that this committee will not proceed in that fashion.
One of the things that we emphasized in our statement at that time was the limited amount of information we had in regard to the aging. The same is true today in spite of all the studies that have been made in the meantime.
We say that there is a great deal of information available in the States. Yes, there is, in the files of welfare departments. But that, after all, concerns only a limited number of the aging in the United States. Many times we have been given to understand that it describes the conditions of all the aging in our country.
Now, the fact of the matter is we have yet very little original research in this field. You might possibly find 10 people in the United States who are doing original research on the aged. I mean the ordinary, run-of-the-mine aged. I am not talking about those who have had needs tests, those who have been "on welfare," as they would call it themselves and I might say that, in my own studies one of the disadvantages I had was that I am supposed to operate as a part of a welfare agency.
In my study of the Fruit Belt in Buffalo, which was a fairly systematic study, the people that I interviewed kept on asking me, "Well
, now, what are you going to do with all this information; we are not on the welfare, you know; we are pretty well able to take care of ourselves”? In this study we did give a good deal of time to figuring out what this group of aged can add to the community, what their constructive work should be in that community. They have organized a center, and I am afraid they have not adhered to our recommendations, because there is so much of a tendency to develop the welfare approach instead of the approach that helps people to think and plan for themselves.
Now, that is my approach to this problem, as it is in all problems of the American community.
I think we have to develop more and more people to think and to plan for themselves and to develop their own strengths, because, after all, these 15 million you talk about are not on welfare; only a very small percentage of them are on welfare of any kind. But maybe we could learn a good deal from the others as to how to operate a program for the aging.
After that meeting of Oscar Ewing's, I began to speculate how I could return it to some of my older approaches. I had made an original study for the State of Ohio in 1919, and they wanted me to study all the poorhouses and all the homes for the aging. I said, “You don't find the ordinary aging in those institutions. I want to study the ordinary rank and file of the aging.
I finally had to compromise with them. I had to study all the county infirmaries but I insisted on studying a good part of the city of Hamilton, Ohio. I wanted to see what the ordinary aging looked like.
I started to follow through on that same plan about 5 years ago and we have already completed three studies. A fourth study is almost complete. It is very interesting to note the difference of attitude that you find when you take the ordinary people in the community--the
independence that you find. I remember, for instance, even in regard to the chronically ill, in our study in St. Louis I was amazed in my own schedules at the number of the chronically ill people that I was running into. I said to our principal consultant who was probably the outstanding authority in this field in the United States, “The chronically ill in my schedules are running rather high.”
She said: "I think you will find about 11 or 12 percent being cared for in their own homes, by their own families, by their own plans." I found about 15 percent of my own schedules were running in that direction. It was very interesting to see how it developed and how their own families taking care of them—and I had a meeting with the medical faculties of Washington University and St. Louis University to discuss this situation. They were all in agreement that that is the thing you had to work at. You had to study it. But where is the research on it? We have very little research in this field.
The British have recently published two excellent studies on the family life of aging peoples. That is a thing that we have not explored.
I have tried in my studies to explore it. We have found, of course many problems because there is a good deal of resistance on the part of the aging to submit themselves to examination, to be questioned. In oúr Milwaukee study we are finding about 20 percent have resisted. In spite of an educational program ahead of time and the fullest cooperation of the leaders around there of the community we have had a great deal of resistance and that is one of the reasons why we have so few really good research studies on the aging.
Will they submit to questioning from Government organizations or State welfare departments, these ordinary aging persons that we met? Are these the type of studies the State welfare departments make? I do not think so. At least those that I have seen, and I have been over most of the reports of the State welfare departments, and I do not think that you have much of that type of study and that is what I would like to see more of.
I recognize that there are problems but I do not think we should exaggerate them; and I hope that the 1961 White House Conference on Aging does not, because I, for one, will raise my voice on the other side if they give the impression that 99 percent of the aging in the United States are pathological and need to be led by the hand.
I think they must be helped to maintain their independence, to think and to plan for themselves. I am convinced that it can be done. Take the aging receiving OASI. In my own studies I talked to dozens of these aging who were receiving OASI, what they call “social security.”
They say, "Well, you pay for that, you have contributed to that yourself. It is not being on the welfare.” But you talk to them about the welfare and then you have another story. They do not want to hear about getting on the welfare."
I would like to undertake another study in the State of Colorado to see what the program of old age assistance has done to family life. I think it is a very natural inquiry. We ought to have studies like that to see what is happening in the loose administration of assistance in many States. What is that doing to families?
I would like to study that thoroughly and objectively, not to go at it with the idea that I was going to come out with a definite conclusion. I think in many of the States it would stand very careful