Burton nursing home projects are hospitals and about half are voluntary nonprofit organizations or a governmental unit such as a city or county.

Mr. EVERETT. Doctor, I know your position with the Hill-Burton system. In the construction of nursing homes, are they being built adjacent to the present hospitals under the Hill-Burton Act or at some other location away from the hospital?

Dr. HALDEMAN. We feel very strongly that nursing homes should have an affiliation with a hospital regardless of where located. About half of our projects, as I say, have been sponsored by a hospital, and usually they are located on the grounds of the hospital. In some instances they are integral parts of the hospital, but more often are a separate building adjacent to the hospital to provide a little more homelike atmosphere.

The remainder are located at various locations, although most of them are within the hospital area. The reason for not putting them way out in the country is severalfold. One thing, it is hard to recruit personnel in these locations and hard to maintain the necessary medical supervision. Also, the individual nursing homes like to be where it is easy for relatives and friends to visit them in the home. Mr. EVERETT. Do you Mr. Secrest have any questions?

Mr. SECREST. No questions.

Mr. EVERETT. Go right ahead, sir.

Dr. HALDEMAN. The partial removal of economic barriers to medical and nursing home care of the aged is included in H.R. 3920, the administration's proposal for hospital insurance for the aged. This bill would extend the social security system to include hospital insurance which would cover almost everyone 65 or older and which would pay, for each spell of illness:

(1) The costs of up to 90 days of inpatient hospital services, with the patient paying $10 a day for the first 9 days or at least $20, or for those people who so choose the costs of up to 180 days with the patient paying the first 212 days of average costs.

(2) All costs of up to 180 days of care in skilled nursing-home facilities affiliated with hospitals after transfer of the patient from a hospital.

(3) All costs above the first $20 for hospital outpatient diagnostic service.

(4) All costs of up to 240 home health-care visits in any one calendar year by community visiting nurses, physical therapists, or other health specialists.

These benefits would be available to everyone 65 or over receiving social security or railroad retirement. The costs of providing these benefits would be covered by increasing the social security tax by one-quarter of 1 percent for both employees and employers and by raising the amount of earnings taxed from $4,800 to $5,200. The average cost for a worker would be about $13 a year.

The program would also cover everyone now 65 or over-or who reaches that age in the next few years-who has not had a chance to be covered by social security. The money to pay for these benefits would come from general tax revenues.

The President's Council on Aging is giving priority attention to several areas of serious concern relating to the aging. The Council

is carrying out its responsibilities through the following committee

structure:

An Executive Committee which meets at least monthly to guide the total Council program; a Committee on Housing the Elderly, headed by the Honorable Robert C. Weaver, Administrator, Housing and Home Finance Agency; a Committee on Employment of the Older Worker, headed by the Honorable W. Willard Wirtz, Secretary of Labor; a Committee on Nursing Homes, headed by Dr. Luther L. Terry, Surgeon General of the Public Health Service; and a Committee on Welfare Services, headed by Dr. Ellen Winston, Commissioner of Welfare, Department of Health, Education, and Welfare. The Committee on Housing is directing its attention to several aspects of housing for the aging. The Committee on Employment is focusing its efforts on the problem of discrimination in the employment of older workers and increasing their opportunities for gainful activity.

The Committee on Nursing Homes is concerned with the broad range of care in long-term medically oriented facilities, including the need for better standards and licensure programs. The Committee on Welfare Services is concentrating on several areas, such as the improvement of homemaker services and adult education.

One further point should be mentioned. Authorities in the hospital and nursing home field now recognize that it is a serious mistake to plan separately for one type of care or one type of facility or service.

Essential relationships exist, for example, between inpatient care and ambulatory care, long-term care and acute short-term care, and home care and long-term care programs. Relationships properly developed in these areas avoid the necessity for duplicating expensive facilities and equipment and further increasing the cost of care.

More importantly, these relationships establish a continuity of care and service which is conducive to rapid movement of the patient through the range of services required, including his eventual return to home and community.

An important consideration in this connection is the emphasis now being given to the location of facilities and services in reasonable proximity to the patient's home. Excessive travel distances frequently make it necessary to place patients in expensive hospital or nursing home beds when the medical, nursing, or rehabilitation requirements could most advantageously be provided through outpatient care facilities or home care programs.

In addition, the recognized therapeutic value of patients being cared for in their own community environment rather than being separated by long distances from their relatives and friends cannot be ignored. Mr. Chairman, I would be glad to attempt to answer any questions which you may have.

Mr. EVERETT. Doctor, you certainly made a wonderful statement. There are several questions I do want to ask. What is the average lifespan of the individual in the United States?

Dr. HALDEMAN. I will have to supply that for the record, Mr. Chairman. The life expectancy at birth has increased substantially. The life expectancy of a person say at age 60 has not increased spectacularly as a total because the prevention of disease has been a greater impact in the lower age groups, whereas until we get a breakthrough

98-638 0-63-50

in the field of cancer, cardiovascular diseases, we will not be able to increase the life expectancy of a person say 50 or 60 as dramatically as we do in the younger age groups.

Mr. EVERETT. But don't you project it under the present medical care that we have an increasing lifespan ?

Dr. HALDEMAN. We can supply some projections for the record. (The material referred to follows:)

1 The life expectancy of veterans is not significantly different than that of the general population.

Mr. EVERETT. That will be fine, sir.

Dr. HALDEMAN. I think it might be helpful also to include the number of individuals 65 and over in the years to come.

(The material requested follows:)

Estimated number of persons 65 and over at present and in projections:

Mr. EVERETT. That is the reason that we wanted to develop this in this committee, is the fact that we realize the lifespan is so much longer than it has been. Yesterday the Budget of the Bureau told us that the income from the veteran was higher than the income from the nonveteran on the average. If we could get some figures as to the life expectancy of a veteran compared to a nonveteran, I think that would be helpful.

Dr. HALDEMAN. We will do our best to get that information. Of course, the majority of the veterans being male, they will have a somewhat shorter life expectancy than would women, just as in nursing homes. Your current population in nursing homes there are two women for every man.

Mr. EVERETT. Men just constitute about 333 percent?

Dr. HALDEMAN. That is correct, sir.

Mr. EVERETT. Now talking about nursing homes, what percentage of them are profitmaking institutions and what percent of them are nonprofit institutions?

Dr. HALDEMAN. Approximately 90 percent are proprietary profitmaking institutions. They care for about 70 percent of all patients in nursing homes. They tend to be smaller than the nonprofit nursing homes.

Mr. EVERETT. The church hospitals, like the Baptist and the Methodist and the Catholic hospitals, would you call those profitmaking? Dr. HALDEMAN. No, sir. Voluntary nonprofit and public sponsorship provide about 40 percent of the beds and only 10 percent of the homes. The remainder are proprietary profitmaking institutions.

Mr. EVERETT. I didn't realize it would run that high. A while ago you mentioned those under social security under the President's plan and those that were not under would come out of the general tax revenue. What percent of the people today are say over 65?

Dr. HALDEMAN. I think I had better supply that for the record. (The information requested follows:)

Twenty-eight percent of the estimated population 65 and over were not OASDI beneficiaries as of January 1, 1963.

Mr. EVERETT. You also stated in the next to the last paragraph that a nursing home for the veterans or any type of nursing homeshould be close to their loved ones. Do you realize in some cases the people have completely forgotten them. And several of them, I say 15 to 20 percent of them, have not had anyone to visit them that was related to them within a year.

Dr. HALDEMAN. Yes, I am quite aware of that. I have had experiences in relation to hospitals closing, tuberculosis or mental hospitals, where there is a really substantial of patients who do not have relatives that could go to see them. A substantial number of institutionalized individuals could be in a private home, but there simply is no home for them to go to.

Mr. EVERETT. They will show up, though, if there is any money coming after they die. I have had that experience several times. Now then let me ask you this. Won't that patient do just as well, where they don't have any loved ones to come to see him, in one hospital with the same medical care as he would in another hospital? Dr. HALDEMAN. Other things being equal, I would agree.

Mr. EVERETT. Mr. Secrest?

Mr. SECREST. No questions. Good statement.

Mr. EVERETT. Mr. Patterson?

COUNSEL. No questions, Mr. Chairman.

Mr. EVERETT. Doctor, we may want you back, you made such a good witness. You are thoroughly familiar with the subject. Isn't it true that the wonder drugs have prolonged the life of the body but we have not found anything in the medical profession yet that can get the mind or the brain to continue to act?

Dr. HALDEMAN. I am not sure that I understand the question. Mr. EVERETT. In other words, what I mean is we prolong the life of the body but not of the mind in a lot of these old people.

Dr. HALDEMAN. Well, the actual causes of senility are several but a most frequent case, the underlying condition, is a cardiovascular condition. The vessels throughout the body, including the brain, play a role in development of the senile condition, so if we develop a major breakthrough in say cardiovascular disease, in all probability, it will have the effect which you are referring to in maintaining alertness throughout the older years.

Mr. EVERETT. Mr. Schadeberg, any questions?

Mr. SCHADEBERG. I am sorry I missed portions of this and I will have to read it.

Mr. EVERETT. We told him we might bring him back, he made such a good witness and is so thoroughly familiar with the subject. I can certainly see why he received that outstanding award now because his statement has been very clear and to the point and very helpful to the committee.

Do you have any questions!

MP. SCHADEBER. No questions.

Mr. EVERETT. Thank you. Doctor.

We will adjourn unt. Tuesday.

The following was submitted for the record:)

: Provides care for merchant seamen, Coast Guard, PHS commissioned officers, Coast and Geodetic Survey commisscted officers and enlisted men. Federal Bureau of Employee Compensation cases, and dependents of miformed service personnel. The 2 neuropsychiatric hospitals provide care for narcotic adducts and persons listed above requiring psychiatric care.

* Provides preventive and curative medial services for Indians and Alaska natives.

• Provides the specialized forms of hospital care necessary for the study of both normal and abnormal physical and emotional phenomena in patients, thereby furthering the quest for new knowledge of the diseases of man.

Hospitals operated by the Department of Defense as of June 30, 1962

(Whereupon, at 10:35 a.m., the subcommittee recessed, to recon

vene at 10 a.m., Tuesday, May 21, 1963.)