TABLE 8.-Percent change between Apr. 1, 1950, and 1960 for all ages, 45 to 64, and 65 and over, by State in order of rank1

1 States ranked in order of decreasing percentages. To avoid fractional ranks, States with identical percentages are ranked alphabetically within that percentage.

Decrease of less than of 1 percent.

Source: Special Staff on Aging, U.S. Department of Health, Education, and Welfare.

Mr. EVERETT. What percent, if you know, in this age group are women and what percentage are men? Does it run 50-50 or 60–40! Mr. SPECTOR. Well, there are, unfortunately, as you get into the higher age groups, more women than men. At age 65-that is for all those over age 65-I would say if you take the population figure of 18 million people over the age of 65 there are about 9 million of them or 9.5 million women.

However, as you get up to age 85, there are only 6 men for every 10 women. As the age goes up, the number of widows increases and the number of men declines. Women apparently are hardier souls. They have lived, on the average, about 10 years longer than men. On the average they marry men 3 years older than they are and on the average they live 7 years longer. This would result in a rather rapid increase in the number of women in relation to the number of men."

Mr. EVERETT. Do you find that the church groups, Protestants, Catholics, and so forth, have entered into this program very actively? Mr. SPECTOR. The church groups are entering into this program very actively. They are our largest single sponsor, the church groups of various denominations. One of the reasons the church groups are so good, Mr. Chairman, is that the sponsors of housing for the elderly have to have a special commitment to this program. They have to have a commitment, first of all, in terms of these loans. They are going to run for 50 years, so we have to be assured that these are social institutions that are going to last a long time and be responsible for these projects for a long time. We also need to be assured that they have the financial capacity to carry these projects because housing for the elderly is a unique phenomenon where incomes generally are not going to increase for those who are in that group.

Thirdly, churches are particularly good because housing for the elderly, to be successful, needs a whole range of services-health, social services, recreation, and participation in the community that churches over the years have been so effective in providing.

Mr. EVERETT. Have the lodges been taking an active part in this, such as the Masonic Lodge, the Knights of Columbus, health clubs, the Elks, Moose, Rotarians, and so on?

Mr. SPECTOR. Yes, sir. Fraternal organizations, and unions are all increasingly coming into this program now.

If you wish, Mr. Chairman, we could even give you some figures on kinds of sponsors that we have.

Mr. EVERETT. I would certainly like for you to do that. Without objection, this will be entered at this point in the record.

(The information referred to follows:)

KINDS OF SPONSORS OF FEDERALLY FINANCED HOUSING FOR SENIOR CITIZENS

FHA Mortgage insurance-Sec. 231

(The following listing is of those nonprofit projects in active status as of Dec. 31, 1962:)

Direct loan-Sec. 202

(The following listing is of those projects under loan agreement as of Dec. 31, 1962 :)

Mr. EVERETT. Are you familiar with the situation of the United Mine Workers down in Kentucky where they are having to abandon a lot of these hospitals? That is, general medicine and surgery? That is not housing for the elderly.

Mr. SPECTOR. I have only a vague knowledge of that, no expert knowledge at all.

Mr. EVERETT. Any further questions?

Mr. ELLSWORTH. One further question occurs to me, Mr. Chairman. This is particularly with respect to nursing home program. How much do you enter into the details of the administration of this thing or in consideration for your financial support? Do you get in and have requirements with respect to income limitation on people who live in these facilities, and so forth?

Mr. SPECTOR. Suppose I start that, Mr. Ellsworth, and then Mrs. Holt who is our special assistant to the Commissioner of FHA on nursing homes could add to that.

We are very much concerned, first of all, with the standards of construction for a nursing home to make sure that it meets our standards and lasts the mortgage period.

Mrs. HOLT. Twenty years for the nursing homes.

Mr. SPECTOR. So they do have to last. We are most interested in fireproofing.

Mr. ELLSWORTH. I see.

Mr. SPECTOR. Safety really is a No. 1 feature.

Secondly, we are very much concerned that they meet the standards that the States have as far as licensing requirements are concerned.

Thirdly, we are very much concerned and interested that they are economically feasible.

Mr. ELLSWORTH. To go back to licensing question, do you find that the State licensing standards generally speaking are met by what you consider to be minimum standards for these kinds of operations or do you find that you have difficulty with some of them and have to upgrade State standards?

Mr. SPECTOR. I think the FHA has not evaluated State standards. We have pretty much gone on what they are. I think all States do have standards of their own and on course they vary. Then we are very much concerned about the economic feasibility so that the insurance which we are providing is not in danger. This means that we have to be shown first of all that there is a need. Secondly, that there is an effective demand that is, enought people who can pay for it to make it feasible.

As a result the rental charges are based in large part on what it costs to amortize the loan and to operate the operation. The operating

costs will depend primarily on the number and type of services provided. This program does not have income limits at all on the persons who want to be patients in these nursing homes; nor do we exert specific control over what the charges will be.

Would you want to add to that, Helen?

Mrs. HOLT. First, to get back to your State standards, the standards as Mr. Spector said vary greatly but we do find that every State is raising its standards little by little each year. They cannot do it all. at once because there are a great many old nursing homes still in use that need to be licensed until the beds are replaced with better ones. Our building standards as of now are higher than most State standards. There are a few that are just about the same as ours.

There are in some instances slight variations. We require that all sponsors meet the State standards before they come in to us with their formal applications. As far as the administration is concerned is that one of your questions?

Mr. ELLSWORTH. I was interested in how much of the details of administration and eligibility and residence and so forth you got.

Mrs. HOLT. No eligibility for residence. As far as the Administrator is concerned, we require that we know who is to be the administrator of the facility, before the commitment is issued. We do not pretend to be qualified to pass upon the administrator but at least we try to have something down to show it is going to be a good administration which is all important in the nursing home business.

We also require reasonable assurance from the State licensing agency which is usually the department of health, that the facility will be licensed. In order to give that assurance State department of health officials want to know what sort of an administrator is going to be running the nursing home and what type of nursing home it is going to be. So there is a double check. We work very closely with the State departments as far as patient care is concerned. Each facility passes upon the admission of its patients. That depends upon the type patient the facility is equiped to care for.

Some nursing homes are primarily for the elderly, but as you know a nursing home is for convalescents of all ages. As Mr. Spector mentioned in his report, there are some that are interested in taking care of children.

There again we depend upon what the State laws allow. In some States nursing home facilities may be licensed to take care of alcoholics. The same is true for mild mental cases. FHA does not designate the types of patients to be admitted.

Mr. ELLSWORTH. Could you provide for the record or maybe off the top of your head the States where we have gotten into the fields of mild mental care and alcoholics?

Mrs. HOLT. We do not have any in operation for that yet but we have some in the processing stage.

Mr. ELLSWORTH. What about alcoholics?

Mrs. HOLT. We have a group in Virginia interested in that type of facility. There is also a group in California. In those specific groups of sponsors we have doctors who specialize in the treatment of alcoholics.

Mr. ELLSWORTH. Thank you very much.

Mr. EVERETT. Mr. Roberts?

Mr. ROBERTS. Nothing.

Mr. EVERETT. We would like to have the names of those States that have a standard of licensing higher than you do and also the names of those States that have a lower standard. Could that be supplied for the record?

Mr. SPECTOR. You mean the building standards? The only standards we have are construction standards.

Mr. EVERETT. I mean construction'standards.

Mrs. HOLT. That would be a little hard to say.

Mr. EVERETT. Forget about it, then.

Mrs. HOLT. We would be hesitant to say what States have lower standards than ours. Maybe they feel that ours are just a little bit different. New York State meets our standards all the way and they have a few variations which might be considered a little bit higher in some instances.

Mr. EVERETT. Could you supply for the record the names of those States that have higher standards than you do?

Mr. SPECTOR. Mr. Chairman, I think it would be difficult for the FHA to make such an evaluation. I think it is essentially in the field of the Department of Health, Education, and Welfare which, through its Public Health Service is actively engaged with this type of function. Mr. ELLSWORTH. Just get the New York standards if they are written down in one place. Are they?

Mrs. HOLT. Yes, sir.

Mr. EVERETT. They will be entered in the record. Also, at this point, if there is no objection, the tables which Mr. Spector has furnished showing nursing home projects by location will be inserted in the record.

(The information related to nursing home standards in the State of New York requested appears on pp. 1579-1607.) (The tables follow :)

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