Mr. MILLER. Well, let me thank all of you for taking your time to come here and give us your impressions of the role of ACTION, your personal experiences with it, or your statements in support or in criticism of the agency. I think it is very important that we hear from people who not only have been directly involved, but those who have been on the periphery of some of these actions to see whether or not they hold up under scrutiny.

So, I appreciate very much you taking your time, some of you came great distances. Thank you.

[Whereupon, at 11:25 a.m. the subcommittee adjourned, to reconvene subject to the call of the Chair.]

OVERSIGHT AND REAUTHORIZATION OF ACTION

AGENCY, 1979

FRIDAY, APRIL 6, 1979

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON SELECT EDUCATION,

COMMITTEE ON EDUCATION AND LABOR,

Washington, D.C.

The subcommittee met, pursuant to notice, at 9 a.m. in room 2257, Rayburn House Office Building, Hon. Paul Simon (chairman of the subcommittee), presiding.

Members present: Representatives Simon and Kramer.

Mr. SIMON. The subcommittee will come to order and resume its hearing on ACTION. Our first panel of witnesses consists of Frieda Gorrecht, Bennie Thompson, Elijah Freeman, Dennis Sparks, Charles Prejean, and Sally Fisher.

What we will do is let each of you speak and what we can do is enter your formal statements in the record, and if you can capsulize them in about 5 minutes or so, then my colleague from Colorado and I will have questions for you, and other members of the subcommittee may join us. And as I identify you, if this is not a correct identification, please let us know.

Freida Gorrecht is with the National Coalition for Nursing Home Reform, Detroit, Mich.

STATEMENT OF FRIEDA GORRECHT, NATIONAL COALITION FOR NURSING HOME REFORM; BENNIE THOMPSON, MAYOR, BOLTON, MISS., HOUSING ASSISTANCE COUNCIL, MISSISSIPPI CONFERENCE OF BLACK MAYORS, INC.; ELIJAH FREEMAN, MANAGER, SEA ISLAND SMALL FARMERS CO-OP; DENNIS SPARKS, DIRECTOR HUMAN ACTION COMMUNITY ORGANIZATION, NATIONAL CENTER FOR URBAN ETHNIC AFFAIRS; CHARLES PREJEAN, EXECUTIVE DIRECTOR, FEDERATION OF SOUTHERN COOPERATIVES; AND SALLY FISHER, PRESIDENT, NATIONAL ASSOCIATION OF NEIGHBORHOODS; A PANEL

STATEMENT OF FRIEDA GORRECHT, NATIONAL COALITION FOR NURSING HOME REFORM

Ms. GORRECHT. I am glad you pronounced my name correctly. It is Gorrecht, and I am president of the Board of Directors of the Citizens Coalition for Nursing Home Reform, which is a national organization based here in Washington, D.C. With our formal presentation is quite

a bit of documentation about what we are, who we are, and how we operate.

Mr. SIMON. That will be entered into the record.

[The prepared statement of Ms. Gorrecht follows:]

TESTIMONY OF FREIDA GORRECHT, PRESIDENT OF THE NATIONAL CITIZENS' COALITION FOR NURSING HOME REFORM BEFORE THE HOUSE COMMITTEE ON EDUCATION AND LABOR SELECT EDUCATION SUBCOMMITTEE, APRIL 6, 1979

My name is Freida Gorrecht. I am the President of the Board of Directors of the National Citizens' Coalition for Nursing Home Reform. This organization is composed of forty-three member groups and over 100 individuals from thirtyfour states. The Coalition was formed in 1975 in order to combine the efforts and resources of local and state citizen groups active in working to improve the longterm care system and the quality of life for nursing home residents.1

The Coalition received a national VISTA grant in September 1978. Until that time it operated almost exclusively with voluntary donations and volunteer work. In February 1979, the Coalition received a grant from the Administration on Aging in order to promote and organize citizen involvement in Government activities related to nursing homes.

Currently, the Coalition is professionally staffed and its offices are located at 1424 16th Street, N.W., Washington, D.C. The Coalition is governed by a nineteen-member board primarily representing local citizen groups throughout the country.

I represent Citizens for Better Care, an organization based in Detroit, Michigan. Our organization began its work to improve local nursing home conditions in Detroit in 1969. Today CBC has locally-initiated and developed chapters which formed as nursing home problems were recognized in other communities throughout the state. CBC is now a state organization. The growth and effectiveness of our voluntary organization have been significantly augmented by the efforts of numerous VISTA volunteers provided through a state VISTA grant. Other Coalition member groups have encountered similar nursing home problems in their communities, and have utilized VISTA volunteer assistance in meeting their local goals.

The Coalition groups' positive experience with the use of these volunteers prompted our national VISTA grant application. Individual citizen volunteers from our local member groups visit nursing homes on a regular basis. We have first-hand knowledge of the problems encountered by elderly institutionalized persons. In our local work we have all discovered that nursing home problems are national in scope and that our experiences at the local and state levels are crucial to national reform. Our information and ideas for improving nursing homes need to be organized and effectively channeled to national policy-makers and enforcement agencies.

Throughout the last fifteen years, there has been ample documentation of this national nursing home problem. The U.S. Senate Special Committee on Aging, and, more recently, the U.S. House Select Committee on Aging have engaged in investigations, held hearings, and released major reports on nursing homes. These studies establish a failure in public policy related to long-term care and reveal serious, life-threatening and degrading conditions for our institutionalized elderly population. In fact, the Department of Health, Education, and Welfare, which administers the federal Medicare and Medicaid programs, has released studies since 1974 which confirm that the nursing home system has failed to assure adequate and decent long-term care, regardless of the billions of taxpayers dollars pumped into it.

Over one million persons reside in America's nursing homes. These people are perhaps this society's poorest, most vulnerable and neglected citizens.

Nationally, approximately 65 percent of nursing home residents rely upon publicly funded programs for their care. These persons generally are entitled to retain only $25 per month to meet innumerable personal expenses. For the most part, these people have been stripped of their property and all but a few personal possessions. As described by the U.S. Senate Special Committee on Aging. and 1973-74 information from the National Nursing Home Survey of the U.S. Public Health Service, elderly people in nursing homes are very old. 80 percent are over 70. Most are female and widowed. They are alone. Almost

1 See app. I for additional information about the coalition.

50 percent have no viable relationship with a close relative, and another 30 percent have no immediate family member near their age. 66 percent of the residents never leave the facility for day trips or overnight visits. 70 percent either die in the nursing home or die after transfer from the nursing home to a hospital.

Nursing home residents generally have chronic or crippling disabilities. Less than one-half can walk unassisted. They take large quantities of drugs. On the average a nursing home resident takes 4.4 different drugs each day, some in doses of 2 or 3 times daily. The average cost of drugs per patient was $300 in 1972, and is certainly much higher today.

Individual facilities often have numerous problems which affect the care and quality of life for these residents. The U.S. Senate Special Committee on Aging report concluded that at least 50 percent of all nursing homes are substandard with one or more life-threatening conditions. These problems include the following:

Inadequate, minimal or no orientation and training of aides and other employees;

Unsanitary and unsafe conditions;

Mental and physical neglect or abuse of residents;

Inadequate supervision of employees;

Lack of rehabilitative, preventive medical and health care services;

Lack of eye care, dental care, hearing health care, podiatry and other special health related services;

Carelessness and neglect of residents' personal properties;

Misappropriation and theft;

Inadequate control of drugs;

Misuse or overuse of drugs to keep residents tranquilized;

Unauthorized or improper use of restraints;

Lack of a grievance system for residents and employees who have problems or complaints;

Reprisals against those who complain; and

Profiteering at the expense of adequate resident services.

The same kinds of problems have been documented in numerous state legislative and governmental reports and other investigative work done by voluntary organizations or the news media. For example, the Ohio General Assembly Nursing Home Commission concluded in a 1978 report that "Ohio's program fails to protect consumers and to ensure the provision of quality care and needed services: state licensure law is inadequate and often unclear; the regulatory process, including inspections, is ineffective; enforcement mechanisms and remedies are unworkable." Similar investigations and reports in over twenty states have reached identical conclusions.

As a national Coalition, we have recognized the influences impacting on this national nursing home system: National Medicare and Medicaid programs finance nursing homes. These programs are also the predominate regulators of the system. Approximately 80 percent of nursing home facilities in this country participate in one or both of these programs and must conform to federally-mandated standards.

Another factor creating common concern around the country has been the rise of chain or corporate-owned facilites. Some corporations own nursing homes in many states. With loss of local ownership and control, communities have often witnessed a decrease in quality of care. Comparisons of services in institutions managed by some multi-state enterprises have revealed a pattern of low quality of care for nursing home residents.

The national VISTA project of the Coalition addresses this national situation. The project focuses on problems associated with a substandard national nursing home system.

In November-December 1978, twelve Coalition member groups recruited, from their own communities, a total of 37 VISTA volunteers to work with them at the local level. Eighteen of those volunteers are over the age of 50; twelve are over 60 years of age and four are over 70. Included in this group are retired or secondcareer persons who bring considerable expertise and demonstrated community responsibility to their respective local VISTA sponsors. The volunteers have varied backgrounds, including religion, education, nursing, social work, nursing home administration, law and business.

In January, the Coalition organized and conducted a four and one-half day orientation-training session for all the VISTA recruits and the individuals who

have volunteered their time to serve as supervisors during the project year. The trainees received instruction in the following areas: (1) orientation to the nursing home system, (2) federal and state regulatory programs, (3) the nursing home ombudsman and aging networks, (4) community organizing, (5) residents' rights, (6) the government reimbursement system, and (7) skills for working with residents and family members.

Since the national training, the volunteers have, of course, received additional on-the-job training. After a necessary orientation and study period, the volunteers are now actively engaged in their year of VISTA service. The primary focus of their work is to promote community awareness of and involvement in nursing home issues. It is expected that their activities will greatly strengthen the twelve local citizen groups in their efforts to improve nursing home conditions. (See Appendix II for a summary of each project's beginning activities.)

There is an important benefit to these nationally coordinated and assisted VISTA projects. In 1975, the Administration on Aging initiated a national ombudsman program. A major objective of this program has been to establish linkages with organized citizens groups working on nursing home issues. The 1978 amendments to the Older Americans Act specifically directed the state ombudsman programs to continue this thrust. Our VISTA project volunteers will work closely with the state ombudsman programs to further common goals.

Besides providing the VISTA volunteers with introductory and basic training related to nursing homes, the Coalition, as a national VISTA grantee offers the volunteers and their sponsors the following benefits:

(1) Technical information on national nursing home issues;

(2) Up-to-date information regarding federal administrative and legislative activities which affect nursing home care and services;

(3) A mechanism for local groups to exchange ideas, information and strategies for action;

(4) A mechanism for ensuring local input at the federal level; and

(5) An opportunity to work on common problems with dozens of other groups throughout the country and thereby achieve maximal impact.

In conclusion, we believe that the efforts of local VISTA volunteers, working as a part of a national program can contribute to solving a common national problem. The Coalition will have the ability, through its national VISTA grant, to coordinate and motivate widespread meaningful local activity; provide needed technical assistance to local and state groups; and to receive, synthesize and transmit relevant information to the appropriate policy-making and enforcement agencies. The national perspective of the VISTA project enhances the prospects for nursing home improvements on the local and national levels. Needy, institutionalized elderly persons are the beneficiaries of this nationally coordinated

program.

Appendix I

A HISTORY OF THE NATIONAL CITIZENS' COALITION FOR NURSING HOME REFORM The National Citizens' Coalition for Nursing Home Reform was first organized in June 1975 when 20 representatives from 12 different citizen groups and 4 ombudsman programs met together in Washington, D.C. Their meeting preceded the group's attendance at a conference sponsored by the American Health Care Association. The Gray Panthers Long-Term Care Action Project called the advance meeting so that representatives from consumer groups could get to know one another and join together in developing recommendations to present to the conference in a united consumer voice.

The results were exciting-for the people attending formed the first National Citizens' Coalition for those working to improve conditions in nursing homes at the local and state level. On the opening day of the AHCA meeting, the Coalition held a press conference announcing its formation. One of the major issues it addressed was accountability for the tax monies being spent in long-term care and the services provided to nursing home residents. The Coalition stated:

... As a Coalition, and in our various local and state reform groups, we intend to strengthen the mechanisms through which we can hold all participants in the system accountable: the industry, including nonprofit facilities; the regulatory agencies; and, community religious, social service and educational institutions which have generally turned their heads away from this issue.

... We accept our part of the neglect and the shame of this tragic social issue. We will use our Coalition effort to mobilize individual consumers and other