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Mr. DOWDY. Do you want to place your statement in the record?

Dr. RIDGLEY. Yes, sir.

Mr. Dowdy. It will be placed in the record.

(The statement of Dr. Ridgley follows:)

STATEMENT Oof Dr. GarreTT RIDGLEY, ROBERT T. FREEMAN DENTAL SOCIETY, INC., OF THE DISTRICT OF COLUMBIA

(Affiliate of the National Dental Association, Washington, D.C.)

Mr. Chairman and members of the Subcommittee, I am Dr. Garrett Ridgley and I represent the Robert T. Freeman Dental Society, Inc., of Washington, D.C. As a member of the medical health team it is our pleasure and privilege to endorse Bill 3972. It is our hope that the passage of this Bill will hasten the District's participation in Title XIX of the Social Security Act. We strongly believe that monies spent medically rehabilitating those under this program will lessen the future need of their remaining among the medically indigent.

As a dentist, I hasten to point out that a person in good physical health, of sound mind, possessing no gross abnormalities and with a pleasant smile is more apt to avail himself of the many opportunities that are presented to him. We of the Dental Profession stand ready to do our part in the Rehabilitation Program with comprehensive treatment aimed at the elimination of disease and the correction of dental and facial defects in order that we might help a "contributing" member of Society.

Thank you for allowing me to be here and to be heard.

Mr. McHUGH. I am John McHugh of the Pharmaceutical Association.

Mr. Dowdy. Mr. McHugh's statement will be placed in the record. (The statement referred to follows:)

STATEMENT OF JOHN R. MCHUGH, PRESIDENT OF DISTRICT OF COLUMBIA
PHARMACEUTICAL ASSOCIATION

The District of Columbia Pharmaceutical Association, representing the Pharmacists of the District of Columbia wish to go on record in support of H.R. 3972, particularly with regard to the availability of pharmaceutical services, under title XIX which H.R. 3972 will enable.

We strongly believe that a system of distribution utilizing both the dispensing facilities of the District of Columbia Health Department and a vendor system which will allow participation by all pharmacies in the District of Columbia is in the best interest of the health needs of the District of Columbia. The utilization of these comprehensive facilities will provide:

A. Freedom of choice of Pharmacy.

B. Availability of twenty-four hour pharmaceutical services to the patients in the District of Columbia.

C. The ready accessibility of pharmaceutical services and resulting convenience to the patients in all geographical locations in the District of Columbia.

We sincerely urge your favorable consideration of this legislation and pledge our support to the District of Columbia Health Department in implementing Title XIX in the District of Columbia.

Mrs. RICHARD MAYFIELD. I am Mrs. Richard Mayfield.
Mr. Dowdy. Your statement will be in the record.

(The statement referred to follows:)

STATEMENT OF MRS. RICHARD MAYFIELD, PRESIDENT, GEORGETOWN CHILDREN'S

HOUSE

Mr. Chairman, Georgetown Children's House is a day care center for children whose mothers must work and who cannot afford to pay for private care.

Almost all our children come from families in the low or marginal economic levels with incomes under $5,000 a year and many of these under $3,000. As we all know the cost of living in Washington is high. Most of our families pay a disproportionate part of their incomes for inadequate housing. These families

cannot afford health or hospital insurance and they have no reserve for medical bills. Clinics are of little use to them because mothers cannot afford to lose a day's pay-and sometimes a job.

Consequently children are deprived of the protective and preventive health care which should be available for everyone. It is ironical to realize that many foreign countries are already providing more liberal health services than are available to us in Washington.

The board, staff, and parents of Georgetown Children's House are heartily in favor of a program such as the one proposed and urge that H.R. 3972 be passed so that children and families of the District of Columbia can benefit by this plan of comprehensive medical care for those who need it most.

Mrs. PETER SOYSTER. Mrs. Peter Soyster, Visiting Nurse Association.

Mr. DOWDY. Your statement will be in the record.

(The statement is as follow:)

STATEMENT OF MRS. PETER SOYSTER, VISITING NURSE ASSOCIATION

The Visiting Nurse Association of the District of Columbia is grateful for the opportunity to appear before this Committee in support of H.R. 3972, a bill "to enable the District of Columbia to participate in the health and medical assistance benefits made available by the Social Security Amendments of 1965, and for other purposes."

The Visiting Nurse Association is a voluntary home health agency providing skilled nursing care and allied therapeutic services to patients in their homes. The agency receives more than half of its annual support from funds contributed by the citizens of the District of Columbia through its United Givers Fund. As a trustee of voluntarily contributed funds, the Association feels an obligation to the community to urge that the official agency assume payment responsibility for services provided to those patients who are eligible for tax-supported services and to assist in obtaining necessary legislation and appropriations to effect appropriate programs.

In the wake of the Social Security Amendments of 1965, we have heard much of the "partnership for health", between voluntary and official agencies, which promises solution to the nation's health problems. In the District of Columbia one "partnership for health" between the voluntary Visiting Nurse Association and the official agency, the District of Columbia Department of Public Health, can best be described as strained and uneasy, as is often the case when one partner feels that he is contributing more than his fair share of the resources. We have termed contracting with the Health Department a losing proposition.

Fifty percent of our service is free and an additional 17% is for less than full fee and we accept as little as a dime in part payment. We consider that poverty or, at least, inability to meet medical expenses exists in 67% of our caseload. At the present time, this 67% is ineligible for tax-supported services. There is an additional 11% which meets current eligibility standards for tax-supported care and for whom the Health Department does pay on a less than cost basis and under contracts with specified ceiling limits. In 1966, the Visiting Nurse Association made 10,332 visits to patients certified as eligible for tax-supported services. Providing this service cost the Visiting Nurse Association $28,863.20, since the Health Department rate of reimbursement was $2.60 below the actual cost of visit.

Enactment of H.R. 3972, permitting the D.C. Commissioners to remove certain restrictions on eligibility for medical care and to permit payment on a "reasonable cost" basis, paves the way for a medical assistance program in which the "partnership for health" can become a reality. The Visiting Nurse Association is already providing high quality home health services to many of the poor of the District of Columbia and welcomes the promise of "reasonable cost" reimbursement for this service and the challenge to grow to meet the needs of the community offered in the proposed Title XIX program. The Visiting Nurse Association strongly urges passage of this legislation.

Dr. GALIBER. Dr. Flavius Galiber, representing the District of Columbia Dental Society. I have a statement I would like to place in the record.

Mr. Dowdy. It will be placed in the record.

(The statement referred to follows:)

STATEMENT OF THE DISTRICT OF COLUMBIA DENTAL SOCIETY

Mr. Chairman and members of this subcommittee, I am Dr. Flavius Galiber and I am here to represent the District of Columbia Dental Society.

I thank this Subcommittee for the opportunity to appear and testify in support of the legislation now under consideration (HR 3972).

This bill will enable the Government of the District of Columbia to put into effect a program of dental care as part of the comprehensive care available under Title XIX of the (Public Law 89-97).

It is an established fact that the lack of adequate dental care and dental treatment is one of the major disadvantages to an individual seeking employment. These disadvantages are both physical and psychological. It follows, therefore, that a program of comprehensive dental care which would be available if this enabling legislation is passed, will permit, among other benefits, dental rehabilitation of those who are eligible and increase their chances of finding gainful employment.

Mr. Chairman and members of the Subcommittee, we feel that this would be a sound investment in the health and welfare of our citizens and respectfully urge favorable consideration of HR 3972.

Thank you Mr. Chairman and members of the Subcommittee.

Mr. DOWDY. Is that all the statements?

Dr. Moskow. Dr. Samuel Moskow of the District of Columbia Podiatry Society.

Mr. DOWDY. Your statement will be in the record.

(The statement is as follows:)

STATEMENT OF DR. SAMUEL MOSKOW OF THE DISTRICT OF COLUMBIA PODIATRY

SOCIETY

I am Samuel Moskow, immediate past president of the D.C. Podiatry Society and its representative to the Allied Health Services Subcommittee of the Public Health Advisory Council Medical Care and Hospitals Committee.

The D.C. Podiatry Society is a non-profit organization, established in 1911 and is an affilliate of the American Podiatry Association.

The D.C. Podiatry Society supports the enactment of this enabling legislation which will permit the District of Columbia to participate in the Title XIX Program of Public Law 89-97.

This will be an important step towards making comprehensive medical care, including the services of the Podiatrist, available for needy people in the District of Columbia.

Medical assistance, under Title XIX, will enable citizens of all walks of life to receive care that is essential to their maintenance of an acceptable sociological and economic standard in the community.

The Gerontology Branch, Division of Chronic Disease, U.S. Public Health Service, emphasizes the necessity of including foot care in any health service planning for the aged. (See attached).

A valid program can be established if this enabling legislation is passed. The D.C. Podiatry Society will meet the foot care needs of both young and old with passage of the enabling legislation that is being considered here today. The members of our society are eager to play a role in helping people to help themselves. We know that one of the facets in medicine is that of healthy feet. To be ambulatory is to be able to help one's self. We are aware that this measure will make available the proper care of the feet to all groups regardless of their economic situation.

The services of the podiatrist will be utilized in the most effective manner. Services can be rendered without delay.

I served as the Acting Chairman of the Allied Health Services Subcommittee. Thank you for the opportunity to appear before this committee. I will be glad to answer any questions that you may have.

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,
BUREAU OF FAMILY SERVICES, WELFARE ADMINISTRATION,
Washington, D.C., December 19, 1966.

In reply refer to: File No. 15: D.
State Letter No. 943.

To: State agencies administering approved public assistance plans. Subject: Provision of podiatric services for elderly welfare clients-Guidelines for a demonstration project under section 1115 of the Social Security Act We are enclosing guidelines for a demonstration project for the provision of podiatric services for elderly welfare clients. In the past, public welfare agencies, as well as the community at large, have given scant notice to the podiatric needs of the elderly, and to the barriers preventing them from obtaining such services. It is unfortunate that such inattention exists, because proper foot care is regarded as an essential service to foster mobility and independence among older persons and to protect their general health and sense of well-being.

The Bureau of Family Services believes that it is timely to suggest that State or local public welfare agencies seek podiatric professional cooperation to initiate demonstration projects to provide such services to elderly public assistance clients.

Therefore, we would like to see innovative projects of this nature developed as demonstrations under section 1115 of the Social Security Act. We hope that the guidelines developed for this purpose will be helpful.

Sincerely,

Enclosure.

FRED H. STEININGER, Director.

[From the Department of Health, Education, and Welfare, Welfare Administration, Bureau of Family Services (15:D), December 19, 1966]

DEMONSTRATION PROJECT FOR THE PROVISION OF PODIATRIC SERVICES FOR ELDERLY WELFARE CLIENTS

BACKGROUND

Great Britain and the Scandinavian countries include foot care for the elderly in their national health programs. This is regarded as an essential service to foster mobility and independence among older persons and to protect their general health and sense of well-being.

The Gerontology Branch, Division of Chronic Diseases, U.S. Public Health Service, emphasizes the necessity of including foot care in any health planning for the aged. Podiatric services are part of the health maintenance projects sponsored by the Gerontology Branch of the U.S. Public Health Service for older persons living in public housing centers. The Public Health Service has also sponsored a very successful "Keep them Walking" plan in conjunction with a school of podiatry, the outpatient department of a hospital, and a city health department. Both of these programs have established useful patterns for the conduct of these services, and could serve as models for a limited number of such projects, which could be funded through section 1115 of the Social Security Act.

GOALS OF THE PROJECT

Projects could be developed to accomplish any or all of the following purposes: (1) Demonstrate methods for the maintenance and restoration of an adequate level of foot care for older persons as part of a comprehensive program of medical services in the local community.

(2) Supply material about the prevalence and incidence of foot infirmities among older individuals receiving public assistance.

(3) Gain information and experience about techniques for providing podiatric services for older individuals.

(4) Yield data on the costs of podiatric care (examination, treatment of types of foot deformities, injuries and diseases, foot appliances and other rehabilitative modalities); and necessary personnel and supportive services. (5) Identify administrative patterns for providing podiatric services as an integral part of public assistance medical care for the elderly.

DESCRIPTION OF THE PROJECT

Medical consultants at the State welfare office level should aid public assistance staff involved with the demonstration throughout its entire sequence and the State medical advisory committee may also be included. Active participation of State and local podiatry societies is essential. Podiatric services could be provided by hospitals, schools of podiatry, medical schools, State or local health departments or a combination of such participants.

Welfare administrative staff at State and local levels should be active in joint planning with the relevant professional groups to assure the successful integration of their views and skills with the role and responsibilities of public assistance. Particular care in the pre-planning and early operational phases will help to establish patterns of collaboration acceptable to each partner.

A project could be conducted in any of a variety of settings within a State or local jurisdiction. A suggested group might include elderly clients living in selected public housing projects, homes for the aged, or nursing homes. Another criterion for selection might be a group of diabetics or those with peripheral vascular disease, since proper foot care is an essential part of their medical treatment.

The public assistance agency will have to plan and conduct an orientation program for project staff. If nursing home patients are included, the operators will also need to be oriented. The agency should develop interpretative material for local staffs to use in explaining opportunities for podiatric care offered to the project participants.

The clients' regular physicians may also need to be informed.

STAFF QUALIFICATIONS

Unless the demonstration encompasses a large population, no additional casework or supervisory staff seems indicated. The State agency might well appoint a full or part-time person as liaison with the professional groups providing the care. This same individual might assume similar responsibility for the State office and local staffs engaged in the project.

It will be necessary for the public welfare agency to assure enough personnel for the maintenance of essential records (aside from those kept by the staff of the cooperating program (s) to service and evaluate the project.

In some instances, the agency will need to pay for or furnish transportation or perhaps supply an escort so clients can be examined and treated.

FUNDING

Expenses that cannot be paid for through the State's regular medical care provisions may be financed from special Federal funds for all projects approved pursuant to section 1115 of the Social Security Act.

EVALUATION AND REPORTING

The collaborating professional groups will assure that records and evaluation are adequate to reflect their share of the goal and accomplishments of the project The public welfare agency must do the same for their part. Systematic reporting forms for insuring this outcome will need to be developed according to the actual design of each demonstration. Careful mutual advance planning should structure reporting content and methods that will yield all the necessary data. Mr. DOWDY. We have also received a number of letters and statements, some from persons who could not be here today. These will be included in the record at this point.

(The communications referred to follow :)

HEALTH FACILITIES PLANNING COUNCIL FOR METROPOLITAN

Hon. JOHN DOWDY,

WASHINGTON, D.C., Washington, D.C., March 23, 1967.

Chairman, Subcommittee No. 3, District of Columbia Committee,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: The Health Facilities Planning Council for Metropolitan Washington wishes to make known to your committee its strong interest in and

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