HOW MY BLACK PHYSICIAN ACTIVIST DAD DRAGGED ME WITH HIM TO APPEAR BEFORE THE US SENATE (REAL STORY)
In August, 1972, my physician activist father was requested to appear before “THE SUBCOMMITTEE ON LONG-TERM CARE OF THE SPECIAL COMMITTEE ON AGING, UNITED STATES SENATE, NINETY-SECOND CONGRESS“. Being a high schooler, I wasn’t quite sure of the importance of his appearance. It should have struck me first of all that he was black (duh!), an OB/GYN specialist, NOT an expert on aging, and yet here he was testifying BEFORE THE US SENATE. I was young.
He took my older brother and I to Washington D.C., and wearing my best suit, I watched my father testify while sitting in one of the US Senate Committee Chambers (or whatever they are called) never truly appreciating the wonder of that moment. Afterwards we went to lunch where it was up to my brother and I to explain to HIM what we had just seen. Believe me when I say my father worked overtime to ensure I became aware of the moment, and the responsibility that came with it. These moments were never exactly “fun”, but I got the point. By then I was truly indoctrinated to the Ways of my Dad, Dr. Hubert Hemsley.
He made me watch and then discuss EVERYTHING, at least it seemed that way. EVERY movie, EVERY TV show was followed up with a discussion, an analysis. And analysis what not limited to what I observed. He first challenged me with the word “introspection” when I was 12 years old. He insisted I develop a 1 year, 2 year, 5 year, and 10 year plan. I planned and charted out my whole college curriculum until graduation EVERY year because of him. He is half of the reason (my wonderful Mother is the other) for whatever is to be considered my success. My value system is theirs. That is why, in my value system, there is an inherent duty that comes with being a physician, ESPECIALLY a black physician. It is my legacy, and I plan on continuing to live it out to the end.
My Dad’s testimony begins on Page #2481, I have copied from this source and posted his testimony below:
HEARINGS BEFORE THE SUBCOMMITTEE ON LONG-TERM CARE OF THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE, NINETY-SECOND CONGRESS https://www.aging.senate.gov/imo/media/doc/publications/8101972.pdf
THURSDAY, AUGUST 10, 1972— EDMUND S. MUSKIE, Maine. PAUL J. FANNIN … Panel on Aging and Aged Blacks: Hubert L. Hemsley, M.D., Compton,. Calif., Charles R. … The subcommittee met at 9:30 a.m., pursuant to call, in room 3110,. New Senate …
Mr. HALAMANDARIS. Thank you, Mr. Jackson. I will ask Dr. Hemsley to present his statement at this point and then we will ask
questions.
STATEMENT BY DR. HUBERT L. HEMSLEY
Dr. HEMSLEY.
Senator Moss, members of the Subcommittee on
Long-Term Care, ladies and gentlemen, I want to thank you for your kind invitation to speak concerning the complex problem of aged blacks and nursing homes.
We are charged with the responsibility of answering the question of why elderly blacks are rarely found in nursing homes and what can be done to improve long-term care for this most deprived segment of our senior citizens.
Long-term nursing care is a small part of the health industry and the
obstacles that continue to impede blacks from securing adequate health services in other areas are also operational here.-
There are vast differences between the culture of the majority population and that of elderly blacks so that goals, priorities, healthv
concepts, et cetera, are viewed in entirely different perspectives. This gap is certainly in existence in Los Angeles today where the aged poor are crying out for needed medical facilities which are
humanistic, comprehensive, and accessible but have thus far received only the traditional crisis-oriented ameliorative programs which failed
so abysmally in the past. There are 1,400,000 blacks 65 years and older and thousands aged 45 to 64 have spent their prime years contributing to the growth and
greatness of America. However, just as their forefathers were kept in physical slavery they have been economically and psychologically enslaved all their lives.
Their health indices reflect a lifetime of substandard housing, limited educational opportunities, and lack of adequate medical and social
resources which are the natural legacy of a society in which white
supremacy and social Darwinism have been the philosophical basis for pathological decisions concerning blacks.
Regarding the status gap, in any social system there are gradations of classes and social statuses. In America, this gap exists between
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physicians and patients. When you consider the fact that minority
physicians have been restricted in medical school opportunities, residency training, and hospital staffing, and thus far from meaningful
participation in emerging health programs, the dilemma grows.
Older Negroes are more than twice as likely to be poor as elderly
Whites: 50 percent in poverty as compared to 23 percent for the
Whites. In rural areas the ratio is 66 percent for blacks and 31 percent
for Whites.
Fifty percent of the black men and four-fifths of the black women
between ages 55 to 64 had a total 1969 income of less than $4,000.
This comparatively low wage during employment years certainly
would reduce Social Security in retirement years. For the 55-to-64
age group and the 65-and-over group, white males are receiving about
twice as much as black males.
The migration of minority groups into urban areas breed conditions
of crowding, poor health and sanitation, maladjustment, unemployment, social revolution, violence toward society, and against themselves-alcoholism, drug addiction, and so forth.
Over half of the total black population still resides in the South, but
this increases to three-fifths for the elderly of.both, sexes. Above age
55, whites are three times as likely as blacks to be living in the suburbs
or in the ring surrounding the central cities of metropolitan areas;
56 percent of all negroes are in central city areas.
Poverty, racism, and institutional rigidity have created a physical
environment where blacks have been systematically deprived of
adequate jobs, income, and housing and have produced a psychological
and cultural milieu where frustrations and repressed aggressions become manifest in greater incidence of stroke, heart disease, mental
disability, and hypertension than is found in the white population.
HIGHER MORTALITY RATE FOR BLACKS
In jeopardy from the cradle to the grave, the black American
finds himself with a higher morbidity and mortality at every stage
of life, except in the very advanced age groups-75 years and over.
From age 45 to 64 black women have twice the mortality rate of
white women.
From age 55 to 64 mortality for black men is 10 percent higher than
for white men. Between the years 1960 and 1968 life expectancy for
black males declined a full year from 61.1 to 60.1 years. Relatively,
fewer blacks live to benefit from Medicare and to collect Social Security
benefits.
Despite the higher incidence of acute and chronic diseases the black
elderly see physicians at an annual rate of 4.9 visits as compared to
a rate of 6.1 visits for whites. The copayment and deductible features
of Medicare act as effective deterrents to utilization of this program
by the black elderly.
Furthermore, a large percentage of black elderly are excluded from
the benefits of Social Security and Medicare by virtue of their previous
employment or occupations (that is, domestic and agricultural workers, and so forth).
It is quite apparent that the black aged are suffering from no
temporary aberration but are experiencing the continuing effects of
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poverty and racism. Now, in their golden years, they are relinquishing whatever hopes they may have had-resigned to ignominious death
in a subtle form of euthanasia.
The casualties of technology, automation, and cybernation are not
accidents. Advanced mechanization, while adding to the gross national
product, is substituting machines for men with increasing frequency. The result is movement out of skilled occupations and semiskilled
positions, underemployment, unemployment, and early retirement.
These trends strike directly at the most vulnerable segment of the
labor force-the black elderly. They have become obsolete, awaiting the inevitable in hopeless isolation. Thus, we find ourselves shackled
with the legacies of the past, inspired by the rhetoric of yesterday, yet facing the realities of today.
How are we to step forward into the future? What specific measures
should be undertaken to provide for the needs of members of minority
groups who are both old and ill? We recommend the following: Medicare coverage should be expanded and improved to provide
coverage for home care, long-term care, and extended care without
prior admission to an acute-care hospital; expanded coverage for home
care; coverage for out-of-hospital drugs; removal of the 100-day time
limit on skilled nursing home care for those patients who continue to
need such care; and, parts A and B of Medicare be merged and all
deductibles and copayments be eliminated.
* Costs for these services should be financed through -taxes on rising payrolls and general revenues rather than from premiums paid by aged persons living on low fixed incomes. Services previously excluded
such as foot care, eyeglasses, eye refractions and examinations for
eyeglasses, examinations for hearing aids, false teeth and dental care, other prosthesis and outpatient psychiatric care should be provided. Medicare coverage should be expanded to include disabled Social
Security beneficiaries. Front-end financing from the Medicaid trust
fund should be utilized to develop senior citizen day care centers and
a full range of geriatric health service centers, including community health outreach workers, transportation, information referral and
advocacy services.
These centers should be owned and operated by nonprofit indigenous community corporations. The Administration on Aging should
identify and design and support opportunities for older persons to
render services to their communities.
JOINT EFFORT NEEDED
The Administration on Aging and any or all public and private agencies should join together in a cooperative effort to develop programs of technical and financial assistance for local community groups in order to provide daily meals to ambulatory older persons in group settings and to shutins at home.
The $2 billion spent yearly by the Federal Government for private nursing home services should be diverted to non-profit social utilities
and homes for the aged sponsored by religious organizations, benevolent organizations, community corporations, et cetera, where there is
joint consumer control and equity by a representative number of
the elderly receiving services.
62-264-72-pt. 20-4
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Existing nursing homes and long-term care facilities owned by black
nonprofit sponsors should be given grants and low interest bearing
loans for rennovation and construction to meet minimum State and
Federal standards.
The archaic practice of static custodial care in institutions where the
elderly go to “lie and die” is self-defeating, inhuman and economically
unsound. We recommend the development of a sociomedical approach
utilizing progressive patient care techniques, phased intensive, intermediate, minimum care, rehabilitation, resettlement and joint effort of the health team integrated with community support to maintain the elderly in their chosen environment.
These services should include but not be limited to home health
services, occupational and physical therapy, recuperative holidays,
meals on wheels, day centers, recreational clubs and ambulance and
transportation services.
The following new trends in long-term care should be researched
and implemented wherever feasible:
1. Holiday admissions, the voluntary admission to nursing
homes, extended care or appropriate facilities during the family’s
planned vacation;
2. Short-term admissions, a program providing for intermittent
2-week admissions of the aged patient every 4 months; and
3. Day hospital, the utilization of a unit combining medical
and nursing care, physical and occupational therapy together
with a noon meal for the aged.
UNIFORM HEALTH CARE LEGISLATION
The implementation of health care legislation should be uniform and
mandatory and not dependent upon matching State funds or voluntary participation of individual States.
Wherever feasible within the black community, comprehensive
health services should be delivered through a community health corporation composed of indigenous consumers and providers rather than
the traditional approach (medical schools, public health departments
and medical health associations, etc.)
This health corporation should secure significant input from informed and relevant consultants within or without their community.
The above will insure that equity, cultural relevance as well as selfsufficiency and self-respect become the end product.
Research in experimental health delivery system should be conducted to determine the best method of financing comprehensive
geriatric services. Arrangements might include front-end financing
from Medicare trust fund, Medicaid appropriation for neighborhood
health centers or a combination of social insurance and general tax
revenues for HMO’s, etc.
We are opposed to restrictive provisions of H.R. 1, the Housepassed Social Security and welfare reform bill scheduled to reach the
Senate in 1972, and consider this a shortsighted attempt at achieving
cost control at the expense of the poor and elderly with the resultant
effect of transmitting cost to the State.
Regarding Medicare cutbacks, the increase in the deductible of
part B supplemental medical insurance from the present $50 to
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$60 beginning January 1, 1972, the provision would make it mandatory that the elderly pay a daily copayment of $7.50 for each day in the
hospital from the 31st to the 60th day. At present they pay $60
deductible only for the first 60 days’ hospitalization. Also included, concerning Medicaid cutbacks. are the provision that would repeal the existing provision requiring States to have
comprehensive Medicaid programs by 1977; the provision that permits States to maintain onlv basic Medicaid services and permits them
to reduce or eliminate other services without prior HEW approval or
utilization control; the provision imposing upon the Medicaid recipient cost sharing in the form of enrollment fees, deductibles and copav- ments; and the provision cutting back Federal matching funds for
Medicaid by one-third after 60-days hospitalization in a general or
tuberculosis hospital, 60 days of care in a skilled nursing home or
90 days of care in a mental hospital.
On May 10, 1971 in our address in Los Angeles we predicted that there would be many blacks, whites and many poor, elderly people who would die as a result of the inhuman treatment Sacramento
had decreed.
I show you a full-paged editorial on page 32 of aged people who have
died as a result of Medi-Cal cutbacks in the State of California.* I call
upon this subcommittee to investigate this and to see whether or
not steps could .be taken to remedy this program. Thank you for the opportunity to present my statement.
Mr. HALAMANDARIS. Thank you, Dr. Hemsley. That is -an eloquent statement and to try to follow that with questions is going to be
difficult indeed. I am wondering if you would comment briefly on
this situation in Los Angeles and surrounding areas specifically about
utilization.
We have heard one of our previous witnesses say that southern
California is overbuilt and there is an excess of nursing home beds.
Secondly, you made a point in your statement earlier relating to whether or not nursing homes should be proprietary or not. If you could comment on those two aspects, I wouli~appreciate it.
Dr. HEMSLEY. I have thought long about profit versus nonprofit and I am convinced that poor people and minority people are being sold a bag of worms over this whole thing about profit versus nonprofit. On our side of the tracks, on the other side of the cotton curtain, everything has been nonprofit for the last 400 years. It has been
nonprofit ever since we have had 100 perce’nt full employment on
the plantation and it is nonprofit now.
BLACK-OWNED ENTERPRISES DECLINING.
The number of’ black-owned and profitmaking enterprises has
steadily declined, despite the fact that our GNP is over the $3 trillion
mark. Also, when you look at it you find that the only business in
the United States which can be nonprofit and exist is the Government.
They are the only people who don’t have to make money. Unfortunately, we do.
The other trick bag is that most nonprofit setups when you look
at them from an accountant’s view-and I am not an accountantshow you the tricks whereby nonprofit enterprises do make money and
*See appendix 1, item 1, p. 2523.
2486
in a significant fashion so that anyone who likes to speak in depth
about profit versus nonprofit and not conduct proper research, can
be led down the bridle path.
What I would like to see are institutions in minority communities
which are viable, which have a broad base are not subject to White
House political expediency.
I think this type of thing has been a steady diet for minority
people in the history of this country. We have got to recognize that
the health care industry is the second largest industry in the United
States, over $85 billion a year.
I feel that there should be institutions in *the black community
who make a profit in the health care industry, but there is a vast
difference between exploitation and providing adequate services
with justifiable return. What I would like to see is the type of efficiency
which exists in the General Motors Corp., and other big corporations
in this country and begin to establish these types of situations in our
own community; for example, co-ops.
I think we are going to have to look closely about whether or not
we can deal with nonprofit institutions in poor areas. About the
overbedding situation in Los Angeles, I happen to be privileged to
serve on the Los Angeles Health Planning. Committee this past year
and I am. aware that there are a great number of nursing beds in
the Los Angeles area, a great number of hospital beds.
Unfortunately, in the curfew area where I chose to practice this
does not exist and there are many reasons why people do not put up
institutions in minority areas. When the question was asked of our
Asian counterparts why there are no Asian-owned nursing homes, or
only one, it was because poor people cannot find the means to finance
or to put up an institution in the nursing home taking care of people
who cannot pay their bills.
* As a result of this, nothing flourishes there. It is an economic
wasteland. That is why if you apply the other principle you always
come up with the same problem. What we need and what poor minority people need in this country is the same type of internal Marshall
plan which allowed Japan to flourish and to grow following the second
World War.
Those of us that have visited areas of Japan which were wasted
by the atom bomb, now find them flourishing. What they did was to
give the people the technological know-how and economic resources
and let them do their thing. I feel that there are not adequate nursing
homes in the Los Angeles area.
BLACK-OWNED NURSING HOMES FACE BANKRUPTCY
Fifty percent of the black-owned nursing homes in the Los Angeles,
Calif., area at this time are bordering on bankruptcy because the
State has placed them in an untenable economic position.
We find the Nixon administration saying to us that the nursing
homes must come up certain standards. Yet, they are not supplied
with the resources. We feel that this is a calculated move to again
put out of business those institutions which have been the lifeline for
the black community.
2487
Mr. ORIOL. Based upon the newspaper article which you submitted
for the record, * you point out that this is part of the Medi-Cal program
or the California Medi-Cal program. It says in this article by David
Shaw-and I know nothing more than what is said here-32 elderly
patients have already died, most of them within a short period,
of even just days or hours after the State said they were not sick
enough to warrant treatment in facilities which had scheduled nursing
care available 24 hours a day.
Nineteen of the 32 patients died after they were transferred, all
of them against their family’s wishes and a great many of them against
their own doctor’s advice to facilities with either a lower level of
medical care or no medical care at all at a savings to the State of
$4 to $7 per patient per day.
Can you tell me if these patients were in a skilled nursing home to
begfin with?
Dr. HEMSLEY. That is correct.
Mr. ORIOL. Can you tell me what category of facility they were
then transferred to? What is this facility without medical care?
Dr. HEMSLEY. What we have in California is intermediate care
facilities. This is a facility in which there is a vocational nurse there.
Usually, they provide services from 8 o’clock until 5 o’clock and
after that there may be one person there throughout the rest of the
evening.
They do have physicians that they relate to for medical problems,
but it is felt that these patients do not require the skilled, intensive
care of a nursing homeMr. ORIOL. And yet several died within hours after the transfer.
They were not sick enough.
Dr. HEMSLEY. According to the Bureau of Health statistics in
Sacramento, they weren’t. This is the sort of thing we pointed to in
our testimony on May 10, 1971, when we predicted it would occur.
We think there are more lives being wasted and we bring it to the
attention of this committee because it needs investigation.
Mr. ORIOL. May I just get a little into the procedure here?
Dr. HEMSLEY. I would appreciate it if you would.
Mr. ORIOL. Who decided that these transfers shall be made. What
power does the physician have for these patients?
CANNOT EVALUATE CONDITION OVER TELEPHONE
Dr. HEMSLEY. As a physician and privileged to practice in Compton,
which is the largest city west of the Mississippi with black population
approaching 92 percent, we found ourselves as medically impotent
that what we can say over the telephone regarding the patient’s
condition is one thing and what the people they have to evaluate
the records-who have never seen the patients themselves physicallydecide is another thing.
This goes from whether or not they are removed from a skilled
nursing home, or whether or not they need surgery. Frequently people
placed in those positions make untenable judgments-most persons
with training could tell y ou you cannot decide whether a person needs
‘See appendix 1, item 1, p. 2123
2488
certain procedures without adequate physical examination which you
yourself have to perform.
Because of the welfare status and the fact that the administration
in California views all people on any State welfare program as being
parasites, criminals, ne’er-do-wells, they are treated accordingly and
their wishes and health status are treated accordingly. As a result,
they) make those types of decisions arbitrarily.
M/r. ORIOL. The people with the paper in front of them, you say they
are.in Sacramento?
Dr. HEMSLEY. Yes.
Mr. ORIOL. So they are not as up-to-date about a condition that
had existed weeks before?
Dr. HEMSLEY. That is correct. Anyone taking care of elderly people
knows this; that the situation can change from moment to moment.
Mr. ORIOL. And they have no right to object?
Dr. HEMSLEY. Many of the administrators have. Many of them
have undergone the cost of keeping them there without getting payments and retroactive denials that Mr. Affeldt was speaking about.
My practice is composed of 75 to SO percent people who are Medicare
or Medicaid recipients.
Mr. ORIOL. Do you as a physician have any reason to doubt the
accuracy of this story?
Dr. HEMSLEY. Not at all. In fact, M,,r. Shaw’s article has been
researebed and I think again his records and resources could be for
the benefit of this committee.
Mr. ORIOL. Do you as a physician believe that the transfer itself
.may have:worsened the patient’s condition bringing on the death?
Dr. HEMSLEY. There is no question in my mind that their transfermoving these patients from one facility to another-is directly the
cause of the death. I believe that one of five deaths of elderlv and
minority people, are directly related to economic differentials and
racist institutions in this country.
Mr. ORIOL. Thank you. If I may turn to Mr. Jackson for a momnent,
and perhaps you have already covered this, as you know there is a
new office within the Department of HEW designated by the President
to deal with nursing homes and nursing programs to approve nursing
homes.
I wonder whether you could, either as chairman of our Advisory
Council or chairman of the caucus on black aged or administrator of
a home for the aged, develop-unless you already have done so-and
to be submitted by you or by this committee a description of what
you would like to see that office do in terms of-I hate to say “demonstrations,” but perhaps we do need some-demonstrations or other
types of action that can be taken to deal with some of the problems
we are dealing with.
Dr. Jackson, if you could, you have indicated in your statement
the lack of hard data and I wonder whether that office could be called
upon to supply this data, too.
BLACKS SHOULD HAVE A HAND IN PLANNING
Dr. JACKSON. While such a department as that designated by the
President to deal with nursing homes and nursing programs to im-
2489
prove nursing homes could be called upon to supply us with much
of the needed data, it may also be necessary to consider several
alternatives. One alternative may be the development of a program whereby the National Center for Health Statistics could be designated
as the agency responsible for obtaining the desired data. Whatever
system is developed, it is crucial that blacks themselves have a hand
in every stage, including decisions about what types of data need to
be collected, how such data shall be presented, analyzed, and interpreted, and what usage will be made of the data. At the very least, the national caucus on the black aged would be critically concerned
about data relative to black access to nursing homes, conditions under
which they reside in those nursing homes, and the statuses of black
employees (including medical personnel) in such homes.
Mr. JACKSON. I think I did include in my statement a recommendation that we would certainly like to pass on. That has to do with the
development of geriatric centers, multipurpose multiservice centers, providing both residential and nonresidential programs and services in black neighborhoods.
Mr. ORIOL. Have you brought this to Dr. Callendar’s attention?
Mr. JACKSON. Perhaps not directly. She did attend a conference
at Duke University at which I spoke on the same subject. It would
appear that the thing that is mostly needed here is some kind .of
center that would take care of the mistakes of the past by not develop- ing residential services in isolation but rather develop one that is
going to be related to the community.. We are recommending that the centers be 100-percent, financed
federally. There should be 100-percent financing of development of
black- sponsors; 100-percent financing of construction costs of these
facilities; ‘and operating costs should be taken care of on a. costreimbursement basis; that is, complete. operating costs. We feel this
is the only equitable way to approach this problem. For example, going back to the question that was posed to Dr.
Hemsley, I think that one of the real problems is that there has been
a reluctance to face up to the cost of nursing home care across the
country. This is not true just in California.
Mr. ORIOL. We are getting cutbacks rather than
Mr. JACKSON. Right, we are not really facing up to the problem.
Mr. HALAMANDARIS. Mr. Jackson, let’s continue along these same
lines. In your opening statement to us you commented that we are
continually faced with nursing homes being closed and the Nixon
administration has been closing nursing homes instead of helping them upgrade. Is that the sense of your statement?
Mr. JACKSON. Yes.
Mr. HALAMANDARIS. And your remedy is that we need to help nursing homes upgrade. Specifically, what would you recommend?
How can we help them? What kind of programs should we offer?
Are you talking about new wings or more construction? Are you talking about training personnel? What are you talking about in terms of the
type of support you would like to see if you had a nursing home that
was on the borderline?
Mr. JACKSON. I have one that is on the borderline.
Mr. HALAMANDARIs. All right.
2490
NATIONAL COST REIMBURSEMENT SYSTEM
Mr. JACKSON. I am talking about a combination of many of
the things that you are referring to. Primarily, however, the great
need is for a national cost reimbursement system in the minority
communities. I am proposing as a prototype-in view of the fact that
it might take legislative action to do some of the things that we are
talking about, on a comprehensive basis-I am proposing the development of the multipurpose geriatric centers with 100 percent Federal
financing in order to get some of these underway. The new concept
here has to do with the nonresidential services including an outreach
to the surrounding community.
With reference to the existing nursing homes, I think the biggest
problem has to do with their funding. Operating costs for those who
cannot afford to pay are not being reimbursed on the basis of the
costs of their care. Many of these homes also have capital loans that
they cannot amortize because of escalating costs. In most cases they
have either adequate management or potentially adequate management with some assistance.
It is primarily a question of getting the resources in order to do the
job. You have a situation, especially among nonprofit facilities in
black communities where impoverished institutions are attempting to
provide services to impoverished people, so you have a compounding
of the financial difficulty. It is primarily, in my opinion, a matter of
money.
Mr. HALAMANDARIS. That was made very clear to me midway in
Dr. Hemsley’s statement. I would like to ask Dr. Jackson if she has
a comment on this as to what is needed to help?
Dr. JACKSON. The question of what is needed to help nursing homes
upgrade themselves I think has been answered very aptly by Mr.
Jackson, and I would add that one has to consider, as he emphasized,
the need for developing new nursing homes in a number of areas
where they do not now exist.
I would also like to reemphasize Dr. Hemsley’s concern about
profitmaking enterprises for blacks.
Mr. HALAMANDARIS. Again, what about this assertion blacks take
care of their own? Is it truth or a myth?
BLACKS CARE FOR THEIR OWN
Dr. JACKSON. No, it is not a myth. The question is whether or
not the kind of care which is provided is sufficient and so what we
find is that to the extent possible blacks provide for themselves and
their families and others in need, that the extent to which they fail
can be laid principally and almost solely to the fact that this society
does not provide the needed supports to enable those blacks who cannot receive effective and efficient care to get that care.
Mr. HALAMANDARIS. That is very well put.
Dr. Hemsley, maybe you can respond to this. Do you see the kind
of erosion in respect for the head of the household that we see in other
communities among the blacks? Do you see the erosion of this tradition which required them to take care and assume responsibility for
2491
parents and grandparents? Is the extended family among blacks on
its way -out?
Dr. Jackson provided me with a very eloquent answer. How would
you respond? Dr. HEMSLEY. It is a very difficult point, there is no question about
that. The black male-you talk about head of the family, you have to understand that in this society the black male has always been placed in the position where he was subordinate to his woman because he could never get a job while she always- could in someone else’s kitchen.
That is still the case today. Unemployment is 27 to 28 percent, according to the new Urban League statistics which just came out 2
weeks ago. As a consequence, it is a little difficult for my sons and
daughters to look up to me if I myself cannot provide for them.
When you talk about erosion and who should be in a certain area in terms of field of responsibility, it is a little difficult for me as a male
and being a chauvinist, which I am. The problem is even more complex because in the St. Louis area the Urban League was only able to
place one black male in a job over the age of 41, which simply means
when you get to my age in life and you don’t have it made, you go
steadily downhill.
Mr. HALAMANDARIS. Thank you. I just want to enter into the
record a letter received’ from David Norman, Assistant Attorney General, Civil Rights Division, and also a letter from J. Stanley Pottinger, Director, Office of Civil Rights. (The letters follow:)
DEPARTMENT OF JUSTICE,
Washington, June 1, 1972.
DEAR SENATOR Moss: I wish to acknowledge and thank you for your letter postmarked April 26, 1972, requesting information with respect to nursing home complaints and actions by this Department. The Civil Rights Division has jurisdiction to bring action against segregated or discriminatorily operated nursing homes under three civil rights statutes: (1) if the home is a public facility within the meaning of Title III of the Civil Rights Act of 1964, 42 U.S.C. 2000b, the Attorney General may bring an action, provided he has received a signed complaint from a directly aggrieved individual; (2) if the home in question is a recipient of federal financial assistance and the agency extending the assistance (e.g., HEW) is unable to bring about voluntary com- pliance with Title VI of the 1964 Civil Rights Act, the agency may refer the matter to us for suit under 42 U.S.C. 2000d-1; (3) inasmuch as nursing homes
may be “dwellings” within the meaning of Title VIII of the 1968 Civil Rights Act, 42 U.S.C. 3602(b), the Attorney General may bring a civil action under the provisions of 42 U.S.C. 3613. In fact, the one lawsuit brought by this Division against a nursing home was brought pursuant to Title VIII, the fair housing law. An examination of our records concerning Title III complaints (received since October 1969) indicated no such complaints with respect to nursing homes. Similarly, available records regarding Title VI matters do not indicate any complaints with respect to nursing homes. Our Housing Section investigated a rest home in Charlotte, North Carolina, in the summer of 1969; ultimately, that
matter was resolved by informal negotiation. As mentioned earlier, this Division brought one action against a nursing home, i.e., United States v. Anderson County (S. Carolina) Home, C.A. No. 69-324, D.S.C., filed in April 1969. The Department of Agriculture, which had Title VI jurisdiction by virtue of the home’s receipt of commodities, had investigated the home and found racial segregation. When efforts to obtain voluntary compliance failed, the Agriculture Department referred the matter to this Division. Meanwhile, the home withdrew from the commodities program. Thus, the suit was brought under the fair housing law. It was resolved by consent order on March 2, 1970.
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Primary responsibility for implementing Title VI’ with respect to nursing homes
belongs to the Department of Health, Education, and Welfare. Since that department should be in the best position to respond to your inquiries, we have-sent a copy of your letter to Mr. J. Stanley Pottinger, Director of the HEW Office for
Civil Rights, and asked him to respond directly to you.
I hope that this information will be of assistance.
Sincerely, DAVID L. NORMAN,
Assistant Attorney General,
Civil Rights Division.
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE,
OFFICE OF THE SECRETARY,
Washington, D.C., August 7, 1972.
DEAR SENATOR Moss: Your letter to Mr. Jerris Leonard, Assistant Attorney
General, Civil Rights Division, Department of Justice, regarding the kind and
number of complaints received against nursing homes has been referred to this
Office. I apologize for the delay in replying. – Under Title VI of the Civil Rights Act of 1964, the Office for Civil Rights, Department of Health, Education, and Welfare, has direct responsibility for the
civil rights compliance determination for approximately 4500 extended care facilities participating in the Medicare program under Title XVIII of the Social
Security Act. We also have responsibility for monitoring the civil rights com- pliance status of continuing grant agencies receiving Federal financial assistance
from this Department. These State agencies, in the administration of their prograins, use approximately 15,000 nursing homes for which they are responsible
for the enforcement of Title VI. In carrying out their civil rights responsibility,
State agencies are required to make civil rights investigations and to have reports on file to support their civil rights compliance determination for each nursing
home. These reports are reviewed by our staff, and a random sample of nursing
homes selected for on-site investigation as a method of evaluating the civil rights
efforts of the continuing grant agencies. Our records show for the year April 1, 1971, through March 31, 1972, Office for
Civil Rights’ personnel reviewed 710 nursing homes. In nearly all instances the
nursing homes were found in compliance; but, in some instances, questions were raised because of low utilization by minority patients. The relatively small
number of minority patients in these nursing homes appears to be due to questionable referral practices. In an effort to correct these practices, State agencies have
been asked to review the referral practices of their local agencies and to eliminate
all elements of discrimination.
During this same period, complaints were received against 19 nursing homes.
These complaints involved discrimination in the assignment of rooms, failure to
provide services on a nondiscriminatory basis, access and acceptance for service,
and discrimination in employment. As of March 31, 1972, twelve of these com- plaints had been investigated and successfully resolved in compliance with Title
V1I. The remaining seven were still pending at the end of the last reporting period.
In July of 1969, all hospitals and extended care facilities participating in the
Medicare program or receiving other types of Federal financial assistance were requested to submit reports reflecting their current compliance status with the
requirements of Title VI of the Civil Rights Act of 1964. This information from
extended care facilities was compared with similar information secured from these
facilities in the spring of 1967. While, in general, these comparative statistics from
4400 extended care facilities reflected gratifying improvements in services to
minority groups, the area of utilization by minority groups was still a cause of concern. Although there was an increase of 82 percent in the number of extended care facilities serving minority patients and an increase of 75 percent in the actual
number of minority patients served, minority patients still constituted only 5.2
percent of the total patient load in these facilities. This study revealed that a substantial number of such facilities located in racially mixed areas were continuing
to serve patients exclusively of one race. This was true despite the fact that these
facilities had adopted and published open admission policies. A study is currently
under way to determine the causes of the above situation and the actions necessary
to correct this problem.
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At this time, the review of one city has been completed. This review covered
the three hospitals and two extended care facilities participating in the Medicare
program in the Selma, Alabama, area. For the purpose of this study, we asked
the three hospitals in Selma to supply a list of all Medicare patients discharged from the hospitals during the month of June 1971. We asked that they indicate
the race of the patient and the type of post-hospitalization care ordered by the
physician. In those cases where the doctor ordered additional care in extended care facilities, we asked that the name of the extended care facility be given. During the 30-day period studied, 67 black and 105 white Medicare patients were discharged from the three hospitals. Of these, four black and four white
patients were referred to extended care facilities. Four of the black and three
of the white patients were admitted to the two extended care facilities and one white patientwas admitted to a nursing home outside the immediate area. While
there appears to be no racial discrimination in the referral and admission process in this case, we believe that the area selected for the pilot study was too small
to provide for an evaluation of the problems. Another such study is under way in the Richmond, Virginia, area which includes
thirteen hospitals and nine extended care facilities. Preliminary information
indicates that the size of the study is sufficient to yield some insight to the
problem.
Sincerely yours,
J. STANLEY POTTINGER,
Director, Office for Civil Rights.
Mr. HALAMANDARIS. I am reading the last line. “In fact, the one
lawsuit brought by this division against a nursing home was brought
under title VIII of the fair housing law.”
The import is that since the 1964 Civil Rights Act was enacted,
the Civil Rights Division of the Justice Department has brought one
action, and only one action, against nursing homes because of discrimination. Let me ask you to go through this little exercise that I
put our Asians through.
Among the four factors that I related, discrimination, cost, social,
and cultural factors and extraneous miscellaneous categories whatever they are-it is hard to separate them, I realize that-would you
agree that this is the proper order, Mr. Jackson?
Mr. JACKSON. Discrimination and cost I would rank almost
together at the top. I think that racial discrimination and poverty
are really the prime factors that are involved. I find great difficulty in separating them out. I think they are equally important.
Mr. IIALAMANDARIS. Do the social and cultural differences play a
role?
Mr. JACKSON. They certainly are a factor, but in my opinion
they do not rank either with the racial discrimination or the costs
involved.
Mr. HALAMANDARIS. Thank you.
CHIEF PROBLEM IS RACISM
Dr. HEAISLEY. I will have to agree with the Kerner Commission that
the chief problem in this country is racism and it reflects itself in
many areas. Why aren’t there proportionate numbers of blacks and
minority people in nursing homes? The question is answered when
vou find out there aren’t any nursing homes which they can ownand operate with their own life style. If the banking institutions,
Government enforcement agencies, could give them the type of
help they give the oil industry, Lockheed, or Amtrak, if they could
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do just that, give that type of “welfare” to poor people, but what we
have in this country is welfare for the rich and free enterprise for the
poor.
We need to understand and most poor people don’t understand,
the aged are the most fearful conservatives that every existed. They
don’t understand these things; what they call subsidies are really
welfare checks for people who have got it made. We need to change
that around.
Most of the minority groups are forced to assimilate. They lose
their own integrity as a result of it and begin to hate themselves.
Once they hate themselves, we have to hate the greater society, so it
is a very complicated thing.
Mr. JACKSON. Racism and poverty are certainly the primary problems that Americans face and I feel that in this situation they both
are tremendously important deterrents in denying services to blacks
in nursing homes.
I interrupted to say that Dr. Jacquelyne Jackson does have to
leave at this time but Dr. Hemsley and I will stay.
Mr. HALAMANDARIS. I would like to puruse this at great length, but
unfortunately we have other panels to be heard. I am going to dismiss
you at this moment.
Mr. JACKSON. I would like to make a further comment that goes
back to the question of whether the system should be primarily nonprofit or profit. I believe that question was addressed to Dr. Hemsley
earlier.
SYSTEMIC CHANGE NEEDED
The way I see it the kind of change that we are calling for here is
systemic change, that neither the nonprofit system nor the proprietary
system as they currently exist are facing up to the problem of the
black and other minority elderly in nursing homes.
The kind of change that we are concerned with would have to do
with the systemic change that would see to it that the program and
policies of these homes would involve consumers, families, and friends
of patients, that these homes would truly be representative public
accommodation and that they would be community related. They
should consider health care a “right” not a “privilege” and should
embrace the social and environmental concepts of care, not just
provide sophisticated medical and nursing services.
It seems to me that a secondary issue is whether or not it is profit or
nonprofit. As I envision this system, I think it would be primarily
best implemented through a nonprofit system, but this would not
mean that it would have to be limited to nonprofit.
I think there is something substantailly immoral about trying to
make a profit on public assistance recipients, but in a public and
affluent market I can see nothing wrong with the proprietary interest.
Mr. HALAMANDARIS. I have one final question to both of you
relating to Senator Moss’ opening statement. It impressed him and I
want to direct it to you. In your experience, about how many black
nursing home administrators are there in the United States?
Senator Moss’ statement contains the rough figure of about two
dozen. Do you think that would be about accurate? Second, would
you comment on the fact that while there are very few nursing home
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administrators that are black and very few nursing home patients
that are black, there are a disproportionately large number of nursing
home employees that are black?
The number of black nursing home employees should be no surprise
to anyone when you consider that nursing home employees are usually
untrained orderlies and receive the minimum wage. Would you comment on that, please?
Mr. JACKSON. I will comment on the latter part of that question
first because 1 have taken public positions on this. One of the things
wrong in the nursing home field is that we expect our greatest philanthropy to come from those who can least afford it. Most of the nursing
home patients are white, but most or the workers are black who work
in direct service.
I am talking about the work at the aide level. We often hear of the
philanthropy of the rich but seldom of the philanthropy of the poor.
To me this is real philanthropy, when you are working at the current
minimum wage of $1.60 an hour and under very difficult working conditions. The thing that comes out of it. is that if we are ever going
to really communicate in any way the concept of “wholeness” to
patients in nursing homes it seems to me with those who are working
in the direct services must also embrace that wholeness concept.
The only way they are ever going to be able to do it is to have a
minimum wage about twice the current level and much better working
conditions.
With reference to the number of black nursing home administrators,
I cannot say definitively-how many there are.:I think -a lot depends on
your definition of an “administrator.”
1 know that there are quite a few black proprietary homes across the
country, not nearly as many good ones as needed, but perhaps the
Senator’s estimate of 24 I would not quarrel with based on the qualifications a good administrator should have. I know that there are not
nearly as many qualified nursing home administrators as we need in
the field.
Mr. HALAMANDARIS. That pretty wvell covered it. I was talking
specifically about the paradoxical number of nursing home employees
that are black or members of minorities and how this compares with
the scarcity of administrators of nursing home owners that are black.
Dr. Hemsley, do you have a comment?
Dr. HEMSLEY. California being the second State in the Union in
terms of numbers of people over the age of 65, second only to the State
of New York, and 1 think the highest number of elderly people over
75, also, and it is one of the areas most people come to live, whether
they be old or young.
I do know in the L.A. area there are very few-I couldn’t give you
a number-why is it that you find at the lower economic level a
predominance of minority people? It has a historical continuum.
It is the same type of philosophical thinking that allowed us to go
from slavery to share cropping, all the way along the line, to the
present day, so that you see a great many blacks working in the
nursing home field, but no administrators.
Blacks and minority groups have helped to build this country.
Then they were doubly penalized by the Social Security Administra-
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tion when it refused to admit that they had given anything all those
years.
We hear people talking about volunteerism. How a person with a
family of four making less than $4,000 a year can volunteer to do
anything but to get out there and fight their own personal war on
*poverty is beyond me. These are the people we call on. It is really
paradoxical.
I see this time and time again, asking poor people to attend meetings and conferences and testify and give up their time and they
can’t even make that house note. I think this is terribly unjust.
It is OK for those of us who have it made.
Mr. HALAMANDARIS. Thank you. That concludes my question. Do
you have any questions, Bob?
Mr. SETO. NO.
* Mr: HALAMANDARIS. I will then ask our next panel on Older
American Indians to present their testimony.
