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The original documents are located in Box 1, folder "Aging (1)" of the Spencer C. Johnson
Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the
United States of America her copyrights in all of her husband's unpublished writings in National
Archives collections. Works prepared by U.S. Government employees as part of their official
duties are in the public domain. The copyrights to materials written by other individuals or
organizations are presumed to remain with them. If you think any of the information displayed
in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential
Library.
Some items in this folder were not digitized because it contains copyrighted
materials. Please contact the Gerald R. Ford Presidential Library for access to
these materials.
THE FITNESS
CHALLENGE
in the Later Years
an exercise program for older Americans
Я
An eminent physician, commenting on the phenomenon
of aging, has said: "Most of us don't wear out, we rust out."
Disuse is the mortal enemy of the human body. We know
today that how a person lives, not how long he lives, is
responsible for many of the physical problems normally
associated with advanced age.
This book has been prepared to help the elderly take
advantage of the added years of life which medical
science is making possible. It outlines methods for
maintaining youthful health and energy, and it suggests
ways of enhancing the enjoyment of leisure.
Advanced age need not mean inactivity or infirmity.
For those who are physically and mentally active, it
can be a time when long experience of life enriches
each passing day.
Prepared by
The President's Council on
Physical Fitness and Sports
and the Administration on Aging
Published by the
Administration on Aging
The Active Life
T
HE YEARS in later life-particularly those of
the post-retirement period-should be happy
years. But the full promise of this stage of life
PHYSICAL FITNESS
comes only to those who are healthy, alert, and active.
The later years can be truly rewarding if you have the
PHYSICAL FITNESS is a quality of life. It is the condition
that helps a person to look and feel well, to carry out his
energy and zest to use them well. The purpose of this
daily duties and responsibilities successfully, and yet have
book is to help older Americans maintain-or regain-
enough physical reserves to enjoy his social, civic, cultural,
a lively way of life.
and recreational interests. In addition, it enables him to meet
The way to keep lively is to be lively; the way to stay
unusual or emergency demands.
active is to move. Energy begets energy, and the only
There are two "mainstreams" of physical fitness: organic
way to develop the capacity to expend more and more
fitness or basic health, and dynamic fitness.
energy is to keep increasingly active.
It is nice to come into retirement with a bankroll of
Organic fitness. The foundation of fitness is good organic
physical resources, just as it is comforting to have suffi-
health-a body free of disease or infirmity and well nour-
cient financial reserves. Some folks hit their 60's with
ished. This may mean an adjustment by the individual to
certain physical conditions that cannot be reversed by medi-
plenty of bounce, having kept fit and active throughout
cal or dental care-wearing properly fitted eyeglasses and
their adult years. And this is an immense wealth to
dentures or using a hearing aid when prescribed.
the older person.
Fortunately, even if you have let too many years slip
Dynamic fitness. A person may be free of disease but not
by when good intentions of keeping fit were sacrificed
fully fit. There is the additional dimension of dynamic fitness
to other demands of life, you still can pick up at some
which involves the resources to move vigorously, to do, to
live energetically. This dynamic quality has several com-
level of physical performance and work yourself up
ponents: efficiency of heart and lungs, muscular strength and
several notches. One of the objectives of this book is
endurance, balance, flexibility, coordination and agility.
to bring you from your present level of fitness up to the
point you would like to attain. The move upward will
depend on the amount of movement you are willing
and able to undertake.
1
FORD & LIBRARY GERALD
The Importance of Exercise
There is an advantage also in keeping fit and main-
taining your physical capabilities to meet conditions
Why strive in these later years for more "bounce to
caused by illness or accident. The person who has good
the ounce"?
control of his body and physical reserves is much better
Most medical authorities support the belief-and
equipped to cope with such problems and to follow a
most active people experience the fact-that exercise
rehabilitative program if he should have to do so.
helps a person look, feel, and work better.
The physically active and able person usually has a
Various organs and systems of the body, particularly
positive feeling about himself. He also possesses a de-
the digestive process, are stimulated through activity
gree of physical courage that propels him into inter-
and as a result work more effectively.
esting and stimulating experiences; moves with grace
Posture can be improved through proper exercise
and ease; and generally presents a trim, attractive, and
by increasing the tone of supporting muscles. This not
self-confident bearing.
only improves appearance but can decrease the fre-
Perhaps the greatest benefit of maintaining physical
quency of lower-back pain and disability.
fitness is the degree of independence it affords. This is a
Physically-active individuals are less likely to experi-
quality to be most prized in the later years. There is a
ence a heart attack or other forms of cardiovascular
great psychological and financial advantage in having
disease than sedentary people. And apparently an
the ability to plan and do things without depending
active person who does suffer a coronary attack will
upon relatives, friends, or hired help. To drive your own
probably have a less severe form and will be more apt
car, to succeed with do-it-yourself projects rather than
trying to find and pay someone else for the service, to go
to survive the experience.
and come as you please, to be an aid rather than a
Physical activity is as important as diet in maintain-
ing proper weight. And being overweight is more than
liability in emergencies-these are forms of personal
a matter of individual discomfort. It is related to several
freedom well worth working for.
chronic diseases, shortened life expectancy, and emo-
tional problems. Medical authorities now recommend
How Exercise Promotes Dynamic Fitness
that weight reduction be accomplished by a reasonable
increase in daily physical activity, supplemented, if
Efficiency and Endurance of the Heart and Lungs
necessary, by proper dietary controls.
The proper working of the heart, lungs, and blood
Exercise can't prevent the stresses of life, but it can
vessels is probably the most important aspect of fitness
help you cope with them. For many individuals, fre-
in the adult years. Vital to good fitness are a strong
quent involvement in some sort of physical activity
and responsive heart that can pump the blood needed
helps to reduce mental fatigue, tension, strain, or bore-
to nourish billions of body cells, good lungs where
dom produced by our highly technical and sedentary
gases of cell metabolism are exchanged for life-giving
way of life.
oxygen, and elastic blood vessels free of obstructions.
2
Activities involving leg muscles help maintain good cir-
joints to increase in thickness and lose their elasticity.
culation by the "squeezing" action of the muscles on the
Moving the joints in a proper exercise program can
veins. This benefit cannot be achieved by any other
delay this process. Exercise of the joints also helps slow
means. More and more evidence from scientific research
down the onset or the development of arthritis, one of
points to the importance of regular physical activity in
the most common and painful diseases associated with
maintaining good circulation and respiration.
old age. Proper exercise that stretches the muscles can
help keep them supple and prevent them from becom-
Muscular Strength and Endurance
ing short and tight.
Muscles grow in size and strength only if they are
Traditional "concern" for older people has perhaps
used. They grow soft and flabby and lose their strength
done them a disservice. The idea has been to put the
and elasticity if they are not used.
pushbuttons in easy reach, to keep the shelves low, to
While strength does decrease with advancing years,
avoid necessity for bending and stretching. Instead,
the rate of decline can be lessened by keeping the mus-
older people should be encouraged to bend, move, and
cles toned through regular exercise. Strength and en-
stretch in order to keep joints flexible, muscles springy,
durance can be promoted by increasing the number of
and the heart feeling young.
times an exercise is performed, by adding more weight
or friction, and by increasing the speed of movement.
Coordination and Agility
A well-coordinated individual should be able to di-
Balance
rect parts of the body in skillful movement, to co-
The balance mechanism of the body is commonly
ordinate different actions with each other and with the
neglected and yet is extremely important in the fitness
eyes, to move and change directions quickly and safely.
of older people. The balance mechanism is maintained
Highly refined skills may not be essential in the later
through use and degenerates when not used.
years. But for enjoyment of recreation and to keep in
Many older people tend to lose their sense of balance
condition to move freely and safely, you should exercise
much more quickly than nature intended. The need to
regularly in order to maintain reasonably good levels
use bi-focal or tri-focal glasses increases the hazards for
of coordination and agility.
many. A well-maintained sense of balance can help
make up for the problems caused by quick changes in
Principles of Exercise and Fitness Programming
vision from one optical focus to another.
Physical fitness can be improved by gradually in-
Flexibility
creasing the amount of work performed, but it is
The ability to move the joints through their normal
necessary to progress in easy stages. The enthusiast
range of motion is important, but here again the aging
who tackles a keep-fit program too fast and too stren-
process and disuse cause the tissues surrounding the
uously soon gives up in discomfort, if not in injury.
3
While some activity has to be sustained to obtain
tem. This is called the "overload principle." Challenge
major benefits, the "cumulative effect" of exercises and
yourself little by little toward improved performance
activities carried on during a period of time counts.
by increasing the amount of exercise performed or the
For example, every movement uses calories, so the way
speed at which you perform it. For example, if you
to "burn up" calories is to move. And even though cer-
repeat an exercise five times, a certain amount of work
tain actions-such as a short walk-may not use many
has been done and value derived. The next step is to
calories at the time, a number of short walks in the
perform the exercise six times, and then gradually in-
course of a day can use up a fair-sized total. Similarly,
crease the count until you can do it, say, ten times with
the benefits of movement to the organs, the joints, the
ease.
muscles add up little by little.
Unless the overload principle is employed, only mini-
Therefore, try to step up activity throughout your
mal gains will be achieved. This is why it is important to
day, in addition to following specifically planned periods
follow a graduated, progressive schedule. This principle
of exercise.
applies to the circulatory system as well as to the volun-
At all ages, but increasingly in later years, it is impor-
tary muscles. To increase the efficiency of the heart and
tant to prepare your body for vigorous activity by
lungs, the performance of continuous rhythmic exercise
"warming up." Any individual, and especially an older
for a period long enough to stress the circulatory system
person, should definitely avoid suddenly undertaking a
is recommended-brisk walking, jogging, bicycling,
strenuous activity. A warm-up period should be per-
swimming, rope skipping, or the like. Action should be
formed by starting lightly with a continuous rhythmical
increased until it can be sustained hard and long enough
activity such as walking and gradually increasing the
to keep the pulse rate above 130 for several minutes
intensity until your pulse rate, breathing, and body
and to increase the body temperature gradually to the
temperature are elevated. It is also desirable to do some
point of perspiration. Programs that promise "fitness"
easy stretching, pulling, and rotating exercises during
in a minute a day are more than inadequate in their
the warm-up period.
effect on circulation. So, too, are the traditionally rec-
Periods of vigorous activity should be alternated with
ommended activities for the elderly, such as puttering
periods of lesser stress. "Put the pressure on" for a
in the garden or taking a leisurely stroll.
while and then release it. By gradually increasing the
Exercise is, of course, only one facet of the active and
stressful interval and reducing the less vigorous interval,
physically-fit life. Medical and dental care, proper diet,
you improve your physical condition. This principle of
sufficient rest, and other good health practices are all
"interval training" can be applied to many forms of
important and part of the "balanced life."
exercise and is particularly adaptable to walking, jog-
However, since this pamphlet is principally concerned
ging, and swimming.
with physical activity, it begins with exercise. Other
The proper way to advance in strength and physical
health matters are discussed briefly in its later pages.
condition is to put increasing workloads on your sys-
Now-to work!
4
Your Exercise Program--Red, White or Blue?
N THIS "reasonable" exercise program planned
First, you should ask your physician for advice. Dis-
for you, there are three series of exercises, graded
cuss your plans with your own doctor (or public health
according to their difficulty or the amount of stress
clinic physician) and follow his recommendations. Take
involved. They are identified as the Red, the White,
this booklet along to show him. Ask him to review the
and the Blue programs, with Red the easiest, White
program recommended here and to advise you accord-
next, and Blue the most difficult and sustained. They
ingly. Also give yourself the following simple tests to
let you start where you should, and they provide for an
determine your present condition and your exercise
easy progression as you improve your physical condi-
tolerance. In other words, find out just what kind of
tion.
shape you are in.
Each of these three exercise programs is designed to
The tests will help you select your appropriate exer-
give you a balanced workout, utilizing all major muscle
cise level and pace. Keep in mind that there are wide
groups. Performing your program regularly will lead to
variations in physical performance. Your own individ-
improvement in the various components of physical
ual physical condition must dictate your personal exer-
fitness, especially in functioning of the heart and lungs.
cise program.
As you grow proficient at the exercises in your pro-
gram, you should increase the number of repetitions of
certain exercises, and increase the duration and speed
Pre-exercise Tests
of walking and jogging.
As you become able to increase the number of repe-
Check yourself in easy stages. First, try the walk test
titions and handle more complicated and demanding
below.
exercises. you can move up to the next level with new
Walk Test
confidence and a growing feeling of well being.
The idea behind this walk test is to determine how
Which Series?
many minutes, up to 10, you can walk briskly, without
undue difficulty or discomfort, on a level surface. Test
How do you know where to start? Are you a Red,
yourself outdoors preferably, but walking around the
a White, or a Blue?
room indoors will do if necessary.
5
If you can finish 3 minutes, but no more, you should
If you complete the 6-minute walk-jog test without
begin your daily exercise program with the RED level.
difficulty, you can probably undertake the BLUE level.
It might be well to warm up for a week or two on the
If you can go beyond 3 minutes, but not quite to 10
WHITE program first, however.
minutes, you can warm up at the RED level for a week
or two, and then move up to the WHITE level.
If you can perform this test without difficulty and
feel you are capable of a more rigorous trial, rest a day,
If you can breeze through the whole 10 minutes, you
and then take "Walk-Jog Test #2".
are ready for bigger things. Rest awhile, or wait until
the next day, and then take "Walk-Jog Test #1".
Walk-Jog Test #2
This test consists of alternately walking 100 steps and
jogging 100 steps for a total of 10 minutes. Follow the
One note of caution. If at any time during the Walk Test
directions and use the same rates of speed-walking
you experience any trembling, nausea, extreme breathless-
and jogging-as described for Walk-Jog Test #1.
ness, pounding in the head or pain in the chest, STOP im-
mediately. These are signs that you have reached your pres-
If you complete this 10-minute test without difficulty,
ent level of exercise tolerance. Start your keep-fit program
you can obviously handle the BLUE program in this
at the corresponding level described in relation to this
book, and might want to consider going beyond it to
test. If these symptoms persist beyond a point of temporary
more advanced exercises contained in another publica-
discomfort, check with your physician.
tion of the President's Council on Physical Fitness. See
note on Adult Physical Fitness-A Program for Men
and Women on page 8.
Walk-Jog Test #1
If you do not complete the 10-minute walk-jog, better
This test consists of alternately walking 50 steps and
stay with the BLUE level for awhile, after warming up
jogging 50 steps for a total of 6 minutes. Read instruc-
a few days on the WHITE program.
tions under Exercise #2 on page 10 and the section on
Jogging (page 24) before undertaking this test.
Walk at the rate of 120 steps per minute; that is, your
Keep an Exercise Schedule
left foot strikes the ground once each second. Jog at the
rate of 144 steps per minute; your left foot hits the
Now that you've tested yourself and determined
ground 18 times every 15 seconds. Time your walking
where to begin, schedule a definite period for your
and jogging intervals for 15 seconds occasionally to
basic exercises every day and stick with it.
check your pace.
This means setting aside 30 minutes to an hour a day
for a planned program of physical activity. You should
If you stop this test before the 6 minutes are up, plan
consider your exercises just as important as eating
your schedule of exercises at the WHITE level.
a proper diet or keeping clean.
6
General Directions-All Levels
interesting when walking or jogging indoors. Some
people also enjoy exercising while watching TV.
The exercises in this program are not graded sepa-
You can exercise with family and friends. Many
rately for men and women but are tailored to individuals.
groups get together in each other's homes or at a local
center or club.
A couple can do the exercises together. More than
likely, however, a man who has been active can start
Wear comfortable clothing. Avoid tight-fitting, re-
at a higher level or progress faster than most of the
strictive clothes, although, if you feel more comfortable
wearing foundation garments, do so. Shorts or slacks,
women who undertake the program.
T-shirts or short-sleeved blouses are usually desirable.
Begin very easily and increase the tempo and num-
ber of repetitions very gradually. This will keep stiff-
Wear well-fitting shoes with non-slip soles and low
(or no) heels.
ness and soreness to a minimum. If you do get a little
stiff during the first few days, don't let it slow you down;
the stiffness will soon be overcome and it is an indication
that you needed the activity.
Follow the directions for your exercise exactly. If, for
Specific Instructions for
example, you are at the RED level and a particular ex-
ercise should be performed only twice as a starter, stop
Individual Programs-Red-White-Blue
after two repetitions-even though you may feel you
can do many more. A warm-up is built into each exer-
cise series. Therefore, the exercises should be performed
Red Program
in the order presented to give best results (see page 9).
Keep a record of the exercises you perform, and how
Try to complete the entire sequence without undue
many times you repeat them. The little extra time re-
rest periods between exercises, but, of course, rest awhile
quired to keep a record of your activities and to set
if you feel overtaxed. One indication of improvement in
more and more challenging goals for yourself is well
condition is the ability to go through the workout in
spent. A fitness program should be carefully designed
less and less time (up to a point), which means doing
and carefully followed. The best way to keep track of
the exercises at a faster cadence and resting shorter
each day's performance is to write it down. The exer-
periods between exercises. However, never let the effort
cise schedules outlined in this booklet will be more
to increase speed cause jerky movements or otherwise
beneficial to you if you keep good records.
interfere with correct performance of the exercise.
One way of adding to the fun of your exercise pro-
For the first week at least, perform only the smallest
gram is to play music while you are exercising. You
number of repetitions or shortest duration of time
can select lively tunes and find music that fits the
shown for each exercise under its illustration (pages
tempo of the various movements. This is particularly
10-18). If you find even this amount to be strenuous,
7
or if you feel fatigued at the end of the week, do not
Blue Program
increase the repetitions or duration but continue at the
same pace for another week.
Follow the same directions as for the Red and White
programs. Start slowly; step up activity gradually.
After the first week-or as you are ready-in each
exercise where a range of repetitions is shown, increase
When you reach the upper limits of the BLUE ex-
the minimum by one. Do this number, but no more, the
ercises and can go through the workout without stop-
second week. (If you need to stay at the lowest count,
ping on 3 straight days, you are ready to tackle bigger
as explained above, don't increase the count at all.) In
things. At this point you can (1) continue with the
the following weeks, gradually increase the number of
exercises in this book, gradually increasing the number
repetitions as you feel you can. Most people should
and speed of repetitions, the distances walked and
take 3 to 4 weeks to reach the highest counts in the
jogged, and also engage in more sports and recreational
RED program.
activities; or (2) obtain a copy of Adult Physical
Fitness-A Program for Men and Women, which
After you reach the point where you can do the
includes more difficult exercises, and advance to its
higher number of repetitions shown for each exercise,
level one without going through its orientation level.
continue on the RED level until you can complete the
You can find out how to order it on page 28.
whole series without resting between exercises.
If you decide to "graduate" to the advanced publica-
When you can do this for 3 days in a row, move on
tion, remember to keep working faithfully at your
to the White level.
BLUE Program until the new book arrives.
White Program
Important Note
When you are ready to undertake the WHITE level,
proceed in a fashion similar to your Red Program. That
Most, but NOT ALL, of the exercises illustrated on the
is, start at the lowest frequency of repetitions and
next pages are included in all three Exercise Programs-
gradually work up.
the Red, White, and Blue; but the same order IS NOT
followed in the three programs.
O Most people should remain at the WHITE level
Do only those exercises included in your program level,
for 3 to 5 weeks before moving to the Blue.
as indicated by color blocks.
O After you pass your "prove out" test by performing
Perform your exercises in the order indicated for your
all of the WHITE exercises at the highest frequency
program.
shown without resting in between for three consecutive
workouts, move on to the Blue level.
8
Order of Exercises
RED Program Sequence
WHITE Program Sequence
BLUE Program Sequence
Exercises * to be performed in the following order.
Walk 2 minutes
Walk 3 minutes
Alternate Walk (50 steps) Jog (50)
Bend and Stretch
Bend and Stretch
3 minutes
Rotate Head
Rotate Head
Bend and Stretch
Body Bender
Body Bender
Rotate Head
Wall Press
Wall Press
Body Bender
Arm Circles
Arm Circles
Wall Press
Wing Stretcher
Half-Knee Bend
Arm Circles
Walk 2-5 minutes
Wing Stretcher
Half-Knee Bend
Lying Leg Bend
Wall Push-Away
Wing Stretcher
Angel Stretch
Walk 5 minutes
Alternate Walk (50 steps) Jog (50)
Walk-a-Straight-Line
Lying Leg Bend
3 minutes
Half-Knee Bend
Angel Stretch
Leg Raise and Bend
Wall Push-Away
Walk-the-Beam
Angel Stretch
Side Leg Raise
(2-inch by 6-inch beam)
Walk-the-Beam
Head and Shoulder Curl
Knee Push Up
(2-inch by 4-inch beam)
Alternate Walk (50 steps) (10)
Side Leg Raise
Hop
1-3 minutes
Head and Shoulder Curl
Knee Push Up
Walk 1-3 minutes
(arms crossed on chest)
Side Leg Raise
Diver's Stance
Head and Shoulder Curl
Alternate Walk (50 steps) Jog (25)
(hands clasped behind neck)
3-6 minutes
Stork Stand
* Illustrations of each exercise and figures for
number of repetitions or length of time to per-
Walk 1-3 minutes
Alternate Walk (50 steps) Jog (50)
form it, appear on pages 10-18. Where two fig-
ures are given, start at the lower figure; gradu-
5 minutes, gradually increasing to
ally increase the repetitions or duration over a
walk 100 steps-jog 100
period of days or weeks until you can perform
Walk 3 minutes
the higher number.
9
Exercises
arms held flexed
flatfooted
2. Alternate Walk-Jog
Blue only at this time
1. Walk
Alternately walk 50 steps and
3. Bend and Stretch
2 minutes
jog 50-for about 3 minutes.
Repeat 2 to 10 times
3 minutes
Starting position: As for walking,
Repeat 10 times
arms held flexed, forearms generally
Repeat 10 times
parallel to the ground.
Starting position: Stand erect, bal-
Starting position: Stand erect, feet
anced on balls of feet.
Action: Jogging is a form of slow
shoulder-width apart.
Action: Simply begin walking briskly
running. Begin walking for 50 steps,
Action: Count 1. Bend trunk forward
then shift to a slow run with easy
on a level space, preferably outdoors,
and down, flexing knees. Stretch gen-
but walking around the room will do
strides, landing lightly each time on
tly in attempt to touch fingers to toes
the heel of the foot and transfer
if necessary.
or floor. Count 2. Return to starting
weight to the whole foot in flatfooted
position.
VALUE: A good warm-up exercise, loosening
style. (Heel-toe running in contrast
muscles, and preparing you for your full
to the sprint in which the runner stays
NOTE: Do slowly, stretch and relax at inter-
exercise schedule.
on balls of his feet.) Arms should
vals rather than in rhythm.
move loosely and freely from the
VALUE: Helps loosen and stretch most mus-
shoulders in opposition to legs.
cles of body; helps relaxation; aids in "warm
Breathing should be deep but not
up" for more vigorous exercise.
labored to point of gasping.
VALUE: Good warm-up for more advanced
exercises. Good for legs and circulation.
10
4. Rotate Head
5. Body Bender
6. Wall Press
Repeat 2 to 10 times each way
Repeat 2 to 5 times
Repeat 2 to 5 times
Repeat 10 times each way
Repeat 5 to 10 times
Repeat 5 times
Repeat 10 times each way
Repeat 10 times
Repeat 5 times
Starting Position: Stand erect, feet
Starting position: Stand with feet
Starting position: Stand erect, head
shoulder-width apart; hands on hips.
shoulder-width apart, hands extended
not bent forward or backward, back
Action: Count 1. Slowly rotate the
overhead, finger-tips touching.
against wall, heels about 3 inches away
Action: Count 1. Bend trunk slowly
from wall.
head in a full circle from left to
right. Count 2. Slowly rotate head
sideward to left as far as possible,
Action: Count 1. Pull in the abdominal
in the opposite direction.
keeping hands together and arms
muscles and press the small of the
straight (Don't bend elbows). Count
back tight against the wall. Hold for
NOTE: Use slow, smooth motion; close eyes
2. Return to starting position. Counts
six seconds. Count 2. Relax and re-
to help avoid losing balance or getting dizzy.
3 and 4. Repeat to the right.
turn to starting position.
VALUE: Helps loosen and relax muscles of
the neck, and firm up throat and chin line.
VALUE: Stretches arm, trunk, and leg muscles.
NOTE: Keep entire back in contact with wall
on Count 1 and do not tilt the head back-
ward.
VALUE: Promotes good body alignment and
posture. Strengthens abdominal muscles.
11
7. Arm Circles
8. Half Knee Bend
9. Wing Stretcher
Repeat 5 each way
Red skip this exercise at this time.
Repeat 2 to 5 times
Repeat 5 to 10 each way
Repeat 5 to 10 times
Repeat 5 to 10 times
Repeat 10 to 15 each way
Repeat 10 to 15 times
Repeat 10 to 20 times
Starting position: Stand erect, arms
Starting position: Stand erect, hands
Starting position: Stand erect, bend
extended sideward at shoulder height,
on hips.
arms in front of chest, extended fin-
palms up.
ger tips touching and elbows at
Action: Count 1. Bend knees halfway
Action: Describe small circles back-
shoulder height. Counts 1,2,3. Pull
while extending arms forward, palms
ward with hands. Keep head erect.
elbows back as far as possible, keeping
down. Keep heels on floor. Count 2.
Reverse, turn palms down and do cir-
arms at shoulder height and return-
Return to starting position.
cles forward.
ing to starting position each time.
VALUE: Firms up leg muscles and stretches
Count 4. Swing arms outward and
VALUE: Helps keep shoulder joint flexible;
muscles in front of legs. Helps improve bal-
sideward, shoulder height, palms up
strengthens muscles of shoulders.
ance.
and return to starting position.
NOTE: This is a bouncy, rhythmic action,
counting "one-and-two-and-three-and-four."
VALUE: Strengthens muscles of upper back
and shoulders; stretches chest muscles.
Helps promote good posture and prevent
"dowager hump."
12
NOTE: At this point in sequence
10. Wall Push-Away
11. Lying Leg Bend
Red now return to WALK (Ex-
White only at this time
Repeat 2 to 5 times, each leg
ercise #1) and walk 2 to 5 minutes
Repeat exercise 10 times
Repeat 5 to 10 times, each leg
Blue return to Alternate WALK-
Then WALK for 5 minutes
Blue skip this exercise
JOG (Exercise #2) and walk 50
Starting position: Stand erect, feet
Starting position: Lie on back, legs
steps, jog 50 for 3 minutes
about six inches apart, facing a wall
extended, feet together, arms at sides.
and arms straight in front, palms on
Action: Count 1. Bend left knee and
wall, bearing weight slightly. Count 1.
move left foot toward buttocks, keep-
Bend elbows and lower body slowly
ing foot in light contact with floor.
toward wall, meanwhile turning head
Count 2. Move knee toward chest as
to the side, until cheek almost touches
far as possible, using abdominal, hip,
the wall. Count 2. Push against wall
and leg muscles; then clasp knee with
with the arms and return to the start-
both hands and pull slowly toward
ing position.
chest. Count 3. Return to position at
NOTE: Keep heels on floor throughout the
end of count 1. Count 4. Return to
exercise.
starting position.
VALUE: Increases strength of arm, shoulder,
NOTE: After completing desired number of
and upper-back muscles. Stretches muscles
repetitions with left leg, repeat the exercise
in chest and back of legs.
using right leg.
VALUE: Improves flexibility of knee and hip
joints; and strengthens abdominal and hip
13
muscles.
12. Leg Raise and Bend
13. Angel Stretch
14. Walk a Straight Line
Repeat 2 to 5 times Blue only
Repeat 2 to 5 times
Red only-walk for 10 feet
After completing desired number
Repeat 5 times
White and Blue skip this, do
with left leg, do exercise with right
Repeat 5 times
Walk-the-Beam (#15) instead.
leg.
Starting Position: Lie on back, legs
Starting Position: Stand erect with left
Starting position: Lie on back, legs
straight, feet together; arms extended
foot along a straight line. Arms held
extended, feet together, arms at sides.
at sides.
away from body to aid balance.
Action: Count 1. Raise extended left
Action: Count 1. Move arms and legs
Action: Count 1. Walk the length of
leg about 12 inches off the floor.
outward along the floor to a "spread-
the straight line by putting the right
Count 2. Bend knee and move knee
eagle" position. Slide-do not raise-
foot in front of the left foot with
toward chest as far as possible, using
arms and legs. Count 2. Return to
right heel touching left toe, and then
abdominal, hip, and leg muscles; then
starting position.
placing the feet alternately one in
clasp knee with both hands and pull
front of the other, heel-to-toe. Count
slowly toward chest. Count 3. Return
NOTE: Throughout the exercise try to com-
to position at end of count 1. Count 4.
press the lower back against the floor by
2. Return to the starting point by
tightening the abdominal muscles. Do not
walking backward along the line, al-
Return to starting position.
"arch" the lower back.
ternately placing one foot behind the
VALUE: Improves flexibility of knee and hip
VALUE: Stretches muscles of arms, legs,
other, toe-to-heel.
joints; strengthens abdominal muscles.
trunk, aids posture; improves strength of
VALUE: Improves balance; helps posture.
abdominal muscles.
14
15. Walk the Beam
NOTE: At this point in sequence
16. Hop
Walk 10 feet on 2" x 6" board
Red perform Half-Knee Bend (#8)
Hop 5 times on each foot
Walk 10 feet on 2" x 4" board
repeating it 2 to 5 times;
Blue only
Wall Push-Away (#10) repeating
2 to 10 times; then skip #15, 16,
Starting position: Stand erect with left
& 17, moving to #18 next.
Starting position: Stand erect, weight
foot on board, long axis of foot in line
on right foot, left leg bent slightly at
with board.
the knee, and left foot held a few
Action: Count 1. Walk the length of
inches off the floor; arms held side-
the board by putting the right foot in
wards slightly away from the body to
front of the left foot with right heel
aid balance.
touching left toe, and then placing the
Action: Count 1. Hop on right foot,
feet alternately one in front of the
moving few inches forward each hop.
other, heel-to-toe. Count 2. Return to
NOTE: Perform the desired number of hops
the starting point by walking back-
on right leg, then change to left leg and hop.
ward along the length of the board,
alternately placing one foot behind the
VALUE: Improves balance, strengthens ex-
tensor muscles of leg and foot; increases cir-
other, toe-to-heel.
culation.
NOTE: The board is placed flat on the floor,
not on the 2" edge.
VALUE: Improves balance; helps posture.
15
FORD & LIBRARY GERALD
17. Knee Push Up
18. Side Leg Raise
19. Head and Shoulder Curl
Repeat 1 to 3 times
Repeat 2 to 5 times each leg
Repeat 2 to 5 times;
Repeat 3 to 6 times
Repeat 5 to 10 times
hold each for 4 seconds
Repeat 10 times
Starting position: Lie on floor, face
Starting position: Right side of body
Starting position: Lie on back, legs
down, legs together, knees bent with
on floor, head resting on right arm.
straight, feet together, arms extended
feet raised off floor, hands on floor
Count 1. Lift left leg sidewards about
along the front of the legs with palms
under shoulders, palms down.
30" off floor. Count 2. Return to
resting lightly on the thighs.
Action: Count 1. Push upper body off
starting position.
Action: Count 1. Tighten abdominal
floor until arms are fully extended
NOTE: Do the desired number of repetitions
muscles and lift head and shoulders
and body is in straight line from head
with the left leg and then turn over, lie on
so that shoulders are about 10 inches
to knees. Count 2. Return to starting
left side and exercise the right leg.
off the floor. Meanwhile slide arms
position.
VALUE: Helps improve flexibility of the hip
along the legs, keeping them extended.
joint and strengthens lateral muscles of trunk
VALUE: Strengthens muscles of arms,
Then hold the position for 4 seconds.
and hip.
shoulders, and trunk.
Count 2. Return slowly to starting
position, keeping abdominal muscles
tight until shoulders and head rest
on floor. Relax.
NOTE: Red skip Exercises #20,21.
16
19. Head and Shoulder Curl
19. Head and Shoulder Curl
20. Diver's Stance
Repeat 5 times;
Repeat 5 times;
White only-
hold each for 6 seconds
hold each for 10 seconds
hold position for 10 seconds
Same as Red except on starting posi-
Same as Red, except on starting posi-
Starting position: Stand erect, feet
tion arms are crossed over chest (kept
tion, hands are clasped behind the
slightly apart, arms at sides.
in that position throughout).
neck (held that way throughout).
Action: Rise on toes and bring arms
upward and forward so that they ex-
tend parallel with the floor, palms
down. When this position is attained,
close eyes and hold balance for 10
seconds.
NOTE: The head should lead in a "curling"
motion, chin tucked to chest, back rounded,
NOTE: Head should be straight and body
not arched.
should be held firmly throughout.
VALUE: Excellent for improving abdominal
VALUE: Improves balance; strengthens ex-
strength and stretching back muscles.
tensor muscles of feet and legs; helps main-
tain good posture.
17
21. Stork Stand
22. Alternate Walk-Jog
23. Walk
Blue only-
(Repeats-Exercise #2)
(Repeats-Exercise #1)
hold position 10 seconds on each leg.
walk 50 steps, jog 10
walk 1 to 3 minutes
1 to 3 minutes.
walk 1 to 3 minutes
walk 50 steps, jog 25
walk 3 minutes
Starting position: Stand erect, feet
slightly apart, hands on hips, head
3 to 6 minutes.
VALUE: Tapering off, as heart rate, breathing,
straight.
begin walk 50 steps, jog 50
body heat, and other functions return to
Action: Transfer weight to the left foot
gradually increasing to
normal.
and bend right knee, bringing the sole
walk 100 steps, jog 100
of the right foot to the inner side of
continue for 5 minutes.
the left knee. When this position is
reached, close eyes and hold for 10
VALUE: Provides an "interval" of exercise for
seconds.
circulatory system, and for strengthening leg
muscles.
NOTE: After holding on left leg, change to the
right leg and repeat.
VALUE: Improves balance.
END OF DAILY WORKOUT
18
Alternatives to Your Daily Exercise Schedule
IF YOU can enroll in a keep-fit program at the Y, at
keep vigorous. Age need not be a barrier to participa-
a school, or the local recreation center, you can skip
tion. These activities should be added to-not substi-
your home-exercise routine on those meeting days.
tuted for-your daily exercise.
IF YOU are able to take part in a sport appropriate
for your physical condition, by all means do so. Swim-
Stepped-up Daily Activities
ming is an excellent activity if you really swim. Take
advantage of any opportunities you may have to swim
To the Daily Exercise Schedule and your supplemen-
regularly. Hiking, hunting, bicycling, tennis, or similar
tary recreation add a little more action. Gradually, day
sports may sometimes be available to you.
by day, find ways to move more rather than less. Walk
to the neighborhood store instead of driving (or being
On days when you can participate in such sports, you
driven). Walk down a flight of stairs instead of taking
can substitute the sport for your home-exercise routine,
the elevator; when you're back in shape, walk up the
or better still, add it to your day's activity. But make
stairs.
sure, if you substitute it, that the exercise involved in
In today's sedentary world, particularly the older
the sport is the equivalent of your regular workout.
person's world, you need to look for opportunities to
Incidentally, by doing your home exercises, you can
keep in shape for an occasional opportunity to partici-
move your body. Many well-meaning friends and rel-
atives try to spare older people from any exertion. It
pate in a sport, and also help avoid soreness, stiffness,
is satisfying to be able to say: "Thank you, but I'd
injury, or overfatigue.
rather do it myself. I can, you know."
Other active forms of recreation should be worked
It is good to always have some active project under-
into your daily life whenever possible. Such activities
way-putting in a new flower bed, cutting wood, build-
as gardening, fishing, archery, horsehoes, ping-pong,
ing a fence, painting a room, mowing the lawn, and a
shuffleboard, a family outing, an evening of social or
thousand other jobs and interests that keep you busy
square dancing are not only fun, but will also help you
and youthful.
19
Keeping Score
T
WO OF YOUR most important pieces of fitness
This level will keep you fairly vigorous.
equipment are the pencil and paper with which
you keep a continuous record of your status and
These point values are approximations based upon
progress. In addition to a record of your special daily
the clinical experience of exercise specialists. Sufficient
exercises, you should also keep account of other activity
research data are not yet available to pinpoint more
undertaken during the day. Remember that the effects
specific and final figures. So set your own goals accord-
of exercise in some respects are cumulative, so the day's
ing to the way you feel. But don't underestimate your
total counts even though it may have been gained a
vitality--and keep increasing the total points achieved
little at a time.
each day until you become one of the "lively ones."
Then stay that way.
On the score card opposite, you will note that various
activities are given a point value. Make a chart like
this for yourself to use each week.
GOALS
Each day you should enter in the appropriate space
Add your points daily, but classify yourself accord-
the number of points you have earned through all the
ing to your weekly total. As you will notice, most
activities you have engaged in during that day. Activi-
weekly goals allow you some time off for good
ties have been grouped in several categories and you
(active) behavior.
should try to gain credits in each category.
Physical
Points
Points
Your total number of points should gradually in-
Activity Level
Per Day
Per Week
crease as you attain higher degrees of physical condi-
RED
10
70
tion. For example, a total of 10 points per day or 70
WHITE
15
100
per week would be satisfactory for someone on the RED
level. The top of the BLUE level would give you 20
BLUE
20
125
points per day or 125 per week. Once there, you can
BLUE +
25
150
push on with an advanced schedule of activities (call
it BLUE +) to earn 25 points per day or 150 per week.
20
Daily Physical Activity Score Card
N ORDER to receive credit for the variety of ac-
After adding up the approximate time spent on ac-
tivities you may participate in each day, the fol-
tivities in each category, give yourself the appropriate
lowing classification and scoring system is provided.
number of points acquired in each category and total
Determine your daily physical activity score by adding
them. Do not exceed the maximum allowable points
up the time you spend performing various activities dur-
for categories 2 and 3.
ing the day according to categories listed below.
Total
Mon
Tue
Wed
Thur
Fri
Sat
Sun
for week
1. Your Basic Daily Exercise Program
For performing any of the following activities,
give yourself the points listed.
RED exercise program = 5 points
WHITE exercise program = 10
BLUE exercise program = 12
BLUE + exercise program, or other programs
such as Adult Physical Fitness, jogging and
calisthenics, swimming, or YMCA keep-fit
programs, lasting 30 minutes or more = 15-19
21
Total
2. Light Activities
Mon
Tue
Wed
Thur
Fri
Sat
Sun
for week
Give yourself 1 point for each hour spent in the
following type activities. Maximum allowable
points per day = 3
-Personal care-dressing, washing, shaving
-Sitting and actively rocking, typing, writing,
playing cards, peeling potatoes, polishing
shoes, sewing, playing musical instrument
-Standing or slowly moving around room or yard
-Shooting pool, shuffle board
3. Light-Moderate Activities
Give yourself 2 points for each 30 minutes spent in
the following type activities. Maximum
allowable points per day = 8
-Domestic work-sweeping floors, ironing,
washing clothes, making beds
-Light gardening, mowing lawn (power mower),
washing automobile
-Light industrial work-auto repair, store clerk
(not lifting), building with wood, painting,
shoe repairing
-Walking on level at slow pace (2-3 mph) or
down stairs
-Bicycling on level at easy pace (51/2 mph)
-Canoeing slowly (21/2-3 mph)
-Pitching horseshoes, playing golf with cart,
archery, bowling
22
Total
Mon
Tue
Wed
Thur
Fri
Sat
Sun
for week
4. Moderate Activities
Give yourself 4 points for each 30 minutes spent in
the following type activities. Maximum
allowable points per day = 12
-Gardening-pulling weeds, digging, mowing
lawn (not motorized)
-Mopping-scrubbing floor
-Walking on level briskly (31/2-4 mph)
-Walking up and down small hills, in sand
-Playing ping pong, golf without cart, badminton,
volleyball, or tennis (doubles)
-Canoeing briskly (4 mph) or rowing for pleasure
-Dancing-Fox trot, waltz, square
5. Heavy activities
Give yourself 8 points for each 30 minutes
spent in the following type activities. No
maximum.
-Walking upstairs, up hills, or climbing
-Bicycling briskly or up and down hills
-Playing tennis (singles)
-Water skiing
-Cross country snow skiing
-Chopping wood, digging holes, shoveling snow
23
Special Notes on Exercise
Jogging
There are many people around the country in their 60's
and 70's who are jogging 2 to 5 miles daily. But don't
The fast-growing number of people who are jogging
set your goals this high unless you have gradually
nowadays is good testimony to its value as a fitness-
raised the distances jogged without experiencing severe
producing activity.
reactions or extreme fatigue lasting for several days.
Jogging lends itself very well to the interval method
Remember too to "taper off" by walking the last inter-
of gradually increasing the stress of the activity. The
val and moving around until your breathing and pulse
main idea is to alternate walking and jogging bouts
rate return to near normal.
and to gradually increase the proportion of jogging
It is important to wear the correct shoes and clothing
to walking. In addition, the total distance covered can
while jogging. Clean, thick, well-fitting socks are a
be gradually increased as well as the speed with which
"must," and the shoes should also fit well and have soft,
the distance is traversed. However, the speed element
nonslip soles, with no heels. If gym shoes are worn, they
is not emphasized beyond the point of getting a good
should have a built-in arch support. Shoes made espe-
workout within a reasonable time.
cially for jogging, having short rippled soles, are now
being sold. Other clothing should fit so as not to restrict
The walk-jog intervals outlined in the RED,
movement and should be sufficiently warm to protect
WHITE, and BLUE exercise schedules provide for
the jogger on cool days. In cold weather, a cap and ear
easy progression. If you can handle the BLUE level
protectors, as well as gloves, are often desirable. It is
fairly easily and wish to go forward with jogging, by
generally not advisable for older people to jog in mid-
all means do so. First work up both the walking and the
day during summer.
jogging intervals simultaneously until you are ultimately
Jogging is great for the circulatory system and the
walking 100 yards and jogging 100 yards (about the
legs but does not provide a complete and balanced
length of a city block). Then hold the walking interval
workout. Therefore, calisthenics or other conditioning
constant at 100 yards, but gradually increase the jog-
exercises should be added to the jogging session each
ging interval to 200 yards-or more as you feel ready.
day. The exercises described in this booklet will serve
Also, gradually increase the total distance covered.
this purpose very well.
24
Swimming and Water Exercises
The next progression might be to swim the length of the
Swimming is such a good activity it deserves special
pool and walk back, and so on. The workout can be
mention. It involves all the major muscles groups, can
varied by using different strokes to swim the intervals.
be adjusted from very mild to strenuous responses, and
The buoyancy of the water makes it easier to do
can be easily graded for progressive conditioning by
some exercises. Therefore, if your physical condition is
gradually increasing the distances.
such that you cannot do even some of the RED exer-
You can work out your own system of interval train-
cises on land, find the ones that you can do in the water
ing. For example, swim across the pool, get out and
and get your workout that way. On the other hand, the
walk around to the other side and repeat this procedure
water also causes resistance for certain other exercises.
until your swimming trips across total a good distance.
Use this medium as a way of increasing the workload.
Exercise Problems Due to
Foot Conditions or Leg Pains
Swimming and water exercises.
Problems with the feet, the legs, and the knee and
"Bicycling" movement, while lying on the floor, hips
hip joints are fairly common. Any problem of the lower
and legs in the air, supported by the arms and elbows.
extremities, be it bunions, arthritic knees, or varicose
Do not try this if you think you will have difficulty
veins, may interfere with proper performance of some
supporting your weight.
of the exercises outlined in this booklet, particularly
Riding a bicycle (choose a safe area).
walking and jogging.
If you have such a problem, first make sure that you
Pedalling a stationary bike.
have done all that you can do to obtain needed medical
Playing golf. (Here's one time a golf cart is justified.)
care.
Next, don't let your ailment sidetrack you in your
Exercising on wall pulley-weights or rowing machine.
determination to get fit. The following activities can
Passing a medicine ball with a partner while stand-
be substituted for walking and jogging, and can provide
ing or seated-or bouncing the ball off a wall in con-
healthful exercises.
tinuous rhythmic movement.
25
Special Notes on Health
A
PROGRAM of physical fitness must, of course,
Authorities recommend that the older person makes
include much more than exercise. It should be-
sure he gets the adequate nourishment provided by the
gin with basic health considerations. Here are a
basic four food groups. These groups and recommended
few reminders:
daily servings are:
Medical and Dental Supervision and Care
Bread and cereals
Fruits and vegetables
The importance of having continuing supervision by
(4 or more servings)
(4 or more servings)
a physician and dentist cannot be overemphasized.
Meat, poultry, fish, eggs
Dairy products
Periodic checkups, at least annually, are the best form
(2 or more servings)
(2 or more cups of milk
of preventive-maintenance.
or its equivalent)
If you do not now have a personal physician, check
on available health services with your local public
Overweight is a problem with many older persons
health officer or the public health nurse who visits your
and, therefore, the total number of calories consumed
neighborhood. If you cannot find a local public health
should be carefully adjusted according to individual
person, ask at the closest hospital to you, or call the local
needs. Because many persons become less and less active
medical society. Remember, it is not only important
as they increase in years and tend to continue eating
to find the physician and dentist, but it is even more
the same amounts, it becomes difficult for them to
necessary to follow their advice once it is given.
avoid getting heavy.
Remember also, your medical "advisor" should know
This is often the case even when they attempt to
your exercise plans before you start your program-be
reduce their diet. Sometimes the energy expenditure
it RED, WHITE, or BLUE. And let him really advise
is so low that they would have to go hungry most of the
you-follow his recommendations.
time to keep from growing fat. But to do this would be
risking the loss of an adequate amount of certain
Diet and Nutrition
vitamins and minerals necessary to maintain good
A good basic diet is necessary at all ages and does
health. This is another reason for increasing your physi-
not change radically when one approaches age 60.
cal activity.
26
Some older people find that they become uncom-
breathing), bronchitis, and heart disease has been well
fortable after eating a large meal. There is evidence to
established. The data show that the chances of develop-
support the suggestion that it may be better to spread
ing these chronic diseases are related to the number
food intake over five or six small meals a day rather
of years a person has been smoking as well as the amount
than the traditional three hearty meals. The total
or number of cigarettes smoked. The evidence also
amount of food, however, should be considered in terms
indicates that it is possible to overcome some of the
of the individual's daily need for calories and nutrients.
harmful effects. That is, the sooner a smoker stops and
The matter of vitamin supplements or special ad-
the longer he stays stopped, the better his chances of
justments in the diet for health conditions is for your
improved health.
physician to decide.
Detrimental effects of smoking cigars and pipes are
not as pronounced as in cigarette smoking-but the risk
Sleep and Rest
is greater than for non-smokers. Also, the incidence of
There is some indication that as you grow older, you
cancer of the lip and oral cavity is greater among those
require more sleep or rest. The day's program should
who use cigars and pipes.
include rest periods. A nap in the afternoon is probably
The data call out loudly, "If you smoke, stop; if you
a good idea. Several rest periods or "cat naps" are
don't smoke, don't ever start." By increasing the amount
particularly desirable for the person who usually sleeps
of daily exercise, you can help prevent an increase in
less than 8 hours during the night.
weight that some people experience when they stop
smoking.
Cigarette Smoking
Studies show that children are more apt to start
The relationship of cigarette smoking to lung cancer,
smoking if their parents smoke-and probably if their
emphysema (a serious condition of the lung affecting
grandparents do, too.
So, That's the Challenge
THE EXERCISES are here-their reasons and prom-
benefits, and before long you will be looking forward
ises-goals and scores to keep. Now the rest is up to
to each day's activities. The self-discipline you must
you. It won't be easy to get going, especially if you
employ pays off in two ways-the act of overcoming
haven't been active for a long time. There is no easy way
the tendency toward a sedentary, self-pampering exist-
to fitness.
ence gives a psychological boost; and your activity
But once you get started you'll begin to feel the
opens the way to a more zestful and worthwhile life.
Good Luck. Good Health.
Want to Read More?
Adult Physical Fitness-A Program for Men and Women,
a President's Council on Physical Fitness publication, available
from the Superintendent of Documents, U.S. Government Print-
ing Office, Washington, D.C. 20402, 35 cents.
Exercise and Fitness, available from the Department of Health
Education, Division of Socio-Economic Activities, American
Medical Association, Chicago, Ill., 10 cents.
Physical Fitness, available from the Department of Health Edu-
cation, Division of Socio-Economic Activities, American Medical
Association, Chicago, III., 15 cents.
Food for Fitness, a U.S. Department of Agriculture publication,
available from the Superintendent of Documents, U.S. Govern-
ment Printing Office, Washington, D.C. 20402, 25 cents.
For Information on programs of the Administration on Aging
write to: Director, Public Information, AoA, U.S. Department
of Health, Education, and Welfare, Washington, D.C. 20201
For sale by the Superintendent of Documents, U.S. Government Printing Office
Washington, D.C. 20402 - Price 75 cents
28
* U.S. GOVERNMENT PRINTING OFFICE: 1975-0-579-033
DHEW Publication No. (OHD) 75-20802
May 1968
(Reprinted June 1975)
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Office of Human Development
Administration on Aging
National Clearinghouse on Aging
Washington, D.C. 20201
R. FORD
GERALD
LIBRARY
Art Quen an 7yi Rogu.
94th Congress
1st Session
}
COMMITTEE PRINT Helen
WHAT
FISCAL FILE: 1976 AGING
THE PROPOSED FISCAL 1976 BUDGET:
WHAT IT MEANS FOR OLDER AMERICANS
A STAFF REPORT
A
PREPARED FOR THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
FEBRUARY 1975
FORD & LIBRARY GERALD
Printed for the use of the Special Committee on Aging
U.S. GOVERNMENT PRINTING OFFICE
47-102
WASHINGTON : 1975
For sale by the Superintendent of Documents, U.S. Government Printing Office
Washington, D.C. 20402 Price 30 cents
Stock Number 052-070-02760
ahiaA
THE PROPOSED FISCAL 1976 BUDGET:
WHAT IT MEANS FOR OLDER AMERICANS
A STAFF REPORT
THOOUT arer ПИЗОЧОЯЯ
President Ford submitted the Administration's proposed budget
аилотяяма ЯНСЛО TI
for fiscal 1976 to the Congress on February 3, 1975.
The new budget recommends $349.4 billion in Federal spending and
a $51.9 billion deficit, a peacetime record.
SPECIAL COMMITTEE ON AGING
To summarize the impact of the fiscal 1976 unified budget on older
FRANK CHURCH, Idaho, Chairman
Americans¹-in terms of trust fund items and discretionary spend-
HARRISON A. WILLIAMS, New Jersey
HIRAM L. FONG, Hawaii
ing-the Committee staff has prepared the following analysis.
JENNINGS RANDOLPH, West Virginia
CLIFFORD P. HANSEN, Wyoming
EDMUND S. MUSKIE, Maine
EDWARD W. BROOKE, Massachusetts
FRANK E. MOSS, Utah
CHARLES H. PERCY, Illinois
AoA FUNDING SLASH
EDWARD M. KENNEDY, Massachusetts
ROBERT T. STAFFORD, Vermont
WALTER F. MONDALE, Minnesota
J. GLENN BEALL, JR., Maryland
A $42.4 million cutback in funding (compared with the fiscal 1975
VANCE HARTKE, Indiana
PETE V. DOMENICI, New Mexico
appropriation levels) is proposed for the Administration's fiscal 1976
CLAIBORNE PELL, Rhode Island
BILL BROCK, Tennessee
THOMAS F. EAGLETON, Missouri
budget for programs under the Older Americans Act. The new budget,
DEWEY F. BARTLETT, Oklahoma
JOHN V. TUNNEY, California
which calls for $202.6 million in funding for AoA programs, repre-
LAWTON CHILES, Florida
sents a 17-percent reduction compared with the fiscal 1975 appropria-
DICK CLARK, Iowa
tion of $245 million. It would also constitute the largest dollar and
WILLIAM E. ORIOL, Staff Director
percentage reduction in the entire history of the Older Americans
DAVID A. AFFELDT, Chief Counsel
Act.
VAL J. HALAMANDARIS, Associate Counsel
JOHN GUY MILLER, Minority Staff Director
The fiscal 1976 budget proposed for AoA programs is identical to
PATRICIA G. ORIOL, Chief Clerk
the Administration's fiscal 1975 request. It recommends $96 million
(II)
for Title III Community Programs on Aging, $7 million for Title
IV Research, and $99.6 million for the Title VII Nutrition Program.
For Title III, the Administration proposes $76 million for Area Plan-
ning and Social Services, $15 million for Administration and $5 mil-
lion for Model Projects. This level of funding would maintain the
current amount of assistance to States and would support at least 412
Area Agencies on Aging. It would also fund approximately 40 Model
Projects grants, nearly the same as for fiscal 1975. For fiscal 1976 the
nutrition program is projected to provide 200,000 meals, five days per
week, in 665 areas. During the first quarter of fiscal 1975 the average
daily participation for Title VII was about 212,000. Nearly 705,000
elderly persons participated in the program during this period.
Again, no earmarked funding is requested for training, a special
transportation study mandated in the 1973 amendments, multidisci-
plinary centers of gerontology, and multipurpose senior centers. The
Congress, however, appropriated $8 million for Title IV Training in
fiscal 1975.
1 As well as rescissions proposed for fiscal year 1975 appropriations. See p. 12 for
discussion.
(1)
GERALD
LIBRARY
2
3
Additionally, $10.2 million is projected for salaries and expenses
of earnings above this amount. But regardless of an individual's
for 128 persons at AoA and 179 aging specialists in the HEW re-
annual earnings, he or she may still receive full benefits for any
gional offices. This sum would also fund the National Information and
month in which his or her earnings do not exceed the monthly
Resource Clearing House and the staff of the Federal Council on the
exempt amount $210. (Projected outlay reductions: $15 million
Aging. Approximately $500,000 is projected for the Federal Council
in 1975 and $205 million in 1976.)
on the Aging.
3. Place a 5-percent ceiling on the cost-of-living increase sched-
uled for July 1975. (Projected outlay reduction: $2.5 billion in
PROPOSED FUNDING FOR PROGRAMS UNDER OLDER AMERICANS ACT
1976.) Present projections place the cost-of-living raise at 8.7 per-
[In millions of dollars]
cent. Senators Frank Church, Edward Kennedy, Walter Mon-
dale, and Harrison Williams have sponsored legislation (S. Con.
Proposed
Budget
rescission
Res. 2),2 which is cosponsored by 50 other Senators (making a
request,
Fiscal 1975
for fiscal
fiscal 1976
total of 5.4 sponsors), to express opposition to any proposed re-
appropriation
1975
duction in the cost-of-living increase.
Title III: State and community programs on aging
$96.0
$105
$96.0
Title IV:
Training
MEDICARE OUTLAYS PROJECTED AT $15.5 BILLION
0
8
0
Research
7.0
7
7.0
Special transportation study
0
0
0
Multidisciplinary centers of gerontology
Medicare outlays in fiscal 1976 for hospital and medical services
0
0
0
Title V:
for the aged and disabled are projected at $15.5 billion ($11.4 billion
Multipurpose senior centers
0
0
0
Annual interest grants
0
0
0
for Hospital Insurance and $4.1 billion for Supplementary Medical
Personnel staffing grants
0
0
0
Title VII: Nutrition program
99.6
125
99.6
Insurance), approximately $2 billion above the fiscal 1975 estimate.
The budget attributed the projected rise in benefit payments to "in-
Total
202.6
245
202.6
creases in the size of the covered population and increases in the cost
1 See p. 12 for additional discussion of rescission.
of medical services." Approximately 24 million persons (22 million
aged and 2 million disabled beneficiaries) will be enrolled in the Part A
SOCIAL SECURITY BENEFITS
Hospital Insurance program for fiscal 1976, and 23.8 million for Part
B Supplementary Medical Insurance. Nearly 5.6 million beneficiaries
The new budget projects that 29.1 million persons will receive almost
are expected to receive reimbursed services under Part A and 13.3
$62.9 billion in Old Age and Survivors Insurance benefits for fiscal
million under Part B.
1976, compared with an estimated $54.7 billion in payments for 28.3
The Administration is also recommending legislation to reduce
million beneficiaries for 1975. Disability outlays are projected to in-
Medicare outlays, including:
crease from $7.6 billion in 1975 to $9.1 billion in 1976. And, the num-
1. Modify Medicare's cost-sharing structure to provide: (a) A
ber of disability beneficiaries is estimated to rise from 4 million in
coinsurance charge under Part A equal to 10 percent of all charges
1975 to 4.4 million in 1976. Benefit payments are expected to increase
above the deductible amount on all covered services (now the
because of the enactment of the two-step, 11-percent Social Security
elderly pay a $92 deductible and nothing thereafter for covered
raise (which became fully effective for checks delivered in fiscal 1975)
hospital services until the 61st day of hospitalization) ; (b) an
and the automatic cost-of-living adjustment in July 1975.
increase in the Part B deductible (effective in calendar year 1976)
The Administration has also called for the enactment of several
from $60 to $70, and rising thereafter in proportion to the per-
legislative proposals to reduce Social Security outlays: Among the
centage increase in Social Security benefits; (c) a 10-percent
major recommendations (which are incorporated into the budget
coinsurance charge on hospital-based physician services and home
allocations)
:
health services, and (d) a ceiling of $750 per benefit period for a
1. Prohibit entitlement to retroactive benefits if future monthly
patient's payments under Part A and a $750 limitation per calen-
payments would be permanently reduced as a result. Under present
dar year for Part B. These amounts would rise proportionately as
law, a person who has just become entitled to Social Security bene-
Social Security benefits increase. (Outlay reductions $225 million
fits may receive up to 12 months retroactive payments. However,
in 1975 and $1.279 billion in 1976.)
future benefits are actuarially reduced if the individual receives
2. Place limits on the rates of yearly increases in provider (e.g.,
payments for any month before age 65. (Projected outlay reduc-
doctors and hospitals) costs recognized as reasonable under Medi-
tions $45 million in 1975 and $443 million in 1976.)
care. (Outlay reduction $100 million in 1976.)
2. Eliminate the monthly test of the Social Security earnings
ceiling except for the first year that an individual receives a cash
S. 574-5, Congressional Record, January 21, 1975; statement by Senator Williams, p.
2 For additional information, see statements by Senators Church and Kennedy, pp. S.
benefit. Under present law, a beneficiary under age 72 who earns
829, Congressional Record, January 23, 1975; and statement by Senator Mondale, p. S. 933,
more than $2,520 in 1975 has $1 in benefits withheld for each $2
Congressional Record, January 27, 1975.
4
5
PROJECTED MEDICARE BENEFIT PAYMENTS FOR FISCAL 1976
staffing positions for the agency, with approximately 7,000 positions
[In millions of dollars]
earmarked for SSI.
Part
Part B-
SSI BENEFIT PAYMENTS AND BENEFICIARIES
Inpatient
1974
1975
1976
hospital
Physicians'
services
services
Payments (in billions)
$1.83
1$4.08
$4.63
Beneficiaries (in millions)
3.60
4.47
5.07
Aged
$9,938
$2,900
Disabled
1,060
408
1 Includes a proposed supplemental appropriation of $83,100,000.
2 Based on President's proposal to put a 5-percent ceiling on benefit programs such as SSI. If SSI is exempted from the
Skilled
ceiling, benefit payments will increase by $85,000,000, estimated on an 8.7-percent cost-of-living rise.
nursing
facility
Outpatient
services
services
HUD EMPHASIZES SECTION 8
Aged
260
358
Section 202.-One major disappointment of the President's new
Disabled
11
322
budget is the lack of any request for increased funding for the popular
Home
Home
Section 202 program. The Housing and Community Development
health
health
Act of 1974 authorized a borrowing level of $800 million. To date,
services
services
the Administration has yet to request that any of this amount be ap-
Aged
107
44
proved. In spite of this reluctance, Congress last November approved
Disabled
4
6
a borrowing level of $100 million for fiscal year 1975, plus the unobli-
gated balance of the monies accumulated in the old 202 "revolving
Other medical
and health
fund" as of December 31, 1974 (representing another $115 million).
services
The new authority combined with the unobligated balance in the
old fund, provides $215 million. The Department of Housing and
Aged
78
Disabled
29
Urban Development (HUD) estimates that the following amounts
will be reserved:
Total
Total
Estimated reservations
benefit
benefit
Fiscal year:
payments
payments
1975
$34,000,000
1976
175,000,000
Aged
10,305
3, 380
Transition period
40,000,000
Disabled
1,075
765
Total
11,380
4,145
Total
249, 000, 000
PROJECTED INCREASES FOR SUPPLEMENTAL SECURITY INCOME
The excess over $215 million is an estimate of the amounts that will
be received by HUD before the end of fiscal year 1976 from loan re-
The Supplemental Security Income (SSI) program's projected ex-
payments under the original 202 program. The transition period is
penditures for fiscal year 1976 total approximately $5.5 billion. This in-
from July 1, 1976, to September 30, 1976, when the budget will go on
cludes $4.63 billion 3 for benefit payments, $275 million for Federal
a new fiscal year.
contributions toward State supplementation, $55 million for vocational
Section 8 (housing assistance payments program) -The fiscal 1976
rehabilitation, and $499 million for administration. These figures rep-
budget states that the new Section 8 program "will be used as the
resent substantial increases when compared with $4.86 billion expendi-
primary vehicle for providing housing assistance to lower income
ture level for fiscal year 1975 $4.08 billion 4 for benefit payments, $255
families in 1975 and 1976." Authority is available for HUD to process
million for Federal contributions toward State supplementation, $49
400,000 units in both fiscal years, 1975 and 1976. However, because the
million for vocational rehabilitation, and $473 million for administra-
program will not be available for all of fiscal year 1975, it is estimated
tion. The number of recipients is expected to reach 4.47 million in
that only 200,000 units will actually be processed. The budget requests
fiscal year 1975 (2.53 million aged and 1.94 million blind and dis-
an additional $662.3 million in contract authority, which, when added
abled). The Social Security Administration will also make a supple-
to contract authority expected to be available in 1976, will support
mental request for $121 million for fiscal year 1975 for 11,500 new
400,000 units.
Conventional public housing.-As required in the 1974 Act, HUD
3 Based on President's proposal to put a 5-percent celling on benefit programs such as SSI.
will continue to provide a limited amount of housing assistance under
If SSI is exempted from the ceiling, benefit payments will increase by $85 million, esti-
mated on an 8.7-percent cost-of-living rise.
the conventional public housing program. The estimate is for 38,000
4 Includes a proposed supplemental appropriation of $83.1 million.
units in fiscal year 1975 and 6,000 units (Indian housing) for 1976.
6
7
There is no request for additional authority for this program, as HUD
Funding for Senior Companions would be cut back by almost $900,000,
wishes to use the Section 8 program instead.
from an appropriation of $2.56 million in fiscal year 1975 to $1.64
Operating subsidies for public housing will be budgeted at $450
million in fiscal year 1976. The number of volunteers would, though,
million in 1975 and $525 million in 1976. Additional assistance for
remain constant at 1,000 for 1976. And, 2,000 persons again are
existing public housing projects will be provided under the moderni-
projected to be served.
zation program with contract authority of $40 million for 1975 and
ACTION'S AGING PROGRAMS
$20 million for 1976.
Section 236 multifamily housing and rent supplement.-Very few,
[In millions of dollars]
if any, new units will be approved under these programs; no new re-
Authorization,
Budget request,
Appropriations,
quest is made. The budget will reflect obligations for commitments
fiscal 1976
fiscal 1976
fiscal 1975
made prior to January 5, 1973 (the start of the housing freeze), and
amendments to existing projects. Projects under these programs will
RSVP
$20.0
$17.5
$15.98
Foster Grandparents and Senior Companions
40.0
127.57
230.84
be approved on a limited basis but only where bona fide commitments
SCORE/ACE
(8)
.4
.4
cannot be met under the lower income housing assistance program
Total
45.47
47.22
(Section 8).
Direct cash assistance.-Th direct cash assistance experimental pro-
1 This includes a breakdown of $25,930,000 for Foster Grandparents and $1,640,000 for Senior Companions.
2 This includes a breakdown of $28,280,000 for Foster Grandparents and $2,560,000 for Senior Companions.
gram will continue during fiscal year 1976, but no additional funds
3 Amount as necessary.
are requested.
Nonprofit sponsor assistance.-Assistance to nonprofit sponsors of
ADMINISTRATION PROPOSES INCREASE IN COST OF FOOD STAMPS
low- and moderate-income housing was authorized by section 106 of
the Housing Act of 1968. Activity under this program was discon-
The Administration proposes an increase in the cost of food stamps
tinued in 1973. and no request is made to revive it.
(effective March 1, 1975), raising the average price of stamps from
Community development block grant program.-Title I of the Hous-
approximately 23 percent of one's net income to 30 percent in nearly
ing and Community Development Act of 1974 authorizes HUD to
all cases.
make grants to units of general local government and States for the
This increase, if implemented, would force many low-income re-
funding of local community development programs (replacing such
cipients, especially the elderly,5 to quit the program because the pur-
programs as urban renewal and model cities).
chase requirement would exceed the bonus value in stamps. With a 30-
In 1976. it is estimated that assistance will be provided to 2,500 com-
percent purchase requirement, the Administration is requesting $3.7
munities, including about 600 metropolitan cities and urban counties.
billion for fiscal year 1975 and $3.85 billion for fiscal year 1976. Other-
Outlavs are projected at $225 million for 1975 and $1.3 billion for
wise, the Administration would request $3.9 billion for fiscal year 1975
1976. The program began operation on January 1, 1975.
and $4.5 billion for fiscal year 1976. It is estimated that there would
be approximately 15.8 million participants in the program for each
PROPOSED ACTION BUDGET FOR AGING Is DOWN $1.8 MILLION
year. Approximately 14 percent of the participants are 60 years of age
and over, and about 10 percent are in the 65-plus age category.
ACTION's aging programs would be reduced by approximately
However, the House of Representatives (on February 4) and the
$1.8 million under the Administration's budget recommendations for
Senate (on February 5) overwhelmingly passed legislation (H.R.
fiscal year 1976. The Retired Senior Volunteer Program (RSVP),
1589) to prohibit an increase in charges for food stamps for 1975. Pres-
Foster Grandparents, Service Corps of Retired Executives (SCORE),
ident Ford announced on February 13 that he would allow H.R. 1589
Active Corps of Executives (ACE), and Senior Companions have a
to become law without his signature.
total budget request of $45.47 million. The proposed fiscal year 1976
budget recommends an increase of approximately $1.5 million for
NURSING HOME EXPENDITURES
RSVP, from $15.98 million to $17.50 million. This would enable
RSVP to increase its volunteers from 140,000 in fiscal year 1975 to 185,-
Expenditures for nursing home care would increase only slightly
000 for fiscal year 1976. Funding for Foster Grandparents would be
in fiscal year 1976 under the President's budget. Expenditures in
reduced by $2.4 million, from $28.29 million to $25.93 million. This
1974 reached $7.5 billion, of which $4 billion represented public funds.
would cause a reduction in participation, from 12,200 for 1975 to
Medicare's contribution in 1974 was only $204 million. It is expected
11,900 for 1976. The number of children served by the Foster Grand-
to increase to $232 million this year and is projected at $239 million in
parents would decrease, from 24,400 served per day in fiscal year 1975
the new budget. Medicaid's contribution will remain more substantial.
to 23,800 children in fiscal year 1976. The SCORE/ACE budget for
In 1974 Medicaid contributed some $3.7 billion, approximately $2 bil-
fiscal year 1976 is identical to the 1975 appropriations level $400,000.
lion in Federal funds and about $1.7 billion in State and local funds.
However, it is estimated that the number of volunteers would increase
from 5,221 to 6,000 for SCORE and from 2,532 to 3,000 for ACE.
5 For additional discussion, see The Impact of the Ford Administration's Proposal to
Raise Food Stamp Prices, published by the Community Nutrition Institute, December 1974.
Special attention is paid to older food stamp recipients.
8
9
The Federal share of Medicaid funds is projected to increase from $2
ment Act was increased from $3 million to $5 million under amend-
billion to $2.4 billion in the 1976 budget. Expenditures for nursing
ments (Public Law 93-259) to the law approved in 1974.
home care comprise 35 percent of total Medicaid expenditures, com-
pared to 26 percent paid to hospitals.
FUNDING REQUEST FOR CETA UNCHANGED
HOME HEALTH EXPENDITURES
Proposed funding for the Comprehensive Employment and Train-
ing Act in fiscal 1976 is identical with the fiscal 1975 appropriation:
Expenditures for home health care would increase very modestly
$1.58 billion for the Title I State and local manpower revenue sharing,
under the President's new budget. Nearly $64 million was spent in
$400 million for Title II public service jobs (in areas with at least
fiscal 1974 under Medicare's Part A (Hospital Insurance) program,
6.5-percent unemployment for three consecutive months), and $414.4
increasing to $94 million for the current fiscal year. Reimbursements
million for Titles III and IV national programs. The number of par-
are expected to reach $98 million in fiscal year 1976. Under Part B
ticipants is projected at almost 2 million for Title I and 156,000 for
(Supplementary Medical Insurance) of Medicare, home health serv-
Title II in 1976.
ices were funded at $36 million in 1974, increasing to $43 million this
Congress has also appropriated $1 billion for the Emergency Jobs
year. Reimbursements are estimated at $50 million for fiscal 1976. In
and Unemployment Assistance Act $875 million for public service
short, the projected figure for Medicare home health services for 1976
jobs (distributed under a nationwide formula) and $125 million for
is $148 million or less than 1 percent of Medicare's estimated $15.5
labor intensive public works. The Administration, however, has asked
billion outlays in that year.
that the $125 million for labor intensive public works be rescinded
and transferred to public service jobs. Present estimates call for $350
NATIONAL INSTITUTE ON AGING
million of the $1 billion appropriation to be expended for fiscal 1975
For fiscal 1976 the Administration is recommending $16.19 million
and $650 million for fiscal 1976.
for the new National Institute on Aging. The budgeted amount for
LEGAL SERVICES REQUEST AT $71.5 MILLION
fiscal 1975 stands at approximately $15.74 million, $14.95 million in
transferred funds from the National Institute of Child Health and
A $71.5 million funding level is requested in the fiscal 1976 budget
Human Development and an additional amount to cover prorated
for legal services. The program is now operated under a continuing
management costs. However, the Administration's proposed rescission
resolution. The Administration, however, plans to request a supple-
for fiscal 1975 would reduce the NIA budget to $14.1 million.⁶ The fiscal
mental appropriation of $71.5 million for this fiscal year. This appro-
1976 request is expected to support 157 grants and projects, up slightly
priation is projected to continue 734 legal services offices into fiscal
from the projected level of 147 for fiscal 1975.
1976. Under the fiscal 1976 budget there would be about 2,000 at-
torneys, nearly 200 below the fiscal 1971 level.
AGING RESEARCH AT NIMH
A $100 million spending level is authorized for legal services under
the Legal Services Corporation Act. The Community Services Ad-
The Administration has requested a $306 million funding level for
ministration (formerly the Office of Economic Opportunity) will be
the National Institute of Mental Health for fiscal 1976, nearly $100
responsible for administering the legal services program until the
million below the fiscal 1975 appropriation ($405.35 million). The
Legal Services Corporation officially comes into existence, soon after
Administration has also proposed a rescission which would reduce
a Board of Directors is confirmed.
funding for 1975 to $363.44 million.⁷ Only about 0.4 percent of the
Major earmarked activities for the elderly now include:
NIMH funding request for fiscal 1976 would be specifically targeted
1. $366,100 (through June 30, 1975) for the National Senior
for aging research ($1.32 million). This figure, however, is $362,000
Citizens Law Center (Los Angeles, California, and Washing-
more than the projected amount allocated for fiscal 1975.
ton, D.C.) which provides legal research and other assistance for
legal services attorneys representing older Americans.
ADEA REQUEST AT NEARLY $2.2 MILLION
2. $175,000 (through June 30, 1975) for California Rural
A $2,168,000 funding level is sought by the Administration for fiscal
Legal Assistance (San Francisco, California) to provide legal
1976 to enforce the Age Discrimination in Employment Act. This
research and community education for legal services lawyers and
amount would support 81 positions, the same number projected for
to serve as a contact point with State agencies in California con-
fiscal 1975. The authorization for the Age Discrimination in Employ-
cerning problems of elderly clients.
3. $87,000 (through November 30, 1975) for the Council of
6 See p. 12 for information about rescission.
Elders (Roxbury, Massachusetts) lay advocates demonstration
7 See p. 12 for additional discussion of rescissions.
program.
10
11
4. $160,000 (through June 30, 1975) for the Presbyterian Senior
RURAL HIGHWAY PUBLIC TRANSPORTATION DEMONSTRATION
Citizens Center in New York City to represent aged clients.
PROGRAM
ADMINISTRATION CALLS FOR TERMINATION OF SOS
For fiscal 1976 the Administration's budget requests $20.35 million
for the Rural Highway Public Transportation Demonstration pro-
For the third consecutive year, the Administration has requested no
gram. A $9.65 million funding level is provided for fiscal 1975.
funds for the Senior Opportunities and Services program. sos, how-
ever, has been continued through Congressional appropriations and
No FUNDING REQUESTED FOR SENIOR COMMUNITY SERVICE
continuing resolutions. SOS is now operating under a continuing
EMPLOYMENT PROGRAM
resolution through February 28. For fiscal 1975, $7.5 million has been
allocated for SOS. This amount of funding is sufficient to continue
For the third consecutive year, the Administration has failed to
sos operations through March 31, 1975. The fiscal 1976 Budget Ap-
seek appropriations for the Title IX Older American Community
pendix states "Administratively phase-out costs are expected to be
Service Employment Act. During the past two years, the Congress has
minimal and no additional funds have been provided."
approved $10 million for fiscal 1974 and $12 million for fiscal 1975.
More than 1 million elderly persons are now served under 300 SOS
Title IX now provides 2,970 jobs in a wide range of community serv-
programs (200 receiving earmarked funding and 100 community
ice activities for low-income persons 55 and above with poor employ-
action agencies funded out of local initiative efforts).
ment prospects. Senator Edward Kennedy, the author of the Older
The Administration gave this rationale for discontinuing SOS:
American Community Service Employment Act, plans to introduce
legislation to continue the program for at least three years.
This program was designed, according to the Act, "to
Mainstream.-Older worker national contractor programs will be
identify and meet the needs of older, poor persons above the
funded through June 30, 1975. Under the Administration's proposal,
age of 60." This authority duplicates similar programs, espe-
national contractors would then apply for funding with State and
cially the Administration on Aging, a much larger program
local governments under the Comprehensive Employment and Train-
within HEW.
ing Act.
RAILROAD RETIREMENT ANNUITIES
SOCIAL SERVICES-TITLE XX
Payments for retirement, disability, spouse, and survivor benefits
Federal costs for Title XX social services under the Social Security
are projected at $3.3 billion in fiscal 1976, approximately $300 million
Act are projected at $1.95 billion in fiscal year 1976, compared with
above the fiscal 1975 estimate ($3 billion). More than 1 million persons
$1.9 billion in fiscal year 1975. This amount will decrease by $488
are expected to receive benefits. And 130,000 individuals will receive
million if the Administration's proposal to decrease the Federal match-
supplemental annuities.
ing share of 75 percent to 65 percent for fiscal year 1976 and 50 percent
for fiscal year 1977 is adopted. However, both estimates are still below
$4 MILLION REQUESTED FOR COMMUNITY EDUCATION
the $2.5 billion ceiling placed on social services expenditures. Outlays
for the aged, blind and disabled (adult) categories for fiscal year 1976
The Administration's budget request of $4 million for community
are expected to be about one-third of the total or approximately $608
education is $13 million below the $17 million authorization level for
million (compared with $556 million for fiscal year 1975). Nearly 2.7
fiscal year 1976 ($12 million for program grants and $5 million for
million aged, blind and disabled persons are expected to receive serv-
training). A decision concerning the distribution of the $4 million
ices under Title XX.
has not yet been made. The Commissioner on Education will make
this decision with the advice of the Community Education Advisory
VETERANS' PENSION AND COMPENSATION PAYMENTS
Council.
More than 2.7 million veterans (1.563 million) and survivors (1.155
No FUNDING FOR SPECIAL EDUCATIONAL PROGRAMS
million) are expected to receive non-service-connected disability pen-
sions in fiscal 1976, including nearly 1 million veterans and survivors
The fiscal 1976 budget makes no request for three educational pro-
from World War I and prior conflicts. The average payment per case
grams for the elderly under Title VIII of the Older Americans Com-
is projected at $1,580 a year for veterans and $942 for survivors. Com-
prehensive Services Amendments: (1) An Older Reader Services
pensation payments for service-connected disabilities or death will be
program (including training of librarians to work with the aged and
made to nearly 4.5 million veterans (3.744 million) and survivors
providing in-home visits by librarians) ; (2) assistance for utilizing
(873,000) in 1976. This projection is identical with the fiscal 1975
the resources of higher education for developing programs concerning
estimate. The average annual payment per case is estimated at $1,693
transportation and housing problems of the elderly in rural and iso-
for veterans and $2,385 for survivors.
lated areas; and (3) special programs for persons with limited Eng-
lish-speaking ability.
12
RESCISSIONS FOR FISCAL YEAR 1975 EXPENDITURES
All budget proposals discussed thus far would apply to expenditures
for fiscal year 1976, that is, the year beginning July 1, 1975.
But the Administration, in another action taken on January 30,
has proposed cutbacks in funding for appropriations already made by
the Congress for expenditures for fiscal year 1975.
This would be done through a "rescission" process now authorized,
should the Congress concur.
Among the major rescissions for aging programs:
1. A $9 million cutback for the Title III State and community
programs under the Older Americans Act, from the Congres-
sional appropriation of $105 million to the Administration's
budget request of $96 million.
2. Elimination of funding for Title IV Training. The Congress
had approved $8 million in the Labor-HEW Appropriations Act
for fiscal 1975.
3. A $25.4 million reduction in funding for the nutrition pro-
gram for the elderly, from $125 million to $99.6 million.
4. Impoundment of the entire Congressional appropriation for
the Older American Community Service Employment Act.
5. A reduction in the budgeted amount for the National Insti-
tute on Aging, from $15.74 million to $14.1 million.
Under the new Budget and Impoundment Control Act, Congress
must give its approval to all executive actions which seek to withhold
funds. If a President proposes a rescission of spending authority in
order to terminate programs or cut funding, both the House and Sen-
ate must pass a rescission bill within 45 days of the President's pro-
posal. Otherwise, the funds must be spent by the Administration. If
the President fails to spend the money under these circumstances, the
General Accounting Office is authorized to bring suit on an expedited
basis in Federal District Court to release the funds.
(8)
Your
Medicare
Handbook
Contents
How to use Your Medicare Handbook 4
What is Medicare 5
Your Medicare card 6
Who can provide services or supplies
under Medicare 7
Two important rules 8
Your Medicare hospital insurance 10
When you are a hospital inpatient 12
Inpatient care in a skilled nursing facility 17
Your Medicare medical insurance 20
Reasonable charges 21
How medical insurance payments are made 23
When a doctor treats you 25
Outpatient hospital services 28
Outpatient physical therapy and
speech pathology services 30
Other services and supplies covered by
medical insurance 31
Home health care under Medicare 34
Coverage of blood under Medicare 38
Your right of appeal 39
Waiver of beneficiary liability 40
Important:
If you are a member of a prepayment plan 41
If you are under 65 and you have Medicare protection under
What Medicare does not cover 42
the special chronic kidney disease provision of the law,
you will receive additional material which describes how
How to get the part of Medicare you do not have 44
Medicare pays for kidney dialysis and kidney transplant
Events that can end your Medicare protection 46
services. For all other covered services you receive, use this
How to submit medical insurance claims 48
Medicare handbook for the information you need.
Where to send your medical insurance claims 51
Index 59
DHEW Publication No. (SSA) 75-10050
FORD is LIBRARY GERALD
How to use Your
Medicare Handbook
What is Medicare
This is Your Medicare Handbook. It tells you what Medicare
is and how it works. Keep the handbook where you can find it.
Medicare is a health insurance program for people 65 and
Then, when you need medical care, you can use the handbook
older and some people under 65 who are disabled. It is a
to find out whether the services you need are covered by
Federal Government program run by the Social Security
Medicare and how much Medicare can pay.
Administration. Medicare has two parts. One part is called
Medicare will help pay for many of your health care
hospital insurance. The other part is called medical insurance.
expenses, but not all of them. You should know in advance
Medicare's hospital insurance (sometimes called Part A)
what expenses Medicare does not cover. On pages 42 and
can help pay for medically necessary inpatient hospital care,
43 there is a list of the services and supplies Medicare cannot
and, after a hospital stay, for inpatient care in a skilled nursing
pay for and some that Medicare can pay for only under
facility and for care in your home by a home health agency.
certain conditions.
Medicare's medical insurance (sometimes called Part B)
Page 48 tells you how to submit your medical insurance
can help pay for medically necessary doctors' services,
claims, and beginning on page 52 there is an address list
outpatient hospital services, outpatient physical therapy and
showing where to send your claims.
speech pathology services, and a number of other medical
Page 39 tells you what to do if you think there has been
services and supplies that are not covered by the hospital
a mistake in a Medicare decision or the amount of payment.
insurance part of Medicare. Medical insurance also can help
As you read the handbook, you will see stars (*) by some
pay for necessary home health services when hospital insurance
words. A star means there is a footnote at the bottom of the
cannot pay for them.
page that will give you additional information.
You are responsible for part of the cost of some services
There is also an index at the back of the book. If you
covered under Medicare. The amounts or the share of the
want to know about a particular subject, look it up in the index
costs for which you are responsible are described in this
to find out what page it's on.
handbook. As general health care costs rise, these amounts
This is the 1975 edition of the handbook. If you have an
may increase. We will keep you informed of any changes in
earlier copy of the handbook, please throw it away. As changes
the amounts you have to pay under Medicare. If you cannot
occur in the Medicare program, we will keep you informed.
pay these amounts or for other health care expenses, you may
Whenever you can't find information you need in this
be able to get help from the Medicaid program in your State.
handbook, call a social security office. Look up Social Security
Medicare payments are handled by private insurance
Administration in your telephone book to get the number of
organizations under contract with the Government.
a social security office near you.
Organizations handling claims from hospitals, skilled nursing
facilities, and home health agencies are called intermediaries.
Organizations handling claims from doctors and other
suppliers of services covered under the medical insurance
part of Medicare are called carriers.
4
5
Who can provide services
Your Medicare card
or supplies under Medicare
Be sure you keep the Medicare health insurance card we sent
To help make sure that health care furnished to Medicare
you in the mail. The card shows the Medicare protection you
beneficiaries is of acceptable quality, persons or organizations
have (hospital insurance, medical insurance, or both) and
providing services must meet all licensing requirements of
the date your protection started. If you don't have both parts
State or local health authorities. Persons and organizations
of Medicare, see page 44 to find out how you can get the part
shown below also must meet additional Medicare requirements
you don't have.
before payments can be made for their services:
The card also shows your health insurance claim number.
Hospitals
The claim number has 9 digits and a letter. In some cases,
Skilled nursing facilities
there will be another number after the letter. Be sure to put
Home health agencies
your full claim number on all Medicare claims and correspond-
Independent diagnostic laboratories and organizations
ence. If a husband and wife both have Medicare, they get
providing X-ray services
separate cards and different claim numbers. Each must use the
Ambulance firms
exact claim number shown on his or her card.
Chiropractors
Independent physical therapists (those who furnish services
Important things to remember
in your home or in their offices)
Always show your Medicare card when you receive services
Facilities providing kidney dialysis or transplant services
that Medicare can help pay for.
All hospitals, skilled nursing facilities, and home health
Always write your health insurance claim number (including
agencies participating in the Medicare program also must
the letter) on any bills you send in and on any correspondence
comply with title VI of the Civil Rights Act, which prohibits
about Medicare.
discrimination because of race, color, or national origin.
Carry your card with you whenever you are away from home.
Except for certain situations described later in this
If you ever lose it, ask the people in the social security office
handbook, Medicare cannot pay for care you get from a
right away to get you a new one.
non-participating hospital, skilled nursing facility, or home
Do not use your Medicare card before the effective date shown
health agency.
on your card.
You should always make sure that the persons or
Permanent Medicare cards made of metal or plastic, which
organizations providing services are approved for Medicare
are sold by some manufacturers, are not a substitute for your
payments. If you are not sure, ask them.
officially issued Medicare card.
6
7
Two important rules
Istiqzod
Under the law, Medicare does not cover care that is not
Some health care services and supplies are not generally
"reasonable and necessary" for the treatment of an illness or
accepted by the health community as being reasonable or
injury. Medicare also does not cover care that is "custodial."
necessary for diagnosis and treatment. This includes acupunc-
These two rules are explained on this page and the next page.
ture, histamine therapy, and various kinds of medical
Care that is not reasonable and necessary
equipment, for example. Medicare cannot cover services and
supplies unless they are generally recognized as safe and
If a doctor places you in a hospital or skilled nursing facility
effective by the health community.
when the kind of care you need could be provided elsewhere,
your stay would not be considered reasonable and necessary.
Care that is custodial
So Medicare could not cover your stay. If you stay in a
Care is considered custodial when it is primarily for the
hospital or skilled nursing facility longer than you need to be
purpose of meeting personal needs and could be provided by
there, Medicare payments would end at the time further
persons without professional skills or training; for example,
inpatient care is no longer reasonable and necessary.
help in walking, getting in and out of bed, bathing, dressing,
To help Medicare decide whether inpatient care is
eating, and taking medicine. Even if you are in a participating
reasonable and necessary, each hospital and skilled nursing
hospital or skilled nursing facility or you are receiving care
facility has a Utilization Review Committee, which is made up
from a participating home health agency, Medicare does not
of at least two doctors. And in some parts of the country
cover your care if it is mainly custodial.
there are Professional Standards Review Organizations, which
are made up of local doctors who review the care prescribed
by their fellow doctors.
If a doctor (or other practitioner) comes to treat you or
you visit him for treatment more often than is the usual
medical practice in your area, Medicare would not cover the
"extra" visits unless there are medical complications. Medicare
cannot cover more services than are reasonable and necessary
for your treatment. Any decision of this kind is always based
on professional medical advice.
8
9
Your Medicare
hospital insurance
Medicare's hospital insurance helps pay for three kinds of
The next two chapters tell you more about inpatient
care. The three kinds of care are (1) inpatient hospital care;
hospital care and inpatient care in a skilled nursing facility.
and, when medically necessary after a hospital stay, (2) inpa-
Home health care is explained in the chapter beginning on
tient care in a skilled nursing facility, and (3) home health
page 34. There is a list of covered and non-covered services in
care.
each of these chapters.
There is a limit on how many days of hospital or skilled
You do not have to send us any bills for care you receive
nursing facility care and how many home health visits
from a participating hospital, skilled nursing facility, or home
Medicare can help pay for in each benefit period. * However,
health agency. Medicare will pay its share of the costs directly
your hospital insurance protection is renewed every time you
to the place where you received the care.
start a new benefit period.
Whenever a hospital, skilled nursing facility, or home
Medicare hospital insurance will pay for most but not
health agency sends Medicare a hospital insurance claim for
all of the services you receive in a hospital or skilled nursing
payment, you will get a notice that explains the decision made
facility or from a home health agency. There are covered
on the claim and shows what Medicare paid. If you have
services and non-covered services under each kind of care.
any questions about the decision or the payment, get in touch
Covered services are services and supplies that hospital
with the intermediary that sent you the notice or call a social
insurance can pay for.
security office.
*Benefit period
If you receive covered services from a non-participating
A benefit period is a way of measuring your use of services
hospital (see page 15) or from a Canadian or Mexican hospital
under Medicare's hospital insurance. Your first benefit
(see page 16), the hospital can tell you about Medicare
period starts the first time you enter a hospital after your
payment arrangements.
hospital insurance begins. When you have been out of a
hospital (or other facility primarily providing skilled nursing
or rehabilitation services) for 60 days in a row, a new benefit
period starts the next time you go into a hospital. There is
no limit to the number of benefit periods you can have.
10
11
When you are a
hospital inpatient
Major services covered when you are a hospital inpatient
Medicare's hospital insurance can pay for these items.
Medicare's hospital insurance can help pay for inpatient
hospital care if all of the following four conditions are met:
1 A semiprivate room (2 to 4 beds in a room)
(1) a doctor prescribes inpatient hospital care for treatment of
2 All your meals, including special diets
an illness or injury, (2) you require the kind of care that can
3 Regular nursing services
only be provided in a hospital, (3) the hospital is participating
4 Intensive care unit costs
in Medicare, and (4) the Utilization Review Committee of
5 Drugs furnished by the hospital during your stay
the hospital does not disapprove your stay.
6 Lab tests included in your hospital bill
If your stay in a hospital is covered by Medicare, you
7 X-rays and other radiology services, including radiation
are responsible for the first $92 in each benefit period. This is
therapy, billed by the hospital
called the hospital insurance deductible. Medicare will pay for
8 Medical supplies such as casts, surgical dressings,
all other covered services for up to 60 days if your medical
and splints
condition requires that you stay in the hospital that long.
9 Use of appliances such as a wheelchair
From the 61st through the 90th day, hospital insurance
10 Operating and recovery room costs
pays for all covered services, except for $23 a day. Hospital
11 Rehabilitation services, such as physical therapy,
insurance pays the rest of the cost for covered services during
occupational therapy, and speech pathology services
this time. (If you ever need more than 90 days of inpatient
hospital care in a benefit period, see page 14 to find out how
hospital reserve days can help with your expenses.)
Some services not covered when you are a hospital inpatient
Hospital insurance does not cover your doctor's services
Medicare's hospital insurance cannot pay for these items.
even though you receive them in a hospital. Doctors' services
are covered under Medicare's medical insurance. Page 25
1 Personal convenience items that you request such as a
tells how medical insurance helps with doctor bills.
television, radio, or telephone in your room
The tables on the following page show some of the
2 Private duty nurses
services that are covered and services that are not covered
3 Any extra charges for a private room, unless you need
when you are in the hospital.
it for medical reasons
4 The first 3 pints of blood you receive in a benefit
period (see page 38)
FORD LIBRAR & CERALD r
13
12
Hospital inpatient reserve days
Care in a non-participating hospital
We said earlier that Medicare will help pay for your care in
a hospital for up to 90 days in each benefit period. But what
Medicare's hospital insurance usually can help with your
happens if you have a long illness and have to stay in the
bills only if you are a patient in a participating hospital.
hospital for more than 90 days? Medicare's hospital insurance
However, hospital insurance can help pay for care in a qualified
includes an extra 60 hospital days you can use if this ever
non-participating hospital if (1) you are admitted to the
happens. These extra days are called reserve days. You are
non-participating hospital for emergency treatment, and (2)
responsible for no more than $46 a day for each reserve day
the non-participating hospital is the closest one to get to that is
you use. Hospital insurance pays the rest of the costs for
equipped to handle the emergency. Under Medicare, emergency
covered services for each reserve day. But once you use a
treatment means treatment that is immediately necessary to
reserve day you never get it back. Reserve days are not
prevent death or serious impairment to health.
renewable like your 90 hospital days in each benefit period.
If the hospital does not submit the Medicare claim, any
social security office will assist you in getting the hospital
*Reserve days
insurance payment for the covered care you received.
Since you only have 60 reserve
days in your lifetime, you can
decide yourself when you want
Care in a psychiatric hospital
to use them. After you have been
Hospital insurance can help pay for no more than 190 days
in the hospital 90 days, you can
of care in a participating psychiatric hospital in your lifetime.
use all 60 reserve days at one
time if you have to stay in the
In addition, there is a special rule that applies if you are
hospital that long. But you don't
in a participating psychiatric hospital at the time your hospital
have to use your reserve days
insurance starts. The days you were an inpatient in the 150
right away if you don't want to.
days before your hospital insurance started must be subtracted
Maybe you have private insurance
from the days you could otherwise use in your first benefit
that can help pay your hospital
period for inpatient psychiatric care. Any social security office
bill if an illness keeps you in the
hospital for more than 90 days.
can give you further information about this special rule.
If you don't want to use your
reserve days, you must tell the
hospital in writing ahead of time.
Otherwise, the extra days you
need to be in the hospital will be
taken from your reserve days
automatically.
14
15
Inpatient care in a
skilled nursing facility
Care in a foreign hospital
Medicare's hospital insurance can help pay for inpatient care
Medicare generally cannot pay for hospital or medical services
in a participating skilled nursing facility* after you have been
outside the United States* except for care in qualified Canadian
in a hospital. Hospital insurance can cover this care if you
or Mexican hospitals in three specific situations. These are:
no longer need all the services that only a hospital can provide,
(1) you are in the U.S. when an emergency occurs and a
but your condition still requires daily skilled nursing or
Canadian or Mexican hospital is closer than the nearest U.S.
rehabilitation services which, as a practical matter, can only
hospital which can provide the emergency services you need,
be provided in a skilled nursing facility.
(2) you live in the U.S. and a Canadian or Mexican hospital
Hospital insurance can help pay for care in a skilled
is closer to your home than the nearest U.S. hospital which can
nursing facility if all of the following five conditions are met:
provide the care you need, regardless of whether or not an
(1) you have been in a hospital at least 3 days in a row before
emergency exists, and (3) you are in Canada traveling by the
your transfer to the skilled nursing facility, (2) you are
most direct route to or from Alaska and another State and an
transferred to the skilled nursing facility because you require
emergency occurs which requires that you be admitted to a
care for a condition which was treated in the hospital, (3) you
Canadian hospital. (This provision does not apply if you are
are admitted to the facility within a short time (generally
vacationing in Canada.)
within 14 days) after you leave the hospital, (4) a doctor
When hospital insurance covers your inpatient stay in a
certifies that you need, and you actually receive, skilled nursing
Canadian or Mexican hospital, your medical insurance can
or skilled rehabilitation services on a daily basis, and (5) the
cover necessary doctors' services and any required use of an
facility's Utilization Review Committee does not disapprove
ambulance. Any social security office will help you get
your stay.
Medicare payment for the covered services you receive.
As we said, all five conditions must be met. But it's
especially important to remember the requirement that you
Care in a Christian Science sanatorium
must need skilled nursing care or skilled rehabilitation services
on a daily basis.
Medicare's hospital insurance can help pay for inpatient
hospital and skilled nursing facility services you receive in a
*Skilled nursing facility
Christian Science sanatorium if it is operated, or listed and
A skilled nursing facility is a specially qualified facility which
certified by, the First Church of Christ, Scientist, in Boston.
has the staff and equipment to provide skilled nursing care
You can get more information at any social security office.
or rehabilitation services as well as other related health
*United States
considered part of the United
services. If you are not sure whether a facility participates in
Puerto Rico, the Virgin Islands,
States, along with the 50 States
Medicare, ask someone at the facility.
Guam, and American Samoa are
and the District of Columbia.
16
17
By skilled nursing care, we mean care that can only be
Hospital insurance does not cover your doctor's services
performed by, or under the supervision of, licensed nursing
while you are in a skilled nursing facility. Medicare's medical
personnel. Skilled rehabilitation services may include such
insurance covers doctors' services. Page 25 tells you how
services as physical therapy performed by, or under the
medical insurance helps with doctor bills.
supervision of, a professional therapist. The skilled nursing
The tables below tell you some of the services that are
care and skilled rehabilitation services you receive must be
covered and services that are not covered when you are in a
under the general direction of a doctor.
skilled nursing facility.
Hospital insurance cannot pay for your stay if you are in a
skilled nursing facility mainly because you need custodial care
Major services covered when you are in a skilled nursing facility
(see page 9). Also, hospital insurance cannot pay for your
stay if you only need skilled nursing or rehabilitation services
Medicare's hospital insurance can pay for these items.
on an occasional basis, such as once or twice a week.
When your stay in a skilled nursing facility is covered by
1 A semiprivate room (2 to 4 beds in a room)
Medicare, your hospital insurance can help pay for your care
2 All your meals, including special diets
for up to 100 days in each benefit period, but only if you need
3 Regular nursing services
daily skilled nursing care or rehabilitation services for that
4 Rehabilitation services, such as physical, occupational,
long.
and speech therapy
5 Drugs furnished by the facility during your stay
If you leave a skilled nursing facility and are readmitted
6 Medical supplies such as splints and casts
within 14 days, you do not have to have a new 3-day stay in the
hospital in order for your care to be covered. If you have some
7 Use of appliances such as a wheelchair
of your 100 days left and you need skilled nursing or
rehabilitation services on a daily basis for further treatment of
Some services not covered when you are in a skilled nursing
a condition treated during your previous stay in the facility,
facility
your care can be covered.
Medicare's hospital insurance cannot pay for these items.
In each benefit period, hospital insurance pays for all
covered services for the first 20 days you are in a skilled
1 Personal convenience items you request such as a
nursing facility. After 20 days, hospital insurance pays for all
television, radio, or telephone in your room
covered services for the 21 st through 100th day, except for
2 Private duty nurses
$11.50 a day. Of course, if you receive any non-covered
3 Any extra charges for a private room, unless you need it
services, you are responsible for these costs.
for medical reasons
4 The first 3 pints of blood you receive in a benefit period
(see page 38)
18
19
Your Medicare
medical insurance
Reasonable charges
Medicare's medical insurance can help pay for (1) doctors'
Under the law, medical insurance payments are based on
services, (2) outpatient hospital care, (3) outpatient physical
therapy and speech pathology services, (4) home health care,
"reasonable charges" for covered services and supplies.
Because of the way reasonable charges are determined, they
and (5) many other health services and supplies which are
may sometimes be less than the actual charges made by doctors
not covered by Medicare's hospital insurance.
and suppliers.*
The following chapters will tell you more about these
The Medicare carrier for your area determines the
different kinds of care, the services that are covered by medical
reasonable charges for covered services and supplies on the
insurance and those not covered, and what part of your
basis of an annual review. New reasonable charges are put into
medical expenses Medicare can pay.
effect on July 1 of each year, based on the actual charges made
As a general rule, after you have $60 in reasonable
by physicians and suppliers in your area during the previous
charges (see page 21) for covered medical expenses in each
calendar year.
calendar year, your medical insurance will pay 80 percent of
Here's how reasonable charges are determined.
the reasonable charges for any additional covered services you
First, the carrier determines the customary charge
receive during the rest of the year.
(generally the charge most frequently made) by each doctor
Your first $60 in covered expenses in each calendar year
and supplier for each separate service or supply furnished to
is called the medical insurance deductible. You need to meet
patients in the previous calendar year.
this $60 deductible only once in a calendar year. The
Then, the carrier determines the prevailing charge for
deductible can be met by any combination of covered
each covered service and supply. The prevailing charge is the
expenses. You do not have to meet a separate deductible
amount which is high enough to cover the customary charges
for each different kind of covered service you might receive.
in three out of every four bills submitted in the previous year
There is also a special carryover rule* that will help you if
for each service and supply.
your medical expenses do not reach the deductible amount
Whenever a medical insurance claim is submitted, the
until the last 3 months of the year.
carrier compares the charge shown on the claim with the
*Carryover rule
your $60 deductible for the next
customary and prevailing charges for that service or supply.
If you have covered medical
year. Any social security office
The charge approved by the carrier will be either the customary
expenses in the last 3 months of
can give you more information
charge, the prevailing charge, or the actual charge, whichever
a year that can be counted toward
if you think the carryover rule
is lowest.
your $60 deductible for that year,
might apply in your case.
they can also be counted toward
*Suppliers
ple, ambulance firms, independent
Suppliers are persons or organi-
laboratories, and organizations
zations, other than doctors or
that rent or sell medical equip-
health care facilities, that furnish
ment are considered suppliers.
equipment or services covered
by medical insurance. For exam-
20
21
How medical insurance
payments are made
If the actual charge by your doctor or supplier is higher
There are two ways payments are made under Medicare's
than the reasonable charge, it may be because he recently
medical insurance. The medical insurance payment can be
raised his charge and it has not been in effect long enough to
made to the doctor or supplier. This payment method is called
be included in Medicare's annual review. In other cases, of
assignment. Or, the medical insurance payment can be made
course, the actual amount billed may be more than the
to you.
reasonable charge because the doctor or supplier has higher
After you or the doctor or supplier sends in a medical
charges for the particular service or supply than most other
insurance claim, Medicare will send you an Explanation of
doctors and suppliers in your area.
Medicare Benefits Notice* to tell you the decision on the claim.
When a doctor or supplier accepts an assignment of the
medical insurance payment (see page 24), he also agrees to
accept the reasonable charge as his total charge to you for
*Explanation of Medicare
Benefits Notice
covered services. For this reason, you may want to find out in
Medicare will send this notice to
advance whether the doctor or supplier will accept assignment.
you whenever a medical insurance
Reasonable charges for kidney dialysis and kidney
claim is submitted, whether you
transplant services are based on special fee arrangements
send in the claim yourself or it is
between Medicare and doctors, hospitals, dialysis centers, and
submitted by a doctor or supplier.
dialysis equipment suppliers who furnish services covered
The notice shows what expenses
were covered, what charges were
under the medical insurance part of Medicare.
approved, how much was credited
toward your $60 deductible, and
the amount Medicare paid. If
there is anything on the notice
that you don't understand, you
can get an explanation from the
carrier that sent you the notice or
from any social security office.
22
23
When a doctor treats you
Assignment
Medical insurance can help pay for covered services you
The assignment method, in which the doctor or supplier
receive from your doctor in his office, in a hospital, in a skilled
receives the medical insurance payment, can be used only if
nursing facility, in your home, or any other location in the U.S.
you both agree to it. If the doctor or supplier is willing to use
Your medical insurance can also help pay for doctors' services
the assignment method, he also agrees that his total charge
you receive in connection with covered inpatient care in a
for the covered service will not exceed the reasonable charge
Canadian or Mexican hospital. See page 16 to find out about
set by the Medicare carrier. Medicare then pays your doctor or
care in Canadian and Mexican hospitals.
supplier 80 percent of the reasonable charge, after subtracting
After you meet the $60 yearly medical insurance
any part of the $60 deductible you have not met. The doctor or
deductible, medical insurance pays 80 percent of the reasonable
supplier can charge you only for any of the $60 deductible
charges for covered services you receive from your doctor.
not yet met, the remaining 20 percent of the reasonable charge,
Payment can be made either to you or to your doctor.
and for any services that Medicare does not cover.
Page 24 describes the two payment methods.
Payment to you
Radiology and pathology services by doctors
Medicare makes direct payment to you covering 80 percent of
While you are an inpatient in a hospital, medical insurance
the reasonable charges, after subtracting any part of the $60
pays 100 percent of the reasonable charges for services by
deductible you haven't met. Charges to you by the doctor
doctors in the fields of radiology and pathology, even if you
or supplier are not limited to the reasonable charge set by the
haven't met your medical insurance deductible for the year.
Medicare carrier.
Because the full reasonable charges are paid, they do not count
See page 48 to find out how to send in a claim for medical
toward meeting your $60 deductible.
insurance payment.
Outpatient treatment of mental illness
Doctors' services you receive for outpatient treatment of a
mental illness are covered, but medical insurance can pay no
more than $250 in any one year for these services.
24
25
Chiropractors' services
The tables below show some of the doctors' services
that are covered and some that are not covered by medical
Medical insurance helps pay for only one kind of treatment
insurance.
furnished by a licensed and Medicare-certified chiropractor.
The only treatment that can be covered is manual manipula-
tion of the spine to correct a subluxation that can be
Major doctors' services covered by medical insurance
demonstrated by X-ray. Medical insurance does not pay for
Medicare's medical insurance can help pay for:
the X-ray or for any other diagnostic or therapeutic services
furnished by a chiropractor.
1 Medical and surgical services
2 Diagnostic tests and procedures that are part of your
Podiatrists' services
treatment
3 Other services which are ordinarily furnished in the
Medical insurance can help pay for any covered services of a
doctor's office and included in his bill, such as:
licensed podiatrist, except for routine foot care. Routine foot
X-rays you receive as part of your treatment
care includes hygienic care; treatment for flat feet or other
Services of your doctor's office nurse
structural misalignments of the feet; and removal of corns,
Drugs and biologicals that cannot be self-administered
warts (including plantar warts), and calluses. However,
Medical supplies
medical insurance can help pay for routine foot care if you
Physical therapy and speech pathology services
have a medical condition affecting the lower limbs (such as
severe diabetes) which requires that such care be performed by
a podiatrist or a doctor of medicine or osteopathy.
Some doctors' services not covered by medical insurance
Medicare's medical insurance cannot pay for these services.
Dental care
Medical insurance can help pay for dental care only if it
1 Routine physical examinations
involves surgery of the jaw or related structures or setting
2 Routine foot care
fractures of the jaw or facial bones. Care in connection with
3 Eye or hearing examinations for prescribing or fitting
the treatment, filling, removal or replacement of teeth; root
eyeglasses or hearing aids
canal therapy, surgery for impacted teeth; and other surgical
4 Immunizations (unless required because of an injury or
procedures involving the teeth or structures directly supporting
immediate risk of infection)
teeth are not covered.
5 Cosmetic surgery unless it is needed because of accidental
injury or to improve the functioning of a malformed part
of the body
26
27
Outpatient hospital services
Medicare's medical insurance helps pay for covered services
The tables below tell you some of the outpatient hospital
you receive as an outpatient from a participating hospital
services that are covered and the services that are not covered
for diagnosis or treatment of an illness or injury.
by medical insurance.
Medical insurance pays the hospital 80 percent of the
reasonable charges for covered services you receive as an
Major outpatient hospital services covered by medical
outpatient after subtracting any of the $60 deductible you have
insurance
not met. The hospital will apply for the medical insurance
Medicare's medical insurance helps pay for these items.
payment and will charge you for any part of the deductible you
have not met plus 20 percent of the remaining reasonable
1 Services in an emergency room or outpatient clinic
charges.
2 Laboratory tests billed by the hospital
When you go to a hospital for outpatient services, be sure
3 X-rays and other radiology services billed by the hospital
to show the people there your most recent Explanation of
4 Medical supplies such as splints and casts
Medicare Benefits Notice. From this form, they can tell how
5 Drugs and biologicals which cannot be self-administered
much of the $60 deductible you have met and how much
of the deductible, if any, they may charge you.
If the hospital cannot tell how much of the $60 deductible
Some outpatient hospital services not covered by medical
insurance
you have met and the charge for the services you received is
less than $60, the hospital may ask you to pay the entire bill.
Medicare's medical insurance cannot pay for these items.
If you pay the bill, any medical insurance payments that are
due will be paid directly to you. Usually, the hospital will
1 Routine physical examinations and tests directly related to
prepare the medical insurance claim for you. But if you ever
such examinations
need help with a claim, get in touch with any social security
2 Eye or ear examinations to prescribe or fit eyeglasses or
office.
hearing aids
Under certain conditions, medical insurance can also
3 Immunizations (unless required because of an injury or
help pay for emergency outpatient care you receive from a
immediate risk of infection)
4 Routine foot care
non-participating hospital.
28
29
Outpatient physical therapy
Other services and supplies
and speech pathology services
covered by medical insurance
Medicare's medical insurance can help pay for medically
Medicare's medical insurance also helps pay for other services
necessary outpatient physical therapy or speech pathology
and supplies described in this chapter. Medical insurance will
services. There are three different ways you can receive these
pay 80 percent of the reasonable charges for these covered
services under medical insurance.
services and supplies after you have met the $60 yearly
You may receive physical therapy or speech pathology
deductible. Usually when these services and supplies are
services as part of your treatment in a doctor's office. In this
furnished by a hospital, skilled nursing facility, or home health
case, the doctor must include the charge for the services in his
agency, it will make the claim for medical insurance payment.
bill. Medical insurance will pay 80 percent of the reasonable
Otherwise, you or the supplier submits the claim. Page 48 tells
charges after the $60 yearly deductible has been met. Either
you how medical insurance claims are submitted.
you or the doctor can submit the claim as described on page 48.
You may receive services directly from an independently
Independent laboratory services
practicing, Medicare-certified physical therapist in his office
or in your home if such treatment is prescribed by a doctor.
Medical insurance can help pay for diagnostic tests provided
Your medical insurance will pay 80 percent of the reasonable
by independent laboratories. The laboratory must be certified
charges after the $60 yearly deductible, but can pay no more
by Medicare for the services you receive. Not all laboratories
than $80 in total benefits in any one year. Either you or the
are certified by Medicare and some laboratories are certified
physical therapist can submit the claim as described on
only for certain kinds of tests. Your doctor can usually tell
page 48.
you what laboratories are certified and whether the tests he
You may receive physical therapy or speech pathology
is prescribing from a certified laboratory are covered by your
services as an outpatient of a participating hospital or skilled
medical insurance.
nursing facility, or from a home health agency, clinic,
rehabilitation agency, or public health agency approved by
Ambulance transportation
Medicare if these services are furnished under a plan your
Medical insurance can help pay for ambulance transportation
doctor sets up and periodically reviews. In this case, the
only if (1) the ambulance, equipment, and personnel meet
organization providing services always submits the claim and
Medicare requirements and (2) transportation in any other
may only charge you for any part of the $60 deductible you
vehicle could endanger the patient's health.
have not met, 20 percent of the remaining reasonable charges,
Under these conditions, medical insurance can help pay
and for any non-covered services.
for ambulance transportation from your home to a hospital
or skilled nursing facility, between hospitals and skilled
nursing facilities, or from a hospital or skilled nursing facility
to your home.
30
31
Medical insurance usually can help pay for ambulance
payments monthly. If you rent, medical insurance will help
transportation only in your local area. However, if there are no
pay the reasonable rental charges for as long as the equipment
facilities in the local area equipped to provide the care you
is medically necessary. If you buy, whether you pay the
need, medical insurance will help pay for necessary ambulance
entire purchase price in a lump sum or pay in installments,
transportation to the closest facility outside your local area
medical insurance will make monthly payments until its share
that can provide the necessary care. If you choose to go to
of the reasonable purchase price is paid or until the equipment
another institution that is farther away, Medicare payment still
is no longer medically necessary, whichever comes first.
will be based on the reasonable charge for transportation to
this closest facility.
Portable diagnostic X-ray services
Necessary ambulance services in connection with a
Medical insurance helps pay the reasonable charges for
covered inpatient stay in a Canadian or Mexican hospital
portable diagnostic X-ray services you receive in your home
(see page 16) can also be covered by medical insurance.
if they are ordered by a doctor and if they are provided by a
Prosthetic devices
Medicare-certified supplier.
Medical insurance helps pay for prosthetic devices needed to
Medical supplies
substitute for an internal body organ. These include, for
example, heart pacemakers, corrective lenses needed after a
Medical insurance can also help pay for surgical dressings,
cataract operation, and colostomy or ileostomy bags and
splints, casts, and similar medical supplies ordered by a doctor
certain related supplies. Medical insurance can also help pay
in connection with your medical treatment. This does not
for artificial limbs and eyes, and for arm, leg, back, and neck
include adhesive tape, antiseptics, or other common first-aid
braces. Orthopedic shoes are covered only when they are part
supplies.
of leg braces. Dental plates or other dental devices are not
covered.
Durable medical equipment
Medical insurance can help pay for durable medical equipment
such as oxygen equipment, wheelchairs, home dialysis systems,
and other medically necessary equipment that your doctor
prescribes for use in your home. You can rent or buy this
equipment. Whether you rent or buy, Medicare usually makes
32
33
Home health care
under Medicare
Sometimes people are confined to their homes because of an
The tables below tell you the home health services
illness or injury and need skilled health services only on a
Medicare covers and the services that are not covered.
part-time basis. These services may be medically necessary, for
example, after treatment in a hospital or skilled nursing
Home health services covered by Medicare
facility. Or, part-time skilled care provided at home could help
Medicare can pay for:
avoid an inpatient stay.
If you need part-time skilled health care in your home for
1 Part-time skilled nursing care
the treatment of an illness or injury, either hospital insurance
2 Physical therapy
or medical insurance can help pay for covered health care
3 Speech therapy
services furnished by home health agencies* participating in
If you need part-time skilled nursing care, physical therapy,
Medicare.
or speech therapy, Medicare can also pay for:
Medicare does not cover home care services furnished
Occupational therapy
primarily to assist people in meeting personal, family, and
Part-time services of home health aides
domestic needs. These services include general household
Medical social services
services, preparing meals, shopping, or assisting in bathing,
Medical supplies and equipment provided by the agency
dressing, or other personal needs.
When care in your home is covered by Medicare, the
services you receive are counted in visits. For example, if you
Home health services not covered by Medicare
receive one home health service twice in the same day, or two
Medicare cannot pay for these items.
different home health services in the same day, two visits
would be counted.
1 Full-time nursing care at home
2 Drugs and biologicals
Home health agencies
3 Meals delivered to your home
A home health agency is a public or private agency that
4 Homemaker services
specializes in giving skilled nursing services and other
therapeutic services, such as physical therapy, in your home.
34
35
When hospital insurance pays for home health care
When medical insurance pays for home health care
Medicare's hospital insurance can pay for home health visits if
six conditions are met. All six conditions must be met. These
Medicare's medical insurance can help pay for up to 100
conditions are: (1) you were in a qualifying hospital for at least
home health visits in a calendar year. You do not have to have
3 days in a row, (2) the home health care is for further
a 3-day stay in the hospital for medical insurance to pay for
treatment of a condition which was treated in a hospital or
home health care. But medical insurance can pay for the
skilled nursing facility, (3) the care you need includes part-time
visits only if four conditions are met. All four conditions must
skilled nursing care, physical therapy, or speech therapy,
be met. These conditions are: (1) you need part-time skilled
(4) you are confined to your home, (5) a doctor determines you
nursing care or physical or speech therapy, (2) a doctor
need home health care and sets up a home health plan for you
determines you need the services and sets up a plan for home
within 14 days after your discharge from a hospital or
health care, (3) you are confined to your home, and (4) the
participating skilled nursing facility, and (6) the home health
home health agency providing services is participating in
agency providing services is participating in Medicare.
Medicare. Medical insurance can also pay for home health
Under these conditions, hospital insurance can pay the
visits if this care is still needed after you have used up the 100
full cost of up to 100 home health visits after the start of one
visits covered under hospital insurance.
benefit period and before the start of another. Payment for
After you meet the $60 yearly deductible, medical
these visits can be made for up to a year following your most
insurance pays the full costs for covered home health services
recent discharge from a hospital or participating skilled nursing
in each calendar year. You may be charged only for any
facility. You may be charged only for any non-covered
non-covered services you receive.
services you receive.
The home health agency always submits the medical
The home health agency will submit the claim for
insurance claim for home health care. You don't have to send
payment. You don't have to send in any bills yourself.
in any bills yourself.
36
37
Coverage of blood
under Medicare
Your right of appeal
Both hospital insurance and medical insurance can help pay
If you disagree with a decision on the amount Medicare will
for blood, except for the first 3 pints (or equivalent units of
pay on a claim or whether services you received are covered
packed red blood cells) you use under each part of your
by Medicare, you always have the right to ask for a review of
Medicare insurance. You will not have to pay for these 3 pints
the decision.
if you can arrange for blood replacement.*
Under Medicare's hospital insurance, the health facility
If you need blood while you are an inpatient in a hospital
that provides the services submits the claim for payment.
or a skilled nursing facility, you are responsible for the first
But, Medicare will send you a notice of the decision made on
3 pints of blood in each benefit period. After that, hospital
the claim. If you feel that the decision is not correct, you can
insurance pays the full cost of any additional blood you need
ask for a review of the claim. Any social security office can
during that benefit period.
help you request a review. If you are still not satisfied after the
If you are receiving blood as an outpatient or as part of
review and if the amount in question is $100 or more, you
other services covered by your medical insurance, you are
can ask for a formal hearing. Cases that involve $1,000 or
responsible for the first 3 pints of blood in each calendar year.
more can eventually be appealed to a Federal court.
After that, your medical insurance will pay 80 percent of the
Under Medicare's medical insurance, whether you or the
reasonable charges, after you have met the $60 annual
doctor or supplier submits the claim for payment, Medicare
deductible, for any additional blood you receive as an
will send you a notice of the decision made on the claim. If
outpatient during the year.
you disagree with the decision, you can ask the Medicare
carrier that handled, the claim to review it. Then, if you still
*Blood
disagree with the decision and if the amount in question is
If you are covered by a blood
$100 or more, you can request a hearing by the carrier.
donor plan, it can replace the
first 3 pints of blood for you. Or,
The notice you receive from Medicare which tells you of
you can arrange to have someone
the decision made on your claim will also tell you exactly what
donate blood for you.
appeal steps you can take. If you ever need more information
about your right of appeal and how to request it, get in touch
with any social security office.
38
39
Waiver of beneficiary
If you are a member of a
liability
prepayment plan
Under the law, Medicare cannot pay for custodial care or
Prepayment plans make health services available to their
other services that are not reasonable and necessary (see
members in a special way. Generally, each member pays
page 8). For example, if you go into a hospital when the
regular premiums to the plan. The member can then receive
kind of services you need could be provided in a less expensive
health services the plan provides, whenever he needs them,
health facility, on an outpatient basis, or in your home,
without additional charges. In some plans, small charges are
Medicare will not pay for the hospital services. Or, for
made for certain services, such as drugs or home visits.
example, if your doctor gives you services that are in excess
Many prepayment plans have made arrangements with
of accepted standards of medical practice in your area for
Medicare to receive direct payments for services they furnish
similar medical conditions, Medicare will not pay for the
which are covered under the medical insurance part of
excess services.
Medicare. Some prepayment plans have contracts with
But there is also a provision in the Medicare law that
Medicare as Health Maintenance Organizations and can
says you will not be held responsible for paying for such
receive direct payment for services covered by either hospital
services if you could not reasonably be expected to know they
insurance or medical insurance.
were not covered by Medicare.
If you are a member of a prepayment plan, ask the
This provision of the law is called "waiver of beneficiary
people in charge of the plan what arrangements have been
liability." Waiver only applies, however, when Medicare denies
made for Medicare payments. Find out, too, what you should
payment on a claim because it is decided that the services you
do when you get health services that are not provided by the
received were custodial or that they were not reasonable or
plan.
necessary for diagnosis or treatment. In addition, the waiver
If you are interested in finding out whether there are any
provision does not apply to medical insurance claims unless
Health Maintenance Organizations or other types of prepay-
the doctor or other person who furnished the services agreed
ment plans in your area, contact any social security office.
to payment under the assignment method.
40
41
What Medicare does not cover
This alphabetical list shows most of the major services and
Naturopaths' services
Services which are not
supplies that Medicare usually does not pay for. Items shown
reasonable and necessary
in blue can be covered by Medicare only under the conditions
Nursing care on a full-time
(See page 8)
described here or on the pages indicated.
basis in your home
Foreign health care
Services payable by work-
Acupuncture
Orthopedic shoes (unless
(See page 16)
men's compensation or
part of a leg brace) and
another government program
Chiropractic services
(See page 26)
Hearing aids and hearing
other supportive devices for
the feet
Services for which neither
examinations for prescribing,
the patient nor another party
Christian Science
fitting, or changing hearing
Personal convenience items
on his behalf has a legal
practitioners' services
aids
that you request such as a
obligation to pay
phone, radio, or television in
Cosmetic surgery
Homemaker services
your room at a hospital or
(See page 27)
(See page 34)
skilled nursing facility
Custodial care
Immunizations unless
Physical examinations that
(See page 9)
required because of an injury
or immediate risk of
are routine and tests directly
related to such examinations
Dental care
infection
(See page 26)
Private duty nurses
Injections which can be
Drugs and medicines you buy
self-administered, such as
Private room (See table on
yourself with or without a
insulin
doctor's prescription
page 13 or 19)
Meals delivered to your
Services performed by
Eyeglasses and eye examina-
home
immediate relatives or
tions for prescribing, fitting,
members of your household
or changing eyeglasses
Foot care that is routine
(See page 26)
42
43
How to get the part of Medicare
you do not have
Most people who have Medicare's hospital insurance do not
If you are 65 or older and have Medicare medical
pay monthly premiums for this protection. They have hospital
insurance, but not the hospital insurance part, you can get
insurance because of credits for work under social security.
hospital insurance by paying a monthly premium. You can sign
If you have Medicare hospital insurance, but do not have
up for hospital insurance in the first 3 months of any year.
the medical insurance part of Medicare, you can sign
Generally, for each year you delay signing up after you
up for medical insurance in the first 3 months of any year.
become 65, the hospital insurance premium* goes up by 10
Generally, for each year you delay signing up after you were
percent. Your protection does not begin until July 1 of the year
first eligible to enroll, your monthly medical insurance
you sign up.
premium* increases by 10 percent. Your protection does not
Your social security office can answer any questions you
start until July 1 of the year you sign up.
may have on how to get the part of Medicare you do not
have now.
*Medical insurance premium
The basic monthly medical insurance premium is $6.70.
*Hospital insurance premium
This premium may go up if the costs of medical care rise.
The basic monthly hospital insurance premium is $36 through
Under the law, however, the premium cannot be raised unless
June 30, 1975. It will be increased to $40 a month for the
there has been a general increase in social security cash benefits
12-month period starting July 1, 1975. This premium
since the last premium change. Also, the premium increase
represents the present cost of Medicare hospital insurance
cannot be more than the percentage increase in cash benefits.
protection. This premium may go up if the costs of hospital
Your medical insurance premium is never more than one-half
care rise. Under the law, however, hospital insurance premiums
the cost of your medical insurance protection.
cannot be changed more often than once a year.
44
45
Events that can end
your Medicare protection
If you are 65 or older and you have Medicare hospital
If you are disabled
insurance because of work credits under social security, you
will have this protection as long as you live. Your medical
If you have Medicare because you are disabled, both your
insurance protection, however, depends on the payment of
hospital and your medical insurance protection will end if your
monthly premiums, which are either deducted from social
entitlement to disability benefits ends before you are 65. Your
security checks or paid directly.
Medicare protection will continue for one calendar month
Medical insurance can stop only if you do not pay
after the month notice is sent to you that you are no longer
premiums or if you voluntarily cancel. Remember, though, that
entitled to disability payments.
you may not be able to get private insurance that offers the
As long as you are getting disability checks, you will have
same protection. Also, you can re-enroll only once, and your
the protection of hospital insurance. If for any reason you
premium will be higher.
ever want to cancel your medical insurance, get in touch with
any social security office.
If you are buying hospital insurance protection, you
cannot cancel your medical insurance without losing your
hospital insurance, too. However, you can cancel your hospital
If you have Medicare because of chronic kidney
disease
insurance and still continue your medical insurance.
If you want more information about cancelling your
If you are under 65 and you have Medicare because of chronic
Medicare protection, get in touch with any social security
kidney disease, your protection will continue until 12 months
office.
after a successful kidney transplant or 12 months after dialysis
treatment ends. Your medical insurance protection could stop
before that if you fail to pay premiums or you decide to
cancel. Get in touch with any social security office if you ever
want to end your medical insurance protection.
46
47
How to submit
medical insurance claims
A Request for Medicare Payment form, also called Form 1490,
deductible, we suggest that you send in your future bills for
must be filled out and submitted in order for Medicare to pay
covered services as soon as you get them so that Medicare
for services of doctors and suppliers which are covered by your
payment can be made promptly. Page 51 will tell you where to
medical insurance. All social security offices, and most
send your claim.
doctors' offices, have copies of the form. Instructions on how
It's a good idea to keep a record of your medical
to fill it out are on the back of the form.
insurance claim in case you ever want to inquire about it.
If the doctor or supplier is willing to use the assignment
Before you send in a claim, write down the date you mail it, the
method of payment, he submits the claim. You complete and
services you received, the date and charges for each service,
sign Part I of the form. He completes Part II and sends in
and the name of the person who provided each service.
the form.
If the doctor or supplier does not accept assignment, you
Claims for a person who died
submit the claim under the payment-to-you method. Complete
When someone who has Medicare dies, any hospital insurance
and sign Part I of the form. Ask the person who provided the
payments due will be paid directly to the hospital, skilled
services either to complete Part II of the form or to give you
nursing facility, or home health agency that provided covered
an itemized bill to send in with the form. An itemized bill must
services.
show (1) the date you received the services, (2) the place
For services covered under medical insurance which were
where you received the services, (3) a description of the
furnished by doctors or suppliers, some special rules apply.
services, (4) the nature of your illness or injury (diagnosis),
If the doctor or supplier accepts an assignment, the medical
(5) the charge for each service, and (6) your name and your
insurance payment can be made directly to him. If the doctor
health insurance claim number, including the letter at the end
or supplier will not accept an assignment, then any medical
of the number. If the bill doesn't include all of this information,
insurance payment due will be paid to whoever pays the bill
your payment will be delayed.
and submits a medical insurance claim with proof of payment.
If you are sending in itemized bills, you may submit a
The person who pays the bill will need to file two forms. One
number of bills with a single Request for Medicare Payment
form, called Request for Medicare Payment, is explained on
form. It doesn't matter whether all the bills are from one
page 48. The other form is called Statement Regarding
doctor or supplier or from different people who gave you
Medicare Payment for Medical Services to Deceased Patient.
services.
Copies of both forms can be obtained at any social security
Before any medical insurance payment can be made, your
office.
record must show that you have met the yearly deductible.
If the patient paid the bill prior to his or her death, call
So, as soon as your bills come to $60, send them to the carrier
any social security office for information about how to get the
that handles your medical insurance claims with a Request for
medical insurance payment.
Medicare Payment form. Once you have met the $60
48
49
Where to send your
medical insurance claims
Time limits for submitting claims
The list beginning on the next page gives the names and
Under the law, there are some time limits for submitting
addresses of the organizations selected by the Social Security
medical insurance claims. For medical insurance to make
Administration to handle medical insurance claims. These
payments on your claims, you must send in your claims within
organizations are called carriers. In most cases, one carrier
handles claims for an entire State. But some carriers handle
these time limits. You always have at least 15 months to
claims for only part of a State. To find out where to send your
submit claims. The table below tells you exactly what the
medical insurance claim, look in the list for the State where you
time limits are.
received the services. Under the name of the State, you will find
the name of the carrier that will handle your claim. If there is
more than one carrier in the State, look for the county where
When you receive services
When your claim must be
you received services to find the carrier that will handle your
submitted
claim. (See page 48 to find out how to submit medical
insurance claims.)
Between October 1, 1973, and
If you are not sure where to send your first claim and
September 30, 1974
By December 31, 1975
happen to send it to the wrong office, your claim will be sent
on to the right place.
Between October 1, 1974, and
Whenever you send in a claim, be sure to include the
September 30, 1975
By December 31, 1976
word Medicare in the carrier's address on the envelope. Also,
Between October 1, 1975, and
be sure to put your return address on the envelope.
September 30, 1976
By December 31, 1977
After you make a claim, the carrier will usually send you
another Request for Medicare Payment form for your next
Between October 1, 1976, and
claim. The form will usually show the carrier's name and
September 30, 1977
By December 31, 1978
address in the top left-hand corner. If you ever need to file a
medical insurance claim and don't have a claim form, you can
get one by phoning a social security office.
Note: If you are entitled to Medicare under the railroad
retirement system, send your medical insurance claims to The
Travelers Insurance Company office which is nearest to your
home-no matter where you received services.
50
51
Alabama
Rest of State:
Medicare
Medicare
Rest of State:
Indiana
Blue Cross-Blue Shield of Alabama
Blue Shield of California
Medicare
Medicare Part B
930 South 20th Street
P.O. Box 7968, Rincon Annex
Blue Shield of Florida, Inc.
120 West Market Street
Birmingham, Alabama 35205
San Francisco, California 94120
P.O. Box 2525
Indianapolis, Indiana 46204
Jacksonville, Florida 32203
Iowa
Alaska
Colorado
Georgia
Medicare
Medicare
Medicare
The Prudential Insurance Co. of
Iowa Medical Service
Aetna Life & Casualty
Colorado Medical Service, Inc.
America
324 Liberty Building
Crown Plaza
700 Broadway
Medicare Part B
Des Moines, Iowa 50309
1500 S.W. First Avenue
Denver, Colorado 80203
P.O. Box 95466 Executive Park
Portland, Oregon 97201
Kansas
Station
Connecticut
Atlanta, Georgia 30347
Counties of: Johnson, Wyandotte
Arizona
Medicare
Medicare
Medicare
Connecticut General Life
Hawaii
Blue Shield of Kansas City
Aetna Life & Casualty
Insurance Co.
Medicare
P.O. Box 169
Medicare Claim Administration
200 Pratt Street
Aetna Life & Casualty
Kansas City, Missouri 64141
3010 West Fairmount Avenue
Meriden, Connecticut 06450
P.O. Box 3947
Phoenix, Arizona 85017
Honolulu, Hawaii 96812
Rest of State:
Delaware
Medicare
Arkansas
Medicare
Idaho
Medicare
Blue Cross and Blue Shield of
Medicare
Kansas Physicians Service
Arkansas Blue Cross and
Delaware
The Equitable Life Assurance
1133 Topeka Boulevard
Blue Shield
201 West 14th Street
Society
Topeka, Kansas 66601
P.O. Box 1418
Wilmington, Delaware 19899
P.O. Box 8048
Kentucky
Little Rock, Arkansas 72203
Boise, Idaho 83707
Medicare
District of Columbia
Metropolitan Life Insurance Co.
California
Medicare
Illinois
1218 Harrodsburg Road
Counties of: Los Angeles, Orange,
Medical Service of D.C.
Cook County
Lexington, Kentucky 40504
San Diego, Ventura, San Bernadino,
550 - 12th St., S.W.
Medicare
Imperial, San Luis Obispo,
Washington, D.C. 20024
Illinois Medical Service
Louisiana
Riverside, Santa Barbara
233 N. Michigan Avenue
Medicare
Medicare
Florida
Chicago, Illinois 60601
Pan-American Life Insurance Co.
P.O. Box 60450
Occidental Life Insurance Co. of
Counties of: Dade, Monroe
New Orleans, Louisiana 70160
California
Medicare
Rest of State:
Box 54905
Group Health, Inc.
Medicare
Maine
Terminal Annex
P.O. Box 341370
CNA Insurance
Medicare
Los Angeles, California 90054
Miami, Florida 33134
Medicare Benefits Division
Union Mutual Life Insurance Co.
P.O. Box 910
Box 4629
Chicago, Illinois 60690
Portland, Maine 04112
52
53
Maryland
Mississippi
Nevada
County of: Queens
Counties of: Montgomery, Prince
Medicare
Medicare
Medicare
Georges
The Travelers Insurance Co.
Aetna Life & Casualty
Group Health, Inc.
Medicare
P.O. Box 22545
1535 Vassar Street
P.O. Box 233-Midtown Station
Medical Service of D.C.
Jackson, Mississippi 39205
P.O. Box 3077
New York, New York 10018
550 - 12th St., S.W.
Reno, Nevada 89505
Washington, D.C. 20024
Missouri
Counties of: Livingston, Monroe,
Counties of: Andrew, Atchison,
New Hampshire
Ontario, Seneca, Wayne, Yates
Rest of State:
Bates, Benton, Buchanan, Caldwell,
Medicare
Medicare
Maryland Blue Shield, Inc.
Carroll, Cass, Clay, Clinton,
New Hampshire-Vermont
Genesee Valley Medical Care, Inc.
700 East Joppa Road
Daviess, DeKalb, Gentry, Grundy,
Physician Service
41 Chestnut Street
Towson, Maryland 21204
Harrison, Henry, Holt, Jackson,
Two Pillsbury Street
Rochester, New York 14647
Johnson, Lafayette, Livingston,
Massachusetts
Concord, New Hampshire 03301
Mercer, Nodaway, Pettis, Platte,
Medicare
Counties of: Allegany, Cattaraugus,
Ray, St. Clair, Saline, Vernon,
New Jersey
Blue Shield of Massachusetts, Inc.
Erie, Genesee, Niagara, Orleans,
Worth
Medicare
P.O. Box 2194
Wyoming
Medicare
The Prudential Insurance Co.
Medicare
Boston, Massachusetts 02110
Blue Shield of Kansas City
of America
Blue Shield of Western
Michigan
P.O. Box 169
P.O. Box 3000
New York, Inc.
Medicare
Kansas City, Missouri 64141
Linwood, New Jersey 08221
298 Main Street
Blue Shield of Michigan
Buffalo, New York 14202
Rest of State:
New Mexico
P.O. Box 2201
Medicare
Detroit, Michigan 48231
Medicare
Counties of: Albany, Broome,
General American Life
The Equitable Life Assurance
Cayuga, Chautauqua, Chemung,
Minnesota
Insurance Co.
Society
Chenango, Clinton, Cortland,
Counties of: Anoka, Dakota,
P.O. Box 505
P.O. Box 3070, Station D
Essex, Franklin, Fulton, Hamilton,
Filmore, Goodhue, Hennepin,
St. Louis, Missouri 63166
Albuquerque, New Mexico 87110
Herkimer, Jefferson, Lewis,
Houston, Olmstead, Ramsey,
Madison, Montgomery, Oneida,
Wabasha, Washington, Winona
Montana
New York
Onondaga, Oswego, Otsego,
Medicare
Medicare
Counties of: Bronx, Columbia,
Rensselaer, Saratoga, Schenectady,
The Travelers Insurance Company
Montana Physicians' Service
Delaware, Dutchess, Greene, Kings,
Schoharie, Schuyler, Steuben, St.
8120 Penn Avenue, South
P.O. Box 2510
Nassau, New York, Orange,
Lawrence, Tioga, Tompkins,
Bloomington, Minnesota 55431
Helena, Montana 59601
Putnam, Richmond, Rockland,
Warren, Washington
Suffolk, Sullivan, Ulster,
Medicare
Rest of State:
Nebraska
Westchester
Metropolitan Life Insurance Co.
Medicare
Medicare
Medicare
276 Genesee Street
Blue Shield of Minnesota
Mutual of Omaha Insurance Co.
Blue Cross-Blue Shield of
P.O. Box 393
P.O. Box 8899
P.O. Box 456, Downtown Station
Greater New York
Utica, New York 13503
Minneapolis, Minnesota 55408
Omaha, Nebraska 68101
Two Park Avenue
54
New York, New York 10016
55
North Carolina
Rhode Island
Vermont
Wisconsin
The Prudential Insurance Co.
Medicare
Medicare
County of Milwaukee
of America
Blue Shield of Rhode Island
New Hampshire-Vermont
Medicare
Medicare B Division
444 Westminster Mall
Physician Service
Surgical Care-Blue Shield
P.O. Box 2126
Providence, Rhode Island 02901
Two Pillsbury Street
P.O. Box 2049
High Point, North Carolina 27261
Concord, New Hampshire 03301
Milwaukee, Wisconsin 53201
South Carolina
North Dakota
Medicare
Virginia
Rest of State:
Medicare
Blue Shield of South Carolina
Counties of: Arlington, Fairfax
Medicare
Blue Shield of North Dakota
Drawer F, Forest Acres Branch
Cities of: Alexandria, Falls
Wisconsin Physicians Service
301 Eighth Street, South
Columbia, South Carolina 29260
Church, Fairfax
Box 1787
Fargo, North Dakota 58102
Medicare
Madison, Wisconsin 53701
South Dakota
Medical Service of D.C.
Ohio
Medicare
550-12th St., S.W.
Wyoming
Medicare
South Dakota Medical Service, Inc.
Washington, D.C. 20024
Medicare
Nationwide Mutual Insurance Co.
711 North Lake Avenue
The Equitable Life
P.O. Box 57
Sioux Falls, South Dakota 57102
Rest of State:
Medicare
Assurance Society
Columbus, Ohio 43216
P.O. Box 628
The Travelers Insurance Co.
Tennessee
P.O. Box 26463
Cheyenne, Wyoming 82001
Oklahoma
Medicare
Richmond, Virginia 23261
Medicare
The Equitable Life
Puerto Rico
Aetna Life & Casualty
Assurance Society
Medicare
1140 N.W. 63rd Street
P.O. Box 1465
Washington
Medicare
Seguros De Servicio De Salud De
Oklahoma City, Oklahoma 73116
Nashville, Tennessee 37202
Puerto Rico
Washington Physicians' Service
P.O. Box 3628
Mail to your local
Oregon
Texas
Medical Service Bureau
104 Ponce de Leon Avenue
Medicare
Medicare
If you do not know which bureau
Hato Rey, Puerto Rico 00936
Aetna Life & Casualty
Group Medical and Surgical Service
handles your claim, call any
Crown Plaza
P.O. Box 22147
social security office
Virgin Islands
1500 S.W. First Avenue
Dallas, Texas 75222
for the address
Medicare
Portland, Oregon 97201
Seguros De Servicio De Salud De
Utah
West Virginia
Puerto Rico
Pennsylvania
Medicare
Medicare
P.O. Box 3628
Medicare
Blue Shield of Utah
Nationwide Mutual Insurance Co.
104 Ponce de Leon Avenue
Pennsylvania Blue Shield
P.O. Box 270
P.O. Box 57
Hato Rey, Puerto Rico 00936
Box 65 Blue Shield Bldg.
2455 Parley's Way
Columbus, Ohio 43216
Camp Hill, Pennsylvania 17011
Salt Lake City, Utah 84110
56
57
Index
A
Covered services: ambulance, 31;
American Samoa
Acupuncture, 9, 42
definition of, 10; doctors',
Medicare
Aides, home health, 35
25-27; home health care, 35;
Hawaii Medical Service Assn.
Ambulance transportation:
in a non-participating hospital,
P.O. Box 860
coverage in U.S., 31; coverage
15; independent laboratory, 31;
Honolulu, Hawaii 96808
in connection with Canadian or
inpatient hospital, 13;
Mexican hospital care, 16, 32
outpatient hospital, 29;
Guam
Appeal, right of, 39
pathology, 25; physical
Medicare
Appliances, 13, 19
therapy, 13, 19, 30, 35;
Aetna Life & Casualty
Assignment of medical insurance
portable diagnostic X-ray, 33;
P.O. Box 3947
payment, 24
radiology, 25; skilled nursing
Honolulu, Hawaii 96812
facility, 19; speech pathology
B
services, 30
Beneficiary liability, waiver of, 40
Custodial care, 9
Benefit period, 10
Biologicals, 27, 29
D
Blood, 38
Deductible: hospital insurance,
12; medical insurance, 20
C
Dental care, 26
Canadian hospital care, 16
Devices, prosthetic, 32
Cancelling Medicare protection,
Diagnostic tests, 27, 31
46
Doctors' bills: how payment is
Card, Medicare, 6
made, 23; how to submit, 48
Carrier, Medicare, list of, 52
Doctors' services: covered, 27;
Carryover rule, 20
for mental illness, 25; in
Casts, 13, 19, 29
Canadian or Mexican hospital,
Chiropractors' services, 26
16; in home, 25; in office, 25,
Christian Science practitioners, 42
27; non-covered, 27; pathology
Christian Science sanatorium, 16
services in hospital, 25;
Civil Rights Act, 7
radiology services in hospital,
Claim number, 6
25
Claims: hospital insurance, 11;
Dressings, surgical, 13, 33
medical insurance, 48; for a
Drugs: covered, 13, 19, 27, 29;
person who died, 49; how to
non-covered, 35, 42
appeal, 39
Durable medical equipment, 32
Colostomy care supplies, 32
Corrective lenses, 32
Cosmetic surgery, 27
58
59
medical equipment, 32; for
facility, 19; list of, 42;
E
Hospital inpatient reserve days,
home health care, 37; for
outpatient hospital, 29
Emergency treatment: definition
14
independent laboratory
Non-participating hospital,
of, 15; coverage of, 15, 28
Hospital insurance claims: 11;
services, 31; for medical
coverage of, 15
Enrolling in Medicare, 44
how to appeal, 39
supplies, 33; for outpatient
Nursing services, coverage of:
Equipment, durable medical, 32
Hospital insurance deductible, 12
hospital services, 28; for
from home health agency, 35;
Events that end Medicare
Hospital insurance premium, 45
outpatient physical therapy
in doctor's office, 27; in
protection, 46
and speech pathology services,
hospital, 13; in skilled nursing
Explanation of Medicare Benefits
I
30; for prosthetic devices, 32;
facility, 19
Notice, 23
Ileostomy care supplies, 32
how to appeal, 39; how to
Eye examinations, 42
Immunizations, 27, 29, 42
submit, 48; payment to you,
0
Eyeglasses, 42
Independent laboratory, 31
24; prepayment plan, 41;
Occupational therapy, 13, 19, 35
Independent physical therapist, 30
Request for Medicare Payment
Operating room, 13
F
Injections, 42
form, 48; time limits for filing,
Operations: by dentist, 26; by
Foot care, 26
Inpatient hospital care: conditions
50; where to send, 51
doctor, 27
Foreign health care, 15
for coverage, 12; covered and
Medical insurance deductible, 20
Orthopedic shoes, 32, 43
Form 1490 (Request for
non-covered services, 13;
Medical insurance, definition of, 5
Outpatient hospital services, 28
Medicare Payment), 48
payment for, 12
Medical insurance, how to get, 44
Outpatient physical therapy, 30
Inpatient hospital reserve days, 14
Medical insurance premium, 44
Outpatient speech pathology
H
Intensive care, 13
Medical social services, 35
services, 30
Health insurance card, 6
Medical supplies, 33
Oxygen equipment, 32
Health insurance claim number, 6
L
Medicare card, 6
Health Maintenance
Laboratory, independent, 31
Medicare carrier, 5; list of, 52
P
Organizations, 41
Laboratory tests, 13, 29, 31
Medicare protection, 5; events
Pathology services, 25
Hearing aids, 42
Liability, beneficiary, waiver of,
that end, 46; how to get, 44
Personal convenience items, 13,
Hearing examinations, 42
40
Medicines: covered, 13, 19, 27,
19, 43
Heart pacemakers, 32
29; non-covered, 35, 42
Physical examinations, routine,
Histamine therapy, 9
M
Mental illness, treatment of: by
27, 29, 43
Home health agencies, 34
Meals: covered, 13, 19;
doctor, 25; in psychiatric
Physical therapist, independent,
Home health aides, 35
non-covered, 35, 42
hospital, 15
coverage of, 30
Home health care: under hospital
Medicaid, 5
Mexican hospital care, 16
Physical therapy: from home
insurance, 36; under medical
Medical equipment, durable, 32
insurance, 37; covered and
Medical insurance, cancelling, 46
N
health agency, 35; from
Medical insurance claims:
Naturopaths, 43
independent physical therapist,
non-covered services, 35
30; in hospital, 13; in skilled
Home health visits, 34
assignment of, 24; Explanation
Non-covered services and
nursing facility, 19; outpatient,
Hospital care, inpatient, 12;
of Medicare Benefits Notice,
supplies: doctors', 27; home
30
outpatient, 28; in Canadian
23; for ambulance
health care, 35; inpatient
Podiatrists' services, 26
and Mexican hospitals, 16; in
transportation, 31; for a person
hospital, 13; in skilled nursing
Prepayment plans, 41
psychiatric hospital, 15
who died, 49; for durable
60
61
Prescription drugs, 42
Speech therapy, 19, 35
Private duty nurses, 13, 19, 43
Statement Regarding Medicare
Private room, 13, 19, 43
Payment for Medical Services
Professional Standards Review
to Deceased Patient, 49
Organizations, 8
Suppliers, definition of, 21
Prosthetic devices, 32
Surgery: by dentist, 26; by
Psychiatric care, 15
doctor, 27; cosmetic, 27
Surgical dressings, 13, 33
R
Radiology services, 25
T
Reasonable charges, 21
Telephone in room, 13, 19
Recovery room, 13
Television in room, 13, 19
Relatives' services, 43
Time limits for submitting
Request for Medicare Payment
medical insurance claims, 50
form (Form 1490), 48
Reserve days, inpatient hospital,
U
14
Utilization Review Committee, 8
Right of appeal, 39
W
S
Waiver of beneficiary liability, 40
Semiprivate room, 13, 19
Wheelchairs, 13, 19, 32
Skilled nursing care: coverage of,
Workmen's compensation, 43
17; definition of, 18
Skilled nursing facility, definition
X
of, 17
X-rays: by chiropractor, 26; by
Skilled rehabilitation services:
independent laboratory, 31; in
coverage of, 17; definition of,
doctor's office, 27; in
18
hospital, 13, 29; portable
Speech pathology services, 13, 30
diagnostic, 33
62
* U. S. GOVERNMENT PRINTING OFFICE : 1975 o - 577-283
Department of
Health, Education, and Welfare
Social Security Administration
Postage and fees paid
Official Business
U.S. Department of H.E.W.
HEW 397
U.S.MAIL
THIRD CLASS
U.S. Department of
Health, Education, and Welfare
Social Security Administration
DHEW Publication No. (SSA) 75-10050
March 1975
FORD & LIBRARY GERALD
azing
MEDICARE PART B CLAIMS
PROCESSING SYSTEM
April 10, 1975
FORD LIBRARY & GERALD
INDEX
Work Flow
Page
Receipt of Claims (Mailroom)
1.1
Receipt of Claims (Department)
1.1
Scanning Function
1.1
Clerical Assigning of Control Number
1.2
Coding Function
1.2
Development and Utilization Review
1.2
CRT Operation
1.2
Duplicate Check/Query Reply Exceptions
1.3
Completed Claims
1.3
Microfilming
1.3
FORD i LIBRARY GERALD
Receipt of Claims (Mailroom)
Medicare Part B claims (1490's, 1554's, etc.) are received in the mail-
room and the envelopes are sliced. The claims and envelopes are then
forwarded to the mail desk in the Medicare Part B and Complementary Claims
Department.
Receipt of Claims (Department)
Claims are removed from the envelopes and sorted by type of claim form
(1490, 1554, etc.). Those claims which are missing Health Insurance
Claim Numbers are separated. All claims are stamped with the julian
date of receipt. The sorted claims are put into four equal batches and
forwarded to the Scanner in each Unit of the Claims Processing Sections.
The Health Insurance Claim Number look-ups are checked against the "CAST"
(alphabetic) microfilm file and then forwarded to the Scanners.
Scanning Function
Scanners review the claims and further sort them into the following cate-
gories: A) claims ready for CRT input, B) claims requiring assignment
of procedure codes and/or creation of "splits" prior to CRT input, C)
claims requiring development, utilization screening, or other review.
Category "A" claims are forwarded to the control clerk, category "B"
claims are forwarded to the fee assigners, and category "C" claims are
forwarded to the appropriate review area.
GERALD
FORD LIBRARY &
1.1
Clerical Assigning of Control Number
The julian calendar date and a unique five digit number are assigned to
each claim as the Control Number. The incorporation of the julian date
in the control number enables the system to age all claims and reflect
this data on management reports, The control numbers are computer-pre-
pared on adhesive labels in team (unit) order. One label is affixed
to each claim, the claims are batched, and then forwarded to the CRT
operator.
Coding Function
Fee assigners review the claims, create splits if necessary, and complete
the required coding. The claims are then forwarded to the control clerk.
Development and Utilization Review
Appropriate area reviews the claim immediately and determines if the claim
can be adjudicated without delay or whether further development is necess-
ary. Claims released back into the processing cycle are returned to the
Scanner. Claims requiring further development are forwarded to the
control clerk.
CRT Operation
Claims are controlled and entered into the system. Those claims needing
further development are entered as "Control Only" claims. Input (the
validity module) and Reasonable Charge (the pricing module) exceptions
FORD is LIBRARY GERALD
1.2
are re-entered on the CRT's. Input validity errors are detected within
the claim itself or between the claim and the Beneficiary Extract File.
(NOTE: The Beneficiary History File is not available via the CRT's).
In the reasonable charge module, the claim is priced by the doctor's/
supplier's customary charge or by the prevailing charge. After the
claims are entered into the system, they are forwarded to the "Freeze
Files," where they are filed in control number order. (NOTE: After
CRT entry, the claim enters the "batch" system and is processed to
completion.
Duplicate Check/Query Reply Exceptions
Claims which cannot be processed to completion are "kicked out 'of the
system as exceptions. Exception report print-outs and "turnaround cards"
are computer generated. The exception claims are manually corrected and
re-entered into the system using the "turnaround cards."
Completed Claims
Claims which appear on the daily completed claims listing are purged
from the "Freeze Files" and forwarded to the Review and Files Section
for preparation for microfilming.
Microfilming
Claims are microfilmed by completed date and in control number order.
Two reels of film are made simultaneously. The film is processed and
reviewed in the Claims Service Department. The film and claims are then
forwarded to the Medicare Part B Claims Department, where the film is
FORD & LIBRARY SERALD
1.3
verified. The SSA 5% sample claims and claims for beneficiaries who
have Medicaid coverage are forwarded to the Social Security Adminis-
tration and the Medicaid Agencies respectively, and the remaining com-
pleted claims are prepared for shipment to the Federal Records Center.
FORD is LIBRARY GERALD
1.4
Jam 3 (1470-
Discoved in Mailycom
2) Envelopes sliced
)ferworded to Med.
Part 6 Claims Dept.
formed Mad. Mail Del
) Remard from envelop
) Sisted by type of
claim form ? Die bdy
SSA - 1490
SSA- - 1554, 1556
1) Check Cost for
SSA 7491
SSA - 1490 a
HIC Lockup
Hie
2) If found, record on
claim
i) Scan Claims
2) Sort into groups
y
2
GERALD FORD LIBRARY
<
China requiring was
Claims rady
Claims regining
for spins frior to
for CRT input
Dru., industring AR
RRT input
surgery
6
4
7
) Resich 5 digit
Centrol Number
2) Stamp Julian
Date
5
for moderned
recul: of only della
2VDrK insur ¿
(Eas. Cig.
Does
Jaim poss
1) Use susprise of
No
less: Charge
has Chg
2) Exanded for
Manual Review
Yes
Enter claim into
1) horows claim
Wotel 5 Ratch
this appropriate and
System
2) Pturns to
(Histon)
CRT
Distalls chem
Donlers in.
Che Into
().1
RALD GERALD AIRPANY FORD
1)Wcrk
Cors claim
pass DUD
No
Exception
Check ?
2)po-enter
998
1) Work
Doas claim
foss - Query
No
Exception
Quiry Peply
2) A-enter
Yes
Completed Claims
Microfilm
completed claims
merofit of storage
Q
Completed Claims
FORD & LIBRARY GERALD
DRIVIRWS claim
2)Creates spht
3)Completes recessary
Coding
Hosidain been
1/0
controlled ?
6
Yes
5
GERALD R. LISBARY FORD
claim
2) Wermines ifo
required
Dissign 5 dicit
CH number
Con info be
district same
No
2) Stamp Juhan
dow?
Date
et;
Eries cy; CRT
Obtain
as CH only
Imfo
Process Control
Conterance to
Los down
EDOMS split / acdive No
Brior to
4
update booten /
CRT?
No
Status
is
Forwards to
appropriate
6
personnel
Obtain
info
4
BERALD
BARY
MEDICAL SERVICE OF D.C.
UTILIZATION REVIEW DEPARTMENT
DATE DEC 1975
PHYSICIAN PAYMENT REGISTER (YEAR TO DATE)
PAGE NO
64
DOCTOR
TOTAL
AVERAGE /
TOTAL
AVERAGE /
TOTAL
AVERAGE /
SPE-
NUMBER
NAME
TOTAL PAID
PATIENTS
PATIENT
SERVICES
SERVICE
CLAIMS
CLAIM
CIALTY
194,738.40
8,943
133.59
19,340
61.78
16,461
72.58
01
865,999.56
6,211
139.43
19,256
44.97
8,563
101.13
49
855,306.61
4,192
204.03
11,952
71.56
10,165
84.14
16
655,539.28
11,462
57.19
13,511
48.52
13,129
49.93
30
454,253.42
160
2,839.08
1,297
350.23
653
695.64
11
452,183.45
1,623
278.61
3,048
148.35
2,307
196.00
35
439,452.99
3,370
130.40
10,364
42.40
5,189
84.69
99
427,946.46
8,085
52.93
9,811
43.62
9,584
44.65
30
424,176.95
3,129
135.56
6,786
62.51
4,922
86.18
20
421,989.38
2,728
154.69
6,270
67.30
3,481
121.23
13
419,177.02
538
779.14
1,821
230.19
1,138
368.35
26
392,804.00
3,454
113.72
6,828
57.53
6,238
62.97
16
354,734.71
4,899
72.41
7,798
45.49
7,575
46.83
20
343,653.52
3,925
87.56
4,259
80.69
4,258
80.71
05
338,426.63
1,540
219.76
7,182
47.12
4,637
72.98
34
324,884.50
3,130
103.80
11,975
27.13
7,188
45.20
11
314,489.28
3,772
83.37
4,101
76.69
4,030
78.04
49
305,899.39
3,613
84.67
4,042
75.68
3,937
77.70
05
304,657.53
4,778
63.76
10,840
28.10
8,354
36.47
01
302,965.56
8,461
35.81
13,562
22.34
12,146
24.94
22
298,993.90
87
3,436.71
901
331.85
373
801.59
49
285,085.24
4,706
60.58
10,966
26.00
7,268
39.22
08
278,108.15
8,763
31.74
12,077
23.03
10,986
25.31
22
276,768.36
1,769
156.45
6,105
45.33
3,006
92.07
11
271,822.72
1,688
161.03
7,173
37.90
3,546
76.66
11
262,493.96
12,615
20.81
14,573
18.01
14,599
17.98
01
261,035.30
1,225
213.09
1,619
161.23
1,523
171.40
16
254,840.71
1,755
145.21
3,105
82.07
2,200
115.84
11
247,599.08
2,230
111.03
6,319
39.18
3,496
70.82
34
246,813.57
4,880
50.53
5,378
45.89
5,369
45.97
30
245,600.35
2,068
118.76
3,916
62.72
3,220
76.27
16
237,897.30
421
565.08
1,041
228.53
549
433.33
33
223,354.52
1,116
200.14
6,028
37.05
2,967
75.28
11
217,109.55
2,888
75.18
4,719
46.01
4,049
53.62
44
216,556.70
2,414
89.71
4,039
53.62
3,100
69.86
20
215,906.51
1,079
200.10
3,046
70.88
2,184
98.86
16
215,475.04
673
320.17
4,084
52.76
2,189
98.44
11
GERALD
P
215,468.65
1,454
148.19
4,347
49.57
3,358
64.17
11
215,406.83
1,072
200.94
1,579
136.42
1,264
170.42
16
209,708.17
1,129
185.75
2,162
97.00
1,531
136.97
16
FORD
205,476.89
673
305.31
2,753
74.64
1,641
125.21
16
202,987.58
10,245
19.81
11,791
17.22
11,797
17.21
01
202,014.60
2,101
96.15
3,362
60.09
3,011
67.09
16
201,023.09
11,838
16.98
13,094
15.35
LIBRARY
13,163
15.27
01
200,066.15
1,302
153.66
2,412
82.95
1,694
118.10
16
198,805.10
980
202.86
2,695
73.77
1,778
111.81
20
** TC41Y ** DOCTOR UTILIZATION REVIEW
01/21/76
PHYSICIAN PAYMENT REGISTER (YEARLY REPORT)
BY SPECIALITY WITHIN COUNTY
COUNTY = 01
SPECIALITY = 07
DOCTOR
DOCTOR
TOTAL
TOTAL
AVERAGE /
TOTAL
AVERAGE /
TOTAL
AVERAGE /
NUMBER
NAME
PAID
PATIENTS
PATIENT
SERVICES
SERVICE
CLAIMS
CLAIM
196,575.95
1,698
115.77
3,110
63.21
2,390
82.25
72,141.93
912
79.10
1,876
38.46
1,492
48.35
72,044.33
976
73.82
2,670
26.98
2,311
31.17
66,424.50
776
85.60
1,946
34.13
1,468
45.25
51,361.40
396
129.70
873
58.83
662
77.59
30,899.84
798
38.72
1,563
19.77
1,377
22.44
27,053.02
478
56.60
921
29.37
744
36.36
24,150.56
444
54.39
1,078
22.40
910
26.54
24,056.50
364
66.09
638
37.71
536
44.83
24,002.50
531
45.20
960
25.00
733
32.75
23,334.08
397
58.78
720
32.41
497
45.95
22,324.45
439
50.85
1,053
21.20
834
26.77
13,974.46
228
61.29
481
29.05
353
39.59
13,301.42
162
82.11
275
48.37
232
57.33
8,464.00
242
34.98
418
20.25
401
21.11
7,954.73
158
50.35
191
41.65
174
45.72
6,611.60
179
36.94
307
21.54
248
26.66
6,054.90
82
73.84
110
55.04
86
70.41
5,909.59
130
45.46
169
34.97
162
36.48
5,235.40
80
66.07
141
37.49
111
47.62
3,119.25
115
27.12
190
16.42
166
18.79
2,534.00
64
39.59
78
32.49
10
36.20
1,953.00
49
39.86
84
23.25
53
36.85
1,796.00
49
36.65
59
30.44
57
31.51
75.00
01
75.00
01
75.00
01
75.00
55.75
03
18.58
03
18.58
03
18.58
0.00
02
0.00
00
0.00
02
0.00
SUB TOTALS FOR SPECIALITY ** 07 ** WITHIN THE COUNTY ** 01 ** ARE:
AMOUNT PAID
TOTAL PATIENTS
AVERAGE/PATIENT
TOTAL SERVICES
AVERAGE/SEPVICE
TOTAL CLAIMS
AVERAGE/CLAIM
711,458.16
9,753
72.95
19,915
35.72
16,073
44.20
GERALD
FORD
LIBRARY
MEDICAL SERVICE UTILIZATION REVIEW
DATE 01/21/76
PHYSICIAN PRACTICE ANALYSIS SUMMARY REPORT
PAGE
2
SPECIALTY AVERAGES
,
SPECIALTY
DESCRIPTION
AVERAGE NUMBER OF SERVICES FOR
AVERAGE
AVERAGE %
OF SERVICE
POT1
POT2
POT3
SERVICES
OF INCOME
01
ANESTHESIA
001
000
000
001
0.3
01
ASST. SURGEON
001
000
000
001
0.4
01
CONSULTATIONS
002
000
000
002
0.8
01
EEG
000
000
000
000
0.1
01
EKG
000
000
033
033
5.5
01
LABORATORY
000
006
212
219
32.8
01
MATERNITY
001
000
000
001
1.9
01
MEDICAL CARE
016
040
012
069
19.1
01
PHYSICAL THERAPY
000
000
000
000
0.0
01
PSYCHOTHERAPY
001
000
000
001
1.2
01
RADIOTHERAPY
000
000
004
004
1.2
01
SURGERY
005
072
058
136
29.2
01
X-RAY
000
001
043
043
7.3
01
OTHER
000
000
001
001
0.1
PEER GROUP AVERAGES
027
121
364
512
100.0
PEER GROUP AVERAGE # OF PATIENTS
296
PEER GROUP AVERAGE # OF CLAIMS
412
SPECIALTY
DESCRIPTION
AVERAGE NUMBER OF SERVICES FOR
AVERAGE
AVERAGE a
OF SERVICE
POT1
POT2
POT3
SERVICES
OF INCOME
02
ANESTHESIA
000
000
000
000
0.0
02
ASST. SURGEON
002
000
000
002
0.8
02
CONSULTATIONS
009
000
000
009
1.6
02
EKG
000
000
003
003
0.3
02
LABORATORY
000
001
035
036
3.7
02
MATERNITY
000
001
000
001
1.2
02
MEDICAL CARE
012
007
003
022
5.0
02
PHYSICAL THERAPY
000
000
000
000
0.0
02
PSYCHOTHERAPY
000
000
000
000
0.0
02
RADIOTHERAPY
000
000
001
001
0.1
02
SURGERY
057
039
061
157
87.1
02
X-RAY
000
000
003
003
0.3
02
OTHER
000
000
000
000
0.0
PEER GROUP AVERAGES
080
048
106
234
100.0
PEER GROUP AVERAGE # OF PATIENTS
163
PEER GROUP AVERAGE # OF CLAIMS
199
GERALD GERALD FORD
MEDICAL SERVICE UTILIZATION REVIEW
DATE 01/21/76
PHYSICIAN PRACTICE ANALYSIS SUMMARY REPORT
PAGE
2
SPECIALTY WITHIN COUNTY AVERAGES
COUNTY
SPECIALTY
DESCRIPTION
AVERAGE NUMBER OF SERVICES FOR
AVERAGE
AVERAGE %
OF SERVICE
POT1
POT2
POT3
SERVICES
OF INCOME
01
01
ANESTHESIA
001
000
000
001
0.2
01
01
ASST. SURGEON
000
000
000
000
0.0
01
01
CONSULTATIONS
006
000
000
006
1.4
01
01
EEG
000
000
000
000
0.0
01
01
EKG
001
001
023
025
4.1
01
01
LABORATORY
001
001
205
207
21.2
01
01
MATERNITY
001
000
001
003
3.8
01
01
MEDICAL CARE
021
078
017
116
21.1
01
01
PHYSICAL THERAPY
000
000
000
000
0.0
01
01
PSYCHOTHERAPY
001
000
000
001
3.1
01
01
RADIOTHERAPY
000
000
004
004
0.8
01
01
SURGERY
016
091
044
152
38.0
01
01
X-RAY
000
000
045
046
6.0
01
01
OTHER
000
000
001
001
0.2
PEER GROUP AVERAGES
050
172
341
563
100.0
PEER GROUP AVERAGE # OF PATIENTS
332
PEER GROUP AVERAGE # OF CLAIMS
480
COUNTY
SPECIALTY
DESCRIPTION
AVERAGE NUMBER OF SERVICES FOR
AVERAGE
AVERAGE %
OF SERVICE
POT1
POT2
POT3
SERVICES
OF INCOME
01
02
ANESTHESIA
000
000
000
000
0.0
01
02
ASST. SURGEON
000
000
000
000
0.1
01
02
CONSULTATIONS
008
000
000
008
1.5
01
02
EKG
000
000
001
001
0.1
01
02
LABORATORY
000
002
028
029
3.2
01
02
MATERNITY
000
002
000
002
2.8
01
02
MEDICAL CARE
012
013
005
030
5.6
01
02
PHYSICAL THERAPY
000
000
001
001
0.0
01
02
PSYCHOTHERAPY
000
000
000
000
0.0
01
02
RADIOTHERAPY
000
000
000
000
0.0
01
02
SURGERY
060
037
066
164
86.5
01
02
X-RAY
000
000
002
002
0.2
01
02
OTHER
000
000
000
000
0.0
PEER GROUP AVERAGES
081
054
102
237
100.0
PEER GROUP AVERAGE # OF PATIENTS
167
PEER GROUP AVERAGE # OF CLAIMS
202
FORD
GERALD
LIBRARY
MEDICAL SERVICE UTILIZATION REVIEW
01/21/76
PHYSICIAN PRACTICE ANALYSIS SUMMARY REPORT
PAGE
3
INDIVIDUAL PHYSICIAN REPORT
DOC
CO SP
DESCRIPTION
TOTAL SERVICES FOR
TOTAL
TOTAL
TOTAL
% OF
% OF
AMOUNT
FLAG
NUM
OF SERVICE
POT1
POT2
POT3
SERVICES
ALLOWED
CHARGED
INCOME
DEV.
ABOVE
11
11
RADIOTHERAPY
000
000
001-
001-
016.50-
018-
21.3
19.5
015.11-
*
11
11
X-RAY
000
000
001-
001-
016.50-
020-
21.3
11.8
009.15-
*
01
11
LABORATORY
000
000
000
000
000.00
000
0.0
48.4-
000.00
01
11
MEDICAL CARE
000
000
001
001
002.40
175
100.0
78.4
001.88
*
01 01 EKG
000
000
005
005
098.75
104
2.1
2.0-
000.00
01 01 LABORATORY
000
000
112
112
4,544.10
4,964
95.8
74.6
3,539.66
#
01 01 RADIOTHERAPY
000
000
001
001
052.50
052
1.1
0.3
014.23
*
01 01 SURGERY
000
000
002
002
032.00
050
0.7
37.3-
000.00
01
01
X-RAY
000
000
001
001
017.50
025
0.4
5.6-
000.00
13
07
LABORATORY
000
000
002
002
034.50
036
3.8
3.7-
000.00
13
07
SURGERY
000
000
045
045
868.00
977
96.2
4.7
042.42
*
01
05
SURGERY
000
000
000
000
000.00
000
0.0
4.4-
000.00
23
18 MEDICAL CARE
000
000
001
001
042.00
042
0.8
6.1-
000.00
23
18
SURGERY
009
001
041
051
5,521.00
6,173
99.2
8.9
495.11
*
13
30 MEDICAL CARE
000
000
000
000
000.00
000
0.0
0.2-
000.00
13
30
SURGERY
000
000
000
000
000.00
050
0.0
3.6-
000.00
01 11 LABORATORY
000
000
002
002
031.00
036
100.0
51.6
016.00
*
13
02
ASST. SURGEON
001
000
000
001
030.19
225
0.1
0.1-
000.00
13
02 CONSULTATIONS
026
000
000
026
821.92
875
2.9
0.9
257.85
*
13 02 LABORATORY
000
000
013
013
065.50
097
0.2
6.0-
000.00
13
02 MEDICAL CARE
006
003
005
014
442.82
615
1.5
3.0-
000.00
13
02
SURGERY
072
025
104
201
27,289.74
33,527
95.3
10.1
2,893.67
*
01 01 LABORATORY
000
000
000
000
000.00
000
0.0
21.2-
000.00
01
01 MEDICAL CARE
000
000
002
002
091.86
455
70.7
49.6
064.41
*
01
01
SURGERY
000
000
001
001
038.00
153
29.3
8.7-
000.00
01 01 X-RAY
000
000
000
000
000.00
001-
0.0
6.0-
000.00
11 60 SURGERY
002
000
000
002
396.00
600
90.8
1.4-
000.00
11
60
X-RAY
001
000
001
002
040.00
040
9.2
1.6
006.98
*
01
24
ANESTHESIA
001
000
001
002
168.00
304
1.6
1.5
153.47
*
01
24
ASST. SURGEON
000
000
001
001
150.00
150
1.5
1.4
143.24
#
01
24 LABORATORY
000
000
000
000
000.00
001-
0.0
0.1-
000.00
01 24 24 SURGERY
012
005
042
059
9,913.42
11,231
96.9
1.9-
000.00
13 30 SURGERY
001-
000
001
000
122.00-
122-
100.0
96.4
117.61-
*
24
20
CONSULTATIONS
020
000
000
020
707.00
795
1.9
1.3
490.41
*
24
20 MEDICAL CARE
014
000
001
015
1,647.00
1,885
4.4
3.1-
000.00
24
20
SURGERY
085
039
208
332
34,940.40
39,850
92.6
29.5
11,128.46
*
MEDICAL SERVICE PAYMENTS TO PHYSICIANS
DOCTOR
DOCTOR
YEAR
YEAR
YEAR
NUMBER
NAME
1973
1974
1975
5,448.55
8,277.80
8,619.90
42,010.50
50,163.00
59,114.74
10.00
0.00
6,653.73
5,757.34
3,040.35
13.00
15.00
4,349.85
6,497.75
6,432.70
2.84
38.58
0.00
27,998.34
26,596.03
23,078.36
4,539.00
29,940.21
76,385.91
37,973.12
36,539.12
41,824.27
16,375.80
16,248.43
20,211.65
12,893.40
11,061.00
12,247.45
1,646.50
1,629.65
1,220.79
13,104.00
7,985.69
11,778.44
657.50
2,251.00
0.00
34,860.50
29,824.50
5,369.75
261.00
413.00
305.50
15.00
0.00
2,989.80
3,183.97
2,923.75
232.00
79.25
4.00
59,576.24
51,590.32
54,896.36
GERALD FORD LIBRARY
75/03/15
MEDICARE B THREE YEAR COMPARISON OF PAYMENTS TO PHYSICIANS
PAGE
7
PROVIDER
PROVICER
1974
1973
1972
NUMBER
NAME
AMOUNT
AMOUNT
AMOUNT
5,527.80
3,234.32
3,484.40
6,170.74
6,253.23
3,630.44
67.60
.00
.00
8,841.31
9,403.31
15,774.15
24.00
.00
.00
12,391.74
9,987.86
12,594.34
.00
235.20
.00
669.20
100.40
413.99
5,297.15
3,822.42
9,258.30
5,328.70
240.80
2,029.48
44.40
.CO
420.00
7,553.10
3,115.96
574.66
.00
.00
12.00
32,590.35
17,636.37
34,895.21
.00
.00
86.4C
4,544.28
3,250.32
3,053.40
4,409.71
3,537.88
4,119.56
409.00
825.40
378.40
2,589.58
2,409.93
2,037.36
135.20
16.00
331.20
27.20
156.80
84.00
637.08
360.00
.00
.00
36.48
.00
15,772.56
10,821.18
4,560.76
2.40
59.60
400.40
.00
.00
308.00
5,179.92
2,152.80
906.44
8,357.32
5,226.34
5,370.27
21,203.32
11,106.24
4,330.36
19,504.77
11,89C.04
7,236.30
1,882.17
3,792.65
6,472.06
.00
.CO
7.95
90.96
316.48
695.20
16.40
.00
18.00
8.00
528.00
.00
2,813.28
5,736.64
4,853.75
.00
52.48
502.96
.00
36.80
.CC
4,712.56
5,504.84
2,234.90
968.00
.00
.00
97.60
124.80
140.00
224.00
97.60
265.60
.00
1,001.48
3,819.00
2,571.56
3,304.88
1,610.56
.00
2,550.97
2,035.76
40.00
188.00
9.60
432.16
611.84
2,538.88
690.20
.00
.00
FORD
225.60
.CO
.00
.00
.00
641.97
GERALD
LIBRARY
SPECIAL MEDICARE B DOCTOR SELECT REPORT
01/24/76
SUPPLEMENTAL CONTROL SHEET
FOR PROVIDER
PROVIDER NUMBER
1976
PAID PROVIDER
PAID BENEFICIARY
ALLOWED
SUBMITTED
PERCENT OF TOTAL
TOS 1
$3,483.04
$.00
$5,082.30
$6,785.00
66.78
TOS 2
$94.32
$.00
$117.90
$220.00
2.17
TOS 3
$1,281.60
$.00
$1,770.00
$2,440.00
24.02
TOS 4
$.00
$.00
$.00
$.00
0.00
TOS 5
$386.72
$.00
$591.20
$715.00
7.04
TOS 6
$.00
$.00
$.00
$.00
0.00
TOS 7
$.00
$.00
$.00
$.00
0.00
TOS 8
$.00
$.00
$.00
$.00
0.00
TOS 9
$.00
$.00
$.00
$.00
0.00
TOS 0
$.00
$.00
$.00
$.00
0.00
TOTAL
$5,245.68
$.00
$7,561.40
$10,160.00
100.01
1975
TOS 1
$69,592.78
$842.96
$94,308.45
$125,620.00
81.78
TOS 2
$1,068.16
$.00
$1,409.20
$2,135.00
1.39
TOS 3
$6,101.76
$47.20
$8,635.00
$13,295.00
8.65
TOS 4
$632.80
$.00
$899.20
$1,240.00
0.81
TOS 5
$5,847.08
$116.32
$8,410.00
$10,928.50
7.11
TOS 6
$.00
$.00
$.00
$.00
0.00
TOS 7
$.00
$.00
$.00
$.00
0.00
TOS 8
$.00
$.00
$.00
$.00
0.00
TOS 9
$24.00
$.00
$30.00
$393.00
0.26
TOS 0
$.00
$.00
$.00
$.00
0.00
TOTAL
$83,266.58
$1,006.48
$113,691.85
$153,611.50
100.00
1974
TOS 1
$88,684.08
$305.08
$117,524.80
$155,754.88
88.70
TOS 2
$645.28
$18.80
$925.85
$1,355.00
0.77
TOS 3
$3,010.40
$200.00
$4,543.25
$7,195.00
4.10
TOS 4
$1,077.48
$.00
$1,505.70
$1,795.00
1.02
TOS 5
$5,017.44
$38.40
$7,411.50
$8,784.00
5.00
TOS 6
$.00
$.00
$.00
$.00
0.00
TOS 7
$.00
$.00
$.00
$465.00
0.26
TOS 8
$.00
$.00
$.00
$.00
0.00
TOS 9
$.00
$.00
$.00
$255.55
0.15
TOS 0
$.00
$.00
$.00
$.00
0.00
TOTAL
$98,434.68
$562.28
$131,911.10
$175,604.43
100.00
BERALD BERALDR.
UR-POST0540/2 1.2
NATIONAL ASSOCIATION OF BLUE SHIELD PLANS
DATE 01/31/76
PAGE
29
UR INFORMATION RETRIEVAL SYSTEM
PROVIDER IDENTIFICATION REPORT
PROVIDERS WHOSE NUMBER OF PATIENTS RECEIVING A SPECIFIC PROCEDURE EXCEEDS HIS PEER GROUPS
AVERAGE NUMBER OF PATIENTS RECEIVING THAT SAME PROCEDURE BY MORE THAN
2.0 STANDARD DEVIATIONS
PROVIDER
TS/PROC
NUMBER-OF-SER
NUMBER-OF-PAT
SV/PAT-RATIO
P/TP
%-CHANGE
RECENT-4-QUARTERS
AVE-CHG/PATIENT AVE-ALL/PATIENT LOB
NUMBER
CODE
PROV
PG-AVE
PROV
PG-AVE
PROV
PG
RATIO
SER
PAT
$-CHARGED
$-ALLOWED
PROV
PG
PROV
PG
067056
23
11
05
02
4.6
5.1
0.06
109+
67+
520
249
104.00
104.61
49.80
71.09
04
067078
09
06
06
02
1.5
3.6
0.07
29+
20+
470
349
78.33
120.88
58.17
56.00
04
0E7900
02
01
02
01
1.0
1.0
0.00
100+
100+
509
441
254.50
96.00
220.50
86.44
04
097
316
17
273
14
1.2
1.2
0.25
15-
19-
4,911
2,050
17.99
27.75
7.51
13.79
04
097900
72
11
72
10
1.0
1.1
0.06
1-
1-
9,354
6,590
129.92
122.06
91.53
84.20
04
099557
29
05
28
05
1.0
1.0
0.03
71+
75+
1,685
1,076
60.18
63.40
38.43
38.18
04
099630
835
91
753
80
1.1
1.1
0.68
2+
1+
24,842
20,779
32.99
32.24
27.59
27.20
04
060678
07
03
04
01
1.8
2.3
0.33
0+
0+
670
78
167.50
111.64
19.50
16.05
04
088746
06
03
06
02
1.0
1.1
0.04
500+
500+
35
34
5.83
6.41
5.67
6.00
04
020103
123
07
44
03
2.8
2.2
0.94
208+
69+
1,935
1,345
43.98
35.71
30.57
24.57
04
088002
56
07
43
07
1.3
1.1
0.34
24+
34+
1,092
970
25.40
25.04
22.56
22.81
04
020445
10
03
10
03
1.0
1.1
0.11
20-
20-
1,785
1,220
178.50
204.38
122.00
145.24
04
023311
09
03
09
03
1.0
1.1
0.10
33-
22-
270
158
30.00
34.80
17.56
21.08
04
088692
20
04
17
03
1.2
1.3
0.10
33+
42+
218
205
12.82
17.38
12.06
14.70
04
088746
11
03
07
02
1.6
1.3
0.04
0+
0+
71
71
10.14
7.64
10.14
7.15
04
088919
17
04
16
03
1.1
1.1
0.09
31+
33+
102
98
6.38
7.34
6.13
6.23
04
020103
172
16
94
09
1.8
1.7
0.08
2-
6-
3,864
2,950
41.11
38.14
31.38
28.95
04
020173
03
02
03
01
1.0
1.4
0.00
100-
100-
140
120
46.57
44.54
40.00
38.92
04
020369
56
05
55
04
1.0
1.1
0.04
17+
17+
657
429
11.95
14.31
7.80
8.64
04
020386
10
02
10
02
1.0
1.3
0.01
60-
60-
94
71
9.40
13.33
7.10
9.02
04
020424
41
07
23
04
1.8
1.7
0.02
29-
26-
972
877
42.26
37.59
38.13
34.06
04
057101
168
18
158
17
1.1
1.1
0.13
2-
6-
3,654
2,782
23.13
23.18
17.61
17.70
04
LIBRARY
UR-POST0540/5
1.2
NATIONAL ASSOCIATION OF BLUE SHIELD PLANS
DATE 10/09/75
PAGE 37
UR...INFORMATION RETRIEVAL SYSTEM
PROVIDER PRACTICE SUMMARY
PROVIDER
TS/PROC
*******QJARIERS
1-4*******
SV/PAT
P/TP
NUMBER
PG AVE
STD DEV
FLAG
PROVIDER
LOB
PEER
NUMBER
CODE
CHARGED
ALLOWED
RATIO
RATIO
SERVICES
SERVICES
SERVICES
NUMBER
GROUP
020171
7)
49
1.00
0.01
02
07
10.74
04 07 11
020172
00
00
0.00
0.00
00
06
4.01
020174
190
171
1.00
0.02
03
02
0.93
020181
55
52
1.00
0.01
01
02
1.10
020193
00
00
0.00
0.00
00
05
4.63
020402
57
50
1.00
0.01
02
04
3.74
020403
00
00
0.00
0.00
00
02
1.13
020404
UJ
00
0.00
0.00
00
03
1.69
020410
115
57
1.00
0.01
02
06
6.04
020415
22
18
1.00
0.01
02
06
8.05
020416
183
112
1.10
0.06
11
09
8.35
020418
4)
18
1.50
0.01
03
03
3.20
020419
55
48
1.00
0.02
04
04
4.03
020424
53
48
1.00
0.01
02
13
16.43
020429
20
08
1.00
0.01
01
05
8.67
022000
175
21
1.00
0.01
02
14
17.79
023311
20
16
1.00
0.01
01
01
0.00
TYPE SERVICE TOTALS
1,552
1,015
64
057605
3)
25
1.00
0.01
02
02
0.00
04 07 11
TYPE SERVICE TOTALS
3.)
25
02
060678
117
21
1.80
0.02
07
17
20.91
04 07 11
060679
4!
38
1.00
0.01
01
04
4.13
067042
105
35
7.00
0.01
07
07
0.00
067056
85
38
1.50
0.01
03
03
0.00
067078
105
35
7.00
0.01
07
04
3.00
TYPE SERVICE TOTALS
454
167
25
087
50
49
1.00
0.02
03
08
7.05
04 07 11
087000
32
05
1.00
0.01
01
02
1.14
087900
2,917
2,592
1.10
0.31
56
29
29.97
088000
05
06
1.00
0.01
01
01
0.00
088001
05
05
1.00
0.01
01
06
6.81
089002
12
10
1.00
0.01
01
02
1.79
088411
13
10
1.00
0.01
01
06
6.36
088628
13
17
1.00
0.02
03
04
2.08
088900
133
121
1.00
0.01
02
02
0.71
088903
52)
403
1.20
0.12
24
56
43.19
088919
02
04
1.00
0.01
01
01
0.00
088920
20
16
1.00
0.01
01
01
0.00
FORD
088933
07
07
1.00
0.02
03
02
1.41
088950
300
241
1.10
0.08
15
09
5.82
GERALD
LIBRARY
Part. 7049
Date: 3/11/76
Specialty: 70 Podiatry
County:
Montgomery
Soc. Sec.
Problem:
Statistical Data:
Blue Shield
Medicare
CHAMPUS
Supplemental
Income 1972
--
$39,476.13
--
--
1973
$23,492.31
GERALD
39,602.75
--
--
1974
12,107.12
977.44
$623.62
--
Y'TD 1975
14,052.10
338.40
590.00
$144.80
Jan. YTD 1976
$
260.00
--
$ 15.00
--
BLUE SHIELD
Total
Average/
Total
Average/
Total
Average/
Patients
Patients
Services
Services
Claims
Claims
December 1975
113
124.35
405
34.70
231
60.83
YTD 1976
10
26.00
13
20.00
10
26.00
Average for
Physicians
Speciality
within County
121.51
39.82
62.85
FOT
POT
POT
TOTAL
: of
S OF
Service
IL
2
3
ALLOWED
INCOME
DEVIATION
AMOUNT ABOVE
Surgery
4
0
265
$10,660.50
75.9
1.4-
--
X-ray
0
0
101
2,956.00
21.0
5.7
$800.97
Lab
0
0
38
630.50
4.5
---
1.9-
Radiotherapy
0
0
1
49.00
0.3
0.2
28.10
MEDICARE
Medical
Surgery
X-ray
Lab
Care
Service
Consult.
Service
Service
Anesth.
Other
Submitted charges,
1974
$18,982.10
$18,122.10
0
$3,105.30
$686.00
0
$2,224.00
% of submitted
charges, 1974
44.02%
42.03%
0
7.20%
1.59%
0
5.16%
Submitted charges
$30,120.00
$19,688.50
0
Dec. YTD 1975
$3,500.00
$626.00
0
$7,526.00
% of submitted
charges
49.01%
32.03%
0
5.69%
1.02%
0
12.25%
File
Box
pro
Programs for
the Aged
FORD LIBRARY y GERALD
MARAGE RESIDENT STATE a
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
DATE: 5/30/75
TO:
Art Quern
FROM:
Don DAN
ood
Per your conversation with Bill
Fischer, attached is a description
of the current status of the Foster
Grandparents Program.
3312
are
REFORD is LIBRARY GERALD
OMB FORM 38
REV AUG 73
тизакзяя 3HT 70 301790
T30008 ФИА ТИЗМЗОЛИАМ 10 301370
25/08/2, 13TAO
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shel - mo he b ACTION OAM & wol AP loN E VITOD 1409 a
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or our van
May 30, 1975
ACTION - Foster Grandparent Program
FY 1975
FY 1976
No. of Volunteers Funded
12,200
11,130
Budget Authority
$28,260,000
$25,903,000
Volunteers - low income persons 60 years of age and over -
serve four homes a day, five days a week. They receive a
stipend of $1,670 per year.
The 1976 budget request would continue all existing projects
at a slightly lower level than FY 1975. No volunteers are
planned to be terminated, however, approximately one-half
of the volunteers who leave the program would not be replaced.
The proposed funding decrease was a choice made with the intent
of restricting the total size of the ACTION budget without
impairing projects for the Older Americans Programs.
It now appears, however, that sufficient funds will be available
from 1975 grant monies to enable ACTION to make grants for this
program at such a level that no reduction in volunteer strength
will be required. A letter to the Appropriation Committees to
this effect is being prepared by ACTION.
FORD i LIBRARY GERALD
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.:
Date: June 5, 1975
Time: 730pm
FOR ACTION: Art Quern
CC (for information): Jim Cavanaugh
Max Friedersdorf
Jack Marsh
Ken Lazarus
Paul Theis
FROM THE STAFF SECRETARY
DUE: Date:
Time:
June 6
400pm
SUBJECT:
Annual Report-Federal Council on the Aging
ACTION REQUESTED:
For Necessary Action
X
For Your Recommendations
Prepare Agenda and Brief
Draft Reply
X
For Your Comments
Draft Remarks
REMARKS:
Please return to Judy Johnston, Ground Floor West Wing
I support the OMB recommendations and draft.
FORD is LIBRARY GERALD
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
James E. Coverage
telephone the Staff Secretary immediately.
For the
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
STATE
SENS
WASHINGTON, D.C. 20503
MAY 15 1975
MEMORANDUM FOR MR. WARREN HENDRIKS
Subject: Annual Report of the Federal Council on the Aging
Attached in response to your request is a draft of Presidential
comments and recommendations on the Annual Report of the Feder-
al Council on the Aging (FCA) for transmittal to the Congress.
Background
The FCA is appointed by the President with the advice and con-
sent of the Senate. The FCA considers its ideal role to con-
sist of a "delicate blend of powers and leadership in planning,
coordination, development, and advocacy." As such, it reviews
Administration policy and Federal agency activity and works in
concert with the Administration on Aging, serving as a spokes-
person on behalf of older Americans.
In addition, the FCA is required by the enabling legislation
to prepare and submit to the Congress three special studies:
(1) Effects of the formulae for allocation of Older
Americans Act (OAA) funds with recommendations
to the Congress. (This study was completed but
recommendations were not included in any versions
of the proposed modifications of the Older
Americans Act).
(2) A study of the interrelationships of benefit pro-
grams for the elderly operated by Federal, state,
and local government agencies.
(3) A study of the combined impact of all taxes on the
elderly.
The latter two studies are not completed and the Administration
has requested an extension of the required reporting dates in
our legislative proposal for the extension of the OAA.
FORD is LIBRARY GERALD
2
Comments
The report clearly does not support the Administration's fiscal
policy (see page 7). It contains several inaccuracies--the
enabling authority language is modified (see page 1) ; there is
no separate line item in the President's FY 1976 Budget (see
page 3).
We also draw your attention to the lack of supporting data and
analysis which would enable the FCA to justify or rationalize
their policy positions and recommendations as well as permit
more responsive Presidential comments.
Recommendations
The OAA requires the President to transmit the annual report
to the Congress together with his comments and recommendations.
The transmittal letter should point out the mandated advocacy
role nature of the FCA, avoid reference to errors in the report,
and re-emphasize the need for FCA to complete the required
studies in a timely fashion. We have drafted the required
transmittal.
Paul H. O'Neill
Deputy Director
Attachment
GERALD FORD
THE WHITE HOUSE
Washington
TO THE CONGRESS OF THE UNITED STATES:
Secretary Weinberger has forwarded the Annual Report of
the Federal Council on the Aging to me, and I hereby transmit
this document to the Congress together with my comments and
recommendations.
The Federal Council on the Aging was established by the
1973 amendments to the Older Americans Act of 1965 to advise
and assist the President on matters relating to the special
needs of older Americans, and for other purposes specified
in the enabling legislation. Members of the Federal Council
on the Aging were appointed June 5, 1974. The Federal Council
on the Aging considers its role to consist of a "delicate
blend of powers and leadership in planning, coordination,
development, and advocacy."
As the annual report indicates, the Federal Council on
the Aging has undertaken a number of advocacy activities
pursuant to their legislated mandate. The report, as sub-
mitted to me for transmittal, does not include supporting
FORD & LIBRARY GERALD
2
data or analysis which would provide the basis for a detailed
review of the stated policy positions and recommendations.
The Administration, on behalf of the Federal Council on
the Aging, has requested the Congress to authorize an exten-
sion until January 1, 1976, of the date for submission to
the Congress of two legislatively mandated studies underway
by the Federal Council on the Aging.
One study would review the interrelationships of all
benefit programs operated by Federal, state, and local
agencies to save the elderly. Such information could pro-
vide a useful perspective for the Executive Branch and the
Congress to rationalize, improve, and more effectively
target our Nation's limited resources on those most in need.
A second study of combined impact of all taxes on the
elderly could also provide insight into the relative values
and limitations of public and private sector mechanisms to
address human needs. I look forward to the availability of
quality analysis and information which will assist in the
economical delivery of services to our elderly citizens.
The Council specifically recommends "legislative action
to develop high standards of safety and care in nursing homes."
The Department of Health, Education, and Welfare has set high
GERALD LIBRARY
3
standards of nursing home care and safety that must be met by
nursing homes participating in the Medicare and Medicaid pro-
grams. The enforcement of these standards is one of my Admin-
istration's highest priorities. Federal funds pay 100 percent
of the costs of inspection to monitor compliance with these
standards. The Federal Government pays its share of the
costs of meeting nursing home standards through health care
financing programs, primarily Medicare and Medicaid. Finan-
cial assistance is also made available by the Department of
Housing and Urban Development to assist nursing homes in
meeting selected fire safety standards.
The Council also expressed its concern about the effect
of restricting the rate of fiscal growth in several areas that
assist the elderly. I am and will continue to be sensitive to
the problem of inflation and the dilution of purchasing power
that affects the elderly. To improve the status of all
Americans (e.g., elderly, poor, rural, urban), it is necessary
to dampen inflationary pressures while at the same time work-
ing to assure a growing and productive economy. My 1976 Budget
was developed with this objective in mind.
This report provides a perspective and recommendations
which are, of course, limited to the particular area of
interest of the Federal Council on the Aging.
FORD & LIBRARY GERALD
4-
They do not reflect the Administration's policies which
must be formed in the context of a comprehensive review of
the total Federal role and capability to assist the aged in
light of other competing priorities.
FORD & LIBRARY GERALD
June 24, 1975
MEMORANDUM FOR:
JACK VENEMAN
FROM:
ART QUERN
SUBJECT:
Federal Council on the Aging
I learned today that the Federal Council on the Aging
which is a federally funded, semi-independent operation
housed in HEW is conducting two Congressionally mandated
studies with a target date of January 1, 1976, for a
report to the President and the Congress. The studies
are:
1.
A study on the interrelationship of all benefit
programs for the elderly.
--
Apparently the Council is negotiating to
have the Urban Institute prepare this study.
2.
A study to determine the combined impact of all
taxes on the elderly.
---
The Council plans to use work underway in
HUD (a broad property tax survey) and Treasury
(a study across the board of how taxes affect
the entire population).
I have expressed interest in working with the Council and
more particularly, in keeping in close touch with them as
they proceed with these studies. Staff of the Council
seemed to be quite ready to cooperate.
FORD & LIBRARY GERALD
FEDERAL COUNCIL ON THE AGING
WASHINGTON, D.C. 20201
THE DEVELOPMENT OF NEW NATIONAL POLICY CONCERNING THE FRAIL ELDERLY
The Federal Council on the Aging has adopted, as a major priority, the
development of national policy recommendations for that group among the
aging population which can be characterized as the "frail elderly". This
target group consists of persons, usually but not always over the age of
75, who require one or several supportive services in order to cope with
daily life. They are expected to become a sizable percentage of this
country's population well before the end of this century.
Concern is being expressed for this population in many quarters. They
comprise the major age grouping in nursing homes. Dissatisfaction with the
quality of care in a number of these institutions is responsible for the
veritable avalanche of proposals for improving institutional care -- and
possibly avoiding it with community-based alternatives.
The Federal Council on the Aging believes that there are no simple ap-
proaches to financing, planning and delivering a package of services to
these frail older persons. The Council does not necessarily conceive of
these as "health" services. Other major programmatic areas in the Federal
government such as social services, income and housing are equally involved.
The FCA has embarked on a process that will produce recommendations for
action by the Federal executive and legislative branches.
This process has and will involve a broad range of interested parties. A
seminar to which were invited national experts in the field was held on
March 13, 1975. Individual dialogue by FCA members and staff has been
initiated with gerontologists and other officials inside and outside govern-
ment. Special studies may be commissioned if the FCA feels they are needed.
Completed and ongoing related research efforts will be tapped for ideas.
This very document will be distributed to solicit recommendations using the
following outline which has been prepared by the Council's Task Force on
the Frail Elderly as a systematic means of obtaining information:
1.
POPULATION AT RISK
Can we achieve a public policy based on the hypothesis that there are
so many people so much at risk that at some certain point the program
of care gets "turned on"?
Are any one or several of the following the indicator of the population
at risk?
age, debility, income, race, sex, marital status, living arrange-
ment, milieu, geography.
FORD & LIBRARY GERALD
June 11, 1975
Federal Council on the Aging
2.
Can a basic set of services be determined?
Can there be a place where people can develop whatever is needed and
one's entitlement is access to that place that does whatever you need
rather than to an individual service (Morris personal services concept) ?
Is intensity and level of the service a criteria?
Is geography a factor in delivery and availability?
Should services be age-only or multi-generational. or both?
Are any one or several of the following the appropriate service package:
social casework, counseling, coordination, advocacy, brokering,
ombudsmanship and "benign oversight"
assessment: social, medical, etc.
reassessment
prescription, recommendation, plan
transportation
nutrition
maintenance: physical environment, personal support
3. SYSTEM OF SERVICES
What system should be developed to deliver the services?
How are roles of family and friends enhanced?
Should it be age oriented or multi-generational?
Should it be centralized or decentralized?
Should it be governmental - Federal, State, local?
Should it be regional or local jurisdiction
Should it be private - voluntary or proprietary?
Should it combine government and the private sectors?
Should it be categorical or generic?
FORD & LIBRARY
Federal Council on the Aging
3.
Are one or several of the following elements of a system of services:
a. planning - - coordination
b. assuring service
C. delivery
d. monitoring
Should the system be built on the existing health care system (Medi-
care - Medicaid) or the multi-generational social services (Title XX)
or the aged-only services (Older Americans Act) or a new system?
How complex and broad can a system be and still work?
4. MANPOWER NEEDS
Are new types of personnel needed to operate services for the frail
elderly? How defined?
What numbers of personnel will be required?
What kind of short- and long-range training will be needed?
5. SPONSORSHIP
Should the auspices or sponsorship of the system be any or several of
the following:
a. public or private
b. proprietary or non-profit
C. health or social services system
d. national, state, sub-state, local
What should be the relationship between and among existing social and
health planning agencies?
What should be the role of the individual citizen including the con-
sumer, client, patient?
What are roles of family, relatives, friends?
FORD is LIBRARY GERALD
Federal Council on the Aging
4.
6.
BENEFIT - ENTITLEMENT
Should it be a categorically funded, generic program for a target group?
Should it be an entitlement tied to an individual?
Should it be an insurance program?
Should the individual participate in cost-sharing through a deductible,
co-insurance or a means test?
7.
FUNDING - REIMBURSEMENT
Should there be provision for capital funding and start-up costs?
Should the services be financed through any or several of the following
measures:
general tax revenues
dedicated tax - trust fund - employer contribution
voluntary - mandatory
participation by consumer in premium payment
use of private insurance carrier
Federal - State - local match
voluntary funding .
vendor - voucher
direct payment to consumer
8. PHILOSOPHICAL RATIONALE
What services should the frail elderly have because they are citizens
and a population at risk? Are these services a right?
Can these basic assumptions be made: that these are services which
cannot be cashed out and that an income floor is guaranteed?
How can freedom of choice and self-determination be assured while at
the same time providing needed protection?
What should be the nature of filial responsibility?
FORD LIBRARY & GERALD
Federal Council on the Aging
5.
What should be the nature of filial responsibility?
How can family involvement be enhanced?
How can universality and equal access be assured?
How can there be sensitivity to racial minority needs?
Are there special problems for frail older women?
How can the role and status of the frail elderly in society be maxi-
mized and enhanced regardless of their level of productivity?
Should need be the only criterion for service? Should age be the only
criterion for service?
How is quality of services monitored?
FORD LIBRARY j GERALD
16/23
Cleo Tarani
1. Berther Altekina
re apportment & Feel Councel
on Agency
2. Council (mandated
priorities:
a) interrelationship of beneft
VON
programs for the elderly
-- Urban Institute
-- recommendations Dr Rres
b) determines combined
impact of all takes
VAN
on elderly (state
NOD
-- property tax study
&
helson
me Clung
Preasuz: request re
BLS: Consumer Expenditure Survey
s
c
Frail Elderly
what services
how finance
means text
FORD i LIBRARY 076870
4 * *
OFFICE OF THE VICE PRESIDENT
WASHINGTON
June 26, 1975
MEMORANDUM FOR ART QUERN
File
FROM:
JACK VENEMAN
SUBJECT:
Federal Council on the Aging
Regarding the Federal Council on Aging, enclosed is a copy of
a letter I received from Bob Harris of the Urban Institute.
When I was on their Board, I recommended that they take on
a project to do an independent study of social security financing
which I believe is underway.
In any event, they are doing a lot of work in the aging field, and
I am sure that we can have access to virtually all of their
material.
Maybe we should have lunch with Bill Gorham and Bob Harris
one of these days.
Attachment
FORD i LIBRARY GERALD
25.
THE URBAN INSTITUTE 2100 M STREET, N.W. WASHINGTON, D.C. 2003
ROBERT HARRIS
Senior Vice President
June 20, 1975
Honorable John Veneman
Counselor to the Vice President
The White House
Washington, D.C.
Dear Jack:
I am responding to your request for information on work we are doing
relating to the elderly, in Bill Gorham's absence. The Urban Institute is
engaged in a number of projects that are relevant, but most are fairly new
and thus have yet to reach any conclusions. I have selected work that is
directly targeted on the aged, or which is problem-oriented but where the
relevance to the elderly is clear and strong. What follows is not a compre-
hensive review--as most of our work has some implications for the elderly.
Income of the Aged. We have a number of studies underway which focus
on earnings, wealth distribution, private pensions, social security, and
longer run trends in factors affecting income distribution. Much of this
work bears on income adequacy of the aged. These are long-term ongoing
projects. The Social Security and private pension studies, which you
encouraged us to develop last year, are fairly new. Some results will be
available this year--but the bulk of the findings will come later.
Combined Benefits. We will be starting work soon on a study for the
National Council on Aging to define and measure the combined benefits
available to the elderly under multiple programs and to analyze the way in
which these programs interact (e.g., what benefits are lost or reduced
when Social Security benefits are increased). In addition, we will try to
pinpoint important gaps in coverage. This study will review all federal
programs and selectively survey a number of states' program packages. The
contract calls for completion in about six months-so results will be
available soon. (This study is in response to a congressional mandate to
the Council.)
Income Maintenance. The above cited studies are part of our income
maintenance group agenda. In addition, other work in the group is relevant
although not focused on the aged per se. For example, we have programmed an
SSI module for the TRIM model, which allows us to prepare estimates of
utilization of that program by the aged, and to measure the impact of SSI on
FORD is LIBRARY GERALD
Honorable John Veneman
- 2 -
June 20, 1975
income of the aged. A Food Stamp module can be similarly used. We expect
over the next year to develop a Medicaid module for TRIM. As you know, the
aged are heavy users of Medicaid, and thus we will be able to conduct analyses
of the impact of the program on that group as well as others. A Medicare
module will also be added to TRIM as part of the study in the National Council
on Aging.
Comprehensive Needs of the Most Severely Handicapped. As you know, the
most severely handicapped are now excluded from vocational rehabilitation
programs--because favorable vocational outcomes are unlikely. In response to
a congressional mandate to HEW for a review of the needs of that excluded group,
the Urban Institute was commissioned last year to conduct a Comprehensive
Needs Study (CNS) of "individuals most severely handicapped" (IMSH). That study
is nearing completion, and will be of great interest to policy makers concerned
with problems of the aged. From original surveys that we conducted, as well
as from analyses of other data sources, we found that over 50% of the IMSH
are over 50. These individuals are generally precluded from rehabilitation
services because they are unlikely to be able to get jobs--yet clearly
rehabilitation services could enhance their ability to function independently.
There are many clear policy implications of the study that bear directly on
needs of the aged.
A draft report has been submitted to HEW for review. A revised version
will be ready in several weeks, and you will no doubt see it when it is
submitted by HEW for clearance prior to submittal to Congress.
Transportation. Our work on para-transit, with which you are familiar,
has implications for the aged, since such programs as dial-a-ride, shared
taxis, etc., frequently are designed with a view towards the needs of the
aged. We have recently completed a book reviewing experience with such
transit systems and assessing future potential. We are working closely
with the Urban Mass Transit Administration of DOT on the design and evaluation
of demonstration projects. One such project is to provide discounted vouchers
for payment for taxi services. The project is designed with three integral
objectives:
to improve the limited mobility of the elderly and other trans-
portation disadvantaged groups through their use of the tickets;
to implement a subsidy mechanism dependent upon the use of the
transportation service being provided; and
to provide an opportunity for taxi operators to maintain economic
viability by offering more flexible taxicab services such as shared-
riding.
Two cities currently have pending applications to UMTA to implement a demonstra-
tion of this type.
GERALD FORD LIBRARY
Honorable John Veneman
- 3 -
June 20, 1975
Making Policy Research More Relevant. We are developing a project
which would attempt to make the results of our problem-oriented policy
research more available to those specifically concerned with policy towards
the elderly. As I have indicated above, much of our problem-oriented research
generates information on the needs and problems of the aged. We plan to
develop a new project focused on extracting those policy implications from
our other ongoing work, as well as from the problem-oriented policy research
of other organizations. I met with Commissioner Flemming two weeks ago to
discuss this idea, and he has encouraged us to develop a proposal for AOA.
We have since met twice with members of his staff to outline the scope of
such a project, and we will submit a proposal in August. This would be a
new one, and a most interesting approach.
If you are interested in papers that are available, or more detailed
information on any of these projects, please let me know.
Warmest personal regards,
Sincerely yours,
Bat
Robert Harris
CC: W. Gorham
H. Guthrie
FORD 3 LIBRARY GERALD
FilE AGING
FOR IMMEDIATE RELEASE
July 24, 1975
Office of the White House Press Secretary
THE WHITE HOUSE
TO THE CONGRESS OF THE UNITED STATES:
I am transmitting herewith the Annual Report of the
Federal Council on Aging, together with my comments and
recommendations.
The Federal Council on the Aging was established by
the 1973 amendments to the Older Americans Act of 1965 to
advise and assist the President on matters relating to
the special needs of older Americans, and for other pur-
poses specified in the enabling legislation. Members of
the Federal Council on the Aging were confirmed by the
Senate on June 5, 1974.
As the annual report indicates, the Federal Council
on the Aging has undertaken a number of advocacy activities
pursuant to its legislated mandate. The report, as sub-
mitted to me by the Secretary of Health, Education, and
Welfare for transmittal, does not include supporting data
or analysis which would provide the basis for a detailed
review of policy positions and recommendations.
Since the Council was only recently formed, the
Administration, on behalf of the Federal Council on the
Aging, has requested that the Congress authorize an
extension until January 1, 1976, of the date for submission
to the Congress of the two legislatively mandated studies.
One study calls for a review of the interrelationships
of all benefit programs -- Federal, State, local -- serving
the elderly. Such information could be useful to the
Executive Branch and the Congress to identify duplicative
and overlapping programs and to propose the necessary re-
forms so that our resources may be more effectively applied
to help those most in need.
A second study, dealing with the combined impact of
all taxes on the elderly, could also be helpful in deter-
mining the burdens and benefits of government actions as
they affect the Nation's elderly.
I look forward to the study reports to help us provide
an effective and economical delivery of services to our
elderly citizens.
The Council specifically recommends "legislative action
to develop high standards of safety and care in nursing
homes.' The Department of Health, Education, and Welfare
has set high standards of nursing home care and safety that
must be met by nursing homes participating in the Medicare
and Medicaid programs. The enforcement of these standards
is one of my Administration's highest priorities. Federal
funds pay 100 percent of the costs of inspection to monitor
compliance with these standards. The Federal Government
pays its share of the costs of meeting nursing home standards
more
FORD is LIBRARY GERALD
2
through health care financing programs, primarily Medicare
and Medicaid. Financial assistance is also made available
by the Department of Housing and Urban Development to assist
nursing homes in meeting selected fire safety standards.
The Council also expressed its concern about the level
of funding for programs to assist the elderly. I sympathize
with this concern, but I am determined to reduce the burden
of inflation on our older citizens, and that effort demands
that government spending be limited. Inflation is one of
the cruelest and most pervasive problems facing older Americans,
so many of whom live on fixed incomes. A reduction of inflation,
therefore, is in the best interests of all Americans and would
be of particular benefit to the aging.
The perspective and recommendations of this report
are limited to a particular area of interest and advocacy.
The report does not reflect the Administration's policies,
which must reflect a broader range of responsibilities and
priorities.
GERALD R. FORD
THE WHITE HOUSE,
July 24, 1975
# # # #
FORD in LIBRARY GERALD
art -FYI
THE WHITE HOUSE
WASHINGTON
September 11, 1975
PRESENTATION CEREMONY TO FOSTER GRANDPARENTS
Friday, September 12, 1975
10:30 a.m. (10 minutes)
The Rose Garden
From: Jim Cannon
I. PURPOSE
To present 10 year service awards to the 20 Foster
Grandparents from throughout the United States who
have been with the ACTION Foster Grandparents Program
since it began. The Foster Grandparents are in
Washington to join ACTION's celebration of the
program's decade of service.
II. BACKGROUND, PARTICIPANTS & PRESS PLAN
A. Background:
The Foster Grandparent Program is an ACTION Agency
program which offers older men and women the oppor-
tunity to provide companionship and guidance for
emotionally, physically and mentally handicapped
children.
Some 13,627 low income persons are serving as
Foster Grandparents in 157 projects throughout
the United States. Volunteers receive needed
financial assistance, transportation allowance,
hot meals while in service, accident insurance,
and annual physical examinations.
As a key member of the child-care team of the
institution where assigned, the Foster Grandparent
is responsible for supplying individual attention
to two children. The "grandparent" devotes two
hours each day to each child. During a five-day
week, tasks may vary from feeding and dressing the
small child, playing games and reading stories,
FORD i LIBRARY GERALD
- 2 -
to helping with speech and physical therapy.
The Foster Grandparent is active in residential
facilities and hospitals for retarded, disturbed
and handicapped children and in correctional
institutions and homes for neglected, dependent
children. Under some circumstances, non-
institutionalized children may receive daily
visits from Foster Grandparents in their own
homes.
B. Participants:
List attached at Tab A.
C. Press Plan:
Open Press Coverage
III. TALKING POINTS
To be provided by Paul Theis.
FORD is LIBRARY GERALD
PARTICIPANTS
Michael Balzano, Jr., Director, ACTION
John L. Ganley, Deputy Director, ACTION
Ronald E. Gerevas, Associate Director for Domestic Operations,
ACTION (Mr. Gerevas was appointed in June by your nomination)
Victor E. Hruska, Director of Older American Volunteer
Program, ACTION (Mr. Hruska is the brother of Senator Roman
Hruska)
Recipients of the Service Awards
Jeffalonie Allison
Pauline Culmer
Dewey DeHart
Cornelia Ford
Ruth Fox
Opal Greaby
Marie Hartos
Nellie Harvey
Dolores Herrera
Mary Ann Hickok
Norvelle Maddox
Lenice McEwen
Regina Novotny
Theresa Papoza
Lois Perry
Freda Peterson
Daisy Pope
Daisy Bell Spear
Edna Wallace
Zela Watts
FORD LIBRARY & GERALD
THE WHITE HOUSE
WASHINGTON
October 14, 1975
Dear Mr. Renner:
In further discussion of your interest in
proposing a new approach to assisting the
poor and the aged, I must report that a
written statement of your proposal is a
necessary prerequisite to any further
explorations.
A written plan will provide the basis for
the analysis which is needed to make any
discussion of these very broad issues
productive.
With best wishes,
Sincerely,
Thith
Arthur F. Quern
Associate Director
Domestic Council
Mr. Fred T. Renner
211 Lindenwood Road
Staten Island, New York 10308
FORDO & LIBRARY GERALD
File
September 12, 1975
Arthur F. Quern
Associate Director
Domestic Council
Dear Mr. Quern:
In response to your letter of September 2.
My plan entails the creation of a walk oriented
city to provide all essential services for the
elderly who no longer are able to afford the
high cost of living in urban areas.
The change in their status will be on a voluntary
basis and would provide financial releif to all
communities and demonstrate the ability of the
Federal Government to assist the economy, and, at
the same time, conserve energy.
The years of thought that have been spent on my
plan cannot be detailed in a letter and I would
welcome the opportunity to go to Washington and
talk to a group of President Ford's advisors
regarding my ideas.
Sincerely, Fred I. Renner
Fred T. Renner
211 Lindenwood Road
Staten Island, N.Y. 10308
FORD :- LIBRARY GERALD
Fred T. Renner
We hold these Truths
211 Lindenwood Road
Staten Island, New York 10308
STATEN ISLAND.RY 12 -PM SEP NY 103
1975
UNITED STATES
Mr. Arthur F. Quern
Associate Director
Domestic Council
GERALD
**
The White House
FORD
LIBRASY
Wash. D.C.
LIS
80
K
arthur Quern
engy's
Boral
FYI
The National Council on the Aging, Inc.
25
Years of Service to the Elderly
1828 L STREET, N.W.
WASHINGTON, D.C. 20036
202/223-6250
November 17, 1975
Dear Colleague:
AO
The National Council on the Aging is pleased to send you the 1975 Public
Policy Statements from the NCOA Board of Directors which were issued at our
25th Annual Meeting held in Washington, D.C. in late September. As you may
know, NCOA is a private nonprofit organization whose membership consists of
individuals and organizations who serve the nation's older citizens. For 25
years, we have provided leadership in the field of aging to public and private
agencies at the national, state and local levels.
NCOA believes that the voluntary sector has a vital role to play in the
development and implementation of a public policy responsive to the needs and
capacities of the nation's older citizens. As firsthand observers of the
elderly's needs, those working in the field are able to evaluate the effective-
ness of programs and services designed to serve the older population. NCOA is
convinced that it can and must serve as a conduit of such information to policy-
makers at all levels of government.
Because the development of policy statements is an ongoing process, we are
interested in your comment on them. In the coming months, NCOA will use the
enclosed papers as a basis for additional policy statements. We hope you will
keep these and forthcoming statements as a cumulative record of NCOA's position
on issues affecting the lives of older Americans.
NCOA's 25 years of service have demonstrated the significance and validity
of the private sector's involvement in the creation of an effective public
policy in aging. Following the lead of the elderly themselves, and working with
organizations and individuals concerned about the wellbeing of older persons,
NCOA will continue to encourage a social policy responsive to the aged. We look
forward to facing that challenge in cooperation with you in the years ahead.
Sincerely,
Albert J. Abrame
Albert J. Abrams
BERALD FORD VIBRARY
President
President
Vice Presidents
Secretary
ALBERT J. ABRAMS
MOTHER M. BERNADETTE DE LOURDES, O. Carm.
HUGH W. GASTON, A.I.A.
HOBART C. JACKSON
Executive Director
JOHN W. MOORE, JR.
Treasurer
JACK OSSOFSKY
SIDNEY SPECTOR
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PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
OLDER AMERICANS AND THE ARTS
HOUSING
INDUSTRIAL
For 25 years the National Council on the Aging has
GERONTOLOGY
INTERNATIONAL
sought to facilitate the full utilization by the aged of ser-
vices and programs that could make their lives more meaningful
MEDIA
and personally gratifying.
RESEARCH &
EDUCATION
NCOA continues to seek new alliances that can improve the
RELIGIOUS
INSTITUTIONS
AND ETHICS
quality of life for older people particularly as that quality
RURAL AFFAIRS
relates to the loneliness, isolation and lack of new social
SENIOR CENTERS
roles that exist in the world of the aged. Leaders and policy-
SOCIAL SECURITY,
PENSIONS & INCOME
makers in the burgeoning field of cultural services must be
MAINTENANCE
SOCIAL SERVICES
increasingly made aware of how the arts network, both public
and private, can serve and be served by older Americans.
Agencies and practitioners in the field of aging must become
active advocates for older persons in the field of the arts.
NCOA believes that while the aged's involvement in cul-
tural services and programs may not be a matter of life and
death for older persons, it can be a matter of happiness or
unhappiness, usefulness or uselessness. The overall goal in
GERALD FORD LIBRARY
The National Council on theAging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Arts
2
this area is to ensure that older persons have an equal opportunity, with
other population groups, to participate in and have access to cultural pro-
grams and services.
In addition, NCOA recognizes the need to preserve the folklore and for-
gotten arts of America, including the ethnic heritages of our diverse popula-
tion, for the enjoyment of all citizens. It is the older adult who has the
knowledge and skills not only to produce such crafts and artwork, but also the
capability to teach others the techniques of these accomplishments.
With these goals in mind, NCOA makes the following recommendations:
1. The arts constituency should be broadened to include the elderly.
2. The quality of arts programs now available to older people should
be upgraded.
3. New employment opportunities for artists young and old in the field
of aging should be provided.
4. Art forms which otherwise might be lost forever must be preserved.
5. Support for the arts should be broadened through better use of the
energy and ability of older persons whether as volunteers or as paid
professionals.
6. Arts resources at local, state and national levels in both the pub-
lic and private sectors that are currently overlooked or underused in
the field of aging should be mobilized.
7. Local initiatives to preserve the folklore and forgotten arts of
America can be encouraged by developing co-ops and/or channels to the
retail market where they can reach the consumer. Any public effort
to develop such channels should ensure that the proceeds of sales benefit
the older artisan.
8. Older artisans should be given opportunities to share their knowledge
Arts
3
with others and be provided opportunities to improve their skills. Both
Federal and state governments need to be sensitive to these needs and
provide avenues by which this unique talent can be shared and enhanced.
To date, cultural services for, with and by the aged is a concept without
priority status in either the arts or aging fields. We recognize that pro-
moting a new concept which is not considered as important as survival support
services is difficult at best and is more so in two fields that are currently
underfunded. The arts are primarily concerned with survival of cultural insti-
tutions and the individual artist. Likewise, practitioners in aging emphasize
survival and support of aging service agencies and the aged themselves. Never-
theless, NCOA remains convinced that there is something positive for both the
arts and the aging fields in the marriage we have proposed.
FORD 3 LIBRARY GERALD s
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
ARTS
September, 1975
HEALTH
CRIME AGAINST THE ELDERLY
HOUSING
INDUSTRIAL
GERONTOLOGY
The elderly, especially the urban elderly, are the most
INTERNATIONAL
vulnerable victims of the recent dramatic increase in crime in
MEDIA
America. Millions of the aged are virtual prisoners in their
RESEARCH &
own homes, self-confined victims who fear even going out in
EDUCATION
the streets. The quality of life for thousands and thousands
RELIGIOUS
INSTITUTIONS
AND ETHICS
of elderly people is degraded not only by the existence of
RURAL AFFAIRS
robberies, assaults, fraud and rape, but also by the threat
SENIOR CENTERS
of such crimes. In a recent NCOA study conducted by pollster
SOCIAL SECURITY,
PENSIONS & INCOME
Louis Harris, those over 65 rate crime or the fear of crime
MAINTENANCE
SOCIAL SERVICES
as their most serious personal problem.
Unfortunately, there is no reliable index of the volume
of such offenses against the elderly. Numerous studies show-
ing the high numbers of unreported and underreported crimes
also indicate that the elderly are more likely to be silent
victims. In addition, reported crime records only note the
age of the criminal, not that of the victim.
NCOA believes that a number of steps must be taken
GERALD FORD LIBRARY
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Crime
2
immediately, at both the national and local levels, to make America safe for
its nearly 21 million older citizens.
1. A national Senior Citizens Crime Index should be developed to moni-
tor the growth and delineate the development of offenses against older
people.
2. The Law Enforcement Assistance Administration (LEAA) of the Justice
Department should undertake studies to determine how localities may best
cope with the problem of crime against older people and to use its re-
sources to fund programs which protect the elderly.
3. Local police authorities should be encouraged to set up strike forces
to prevent attacks on the elderly and to pinpoint the locations and modus
operandi of the attacks.
4. Local police should undertake regular visits and liaison to facilities
used by the elderly such as senior centers, housing projects, etc.
5. Self-help programs which train the elderly themselves in crime-
prevention procedures should be developed.
6. Senior center leaders should be trained to train their members in
crime prevention.
7. Community watch programs, involving community groups of all ages
(teen patrols, radio-dispatch cab drivers, police hookups, high school
student escorts, etc.) should be established to be alert to threatening
or suspicious activities.
8. Patrol of streets (perhaps by retired policemen or police cadets)
and areas older people use that have high incidences of criminal activities
should be encouraged, and escort services to and from transportation ser-
vices to housing projects, shopping malls, senior centers, clubs, clinics,
etc., should be set up.
Crime
3
9. The police should train and assign the elderly stay-at-homes or home-
bound to observe streets or sections of their neighborhoods, and to report
suspicious behavior to police.
10. Regular police security checks of buildings and sites housing the
elderly should be made (just as the fire department makes regular fire
prevention inspections).
11. Housing for the elderly should have installed (on government subsidy
or as tax-deductible expense) burglar-proof photoelectric beams on win-
dows and doors, one-way glass, TV monitors in elevators and corridors,
and central alarm buzzer systems linked to police dispatchers or patrol
units.
12. Since crime against the elderly is reduced in specific housing as com-
pared to intergenerational housing, more housing especially for the elderly
should be encouraged and built.
13. Government checks should be mailed to banks for individual deposit;
banks should provide free checking accounts for the elderly.
14. An offense against an older person should be made a Federal crime if
committed in Federally funded facilities such as housing projects, centers,
etc.
FORD & LIBRARY GERALD
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September 1975
ARTS
HEALTH
EMPLOYMENT
HOUSING
INDUSTRIAL
The nation is experiencing its highest unemployment
GERONTOLOGY
rates since the Depression. Millions, regardless of
INTERNATIONAL
occupation or age, are suffering. Middle-aged and older
MEDIA
workers, with heavy family and financial responsibilities,
RESEARCH &
EDUCATION
tend to suffer special hardships when the economy takes
RELIGIOUS
INSTITUTIONS
AND ETHICS
a downward turn. Men and women over 40 constitute almost
RURAL AFFAIRS
half of the present labor force and more than a fourth of
SENIOR CENTERS
all unemployed. As Bureau of Labor Statistics figures
SOCIAL SECURITY,
PENSIONS & INCOME
indicate, they undergo longer terms of unemployment than
MAINTENANCE
SOCIAL SERVICES
younger age groups. They tend to drop out of the labor
force through discouragement in a futile job search.
Advocates of a broader definition of unemployment believe
that present figures--which categorize discouraged workers
as not-in-the labor force--understate by a considerable
extent the true unemployment rate. Middle-aged and older
workers are often victims of age discrimination on the part
of both employers and employment-manpower service agencies.
GERALD R.FORD LIBRARY
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Employment
2
One goal of a national employment policy should be to assure continued
participation for all age groups since it is a major factor in a full and
satisfying life style. It should also be noted that periods of unemployment
have serious repercussions in terms of unemployment insurance, welfare
costs and social security benefits.
The basic premise of employment and manpower programs from the inception
of the Wagner-Peyser Act of the 1930's to the categorical manpower develop-
ment and training programs of the 1960's to the present Comprehensive
Employment and Training Act (CETA) approach, has been that all Americans in
need of assistance related to employment may fully participate in available
programs. The desired outcome is free access for all individuals to the
job market regardless of age and other possible limiting factors over which
the individual worker has no control.
The Comprehensive Employment and Training Act (CETA)
There is no question that middle-aged and older workers are not receiving
an equitable share of manpower services through the CETA and the United
States Employment Service networks. These groups of workers lack priority
in these systems - only 4 to 8 percent of the CETA participants are men
and women over 45 and analysis of Employment Service data reveals that middle-
aged and older workers are less likely to receive services than those under
age 40.
NCOA's concern, therefore, with the current regulations pertaining to
CETA is that they in no way guarantee improved status for middle-aged and
older persons in need of employment assistance. CETA regulations must be
established which assure that funds allocated to prime sponsors are equitably
distributed to all participating age groups.
Emp loyment
3
NCOA recommends that the Department of Labor include the following
general guidelines and specific changes in revised regulations pertaining
to Title I and II of the Comprehensive Employment and Training Act.
Prime sponsors and their agents in order to assure fair and equitable
participation of middle-aged and older men and women of all racial
and ethnic backgrounds in CETA programs must include within any state
plan an analysis of the universe of need of individuals they intend
to serve by age and sex categories. The following groupings are
suggested: Under 22; 22-39; 40-54; 55-64; 65+.
An appropriate reporting system should be standardized whereby Prime
Sponsors and any Subcontractor can report comparative services to age
groups on a quarterly basis.
Prime Sponsors should see to it that middle-aged and older individuals,
familiar with the manpower and employment needs of workers over 40, are
included in fair proportions of all state and local manpower planning
committees.
Any Prime Sponsor with responsibilities for implementing a Title II
Public Employment Program must develop an Affirmative Action Plan to ac-
commodate individuals within the protected group of the Age Discrimi-
nation in Employment Act. All state and local government and/or public
employers are now covered and bound by federal age discrimination in
employment legislation.
Middle-aged and older workers, by reason of their long neglect on the
part of the Department of Labor, should be regarded as a new minority.
Each Prime Sponsor, therefore, should be bound to submit within his
state plan special training and technical assistance provisions to
agents, or subcontractors on how to:
-- Assess the needs of middle-aged and older workers within a community.
-- Develop outreach capabilities to bring these older workers into
CETA training and employment programs.
-- Develop special training methodologies and skill conversion tech-
niques for middle-aged and older men and women.
-- Develop job placement strategies, in cooperation with other employ-
ment related agencies (e.g., the State Employment Security Agency)
for those older individuals.
Appropriate Prime Sponsors should be informed and directed by the Man-
power Administration that it is their responsibility to support all
Senior Aide programs currently being funded by the Department of Labor
through national contractors. These are programs of demonstrated
effectiveness.
FORD & LIBRARY GERALD
Employment
4
A separate title should be established under CETA that will address the
manpower needs of the middle-aged and older worker, just as the Job
Corps has been established for youth. It is important to note that al-
though older workers were specifically mentioned along with Indians and
youth in Title III, no money has ever been appropriated for this group.
Age Discrimination in Employment (ADEA)
The Age Discrimination in Employment Act (ADEA) has recently fostered
significant legislative, administrative and judicial activity. The law's
major objective is to eliminate discrimination against individuals between
40 and 65 years of age in matters of hiring, job retention, compensation or
other terms, conditions and privileges of employment. ADEA promotes a policy
of employment according to ability rather than age. Despite recent legisla-
tive improvement in the Age Discrimination in Employment Act, systematic
implementation and enforcement is needed. In addition, because any worker,
regardless of age, should be evaluated according to functional ability,
NCOA recommends that the present upper age limitation for application of
ADEA be removed.
To ensure uniform national standards protecting all citizens against
discrimination in employment, NCOA further recommends the establishment of
one national regulatory body with the authority and resources to enforce
effectively one federal statute which prohibits employment discrimination on
the basis of race, color, religion, sex, national origin, age and handicapped
status. *
Mandatory Retirement
A recent survey conducted by Louis Harris and Associates for NCOA
* Basic recommendation from the Federal Civil Rights Enforcement Effort 1974,
U.S. Commission on Civil Rights, July 1975.
Employment
5
found that a large majority of Americans feel that "nobody should be forced
to retire because of age," and a smaller majority agree that "most older
people can continue to perform as well on the job as they did when they were
younger.' Yet in mid-1974 there were over four million unemployed or re-
tired persons age 65 and over who wanted to work but were not employed, com-
pared to some 2.5 million who were working full-or part-time.
NCOA strongly urges that flexible rather than fixed retirement ages be
adopted by employers and unions, allowing those who wish to retire early or
at the "normal" retirement age of 65 to do so and allowing others to work as
long as they are able, perhaps as determined by a physical examination or an
objective scale such as that employed in the Industrial Health Counseling
Service for the last four years in Portland, Maine. The fact that not all
employers require mandatory retirement is evidence that flexible retirement
is administratively feasible.
United States Employment Service
To increase services to middle-aged and older workers, NCOA recommends
that the Manpower Administration mandate that the Older Worker Specialist be
a full-time position at the state and local office level and institute a sys-
tem for financial incentives to local offices that do an outstanding job of
placing older workers. In addition, we recommend that the Manpower Adminis-
tration set up on a pilot basis an employment service based on the 40-plus
methodology to test techniques and procedures for adequate service to middle-
aged and older workers.
Senior Community Service Project (SCSP)
The Senior Community Service Project has clearly demonstrated that older
workers can adequately carry out diverse work assignments, involve people in
FORD i LIBRARY GERALD
Employment
6
meaningful relationships, motivate them to initiate action on their own
behalf, mobilize community resources and generally serve as a bridge between
the consumer of services and the agency providing the services. It has also
demonstrated that the program participants measure up in all ways to stand-
ards for younger workers - and often exceeded these standards. SCSP is a
manpower model for the older disadvantaged worker. It has successfully
carried out its primary mission of providing meaningful public service em-
ployment for older workers.
NCOA believes that the funds available for this program and similar
ones are totally inadequate and that steps should be taken by the national
Manpower Administration, local prime sponsors and national contractors to
establish these projects at the local level on a permanent basis.
Functional Capacity
NCOA believes that middle-aged and older persons should be assured of
opportunities for continuing employment. The extension of employment oppor-
tunities for this group and the removal of barriers to their employment remain
primary goals. There is a need for the expanded use of techniques which have
been developed for relating the functional abilities of workers to the func-
tional requirements of jobs. In general, functional capacity and not chrono-
logical age must become the primary employment standard.
Pre-retirement Planning
Planning ahead for retirement can significantly reduce the mistakes and
frustrations that accompany a trial-and-error approach after retirement. Pro-
blems may still arise, but the individual will be better prepared to cope with
them. The three critical elements are opportunity and incentive to plan, and
concrete, relevant data on which to base the planning.
Employment
7
NCOA recommends that the Federal government recognize the need for
planning and assume a partnership with educational institutions and private
industry by funding research and training programs, sponsoring demonstration
projects and providing incentives for employers to pay the tuition for appro-
priate courses as well as setting an example as a model employer.
Second Careers
A change in mid-life from one job pursuit to a different field is no
longer considered unusual in our rapidly changing society. For some workers,
because of technological displacement or involuntary early retirement, the
need for a second career is a necessity. To fill the need, career oriented
educational and training programs should be developed which are aimed not at
the beginning worker but at those who must transfer from one career track to
another.
Women and Minorities
Unemployment and poverty among middle-aged and older single women and
members of minority groups are particularly severe problems. NCOA urges
that special attention be paid to the employment problems of these groups in
Employment Service job development and in training programs.
FORD & LIBRARY GERALD
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
X
September, 1975
ARTS
HEALTH
ENERGY AND THE ELDERLY
HOUSING
INDUSTRIAL
A limited supply of electricity, natural gas, fuel and
GERONTOLOGY
motor oil at inflated prices is potentially damaging to older
INTERNATIONAL
people themselves, as well as to the institutions and pro-
MEDIA
grams which serve them. As the price of energy continues to
RESEARCH &
EDUCATION
rise, increasing numbers of older people living on fixed in-
RELIGIOUS
INSTITUTIONS
AND ETHICS
comes will be forced to decide between heat or food. Cost-of-
RURAL AFFAIRS
living increases in Social Security and Supplemental Security
SENIOR CENTERS
Income benefits are quickly eroded by inflation in this area
SOCIAL SECURITY,
PENSIONS & INCOME
alone. Already inadequate public and private transportation
MAINTENANCE
SOCIAL SERVICES
becomes either too expensive or non-existent. The loss of
volunteer drivers due to the lack, or high cost, of gasoline
can cripple many programs geared to serve older Americans, in-
cluding homemaker-home health aide projects, escort services,
meal deliveries and senior centers. Reduced heat in the home
aggravates arthritis and many other chronic conditions that
affect the elderly. The benefits of programs, including those
authorized under the Older Americans Act, are reduced because
FORD & LIBRARY GERALD
ALBERT J. ABRAMS, President
The National Council on the Aging, Inc.
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Energy
2
appropriations do not include increased costs for lighting, heating, cooking
and transportation.
To avoid and/or alleviate these present or potential problems, NCOA recom-
mends the following:
1. The development and implementation of a national energy policy
should assure that all citizens are equitably treated and particularly
that the elderly and other vulnerable groups are not adversely affected.
2. The use of any gasoline allocation formula should include extra
supplies to agencies who operate elderly transportation services and
unrestricted access for volunteer agency drivers.
3. Any fuel allocation and/or rationing, if developed, should take into
consideration the special needs of the elderly.
4. Government program regulations which restrict reimbursement of
drivers should be changed periodically to reflect the higher price
of gasoline.
5. The appropriations for service programs dependent on energy re-
sources should be increased to account for inflation's impact on the
cost of energy.
6. The Federal government should institute a program of low-cost loans
for housing insulation.
7. Comprehensive consumer information on energy conservation and rights
should be developed for the elderly and effectively distributed to them.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
X
September, 1975
ARTS
HEALTH
THE PRESIDENT'S RESPONSE TO
HOUSING
THE ANNUAL REPORT OF
THE FEDERAL COUNCIL ON THE AGING
INDUSTRIAL
GERONTOLOGY
INTERNATIONAL
The National Council on the Aging urges the President to
reconsider his rejection of the major recommendations made by
MEDIA
the Federal Council on the Aging in its first annual report.
RESEARCH &
EDUCATION
The Federal Council on the Aging was established by the
RELIGIOUS
INSTITUTIONS
AND ETHICS
1973 Amendments to the Older Americans Act to advise and
RURAL AFFAIRS
assist the President on the special needs of the elderly.
SENIOR CENTERS
Members of the Council were confirmed by the Senate on June 5,
SOCIAL SECURITY,
PENSIONS & INCOME
1974, and, on March 31, 1975, as required by law, they sub-
MAINTENANCE
SOCIAL SERVICES
mitted their first annual report to the President. On July 2,
President Ford transmitted that report with his comments to
the Congress.
NCOA believes that, because the FCOA is composed of lead-
ing experts from the field of aging, the recommendations and
advice in that report deserve more consideration than the
President's negative comments gave them. It is especially
unfortunate that the first official dialogue between the
GERALD FORD LIBRARY
ALBERT J. ABRAMS, President
The National Council on the Aging, Inc.
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Federal Council
2
President and the FCOA should be so negative. We hope that this is not the
beginning of a pattern of animosity which would destroy a potentially valuable
relationship for all concerned - particularly for the nation's 21 million older
people.
The President criticized the report for being "limited to a particular
area of interest and advocacy." NCOA believes this criticism is inappropriate
and unjustified. The Congress established the FCOA to perform a limited and
particular function which it also considered essential; that is, the Council
was to provide advice, assistance and advocacy on the special needs of older
Americans. The FCOA's first report definitely fulfills this mandate.
NCOA has consistently supported the major policy recommendations con-
tained in the FCOA report: The development of high standards of safety and
care in nursing homes and the rejection of Administration proposals to cut
back Federal programs essential to the welfare of the elderly.
We congratulate the FCOA on its initial efforts and look forward to the
findings and recommendations of its ongoing studies. NCOA remains hopeful
that, in the future, the President will be more receptive to the recommenda-
tions of the Federal Council on the Aging.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
HEALTH OF THE ELDERLY
HOUSING
INDUSTRIAL
Good health is a basic ingredient of a satisfactory life
GERONTOLOGY
for all people. For older Americans this goal is more diffi-
INTERNATIONAL
cult to attain and maintain than for the remainder of the
MEDIA
population. Growing older is almost always accompanied by
RESEARCH &
EDUCATION
an increasing need for health care services (people aged 65
RELIGIOUS
INSTITUTIONS
AND ETHICS
and over, while approximately 10 percent of the population,
RURAL AFFAIRS
account for 30 percent of health care costs).
SENIOR CENTERS
While recognizing that good health should be a public
SOCIAL SECURITY,
PENSIONS & INCOME
policy goal for all Americans, the National Council on the
MAINTENANCE
SOCIAL SERVICES
Aging is particularly concerned that there be a public commit-
ment to assuring that the necessary steps are taken so that
older Americans can live healthfully and can choose and pur-
chase appropriate health care services.
NCOA believes that the final responsibility for compre-
hensive health services, both physical and mental, for older
Americans lies in the public sector at the Federal level. The
objective of such health services should be the provision of
GERALOP FORD LIBRARY
The National Council on theAging. Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Health
2
expanded and specialized health programs and facilities and rehabilitative and
preventive care, including mental health services, for older persons. The pro-
vision of these facilities and services must be complemented by the establish-
ment and enforcement of national standards to guarantee quality physical and
mental health care and decent living conditions. Therefore, NCOA supports the
early establishment of a national health security program which incorporates the
following principles:
1. Comprehensive physical, mental, environmental and social health care
benefits for all Americans;
2. The integration of Medicare into a national health security program for
Americans throughout the life span;
3. The elimination of all co-insurance, deductibles and premiums;
4. Administration and fiscal management of the new health security program
by a public agency without an intermediary between the providers and the
public agency;
5. Financing of the health program through general revenues and payroll
taxes.
6. Consumer participation of the aged in the development and implementa-
tion of this program including involvement in quality controls (in such
areas as accessibility, acceptability and accountability) and in cost
controls.
7. Coverage for the full range of long-term care services, including
home-based, community-based and institutional-based services, with appro-
priate quality and cost controls specifically designed for the aged.
8. Monies allocated to research and output measurement to include appro-
priate attempts to develop criteria for evaluation of health care delivery
to the aged related to functional capacity, ranging from minimal self-care
Health
3
to full independence; and
9. The exclusion of means tests from any aspect of the program.
Pending the establishment of a national health security program and recog-
nizing that health care costs are now increasing 50 percent faster than the
economy as a whole; that per capita health care costs in 1973 were 3 1/2 times
greater for people aged 65 and over than for younger age groups; that Medicare,
which covered 49 percent of the total costs for medical expenses in 1969 cover-
ed only 38. percent of these expenses in 1974; and that skyrocketing costs of
health programs do not reflect advances in health services for older people,
NCOA recommends:
10. The present Medicare and Medicaid programs should be improved and
expanded immediately to meet more adequately the health needs of older
persons in relation to such matters as length of stay in acute hospitals;
extended care and nursing home facilities; psychiatric hospitals; cover-
age for home care; diagnostic and preventive services; and out-of-hospital
drugs and medicines; the elimination of the premium paid for Medicare
Part B and the co-insurance features related to hospital care.
11. Greater coverage should be provided for dental care, eye and hearing
care and aids as well as for other prosthetic devices which contribute
to social and health functioning, and which facilitate mobility.
12. A nation-wide program of comprehensive long-term care for older per-
sons suffering from chronic disease and disabilities must be developed.
Such a program should include specialized health programs and facilities
for rehabilitation and resocialization as well as alternatives to insti-
tutional care, such as health maintenance organizations, neighborhood
clinics, day or night hospital care, and home care services.
FORD is LIBRARY GERALD
Health
4
13. Present standards of care should be better enforced and, when promul-
gated, vigorous state implementation of national standards for nursing
homes and personal care homes should be encouraged. This should assure
not only the safety and appropriate levels of health care for older per-
sons, but also the inclusion of social care perspectives which help to
preserve the human rights and dignity of the older residents.
14. The encouragement of specialties in geriatric medicine and other
health professions should be a matter of national policy, with funds made
available for recruiting and training these specialists required to staff
a comprehensive health service for older persons.
15. A national policy and program on the physical fitness of older Ameri-
cans should be developed and coordinated.
8
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PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
HOUSING FOR THE ELDERLY
HOUSING
X
With the moratorium on subsidized housing, instituted
INDUSTRIAL
GERONTOLOGY
in the last several years, the need for suitable housing for
INTERNATIONAL
older persons has reached critical proportions. Waiting
MEDIA
lists for existing low and moderate income housing for the
RESEARCH &
EDUCATION
elderly are extensive and growing. Hundreds of thousands of
RELIGIOUS
INSTITUTIONS
America's older people are forced to live in environments
AND ETHICS
RURAL AFFAIRS
which are substandard, too expensive, too difficult to main-
SENIOR CENTERS
tain, too inefficient for their age and capacities.
SOCIAL SECURITY,
Older people everywhere find it difficult to understand
PENSIONS & INCOME
MAINTENANCE
SOCIAL SERVICES
why a demonstrated need for a program which has been singularly
successful - financially and socially - should be suspended
and unfulfilled.
Because of time, because of special needs with age, older
Americans require a special priority today. They have the
right to make independent choices of their living arrangements
regardless of their current income situation. These choices
can include single family homes, independent apartments,
GERALD FORD LIBRARY
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Housing
2
congregate facilities and rehabilitative centers. In all instances, such housing
should have easy access to senior center activities, health services, therapy
programs, nutrition programs, cultural activities - all designed and implemented
to maintain independent living even when disability occurs.
NCOA has the following specific recommendations:
1. To achieve independent choice of living arrangements, all the programs
of low and moderate income housing authorized by the Congress should be
used fully and immediately. Of vital importance in this regard is the
full implementation of the Section 202 Program. Congress has authorized
and appropriated substantial funds for a new beginning of this very suc-
cessful program of housing for the elderly. The Administration should
accept this action and institute an effective program of direct financing
both in the construction period and for the permanent loan for qualified
nonprofit applicants.
2. Such loans should have available to them a special set-aside of Sec-
tion 8 subsidy to ensure that low incomes will not bar older people from
suitable housing. This is a priority, major action required today.
3. There should also be enactment and execution of full appropriations
under the Section 8 Program and Section 236. These programs individually,
and especially in combination, could generate the volume of specially-
designed housing older Americans need and require.
4. In addition, a substantial program of special grants to senior citi-
zens who own their own homes should be underway on a sizeable basis. This
will permit older persons of modest incomes to improve and rehabilitate
their own homes and to go on living independently in neighborhoods of their
own choice.
5. In any housing program, more than sheer shelter is required. Urgently
Housing
3
needed senior centers, adequate nutrition programs, physical and occupa-
tional therapy, health programs, cultural enrichment programs, etc.,
should be financed by grants, rather than out of the rents of residents.
6. Administration of the subsidy programs must be realistic if the pro-
gram is to be effective. This means reassessing fair market rents, con-
struction costs, methods of financing and speed of administrative pro-
cessing.
7. New construction should be emphasized. Too many older persons live
in homes which are too old and too inefficient for them. They require
having arrangements suitable to their age and physical conditions at rentals
and prices they can afford.
8. A major national focus must be directed at rural America with particu-
lar emphasis given to the housing needs of older adults. An effort to
broaden the programs of, and the appropriations for, the Farmers Home Ad-
ministration specifically to meet the housing needs of rural America would
be an important step in this regard.
9. There is a great need for a new investment in research on the physical
and social aspects of housing for the elderly. New generations of older
Americans with different values and different abilities will soon consti-
tute our retirement populations. We need to evaluate the past, conduct
research on the frontiers of our knowledge and develop criteria for the
near future.
10. There should be legislative enactment creating the Office of Assistant
Secretary of the Department of Housing and Urban Development for Housing
for the Elderly. The field is so large and so important that overall policy
and planning should be centered by law in an Assistant Secretary with
GERALD R. LIBRARY FORD
trained staff to ensure effective knowledge, coordination and administration.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
X
THE DEVELOPMENT OF SOCIAL UTILITIES FOR LONG-TERM CARE
HOUSING
INDUSTRIAL
The growth of the nursing home industry in recent years
GERONTOLOGY
has been phenomenal; and, for the most part, caused by the
INTERNATIONAL
introduction of Federal funds through Medicare and especially
MEDIA
the Medicaid program. In fact, public funds now account for
RESEARCH &
EDUCATION
approximately $2 out of every $3 in nursing home revenues.
RELIGIOUS
INSTITUTIONS
AND ETHICS
In 1973, Medicare contributed $200 million and Medicaid $2.1
RURAL AFFAIRS
billion to the industry. In addition, there are almost 50
SENIOR CENTERS
other Federal programs which assist nursing homes. These pub-
SOCIAL SECURITY,
PENSIONS & INCOME
lic funds support an industry in which 77 percent of the nurs-
MAINTENANCE
SOCIAL SERVICES
ing homes are operated for profit, 15 percent are philanthropic,
and only 8 percent are government owned.
Despite this rapid growth and public support, a recent
study by the Subcommittee on Long-Term Care of the Senate
Special Committee on Aging concludes that there is no coherent
policy on the long-term care of older Americans. As a result,
in too many cases, public funds are used to perpetuate defi-
cient care for thousands of older people, thus causing them
GERALD FORD LIBRAR,
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N:W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Long-Term Care
2
to live in unconscionable conditions. That Senate report concludes that the
majority of nursing homes in the country do not meet minimum standards of
acceptibility.
It is critical that the Federal government redirect public funds to en-
courage the development of quality long-term care institutions. Therefore,
NCOA believes that there should be a systematic diversion of Federal funds now
being spent on proprietary nursing homes (estimated between $3.5 and $7.5
billion) into public or private nonprofit social utilities for long-term care.
By social utilities we mean facilities or services not exclusively oriented
to the care of in-patients, but also planned to provide services beyond their
walls. In other words, those facilities would become an integral component
of the service delivery network to the elderly throughout the community.
The possible services are many and diverse - day care, congregate dining,
disease detection, intellectual and social programs, group and individual
counseling and psychotherapy, outreach care, social services and health educa-
tion. Thus, while offering a quiet sanctuary for those who require it, these
facilities for long-term care could also become lively places with ties to the
larger community. Instead of the dread of inhumane treatment or the fear of
being left in a home only to die, an older person entering such a facility
would expect and receive the kind of care which offers rehabilitation and a
renewed sense of hope and self-esteem
The elderly need and deserve long-term care facilities geared to meeting
the full range of their medical and social needs, places where they can go and
be assured of quality treatment. In the best tradition of American society,
public support for the social utilities described here would reinforce competi-
tion in the nursing home industry and encourage proprietary homes to develop
similar constructive programs.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
THE MEDIA AND THE ELDERLY
HOUSING
INDUSTRIAL
Because the Media reflect society's perception of older
GERONTOLOGY
INTERNATIONAL
persons and also make these perceptions self-fulfilling, the
MEDIA
National Council on the Aging believes that the Media must
RESEARCH &
make a major nationwide effort to develop greater public un-
EDUCATION
derstanding of the diverse character and characteristics of
RELIGIOUS
INSTITUTIONS
AND ETHICS
older persons. NCOA, through the National Media Resource
RURAL AFFAIRS
Center on the Aging, has developed recommendations for a new
SENIOR CENTERS
focus within the Media on a more positive and accurate por-
SOCIAL SECURITY,
PENSIONS & INCOME
trayal of older men and women.
MAINTENANCE
SOCIAL SERVICES
1. The Media should enable more older persons to play
a fuller role in the community by exposing and reducing
ageism and discrimination by increasing public under-
standing of the older population's value.
2. The general public should be educated to a better
understanding of the processes and potentials of aging.
Everyone ages and therefore has a stake in assuring
that society provides the elderly with opportunities
GERALD FORD LIBRARY
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Media
2
and options making it possible for them to live a full and contributing
life.
3. The Media should stimulate consciousness-raising among the elderly
themselves to enhance their own sense of worth and power.
4. The social issues and programs which affect the elderly should be
dealt with more fully so that lack of information or misinformation does
not prevent them from participating in activities and assistance pro-
grams which are available.
5. Staff should be developed with special knowledge in the area of
aging, perhaps to monitor neighborhoods with a high concentration of
elderly residents and report accurately on developments within them.
6. More cultural programs which are for, by and with the elderly should
be initiated by the broadcast media.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
X
NUTRITION FOR THE ELDERLY
HOUSING
INDUSTRIAL
Proper nutrition is a prerequisite of good health, but
GERONTOLOGY
it is often hard for older people to maintain an adequate diet.
INTERNATIONAL
Poor nutrition is frequently found among older adults because
MEDIA
they live alone; they are often frail; and many more are poverty
RESEARCH &
EDUCATION
stricken. Inflation has increased food costs alone by 20 per-
RELIGIOUS
INSTITUTIONS
cent in the last year. Thus, the elderly poor are forced to
AND ETHICS
RURAL AFFAIRS
"pay more to eat less." To ensure an appropriate public com-
SENIOR CENTERS
mitment to providing adequate nutrition benefits for older
SOCIAL SECURITY,
PENSIONS & INCOME
Americans, NCOA believes:
MAINTENANCE
SOCIAL SERVICES
1. Title VII of the Older Americans Act should be fully
funded to provide the necessary support for the Nutrition
Program for the Elderly which, despite its success, now
reaches only a minority of those who need such support.
2. The food stamp program should have an expanded out-
reach as well as an improved administration in order to
be of greatest value to older persons.
3. Information about the influence of nutrition on the
GERALD FORD LIBRARY
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Nutrition
2
aging process should be incorporated into all health education programs.
Such programs should be given in the public schools, be an integral part
of the health education functions of the proposed national health security
program, and be a significant part of senior center programs and of other
services through which large numbers of older persons can be reached.
4. Standards for nutritional quality for food services for older people
should be established at the Federal level and be included in the licensing
and inspection procedures in every state and community.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
RESEARCH ON AGING
HOUSING
INDUSTRIAL
During the past decade there has been a substantial de-
GERONTOLOGY
INTERNATIONAL
gree of Federal government support for research and develop-
MEDIA
ment of social, behavioral and biomedical research on aging.
RESEARCH &
This has come through as many as 30 government agencies and
EDUCATION
departments, each of which has found that it needs to support
RELIGIOUS
INSTITUTIONS
AND ETHICS
research on problems of aging and evaluation of its programs
RURAL AFFAIRS
for the elderly.
SENIOR CENTERS
There is naturally some question whether this variety
SOCIAL SECURITY,
PENSIONS & INCOME
of research projects and programs is well planned and coordi-
MAINTENANCE
SOCIAL SERVICES
nated so as to cover essential problems without overlapping
in some places or causing serious gaps in other areas.
The situation is now ripe for a major effort to get more
coherence and better planning into the Federal government's
support of research on aging.
The new National Institute on Aging is almost ready to
function and its National Advisory Committee has been at work
for several months. Also, the Department of Health, Educatio
FORD & LIBRARY GERALD
The National Council on theAging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Research
2
and Welfare has a Federal Council on Aging consisting of non-governmental per-
sonnel which advises on programs in HEW. We urge these two groups to get
together, and perhaps to jointly create a Task Force on Research and Development
in Social Gerontology, with the mission of producing a Five Year Plan for
government support of research and development in this area.
Some of the most needed research can be foreseen. NCOA recommends:
1. Studies of methods of providing long-term care of elderly persons in
feeble physical condition should be undertaken. This involves studies
of standards and methods of financing nursing homes; as well as studies
of facilities that can serve home-bound or physically impaired people
through home-maker services and home-delivered meals - thus avoiding the
cost and difficulty of moving into a nursing home.
2. Research should be started on ways of protecting the incomes of elderly
people from erosion by monetary inflation.
3. Senior centers should be carefully studied. These agencies are in-
creasing in numbers, and probably are the most useful single service
facility for the elderly. A variety of model programs should be studied,
evaluated and then those that work well should be spread over the land.
4. Television and radio programs, as well as the printed media, should
be monitored and evaluated for their values to elderly viewers. Possibly
some experimental programs should be created and tried out.
5. Research should be done on the adequacy of existing retirement roles
and programs for development of new retirement roles.
6. Factors that affect policies governing retirement age should be studied.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
RETIREMENT INCOME
HOUSING
INDUSTRIAL
In the last few years, there has been a sharp reduction
GERONTOLOGY
in poverty for persons 65 and older, from one out of four
INTERNATIONAL
older Americans in 1969 to one in six by 1973. Nevertheless,
MEDIA
the elderly are still the most economically disadvantaged age
RESEARCH &
EDUCATION
group since the proportion of aged living in poverty (16.3 per-
RELIGIOUS
INSTITUTIONS
cent) is higher than for any other age group. The majority
AND ETHICS
RURAL AFFAIRS
of aged persons in poverty are women living alone.
SENIOR CENTERS
Many more older Americans, although not considered to be
SOCIAL SECURITY,
PENSIONS & INCOME
in poverty, do not have incomes sufficient to meet a modest
MAINTENANCE
SOCIAL SERVICES
standard of living. Almost half of all aged couples have in-
comes below the Bureau of Labor Statistics intermediate budget
for a retired couple ($6,041 in 1974) which was recommended
as a standard by the 1971 White House Conference on Aging.
Thus, the nation has still not achieved the long-sought
goal of an adequate retirement income for all even though in-
come maintenance for the aged has been improved in three major
areas: Social Security benefits have been substantially raised;
GERALD FORD LIBRARY
The National Council on theAging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Retirement Income
2
the old age assistance welfare program has been federalized by enactment of
the Supplemental Security Income program administered by the Social Security
Administration; and, private pensions have been made more secure by the pen-
sion reform law.
At the same time that these improvements have been made, however, infla-
tion has offset their impact on retirement income. Social Security increases
have lagged behind price increases, particularly in the areas where the elderly
have their greatest expenditures--housing, food, medical care and transporta-
tion. In the SSI program, recipients in at least 21 states will not even re-
ceive the benefits of a recent eight percent cost-of-living increase which they
are entitled to along with other Social Security and SSI recipients.
Reduced Social Security taxes because of the recession and a long-term
change in the population mix, have generated questions about the financing of
the Social Security program. The National Council on the Aging has addressed
itself to the financing aspects as well as to the adequacy of benefits in a
statement adopted earlier this year. The goal with regard to financing
is to bring income and outgo of the Social Security trust funds into balance
within the next few years and maintain them in balance over the long-range
future. There is no need to achieve a close balance in the present recessionary
period or to maintain such a balance in the future over every year or short
period of years.
The suggested measures to achieve this goal are:
1. The amount of earnings subject to Social Security taxes and counted
in determining Social Security benefits should be increased substantially,
as of 1977, from the present $14,100, and from then on adjusted, on an
automatic basis, to increases in average wage levels. An increase to
$24,000 in 1977 could be expected to bring the Social Security system as
Retirement Income
3
a whole (cash benefits and Medicare) into financial balance for the next
several decades without an increase in the tax rates.
2. Beginning in about 1985 and increasing over the following three or
four decades until covering about one-third of costs, a contribution from
general tax revenues should supplement employer and employee tax contri-
butions to the Social Security cash-benefits program. The general revenue
contribution should begin within the next decade and be phased in gradu-
ally.
In order to achieve more adequate Social Security benefits (and sup-
plemental work income) the National Council on the Aging recommends:
3. An increase in the amount of earnings covered (see above no. 1) which
would lead to higher future benefits and therefore greater economic secur-
ity for workers in the middle and upper income brackets.
4. Gearing benefits to total wages in covered employment instead of to
changes in the cost-of-living. Thus, as standards of living and levels of
living increased for the working population, the retired would have a
share in the increases.
5. Abolishing the premiums paid by beneficiaries for Part B Medicare.
6. Increasing the amount a Social Security beneficiary may earn in a year
without reduction in benefits from $2,520 to $3,000.
The objective of the Supplemental Security Income program for the elderly
is to provide an adequate standard of living for those who do not have income,
or enough income, from Social Security, pensions or savings. It provides a fed-
eral "income floor" for those without other adequate income resources. Experi-
ence with the program has shown, however, that although there are some 2.3
million aged persons receiving benefits, there are still many aged persons not
receiving benefits to which they are entitled, and that implementation of the
BERALD FORD LIBRARY
Retirement Income
4
program is reducing already limited benefits.
-
To achieve the goal of bringing all eligible aged persons into the program
and to provide a more adequate income from SSI benefits, NCOA recommends that
the Social Security Administration take the following, necessary administrative
steps:
7. Field visits to those potential beneficiaries who are homebound and
unable to come to local SSA offices.
8. Development and implementation of a permanent outreach and information
program to inform potential recipients of their rightful benefits.
9. States should be mandated to pass along all cost-of-living increases
in the federal portion of the SSI payment by requiring states to at least
maintain supplementation payments at June, 1975 levels.
10. SSI recipients should be guaranteed that SSI benefits will not be re-
duced when Social Security benefits rise.
11. All applications for SSI benefits should be processed with the utmost
promptness, preferably within thirty days. The present $100 advance
should be increased to cover the full amount of the standard monthly pay-
ment for two months, and the present provision for advance payments on the
basis if presumptive disability should be broadened to include presumptive
blindness.
12. Legislation should be enacted authorizing the Secretary of HEW to
provide a permanent mechanism for on-going emergency assistance, as often
as needed, effective within twenty-four hours of a recipient's application
for such aid.
13. The use of an Ombudsman at the state or regional level to respond to
claims that individuals have been denied benefits to which they are enti-
tled should be studied and seriously considered for use in the program.
Retirement Income
5
The Employee Retirement Income Security Act of 1974 provided some new pro-
tections and guarantees for the some 30 million employees covered by private
pension plans.
Enforcement of the new pension reform law has just begun and it is too
early to assess its impact. Studies will be needed (and some are provided in
the law) to determine its impact in such areas as the employment opportunities
of middle-aged and older workers, the improvement of survivor provisions and
the expansion of private plan coverage. The provision establishing individual
retirement accounts for those not covered by other pension plans is already
quite popular, but there is little information if the additional requirements
provided by the law have had any effect on establishment of additional group
plans. It is important that additional plans be established to extend coverage
for less than half of the work force in private industry is now covered by re-
tirement plans.
NCOA recommends two goals with regard to private pensions:
14. Existing pension plans should continue to be liberalized with regard
to such features as early vesting, portability between employers and the
provision of survivor benefits.
15. The establishment of new pension plans should be encouraged so that
coverage would be extended to a larger proportion of the workforce.
Specific legislative and other recommendations await further study and ex-
perience under the new pension reform law.
FORD is LIBRARY GERALD
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
EXTENSION OF THE GENERAL REVENUE SHARING PROGRAM
(STATE AND LOCAL FISCAL ASSISTANCE ACT OF 1972)
HOUSING
INDUSTRIAL
Since the inception of the General Revenue Sharing Pro-
GERONTOLOGY
gram in 1972, the National Council on the Aging has provided
INTERNATIONAL
technical assistance to public and private local, state and
MEDIA
national agencies serving the elderly and poor on how they
RESEARCH &
EDUCATION
should go about obtaining their "fair share" of the allocated
RELIGIOUS
INSTITUTIONS
funds. We were pleased that social services to the poor and
AND ETHICS
RURAL AFFAIRS
aged was one of the priority areas in which local governments
SENIOR CENTERS
were required to spend their funds. Yet a recent study by
SOCIAL SECURITY,
PENSIONS & INCOME
the General Accounting Office revealed that less than half
MAINTENANCE
SOCIAL SERVICES
of one percent of the total monies authorized for expendi-
ture by the local governments surveyed were directed speci-
fically to programs to benefit the aged. To compound the
problem, cutbacks in and even complete elimination of cate-
gorical programs benefiting the poor and aged have been jus-
tified on the existence of general and special revenue shar-
ing funds to take their place.
It is clear that, without additional safeguards in the
GERALD FORD LIBRARY
The National Council on heAging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Revenue Sharing
2
legislation being drafted to extend the program, the needs of the poor, par-
ticularly the elderly poor, will not be a significant objective of revenue
sharing programs. Therefore, NCOA urges the Congress and the President to
support in any legislation extending the State and Local Fiscal Assistance
Act of 1972 the following provisions:
1. A restriction on the use of general revenue sharing funds by both
state and local governments to the eight priority areas in the current
legislation.
2. A requirement that states and local governments spend no less of
these funds on social services for the poor and aged than the percentage
of aged and poor in that particular political jurisdiction as deter-
mined by Bureau of the Census data.
n
- ibnoqxo
of
bring Isoling
по
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
THE RURAL ELDERLY
HOUSING
Until very recently there has been a large migration of
INDUSTRIAL
GERONTOLOGY
the American people from rural to urban areas. Thus, people
INTERNATIONAL
residing in rural areas faced a dramatic reduction in income,
MEDIA
a lack of essential services and, of course, a reduced popula-
RESEARCH &
EDUCATION
tion. Rural America became less visible in terms of priority
RELIGIOUS
INSTITUTIONS
in Federal and state programs. What was once the backbone of
AND ETHICS
RURAL AFFAIRS
X
the country became a skeleton, standing alone and forgotten.
SENIOR CENTERS
Interestingly, the same could be said of the older adult
SOCIAL SECURITY,
throughout America. For an older adult living in rural America,
PENSIONS & INCOME
MAINTENANCE
SOCIAL SERVICES
the problems of poverty, isolation, poor health, inadequate
housing, and lack of visibility were compounded.
However, recent migration trends seem to be changing.
The population is now leaving urban areas for rural ones, al-
though services are not so quick to follow. The National Council
on the Aging calls for a national effort through the voluntary
public and private sectors to utilize the capabilities of rural
older adults to restore them to productiveness and to expand
GERALD FORD LIBRARY
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
10
25
Years of Service to the Elderly
202/223-6250
Rural Elderly
2
and develop services to enable rural older adults to enjoy a life of
dignity, health, and safety. To this end, we make the following
recommendations:
In non-metropolitan society, pensions or annuities are almost non-
esistent. Therefore, older adults rely on social security benefits or
income maintenance programs for their only source of income. To
relieve the burden of these often inadequate income levels for older
adults in rural areas:
1. An accelerated effort to develop rural manpower programs
should be made to enable older adults to remain self-sufficient.
2. An income maintenance program tailored and directed to meet the
needs of the rural older adult should be established. Such programs
should take into account the traditional multi-generational family
model which is still common in rural America since this structure often
prevents older family memebers from receiving full income benefits al-
though they must contribute to the family's income in order to avoid
impoverishing them.
3. An effort by Federal, state and local governments must be
made to protect the independence of rural older adults by reduc-
ing property taxes, especially those of persons on limited
incomes.
Noting that in 1973 the U.S. Department of Health, Education and
Welfare spent only $7 million out of $175 million on health services
delivery in rural areas although statistics show that approximately
140 rural counties in the nation do not have a physician and very
limited auxiliary health services, NCOA recommends the following:
Rural Elderly
3
4. The Federal government should collaborate with medical schools in
planning for special stipends for medical students who make a commit-
ment to serve in rural areas (as well as other delivery areas) following
their training as well as field placements during their training.
5. More support should be given to developing other professionals such
as doctor's assistants, nursing and medical aides to provide supportive
medical servcies to older adults in rural areas.
6. Mobile health service units, mini-medical clinics, visiting nurses
services and emergency transportation services should be developed to
alleviate this serious problem.
7. More emphasis should be given to medical service development, linkage
of auxiliary services and provisions to enable the utilization of these
services.
Public transportation is virtually non-existent in most rural areas and
medical and social facilities are too distant from residential areas to be
reached by taxi or by walking. These conditions immobilize older adults and
keep them from making social contacts and reaching professional services.
NCOA recommends:
8. The National Mass Transportation Act of 1974 should be re-examined
and new allocations made to offer more than token assistance to rural
areas.
9. Efforts should be made toward ensuring the full development and
utilization of volunteer transportation services, minibus services and
school buses during "off hours" to fill this transportation gap.
10. State Public Commissions should remove those regulations which might
restrict the implementation of transportation programs, and state
Agencies on Aging should be prepared to follow up such action with
FORD is LIBRARY GERALD
Rural Elderly
4
recommendations of transportation programs which would benefit the elderly.
Sixty percent of the substandard housing reported in the nation's counties
is in rural areas; one-fourth of those dwellings are occupied by the older
adult. NCOA recommends the following:
11. A major national housing focus must be directed at rural America with
particular emphasis given to the housing needs of older adults. An ef-
fort to broaden the programs of, and the appropriations for, the Farmers
Home Administration specifically to meet the housing needs of rural Amer-
ica would be an important step in this regard.
12. Legislation should be enacted to make available funds for low-interest
rate loans for major home repairs. The development of community services
to provide minor home repairs could enable many older adults to maintain
their independence by remaining in their own homes. Many others, by
using their skills in carpentry, masonry and plumbing could earn extra
income.
13. Planners and administrators should make greater efforts to provide
social services, which are so often dénied the rural elderly because of
their limited mobility, with public housing projects for the elderly.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
ARTS
September, 1975
HEALTH
SENIOR CENTERS
HOUSING
INDUSTRIAL
GERONTOLOGY
Findings from the National Institute of Senior Centers'
INTERNATIONAL
Multipurpose Senior Center Research Project affirm the role
MEDIA
of the Senior Center as a community focal point for older
RESEARCH &
person services and activities. Nutrition, health and social
EDUCATION
RELIGIOUS
services plus educational, recreational and community service
INSTITUTIONS
AND ETHICS
opportunities are made accessible and available for older per-
RURAL AFFAIRS
sons through Multipurpose Senior Centers in thousands of com-
SENIOR CENTERS
munities throughout the country. There are, however, great
SOCIAL SECURITY,
PENSIONS & INCOME
MAINTENANCE
gaps in the development of Multipurpose Senior Centers. In
SOCIAL SERVICES
rural areas, for instance, where services are particularly
sparse and accessibility a major problem, there are great num-
bers of older persons who could benefit from Center services;
yet, these are the communities which do not have sufficient
local resources for such programs. NCOA thinks the following
steps are necessary:
1. The Congress should appropriate funds to provide
Title V of the Older Americans Act with the means to do
FORD & LIBRARY GERALD
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Senior Centers
2
the task it was authorized to accomplish. At the minimum, each planning
and service area should have a Multipurpose Senior Center from which ser-
vice delivery could be coordinated - in a sense the action arm of the
Area Agency on Aging.
2. A Part C for Title V of OAA, which would provide assistance to exist-
ing programs which qualify or have the potential to become Multipurpose
Senior Centers by authorizing grants to sustain all or part of the costs
of staff, should be developed. The current focus of Title V is too
limited. It reflects a major restriction on service delivery through-
out the Older Americans Act - no support for ongoing programs. Emphasis
is on new projects, with nothing to maintain services and activities
which have been proven to be life-sustaining to millions of America's aged.
3. Community Development funds should be authorized for nonprofit Senior
Centers in addition to those which are publicly sponsored. We also urge
the Department of Housing and Urban Development to encourage support of
Senior Centers in the Community Development program. The extension and
ultimate funding of Title V remains the primary route of Federal support
for Senior Centers. Reports from around the country indicate that centers
are not receiving monies under the Housing and Community Development Act
of 1974. Although Centers were specifically designated by the Congress
as eligible recipients of such funds, little support has emerged.
4. The Administration on Aging should encourage Area Agencies on Aging
to develop service contracts with Senior Centers whenever possible, thus
recognizing and extending the comprehensive service delivery system which
Multipurpose Senior Centers represent.
5. The Administration on Aging should provide support for the development
of standards for Senior Centers. This would be an important step forward
Senior Centers
3
in the provision of services for older people because it would assure
more consistency in quality and a means to maintain programs meaningful
to the community and to older persons. The Senior Center field as a
whole should assist in the development of these standards and be involved
subsequently in their adoption as a means of promoting the best for those
who deserve the best - the older people of America.
FORD & LIBRARY GERALD
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
SOCIAL SERVICES AND THE ELDERLY
HOUSING
A social service system exists to help individuals and
INDUSTRIAL
GERONTOLOGY
families to make optimal use of the resources which exist to
INTERNATIONAL
sustain and enhance social functioning in our very complex
MEDIA
society and its physical environment. Social services are
RESEARCH &
EDUCATION
needed by all people at some time in their lives to maintain
RELIGIOUS
INSTITUTIONS
or to attain their roles as socially or economically produc-
AND ETHICS
RURAL AFFAIRS
tive members of society, and to effectively cope with their
SENIOR CENTERS
environment.
SOCIAL SECURITY,
PENSIONS & INCOME
The elderly particularly, because of their vulnerability
MAINTENANCE
SOCIAL SERVICES
X
and the impact of their problems on family and society, as well
as their relatively little knowledge about the social inter-
ventions which are needed, represent a primary target for
social services. The provision of social services in their
preventive, supportive and restorative functions can provide
for the individual and collective needs of older persons.
Social services can include a wide variety of individual
and group or community services, such as nutrition, health,
GERALD LIBRARY GERALD R. FORD
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Social Services
2
educational or recreation and involve not only delivery systems but policy for-
mation, training, education, and research. Transportation as well is an impor-
tant ingredient of services and a link to resources in the community.
Where responsibility rests for providing needed social services for the
aged has not been clearly defined. Neither has accountability been clarified
nor the mechanisms for this developed. Perhaps most importantly, the resources
which are provided are insufficient.
Social services have developed in three separate systems, one private
profitmaking, and the others private-voluntary and public. None of these
systems functions adequately for the aged and the separation of the three sys-
tems has been dysfunctional to meet all needs of the total elderly person. The
identification of this group as a special category to receive government re-
sources has weakened not only the principle of right to service but the integra-
tion of all services, private (profit-making and voluntary) and public, into
one cooperative system which functions effectively.
The National Council on the Aging is aware of the wide disparity which
exists at present between the needs of the elderly and the social services which
are provided to meet the greatly varied needs and wishes of this diverse popu-
lation. No national policy now exists regarding meeting the needs of all Ameri-
cans; this should be a primary goal. There should be a public commitment to
the elderly so that necessary steps may be taken to ensure that the gap be
closed between service needs and services for Older Americans.
The new Social Service Amendments of 1975 (Title XX) basically represent
special revenue sharing as applied to public service programs. Unfortunately,
Title XX does not provide for the provision of essential services and omits the
specific language permitting group eligibility or standards for adult care; it
does not define strongly what constitutes an eligible service. What is most
Social Services
3
important, moreover, is that no attempt has been made to coordinate this social
service program with other programs - private and public - which provide
services to the elderly.
NCOA has continually worked for improvements to insure that the current
delivery and future expansion of critical social services to older Americans be
facilitated. Delivery and expansion of services, however, is not enough. NCOA
is concerned with regulation and means to insure the quality of the services.
The assumption is that there will be little change this year in provision
of social services, and the present pattern will continue until review and
planning can affect new modes of implementation. Since Title XX provides for
public review and comment, mechanisms for utilization of these to maximize
allocations for the elderly are essential. In this way changes may take place
in direct response to service needs of the elderly.
The National Council on the Aging makes the following policy recommenda-
tions accordingly:
1. Title XX should make explicit that services be designated for the el-
derly specifically, so that low-income elderly are not in competition with
other groups for services;
2. Group eligibility in the provision of services to adults should be al-
lowed under Title XX.
3. Standards which ensure quality adult care must be established under
Title XX. Funding to ensure enforcement of these standards through inspec-
tion and education must also be forthcoming.
4. Attempts should be made to coordinate the Title XX programs with other
service programs - private or public - which serve older people.
5. Provision of services under any law is useless unless knowledge and
access to the services is made readily available to the group which needs
GERALD FORD LIBRARY
Social Services
4
Isions
them. Thus, a system which will provide information and make referral for
the elderly to link them to services should be developed.
6. Transportation is a means to bring services and older people together.
Mass transportation and/or diverse mobility systems which are responsive
to the unique needs of older people should be developed.
AOOU
7. Levels of appropriation for services should meet the massive needs of
at
the elderly. Insufficient funding represents tokenism and results in
noisquees
inadequate services and blocks access to services.
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PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
THE SPIRITUAL WELL-BEING OF THE ELDERLY
HOUSING
INDUSTRIAL
Spiritual well-being is the affirmation of life in a
GERONTOLOGY
INTERNATIONAL
relationship with God, self, community and environment that
nurtures and celebrates wholeness.
MEDIA
The spiritual is not one dimension among many in life;
RESEARCH &
EDUCATION
rather it permeates and gives meaning to all life. We call
RELIGIOUS
INSTITUTIONS
AND ETHICS
attention to this fact of life: To ignore or to attempt to
RURAL AFFAIRS
separate the need to fulfill the spiritual well-being of man
SENIOR CENTERS
from attempts to satisfy his physical, material and social
SOCIAL SECURITY,
PENSIONS & INCOME
needs is to fail to understand both the meaning of God and
MAINTENANCE
SOCIAL SERVICES
the meaning of man.
We recognize that human wholeness is never fully attained.
Throughout life it is a possibility in process of becoming;
thus, it is no less important to the older man and woman than
it is to the adolescent. In the Judeo-Christian tradition,
life derives its significance through its relationship with
God. While we acknowledge and respect the rights of others
to have other frames of reference, we reaffirm our belief that
The National Council on theAging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
25
Years of Service to the Elderly
202/223-6250
Spiritual Well-being
2
it is this relationship with God that awakens and nourishes the process of
growth through wholeness in itself, crowns moments of life with meaning and
extols the spiritual fulfillment and unity of a person. 1
Spiritual wholeness is the right of all people. So that older persons
can achieve and maintain a state of spiritual well-being and fulfillment, the
National Council on the Aging recommends the following:
1. The spiritual leadership of the nation should address itself to a
greater commitment of psychic and financial resources toward serving the
elderly. While meeting the needs of the elderly and working for programs
that contribute to the well-being of the elderly, religious bodies should
attempt to ensure that older persons share in the planning and implemen-
tation of all programs related to them, and that these programs are directed
not only to the independent aged in the community, but also to the elderly
living in public or private institutions.
2. The religious community should take it upon itself to become the prime
impetus toward developing special understanding and competency in satis-
fying the spiritual needs of the aging among its members and among those
who deliver services to the aging in private and public agencies.
3. Religious bodies should take the initiative in developing a greater
sensitivity toward, and appreciation of, the cultural and ethnic diversity
of our nation in order to better serve the elderly. They should work
closely with the diverse minority communities to ensure that cultural or
language barriers to communication are broken down without destroying
LIBRARY
the common ethnic or racial identities which bind those communities and
which give greater meaning and identity to so many older people.
FORD
GREATO
1 The introduction was adapted from a statement on Spiritual Well-Being developed
by the National Interfaith Coalition on Aging at its Fourth Annual Meeting,
April 29-30, 1975, in Washington, D.C.
Spiritual Well-being
3
4. Religious organizations should be aware of agencies and services
other than their own which can provide a complete ministry to older per-
sons. Other organizations designed for the benefit of older persons
should develop, as part of their services, channels to persons and agencies
who can help in spiritual problems.
5. Religious bodies have traditionally and properly developed their
own philosophies. In this context, they should work together with the
elderly and coordinate their efforts with other groups to develop and
declare an affirmation of rights for the elderly as well as to become
actively concerned with spiritual, personal and social needs. Such ef-
forts would work to ensure the basic values of all while guaranteeing
the basic right of freedom of religion.
6. Religious bodies and the government should affirm the right to, and
reverance for, life. In that framework, we believe an individual has the
right to choose to die a natural and dignified death. When there is no
reasonable expectation of recovery from physical or mental disability,
an individual should be allowed to die and not be kept alive by artificial
or heroic means. Medication should be mercifully administered during times
of terminal suffering, even if it hastens the moment of death. Such a
decision by an individual does not ask that life be directly taken, but
that dying be not unreasonably prolonged. This decision should be made
by an individual for himself or herself. To ensure that such a request
for a natural death is understood and not abused by others, individuals
are urged to compose living wills. These wills would communicate the
conscious desire to be allowed to die even though the individual be
unconscious or otherwise incapacitated near the moment of death.
7. Institutions caring for the aged should provide the opportunity
for BERALD FORD LIBRARY
Spiritual Well-being
4
chaplaincy services. In all cases, however, the aged resident should be
the sole arbiter of the religious denomination and degree of any assistance
provided.
8. The government should cooperate with religious bodies and private
agencies to help meet the needs of the elderly, but, in doing so, should
observe the principle of separation of church and state.
.2
We hope that these recommendations will stimulate a rededication of national
efforts toward enriching the lives of older people. In particular, we seek a
society and spiritual atmosphere in which the elderly can grow to accept the
past, to be aware and alive in the present, and to live in hope of fulfillment.
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PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
TRAINING AND EDUCATION
HOUSING
Training
INDUSTRIAL
GERONTOLOGY
With what is bound to be a major expansion of services
INTERNATIONAL
and programs for the elderly during the next few years, there
MEDIA
is a growing need for continuing education of people in the
RESEARCH &
X
EDUCATION
field. NCOA believes the following steps are necessary:
RELIGIOUS
INSTITUTIONS
1. Continuing education and supplementary training
AND ETHICS
RURAL AFFAIRS
programs for people who wish to serve as staff members
SENIOR CENTERS
of area agencies, as staff members of senior centers,
SOCIAL SECURITY,
PENSIONS & INCOME
and as staff of long-term care institutions should be
MAINTENANCE
SOCIAL SERVICES
supported.
2. The present flow of young people through doctoral
programs in gerontology and related disciplines should
be maintained. The provision of a limited number of
fellowships for doctoral candidates in the spring of
1975 is commendable and should be continued.
3. Training grants for university programs in the social
and biological aspects of aging should be maintained with
BERALD FORD LIBRARY
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Training and Education
2
funds that will guarantee the supply of research and university teaching
personnel at a somewhat increased level.
4. The continuing needs for training persons at the doctoral and the
semi-professional levels should be coordinated with the aid of the National
Institute on Aging and the Federal Council on Aging. The time has come
to set up an ongoing program for at least five years, with funding author-
ized by the Congress. Appropriations for training have been $8 million
in the most recent years, and support should be continued at this level,
or increased over the next five years.
Education
Programs of general cultural and socio-civic education provided for people
in their 50s, 60s, and 70s are now beginning to catch the attention and interest
of mature people much more than they have in the past. This is partly due to
the ingenuity and effort of educators, working especially in community colleges
and in extension divisions of the state universities. It is also partly due to
the increasing level of formal education of elderly people. Within ten years,
the majority of people aged 65 will be high school graduates. And those who
have the most formal education are the ones who want more continuing education.
To encourage and meet this growing interest, NCOA recommends:
1. Educational programs should be effectively free of tuition charges for
all people over age 60, which means that colleges and public schools should
have access to Federal or state funds to support such programs.
2. Legislation has paved the way for support of continuing education pro-
grams, but very little money has yet been appropriated and made available.
Federal funds should be appropriated specifically for these programs.
3. Curricula regarding the aging process should be developed and intro-
duced at all educational levels.
PUBLIC POLICY
NC
BOARD
STATEMENT
OF
DIRECTORS
GENERAL
September, 1975
ARTS
HEALTH
TRANSPORTATION AND THE ELDERLY
HOUSING
Transportation provides a link to needed services for
INDUSTRIAL
GERONTOLOGY
the elderly, who are more reliant on transportation than any
INTERNATIONAL
other segment of the population. Yet the elderly are least
MEDIA
likely to be served by the present transportation system.
RESEARCH &
EDUCATION
Most transportation money goes to networks serving the pri-
RELIGIOUS
INSTITUTIONS
vate automobile, and the elderly are generally non-drivers.
AND ETHICS
RURAL AFFAIRS
Where transportation is available - and almost none is avail-
SENIOR CENTERS
able in rural areas - the elderly either can't afford it or
SOCIAL SECURITY,
design, routing or scheduling make use of facilities difficult.
PENSIONS & INCOME
MAINTENANCE
SOCIAL SERVICES
X
Thus, barriers are created to service and employment for the
elderly, particularly the elderly poor. NCOA, therefore, re-
commends:
1. The Federal government must take the leadership in
increasing the mobility of older people through subsidies
and promotion of free or low-cost coordinated, accessible
transportation systems with special attention to their
unique needs. Ultimately, the responsibility in this
FORD & LIBRARY GERALD
The National Council on the Aging, Inc.
ALBERT J. ABRAMS, President
JACK OSSOFSKY, Executive Director
1828 L St., N.W., Suite 504
Washington, D.C. 20036
8
25
Years of Service to the Elderly
202/223-6250
Transportation
2
area must rest with state, regional and local transit authorities.
2. The provision of transportation is an essential part of any social
service, welfare or health program serving older people. Any of these
which receives subsidy from local, state or Federal government should
include transportation as the vital linkage between the older person
and the service.
3. Funds should be provided by all levels of government to test out new
alternative ways to provide low-cost transportation to meet the needs of
older persons in both urban and rural areas.
4. Older people themselves should be actively involved in the planning,
policy making and development of transportation programs designed to
serve them.
03
.1
molsomorq
THE NATIONAL COUNCIL ON THE AGING
1828 "L" STREET. N. W.
WASHINGTON. D. C. 20036
MASHIN
JU.S.POSTAGE
NOV19'75
WILL E05
:
DC
PB.614228
NON PROFIT
ORGANIZATION
NOV 21 1975
WHITE TION REC HOUSE Processed MOV & SECURITY 21 by: 1975
20501FRD0G
9
0
HON GERALD R. FORD
PRESIDENT OF THE UNITED STATES
OF AMERICA
WHITE HOUSE
WASHINGTON, DC 20501
HEARINGS ON THE PRESIDENT'S MEDICARE PROPOSALS - February 9, 1976
Before the House Ways and Means Health Subcommittee
Members Present: Dan Rostenkowski (D-I11.), Chairman
Representatives Corman (D-Calif.), Burleson (D-Tex.),
Keys (D-Kans.), Martin (R-N.C.)
Witness List attached.
The witnesses, mostly Health Security Act proponents, opposed the
Administration's Medicare catastrophic proposal, calling it arbitrary,
deceptive, a gimick and an attempt to shift a greater burden of health
care costs on to the recipients of Medicare and to State and local
assistance programs. They were totally convinced this is not a catastrophic
measure in any sense except that it actually would create the catastrophes
for the program; i.e. many would be forced into catastrophic costs through
the new co-insurance system and out-of-pocket requirements. Some came
armed with figures, charts and examples to bear out this claim.
The central theme running through most of these statements (besides the
philosophical rhetoric) was:
--The numbers of beneficiaries would be small--only 25,000 who would
be hospitalized for 70 - 75 days. (One witness asked how many of the
25,000 are the elderly; what about ESRD patients for instance).
--The 4% cap on physicians' fees only limits the amount reimbursable
under Medicare; a greater portion ofthe patient's bill would be passed
along to the patient. (In that connection, several witnesses and
Rep. Corman indicated a fixed fee is in order.) Further, the witnesses
claimed this would lead to a decline in the assignment rate.
--The 7% cap on hospital fees would be passed along to non-Medicare patients.
--Medicare recipients would be inclined to seek care only after they
become critically ill.
-Secretary Mathews' statement that "more would have to pay more" was
quoted by one and all, but at times (such as during Senator Pepper's
statement) was translated to mean "more poor would have to pay more."
Representative Martin was quick to emphasize that not all the elderly
are poor (Mr. Turk of the NASW put the poverty level for this group at
50%)
--Several witnesses voiced general but vague criticism with respect to
the block grant proposal. Nelson Cruikshank, who seemed to have a
better grasp of the concept of Share than the other witnesses (and
perhaps some Members of the Committee) was concerned that the Medicare
proposal would force more individuals onto Medicaid rolls and weaken
that program's ability to meet the load.
GERALD FORD LIBRARY
2,
With respect to the Administration's rationale that the proposal
would prevent overutilization, Mr. Cruikshank said it is the doctor,
not the patient, who determines the use of hospital care. The
overutilization of services was mentioned in connection with
criticism of the Administration's home health policies by Rep.
Keys and several witnesses within the framework of alternatives
to institutionalization.
Several spokesmen offered their own Medicare improvement proposals:
i.e., the AFL-CIO, the NRTA-AARP (the Medicare Reform Act of 1975--
Ribicoff/Matsunaga), and Senator Pepper's Home Health Improvement
package.
The testimony of the National Association of Patients on Hemodialysis
was not covered; however, in their prepared statement they opposed the
amendments on the basis that they would cause the first experiment
in catastrophic illness coverage to fall short of its goal because
it would be too costly to those on fixed incomes, to the Federal govern-
ment by shifting reimbursement from States and private carriers, to
the renal program because it would block cost saving incentives; and
it would give very little direct aid to those suffering from catastrophic
illness.
The few questions asked of the witnesses by Committee Members were
very basic ones.
L(H):td:2/9/76
GERALD FORD LIBRARY
LIST OF WITNESSES TO APPEAR BEFORE
THE SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON WAYS AND MEANS
ON
THE PRESIDENT'S MEDICARE PROPOSALS
MAIN COMMITTEE HEARING ROOM - LONGWORTH HOUSE OFFICE BUILDING
10:00 A.M.
MONDAY, FEBRUARY 9, 1976
1. Claude Pepper, M. C. (Florida)
2. American Federation of Labor
Congress of Industrial Organizations:
Bert Seidman, Director, Social Security Department
Larry Smedley, Assistant Director, Social Security Department
Robert McGlotten, Legislative Representative
3. National Council of Senior Citizens:
Nelson H. Cruikshank, President
4. United Mine Workers Health & Retirement Funds:
Jerry N. Clark, Director of Research
5. National Council on Aging:
Jack Ossofsky, Executive Director
6. American Association of Retired Persons
National Retired Teachers Association:
Laurence F. Lane, Legislative Representative
Peter Hughes, Associate Counsel
7. National Association of Social Workers:
Oscar Turk, ACSW, Member, Health Action (New York Chapter)
(Coordinator of Discharge Planning, Bird S. Coler Hospital,
New York City)
8. Women's Lobby:
Carol Burris, President
9. National Association of Patients of Hemodialysis and
Transplantation:
GERALD FORD VIBRARY
Phyllis Messer, Executive Director
THIS HEARING WILL CONTINUE AT 9:00 A.M., TUESDAY, FEBRUARY 10,
IN THE MAIN COMMITTEE HEARING ROOM.
NA. Council of
- 3 -
SR. Citizens
Table I Comparison of the out-of-pocket costs for covered hospital
services under the existing Medicare program with the
President's proposal, by number of days in hospital
Deductible & Coinsurance
Deductible & Coinsurance
under present Medicare
under Administration's
program
proposal--based on average
Days in hospital
daily hospital charges of:
$100
$150
$200
1
$124*
$100
$127
$132
5
124
162
187
212
10
124
212
262
312
15
124
262
337
412
20
124
312
412
500
25
124
362
487
500
30
124
412
500
500
35
124
462
500
500
40
124
500
500
500
45
124
500
500
500
50
124
500
500
500
55
124
500
500
500
60
124
500
500
500
65
279
500
500
500
70
434
500
500
500
75
589
500
500
500
80
744
500
500
500
85
899
500
500
500
90
1054
500
500
500
*Deductible (now $104) estimated to be $124 in 1977 when
President's proposal would go into effect
FORD is LIBRARY GERALD
Chart I
Increases in Hospital Costs for Medicare Patients
Under the President's Proposal*
(Based on three average hospital charges per day)
$700
*Effective in 1977 when Medicare deductible would be $124
600
500
DEDUCTIBLE & COPAYMENT CHARGES
400
PRESIDENT'S
300
PROPOSAL
$200 per day
200
$150 per day
$100 per day
100
I
Existing Medicare
MEDICARE NOW
semon Citizen
Na. Council
20
30
40
50
60
70
80
GERALD LIBRARY R. FORD
DAYS IN HOSPITAL
Chart II
35%
LENGTH OF STAY OF MEDICARE
35%
HOSPITAL PATIENTS, FY 1974
Source: Social Security Administration
31.5
30
30
29.1
25
25
Percent of Patients Discharged
20
20
GERALD
R.
I
16.6
FORD
r
15
LISAREY
15
10
9.1
I
5.3
5
na Coursel
3.0
2.9
1.2
0.6
0.7
0
0
5 or less
6-10
11-15
16-20
21-25
26-30
31-40
41-50
51-60 61 & over
Days in Hospital
-14-
United Mine Warhers
Assumptions:
For the analysis of the cost impact on the Funds of these
Medicare changes, the following assumptions are made:
1. The number of Medicare - covered beneficiaries
included in the Fund population is assumed to be:
Over 65 - 95,000
Under 65 - 11,000
Total 106,000
2. Hospital admission rate per 1000 Medicare covered
beneficiaries is based on the FY 1975 level of 479
per 1000 beneficiaries.
3. Average length-of-stay is the same as US Medicare
experience, or 11.7 days per admission.
4. Average hospital per-diem charge to Medicare is equal
to $104 for calendar 1976; a 7% increase is projected
for the next two years, to $111 in calendar 1977; and
to $119 in calendar 1978.
FORD LIBRARY & GERALD
-CT-
TABLE I
ESTIMATED CHANGES IN FUNDS HOSPITALIZATION
COSTS UNDER MEDICARE, ADMINISTRATION PROPOSALS
(Assumes 7% cost limitation)
A. FISCAL YEAR 7/1/76 - 6/30/77
Administration
Present
Proposal
1. Number of admissions
50,774
50,774
2. First day deductible
$5,465,306
5,465,306
3. 10% Coinsurance
-
4,435,288
4. Less catastrophic coverage
-
177,455
5. Net coinsurance cost
4,257,833
6. Total Funds cost
$5,465,306
9,723,139
7. INCREASE
78%
B. FISCAL YEAR 7/1/77 - 6/30/78
Administration
-
Present
Proposal
1. Number of admissions
50,774
50,774
2. First day deductible
$5,847,895
5,847,895
3. 10% Coinsurance
-
6,257,248
4. Less catastrophic coverage
-
250,257
5. Net coinsurance cost
-
6,006,991
6. Total Funds Cost
$5,847,895
11,854,886
7. INCREASE
103%
GERALD FORD GRART
-16-
TABLE II
INCREASE IN DEDUCTIBLE COSTS
UNDER ADMINISTRATION PROPOSAL
YEAR ENDING 6/30/77
1. No. of beneficiaries
106,000
2. Cost at $46.20 average deductible
$4,897,200
3. Cost at $33.16 average deductible
3,514,960
4. Difference
1,382,240
YEAR ENDING 6/30/78
1. No. of beneficiaries
106,000
2. Cost at $48.60 average deductible
$5,151,600
3. Cost at $33.16 average deductible
3,514,960
4. Difference
1,636,640
TABLE III
SAVINGS FROM PART B CATASTROPHIC
COVERAGE
YEAR ENDING 6/30/77
1. Estimated Part B costs
$31,527,518
2. 4% catastrophic
1,261,100
-
3. 20% presently paid
252,220
(savings)
YEAR ENDING 6/30/78
1. Estimated Part B costs
$34,680,822
2. 4% catastrophic
1,387,232
3. 20% presently paid
277,446
FORD is LIBRARY GERALD
(savings)
-17-
TABLE IV
INCREASED CO-INSURANCE FOR PHYSICIANS
IN-HOSPITAL SERVICES AND HOME HEALTH
YEAR ENDING 6/30/77
Physicians In-Hospital
Home Health
1. Total Costs
$ 10,908,408
$ 252,395
2. Minus share of deductible
712,727
861
3. Net
10,195,681
251,534
4. 30% co-insurance
3,058,704
75,460
5. 20% co-insurance
2,039,136
50,307
6. Difference
1,019,568
25,153
7. Total Difference
$ 1,044,721
YEAR ENDING 6/30/78
1. Total Costs
$ 11,999,169
$ 277,633
2. Minus share of deductible
712,727
861
3. Net
11,286,442
276,772
4. 30% co-insurance
3,385,933
83,032
5. 20% co-insurance
2,257,288
55,354
6. Difference
1,128,645
27,678
7. Total Difference
$ 1,156,323
TABLE V
NET COST IMPACT OF INCREASED
DEDUCTIBLE AND COINSURANCE AND
CATASTROPHIC COVERAGE, PART B
MEDICARE
YEAR ENDING
6/30/77
6/30/78
Increase from deductible $1,382,224
$1,636,640
Increased coinsurance
1,044,721
1,156,323
Savings from catastrophic
252,220
277,446
Net increase
$2,174,725
$2,515,517
FORD & LIBRARY GERALD
-18-
TABLE VI
EXPECTED MEDICARE REIMBURSEMENTS
FOR PART B
Medicare Reimburse-
Medicare Reimburse-
Total
ment expected at
ment expected
FY
Cost
current rates
changes
Difference
8
1975
$24,000,000
$17,300,000
-
-
1976
30,290,000
22,190,000
-
-
1977
33,319,000
24,322,870
$23,077,600
$1,245,270
1978
36,650,900
26,755,157
24,000,704
2,754,453
$3,999,723
FORD is LIBRARY GERALD
-19-
TABLE VII
SUMMARY OF INCREASED COSTS
TO FUNDS OF ADMINISTRATION
MEDICARE PROPOSALS
FY 1977 & 1978
FY 1977
FY 1978
1. Due to Part A direct increases
4,257,833
6,006,991
2. Due to Part B direct increases
2,174,725
2,515,517
3. Due to Part A indirect costs
5,000,000*
10,000,000*
4. Due to Part B indirect costs
1,245,270
2,754,453
Total Cost
$12,677,828
$21,276,961
Grand Total $ 33,954,789
#####
FORD is LIBRARY GERALD
HEARINGS ON THE PRESIDENT'S MEDICARE PROPOSALS - February 10
Before the House Ways and Means Health Subcommittee
Members present: Dan Rostenkowski (D-I11.), Chairman
Representatives Corman, Cotter, Keys
Duncan, Crane
Witness List attached.
The witnesses unanimously opposed the Administration's proposals and
urged the Committee to reject them. The Administration was criticized
by several of those testifying because of the "secrecy" surrounding
these proposals and the vagueness of the information offered. They
expressed an interest in analyzing them when they are put in legislative
language.
The primary concern of today's witnesses was the 4% and 7% limitation
on physicians' fees and hospital reimbursement (especially the latter).
They stated the President had decided to subject the health industry
to limitations not imposed on other sectors of the economy. Further, they
--warned of a further decline in assignment rate (estimated at 50%
for 1975)
-predicted a wide variety of responses to the "intolerable" ceiling,
including a reduction in quality of and accessibility to services.
--compared the rise in overall cost-of-living with the (comparatively
low) allowable physician fees during the same period of time
--deplored the shift of costs to non-Medicare hospital patients
justified increases in health care costs due to economy-wide inflation,
citing increases in salaries, malpractice insurance, drugs, utilities, etc.
--stated that these controls duplicate existing authority (Section 223
of P.L. 92-603) and referred to cost controls already in place (UR, PSRO)
As did yesterday's witnesses, those testifying today opposed the $500-$250-
coinsurance combination and said it was catastrophic only to the
beneficiaries. They objected to increased out-of-pocket costs and said
those who could least afford the added expense (i.e. the hospitalized)
would have to pay. The witnesses performed basically the same
Now-and-Proposed exercises and comparisons with the Proposed coming under
sharp criticism. The AMA, though in basic agreement with the need for
cost-sharing (they cited their NHI proposal, H.R. 6222 as an example) ob-
jected to the financing of the Medicare catastrophic and suggested costs
be spread over the entire Medicare population. Concern was expressed that,
since most Medicare patients cannot absorb more increases, the Medicaid
rolls will swell, the States wont be able to meet the burden, and the re-
sult will be a reduction in health care services.
FORD & LIBRARY 076870
Page 2 - - Feb 10 hearing
Dr. Charles Phillips, President of the American Protestant Hospital
Association, spoke out against FAHCA. He said the past history of
the States in providing services to the poor and medically needy is
not too promising for the success of this program, and that the
hospitals of this country are in no position to absorb any gap between
what the States decide to pay for care and the cost of providing that care.
He provided also specific examples of the impact of the 7% limit, which
are attached.
8
Committee interests:
Rostenkowski - acceptable approaches to control hospital costs;
effect on patients of the 7% lid; whether coinsurance
-1
is an effective method of controlling utilization
Corman
Possibility of required assignment; reasonable fees
Keys
Home health; cut back in services; the cancer study*
Duncan
Financing
Cotter
Whether physician services in a hospital are affected by
the 4% or 7% limit
Crane
H.R. 11030 (his bill to require consultation between
the Executive Branch and Congress prior to issuing
proposals
* The National Cancer Foundation cited a hospital survey which indicated
the average hospital stay among cancer patients is 15 days; and
17 days for cancer patients over 65.
L (H):td:2/10/76
FORD is LIBRARY GERALD
LIST OF WITNESSES TO APPEAR BEFORE
THE SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON WAYS AND MEANS
ON
THE PRESIDENT'S MEDICARE PROPOSALS
MAIN COMMITTEE HEARING ROOM - LONGWORTH HOUSE OFFICE BUILDING
9:00 A.M.
TUESDAY, FEBRUARY 10, 1976
1. American Hospital Association:
John Alexander McMahon, President
Dr. Leo J. Gehrig, Senior Vice President
2. American Medical Association:
Dr. Raymond Holden, Chairman, Board of Trustees
Harry Peterson, Legal Counsel, AMA Legislative Council
3. Association of American Medical Colleges:
Dr. David D. Thompson, Chairman-Elect, Council on
Teaching Hospitals (Director, New York Hospital)
4. American Protestant Hospital Association:
Charles D. Phillips, President
Kenneth Williamson, Consultant on Washington Affairs
5. National Cancer Foundation:
Eric L. Hirschhorn, Member, Board of Directors
6. Council of Community Hospitals:
John F. Horty, President
7. Friends Committee on National Legislation:
Dr. Malcom Lee Peterson (Johns-Hopkins, Dean of Health
Services)
8. Hospital Financing Study Group:
John M. Vickers, Chairman (Vice President, E.F. Hutton & Co.)
9. National. Union of Hospital and Health Care Employees,
District 1199:
Judith Berek, Legislative Representative
10. Welborn Baptist Memorial Hospital, Evansville, Ind.:
Donald I. Gent, Executive Director
11. Monongahela Valley (W. Va.) Assn. of Health Centers:
GERALD FORD FIBRARY
Jim Burnell, Controller
12. Daniel J. Foley, Senator, Commonwealth of Massachusetts
THIS HEARING WILL CONTINUE AT 9:00 A.M., WEDNESDAY, FEBRUARY 11,
IN THE MAIN COMMITTEE HEARING ROOM.
Further, to force health care facilities to curtail needed ser-
vices in order to keep within the limits of proposed unreasonable
percentages of increases is arbitrary and unjust. Such a proposal
may be consistent with the administration's objectives of reducing
the influence of big government and the Federal budget, but it is
not a rational manner to achieve such an objective nor to assure
the best of health care for the nation's aging populątion.
In concluding my statement, I felt that I might be of more help
to the committee by citing some additional specific examples of
the impact the proposed limit of a 7% increase in reimbursement
would have on some of our institutional members. I requested
several institutions across the country to provide data which
projects with specificity the effect of the 7% ceiling on their
operation.
1. Presbyterian Hospital, Charlotte, North Carolina, experienced
a 12.75% increase in the costs of care for Medicare patients during
the last fiscal year. Had they been limited to the proposed 7%
increase, and had they maintained their level of services, all
non-Medicare patients would have been required to pay an additional
amount of $2.00 per day to offset the loss.
2. Walther Memorial Hospital, Chicago, located in the district
represented by the Chairman, experienced in the fiscal year just
past an increase in per diem costs of 14.69%. Non-Medicare-Medicaid
patients, under the proposed cap, would have been forced to absorb
an additional $5.70 per diem, not including increases in malpracticce.
GERALE Burond VIBRARY
3. Hendrick Memorial Hospital, Abilene, Texas, experienced
an increase in per diem costs during FY1975 of 15.22%. The pro-
posed cap of 7% would result in a loss on Medicare patients of
$277,040 and force an increase in per diem charges to non-Medicare
patients in excess of $4.00 per day. This institution reports an
increase of some 20% in costs of paper goods this year and an
increase of more than 7% in labor costs.
4. The data from Bethesda Hospital in Cincinnati, Ohio, reflects
data just as astounding. Increased costs at Bethesda forced that
institution's per diem costs up from $98 in 1974 to $117 in 1975.
The 7% limit would have limited reimbursement to a maximum of
only $106 per diem, a loss of $704,000 on Medicare patients which
would have to be recovered from non Medicare payors. The Vice-
President of Finance for Bethesda reported that an institution
which undertakes any type of expansion program, should the admin-
istration proposal be enacted, would be engulfed in an absolute
disaster.
Finally, I want to state once again the total opposition of the
American Protestant Hospital Association to the imposition of
any arbitrary ceiling on reimbursements to hospitals and other
facilities which does not relate rationally and operationally
with other ever-present forces which affect the costs of providing
health care services. On its face the proposal before you is
arbitrary, inequitable, and untenable for the providers of ser-
vices. It is counter-productive as a service on behalf of most
recipients of Medicare.
FORD LIBRARY
When specific bills are written, we stand ready to offer any
assistance possible as you consider them.
PRESS CONFERENCE NO. 26
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QUESTION: Mr. President, a two-part question,
sir.
STATE CHTIMU 3HT 10
Since you took office, you have lashed out somewhat,
of course, at Congress for its slowness in investment of a
research and energy conservation plan. We now understand from
ERDA that it will be possibly more than six months before
the site for the solar research center is chosen and that
politics has entered into the picture so much in that site
selection that all the States in the Union may soon join
in that competition. na edit JA
nnI froggel
The question is, sir, is the pot -- meaning the
Ford Administration -- calling the kettle black?
Page 3
in the best interest of the country's taxpayers to develop
QUESTION: Mr. President, would it possibly be
the center here in Florida, in Brevard County, with the
expertise of the Kennedy Space Center is nearby, and
particularly as Broward maintained a 17 percent
or more unemployment rate?
THE PRESIDENT: Certainly, Broward County
and the whole area have many, many assets that certainly
will be important at the time they submit their application
under the criteria established by ERDA. But it would be
ill-advised and probably completely wrong for me to make
any commitment on behalf of ERDA because that is a technical
decision. I am sure that the application will be a good
one. I am certain this area will get excellent consideration,
but it would be, I think, wrong for me to make a decision
other than to say I know you had lots of sunshine.
QUESTION: Mr. President, you have given the
first of some special messages to Congress on the problems of
the alderly What kind of help do you propose to help Florida's
many senior citizens?
THE PRESIDENT: In the first place, I fully agree
with whatever the increases in Social Security benefits will
be under the cost of living escalator clause. That will
take place later this year. I fully concur with that.
Number two, I happen to believe it is vitally
important for us to make certain that the Social Security
Trust Fund is fully funded. At the present time, it is running
in a deficit of about $4 billion per year. Sometime in
1980, if we don't do something, the funds will be depleted.
I have recommended one proposal to make sure--to make positive--
that those who are retired and those who are to be retired
will have a continuous flow of the benefits under Social
Security.
Number three, I have recommended that we incorporate
in the law a new program to take care of roughly the
3 million individuals, most of whom are among our older
citizens, who are suffering from what we call catastrophic
illnesses. At the present time, there is no program to
take care of those who have expanded and serious illnesses.
I have proposed a catastrophic health care plan that will take
care of about 3 million people under Medicare. I think it is
a good proposal and I hope the Congress will respond to it.
In addition, I have recommended good funding,
I think, for what we call the Older Americans Act. It has
a wide variety of services that are incorporated and I hope
the Congress does as I have recommended in the funding of
those
programs.
MORE
GERALD FORD LIBRARY
Page 4
QUESTION: On the health care plan you mentioned,
Dr. Hobert Jackson, Vice President of the National Council
on Aging, said in Gainesville that your health care program
has some good concepts, but, in effect, it would help
only one in every 300 people affected.
THE PRESIDENT: As I understand it, it would help,
very specifically, 3 million out of roughly 24 million.
Now the good part of it is that these 3 million are the ones
who are most adversely affected by the cost of two, three and
five years of extended care in mounting doctor bills. It
seems to me that we ought to put special emphasis on
taking care of those tragic cases where you have extended
illnesses.
In the meantime, under Medicare, there still
would be a health care program for those who participate.
But we put a new tilt, trying to be helpful to the people
affected with a catastrophic illness.
QUESTION: Mr. President, not too many years
ago another American President put a challenge fourth to this
country and put a man on the moon, technology met that
challenge, as you know that task was met. The Project
Independence was recently launched to make this country
self-sufficient. This is failing and failing miserably.
Why is it failing, Mr. President? Why can't this country
be energy self-sufficient and would you put a timetable
on that?
THE PRESIDENT: In January of 1975 in my State of
the Union Message I laid out a ten year program. I have a
number of specific items that, if Congress would respond,
we could become energy independent in ten years, by 1985.
Unfortunately, the Congress dilly-dallied, day after day
after day, and finally in December they passed a partial
answer to the request that I had made in January. The bill
which I signed is a base from which we can operate. It
provides for some conservation. It provides over a 40-month
period, for increased production, domestically, and it has
some conservation features,
On the other hand, it has done nothing to deregulate
natural gas. Tragically, we had a setback a week or so ago
in the House of Representatives, but we hope we can retrieve
that That would be something that I recommended Congress
should do. In addition, I have recommended for the Energy
Research and Development Program $2 billion, 900 million.
It is about a 30-some percent increase in research and
development funds for energy, including solar, geothermal,
fossil fuels, nuclear energy. And if Congress appropriates
the money, it will move us ahead in those fields as well
as several other exotic fields. In the case of solar energy,
the increase in research and development funds was over
40 percent. So we are trying to move ahead in conservation,
in increased omestic production, the greater utilization of
coal in research and development for the long term. Although
the Congress did not respond as well as I would have liked last
year, I think we will make more headway in 1976.
MORE
GERALD FORD LIBRARY
Medicine
FOR IMMEDIATE RELEASE
FEBRUARY 14, 1976
OFFICE OF THE WHITE HOUSE PRESS SECRETARY
(St. Petersburg, Florida)
THE WHITE HOUSE
REMARKS OF THE PRESIDENT
AT
WILLIAMS PARK
GERALD LIBRARY R. FORD
11:00 A.M. EST
Page 2
I pledge to you this morning that I will continue
to uphold that commitment. In recent years, there has been
dramatic progress in our efforts to meet the continuing
needs of America's older generation. But, I want to do
better, and with your help and with the help of the Congress,
I will, and I am sure we will.
As President, I intend to do everything in my
power to help our Nation demonstrate its deep concern for
the dignity and the well being of our older generations.
For those who need our help we have already a number of
Federal programs providing assistance in a variety of
ways.
The Social Security program, the largest of its
kind in this world, will pay almost $83 billion to more than
32 million Americans in fiscal year 1977. That is more than
a $10 billion increase over the current year.
Here in Florida the Social Security. Trust Fund
will pay an estimated $4 billion 400 million to participants
in the next fiscal year. In my budget for fiscal year 1977,
I am recommending that the full cost of living increase in
Social Security benefits be paid during the coming year.
Now, let me assure you of one thing very emphatically.
My Administration fully intends to preserve the integrity
and the solvency of the Social Security system for your
benefit and that of all working Americans, men and women,
now as well as in the future.
I think that is good news, but now let's have some
bad news.
This year it is projected that the Social Security
Trust Fund will run a deficit of about $3 billion. Next
year, unless my reforms are adopted, we will run a deficit
of $3.5 billion. If this trend continues, there will be no
Social Security for old or young.
As long as I am President, we are going to keep
Social Security protection and every other retirement program
strong, sound and certain, and we will do it.
Yesterday, the Department of Labor announced that
wholesale prices were unchanged in January. In fact, whole-
sale prices have shown no appreciable change since October
of last year.
This is more good news in our fight against
inflation, and we are going to keep the pressure on.
MORE
GERALD FORD LIBRARY
Page 3
In addition to the Social Security program, we
are continuing our strong commitment to benefit programs
for more than three million railroad, military and Federal
Government employees. Of course, that means we will do the
same job for the veterans who live here and live elsewhere
in 49 other States.
After many, many years of sacrifice and hard
work, you have contributed to America. You have earned
the respect, and you have earned more than the prospect
of poverty in your retirement years.
In my budget, the Supplemental Security Income
program, or SSI, will pay almost $6 billion in Federal
benefits to more than five million disabled and disadvantaged
older Americans in 1977, 170,000 of them right here in
Florida.
Let's be frank. There have been some problems
with this program, as you probably know, because the SSI
replaced a great number of Federal assisted State programs
and inevitably there was some confusion in the process.
We have already begun to take extensive steps
to correct these problems, and we will make sure that if any
American qualifies for these benefits, he or she will get
them, period.
Those who don't qualify won't be taking money
that you should have. In the field of health care, the
Federal Medicare program in 1976 will provide more than $17
billion for the health care of 24 million older and dis-
abled Americans, about 1 million 400 thousand right here
in the great State of Florida.
But, there are flaws in this program, which
actually help raise the cost of your medical care and which
fail to protect you adequately against the economic burdens
of prolonged illness.
I
have proposed major improvements in the
Medicare program to make it serve you better. One of the
most important improvements is the creation of a system of
health insurance that would pay all but a very small
fraction of the catastrophic cost of complex or extended
care and treatment.
I don't have to tell you that medical treatment
is very, very expensive today. Hospital costs have risen
by more than 200 percent since 1965, to an average cost
of $128 per day. If you have to stay in a hospital or a
nursing home or under doctor's care for a very, very long
time, it puts an incredible strain on your lifetime savings
and on your peace of mind, and that strain is felt by
your loved ones as well.
MORE
BERALD FORD LIBRARY
Page 4
All of us know of cases in which someone in the
family or a close friend or a member of your church has
been stricken with an illness that lingers on and on and
on. We know of the pain and of the heartache associated
with a prolonged illness.
We know that being sick and bedridden for a long,
long time is bad enough without having a person's income
and life savings dwindle away as the medical bills keep
piling up.
This must not continue, and it won't, with my
program.
Let me put it this way. There is no reason
that older Americans should have to go broke just to
get well or stay well in the United States of America.
Under my proposal the individuals' contribution would go
up slightly, but consider what the increase would
provide.
Nobody eligible for Medicare would have to pay
more than $500 a year for hospital or nursing home care,
and this does not mean that you pay the first $500 of
your total cost. You would pay only 10 percent of the
total cost, or $500, whichever is less, and the maximum
annual cost to you for covered doctor's services would be
$250, or 20 percent, whichever is less.
Medicare would pay the rest, whether it costs
$1,000 or $10,000 or $50,000. It is a good program, and
we are going to make it.
If the Congress passes my program, the ruinous
economic burden of catastrophic illness is ,one thing you
will never have to worry about again. Another of my programs
would consolidate 16 Federal health programs, including
Medicare, into a single $10 billion block grant program to
the States.
If we can consolidate these programs, we can
make them more humane and more effective. We can improve
the services that they provide to you and millions like
you, and we can get those services to more people who really,
really need them.
Programs of this kind, despite some abuses, do
a tremendous amount of good. For some of our neighbors,
they provide the means for life itself. They provide the
food, the services, the health care, without which
some peoplewould not be able to enjoy this beautiful sun-
shine today in St. Petersburg and in Florida.
MORE
GERALD FORD LIBRARY
Page 5
It is all too easy to say that the Federal
Government is too big, that this program and that program
ought to be cut out of the Federal budget, tossed back
to the States to cope with, if their taxpayers will permit
it.
It is not that simple, and you know it and I
know it.
I am concerned, as you are, about the growth of
the Federal budget. I have been fighting to hold down the
Federal budget in a responsible way for 27 years, 25-plus
years in the Congress, a few months as Vice President,
and approximately 18 months as your President.
You all know how hard I have been trying for the
last 18 months to get control of the inflation which has
done so much economic damage to all Americans. During
1974, when I became President, inflation was ranging at
an annual rate of more than 12 percent, eating away at
everybody's buying power but absolutely devouring the liveli-
hood of people on fixed incomes.
I knew that something had to be done to bring
that situation under control. I knew that deficit spending
by the Federal Government was a major contributor to
inflation and that slowing the growth of Federal spending
was essential to solving the problem.
I have used my Constitutional power, that of
veto, 46 times since becoming President, trying to hold
down the level of Federal spending, trying to break the
back of inflation. To hold down the cost of living, we
must hold down the cost of Government. It is just that
simple.
We made some very encouraging progress with these
vetoes, saving the taxpayers about $10 billion. The
inflation rate that was 12 percent has been cut nearly in
half.
That is not good enough. That is progress,
real progress, that helps especially people on fixed
incomes more than anybody else in our society.
Just yesterday the Department of Labor announced
the Wholesale prices stayed level in January. In fact,
wholesale prices have shown no appreciable change since
October.
MORE
FORD is GERALD LIBRARY
Page 6
I want to drive that point home. This is more
good news in our fight against inflation, and we are going
to keep the pressure on, and we are going to be successful.
You probably heard that we had some other good
economic news just about a week ago. Employment in
January took its sharpest drop in 16 years. Ninety-six
percent of all jobs lost during the depression have been
recovered.
America is getting back to work, and we are going
to make better and better and better progress in reducing
unemployment. But, there is so much more that we have
to do. I want all Americans, young or old, black or white,
rich or poor, to live in dignity and security and in peace.
If we can continue making the progress America
has made in the past, we will see that wonderful goal
achieved. Too often people forget just how far and how fast
we have come as a Nation. We have our problems, and we
are not afraid to admit them.
Honesty in this situation is essential, but I
think it is time people stop running down America.
I think it is time we remember how richly blessed
this Nation is. You, or many of you, in this audience have
seen much of America's phenomenal progress with your own
eyes. In the space of your lifetime, man has taken
himself from the horse and buggy and explored the far
reaches of space.
Diseases which were once crippling and killing
millions of Americans have now been conquered. America's
population has more than doubled since 1910. Life expectancy,
which in 1910 was only 50 years, is today more than 71
years.
The Gross National Product, the index of our total
production, is now seven times greater than it was in 1910.
To put it another way, the strength and growth of the American
economy provides the average American living today with
three and one-half times more in goods and services than
Americans enjoyed in 1910.
No other generation of Americans has achieved such
growth, and all of us thank you from the bottom of our hearts.
In 1910, some 156,000 young people graduated
from America's high schools. Last year's college graduates
totaled 944,000. That is another indication of the
progress we are making in this great country.
MORE
BERALD FORD LIBRARY
Page 7
In 1910 there was no regularly scheduled radio
broadcasting in the United States. Nobody had ever heard
of television -- maybe a few very outstanding scientists.
Today, we are living in an age of instant and global
communications. These examples -- and there are many, many,
many more -- serve to remind us of how much has changed,
of how much progress there has been in health, wealth,
education, communication, law, and in every other aspect of
life in our great country.
The fact is that you, your generation, has been
the greatest pioneer of progress and change in the entire
history of the human race.
But, some things thankfully have not changed at
all. We are still a people in America with love of freedom,
and after 200 years that love is undiminished. We are
still a Nation dedicated to progress and peace in the world,
We are still a Nation of compassion. We are still, as
Lincoln called us a century ago, "The last, best hope of
earth."
The United States is a great country, the greatest
in the world. You helped to make it that ..ay, and this
Nation will never, never, never forget your contribution,
past, present or future.
We will never forget the lesson which President
Eisenhower taught us from the wisdom of his years. "America
is not good because it is great" -- the President said --
"America is great because it is good. If
Thank you very, very much.
END
(AT 11:20 A.M. EST)
GERALD FORD LIBRART
file
THE WHITE HOUSE
WASHINGTON
aging
DATE 2/23
TO:
Spence
FROM: SARAH MASSENGALE
7.Y.I
FORD & LIBRARY GERALD
which have jumped from $5.6 million in
vestment financing. He would also do
SOCIAL ISSUES
1971 to $82.7 million last year.
away with the double taxation of divi-
FORD
One of the main uses of ESOPS by pri-
dends, phase out the corporate income
vate companies has also been to fore-
tax, and encourage companies to dis-
stall a sale to outsiders by providing a
tribute most of their earnings to share-
market for closely held shares. Thus,
holders-thus providing a significant
GERALD
Hallmark Cards Inc. converted its
second income to wage earners. He
profit-sharing plan to an ESOP last year
would also establish special stock own-
Getting rid of
partly to assure its 10,000 employees,
ership plans for consumers and govern-
who already enjoy pension and life in-
ment workers, set up insurance funds
65-and-out
surance benefits, that the company will
to insure employee accounts, and em-
not go the merger route after its
power banks to borrow low-interest
founder, Joyce Hall, and his wife die.
ESOP funds directly from the Federal
Says Bill Johnson, director of corporate
Reserve.
Senior citizens flex their
communications: "We wanted to share
Until now, most economists have dis-
political muscle on the
ownership with our employees and
missed Kelso's ideas out of hand-
grounds of discrimination
demonstrate that Hallmark will be
partly because such a radical restruc-
staying in Kansas City."
turing of the economy seems totally
A growing use of ESOPS has been to
unrealistic and partly because he turns
"Mandatory retirement at age 65,"
facilitate the divestiture of subsidi-
many economic concepts upside down.
says Dr. Arthur S. Flemming, former
aries by large companies. This week,
"Kelso really doesn't understand how
Secretary of Health, Education & Wel-
for example, the trustees of Omega-Al-
the economy works," says one academic
fare, "is just a lazy man's device to
pha Inc, which is currently being
economist, "and he has compounded his
avoid making a difficult personnel deci-
reorganized under bankruptcy proceed-
problems by launching a hysterical at-
sion."
ings, announced that they were selling
tack on the profession."
Flemming, 70, heads HEW's Adminis-
the company's Okonite Co. subsidiary
Nonetheless, a few economists have
tration on Aging, one of the fastest-
to an Okonite ESOP for $38 million.
become intrigued with Kelso's theories.
growing social agencies in the federal
'Make it grow faster.' To Louis Kelso, the
James L. Green of the University of
government. Along with other organi-
man most responsible for the mush-
Alabama terms them "the only viable
zations representing older Americans,
rooming interest in employee stock
alternative to wage and price controls
it is pressing for abolition of the 65-
ownership plans, the ESOPS that have
and state planning." Abel Beltran-del-
and-out rule-the actuarial bedrock of
been springing up are only the van-
Rio of Wharton EFA, Inc., the econo-
corporate pension plans, health insur-
guard of what he hopes will become a
metric research organization, acknowl-
ance, and personal careers-as No. 1 on
major movement. He has long argued
edges that Kelso's program is "theoret-
a long list of legislative goals. Last
that the basic cause of the nation's eco-
week the House subcommittee on ag-
nomic ills lies in the maldistribution of
Kelso says ESOPs can
ing held hearings on a bill that would
wealth, which results in a chronic gap
increase productivity and
achieve this end by including over-
between production and consumption
raise capital for growth
65ers in the law forbidding job dis-
and the need for ever greater govern-
crimination against the aged, a cate-
ment intervention to redistribute in-
ically weak and inflated in its claims,"
gory that now spans those 45 to 65. The
come and manage demand. He believes
but he feels that it "contains nuggets
bill would also open up pension plans
that using ESOPS to finance new invest-
of gold surrounded by mud."
that require retirement at 65.
ment would restructure both wealth
In light of the growing interest in
Although 47 congressmen joined
and income patterns in a fairly pain-
ESOPS, several economists have begun
Representative Paul Findley (R-Ill.) in
less way. "The point," he says "is to
to look more closely into Kelso's ideas.
sponsoring the bill, no one expects it to
make the pie grow faster and distrib-
Wharton EFA itself, is planning an
meet instant success. Aside from its
ute the new growth more equitably."
econometric study testing the potential
complicating effect on benefits pro-
To some observers, all of this is "pie
impact of Kelso's proposals and other
grams, open-ended retirement inspires
in the sky," but Kelso's analysis has a
capital diffusion schemes on the U.S.
mixed feelings in industry, with some
certain pragmatic logic that many find
economy. And Carter Bacon of the
companies easing employees toward
appealing. Unlike traditional economic
Congressional Reference Service of the
early retirement while others laud the
theory, which tends to stress labor as a
Library of Congress, is at work on a
work of employees over 65. At the same
major factor of production, Kelso holds
background report. "There's no ques-
time, inflation has motivated many
that capital goods are the main produc-
tion that ESOP financing can help some
older workers to keep working to es-
ers of wealth and growth in a modern
companies," he says, "and it seems
cape the hardships. of life on a
economy. Because capital ownership is
likely that investment and savings
shrunken pension, swelling the ranks
already highly skewed, the common
would be higher in an economy that
of those who work as a matter of
methods of financing new investment
functions that way. But implementing
lifestyle.
(mainly through retained earnings and
such a change would raise serious ques-
In the groove. "Time doesn't change our
debt) increases the concentration of
tions of equity and would risk unsound
habits of self-discipline or teamwork,"
wealth. The result is increasing efforts
patterns of capital allocation."
says Hoyt Catlin, 85, who runs Fertl
by labor to boost its share of national
For the moment at any rate, such
Inc., a $600,000-a-year plant nursery in
income, a quickening of inflation
questions are not fazing Kelso and his
South Norwalk, Conn. "We've had less
through the wage-price spiral, and the
followers on Capitol Hill. Among other
absenteeism and turnover than any
intervention of the government to al-
bills they are pushing is the so-called
firm of our size that I know," says Cat-
ternately brake and accelerate the
Accelerated Capital Formation Act,
lin, whose workers average 68 years of
economy. "The system today aggra-
which would remove the limit on em-
age.
vates the trends toward concentration
ployer contributions to an ESOP and
"I think there are some things we
and socialism," says Kelso. "The an-
make dividends paid on ESOP-held stock
can learn from Fertl," says C. Richard
swer is a democratic capitalism."
tax deductible to employers. If that
Blundell, vice-president of personnel at
Kelso's game plan goes beyond mak-
passes, there may be no stopping the
General Foods Corp., which acquired
ing ESOPS the principal source of in-
ESOP bandwagon.
the nursery in 1972. General Foods has
DI
1076
SOCIAL ISSUES
THE WHITE HOUSE
WASHINGTON
February 25, 1976
MEMORANDUM FOR:
JIM CANNON
Medicare
FROM:
SPENCE JOHNSON
SUBJECT:
Catastrophic Health Insurance
This is in response to your memo to Art Quern concerning
questions raised by Bill Kovach regarding the Medicare
catastrophic proposal.
About 98% of aged persons have Medicare coverage,
and there is absolutely no reason for that percent to
change as a result of the President's proposal.
Medicare does not have the concept of a participating
physician. An enrollee can essentially go to any licensed
physician and be reimbursed for necessary medical services.
Physicians may, however, elect whether or not to accept
assignment. Accepting assignment means that the physician
bills the Medicare program, which in turn pays the physician
for any benefits due the patient. The physician in turn
bills the beneficiary for any applicable coinsurance or
deductible. This election is on a claim-by-claim basis,
and most physicians accept assignment on some claims but
not others.
A physician who accepts assignment agrees to the reasonable
charge determination of Medicare and may not bill the patient
for amounts above that level. When a physician does not
accept assignments, he bills the full amount directly to
the patient, who in turn collects from Medicare. Physicians
do not face any charge limitation when they bill the patient
directly.
As a result, as Medicare reduces the level that it will
recognize relative to the amounts that physicians customarily
charge, the assignment rate will drop and the patient will
have to pick up a higher proportion of the bill. Currently,
roughly 50% of claims are assigned. The fee increase
FORD & LIBRARY
2
limitation of 4% proposed by the President is expected
to cause the assignment rate to drop significantly.
In addition, the $250 cap would apply only to covered
charges. Physician billings over the Medicare-recognized
level are not considered covered and thus would not be
credited towards the $250 limit.
GERALD FORD LIBRABA
HEALTH.
OF
U.S.A MELIVERY
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
WASHINGTON, D.C. 20201
NOTE TO SPENCER JOHNSON, DOMESTIC COUNCIL STAFF
Subject: Your Query on Cannon Memo re. Medicare
There are currently 24.9 million persons enrolled in Part A and 24.6
million enrolled in Part B. Roughly 98% of aged persons have Medicare
coverage, and there is absolutely no reason for that percent to change
as a result of the President's proposal.
Medicare does not have the concept of a participating physician. An
enrollee can essentially go to any licensed physician and be reimbursed
for necessary medical services. Physicians may, however, elect whether
or not to accept assignment. This election is on a claim-by-claim
basis, and most physicians accept assignment on some claims but not
others. Accepting assignment means that the physician bills the
Medicare program, which in turn pays the physician for any benefits
due the patient. The physician in turn bills the beneficiary for
any applicable coinsurance or deductible. A physician who accepts
assignment agrees to the reasonable charge determination of Medicare
and may not bill the patient for amounts above that level. When a
physician does not accept assignments, he bills the full amount
directly to the patient, who in turn collects from Medicare. Physicians
do not face any charge limitation when they bill the patient directly.
As a result, as Medicare reduces the level that it will recognize
relative to the amounts that physicians customarily charge, the assign-
ment rate will drop and the patient will have to pick up a higher
proportion of the bill. Currently, roughly 50% of claims are assigned.
The fee increase limitation of 4% proposed by the President is expected
to cause the assignment rate to drop significantly. In addition, the $250
cap would apply only to covered charges. Physician billings over the
Medicare-recognized level are not considered covered and thus would not
be credited towards the $250 limit.
Pete
Peter D. Fox, Director
Office of Health Analysis
FORD & GERALD LIBRARY
Spence
Would you Rend
THE WHITE HOUSE
WASHINGTON
dealt a
note P.
January 26, 1976
Im on
the
MEMORANDUM FOR:
ART QUERN
A
FROM:
SUBJECT:
Catastrophic JIM CANNON Jan
Health Insurance
Bill Kovach, No. 2 man in the Washington Bureau of
the New York Times, told me Saturday that a part of
the attached paragraph does, in effect, have the
President promising something he cannot deliver.
Specifically, he says the section that states,
"Nobody, after reaching age 65, will have to pay
more
than $250 for one year's doctor bills,"
is not true, for this reason:
Only 40% of doctors now participate in the Medicare
programs, and with the fee limitations we are proposing,
that percentage will become lower.
Is this correct?
What percentage of people over 65 now take part in
these programs? Under the President's program, is
this percentage likely to become lower?
FORD 3 LIBRARY GERALD
ederal petroleum reserves, stimulate effective conservation,
including revitalization of our railroads, and the expansion
of our urban transportation systems, develop more and cleaner
energy from our vast coal resources; expedite clean and
safe nuclear power production, create a new national Energy
Independence Authority to stimulate vital energy invest-
ment and accelerate development of technology to capture
energy from the sun and the earth, for this and future
generations.
Also, I ask, for the sake of future generations,
that we preserve the family farm and family-owned small
business. Both strengthen America and give stability to
our economy. I will propose estate tax changes so that
family businesses and family farms can be handed down
from generation to generation without having to be sold
to pay taxes.
I propose tax changes to encourage people to
invest in America's future and their own, through a plan
that gives moderate income families income tax benefits
if they make long-term investments in common stock in
American companies.
The Federal Government must, and will, respond
to clearcut national needs for this and future generations,
Hospital and medical services in America are among the best
in the world, but the cost of a serious and extended illness
can quickly wipe out a family's life savings.
Increasing health costs are of deep concern to
all, and a powerful force pushing up the cost of living.
The burden of catastrophic illness can be borne by very
few in our society. We must eliminate this fear from every
family.
I propose catastrophic health insurance for everybody
covered by Medicare. To finance this added protection, fees
for short-term care will go up somewhat, but nobody, after
reaching age 65, will have to pay more than $500 a year
for covered hospital or nursing home care, nor more than $250
for one year's doctor bills. We cannot realistically afford
Federally dictated national health insurance proving full
coverage for all 215 million Americans. The experience of
other countries raises questions about the quality as well
as the cost of such plans.
MORE
GERALD FORD LIBRARY
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