September 10, 1974.
Page 30612
Mr. MUSKIE. Mr. President, I am pleased to add my cosponsorship to S. 3280, the Health Services Act of 1974. This bill will provide a sound basis for continuation and expansion of programs under the Public Health Services Act; including community health centers, migrant health programs, community mental health centers, health revenue sharing, home health services, and hemophiliac centers, and needed study of mental health and illness of the elderly, epilepsy, and rape prevention and control.
I am particularly pleased about two of the provisions of this legislation – the inclusion of authorization for a Commission on Mental Health and Illness of the Elderly, and the authorization of home health services startup funds. Support for both of these measures is based on the work of the Senate Special Committee on Aging's Subcommittee on Health of the Elderly, which I chair.
The authorization for the Commission on Mental Health of the Elderly incorporates the language of S. 1763, a bill which I introduced on May 9, 1973. This legislation, in turn, carries out one of the recommendations of the Senate Committee on Aging's 1971 report: "Mental Health Care and the Elderly: Shortcomings in Public Policy."
I testified in support of this legislation before the Health Subcommittee of the Labor and Public Welfare Committee on May 1, 1974. I pointed out in my testimony that there is great confusion with respect to mental illness and old age. Most people assume that "senility" is synonymous with old age and yet many studies suggest that senility is not natural to old age and that it is not only preventable, but reversible.
The failure in public policy to reconcile these conflicting positions is apparent. Even more serious, an estimated 3 million older Americans require mental health services but only 20 percent of this number have their needs met in any way by existing programs. To make matters worse, there is currently underway a widespread trend in the States to move individuals from State hospitals into nursing homes or more often, into boarding homes or old hotels. Committee data indicates that the number of elderly in State hospitals has been reduced by 40 percent from 1969 through 1973. All too often, these patients have been discharged indiscriminately. There is virtually no screening to establish who are proper candidates for discharge and little followup to decide if patients are properly placed. There is little if any psychiatric or medical care available. in these facilities. Many patients are subjected to unsafe conditions, poor food, and abuse.
The 1971 report by the Senate Aging Committee aptly summed up the situation:
Public policy in the mental health care of the aged is confused, riddled with contradictions and shortsighted limitations; and is in need of intensive scrutiny geared to immediate and long term action.
As the committee report accompanying S. 3280 points out, these problems are all the more acute today.
It is the express purpose of the Commission on Mental Health and Illness of the Elderly to develop a national policy for proper maintenance of mental health for aged and aging people. The Commission will undertake studies to assess the future needs for mental health facilities, manpower, research, and training. It will cooperate with the executive and legislative branches for purposes of implementing policy proposals recommended by the White House Conference on Aging in 1971. The Commission's progress toward meeting these responsibilities will be disclosed annually in a report to the President for transmittal to the. Congress.
The nine members of the Commission will be appointed by the President, by and with the advice and consent of the Senate with at least one member from each of the fields of psychology, psychiatry, social science, social work, and nursing. In addition a nine-member Advisory Council is established, with members appointed by the President for purposes of aiding the Commission in its work.
I believe that this proposal constitutes a constructive step toward the creation of a national policy concerning mental illness and aging. I commend the members of the Senate Labor Committee for including this provision in S. 3280.
Similarly, the proposal for home health services startup funds, contained in S. 3280, is based on S. 2695, a bill introduced by Senator CHURCH on November 13, 1973, with my cosponsorship.
The need for home health services, as an alternative to costly hospitalization or other institutionalization, has been well documented by hearings held in my Subcommittee on Health of the Elderly in July of 1973 and again this year, on July 9, 1974. These hearings demonstrated the need not only for the direct aid to home health services now contained in S. 3280, but also liberalization of the standards for reimbursement of home health services under Medicare. On November 13, 1973, I introduced S. 2690, with the cosponsorship of Senator CHURCH, to make those changes in the Medicare law, and I hope that its provisions can be included in any future legislation affecting our program of health insurance for the aged.
Mr. President, Senate consideration of S. 3280 today marks real progress toward improving the delivery of health services to all Americans. I urge its passage.