Conversation 747-006

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Good morning, Mr. President.

I think we're good.

Arthur, we'll put you here.

Well, there you go.

She'll be out in a few moments.

She is, isn't she?

She'll be out in a few minutes.

All right.

the doctors, the nurses, the hospital department, and so forth.

When they get a little light in the day, it will encourage them.

It's the only day they have is within the confines of those, of course, of our service, and they're evasive in terms of providing food, a decent place, and so forth.

But all that junk, you can see some of the saddest people in some of the richest homes.

That's right.

Nobody wants to see them.

But there's just no light in the night.

They're all rousing around.

I hope that you all keep the personal thing very much in mind.

I'm not sure we do.

Of course, there's part of the state that we're going to be talking about.

But the nurses, the doctors, they're asking that from the bodies.

And that's what matters the most to me, doing all this work.

You go to see people, and they're all going to be sick.

Everybody's going to feel pain here and this and that.

And that's one of the problems of aging.

But what they really need is a bedside.

They really need it.

And they must not be told they're not sick.

Never told.

Never told particularly an older person or anyone who's been sick.

Because then you discourage them from having a visit.

You know, skip up or let them bear the word of the sun.

It doesn't mean you're going to miss it.

But there are people who have a feeling of depression and the rest, which affects them physically.

They're sick.

Right.

And it is the psychiatrist sometimes they need.

It's just somebody that cares.

That's why the ministers can help.

I was at a church, a little church out in San Juan.

It was a tiny church, a hundred people.

Yeah.

No, Christian.

And it is their project to see San Juan.

I mean, it's a very, very nature-worthy institution.

I think it's there.

working with, going to the nursing homes and working with people and so forth.

You know, just all of that.

That's a great thing.

Now you learn about the world, about being an older person by doing that.

But they go and they love these people.

I have this friend of mine in California, Stanley, whose 18-year-old daughter is now doing therapy work in a nursing home and just really enjoying it.

In fact, she's

in a paraprofessional field as a result of experience.

But that's what she's been saying.

The same kind of thing.

The minister of my industry, a lot of salary, and he's been talking about this for a long time.

He pointed out that what they call their teen Sunday school class, every week visited this person's home.

It's a good mention of experience.

Oh, as a candidate, I realize the old folks

I mean, they're going to be over what they do.

It's a present witness.

Now, tell me about what you're going to address about, what we need to say.

On this later one, we must tell that story, I hope, because that will be an incentive to the whole religious community.

You talk about that.

You, you know, you, you know, but I just don't know.

Yeah, that's what you said.

It's all lawyers, you know, you can say who's talking about it.

I don't, I feel that there's nothing more important than

Well, volunteer, you take searches.

So many of them, you know, they want to be involved in this one.

Well, but nothing is more rewarding, more important than this one.

The second point is that, in terms of the people who work, the paratransitionals, the nurses and the rest, I mean, this is darn hard work.

And they've got to realize that it's terribly important.

Terribly important.

And what really matters is

The body, yes.

The food, yes.

But it's a spirit.

They come in there, you know.

The nurse comes in there with a smile.

Why can't the older man and so forth?

Makes it awful, doesn't it?

No, just quite.

And also, another thing you've got to tell them is that the kids, they don't get off their tails.

That's right.

Too many of them.

They want to say, well, he is my son.

I've never heard of him.

Well, of course, it's hard.

It's hard.

It's hard, isn't it?

But if they live it out, don't put them out there.

Go see them.

I mean, they're only money.

They're out of sight, not of mind.

Out of sight, not of mind.

That's right.

It's hard.

I mean, they've got to feel it.

They've got to believe it.

We can put up the dough, but we can't put up the heart.

You've got to sell it.

Of course, all your people know.

But I .

Maybe I'll give you a little rundown as to where we are from the time that you had your both the Chicago speech and the New Hampshire speech, where he came on board to coordinate all the nursing home activities.

And it's been one hell of a job.

But what we did, essentially, what we found that, you know, the federal money going into these kinds of homes is relatively, since Medicare and Medicaid, periods of time.

So the first thing we had to do was make sure the states knew how to survey and would have had their procedures set up so they could really determine whether or not they were in fact meeting our new federal standards that you asked us to set in place.

We needed until February 1st to do that, get your procedures set up.

All but one came in, Pennsylvania was the only one that was hung up, and they're all right now.

So then we gave it until July the 1st to actually go out and survey the homes.

and certifying.

They had to have provider agreements.

And that actually said that they are in compliance with the federal standards, more substantial than compliance.

We gave some waivers.

The result is that all but 10 states on July 1st were there and did a hell of a job.

I think we got to give them an awful lot of credit for getting out and serving.

But 10 states, four since July 1st have come in.

We still have five, and we expect those five to be in by August 1st.

What we have said, New York, Massachusetts, and we're in touch with them.

I talked to Bobby Douglas in the governor office.

We're in touch constantly with them.

They're coming around.

New York has one unique problem.

They have a court case where they tried to decertify some homes, and the court's been joining them from...

decertifying, we will say that we are not going to make any federal payments to those homes.

So we expect the court to tell us you can't quit making federal payments.

We don't have to pay that.

Well, the thing about those, if I can just interrupt for a moment, we all know that a state like New York and a state like Massachusetts is going to be worried about them.

And that's probably because the, you know, Rockefeller and Massachusetts are very, very, very,

It's supposed to be very interesting in this way, right?

I would be concerned about some of the things that came in right in the middle there.

Well, the things we've done some good, that's the point.

This really breaks these people up.

Absolutely.

That's the thing.

Every time they go, it's just paperwork.

I worry about them having paperwork.

They buy all this stuff, and they have a lot of experience.

We had, what is it, six that are, I mean, how many of them have six months waivers?

Which means that there is substantial compliance.

We only gave them permission to continue for six months until they clean up.

So if you go out, have you been out to look?

We have been out to many of the regions.

And if you make sure that you sort of make spot checks and see if there's any problems.

I think that we grab on to things because of your interest in the department's efforts.

The states really haven't done enough to take over this program.

It was one that was kind of on the back burner.

But they're really not beginning to say that it's a terribly important program.

They're beginning to look at it.

It's very critical, and we need to allocate resources to it that have never passed.

The other thing that we have now that we did not have before was an estimate or at least a picture of what the nursing homes do look like out there.

Are they good or are they bad?

The ones that were really bad have now been taken away from the program.

So that we, I think, have come down to at least a fairly good way of saying what nursing homes are out there now at least do look like they are.

The vast majority of them still have some way to go, but we have at least eliminated those that were very bad.

And those that do need some further correction, we know where they are, who they are, and what they need to do.

Just under 600 have either been decertified or withdrawn from the program as a result of this activity.

As I understand it, you have a program for trying to work with those

are in effect in homes that are going to be shut down or haven't been shut down.

Yeah, actually some of them have been transferred over to another level of care that we refer to as intermediate care facilities.

You know, Congress authorized payment to those facilities last year.

And we'll get regulations out on those.

That takes care of a lot of them.

A couple thousand went into skilled nursing, you know, good ones.

They just moved them out.

And then others, of course, are in rest homes and convalescent care homes and things like that, where there aren't federal dollars going in for medical care.

And we will let you know.

Fortunately, in New York, we had the biggest number that was transferred over to other skilled nursing homes.

And these were newly constructed buildings that they removed, which came out to be a shame.

We didn't get any of the people kicked out of the street type of thing.

There's another dimension, Jack, that may not occur to a lot of people, and that is this is a program, Mr. President, that does mandate a state and federal partnership with a co-equivalent effort on both sides to make it work, and the states have it.

Now, to the extent that it's a prototype for a lot of things we believe in, in other words, we may lay down certain standards, but you guys get the chance to make the local decision and make it work.

They have failed.

They now know we need business, and they come into line.

This sets the stage for a lot of others.

Not just in the nursing homes.

I mean, otherwise, in joint federal-state relationships, governor's office is now another leading business.

Same to me, Mr. President.

A trust here should be human.

laid out a policy about a year ago, and he announced an enforcement program designed to meet that policy.

Now, here's the evidence of the fact that that policy has done what it is working, that you mean business, that we're not going to tolerate these sub-substandard nursing homes.

And I think we've got that kind of a

picture now that we can present to the country and keep presenting to it over and over again in the next few months.

I think of the first administration in my position of fighting for the interests of these older persons that have been living under intolerable conditions.

Of course, we've got a little flack on this.

I mean, some of these operators, you know, they're going to... We've kept it because it's awful tough to... We realize it's a tough problem.

You think of the family.

I mean, let's face it.

You know, the median income is not $10,000 a year.

You think of the fact, I guess, that maybe you're spending $20,000 a year.

And so you're going to try to find $400 or $500 a month.

That's wrong.

It's very wrong.

And I just, I don't know where it is in that tonight.

I sympathize with those, with those management.

What are we going to do with the LA or Poplar or whatever the case might be?

We just can't afford a good place, you know?

And so have all sorts of people around us.

Jacob Weiss is there thinking of, I mean,

I said, they're needing the well.

You know, they're needing the demand.

It's like somebody who goes to the basement rather than the fancy second floor or all the dimensions.

Sure.

Because that's all they got.

Well, I think we've done, we've covered both the tension dimensions.

I remember both of them last year.

Maria's been on most of the state dimensions.

So I think as far as the nursing home association is concerned, we met with their principals in my office last week and they'll get the name in.

They're not, they know that we're not getting anything with their, you know, they don't see them as a type of funerary.

You know, they want more money, but, you know.

I think that they're in a tough position to say that we shouldn't enforce tenders.

Isn't it impossible, let me be quite candid, isn't it an impossible situation?

What I mean is that, can we really do an adequate job in this?

We just really haven't got the funds.

I mean, to upgrade these things to what they really ought to have.

Well, I think we could do a better job than to have your pessimism displayed for a moment.

I really think we're on the road.

What funds are we using to upgrade them?

Well, of course, by and large, we're using the supplemental appropriation to add the additional staff that are necessary at the state level.

I didn't mean to throw this off, but I'm so persuaded that the states now are going to start working.

Well, the other thing, too, I think the industry has been one which hasn't had a great deal of recognition and status in the past.

If you look at, for instance, just in the last 10 years, the caliber of the individual who so chooses now to either operate or work at the nursing home is considerably bigger.

So it's not just the money, as you were talking about before, that because now it's getting recognition in the sense

In a funny sort of way, the effort that we've put on the last few months, and because of your interest in the program, the nursing homes are beginning to say, yeah, things were not as good as they might have been.

Let's take a look at ourselves.

Let's do some more policing of ourselves.

They're getting a, maybe it started out as a negative recognition in the beginning, but they're beginning to get some positive recognition out of this now that this is

an area that's a legitimate area of medical care.

This is a legitimate area for the government to be interested in.

So we're going to get better people, and we're going to run a better operation ourselves.

So just the number of people who are interested in it, and really good people who are interested in going into this program now is considerably increasing.

Before it was...

You know, what are you doing that for?

You know, if you really are any good at all, why do you want to work in a dead place like that?

And that whole image has changed now.

And so we're getting much more efficiency out of what it is that we're doing now, rather than working with people who really didn't have a great deal to give.

Question.

I've got a question to answer.

Getting a bit tough, unfortunately.

What are you doing about making it possible for the quality of care to be improved?

Now, that was a part of your equine program that we were to set up a group to work on that.

So that's been set up by Dr. Gallagher, for the ball.

And that's the way I respond.

But your interest is, yes, in recognizing

the federal government's obligation to be tough on sin, to use the power of the presidency to make sure that people understand that we're tough on sin, but you're also interested in using it to encourage people to lift the quality of care and that we're just as much interested in one as the other.

It isn't either or.

It's both and.

How did you get into this work?

Well, I...

Thank you for the question.

I was the graduate of the first school of nursing at UCLA.

And we didn't have a hospital in those days, so we used the veterans hospital.

And of course that was Sautel, which was the enormous hospital where there was a, you know, very active geriatric rehabilitation center.

And so I decided right then and there that was for me to stay in it, in very good capacity to stay in it.

We heard you were attending.

You were attending.

Yeah.

Then I left there and went to New York where I ran the chronic disease department for New York State.

Yeah.

And then went to Yale and stayed there.

You were at Yale.

Is that the University of Kentucky?

Yeah, that's my name.

I actually do that job.

I tell you, I've been meeting with the federal regional councils, the regional directors of ATW, and they are very appreciative of the relationship you have with them out in the field.

It's very impressive.

We've had our good people go in to nursing these kids, sort of.

That's another concern I've often had, you know, they were so underpaid and not respected and the rest.

It's better now.

Yeah, I think as the collegiate programs have improved, the attraction is greater.

I don't think it's much better than it was before.

How about the other one?

Do they want to go in?

I didn't notice.

Oh, okay.

Do they want to go into recruiting programs?

Yes, I think they're doing a much better job of attracting good people because the curriculum is much better.

And this has been one of the difficulties in the dairy and my chronic disease management for people working in nursing homes.

The curriculum in that area, it hasn't been, what you call, really terribly exciting.

It's like curriculum in education schools.

If there isn't very much there, and it's not very challenging at all, then you don't want to do it.

And this has improved considerably, both in terms of technology, as well as saying, this is an area.

Speaking of correcting curriculum, Jack, I mean, it relates to this.

Read that.

I don't know if you saw it, but you know,

a piece by William Shannon in the New York Times, one of the Barbarians.

It was about two weeks ago, about the schools of education and why people live in them.

I don't mean to narrow that down, but it's one of our thoughts.

Yeah, yeah.

Well, if you could go over the first, and actually take any license you want and quote it.

But I think in terms of support for the program, congratulating you on what you've done and urging you to continue your effort in this field, I think in terms of your speeches and your appearances as you go around, I think if you could emphasize the material considerations, of course, that's what this program is, that's what the government can do.

But if you can particularly put emphasis on what I call the personal side and the human side,

I mean, it's not going to make much use or anything of that sort of thing, but it will mean a great deal to the people in the work.

I mean, as well as those that are taking care of the people in the work.

This is enormously important in their doing.

It really is a labor of love.

I mean, the money they've got to have to

What can we do if we can decrease?

One of the things that elderly people are so frightened about is the dependency that's created for them.

Oh, they don't want to go.

Oh, they hate to go to campus.

And if we can reduce their anxiety, because we talked about going into a facility, knowing that they must, maybe.

If we can reduce that anxiety, I think that will be very helpful.

Speaking of labor and love, I remember

I was very much a Rhodes Scholar, was one of my government professors in 1934.

And he got shot at the end of class, and he had a little bit of a brain, a bunch of other things.

Money was more important than some other things.

He was talking about what we should all do.

He said, when I said you're going to get a lot of advice to study art, he said, my advice to you is to marry for money and practice law for love.

Anyway, so now I'm pushing for both, I guess.

The thing that we really need, though, is to admit the administration, because we are, we think, a responsible administration.

constantly has taken on to it.

We don't care.

And people, we're, and administrations are generally, and programs are generally being entered by how much money.

So we're putting as much money as we can, believe me, without blowing the whole economy and having a tax increase, a price increase that will fall the heaviest on many of our citizens and those who are having to buy them.

The answer is no, but don't care.

It's got to be answered in very personal terms.

Sure we care.

We're going to put money in.

We're going to run it well.

But we have a deep concern in a very personal way about people.

That's what you've got to get across.

You really have to get that across.

And the only way you can do this money, you're saving it.

You know, you walk through the corridors there and you see so many of them.

And it's very bad for old people to be there just with old people, particularly when they're more alert than some of the others.

Some just sit there like vegetables and others, of course, are a little more alert.

Some talk too much and some blur the radios and the rest.

But the most important thing is for personnel to treat them all as individuals and not as what you count on.

And second, for outside people, first, they're mad ones who haven't made the responsibility.

They may not be able to afford it, but they want to get off their panties and go down and see them.

They've got to do that.

The kids have got to do that.

These little brats, you know, that, you know, want to change the world, get them down to see the old folks now.

And they'll do it.

And they'll rely on them.

Well, they'll rely on them.

Sure.

It'll be different then.

It'll be okay.

And the other thing is that they're also all volunteer organizations.

I mentioned Cherokee and some of their others, you know.

Right.

I mean, you were saying about women's gloves and others and so forth.

One of the good things, you know, see that the birds aren't, you know, destroyed by the insects or whatever we're saying.

That's right.

I had another thing I was interested in.

You mentioned Sawtooth.

more and more people visiting.

It's a great thing for old people.

We've got to remember that those in the field, the nurses and the paraprofessionals and the rest, they've got to realize that while they are probably underpaid and overworked for what has never been, that they really are appreciated.

And that there are just lots of people that know they're doing a job that very few others will.

It's just, and every time you get out of here, it's me that I told them, okay, okay, pass the word.

And we'll share it up with you.

All right.

Well, thank you so much.

We wish you well.

We'd like to UCLA.

Well, have you followed them since you left?

Yeah.

They're pretty fast to follow.

Two and a half years since they were there now.

Yeah.

Well, we had one of you, Bob Baldwin, at UCLA first.

I am involved in sports as much as UCLA is, and they're fantastic in basketball.

I watched them in basketball.

Yeah.

Yeah, and football.

Ah.

I didn't know UCLA.

That's right.

Thanks, Ivan.

Good to see you, Ivan.

It's always a pleasure to get to know you.

Thank you, sir.

Thank you.

For ladies, we can do this.

Were you looking at this?

Yes.

That's a special student, a water handkerchief.

He had made it last year.

It's becoming, of course, a lot less time.

But he designed it to start with a seal on the side.

Oh, my God.

And that was presented, that's a very old thing here.

That was presented by .

That was a state gift.

So I don't know what it is.

We always put a state gift out here.

I like it.

I've been invited to go chair a session.

We've got it.

It's very hard.

Sure, I'm all for it.

Right.

Well, it's true that yesterday my wife visited the hospital, and all that sort of thing.

And it means something to me.

It means something to me.

Even the chair talks.

Thank you very much.

Thank you so much.

Nice to see you.

Delighted the way you got important policies.

Wish you the best.

I do.

I'm delighted for the best.

Thanks.

Can't we just, you know, just now see some carrots in the day?

That was all for the medicine.

That'll happen on a break for a while.