[Congressional Record (Bound Edition), Volume 149 (2003), Part 4]
[House]
[Pages 5059-5062]
[From the U.S. Government Publishing Office, www.gpo.gov]




         ESTABLISHING AN ANNUAL VISITING NURSE ASSOCIATION WEEK

  Mrs. MILLER of Michigan. Mr. Speaker, I move to suspend the rules and 
agree to the concurrent resolution (H. Con. Res. 54) expressing the 
sense of the Congress that there should be established an annual 
National Visiting Nurse Association Week.
  The Clerk read as follows:

                            H. Con. Res. 54

       Whereas visiting nurse associations (VNAs) are nonprofit 
     home health agencies that, for over 120 years, have been 
     united in their mission to provide cost-effective and 
     compassionate home and community-based health care to 
     individuals, regardless of the individuals' condition or 
     ability to pay for services;
       Whereas there are more than 500 visiting nurse 
     associations, which employ more than 90,000 clinicians, 
     provide health care to more than 4,000,000 people each year, 
     and provide a critical safety net in communities by 
     developing a network of community support services that 
     enable individuals to live independently at home;
       Whereas visiting nurse associations have historically 
     served as primary public health care providers in their 
     communities, and are today one of the largest providers of 
     mass immunizations in the medicare program (delivering over 
     2,500,000 influenza immunizations annually);
       Whereas visiting nurse associations are often the home 
     health providers of last resort, serving the most chronic of 
     conditions (such as congestive heart failure, chronic 
     obstructive pulmonary disease, AIDS, and quadriplegia) and 
     individuals with the least ability to pay for services (more 
     than 50 percent of all medicaid home health admissions are by 
     visiting nurse associations);
       Whereas any visiting nurse association budget surplus is 
     reinvested in supporting the association's mission through 
     services, including charity care, adult day care centers, 
     wellness clinics, Meals-on-Wheels, and immunization programs;
       Whereas visiting nurse associations and other nonprofit 
     home health agencies care for the highest percentage of 
     terminally ill and bedridden patients;
       Whereas thousands of visiting nurse association volunteers 
     across the Nation devote time serving as individual agency 
     board members, raising funds, visiting patients in their 
     homes, assisting in wellness clinics, and delivering meals to 
     patients;
       Whereas the establishment of an annual National Visiting 
     Nurse Association Week would increase public awareness of the 
     charity-based missions of visiting nurse associations and of 
     their ability to meet the needs of chronically ill and 
     disabled individuals who prefer to live at home rather than 
     in a nursing home, and would spotlight preventive health 
     clinics, adult day care programs, and other customized 
     wellness programs that meet local community need; and
       Whereas the second week in May is an appropriate week to 
     establish as National Visiting Nurse Association Week: Now, 
     therefore, be it
       Resolved by the House of Representatives (the Senate 
     concurring), That it is the sense of the Congress that there 
     should be established an annual National Visiting Nurse 
     Association Week.
  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Michigan (Mrs. Miller) and the gentleman from Illinois (Mr. Davis) each 
will control 20 minutes.
  The Chair recognizes the gentlewoman from Michigan (Mrs. Miller).


                             General Leave

  Mrs. MILLER of Michigan. Mr. Speaker, I ask unanimous consent that 
all Members may have 5 legislative days within which to revise and 
extend their remarks on the concurrent resolution under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Michigan?
  There was no objection.
  Mrs. MILLER of Michigan. Mr. Speaker, House Concurrent Resolution 54, 
introduced by my distinguished colleague, the gentleman from 
Massachusetts (Mr. Markey), expresses the sense of the Congress that 
there should be established an annual National Visiting Nurse 
Association Week.
  Mr. Speaker, visiting nurses provide an invaluable medical service to 
countless people across our great country. For more than 120 years, 
these admirable citizens have helped to promote health and to prevent 
disease by providing skilled nursing care in the homes of millions of 
sick Americans each and every year. These caring nurses treat illnesses 
of all varieties, from the initial symptoms of the common cold and flu 
to the gravest stages of heart disease, of AIDS, and of cancer.
  I would like to just give an example of one such person. Her name is 
Marcia Nowc, and she lives in my district, the Tenth Congressional 
District of Michigan; and she truly epitomizes the hard work and 
selflessness demonstrated by visiting nurses across our great country.
  Her profession is nursing, and while she makes her living doing this, 
she also volunteers for an organization called Neighbors Caring for 
Neighbors Outreach Clinic. This clinic provides medical services, 
laboratory tests and x-rays to some of our most vulnerable families and 
individuals, often free of charge, thanks to the volunteer efforts of 
visiting nurses, like Mrs. Nowc. Nurse Nowc's volunteer activities are 
supported by 16 churches in Macomb County, Michigan; and oftentimes 
visiting nurses, just in their everyday work, truly demonstrate how 
faith-based initiatives can provide an essential support system within 
our communities.
  Many of these visiting nurses literally work miracles every day 
because they give so generously of their time and of their spirit and 
because they recognize the dignity of every citizen and the 
possibilities of every life. Many times visiting nurses provide care to

[[Page 5060]]

those that might be considered on the outer fringe. Perhaps they are 
underinsured; they may be the working poor or may even be homeless.
  Visiting nurse associations are nonprofit home health agencies 
located throughout the United States that aim to enhance the quality of 
life of all through comprehensive home and community health services. 
Often, these organizations provide in-home services that are available 
24 hours a day, 7 days a week to Americans in need. It is truly 
worthwhile for this House to honor the compassion and the sense of 
obligation exhibited by visiting nurses for well over a century.
  It is not an exaggeration to say that America's visiting nurses are 
some of our Nation's greatest treasures and greatest traditions. 
Therefore, Mr. Speaker, I urge all Members to support the adoption of 
House Concurrent Resolution 54.
  Mr. Speaker, I reserve the balance of my time.

                              {time}  1430

  Mr. DAVIS of Illinois. Mr. Speaker, I yield such time as he may 
consume to the gentleman from Massachusetts (Mr. Markey), the sponsor 
of this legislation.
  Mr. MARKEY. Mr. Speaker, I thank the gentleman for yielding me this 
time, and I thank the gentleman from Pennsylvania (Mr. Peterson) for 
all of the gentleman's excellent work on this legislation.
  This is the kind of thing that kind of mystifies the American public 
sometimes, they do not understand that 80 percent of everything that we 
do, we agree. Most of the time they only focus on the 20 percent where 
we disagree. For the vast majority of issues, there is a consensus in 
terms of what our country should be doing and where we agree. Today I 
am proud, with these other great Members, to offer this resolution to 
establish an annual National Visiting Nurse Association Week in honor 
of the army of health care heroes, who every day comfort, care for and 
assist our loved ones.
  I appreciate the support and the dedication of the Visiting Nurse 
Associations. Every Member of Congress does, as does every American. 
Visiting Nurse Associations of today are founded on the principle that 
the sick, the disabled and the elderly benefit most from health care 
when it is offered in their own homes.
  They are nonprofit home health agencies that provide cost-effective 
and compassionate home and community-based health care to individuals, 
regardless of their condition or ability to pay for services.
  Through these exceptional organizations, 90,000 clinicians dedicate 
their lives to bringing health care into the homes of over 4 million 
Americans every year.
  In the face of rising costs and drastic changes in our health care 
system, visiting nurse associations have continued to deliver high 
quality health services for over 120 years.
  When Henry Wadsworth Longfellow read of the work of Florence 
Nightingale, he penned a poem, Santa Filomena, that spoke of the keep 
appreciation owed by all of us to those dedicated to service in the 
ultimate caring profession, the visiting nurse. He wrote of her as he 
could have written of every other visiting nurse. ``Whene'er a noble 
deed is wrought, whe'ever is spoken a noble thought, our hearts, in 
glad surprise, to higher levels rise.
  ``The tidal wave of deeper souls into our inmost being rolls, and 
lifts us unawares out of all meaner cares.''
  Mr. Speaker, today I would like to say my own thank you to our 
Visiting Nurse Associations. Through their work and their philosophy of 
nursing, they teach us every day about human kindness, the strength of 
human character, and the true definition of what it means to care. I 
thank them for their sharp minds, their watchful eyes, their nerves of 
steel; and, of course, their hearts of gold.
  In recognition of their hard work and dedication that visiting nurses 
bring to the nursing profession, and the comfort and quality care that 
they provide to patients, I ask Congress to please support this 
resolution to set aside one week each year to recognize and honor 
visiting nurses across the country. Democratic, Republican, liberal, 
conservative, each of us owes them an enduring debt.
  Mrs. MILLER of Michigan. Mr. Speaker, I yield such time as he may 
consume to the gentleman from Pennsylvania (Mr. Peterson).
  Mr. PETERSON of Pennsylvania. Mr. Speaker, I thank the gentlewoman 
for yielding me this time.
  Mr. Speaker, I am delighted to join the gentleman from Massachusetts 
(Mr. Markey) and the gentlewoman from Michigan (Mrs. Miller) today on 
this resolution establishing a national Visiting Nurse Associations 
Week.
  As we were growing up, doctors visited homes and nurses visited 
homes. Today it is seldom that a doctor visits a home unless it is a 
personal friend; but the visiting nurses just keep right on trucking.
  Serving communities around the country for over 120 years, 
congressional recognizing and gratitude for these nonprofit health 
agencies is long overdue. The nearly 500 VNAs across the country 
collectively provide home and community-based services to over 4 
million Americans each year. Founded in the 1890s, VNAs have 
continuously served as charitable providers in their local communities, 
creating a safety net for the poorest and most chronically ill and 
functionally disabled individuals. VNAs serve the majority of Medicaid 
home health beneficiaries and represent nearly one-half of all 
nonprofit home health agencies in the United States. On average, 
Medicare and Medicaid represent approximately 82 percent of VNAs' 
revenue, and this percentage is even greater in rural areas such as my 
rural congressional district.
  Mr. Speaker, this fact is significant because rural America has 
always been shortchanged in the Medicare payment system. My rural 
providers are asked to provide the same level of care with less Federal 
dollars, even though wage rates have largely equalized between rural 
and urban areas due to the current workforce shortage. The Medicare 
home health reimbursement was slashed by 15 percent last October, and 
the 10 percent rural add-on is set to expire this April. Home health 
providers, including VNAs, are being crippled by these cuts and I will 
continue to fight as co-chairman of the Home Health Working Group to 
resist them. In the meantime, I am pleased to introduce this resolution 
with my colleague from Massachusetts to demonstrate our continued 
support for these under-recognized heroes.
  In a country struggling with staggering health care costs, the 
Visiting Nurse Association continually and successfully works to 
achieve its mission of cost-effective and compassionate home and 
community-based health care to individuals, regardless of the 
individuals' condition or ability to pay for those services. They are a 
leading provider of mass immunizations in the Medicare program and 
constitute over 50 percent of all Medicaid home health admissions. The 
association relies heavily upon volunteer nurses and reinvests any 
budget surplus into charity care, adult day care centers, wellness 
clinics, Meals-on-Wheels, and immunization programs.
  This resolution will establish an annual National Visiting Nurse 
Associations Week in order to increase public awareness of the charity-
based organization. They unquestionably deserve recognizing for their 
noble services; and by establishing this resolution, Congress would 
support the continuation of their mission.
  I want to particularly mention, too, Ruth Ann Nerlich, who has been a 
part of VNA in Venango County as long as I have been aware. When I 
served in the State legislature, she was the go-to person State-wide. 
She was the person that best understood and best sold the message of 
home health care delivered by the VNA. And also Betsy Roberts of Elk 
County, who for decades has been a leader in providing home health 
care.
  I want to conclude my comments with when the Balanced Budget Act was 
passed, there were problems in this country, mainly with for-profit 
home health care agencies which were really

[[Page 5061]]

taking advantage of the system. Unfortunately, Congress, at that time, 
squeezed the system equally, and the Visiting Nurse Associations, 
scattered around much of this country, were not fat and wasteful. They 
raised millions of dollars to give free care to those who could not 
pay. They were made up of boards of local people, in health care and 
out of health care, who cared about and helped deliver the services 
that they provided.
  So when the Balanced Budget Act cut them and squeezed them about 30 
percent, it squeezed some of them out of business. Some of the VNAs in 
my district today, the only reason they stayed in business, they 
borrowed money to continue providing those services. They have debt to 
service today.
  Mr. Speaker, it is vital that this 15 percent cut is taken away, and 
it is vital that the 10 percent add-on that was proven was needed for 
home health care is continued on past April.
  With that, I am proud to recognize these individuals and the 
invaluable contributions of our VNAs by cosponsoring this legislation, 
and urge the support of my colleagues.
  Mr. DAVIS of Illinois. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, the National Visiting Nurse Association of America, 
VNAA, is the official association for not-for- profit, community-based 
home health organizations known as Visiting Nurse Associations. VNAs 
care for patients of all ages, from infants to the elderly, and offer 
comprehensive services that begin with maternal-child health programs 
and end with hospice care. VNAs provide a broad range of essential home 
health care and support services to patients in the security and 
comfort of their homes. These services include skilled nursing, 
rehabilitation, physical and occupational therapies, speech-language 
pathology, home medical equipment, and behavioral and mental health 
counseling, to name just a few.
  Many VNAs provide homemaker services that help patients remain 
independent in their home while reducing the burden on family members. 
These services can include cooking, housekeeping, shopping, 
transportation, personal care, and a variety of other essential 
nonmedical services.
  These services are critical at a time when the latest projections 
from the U.S. Bureau of Labor Statistics, published in the November 
2001 Monthly Labor Review, estimated that more than 1 million new and 
replacement nurses will be needed by the year 2010. The U.S. Department 
of Labor projects a 21 percent increase in the need for nurses 
nationwide from 1998 to 2008, compared with a 14 percent increase for 
all other occupations.
  Furthermore, according to a July 2001 report released by the General 
Accounting Office titled Nursing Workforce: Emerging Nurse Shortages 
Due to Multiple Factors (GAO-01-944), ``a serious shortages of nurses 
is expected in the future as democratic pressures influence both supply 
and demand. The future demand for nurses is expected to increase 
dramatically as the baby boomers reach their sixties, seventies and 
beyond.''
  As baby boomers age, the role of visiting nurses is more important, 
as patients spend less time in the hospital and demand the same quality 
of services at home. VNAs contribute to the well-being of the Nation, 
and I urge my colleagues to support this resolution as we pay special 
tribute to those who come into our homes, into our places of being, and 
bring not only their technical and professional services, but also 
bring the individuality of their care.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in support of H. Con. 
Res. 54, expressing the sense of the Congress that there should be 
established an annual National Visiting Nurse Association Week.
  Our health care system is in a state of crisis. Our health care costs 
are rising exponentially, but it seems that these added expenses are 
not translating into rising access to quality compassionate care for 
the American people. Instead, it seems that too often, profits are 
driving our health care system--rather than the needs of the sick, our 
children, and the elderly.
  Pharmaceutical companies are making record profits, while people in 
America are choosing between food and the prescription drugs their 
doctors have prescribed. Reimbursements for Medicare and Medicaid 
treatments are so low that many health providers are turning away sick 
patients. Due to massive tax cuts for the wealthy, the Administration 
has not left adequate funds to help financially-strapped State and 
local governments to continue health care programs for the poor and 
underserved. For example, this has led to the recent closure in my 
District of two mental health clinics, that serve 1,400 adults and 240 
children. Yes, this is a crisis.
  But in the midst of that crisis, there are some shining examples of 
groups that truly seem to embody what health care can and should be. 
The Visiting Nurse Associations (VNAs) fall into that noble category. 
Visiting Nurse Associations are non-profit agencies that, for over 120 
years, have been working toward their mission of providing cost-
effective and compassionate health care to millions of individuals per 
year, regardless of their condition or ability to pay.
  Nurses from VNAs go into communities and individual homes, providing 
primary care of all sorts, and prevention such as immunizations. Such 
care dramatically improves quality of life for seniors and the disabled 
who would prefer to live in their own homes, in their own 
neighborhoods, but need a bit of help from a visiting professional. 
Besides providing comfort and dignity to those in need, VNAs also save 
us millions of dollars in hospital and long-term care costs.
  I am very pleased with the excellent work of the VNA of Houston. 
Their 50 nurses partner with social workers, physical therapists, home 
health aids, occupational therapists and speech therapists, in order to 
provide services to some 1,600 to 1,700 hundred patients per day in the 
area of Harris and the surrounding counties. This kind of care is the 
way of the future--helping people stay in the comfort of their homes, 
where they want to be.
  I am sometimes frustrated when I ask members of the medical 
community, why they do not spend more time pushing prevention and 
education. They often reply that doctors don't have the time to talk to 
their patients for that long, or that a doctor's time is too expensive 
to spend on education. I am bothered by this, because as most people 
know, nurses and physician's assistants and auxiliary health 
professionals, are often much better communicators than their physician 
colleagues anyway. Expanding our utilization of nurses is a cost-
effective way of improving American health.
  The problem is that we have a nursing shortage. Our clinics and 
hospitals are being forced to squeeze too much out of the nursing 
staffs they have. The added workloads are driving many qualified nurses 
out of the field, and may be jeopardizing treatment for some patients. 
We need to find ways to recruit more nurses and to maintain the ones we 
have.
  For example, I have introduced HR 87, which would alter H-1C non-
immigrant visa requirements, in order to make it easier to bring in 
qualified foreign nurses to fill in some of the gaps in our own nursing 
workforce. I would like to see some action on that bill soon.
  Today's bill, H. Con. Res. 54, represents another way of improving 
our pool of nurses. By establishing an annual National Visiting Nurse 
Association Week, not only will we be honoring an excellent and 
deserving group of health care professionals, but we will also be 
raising awareness of the important role they serve in our communities. 
I hope that by focusing Congressional and public attention on Visiting 
Nurse Associations, we will inspire more bright young people to go into 
that noble profession.
  I commend our nation's visiting nurses, and my colleague from 
Massachusetts for seeking to honor them. I support H. Con. Res. 54.
  Mr. BACA. Mr. Speaker, our nation is facing a catastrophic nursing 
shortage. The average age of nurses in America is 43 years of age. 
Nurses are leaving the profession in droves, and fewer people are 
choosing to enter the profession. We have to do more to not only retain 
the nurses that we have but also to increase their numbers. We need to 
send the message that nursing is a rewarding and much needed 
profession. We need to do our best to make sure that nurses get the 
recognition that they deserve so that we can turn around the shortage. 
Nurses need to know that they are needed. I support H. Con. Res. 54 
because it helps bring more recognition, not only to the individualized 
profession of visiting nurses, but also to the profession as a whole.
  Visting nurses deserve all of the recognition that can be afforded. 
They are a valuable group of professionals that travel to the homes of 
some of the sickest individuals to ensure that they are receiving much-
needed health care in the comfort and privacy of their own

[[Page 5062]]

home. By supporting Visiting Nurses Associations we are supporting a 
system of health care that is compassionate and that allows patients to 
receive care while maintaining their dignity. In my district, The 
Visiting Nurses Association of the Inland Counties works hard to bring 
care to patients all over the area. I know that they are working to 
obtain the necessary grant money to implement essential technology so 
that they could treat more patients while offering the individualized 
care that every patient deserves. I applaud the effort of the nurses 
and I applaud the Congress for bringing recognition to their noble 
work.
  Mrs. JONES of Ohio. Mr. Speaker, I rise in support of House 
Concurrent Resolution 54, honoring the Visiting Nurse Association.
  In 1902, 13 young women met in Cleveland to form a local organization 
that would become one of the earliest pioneers of a new concept called 
community health nursing. From those women the Visiting Nurse 
Association of Cleveland was born.
  These nurses understand that most people prefer the comfort and 
security of their home to recover and rehabilitate from an illness or 
injury. Making home health care an essential part of health care today. 
The Visiting Nurse Association touches the lives of nearly every 
American in some way.
  While the size of the Visiting Nurse Association has grown 
tremendously, the quality of health care that they provide to people 
regardless of their ability to pay, continues to be superb. The 
organization serves over 15,000 people a year in Ohio. I would like to 
honor the visiting Nurse Association for the hard work and dedication 
they continue to provide to those in need.
  Mr. FOLEY. Mr. Speaker, I rise today in support of H. Con. Res. 54, a 
bill expressing the sense of the Congress that we should establish an 
annual National Visiting Nurse Association Week.
  As you know, Mr. Speaker, the visiting nurse associations are 
nonprofit home health agencies that, for over 120 years, have been 
united in their mission to provide cost-effective and compassionate 
home and community-based health care to individuals, regardless of the 
individuals' condition or ability to pay for services. There are more 
than 500 visiting nurse associations, which employ more than 90,000 
clinicians, provide health care to more than 4,000,000 people each 
year--with 95,000 visits in Florida alone--and provide a critical 
safety net in communities by developing a network of community support 
services that enable individuals to live independently at home.
  In my home state, the Visiting Nurse Association of Florida serves 13 
counties with a complete array of home health services. With 
headquarters in Stuart since 1976, VNA last year provided more than 
$346,000 in charitable care to the most vulnerable in our communities.
  The establishment of an annual National Visiting Nurse Association 
Week would increase public awareness of the charity-based missions of 
visiting nurse associations and of their ability to meet the needs of 
chronically ill and disabled individuals who prefer to live at home 
rather than in nursing homes, and would spotlight preventive health 
clinics, adult day care programs, and other customized wellness 
programs that meet local community needs. I encourage all of my 
colleagues to join me today in support of this important resolution.
  Mr. DAVIS of Illinois. Mr. Speaker, I yield back the balance of my 
time.
  Mrs. MILLER of Michigan. Mr. Speaker, I have no further requests for 
time, and I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Culberson). The question is on the 
motion offered by the gentlewoman from Michigan (Mrs. Miller) that the 
House suspend the rules and agree to the concurrent resolution, H. Con. 
Res. 54.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of 
those present have voted in the affirmative.
  Mrs. MILLER of Michigan. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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