for rehabilitation facilities, and for nursing homes, and to provide assistance in the construction of such facilities through grants to public and nonprofit agencies, and for other purposes." Since nurses support measures which promise to bring better health to the American people through the expansion of health facilities, we would favor the general principles of the proposed legislation. We recognize the great need for more hospital beds, and for the other special facilities which the enactment of these bills would provide. However, we are greatly concerned that there appears to be little or no consideration given to the problem of providing personnel, especially nursing personnel. Already existing facilities are not as effective as they could be had communities planned for personnel at the same time that they planned for their buildings. Surveys of nursing needs and resources have been completed in most States. Reports of these studies are available and should prove very useful in the surveys authorized in proposed amendment to the Hospital Survey and Construction Act. We trust that you and your committee will bear in mind the ever increasing demands for nursing care when you consider this and other legislative proposals for meeting the health needs of this country. Respectfully yours, ELIZABETH K. PORTER, R. N., President. AMERICAN FARM BUREAU FEDERATION, Hon. WILLIAM A. PURTELL, Chairman, Subcommitte on Labor and Public Welfare, United States Senate, Washington, D. C. DEAR SENATOR PURTELL: The American Farm Bureau Federation supports the enactment of legislation which would expand the Hill-Burton Hospital Survey and Construction Act by providing specific appropriation authority, and appropriation of the authorized amounts, as funds to be matched, to encourage the construction of diagnostic and treatment centers, hospitals for the chronically ill and impaired, rehabilitation facilities and nursing homes for the remaining life of the act. Of the legislation before the Congress we believe H. R. 8149, passed by the House, more adequately meets the need. The American Farm Bureau Federation has been interested in the HillBurton Act since its inception in 1946. Members and officials of the organization have been and are taking an active part in helping with the program at all levels. Under the encouragement of this program a good job has been done in providing general hospitals and health centers in many of the areas of greatest need. Some of the projects have run into growth problems that were not fully anticipated in the beginning, but the overall has been good. There are still areas where facilities need to be provided, but because of the progress already made the time has come to provide more encouragement in more specific fields. Too, it has been demonstrated that a more complete and less costly program can be provided. Farm Bureau members are concerned about the costs involved in providing adequate health facilities. The policies they adopted in regard to health at our last annual meeting state, in part: "Rural people continue their interest in better health. They are taking steps to provide more adequate medical, dental, hospital, nursing, and public-health care in an increasing number of rural communities. In some areas still more physicians, nurses, and hospitals are needed. In other areas there is evidence that hospital construction under the Hill-Burton Act has provided hospital space which is creating difficult problems of economical hospital administration. We urge that local communities carefully study the potential difficulties of this program and that adequate safeguards be provided. "Where necessary, State and local communities can and should further expand their programs; economic factors must be given adequate consideration in determining additional hospital needs." In encouraging communities to provide facilities specifically designed for diagnostic or treatment centers, hospitals for the chronically ill and impaired, rehabilitation facilities, and nursing homes, we see an opportunity to reduce capital outlay and per patient-day costs. Construction, alteration, maintenance, and operating costs have risen to the point where great care must be exercised in providing facilities of any kind in any community. Obviously, neither every rural area nor every rural county can support a general hospital. Many of them can support health centers and/or diagnostic and treatment centers. Most can support nursing homes and/or hospitals for the chronically ill or impaired. By providing proper professional supervision for these smaller facilities and working with nearby general hospitals the more sparsely settled and low income rural areas and counties can support needed programs with the greatest economy. Undoubtedly, such programs would be encouraged by the Federal aid that is envisioned in H. R. 8149. Through such means many rural counties could avail themselves of adequate, high-quality health and medical facilities most economically. Under the Hill-Burton Act general hospitals have been built where none existed before and additions have been built onto existing facilities. Patients needing only chronically ill or impaired or nursing home care pay excessively for care but do not make use of all of the facilities in these general hospitals. County governments house indigent chronic and nursing home cases in these general hospitals. Besides being excessively high in per day cost (House testimony showed an average general hospital per day cost of $18.35 as compared to $6.63 average for long-term cases housed in proper facilities) this is an uneconomic use of a costly facility (Department of HEW shows average for general of $17,000 per bed and about $11,000 long-term). On occasion this procedure denies full use of a general hospital for the purposes for which it was provided. Providing chronic and nursing home care facilities designed for such purposes where needed would: (1) free general hospital beds for general hospital purposes, (2) lower the capital outlay required to provide adequate general hospital facilities, (3) reduce per patient-day cost to patients who pay, and (4) decrease the cost of care for indigent chronic and nursing cases. Diagnostic and treatment centers in rural areas offer an opportunity for better medical care to rural people. A program to encourage the building of such centers also gives rural people a means of providing another incentive to attract doctors into rural areas; which is a major consideration. small trend in this direction, now. It needs a boost. There is a In the rehabilitation field we are not able to speak with the knowledge or authority that we have in the others. We do observe that recent developments in this field seem to indicate that a sound and intelligent program here is very worthwhile. We believe legislation embodying the principles contained in H. R. 8149 should be enacted and that funds to carry out the authority granted should be provided. We respectfully urge you to support such legislation. We request the inclusion of this statement in the record of your hearings dealing with this subject. Sincerely yours, JOE BETTS, Legislative Assistant. UNITED STATES SENATE, Hon. WILLIAM A. PURTELL, Chairman, Subcommittee on Health, United States Senate, Washington, D. C. DEAR SENATOR: In the last few weeks I have received a number of letters and telegrams from Washington State calling attention to those provisions of S. 2758 having to do with "nursing homes." I'm passing along to you some of the thinking I have done in regard thereto. Although I have studied the proposed legislation and the explanations of the bill put forth by the administration, I am still not at all clear as to exactly what is meant by the phrase "nursing homes" as used in the bill. If the administration proposes to reduce the cost of hospital care by helping to provide facilities into which patients who have passed the acute stage of illness but who are still under continuing medical care can be moved, then the idea seems praiseworthy. Obviously such facilities cannot only provide care at a much lower rate but, in addition, can relieve our general hospitals of much of the load under which they are currently burdened. The reference of the Bureau of the Budget in its comments on the bill to "medically supervised nursing and convalescent homes" indicates that perhaps that is what is intendedIf that is the administration's intention, I should like to suggest : (1) That these facilities be labeled "convalescent centers" rather than "nursing homes"; (2) That, since they are to provide for people still receiving hospital care even though they are over the potential-emergency stages of illness, they should be built "in connection with" hospitals and not as legally separate entities; (3) That, since such facilities can be built under the existing Hill-Burton Act, no new legislation is needed save perhaps a provision permitting the construction of one convalescent center by a group of hospitals. If, however, the administration, when it refers to "nursing homes," means to provide Federal funds to build facilities for the care of individuals not requiring regular medical care and to deprive States which already have many such nursing homes run by private individuals and under competent State supervision of their proper share of hospital construction funds if such States do not want or need such Government-financed nursing homes, then I must enter a vigorous protest. In the first place, such a proposal does not belong in either a hospital construction or a medical facilities construction bill. In the second place, if such facilities are needed in some State, it would be much better if the Federal Government began by making long-term, low-interest loans available to private individuals who would agree to build and to maintain such homes in accordance with State-designated standards rather than to put out of business, through federally financed competition, those individuals who through their own initiative have already built and are operating such nursing homes. Finally, no matter what type of nursing homes the administration has in mind, I think it is decidedly out of order for the administration to attempt to vitiate the basic principle of one of the best accepted laws of the land by attempting to earmark funds under the Hill-Burton Act-by telling the States and local communities that they must do what Washington thinks best or be deprived of their due share of tax funds to which they have contributed. I will appreciate receiving any comments you or the staff feel inclined to make as a result of the observations contained in this letter. Likewise, I will appreciate it if you will have this communication incorporated in the hearings. Kindest personal regards. Sincerely, WARREN G. MAGNUSON, (Whereupon, at 12:38 p. m., the subcommittee recessed until 10 a. m., Monday, March 29, 1954.) PRESIDENT'S HEALTH RECOMMENDATIONS AND RELATED MEASURES MONDAY, MARCH 29, 1954 UNITED STATES SENATE, COMMITTEE ON LABOR AND PUBLIC WELFARE, SUBCOMMITTEE ON HEALTH, The subcommittee met at 10:05 a. m., pursuant to notice, in the Old Supreme Court Chamber, Senator William A. Purtell presiding. Present: Senators Purtell (presiding), H. Alexander Smith, Goldwater, Cooper, Hill, and Lehman. Senator GOLDWATER (presiding). The committee will come to order. We will dispense with the call of the committee's roll. The other members of the committee are on other committee assignments, and Senator Purtell, in particular, wanted me to give his apologies for not being here today to begin the hearing. It is the first meeting and probably the only meeting the Senator will miss. This morning we are going to commence hearings on S. 2778, which is one of several bills pertaining to a revision of the Federal grants-inaid formula. I would like to insert in the record at this time the bill S. 2778 and a report from the Bureau of the Budget on this bill, together with a report from the Department of Health, Education, and Welfare. (The bill and the reports are as follows:) [S. 2778, 83d Cong., 2d sess.1 A BILL To amend the Public Health Service Act to promote and assist in the extension and improvement of public health services, to provide for a more effective use of available Federal funds, and for other purposes Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "Public Health Grant-in-Aid Amendments of 1954." SEC. 2. Section 314 of the Public Health Service Act is hereby amended to read as follows: "GRANTS AND SERVICES TO STATES "SEC. 314. (a) There are hereby authorized to be appropriated for each fiscal year, beginning with the fiscal year ending June 30, 1956, such sums for grants to carry out the purposes of this section as the Congress may determine. The sums so appropriated for any fiscal year shall be available for "(1) grants to States to assist them in meeting the costs of public health services; "(2) grants to States to assist them in initiating projects for the extension and improvement of their public health services; and "(3) grants to States and to public and other nonprofit organizations and agencies to assist in combating unusually severe public health problems in specific geographical areas, in the carrying out of special projects which hold unique promise of making a substantial contribution to the solution |