disease hospitals, the nursing homes, and also lightens the load on diagnostic and treatment facilities.

Now, comprehensive facilities may be located in a hospital or may be located in connection with vocational schools or may be entirely separate depending on the need in the particular community, as the survey will develop.

At the present time, in the comprehensive facilities which are now existing, approximately 50 percent of the persons being rehabilitated are returned to employment through the vocational rehabilitation program and approximately 50 percent are being returned to a status of at least self-care which in turn often releases some other member of the family to go out and be the breadwinner.

Senator PURTELL. Do you mean 49 percent, 50 percent, or 51 percent, or from information available you think that?

Mr. KIMBALL. Information.

Senator PURTELL. Would you say it was correct between 5 and 10 percent?

Mr. KIMBALL. Yes, sir.

Senator PURTELL. Thank you.

Mr. KIMBALL. I would like, if I could, Mr. Chairman, to wait until a little later in the presentation to speak about the vocational rehabilitation program because these facilities we are speaking of this morning will be available for both vocational rehabilitation and for the care of children, older persons and others who will not be returned to employment.

I think it is important to consider for a moment what types of severe disabilities require the use of a comprehensive rehabilitation facility.

Ths next chart lists some of the more common types of severe disabilities, the different types of paralysis cases, paraplegia, and so on; blindness which the Secretary mentioned, and heart disease and other more severe disabilities which may have been caused by an accident, disease, such as polio and so on.

Now, a comprehensive center to meet the requirements of this particular legislation must contain a combination of professional and other services which are designed to bring about the rehabilitation of a person with these types of severe disabilities. It will be noted on this next chart, Mr. Chairman, that the three basic types of services which must be provided include medical, psychological and social, and vocational; and to meet the requirements of this act, then, there must be a combination of these types of services. When the patient comes into the center, his case is diagnosed as an individual and a plan is prepared for him. These various types of services are made available and his plan is adjusted as he goes through the process of rehabilitation.

If I may mention just one case to give you an idea of the possibilities of such a center, I am thinking of a miner who was in a very severe mine accident, was paralyzed from his waist down; and for 5 years was completely bedridden, which also tied up his wife, fulltime, caring for him.

When facilities of a comprehensive center became available, he was not only rehabilitated to self-care, he was rehabilitated to the point of learning a new trade and now runs his own watchmaking establishment, in which his wife also works.

In other words, he has been restored to full dignity and is able to support himself and his family.

That type of severe case can be rehabilitated in this kind of a center. Now, the next chart, Mr. Chairman, shows where the comprehensive rehabilitation facilities are available today, where they are located. It also shows the number. I think the committee will be interested to see that at the present time there are 23 such facilities in the United Sates, and you will notice at a glance the wide areas of the country where there are no such facilities. Just to pick one facility, I happened to visit about 2 or 3 weeks ago the Woodrow Wilson Rehabilitation Center at Fishersville, Va. At one time in January there were patients there from a total of 21 States from as far away as Wyoming. One sister State had a total of 62 patients at Fishersville, Va., last year and still had several hundred on their waiting list, like our miner who was 5 years before he got treatment.

Under this bill, the State-by-State surveys would determine where the centers should be placed to provide more economic distribution as well as to provide the needed additional facilities.

Senator HILL. How are those facilities financed?

Mr. KIMBALL. The facility is financed by a Federal grant which is matched, sir, by State and local funds. The matching works out at about $8 million of State and local funds against the $10 million Federal. Under this bill, a 3-year bill, it would provide a total of $18 million each year.

Senator HILL. I am only speaking about this particular facility. Mr. KIMBALL. I am sorry, sir.

Senator HILL. How is it financed today?

Senator GOLDWATER. That Woodrow Wilson facility.

Miss SWITZER. The Woodrow Wilson Center is the old Woodrow Wilson Army General Hospital which the State of Virginia acquired after the war; and, through the cooperative work of the State of Virginia Division of Vocational Rehabilitation and the Federal Office of Vocational Rehabilitation, comprehensive rehabilitation services were set up in that center. They had a big start because they had the buildings, you see.

Senator HILL. They had the hospital.

Miss SWITZER. And also the surrounding buildings were used to expand the system of vocational shops which is part of the State of Virginia's comprehensive vocational training program for that whole region. So, in addition to having the general hospital building to renovate for the rehabilitation facility needs, they also had immediately available dozens and dozens of different kinds of shops and trades around which to build the vocational rehabilitation right under the same roof as the center.

Now, the Federal appropriation did not go for equipment or building or renovation or anything like that. It went through the peculiar provisions of Public Law 113 through which we operate to help the State with staffing in the early days and administrative organization and that type of thing.

Then, of course, the center is maintained by the payment for the service received by vocational rehabilitation clients from many States. Senator HILL. They still get some Federal funds under the Vocational and Rehabilitation Act?

Miss SWITZER. Yes; all of the funds that go into the salaries at the present time are Federal funds, because that is, as you know, 100 percent Federal financing at the moment.

Then, the money that is paid for services, that is the per diem rate for services, is 50-50 Federal and State.

Senator PURTELL. That is true of the rehabilitation workshops up through New England, for instance, is it?

Miss SWITZER. The rehabiiltation workshops in New England, like the Hartford center, which you probably know very well, those are privately owned just like a hospital. They would get their pay for patient service just the way a hospital would from the State that sends the patient there.

Senator PURTELL. Thank you.

Senator LEHMAN. Does New York have a rehabilitation and reconstruction home at West Haverstraw?

Miss SWITZER. Yes.

Senator LEHMAN. Does that specify Federal aid?

Miss SWITZER. That does not receive Federal aid from our program. I am not sure whether it received Federal aid from Public Health Service funds or not. But it does receive payment through the public programs for patients. There are a number of New York State rehabilitation patients going there for service.

Senator HILL. Then half of those funds come from State and half from the Federal Government; is that right?

Miss SWITZER. Yes. You will recall that the financing of the present vocational rehabilitation law is in two parts: one, 100 percent Federal funds for salaries of counselors, guidance and placement staff, and administration, and then the case service funds which are matched 50-50 State-Federal for the purchase of service.

Mr. KIMBALL. As it was pointed out, Mr. Chairman, when we saw that first chart where about 50 percent of the people were in the vocational rehabilitation program, of course, the other 50 percent might be sent by doctors, or by insurance companies, by various institutions, but whoever sends them would pay for the care depending on what the program was. In addition—

Senator HILL. Your chart here on the left shows that that great western section of the country all the way from Oklahoma west, you have got no rehabilitation centers in there at all.

Mr. KIMBALL. No comprehensive centers at all, Senator.

Senator HILL. They are carrying on rehabilitation work there; they are taking advantage of the Federal statute, of course, the Federal aid. But you have not got a comprehensive center there; is that the idea?

Mr. KIMBALL. There is no comprehensive center which fills the requirements of this legislation. I might say that the next charts are concerned with certain partial centers, that is, centers which have been established and provide some of these services, but not all of them. To indicate what a typical partial center looks like from a chart point of view, this next chart shows that it might have some medical, some social service, but not a completely rounded program needed for the severely disabled.

This map shows where the partials are located. You will see some located in the parts of the country which were blank under the comprehensive, but it still is a widely scattered picture, as you can see.

Senator PURTELL. This whole concept of your comprehensive rehabilitation facilities is something relatively new, within the last 6 or 8 years?

Miss SWITZER. Five, even.

Senator PURTELL. Five. Thank you.

Senator HILL. The Veterans' Administration carries on rehabilitation services within its veterans' hospitals, does it not?

Mr. KIMBALL. Yes, sir.

Mr. Chairman, the Secretary a little earlier mentioned that special consideration was given in the program to facilities for the blind. The next chart shows the location of those facilities, rehabilitation facilities which are available in the United States today for the blind. It will be noted that there are 7 comprehensive facilities and 13 partial facilities. I would like to mention in connection with the rehabilitation of the blind that the very first step, with someone who loses his sight is to rehabilitate him to the very needs of living without sight.

For example, it is necessary for them to learn means of selecting their food, how to eat without embarrassing family and friends, to walk with a cane, that is, without assistance. The most basic things of life must be learned before they can then move farther into other steps of rehabilitation.

This chart does show that, for example, in the entire Western United States at the moment there is but one partial rehabilitation center for the blind.

Earlier, I mentioned, Mr. Chairman, that I would like to discuss the vocational rehabilitation program specifically. At the present time, it is estimated that approximately 250,000 persons each year become disabled who could be rehabilitated to employment were the facilities and services available. The program at this time rehabilitates at a level of approximately 60,000 annually. In the President's message, his proposal for a 5-year program of major expansion would provide that by 1959 that program be increased to the point where it could rehabilitate 200,000 individuals per year.

Now, it is also stated

Senator HILL. What are your plans now? Of course, you build these facilities and the Federal Government has been carrying a good big part of the cost of the rehabilitation; what is your proposal about the Federal Government continuing to carry that cost? I mean, when you build a facility you have just started. You have got that cost of maintenance, operation, the cost of the service, staff, personnel, experts, and all that business.

Mr. KIMBALL. Senator, the 5-year program, contemplates that starting off in the first year with a small additional appropriation in the amount of $5 million, which would be 100-percent Federal to get it started; in the 5th year the program would reach a national average of 50-percent State and 50-percent Federal. Thereafter it would be on a national average of 50-50 in the actual operation of this vocational rehabilitation program.

Senator PURTELL. Mrs. Secretary.

Mrs. HOBBY. Might I add, too, Senator Hill, that another bill which you have scheduled, S. 2759, deals with that in the new grantin-aid approach to this whole problem.

Senator HILL. I guess we will go into it more fully with that other bill.

46293-54-pt. 1

Do you have any plans to change the 100-percent grants that you are now making?

Mr. KIMBALL. There is a plan, Senator, on the present program, which over a period of 3 years, that is, the next 3 fiscal years, using the Hill-Burton formula, would bring the Federal-State sharing to a 50-50 basis nationally and would not specifically provide 100-percent administrative-type support. That will all be covered in this S. 2759 which I believe will be before your committee on March 30.

Experience has indicated that of the people who have come under the vocational rehabilitation program, approximately 20 percent are so severely disabled as to require the services of a comprehensive rehabilitation facility.

Now, considering again the President's goal by 1959, 200,000 per year, that would mean if the 20-percent ratio carries out through that entire group, comprehensive rehabilitation facilities will be needed to the extent of 40,000 disabled persons per year by 1959 just to meet the President's expanded proposals on vocational rehabilitation, and not taking into account, of course, children and older persons who would not be in that program.

At the present time, we estimate that the comprehensive facilities now in existence care for approximately 8,000 disabled persons annually. The proposals under this legislation of $10 million per year for 3 years, matched by $8 million State and local funds would provide facilities for approximately 12,000 additional persons per year in each of the 3 years which, in effect, would mean if the States and the localities were able to carry this program out fully, as contemplated by the Federal legislation, provision in this 3-year period of facilities with 36,000 additional capacity or a total of 44,000.

Now, this is a 3-year program for the fiscal years 1955, 1956, and 1957. I call attention to the fact that the President's goal of 200,000, if carried out, would be reached in 1959. But because we do need to survey to determine for specific localities where and what facilities are required, later on we will be able to come back to the committee and furnish much more specific information as to the total need which you will notice on this chart is an unknown figure at the moment.

At least, the facilities proposed under this bill are clearly needed just in the light of the President's vocational rehabilitation program alone.

Mr. Chairman, if I may just summarize with two points I think it would be interesting and particularly helpful for the committee to keep in mind.

No. 1, the establishment of these comprehensive rehabilitation facilities will lessen the loads on hospitals and other facilities which are so short at the present time; and secondly, the vocational rehabilitation program alone will require the facilities which are requested at this particular time.

I have a statement of 2 or 3 sheets, Mr. Chairman, which gives some general background information on the present vocational rehabilitation program, if the committee would like to have it.

Senator PURTELL. We will be happy to have it inserted in the record at this point.

(The information referred to is as follows:)