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found that many corporations and public institutions systematically require applicants to meet medical qualifications completely unrelated to job performance.

If this legislation is to achieve its goals of more satisfying and independent lives for America's disabled and less dependence upon public aid, then Congress must pass concurrent bills prohibiting discrimination on the basis of handicap, or, more to the point, on the basis of any factors not directly related to the task at hand.

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We Co-Sponsor
5.

Senator CRANSTON. Thank you very much. Your study is a very important one and your testimony is very helpful.

Our next witness is Mae Hightower, director, Delaware Curative Workshop, representing American Occupational Therapy Association; accompanied by Mary K. Bailey, chief, Occupational Therapy Department, John Hopkins Hospital; Claudia Allen, assistant chief, psychiatry, Occupational Therapy Department, John Hopkins Hospital: and Leo C. Fanning, executive director, American Occupational Therapy Association.

I would appreciate it very much if you could briefly summarize your prepared statement, which will go fully in the record, so there will be time for questions. We are running into a time problem.

STATEMENT OF MAE HIGHTOWER, DIRECTOR, DELAWARE CURATIVE WORKSHOP, REPRESENTING THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION; ACCOMPANIED BY: MARY K. BAILEY, CHIEF, OCCUPATIONAL THERAPY DEPARTMENT, JOHN HOPKINS HOSPITAL: CLAUDIA ALLEN, ASSISTANT CHIEF, PSYCHIATRY, OCCUPATIONAL THERAPY DEPARTMENT, JOHN HOPKINS; AND LEO C. FANNING, EXECUTIVE DIRECTOR, AMERICAN OCCUPATIONAL THERAPY ASSOCIATION

Miss HIGHTOWER. I am Mae Hightower. This is Mrs. Bailey and Mr. Fanning.

I just want to say a brief word about the Occupational Therapy Association and its role in the whole rehabilitation movement. Just 5 years ago we celebrated our 50th anniversary; and our 13,000 members are involved in all phases of rehabilitation.

Although we have reviewed the other bills that were submitted for the original House hearings, we have given particular attention to and are most concerned about House bill 8395.

There are several things that concern us about this bill. Instead of reading the entire statement. I am going to address my comments to the items that concern us.

One is the subject of titles.

The act is now broken down in six titles, which we feel is an inadequate breakdown. We feel that some of the things that are lumped under title IV should have more emphasis and should be brought out into separate titles.

These, specifically, are the provisions for facility construction and improvement and the provisions for training and research.

I feel that we could do more with the moneys that are appropriated for these categories if they were given separate titles in the act. We support the increase in the State appropriations and also support proposed advanced funding, which we feel will insure smooth continuation of programs with no interruption.

As an administrator of a rehabilitation facility-and I deal with vocational rehabilitation services continuously-I know the problems that State vocational rehabilitation agencies have with the uncertainty of the flow of funds. Sometimes they are held up with planning for the handicapped because of an appropriation coming very late within a fiscal year.

So the advanced funding provisions would be of great help to State and local agencies.

Under title III, we urge that more definitive explanations of "comprehensive rehabilitation services" and "severely handicapped individuals" be written into the act.

In the last 18 months, the act for developmental disability has been approved and implemented. I think this is an outstanding example of the lack of definition within the law.

Developmental disabilities cover those people who are suffering from epilepsy, from cerebral palsy and other conditions, as well as mentally retardation. Unfortunately the other neurological conditions have never been defined, although the act has been in force now since 1970.

Back to title IV and the training and construction and initial staffing of rehabilitation facilities. The amounts of money that are allocated in this bill have been cut from $60 million, which was recommended in 1972, to $35 million for construction and initial staffing of rehabilitation facilities.

We feel that the appropriations for construction have been really negligible considering the needs. They have ranged from zero to $3 million for the entire country during the last few years.

We have a critical need for bricks and mortar at this point, if we are to provide the services that are being legislated. It seems to me, as administrator of an agency and living in a State that is really a microcosm of the United States, that we are up against a proverbial wall.

I have some charts that describe the situation in my own agency that I would like to share with you, Senator Cranston, to show you what has happened, in that facility. I do not feel that our situation is abnormal. I think it is pretty typical due to the legislation that has been passed in the last few years, and the demands that have been put on rehabilitation facilities.

You will notice a tremendous growth shown on this chart. We added an addition in 1967; we added that addition, costing $640,000, and increased our facility by one and a half times. We became two and a half times as large as we were. We had some brains working on predictions of how long this space could be utilized, and these were people from large industry who had access to all kinds of trends in service, and so forth. We thought we had built a 10-year building. But because we added additional services, we anticipate taking only 50-percent increase in caseload within that 10-year period.

We had approximately 400 patients or clients in 1967 when we opened this addition; and we are averaging 1,000 a month at this time. So we have more than doubled our caseload in a facility that was built to take care of 50 percent more. We are really bursting at the seams.

If we cannot get additional space and we are an example, as I said, typical of other agencies, then we are simply not going to be able to provide the services for which moneys are being legislated.

The other item that concerns us is the $250,000 limitation mortgage

insurance.

With the construction costs what they are today, and we are investigating now an addition which would cost about $50 a square

foot (this is an outpatient facility which is much lower than an inpatient facility would be) $250,000 would really not be very much help to us. If we add just two more floors to one part of the building, ít will cost us about $650,000.

So I think when you say you are offering this kind of mortgage insurance with the problem of raising funds from the public sector being what it is, I think you are saying, in essence, that you really cannot fund the construction of rehabilitation facilities through mortgages.

We asked also under title IV that the term "multipurpose rehabilitation facility" be more clearly defined. This is really an ambiguous sort of a title, and we would like to know what you mean by "multipurpose rehabilitation facility."

Senator CRANSTON. On that point, would you submit for the record what you consider to be an appropriate definition for that? Miss HIGHTOWER. I will be happy to.

We have noted with great concern the severe cutback in the funds provided for training programs for producing more professional and technical personnel. This goes back again to the number of people who need rehabilitation and the number of trained people that are able to provide the services they need.

The OT Association entered into agreement with the Federal Government some years ago to cooperate in introducing better trained. people, more personnel in the field of occupational therapy.

We have enjoyed a grant from the Federal Government made directly to the OT Association for graduate study. Last year, these funds were cut drastically. This year we were told we would receive no funds after this year.

As chairman of the finance committee for the American OT Association, I just received notice that we had been given $27,000 to continue support for our candidates that we have in a Ph. D. program at this time. However, we were notified that this would be the last year and OT could expect no more funds from this particular agency for training professional people in our field.

In another role, I am serving on a scholarship committee in the little State of Delaware. Somehow, the word got out that scholarships are available, although they are only available to Delaware residents.

We have received some 250 letters this year from physical therapy, occupational therapy, and speech therapy students, all over the country, asking for funds. There is no money available to meet these requests.

Federal resources that were available previously through the universities are no longer there. Some of these students are in their senior year and will not be able to graduate unless they can find some kind of scholarship funds that will replace the Federal funds that have been withdrawn.

We feel that if the legislation is going to ask for services, the construction of adequate facilities and the provision of adequately trained professional people to offer services within these facilities are also absolutely essential.

We recommend that a separate title be set up for training and that an appropriation be authorized; and also that a provision be made

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that if this appropriation is cut, that all other grants under this law be cut in the same proportion.

We support the National Information and Resource Center for the Handicapped, and the remainder of the bill, with the exception of the provisions I have just described.

We want to express our appreciation for having the opportunity to appear before you; and we will be glad to answer any questions that you have.

Senator CRANSTON. Thank you very, very much. I appreciate your presence and your helpful testimony very much.

On page 4 of your statement you refer to your doubts about title III of H.R. 8395 being effective to serve the purpose intended.

Specifically, you feel the present definition of "severely handicapped individual" is somewhat vague? Could you explain exactly why you feel this way?

Miss HIGHTOWER. Well, I don't think the term has been well enough defined. It is pretty broad-when you say "severely disabled," that is a pretty broad definition. I personally feel that you cannot categorize the severely disabled by diagnostic titles. "Severely disabled person" can conceivably be someone under certain conditions-let me give you an example of what I mean.

A person who has no education, who has always worked as a laborer or in some menial kind of job, if he loses a leg, is "severely disabled." There is no question about it. He has to have many, many services offered to him through rehabilitation before he can reenter the labor market.

A teacher who has an education who loses a leg is handicapped, but is not severely disabled. He can return to his trade as a teacher and continue to earn a living. Therefore, I do not feel you can say this category represents the severely disabled and this category does not. I think it depends on the amount of services that the person is going to have to have before he can reenter the labor market and that all of the complex problems involved have to be considered and not just the diagnosis.

I feel there is no question that a paraplegic and quadraplegic are severely disabled, no matter where they fall. But there are other types of disabilities that may not appear written out on paper as a severe disability which can be, if they happen to the wrong person.

Senator CRANSTON. You mentioned that there had been a severe cutback in training programs for occupational therapists.

Do you have any figures on the numbers of personnel needed and the number currently being trained?

Miss HIGHTOWER. There are approximately 500 graduates of the OT curriculum each year throughout the United States. Some figures have been compiled on this which are pretty fascinating.

A few years ago, a study was done. We found that within the first year, almost 50 percent of those 500 got married and pregnant and quit the field. It gradually diminished down to-well, we had something like 15 percent of each graduating class left in the field after 5 or 6 years.

There are some 10,000 known job openings in the United States today unfilled, and I am sure there are many that are not known. The curătive workshop enjoys a full staff right now; but if I could find OT's