Mr. BOCHE. Halfway houses have been staffed for the most part by recovered addicts who have been especially trained. Now, this is not Mr. ROGERS. I mean, would it be a staff that runs the community mental health center, or would it be private groups? Or who would establish it, in other words? Mr. BOCHE. I think a strong point can be made for the private nonprofit, community-oriented group working on a voluntary basis in cooperation with the community mental health clinic. I think the big value of this is that you provide in this kind of organization, an army of volunteers which can help in the resocialization process. Mr. ROGERS. Could you let us have a rundown of examples of halfway houses, the costs of maintaining them, the services provided, maybe some examples of success, or problems? Mr. BOCHE. Yes. I could deliver for you outlines of some of the more successful and ideal programs. (The information requested by Mr. Rogers and submitted by Mr. Boche may be found in the committee files.) Mr. ROGERS. If it is going to be voluntary-that is, you don't envision that the people running the halfway house would all be voluntary? Mr. BоCHE. Oh, no. I am saying that in terms of its organization and board of directors, that we are dealing with a voluntary agency which hires a staff and then is able to enroll and bring in an army of volunteers. Mr. ROGERS. Yes. This would provide shelter, I presume. Mr. BOCHE. Yes; we find the halfway house is providing a substitute home, with all the productive possibilities that a substitute home can provide. Mr. ROGERS. This is what would be covered, I assume, in the legislation by residential Mr. BоCHE. Yes, sir; or after-care facilities on a live-in basis; yes. Mr. ROGERS. Do you estimate how much would be needed? Mr. BOCHE. This is very difficult. Out of the experience of St. Louis, for instance, they could probably use, without any difficulty, six or eight facilities of 30 beds each. The big advantage that the halfway house has is that it is able to operate at significantly less cost, and that approximately-in facilities for men-about half of the cost of running the house comes from their own contribution. With women, this runs approximately a third. Mr. ROGERS. While they are in the halfway house, is it essential that they take treatment? Mr. BоCHE. We believe that before a person comes to a halfway house that they should be involved in significant inpatient treatment, and that such after-care as indicated by the professional community be carried on when the resident is living in the halfway house, so that when he leaves the halfway house he basically takes with him all of his therapeutic relationships. Hence, we do not believe that these kinds of supportive therapeutic relationships should be contained within the house, but rather within the community, so that this continuum of care can be continued beyond this living-in situation. Mr. ROGERS. Is there any compulsion, or is this all voluntary? Mr. BOCHE. Well, there is, of course, a question always raised, Is alcoholism ever voluntarily treated? Working in a community program, I have known of many instances where a man went voluntarily to get help because if he didn't his wife was going to divorce him. So there are many forms of coercion. Mr. ROGERS I mean in a legal sense. Mr. BOCHE. In a legal sense, no. The halfway houses in operation do not use legal means to keep a man in residence. At the present time we have had no experience in that area. Mr. ROGERS. Thank you very much. We appreciate your help to the committee. The record may stay open for 5 days for anyone to make a statement, if they desire. There are no other witnesses. This concludes the hearings. (The following material was submitted for the record:) STATEMENT OF JUDITH G. WHITAKER, EXECUTIVE DIRECTOR, AMERICAN NURSES' ASSOCIATION, INC. The American Nurses' Association wishes to record its support of the provisions of H.R. 15758 which will extend and improve the provisions of the Regional Medical Program, extend the special grants for health of migratory workers, and provide for specialized facilities for alcoholics and narcotic addicts. We believe that the Regional Medical Programs, P.L. 89-239 is one of the very significant programs enacted by the Congress in the last few years. It is demonstrating that it has great potential for making more readily available to the people of this country the results of the latest advances in the treatment of heart disease, cancer and stroke and related diseases. Physicians, nurses and other health personnel have the opportunity through the programs to become familiar with these advances and to update their skills in caring for patients. The programs have further stimulated cooperation between members of the health professions as they prepare to give the highest quality of service to people. The legislation was devised as a means of reducing the gap between care possible in a medical center and that available to persons remote from the centers. To achieve this end we have encouraged active participation of the registered nurse as a member of the health team in both the planning and the implementation of the law. Title II of H.R. 15758 proposes the extension of the special grants for health of migratory workers. We urge that this extension of the special grants for health proposed in the bill. Migrant workers have always faced difficulties in obtaining adequate preventive and therapeutic health services. Studies show the disease rate for farm workers to be three times that of industrial workers. Forty percent of these diseases result in permanent disability for regular work as compared with twenty-seven percent among industrial workers. Women in farm worker families reecive no prenatal care or late care in 33% of cases as compared with 6% in skilled worker families. Special means have to be taken to correct these serious deficiencies in the provision of health and preventive care services. Assistance from the federal government is essential. Many states alone are unable to provide such services because of insufficient resources. Also, eligibility to receive medical and health care services is often governed by the residence requirements of a state. Since migrant farm workers move from state to state, establishing residency is frequently not possible. The Association also supports Title III of H.R. 15758 which proposes construction grants and staffing, operation and maintenance grants for centers for the treatment and rehabilitation of alcoholic and narcotic addicts. We urge the Committee to act favorably on H.R. 15758. STATEMENT OF MYRON KOWALS, ASSISTANT DIRECTOR, SEATTLE MENTAL HEALTH INSTITUTE Alcoholism in particular has long been a critical problem in the Seattle area. Facilities such as the Pioneer Fellowship House, the Women's Studio Club, the Lewis Martin Home, and the Alcoholism Treatment Clinic, have been struggling to devote services to alcoholics in an effort to promote their rehabilitation. However, the financing of these projects is a constant struggle. We recognize alcoholism as a mental health problem which is properly the province of the community mental health center and therefore these facilities dealing with the problem of alcoholism should be funded under community mental health centers legislation. Due to the immense problem of lining up state and local support in order to permanently fund these facilities, it is felt that a declining federal support over a period of ten years would give the facilities the best chance for permanent success. Because the Seattle Mental Health Institute feels so strongly about the problem of alcoholism a great effort was made to establish working agreements with the alcoholic facilities as part of the grant application for community mental health centers staffing funds. Even though SMHI felt that alcoholism was a mental health problem and therefore should be included in the service centers, it is still important that the legislation puts clearly into writing the eligibility of the alcoholic rehabilitation facilities. However, to allow a period of ten years of federal support alcoholic facilities and at the same time to limit community mental health centers in general to a period of support of 51 months seems to me to be putting the cart before the horse. Every effort should be made to amend the bill to lengthen the period of support for community mental health centers in general to a period longer than 51 months. It is my personal belief that community mental health centers can be supported by state and local sources without any permanent federal support, but achieving this will definitely be a challenging task. State legislation is going to play an important part in establishing the permanent sources of non-federal support. County funds can also be expected to play an important part in local support. However, promoting state legislation to provide the support funds would take considerable work in more than one session of the legislature. Under the present federal law the level of support by the fourth year of funding of a community mental health center is at a critical low level. If two sessions of the legislature were sufficient to provide legislation for the funds needed by the time the laws became effective the centers would have already experienced considerable financial difficulty. If community mental health centers are unsuccessful within the 51 month period in lining up sources of support to supplant federal funds it is inevitable that these centers will gravitate towards the serving of the paying patients. This will result in a drastic cut-back of service to citizens who are unable to pay or capable of paying only a portion of the cost. Naturally this would defeat the purpose of the federal community mental health legislation. I strongly urge the committee to consider amending the bill in such a fashion as to provide longer period of support than 51 months. To wait for community mental health centers to begin failing before doing so would be indeed shortsighted. I believe there is enough evidence to this date to show that the entire burden of the community mental health centers cannot be shouldered by state and local sources in such a short period of time. STATEMENT OF THE NATIONAL CONSUMERS LEAGUE The National Consumers League has for over half a century concerned itself with the problems of the migratory agricultural workers, the most neglected segment of our working population, and in their behalf wishes to go on record in support of extension of the Migrant Health Act of 1962, as amended in 1965, provided for in the Health Services Act of 1968, H.R. 15758. It is estimated that there are about one million Americans-migrant farm workers and their families-who suffer from inadequate health care. Until the Migrant Health Act was passed in 1962, health care for migrants was practically nonexistent. Since that time, some real progress has been achieved, but the "health gap" among this group is still shockingly large. Only about one-third of the migrants have received health services under the program, and almost 40% of the counties where seasonal migrants work still have no grant-assisted project services. Six out of ten of the counties serving as "home base" for migrant workers have no personal health care for farm workers. Among this group of workers deaths from influenza, pneumonia, tuberculosis, infant diseases and accidents are from one and a half to four times the national average. National per capita health expenditures are almost twenty times greater than the per capita health expenditures for migrants. Until this gap is significantly narrowed, the need to continue the special program of Migrant Health Services is urgent. Not only should present projects be continued, but new ones must be established in those communities which now have none. The National Consumers League therefore strongly urges that you extend the Migrant Health Program for at least two years, and that at least $10 million be authorized for each of the fiscal years ending June 30, 1969 and 1970. [Telegram] Hon. JOHN JARMAN, CARMEL, CALIF., March 27, 1968. Chairman, Subcommittee on Public Health and Welfare, The Board of Directors of the National Council on Alcoholism, Monterey Peninsula Area, Monterey County, California, composed of physicians, clergymen, judges, lawyers, educators, and businessmen, voted unanimously today to convey to the Subcommittee on Public Health and Welfare concerns for the vast unmet need of alcoholics in this area and throughout the Nation. We heartily approve the purposes of H.R. 15758, especially its provision for facilities for alcoholics. With very limited facilities to date our community has demonstrated the unlimited potential for conservation of human resources through alcoholic rehabilitation. The need for more facilities is crucial to prevent needless waste. We urge favorable action on H.R. 15758. GEORGE E. RIDGWAY, President. [Telegram] SAN RAFAEL, CALIF., March 25, 1968. Subject: Hearings on H.R. 15758. Hon. JOHN JARMAN, Chairman, Subcommittee on Public Health and Welfare, Legislation pertaining to recognition and treatment of alcoholics is long overdue. Presently only small fraction of alcoholics are being reached by public and private agencies. Features in this bill represent important steps toward meeting imminent tremendously increased demand for expansion in all areas of field. ALLEN SKINNER, Chairman, Alcoholic Recovery Homes Association, San Francisco, Calif. HOUSE OF REPRESENTATIVES, Washington, D.C., March 26, 1968. Hon. JOHN JARMAN, DEAR MR. CHAIRMAN: Hearings are currently being held by your Subcommittee on H.R. 15758, a bill to amend the Public Health Service Act so as to extend and improve the provisions relating to regional medical programs, to extend the authorization of grants for health of migratory agricultural workers and to provide for specialized facilities for alcoholics and narcotic addicts, which was introduced by the distinguished Chairman of the Committee on Interstate and Foreign Commerce, the Honorable Harley O. Staggers. Because of the increasing involvement in medical programs in the Pacific by the relatively young University of Hawaii School of Medicine, I would like to take this opportunity to comment specifically on Section 103 of the bill, under the subtitle "Inclusion of Territories." This section apparently is designed to extend the regional medical programs to Guam, American Samoa, and the Trust Territory of the Pacific Islands, as well as to other areas. The extension of such programs would promote the acquisition and dissemination of medical knowledge and skills throughout U.S. territories in the Pacific. Medical research and training in which the University of Hawaii School of Medicine is presently engaged in several cooperative ventures in these Pacific areas, would be strengthened and improved. The result of all this is that the people in these areas would receive the full benefits and assistance of American medical science and technology. For the foregoing reasons, I strongly urge that Section 103 be retained in the measure that is reported out by your Subcommittee. It is requested that this letter be included in the record of hearings on H.R. 15758. Aloha and best wishes. Sincerely, SPARK M. MATSUNAGA, AMERICAN HOSPITAL ASSOCIATION, Hon. HARLEY O. STAGGERS, Chairman, Interstate and Foreign Commerce Committee, DEAR CONGRESSMAN STAGGERS: This statement expresses the views of the American Hospital Association on H.R. 15758 which amends the Public Health Service Act so as to extend and improve the provisions relating to regional medical programs, to extend the authorization of grants for health of migratory agricultural workers, to provide for specialized facilities for alcoholics and narcotic addicts, and for other purposes. REGIONAL MEDICAL PROGRAMS This Association strongly supported the development of the legislation which resulted in P.L. 89-239. We were pleased that certain recommendations, which we felt were essential to the most effective development of the program, were incorporated in the law. We have continued to follow carefully and with great interest the progress of the program. The past two years appear to have been spent in the main in the establishment of regional programs and in their planning. The operating stage of the program is really only just beginning with a limited number of projects having been approved to date. Though good planning is highly essential it is to be hoped that the program will move forward rapidly in its application. We have always believed the purpose of the bill is to establish a bridge between the science of medicine and its full application to the care and treatment of patients. In the coming months, therefore, it is to be hoped that the programs developed will be felt by the public in terms of a broadened application of knowledge in the treatment of these diseases covered under the program. We urge the Committee to authorize the full amount requested for the program for the fiscal year ending June 30, 1969. The Association has continued to feel that implementation of the intent of the law would necessitate a full involvement on the part of hospitals and their medical staffs. This will necessitate not only the participation of the medical schools and the larger teaching and community hospitals but the smaller hospitals spread throughout the nation which provide a focal point for medical care and treatment in smaller communities. We have been disappointed at the extent of involvement of hospitals and particularly the minimal participation of these smaller community hospitals which is so essential if the program is to have meaning to the public at large. Therefore, the American Hospital Association will undertake a number of steps which it is hoped will result in a much wider involvement of hospitals. We have also noted that very little emphasis has been given thus far to preventive care and long-term patient care and we intend to stimulate leadership on the part of the hospital field in fostering such a broad approach to the regional medical programs. We will continue to work closely with the administrators of the program and to work for the fullest participation of the hospital field. |