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necessary expenses, and any veteran in receipt of such pension shall be exempt from making any statement under oath regarding his inability to defray necessary expenses.

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OCTOBER 17, 1969.-Ordered to be printed

Filed under authority of the order of the Senate of OCTOBER 16, 1969

Mr. CRANSTON, from the Committee on Labor and Public Welfare, submitted the following

REPORT

[To accompany H.R. 2768]

The Committee on Labor and Public Welfare, to which was referred the bill (H.R. 2768) to amend title 38 of the United States Code in order to eliminate the six-month limitation in the furnishing of nursing home care in the case of veterans with service-connected disabilities, having considered the same, reports favorably thereon without amendment and recommends that the bill do pass.

INTRODUCTION

The Subcommittee on Veterans' Affairs conducted hearings on H.R. 2768 on July 17, 1969. Testimony was presented by spokesmen of the administration, veterans' organizations, and by U.S. Senators. In executive session on October 2, 1969, the subcommittee considered H.R. 2768 and unanimously ordered it reported to the full Labor and Public Welfare Committee. The Committee on Labor and Public Welfare met in executive session on October 9, 1969, at which time H.R. 2768 was unanimously approved and ordered reported.

EXPLANATION OF THE BILL

Section 620 of title 38, United States Code, authorizes the placement in a community nursing home at the Veterans' Administration's expense (generally for a period of 6 months), hospitalized veterans who are no longer in need of hospital care and whose primary requirements are for nursing care. This bill would authorize such community nursing home care of unlimited duration for veterans hospitalized for a service-connected disability. Service-connected veterans are admitted as a matter of right for their service-connected disabilities to

all Veterans' Administration hospitals. Veterans with non-serviceconnected disabilities are admitted on a bed-available basis if unable to defray the necessary expenses.

Placement in community nursing homes under 38 U.S.C. § 620 has been a factor in bringing about the desired reduction of the workload of the Veterans' Administration hospital system. In the committee's view, the bill's provisions would further reduce that workload and also the cost for medical care for service-connected veterans in Veterans' Administration facilities. Cost of care for beneficiaries of this bill now ranges as high as $50 a day for hospital care in contrast to approximately $19.50 a day for community nursing care.

The committee is also of the view that the original intention of section 620, to aid the veteran and his family in making the transition from a hospital to his place in the community, should be expanded for veterans hospitalized with service-connected disabilities. Such a veteran should be entitled to all necessary nursing home care at Veterans' Administration expense as close as possible to his home community. Indeed, the longer the duration of his stay in a nursing home, the greater may be the veteran's need for location in his home community in order to permit visits by friends and relatives residing there. Unfortunately the location of Veterans' Administration operated nursing home beds does not in many cases permit a veteran to be near his home community.

The Veterans' Administration estimates that approval of this proposed legislation would increase the daily nursing care load in community nursing homes by approximately 350 at a cost of $1,500,000 annually.

As part of its consideration of H.R. 2768, the committee also considered H.R. 692, which the subcommittee had ordered reported to the full committee without recommendation. That bill, also amending section 620, would permit community nursing home confinements of 9, rather than the present 6, months. With the adoption of H.R. 2768 for service-connected veterans, the impact of H.R. 692 would be limited to veterans with non-service-connected disabilities. The full committee did not feel that favorable action on H.R. 692 was warranted in light of testimony from the Chief Medical Director, and the Director, Extended Care Service, of the Veterans' Administration that since establishment of the community nursing home program in 1965 only 302 requests for extensions beyond 6 months confinement were made from a patient population of over 25,000 and that 92 percent of them had been granted.

These officials also testified that the Veterans' Administration was "not reluctant" to grant these exceptions and did so "when there is medical and economic necessity" or "factors of humanity" (hearings, p. 64). However, VA regulation section 6051.1, which limits extensions to "circumstances of a most unusual nature such as when additional time is needed to complete imminent arrangements for other care," seems narrower than the testimony quoted above. In the committee's view, these regulations should be revised in accordance with the testimony. When that is done, the committee believes that extensions. will be granted to those non-service-connected veterans for whom there is no other reasonable alternative to continuation of community nursing home care at Veterans' Administration expense beyond 6 months.

S. Rept. 91-482

Finally, the committee was concerned that a blanket extension from 6 to 9 months of community nursing home care for non-serviceconnected veterans might, by virtue of budget limitations, significantly reduce the number of needy veterans who could receive any care in such facilities at Veterans' Administration expense.

AGENCY REPORTS

The reports of the Veterans' Administration on H.R. 2768 and H.R. 692 follow:

OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,

Hon. RALPH YARBOROUGH,

VETERANS' ADMINISTRATION,

Washington, D.C., July 9, 1969.

Chairman, Committee on Labor and Public Welfare,

U.S. Senate, Washington, D.C.

DEAR MR. CHAIRMAN: The following comments are furnished in response to your request for a report by the Veterans' Administration on H.R. 2768, 91st Congress, as passed by the House of Representatives on June 2, 1969.

The purpose of the bill is to authorize community nursing home care at Veterans' Administration expense for veterans whose hospitalization was primarily for a service-connected disability without limitations as to the length of time such care may be provided.

The proposal would amend section 620 of title 38, United States Code, which was added by Public Law 88-450. That section authorizes transfer of a hospitalized veteran patient, who has reached the nursing home care stage, to a public or private institution for nursing home care at Federal expense for a period of not to exceed 6 months in the aggregate in connection with any one transfer, except when the Administrator determines that a longer period is warranted. The bill, if enacted, would eliminate the 6-month limitation in the case of those veterans whose hospitalization was primarily for a service-connected disability. In the case of other veterans, the Administrator would still have to determine that a longer period of nursing home care is warranted before the 6-month limitation could be exceeded.

After reviewing the established modes of nursing home care for service-connected veterans, we conclude there is little need for this legislation. The Veterans' Administration accords the highest priority to service-connected cases for admission to VA nursing home care units.

Care for service-connected veterans placed in community nursing homes can be extended at the Administrator's discretion upon expiration of their eligibility for VA-financed care, or they can be returned to a VA facility. Moreover, in the case of veterans with eligibility under medicare or medicaid, the period of care in community nursing homes can be extended by use of those Federal health support programs. Thus, in view of the fact that service-connected veterans are currently receiving appropriate care in extended care facilities, it is difficult to find compelling need for the proposed bill. The only possible advantage that the bill would provide would be the greater convenience of being closer to home for the service-connected veteran whose expected duration of stay in a community nursing home might exceed 6 months.

S. Rept. 91-482

Enactment of this legislation would increase by approximately 350 the average daily nursing care load in community nursing homes at VA expense. This would result in a total increased annual cost for the first few years of approximately $1.5 million annually.

For the above reasons, I recommend against favorable consideration of this bill at this time.

We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program.

Sincerely,

DONALD E. JOHNSON,

Administrator.

OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,

Hon. RALPH YARBOROUGH,

VETERANS' ADMINISTRATION,

Washington, D.C., July 9, 1969.

Chairman, Committee on Labor and Public Welfare,

U.S. Senate, Washington, D.C.

DEAR MR. CHAIRMAN: The following comments are furnished in response to your request for a report by the Veterans' Administration on H.R. 692, 91st Congress, as passed by the House of Representatives on June 2, 1969.

The purpose of the bill is to extend the length of time community nursing home care may be provided at the expense of the United States.

The bill would amend section 620 of title 38, United States Code, which was added by Public Law 88-450. That section authorizes transfer of a hospitalized veteran patient, who has reached the nursing home care stage, to a public or private institution for nursing home care at Federal expense for a period not to exceed 6 months in the aggregate in connection with any one transfer, except when the Administrator determines that a longer period is warranted. The bill would extend the 6-month limitation to 9 months. The change would not affect the Administrator's existing authority to approve on an individual care basis a longer period, when in his judgment, an extension is warranted.

To be eligible for placement in a community nursing home, the veteran must have been admitted to a VA hospital and transferred with a maximum hospital benefits discharge. Only patients needing skilled nursing home care for convalescence, rehabilitation or continued care for a protracted period of time are eligible for transfer to community nursing homes. Normally this is interpreted to mean a minimum of 2 months.

In almost all cases, 6 months of authorized care provides sufficient time to accomplish the primary purpose of this program, which is to aid the veteran and his family in making the transition from a hospital to his place in the community. Patient care, however, in community nursing homes can, upon expiration of 6 months, be extended at the Administrator's discretion, or the veteran can be returned to a VA facility. Moreover, in the case of veterans with eligibility under medicare or medicaid, the period of care in community nursing homes can be extended by use of those Federal health support programs.

S. Rept. 91-482

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