Mr. COHEN. I said that this is one of the most difficult fields working with these people. Even Government counselors, if they see a person in a wheelchair or bedbound or have residuals of a stroke and arms and legs severely affected, they say "useless"-no hope for employment.

We are proving that they are not useless. So therefore we need this national center, sir, so that they who lack mobility, can be successfully employed.

Talcott Industries, one of the largest corporations of its kind, 2 weeks ago, because of a breakthrough in our efforts in the field of the homebound, have taken seven of our homebound people out of the home and are paying 50 percent of the transportation costs on a regular basis.

It costs $40 a week by private transport to bring each individual into the Talcott Industries. Talcott Industries is paying $20 on top of direct labor, because they feel that our kind of people, through our training, through our personal adjustment skills, will be made into the kind of employees they want and I have a letter that the successful experiment, if it continues, as I know it will, are going to employ more. This is the kind of demonstration program, which we have been doing for years, and now requires an ongoing center. The figure that we know, that we can substantiate through our research is that 1 out of every 100 are homebound.

Mr. BRADEMAS. What you are really saying, if I am not unfair in my conclusion, is that Congress and the executive branch of the Government, because we share responsibility in this area, have not yet received in your judgment, that the homebound problem is important enough to be assigned priorities among the several kinds of vocational rehabilitation services that can be provided. Because I take it, that if the executive branch made the judgment that it wished to give some particular attention to homebound disabled persons, it could do so.

There is nothing in the law that prevents them from doing that. Mr. COHEN. There is nothing in the law that will prevent the providing of services, that is correct.

Mr. BRADEMAS. So I assume even under the present vocational rehabilitation law some of the Federal funds present probably are being used someplace for homebound services, are they not? Mr. COHEN. It is so minimal.

Mr. BRADEMAS. But they are. In other words, there is no statutory prohibition against the use of Federal vocational rehabilitation funds for homebound services?

Mr. COHEN. No, sir. I cannot answer anything more honestly by saying no, but this will not resolve the employment problem for these people who have potential employment possibilities. This will not remove people in substantial numbers from welfare.

If it continues on the same level, sir, nothing will be done, and the advocacy that we are trying to provide will be submerged as well. We have gotten along because we feel that the country at large, that it is, not only the Government agencies that need this type of national center, but that the ones who really need this kind of center are the voluntary rehabilitation facilities and these organizations are the ones that operate these programs, not the Government agency.

The Government agency provides some kind of fee schedule that will enable the voluntary agency to help these homebound people and provide them with service. There are thousands of facilities around the country, including the ones that Mr. Kemp pointed out this morning, and he spoke about the Easter Seal Society, they have a large number of organizations struggling with the problem of homebound and they come to our regional meetings all over the country and say, “Please tell us about new skills and help train our staff, please come to us."

We are doing this without any substantial support and help and we know economically this can be the greatest program that the Government can support because we can turn back more moneys in terms of tax dollars by helping these people than the money that would be expended on a national center if it came to pass.

Mr. BRADEMAS. Of course, that is a very strong assertion and I am sure that is your judgment. It would be helpful if you could give us some analysis that would document why you feel you can make that judgment.

Mr. COHEN. I can document it.

Mr. BRADEMAS. I don't mean now but when you get to it.

Mr. COHEN. But if we could take, as we have proven, Mr. Chairman, a large number of people off of welfare and each person on welfare getting $2,000 to $3,000 a year, if we could prevent institutionalization, which costs $6,000 a year on a recurring basis, and as we in the field of rehabilitation have always said, RSA, SRS, and the executive branch would concur, that for every dollar of taxpayers' money, $10 flow back.

All I am saying is if you spend $1 million you will get that back and not only will you get that amount back but there will be plus dollars as well. I know that, because in our program, we have been able to maintain a service and if what we are accomplishing with one agency, I can just imagine what we can demonstrate with 50 to 100 agencies; it multiplies the number of homebound who are being helped and put into employment and it multiplies the increased taxpaying revenues of these people.

I have never felt more strongly in my 35 years in this field, of their employability, in the positive nature of these people who are locked into their homes who want an opportunity, who are on welfare. Yet many people say you can't do a thing with them because they are not motivated and they don't want to do anything.

I can document these people who are on public assistance, want to get out of their homes and want to be dignified and want to work.

Mr. BRADEMAS. I wish we could go on, but we have another witness and I have appointments, Mr. Cohen, throughout the rest of the afternoon, so at this time I thank you for your eloquent statement and all of your statement will be included in the record. I can assure you we will give serious attention to your proposal and the support which Congressman Carey has given it.

Mr. COHEN. I thank you, sir. May I make one brief statement and quote our St. Louis Conference keynote speaker, Adrian Towne, of Wisconsin who operates the only State agency program for the homebound and he concluded his remarks by saying that 35 years ago Franklin Delano Roosevelt told the Nation the test of our progress is

not whether we add more to the abundance of those who have too much but whether we provide enough for those who have too little. I want to simply say that in applying that test to the severely homebound, the lack of progress is evident. The rehabilitation of homebound has no place to go but up, and I say to you, Mr. Chairman the start of that ascent is in your committee's hands.

Mr. BRADEMAS. Thank you for coming.

Mr. COHEN. Thank you, sir, for bearing with me. (The prepared statement follows:)

TESTIMONY OF MILTON COHEN, EXECUTIVE DIRECTOR, FEDERATION OF THE HANDICAPPED

I am Milton Cohen, Executive Director of Federation of the Handicapped, one of the largest rehabilitation facilities in the United States, Past President of the International Association of Rehabilitation Facilities, former member of the National Policy and Performance Council of the Rehabilitation Services Administration, current legislative chairman of the International Association of Rehabilitation Facilities, and Co-director of the Programmatic Research Project on the Rehabilitation of Homebound Persons. I have come before you primarily to urge the adoption of the Carey Bill to amend the Vocational Rehabilitation Act to provide the establishment of a National Center for the Homebound.

In 1954, as authorized by Public Law 565, the Vocational Rehabilitation Act of that year, the Secretary of the Department of Health, Education and Welfare organized a six-month study of rehabilitation programs for the homebound in the United States, Thus, as long as 18 years ago, as an expression of its concern for those who cannot regularly leave their homes to participate in rehabilitation and employment activities, the Congress had directed the Secretary to conduct a factfinding effort to explore the problems and status of homebound people. In response, HEW collected much relevant data from a group of distinguished rehabilitation specialists concerning this subject and emerged with the conclusion that with few exceptions, homebound individuals in 1954 had little reason to hope for an improvement in their status. A few agencies such as Federation of the Handicapped were offering relatively comprehensive rehabilitation programs but, by and large, the 1 million homebound Americans then thought to be living within our borders had no place to turn. At that time, the future held little for them to be a continued drain upon their families, welfare agencies, and the community.

Today, some eighteen years later, the picture is only slightly brighter. Consistent with its interest in all handicapped persons, regardless of severity, background, or problem, the Social and Rehabilitation Service awarded a five-year Programmatic Research grant to Federation of the Handicapped in 1967 to explore the problems of homebound persons on an action research basis. Since that date, more progress has been made in relation to homebound persons than in the previous century. At this time, I would like to share with the Subcommittee some of the general findings of the Programmatic Research Project with the understanding that the precise statistics and reports can be made available to you upon request. These findings include:

1. The status of homebound persons in the United States today is deplorable. The large majority of them are economically impoverished and are on welfare; they live out their lives in idleness and despair; and instead of contributing to the economy of this country, the now estimated two million homebound living in this country are draining off family and community resources and, in many cases, unnecessarily.

2. The large majority of these neglected and deprived homebound persons have real potential for greater independence and self-support than most people realize. In a longitudinal study of 200 homebound persons in New York City, the Programmatic Research Project found that all but a handful could be helped to become more useful and self-sustaining individuals.

3. Despite unequivocal evidence that the homebound can be rehabilitated, the Programmatic Research Project in a national survey of state and local rehabilitation organizations found that only about 25 actually offer systematic services to homebound persons and that many of these work partialistically with very small homebound caseloads. For its part, Federation of the Handicapped is daily demonstrating what can be done by giving service to more than 400 different homebound persons every week, many of whom are earning at least partial selfsupport in their own homes.

4. Perhaps most important of all, the Programmatic Research Project discovered that, if the homebound are given a suitable rehabilitation program, at least 20 to 25 percent may be expected to cease to be homebound and, consequently, to resume their rightful places in the community.

5. The barriers to the rehabilitation of the homebound are in the minds of men. Although a variety of reasons are given for the failure to provide them with the rehabilitation these reasons all boil down to three factors:

(a) As a group, rehabilitation workers and lay people in the community do not have adequate and accurate information about the surprising potential of homebound persons and how to develop this potential.

(b) Powerless by reason of an inability to form groups that can articulate his hopes and aspirations, the homebound individual stands alone, a condition that renders him impotent in dealing with society's agencies and organizations. Thus, without a strong advocate, the homebound rank low on official priority lists and are among the last to receive attention.

(c) Rehabilitation personnel trained especially to work with the homebound are very few in number. In a few agencies where such personnel do exist, as in the New York State Office of Vocational Rehabilitation, the homebound receive a far more equitable share of available service and achieve far greater independence.

These facts and many others developed by the Programmatic Research Project are being disseminated widely. With the assistance of grants from the Social and Rehabilitation Service, the Programmatic Research Project is conducting five regional dissemination conferences. The four already held in New York City, Atlanta, Los Angeles, and St. Louis have attracted large groups of rehabilitation personnel and have made a start toward educating them about the homebound. The fifth regional meeting, scheduled for Houston, Texas, early in March, will have the same success. But, this is only a beginning.

The dimensions of the task that faces us are suggested by the findings of the National Conference on the Rehabilitation of Homebound Persons held at Arden House, Harriman, New York, in February 1971. This Conference, supported in part by a grant from the Rehabilitation Services Administration, and attended by 100 distinguished rehabilitation leaders, reviewed the findings of the Programmatic Research Project and made a series of recommendations to government and the private sector concerning means of improving rehabilitation services for the homebound.

First and foremost among these recommendations was the suggestion that a National Center for the Homebound should be set up to provide leadership, visibility, and advocacy for the homebound, and to launch a major national movement on their behalf. This recommendation is being translated into action through the current efforts of such distinguished rehabilitation leaders as Mr. E. B. Whitten, Executive Director of the National Rehabilitation Association and Mr. Charles Roberts, Executive Director of the International Association of Rehabilitation Facilities to incorporate the establishment of such a center into the proposed rehabilitation legislation of 1972.

A proposed National Center for the Homebound will engage in the following activities:

1. It will rehabilitate homebound persons who cannot be rehabilitated locally for whatever reason.

2. In doing its rehabilitation job, it will provide opportunities for training personnel from every section of the United States; it will do research on improved means of rehabilitating the homebound; it will demonstrate for all to see the most efficacious means of rehabilitating this group, and it will be a model for other agencies to follow.

3. It will serve as a nationwide advocate for homebound persons, working with state legislatures, public and voluntary agencies, various consumer groups, antipoverty agencies, professional associations, and others to organize maintain, and improve rehabilitation services for the homebound.

4. It will establish standards for homebound programs, preparing manuals that will guide organizations in their efforts to work with this group.

5. It will set up regional offices in every section of the United States through which field workers associated with the National Center can help state and local agencies to strengthen their programs for the homebound.

6. It will provide modest amounts of seed money and the time and energy of Center personnel to help local groups to develop services for the homebound. 7. It will assist institutions for the physically and emotionally handicapped the aged, the retarded, and the poor to establish dynamic programs for assisting suitable residents of those institutions to move back into the community.

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8. It will develop innovative means for keeping homebound persons out of institutions through the use of hostels, semi-sheltered apartment living, and selfhelp groups.

9. It will explore new occupations for people who must work at home. Initial efforts in this direction made at George Washington University and Federation of the Handicapped have already opened a number of new fields of work that can be performed at home.

10. It will give unparalleled visibility to the homebound. The presence of the National Center will make it less possible for states and communities to sweep the homebound problem under the rug, and no longer will the homebound be out-of-sight and out-of-mind. For the first time in the history of this country, an organization will be created which can speak up for the homebound and represent their needs and concerns.

The two alternatives that face us at this time are: (1) continuation of the present situation for homebound persons and (2) establishment of a National Center. If present conditions continue, the more than two million Americans who now are homebound almost certainly will continue to clog our welfare rolls, drain off family income, live out unhappy and unproductive lives, and be a constant remainder of our inability to help our homebound neighbors. If, on the other hand, we establish a National Center for the Homebound, we will create a light at the end of the tunnel. The 70's can become the decade during which the homebound finally got their chance. With the National Center leading the way, many more homebound people will begin to care for themselves, earn a livelihood, lead useful and satisfying lives, and become contributing members of the community. At this turning point in the history of rehabilitation, the choice is ours. My colleagues and I hope that, with your help, there will be created a new and better mechanism for rehabilitating the homebound.

You may ask whether the homebound constitute an important part of the population. The fact is that many of us are not even aware of their presence because so many of them live behind the walls of their own homes and their institutions. But some members of Con,ress know about the miners made homebound by black lung disease and mine injuries. Other Congressmen know about people in the inner city ghetto made homebound by poor health conditions; others know about homebound suburbanites who cannot find ways of working at home, and others know about homebound persons living on farms and in small towns who cannot share in the life of the family and the community because needed training is not available to them. In brief, the homebound may be invisible, but they are all around us-in our cities, suburbs, small towns, and farms. The fact that we cannot readily see them does not lessen their need or their importance.

My colleagues and I feel that the only real hope for the homebound in the next decade is for us to create a central source of leadership, a clearinghouse, a training site, a research and demonstration facility, and a showplace where others can observe how the mission is performed. All we ask is for the subcommittee to give us the tools to do the job. We know that it can be done that the homebound can be rehabilitated. But the way to spark this country to do it is through a National Center. We ask that you please include a provision for such a Center in your bill. If you do, you will be making this bill a landmark in the history of America's concern for its most deprived and disadvantaged citizens.

Mr. BRADEMAS. Our final witness is Harry Schnibbe, executive director of the National Association of State Mental Health Program Directors.

STATEMENT OF HARRY C. SCHNIBBE, EXECUTIVE DIRECTOR, ACCOMPANIED BY E. CLARKE ROSS, LEGISLATIVE ASSISTANT, NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS

Mr. SCHNIBBE. Mr. Chairman, I am accompanied by Clarke Ross from our Washington office. I am Harry Schnibbe, executive director of the National Association of State Mental Health Program Directors. Our association, Mr. Chairman, is a cooperating agency of the Council of State Governments.