Mr. NATCHER. Can the States match the full authorization? Mr. NATCHER. For the record, insert a chart by State of the matching funds required for both $720 and $740 million. Mr. ADAMS. We have estimates as to what the States feel they can match. We will be glad to furnish that. [The information follows:] FEDERAL GRANTS AND STATE FUNDS REQUIRED FOR BASIC SUPPORT PROGRAM 1/ Does not include an additional amount of $309,318 required to maintain the allotment for the State of North Dakota at the FY 1973 level as required by Section 110 (b) of the Rehabilitation Act. RENAL DISEASE ACTIVITIES Mr. NATCHER. What kind of projects are currently being supported for rehabilitating individuals with kidney disease? Mr. THOMAS. Our emphasis has been to pull together the basic elements of all those concerned. As a result, 29 State coordinators are sitting on advisory groups relative to renal disease. Dr. Adams may wish to comment. Mr. ADAMS. Yes. We are planning special research projects. We have done some survey work and attended the National Conference on Renal Dialysis. I would like if I may, sir, to ask our Director of Research and Demonstration for some specifics in this area, in which he is very knowledgeable. May I do that with Dr. Garrett? Mr. NATCHER. You certainly may. Dr. Garrett, we would be delighted to hear from you. Dr. GARRETT. Our plan for this disease group is twofold. No. 1 is to try to determine the effect of the type of individualized care a person has to go through because of having renal dialysis and what effect that has on things like work hours, type of work that can be done and things of that nature. This type of information is not current. We are also concerned about the effect which the disease has on the personal adjustment, and on the social adjustment. We find, for example, in some of what we are doing that a heavy contributing factor is is upset in the family. We know that the family and the support you get in the family is the single most important factor in the outcome of any rehabilitation process. The other type of activity in which we are engaging is the development of patient education materials which tell them how to deal with their problems, particularly as it relates to their vocation. These are largely the types of activities we are doing. SPINAL CORD PROJECTS Mr. NATCHER. What projects do you have for persons with spinal cord injuries? Mr. THOMAS. Mr. Chairman, we have initiated a number of projects concerning spinal cord injuries. I believe there are about 12 projects that are specifically designed to work with spinal cord injuries. Again Dr. Adams and/or Dr. Garrett. Mr. ADAMS. More specifically I would like to turn to Dr. Garrett. But just to add to Mr. Thomas' statement, we continue to emphasize these projects at a rather high level. We are talking of over $3 million. We have our spinal cord centers, costing approximately $1 million, which we started under research and demonstration and have since moved under the special project area. The next step is to implement them in our programs. So in general we are emphasizing spinal cord injury research and expanding program development through special projects. For the specifics I would like to call on Dr. Garrett. Dr. GARRETT. I think the important thing that we have done is to telescope the system of services to individuals who suffer trauma of the spinal cord by getting the individual involved from point of accident through followup into the community. Just by way of a few statistics, for example, in terms of costs, it has been possible to reduce the cost for the hospitalization and medical rehabilitation phase of the program from an average of $30,000 to an average of $11,000; to reduce the cost of post-hospital care from $3,000 a year to roughly $500 a year. So, as Mr. Thomas has said, it is a cost-effective system. We are now setting up a program to compare our model systems with the usual pattern of care in hospitals. The best evidence we have right now is that we save roughly about half the cost and roughly about half the time, but, as Dr. Adams has indicated, what we are doing now is providing for the transition of that system from research over to special projects. Then the next step is that the State agencies will pick this us and incorporate this into our regular program. Mr. ADAMS. May I make just a quick statement? Mr. NATCHER. Yes. ram. Mr. ADAMS. Because of your keen interest, we are finding that if we can start the rehabilitation for the spinal cord injury from the point of trauma, we can cut down tremendously on those costs and expedite the rehabilitation process. I am talking about immediate care right at the scene of the accident to treat that spinal cord injury. INNOVATION AND EXPANSION GRANTS Mr. NATCHER. Again, the budget proposes to terminate innovation and expansion grants. Explain how the States have used these funds. in the past. Mr. THOMAS. Basically the States have utilized those resources to tool up and improve the delivery of their services to the severely disabled, which is a result of the Congressional mandate. Mr. NATCHER. Could the States, Mr. Thomas, use part of their basic grants for supporting innovation and expansion projects? Mr. THOMAS. The States have the flexibility to do that, Mr. Chairman, but at the same time we are obviously most interested in their meeting our objective which is the rehabilitation of handicapped people. Through our own research programs we are in a position to learn. new techniques and new methods, and we can transfer that information to the States. While they have the flexibility to make that determination, the great emphasis will be on actual service delivery. REHABILITATION RESEARCH Mr. NATCHER. You are proposing a $6 million reduction in vocational rehabilitation research. Describe the kind of project that you plan to terminate. Mr. THOMAS. I suspect, Mr. Chairman, and Dr. Adams may wish to expand on this, that our basic action in research will be to reduce proportionately those activities in which we are currently engaged, so that no one activity will be harmed to the ultimate degree. Mr. ADAMS. You appropriated an additional $4 million to us in 1976 for planning. About $1 million will be used for research and training centers, rehabilitation engineering about $1 million, spinal cord injury another $1 million, and renal, half a million—and incidentally these |