APPROPRIATION LANGUAGE CHANGE The changes in language are necessary to incorporate additional authority for project grants (sec. 316) and grants to States under section 314 (c) of the Public Health Service Act. This authority is contained this year in the Supplemental Appropriation Act, 1962. The amount of the allotments and payments to States under section 314 (c) has been specifically stated in the language as a limitation. Transfer to "Operating expenses, Public Buildings Service," General Services Transfer from "Community health practice and research". Total... Summary of changes 1962 enacted appropriation__- search". Transferred from "Community health practice and research". Administrative reserve---. Total estimated obligations 1962____ 1963 estimated obligations--. Total change____. $10, 958, 000 -75,000 +2, 000, 000 -2, 000 -1, 193, 000 11, 688, 000 22, 942, 000 11, 254, 000 INCREASES A. "Built in": 1. Annualization of 42 new positions for chronic disease activities authorized in 1962 for part of the year: Personnel compensation__. Personnel benefits__. EXPLANATION OF CHANGES An increase of $7 million is requested for grants to States to assist in expanding and improving statewide programs for the development of community facilities and services for the care of the aged and chronically ill. An increase of $3,681,000 is requested for project grants to States or other public or nonprofit private agencies for studies and demonstrations which look toward the development of new and improved methods of providing services outside the hospital. An increase of $475,000 and 30 positions is requested to expand early detection activities providing for the development and improvement of techniques and methods for the identification and prevention of chronic illness. An increase of $100,000 and seven positions is requested to expand restorative services activities providing for the care and restoration of the chronically ill and aged, and for meeting special health problems of older people. Allocation of grant-in-aid funds for the chronically ill and aged 1 Includes $2,000,000 transferred from the appropriation "Community health practice and research." PREPARED STATEMENT Dr. KNOTT. Thank you, Senator. I have a statement for the record if you choose to accept it, and then I would like permission to make just a few remarks. Senator HILL. You may proceed in any way you see fit, Doctor. Dr. KNOTT. Thank you, Senator. (The statement referred to follows:) STATEMENT BY CHIEF, CHRONIC DISEASES, ON CHRONIC DISEASES and HEALTH OF THE AGED Mr. Chairman and members of the committee, today I am speaking to the appropriation "Chronic diseases and health of the aged." This includes three categories of funds all of which are for the common purpose of improving and extending community health services for the chronically ill and aged. These three kinds of funds are (1) research, training, and technical services which are used for central office staff and activities and for cooperative agreements with communities for establishing out-of-hospital services and preventive services programs; (2) formula grants to States for initiating, expanding, and improving community health services for the chronically ill and aged, and (3) project grants for studies, experiments, and demonstrations for the developing of improved methods for providing health services outside the hospital particularly for the aged and chronically ill. RESEARCH, TRAINING, AND TECHNICAL SERVICES Last year I had the privilege of presenting to you our plans for a new program for providing assistance to communities for establishing out-of-hospital community health services projects. You will recall that we had proposed that our direct operating funds be increased for the specific purpose of providing support for 60 to 70 community cooperative agreements which would show what could be done in different parts of the country to provide health services to older people in their own homes. As expressed at that time, the emphasis was to be on service to the individual and not on surveys and studies. I can report to you that this initial year of operation has been a most successful one in many ways. Out of the total increase of $2 million made available, $1.2 million were set aside for financing cooperative agreements with communities for establishing as demonstrations, new programs which would emphasize such out-of-hospital services as, nursing care of the sick at home, homemaker services, information and referral programs, improvement of care in nursing homes and coordinated home care services. We have received 111 applications for assistance from communities throughout the country. The total dollar assistance requested was over $2.9 million. We have approved 45 projects for funding, we have disapproved 22, we have deferred action on 19, and an additional 25 were approved but not funded. The effect of this program on individual States has been outstanding, and for the first time many communities are taking a critical look at the need for health services outside the hospital. They are showing a new appreciation for the total health resources available in their communities and are becoming increasingly aware of both the overlaps and the gaps in their health services. Individual States experiences in developing cooperative agreements utilizing the increased funds provided for this year range from an award of $10,000 to the community of Beatrice, Nebr., which though lacking an organized health department, is initiating a homemaker services program, to a Florida project for providing home nursing services in a 26-county area, to New York State, where many of the basic health services are available in communities, and where it is proposed to carry on a statewide program of information and counseling services to all communities within the State. Another effect of this new program has been to create an increasing awareness among State health agencies that they must assume leadership in securing legislative authority to enable local health departments to collect fees for services. As an example, the State of Ohio has recently enacted legislation to enable their local health departments to collect fees for home nursing care services. The fee for service practice will facilitate an earlier assumption of full project support by the community, as we are insisting that Federal support for projects be for a limited period of time, generally with a gradual withdrawal of Federal funds. An additional advantage is that it makes these services available to those who can pay part or all of the fee and does not limit the services to the medically indigent. I would be remiss in my duty if I neglected to tell you of some of the difficulties encountered in implementing this program. New community projects to provide out-of-hospital care require certain types of professional personnel which for the most part are already in short supply. We are trying to help communities meet this problem in a number of ways-by assisting in the conduct of training programs for personnel to be employed in these new activities, by suggesting that registered and practical nurses now inactive be sought for employment on a full- or part-time basis, by suggesting the employment of health aids to assist professionals in home care programs following the pattern of nurses aids in hospitals, and by promoting the use of voluntary help in these new program activities. In one agreement which we are supporting as a pilot program, it is proposed to utilize older persons themselves to serve as homemakers. |