PRESIDENT'S HEALTH RECOMMENDATIONS AND

RELATED MEASURES

TUESDAY, MARCH 30, 1954

UNITED STATES SENATE,

COMMITTEE ON LABOR AND PUBLIC WELFARE,

SUBCOMMITTEE ON HEALTH, Washington, D. C. The subcommittee met at 10 a. m., pursuant to adjournment, in the old Supreme Court chamber, Senator William A. Purtell presiding. Present: Senators Purtell (presiding), H. Alexander Smith, Cooper, and Lehman.

Senator PURTELL. Mrs. Hobby, we are very happy to have you with us here again today, and our committee will come to order. We are very happy to have you tell us about your plans for vocational rehabilitation.

STATEMENT OF OVETA CULP HOBBY, SECRETARY OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY NELSON A. ROCKEFELLER, UNDER SECRETARY OF HEALTH, EDUCATION, AND WELFARE; ROSWELL B. PERKINS, ASSISTANT SECRETARY OF THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ARTHUR KIMBALL, ACTING DEPUTY DIRECTOR OF THE OFFICE OF VOCATIONAL REHABILITATION; AND DONALD DABELSTEIN AND JOSEPH HUNT, OFFICE OF VOCATIONAL REHABILITATION Secretary HOBBY. Thank you, sir.

Mr. Chairman, before proceeding with my prepared statement I should like to indicate for the record that Mr. Nelson A. Rockefeller, the Under Secretary, and Mr. Roswell B. Perkins, the Assistant Secretary of the Department of Health, Education, and Welfare, will participate in the presentation of our testimony.

Also present to assist in answering technical questions are Mr. Arthur Kimball, Acting Deputy Director of the Office of Vocational Rehabilitation, and Mr. Donald Dabelstein and Mr. Joseph Hunt, who are also from that Office.

Miss Mary E. Switzer, the Director, is unable to be here today because she is today receiving, in Florida, the 1954 research award presented to the Office of Vocational Rehabilitation by the American Pharmaceutical Manufacturers' Association. Miss Switzer will be back in Washington tomorrow and will be available to your committee. Senator PURTELL. I wish you would extend to her our compliments and the compliments of the chairman and the full committee for this commendation.

Secretary HOBBY. Thank you. It makes me very happy and it will certainly make her very happy.

Mr. Chairman and members of the committee, I welcome the opportunity to appear before you today in support of S. 2759. This bill was introduced by the chairman of the Committee on Labor and Public Welfare to give effect to the administration's recommendations for extending the opportunity for vocational rehabilitation to more disabled persons. These recommendations constitute a basic part of the administration's program for improving the health and well-being of the American people.

Recent hearings before your committee have been concerned with proposals for better health facilities and a new grant structure to finance programs for prevention, care, and research. Other health proposals are scheduled for future consideration. These measures will be incomplete unless we take steps, at the same time, to deal with the residual disability which so often follows in the wake of serious illness and injury.

Chronic diseases and the disablement they produce loom very large in the health problems of this country. In addition to those crippled by disabling disease or illness, thousands of others will be the victims of disabling accidents-in industry, on the farm, on the highway, and at home-despite the progress being made in accident prevention and safety education.

Rehabilitation is the process which has been developed to deal with disability. It restores a physically handicapped person to the point where he can take care of himself in the home, or even better, also assume a position in productive employment. The latter is called Vocational rehabilitation.

In 1920, largely as a result of the needs and the experience growing out of World War I, the Congress determined that the Federal Government should assist the States to establish vocational rehabilitation services for all our people. The original act authorized Federal grants to each State for this purpose, to be administered under approved State plans. The State programs today cover a wide range of services, including, for example, the complex combination of services that teaches the blind person or the paraplegic how to perform the activities of daily living and simultaneously trains him in a new trade.

These programs are now in operation in all of the 48 States, the District of Columbia, Alaska, Puerto Rico, and Hawaii. In all States there is a rehabilitation agency under the State board of vocational education. In 16 jurisdictions this agency serves all types of disabled, including the blind. In 36 jurisdictions, separate agencies administer services for the rehabilitation of the blind.

The relationship between disability and public dependency is a significant one. At present the Federal-State public-assistance programs support about 1 million persons who themselves are disabled or, in the case of the aid-to-dependent-children program, whose father or mother or other caretaker is disabled. Thousands of these disabled persons can be rehabilitated and returned to useful employment and self-support.

At this point, Mr. Chairman, I should like to ask Mr. Rockefeller to present additional background information in graphic form portraying the scope and accomplishments of the present program.

Senator PURTELL. We would be very glad to have Mr. Rockefeller do so.

Mr. ROCKEFELLER. Mrs. Secretary, Mr. Chairman, and gentlemen. As the Secretary suggested, these charts might be helpful in giving a little background of the problem. .

Senator PURTELL. Would you suspend for a moment? I know there are people in the audience who are most anxious to see these charts and understand what we are doing. Can you see them from where you are sitting? That is good. I am sorry, but I thought we would like to have as much of this known to the people as we are today showing on your charts.

Mr. ROCKEFELLER. The first question is the size and character of the group under discussion. The main point is that they are people who are disabled but who can be rehabilitated and thus get back to work and become self-supporting individuals. There is a backlog of 2 million people at present in the United States who are disabled who could be rehabilitated. There are approximately 250,000 a year who are not taken care of by private organizations who could be rehabilitated.

Of that number the Secretary's present program takes care of about 60,000. So that leaves about 190,000 people who are added each year to the backlog.

Of that number I think it is fair to say that a substantial number of this group will go on relief at some time and get public assistance, and will average about 9 years on public assistance.

So we find this group in the country who could be rehabilitated and brought back to a dignified, self-respecting, self-supporting life. That is the background.

This chart shows the causes of the disability percentagewise of this 2 million people who are now in the backlog and who could be rehabilitated. Eighty-eight percent of those have been disabled because of disease, 10 percent because of accidents-half of them home and highway accidents, and the other 5 percent from accidents during employ

ment.

The remaining 2 percent is from congenital causes.

Now we come to the next chart, which shows the present modern rehabilitation process. The key figure in this process is the counselor who is in the rehabilitation agency-the State agency. There are about 88 State agencies throughout the country.

The client, or disabled person, comes to the agency, and is taken in hand by the counselor. The counselor stays with him and works right through the process.

The first step is a medical examination, which is undertaken by a local, private doctor in the community, who performs the medical examination to see what the character of his disability is, and what his potential is, both from the point of view of rehabilitation and the type of occupation. On the basis of that, the counselor makes a Vocational diagnosis and lays out plans for the client, or disabled person.

They go through a series of steps, which include medical services first, which is whatever is prescribed, and then medical appliances, such as artificial limbs, and then a training period for his job. It may involve transportation and maintenance during the period.

Then there may be needed tools and equipment. Finally the whole process is carried through, and then there is the problem of placement, which is very important, and where both the rehabilitation office and the State employment service offices cooperate.

After he has received his job, then he is followed up by the counselor to be sure everything is going satisfactorily.

In this process, money has to be expended for medical services and medical appliances, transportation, and maintenance, and tools and equipment. He or she is assisted in that according to need, and based on a means test. So that is the process that takes place today under today's circumstances.

Senator PURTELL. May I interrupt here?

Mr. ROCKEFELLER. Please.

Senator PURTELL. It is quite evident then that the whole training up to the actual placement belongs to this department we are talking about now.

Mr. ROCKEFELLER. That was the decision that was made by the administration when they reviewed this at the time of the reorganization studies a year ago this spring.

Senator PURTELL. Your various charts show it.

Mr. ROCKEFELLER. I think the point is extremely well taken and there is cooperation at this point of placement.

Senator PURTELL. Fine.

Mr. ROCKEFELLER. I might say about 20 percent of these people are so severely disabled that they can only be treated in these comprehensive rehabilitation centers which were discussed the other day. That is one of the reasons for the need for additional comprehensive rehabilitation centers.

Coming to the next chart we will take for illustrative purposes 1952. There were 64,000 people rehabilitated that year by this combined Federal-State program of the Department of Health, Education, and Welfare. This particular chart shows the types of disabilities percentagewise that this group had.

Orthopedic represented the largest percentage, which was 41 percent. Then you had 7 percent mental cases; aural, 8 percent; visual, 12 percent; tuberculosis, 9 percent; cardiac, 4 percent; and all other diseases, 19 percent.

That gives the feel of the character of the group involved and the causes of their disability.

Now we come to the next very interesting chart which shows all kinds of jobs that these 64,000 people obtained after they had completed their training. The interesting thing about this chart is that you have here the different categories, and you have here the spots into which these people fit.

Then the next column shows the division of the total labor force in the United States. You will see that, with the modern rehabilitation process, the disabled are able to fit pretty much into the regular labor pattern in the United States. In other words, the percentage in managerial; another percentage in clerical and sales; another in skilled and semiskilled work; another in service; another in unskilled; and another in farm and family workers. I think that is very dramatic evidence which contradicts the idea that a person who has been