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eager to get anything that we have that will help them with this problem.

To me, this is a tool for international understanding that transcends political dogma, religion, geographic barrier, color, creed, and so forth.

So, I think what we have started to do here, in a minor way, and now will be allowed to do in a major way, will mean much to us in spreading the understanding of democracy in the places in the world we would like to have understand it.

(The prepared statement submitted by Dr. Rusk is as follows:)

TESTIMONY OF HOWARD A. RUSK, M. D. My name is Howard A. Rusk. I am a physician and practiced internal medicine in St. Louis prior to World War II. During my military service in the Army Air Force, I had the privilege of organizing and supervising the Army Air Forces convalescent-rehabilitation program. Since that time, I have been professor and chairman, Department of Physical Medicine and Rehabilitation, New York Uni. versity College of Medicine; chief, Physical Medicine and Rehabilitation Sersice, Bellevue Hospital, New York City; and director, the Institute of Physical Medicine and Rehabilitation, New York University-Bellevue Medical Center.

I have also served during the past 8 years as a consultant in rehabilitation to the New York City Department of Hospitals, the Office of Vocational Rehabil. itation, the Veterans Administration, the National Society for Crippled Children and Adults, the International Society for the Welfare of Cripples, the World Veterans Federation and the United Nations. In my testimony to you, I do not speak officially for any of these or any other organization, but, first, as a citizen and, second, as a physician who is interested in the expansion of rehabilitation opportunities for our Nation's handicapped.

Attention has been repeatedly called to the fact that today there are an estimated 2 million physically disabled persons in the United States who could benefit from modern rehabilitation services and that each year some 250,000 who could benefit from such services become newly disabled. Yet as the Task Force on the Handicapped of the Office of Defense Mobilization pointed out in its report on January 25, 1952, after an exhaustive study of this problem, “The most important single point to be remembered in considering plans for the handicapped today is the fact that we are now in a positon to do more to overcome the handicapping effects of disability than at any time in our history”,

To me the most siunificant factor in S. 2778 and S. 2759 is that for the first time in our Nation's history, it is proposed that we approach the problem of providing these needed services to all of those who need them on a sound, rational basis under a well-developed plan. In the past, our efforts have been piece-meal and unilateral. As a result, too few of those needing services received such serv. ices and too few who were sererely disabled received the comprehensive services which they needed. A combination of medical, social and technological advances, however, have now made it possible for us to develop a national philosophy on rehabilitation and to put that philosophy into operation so that it will bring maximum benefits to the maximum number of persons. This legislation which you have before you provides for a unified, comprehesive approach to the problem and a method of putting this national philosophy on rehabiltation which has developed over the past few years into pratcical operation.

The amendments to the Hospital Survey and Construction Act proposed in S. 2758 are urgently needed. The success of American medicine in the preventive and curative phases has made some profound changes in our Nation's needs for institutional facilities. Better medical care and better environmental and other health conditions have saved countless lives. These people, some disabled in youth or their middle years, and others the victims of diseases that characterize the later years, present a constantly mounting problem in chronic care that will continue to grow as the average age of our population increases.

The solution does not rest simply in creating more and more acute hospital beds in which these men and women may wait out the remaining years of their lives in uselessness, a liability to themselves, their families, their communities and the Nation.

Our emphasis in the construction of medical facilities must be shifted to the creation of facilities which can rebuild the abilities of these persons to care for their own daily needs and, whenever possible, to return to productive employment. By such action, we can free the general hospitals of thousands of chronic cases who are now "freezing" beds for long periods of time and thereby make those beds available. Convalescent and rehabilitation facilities are our best hope to accomplish the two things most urgently needed today:

First, they will help make the rehabilitation concept an established, working part of the community's health system, so that every person who can be restored, either to a self-supporting job or to self-sufficiency in caring for his own needs at home, will have that chance. Some rehabilitation centers will serve only the basic function of a service facility to the community's doctors, hospitals, rehabilitation agencies and other groups; other centers affiliated with medical teaching centers, will not only serve the disabled but will also be vitally important in expanding the number of specialists trained in the techniques of rehabilitation.

Second, these facilities, and particularly those for convalescent care, will feel a widespread need among large numbers of patients who today are in general hospitals because there is no place else for them to go. For such cases, who need some care but do not require general hospital services, such facilities as this bill proposes will substantially lower the cost of care and at the same time reduce the demands upon our available supply of doctors, nurses, and other professional personnel.

The Hospital Survey and Construction Act has already shown itself to be an effective method of cooperation between the Federal Government, State, and local communities in meeting the institutional health needs of the people. Building upon this experience, in developing rehabilitation centers, is, to me, most sensible.

The amendments to the Vocational Rehabilitation Act incorporated in S. 2759 should receive the prompt and favorable attention of your committee. The public rehabilitation program has long been one of the bulwarks in our Nation's efforts to combat disability. The present act has served its purpose remarkably well during the past 10 years. The fact is, however, that both the scientific advances of recent years and the development of the capabilities of the program itself hare now rendered the present act obsolete in many respects. This bill, which I understand to be in accord with the President's program, is also, in my opinion, in accord with sound professional planning to meet the needs of the disabled in this country.

The provisions for financing the program, as contained in the bill, are more properly for consideration of fiscal experts and I shall not comment upon those features of S. 2579. Certain features of the bill, however, are most important.

In reviewing the bill, I have been pleased to note that it proposes to take full advantage of the basic program already in operation. The resources in this country for rehabilitation are so limited that it is important to insure that work presently being done will be sustained.

The bill's provisions for extension and improvement, and for encouraging special projects to bring new ideas into the work, are admirably suited to the needs of rehabilitation work today. This is an expanding field in which the lifeblond is new knowledge and new projects which will make it possible in future Fears to restore disabled people who cannot be helped today. The use of the special projects to help get the new program underway rapidly during the next 2 Sears is a very practicable measure, and a necessary one, if the general goals of these proposals are to be reached.

The bill would make it possible to help local communities wishing to enlarge their rehabilitation centers and sheltered workshops into more comprehensive facilities, geared to the known needs of their own people. This is a matter of intense interest to the many groups in various places of the country who have struggled to proride at least minimum services but whose needs far outstrip their prpent resources.

One feature of the bill is of special interest to me. It charges the Secretary of the Department of Health, Education, and Welfare with responsibility for making studies, investigations, demonstrations, and reports on the abilities of the bandicapped and their potential for rehabilitation and return to suitable employment. Along with this is the responsibility to make the results of these studies available to other organizations working with the disabled and in related fields. Today there is no organization which performs this important function on a sufficient scale to insure that the disabled receive the benefit of all the information which is accumulating in the various specialty fields, in industry, and elsewhere. It seems to me to be the essence of good sense to insure that we

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not only devote ourselves to the pursuit of new knowledge but that we make sure we have the means of disseminating it and putting it to use.

Finally, I would like to comment on the research and training aspects of the bill. In my opinion, the great single obstacle to the more rapid developinent of all types of rehabilitation services is the shortage of trained personnel. Al. though the number of physicians receiving specialized training in rehabilitation has increased tenfold since before World War II, the supply can fill only a frac. tion of the needs. The need for physical therapists, occupational therapists, speech and hearing therapists, rehabilitation counselors, social workers, and other rehabilitation workers is even greater. I shall not go into the details of the actual number of persons needed in these categories, for as a result of a number of studies, those facts are now available and are a matter of record. I would like to emphasize, however, that the granting of these funds for research and training is an essential part of this proposed comprehensive program, for the other aspects of the program cannot be implemented unless we have additional trained rehabilitation workers to staff our expanded program.

There is one other implication in this legislation upon which I should like to comment. During the past several years as a consultant in rehabilitation to the United Nations and the World Veterans' Federation, a member of the International Society for the Welfare of Cripples, a member of the American-Korean Foundation and as a private citizen I have had the opportunity of visiting a substantial number of foreign nations to observe their rehabilitation work for their handicapped. I have been deeply impressed upon these visits by the manner in which the other nations of the world have looked to American leadership in rehabilitation. To them the way that we in the United States serve our bandicapped, providing not charity, but a chance, exemplifies a democracy and the inherent values which it places on the dignity of the individual. This is but one of the many reasons why I hope this legislation will be enacted.

Senator PURTELL. Are there any questions, Senator Hill, you would like to ask Dr. Rusk?

I want to thank you, Doctor, for being here again.

Senator Hul. Let me ask you this, Doctor: You told us a story here that is certainly most interesting and surely appeals, I am certain, to all of us to carry on this work of the restoration and rehabilitation of these neighbors of ours, so to speak.

Do you carry on most of this work in connection with the hospital or in a separate center, or how do you do it?

Dr. Rusk. I have three programs that we operate in my department. In Bellevue Hospital we took two wards and made them over into rehabilitation wards, and we combined the children's orthopedic ward with the children's rehabilitation ward and it operates as a unit of it.

At the present time our institute is separate, but eventually it will be a part of the hospital.

I feel very definitely this program is a service program to physicians and to patients. It should be a part of the general hospital structure-and, if not, integrally associated, connected with either geographically or by staff relationship.

Senator Hill. In other words, you tie it in pretty close, then, with your hospital?

Dr. Risk. Yes, sir; and I don't feel it can work without it, because you have to have all the other branches of medicine as consultants. They are a part of the team, and I don't believe it works as an isolated institution.

Senator Hill. Then there is really no reason why these centers and surely they should be built-couldn't be built under the existing law: is that right?

Dr. Risk. No reason that I would see, sir.

Senator Hill. In other words, they can be built today under the existing law!

Dr. Rusk. As a part of the hospital. Senator HILL. As a connection with the hospital or as a unit of the hospital, or in a sense they are a hospital, themselves, aren't they? Dr. Rusk. For a third phase. Senator Hill. They are a hospital, themselves, aren't they? Dr. Rusk. Unfortunately, some of the hospital and insurance groups don't feel that, because in our own institute, for example, if you have a stroke of apoplexy and go into the general hospital you are covered by hospitalization; but if you go in the rehabilitation center, where you get active training, because it is a different type of institution, We are not covered, and I think there would be instances, Senator Hill-for example, if you had a city of 100,000 people and the hospitalization was divided into, say, 5 hospitals, all relatively small-now, you would set up a simple type of rehabilitation program there, because I am one who feels that 75 percent of rehabilitation should be done by a practitioner right in the hospital.

Senator Hill. You mean by the doctor in the hospital?

Dr. Rusk. That is right, but the centers should be saved for the very difficult cases.

In our hospital yesterday or day before yesterday, when I made rounds, we had 14 boys with broken necks who had come to us from all over the country. Those cases cannot be handled unless you have a very highly specialized group of people.

So, in a city like I described, you might want a rehabilitation center that would serve all 5 of the hospitals for the difficult cases, but with a staff association with either 1 or 2 or all.

Senator HILL. Medical staff ?
Dr. Rusk. That is right; yes, sir.

Senator HILL. In other words, these things have to be under medical supervision and under medical staffing and medical servicing ?

Dr. Rusk. That is right. That is why ISenator Hill. Therefore, I come back again to say they could be built under the present law. Dr. Rusk. Well, that would be fine, as far as I am concerned. Senator Hill. And, understandi, I am very sympathetic with what you are seeking to do-very, very sympathetic.

Now, you addressed yourself, I noticed, in your full testimony, prepared testimony, Doctor, not only to the amendments to the hospital survey and construction act, but also amendments to the Vocational Rehabilitation Act. Dr. Rusk. Yes, sir. Senator Hill. And I notice in conclusion you say: I would like to emphasize, howerer, that the granting of these funds for research and training is an essential part of this proposed comprehensive program, for the other aspects of the program cannot be implemented unless we have additional trained rehabilitation workers to staff our expanded program. Do you think it will take some time to get those additional workers ? Dr. Rrsk. Well, our own institute—6 years ago we had 1 man in training, and at the present time, as of the 1st of July, we will have 41. Unfortunately, that is more than half of those in training through

out the country.

46293_-54-pt. 1-11

Senator Hill. More than half in the whole country?
Dr. Rusk. Yes, sir.

Senator HILL. You mean in the whole United States, with 160 million, that you have there about half of the whole thing?

Dr. Rusk. "Yes, sir.
Senator Hill. Right there in your center?
Dr. Risk. Yes, sir.
Senator Hill. That presents quite a problem.

Dr. Rusk. That is where the bottleneck is, and there are 15 jobs for every young man or woman who comes out of the head center.

If we don't increase our training opportunities, we can never meet these goals.

Some 5 years ago the National Foundation for Infantile Paralysis set up certain fellowships, and that was the beginning; and 2 years ago the Public Health Service, through the Heart Institute, and the other institutes, came in and saw this need, and 2 years ago they started a fellowship program. Had it not been for that, we would have been much further behind than we are now.

That is just the doctor end of the thing.

There are about 5,000 qualified physical therapists in the country. There are more than 2,500 position vacancies open right now.

I have seven in my own hospital service at Bellevue, which is a coveted service because we do a lot of teaching.

Senator HILL. Bellevue ?
Dr. Rusk. Yes, sir.

Senator Hill. In other words, if you can't get them, surely other places are having more difficulty, I take it, than you would be?

Dr. Rusk. I think that is true.

Senator Hill. I would think from what you said this morning, Mr. Chairman, if I were seeking to go into this work, I would certainly seek, if possible, to go there with Dr. Rusk. That would seem to be the choice place.

Senator PURTELL. It would, Senator.

I wonder, though, what prevents these people from going into this program, or what causes this lack of attraction apparently for trained specialists. Is it the pay they get when they are subsequently out in the field?

Dr. Rusk. That has improved. When I first started the program in New York, a physical therapist was getting $2,160 a year. Therefore, we didn't have any trained physical therapists. At the present time they start around $3,300 a year.

No, sir. I think it has been a lack of education and understanding, and all of a sudden this has mushroomed; and I think if we doubled the number of graduates from physical therapy schools, from occupational therapy schools, which is just as bad, and social work schools, for the next decade, we would still be short because every time yon set up a program, then immediately the demand increases.

Senator PURTELL. Could you handle more? For instance, could you in your present facilities handle more trainees?

Dr. Rusk. Yes.

Senator PURTELL. What is it about it that won't attract these people to come in for training?

Dr. Risk. Well, I think as far as the therapists are concerned, we have to go back into our vocational counseling service in the schools,

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