goals are to be met, two major steps must be taken. First, our total rehabilitation facility capacity must be greatly enlarged, and, second, we must have more trained personnel and increased financial support for providing rehabilitation services.

The bill we are now considering seeks to meet the first of these objectives. S. 2759, scheduled for consideration by your committee at a later date, is designed to achieve the second objective.

The bill defines a "rehabilitation facility" as one which is

operated for the primary purpose of assisting in the rehabilitation of disable persons through an integrated program of medical, psychological, social, and Vocational evaluation and services under competent professional supervision

Under the present act, rehabilitation facilities are eligible for Federal construction aid only if they are part of a hospital. This bill would extend eligibility to include separate facilities.

It should be noted that the rehabilitation facilities contemplated in the bill would be available to all disabled persons of the community-children, aged, and others-irrespective of whether they are being rehabilitated for employment. Thus, these facilities would not be limited to persons coming within the scope of the FederalState vocational rehabilitation program.

The legislative proposal before you includes rehabilitation facilities for the blind. Although the medical services required by the blind are often less extensive than those required by other disabled persons, the adjustment training conducted in these centers for the blind is a crucial part of their rehabilitation.

The construction and planning of rehabilitation facilities is in the developmental stage. It is too early, therefore, to be precise in presenting the actual needs or the extent to which the $10 million authorized in S. 2758 would meet these needs. The survey provided for in the bill will give us these facts.

I will now ask Mr. Kimball to present charts showing the present status of our rehabilitation facilities and illustrating our proposal. Senator PURTELL. We will be very happy to hear from Mr. Kimball. Mr. KIMBALL. Thank you.

Mrs. Secretary, Mr. Chairman, members of the committee, this next series of charts is concerned with the fifth category of grants under this proposed legislation. That is, they would provide for the authorization of $10 million per year for 3 years for the construction of comprehensive rehabilitation facilities.

As the Secretary has pointed out, in this particular field there is particular need for this survey and planning authorization because, today, there is not too much known about the need for such facilities. that is, where they should be placed and the exact type of facility in each locality.

The important fact to keep in mind in connection with the comprehensive rehabilitation facilities is that they lessen the load on hospitals and other of the types of facilities which have been discussed earlier this morning.

As the Secretary has pointed out, they are closely related to hospital and nursing facilities.

It will be noted in this next chart that the comprehensive rehabilitation facility draws from the general hospitals, the chronic

disease hospitals, the nursing homes, and also lightens the load on diagnostic and treatment facilities.

Now, comprehensive facilities may be located in a hospital or may be located in connection with vocational schools or may be entirely separate depending on the need in the particular community, as the survey will develop.

At the present time, in the comprehensive facilities which are now existing, approximately 50 percent of the persons being rehabilitated are returned to employment through the vocational rehabilitation program and approximately 50 percent are being returned to a status of at least self-care which in turn often releases some other member of the family to go out and be the breadwinner.

Senator PURTELL. Do you mean 49 percent, 50 percent, or 51 percent, or from information available you think that?

Mr. KIMBALL. Information.

Senator PURTELL. Would you say it was correct between 5 and 10 percent!

Mr. KIMBALL. Yes, sir.

Senator PURTELL. Thank you.

Mr. KIMBALL. I would like, if I could, Mr. Chairman, to wait until a little later in the presentation to speak about the vocational rehabilitation program because these facilities we are speaking of this morning will be available for both vocational rehabilitation and for the care of children, older persons and others who will not be returned to employment.

I think it is important to consider for a moment what types of severe disabilities require the use of a comprehensive rehabilitation facility.

Ths next chart lists some of the more common types of severe disabilities, the different types of paralysis cases, paraplegia, and so on; blindness which the Secretary mentioned, and heart disease and other more severe disabilities which may have been caused by an accident, disease, such as polio and so on.

Now, a comprehensive center to meet the requirements of this particular legislation must contain a combination of professional and other services which are designed to bring about the rehabilitation of a person with these types of severe disabilities. It will be noted on this next chart, Mr. Chairman, that the three basic types of services which must be provided include medical, psychological and social, and vocational; and to meet the requirements of this act, then, there must be a combination of these types of services. When the patient comes into the center, his case is diagnosed as an individual and a plan is prepared for him. These various types of services are made available and his plan is adjusted as he goes through the process of rehabilitation.

If I may mention just one case to give you an idea of the possibilities of such a center, I am thinking of a miner who was in a very severe mine accident, was paralyzed from his waist down; and for 5 years was completely bedridden, which also tied up his wife, fulltime, caring for him.

When facilities of a comprehensive center became available, he was not only rehabilitated to self-care, he was rehabilitated to the point of learning a new trade and now runs his own watchmaking establishment, in which his wife also works.

In other words, he has been restored to full dignity and is able to support himself and his family.

That type of severe case can be rehabilitated in this kind of a center. Now, the next chart, Mr. Chairman, shows where the comprehensive rehabilitation facilities are available today, where they are located. It also shows the number. I think the committee will be interested to see that at the present time there are 23 such facilities in the United Sates, and you will notice at a glance the wide areas of the country where there are no such facilities. Just to pick one facility, I happened to visit about 2 or 3 weeks ago the Woodrow Wilson Rehabilitation Center at Fishersville, Va. At one time in January there were patients there from a total of 21 States from as far away as Wyoming. One sister State had a total of 62 patients at Fishersville, Va., last year and still had several hundred on their waiting list, like our miner who was 5 years before he got treatment.

Under this bill, the State-by-State surveys would determine where the centers should be placed to provide more economic distribution as well as to provide the needed additional facilities.

Senator HILL. How are those facilities financed?

Mr. KIMBALL. The facility is financed by a Federal grant which is matched, sir, by State and local funds. The matching works out at about $8 million of State and local funds against the $10 million Federal. Under this bill, a 3-year bill, it would provide a total of $18 million each year.

Senator HILL. I am only speaking about this particular facility. Mr. KIMBALL. I am sorry, sir.

Senator HILL. How is it financed today?

Senator GOLDWATER. That Woodrow Wilson facility.

Miss SWITZER. The Woodrow Wilson Center is the old Woodrow Wilson Army General Hospital which the State of Virginia acquired after the war; and, through the cooperative work of the State of Virginia Division of Vocational Rehabilitation and the Federal Office of Vocational Rehabilitation, comprehensive rehabilitation services were set up in that center. They had a big start because they had the buildings, you see.

Senator HILL. They had the hospital.

Miss SWITZER. And also the surrounding buildings were used to expand the system of vocational shops which is part of the State of Virginia's comprehensive vocational training program for that whole region. So, in addition to having the general hospital building to renovate for the rehabilitation facility needs, they also had immediately available dozens and dozens of different kinds of shops and trades around which to build the vocational rehabilitation right under the same roof as the center.

Now, the Federal appropriation did not go for equipment or building or renovation or anything like that. It went through the peculiar provisions of Public Law 113 through which we operate to help the State with staffing in the early days and administrative organization and that type of thing.

Then, of course, the center is maintained by the payment for the service received by vocational rehabilitation clients from many States. Senator HILL. They still get some Federal funds under the Vocational and Rehabilitation Act?

Miss SWITZER. Yes; all of the funds that go into the salaries at the present time are Federal funds, because that is, as you know, 100 percent Federal financing at the moment.

perience, that there would be added to that amount $16 million in State and local matching funds, making $36 million for construction of chronic-disease beds.

If this $36 million were to be expended for the construction of general beds, which run approximately $16,000 each, we would obtain approximately 2,250 beds. However, to be spent for cheaper facilities, chronic-disease beds, which some studies show run in the neighborhood of $13,000 per bed, we would receive a larger number of beds; we could construct a larger number, namely, 2,770, contrasted with 2,250.

I might say that this is a very conservative approach to the number of chronic-disease beds that we would get because the 13,000 figure is taken from some studies of separate chronic-disease hospitals. In those instances in which new chronic-disease beds would be built either as wings on existing hospitals, or as separate units, across the street from an existing general hospital, a large number of the ordinary hospital facilities that would be in separate distant facilities would not have to be built

In other words, we could take the patient requiring acute care suddenly across the street to the other building through the tunnel, or into the main part of the hospital. So that this is in a sense an outside figure and one could anticipate that we would get even more than this for our money.

In the field of nursing-home construction, if the full $10 million were appropriated, we would expect approximately $8 million of matching funds from State and local sources. The combined total of $18 million, then, used to construct general hospital beds at $16,000 each, would give us approximately 1,125 beds.

However, used to construct nursing homes, running in the neighborhood of $8,000 per bed, would provide 2,250 beds. As you see, a substantially larger number. In fact, exactly twice as many as we could build if we were putting that same amount of money into general beds.

This program in total, then, would provide emphasis on early diag nosis and treatment. It would provide increasing emphasis on ambulatory care. In addition, it would take cognizance of the economic problems of medical care by providing facilities, worthwhile facilities, for patients at lower cost than we have in providing general beds at the present time. In addition, it would provide facilities in which care could be given at lesser cost.

And, as we pointed out earlier, it would free general beds that are now occupied by chronic-disease patients who could be taken care of in the other type facilities.

Finally, as the Secretary has said, it would provide rehabilitation facilities.

Senator GOLDWATER. Mr. Chairman, you have got me a little confused.

I think from my own experience with hospitals that your general per bed construction cost is low and your nursing home is high. Is it not true that general hospital construction has been running around $20.000 per bed?

Dr. SCHEELE. Because many of the hospitals built under the HillBurton program have been rural hospitals and have been small, 25-3035-bed hospitals, the per bed cost for the general hospitals has been

in the neighborhod of $16,000. But your general observation is a good e. Possibly that $8,000 is a high figure for nursing-home beds. I here the point that you are making, with which we can agree in a general way, is that we would get even more for our money, get less general beds per dollar if you were to spend these amounts for general beds and we would probably get more nursing homes. As I indicated, we would probably get more chronic-disease beds than are shown here. So this is the most conservative picture of what we would get for our money.

Actually, we might get a great deal more as you point out.

Senator GOLDWATER. I am connected with 2 hospitals in my home town that have just completed construction under Hill-Burton funds, artly. In the general, it runs $22,000 and the tuberculosis, that ran 00 a bed. I cannot understand where there would be such a difference between a nursing home and a tuberculosis sanitarium in that neither of them would be operated with certain specialized facilities, and so forth, except VA. I think your $8,000 is high and I am not being critical of it, but I think you will find that as this program gets out to the people who build hospitals, that they may take a quick look at it and figure that we have not done a good job on figures back here. For my own information, I would like to have that studied a little bit to see if we are a little bit low on the top and high on the bottom. Mrs. HOBBY. Senator, I think you are certainly right, being low on he top, because I think all of us around the table know of hospitals There we have spent far more than $16,000 a bed. I have had a recent experience where the cost was $27,000 a bed. So I am very sure that e are very low. But it depends on the type of hospital you are building. If you are building a hospital in connection with a large medical center, and where it is a teaching unit, it will be much more pensive to build than if you build a community hospital that is essentially a hospital without being related to a university as a teaching center or part of a medical center. That is where some of this very

high cost comes.

Now, those were the best figures that we had on nursing homes, but I must say I am inclined to agree with you. I think that is a high Eure. Ithink they could be built for much less.

Senator GOLDWATER. I do think that the $16,000 is unrealistic. I cannot conceive of it, and I have been connected with small hospitals and big ones. I have yet to see a hosiptal to be built for $16,000 in the

last 5 years.

Dr. SCHEELE. Dr. Cronin would like to amplify.

Dr. CRONIN. Senator Goldwater, $16,000 is the national average of the cost of general hospital beds under the Hill-Burton experience. Now, the non-Hill-Burton experience is essentially the same. I think he Secretary basically put her finger on the problem here. And that what are you building? Bed costs are tricky things to talk about. The best way to estimate construction is the square foot cost. Square fut costs on general hospitals today run about $20 a square foot. When you talk about bed costs, you can take two small hospitals of beds apiece. In one small hospital you have a diagnostic X-ray partment. In the second small hospital you have a diagnostic -ray department and a therapeutic X-ray machine. The bed cost is