It seems to me that we can draw three conclusions from this information that Dr. Scheele has just presented: First, what has been done so far in improving and expanding our hospitals has been especially inadequate with respect to beds for the chronically ill; second, our shortage of chronic beds is expensive, for it has led to the crowding of chronically ill patients into our general hospitals, which are the most costly to operate and which are needed for patients with acute conditions; third, the relative demand for chronic facilities will continue to rise in the future because of our aging population. A fourth conclusion, although not specifically illustrated in the charts themthemselves, is that the need for institutional bed care must be minimized by placing greater emphasis on preventive health services. Under the present program relatively little attention has been given to outpatient departments of hospitals and other centers for the diagnosis and treatment of ambulatory patients, that is, those who do not require bed care. Such diagnostic and treatment clinics are essential if our communities are to have well-balanced medical services at a cost which they can afford. The bill you are now considering contains five major proposals, in accordance with the President's recommendations, for achieving a better-balanced program. 1. SURVEY AND PLANNING Following the precedent of the original Hospital Survey and Construction Act, the bill authorizes an appropriation of $2 million, to remain available until expended, for grants to assist the States in surveying their existing facilities in the categories covered by the bill, and in developing revised State plans and construction programs. The minimum grant to any State for this purpose would be $25,000. Every State would be required to match these funds on a dollar-for-dollar basis. The importance of this survey and planning feature in assuring the sound investment of construction funds cannot be too strongly emphasized. The surveys made under the original act have contributed greatly to the success of the program. For the first time in the Nation's history each State and Territory undertook an orderly inventory and appraisal of its existing hospital and public-health center facilities, and developed a comprehensive Statewide plan for exapnding and improving these facilities in accordance with the most urgent needs. These State plans will need to be revised to conform to the provisions of S. 2758 since 3 of the 4 construction categories covered by the bill are new or broadened. 2. FACILITIES FOR THE CHRONICALLY ILL For each of the 3 remaining fiscal years of the present program, the bill would authorize appropriations of $20 million specifically earmarked for grants for construction of nonprofit hospitals for the chronically ill and impaired. In terms of program categories, this provision is new only in emphasis, for such facilities are now authorized under the present act. The purpose of this new emphasis is to stimulate and accelerate the construction of hospital beds for the increasing number of persons with long-term illnesses who require hospitalization, but who do not need care in facilities as expensive to construct and operate as the general hospital. While the language of the bill refers to "hospitals for the chronically ill and impaired," it should not be inferred that these will always be institutions independent of general hospitals. On the contrary, it is probable that many of the units constructed with the aid of these grants will simply be wings or other structures related to a general hospital. In one recent study of 2,600 general hospitals having 50 or more beds, only 3 percent reported that they had special facilities or arrangements for chronic care. This percentage must be increased markedly if we are to promote better bed utilization and operating economy. 3. NURSING HOMES The third major proposal of S. 2758 is the authorization of $10 million annually for grants for construction of nonprofit nursing homes in which patient care is under medical supervision. Nursing homes would constitute an entirely new program category, since aid for the construction of such facilities is not provided under the present program. This proposal represents an auxiliary approach to the provision of beds for patients with chronic illnesses and impairments. The bill defines a nursing home as a facility for the accomodation of convalescents or other persons who are not acutely ill and not in need of hospital care but who require skilled nursing care, and related medical services ***” From this definition it is clear that the bill would not encompass old-age homes or any other institution furnishing domiciliary care without the essential elements of skilled nursing or medical services. That the bill is confined to nonprofit nursing homes does not mean that nursing homes of this type are the only necessary or desirable ones. We are well aware that there are many thousands of proprietary nursing homes now in existence. It is not our intention to overlook or detract from the fine work being done by appropriately staffed and equipped proprietary nursing homes. They are rendering the Nation a laudable service in caring for their patients. However, there can be no doubt as to the need for additional high-quality nursing homes. Here as in the case of all other facilities covered by the present act and by the bill, it seems appropriate to limit eligibility for Federal construction funds to those which are sponsored by public or other nonprofit agencies or associations. Nothing in the bill would authorize or permit Federal ownership or operation of any nursing home. 4. DIAGNOSTIC OR TREATMENT FACILITIES In addition to the authorizations for the construction of facilities for inpatient care, the bill also authorizes $20 million annually for the construction of nonprofit diagnostic or treatment facilities. A diagnostic or treatment center is defined as one for the diagnosis or treatment, or both, of ambulatory patients. Because such facilities are designed to serve ambulatory or outpatients, and to emphasize prevention, they help to decrease the need for inpatient care. This type of facility enables medical specialists and technicians to work together as a team. It is a well recognized fact that the team approach results in earlier diagnosis and better treatment for the patient. The full extent of the need for diagnostic and treatment centers is unknown, and will remain so until such time as the States have completed their surveys and have established measures of need. We do know that such diagnostic and treatment facilities as now exist are concentrated largely in metropolitan areas and are generally associated with large medical centers. While many of the centers constructed under this provision of the bill would be component parts of hospitals, others may be separate establishments. Indeed, communities which have no hospital at all could build and maintain modern diagnostic and treatment centers for their own citizens and for those of surrounding rural areas. This portion of the bill would broaden the existing act, because facilities for ambulatory patients are presently eligible only when they are component parts of a hospital-as in the case of an outpatient department. Rehabilitation facilities The final item in this five-point program is the authorization of $10 million annually for grants for construction of nonprofit rehabilitation facilities. Because the objectives and background of this particular proposal are somewhat different from the four I have already discussed. I should like, with your permission, Mr. Chairman, to discuss this part of the proposed program at a later point in my testimony. At this time it may be helpful to have Dr. Scheele supplement, with the help of several charts, this explanation of the first four points of the bill. CHARTS RELATING TO FIRST FOUR PROPOSALS Chart H-Proposed amendments to broaden Hospital Survey and Construction Act Chart H summarizes the five major proposals of S. 2758. Chart I-Facilities under consideration Chart I illustrates the types of facilities now under construction under the Hospital Survey and Construction Act, and the relationship of the proposed categories to these present facilities. The present categories are general, mental, chronic, and tuberculosis hospitals, outpatient facilities, and health centers. The proposed program would earmark additional funds specifically for chronicdisease hospitals—a category already authorized but for which there has been relatively little construction. The proposal would also authorize three new types of facilities-the nursing and convalescent homes, diagnostic or treatment centers, and rehabilitation facilities. Chart J-Annual cost of proposals for next 3 years The first proposal calls for $2 million for survey and planning purposes. This is a one-time appropriation and would be available to the States until expended. The $60 million proposed for the other types of facilities, as indicated on the tart, would be an annual appropriation for each 3 years through fiscal 1957, ch is the last year of the program as presently authorized. The K-Construction costs This chart shows how the need for beds for long-term illnesses can be met more mically by applying construction funds for chronic-disease hospitals and arsing homes rather than general hospitals. Current general hospital-construction costs average $16,000 per bed. ChronicAwise hospital beds cost substantially less. When built as complete independtits it is estimated that they will cost a maximum of $13,000 per bed. When as units of existing hospitals the per bed cost should be considerably less. Convalescent and nursing home beds are estimated to cost a maximum of $8,000 pered. Here again the average cost may be considerably less. The $20 million proposed for chronic-disease hospitals would be matched by oximately $16 million of State and local funds. This will provide 2,770 thaie-disease beds, whereas the same funds would provide only 2,250 general The $10 million proposed for nursing homes would be matched by approxirey $ million State and local funds. This will provide 2,250 nursing-home ds, whereas the same funds would provide only 1,125 general hospital beds. PROPOSED AMENDMENTS TO BROADEN Provide Grants For: SURVEYING & PLANNING CONSTRUCTION OF: CHRONIC DISEASE HOSPITALS NURSING & CONVALESCENT HOMES DIAGNOSTIC & TREATMENT FACILITIES REHABILITATION FACILITIES |