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From what you have just seen, I believe it is clear that the proposals described thus far in our presentation would provide better medical and hospital services to more people - with lower unit costs for construction, and with lower daily costs for patient care.
5. REHABILITATION FACILITIES Having discussed the first four major proposals of S. 2758, let us turn now to the fifth proposal—the construction of rehabilitation facilities. Rehabilitation is the process of restoring a physically handicapped person to the point where he can either take care of himself in the home, or even better,
sutne a position in productive employment. The latter is called vocational rehabilitation.
As the President stated in his message of January 18 on the health needs of the Nation, considerations of both humanity and self-interest demand imme. date measures for the expansion of our rehabilitation programs. While, as the President states, "there are no statistics to portray the full depth and meaning in kuman terms of the rehabilitation program," nevertheless it also has a very practical dollars-and-cents meaning. Rehabilitation for self-care is an importaat step in relieving the economic burden on families and the patient load in hospitals and nursing homes. Rehabilitation for employment has a direct efect in reducing governmental relief expenditures in those instances wbere disabled persons are receiving public assistance. Furthermore, as a group, disabled persons who have returned to work will, during their remaining workAres
, more than repay the cost of their rehabilitation through Federal income In the area of vocational rehabilitation, the President's health message calls for 4 vastly expanded program-a goal of 200,000 rehabilitants annually by 1959 as compared with the present 60,000. If these goals are to be met, two major steps must be taken. First, our total rehabilitation facility capacity must be Kreatly 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. 8 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 disabled persons through
an integrated program of medical, phychological, social, and vocational evalua. tion 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 Hill would be available to all disabled persons of the community-children, ar. 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 Federal-State 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 exted. sive 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 develop mental 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 woulu mert 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.
CHARTS RELATING TO FIFTH PROPOSAL
(hart I-Comprehensire rehabilitation facilities lexsen hospital load
(hart L is designed to illustrate, in pictorial fashion, the point that the load in hospitals can be materially reduced through use of rehabilitation facilities, Many can be rehabilitated for employment. Others can be made capable of slf. care at home, thus reducing cost of chronic illness. Also, self-care often will trlease another member of the family for employment.
A rehabilitation facility may be luated within a hospital, in a vocational school, or may be a separate institution. ('hurt W - Disabilities treated at a comprehensire rehabilitation facility
(hart II lists common types of disabilities,
Comprehensive rehabilitation facilities offering intensive and integrated serve jce by a team of spurialists are essential in dealing with the problems of the severely thimishlech. Those who suffer extensive pralysis of both legs, or one arm and one leg, for example, find it very difficult either to care for themselves or to Work without first having the kind of service which reduces the handicapping efforts of disablement. The fact that many very severely disables are guinfully employed after receiving such service indicates how much can be done when fuentities are available. Charts Comprehensire rehabilitation facility
The comprehensive rehabilitation facility offers service in three basic areas.-medical, povrchological and social, and vocational, Serere disability treates prob 1*11* in all three arons, and rehabilitation depends upon successful treatment of The whole than not just one or another phase of his disability. Comprehensile freilities are distinguished also be the plane integration of all serices accompijn hed through the staff and the patient working as a team. concentration and intensity of sertice are pasential. (hart ( f'omprehensire rehabilitation facilities (map) The number of comprehensive rehabilitation facilities in the country is not
on the basis of available information, 23 units may be so described. Even in these facilities the programs and patient capacities vary tremendously. Soome have intensive programs, many kinds of services from each of the 3 basic felis, and care for as many as 30) patients at a time. Others hare very limited pro grams and provide mers ice* to perhaps only 30 patients. Large areas of the t'intry have no such facilities (hart P Partial rehabilitatim facilities
Many communities, although recognizing the need for rehabilitation service of this up have, frause of ihnited funds and passobbel, only been able to etab lish forilities which provide a very limited variety of services. Typically, themes use some medical services and shrhaps one service in the sustehosocial area. They pud to be expanded into full-scale facilities and to increase patient magarits. 16 257 - Partial rehabilitation facilities (map) fi is believed that 38 partial facilities exist. Note the geographic distribution.
op of these partial facilities could be expanded under S. 2758 into comprehen45+ facilities which could handle many more patients and the more severe sabilities. ('h477 R-Blind rehabilitation facilities (map)
Expwrience has shown that the problems of the blind are different from those in vihet groups of disabled and that special centers to meet their needs are derable. The great need of the blind is to adjust to blindness. That thousands bave done so, and lead normal and useful lives, is the best proof that such adjustDent is inssible. Like general centers, rehabilitation centers for the blind may bocassinel as comprehensive and partial. There are 7 comprehensive centers tot 13 martials known at the present time. Geographic distribution is limited, ndicating that particularly in the West and Far West blind persons do not be access to these facilities. Thart 8 --Vocational rehabilitation, past and proposed programs
The President's proposal for the expansion of the vocational-rehabilitation frictam calls for an increase in the number of persons rehabilitated from the heat 60.000 annually to 200,000 annually by the fiscal year 1959. To meet this goal would require a great expansion of comprehensive rehabilitation fiaties. Mart T-Facilities required for President's locational reliabilitation recom
mendations To accomplish the 1959 goal set by the President, it is estimated that at least [pretent of those served in the vocational-rehabilitation program will need to be referred to comprehensive rehabilitation facilities in order to accomplish their rehabilitation. On this basis we would need, by 1959, rehabilitation facilities that would serve at least 40,000 disabled persons per year under the vocational
habilitation program alone. In addition, comprehensive rehabilitation facilities must serve children, aged persons, and others who need to be rehabilitated to selfcare but who will not necessarily reenter the labor market. Chart I -- Proposal to increase number and capacity of comprehensive rehabilita
tion facilities It is estimated that the present capacity of comprehensive facilities in the funtry is $,(
W0 persons per year. The precise unmet need is unknown, but it de known to be large. It is estimated that to construct capacity in a compre. hensive rehabilitation facility for one additional person per year will cost $1,500. Assuming that $10 million Federal funds will be fully matched by $8 million State and local funds, the increased capacity to be expected will amount to about 12.08/disabled persons annually.