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4. To the ford place, the expansion of workshop facilities for the severely hard eapped will be of great assistance in assuring forward progress in rehabillཙྩོམཔྟཱཿཝོ། ཧིནཾ ཝབྷིཀྑུ

The pits the progress in rehabilitation, there remain many people, 300,000 it has been estimated, who are too severely disabled to be placed in competitive employ

With respect to these people, this question must be answered. Shall they

be left idle and helpless in their homes or in tax-supported institutions, or shall they be given the opportunity to work to whatever degree they are able? From the standpoint of economics, the rehabilitation of this group is not as profitable as the rehabilitation of those who can take their place in competitive employment. They do not earn as much. They do not pay as much in taxes. The sheltered shops which we are suggesting for such individuals are not moneymaking institutions, in fact, they may lose considerable sums at times. It is usually necessary to have some sponsoring agency in the community which is willing to take the responsibility for such deficits as may exist.

On the other side of the picture, a considerable number of people who are employed in sheltered workshops develop to the extent that they can move out to other employment.

The human values are self-evident. We cannot allow human beings to be cast aside just because they cannot produce at normal rates. The respect we have for human dignity in this country demands that we give every citizen an opportunity to do his best.

Incidentally, in the management of sheltered workshops, care must be exercised to see that they do not become filled with people who could make a living elsewhere. Careful planning and firm administration are necessary to prevent such a situation from arising.

PERSONNEL FOR REHABILITATION

4. Fourth, it is axiomatic that rehabilitation work cannot be done unless there are people to do the work. At the present time, there is a great shortage of personnel in practically all professional areas of rehabilitation. Rehabilitation is unique in that there is no one profession whose members are trained to do a complete rehabilitation job. The successful rehabilitation of the severely handicapped depends upon the combined efforts of the physician, the physical therapist, occupational therapist, nurse, vocational counselor, and numbers of other professional people with equally specialized skills. In practically all of these areas, there are serious shortages. In any program designed to advance rehabilitation in the immediate future, provision must be made for recruiting and training professional workers.

RESTRICTIONS IN PRESENT VOCATIONAL REHABILITATION ACT

5. Fifth, there are certain restrictions which should be removed from the Vocational Rehabilitation Act in order to allow the State agencies to do a more complete job of rehabilitating the handicapped of the various States. For instance, an arbitrary limitation of 90 days hospitalization for any one disability mitigates against the rehabilitation of the severely handicapped who may require a longer period of hospitalization. The removal of this restrictive language would in no way endanger the basic operation of the program and would undoubtedly enable many of the severely handicapped persons now being denied service an opportunity to be rehabilitated.

The present law has also been interpreted so as to mean that Federal funds cannot be used to reimburse State agencies for personal services in connection with the management and supervision of homebound or other small-business enterprises. Neither can Federal funds be used to stock inventory for such business enterprises. A clear-cut statement in the law authorizing the agencies to render such services would be extremely helpful.

PRINCIPLES THAT SHOULD GOVERN FEDERAL PARTICIPATION IN A PROGRAM OF
VOCATIONAL-REHABILITATION CENTERS AND SHELTERED WORKSHOPS

In our judgment, the following principles should prevail in a program of Federal assistance to the States for the purpose of establishing rehabilitation centers and sheltered workshops.

1. Federal financial participation should be based upon the needs of the States for assistance. We recommended the formula used to distribute funds under the Hill-Burton Construction Act.

2. Funds should be available to State governmental units and to private nonprofit corporations.

3. Preference for services in rehabilitation centers and workshops established with Federal assistance should be given to persons referred by the vocationalrehabilitation divisions, crippled-children services, workmen's compensation com

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n the preceding parts of this test mony an outline of the meme principlew upon which we be reve that sound growth can proceed we shail how undertake to refer specifically to bails which are before this committee for

AMENDMENTS TO HOSPITAL SURVEY AND CONSTRUCTION ACT (S. 2758)

S. 2758 would amend the Hospital Survey and Construction Act to make Federal aid available to the States to assist in the establishment of treatment and diagnostic centers, chronic-illness hospitals, rehabilitation facilities, and nursing homes. We wish to comment on this bill as it relates to rehabilitation facilities. Since 1949, the National Rehabilitation Association has been sponsoring legislation which would make Federal assistance to the States for the establishment of rehabilitation centers possible.

The purposes of S. 2758 appear identical with the purposes of the National Rehabilitation Association sponsored bill S. 2437. Accordingly, we are supporting S. 2758, but would like to make a few comments with respect to certain phases of the bill which we think to be extremely important.

In the House of Representatives, we notice that an effort was made to throw together in 1 fund appropriations for the 4 types of facilities envisaged in this bill. We insist strongly that funds be earmarked for rehabilitation facilities. If this is not done, we fear that the pressure for other types of facilities may result in the neglect of this very important area of unmet need. If, after the categorical approach has been tried for a few years, reasons develop for combining 2 or more of the funds into 1, consideration can be given to this at that time. In the second place, we approve heartily the amendment which was added in the House of Representatives which allows 1 State to assign its allotment of funds to another for the purpose of establishing a facility to serve the handicapped of more than 1 State. Certain types of rehabilitation facilities, particularly the more comprehensive type, may not be needed in everyone of the States. The assignment by One State of its allotment to another should facilitate the establishment of reZonal facilities. Third, we want to emphasize the importance of maintaining in this piece of legislation the definition of rehabilitation facilities which encompasses both vocational and medical aspects of rehabilitation. In our judgment, the definition of the rehabilitation facility found in S. 2758 is satisfactory. Several times while hearings were being conducted specifically on S. 2758, the question was asked as to whether rehabilitation centers could not be built under the Hospital Survey and Construction Act as it is now written. Such queries seem to question the necessity for additional legislation. It is undoubtedly true that a Certain type of rehabilitation center could be built under the present statute. This would be a center which is a part of a hospital, as a hospital is defined in the Hill-Burton Act. It is significant that some of our finest rehabilitation centers in the country could never have been built under this definition. Notable among these are: The Institute for the Crippled and Disabled in New York City, which is not a part of a hospital and which carries on a broad program of vocational training along with medical services; the Woodrow Wilson Rehabilitation Center at Fisherville, Va., which was built in connection with a large vocational-training school, and where physical medicine facilities were brought to the vocationaltraining school, rather than vocational-training facilities being brought to the hospital; and the Okmulgee Rehabilitation Center at Okmulgee, Okla., established by Oklahoma A and M College in connection with a huge vocational school. Again, physical medicine facilities were brought to the vocational school. All such centers, of course, have staff connections with medical institutions.

It is also important to point out that in communities having several hospitals, not all of them could afford to have rehabilitation centers, even if they could be built under the definition of a hospital. Rather than to have several competing rehabilitation centers, it will be preferable in many instances that 1 comprehensive rehabilitation center be built in the community, probably not connected administratively with any hospital, but having staff service from 1 or more hospitals; and this rehabilitation center could then serve patients coming from all of the hospitals in the community.

It is significant, I think, that even with the great need for comprehensive rehabilitation facilities which has been evident for several years, not a single such facility has been established under the present act, although some departments of physical medicine may have been included in teaching hospitals built under it. One other comment I would like to make, that is, that $10 million a year is very little money to distribute among 48 States for the purpose of establishing rehabilItation facilities. With this allotment base, Connecticut's yearly apportionment Would he $73,000, New York, with one of the highest allotments, would have about $450,000 a year, while many of the smaller States would fall in the $50,000 minimum allotment class.