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Mr. Chairman, I want to express my appreciation for being invited to appear
at this hearing. You will find State directors of vocational rehabilitation anx;
ions to cooperate with the committee in its efforts to pass a bill which will result
in more people being rehabilitated than ever before. What we have learned as
a result of 30 years in administering programs of vocational rehabilitation is at
Four disposal.

Since ereryone who has testified at these hearings seems to have exactly the
salle purpose in mind, that is, to increase as rapidly as possible the number of
handicapped persons being rehabilitated in this country, it should not be difficult
for the committee to resolve the differences that do appear and report a bill
without too much delay.
Mr. Thompson. I am merely representing Mr. Earl Caulfield of the
State of Michigan, who is president of the States council. He could
not come down today and my testimony is in his behalf and that of the
Mr. Chairman, there are just 1 or 2 things I would like to say. The
first is that the primary interest of the States council, that is, the State

, is to see that more services are made available to more disabled people. Whatever the Congress decides is the best way to accomplish that

, of course, is the way we will try to work it out. We heartily approve the objectives of the President's program, and generally we are in agreement with S. 2759, except in the matter of financing. We believe perhaps some other change would be more helpful to promote the program throughout the country. First we would like to request the committee to give some consideration to removing the restrictions that exist in our present Appropriations Act, because it just is not possible to go forward as long as we have this weight hanging on our shoulders.

There is a bill before Congress, S. 2873, which I believe would remove the present restrictions. Senator GOLDWATER. S. 2873? Mr. THOMPSON. I think that is the number. We feel that is the most urgent thing confronting us. It is the passage of a bill which would make it possible for the Congress to appropriate the same amount of money as was appropriated last year, because we feel it would be unwise to set the programs back beyond their present level. So attention to that bill is what we feel is most urgent.

Senator GOLDWATER. I believe that bill is probaby before the Appropriations Committee. It has not come to this committee.

Mr. Thompson. I do not know, sir. Mr. Whitman, is it S. 2873, which is the bill that would remove the restrictive language?

Mr. WHITMAN. I believe that is right. Senator Kefauver has introduced over here, and I believe Mr. Hope in the House.

Senator (OLDWATER. Thank you very much. We will look that up.
It is probably in the Appropriations Committee.
Mr. Thompson. Thank you very much.

I would like to say a word about the method of financing, which is so extremely important. As the chairman of the committee pointed out this morning, of course what you folks are interested in is setting up a framework that would meet the total problem, and the matter of appropriations is something that would have to be taken care of in another way. But a part of the total problem is the method to be used in financing whatever programs are set up. We think that Senator Potter has presented a very workable plan in his bill, S. 3039, and we

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would like to urge serious consideration to that program as he presents it.

In the matter of extension and improvement of facilities we feel that such extension should apply first to the programs as now in effect, rather than to go all out for starting something new before we are doing the total job within the framework of what we had at the present time.

There is a great need for research in the field of rehabilitation. So one individual can keep up with all of the literature that comes out. Nor can he make himself acquainted with the methods that develop as time goes on. So we hope that attention will be given to this phase of the program, and that facilities for research will be made available not only to the Federal Office of Vocational Rehabilitation, but to the States.

The Federal Government has taken the lead in this program from the very beginning. We want your leadership. We want to pay tribute, and this is a personal tribute on my part, and I am sure it is shared by most of the State directors, or all of those in State rehabilitation-we want to pay tribute to the splendid leadership we have in the Office of Rehabilitation here in Washington. Miss Mary Switzer is a person who is conscientious and competent, and doing a wonderful job. We hope that our relationship can be continued and that the Office of Rehabilitation can be anchored legally and made a separate organization.

Thank you very much, Senator, for the courtesy of appearing here.

Senator GOLDWATER. Thank you very much, Mr. Thompson. This concludes the hearings devoted primarily to the subject of vocational rehabilitation.

The subcommittee will stand in recess until Tuesday next, April 13, when we will convene at 10 o'clock, to begin the hearing of testimony on the President's recommendation for encouraging the extensions and improvement of voluntary health insurance plans.

The committee will stand in recess.


IN VIRGINIA, AND PAST PRESIDENT, NATIONAL REHABILITATION ASSOCIATION The President's statements regarding vocational rehabilitation, with elab oration by Serretary Llobliv. contain the most realistic and far-reaching pro posals yet advanced for raising the level of rehabilitation services provided disabled individuals to correspond reasonably with the need. The statement of need is not exaggerated and the goals of expanded service, when realized, mean that each year additional tens of thousands of our handicapped now dependent on family, community, or government for support will achieve a status of dignity and productivity through self-supporting employment.

I have worked in the field of vocational rehabilitation for 12 years. The most distressing situation faced in this work is the thousands of applications that have accumulated from persons unemployed because of disability who must be denied service because of the limited resources available. No one disputes the human or economic values derived from successful rehabilitation. There is no logic to our present state that allows us to provide service to one individnal but not to others similarly affected by disability. Hence I must register most hearty approval of the President's desire to stimulate the improvement and expansion of rehabilitation services to the point that prodne tivity in the State Federal program will be increased from 60,000 to 200,00) rehabilitated persons per year.

The President and Secretary Hobby are also realistic in defining the means to be employed in this effort toward expansion and improvement. These needs are emphasized :

(a) Increasing the number of trained rehabilitation workers. (6) Development of facilities designed specifically to do the rehabilitation job.

(c) Provision of additional fund to be used in purchasing necessary diag. nostic, treatment, and training services for clients.

(d) Discovery of new and more effective rehabilitation methods and techniques, particularly as applied to the more severely disabled applicant.

The rehabilitation counselor is the key person in bringing rehabilitation services and disabled persons together. In our State, we feel that each of our counselors is working up to his capacity. Yet there are hundreds of applicants on the waiting list in every district. As we expand services to include more of the severely disabled, the psychiatrically disabled, and the mentally retarded, more staff time per case will be required. Thus to expand substantially the number of persons rehabilitated there must be a corresponding increase in professionaly trained workers. Since new recruits to the field must be trained, funds must be provided for both their employment and their training.

We have worked hard and with some success in developing rehabilitation facilities as a part of the overall program in our State. The Woodrow Wilson Rehabilitation Center, now enrolling over 300 students, has already made rehabilitation feasible for many hundreds of handicapped persons who otherwise could not have been accommodated. It is an inspiring sight to watch these students, one-half of whom are in wheelchairs, go purposefully to the counseling, theraps, and vocational training departments to prepare for jobs. Over 80 percent of the students accepted at this center are successful in finding employment after completion of their programs of preparation. Such centers must be multiplied by many times if we really do something for large numbers of severely disabled.

The present State-Federal program achieves 60,000 rehabilitations per year at an aggregate cost to agencies of approximately $36 million. If we triple the number of rehabilitants then funds for their rehabilitation will have to be increased at an even greater rate. Our greatest need for expansion is in service to severely disabled persons. Case costs per individual will go up sharply with increase in severity of disability. Our average cost per case is approximately $400. The average cost for a paraplegia is in excess of $2.000.

Vocational rehabilitation is a relatively new professional field. There has been steady improvement in the methods and techniques employed in getting all phases of the work performed. However, success in new areas of disability will depend greatly on the improvement of present techniques and the discovery of new ones. Exploration and research into all promising areas is vital to a program of expansion.

Provisions in S. 2758, S. 2759, and H. R. 8149 provide a decent beginning for expanding rehabilitation facilities, for undertaking necessary research and for undertaking the training of new personnel. I approve of these provisions and will make no further reference to them. I do want to comment in more detail on the remaining major provision of S. 2759, specifically the financing provisions contained in sections 2, 3, 10, and 11.

In terms of financing rehabilitation programs as they now exist these prorisions attempt four separate actions: (1) To provide hasir level : (2) nrovide incentive for expansion and improvement of present programs; (3) reduce the vote of Federal participation; and (4) institute a new variable grant system in alloting Federal funds. If we consider these objectives in the light of the President's major goal to expand substantially the level of service, then there is real danger that certain of these provisions effectively cancel out the opportunity of achieving this major objective. It is useless to expect States who Jose a major share of their present Federal support under these provisions to be able to expand the size of their effort. Experted improvement in State appropriations could do little more than offset the loss of Federal funds. Manr States would actually have to cut back the level of operations each year 1955, 1956, 1957 rather than carry forward the exnansion needed to meet target levels set for those years by the President and the Secretary.

Certain principles should guide any efforts toward revising the present plan of financing. Important among these are

(1) More support. dollarwise, must be provided if the rehabilitation program is to experience substantial growth.

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(2) No financing plan should be considered which would jeopardize gains already made and consolidated in the program.

(3) Greater equity should prevail in the distribution of the Federal appropriation to the States. States in like cireumstances (as in wealth and popuiation) should share equally in Federal grants.

(4) An equalization fund, an earmarked portion of the regular appropriation, should be used to equalize financing ability for the program in poorer States.

(5) Reduetion in the ratio of Federal participation should be made gradually and in such a degree that no program would suffer a serious loss of funds.

(6) Long-range goals for the program, in number of cases to be served, appropriations to be required, and desired sharing ratio, should be set up. This and. subsequent legislation should be designed to support the achievement of these goals.

(7) After a resonable number of years (10 years suggested) each State would achieve its desired ratio of support, some (the richer States) by expanding State funds at a higher ratio and others (the poorer States) by receiving a larger share of additional Federal appropriations. In other words, readjustment to new ratios would be achieved through proper handling of new money rather than to risk tampering with the dollar support to the present program,

I strongly oppose the plan proposed for distribution of funds as being too drastically different from the present basis and the time allotted for transition as being far too short. There is nothing immoral in the present situation that we must abandon it so rapidly and so radically. A more modest rearrangement, spread out over a minimum of 7 years, and preferably 10, would give far greater assurance that the President's goals would some day become a reality.

I would recommend the stabilization of Federal matching on a dollar-for-dollar basis for all Siates with an equalization fund being distributed to States with less than the national average of per capita income, not to exceed 15 percent of the amount used for matching and graduated in proportion to wealth. The following table illustrates how this might be achieved:

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Under this plan, in 1939, $35 million in Federal funds would be used to match State appropriations, dollar-for-dollar-$5 million would be used as an equal. ization fund, no State to get more than 15 percent increase in funds from this source. Any State now exceeding its eventual share of Federal funds would simply be frozen at the present level until other States not so formed had im. proved their States by receiving greater shares of new Federal money. All States would be expected to increase greatly their own State appropriations.


New York 19, V. Y., April 6, 1951.
Chairman, Subcommittee on Health,
Senate Committee on Labor and Public Welfare,

Senate Office Building, Washington, D. C.
DEAR SENATOR PURTELL: I would like to submit for your committee's con-id-
eration a few comments in support of S. 2759 introduced by Senators Smith,
I'pton, and lres to extend and improve vocational rehabilitation services.

The problem of rehabilitation as it relates to tuberculosis patients in par
ticular has long been a concern of the National Tuberculosis Association, a volub-
tary organization which has been fighting tuberculosis for the past 50 years.
Along with the advances in knowledge about the disease, we have increasingly

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come to realize that an adequate program for rehabilitation is an essential part of the general program for the control of tuberculosis.

As we have participated in the development of rehabilitation programs for the tuberculosis in this country through our own rehabilitation service, we have noted how vocational rehabilitation has resuled in tuberculosis patients returning to a useful place in society.

We are gratified to note that S. 2759 has been introduced and believe that passage of such a bill with an adequate appropriation for administration and grants-in-aid will be a tremendous impetus to rehabilitation in this country. Before its passage, however, we would like to submit three suggestions for amendments in the interest of clarification and amplification.

Under section 10 (b) (p. 16 of the bill), the term “disabled individual" is defined as “any individual who is under a physical or mental disability which constitutes a substantial handicap to employment but which is of such a nature that vocational rehabilitation services may reasonably be expected to render him fit to engage in a remunerative occupation." The term "remunerative occupation" has been interpreted in some States to exclude the housewife although the Federal interpretation does include them. To avoid omission of the housewife who we believe is in need of vocational rehabilitation to prepare her properly for her job as a homemaker, we suggest that the language of the act explicitly mention the housewife as being included. If a housewife is not properly prepared with a "home mechanics program," she is more inclined to have a relapse of tuberculosis thus creating, aside from needless medical expense, a serere strain on the family both emotionally and financially.

The act also provides for establishment of workshops primarily for employ. ment of sererely disabled individuals who cannot be absorbed into the labor market. Such workshops are needed but primarily as training centers. I believe that an addition should be put into the bill to permit the disabled individual to be admitted to such workshops in order that he may develop and improve work habits and receive work training which would enable him to go either directly into employment or prepare for vocational rehabilitation. If used only for employment, the workshop would be limited in its scope in that the number of those served would remain relatively static. A workshop which would admit such patients as the convalescent tuberculous would have a changing population and all its services would achieve greater results not only in the number of people serred but primarily in returning people to rocational and economic usefulness in the community.

It is also suggested that since rehabilitation programs are now limited in all parts of the country by shortage of professionally trained staff, it would be desirable to provide Federal funds to expand training facilities and to provide fellowships for all professional fields involved, in addition to research fellowships. Such a precedent was set in the Mental Health Act.

May I respectfully submit these suggestions for the committee's deliberations and urge the bill's passage to meet the increasing and expanding need for vocational rehabilitation today. Very truly yours,


Managing Director.

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March 23, 1954. Hon. WILLIAX A. PURTELL, United States Senate,

Washington 25, D. C. DEAP SENATOR PURTELL: As secretary to State Senator James J. McBride's Interim Committee on Education and Rehabilitation of Handicapped Children and Adults, I am writing to you concerning S. 2759 which is being heard by the Senate Committee on Labor and Welfare at this time.

The report of Senator McBride's committee heartily endorsed the vocational rehabilitation program in California and recommended its expansion and faced realistically the need for increased State participation. After studying S. 2759

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