nonhomebound as well. We provide a general service for those who can come to our agency. But we have a specific interest in this one severely disabled group.

Senator CRANSTON. How do you define "homebound?"

Mr. COHEN. That is a good question. We have an operational definition, sir. It is one who is so disabled physically, intellectually, or emotionally that he cannot regularly leave his home by normal transportation available to him to go to industry or rehabilitation. In other words, this individual lacks mobility for a variety of reasons.

The preceding witnesses speaking of dialysis patients, when they are in their extreme critical condition, they also are homebound, and they are good vocational prospects and they, too, can be identified as homebound. In fact, we can include the blind, the aged, emotionally disturbed, emotionally ill, mentally retarded, stroke patients, and many others who are good vocational prospects and have abilities, but they are limited by lack of mobility.

Under Public Law 565, 1954, Congress at that time asked for a study for the homebound and they prepared a study but nothing much has been accomplished since.

In fact, in the past 4 years of committed interest by the Rehabilitation Service Administration, and the Social and Rehabilitation Services they provided Federation of Handicapped with several grants.

One grant, in 1967, was called the Programmatic Research on Rehabilitation of the Homebound, and we conducted five regional meetings around the country disseminating information about the homebound. But nothing of consequence, since 1955, has actually occurred.

LIMITED SUPPORT GIVEN TO THE HOMEBOUND

I would like to cite that SRS has approved, since 1955 to 1970, 1,556 projects.

Out of this number only 19 were approved for the homebound and most of these 19 were approved for our organization.

Out of this 1,500-plus projects, totaling $69 million, only $1.8 million were expended on the handicapped homebound.

My agency alone last year spent on the homebound five times more than the Government spent last year on this group.

It seems that there is an inadequate amount of effort, work, money, display of interest, in this group of people.

The current status of homebound shows that less than 5 percent, much fewer than 5 percent are being served. It shows more than 50 percent can be rehabilitated. It shows as many as 75 percent are on welfare. It shows that they are amongst the most poverty-stricken people, and that that many of them are heading for institutions.

If the strategy of SRS and RSA is to work toward deinstitutionalization, prevent individuals from going into institutions then unless we provide constructive services for the handicapped homebound; that is where they are heading.

We say that tens of millions of dollars of unnecessary welfare are being expended for this particular group. They have talents, unused skills, and talents that can contribute to society, that the cost of taking care of their daily needs run into millions and millions of dollars.

Many of the reasons for this is because there is community apathy. They are invisible. Nobody knows where they are.

Yet, they are around us everywhere. The chairman of the full committee, has more known homebound in his State, those with black lung disease and parenthetically, by curious coincidence, the chairman of the House committee, equally has the largest known number of homebound, also with black lung disease in his State.

There is little being done for these people. Yet they do have a vocational future. If we had a national center for the homebound we could develop techniques, expertise, make surveys of the communities, train personnel for these particular organizations and States and do everything that a national center can accomplish.

It would demonstrate for all to see that the handicapped homebound can be rehabilitated. It would find new and better methods of rehabilitating homebound. It would send teams of specialists into the homes and into States and into communities as well as accepting professionals from the States and communities and training them. It would serve as an advocate of the homebound. That is one thing that the homebounds did not have.

The Kennedys were the patrons for the mentally retarded.

In the early 1930's, President Roosevelt was the patron for polio patients.

We need a national center to be the patron for the homebound. I can say in conclusion that homebounds are the most deprived and disadvantaged of all Americans, that less is done for them than any other disabled group; and the only hope they have is a national center. While the current legislation-in fact, legislation since 1920, authorizes that services can be provided for the homebound-I am saying that very little is being done. It is axiomatic that the severely disabled have a low priority any time you develop such a list, and that unless there is mandated a national center, this group of individuals will not receive the service they require and need.

Senator CRANSTON. Does your definition of "homebound" include people who are institutionalized?

Mr. COHEN. Yes; it does, sir. In fact, we have had studies, we have done work with institutions, and we have taken alcoholics and others with severe disabilities. We have brought them into our center on a day-to-day basis. They were night patients at the hospitals, and we moved them from these institutions and helped them find residences and made them employable.

Senator CRANSTON. Did the programmatic research project that you mentioned define why these individuals were homebound? Mr. COHEN. There are a number of reasons.

One great reason is lack of mobility. Many of them are poor and disadvantaged and live on fourth and fifth floors of apartment buildings with no elevators. They live in innercity ghetto areas; they are in wheelchairs; they are severe cardiacs.

Many of them cannot walk steps, cannot use public transportation, and they cannot use subways or buses. They have limited tolerance.

U.S. DEPARTMENT OF LABOR AIDS THE HOMEBOUND

But within the confines of their home, they are capable workers. One of the most exciting breakthroughs, a landmark, occurred on May 6. The Department of Labor, from my point of view, did something most exciting for the homebound.

At our urging, with the cooperation of Senator Javits' office, we were able to have the Fair Labor Standards Act amended to enable a workshop, be extended as part of its facility, into the home. In other words, work done at home in an apartment or residence, is now an extension of a work activities center of a sheltered workshop.

This means that the Labor Department itself believes that people who are capable of working, capable of going off welfare, should have this opportunity, and the Labor Department has accordingly amended the act as of May 6.

Senator CRANSTON. By your definition, if people in institutions and homes are both considered homebound, then providing money for institutions is not going to get them out?

Mr. COHEN. Not at all. They need new techniques and other help. We had one exciting experiment with Kingsbrook Hospital in Brooklyn.

We took out of the hospital for 1 week a group of individuals, five a day; for 1 solid week, and provided them with the full gamut of professional services, psychiatric, social work, psychological testing, et cetera, and gave them also small, sample remunerative tasks.

We noted out of the 25 that we dealt with over a period of 5 weeks that these people had vocational potential, that they were institutionalized because there was no place for them to live in their community; that many of them could work and could at least partially be self supporting.

It cost up to $6,000 a year on a recurring basis to maintain them in an institution. Yet, we think within a cost of $1,500 to $2,000 maximum, we can rehabilitate them on a one-time cost basis.

Now, the reason for the cost of $1,500 to $2,000 is because we have to provide them with transportation, and transportation is the most expensive ingredient for rehabilitating these people. But definitely, many people in institutions today do not belong there. They have potential, work potential.

Senator CRANSTON. What percentage of homebound cases involve situations where the family is a deterrent to the removal of the patient from homebound status?

Mr. COHEN. We believe that it works just the opposite, that the homebound person deters the family constellation from really being a normal family. Many of them cannot work, cannot live a normal life. They cannot entertain friends. It causes the whole family to suffer. There are many exciting avenues of developing satellite situations within a community, mobile work forces; you can rig up an evaluation unit, and move it around. You can develop apartment complexes; you can bring the homebounds out into the community. There are many other tools and devices and techniques, if only we could impart these tools and techniques to others around the country.

Senator CRANSTON. The HEW testimony indicated that quite often there is difficulty in reaching the patient who is homebound with alternatives, because the family sort of frustrates communication and may feel that the individual should not leave the home.

Have you not encountered that?

Mr. COHEN. This has not been our experience at all. We are a service-oriented organization of 37 years of experience. We believe it is just the opposite.

We do not believe that we want to impose work on people who do not want to work, but we believe that many of them do want to work and they want the opportunity, and they do not have the opportunity; and that you cannot accomplish what we are suggesting by permissive statements within legislation.

It has to be mandated specifically, and this is our strong feeling. We do feel that H.R. 8395 is a turning point-a turning point wherein the Secretary is authorized to conduct research and demonstrations and studies for the homebound.

HOMEBOUND MENTIONED FIRST TIME IN LEGISLATION IN 52 YEARS

The word "homebound" for the first time, Senator Cranston, in 52 years of vocational rehabilitation legislation has mentioned the word "homebound," "handicapped homebound." But mentioning it in the committee report, that it hopes that something will be done that there is a need for this type of service this will not provide services for up to 2 million individuals. We can remove many of them from welfare to a large extent. We can help slow down the process of institutionalization. I can say to you, Senator, that in the last 15 years our own agency alone provided income upward of $3 million to this one group of individuals. This is just one agency.

I am saying that this type of legislation can pay for itself. It can because it is a nonrecurring cost. It gives dignity to the people. They can work. They are capable of work, and I know that we can do it for them.

Senator CRANSTON. Would you please, incidentally, make available to the committee the full report of the programatic research project? Mr. COHEN. Yes, sir.

We have four such annual reports.

Senator CRANSTON. In your present program in New York, you indicate you are serving 400 individuals each week. Could you give us some indication of the number and types of staff that you use for that?

Mr. COHEN. These 400 individuals range from-one program we call our high school homebound program. These are young people who, for physical and emotional reasons, are not capable of going to the regular board of education program. We provide them with transportation and we bring them into our agency.

We give them psychological services, preevaluation services, social work, psychiatric services, and prepare them to go on to one of three

areas.

We prepare them for higher education, prepare them to go to a trade school or technical schools or home employment.

Two out of every three of these catastrophically disabled young people end up on a positive level of service.

Another program that is part of that 400 is our personal aides to the homebound.

Senator CRANSTON. Give us a breakdown of the staffing for the record.

Mr. COHEN. Yes.

The staffing pattern for these 400 individuals, in terms of professional staff, would number approximately 80.

Senator CRANSTON. Give us a breakdown of that for the record.
Mr. COHEN. Surely.

They would include intake counselors, prevocational counselors, social workers, vocational counselors, employment counselors, vocational trainers, contract solicitors, researchers, psychologists, psychiatrists, physiatrists, paraprofessionals, remediation specialists, and community developers.

Senator CRANSTON. What is the cost per individual served?

Mr. COHEN. $1,500.

Senator CRANSTON. Under the 10-minute rule, my time is up.
Senator Stafford, do you have any questions?

Senator STAFFORD. I have no questions of this witness, Mr. Chair

man.

Senator CRANSTON. In your prepared statement you indicate that the center you propose would engage in research.

What kind of research?

Mr. COHEN. Research in terms of occupational skills, research in deinstitutionalizing individuals, research in showing how we can do away with expensive cost of transportation by certain techniques. Research in terms of training staff, moving into the community. We call this, Senator Cranston, action research, not just research to develop statistics, but actually working with individuals.

We are working now with a group of individuals in the Bowery section of Manhattan. This is an area where there were many alcoholics.

We went into this community to do a geographical study. They told us there was no homebound people. Yet, we found a resident home for men, of 200 alcoholics, everyone was, by our definition, homebound. They were not capable of going into industry.

Yet, at this moment we have gone into this institution which is a residential home, supported by welfare funds.

We are giving work to some of these alcoholics. There must be 12 to 15 who are starting to work. We instituted a different payment device.

Every hour we pay these people what they earn. We have to bring back their faith in us, so after 1 hour of work, they are payed by cash at the end of that hour. Two individuals have left this residence and moved into our organization now for more intensive occupational skills training.

Now, this is the kind of thing, sir, that we mean by "research." Senator CRANSTON. How would the center work with legislative and other groups mentioned on page 6 of your statement?

Mr. COHEN. We would work with States who have laws which do not allow people who are homebound to work at home.

We would move into different States, like we are doing with New York State right now, stating that the homebound really are an extension of the long-term sheltered workshop, that there should be State efforts to reimburse organizations like ours to support the maintenance of these people.

We have had people on employment whom we have maintained for over 20 years, who are working at home. It costs upward of $500 to $1,000 a year to transport merchandise, to retrain them, and to keep them in employment.

This is an ongoing cost that no one else provides, and we believe that we can help State agencies understand the nature and need of peo