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, me 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 da Nation, considerations of both humanity and self-interest demand immedate 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 human terms of the rehabilitation program," nevertheless it also has a very practical dollars-and-cents meaning. Rehabilitation for self-care is an important step in relieving the economic burden on families and the patient load effect in reducing governmental relief expenditures in those instances where hospitals and nursing homes. Rehabilitation for employment has a direct disabled persons are receiving public assistance. Furthermore, as a group, disabled persons who have returned to work will, during their remaining worklives, more than repay the cost of their rehabilitation through Federal income

taxes.

In the area of vocational rehabilitation, the President's health message calls for as compared with the present 60,000. If these goals are to be met, two major a vastly expanded program-a goal of 200,000 rehabilitants annually by 1959 steps must be taken. First, our total rehabilitation facility capacity must be greatly 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 primary purpose of assisting in the rehabilitation of disabled persons through The bill defines a rehabilitation facility as one which is "operated for the

to achieve the second objective.

an integrated program of medical, phychological, social, and vocational evaluation 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 bill would be available to all disabled persons of the community-children, aged. 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 extensive 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 would meet 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

Chart L-Comprehensive rehabilitation facilities lessen hospital load

Chart 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 selfcare at home, thus reducing cost of chronic illness. Also, self-care often will release another member of the family for employment.

A rehabilitation facility may be locate 1 within a hospital, in a vocational school, or may be a separate institution.

Chart M-- Disabilities treated at a comprehensive rehabilitation facility

Chart M lists common types of disabilities.

Comprehensive rehabilitation facilities offering intensive and integrated service by a team of specialists are essential in dealing with the problems of the severely disabled. Those who suffer extensive paralysis 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 effects of disablement. The fact that many very severely disabled are gainfully employed after receiving such service indicates how much can be done when facilities are available.

Chart N Comprehensive rehabilitation facility

The comprehensive rehabilitation facility offers service in three basic areas— me fical, psychological and social, and vocational. Severe disability creates problems in all three areas, and rehabilitation depends upon successful treatment of the whole man not just one or another phase of his disability. Comprehensive facilities are distinguished also by the close integration of all services accomp'ished through the staff and the patient working as a team. Concentration and intensity of service are essential.

Chart 0 Comprehensive rehabilitation facilities (map)

The number of comprehensive rehabilitation facilities in the country is not large. On the basis of available information, 23 units may be so described. Even in these facilities the programs and patient capacities vary tremendously. Some have intensive programs, many kinds of services from each of the 3 basic fields, and care for as many as 300 patients at a time. Others have very limited programs and provide services to perhaps only 30 patients. Large areas of the country have no such facilities,

Chart P- Partial rehabilitation facilities

Many communities, although recognizing the need for rehabilitation service of this type, have, because of limited funds and personnel, only been able to establish facilities which provide a very limited variety of services. Typically, these have some medical services and perhaps one service in the psychosocial area.

They need to be expanded into full-scale facilities and to increase patient capacity.

Art-Partial rehabilitation facilities (map)

It is believed that 38 partial facilities exist. Note the geographic distribution. Some of these partial facilities could be expanded under S. 2758 into comprehenare facilities which could handle many more patients and the more severe

disabilities.

Chart R-Blind rehabilitation facilities (map)

Experience has shown that the problems of the blind are different from those in her 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 have done so, and lead normal and useful lives, is the best proof that such adjustnent is possible. Like general centers, rehabilitation centers for the blind may cassified as comprehensive and partial. There are 7 comprehensive centers and 13 partials known at the present time. Geographic distribution is limited, ndicating that particularly in the West and Far West blind persons do not have access to these facilities.

Chart 8--Vocational rehabilitation, past and proposed programs

The President's proposal for the expansion of the vocational-rehabilitation program calls for an increase in the number of persons rehabilitated from the present 60.000 annually to 200,000 annually by the fiscal year 1959. To meet this goal would require a great expansion of comprehensive rehabilitation facilities.

Chart T-Facilities required for President's vocational rehabilitation recom

mendations

To accomplish the 1959 goal set by the President, it is estimated that at least 30 percent 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 rehabilitation program alone. In addition, comprehensive rehabilitation facilities must serve children, aged persons, and others who need to be rehabilitated to self-care but who will not necessarily reenter the labor market.

Chart U-Proposal to increase number and capacity of comprehensive rehabilita

tion facilities

It is estimated that the present capacity of comprehensive facilities in the untry is 8,000 persons per year. The precise unmet need is unknown, but it is known to be large. It is estimated that to construct capacity in a comprehensive 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 12.000 disabled persons annually.