ng-care eligibles in Veterans' Administration hospitals, by areas- -Continued ed on question VII 1(b) of questionnaire. Published as Committee Print No. 1, 88th Cong.; comy Reports and Statistics Service, Department of Medicine and Surgery. sed on question X 5 of questionnaire. ing-care beds availability in selected VA hospitals based on subcommittee survey MARCH 7, 1963. The buildings which we propose are part of the old Aspinwall Hospital, and photographs are attached so that you can be aware of the sound basic construction available. These buildings are attached by corridors to the main hospital facilities, and have wheelchair runs to the outside lawn and recreation areas for use during summer months. The cost actually figured is based upon many of these cases needing full care and the utilization of hospital facilities for their continued maintenance, i.e., laboratory services, radiology services, and physical medicine services. The care could be provided at a lesser cost and renovation at a lesser cost if the quality desired were to be reduced. I strongly urge that your committee consider the highest quality available for our deserving veteran population. In reply to your telegram of March 11, 1963, relative to nursing-care beds, you are informed that there are two domiciliary buildings at this station of modern construction which could be converted to nursing-care beds to provide an estimated 300 beds. The cost of renovation is estimated at $500,000 and the cost of equipment at $150,000. The per diem would be $15.00. It is believed that these nursing-care beds could be activated within 12 months after authority, funds, and final plans are made. Over the years since this installation was opened in 1877, there has been developed a staff of dedicated people which can be augmented without difficulty, except in a few scarce category positions. While these buildings can be renovated and will give far better accommodations than a majority of nursing homes, there have been, as you know, rapid advances in nursing-care institutions during the recent past, a good example of which is the Pavilion Nursing Home adjacent to Genesee Hospital in Rochester, N.Y., which was opened on March 3, 1963. We are taking the liberty of forwarding a fairly complete description of this institution which appeared in the March 3 issue of the Rochester Democrat and Chronicle. Construction of this type, adjacent to and connected with our modern 273 G.M. & S. hospital, would be more efficient and more in line with present-day trends in nursing-home and convalescent-care facilities. BATAVIA, N.Y. MARCH 4, 1963. Your letter of February 25 requesting information regarding the establishment of nursing-care beds has been discussed with appropriate members of our staff. The thoughts we have on this idea do not lend themselves to proper expression if the format at the bottom of your letter is completed. This is a hospital with 257 authorized beds, of which we are presently operating 240 beds, divided among 5 wards. The nonoperating beds are distributed among three different wards. Our discussion has led us to one common conclusion: to establish nursing-care beds, there must be a somewhat separate and identifiable area in which these beds would be located and which would not be a part of the regular hospital operating beds. Were such nursing-care beds scattered throughout the hospital and intermingled with the otherwise active beds, a differentiation would not be possible, particularly in the area of the medical attention devoted to the bed occupants and the level of nursing attention provided to them. For the above reasons, it is my opinion that there are no beds at this hospital which could properly and productively be converted to a nursing-care type of operation. There is no one ward or any portion of one ward which could be so designated and continue to maintain the other beds at the present level of activity and turnover rate. Therefore, it is our feeling that there are no beds which could be provided for a nursing-care type of operation, and this would lead to negative answers in the other four questions that you also asked. r interest and that of your committee in the continuing study of the needs eligible veteran population, and in providing adequate plans to provide for needs, is an objective well worthy of our mutual understanding and coLion. st, I want to tell you how much I regretted not being here when you and ressman Roberts visited our Center in November. All of us greatly appreI the kind remarks you made about our Center, and will continue to do our -o merit such high praise. e figures entered on the enclosed letter are based on the following general The 44 beds represent one-half of our second floor, Domiciliary Building. These beds will be utilized for a combination of bedfast but largely semiamory patients. The estimated per diem cost will gradually become considerhigher if and when a majority of these patients deteriorate to the point that need much more individual care. Then they will be the type of patients cost $350-$450 a month even in private nursing homes, which generally de minimal care. d. "Renovation costs" include installation of a nurses' call system, bedside system, bedpan sterilizer, etc. Very little building alteration will be reUnder "cost of equipment," I have also included an additional amount for 1 supplies (linens, dietetic, drugs, etc.). About 20 additional employees will be required. establishing this 44-bed nursing-care unit, we will lose 53 domiciliary beds. will be unfortunate, as for some reason we have not had the decline in demand omiciliary beds experienced throughout the VA the past few years. For ple, we now have 77 on our waiting list, plus 20 requests for transfer, even referring as many applications as possible to other domiciliaries. Thus, our standpoint, a better solution would be to increase aid and attendance rances so a larger number of eligible veterans can be placed in nursing homes. unately, we have some very good ones in this area, with reasonable rates for ut the "100 percent bed care" type of case. Rates for the latter are too high ost veterans to pay, and VA per diem costs will be quite high for this group, ease let me know if this Center can provide any additional information, or be sistance to you at any time. timated per diem cost. This hospital has had experience with nursing-care ents over the past 3 years. We have found that the treatment of these pas costs much more than the regular G.M. & S. or T.B. patients. This is esented in personnel, subsistence, drugs, and necessary equipment. HOT SPRINGS, S. DAK. MARCH 18, 1963. stablishment of nursing-care beds at this Center could be provided by converof domiciliary quarters units. Conversion of first unit as needed would pro28 beds. Cost of renovating this unit, $2,100; initial equipment needed, 125; per diem cost, $13.50. Time required to activate unit, 5 months, asing nursing employees can be recruited. If additional conversion considered, unit would provide 28 to 30 nursing-care beds. Comparable cost of equipt and per diem as above. Renovation costs would increase by $6,000 per unit rovide similar bath and toilet facilities. Any extended conversion of domiry facilities to provide nursing care will require installation of elevators. MCKINNEY, TEX. MARCH 6, 1963. I am taking the opportunity, in reply to your letter of February 25, 1963, of explaining the figures submitted at the bottom of the page. In addition, I received a telephone call on February 28 from the Honorable Ray Roberts requesting that I furnish the Subcommittee on Intermediate Care all information relative to excess buildings which we now have on the station. INFORMATION ON BEDS NOW AVAILABLE At the present time, we have 41 inactive and unused hospital beds in ward 111 and 112. This ward is fully equipped and would require minor design changes costing approximately $1,840 to convert it to a 39-bed unit to fit the needs of the following type intermediate nursing care cases: (a) The chronic brain syndrome, or burned-out psychotic, not a subject for psychiatric hospital or nursing home care-an amiable patient almost completely bedridden. (b) The cerebro-vascular accident (stroke) cases surviving the acute episode but left with moderate to severe residual paralyses requiring special nursing and physical medicine care above that which could be supplied in an average nursing home (for instance, physiotherapy and corrective therapy to prevent contraction deformities.) (c) Cases of multiple sclerosis chronically advanced to a degree, not requiring hospital care, but requiring nursing care of a special type (placement of indwelling catheter, bladder irrigation, etc.). (d) Cases of advanced pulmonary emphysema (so-called pulmonary cripples) requiring compressed air or oxygen nebulization and the skillful use of oxygen and carbon dioxide mixtures. (e) Postpoliomyelitis cases with crippling deformities who must be moved in and out of Rocker beds. (f) Cancer cases, deteriorating or terminal, which do not require hospital treatment, but do require special nursing care with medical supervision to make them symptomatically comfortable. (g) Complicated cases of degenerative disease requiring individual nursing and special care not available in the average nursing home. This would include cases of diabetes with advanced retinopathy, neuropathies, renal involvement, and trophic disturbances. Cases of crippling rheumatoid arthritis who would need some corrective therapy and physiotherapy to prevent further contractures. None of these patients, being chronic, would need real hospital treatment except for their acute episodes, in which case they could be transferred. (h) The aging veteran with moderate to marked senile deterioration who is not a subject for either a psychiatric or a nursing-home care because of his complete dependency, inability to feed himself, care for himself, and tend to his physiological needs. All of the above-cited cases are scattered in our medical population. It is this type of case for which nursing care of the special type needed cannot be furnished in the average nursing home. If special arrangements were made to furnish such care, it would be so expensive that it would preclude the veteran's ability to pay for it. However, this kind of care could be furnished in a hospital setting in an area set aside for nursing care. Such a setting would permit, without delay, use of the hospital treatment facilities whenever needed through transfer to the medical or surgical facilities. We have estimated the cost of this type of nursing care to be somewhere between $17 and $19 per day as contrasted with our present hospital per diem of $27.80. In such a setup, however, this cost would tend to lower our overall hospital per diem. The veteran not needing the special nursing care outlined above can be cared for in a nursing home at a cost of $150 to $250 a month. For the most part, we have no difficulty in assigning a veteran patient in this locale to such a nursing home. In many instances, the nonservice-connected pension, plus the aid and attendance, will furnish such_moneys in agreement with the nursing-home operator to admit such a patient. In other instances, any difference for the agreed care can be made up by the family. |