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a shrinkage or absorption of 10 percent of that. Of course it hasn’t worked down to the departmental level. Mr. Monk. No, sir, it is not in the request. Mr. GLEAsoN. When we get the medical care that will show up for the increases of the doctors as programed. Senator MAGNUsoN. But if that is passed this session, it depends on what date they make it take effect. Some of the bills as I understand it, Mike, are retroactive, I mean the proposals. One is retroactive to January 1 and the other proposes to take effect this next January. Then you would have to come up. I suppose there would have to be a supplemental for all departments if that took effect. Senator MonroNEY. The President's overall budget. Senator MAGNUsoN. Do you have any further questions on that? Senator MoMRoNEY. No.

NURSING HOME BEDS

Senator MAGNUson. You keep referring to 2,000 nursing home beds. Where is that located?

Mr. GLEAsoN. They will be located throughout the entire country.

Senator MAGNUson. It isn't one place?

Mr. GLEAsoN. No, sir.

Senator MAGNUsoN. What is the purpose of this, just what the name implies?

Mr. GLEAsoN. Yes, sir.

Senator MAGNUsoN. The older veterans?

Mr. GLEAsoN. We have approximately maybe 5,000 to 7,000 veterans who are currently in our hospitals that have received maximum hospital care, and they have no place to go, so President Kennedy approved the expansion of this program to include 2,000 nursing home beds, so that we could start a new program, in addition to the hospitalization and domiciliary program.

Seantor MAGNUsoN. o would relieve the bed situation by being able to take these people?

Mr. GLEAsoN. In the hospitals, yes, sir.

Senator MAGNUsoN. These people who unfortunately have become somewhat terminal cases, isn't that correct?

Mr. GLEAsoN. Not just terminal cases but their age and illness just prevents them from taking care of themselves.

Senator MAGNUson. But they can be taken care of probably better in this type of accommodation.

Mr. GLEASON. Yes, sir; we think it is more economical.

Senator MAGNUson. Than in the actual hospital; is that correct.

Dr. McNINCH. Sir, they can be taken care of as well and at less expense.

Senator MAGNUson. But that is all over.

Mr. GLEASON. Yes, sir. It wouldn't be necessarily located in each State, Senator.

Senator MAGNUson. Put in the record where you are going to start the program.

Mr. GLEASON. Yes, we can supply that.

[graphic][graphic]

(The information referred to follows:)

Number of beds

60 50 44 36 38 60

36

Locations for nursing home program
Group I (activate fiscal year 1965):

Alexandria, La--
Biloxi, Miss__
Bonham, Tex.
Buffalo, N.Y.---
Cincinnati, Ohio.
Dayton, Ohio.
Dearborn, Mich.
Dublin, Ga----
Fargo, N. Dak.
Houston, Tex-
Indianapolis, Ind.
Lebanon, Pac---
Livermore, Calif.
Los Angeles, Calif.
Mountain Home, Tenn..
Poplar Bluff, Mo---
Reno, Ney--
Rutland Heights, Mass.
Wadsworth, Kans_

76 24 68 46 40 36 75 80 46 22 105 50

[blocks in formation]

Total Unselected---

315 693

Total, group II.

1, 008

Total...

2,000

PROCEDURE IN USE OF NURSING HOMES

Senator YOUNG. Would you yield for a question, Mr. Chairman? Senator MAGNUSON. Yes.

Senator Young. You send veterans now from the hospital to nursing homes when you feel you can do no more for them? Mr. GLEASON. This is at their

own expense, not at the Government expense. Some of these people, Senator, have no home to go to. They are all alone in the world, and this is why we figure that we will only need 2,000 to start this program off.

Senator Young. I know some cases now where they haven't much income of their own.

Mr. Gleason. They may be receiving compensation or a pension and they may be able to pay for it themselves. This is what we prefer to do. But if they have no family at all and they can't possibly care for themselves, then we have to do something with them.

Senator Young. You plan to take care of these people yourselves then ?

Mr. GLEASON. Yes, sir.

Senator Young. Rather than putting them into private institutions?

Mr. GLEASON. We think that we can relieve the hospital program, as the chairman just mentioned, and do it more economically in a nursing home program than we can in the hospital system.

UTILIZATION OF PRIVATE NURSING HOMES

Senator Young. Couldn't you utilize private nursing homes?

Mr. GLEASON. Sure we could under legislation that has been proposed.

Senator Magnuson. That is the question I was going to ask.
Mr. GLEASON. Oh, yes.

Senator MAGNUSON. Is there some reason why you can't go out and get a competent nursing home and pay for that, rather than to do this?

Mr. GLEASON. We don't think we can do it as economically, Senator.
Senator MAGNUSON. You don't?
Mr. GLEASON. No, sir.

Senator MONRONEY. There is now a very great supply of suitable fireproof facilities in the country.

Mr. GLEASON. That is right.

USE OF EXISTING FACILITIES

Senator ALLOTT. Where are these going to be constructed? What are you thinking of now? What are your plans?

Mr. GLEASON. There is no new construction in this program at all, Senator. This is existing facilities. Under the President's directive of a year ago, we are required to use existing facilities that we have in the Veterans Administration now.

Senator ALLOTT. Where do you contemplate establishing them?

Mr. GLEASON. We are going to furnish that for the record. There are approximately 40 locations throughout the country,

Dr. McNINCH. They run from 30 to 70 beds, because this generally is the capacity of existing facilities that are available in the VA hospital system. They will all

They will all be in VA facilities that contain a hospital. They will not be with a separate domiciliary facility. They should have available to them medical care if this becomes necessary.

Senator MAGNUSON. What is bothering the committee, and there may be great justification for this, surely we want to take care of them, is that we don't want to embark upon a nursing home program here, the Government, if and when there are competent reliable private nursing homes that are available. Now it is my understanding that these patients are sort of in between. They are nursing home patients but they require hospital care at all times.

Mr. GLEASON. No, sir.
Senator MAGNUSON. No?
Mr. GLEASON. No.
Senator MAGNUSON. Then why have them in the hospital?
Mr. GLEASON. Because there is no other place to put them right now.

Senator MAGNUSON. Couldn't you go out and find a competent nursing home?

31-706-64pt. 14-42

Mr. GLEAsoN. This we try to do, Senator, but there just aren't enough competent nursing homes.

Senator MAGNUsoN. This is the point I make. If that is correct, then of course naturally you would have to do this.

PEnding LEGISLATION ON NURSING Homies

Mr. GLEASON. There is pending, I would like to mention to the committee, there is pending right now before the Senate H.R. 8009, which deals with nursing homes, that has passed the House and is now before the Senate. Senator ALLOTT. Is that nursing homes under the Veterans' Administration? Mr. GLEASON. The whole area. Mr. DRIVER, This would give us legal authority to buy facilities on the outside now. We have no authority but this bill would provide that. Mr. GLEASON. The only way a veteran can go into a nursing home now is if he is getting pension or income from other sources. Once he receives maximum hospital care, then we discharge him and what nursing home he goes into, this is his own choice or his family's. Senator MAGNUsoN. But you could pay for the care of a veteran, socalled outside. Mr. GLEASON. Not even for a service-connected disability. Senator MAGNUson. I understand that, but this could be accomplished by this bill. Mr. GLEASON. Oh, yes, very definitely, yes. Senator Most son. And then you might be able toMr. GLEAsON. That is very true. Senator MAGNUsoN. I would think the cost, if you can find available places, would be less than doing this. Maybe it wouldn't, I don't know. Senator MonroNEY. Would that make a non-service-connected veteran eligible for a nursing home? Mr. GLEASON. Yes, sir. Senator MAGNUsoN. I think this committee would look very carefully and with some feeling about the Government going into the nursing home business, if there are competent available and reliable nursing homes in an area. We would rather give you the authority to make the monthly payment, so that we could continue, because the need for competent nursing homes is growing and growing and growing, and this would be some help to get better ones and good ones. Senator ALLOTT. May I ask a question to clarify? Senator MAGNUson. Yes. Do I state it right about this?

FUNCTION OF PROPOSED NURSING HOME SERVICE

Senator ALLOTT. Yes, I think I feel like you do about it. The one thing I want to clarify in my own mind is this. Do I understand it that the so-called nursing home service that you propose, and I will address this to you, doctor, is primarily for the purpose of taking care of those people who have passed the stage where active minute by minute hospitalization and care by nurses and doctors, is required, and

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who can be sustained and taken care of primarily by sort of a general
housekeeping and care activity, but for whom the Government still
has a responsibility? Now do I have the right concept of this or not?
Dr. McNINCH. Not quite, sir. The difference is that a patient in
one of our proposed nursing home beds, and this is true in what is
now being conceived of as nursing homes in the civilian community—
I might point out this term has been used very loosely for many years
in civilian life, varying from a home for the aged to a home where
actual nursing care is É. given—for the type of patient who no
longer needs the attention .# a physician, but who has disabilities that
.* that he cannot maintain himself and look after his personal
IleeCIS.
Senator ALLOTT. Isn’t that what I said?
Dr. McNINCH. He does need skilled nursing. It is more than house-
keeping type personnel. He will need skilled nursing personnel.
Mr. GLEAsoN. That is why we have it with our hospitals.
Senator MAGNUson. There has to be some reason to connect it with

a hospital.
Mr. GLEASON. That is right. -
Senator SALTONSTALL. at you are saying, you want to have a

place where a person can live after he no longer has the need of hos

pital care. It isn't going to be special nursing or anything like this.

It is just going to be really a home, isn’t it?
Dr. McNINCH. No, he will need skilled nursing care.
Senator SALTONSTALL. Will you have nurses there?
Dr. McNINCH. We will have nurses there, registered nurses.

MEDICAL CARE IN EMERGENCIES

Senator SALTONSTALL. Where will you get the medical care? Dr. McNINCH. They will not need medical care unless it is an emergency. These people are for the most part elderly, and having disabilities they of course are more heir to an acute emergency .# a physician than the others. This would be available of course on cal from the hospital. Senator SALTONSTALL. And how far will they be from the hospital? Dr. McNINCH. They will be part of our existing hospital complex. There is no new construction. We do have facilities, unused buildings that we have accumulated over the years, and these will be renovated. Senator SALTONSTALL. Then these will be alterations of existing buildings? Dr. McNINCH. That is right. Senator ALLOTT. I want to clarify this thing then. My original statement would be correct because I think I do have the right concept of this thing, except as you say, they would need nurses. They would need nurses for ordinary shots, and for this reason you would have to have them rather than a housekeeper. Dr. McNINCH. That is right. Senator ALLOTT. But they are past the stage where they need active medical care day by day or hour by hour? Dr. McNINCH. Right, sir.

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