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 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?

31-706-64-pt. 1-42

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 HOMES

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 MAGNUSON. And then you might be able to

Mr. 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

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 communityI 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 being given for the type of patient who no longer needs the attention of a physician, but who has disabilities that are such that he cannot maintain himself and look after his personal needs.

Senator ALLOTT. Isn't that what I said?

Dr. McNINCH. He does need skilled nursing. It is more than housekeeping 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. What you are saying, you want to have a place where a person can live after he no longer has the need of hospital 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 needing a physician than the others. This would be available of course on call 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.

PROGRAM IN STATE VETERANS' HOSPITALS

Senator MONRONEY. What about the State veterans' hospitals? Will you continue that program? Most of these have been of the nursing home type, as well as hospitals for more serious disabilities, haven't they? Perhaps not.

Mr. GLEASON. No, sir; most of these homes are more like the domiciliary program.

Senator MONRONEY. You like to have hospital facilities connected with them. We do in my State.

Mr. GLEASON. This is more the exception rather than the rule.
Senator MONRONEY. It is?

Mr. GLEASON. Yes, sir.

NO REOPENING OF HOSPITALS

Senator MONRONEY. These nursing homes that you anticipate making from converted VA facilities, this will not require any reopening of hospitals?

Mr. GLEASON. No, sir.

Senator MONRONEY. That have been discontinued?

Mr. GLEASON. No, sir; and it won't stop our closing of hospitals that we have programed to close.

Senator MONRONEY. You wouldn't consider maybe converting these over to full nursing homes?

Mr. GLEASON. Not unless the program sometime in the future gets so large. We just don't anticipate something like that.

REACTIVATION OF UNUSED SPACE

Senator SALTONSTALL. Assume that you have empty beds in a hospital, we will say 30 empty beds or 50 empty beds, and you have 30 of these people that you might put in a nursing home. Wouldn't it be more economical and easier for you people and more efficient to keep them in those beds?

Mr. GLEASON. That is exactly what we are going to do, Senator. We are going to reactivate that one ward or wing, whatever it might be that is not now being used or utilized, and turn this wing or ward to the care of nursing home type patients.

Senator SALTONSTALL. It would be all the same heating, all the same food, and everything like that.

Mr. GLEASON. Yes, sir.

Senator SALTONSTALL. But just a different type of care?

Mr. GLEASON. Right, and we think we can cut this cost from around $26 a day down to $12.50 a day per patient.

Senator SALTONSTALL. That is very interesting.

POSSIBLE UPGRADING OF NURSING HOME STANDARDS

Senator MAGNUSON. It seems to me if you got the authority to be able to go outside in cases that you would be justified and place veterans in competent reliable nursing homes, that that very authority itself would upgrade all over the United States the standards of nurs

ing homes, so that they might be taking advantage of the opportunity to have a little more income in taking care of veterans, wouldn't it? Mr. GLEASON. That is a possibility, Senator.

Senator MAGNUSON. In some places they are pretty bad.

Mr. GLEASON. Some are terrible.

Senator MAGNUSON. In some places they are good. I must say in my State we happened to have some problems before people woke up to it but now they have a real stringent nursing home code. If this could be done all over the United States, it might save the taxpayers a little money, and use them and have the secondary effect of upgrading, because you wouldn't put them in unless they were reliable.

COSTS OF PRIVATE CARE

Mr. GLEASON. You see, Senator, it would cost us so much more to put them in most of the nursing homes that are reputable.

Senator MAGNUSON. Yes.

Mr. GLEASON. If these people had any money, we wouldn't be putting them in our nursing program at all, you see. These are indigents. Senator MAGNUSON. The whole program might have a twofold beneficial effect for the veterans and for the people. Are there any questions on staff service or data management?

DATA MANAGEMENT

Senator ALLOTT. We are up against the same thing on this data management.

Senator MAGNUSON. Yes.

Senator ALLOTT. We are always going to save money and we come back up with more employees.

Mr. GLEASON. Not quite, Senator. I think, sir, as we go through the statement, you will see where the number of employees is decreased. Senator ALLOTT. In this particular area you have got an increase of 34.

Mr. GLEASON. Yes, sir.

Senator MAGNUSON. But a lot of those people have come from Mr. GLEASON. All of these people have come from the other divisions.

Senator MAGNUSON. Have come from some other division. Therefore there is less in the other division.

Senator ALLOTT. They are still going up from 872 to 906.

Mr. GLEASON. That is right, and I wouldn't be surprised, Senator, if next year it went up as much or even a little bit more.

Senator ALLOTT. I will.

Mr. GLEASON. In data management that is.

Mr. MONK. For the very reason that the chairman pointed out.

NURSING HOME BED COSTS

Senator SALTONSTALL. General, a hasty calculation. If you are going to save $12 a day on these patients, and this is going to cost you $25 million, theoretically you are going to pay for it in 3 years; is that correct?