WA LEGISLATIVE POLICY-ADMINISTRATOR OF VETERANS' AFFAIRS WEDNESDAY, APRIL 3, 1963 HOUSE OF REPRESENTATIVES, Washington, D.C. e committee met at 10 a.m., pursuant to call, in room 356, on House Office Building, Hon. Olin E. Teague (chairman of committee) presiding. r. TEAGUE of Texas. The committee will come to order. e have with us this morning Mr. John Gleason, Administrator of rans' Affairs, and I think a good part of the Veterans' Adminis on. TEMENT OF JOHN S. GLEASON, JR., ADMINISTRATOR, ACOMPANIED BY W. J. DRIVER, DEPUTY ADMINISTRATOR; H. MONK, ASSOCIATE DEPUTY ADMINISTRATOR; DR. H. M. IGLE, ACTING CHIEF MEDICAL DIRECTOR; AND ROBERT C. BLE, JR., ACTING GENERAL COUNSEL r. GLEASON. Yes, sir. r. TEAGUE of Texas. We have asked the Administrator to discuss ng homes and related types of care, pensions, judicial review, ance, compensation, peacetime G.I. bill, and an overall general ssion on the whole of VA policies, and tell us the position of the inistration on each of these different programs. If you look at his ment, it is, I would hope, a rather complete statement, and from ooks of it, it is. It is divided into sections. I would like to est to the committee that we go through it section by section, after we go through one section, we have questions on that section proceed through the statement in that way. r. Administrator, it is good to have you with us. I think this is irst time you have been before the full committee, isn't it? r. GLEASON. Yes, sir, that is correct. T. TEAGUE of Texas. You have had a long honeymoon. I hope have enjoyed it. r. GLEASON. I hope it isn't over. r. TEAGUE of Texas. All right, sir. Go right ahead. he letter of the chairman of February 20, 1963, to the Adminisr of Veterans' Affairs follows:) HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS' AFFAIRS, Washington, February 20, 1963. OHN S. GLEASON, JR., ar Mr. GLEASON: The committee is planning a hearing in a few weeks for urpose of discussing major legislative proposals which are pending before the latter part of March. We would like to have you appear before the committee to discuss veterans' programs and changes which have been proposed. It is the purpose of this letter to suggest the areas of discussion. I will set out below some areas for discussion and indicate questions which will be of interest. I believe that a good approach would be for you to prepare a statement covering the subject matter outlined below, which you could read to the committee. Committee members would be given an opportunity to ask questions on each major subject area. Subjects for discussion are: 1. Intermediate or nursing care to be provided certain veterans with chronic conditions: I am appointing a special subcommittee on this subject and it is our intention to develop a program of intermediate or nursing care for elderly veterans. Quite a number of bills are pending before the committee now; however, H.R. 224 contains several proposals. We will be particularly interested in having you discuss the following: (a) What steps can be taken to place into service immediately 1,000 unused beds in the VA system devoted to intermediate or nursing care. This plan contemplates the use of existing VA facilities and does not anticipate construction of new facilities. It is recognized that additional staffing and, in some instances, additional equipment would be necessary. (b) The raising of the aid and attendance allowance to a level which would be sufficient to provide care in a private nursing home in most areas of the country. (This subject will be mentioned under the heading of non-serviceconnected pensions since any raise in the aid and attendance allowance would probably come through amendment to Public Law 86-211.) (c) Revision of the formula for subsidy to State soldiers' homes to include payment of the subsidy for those individuals receiving nursing and hospital care and a program of matching funds for capital improvements by State homes to provide additional hospital and nursing home facilities. (d) A program for the furnishing of all or part of the drug cost incurred by aid and attendance veterans. 2. Non-service-connected pensions: The committee has approximately 66 pension bills pending before it. About one-third of these are identical to H.R. 2332. About 10 are similar to H.R. 3745 of the last Congress. About a dozen are general $100 per month pension bills and the remainder propose various changes in existing law. The major proposals advocated by various organizations are H.R. 33, H.R. 1927 and H.R. 2332. Several weeks ago I requested a report and cost estimates on these bills. It is hoped that by the date of these hearings tentative cost estimates are available and you will be in a position to discuss these proposals and outline the position of the VA with regard to them. The Veterans' Affairs Committee and the VA have made extensive studies of the operation of Public Law 86-211, with particular emphasis on the failure of several hundred thousand veterans and widows to elect the higher benefits of Public Law 86-211. These findings have been either ignored or rejected by certain veteran groups. The findings of VA in this regard should be reviewed. You will probably be questioned as to the general policy of VA with regard to changes in the non-service-connected pension program. 3. Service-connected compensation legislation: There is a wide variety of specialized legislation pending on this subject. However, the bills being advocated by various groups, which would result in considerable expenditures, are those which propose the payment of a dependency allowance to those veterans with dependents who are receiving compensation less than 50 percent. There are also proposals pending which would, if enacted, result in revising the rating schedule to create a mathematical relationship 10 percent through 100 percent in compensation payments. H.R. 2582, sponsored by one of the organizations, embodies this proposal and the dependency allowance below 50 percent proposal. Will you please be prepared to comment on the cost of these proposals and state a position for the VA. 4. Survivor benefits: The President in his budget message recommended increases in compensation for dependent parents and surviving children. We have pending H.R. 211 and the report filed by VA indicates that this bill is acceptable to the administration and carries out the recommendations of the President. This bill does not provide for increases in compensation for surviving widows. There is pending before the Armed Services Committee a military pay proposal, recommended by the administration. If this is enacted, widows would receive an increase depending on the rank of their deceased husband. Would you please analyze the increases for widows which would result from enactment of the military oposal and be prepared to discuss with the committee whether widows be included in the legislation granting compensation increases to dependent s and surviving children. eacetime GI bill: S. 5 has been introduced in the Senate and its sponsor has aced that early hearings are expected. Several similar bills have been uced in the House, including H.R. 2637, which propose to extend education aining benefits to peacetime veterans but with a reduced scholarship allowIn view of the Federal aid to education program recommended to the ess by the administration which costs several billion dollars, there has been reased interest in legislation proposing educational benefits for veterans. ou please be prepared to discuss the position of the VA on these legislative sals. committee proposing There are other bills H.R. 220 and H.R. nsurance: There are several bills_pending before the ing of the National Service Life Insurance program. sing reopening for service-connected veterans only. which provide for a modified life plan with reduced premiums for certain s of term insurance, are pending before the committees. H.R. 2135 prodisability income for certain disabled veterans less than totally disabled. 1 you please be prepared to discuss the administration's position on these Judicial review: There are several bills pending before the committee to de judicial review of decisions of the VA. H.R. 3531 is typical of these bills. d you please be prepared to discuss the position of the VA on this proposal. . Meadows, staff director of the committee, will be in contact with Mr. field regarding a date. If clarification is needed of any of the questions to be ssed or of the procedure to be followed, please let us know. Sincerely yours, OLIN E. TEAGUE, Chairman HOUSE OF REPRESENTATIVES, COMMITTEE ON VETERANS' AFFAIRS JOHN S. GLEASON, Jr., inistrator of Veterans Affairs, ans' Administration, Washington, D.C. EAR MR. GLEASON: This has reference to the letter dated February 20, 1963, ding a hearing to be held in March on general policy matters affecting the rans' Administration's programs. There would like to supplement the letter and include an additional subject. tached a copy of H.R. 4347, a bill to limit the authority of the Veterans' inistration and the Bureau of the Budget with respect to new construction teration of veterans' hospitals. Will you please develop a report on this and be prepared to present your report and discuss the bill during these ngs. Sincerely yours, OLIN E. TEAGUE, Chairman. Ir. GLEASON. Mr. Chairman and members of the committee, I come this opportunity to discuss with you some very important ters affecting our major benefit programs for veterans. This will ude certain legislative proposals which are now before you for sideration and which, if enacted, would very materially alter these grams or authorize new ones. In the main, I shall gear this stateit to the agenda set forth in the Chairman's letter of February 20, 3. ursing home and related types of care: As the committee well ws, we are faced with an ever-growing problem concerning the insing numbers of our aging war veterans who require a type of not generally provided by the present system of hospital, domiry, and outpatient services. For example, there are now in VA pitals several thousand veterans who have received maximum pital benefits and are now in need of a form of care which is proed in nursing homes or similar facilities. ssistance were available. Others would accommodate well to a oster home environment. The crux of the problem is that despite our efforts to place these atients in suitable community facilities, it is often impracticable to lo so, especially where the veteran's income is severely limited. This ituation is progressive and is becoming more widespread. Where we re unable to find a place for the chronically ill veteran who has eached the point of maximum hospitalization, we sometimes must etain him as a patient for an indefinite period of time. This limits he availability of beds in our general hospitals for the care of other eterans who require definitive hospital treatment. We are hopeful that the restoration center plan will produce good esults. As you know, this is now being tried out at Hines, Ill., and vill be tested at East Orange, N.J. In this effort we concentrate on ehabilitation of chronically ill veterans who have been transferred rom the hospital and offer a real prospect of early return and adjustnent to their home community. There are other patients who cannot e rehabilitated to this point and need attention in a nursing home or ther suitable environment. What to do for this group poses a large [uestion to which we have not found the answer. In the last Congress, the House of Representatives passed a joint esolution reported by this committee which would have authorized $300,000 for a special study in this field. This would have included a ilot project involving various kinds of services outside VA facilities, oupled with supplemental payments, to test ways and means for neeting the needs of chronically ill patients who have received maxinum hospital benefits. We agree that a suitable study should be nade but feel that it should not be as broad as that provided by the esolution which is again before you this year. Our budget requests for 1964 include an item of $150,000 for initiatng a special study of this kind. If this is granted, we will explore carefully the availability and adequacy of community facilities in elation to the needs and circumstances of veterans actually hospitalzed in VA facilities in various localities. In developing solutions to his difficult problem it may ultimately be necessary for us to try arious approaches. Your committee is interested in the possibility of placing into servce a number of unused beds in the VA system to provide nursing home or intermediate type of care. It has been our practice to interperse chronically ill patients who continue to need active hospital reatment with other patients and not to set them apart; and we ave some serious doubts about the advisability of providing separate acilities for intermediate care, as distinguished from nursing-home care. As to those whose primary need is for attendant type care such as hat provided in skilled nursing homes, we are confronted at the outet by a serious question of policy. How far should the Federal Government go in assuming a special responsibility to veterans in his field? This responsibility is being partially met through existing Federal programs for the aged under which State and local expenditures for nursing-home care qualify for Federal matching grants. For example, he Bureau of the Budget tells us it is estimated that during fiscal |