1962 total expenditures from all sources under these programs ursing-home care exceeded $200 million and represented almost ercent of all medical-care expenditures under these programs. ans, of course, may qualify for this assistance. The committee o aware of the President's recommendations concerning the enent of a hospital-insurance program for the elderly under the security system. This would include nursing-home services diately following discharge from a hospital. retofore this has been regarded as chiefly a community respony, with such Federal assistance as may be extended under general rograms. Meeting the problem at the community level also has ractical advantage over regional Federal facilities of keeping the nt in or near his accustomed home surroundings. m very doubtful that we can place a limited number of unused ties in our hospitals into use for nursing home type care without ng a heavy commitment to the future. This would doubtless be ved by insistent and quite logical demands for increasing these ties to meet the mounting requirements for this care from our and aging war veteran population. hink we must realize that the initial step in providing nursing e care on a small scale could not be held to those who have ved maximum hospital benefits in VA hospitals. This would the foundation for an expanded Federal system to furnish this of care, at the complete expense of the Federal Government, large potential group who have not been previously admitted to hospitals. turn, this could lead to the problem of how to establish and tain sufficient nursing home facilities to meet the ultimate ands to a substantial extent. To do this would require either dditional layer of nursing care facilities at considerable cost to Government or a sharp change in planning to substitute nursing e beds for either hospital beds or the present type of domiciliary mmodations, or both. It is by no means fanciful to foresee that e now begin the process of setting up a VA nursing home estabnent our planned hospital program may be adversely affected. s you know, we have a substantial number of chronically ill ents in our hospitals who are receiving a type of care sometimes red to as intermediate care. Some of these will finally reach the t at which medical attention is merely incidental and their essenneeds could be met through nursing home services. As I have cated, others who were admitted for hospital care have already hed the nursing home stage but cannot be placed in community ities and we must continue to provide for them. hese groups offer a sufficient basis, I believe, for an intensive study o the feasibility and soundness of a Federal venture into the ation of nursing home facilities. I have therefore directed that, g with the other study already described, our Department of licine and Surgery with other staff elements shall conduct a careful oration of this matter with a view to developing facts which will er enable us to make a final recommendation on this critical olem. I feel that no actual pilot test of nursing home facilities, such, should be undertaken pending the results of this study. was indicated in the President's recent messages on elderly citizens on health program, the problem of nursing home care which we Successful solution will require the best efforts of all governmental levels and various Federal agencies. We shall, of course, persist in our efforts to facilitate the return of hospitalized veterans to their homes or other community facilities wherever it is feasible for them to do so. Through our social work service we have had considerable success in placing those patients who need not remain continuously in the hospital. During the calendar year of 1962, almost 5,600 patients, excluding psychiatric, were assisted in arrangements for placement in homes other than their own homes. Over 3,100 of them were placed in nursing homes, almost 200 in foster homes, and nearly 2,300 in other facilities such as boarding homes and personal care homes. Of these 5,600 veterans, 21 percent had received 6 months or more hospitalization during their last stay in VA hospitals, and over 72 percent were at least 60 years of age. More than 23,000 patients were helped with planning for their release from the hospital to their own homes during 1962. The special importance attached to this matter by your committee is shown by the appointment of a subcommittee under the chairmanship of Congressman Everett to consider the needs and type of care required by our older veterans. Emphasis on the nursing care aspect is indicated by the requests recently sent by the subcommittee to various hospital directors for information on available facilities at their installations which could possibly be converted to nursing care beds. We shall be pleased to cooperate with the subcommittee to facilitate its consideration of these matters. There are several other avenues open to the Federal Government if it were determined that direct Federal assistance should be provided in the area of nursing home and related types of care. Legislation now before you, H.R. 244, would provide assistance to the States in constructing nursing home facilities for veterans. In relation to this approach, I must note the President's recommendation in his recent health message that the Hill-Burton Act be amended to increase the appropriation authorization for assistance to the States in constructing nursing homes from $20 to $50 million annually. Naturally, our administrative consideration of special assistance of this kind for veterans must take cognizance of what has been proposed by the President on a more general basis. Another proposal before this committee, H.R. 246, would broaden the program of Federal aid to State soldiers' homes so that payment could be made up to $2.50 per day for war veterans admitted to these homes as nursing care members. Payments are now limited to those State home members who are eligible for hospital or domiciliary care in VA facilities. The Chief Medical Director has heretofore advised me that a veteran who requires only nursing home type care is not in need of hospitalization. Since hospitalization is not involved, the veteran admitted to the State home for nursing care only is not eligible for these payments. Likewise, the veteran is not qualified for the payment as a domiciliary member. Apart from the basic policy question regarding the appropriateness of extending Federal responsibility in the nursing care area, partial Federal support for this type of care through payments to State homes would be helpful in meeting the problem to the extent that State facilities for this purpose could be made available. Obviously, such a measure would work unevenly since some States do not have State s, and others. could not or would not provide nursing home care ese institutions. e problem which I have been discussing largely involves those non-service-connected conditions. Our primary responsibility veterans with service-connected disorders, and it could well be ed that Federal assistance in providing nursing home or similar care should be restricted to those whose ailments are of service 1. is is an important factor in appraising a proposal, such as you before you, H.R. 224, to assist veterans entitled to the higher of pension based on the need for regular aid and attendance in hasing drugs and medicine prescribed by licensed physicians. can defray the cost of medicines for outpatient treatment of ce-connected conditions. This cannot be done for non-serviceected disabilities since the outpatient program has traditionally restricted to those whose injuries and ailments resulted from ce. An exception is when we furnish medical services in preparing veteran for hospital admission or to complete treatment following italization. Even though we feel a special concern for the needs ose requiring regular aid and attendance, I would think any move eimburse these pensioners for the cost of drugs and medicines d lay the foundation for providing outpatient assistance on a r basis and to additional groups. believe that enough has been said to demonstrate that further nsive study must be given to the question of what should be done the disabled veteran who must receive care and attention not ided within the range of our existing medical, hospital, and iciliary programs. We are struggling here with a most complex far-reaching issue of Government policy which, as I have said, is iving increased attention on a governmentwide basis. I hope our planned administrative study will contribute toward restion of patients who have received maximum hospital benefits to community and community facilities. In this endeavor, we bee we are also serving the objectives of this committee. nformation regarding nursing-care eligibles in Veterans' Adistration hospitals and nursing-care beds availability in selected hospitals follows:) Nursing-care eligibles in Veterans' Administration hospitals, by areas |