taken into consideration in arriving at our estimates. We feel that our estimates present a realistic picture of the amounts required if we are to activate nursingcare beds in the building available at the station. A local committee, with myself as chairman and the assistant hospital director, chief of staff, and other key department heads as members, has given your letter serious consideration, and the answers presented to you were arrived at after thorough study and discussion of all essential factors. We enjoyed working out the answers to your questions, and it is hoped that the information presented to you will prove to be of value. If you desire further details, please do not hesitate to ask us and we will make every effort to give you whatever additional information you need. We wish you and your subcommittee every success in conducting the hearings. It is hoped that you will be able to arrive at definitive answers to the questions arising in relation to the type of care required by our older veterans, as we know that with the increasing age of our veteran population more and more information will be required if we are to be able to meet their medical needs. NUMBER OF NURSING-CARE BEDS WHICH CAN BE PROVIDED At the present time, we have two buildings which are not being fully utilized. They are building No. 75 (a small building not economically usable as a ward) which is vacant and building No. 74 (wards 4 and 5). The lower floor of building No. 74 (ward 4) is now in use as office space for nursing service, social work, psychology service, and the contact representative. Building No. 74 was formerly used to house ambulant and semiambulant tubercular patients. After surveying the available space, we reached the opinion that the offices now located on ward 4 could be moved to building No. 75, making building No. 74 (wards 4 and 5) available for use for nursing-care beds. There would be 32 beds on each ward, or 64 beds total in the building. Cost of renovation-Building No. 74 1. Construction of elevator shaft and installation of new fully automatic elevator___. 2. Installation of additional sewer and water facilities. 4. Improvements and changes to existing toilet and bath facilities-- 6. Remove existing casement windows; enclose areas including the new screens_ 7. Painting complete interior_ Total. $30,000 1, 300 2,500 1, 500 4,500 5, 700 1, 800 47, 300 In computing our estimate of per diem cost, we estimated first that the average daily patient load of the building with 64 beds would total 55 patients, i.e., approximately 85 percent of capacity. In computing costs, we estimated that it would be necessary to add personnel and supply costs as indicated below: Drugs and medicines, other medical supplies, utilities, linen, etc.- 22, 685 22, 215 Total costs___ 153, 534 Dividing 55 into the total cost of $153,534, we arrive at a per diem cost of $7.65. It should be noted that we have not included any of the overhead costs of the hospital operation in the per diem figure. It was our opinion that we should show only the additional costs brought about by the activation of the 64 nursingcare beds. No areas except those indicated above as requiring additional personnel were considered as we can absorb the additional workload created by the activation of a nursing-care ward without increasing numbers of employees in all other departments. Our boiler plant facilities, laundry, and kitchen have more than adequate capacity to meet any increased demand which would arise through the activation of these beds. ESTIMATED TIME (MONTHS) TO ACTIVATE NURSING-CARE BEDS We estimated that it would take 5 months to fully activate the nursing-care beds, since it would take time to advertise and award bids for the construction of an elevator from the first to the second floor of building No. 74. This building has never had an elevator, and it would be necessary to construct shafts and make all necessary installations. It might be possible to activate one-half of the ward at an earlier date, but we felt we should estimate 5 months for full activation in order not to present too optimistic a picture regarding time required. WHITE CITY, OREG. MARCH 7, 1963. Our entire staff has given much thought and study to the possibility of establishing some nursing-care beds at this domiciliary. The staff recalls your visit here in July 1960. You are aware that this station is one of three straight domiciliaries without the general medical and surgical facilities of a Center. This would make it impossible from the medical-care viewpoint to establish nursing-care beds or an intermediate-care service without the required supporting medical services. Our medical staff advised that a portion of the beds would have to be designated and staffed as an acute service. This is essential to assure acceptable medical care. In keeping with the criteria of the D.M. & S. service for standards of care in the VA, we have tried to be as realistic as possible in projecting our estimated requirements for the cost of staffing, renovation and equipment, and per diem: Number of beds which can be provided.. Estimated cost of renovation___ 275 $527,000 (This includes expansion of various clinical, dietetic, canteen, and Estimated cost of equipment.--. $330,000 (This includes $108,000 for basic items not classified as equipment and for essential medical supplies that would have to be on hand before units could be activated.) Estimated annual cost of staffing.. $743, 000 Estimated per diem cost___ $28 Estimated minimum time to activate these beds.. (months) __ 6 careful study of the existing facilities for conversion into patient care nical areas an because of the possible difficulty to recruit required staffing, ve determined that 275 beds could be established. We propose that at 00 of these beds must be staffed and equipped for the acutely ill. The f service and care established also has a great bearing on our ability to and retain professional personnel. he present time, we maintain an average daily number load of 940 with 025-bed domiciliary. Members requiring short-time medical and nursing re presently admitted to our domiciliary infirmary. Those requiring ve hospital care are transferred to a VA hospital. This includes transthose requiring intermediate care. In our proposal the domiciliary iny would be eliminated and would become a part of the 90 beds for the acutely his is emphasized, since there would be quite a demand for both acute termediate care of our present domiciliary member population. will be happy to furnish any additional information that you may desire. WOOD, WIS. ding No. 43 with 226 beds could be activated in the early part of fiscal year about 30 months from now); balance (800 to 1,000) could be activated in ear 1968 (about 66 months from now). These possibilities and the timing to the construction of a new hospital here which is now in progress. plans would necessitate VA policy decisions. The completion of the new l would permit release of existing hospital buildings for accommodation of liary activities. The plans, in part, would be for consideration of the tion of the best of the domiciliary buildings for the 800-1,000 nursing-care The 226 beds above referred to are in a hospital building somewhat relocated from the main hospital. This building will also be vacated when w hospital is completed. ther possibility, perhaps the most practical and most economical, would be vert for nursing care the present main hospital building when it is vacated. would put the nursing-care facility adjacent to the new hospital building y affording flexibility in the utilization of staff. In this event, the best of isting domiciliary buildings plus building No. 43 could be used for domactivities. ming that authority would be available for nursing care by the VA, the ng agency policy decisions would still be involved: Use of domiciliary buildings, eventually to be vacated, for nursing care 1 of abandoning them. Use of building No. 43 for nursing care instead of creating a separate liary activity in this building. Use of existing main hospital building when vacated as nursing-care facility I of domiciliary activity. above is not submitted as a firm opinion or a recommendation that the VA assume responsibility for nursing care for veterans. The statement is an expression of possibilities if legislative authority should be developed. SUMMARY ibparagraphs (1), (2), and (3): under (1) and (2) combined would provide 226 beds in fiscal year 1965 and 1,000 in fiscal year 1968; : Renovation, $7 million; equipment, $75,000; renovation cost includes ed cost of renovation which would still be required in existing hospital g needed for conversion of domiciliary. under (3) would provide 800 to 1,000 beds in fiscal year 1956; : Renovation, $2 million; equipment, $30,000. ; estimates are not based on detailed study because of time limitation. ON INTERMEDIATE CARE FEBRUARY 25, 1963. Assuming the existence of authority and availability of funds, the subcommittee would like to know how many nursing-care beds you could provide and staff at your installation and the cost of renovating or modernizing existing structures (including equipment), but not involving the construction of any new buildings. Please indicate your reply in the space provided. Number of nursing care beds which can be provided__ Cost of renovation. Cost of equipment Estimated per diem cost- Estimated time (months) to activate nursing care beds.. Letter sent to stations listed on page 151 and the following who submitted neg ative replies: Mr. TEAGUE of Texas. As you say, there will be further study by this subcommittee. May I ask one question? You state on the first page: "For example, there are now in VA hospitals several thousand veterans who have received maximum hospital benefits and are now in need of a form of care which is provided in nursing homes or similar facilities." Mr. GLEASON. That is right. Mr. TEAGUE of Texas. Can you keep a veteran like that legally? Mr. GLEASON. Mr. Chairman, there doesn't seem to be much else that we can do with them if there isn't any place for them to go. Mr. TEAGUE of Texas. That is true, but I didn't ask you that. I asked, legally, can the VA keep a veteran that the doctor says has received maximum hospitalization? Mr. GLEASON. I am afraid I might have to ask the General Counsel that question, Mr. Chairman. Mr. TEAGUE of Texas. Let's let him answer it. Identify yourself, please. Mr. FABLE. Robert C. Fable, Jr., General Counsel. There is no question, sir, that title 38 gives complete authority to the Administrator of Veterans' Affairs to give hospitalization or domiciliary care to all veterans who need any type of institutional care. Nursing home care is a phrase that is not known to our law, but the Administrator has the legal authority today to give complete institutional care to all types of veterans regardless of the type of disability which affects them. Mr. TEAGUE of Texas. Now will you answer the question I asked? Legally can you keep these veterans? Mr. FABLE. Yes, sir. |