you young. When the wires are all down and your heart is covered with the snows of pessimism and the ice of cynicism, then and then only, are you grown old.

In this meaning I am saying that I feel confident that the Congress at this time will not be a party to the creation of doubt, fear, despair, pessimism, and cynicism, in the later years of our war veterans' lives.

Almost daily there are reports of the special hazards that our men in uniform must face. There is no limit to the sacrifices they must make just to maintain the image of a nation strong enough to meet its worldwide commitments.

They are indeed a special brand of citizens. In the things they are called upon to do in the hot phases of the cold war, they are a reminder of the fact that the veterans of our wars are a special group-and the number and cost of providing for them is a measure of the size and strength of our Nation in war.

We have been disturbed and discouraged by the statements of some of those who have come before your subcommittee. Insofar as veterans and their problems are concerned, there is a negative attitude.

Almost uniformly they express a mental blackout regarding the need to care for the aging war veterans. They do not recognize that no matter whether it was the colonial soldier winning a revolution; the soldier who provided for the survival of the Union; the modern soldier who preserved ours as a free nation; or the present-day man in uniform losing his life in Vietnam or Laos; or the soldiers yet to come the man at arms performs a special service that is a part of our history, is a part of our present everyday life, and will remain in such relation so long as nations exist.

Such witnesses have pointed with pride to other programs in being, but have said little about the costs of such programs. They have discussed relief and welfare programs, with never a word of fear at the costs. They have pointed with pride to programs that are yet to come into existence; and tell us that war veterans should wait for such programs to develop.

They have not recognized that it is seemly that the more veterans there are, the greater dollar cost there will be. Neglecting the special place that war veterans have held in our national life, they complain that veterans are doing better than nonveterans, and so it is proper to downgrade the care for veterans.

When they discuss the other programs that should be used as a stop for improvement of veterans' programs, there is no mention of what the cost will be in the years 2000 and beyond. But when veterans' programs are considered, the first objections revolve around the often faultily projected estimates of cost for the period many decades in advance.

Apparently those who have a negative attitude toward veterans' affairs cannot, or will not, recognize the fact that the cost of veterans' affairs has been constant since the decade 1890-1900, in terms of the percentage of the gross national product.

Nor do those who so proudly point to other programs, either in being or projected for the future, as reasons why there should be no improvement of veterans' care programs, recognize the fact that to the extent veterans are cared for through the Veterans' Administrationthere will be a reduction in present-day, or future-day costs, for other programs.

Lay opinion versus professional interest: One difficulty in finding a solution to the problems of care for the aged and aging war veteran lies in the fact that the layman is at a disadvantage in telling, or attempting to tell, the professional personnel in the VA Department of Medicine and Surgery just how they shall treat the individual veterans involved.

You may use statistical studies such as those reported by the U.S. Public Health Service indicating that by diagnostic category 65.6 percent of all diagnoses found in a 13-State study of proprietary nursing homes had cardiovascular diseases; 25.6 percent were plagued by senility; 11.3 percent had fractures; paralyses, and degenerative diseases of the central nervous system accounted for 5.8 percent; mental disorders afflicted 5.5 percent; neoplasms 4.5 percent; and all other 39.1 percent.

Or you may learn from another phase of the report on the same study that 31.4 percent do not walk or get about; 20.4 percent are in bed all of the time; 55 percent are confused mentally part or all of the time; and 35 percent are incontinent.

The data presented are impressive in indicating the nature of the problem of care. But the procedures, other than financial costs, are still a matter for medical determination. It is for such reasons that the American Legion is disappointed in the apparent delay in the VA Department of Medicine and Surgery in advancing ideas for the care of such people.

In the absence of definitive word from the proper officials in VA, our organization is limiting its suggestions for improvements within the framework of established VA programs.

Veterans' Administration care of aged and aging war veterans: There are two statements of fact that seem proper to be brought to the attention of the members of this subcommittee at this time. Both are from VA sources.

The first relates itself to the urgency of immediate action for what is to be done for the World War I veteran, whether in the field of pensions, medical care, care of the aged and aging, or other fields.

In its July 1962 report of "Veteran Population Projections (19622040)," the Research Statistics Service of VA made the following

statement:

More than 2 million deaths are projected in each 5-year period of the 25 years from 1986 to 2010. The greatest number of World War I veteran deaths will occur between 1966 and 1970; of World War II veterans between 1996 and 2000; and of Korean conflict (only) veteran deaths between 2011 and 2015. The greatest number of veteran deaths (2.63 million) in a 5-year period will occur between 2001 and 2005.

According to tables in the same publication, there will be 841,000 deaths among World War I veterans between 1963 and 1970. And from 1970 to 1975 another 529,000 World War I veteran deaths will

occur.

The second fact is provided by Dr. Oreon K. Timm, in his capacity as assistant chief medical director for professional services. In its March 1963, bibliography of medical care of the veteran in the United States (1870-1960), VA is authority for the statement that the domiciliary is the forerunner of its hospital system of today.

In his introduction to this publication, Dr. Timm included the following:

The first domiciliary and medical facilities for veterans were provided by the Federal Government in 1811 with the establishment of the U.S. Naval Home in Philadelphia as a permanent home for disabled and decrepit officers, seamen, and mariners. The home was first occupied in 1836 and in 1864 a separate hospital building was authorized.

The American Legion position: The American Legion accepts the principle that Veterans' Administration will continue to provide medical, hospital, and domiciliary care for only a certain portion of the war veteran population. We accept the present authorized strength of 125,000 hospital beds and the 18,000 authorized domiciliary memberships as a minimum.

Veterans' Administration has in process a study to determine whether one-half, one-fourth, or some other percentage of the war veterans needing medical and hospital care are being treated in the VA facilities. With the rigid screening for admittance to VA medical facilities, it is a certainty that a minimum of applicants are, or will, come under VA care.

Within the structure of our national executive committee Resolution 52 (May 1963), we hold that the Veterans' Administration has responsibility for care of eligible aged and aging war veterans.

Mr. Chairman, with your permission, I would like to submit at this point a copy of Resolution 52.

Mr. EVERETT Without objection, it may be submitted and entered in the record.

(Resolution referred to follows:)

NATIONAL EXECUTIVE COMMITTEE MEETING OF THE AMERICAN LEGION, MAY 1-2, 1963

Resolution 52.

Commission: Rehabilitation.

Subject: Veterans' Administration care of aged and aging war veterans.

Whereas the Veterans' Administration has responsibility for care of eligible aged and aging war veterans, viz

1. The Veterans' Administration was created to administer the programs established by the Congress in the field of veterans affairs; and

2. That part of the war veteran population 65 and up in age now represents approximately one in four of our male population in such an age group; and

3. The Veterans' Administration should accept its responsibility to care for those war veterans in this age group who otherwise are dependent upon public or private charity; and

4. There are available beds within the existing system, and the currently authorized 125,000 beds, to care for these veterans; and

Whereas the Veterans' Administration must maintain an improved type of domiciliary system at full strength, viz

1. In recent years of high economic standards, the VA has reported some areas in which the domiciliary has not operated at maximum capacity, and this factor has been used as one reason for curtailing the number of beds for members in such facilities; and

2. The VA has not had a firm policy with regard to the type of care provided in such facilities, to the extent that at one time within the past 5 years there was an extensive program planned to improve the conditions under which members lived, were managed, and were prepared for return to home life or its equivalent, and that subsequently such a plan was not placed in operation; and

3. No competent authority within the VA has currently stated positively what is the ultimate future of the domiciliary system, although reductions in bed capacity for members are being announced, with no notice being provided regarding plans to restore such bed capacity now or in the future; and

Whereas the VA Restoration Center has limited field of operation insofar as eligible aged and aging war veterans are concerned, viz

1. While the VA Restoration Center, as operated on a pilot basis, has much to commend for those veterans capable of rehabilitation and return to the work force, it is of little value to the war veteran 65 and up in age; and may not be used properly as a basis for liquidation of the domiciliary system as announced by VA spokesmen in the past (see report of hearings, Senate Special Committee on Aging, August 23 and 24, 1961); and Whereas there is need for a new concept in the VA care of eligible aged and aging war veterans, viz

1. The VA Department of Medicine and Surgery, and particularly in the years since World War II, has maintained a program that is uniquely successful in its general medical and surgical program, has led the field in its tuberculosis program, and has attained new standards of leadership in treating those war veterans suffering mental illness, has pioneered in other areas of medicine; and

2. There is a need for a successful domiciliary system of care to include those aged and aging war veterans not immediately in need of definitive medical and hospital care, but who, through conditions caused by advancing years and lack of resources, are unemployable and lacking in the means for self-support; and

3. There remains a field in which there is a wide gap in the complete care and treatment of the aged and aging war veteran who has reached the socalled maximum hospital benefit, in that for the lack of individual or family capability, or due to the weaknesses of the human frame in the upper decades of life, or for other reasons, he has no place to go upon discharge from the hospital; and

Whereas the Veterans' Administration must abandon its delaying and disturbing policy of reliance on public and private charity and relief and welfare programs under the imperfect and incomplete program of returning certain aged and aging war veterans to the community, viz

1. The VA under the prebed and completion of bed occupancy program has demonstrated that it can expand its care and treatment of war veterans at a minimum of added costs; and

2. The VA has made use of the halfway house, the day care center, and other institutions in and out of the VA, in pursuance of a program for those who have reached maximum hospital benefit and seek return to the community; and

3. The VA has used public and private relief and welfare program funds as a means of getting maximum hospital benefit patients out of the VA system in violation of the principle upon which benefit programs are established for war veterans; and

4. The VA restoration center has much to recommend it as a method of returning the employable veteran to useful life. It has little future as a means for solving the problems of the aged and aging war veteran, and the long-term patient who needs continuing medical attention: Now, therefore, be it

Resolved by the National Executive Committee of the American Legion in regular meeting assembled in Indianapolis, Ind., on May 1-2, 1963, That

1. The American Legion seeks the assistance of Congress to the end that an investigation of present VA plans to reduce the membership capacity of, or discontinue, the domiciliary system may produce sufficient information so that appropriate steps may be taken officially to end the situation under which the membership capacity is being reduced according to a plan which is not fully revealed;

2. Congress be asked to direct the operation of the domiciliary system at full capacity, with authorization for improvement of domiciliary facilities so that existing limitations on care and treatment in such VA facilities may be made more flexible and in accordance with modern practice (when the VA policy of authorizing 125,000 hospital beds was established February 26, 1959, the VA had 17,454 operating domiciliary beds);

3. Congress be requested to survey and investigate the activities of the VA in the field of the aging war veteran, with a view to the enactment of such legislation as will enable the VA to provide for eligible war veterans otherwise in need of adequate social service, domiciliary, and nursing care so that no war veteran may thus become a public charge;

4. Congress be urged to survey and investigate the needs of the aged and aging war veteran with particular attention to the need for legislation to authorize the

provision of further VA care, in some ancillary type of facility, however it may be designated in name, but having the function of caring for those where the onset of age has been accompanied by failing powers denying to such war veterans the ability to lead normally independent lives;

5. The American Legion deplores those expressions of VA policy seeking the termination of domiciliary care and thereby the misuse of the restoration center for such purposes;

6. The American Legion condemns the practice under the guise of restoration to the community of placing any veteran patient of the VA in a public or private nursing home with the cost of such care for the veteran supported in whole or in part by public or private aid and charity.

Mr. CORCORAN. This position is strengthened by the opinion of the Veterans' Administration General Counsel (May 7, 1963)

that there is ample authority for providing attendant type or so-called nursing type care for those admitted initially for that purpose, providing the regulations are changed to authorize admission into the domiciliaries of veterans requiring such care.

Mr. Chairman, I understand that a copy of the General Counsel's opinion has already been introduced into the record.

Mr. EVERETT. That is right, is it not, Mr. Patterson?
COUNSEL. Yes, sir, Mr. Chairman.

Mr. CORCORAN. We believe the VA should accept its responsibility to care for those war veterans in this age group 65 and up-who otherwise are dependent upon public or private charity.

Secondly, we believe the VA should-and must-maintain an improved type of domiciliary system at full strength.

We refer to a statement of principles for a domiciliary program discussed by Dr. M. N. Travers, while he was Director of Domiciliaries for the Veterans' Administration. Dr. Travers said these principles were based upon recommendations of a Veterans' Administration Special Medical Advisory Group Committee on the Domiciliary.

Prior to becoming Director, Dr. Travers had served with several VA hospitals, including teaching hospitals, and at least one domiciliary. Dr. Travers' discussion of these principles for a program was lengthy. I quote from a section of the discussion, pertinent to the present considerations of your subcommittee:

*** We would like to suggest what we call the "design of a proposed program." Combine the domiciliary with the hospital. We recommend "a domiciliary ward service" be established. This would have the same organizational pattern as the mental, surgical, or NP service of the hospital. The service would be provided in the three areas:

1. Residential area for residents wholly capable of caring for themselves.

2. Personal care area for veterans who are partially able to take care of themselves.

3. Nursing care area for veterans not in need of acute hospital care requiring complete or quasi-complete nursing care.

This could very well be the intermediate program as you know it.

There followed a blackboard chart.

Now if you like to draw a line, draw it any way you want to. Move the patient as his condition dictates without the paperwork you now have to go through in order to get somebody moved out of one place to another. Sound medical judgment would dictate the moving of any veteran within these three areas as part of a ward service, where transfer to and from the acute wards can be accomplished with a minimum of administrative and paperwork. It is the same as you now transfer a patient, let's say, who is an ulcer case in the medical service and ends up as a surgical procedure and is going to be transferred to surgery.

Mr. Chairman, the significance and importance of this particular quote, made as a result of a study by a special medical advisory group