The average cost to the Veterans' Administration of a fee basis visit is $6.43 (excluding administrative costs). If our pensioners received outpatient care from their hometown physician the cost of this service to the Veterans' Administration would be $7,073,000 now and by 1975 this would at least be double. HOSPITALIZATION At the present time hospitalization is furnished to all service-connected veterans for their service-connected disability and its adjunct illnesses, and for any other illness requiring hospitalization for which they cannot afford the cost of hospitalization. The Veterans' Administration furnishes hospitalization for all veterans in need of such care who are suffering from an emergent condition and they need only certify their inability to defray the cost of such care. All other non-service-connected veterans suffering from nonemergent conditions for whom hospitalization is deemed necessary, who certify that they are unable to defray the cost of hospitalization are furnished hospital care by the Veterans' Administration when a bed is available. Female veterans, even though suffering from non-service-connected disability, because of the limited VA facilities for female care, when determined to be in need of and eligible for VA care, may have the cost of their care paid for by the VA in a private or contract hospital when VA facilities are unavailable, just like service-connected male veterans. They are not eligible for any physiological disability (pregnancy) care except for illness and disabilities resulting from such disability. This is a limitation of care available to female veterans. No dependents of veterans have any entitlement to hospital care even though they may be in receipt of compensation death benefits or pension from the VA. Veterans' Administration hospitals are available to the general public for humanitarian reasons wherever other health facilities are not readily available, and the Veterans' Administration will bill the recipient for the costs of such services. Hospital facilities are available to beneficiaries of Allied Governments upon arrangements for such care by the Allied Government on a reimbursable basis. Hospital facilities of the Veterans' Administration are available to other agencies of the Government upon the arrangements of the other agencies on a reimbursable basis, i.e., Defense Department, State Department, Railroad Retirement Board, etc. CHRONIC HOSPITAL CARE There has never been established a clear definition of what is meant by chronic hospital care. An arbitrary time definition is usually resorted to for the distinction. Any case requiring care for more than 90 days is usually referred to as a chronic care case. This is obviously invalid. A fracture of the femur in a mature heavy adult may require hospital care for as long as 6 to 8 months, yet this is obviously an acute condition. An uncontrolled severe diabetic may need no more than a few days or weeks hospital care to bring the condition under control, yet this is a chronic illness. Usually we mean that acute care will result in cure or complete arrest of the disease process while chronic care means that the hospital treatment is necessary to relieve the patient of suffering or progressive damage from the uncontrolled effects of the disease though the disease process is still present and the disease or its residuals will continue for a long time or even for lifetime. The Veterans' Administration hospital system includes both acute and chronic care where hospitalization is necessary for the treatment. We have specialized hospitals where long-term care is considered usual, such as tuberculosis hospitals and psychiatric hospitals. However, with the rapid advance in the science and art of treatment we are moving toward the elimination of special type hospitals and moving toward "total treatment" hospitals. Long-term patients as well as some short-term patients after completing the need for hospital care, sometimes are left with such residual disabilities as to make their continuing care at home difficult or impossible. These patients need some continuing institutional care. There are in the Veterans' Administration hospital system in all about 11,000 patients who do not need the care of our institutions, yet who remain because no suitable facilities can be provided to continue the care they need. This figure is based on a questionnaire sent to all our hospital directors asking how many patients could be moved out of the hospital or domiciliary if suitable nursing homes could be found to take care of them. 98-638 0-63 -7 This figure would be increased if we included those in our NP hospitals who did not need further professional psychiatric treatment. NURSING HOMES The Veterans' Administration is providing hospital space for at least 11,000 nursing home type cases in our general medical and surgical hospitals and domiciliaries To this figure could be added at least a like number who are receiving only custodial care in our NP hospitals. This group of nursing care problems are with us because having originally met the criteria for hospitalization or domiciliary care, they could not be suitably disposed of when they no longer needed this care or met the criteria. Since the Veterans' Administration does not provide nursing home care for veterans as a prime need, we have no accurate knowledge of how many veterans in the Nation require such care. On the basis of standards of need set forth by the Public Health Service, it is estimated that there is currently a need for about 60,000 nursing home beds for veterans. This does not represent the number that might seek that care if available. Our best estimate of that number is 200,000. The basis for these estimates, extrapolation of possible nursing home needs for future years, and detailed data on the aging veteran population are shown in the appendix. Anyone in the need of nursing home care should be provided that care as close to his home as possible so that he is not deprived of an important source of comfort to a confined individual-the visits of family and friends. There are 2,500 major communities in this country and there are 200 major suburbs to these. Thus, to satisfy a major consideration of location of nursing homes for veterans we would need nearly 2,700 small nursing homes. At present estimates it would cost between $5 to $8 per day to provide good nursing home care. The cost of nursing home care of satisfactory quality varies across the country from $150 to $300 per month per average case. The average length of stay of a patient in a nursing home today is about 1 year. It can be assumed that the average veteran in need of nursing home care could not afford to pay much of the cost of such care since the cost would need to be met from resources other than wages, which can be presumed to have stopped when nursing home care is needed. Thus, if the Government were to provide nursing home care for all veterans now needing such care the annual cost would be over $100 million. This will increase substantially as the veteran population ages. This would be reduced to the extent that other types of services currently provided would not necessarily continue during nursing home care. In order to reduce the size of the demand, eligibility for Veterans' Administration paid nursing home care could be limited to service-connected cases and pensioners. The cost to the Government could further be reduced by paying to State-operated nursing homes or nursing homes approved by the State for veterans care a partial subsidy of the cost of such care. THE RESTORATION CENTER The restoration center concept is based on the presumption that many of the beds in our hospital system, frozen with the care of intermediate care problems, could be freed by the positive attention to the patient's restoration needs and a forceful effort made to restore him to his own home or some other community sponsored and operated facility. The emphasis here is to restore the veteran to his home community. DOMICILIARY CARE The Veterans' Administration provides domiciliary care to eligible needy veterans in a system made up of about 16,000 beds. These beds are often located in out-of-the way places in excessively large domiciliaries, many with no medical facilities. The men live in a barracks-type environment in a military-type organization. Our domiciliaries are for the most part old and money has not often been available to keep them modernized. Ideally, men needing a place of residence because they cannot maintain one for themselves should be housed as close to their home community as possible so that social relationships with family and friends can be readily maintained. Also the residence unit should be relatively small, housing about 50 people in order that group integration can be easily established. To provide homelike responsibility, some voice in the residence affairs should be given to the members. Eight States operate homes for veterans and the Veterans' Administration reimburses the State one-half the cost of maintaining a veteran, not to exceed $2.50 per day, who would be eligible for Veterans' Administration domiciliation. Many of the State homes accept wives of veterans as well and this is a distinct advantage. We could relieve much of our burden of Veterans' Administration domiciliation by encouraging the development and use of foster home care. A foster home is an arrangement with a private family who for a monthly fee will accept as a boarder and member of their household a dependent outsider. APPENDIX A. "Adequate" service according to Public Health Service regulations are 30 nursing home beds or 50 long-term-care beds per thousand persons 65 and over.1 On this basis, need is: B. Over 2 million persons 65 or over outside of institutions have major limitations in their activities. Since over 10 percent of those 65 or over are veterans, this group probably includes over 200,000 veterans now and the latter may be expected to increase to 300,000 by 1980 and to three-fourths of a million by the end of the century. Many of the foregoing may seek admittance to nursing homes. If we add to these figures, those currently in nursing homes or other institutions who require nursing home service, the foregoing may be raised at least 10 percent. This would appear to be an upper limit on need. C. Population data on veterans 65 or over, 1960–2000 "General Population Characteristics 1960," PC(1)B, U.S. Bureau of the Census. VA Annual Report, 1961. VA Controller's report (table, "Estimated Number War Veterans in Civil Life by Age, 1950-2000"). 1 Public Health Service Regulations, revised Dec. 22, 1959, pt. 53, pp. 4 and 5. * Health Statistics Series B-11, "Limitation of Activity and Mobility Due to Chronic Conditions, 1957-58," and B-31, "Duration of Limitation of Activity Due to Chronic Conditions, 1959-60," U.S. Public Health Service. |