WASHINGTON, D.C., July 17, 1967. Hon. ROBERT A. EVERETT, I urge favorable action by your subcommittee on H.R. 2002 and related bills which would provide for Federal payments of per diem rates for domiciliary, nursing home, and hospital care for veterans receiving such care in a State home. Massachusetts maintains such homes at Chelsea and Holyoke. It is becoming inceasingly urgent that the Federal Government undertake its share if we are to provide the quality of service our veterans deserve. JOHN A. VOLPE, Governor of Massachusetts. Mr. EVERETT. The committee stands adjourned. VETERANS' ADMINISTRATION NURSING HOME CARE WEDNESDAY, JULY 19, 1967 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON INTERMEDIATE CARE OF THE COMMITTEE OF VETERANS' AFFAIRS, Washington, D.C. The subcommittee met at 10 a.m., pursuant to call, in room 356, Cannon House Office Building, Hon. Robert A. Everett (chairman of the subcommittee) presiding. Mr. EVERETT. The subcommittee will come to order. We will hear now from Mr. Howard L. Bennett of the Paralyzed Veterans of America. STATEMENT OF HOWARD L. BENNETT, EXECUTIVE SECRETARY, PARALYZED VETERANS OF AMERICA Mr. BENNETT. I might say for the record that our national services director, William Green, was planning to come with me but he had one of the ills of paraplegics and his doctor suggested that he stay at home, so it is my privilege to express the views of the Paralyzed Veterans of America as it applies to the paralyzed veteran. In preparing this testimony, we were faced with the unhappy realization that our problems and needs in this field of medicine must be considered as a part of a much larger group with substantially different problems and needs. I think the sound judgment and foresight of this subcommittee under the leadership of Mr. Everett, in establishing the nursing home care program has been proven. As of June 22, 1967, 4,000 nursing beds have been provided for the care of the veteran. The magnitude of the wisdom of this plan is borne out by the fact that 5,400 patients from hospital beds have been admitted to nursing care facilities, thereby providing more than 1 million hospital bed days for veterans who are now acutely ill. Unfortunately, few of these hospital beds were made available to the veteran suffering spinal cord injury or disease. This is because the care necessary for a paraplegic or a quadriplegic is not now available in the nursing home care program. The spinal cord injured require considerably more care than the usual nursing home patient. Mr. EVERETT. Let me ask you here, how many are on the waiting list to get into hospitals with spinal cord injuries? Do you know? Mr. BENNETT. We have an appointment list and it varies from down at Richmond and the various hospitals. I can't give you a total overall because we come in for checkups and it varies from the time of checkups. These boys come in for a checkup and stay for about a week. As far as any acutely ill people, I understand from Dr. Kessler that there are no acutely ill paraplegics on the waiting list. They become acutely ill with urological problems or orthopedic problems and they put them in the orthopedic section or the urology section. Mr. EVERETT. Thank you. Go ahead. Mr. BENNETT. A little carelessness-failure to turn a patient, sheet burns, or a slight blow-can result in tissue breakdown and confinement to bed for months. In other words, we get pressure sores or pressure areas and these are one of our major problems. Urological problems and bowel care are other specialized areas which must be dealt with. The quadriplegic who cannot use his hands must be assisted in almost every phase of his daily life. They are probably the most severely disabled of any human being. Such things as getting in and out of bed, taking a shower, eating, or such a seemingly simple task as getting dressed are things which he cannot do for himself. Ignorance or neglect in this care can only lead to serious complications for the spinal cord injured patient. These problems call for an adequate number of personnel who are trained in the needs of the quadriplegic and paraplegic. We believe, and recommend that nursing care facilities, properly staffed to care for the paralegics and quadriplegics, should be made an integral part of our spinal cord injury program. Mr. EVERETT. Do you think that they would get better treatment from a nursing home than a hospital? Mr. BENNETT. No; I think we ought to separate these things. When these boys come to a point of having maximum hospital benefits and cannot make the transition back to our normal life then when we put acutely ill and these type of patients together our staffs have a tendency to work with these people who are not acutely ill and therefore, we feel like our acutely ill people are getting more or less maintenance care. By separating these two types of patients, when these boys get practically MHB, we think it would improve the type of care and open up some beds. In other words, some statistics that were given at the recent hearings will show that we are reaching this problem where we are going to have more and more of this thing. Mr. EVERETT. How much more does it take to maintain a paraplegic than it does a regular patient? Three times as much? Mr. BENNETT. No. I really don't have a statistic on this and this is one of the things I have discussed with Dr. Kessler, and he has told me that he agrees with the principle of what our organization is asking for here on this legislative thing, but they have never developed a statistic or a figure on how much more it would take to staff a nursing care facility. They know it takes more because we have a bigger staff on our spinal cord injury than medical or pulmonary hospitals. I have never seen a figure and Dr. Kessler has never given me one, but it may be twice as much. The House Committee on Veterans' Affairs, in establishing the spinal cord injury services within the Veterans' Administration hospitals, instituted a comprehensive and successful program for the care of the veteran with spinal cord injury or disease. This was immediately after World War II, when it was found that the miracle drugs, antibiotics, would greatly prolong the life span of a person with a spinal cord injury. Now, 20 years later, we are in need of a similar approach with the nursing home care program. We recognize, Mr. Chairman, that the basic principle of nursing home care is a good one. However, VA regulations provide only generally for the care and treatment of the sick and disabled veteran. The accepted budgetary limitations of our present program have prohibited the staffing of nursing care facilities for the care of the spinal cord injured. Undoubtedly, the Veterans' Administration has felt forced to keep the costs of their nursing care beds in line with the currently authorized maximum per diem rates for contract nursing homes. Presently the authorized contract rate is 333 percent of the cost of care in our general hospitals. As of July 1, 1967, this was $12 per day. In his testimony of June 21, 1967, before this committee, Dr. H. M. Engle, Chief Medical Director for the Veteran's Administration, advised that VA daily nursing care cost was $14. This rate obviously would not allow for sufficient staffing to care for the most seriously disabled of all our veterans, the quadriplegic and paraplegic. We believe that the present law should be amended to allow for a higher per diem rate for the nursing care of the spinal cord injured. Certainly the additional care required by this type of patient warrants such action. The Veterans' Administration would then be able to justify the higher costs of staffing a spinal cord injury nursing care facility in conjunction with our spinal cord injury service. With the creation of such care, patients from our spinal cord injury services who have received maximum hospital benefits, and are unable to find suitable living conditions, could be transferred to this nursing care unit, thereby freeing a bed for a more acutely ill spinal cord injured patient. As our World War II and Korean conflict paralyzed veterans become older, their need for more frequent hospitalization becomes greater. This fact, along with the Vietnam war veterans who have received spinal cord injuries, is causing an increasing demand for beds in our spinal cord injury services. Dr. Harry Kessler, chief of the spinal cord service of the Veterans' Administration, has stated that 8 percent of the patients now being transferred from military hospitals to the Veterans' Administration hospitals are cord injury patients. This new influx, plus the large number of non-service-connected patients who are admitted and become long-term patients, is causing a bed shortage problem on our spinal cord injury services. The creation of nursing care beds for the spinal cord injured patient by the Veterans' Administration is the quickest and most practical solution to this problem. The past success of our spinal cord injury services in treating and rehabilitating veterans with spinal cord or disease emphasizes the necessity of maintaining available bed space in these services for the future care of such patients. Mr. EVERETT. Do you believe you can get any of them to go to a nursing home, with the fine hospital care that we are giving them in |