FISCAL YEAR 1979 BUDGET General UNGER. Our budget this year is only $57,000 more than fiscal 1978. We have no requests for capital outlay expenditures. I can briefly state that we recommend that your committee approve our request. Now, when I say that our budget is $57,000 more than fiscal 1978, I quickly add, as you well know, that in October of 1978 there will be a pay raise. We estimate that pay raise to be, say, 6.1 percent, and if we add $200,000 for price increases, it would bring our fiscal 1979 budget to about 6.2 percent over fiscal 1978 is. Mr. FLOOD. General, you have been up here before. General UNGER. Yes, sir. Mr. FLOOD. By the way, how many years have you been governor of the home? General UNGER. I have been there a little over 6 years, sir. Mr. FLOOD. I might say that you are one of the few witnesses who testify before this subcommittee year after year after year on what most observers would characterize as a conservative budget. General UNGER. As a what, sir? Mr. FLOOD. As a conservative budget. Mr. FLOOD. Are you convinced that this 1979 request will provide fully now for the needs of the home and its members? General UNGER. Yes, sir, I am. WAITING LIST Mr. FLOOD. How long is the waiting list for admission to the home's domiciliary facility? General UNGER. We have 164 people on our waiting list, but every one of those 164 people is someone who requires extended hospitalization. In other words, when one of those people arrives at the Home, he generally arrives in an ambulance. Of course, our hospital is full. That is why we have a waiting list. If a man is able-bodied and does not need to go directly into the hospital, there is no problem. There is no waiting list, whatsoever. Mr. FLOOD. Your statement I see indicates a waiting list for the hospital. Tell me, how long does a patient have to wait once he gets on the list? General UNGER. To get in? Sir, that depends on the death rate, and our death rate usually runs about 14 to 15 a month. In some months, we have a lot more. For those on the top of the list, they may wait as much as 6 to 8 months to get in; for those on the bottom of the list, probably a couple of years. Every one of those, Mr. Chairman, because he requires extended hospitalization, is being hospitalized somewhere else, usually in a Veterans Administration hospital. Mr. FLOOD. Do you anticipate any significant reduction in this delay for hospital care General UNGER. No, sir, I don't. Mr. FLOOD [Continuing]. during the coming year? General UNGER. No, sir, I don't. The reason I don't is because most agencies, as you know, in today's pinch on the dollar are always trying to find ways in which they can reduce their budgets, and they are trying to put some of their patients somewhere else. They would very much like to give the Home a lot of their patients. HOME MEMBERHSIP Mr. FLOOD. Let me ask you this: With all these waiting lists you are talking about, why are you planning to reduce the occupancy of the home by another 45 persons? General UNGER. I am not planning that, sir. Mr. FLOOD. You are not? General UNGER. No, sir, I am not. I am saying that as we look to the future, we anticipate, with the help of ŎMB, that the number of people in the Home will be further reduced by 45 people. Our membership has been going down, sir. Mr. FLOOD. Of course, I am referring to that sentence on page 3 of your statement in which you—— General UNGER. Said 45 less. Mr. FLOOD. Yes. General UNGER. Yes. In planning the number of rations and in planning the number of supplies for the people in the Home, I say that in coordination with OMB, we will have 45 less members. MEMBER FEE Mr. FLOOD. I believe the law has very recently been changed to allow increases in your user fee income. Will you explain to the subcommittee how that system works, and whether or not it is possible under the system for a potential member to be denied admission because of financial considerations? General UNGER. Sir, our user fee was one of the elements included in Public Law 94-454, which was approved in October of 1976. What this requires is that every member in the Home pay a user fee, and the amount of that fee by law cannot exceed 25 percent. It was the determination of the Board of Commissioners, which gives policy direction to the Home, and I am chairman of that group, that we should start at a 12.5 percent figure, and possibly work up to 25 percent by annual increments of increase of 2.5 percent. We are currently at a rate of 15 percent, and that is 15 percent of what a member receives from the government by way of retired pay or Veterans Administration disability pay. Mr. FLOOD. What is the plan and maximum charge to a member under this new system? General UNGER. It is 25 percent of whatever the man receives from the government, sir. Mr. FLOOD. Would there be any attempt to collect anything from the family of a member? General UNGER. No, sir, none whatsoever. PRIORITY SYSTEM Mr. FLOOD. How does your priority system operate, both as it relates to the hospital and the domiciliary? General UNGER. The priority system, Mr. Chairman, was developed in 1966 by the Board of Commissioners. What it endeavored to do was to make sure that when the Home is full, among that those members who apply for the Home, those who are in most need of the Home will be admitted to fill the vacancies created by attrition, such as deaths and so forth. This system is handled by an allocation of points-many points for age, so many points for disability, and so many points for length of service. Each man or lady on the list is given a number of points which determines where he or she stands. Mr. FLOOD. You do have a set formula then. Mr. FLOOD. That is what we are concerned about. MEMBER PARTICIPATION Mr. FLOOD. Does the composition of your governing board provide for the participation of the members of the home in the decisions about the future of the home, such as increases in user charges? General UNGER. We have a Members Council, Mr. Chairman, and that Members Council is headed up by the Home's sergeant major. On the Members Council are representatives of all members in the Home. I have four domiciliaries, and some of my domiciliaries have seven or eight floors, some have two or three. On every floor there are about 150 people, and every floor has a representative on that Council. The Council brings to my attention, through my deputy, what the members believe would be improvements in the operation of the Home. The Council is used, sir. CAPITAL OUTLAY Mr. FLOOD. There is no capital outlay for fiscal year 1979. Mr. FLOOD. What was the last year in which the home had any substantial new construction? General UNGER. Mr. Chairman, the last time we built anything at the Home was when we added two wings on our newest domiciliary building, and they were constructed in 1968. The money for that, however, was budgeted some 2 or 3 years prior to that. I can give it to you exactly. That is the last new construction we have done. We did have a renovation job, sir, on our oldest building. That was done in 1973-1974. We spent $1.5 million on the oldest building we have, which was started in 1852. That is the last money spent for capital outlay. Mr. FLOOD. Do you have a long-term facilities plan which provides for major renovation and replacement of your buildings? Do you have such a plan? General UNGER. Yes, sir, we do. We have a long-range plan for the construction of new and additional facilities, both domiciliary facilities and hospital facilities. We have a plan to build in two different places on the Home grounds. As you well understand, we have had no need of that of recent date because the membership has gone down, but these plans are still in force and can be implemented come the time when they need to be. HOSPITAL CAPACITY Mr. FLOOD. I believe your statement indicates the capacity of the hospital is 410. General UNGER. Yes, sir. Mr. FLOOD. The ideal occupancy is 85 percent. General UNGER. Yes, sir. Mr. FLOOD. However, what about this? Given the very special purpose of your facility General UNGER. Yes, sir. Mr. FLOOD [Continuing]. And the number of persons you tell us that you have on the waiting list, wouldn't a higher occupancy rate be justified? General UNGER. We have a higher occupancy rate than 348, which is the optimum, sir. The optimum was set at an 85 percent figure, and that is to take care of the separation of the sexes where need be; second, to take care of any epidemics we may have; and, thirdly, to have some backup in case of a disaster. Now, instead of having 348 in our hospital, we have been running anywhere during the year between 378 to 380. So, really, we have a lot more in our hospital than that optimum figure shows. APPROPRIATION LANGUAGE Mr. FLOOD. The appropriation language for your funds has provided many, many years special language regarding the rateGeneral UNGER. Yes, sir. Mr. FLOOD [Continuing]. The rate you are permitted to pay for contract hospital care. General UNGER. Hospital, inpatient per day rates. Mr. FLOOD. Could this limitation have the effect of denying a member access to a more expensive facility? General UNGER. Would you kindly phrase that question again? Mr. FLOOD. Could the limitation that you have, have the effect of denying a member access to a more expensive facility? General UNGER. No, sir. Mr. FLOOD. It wouldn't. General UNGER. Any Army hospital, or any military hospital where he can be admitted, we are charged $3 a day. Mr. FLOOD. What is the hospital reimbursement rate currently in effect? General UNGER. $3. PAY SUPPLEMENTAL Mr. FLOOD. In another section of the President's budget you have a request for a pay supplemental for $526,000. Is this solely for the cost of mandatory pay raises? General UNGER. Yes, sir. GAO REPORT Mr. FLOOD. Your statement and your justifications do not mention the latest GAO report. As we read that study, you have agreed to some significant changes in the way the home operates, particularly the hospital. Why the silent treatment about these changes? General UNGER. Why the what, sir? Mr. FLOOD. Silent treatment. General UNGER. I have not purposely stayed away from that problem. The GAO, Mr. Chairman, was directed to review the short- and long-term financial requirements of the Home by Public Law 94-454, which I mentioned before. They were in residence with us for about 8 months, and they turned in their report on August 1, 1977. That report, in effect, as you mentioned, had a recommendation for some changes in the organization of our hospital. They said "Let's separate the acutely ill from those who are the long-term patients," which we agreed to. Moneywise, they said "We believe that you can reduce the number of physicians you have by 4, and the number of nursing assistants you have by 40, and if you do this, this will save you in the neighborhood of $450,000 to $500,000 a year." Now we disagree with that. We don't think that we can reduce that much, and we have turned in a report to that effect to the GAO and to the Congress—— Mr. FLOOD. I would like a synopsis of that report for the record. General UNGER. Fine. I will be glad to do it, sir. [The information referred to follows:] |