Mr. BURLEIGH. One of the difficulties is that the survey that you allude to back in 1956 which involved $1 billion worth of modernization needs obviously was not a complete survey of this problem, because only 4 years later we come up with reports from State agencies that total $3.6 billion.

Mr. ROGERS of Florida. I don't know that is a proper assumption because the survey was conducted in connection with the U.S. Public Health Service in 1956, to determine what the needs are.

Mr. BURLEIGH. If I could speak to this problem just a minute, it is more than just a reporting problem. You can get general estimates as to what the needs are in a particular urban area or a particular community. But to determine the needs of a particular hospital the authorities in the field have given a great deal of study to this problem and have decided that the only way to do it is for a team of engineers and architects and possibly hospital consultants or physicians to visit each hospital and spend as much as 2 to 3 days going through that facility and examining its structural soundness and whether or not the functional layout is now obsolete and requires modernization. It is a very complex problem. We do not think that the study we made the $3.6 billion study that the Public Health Service made on the basis of reports from State agencies gives us sufficient detail on which to project the modernization needs of the individual States. We think it is a good national estimate but does not represent figures that can stand for particular States.

Mr. ROGERS of Florida. How about the 1956 survey?

Mr. BURLEIGH. I must confess ignorance to the 1956 survey.

Mr. ROGERS of Florida. I think it might be interesting for usI don't know what validity it has either-to get that report and look at it and get familiar with it because it may help answer this prob

lem.

Mr. BURLEIGH. May I say one further thing, sir?

Mr. ROGERS of Florida. Yes.

Mr. BURLEIGH. The reason we made the survey in 1960 was the fact that we had no reasonable estimates as to the magnitude of the modernization problem in the United States.

Mr. ROGERS of Florida. I though you had in 1956. You had a billion dollars there. That is a better indication than the number of beds in 1948, isn't it?

Mr. BURLEIGH. I would say the $3.6 billion in 1960 is a better indication than the study of 1956.

Mr. ROGERS of Florida. I am not sure. You just did some spot checking in 1960. I think it would be well to look at the survey and see how thorough it was in 1956. Let us consider it. Perhaps it is not a proper basis. I would feel a little better about approaching this problem.

In other words, what is the point of spending money for surveys to determine need, and then ignoring the surveys? There is no point spending this money if you are going to ignore these surveys.

Dr. TERRY. We will certainly look into this. I am not sure of the details.

Mr. ROGERS of Florida. I think you should study it.

Dr. TERRY. We will be glad to look into it and report to the committee if the chairman would like.

Mr. ROGERS of Florida. I think this would be helpful. I would like to see a report, if I may.

Dr. TERRY. Yes, sir.

Mr. ROGERS of Florida. Thank you, Mr. Chairman.

Mr. BENNETT. I have just one question for information. Doctor, would you submit for the record the most recent surveys that have been made by the States, showing by State the number of nursing beds that are needed? That is No. 1.

Dr. TERRY. Yes, sir.

Mr. BENNETT. Ánd No. 2, the number of approved applications by States which have been approved by the State for nursing homes but for which no funds are available.

Dr. TERRY. I am not sure that we would be able to provide that because the States do not, I believe, submit to us those applications for which they do not have funds to back up.

Mr. BENNETT. Could you get that information? I think it would be very helpful. Can you get it from the State agencies?

Mr. BURLEIGH. We can submit to you a statement which State agencies give to us before appropriation hearings each year which shows the total number of projects which they could approve within each State if there was no limitation on Federal funds.

This may well give you an indication of the magnitude of the problem. We would be glad to submit that for the record. (The information requested follows:)

INFORMATION REGARDING 1956 STUDY OF HOSPITAL MODERNIZATION

In June 1954, the AHA board of trustees directed two of its councils to study the desirability of a proposal "for the rehabilitation and/or construction of new hospital facilities under any public works program which might become necessary because of depressed economic conditions." The joint committee of the two councils decided "that rehabilitation and remodeling of existing hospitals offered the most practical and helpful activity during a period of recession."

In January 1956 a questionnaire developed with the assistance of the Public Health Service was mailed to all non-Federal member hospitals of the AHA. Returns were received from slightly more than 2,600 hospitals-54 percent of the total sent out. These represented all sizes, types, and ownership groups as well as all geographical regions in the country. The cost of reported modernization needs amounted to about $400 million. A national projection of survey results indicated that almost one-half of all hospitals in the country needed some form of modernization at a total estimated cost of about $1 billion.

The survey was well planned and developed, and the resulting national projection of modernization costs was considered useful and valid for the intended purpose at that time. However, the survey was limited in scope since it did not reflect the cost of replacing obsolete facilities which were beyond the possibility of modernization work.

Because of the early date and limitations of the 1956 survey, the Public Health Service, in cooperation with Hill-Burton State agencies, make a study in 1960 of the backlog of modernization work, including the replacement of obsolete facilities. This study showed that replacement costs comprised a substantial portion of the total modernization and replacement requirements of $3.6 billion.

Total

1,821 1,234

587

81,975

9, 724

995

276

87

113

3, 391

66

22, 879 $2,855, 811 $1, 213, 693 $2, 436, 977 $1, 034, 162 $418, 834 $179, 531