Beds for inpatient care, United States and possession, 1948-63-Continued 2 As of Jan. 1, each year. 3 Based on bed needs as reported in State plans submitted by Hill-Burton State agencies under title VI of the Public Health Service Act and regulations thereunder. 4 Classified by State agencies on the basis of fire and health hazards. Includes beds in chronic disease hospitals and skilled nursing homes. Source: State plans for hospital construction, approved under title VI of the Public Health Service Act. Mr. ROGERS of Florida. Let me ask you: What will this legislation. do to solve the need that you have just stated? Secretary CELEBREZZE. Under the "long-term care" category, both the administration proposal and the Harris and Hill bills Mr. ROGERS of Florida. Would it be as convenient for you just to go down through the same breakdown? In other words, what is the total number of hospital beds anticipated that this legislation will bring about, in the general, mental, tuberculosis, and long-term? Secretary CELEBREZZE. I will start with long-term care beds. Under the bill, there will be an additional 15,000 beds annually; but that 15,000 would be added to, I think, the 30,000 that are built outside the program, for a total of 45,000. But the bill, itself, will produce only 15,000 long-term care beds. Mr. ROGERS of Florida. Is that in consideration of the mortgage provisions as well, or is this under the grant program? Secretary CELEBREZZE. This is wholly under the grant program. Mr. ROGERS of Florida. So that is 15,000 under the grant program alone for long-term care. Secretary CELEBREZZE. That is right. Mr. ROGERS of Florida. All right, sir. Secretary CELEBREZZE. Then the $100 million annually for hospitals and health centers would produce approximately 11,700 additional general beds each year. Mr. ROGERS of Florida. Is that over the total 5-year program or per year? Secretary CELEBREZZE. Per year. We are taking about per year now. All the figures are on a per year basis. Mr. ROGERS of Florida. I see. Secretary CELEBREZZE. That is under Hill-Burton-of course, there are others, about 14,000 general beds built outside of the program. Mr. ROGERS of Florida. About 14,000 built outside of the program each year? Secretary CELEBREZZE. That is right. Mr. ROGERS of Florida. What do you envision from the provision of the mortgage insurance for hospital and medical facility construction? Secretary CELEBREZZE. We anticipate that with the assistance under the proposed new mortgage insurance program, there will be a considerable impact on the need for $2.8 billion in general hospital modernization. Mr. ROGERS of Florida. Over the 5-year period? Secretary CELEBREZZE. Yes. That is a 5-year period. That is as against the $3.6 billion needed, as I testified earlier. So this doesn't completely cut off the total backlog of modernization. We need about $3.6 billion in modernization work which was on the basis of the 1960 survey. We anticipate it will be about $4 billion now. We anticipate that under this modernization program, and the proposed mortgage insurance program, about $2 billion of modernization work would be produced. I am informed by Dr. Graning that this is over a 10-year period. Mr. ROGERS of Florida. On the mortgage? Secretary CELEBREZZE. On the mortgage and grant programs for a 10-year period. Mr. ROGERS of Florida. Are we approving in this legislation a 10year mortgage program? Secretary CELEBREZZE. No. Actually authority is requested for a 5-year program. But, of course, your mortgages can run as high as 40 years. It is a 5-year program, however. Mr. ROGERS of Florida. It must be committed within the 5 years? Secretary CELEBREZZE. Yes. There is a provision in the bill puting a termination date as to when you can make the last loans within the 5-year period. Mr. ROGERS of Florida. But in projection of this figure for 10 years, you figure that perhaps they will not have constructed those buildings for 8 or 10 years? Secretary CELEBREZZE. What happens, Mr. Rogers, as you know, generally by the time they get their planning out, by the time they get their mortgage issued, a year or a year and a half has gone by, generally; so that there would be a carryover. Mr. ROGERS of Florida. What does this figure relate to as far as hospital beds, the $2.8 billion? Secretary CELEBREZZE. I testified in my opening statement, Mr. Rogers, that with the modernization of general hospitals alone requires $2.8 billion-there would be no additional beds produced since this is wholly a modernization program. Mr. ROGERS of Florida. On the mortgage? Secretary CELEBREZZE. The $2.8 billion is the need for modernization of general hospitals. There would be no additional beds. It would be merely bringing the present facilities up to today's requirements in health facilities. Mr. ROGERS of Florida. Then your mortgage program will do nothing except modernizing? Secretary CELEBREZZE. No, the mortgage program applies across the board. What I am trying to get is the figures. You want the figures as to work produced outside of the modernization program. We have to take and I will furnish greater detail for you for the record an example. I am informed that a $150 million expenditure of grant funds would produce about 17,595 additional general beds. Mr. ROGERS of Florida. This is the loan program? Secretary CELEBREZZE. This is the grant program. Secretary CELEBREZZE. Yes. The factor that we are having a difficult time taking into consideration is that there are actually being built today 30,000 additional beds under private or other loan programs. Just how much of that will be absorbed over to our program of mortgage insurance, we are unable to tell at this time. Mr. ROGERS of Florida. Do we know the extent now of FHA participation in this program? Secretary CELEBREZZE. The FHA, of course, is limited to the proprietary nursing homes. Mr. ROGERS of Florida. So it is not in the nonprofit field at all now? Secretary CELEBREZZE. No. The FHA has no application whatever to general hospital beds. Its program applies only to proprietary nursing homes. Mr. ROGERS of Florida. Isn't your program going to apply also to proprietary, your mortgage loans? Secretary CELEBREZZE. No. Our program will apply to nonprofit health facilities as well as proprietary nursing homes. This is where we get into difficulty; the proprietary program is now being conducted by FHA, and we ask that it be transferred over so that it is all under one unit. Mr. ROGERS of Florida. Maybe you don't have these figures, but how much is FHA now contributing to the proprietary program that you will include in your figures? Secretary CELEBREZZE. I would like to furnish that for the record. We do not know. May I furnish that? Mr. ROGERS of Florida. Yes. 30-883-64-6 In other words, if you could give us for the record a complete picture on hospital needs, what this legislation will do, and a breakdownthat is really what I am trying to get at-with the present program under FHA which would be assumed by your department under this proposed legislation, it would be of assistance. (The information regarding the Federal Housing Administration follows:) FEDERAL HOUSING ADMINISTRATION.-Proprietary nursing home project data, fiscal years 1960-63 Mr. ROGERS of Florida. If this program is adopted, FHA will no longer participate, is that correct? Secretary CELEBREZZE. In the proprietary, that is correct. Under the present bill, all we are doing is transferring the proprietary nursing home loan insurance program-the same as in the Harris proposal and the Hill bill. These insured loans can go up to 90 percent. We will furnish that information for you, Congressman. Mr. ROGERS of Florida. Can you make any estimate as to the possible termination date, or do you feel this is a program that will have to continue many years beyond? Have you any information at all? Secretary CELEBREZZE. Of course, there is a termination date in the bill as to loans. The extent of it is always a difficult question, because 5 years from now we just don't know what the conditions are going to be. We don't know whether additional legislation may have been passed which may affect some of these programs. My suggestion would be that perhaps, because of the tremendous backlog, there will have to be some kind of renewal of the program. Just what the extent of it will be, the amount, you cannot project very accurately, past the 5 years. But to answer your question specifically, based on this 5-year period, I would say there would have to be some extension later on to take up the backlog of hospital beds and modernization work. Mr. ROGERS of Florida. I believe there is a different formula that was discussed this morning. Could you give us just a quick explanation as to what programs that will apply to? Secretary CELEBREZZE. I am going to have Dr. Graning do that, if you don't mind. Dr. GRANING. Sir, the reference this morning to a separate formula is applicable only to the modernization feature of the Administration proposal and the Harris bill. This modernization category is provided for in the Harris bill, the Hill bill, and the Administration proposal. In essence, the modernization formula simply is a method for allocating money to States on the basis of their need for modernizing their hospital facilities. The first available information on a national scale, available to the U.S. Government, is the inventory of beds reported by States in 1948. These beds have been undergoing obsolescence, and it is in this manner that we provide the scale for modernization. Mr. ROGERS of Florida. What time element do you consider being the determining factor? Do I understand you to say that if beds had been in existence since 1948, that they are now considered a proper subject for modernization? What is your criteria? Dr. GRANING. The older the bed, the more likely it is to be in need of obsolescence. Each State would have to develop a plan in the Harris bill for apprising its modernization needs. The State agencies, working with the people, the hospital people in the State, the professional people, will develop a plan allocating, on the basis of modernization need, their proposed utilization of modernization money. Mr. ROGERS of Florida. What are your guidelines? Dr. GRANING. Our guidelines to the State agency? We do not specifically tell them what constitutes a bed that needs modernization. The modernization formula is indicated in the bill, merely relates to how much money they will get for modernization. But the Federal Government, as such, is not going to tell them that they should replace this hospital or renovate that one. This is entirely a matter for community and State decision. "We Mr. ROGERS of Florida. Then one State could come in and say, want to modernize the beds in this hospital that is 5 years old," and another State may come in with one 3 years old, another 10, one 20, and one 50. How do you determine that? Dr. GRANING. The State would have to make this determination. It is possible, sir, that this could happen, but not very likely. Mr. ROGERS of Florida. If there are no guidelines, I would think it could be quite possible; couldn't it? Dr. GRANING. The competition for funds within the States of Florida, Georgia, and so forth, is such that only those that had the greatest need for modernization would be likely to get it. Mr. ROGERS of Florida. This is what I wonder. Are you going to set it at a point of time? Dr. GRANING. It might be useful at this point to say that every State must have an advisory council. This is made up of representative people throughout the State. It is a public matter in terms of how they allocate their money. It is carefully considered. No illadvised proposal is likely to get approval by the advisory council to the State agency. |