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3. Long-Term Care Facilities

Our lengthening life span has brought with it an increase in chronic diseases. This swells our need for long-term care facilities.

We have been making some progress in meeting the backlog of demand for nursing homes and chronic disease hospitals. But there is still a deficit of over 500,000 beds for the care of long-term patients.

This is a national health problem.

Our communities need better and more facilities to deal with prolonged illness, and to make community planning of these facilities more effective. Therefore:

(d) I recommend that the separate grant programs for chronic disease hospitals and nursing homes be combined into a single category of long-term care facilities. The annual appropriation for the combined categories should be increased from $40 million to $70 million.

4. Mortgage Insurance

Raising funds to build health facilities is a problem for almost every community:

-- Federal aid is not always obtainable.
-- States must set priorities for hospital projects which are to receive Federal aid; many worthwhile projects necessarily fail to win approval.
-- Nonprofit agencies often have great difficulty raising local funds to match Federal grants.
-- Loans available from private lenders often call for large annual payments and short payoff periods. This can either threaten a hospital's financial soundness or lead to excessive increases in the cost of hospital care.

These financing difficulties do not alter the fact that the need for hospital beds is increasing. Therefore:

(e) I recommend amendment of the Hill-Burton Act to permit mortgage insurance of loans with maturities up to 40 years to help build private nonprofit hospitals, nursing homes, and other medical facilities.

(f) In addition, I recommend that authority to insure mortgage loans for the construction of nursing homes operated for profit be transferred from the Federal Housing Administration to the Public Health Service.

These changes will help us build more hospitals and other medical facilities. And they will bring together in the Public Health Service an adequate and interlocking program of Federal aid to profit-making--as well as nonprofit-nursing homes, hospitals, and other facilities.

Encouragement of Group Practice

To meet the needs of their communities, groups of physicians -- general practitioners and specialists -- more and more are pooling their skills and using the same buildings, equipment, and personnel to care for their patients.

-- This is a sound and practical approach to medical service.
-- It provides better medical care, yet it yields economics which can be passed on to the consumer.
-- It makes better use of scarce professional personnel.
-- It offers benefits to physicians, patients, and the community.

The specialized facilities and equipment needed for group practice are often not available, especially in smaller communities. Therefore:

I recommend legislation to authorize a 5-year program of Federal mortgage insurance and loans to help build and equip group practice medical and dental facilities.

Priority should be given to facilities in smaller communities, and to those sponsored by nonprofit or cooperative organizations.

III. HEALTH MANPOWER

Medical science has grown vastly more complex in recent years -- and its potential for human good has grown accordingly. But to convert its potential into actual good requires an ever-growing supply of ever better trained medical manpower.

-- The quantity and quality of education for the health disciplines his been unable to keep pace.
-- Shortages of medical manpower are acute.

By enacting the Health Professions Educational Assistance Act of 1963, the Congress took a major step to close this gap in medical manpower, especially as it relates to physicians and dentists.

But the task is far from finished.

A Stronger Nursing Profession

The rapid development of medical science places heavy demands on the time and skill of the physician. Nurses must perform many functions that once were done only by doctors.

A panel of expert advisors to the Public Health Service has recommended that the number of professional nurses be increased from the current total of 550,000 to 680,000 by 1970.

This requires raising nursing school enrollments by 75 percent.

But larger enrollments alone are not enough. The efficiency of nursing schools and the quality of instruction must be improved. The nursing profession, too, is becoming more complex and exacting.

The longer we delay, the larger the deficit grows, and the harder it becomes to overcome it.

I recommend the authorization of grants to build and expand schools of nursing, to help the schools perfect new teaching methods, and to assist local, State and regional planning for nursing service.

We must remove financial barriers for students desiring to train for the nursing profession and we must attract highly talented youngsters.

I therefore recommend Federal loans and a national competitive merit scholarship program. For each year of service as a nurse up to 6 years a proportion of the loan should be forgiven.