outpatient basis for as long as necessary to attain the rehabilitation of the alcoholic veteran. Clearly, the relatively short periods of acute or structured inpatient treatment would cause slight disruption to educational pursuit, raising a question as to the value of granting an extension for only such periods. On the other hand, the long periods of "treatment" under maintenance-type programs, which largely employ a self-government modality, raise questions of proof for purposes of determining entitlement to an extension of a delimiting date, and lend themselves to submission of fraudulent claims. Moreover, the latter could result in having to grant overly generous periods of extension not contempleted by the Congress as necessary to accomplish the statutory objective. In view of the above, it is extremely dubious that the VA could adequately define eligibility requirements or draft regulations to implement a statute granting extensions of delimiting dates based on alcohol or drug abuse conditions. At the very least, a legislative liberalization affecting determinations involving alcoholism and drug abuse conditions in connection with education and vocational rehabilitation programs would set a precedent. Such a precedent would inevitably lead to pressure to consider these conditions compensable under other benefits programs (e.g., compensation and pension). could produce the undesirable consequences for such programs This previously noted. Chairman SIMPSON. Now, we have a second panel, Dr. Ewald W. Busse, chairman, Geriatrics and Gerontology Advisory Committee; and Dr. Terrie Wetle, Harvard University Medical School. We will have your testimony as soon as the room clears a bit. Thank you. Dr. Busse, you may proceed and then we will have Dr. Wetle. It is nice to have you with us. TESTIMONY OF A PANEL CONSISTING OF EWALD W. BUSSE, M.D., DEAN EMERITUS, DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NC, AND CHAIRMAN OF THE GERIATRICS AND GERONTOLOGY ADVISORY COMMITTEE TO THE VETERANS' ADMINISTRATION; AND TERRIE WETLE, PH.D., ASSISTANT PROFESSOR, DIVISION OF HEALTH POLICY RESEARCH AND EDUCATION, HARVARD UNIVERSITY MEDICAL SCHOOL, CAMBRIDGE, MA Dr. BUSSE. Thank you, Mr. Chairman. I am E.W. Busse. I am the dean emeritus of Duke University Medical Center. In addition I happen to be the Chair to the Veterans' Administration Geriatrics and Gerontology Advisory Committee. My remarks today are as an individual and do not reflect any opinion of the VA Advisory Committee on Geriatrics and Gerontology. I will limit my remarks only to that provision in S. 2514 that is concerned with referrals and arrangements of our community services. I am quite aware that the Veterans' Administration has made a determined effort to try to meet this challenge and, as indicated by Mr. Fulton earlier this morning, I am aware that the VA has utilized their social services in various facilities to try to develop and extend their referrals and their arrangements with their community services. I am also aware that each medical district has designated a senior professional responsible for coordination and exploring further use of community services, not only for the disabled veteran but also for the elderly veteran. It is my opinion that that section of S. 2514 gives real credibility to established VA efforts and from my viewpoint, the section has merit simply because at times it is important to have certain activities strengthened by recognition of their importance. The adequate coordination of health and human service is a serious problem, not only within the Veterans' Administration but for the entire health-care system, particularly in what is called longterm care which usually involves elderly people. I believe that the Veterans' Administration can make numerous contributions to improving the well-being of our elderly system as well as other disabled people and for this reason, I very strongly urge this effort be supported and expanded. I believe that soon studies will have to be put in place to determine and evaluate the various systems that are trying to be developed to do this particular effort. And I believe that it can be done. This concludes my statement. I again want to salute you in your efforts and your determination to make this come about. Chairman SIMPSON. Thank you, sir. [The prepared statement of Ewald W. Busse, M.D., dean emeritus, Duke University Medical Center, Durham, NC, and chairman of the Geriatrics and Gerontology Advisory Committee to the Veterans' Administration, follows:] PREPARED STATEMENT OF EWALD W. BUSSE, M.D., DEAN EMERITUS, DUKE UNIVERSITY MEDICAL CENTER, DURHAM, NC, AND CHAIRMAN OF THE GERIATRICS AND GERONTOLOGY ADVISORY COMMITTEE TO THE VETERANS' ADMINISTRATION My remarks are targeted on the proposed section "Referrals and Arrangements for Community Services." This is a portion of the bill "Veterans Administration Health Care Amendments of 1984." This section addresses the serious problem of coordinating the various treatment and support programs that are often necessary to take care of the veteran with serious service-connected disability as well as the elderly veteran. A Veterans Administration health care facility cannot provide all the range of services that are often needed by these veterans. These outside services should be obtained without expenses to the Veterans Administration. To accomplish this, the amendment states that the administrator "shall designate one office in each Veterans Administration health care facility and in the Central Office to coordinate and make arrangements for the provisions of referral services." The objectives and the mechanism are meritorious. The Veterans Administration has given social work and other services within the Veterans Administration the authority and responsibility to identify and provide access to such community services for veterans. In the past two years, the Veterans Administration has taken steps to increase the initiative of community integration both at the local level and at the level of the Central Office. Of particular importance is the Veterans Administration District Initiated Program Planning. These district plans are directly related to the coordination and utilization of 37-524 0-84--16 |