The state-of-the-art technology offers mnay types of assistive listening devices and systems. In additional to conventional hearing aids, these devices may include hardwire, infrared, FM, loops, telecaptioning, and alerting devices. If being able to see the captions is a problem, there are several assistive devices that can improve the user's visual functions. Assistive listening devices help overcome many of the listening problems encountered by hearing impaired persons who wish to listen to television, use the telephone, understand one-or-more talkers in a restaurant or other noisy environment, communicate on the telephone, or listen to speech or music in large areas such as houses of worship, lecture rooms, concert halls, and arenas. I should like to suggest that after the need for medical and suugical treatment of the hearing loss has been ruled out, an audiologist should determine the appropriateness of recommending a telecaptioning device. If the screening of vision and reading reveals some problem, a vision specialist should be consulted. If it is established that a veteran is so profoundly hard of hearing or deaf that a telecaptioning device is needed, other devices may be required, such as teletypewriters and alerting devices, including flashing lights or vibrators. Hearing loss is a devastating condition. I am gravely concerned that we are allowing great numbers of veterans with moderate and severe service-connected hearing losses to face serious difficulties. Many of the veterans with hearing impairments are unable to hold jobs, keep up communication with their families and friends, or participate in community activities. One of their most serious problems arises when they cannot communicate effectively with their physicians and other members of the health care delivery teams, or with their religious advisors. In the majority of cases, appropriate assistive listening devices could resolve these communication problems. The Veterans Administration is dedicated to quality care and quality rehabilltation for hearing impaired veterans. It is my professional opinion that the provision of assistive listening devices to hearing impaired veterans.could offer them the opportunity for the achievement and maintainance of the quality of life they deserve. I wish to express my appreciation to Senator Simpson and the Members of the Senate Committee for permitting me this opportunity to speak in behalf of the many hearing impaired veterans. PREPARED STATEMENT OF JOE COLLINS, EXECUTIVE DIRECTOR, CALIFORNIA ASSOCIATION OF ALCOHOLIC RECOVERY HOMES, INC., LOS ANGELES, CA The Treatment and rehabilitation for alcohol or drug dependence or abuse disabilities Pilot Program enabled under Public Law 96-22, 1979, has proved itself highly cost-effective and recovery-effective (see attached reports by the California Association of Alcoholic Recovery Homes, and National Capitol Systems Incorporated/Associated Research Analysis Corporation). Both the national survey and study contracted by the Veterans Administration, and the California survey and study done independently, agree that for appropriate veterans, the services provided in community based alcoholism programs under contract with the Veterans Administration Health Facilities: 1. 2. 3. 4. 5. Cost about a tenth or less of inpatient services in VA facilities. Present a major potential for providing effective recovery services Allow veterans to obtain needed alcoholism recovery services in their own communities; veterans who would otherwise go unserved because of geographical remoteness, lack of available space in VA facilities, or procedural (paperwork) barriers within the bureaucracy. Has significantly expanded the VA's ability to serve veterans needing alcoholism recovery services with no capital outlay, and at little or no additional personnel outlay. RECOMMENDATIONS A. B. C. The Pilot Program should be made a permanent part of the Veterans Administration overall Health Service Program. All investigators have arrived at the same conclusion the Pilot Program has shown itself to be a cost-effective, program-effective activity. Rates for services should be established on the basis of actual costs in communities in which contracting facilities are located. It goes without saying that costs of living vary greatly from rural to urban areas, and from one section of the nation to another. If equal quality services are to be provided, then allowance must be made for the differences in costs of providing services. Criteria for quality of services and allowable length of stay in contracted facilities should be fully coordinated with State Alcoholism/Drug Authorities, most particularly where states have established quality assurance programs. It makes little sense for the federal government to fund state alcohol and drug programs under the Alcohol, Drug Abuse, and Mental Health Administration block grants, and then to have the Veterans Administration propose quality D. E. F. G. H. standards which may be inconsistent or even in conflict with state standards. Is it inconceivable that the Veterans Administration might not just qualify local contract providers on the basis that a state has licensed and certified a program, when the federal government is already underwriting such quality assurance through Department of Health and Human Services funding? Is it necessary for the VA to independently create standards and quality assurance systems where states already have done the job? 1. The allowable length of stay of a veteran in a community based alcoholism recovery program should be studied and reassessed. Studies show that the present sixty day limit is simply inadequate for the veterans' needs. In the California study, the average stay for maximized recovery was eighty-nine days, even though the VA stopped paying after the sixtieth day. The types of services provided under contracts should be expanded to at least include social model detoxification services. It is well and fully established that most recovering alcoholics (including veterans) do not need to undergo initial withdrawal in a hospital setting, and in fact several reputable studies have shown that persons who detox in a social (nonmedical) setting achieve a higher proportion of full recovery than those who do not. Eligibility procedures should be established which do not require that a veteran first enter a VA hospital or inpatient unit. If a veteran is attracted to and is willing to enter a community alcoholism recovery program, he/she should be allowed to do so and then seek eligibility for payment. Many veterans are essentially denied services at a critical time because of problems of geographical location, nonavailability of bed space in VA facilities, or procedural (paperwork) delays. If a veteran were approved, the contract provider should be paid retroactively. If a veteran were not approved, the contract provider would have to accept the loss. Followup studies and other analyses should be closely coordinated with state alcohol/drug authorities. Re-inventing the wheel is costly. Nearly all states have effective programs The words "halfway house" should everywhere be replaced with the phrase Serious consideration should be given to an appropriate, but fairly major Reports on the subject all show that large numbers of veterans with alcohol BACKGROUND CALIFORNIA ASSOCIATION OF ALCOHOLIC RECOVERY HOMES VETERANS ADMINISTRATION PILOT PROGRAM SURVEY SUMMARY REPORT CALIFORNIA ASSOCIATION of ALCOHOLIC RECOVERY HOMES 2146 W. Adams Boulevard LOS ANGELES, CA 92018 During the months of October and November of 1983, the California Association of Alcoholic Recovery Homes surveyed 184 community based Alcoholism Programs throughout California to determine the programmatic benefits and cost effectiveness of the Veterans Administration's Pilot Program, authorized under Public Law 96-22, Section 104. This law calls for the Veterans Administration to contract with community based residential Alcoholism Recovery Homes and Halfway Houses to provide alcohol recovery and rehabilitation services to the chronic alcohol and related drug dependent veteran. 184 survey questionnaires were sent out to community based organizations operating alcohol recovery programs throughout California, (Refer to ADDENDUM I). 61 eligible organizations statewide responded to the questionaire. 15 or 25% of the respondent organizations indicated they were presently contracted with the Veterans Administration under the Pilot Program, (ADDENDUM II and III). Each of the 15 V.A. contractors indicated they were Certified by the California State Department of Alcohol and Drugs and Licensed by the Department of Social Services, Community Care section. PROGRAMMATIC EFFECTIVENESS The V.A. contracted programs surveyed, received a total of 214 referrals or admissions from the participating V.A. Hospitals during the 1982-83 fiscal year. The average V.A. reimbursement rate for each admission reported was $18.85 per residency day. The average length of stay reported for 214 admissions was 89 days. Length of stay ranged from 52 days to 210 days. Since the Pilot Program calls for a maximum reimbursable length of stay of 90 days, not all reported residency days were actually reimbursed by the V.A.. Public Law 96-22 indicates that the Pilot Program is designed in terms of: 1 |