Committee on Economic Security (CES)
Volume VI. Social Insurance
G. Workmen's Compensation
ECONOMIC SECURITY FOR THE PHYSICALLY HANDICAPPED
Memorandum submitted by the International Society for Crippled Children
Any program for promotion of economic security or our citizenry would be inadequate did it not include specific provision for the physically handicapped.
Each year many thousands of persons in the United States become permanently physically disabled through accident, injury, disease, or congenital cause. Reliable studies made in many parts of the country show that for every 1,000 of our population, six persons have permanent physical handicaps which interfere with or prevent their social and economic adjustment. Of these six persons per thousand in any community, three are children and three are adults. Most of the children and a considerable proportion of the adults need and can profit by surgical corrective measures. Many of the children are also in need of special facilities to enable them to secure at least an elementary education. Again, both children, after they reach the age of employability, and adults require guidance, vocational training, and placement if they are to become economic assets rather than liabilities in our social order.
Naturally, much had been and is being done in the states to meet this situation. The problem of serving the physically handicapped is fundamentally on of rehabilitation. Rehabilitation falls logically and in practice into two main divisions. First, physical rehabilitation; second, vocation rehabilitation. The former includes location, diagnosis, medical or surgical correction, prosthesis, and after-care. Involved with or following these processes is the education of the crippled child. Hospital schools, special schools and classes, and home teaching are required. Guidance, vocational training, and placement are the logical processes in the second phase of service to the physically handicapped.
What is being done in the field of rehabilitation of the physically handicapped? Various private agencies, fraternal orders, and service slubs are doing much to stimulate certain phases of the work. Eighteen states have laws for hospitalization of crippled children. Twenty states have laws providing for their education. Forty-five states have laws for, and receive aid from the federal government for the vocational rehabilitation of physically disabled adults. While the work thus done is reaching many of the disabled, particularly in the larger centers of population, the field is very inadequately covered. If the problem of rehabilitation of the physical handicapped is to be met to the degree that the needs of this important group in society require in order to bring about their social security and economic independence, all of the states and their subdivisions should be stimulated to make adequate provision for this group through legislation. Such legislation should recognize that the problem is fundamentally one of rehabilitation -- both physical and vocational.
Accomplishments in the field of vocational rehabilitation of disabled adults, as promoted by the federal government since 1920, indicate conclusively both the need for, and the practicability of maintaining the work by the states with the financial aid and leadership for the federal government. This vocational rehabilitation program for adults has demonstrated the urgent need in the states for more comprehensive and better correlated service by all agencies involved in serving the crippled child and the disabled adult. Rehabilitation is a continuous process, starting with the child and carrying through the adult group. This can be most readily accomplished through legislation providing for promotion of the whole program by one agency of the federal government, charged with the responsibility for promoting and developing the whole program.
Federal participation in vocational rehabilitation of the adult, in vocational education for the able-bodied, and in other similar enterprises is based upon the sound principle that financial aid given by the federal government is matched by state and local expenditures. This is known as the 50-50 plan of operation. Apportionments to the states are made on the basis of population. Such legislation as is proposed for more adequate promotion of rehabilitation of the physically handicapped should follow this fundamental principle. While such a plan does not in all cases provide financial aid to the degree that it is most needed, the population ration basis of distribution is the most practical and equitable plan that had thus far been devised.
As stated before, administration of federal promotion of the program should be lodged with but one federal agency. Logically, this agency should be the one which is already engaged in the promotion of vocational rehabilitation of the disabled adult, that is the Vocational Rehabilitation Division of the U.S. Office of Education. This agency is familiar with the problem, has had 15 years's experience in maintaining federal-state relations, in administering grants of federal aid to the states, and in rendering assistance to them in carrying on their programs.
With respect to administration of service to physically handicapped individuals in the states, cooperation with the federal government should be maintained by such state agencies as are already by state law engaged in some major phase of rehabilitation service' and where there is no agency, by such agency as is designated by the state legislature through its acceptance of the proposed Federal Act. In forty-five states there are vocational rehabilitation agencies. These should be designated to function in the states with respect to vocational rehabilitation, both of children and adults. In these states where state agencies have been established by law to provide for physical rehabilitation and education of crippled children, these agencies should be designated as the state cooperating departments.
Legislation for promotion by the federal government of a comprehensive rehabilitation program for the physically disabled should, with respect to the use of the federal and matching funds, provide that the state shall determine in which fields the funds will be used. The determining factors should be - (1) the degree to which needed services are already being adequately maintained, and (2) the services for which inadequate or no provision is being made. Naturally such plans for expenditures of funds in the states would be subject to approval by the federal agency to the end that the purposes and objectives of the federal legislation be carried out.
Purposes for which the federal and matching funds are to be used should include the following; location, diagnosis, hospitalization, surgical and medical care, therapeutic care, prosthesis, guidance, education, vocational training, and placement.
With respect to the type of persons who would be eligible to receive the services contemplated under the proposed legislation, a carefully drawn definition of the physically handicapped should be set up in the law. In view of provision already made in the states for education of children who are blind or deaf, or have visual or hearing defects, eligibility should be restricted to the orthopedically handicapped. The following definition, presented in the report of the recent "White House Conference", seems applicable:
"The physically handicapped child in the orthopedic sense, is a child that has a defect which causes deformity or an interference with normal function of the bones, muscles, or joints. His condition may be congenital or it may be due to disease or accident. It may be aggravated by disease, neglect, or by ignorance".
Carefully made estimates regarding the amount of federal money which would be needed to stimulate the program and aid the states in carrying on the work show a requirement of an appropriation of $3,000,000 annually. Such a fund, distributed to the states on the basis of the ration of their populations to the entire population of the country, matched by state and local expenditures, and supplemented by cooperation by private agencies, would go far to meet the needs of the physically disabled youth of the country and would represent an investment of public funds which would yield handsome returns in bringing about economic independence of a group which is all too likely to be forgotten in a program calculated to provide economic security for our people.