Broken down by weekly earnings, the approximately 56,000 who upon rehabilitation were placed in wage paying jobs were in the following income groups:

Under $20.

$20 to $29.

Percent

Percent

15. 4

10. O

8.0

$30 to $39.

$40 to $49..

21. 0 $70 to $89..

19. 6 $90 and over.

2. 4

In addition, 1,659 blind persons, previously rehabilitated under the programs, are operating 1,599 vending stands established in Federal and other buildings under the Randolph-Sheppard Act. These operators had total net earnings of $3,638,047 in 1954, or an average net income of $2,193. These blind operators also provided employment in the stands to 273 blind assistants, who had an average net income of $1,400. Many of the assistants were employed on an hourly or seasonal basis to help during peak periods accounting for the lower average net income.

VOCATIONAL REHABILITATION AND NATIONAL ECONOMIC GROWTH AND STABILITY

In addition to the increase in dollar earnings of disabled persons after rehabilitation described above, the vocational rehabilitation program makes the following contributions to national economic growth and stability.

(a) Increase in tax revenue.--The taxes paid by disabled persons after return to gainful work make a substantial increase in the revenues-Federal, State, and local-available to support public functions. Federal income taxes alone for 56,000 persons rehabilitated

in 1954 will amount to an estimated $8.5 million a year. Also, the effect is cumulative, since the majority of these individuals continue to pay taxes for the balance of their working lives. Estimates indicate that the Federal income tax yield amounts to more than $10 for each Federal dollar spent for rehabilitation. In addition, they pay an uncalculated sum each year to State and local governments.

(b) Reduction of public assistance.-At present about one-half billion dollars is being spent each year through the State-Federal publicassistance programs to maintain around 1 million persons who themselves are disabled, or, in the case of the aid to dependent children program, whose father, mother, or other caretaker is disabled.

A special study for the 1953 fiscal year showed that approximately 12,000 disabled persons who had been receiving public assistance at sometime during their rehabilitation were rehabilitated and placed in productive jobs. To maintain these disabled people on assistance for a single year would have cost around $8.5 million. Their rehabilitation for useful work cost only about $6.4 million.

A recent followup study of 321 handicapped persons who were rehabilitated in the 1951 fiscal year under the vocational rehabilitation program of the State of Washington, shows very significant findings with respect to the effectiveness of vocational rehabilitation in enabling the disabled to become productive and self-supporting members of society. At approximately 3 years after their "rehabilitation" and the closure of their cases by the Washington agency, 92 percent of the 321 "rehabilitants" were self-supporting. Only 9 persons, or less than 3 percent, were receiving public assistance. (Fifty-three percent of these "rehabilitants" had been receiving public assistance at the time they were accepted for rehabilitation services or were referred by welfare departments. The remaining persons were referred by various agencies.) Most of these rehabilitated people were able to do more than just remain self-supporting. Eightyfive percent had received wage increases and in one-half of the cases the increases amounted to more than $1,000 per year. Here a sizeable group of people, precluded by disability from working, with no income and dependent upon the public for support, were not only able to become self-supporting but were also able to achieve substantial increases in earnings through vocational rehabilitation.

(c) Preventing dependency.-The rehabilitation of the disabled to prevent their dependence upon public assistance or care in public institutions is of the greatest significance in promoting the national welfare and improving the national economy. Generally, because of their health problems, the resources of the disabled quickly become exhausted. (Only 6 percent of the handicapped who were rehabilitated in 1954 reported insurance benefits of all types as their primary source of income.) Vocational rehabilitation services, including remedial or ameliorating physical restoration services, must be provided as soon as possible after disablement to prevent the individual from becoming dependent upon public facilities and programs for his maintenance. The longer disability remains uncared for, the more difficult and costly becomes rehabilitation because of deteriorating attitudes, loss of work habits, and so forth. The early provision of psychiatric services to a person who is emotionally disturbed and the placement of that person

1 Breul, Frank R., Do They Stay Rehabilitated, State Board for Vocational Education, Division of Vocational Rehabilitation, Olympia, Wash., June 1, 1954.

in a suitable job may prevent more serious illness and avoid admission to a mental institution.

Similarly, extensive economic and social benefits derive from the vocational rehabilitation of the physically and mentally disabled who are now in institutions. These benefits will be found in earlier discharges from the institution; in reductions in readmissions; in the restoration of confidence to the individual, particularly to the mentally disturbed; and in the attainment of suitable work and financial independence by the disabled person instead of a possible resort to public assistance.

Recently a study was conducted on a group of ex-tuberculous sanatorium patients who, following discharge, participated in the State vocational rehabilitation program and on a comparable group which did not participate in that program. This study disclosed that the former group derived substantial financial and other benefits from the vocational rehabilitation services provided, and that their communities also benefited. Those who participated in the State program had higher earnings, held more suitable jobs, had better tenure and otherwise enjoyed better working conditions. The participants had considerably lower relapse rates than the nonparticipants61.5 percent of the nonparticipants experienced a relapse at least once during the 5-year interval following discharge, whereas only 25.6 percent of the participants experienced recurrences. Hospitalization and public welfare costs during the 5-year interval averaged $463 per participant and $1,082 per nonparticipant. Moreover, hospitalization and welfare costs were on the decline for the participants at the time of follow-up; whereas, for the nonparticipants, the trend was such that a much wider gap could be expected between the groups in the years subsequent to the survey. Thus, the individuals who accepted the services that the vocational rehabilitation program has to offer were far more successful in their economic, social, and vocational adjustments in their communities following their discharge from the sanatorium than were the nonparticipants. Their communities benefited from the greater earnings of the participants, the fewer demands they made upon the social agencies for services, and (by virtue of their better vocational and social adjustments) the great savings in welfare and hospitalization costs.

Approximately 3,500 or 5.5 percent of the total group of rehabilitants in 1953 were in tax-supported institutions at the time they were accepted for vocational rehabilitation. These people were in tuberculosis sanatoria, institutions for the mentally ill and mentally retarded, special facilities for the epileptic, and in facilities for the chronically ill. In view of the cost of institutional care and the social and other problems resulting from removal of the individual from the family, development of the vocational rehabilitation and related programs to their full potential so as to obviate in all cases where possible the need for institutional admission or readmission will be of the greatest significance financially and otherwise.

2 Warren, Sol L., A Comparative Analysis of the Post-Discharge Experiences of Tuberculous Patients, The American Review of Tuberculosis, vol. 69, No. 2, February 1954.

LONG-RANGE NEEDS AND OBJECTIVES

The State-Federal vocational rehabilitation program has been reachg only about 60,000 handicapped persons per year, roughly a fourth f the people who, within each year, come to need vocational rehabilitaon services to earn their livelihood. For this reason the President,

1954, recommended and the Congress enacted legislation for a radually expanding program, the ultimate goal of which is the ehabilitation each year of 200,000 disabled persons.

This new program provides funds and authority for personnel trainng to help relieve the present extremely acute shortages of doctors specializing in rehabilitation, physical therapists, occupational therapists, rehabilitation counselors, and psychologists and social workers skilled in rehabilitation. It provides for research and demonstration to develop new rehabilitation techniques, to improve present techniques, and to disseminate knowledge concerning these techniques. It provides for an expansion of present rehabilitation facilities, speech and hearing clinics, sheltered workshops and other specialized facilities for which there is a great and urgent need throughout the Nation. And, finally, additional Federal financial support is made available for the basic State programs.

As indicated earlier, the economic and social benefits of the present State-Federal vocational rehabilitation program are very substantial. When the goals of the expanded program are finally realized the results will be even more striking. For then each year 200,000 handicapped people will be rehabilitated as wage earners contributing to the Nation's production. Without rehabilitation, the majority would remain unemployed and of those few who were able to continue work, even though hazardous to themselves or others, the greater number would be in the lower-income brackets with little or no chance of higher earnings. On the contrary, because of the unsuitability of their jobs or their deteriorating conditions, they would be faced with job loss. A substantial number of these people, who at the time of acceptance will be unemployed, will upon rehabilitation be holding well paying jobs. Some will, of course, be in the lower-income groups but they would have moved upward from no income to some income or from a lower income to a better income. Finally, the increased tax revenues and the reduction in public-assistance costs that will result from the ability of these people once again to be self-supporting will be substantial.

It is of note that estimates of the proportion of persons with longterm disabilities in the civilian noninstitutional population in the United States and in Canada compare quite closely. In the United States, it is estimated that 2.6 percent of this population group has long-term disability, as compared with 3.1 percent in Canada. Tables 1 and 2 present these comparisons.

3 The United States estimates for 1954 were chiefly derived from data developed by two studies (1949-50) of the prevalence of disability in the civilian noninstitutional population aged 14-64 years, made by the Social Security Administration, the Office of Vocational Rehabilitation, and the Public Health Service from data collected for this purpose by the Bureau of the Census. The Canadian Sickness Survey (1950–51) was similar to the United States surveys except that the 2 age groups under 14 years and over 64 years were included in the Canadian field samples but not in the surveys conducted in the United States.

Source: Comparison of Estimates of Prevalence of Long-Term Disability in United States and Canada, Research and Statistics Note No. 43, 1955. Prepared by Alfred M. Skolnik, Division of Research and Statistics, Social Security Administration, Department of Health, Education, and Welfare.

TABLE 1.-Estimated number and percentage of persons with long-term disabilities in the civilian noninstitutional population, United States and Canada, by age

'Social Security Bulletin, June 1955, p. 21, and unpublished data. Estimates refer to an average day in 1954.

'Canada, Dominion Bureau of Statistics and the Department of National Health and Welfare, Canadian Sickness Survey, 1950-51, No. 6, Permanent Physical Disabilities (National Estimates), Ottawa, February 1955, p. 9.

Civilian noninstitutional population estimated from Bureau of the Census, Current Population Reports, Series P-25, No. 101, table 2.

Population universe from which sample was drawn, after adjustments for excluded sections of the population. Canada, Dominion Bureau of Statistics and the Department of National Health and Welfare, Canadian Sickness Survey, 1950-51, No. 7, Incidence and Prevalence of Illness (National Estimates), Ottawa, April 1955, p. 13.

TABLE 2.-Estimated number and percentage distribution of persons with long-term disabilities in the civilian noninstitutional population, aged 18-64 in Canada and aged 14-64 in the United States, by employee status

1 Based on Marjorie E. Moore and Barkev S. Sanders, Extent of Total Disability in the United States, Social Security Bulletin, November 1950, table 5; and Estimates of the Prevalence of Disability in the United States. September 1950, Rehabilitation Service Series No. 317, Office of Vocational Rehabilitation, April 1955, table 5.

2 Canada, Dominion Bureau of Statistics and the Department of National Health and Welfare, Canadian Sickness Survey, 1950-51, No. 6. Permanent Physical Disabilities (National Estimates), Ottawa, February 1955, p. 10. Includes employed or seeking employment, at school, and retired or not seeking employment.

SECTION 3. CHARACTERISTICS OF THE AGED POPULATION

This section includes some of the most recent statistical materials on the economic status of the aged population in the United States. They show that of the aged not living in their own households, a substantial portion received little or no income. In 1954, as shown by the census data included in part 1 of this report, 46 percent of all unrelated individuals with incomes of less than $1,000 were aged 65 years or over, and 31 percent of the families of 2 or more persons at