[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
DIGNITY DENIED: THE CASE FOR REFORM
AT STATE VETERANS HOMES
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
TUESDAY, APRIL 29, 2025
__________
Serial No. 119-17
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
U.S. GOVERNMENT PUBLISHING OFFICE
61-150 WASHINGTON : 2025
COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON HEALTH
MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman
JACK BERGMAN, Michigan JULIA BROWNLEY, California,
GREGORY F. MURPHY, North Carolina Ranking Member
DERRICK VAN ORDEN, Wisconsin SHEILA CHERFILUS-MCCORMICK,
JEN KIGGANS, Virginia Florida
ABE HAMADEH, Arizona MAXINE DEXTER, Oregon
KIMBERLYN KING-HINDS, Northern HERB CONAWAY, New Jersey
Mariana Islands KELLY MORRISON, Minnesota
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
TUESDAY, APRIL 29, 2025
Page
OPENING STATEMENTS
The Honorable Mariannette Miller-Meeks, Chairwoman............... 1
The Honorable Julia Brownley, Ranking Member..................... 3
WITNESSES
Panel I
Dr. Scotte Hartronft, M.D., Executive Director, Office of
Geriatrics & Extended Care, Veterans Health Administration,
U.S. Department of Veterans Affairs............................ 4
Ms. Sharon Silas, Director, Health Care, U.S. Government
Accountability Office.......................................... 6
Panel II
Mr. Ed Harries, President, National Association of State Veterans
Homes.......................................................... 16
The Honorable Charlton J. Meginley, Col. (Ret), USAF, Secretary,
Louisiana Department of Veterans Affairs....................... 18
APPENDIX
Prepared Statements Of Witnesses
Dr. Scotte Hartronft, M.D. Prepared Statement.................... 29
Ms. Sharon Silas Prepared Statement.............................. 30
Mr. Ed Harries Prepared Statement................................ 45
The Honorable Charlton J. Meginley, Col. (Ret), USAF Prepared
Statement...................................................... 57
Statements For The Record
Florida Department of Veterans Affairs Prepared Statement........ 65
Veterans of Foreign Wars of the United States Prepared Statement. 66
The National Association of State Directors of Veterans Affairs,
Inc. Prepared Statement........................................ 69
The Honorable Sheri Biggs, U.S. House of Representatives, (SC-3)
Prepared Statement............................................. 72
Questions for the Record Submitted by The Honorable Mariannette
Miller-Meeks, U.S. House of Representatives, (IA-2)............ 75
DIGNITY DENIED: THE CASE FOR REFORM
AT STATE VETERANS HOMES
----------
TUESDAY, APRIL 29, 2025
Subcommittee on Health,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:17 p.m., in
room 360, Cannon House Office Building, Hon. Mariannette
Miller-Meeks [chairwoman of the subcommittee] presiding.
Present: Representatives Miller-Meeks, Taylor, Brownley,
Cherfilus-McCormick, Conaway, and Morrison.
Also present: Representative Taylor.
OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN
Ms. Miller-Meeks. Before we get started, in accordance with
committee rule 5E, I ask unanimous consent that Representative
Dave Taylor from Ohio be permitted to participate in today's
committee hearing. Without objection.
This oversight hearing of the Subcommittee on Health will
now come to order. I would like to welcome all members and
witnesses to today's hearing. We look forward to a very
productive discussion about care for aging veterans.
Every veteran deserves independence and dignity with age.
With age however comes challenges. The Baby Boomer generation
is getting to an age where long-term care is increasingly
needed. More and more veterans are entering a period in life
where they are physically and mentally vulnerable or do not
live near family members who can assist.
The demands on the U.S. Department of Veterans Affairs (VA)
from long-term care will only grow due to the incoming veterans
who served during the Vietnam and cold war eras. For some, they
have trouble advocating for themselves because of their health
needs which can undermine their independence.
This subcommittee works every day to make sure VA health
care meets veterans where they are. We know older veterans
experience social isolation, or may, chronic pain, mental
health challenges, and the VA healthcare must meet our aging
veterans' needs. Recent incidents show that there is still work
to be done.
I am particularly troubled by veteran suicide later in
life. We have talked a lot about suicide in our younger
veterans and our veterans who transition out of the service but
not much about veterans who commit suicide late in life. Just 2
weeks ago a 77-year-old veteran tragically committed suicide at
a VA medical campus.
Sadly, very little research exists about why veterans end
their lives at a time when they should be enjoying the fruits
of all of their labor.
Through this subcommittee's oversight trips we have heard
that older veterans who commit suicide are an invisible
population. As a 24-year Army veteran and physician, I refuse
to let this issue live in the shadows.
Health care programs through VA are a major contact point
where the VA can interact with older veterans. Uniquely, State
veterans' homes deal with this population almost exclusively.
They are a key means by which we can support older veterans on
a daily basis.
State veterans' homes are long-term care facilities for
veterans and often for their spouses. They are state-run but
receives substantial amounts of funding from the VA.
When VA supports State veterans' homes it is also
supporting a compilation of smaller programs. VA gives funds
for State veterans' homes to support programs like resident
care, domiciliary care, and adult daycare.
In addition, VA provides grants for facility construction
through a matching program with states. The VA also provides
grants for nursing retention at State veterans' homes. These
programs help veterans flourish later in life.
Are we sure that the VA is helping State veterans' homes
meet their full potential? This oversight hearing is meant to
answer this question. I know that most homes throughout the
country give the quality of care that veterans in need deserve
but there are notable outliers.
In 2020, at a State veterans' home in Holyoke,
Massachusetts, over 70 veterans died with COVID-19 during an
outbreak during the pandemic. Many more suffered infections. An
independent investigation revealed that this horrific tragedy
was preventable.
Additionally, Government Accountability Office (GAO)
reported that the total number of demerits for failing
requirements in the annual VA audit increased from 2019 to
2021.
The good news is that these are exceptions rather than the
rule, but what can we do to make sure all homes offer the
standard of care veterans deserve? I believe the VA can help
State veterans' homes succeed.
We know that the VA has money. We give it to them every
year. Again, the VA disburses a substantial amount of funding
to support State veterans' homes through reimbursements and
grants. We must make sure the VA allocates these funds to the
right resources.
That is why I have introduced a bill to provide veterans
with more access to essential medications. My bill would
reimburse State veterans' homes for medication cost.
Currently, the VA does not pay State veterans' homes for
high cost medications for severely disabled veterans, yet they
are often revolutionary cancer drugs that can help
significantly lengthen the veteran's life and quality of life.
These medications are covered outside of the facility rather
than through the State veterans' homes.
I have said it before, I will say it again. It is critical
to expand the network veterans can use to access lifesaving
medications. I also know that construction grants come with
strings attached that may not make sense for the veteran or the
State veterans' home supporting them. I look forward to
discussing this and more with the witnesses before us today.
Older veterans deserve quality long-term care. We owe it to
them to put them at the forefront of our conversation about
veteran healthcare.
I now yield to Ranking Member Brownley for any opening
remarks she may have.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Thank, you Madam Chair. Overall, an estimated
80 percent of veterans will need long-term services and
supports at some point during their lifetime. The overwhelming
majority of aging adults, including veterans, would prefer to
age in place in their homes rather than nursing homes.
With the recent enactment of the Elizabeth Dole Act,
Congress bolstered VA's authority to offer home and community-
based services for aging and disabled veterans. We are eager
for VA to implement this law as soon as possible.
However, even with this expansion of VA's non-institutional
long-term care programs, not every veteran will have enough
support from family members or other caregivers to enable them
to safely age at home. For that reason there will always be a
need for nursing homes.
State veterans' homes, which are owned and operated by the
states with Federal investments in the form of construction
grants and per diem payments, are the largest provider of
institutional long-term care for veterans. Collectively, they
serve more than 43 percent of the veterans receiving VA-funded
nursing home care on any given day in 2023.
VA-operated community living centers served about 20
percent and VA purchased care from community nursing homes
through the remaining third of veterans.
Despite serving the majority of veterans for whom VA
purchases nursing home care, State veteran homes receive only
about 18 percent of VA's total payments for institutional long-
term care. VA's basic per diem for State veteran homes now
covers less than 30 percent of the actual cost of care and as
little as 20 percent in some states with higher costs of
living.
State veteran homes make up the balance of their costs
through other funding sources including State support, Medicare
and Medicaid, and the veterans themselves who share in the
cost.
This week and next, 11 other House committees will mark up
budget reconciliation legislation ramming through draconian
cuts to Federal programs that serve the most vulnerable among
us, all to fund tax cuts for the very wealthy.
The House Energy and Commerce Committee has been instructed
to cut $880 billion over 10 years and nearly all of those cuts
are expected to come from Medicaid, which funds long-term care
for more than 60 percent of nursing home residents.
With many community nursing homes already teetering on the
brink of financial insolvency, these Republican budget cuts
would put them at greater risk of closures.
Medicaid also funds many home and community-based services
enabling aging and disabled people, including veterans, to
avoid institutional settings and care. Should these Medicaid
cuts come to pass, veterans will become more reliant on VA and
State veteran homes for long-term services and supports.
I certainly hope both the administration and the states
will be factoring this into their budget proposals in the
coming years.
I also must say I am perplexed by the title of today's
hearing. For many veterans the sense of community and
culturally competent care that has historically been provided
by State veteran homes allows them to retain their dignity in
their later years. State veteran homes were established by the
states and are supported by VA as a way to honor our Nation's
promises to veterans through the end of their lives.
If anything, I would argue that cutting safety net programs
on which many veterans rely, like Medicaid, will ultimately
deny them the dignity they deserve. This subcommittee last held
an oversight hearing dedicated to State veteran homes almost 5
years ago in the early months of the COVID-19 pandemic. At the
time, heartbreaking tragedies were unfolding in nursing homes
across the country, including at several State veteran homes
where staffing shortages, outdated physical infrastructure, and
poor infection control practices led to the rapid spread of the
virus.
The pandemic quickly exposed the critical importance of
strong oversight and ongoing monitoring of the quality of care
and patient safety at nursing homes. During the pandemic,
Congress acted to address gaps in State veteran home oversight
and provided $1 billion in funding to support grants for State
veteran homes' instruction and operational needs.
Unlike the slash and burn budget reconciliation process
House Republicans are undertaking, we used the budget
reconciliation process in 2021 to infuse much-needed funding
for State veteran homes and other critical programs on which
Americans rely.
We also improved VA's oversight of State veterans' homes
under the Cleland-Dole Act, which was enacted in 2022. VA is
now required to document all deficiencies identified during
State veteran home inspections, even ones that are corrected on
the spot.
In addition, this law required VA to publish the results of
State veteran home inspections and corrective action plans on
its public-facing website so that veterans and their loved ones
can make more informed choices about where to receive nursing
home care.
I look forward to hearing more from our witnesses today
about the progress that has been made and the challenges that
still remain in State veteran home operations and oversight.
With that, Madam Chairman, I yield back.
Ms. Miller-Meeks. [Audio malfunction.]
STATEMENT OF SCOTTE HARTRONFT
Mr. Hartronft. Good afternoon, Chairwoman Miller-Meeks,
Ranking Member Brownley, and distinguished Members of the
Subcommittee. My name is Dr. Scotte Hartronft, and I am the
Executive Director of the Office of Geriatrics and Extended
Care at the Department of Veterans Affairs. I am honored to
discuss the strategic approach VA employs, which results in
high-quality health care outcomes and support for the Nation's
heroes at State Veterans Homes (SVH). SVHs are owned, operated,
and managed by the states. VA's role as it relates to SVHs is
as a support to ensure Veterans receive the high-quality care
which meets the Department's standards, through annual
certification and recognition surveys, Medical Sharing
Agreements, and grants to construct, renovate, or repair State
owned facilities. Currently, the Department supports 172 SVHs,
which administer a combined 166 Nursing Home Programs, 47
Domiciliary Care Programs, and 3 Adult Day Health Care
Programs. To participate in the SVH program and its benefits,
VA must formally recognize a care facility as an SVH through
the certification process and a recognition survey. Along with
compliance with VA standards, a recognition survey requires
adherence to all applicable Federal, State, and local laws
including the relevant professional standards for VA purposes
to recognize the home as an SVH. After formal recognition, VA
conducts at least one unannounced annual survey at each
facility to ensure compliance with VA standards. The VA surveys
cover 200 clinical standards, fire and life safety standards,
administrative standards, and fiscal standards. Page 1 of 2
Many of the standards are based on the Centers for Medicare and
Medicaid Services (CMS) nursing home standards but others are
VA and SVH unique. Any areas of non-compliance identified on
surveys are addressed through corrective action plans in
collaboration with the Veterans Health Administration (VHA)
survey team. During the corrective action plan follow-up period
an ad-hoc for cause full survey can be completed if felt
necessary. Compliance with VA regulations under 38 C.F.R. part
51 and VA's survey and certification process is required for
SVHs that provide nursing home care, domiciliary care, or adult
day health care to remain eligible to receive per diem payments
or participate in the State Home Construction Grant Program.
The VA survey process mirrors the Centers for Medicare and
Medicaid Services for long-term services and long-term care
facilities. VA offers support to State veterans' homes by
permitting recognized State veterans' homes to enter into
medical sharing agreements with our local VA medical centers to
secure additional clinical services, more secure discounted
pharmaceutical prices.
As of February 2025, State veterans' home nursing homes
that are CMS-certified scored on average higher on the overall
star rating for the national CMS nursing home average.
To maintain State veterans' home recognition, VHA may also
provide funds to ensure adequate levels of nursing staffing. In
Fiscal Year 2025, VA approved $4.7 million for the 17 states
and 47 State veterans' homes that applied for Federal grants to
support programs to hire and retain nursing staff.
The State Home Construction Program is a partnership
between VA and the states to construct, renovate, or repair
state-owned and operated nursing homes, domiciliary, and/or
adult day health care facilities.
VA provides reimbursement up to 55 percent of allowable
costs to states for the construction and renovation of State
veterans' homes. The number of awards provided each year
depends on the number of projects, their costs, and the amount
of appropriation received for the fiscal year. VA as well is
responsible for determining the priority for the funding for
facility improvement, which may include bed replacement, mold
removal, and repairs to structural hazards to State veterans'
homes to maintain their recognized status.
In conclusion, VA remains steadfast in its dedication to
continuous improvement in the oversight of State veterans'
home. We appreciate the oversight from the committee and look
forward to answering any questions you may have.
[The Prepared Statement Of Scotte Hartronft Appears In The
Appendix]
Ms. Miller-Meeks. Well, thank you. I would just like to
remind our witnesses to speak more directly into the
microphone. Either move it closer to them or move closer to the
microphone.
Ms. Silas, you are now recognized for 5 minutes to present
your testimony.
STATEMENT OF SHARON SILAS
Ms. Silas. Chairwoman Miller-Meeks, Ranking Member
Brownley, and members of the subcommittee, I am pleased to be
here today to discuss our prior work on State veterans' homes.
My testimony today describes the oversight structure of State
veterans' homes and opportunities to improve VA's oversight.
VA projects that the demand for long-term care will
continue to increase, driven in part by growing numbers of
aging veterans and veterans with service-connected
disabilities.
As of Fiscal Year 2023, there will be about 15,000 veterans
living and being cared for in State veterans' homes at a cost
of $1.5 billion.
In our November 2022 report, we reported that there were
153 State veterans' homes providing nursing home care in the
United States. These homes are an important resource for
housing and care for some of our most vulnerable aging
veterans.
State veterans' homes are owned and operated by the states,
however, VA provides per diem payments for eligible veterans to
receive care in these homes, and as of Fiscal Year 2023 the
average daily cost per veteran per day was $265.
There are three entities that may have a role in overseeing
State veterans' homes: the VA; the Centers for Medicare and
Medicaid Services, or CMS; and the states.
First, VA is the only Federal agency that has oversight
responsibilities for all State veterans' homes. While VA does
not exercise any supervision or control over the
administration, personnel, or maintenance of the homes, VA does
provide oversight through annual inspections.
Through these inspections, homes are assessed against
quality standards, cited deficiencies if they do not meet these
standards, and then they are required to develop a corrective
action plan to address the deficiencies.
CMS also provides oversight of those State veterans' homes
that has received Medicare or Medicaid. CMS certifies homes in
order for them to receive funding.
Once certified, CMS will conduct inspections about every 15
months to determine whether the home is meeting quality
standards. We found that nearly 76 percent of the 153 homes in
our study were also inspected by CMS.
Some states also provide state-specific oversight of State
veterans' homes. For example, these states may have state-
specific regulations for nursing home quality or they are able
to take enforcement actions at the home.
As part of our review, we found that 43 states conducted
their own oversight in addition to oversight conducted by VA
and CMS, but the remaining seven states where there was no
State oversight, five states' State veterans' homes received
oversight from CMS and VA and two State homes only received
oversight from the VA.
In our report we made four recommendations for VA to
improve its oversight of State veterans' homes and one
recommendation remains open. During our review we found that
VA's only enforcement action to compel homes to address
deficiencies was to withhold per diem payments for veterans, a
severe action that could ultimately impact the veteran's care.
Officials expressed reluctance to use the enforcement tool
unless under extreme circumstances. In fact, at the time of our
review, VA officials could not recall ever withholding a State
veterans' home's per diem.
Further, we found in our November 2022 review of 153 State
veterans' homes there were a total of 756 deficiencies. 40
percent of State veteran homes were cited for the same
deficiency in 2019 and 2021. 21 percent of the deficiencies had
corrective action plans that were past their due date.
Moreover, in our review, we cite an example of a State
administrator that noted they were more concerned with CMS'
inspections because of the civil penalties.
VA could benefit from having a range of enforcement actions
similar to CMS that would provide a more effective tool to
motivate State veterans' homes to comply with standards. CMS
has a range of enforcement actions, including civil penalties
that are aligned with the scope and severity of the deficiency.
Having a similar approach to help VA more effectively target
penalties and better compel State veterans' homes to come into
compliance with quality standards.
During our review, VA told us that they were considering a
legislative proposal to Congress for authority to impose fines
or withhold a percentage of the per diem payment to address
noncompliance with quality standards. We believe this to be a
good step to creating a range of enforcement actions that would
be effective.
Subsequently, GAO recommended VA identify additional
enforcement actions that would help ensure State veterans'
homes' compliance with quality standards and seek legislative
authority to implement those actions. Although VA concurred
with our recommendation, they have not identified additional
enforcement actions. Instead, VA has responded by developing a
new enforcement plan that strengthens internal timelines and
increases the follow up with homes that have deficiencies.
While these are good steps to strengthen oversight of State
veterans' homes, they are not necessarily actions that will
compel the homes to comply with quality standards. Our veterans
residing and receiving care in State veterans' homes are our
most vulnerable. Having a range of enforcement options that,
for example, are scaled to the scope and severity of
deficiencies similar to CMS' range of enforcement actions would
provide VA with more effective enforcement and better ensure
that State veterans' homes are providing the high quality care
veterans and their families deserve.
That concludes my statement and I am happy to take any
questions.
[The Prepared Statement Of Sharon Silas Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much, Ms. Silas. As is my
typical practice, I will reserve my time for questions until
all of the members have had a chance to ask their questions.
I now recognize Ranking Member Brownley for 5 minutes for
any questions she may have.
Ms. Brownley. Thank you, Madam Chair.
Dr. Hartronft, it is nice to see you again. My first
question to you, and I would appreciate a brief answer, is if
these Medicaid cuts happen, if there is a significant cut to
Medicaid, have you done any kind of analysis on the extent to
which this would increase veterans' reliance on the VA for
long-term services and supports?
Mr. Hartronft. Thank you for that question. We have not
heard of any specific amount so we have not had any
discussions, but the VA, as usual, can be flexible with any
changes in the market based on expanding our use of other
contractors in homes and other facilities.
Ms. Brownley. You do agree that if there were significant
cuts to Medicaid it would have an impact on, you know, veteran
services and longer term care such as state-owned nursing
homes?
Mr. Hartronft. Most of any potential impacts I would have
to defer to CMS but, obviously, we would respond if we think
that adequate changes are necessary.
Ms. Brownley. Okay. Let me ask you in terms of the GAO's
recommendations, there are 20, 22 recommendations to seek
legislative authority for a broader range of enforcement
actions. According to the GAO as of 2025, VA is no longer
interested in pursuing additional legislative authority.
You were the executive director of the geriatrics and
extended care program when GAO made this recommendation, so
what changed between 2022 when you concurred with it and now,
aside from the obvious change in Presidential administration,
did new leadership within the VA directives change?
Mr. Hartronft. What I can explain is as to in 2022 we were
in the process of a modernization effort which we centralized
all the surveys within VA central office instead of each local
VA doing that. What we did was we also added what we call an
escalation plan that puts, based on the number of survey
findings and severity in the categories of one through four,
and that prescribes a frequency of oversight.
What we have done is since February we have noticed that
the outcomes has been positive in the sense that 100 percent of
our corrective action plans are now on time and they are
meeting their compliance. We also addressed in our corrective
action escalation plan what we need to do. If we were to seek
any penalty we would work with the Veterans Integrated Service
Network (VISN), the local VA, and determine within what is in
our current Code of Federal Regulations (CFR) and regs to
propose any penalties.
Ms. Brownley. You did not feel with this reorganization
that you are speaking of, did not feel the need for any kind of
financial as in a fine or percentage of the per diem as
something that would leverage better accountability?
Mr. Hartronft. Well, based on external feedback we have
been able to restart discussions internally and we are, kind
of, in the discussion and concurrence phase, so we have not
ruled that out. We are just now going back to that.
Now that we have something in place that we did not have
before and we have shown good compliance with it we now are
going back to see and discuss do we think there is any other
appropriate actions that we might need to have in place if we
would have problems.
Ms. Brownley. Ms. Silas, do you, kind of, agree with that
assessment?
Ms. Silas. Yes. I mean, we believe that the steps that the
VA has taken to increase their oversight was really helpful.
They strengthened their timelines. They were doing more follow
up with the homes and that is really gone a long way I think to
improve oversight.
We still think that there needs to be some sort of tools
that have some teeth to them to make sure that they can hold
the State veterans' homes accountable. I think it is also
really important that it is a range and so that it is very
similar to CMS, as I mentioned in my statement, where it is a
range that is aligned with the scope and severity of the
deficiency and that way you can, kind of, right-size the tool
to ensure there is accountability in the home.
Ms. Brownley. Great. Dr. Hartronft, so the next panel there
is going to be testimony from the State Veteran Home
Association expressing some concern that the VA medical centers
are not really working with the residents in the State home to
ensure that they receive specialty care, including mental
health and psychiatric care, that this has been, sort of, an
ongoing concern. Can you speak to that?
Mr. Hartronft. Yes, ma'am. It is a continuous improvement
that we work with the association because there we are paying
part of our per diem does cover basic primary care, and in
nursing homes it does count for normal primary care-related
mental health levels working with depression, things like
anxiety. Really just us clarifying the difference between
primary care level that we are paying per diem versus specialty
care, and that is why we have local liaisons that work with the
State veterans' home to try and make sure they can afford the
medicine and specialty care that is above the ability of the
State home.
Ms. Brownley. I yield back.
Ms. Miller-Meeks. Thank you very much, Ranking Member
Brownley.
The chair now recognizes Representative Cherfilus-McCormick
for 5 minutes for any questions she may have.
Ms. Cherfilus-McCormick. Thank you so much. In typical
fashion we are hearing the same old tired playbook from our
colleagues across the aisle, identify a program that serves the
most vulnerable and put the program under a microscope, pick
out any perceived flaws, ignore the program's success, defund
that program, and push veterans into the private sector.
Today's strategies are the State veterans' homes, which
provide almost half of all of our Federal long-term care
support services to our Nation's veterans. This critical
lifeline is one of the most lean and effective programs in all
of VA.
Per diem payments to these homes for skilled nursing care
are one-third less than the cost of private sector nursing
homes and almost 90 percent less than the VA's community living
centers. State veterans' homes only have the capacity to serve
30,000 veterans, well short of the 8.4 million veterans who are
65 and older.
Instead of cutting funding for these programs, we should be
actively pursuing solutions that expand the capacity of these
facilities to treat more veterans and equip VA with the staff
needed to conduct effective oversight.
Dr. Hartronft, as the executive director of the Office of
Geriatrics and Extended Care at the VHA, you are responsible
for ensuring VA's veterans' homes are safe and provide quality,
long-term care to our veterans. In your view, does your office
currently have enough staff to fulfill this core mission?
Mr. Hartronft. Currently we are adequately staffed.
Ms. Cherfilus-McCormick. What is your plan to move these
deficiencies that were pointed out that have been consistent
and pervasive?
Mr. Hartronft. Okay. Most of them have been fully addressed
with oversight. Again, what we did before was each local VA was
responsible for the surveys and the follow up, whereas now we
have centralized it where we have a consistent, assigned staff
that they go, that work and oversee the same nursing homes.
Then that way they can follow them all the way through the
survey through all the steps and the corrective action plan and
then get them from provisional to full certification.
Ms. Cherfilus-McCormick. Now, your statement sounds the
contradictory to what Ms. Silas has stated with the consistent
deficiencies. Is that correct or is there--am I missing
something, Ms. Silas?
Mr. Hartronft. Then I guess I must have heard the question
wrong, my apologies. Can I--could you----
Ms. Cherfilus-McCormick. The deficiencies. When we talked
about the deficiencies, well, when Ms. Silas spoke about the
deficiencies and the consistency of those deficiencies and how
there seems to be more direction in toughening up the standards
and not really curing the deficiencies. I wanted to know if you
had enough staff and if so, if not, how are you actually
planning on meeting and reversing course on these deficiencies?
Mr. Hartronft. Okay, thank you, ma'am. Just as an overall
industry, in the CMS whenever they survey homes the number of
survey findings in the community, as well as the State
veterans' home deficiencies over time, as well as the fair
review of those deficiencies. We are a reflection of the larger
industry.
What has changed over the time since the last time we
really had the full review from the GAO is our centralization
of the process. They may have an increased number of
deficiencies, but our staff are working with them from the day
of the survey until the completion of the corrective action
plan and getting evidence of compliance. They are getting
evidence of closure much more and to the point where it is
higher quality and much improved over time.
Ms. Cherfilus-McCormick. Now, I have listened and spoke to
many State homes and they have all complained about the same
issues when it comes to funding and not having enough staff,
not even being reimbursed for a certain amounts to provide
food, especially at this time when there is inflation.
Ms. Silas, I would like to hear from you what your view is
on the deficiencies and do you feel like cutting funds would
actually help them to cure or would it actually exacerbate the
issues you are finding?
Ms. Silas. I do not think I can speak directly to the cuts
because we have not conducted a review looking specifically at
those, but I will say that my testimony, the report that we did
that was back in 2022, we had four recommendations we made.
Some of the things that Dr. Hartronft was talking about in
terms of the centralization of the Geriatrics and Extended Care
Office and the oversight----
Ms. Cherfilus-McCormick. Well, I do not mean to cut you off
because my time is running out----
Ms. Silas. Sure, Okay.
Ms. Cherfilus-McCormick [continuing]. but I just wanted to
add this fact to you, so as you are going on. They are looking
to cut 72,000. With that fact being there you can go ahead and
continue.
Ms. Silas. Sure. I do know that the oversight for the State
veterans' homes was very decentralized to the VA medical
facilities and so there was, I guess, over 100 staff that were
trying to monitor the State veterans' homes. With the
centralization I think there is four or five staff now that are
focused on monitoring a set of homes within the region.
They are able to, as Dr. Hartronft was saying, being able
to track the corrective action plans and make sure that there
is closure and that the deficiencies are being addressed.
Ms. Cherfilus-McCormick. Thank you.
I yield back.
Ms. Miller-Meeks. Thank you very much.
The chair now recognizes Dr. Conaway for 5 minutes for any
questions he may have.
Mr. Conway. Thank you. I would start by just providing some
background, a New Jersey situation. Last year the former
Attorney General Merrick Garland, filed a complaint in the U.S.
District Court for New Jersey against New Jersey Veterans
Memorial Homes at Menlo Park and Paramus.
The two veterans' homes landed in the national spotlight
for reports of a significant number of deaths that occurred
during the pandemic and called for more oversight and
investigation. Well, as a result of the action by the district
court, families of 119 residents of those facilities entered
into a settlement in which each family received an average of
$455,000 and a total settlement of $53 million. The State was
responsible for paying 60 percent of that.
Now, as the outbreak was raging, did the VA get into
veterans' homes, not only in New Jersey but across the country,
to respond to the deaths that were occurring and the other, you
know, related illnesses that were occurring in the homes? That
is, did somebody from the VA go to these various homes to
enter--to conduct a review of operations during the pandemic in
those homes?
Mr. Hartronft. Thank you, sir, for that question. The local
VA's were in constant contact with their State veterans' homes,
but obviously since the State owns, operates, and manages them
there was only so much we can do outside of our oversight. It
was individualized and different for each home, so if there is
any specific homes we can go back and ask and find out more
details what the local VA actually did with each facility,
whether it was in-person, whether it was a telephone consult,
or if they provided staff or resources or other things.
Mr. Conway. There were in-person visits to the homes to try
to understand if there were attempts to separate the ill
patients from patients that were not ill or to review any
recent deaths in those homes and whether or not they had
adequate staffing in the homes to make sure that the residents
of those homes were safe in light of the pandemic?
Mr. Hartronft. It varied from home to home based on what
the State facility was working and communicating with the local
VA, so it varied from site to site, but I do not have the
details from each specific VA, data from each specific State
home, but I can take that for the record if you would like to
know more about any specific home.
Mr. Conway. Ms. Silas tells us that the VA, and perhaps you
mentioned it and I am sorry if I missed it, that the VA does
not have the kind of authorities that, as I heard it, they
ought to have to ensure compliance with outcome standards, with
standards of care in the home.
Do you agree with that statement? This is to the doctor to
provide me--you made the statement, Ms. Silas, but I wonder if
the doc agrees with what you said?
Mr. Hartronft. Yes. We are working within our current
limitations with the CMR and USC, so that is why we put the
escalation in place because that could be done more immediately
while we do have now internal discussions as to what we need to
do above that. We are in the concurrency discussion phase, but
we, again, I would point out that so far the outcome from our
new plan has been successful and there not being anybody out of
timelines for any corrective action plans not being addressed.
Mr. Conway. Now, well, Ms. Silas, do you want to--well, let
me get to this. Do you feel that if you do not have the
appropriate authorities, if you will, or actions beyond
reviewing a corrective action plan, which are very important,
of course, what do you do without legislation? What can you do
to really improve that without legislation to give you more
authority and to ensure compliance with what one would consider
to be appropriate nursing home standards?
Ms. Silas. Sure. Without having some of those authorities,
I mean, what we were really looking for is the ability to apply
civil penalties or to take part--do a partial per diem payment
to stop back. If you do not have the authority to take those
types of actions you are going to have to get faith in word and
do changes internally, which I think the VA has done where they
have strengthened their timeline. They have done more follow up
with the homes.
They also have an option to pause admissions to the State
veterans' homes, even though veterans can still be admitted to
the State veterans' homes. They do not have to be referred from
the VA itself.
They have taken some actions but they are all very internal
and they are all around the processes and what we really want
to see is to see something that has a real, again, I will say
teeth again and a real penalty so that there is more
accountability for the State veterans' homes.
Then having some of those tools and especially providing a
range they can, kind of, right-size the accountability to the
State veterans' homes.
Mr. Conway. Thank you.
Thank you, Madam Chair.
Ms. Miller-Meeks. Thank you, Dr. Conaway.
The chair now recognizes Representative Taylor for 5
minutes for any questions he may have.
Mr. Taylor. Thank you, Chairwoman Miller-Meeks and Ranking
Member Brownley for holding this hearing today and allowing me
to participate.
Thank you to our witnesses also for your insight and
testimony. My home State of Ohio has two State veterans' homes
with one being located in my district in Georgetown, so I
appreciate the opportunity to engage on this important issue.
Dr. Hartronft, I understand there is a large backlog of
State veterans' homes awaiting Federal construction grant
funding. These projects that have already secured their State
share of the funding and are ready to go as soon as they
receive their matching Federal grant. However, at current
funding levels some projects may have to wait 5 to 10 years to
receive their matching Federal dollars.
Can you describe some of the projects and some of the
conditions that veteran residents may have to face while these
homes await Federal funding?
Mr. Hartronft. Thank you, sir. I do not have the list of
the actual approval and projects in front of me, but what we do
is with the funds that we do have each year it is a dynamic for
anything necessary from 1 year to the next if it is not covered
in the funding zone window it is moved to the next year. They
may change in the listing order based on if there is a new
application that has a higher priority level based on necessity
or some other issues.
We do carry them over and then we continue to construct
based on the length and----
Mr. Taylor. As the veteran population ages and as the
backlog of State veteran home construction projects continues
to grow, how does the VA plan to alleviate the backlog?
Mr. Hartronft. The good news is that we already have
several facilities that we know are coming online within the
next year, or the next 2 years, so there are many projects that
are going through, which really working with the states to
identify where those best locations are.
Again, we do not determine where the states place them or
how big they or the services. We largely respond to the
applications that we receive title work for the State to see
how we can best make the situation the best possible.
Mr. Taylor. You have new projects coming online while
these, I think there are in excess of 80 tier one projects that
have their State funding lined up waiting for Federal funding.
There is no plan to do more than what has usually been done to
chisel down that list?
Mr. Hartronft. We received around, I think it was during
COVID, we received a larger financial appropriation and we were
able to go further down the list. We were able to also help
those facilities during that time to renovate so that they
could have better ventilation systems, largely focused toward
COVID. Many of them benefited from us having that larger thing
to where they could actually do Heating, Ventilation, and Air
Conditioning (HVAC) changes and other benefits.
Mr. Taylor. Thank you, Doctor.
To me it appears this is a question of priorities and I
think now is a great time for Congress to have this
conversation as we consider where our Federal Government spends
our tax dollars we must always keep veterans at the forefront
as we root out waste, fraud, and abuse from several different
programs within the Federal bureaucracy. We would recognize
State veteran homes from across the country are being left
behind. It is unacceptable to me that our government would send
tens of billions of dollars overseas while leaving veterans to
wait years for much-needed modernizations at State veterans'
homes, including the Georgetown home I represent.
That is why I introduced the Veterans First Act, which
would take a small fraction of the identified wasteful spending
and repurpose it to clear up the existing backlog of State
veterans' home construction grants.
For President Trump and the White House the days of
spending money on things like electric cars in Vietnam and
Diversity, Equity, and Inclusion (DEI) projects in Serbia are
over. To that end, I will keep working to get our Nation's
spending priorities straightened out and the veterans are at
the top of the list.
Once again, I thank the committee for the opportunity to
speak today. I yield back.
Ms. Miller-Meeks. Thank you very much, Representative
Taylor.
I now recognize and yield myself 5 minutes to ask
questions. First and foremost, thank you very much for being
here. State veterans' homes being State run do they also get
oversight or investigations, if you will, from a state's
Department of Inspections and Appeals that oversees nursing
homes within the states that are not a veterans' home?
Ms. Silas or Dr. Hartronft.
Ms. Silas. Sure. As we reported in our report, there were a
total of seven homes that were not getting State oversight.
Five of them were getting oversight by CMS and then there were
two states that will have no oversight except for the oversight
from VA.
Ms. Miller-Meeks. The majority then would have oversight at
the State, as well as the VA?
Ms. Silas. Yes.
Ms. Miller-Meeks. Thank you for that.
Dr. Hartronft, our subcommittee has learned that older
veterans are considered an invisible population when it comes
to suicide prevention. What has the VA observed about older
veteran suicide and what mental health care service is
available at the VA for older veterans and help lower the
incidence of suicide deaths? I know you mentioned this in your
remarks.
Mr. Hartronft. Thank you, ma'am. There is a lot of layers
that we do at the State veterans' homes and we really respond
to what education they request because of what they are seeing
in their population at the time. A lot of our mental health
training and education has been over disruptive and disturbing
behaviors, obviously, as well as falls, but we have been
working with the Office of Mental Health and Suicide Prevention
and they are actually in the active process of planning new
educational interventions at the State homes and others when it
comes to suicide prevention, especially in the elderly
population, which is actually psychiatry.
Ms. Miller-Meeks. Could is also being complicated by the
incidence or, excuse me, prevalence of Alzheimer's or dementia
as one ages?
Mr. Hartronft. Yes and no. From the geriatric perspective,
obviously, there is dementia and other aspects but also,
especially in elderly men after they become recent widows,
there is those significant changes in life when they do have
that increase across all populations, the veteran and non-
veteran based on age. That is one reason why we are working
with the Office of Mental Health to get geriatric psychiatry to
get those levels of education and recognition because they can
be very subtle in the older population.
Ms. Miller-Meeks. I would also like to commend you on the
response by the modernization, the changing in your processes,
the going from decentralization to some centralization which
has helped to clear up a lot of the deficiencies and demerits
within the system, so I am just going to--there has been a
little bit of criticism toward you for that but let me commend
you on being able to do as much as you have by looking at the
process itself and to see how you can change behavior through
that mechanism.
Can a State veterans' home that receives citations for
deficiency in the annual VA audit still get funding on the same
terms as a home that receives no deficiencies?
Mr. Hartronft. In the overall nursing home industry it is
rare that no one gets no deficiencies, but just, kind of,
showing that single digits usually. Because there is over 200
standards at the VA we call it the CMS standards plus fiscal
with the administration, we do a ton of standards.
It would be very rare that you do not have at least one, no
matter being a very good facility. There is always some policy
or something that might get you somewhere, but overall we have
seen where we work with them very closely and really just
making sure that things get cleared up and they get the support
they need.
We have literally had some State veterans' homes where the
local VA sent staff to provide direct education just in time
and others to really make sure that we are getting--we are
really wanting the outcomes. The outcome is really to make sure
that the veteran gets better care, so the local VAs have
invested a lot in their local VA State veterans' homes.
Ms. Miller-Meeks. Would more enforcement measures create
more opportunity for correction?
Mr. Hartronft. At this time based on the outcomes we are
seeing with our current escalation plan, which is our outcome
is to get these compliant and we have been successful. Again,
as I said, we have been taking some external feedback to the
point where that we are discussing are there next steps? That
will obviously take longer in time, but we really wanted to
focus what could we do more immediately within our parameters,
knowing that some of the other measures may take a little
longer going through other processes.
Ms. Miller-Meeks. Again, I commend you for what you have
been able to achieve thus far.
I had a question for Ms. Silas but, Ms. Silas, I will
submit it for the record since my time is running out.
On behalf of the subcommittee I want to thank you all for
your testimony and for joining us today. You are now excused
and we will wait a moment as the second panel comes to the
witness table. Thank you so much.
I would now like to introduce the panel two witnesses.
Testifying before us today we have Mr. Ed Harries, president of
the National Association of State Veterans' homes. Mr. Harries,
if I have mispronounced your name please feel free to correct
me. The Honorable Charlton J. Meginley, colonel, retired U.S.
Air Force, secretary of the Louisiana Department of Veterans
Affairs (LDVA).
Mr. Harries, you are now recognized for 5 minutes to
deliver your opening statement.
STATEMENT OF ED HARRIES
Mr. Harries. Chairwoman Miller-Meeks and Ranking Member
Brownley, as president of National Association of State
Veterans' Homes (NASVH) thank you for inviting me to testify
today.
State homes provide about half of all VA-supported skilled
nursing care for veterans, yet we consume only 18 percent of
the VA's total budget for this care. According to the VA, the
calculated institutional per diem for State homes is $262
compared to $424 for private community homes, and $1,971 for VA
Community Living Care (CLC).
According to CMS data, the veterans' homes are safer, have
a higher quality rating, and receive fewer substantiated
complaints and citations compared to community nursing homes.
Approximately 70 percent of the State homes are rated as four
or five star facilities compared to just 35 percent of the
community homes.
State homes also had 70 percent fewer substantiated
complaints and half the number of infection control citations.
Community homes are primarily overseen by CMS while State homes
have significant oversight from VA, CMS, and our State
government.
All homes receive annual VA inspections and 75 percent are
also inspected by CMS. 85 percent are subject to either annual
or for cause infections by their states.
Madam Chairwoman, while oversight is a necessary component
of any well-run organization, it must be balanced against the
dangers of overregulation.
Nursing home administrators spend an estimated 20 percent
to 30 percent of their time on regulatory compliance and
reporting, diverting focus from resident care and staff
management.
Overregulation creates a high pressure environment for
staff. Studies from the Journal of Nursing Regulation linked
high levels of regulatory burden to increased stress among
frontline staff and administrators alike.
Overly burdensome regulations can also stifle innovation.
The Rand Report noted that facilities hesitant to adopt
telehealth, personalized dementia interventions, or adaptive
care models often cited fear of regulatory noncompliance as a
primary barrier.
While good governance of any organization must include a
through and effective oversight, overregulation can undercut
its efficacy.
Madam Chairwoman, NASVH has several recommendations to
strengthen and expand services for aging veterans at State
veterans' homes. We strongly support the Providing Veterans
Essential Medications Act, and we want to thank you and
Congressman Pappas for introducing this legislation to address
the problem of high cost medications.
We were both surprised and disappointed that the VA
testified in opposition to your bill. VA officials were aware
of the problem and have told NASVH on multiple occasions in
recent years that they were interested in solving it.
The technical concerns raised by the VA could all be easily
overcome with clarifications and additional legislative
language. We stand ready to work with you and your committee to
perfect this legislation.
Another problems State veterans' homes must overcome is the
VA's failure to cover the cost of specialty care. Although VA
is required by law to pay for specialty care, in practice the
VA is regularly refusing to do so, particularly for psychiatric
care.
Madam Chairwoman, many State veterans' home face continuing
and significant financial challenges due to the COVID pandemic.
We are still recovering. To help address this problem, NASVH
supports an increase in the basic per diem rates and calls on
Congress to appropriate at least $650 million to put toward
ending construction projects.
Finally, I would like to discuss how the veterans' homes
may help improve mental health support for aging veterans.
Public Law 117 through 28 require the VA to create a geriatric
psychiatry pilot program in the State veterans' homes. Instead,
the VA implemented only a limited expansion telemedicine mental
health services.
NASVH believes that the homes could play a larger role in
addressing the mental health needs of our aging veterans. We
would like to work with you to develop a new pilot program to
do exactly that.
Research has shown that many of the supports that State
veterans' homes provide to its aging veterans require
protective factors for veterans in crisis and at risk for
suicide. Expanding the scope of the long-term care services
offered by veterans' homes could play a small but meaningful
part in the VA's suicide prevention efforts.
That concludes my statement, and I would be pleased to
answer any questions you or any members may have.
[The Prepared Statement Of Ed Harries Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mr. Harries.
Secretary Meginley, you are now recognized for 5 minutes to
deliver your opening statement.
STATEMENT OF CHARLTON MEGINLEY
Mr. Meginley. Chairwoman Miller-Meeks, Ranking Member
Brownley, distinguished members of the House Veterans Affairs
Committee (HVAC), on behalf of Governor Jeff Landry thank you
for providing us the opportunity to address the critical topic
of long-term care for our veterans, specifically in Louisiana's
veterans' homes, which I will give you a little bit of
information about.
While I cannot speak for the operations in other states, I
assure you that Louisiana we have the requisite leadership,
oversight, and a highly competent and dedicated staff to ensure
that our veterans receive high quality, safe patient care and
are always treated with the dignity they have earned and
deserved.
Our five veterans' homes in Louisiana are situated and
placed across the State. They are sanctuaries for those who
have sacrificed greatly for our Nation. These facilities
provide more than shelter and medical care. They offer a
community where veterans are honored, respected, and cared for
with deep compassion.
Our staff, the nurses, administrators, aides, social
workers, therapists, and support personnel are the heart of
this sacred mission. They take the time to understand each
veteran's needs, stories, and preferences and, in turn, build
meaningful connections.
Whether assisting with daily activities or maybe medical
care or simply listening, these professionals create an
environment of dignity and respect. Their work reflects a
profound commitment to preserving each veteran's worth through
connection, purpose, and recognition.
Now, contrary to the 2022 GAO report, we believe our
veterans' homes operate under significant oversight to ensure
the highest standards are maintained.
Federal and State agencies, including the Department of
Veterans Affairs, Centers for Medicare and Medicaid Services
via Louisiana Department of Health, Louisiana legislative
auditors, Louisiana Office of Risk Management, Louisiana civil
service, along with our own DVA internal auditors and our own
DVA compliance team conducts regular inspections to evaluate
everything from medical care quality to facility safety.
Compliance with these rigorous standards is mandatory. This
oversight is complemented by internal quality assurance
programs and an ongoing policy revision and staff training that
prioritize quality care and resident rights, patient safety,
and well-being.
Any concerns raised by any resident or their family members
are addressed through formal grievance processes, which ensures
accountability at every level. Under our leadership, our
clinical teams have driven significant improvements in care
quality.
VA survey deficiencies decreased by 36 percent from 53 in
2023 to 34 in 2024, but the 34 does not really tell the whole
story. Further breakdown of these 34 deficiencies across all
five of our veterans' homes shows that 91 percent were minimal
with no actual harm, essentially a level B or below.
In fact, one of our deficiencies was for a burned out light
bulb. Another was for a fryer that had been cleaned and
replaced one inch from its original position.
I note that our system-wide pressure ulcer rates remain at
or below 5 percent, approximately one-third of the national
average of 15 percent for long-term care facilities.
According to the CMS Nursing Home Care Compare Survey,
three of our five facilities have earned five star ratings with
the remaining two achieving four star ratings, all by
prioritizing robust census growth. We are proud of the care
that we provide our veterans in Louisiana.
However, Ms. Chairwoman, we recognize that there is always
going to be improvement or room for improvement. In a written,
excuse me, in our written statement we provided some
information about the escalating cost of medication, which we
have covered here today is, something that we fully support.
The LDVA would also like to see greater support for our
veterans' mental health and behavioral programs. We are
experiencing a continued rise in the prevalence and acuity
level of mental health and behavioral issues which negatively
impact both clinical coordination and home admissions. In
essence, there are plenty of veterans who we have to turn away
because we simply do not have the capability to meet their
needs.
Pilot studies to identify optimal staffing, infrastructure,
and operations of enhanced geriatric psychiatric care
capabilities are warranted and Louisiana is ready to lead this
effort.
Ms. Chairwoman, veterans in our homes are not just
patients. They are family members. They are heroes. Our staff's
clinical competency and dedication ensures that their dignity
is not only preserved but celebrated while they continue to
receive high quality and safe care.
Robust oversight from engaged leaders and unwavering
commitment of staff create a foundation of trust and respect
that honors our Nation's promise and our state's promise to our
veterans.
I want to thank you for your continued support of our
veterans and the homes that serve them. I welcome any questions
that you may have.
[The Prepared Statement Of Charlton Meginley Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Secretary Meginley. As is my
typical practice I will reserve my time until all other members
have had a chance to ask their questions.
I now recognize Ranking Member Brownley for 5 minutes for
any questions she may have.
Ms. Brownley. Thank you, Madam Chair.
Mr. Harries, I just wanted to start off with Mr. Taylor was
here and seemingly introduced a new bill, and my understanding
of the bill is that he wants to take $2 billion in funds that
were appropriated to the U.S. Agency for International
Development, or USAID, and reallocate those funds to the VA for
State veteran homes construction grants. Is that a bill that
you support or have you had a chance to look it over?
Mr. Harries. Yes. Actually, I have. The NASVH cannot
determine where the money is going to come from. However, there
is a huge need for more State veterans' homes across the
country. If you think about it, and you are well-aware, the
bolus or bubble of veterans coming at us in the age group we
care for, it is not stopping. It is coming at us.
On top of that, with respect to the high-cost medication
mitigation, more and more of these are coming through toxic
exposures, cancer diagnoses, Parkinson's, very, very complex
care.
More veterans' homes actually allows the VA to or
accelerates the VA to complete their mission of reaching out to
veterans across the country. Let us provide the footprint that
they can build on.
Ms. Brownley. Well, thank you for that. You know, and I
agree with you. I think we need to provide more resources. I
have worked very hard in my tenure in Congress to expand and
extend long-term care. My veterans' home, my State veterans'
home within my district, is an extraordinary place with many
happy, happy, happy veterans and their spouses as well and so I
agree with you.
I just, in terms of Mr. Harris' (sic) bill I just, kind of,
feel as though, from my perspective anyway, that U.S. foreign
assistance is essential, a component to our national security.
I think veterans who serve abroad probably understand that very
well in terms of what USAID does in fostering goodwill toward
our Nation.
I think USAID literally saves lives by bringing food,
medicine, and stability to impoverished nations, and I think
the bill just represents a false choice between funding veteran
programs versus global security and international cooperation.
Quite frankly, I think that we must fund both is my
perspective and we can do both if we do so with rational tax
policies that require millionaires and billionaires to pay
their fair share rather than providing massive giveaways. I
think that is what is happening right now as we speak under the
dome here through reconciliation as we are working through a
tax plan to give millionaires and billionaires great tax cuts
at the expense of others.
I just wanted to State that for the record, and I will move
on and wanted to ask you both with the question that I had
asked Dr. Hartronft earlier when he was here. If there is a
significant cut to Medicaid over the next 10 years, have your
respective states analyzed the extent to which this may
increase veterans' reliance on State veteran homes? If these
cuts lead more veterans to turn to State veteran homes for
long-term care services?
Mr. Harries. I am assuming the question is for me?
Ms. Brownley. Yes, either one of you.
Mr. Harries. Well, first, we would want all veterans to
come to the State veterans' homes.
Ms. Brownley. Yes.
Mr. Harries. I mean literally.
Ms. Brownley. Understood.
Mr. Harries. We do serve and provide a much higher level of
service and quality of life. We firmly believe that I have seen
it firsthand. With those Medicaid cuts, 75 percent of the
veterans' homes are covered by CMS so therefore they would have
a significant Medicaid population in the mix.
If the cuts are applied to long-term care limit levels at
that point. We have done those studies to accommodate for that
at this point but would be willing to look at that and any
studies that do come forward.
Ms. Brownley. Very good. I think I, you know, and this last
week I visited several facilities in my district within our
county hospital and, you know, they were talking about the
devastation the hospital would undergo if these cuts were
pursued.
They also were, sort of, in a wait and see mode to just,
kind of, see what happens before they take any action,
obviously, but they went through a quick laundry list of where
the impacts would be. They would be pretty devastating and I
guess my time is up and I yield back.
Ms. Miller-Meeks. Thank you very much. I thank your county
hospitals for not responding to stuff that has not yet
occurred. Thank you for that.
Again, I am going to apologize to the witnesses for members
that are not here given the numbers of markups that are going
on throughout.
I also appreciate that it seems that Mr. Harries and
Secretary Meginley that you understood the point of my
questioning to Ms. Silas regarding oversight, that oversight
for State veterans' homes occurs far beyond just the VA or the
HVAC Health Subcommittee or HVAC Committee here in Congress,
that you have multiple regulatory bodies conducting oversight.
To your point Mr. Harries, it sometimes actually creates
burdens and hurdles and lack of innovation or new processes.
Again, I commend the VA and Dr. Hartronft for the progress they
have made in clearing deficiencies, so I just wanted to
recognize that.
Mr. Harries, how could VA health care be improved to
address gaps in medication reimbursement at State veterans'
homes?
Mr. Harries. How could it be improved? If the VA were to
accommodate the State veterans' homes through as they do the
private sector nursing homes by paying for, reimbursing for
those high-cost medications.
Ms. Miller-Meeks. For medication that they cover outside--
--
Mr. Harries. Correct.
Ms. Miller-Meeks [continuing]. of the veterans' homes?
Mr. Harries. Exactly. My point is we are doing it for one
party but we are not doing it for another and we are the party
that is not getting that reimbursement.
There are states, and I have stories already in my previous
testimony, and I believe there may be some in this one where
veterans have been turned away because they have $100,000
medication or a $28,000 medication coming in which it is the VA
per diem rates that are paid. That is a financial loss for the
facility. That loss has to be made up somewhere else, which
would probably be in resident care, probably not adding another
admission, and just the cascading effect.
I think the key thing is covering those medications as they
are coming, and as I spoke earlier, the number of residents
that we are seeing now, the number of patients coming to us
with high-cost medications and complex comorbidities, such as,
well, the reimbursement has got to come, especially with all
the toxic exposures and Agent Orange exposures and such.
Ms. Miller-Meeks. Last month we discussed a pilot program,
the Communities Helping Invest through Property and
Improvements Needed for Veterans (CHIP IN) Act, which had been
used to instruct a VA clinic next to the VA Medical Center in
Omaha, Nebraska, and extending the CHIP IN Act from its pilot
program for construction for either VA hospitals and/or VA
clinics.
Even though the State veterans' home are a combination of
State funding and VA funding, is this something that a little
bit of out-of-the-box thinking that could be applied to
construction grants for State veterans' homes?
Then I have got an extension to that question.
Mr. Harries. I do not see why not. It sounds like a
fantastic idea.
Ms. Miller-Meeks. We might need to expand our potential
legislation. The current interpretation of Federal regulations
does not allow a State veterans' home to apply for a
construction grant in order to begin new adult daycare health
program. A home may only seek a grant to expand or replace a
facility currently being used for adult day health care. What
complications does this pose for State veterans' homes that
want to provide adult daycare?
Mr. Harries. It cannot do it unless they pay for it
entirely on their own and it is a sizable investment in care.
Adult daycare, and we have talked about suicide prevention and
mental illness with our veterans that are coming in, adult
daycare, the medical model of adult daycare, the residents are
assessed on a daily basis to make sure that does not happen.
It also takes out the isolation that causes a lot of
suicides. It would be vital for us to be able to expand that
program and have satellite offsite clinics available under
outpatient or adult daycare facilities so that we can monitor
and take care of those residents. Their life would be much
better improved if we could do that.
Ms. Miller-Meeks. Thank you.
Secretary Meginley, several of Louisiana's State veterans'
homes are in rural areas. What are challenges and best
practices for coordinating transportation for veterans who need
specialized care?
Mr. Meginley. Yes, ma'am. One of our homes is in the rural
area of Jennings. One of the challenges that we have, because
it is in a rural area, is making sure that we have the
appropriate staff. Obviously, making sure we have the Licensed
Practical Nurses (LPNs), the Registered Nurses (RNs) to be able
to come in.
We are having to pull from different metropolitan areas
making sure that these individuals are well-funded, well-paid
is something that we consistently work with our Louisiana civil
service to make sure that those folks are paid at least market
rate at a minimum and offered additional co-pays as needed.
As far as getting them to the facilities, luckily, Bossier
is okay. Our home in Bossier is next to Overton Brooks in
Shreveport so they have easy access to the hospital. Reserve is
close to New Orleans VA. Jackson is not too far from our
Community-Based Outpatient Clinic (CBOC) in Baton Rouge, which
is very well equipped, I think.
Yes, that is a problem. Something that we have talked about
extensively is about rural transportation for veterans to VA
hospitals and something that we have had since the
conversations with our administrators about making sure that we
can facilitate those needs.
Ms. Miller-Meeks. Thank you. I would yield. I know. I am
sorry. She was telling me Dr. Morrison is here. Do I know Dr.
Morrison is here? I was just about to say I yield the remainder
of my time.
The chair now recognizes Dr. Morrison for 5 minutes for any
questions she may have.
Ms. Morrison. Thank you, Madam Chair.
Thank you to our witnesses for testifying today on the role
of State veterans' homes play and caring for our aging
veterans. You know, a key aspect that strikes me as fundamental
to today's hearing is the importance of having robust data to
review as we discuss opportunities to improve oversight and
ultimately the quality of care in State veterans' homes.
I know several years have passed since the last hearing on
this issue here in Congress with my colleagues, and I have had
the benefit of being able to review data GAO compiled in their
2022 review, as well as data from research conducted in
collaboration with the VA and other research entities.
I emphasize that we have this data as a result of
intentional and consistent efforts to monitor the quality of
care at State veterans' homes and conduct research in this
area. As a result of these research and monitoring efforts, we
are able to better understand elements such as the population
of veterans that use State veterans' homes, how State veterans'
homes are meeting needs in comparison to community nursing
homes and VA's community living centers, how well State
veterans' homes responded to the COVID-19 pandemic, and even
what areas of operation oversight might warrant additional
review.
Having spent over 2 decades of caring for patients as a
physician myself, it is important to me that our next steps
consider evidence-based strategies and place data and form
responses at the forefront of our actions, so I want us to
continue using the data available to us in hearings like the
one we are having here today.
Equally and perhaps more critical in this particular
moment, I think it is imperative that we continue to collect
this data and not undermine the research that supports our
collective pursuit of best practices and quality care for our
veterans.
Secretary Meginley, in your testimony you discussed best
practices for the State veterans' homes under your management.
I appreciate that you began your statement affirming your
state's unwavering commitment to safely and effectively
managing State veterans' homes and conclude expressing your
willingness to continue working closely with your VA partners
turn to ensure clinical quality and patient safety.
Can you elaborate a little bit more on how this partnership
with VA has contributed to your ability to deliver high quality
care in State veterans' homes?
Mr. Meginley. Yes, ma'am. I will tell you all, I am not
just a veteran. I am a patient of the New Orleans VA. That is
where I go to all my healthcare. I have a phenomenal
relationship with my administrator. I can call my administrator
at midnight on a Friday night, which I have done, to ensure
that a veteran who is having a mental health crisis is taken
care of immediately.
My administrators both in Alexandria and Shreveport are
very much the same. The rural health care question, recently I
was at Monroe and the honeymoon period of my time ended very
quickly when I got confronted about community care issues.
I contacted my administrator in Shreveport and gave him the
questions that some of the veterans had had concerns about, and
that administrator answered those questions within 72 hours and
restored some of these processes to make sure that our rural
veterans were getting the health care that they needed through
the CBOC entity in Shreveport.
The same for Alexandria as well, so, ma'am, I think my
relationship with my administrators is phenomenal, and I can
call any of my VA partners in a heartbeat and the answers and
the questions that I have will get taken care of without
question.
I think that is one of the strengths. I am in Alexandria. I
live on the north shore of Louisiana not too far from New
Orleans. I have been to Shreveport almost a dozen times, and
every time I go either myself or my deputy, who is behind me,
go and visit the VA administrators and ask them what can we do
for you as a state? We give them what our questions are as to
how they can help us with our veterans as well.
To me, that is the forefront and the heart of everything
that I do. As a State VA I cannot do my job without being
intertwined at the hip with my VA administrators and my VA
partners.
Ms. Morrison. Thank you for that response. Colonel--
Secretary, I should say, you also mentioned rigorous oversight
is an element that supports your delivery of compassionate,
high quality services.
Mr. Harries, you specifically cited the layers of oversight
for State veterans' homes as a reason that they offer higher
quality. Could each of you speak just briefly to the importance
of collecting robust data at the Federal and State levels and
how additional research informs the administration of the care
provided at State veterans' homes?
Mr. Meginley. Well, I will tell you this. My deputy and I,
my deputy is a retired Army doc, by the way, on my staff, so I
have an on-staff physician to be able to help me answer some of
the questions.
You talk about data. We have been talking about data since
day one, and I will tell you one of the most important pieces
of data that has stuck with me over and over is the fact that
we turn away 72 percent of veterans who have mental health
issues. We do not have the capability to be able to take care
of their needs.
When you start talking about those numbers--we talk about
pressure ulcer rates. One of our homes had a very low pressure
ulcer rate. We wanted to know why your rate was so much lower
than the others. They were all still below the national
average, but what were you all doing differently?
That data allowed us to go find the answers and take that
best practice and put it and put it in the other four homes. We
have also talked about, you know, other data points that would
make our workforce stronger, our medication issues stronger,
because as Mr. Harries talked about, prescription costs are
extraordinary, particularly in some cases. Trying to figure out
ways to make sure that our veterans are being taken care of,
again, having the data is very vital to us. We live and die by
data essentially every day so that we can make our homes
better.
Ms. Miller-Meeks. Is there----
Ms. Morrison. Well, I was hoping that Mr. Harries might
comment, too, in----
Mr. Harries. Sure.
Ms. Miller-Meeks. Briefly, sir.
Ms. Morrison [continuing]. 39 seconds left.
Ms. Miller-Meeks. The gentlewoman's time has expired.
Mr. Harries. I am a six sigma black belt, which means that
I love data and the more data I can get the better. It is the
way you are going to solve your problems. It is the way you are
going to get there.
Before we close or you cut me off, what I do want to State
is I have heard it once that VA has the largest compilation of
health care data in the world. Utilize that. Let us look at
that. Let us see what we can do to leverage that to make some
improvements.
Ms. Morrison. Thank you.
Thank you for your indulgence, Madam Chair.
Ms. Miller-Meeks. Thank you for yielding.
Members can always submit questions for the record, which I
have done earlier so that I would not go over time.
Ranking Member Brownley, would you like to make any closing
remarks?
Ms. Brownley. I thank you for having the hearing. I think
this topic is an important one. With the colonel's answer to
Ms. Morrison's question, I wonder how we can have the
relationship that you described between your medical center and
your State veteran home, how that relationship, how we can have
that everywhere across the country.
Mr. Meginley. Well, I will tell you, ma'am, it helps when
you are a patient because I go in 1 day as a State secretary
leader and the next thing I am getting my knee injected. I get
a chance to see what they are doing.
Ms. Brownley. Thank you. Yield back.
Ms. Miller-Meeks. Thank you.
I will recognize you in the future, sir.
Mr. Meginley. I am sorry, ma'am.
Ms. Miller-Meeks. Sorry, chain of command. Two veterans
ought to know.
Number one, again, I want to apologize. My sincere
apologies to our witnesses, to the VA, to the secretary, to Mr.
Harries for the lack of members who are here. I thank the
members who came. I thank you all very much.
When we set up hearings we do not necessarily know that
there are going to be markups and there are numerous markups by
numerous committees today. I am supposed to be over in one in
Energy and Commerce but thank you for being here.
Thank you for your participation and taking the time in
today's hearing. This actually is an extremely important topic,
both given how much regulatory burden there is and oversight
there is in health care and also the very important work that
you do given the population that you serve and the increasing
numbers of that population receiving access for care.
The complete written statements of today's witnesses will
be entered into the hearing record. I ask unanimous consent
that all members have 5 legislative days to revise and extend
their remarks and include extraneous material. Hearing no
objection, so ordered.
I thank all members and their witnesses for their
participation today. This hearing is adjourned. Thank you so
much.
[Whereupon, at 3:33 p.m., the subcommittee was adjourned.]
?
=======================================================================
A P P E N D I X
=======================================================================
Prepared Statements of Witnesses
----------
Prepared Statement of Scotte Hartronft
Good afternoon, Chairwoman Miller-Meeks, Ranking Member Brownley,
and distinguished Members of the Subcommittee. My name is Dr. Scotte
Hartronft, and I am the Executive Director of the Office of Geriatrics
and Extended Care at the Department of Veterans Affairs (VA). I am
honored to discuss the strategic approach VA employs, which results in
high-quality health care outcomes and support for the Nation's heroes
at State Veterans Homes (SVH). SVHs are owned, operated, and managed by
the states. VA's role as it relates to SVHs is as a support to ensure
Veterans receive the high-quality care which meets the Department's
standards, through annual certification and recognition surveys,
Medical Sharing Agreements, and grants to construct, renovate, or
repair State owned facilities.
Currently, the Department supports 172 SVHs, which administer a
combined 166 Nursing Home Programs, 47 Domiciliary Care Programs, and 3
Adult Day Health Care Programs. To participate in the SVH program and
its benefits, VA must formally recognize a care facility as an SVH
through the certification process and a recognition survey. Along with
compliance with VA standards, a recognition survey requires adherence
to all applicable Federal, State, and local laws including the relevant
professional standards for VA purposes to recognize the home as an SVH.
After formal recognition, VA conducts at least one unannounced
annual survey at each facility to ensure compliance with VA standards.
The VA surveys cover 200 clinical standards, fire and life safety
standards, administrative standards, and fiscal standards. Many of the
standards are based on the CMS nursing home standards but others are VA
and SVH unique. Any areas of non-compliance identified on surveys are
addressed through corrective action plans in collaboration with the
Veterans Health Administration survey team. During the corrective
action plan follow-up period an ad-hoc for cause full survey can be
completed if felt necessary. Compliance with VA regulations under 38
C.F.R. part 51 and VA's survey and certification process is required
for SVHs that provide nursing home care, domiciliary care, or adult day
health care to remain eligible to receive per diem payments or
participate in the State Home Construction Grant Program (SHCGP). VA's
survey process mirrors the Centers for Medicare and Medicaid Services
(CMS) for long-term care facilities.
VA offers support to SVHs by permitting recognized SVHs to enter
into Medical Sharing Agreements with their local VA Medical Centers to
procure additional clinical services or secure discounted
pharmaceutical prices. The SVH's that are CMS certified also on average
outperform the US nursing home star rating on their CMS surveys. To
maintain SVH recognition, VHA may also provide funds to ensure adequate
levels of nursing staff. In Fiscal Year 2024, VA approved $4.7 million
for the 17 states and 47 SVHs that applied for Federal funds to support
programs that hire or retain nursing staff.
SHCGP is a partnership between VA and the states to construct,
renovate or repair state-owned and operated nursing homes,
domiciliaries, and/or adult day health care facilities. VA provides
reimbursement of up to 65 percent of allowable costs to states for the
construction and renovation of SVHs. The number of awards provided each
year depends on the number of projects, their costs, and the amount of
appropriation received in the fiscal year. VA is responsible for
determining the priority for funding facility improvements, which may
include bed replacements, mold removal, and repairs to structural
hazards to assist SVHs in proving high-quality care for Veterans.
Conclusion
In conclusion, VA remains steadfast in its dedication to continuous
improvement in the oversight of SVHs. We appreciate the oversight from
the Subcommittee and look forward to answering any questions you may
have.
Prepared Statement of Sharon Silas
Prepared Statement of Ed Harries
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Charlton Meginley
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Statements for the Record
----------
Prepared Statement of Florida Department of Veterans Affairs
We operate nine State veterans' homes in Florida with a
total of 1,102 beds. Eight are skilled nursing facilities and
one is a domiciliary offering assisted living. Florida's State
Veterans' Nursing Homes are among the top nursing homes in the
State.
The relationship between the VA and Florida is good;
however, the VA long-term care system has historically
struggled to keep up with current national long-term care
models. Highlighting home and community-based care should be
encouraged. We recommend VA support States and Territories that
desire to integrate a long-term care campus that allows them to
offer additional services to Veterans to remain in their homes
in the community.
We recommend changing the static model of traditional
nursing home beds to one that provides Veterans with a more
robust venue of long-term care services. Florida is planning a
120-bed State Veterans' Nursing Home that includes adjoining
Adult Health Day Care, outpatient rehabilitation services and a
community wellness center for local Veterans. We feel the
decades-old model for strictly long-term care beds is
restrictive and does not reflect the needs of today's aging
Veteran. Additionally, our proposed model will allow Veterans
to access health care services while providing an avenue for
camaraderie that can improve their health outcomes.
Previous attempts to provide these updated services in
existing State Veterans' Home sites have been denied by the VA,
citing 20-year moratoriums imposed on original construction
grants designed solely for long-term care beds. The denial is
based on VA's interpretation of 38 CFR Sec. 59.110.
Providing enhanced services to local Veterans in areas with
a small VA footprint saves travel time and keeps Veterans in
their homes, allowing much-needed respite care for their family
members and caregivers. The added socialization combats
isolation and conversely helps combat veteran suicide.
VA's State Veteran Home Construction Grant Program should
reflect these new national models of long-term care as States
seek to expand their services for Veterans. We also recommend
an overall increase in funding for the State Veteran Home
Construction Grant Program to combat a backlog of vital
projects. Previous years funding has made only a small dent in
expanding and enhancing long-term care services for our
Veterans. Many needed construction and rehabilitation efforts
are delayed by years due to inadequate funding. According to
the VA, the State of Florida is currently short of more than
2,900 Veterans' Nursing Home beds. At the current rate of
funding, it would take decades to fill the gap. We believe
increased funding, coupled with access to non-institutional
long-term care, can provide a bridge for our aging Veterans'
long-term care needs.
In Florida, it costs nearly twice the reimbursement rate
provided by VA to pay for care of Veterans in our 150-bed
Domiciliary home. We recommend VA review their compensation
rates for long-term care, as reimbursements to States for
Veterans in Veterans' Domiciliary Homes vastly understate the
true cost of healthcare.
We appreciate the opportunity to provide testimony and
continue our collaborative work with the VA to enhance care for
our Nation's Veterans.
Prepared Statement of Veterans of Foreign Wars of the United States
Chairwoman Miller-Meeks, Ranking Member Brownley, and members of
the subcommittee, on behalf of the men and women of the Veterans of
Foreign Wars of the United States (VFW) and its Auxiliary, thank you
for the opportunity to provide our comments on this important topic.
As the United States veteran population ages, the demand for long-
term care will increasingly represent a significant portion of the
Department of Veterans Affairs (VA) health care. Long-term care
includes various services to address a veteran's health or personal
care needs when the individual can no longer perform daily activities
unassisted. VA offers care through nursing homes, assisted living, home
health care, and State Veterans Homes (SVHs). SVHs are nursing
facilities, assisted living facilities, or domiciliary care homes
operated by State governments specifically for veterans. They provide
long-term care services customized to address the unique needs of
veterans. There are many benefits to SVHs, such as subsidized care, VA
per diem grants that lower out-of-pocket expenses, and a supportive
environment to connect with fellow veterans and build camaraderie. VA
provides general oversight to all 153 SVHs, which collectively care for
approximately 14,500 veterans.
Background
State Veterans Homes trace their origins back to the pre-Civil War
era, designed initially to care for injured and aging soldiers. These
facilities were commonly referred to as soldiers' homes. In 1888,
Congress authorized Federal funding to support state-operated veterans'
homes, establishing a partnership between State and Federal Governments
that continues today. VA provides per diem payments for each veteran
receiving care in these homes. It is another way to assist the veteran
in cutting out-of-pocket costs. VA also provides construction grants
covering up to 65 percent of building or renovation costs of SVHs.
States are required to provide at least 35 percent in matching funds.
To qualify for VA funding, SVHs must adhere to VA quality standards in
areas such as quality of care, standard of living, infection control,
and resident rights.
All 50 states and Puerto Rico either have at least one SVH or have
been approved to build one, and some states have multiple homes due to
population size or geographic distribution. Examples of State agencies
that oversee SVHs include the California Department of Veterans Affairs
(CalVet), the Texas Veterans Land Board, the New York State Division of
Veterans' Services, and the Florida Department of Veterans Affairs.
SVHs typically offer services, including skilled nursing care, assisted
living for independent veterans needing support, memory care units, and
short-term rehabilitation or post-acute care. Eligibility criteria for
SVHs generally require service in the U.S. Armed Forces with an
honorable discharge, residency in the State, and medical or personal
care needs that align with the services provided.
Needs of the Aging Veteran
Aging veterans are unique individuals shaped by their military
experiences, natural aging processes, and socioeconomic circumstances.
Many elderly veterans face multiple chronic conditions and may have
health issues related to their service, which can lead to the need for
assisted living or nursing care. They may encounter various challenges,
including limited income, transportation barriers, social isolation,
difficulty accessing benefits, and cognitive decline.
Essential services for aging veterans include geriatric primary
care, mental health support, neurology and memory care, rehabilitation
and physical therapy, and dental and vision care. For veterans who can
no longer live independently, a skilled nursing facility may be the
best option, particularly if they are unable to perform activities of
daily living or require supervision due to vulnerability. Loneliness
and a diminished sense of worth often become more pronounced as they
age. The camaraderie once enjoyed may be a distant memory, overshadowed
by declining health and the loss of family and friends. All of these
factors can contribute to higher risks for suicide among aging
veterans.
A coordinated, veteran-centered approach is necessary to
effectively meet the needs of aging veterans and address their overall
well-being. This approach should include medical and mental health
care, housing, social connections, and the dignity that should be
afforded to them. Delivering comprehensive care including geriatric-
specific services, and integrated mental and behavioral health support,
is critical for enhancing the quality of life for these individuals.
SVH Oversight
State governments and VA collaborate to provide SVHs as an option
for veterans. VA is responsible for providing per diem for eligible
veterans, and construction grants for building and renovating
facilities. Unfortunately, there is a massive $1.2 billion backlog in
construction needs of SVHs, which potentially places some veterans in
unsafe living conditions and others waiting for available facilities.
VA's Geriatrics and Extended Care program oversees the per diem
funding and ensures compliance with VA standards. These standards
include maintaining quality of care, adequate staffing levels, timely
recordkeeping, and safe, sanitary living conditions. VA conducts
regular inspections, and homes that do not meet these standards are
cited for deficiencies. According to a November 2022 Government
Accountability Office (GAO) report, VA Nursing Home Care: Opportunities
Exist to Enhance Oversight of State Veterans Homes, deficiencies
increased from 424 in 2019 to 766 in 2021. This included a 12 percent
rise in deficiencies that resulted in actual harm or immediate
jeopardy. Additionally, data from 2020 was missing from this report as
VA suspended inspections during the COVID-19 pandemic, precisely when
inspections were most critical. The report also found that an outdated
data system led to insufficient analysis of SVH data, and current plans
for a replacement data system would not guarantee that VA would have
the necessary analytical capabilities to improve efficiency. GAO
recommended that VA identify additional enforcement tools and seek
legislative authority to strengthen its oversight capabilities.
VA published a policy notice in August 2024 on oversight
requirements for SVHs that provide nursing home care, domiciliary care,
and adult day health care. This notice detailed the administration,
oversight, and certification processes for Recognition, Annual, and
For-Cause Surveys of SVHs, explicitly focusing on compliance with
Federal regulations. Key elements include the survey processes,
corrective action plans for addressing noncompliance, and the roles of
various VA personnel in managing and overseeing SVH operations. The
goal is to ensure eligible veterans receive high-quality care in a safe
environment while VA maintains proper oversight of the SVHs.
VFW Concerns
VFW members have raised concerns about long waitlists for admission
to SVHs due to the limited number of facilities and available beds. The
quality of care at SVHs is generally good, though veterans have had
issues with slow communication and responses concerning inquiries about
patient care, billing issues, eligibility, and space availability for
individuals waiting to be transferred from medical hospitals. These
delays create significant stress for veterans and their families.
For example, one Missouri veteran had been waiting so long for
placement in an SVH that VA moved him to a nursing home with a low
standard of care. He also experienced poor communication from the staff
while he waited for a bed to become available at an SVH.
Veterans have told the VFW they have concerns about the lack of
clear communication and setting expectations during the eligibility,
application, and waitlist processes. The perception exists that if a
veteran or that person's caregiver contacts a civilian nursing home,
the veteran could likely secure a bed within a few days. However,
delays in access and availability are prevalent at SVHs due to the
limited number of facilities and a lack of beds required to meet the
current demand.
Veterans in Alabama have voiced concerns about obtaining
information regarding eligibility criteria for SVHs. They are
particularly troubled by the significant variation in eligibility
requirements and processes, even among specific facilities within the
same state.
Maryland veterans and their families have reported multiple
concerns including the lengthy application process and waitlists for
admission to SVHs and lack of communication during this time,
insufficient communication with survivors regarding billing issues and
difficulties obtaining documentation even after payment has been made,
and challenges in processing new patients during periods of system
upgrades and changes in contracts. When veterans and their families
raise concerns about living conditions at SVHs, VA should be responsive
and address these issues effectively since it funds a significant
portion of these services.
It is time for VA to proactively address the concerns of the aging
veteran population. VA can enhance compliance with quality standards by
developing a range of enforcement options to correct deficiencies
identified during inspections. Additionally, VA needs to establish a
process for monitoring the implementation of corrective action plans,
enabling it to track how care facilities address noncompliance issues.
It is also crucial for VA to improve its ability to set and manage
expectations for medical or care facilities that serve our veterans,
while communicating those expectations to their families.
The VFW urges Congress to provide full funding for VA to address
the backlog of pending State Home Construction Grants. This would
address the growing need and ensure these facilities are safe for
veterans. We also urge Congress to provide oversight of VA's surveys
and monitoring of SVHs to ensure high-quality standards for our
Nation's veterans.
Chairwoman Miller-Meeks, Ranking Member Brownley, this concludes my
statement. Thank you for the opportunity to offer our comments on this
important issue.
Information Required by Rule XI2(g)(4) of the House of Representatives
Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW
has not received any Federal grants in Fiscal Year 2025, nor has it
received any Federal grants in the two previous Fiscal Years.
The VFW has not received payments or contracts from any foreign
governments in the current year or preceding two calendar years.
Prepared Statement of The National Association of State Directors of
Veterans Affairs, Inc.
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Sheri Biggs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Questions for the Record Submitted by Mariannette Miller-Meeks
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]