[Congressional Record Volume 153, Number 83 (Monday, May 21, 2007)]
[Senate]
[Pages S6404-S6405]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CRAIG:
  S. 1441. A bill to amend title 38, United States Code, to modify 
authorities for the Secretary of Veterans Affairs to accept new 
applications for grants for State home construction projects to 
authorize the Secretary to award grants for construction of facilities 
used in non-institutional care programs, and for other purposes; to the 
Committee on Veterans' Affairs.
  Mr. CRAIG. Mr. President, I rise today to introduce legislation to 
make, what I believe to be, vital and necessary changes to one of the 
most successful Federal-State partnership programs in the Nation today. 
I am speaking of the State Veterans Home Program at the Department of 
Veterans Affairs.
  For those of my colleagues who do not know very much about this great 
program, the Federal-State partnership known as the State Home Program 
dates back nearly 120 years. It was August 7, 1888, when a $100 check 
from the Federal government helped the State of Connecticut offset the 
financial burden of caring for aging Civil War veterans. Since that 
time, of course, the program has greatly matured. And it has grown into 
the largest institutional provider of long-term care services for our 
Nation's aging veterans.
  Today, the grant part of the program receives an annual appropriation 
of about $100 million. VA uses the money to pay for two-thirds of the 
costs of constructing State home beds pursuant to applications 
submitted by the States. After a home is built, the State operates the 
nursing facility and maintains the property for the benefit of 
veterans. VA, in turn, pays a daily stipend to the State of 
approximately $60 for each veteran in the home. The States then support 
the rest of the cost of care either by collecting some money from the 
veterans or through direct appropriation from the State legislature.
  I realize that my description of this program may have some of my 
colleagues scratching their heads trying to find out why I believe the 
program needs to change and modernize. Let me explain.

  As many of you know, during the 107th Congress, I served as chairman 
of the Senate Special Committee on Aging. I did a lot of work on long-
term care issues and held many hearings on the topic. What I learned is 
that there is a big shift across the country from the traditional 
institutional care to a less restrictive, family oriented, home and 
community based approach to care.
  When I became chairman of the Senate Committee on Veterans' Affairs, 
I found that VA's system is strongly biased toward institutional care. 
We spend most of our long-term care budget on institutional beds.
  I realize that nursing homes are sometimes the best place for a sick, 
aging person to be properly cared for. Therefore, clearly VA needs to 
provide that service. But, let's face it. All of us would prefer that 
we never end up in a nursing home. We would do everything within our 
power to remain in the comfort and safety of our homes and with our 
families.
  The interesting thing about our human desire to remain in our own 
homes and out of nursing homes is that our human desire is also a 
positive financial desire. Noninstitutional long-term care services are 
much more cost-effective than care provided in an institutional 
setting. Providing people with long-term care options and the 
opportunity to remain in their homes for as long as possible is exactly 
what my legislation is about.
  There is an old saying that goes ``when all you have is a hammer, the 
whole world looks like nails.'' Essentially what that means is, we use 
the tools we have to solve whatever problem arises, even if a different 
tool might be more appropriate.
  For nearly 120 years, with little exception, the only tool available 
through the State Veterans Home Program has been a bed: an 
institutional nursing home bed. So, whenever a veteran in a local 
community has independent living challenges, the State home program has 
a tool to help them: it has a bed. My Legislation would give the State 
homes additional tools to offer our veterans.
  My bill would establish a noninstitutional care State home grant 
program. The premise of the new program would be the same as the 
current institutional program. States would submit an application to 
construct a building or renovate part of an existing state home to 
offer noninstitutional services to veterans. The State would have to 
provide one-third of the cost for construction and then take ownership 
and operational responsibility for the building and the care after the 
facility opens.
  Similar to the payment structure today, VA would provide a daily 
payment for each veteran who receives services from the facility.
  My legislation would also make some changes in the state home grant 
program that would help it transition into a more modern care delivery 
system.
  As my colleagues may be aware, under the current program, States 
submit applications to VA to receive construction assistance. If the 
State can demonstrate that the project meets VA's requirements for 
quality; that its use will be primarily for veterans; and that the 
State has its one-third matching funds, then VA approves the project 
and places it on list according to a statutory priority.

  My bill would create a 2-year window, starting with the date of 
enactment, for States to submit their new bed applications. Similarly, 
it would create a 2-year window for any State to come up with matching 
funds for any approved application that currently lacks the required 
match. After the 2-year window, VA would be prohibited from accepting 
any new applications for new bed construction.
  I believe the reason we need this change is simple. For fiscal year 
2007, there are $808 million in grant proposals on VA's approved list. 
Approximately $490 million in project proposals are in priority one 
status, meaning that the States have provided the required one-third 
matching funds.
  At the rate of $100 million per year provided by Congress to fund 
these grants, it will take nearly 9 more years for Congress to fund all 
of the current projects on the list. That, of course, is assuming that 
no new projects will be added to it. And construction of all of those 
projects would probably not be completed until about 15 years from now.
  All of that may sound like long-term planning for future care needs. 
However, as I mentioned earlier, the Nation as a whole is moving away 
from institutionalizing the elderly.
  Our aging years are supposed to be our golden years. We conjure up 
images of sitting on a porch, sipping tea with our spouse of 50 plus 
years watching the sun set. The reality, unfortunately, is that in many 
cases those years are spent separated from one another as one spouse is 
no longer able to fully care for the other. And the only option 
available for assistance is institutionalization. We can do better. And 
this bill will move us in that direction for our veterans.
  I ask all of us to consider why we have a policy at VA that 
encourages spending nearly $1 billion building 5,300 more new beds in a 
system that already has about 20,000 beds when we as a nation are 
trying to move in a direction that provides home and community based 
care programs that keep the elderly in their homes and out of long-term 
care institutions. I think VA and the States should change course for 
the betterment of our Nation's heroes.
  I believe that by phasing out the current institutional bias and 
focusing the

[[Page S6405]]

energy and finances of the program on noninstitutional alternatives, VA 
and the States will serve more veterans and keep those veterans in 
their homes, where they want to be, for a much longer time.
  I realize that we will still probably fund 5 or 6 thousand more new 
beds in the State home program just because of the 2-year window. But I 
recognize that Senators and Representatives will strongly support the 
institutional grants so long as their State has an application pending. 
I do not blame the Members. I would do the same thing if Idaho had 
submitted an application. So, I want to give everyone's State a fair 
chance to participate in the program.
  But, I also believe that we need to transition beyond beds. And if we 
fail to set out the transition soon, I believe we will find ourselves 
20 years from now undertaking a painful study on what to do with 15,000 
empty nursing home beds in all of our States. Noninstitutional service 
is simply the direction of long-term care and health care today because 
families want to be together and home is where they want to be.
  VA's partnership with the States to provide long-term care to our 
Nation's veterans is an unmitigated success. We must continue to 
support the 20,000 beds we currently have. And we will. They provide 
the most compassionate, cost-effective institutional care in the 
Nation. But, we also must modernize the program.
  We must keep up with the trends in health care that are pointing us 
in the direction of home and community-based services and away from 
institutions. We must change to find a way to serve more veterans with 
the same amount of resources. But, most importantly, we must modernize 
because it is the humane and right thing to do in responding to the 
wishes of our constituents to stay home in their later years and grow 
old with the people they love.
  I urge all of my colleagues to join in this effort by cosponsoring 
this legislation.
                                 ______