▶ 0:26:11before 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, uh this oversight hearing of the subcommittee on health will now come to order. I'd 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.
▶ 0:26:40The 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 don't live near family members who can assist. The demands on the VA for long-term care will only grow due to the incoming veterans who served during the Vietnam and Cold War errors. For some, they have trouble advocating for themselves because of their health needs, which can undermine their independence.
▶ 0:27:08This 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 shows that there's still work to be done. I'm particularly troubled by veteran suicide later in life.
▶ 0:27:31We've talked a lot about uh 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. And just two weeks ago, a 77year-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.
▶ 0:27:57Through 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. Healthcare 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.
▶ 0:28:24State veterans homes are long-term care facilities for veterans and often for their spouses. They are state-run but receive substantial amounts of funding from the VA. When VA supports state veterans homes, it's also supporting a compilation of smaller programs. VA gives funds for state veterans homes to support programs like resident care, domicillary care, and adult daycare. In addition, VA provides grants for facility construction through a matching program with states.
▶ 0:28:53The VA also provides grants for nursing retention at state veterans homes. These programs help veterans flourish later in life. But 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.
▶ 0:29:15In 2020, at a state veterans home in Holio, Massachusetts, over 70 veterans died with CO 19 during an outbreak during the pandemic. Many more suffered infections. An independent investigation revealed that this horrific tragedy was preventable. Additionally, 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.
▶ 0:29:44But 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 disperses 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's why I've introduced a bill to provide veterans with more access to essential medications.
▶ 0:30:13My 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 veterans life and quality of life. These medications are covered outside of the facility rather than through the state veterans homes. I've said it before, I'll say it again.
▶ 0:30:41It's critical to expand the network veterans can use to access life-saving 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.
▶ 0:31:10Thank you, Madam Chair. Overall, an estimated 80% of veterans will need long-term services and support supports at some point during their lifetimes. The overwhelming majority of aging adults, including veterans, would prefer to age in place in their homes rather than nursing homes.
▶ 0:31:31With 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 longterm care programs, not every veteran will have enough support from family members or other caregivers to enable them to safely age at home.
▶ 0:32:01For that reason, there will always be a need for nursing homes. State veteran homes, which are owned and operated by the states with federal investments in the form of construction grants and PDM payments, are the largest provider of institutional long-term care for veterans. Collectively, they serve more than 43% of the veterans receiving VA funded nursing home care on any given day in 2023.
▶ 0:32:29VA operated community living centers served about 20% and VA purchased care from community nursing homes for 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% of VA's total payments for institutional long-term care.
▶ 0:32:53VA's basic pdeium for state veteran homes now covers less than 30% of the actual cost of care and as little as 20% in some states with higher costs of living. State veteran homes make up the balance of their cost through other funding sources including state support Medicare and Medicaid and the veterans themselves who share in the cost.
▶ 0:33:17This 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.
▶ 0:33:34The House Energy and Commerce Committee has been instructed to cut $880 billion dollars over 10 years, and nearly all of those cuts are expected to come from Medicaid, which funds long-term care for more than 60% of nursing home residents. With many community nursing homes already teetering on the brink of financial insolveny, these Republican budget cuts could put them at greater risk of closure.
▶ 0:34:00Medicaid also funds many home and community-based services, enabling aging and disabled people, including veterans, to avoid institutional settings of 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.
▶ 0:34:27I also must say I am perplex per 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.
▶ 0:34:54If 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.
▶ 0:35:12In the early months of the CO 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.
▶ 0:35:41During 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 construction and operational needs. Unlike the slash and burn budget reconciliation process House Republicans are undertaking, we use the budget rec reconciliation process in 2021 to infuse much needed funding for state veteran homes and other critical programs on which Americans rely.
▶ 0:36:11We also improved VA's oversight of state veterans homes under the Cleveland 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.
▶ 0:36:29In addition, this law required VA to publish the results of state veteran home inspections and corrective action plans on its public-f 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.
▶ 0:36:56With that, u Madame Chairman, I yield with
▶ 0:38:55the VA survey team. Compliance with VA survey and certification process is required for the state veterans homes to provide nursing home care, domicillary care or adult day healthcare to remain eligible to receive grant perm payments or to participate in the stay-at-home construction grants program. VA survey process mirrors the Centers for Medicare and Medicaid Services for long-term services, long-term care facilities.
▶ 0:39:19VA 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 procure additional clinical services or 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 ratings than the national CMS nursing home average. To maintain state veterans home recognition, VHAA also may also provide funds to ensure adequate levels of nursing staffing.
▶ 0:39:49In fiscal year 25, VA approved 4.7 million for the 17 states and 47 state veterans homes that applied for federal grants to uh support programs with 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, domicillies, and or adult day healthcare facilities.
▶ 0:40:13VA provides reimbursement up to 65% 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 amount of appropriation received in the fiscal year. The A is responsible for determining the priority for funding facility improvement, which may include bed replacements, mold removal, and repairs to structural hazards to assistate veterans home maintain the recognized status.
▶ 0:40:40In 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. Thank you. I'd 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. Um, Miss Silus, you're now recognized for five minutes to present your testimony. Thank you. Uh, Chairwoman Miller Meeks, Ranking Member Brownley, and members of the subcommittee.
▶ 0:41:08I'm 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.
▶ 0:41:37In 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 PDM 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.
▶ 0:42:05There are three entities that may have a role in overseeing state veterans homes. The VA, the Centers for Medicare or Medicaid Services or CMS, and the states. First, VA is the only federal agency that has oversight responsibilities for all state veterans homes. And 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.
▶ 0:42:29Through 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 is receive 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.
▶ 0:42:55We found that nearly 76% 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.
▶ 0:43:20Of the remaining seven states where there was no state oversight, five states, state veterans homes received oversight from CMS and VA and two states 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 is to withhold PDM payments for veterans. A severe action that could ultimately impact the veterans care.
▶ 0:43:50Officials expressed reluctance to use the enforcement tool under unless under extreme circumstances. In fact, at the time of our review, VA officials cannot recall ever withholding a state veterans homes payment. Further, we found in our November 2022 review of 153 state veterans homes, there were a total of 766 deficiencies. 40% of state veterans homes were cited for the same deficiency in 2019 and 2021. And 21% of the deficiencies had corrective action plans that were past their due date.
▶ 0:44:20Moreover, in our review, we cite an example of a state administrator that noted they were more concerned with CMS's 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.
▶ 0:44:44Having a similar approach would 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 PDM payment to address non-compliance with quality standards. We believe this to be a good step to creating a range of enforcement actions that would be effective.
▶ 0:45:07Subsequently, 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.
▶ 0:45:31While 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's range of enforcement actions would provide VA with more effective enforcement and better ensure that state veterans homes are providing the highquality care veterans and their families deserve. That concludes my statement.
▶ 0:46:00I'm happy to take any questions. Uh, thank you very much, Miss Silus. As is my typical practice, I'll 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 five minutes for any questions she may have. Uh thank you, Madam Chair. Um uh Dr. uh Hardrauff, it's nice to see you again. Um so my first question to you and I would appreciate a brief a brief answer.
▶ 0:46:29um is um if these Medicaid cuts if if these Medicaid cuts happen, if there's a significant cut uh to Medicaid, have you done any kind of analysis to uh on the extent to which this would increase um veterans reliance on the VA for long-term services and supports? Thank you for that question. Uh we haven't heard of any specific amount.
▶ 0:46:56So we haven't uh had any discussions but VA as usual can be flexible with any changes in the market based on expanding our use of other contract nursing homes and other facilities in the country. But you do agree that if there were significant cuts to Medicaid, it would have an impact on on, you know, veteran services and long longerterm care such as uh nursing uh stateowned nursing homes.
▶ 0:47:25Most of any potential impacts I'd have to defer to CMS, but uh obviously we would respond and make adequate changes as necessary. Okay. Um, so let me ask you in terms of the GAO's uh recommendations, their 2022 recommendations to seek legislative authority for a broader range of enforcement actions.
▶ 0:47:48Um, so um, according to the GAO, as of 2025, VA is no longer interested in p pursuing additional legislative authority. You were the executive director of the geriatric geriatrics and extended care program when GAO made this recommendation. So what change what changed between 2022 when you concurred with it and now aside from the obvious change in presidential administration?
▶ 0:48:18Did new leadership within the VA direct this What I can explain is in 2022 we were in the process of modernization effort which we centralized all the surveys within VA central office instead of each local VA doing that. And 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 a categories of one through four. And that prescribes a frequency of oversight.
▶ 0:48:44And what we've done is since February, we've noticed that the outcomes has been positive in the sense that 100% of our corrective action plans are now on time and they're meeting their compliance. But we also addressed in our corrective act in our escalation plan what we need to do if we were to need to seek uh any penalties. We would work with the the vizen the local VA and determine within what's in our current CFR and rigs too to pose any penalties.
▶ 0:49:10So, you didn't feel with this reorganization that you're speaking of, didn't feel the need for any kind of um financial tool as in a fine or a percentage of the PDM uh as something that would uh leverage better accountability. Well, uh based on external feedback, we've been able to we've restarted discussions internally and we're kind of in the discussion and concurrence phase. So, we haven't ruled it out.
▶ 0:49:37We're just now going back to now that we have something in place that we didn't have before and we've shown good compliance with it. We now are going back to see and discuss do we think there's any other appropriate actions that we might need to have in place if we were to have problems and that wouldn't work. And uh Miss Salis, do you kind of agree with that assessment? Yes. I mean, we believe that the steps that the VA has taken to increase their oversight was really helpful. They strengthened their timelines.
▶ 0:50:06they're doing more followup with the homes and that's really gone a long way I think to improve oversight but we still think that there needs to be some sort of tools that have some teeth um to them to make sure that they can hold the state veterans homes accountable um and I think it's also really important that it is a range and so that it's very similar to CMS as I mentioned in my statement where it's uh a range that is aligned with the scope and sever severity of the deficiencies and that way you can kind of rightsize
▶ 0:50:36the tool to ensure there's accountability in the homes. Great. And Dr. heart hard truff. So, um the next panel um there's going to be testimony that uh from the state veteran home association expressing some concern that the VA medical centers aren't really working with the the residents in the state home to ensure um that they receive specialty care including u mental health
▶ 0:51:06and psychiatric care that this has been sort of an ongoing concern. Can you speak to that? Yes, ma'am. It's a continuous improvement that we work with the association because there we are paying part of our PDM does cover basic primary care and in nursing homes that does count for normal primary care related mental health levels which you know depression potential anxiety.
▶ 0:51:29So really just us clarifying the difference between primary care level that we're paying a PDM versus specialty care and that's why we have local leaison that work with the state veterans home to try and make sure that they coordinate any specialty care that's above the needs abilities of the state home. I yield back. Thank you very much ranking member Brownley. The chair now recognizes Representative Sher Phelis McCormack for five minutes for any questions she may Thank you so much.
▶ 0:51:59In typical fashion, we are here. You're 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 long our federal long-term care support services to our nation's veterans.
▶ 0:52:28This critical lifeline is one of the most lean and effective programs in all of VA per DM payments to these homes for skilled nursing care are one-third less than the cost of private sector nursing homes and almost 90% 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.
▶ 0:52:54Instead 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. Hartnov, as the executive director of the Office of Geriatrics and Extended Care at the VHA, you're responsible for ensuring VA's veterans homes are safe and provide quality long-term care to our veterans.
▶ 0:53:22In your view, does the current does your office currently have enough staff to fulfill this core mission? Currently, we are adequately staffed. And so, what is your plan to meet these deficiencies that were pointed out that have been consistent and pervasive? Okay, most of them have been fully addressed with oversight.
▶ 0:53:41Uh again, what we did before was each local VA was responsible for the surveys and the followup, whereas now we've centralized it to where we have a consistent assigned staff at Veco that work oversee the same nursing homes and then that way they can follow them all the way from the survey through all the steps in the corrective action plan and then get them from provisional to full certification. Now your statement sounds slightly contradictory to what Miss um Cleas has stated with the consistent deficiencies.
▶ 0:54:10Is that correct or is there am I missing something miss? Uh and I guess I must have po heard the question wrong. My apologies. Uh can I would you repeat it please? the deficiencies um when we talked about the deficiencies well when Miss Cleas spoke about the deficiencies and the consistency of those deficiencies and how there seems to be more um more direction in toughening up the standard but not really curing the deficiencies.
▶ 0:54:37So I wanted to know if you had enough staff and if so or if not how are you actually planning on meeting and um reversing course on these deficiencies. Okay, thank you ma'am. I just as an overall industry in the CMS whenever they survey homes uh the number of survey findings in the community as well as the state veterans home have been increasing over time uh as well as the servi so we're a reflection of the larger industry but what was has changed over the time since the last time we really had the
▶ 0:55:07full review from the JO 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 correct ive action plan and getting evidence of compliance and they're getting evidence of closure uh much more and to the point where it's it's higher quality and but a much improved oversight.
▶ 0:55:29Now, I've listened and spoke to many state homes and they've all complained about the same issues when it comes to funding and not having enough staff, not even being reimbured a certain amount to provide food, especially at this time where there's inflation. Miss Solaris, I would like to hear from you what your view is on these efficiencies and do you feel like cutting funds would actually help them to cure or would it actually exacerbate the issue we're finding?
▶ 0:55:54I don't think I could speak directly to the cuts because we haven't conducted a review looking specifically at those. Um, but I will say that the my testimony, the report that we did that was back in 2022, we had four recommendations we made and some of the things that Dr. Hardroof is talking about in terms of the centralization of the Jerash extended care office and the over to cut you off because my time is running out but I just wanted to add this fact to you. So as you're going on um they're looking to cut 72,000.
▶ 0:56:24So with that um fact being there you can go ahead and continue. Sure. Um, I do know that the the oversight for the state veterans homes was very decentralized to the VA medical facilities. And so there was, I guess, over a hundred staff that were trying to monitor the state veterans homes. With the centralization, I think there's four or five staff now that are focused on monitoring a set of homes within the region. And so they are able to, as Dr.
▶ 0:56:54Hard trough was saying be able to track the corrective action plans and make sure that that's there's closure and that the deficiencies are being addressed. Thank you. I yield back. Thank you very much. Uh the chair now recognizes Dr. Conaway for five minutes for any questions you may have. Uh thank you. Um I would uh start by uh just providing some background on New Jersey situation.
▶ 0:57:17Uh last year the former attorney general Merritt Garland filed a complaint in the US District Court for New Jersey against New Jersey Veterans Memorial Homes at Menllo Park and Pamis. The two veterans homes landed in the national spotlight sadly for um after reports of significant numbers of deaths that occurred during the pandemic and called for more oversight and investigations.
▶ 0:57:42Uh and um well, as a result of uh of the action by the district court, uh families um 119 families of 119 residents of those facilities entered into a settlement uh in which each family received an average of $455,000 uh and a total settlement of $53 million and the state was responsible for paying uh 60% of that.
▶ 0:58:08Now, uh, in as the heart outbreak was, um, raging, um, did the VA, uh, get into veterans homes not only in New Jersey, but across the country, um, to respond to, uh, the, um, the deaths that were occurring and the other um, you know, rate of illnesses that were occurring in the homes.
▶ 0:58:32that is did somebody from the VA go to these various homes to make to enter to conduct a review of operations during the pandemic in those homes. Thank you sir for that question. The local VAS were in constant contact with their state veterans homes but obviously since the state owns operates and manage them there's only so much we can do outside of our oversight. So it was individualized and different from each home.
▶ 0:59:00So if there's 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 in telephone consult or if they provided staff or resources or other.
▶ 0:59:12So there were inerson visits to the homes to try to understand if there were attempts to separate ill from ill patients from patients that were not ill or to review uh any um recent deaths uh in those homes and whether or not they had adequate staffing in the homes to to make sure that the residents of those homes were safe in light of uh the pandemic.
▶ 0:59:38It varied from home to home based on what the state facility was get working and communicating with the local VA. So it varied from site to sites but I don't have the details from each specific VA in each specific state home but I can take that for the record if you would like to know more about any specific home.
▶ 0:59:54Um, Miss Silas tells us that um, uh, the VA and perhaps you mentioned, I'm sorry if I missed it, uh, that the VA doesn't have the kind of of authorities uh, that um, as I heard it, they ought to have to ensure compliance with uh, with uh, outcome standards with standards of care in the homes. Um, do you agree with that statement? This is to the doctor for I mean I you you made the statement silos, but I wonder if uh, if the doc agrees with what you said.
▶ 1:00:23Uh yes, we're working within our current uh limitations with CMR and and USC. So that's why we put the escalation in place because that could be done more immediately while we do have now internal discussions to what we need to do above that. So we're in the concurrence and discussion phase.
▶ 1:00:41Uh but we again I point out that so far it has the outcome from our new plan has been successful and there not being anybody out of timelines or any corrective action plans not being addressed that was found prior to our centralization and the current escalation plan. now. Well, Ms. do you want to Well, let me get to this.
▶ 1:00:59The um do you uh feel that um if you're if you don't have the appropriate uh stick, if you will, or um actions beyond reviewing corrective action plans, which are very important, of course. Um what do you do without legislation?
▶ 1:01:16What can you do to really improve things without leg uh without legislation to give you uh more authority to ensure compliance with uh with with what one would consider to be uh appropriate nursing home stat um um appropriate nursing home standards? Sure.
▶ 1:01:34um without having some of the authorities any I mean what we're really looking for is the ability to um apply civil penalties or to take part of do a partial PDM payment take that back and if you don't have the authority to do to take those types of actions you're going to have to be face inward and do changes internally which I think the VA has done where they have strengthened their timelines they have done more followup with the homes um they also have um have an option to
▶ 1:02:04pause um uh admissions to the state veterans homes even though veterans can still be admitted to these state veterans homes. They don't have to be referred from the VA itself. So, they have taken some actions, but they're all very internal and they're all around the processes. And what we really want to see is to see something that has a real, again, I'll say teeth again, um, and a real a penalty so that there is more accountab accountability at the state veterans homes.
▶ 1:02:32Um, and then having some of those tools and especially providing a range, they can kind of rightsize the um, uh, accountability to the state veterans homes. Thank you. Thank you, Madam Chair. Thank you, Dr. Conway. The chair now recognizes Representative Taylor for five minutes for any questions you may have. Thank you, Chairwoman Miller Meeks and Ranking Member Brownley for holding this hearing today and allowing me to participate. Uh, thank you to our witnesses also for your insight and testimony.
▶ 1:02:59My home state of Ohio has two state veterans homes with one being located in my district in Georgetown. So, I appreciate the opport opportunity to engage on this important issue. Dr. Harro, I understand there's a 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.
▶ 1:03:30Can you describe some of the projects and some of the conditions veteran residents may have have to face while these homes await federal funding? Thank you sir. I don't have the list of the actual uh approval and projects in front of me but what we do is with the funds that we do have we each year it's a dynamic ranking in the sense that from one year to the next if it's not covered in the in the funding zone window it's moved to the next year.
▶ 1:03:57They may change in the listing order based on if there's a new application that has a higher priority level based on safety or some other issues. So, uh, we do carry them over and then we can reconstruct based on the ranking that's in the C 38 CFR. Okay.
▶ 1:04:13Um, as the veteran population ages and as a backlog of state veteran home construction projects continues to grow, how does the VA plan to alleviate the Uh, the good news is we already have several facilities that we know are coming online within the next year uh next and then the next two years. So there are many projects that are going through. It's really working with the states to to identify where those best locations are.
▶ 1:04:40And again, we we don't determine where the states place them or how big they are, the type of services. We largely respond to the applications that we receive, but we do try to work with the states to to see how we can best uh make uh the situation as best as possible with them. So you have new projects coming online while these I think they're in excess of 80 tier one projects that have their state funding lined up waiting for federal funding.
▶ 1:05:06There's there's no plan to do more than what's usually been done to to chisel down that list. Uh it we received around uh I think is during COVID we received a larger uh 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 towards uh COVID.
▶ 1:05:28So many of them benefited from us having that larger thing to where they could actually do HVAC changes and other things that would Thank you, doctor. To me, it appears this is a question of priorities, and I I think now is a great time for Congress to have this conversation as we consider where our federal government uh spends our tax dollars. We must always keep veterans at the forefront as we root out waste, fraud, and abuse from the several different programs within the federal bureaucracy.
▶ 1:05:55We need to recognize state veteran homes from across the country are being left behind. It's unacceptable to me that our government would send tens of billion 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's why I introduced the Veterans First Act, which would take a small fraction of the identified wasteful spending and repurpose it to clear out the existing backlog of state veterans home construction grants.
▶ 1:06:21With President Trump in the White House, the days of spending money on things like electric cars in Vietnam and DEI projects in Serbia are over. To that end, I will keep working to get our nation's spending priorities straightened out and veterans at are at the top of the list. Once again, I thank the committee for the opportunity to speak today and I yield back. And thank you very much, uh, Representative, uh, Taylor. I now recognize, uh, and yield myself five minutes to ask questions. Uh, first and foremost, thank you, uh, very much for being here.
▶ 1:06:51And, uh, state veterans homes being staterun, do they also, uh, get oversight or uh, 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. Miss Silus or Dr. heart run. Sure.
▶ 1:07:15Um so as we reported in our report, there were uh a total of seven homes that were not getting um state oversight. Um five of them were getting oversight by CMS and then there was uh two states that have no oversight except for the oversight from VA. Uh but the majority then would have oversight at the state as well as the VA. Yes. Thank you for that, Dr. Dr.
▶ 1:07:39Hartrron, um, our subcommittee has learned that older veterans are considered, uh, an invisible population when it comes to suicide prevention. What has the VA observed about older veteran suicide and what mental health care services available at the VA for older veterans can help lower the incidence of suicide deaths? And I know you mentioned this in your remarks. Thank you, ma'am.
▶ 1:08:02Uh there's 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're 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've been working with office of mental health and suicide prevention and they're actually in the active process of planning some a new educational interventions the state homes and others when it comes to suicide prevention especially in the elderly population with geriatric psychiatry.
▶ 1:08:34Could this also be complicated by the incidence or excuse me prevalence of Alzheimer's or dementia as uh one ages? Uh yes and no. From the geriatrics perspective, obviously the dementia and other aspects, but also uh especially in elderly men after if they become recent widows, there's those significant changes in life when they're ep they do have that increase across all populations, veteran and non-veteran based on age.
▶ 1:09:00But that's one reason why we're 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 in the older population. Um I'd also like to uh commend you on uh the u the response by the modernization the changing in your processes the going from decentralization to some c centralization which has helped to clear up a lot of the deficiencies and demerits within the system.
▶ 1:09:29So, I'm just going to there's been uh a little bit of criticism uh towards 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 uh 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?
▶ 1:09:58In the overall nursing home industry, it's rare that no one gets no deficiencies. They're just kind of showing that single digits usually. So, it's because there's over 200 standards at the VA. We follow the CMS standards plus physical. We do administration. We do ton of standards. So, it it'd be very rare that you don't have at least one no matter being a very good facility. There's always some policy or something that might get you somewhere.
▶ 1:10:20Uh but overall we have uh scene where we work with them very closely and and really just making sure that uh things get cleared up and they get the support they need. We've 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're getting we're really wanting the outcomes and the outcome is really to make sure that the veteran gets better care. So, the local VAS have invested a lot in in their local VAS and state veterans homes.
▶ 1:10:49And would more enforcement measures create more opportunity for correction? Uh, at this time based on the outcomes we're seeing with our current escalation plan, which is our outcome is to get these in compliant and we have been successful.
▶ 1:11:04But again as I said we we've been taking some external feedback and to the point where we are discussing are there next steps that will obviously take longer in time but we 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. Again I commend you for what you've been able to achieve uh thus far. I had a question for Miss Silas but Miss Silas I'll submit it for the record since my time is running out.
▶ 1:11:32Um, I on behalf of the subcommittee, I want to thank you all for your testimony and for joining us today. You're now excused and we'll wait a moment as the second panel comes to the witness table. Thank you so
▶ 1:12:42I would now like to introduce the panel two witnesses testifying before us today. We have Mr. Ed Hares, president of the National Association of State Veterans Home and Mr. Hares, if I mispronounced your name, please uh feel free to correct me. and the honorable Charlton uh J. McInley uh Colonel, retired US Air Force, Secretary of the Louisiana Department of Veterans Affairs. Mr. Hares, you're now recognized for five minutes to deliver your opening statement. Excuse me. Uh Chairwoman Miller Meeks and Ranking Member Brownley.
▶ 1:13:12As president of NASVA, 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% of the VA's total budget for this care. According to the VA, the calculated institutional PDAM for state homes is $262 compared to $424 for private community homes and $1,971 for VA CLC care.
▶ 1:13:39According to CMS data, state veterans homes are safer, have a higher quality rating, and receive fewer substantiated complaints and citations compared to community nursing homes. Approximately 70% of the state homes are rated as four or five-star facilities compared to just 35% of the community homes.
▶ 1:14:02State homes also had 70% 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 governments. All homes receive annual VA inspections and 75% are also inspected by CMS.
▶ 1:14:2785% are subject to either annual or forcaus inspections by their states. Madame Chairwoman, while oversight is a necessary component of any well-run organization, it must be balanced against the dangers of overregulation.
▶ 1:14:44Nursing home administrators spend an estimated 20 to 30% of their time on regulatory compliance and reporting, diverting focus from resident care and staff 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 al regulations can also stifle innovation.
▶ 1:15:15A Rand report noted that facilities hesitant to adopt teleaalth personalized dementia interventions or adaptive care models often cited fear of regulatory non-compliance as a primary barrier. While good governance of any organization must include a thorough and effective oversight, overregulation can undercut its efficacy. Madam Chairwoman, NASVA has several recommendations to strengthen and expand services for aging veterans at state veterans homes.
▶ 1:15:46We strongly support the Providing Veterans Essential Medications Act and want to thank you and Congressman Papus for introducing this legislation to address the problem of high-cost medications. We were both surprised and disappointed that the de the VA testified in opposition to your bill. Uh VA officials were aware of the problem and have told NASVA on multiple occasion uh occasions in recent years that they were interested in solving it.
▶ 1:16:16The technical concerns raised by the VA could all be easily overcome with clarifications and additional language. We stand ready to work with you and uh your committee to perfect this legislation. Another problem state veterans homes must overcome is the VA's failure to cover the cost of specialty care.
▶ 1:16:38Although VA is required by law to pay for specialty care, uh in practice, the VA is regularly refusing to do so, particularly for psychiatric care. Madame Chairwoman, many state veterans homes face continuing and significant financial challenges due to the COVID pandemic. We are still recovering.
▶ 1:17:00To help address this problem, NASVA supports an increase of the basic predium rates and calls on Congress to appropriate at least $650 million to put towards pending projects. Finally, I'd like to discuss how the VA the the veterans homes may uh help improve mental health support for our aging veterans.
▶ 1:17:22Public law 117328 required the VA to create a geriatric psychiatry p pilot program in the state veterans homes. Instead, the VA implemented only a limited expansion of tele medicine um mental health uh services. NASVA believes that the homes can play a larger role in addressing the mental health needs of our aging veterans and we'd like to work with you to develop a new pilot program to do exactly that.
▶ 1:17:50Research has shown that many of the supports that state veterans homes provide to its aging veterans are are 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 port part of in the VA suicide prevention efforts. That concludes my statement and I would be pleased to answer any questions you or the members may have. Thank you, Mr. Harry.
▶ 1:18:19Secretary McInley, you're now recognized for five minutes to deliver your opening statement. Chairwoman Miller Banks, Ranking Member Brownley, and distinguished members of the House Veterans Affairs Committee. On behalf of Governor Jeff Landry, thank you for 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'll give you a little bit of information about.
▶ 1:18:42Ma'am, while I cannot speak for the operations in other states, I assure you that in Louisiana, we have the requisite leadership, oversight, and a highly competent and dedicated staff to ensure that our veterans receive highquality, safe patient care and are always treated with the dignity they have earned and deserve. Our five veterans homes in Louisiana are situated in place across the state. They're sanctuaries for those who have sacrificed greatly for our nation. These facilities provide more than shelter and medical care.
▶ 1:19:11They offer a community where veterans are honored, respected, and cared for with deep compassion. Our staff, the nurses, administrators, aids, social workers, therapists, and support personnel form 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.
▶ 1:19:33Whether assisting with daily activities, coordinating 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.
▶ 1:19:58federal and state agencies including the Department of Veterans Affairs, Centers for Medicare and Medicaid Services via the 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 conduct regular inspections to evaluate everything from medical care quality to facility safety.
▶ 1:20:27Compliance 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.
▶ 1:20:53Under our leadership, our clinical teams have driven improvement uh significant improvements in care quality. VA surveyed deficiencies uh decreased by 36% from 53 in 2023 to 34 in 2024. But the 34 doesn't really tell the whole story. A further breakdown of these 34 deficiencies across all five of our veterans homes shows that 91% were minimal with no actual harm, essentially a level E or below.
▶ 1:21:21In fact, one of our deficiencies was for a burnedout light bulb. Another was for a fryer that had been cleaned and replaced one inch from its original position. I note that our systemwide pressure ulcer rates remain at or below 5%, approximately one-third the national average of 15% for long-term care facilities.
▶ 1:21:41According 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 while prioritizing robust census growth. We are proud of the care that we provide our verdance in Louisiana. However, Mr. Mr. Chairman woman, we recognize that there's always going to be improvement or room for improvement.
▶ 1:22:05In our w written rest, uh, excuse me, in our written statement, we provided some information about the escalating cost on medication, which we have covered here today, something that we fully support. But 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 negative negatively impact both clinical coordination and home admissions.
▶ 1:22:30In 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 and capabilities are warranted and Louisiana is ready to lead this effort. Mr. Chairwoman, veterans in our homes are not just patients. They're family members. They're heroes.
▶ 1:22:56Our staff's clinical competency and dedication ensures that their dignity is not only preserved but celebrated while they continue to receive highquality 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. Thank you, Secretary McInley.
▶ 1:23:25As is my typical practice, I'll 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. Um, thank you, Madame Chair, Mr. Harry's. Um, I just wanted to start off with Mr. Taylor was here and seemingly introduced a new bill.
▶ 1:23:45Um, and my understanding of the bill is that he wants to take $2 billion uh in funds that were appropriated to the US Agency for International Development or US Aid um and reallocate those funds to the VA for state veteran homes construction grant grants. Is that a bill that you support or have you had a chance to look it over? Yes, actually I have.
▶ 1:24:13The NASVA uh can't 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're well aware, the bullis or bubble of veterans coming at us in in the age group we care for it it's not stopping. It's coming at us.
▶ 1:24:35On top of that and in in uh respect to the highass medication l litigation more and more of these are coming with toxic exposures cancer diagnosis Parkinson's very very complex care so 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 upon. Well, uh, thank you for that.
▶ 1:25:05And, you know, and I I agree with you. I think we need to provide, uh, more resources. Um, I I have, uh, worked very hard in my tenure in Congress to expand and extend long-term care. My veterans home, uh, my state veterans home within my district is an extraordinary place with many happy, happy, happy veterans and their spouses as well. Um, and so I agree with you.
▶ 1:25:34I I just in in terms of Mr. Harris's bill, I just kind of feel as though um from my perspective anyway that US foreign assistance is essential a component to our national security. Um, and I think veterans who serve abroad probably understand that very well in terms of what US A does and fostering goodwill towards uh our nation.
▶ 1:25:57Um, I think US A literally saves lives by bringing food, medicine, and stability uh to impoverished nations. And I think the bill just represents a false choice between funding veteran programs versus global security and international cooperation. And quite frankly, I think that we must fund both is my is my perspective.
▶ 1:26:21And we can do both if we do so with rational tax policies uh that require millionaires and billionaires to pay pay their fair share rather than providing uh massive giveaways.
▶ 1:26:35And I think that's what is happening right now as we speak uh un under the dome here through reconciliation as we're working through a a tax plan to give millionaires and billionaires um great tax cuts at the expense of at the expense of others.
▶ 1:26:53So I I just wanted to state that um for the record and I will move on and wanted to ask you both um uh with the question that um that I had asked Dr. uh Hartref uh earlier when he was here.
▶ 1:27:12So if there is a significant cut to Medicaid um uh over the next 10 years, have your respective states analyzed the extent to which this may increase veterans reliance on state veteran homes? Um and if these cuts lead more veterans to turn to s to state veteran homes for long-term care services. Assuming the question is for me. Yeah, either one of you.
▶ 1:27:41Well, first we we would want all veterans to come to the state veterans homes. I mean, it literally we do serve provide a much higher level of service uh and quality of life and firmly believe that and I've seen it firsthand. Uh with those Medicaid cuts, uh 75% of the veterans homes are covered by CMS.
▶ 1:28:02So therefore, they would have a significant Medicaid population in their um if the cuts are applied to long-term care payment levels that that could make an impact at that point. Uh we have done those studies to accommodate for that at this point but uh be willing to look at that and any studies that do come forward. Very good.
▶ 1:28:25I think I, you know, this last week I visited several facilities in my district, including our county hospital, and you know, they were talking about the devastation the hospital would undergo if if these cuts um were pursued. And but they also were sort of in a wait and see mode to kind of see what happens before they um uh before they take any action, obviously.
▶ 1:28:52but they went through a quick laundry list of where the impacts would be and they would be pretty pretty devastating and I guess my time is up and I yield back. Uh thank you very much and I thank your county uh uh hospitals for uh not responding to stuff that has not yet occurred. Uh thank you for that. Um and uh again I'm going to apologize to the witnesses for uh members that are not here given the numbers of markups that are going uh on throughout.
▶ 1:29:21Um, I also uh appreciate uh that it seems that Mr. Harry's and uh Secretary McInley that you understood the point of my questioning to Miss Silas regarding oversight. that oversight for state veterans homes occurs far beyond just the VA or the uh HVAC health subcommittee or HVAC committee here in Congress that you have multiple regulatory bodies with that conducting oversight and to your point Mr.
▶ 1:29:51Harris it sometimes actually creates burdens and hurdles and lack of innovation or new processes uh and again commend uh the VA uh and Dr. hard for the progress they have made in clearing deficiencies. So, I just wanted to recognize that. Mr. Hes, how could the VA healthcare be improved to address gaps in medication reimbursement at state veterans homes? How could it be improved?
▶ 1:30:18uh if the VA were to uh accommodate the state veterans homes as they do the private sector nursing homes by paying for or reimbursing for those high-cost medications um for medication that they cover outside correct of the veterans. Exactly. My point is we're doing it for one party but we're not doing it for another and we're the party that is not getting that reimbursement.
▶ 1:30:44Uh there are states and I've have uh stories in there in previous testimony and I believe there might be some in this one where uh residents or veterans have been turned away because they have a $100,000 medication or a $28,000 medication uh coming in and and with the VA PDM rates that are paid that's a financial loss for the facility.
▶ 1:31:07that loss has to be made up somewhere else which would probably be in resident care pro probably not adding another admission and uh it it just a cascading effect um I think the key thing is covering those those medications as they're coming and as I spoke earlier the number of residents that we are seeing now number of patients coming to us with high-cost medications and complex coorbidities that just
▶ 1:31:37that it's with the reimbursement's got to come especially with all the toxic exposures and agent origins exposures and such. Um last month we discussed uh uh a pilot program the chip in Act which uh had been used to uh um construct a VA clinic uh next to the VA medical center in Omaha, Nebraska and extending that um extending the chip in act from its pilot program
▶ 1:32:07uh for construction for either VA hospitals and or VA clinics. And even though uh 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 um state veterans homes? And then I've got an extension to that question. I don't see why not. It sounds like a fantastic idea. So, we might need to expand our our uh potential legislation.
▶ 1:32:37Uh 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 uh day health care. What complications does this pose for state veterans homes that want to provide adult daycare? They can't do it unless uh they uh uh pay for it entirely on their own.
▶ 1:33:06and it's a sizable investment in care, adult daycare, and we've talked about suicide prevention and mental illness with uh with our veterans that are coming in. Adult daycare, the medical model, adult daycare, the residents are assessed on a daily basis to make sure that doesn't happen. It also takes out the isolation component that causes a lot of suicides.
▶ 1:33:29Um it would be vital for us to be able to expand that program and have uh satellite off-site clinics available I um outpatient or adult daycare facilities so we can monitor and take care of those residents. Their life would be much more better improved if we can do that. Thank you. Secretary McInley. Several of Louis Louisiana's state veterans homes are in rural areas. What are challenges and best practices for coordinating transportation for veterans who need specialized care?
▶ 1:34:00Yes, ma'am. Uh, one of our homes is in a rural area. It's in Jennings. Uh, one of the challenges that we have because it's in a rural area is making sure that we have the appropriate staff. So, obviously making sure that we have the LPNs, the RNs to be able to come in. We're having to pull from different metropolitan areas. uh making sure that those those individuals are well funded, well paid uh is something that we have consistently worked with our Louisiana civil service to make sure that those folks are are paid at least market rate at a minimum and uh offered additional props as needed.
▶ 1:34:30As far as getting them to the facilities, um luckily Boer is okay. Our home in Boer is next to Overton Brooks and Shreveport, so they have easy access to the hospital. Reserve is close to New Orleans VA. Jackson is not too far from our uh Seabbach in Baton Rouge which is uh very well maintained I think. But yes, that is a problem and something that we have talked about extensively is about rural transportation for veterans to VA hospitals.
▶ 1:34:56Uh and something that we have had extensive conversations with our administrators about making sure that we can facilitate those those needs. Thank you. Um I you know I'm sorry she was telling me Dr. Morrison is here who 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 five minutes for any questions she may have. Thank you, Madam Chair.
▶ 1:35:21Uh and thank you to our witnesses uh for testifying today on the role of State Veterans Homes play in 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.
▶ 1:35:41I know several years have passed since the last hearing on this issue here in Congress, but 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 a result of intentional and consistent efforts to monitor the quality of care at state veterans homes and conduct research in this area.
▶ 1:36:05And as a result of these research and monitoring efforts, we're 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 CO 19 pandemic, and even what areas of operation oversight might warrant additional review.
▶ 1:36:29Having spent over two decades caring for patients as a physician myself, it's important to me that our next steps consider evidence-based strategies and place data informed 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're having here today. But equally, and perhaps more critical in this particular moment, I think it's 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.
▶ 1:36:59Um, so, Secretary McInley, 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 safety to safely and effectively managing state veterans homes and conclude expressing your willingness to continue working closely with your VA partners to to ensure clinical quality and patient safety.
▶ 1:37:22Can you elaborate a little bit more on how this partnership with VA has contributed to your ability to deliver highquality care in state veterans homes? Yes, ma'am. I will tell you all um I'm not just a veteran. I am a patient of the New Orleans VA. That is where I go to all of my health care. Uh I have a phenomenal relationship with my administrator. I can call my administrator at at midnight on a Friday night, which I have done to ensure that a veteran who is having mental health crisis is taken care of immediately.
▶ 1:37:51My administrators both in Alexandria and Shreveport are very much the same. The rural health care question. Uh recently I was in Monroe and uh the honeymoon period of my time ended very quickly when I got confronted about community care issues.
▶ 1:38:07I contacted my administrator in Shreveport, gave him the questions that uh some of the veterans had had concerns about and that administrator answered those questions within 72 hours and restarted some of his processes to make sure that our rural veterans were getting the health care that they needed through the Seabach and through Shreveport. The same from uh 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.
▶ 1:38:37And I think that is one of the strengths. I am in Alexandria. So I live in uh on the north shore of Louisiana, not too far from uh New Orleans. I've been to Shreport almost a dozen times and every time I go either myself or my deputy who's behind me go and visit the VA administrators and ask them what can we do for you as a state and we give them what what our questions are as how they can help us with our veterans as well. And so to me that is the forefront and the heart of everything I do.
▶ 1:39:02I as a state VA I cannot do my job without being intertwined at the hip with my VA administrators and my VA partners. Thank you for that response. And Colonel Secretary, I should say you also mentioned rigorous oversight as an element that supports your delivery of compassionate highquality services. And Mr. Harris, you specifically cited the layers of oversight for state veterans homes as a reason that they offer higher quality care.
▶ 1:39:30Could 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? Well, I'll tell you this. My uh my deputy and I my deputy is a is a retired army doc by the way on my staff. So, I have an onstaff physician to be able to help me answer some of the questions and talk about data. We've been talking about data since day one.
▶ 1:39:55And I will tell you one of the most important pieces of data that that has stuck with me over and over is the fact that we turn away 72% of veterans who have mental health issues. We do not have the capability to be able to take care of their needs. And so 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 y'all doing different?
▶ 1:40:21we that data allowed us to go find the answers and take that best practice and put it in the other four homes. And so we've also talked about, you know, other data points that that will make our our our workforce stronger, our medication issue stronger because as Mr. Har talked about, prescription costs are extraordinary, particularly in some cases, and 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.
▶ 1:40:46We live and die by data essentially every day so that we can make our homes Does it does well I was hoping Mr. Har's might comment too if in 30 briefly seconds your time is expired. I am a six sigma black belt which means that I love data. The more data I can get the better. Uh it's the way you're going to solve your problems. It's the way you're going to get things.
▶ 1:41:12But before we close or you cut me off my uh what I do want to state is I heard once that the VA has the largest compilation of healthc care data in the world utilize that. Let's ma let's look at that. Let's see what we can do to leverage that to make some Thank you. Thank you for your indulgence, Madam Chair. Thank you for yielding. Um members can always submit questions for the record, which I've done earlier so that I would not go over time. Ranking member Brownley, would you like to make any closing remarks?
▶ 1:41:42I thank you for having the hearing. I think uh this topic is an important one and with the colonel's answer uh to Miss Morrison's question, I wonder how we can have the relationship that you described between your medical center and your uh vet state veteran home. How that relationship how we can have that everywhere across the country?
▶ 1:42:07Well, I I'll tell you, ma'am, it helps when you're a patient because I go in one day as as a state secretary leader and the next thing I'm getting my knee injected and so I get a chance to see what they are doing. Thank you. Yield back. Thank you. I'll recognize you in the future, sir. Sorry. Sorry. Chain of command. Two veterans ought to know. Uh I number one again I want to apologize.
▶ 1:42:36My sincere apologies uh to our witnesses uh to the VA VA to the secretary uh to Mr. Harry's uh for the lack of members who are here. I thank the members who came. Uh thank you all very much. Uh when we set up hearings uh we don't necessarily know that there's going to be markups and there are numerous markups by numerous committees today. I'm supposed to be over in one in energy and commerce, but thank you uh for being here. Thank you for your participation, taking the time in today's hearing.
▶ 1:43:03This actually is an extremely important topic uh both given how much uh regulatory burden there is and oversight there is in healthcare and also the very important work that you do given the population that you serve and the increasing numbers of that population uh receiving access for care. The complete written statements of today's witnesses will be entered into the hearing record.
▶ 1:43:27I ask unanimous consent that all members have five 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 participation today. This hearing is adjourned. Thank you so much.