Dignity Denied: The Case for Reform at State Veterans Homes

Hospitals and Health Care

2025-04-29

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Source: Congress.gov

Summary

This hearing focused on the quality of care and oversight of state veterans' homes, particularly concerning aging veterans and their long-term care needs[ 00:31:47 ]

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. Discussions highlighted the growing demand for long-term care for veterans and the role of the Department of Veterans Affairs (VA) in supporting and overseeing state-run facilities[ 00:32:05 ]

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. Members expressed concerns about existing deficiencies, funding mechanisms, and the need for improved services, including mental health support[ 00:33:34 ]

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Themes

Care for Aging Veterans and Long-Term Needs

The baby boomer generation's aging means an increasing need for long-term care for veterans, who often face physical and mental vulnerabilities, social isolation, and chronic pain[ 00:32:05 ]

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. While many veterans prefer to age at home, nursing homes, particularly state veterans' homes, remain essential for those requiring institutional care[ 00:39:19 ]

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. State veterans' homes serve a significant portion of veterans receiving VA-funded nursing home care and offer culturally competent care and a sense of community[ 00:40:13 ]

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Oversight and Accountability of State Veterans' Homes

Oversight of state veterans' homes involves the VA, the Centers for Medicare and Medicaid Services (CMS), and in most cases, state-specific oversight. While VA conducts annual inspections and requires corrective action plans for deficiencies, it lacks a range of enforcement actions similar to CMS, making it difficult to compel compliance beyond withholding per diem payments. The VA has recently centralized its survey process and implemented an escalation plan to improve follow-up and ensure timely resolution of deficiencies. Some expressed concern that overregulation might burden staff and stifle innovation.

Funding and Resources for State Veterans' Homes

State veterans' homes receive substantial funding from the VA through per diem payments, construction grants, and grants for nursing retention[ 00:35:05 ]

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. However, the VA's basic per diem often covers less than 30% of the actual cost of care, with homes relying on other sources like state support, Medicare, Medicaid, and veteran contributions[ 00:40:32 ]

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. There is a significant backlog of state veterans' home construction projects awaiting federal grant funding, potentially delaying projects by years[ 01:03:40 ]

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. A specific legislative proposal was introduced to reimburse state veterans' homes for high-cost medications for severely disabled veterans, which are currently not covered by the VA within these facilities. Potential cuts to Medicaid could significantly impact funding for long-term care and increase reliance on VA and state veterans' homes.

Mental Health and Suicide Prevention for Older Veterans

Older veterans, particularly those committing suicide later in life, represent an "invisible population" with very little research dedicated to understanding their specific challenges[ 00:34:10 ]

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. Challenges include social isolation, chronic pain, and mental health issues, which the VA needs to address more effectively[ 00:33:05 ]

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. There is a recognized need for increased mental health and psychiatric care in state veterans' homes, especially given the prevalence of mental health and behavioral issues among veterans, including those with Alzheimer's or dementia<citation data-15.1" data-id="61.5" data-id="62.1" data-id="71.31">. State homes believe they can play a larger role in addressing these needs and advocate for a geriatric psychiatry pilot program.

Tone of the Meeting

The tone of the meeting was largely one of serious concern and a desire for improvement, marked by a collaborative spirit among most participants, though with some underlying political tension[ 00:31:47 ]

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. Speakers expressed strong advocacy for veterans' welfare, highlighting both successes and critical areas needing attention[ 00:31:59 ]

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. There was a notable point of disagreement regarding the VA's willingness to pursue additional legislative authority for enforcement and some political debate over funding priorities[ 00:48:50 ]

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. Despite these differences, there was a shared commitment to ensuring high-quality care for aging veterans.

Participants

Transcript

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'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.  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 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 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 health care 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.  We've 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.   And just two 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.  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.   State 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, domiciliary care, and adult day care.  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.  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.  In 2020, at a state veteran's 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, 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 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.  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

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