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Statements On Introduced Bills And Joint Resolutions

Floor Speech

Location: Washington, DC




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
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.


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