Today, Randy Reeves, the former Under Secretary for Memorial Affairs for the VA, and the former Executive Director for Mississippi's Veteran Affairs Board, shares his understanding and experience being responsible for a State Veteran Home network. He explains the problems that occurred with the Holyoke Soldiers' Home in Massachusetts, and still proclaims that he would prefer living in a Veteran home over a privatized home.
Today, Randy Reeves, the former Under Secretary for Memorial Affairs for the VA, and the former Executive Director for Mississippi's Veteran Affairs Board, shares his understanding and experience being responsible for a State Veteran Home network. He explains the problems that occurred with the Holyoke Soldiers' Home in Massachusetts, and still proclaims that he would prefer living in a Veteran home over a privatized home.
Holyoke, specifically in Massachusetts, would be a case study and how not to do things. The superintendent or the person who ran the home was not a licensed nursing home administrator. Holyoke itself was not a state licensed facility. When, you know, the crisis for COVID got to its height and was was really bad. They made a lot of bad decisions by combining people COVID sick people combined in spaces with people that weren't sick, basically, not following, you know, what I would think is basic infection control protocols. When they went into crisis. There was no one person to point to, as to having responsibility. And then when the fallout came, of course, you know, they looked to blame someone.
Announcer:Welcome to the policy beds podcast, engaging with leaders, scholars and strong voices to fill a void in support of policy development for America's veterans. With your hosts, former Secretary of Veterans Affairs Dr. David shulkin, and former executive director of the American Legion Louis Celli, today's guest, Randy Reeves, former Undersecretary for Memorial affairs for the VA, and the former executive director for Mississippi's Veterans Affairs board.
Louis Celli:Hey, Mr. Secretary, I can't tell you how excited I am every time we get one of our policy vets to join us on these podcasts.
Dr. David Shulkin:Yeah, I think it really shows the depth of the policy of vets organization that there are all these people who have such knowledge and substance they've spent their careers, really in public service helping veterans, and you just begin to get a sense that their knowledge is untapped. And that's really what as you know, love we're doing we're providing people like Secretary Reeves a chance to be able to share his knowledge about how these state homes work.
Louis Celli:Absolutely true. And you know, when things come up in the media, and in the news, when you hear from somebody directly from VA, and this is not a knock on va, they have certain guidelines that they have to go by when they when they're interviewed, there are certain things that they need to say. And then lawmakers of course have, you know, their agenda on the things that they want to talk about. So it's really hard just to get the straight facts, which is one of the beauties of having no longer been associated with government service. But now being a policy that and being able to join us on a show like this.
Dr. David Shulkin:And of course, it's true that after you leave public service, and you have a chance to sit back and reflect and say, you know everything that's going on, I wish that I had been able to look at it through a different lens. You are getting this wisdom of experience from people like Randy Reeves and other policy vet scholars and and senior fellows and advisors that is really invaluable. And so I think this is going to be the case with today's podcast where we're going to talk about what went wrong in some of these state veterans homes during the COVID crisis.
Louis Celli:New Jersey, Texas, Massachusetts, New Mexico, New York, all had scandals involving disproportionate death rates among veterans and state veterans homes and state veterans homes are in the news again, Senator Grassley just came out with a statement. He's not even on the senate Veterans Affairs Committee, and he wrote a letter to Secretary mcdonogh complaining about, you know, the oversight recommendations from the GAO that still haven't been implemented despite the lopsided death count of veterans living in VA state funded homes.
Dr. David Shulkin:I have to tell you, this is one of the most confusing parts of running the VA, the VA provides a significant amount of funding to the state homes often paying for almost all the care of a service disabled veteran who lives in the homes yet they're not responsible for running them. So it's this. It's this weird relationship between the state and the federal government. And, of course, when something goes wrong, everybody gets the blame. But it's sometimes unclear as to who has all the responsibility for oversight and making sure that veterans are getting the right care.
Louis Celli:Absolutely blows me away almost 5000 veterans in New York, died of the Coronavirus and you know of all the nursing homes in America, you would think that that veterans homes would be the safest I mean, after all, they fall under two completely separate and distinct jurisdictions you would think that they would both have an interest in making sure that they run right.
Dr. David Shulkin:Well, Lou, this is a this is an error. That's really of significant interest for me, when I took a look at what was going to happen to the VA in the future. What scared me the most and looking at projections was the amount of veterans who were getting older who are going to require care as they get older. And either we're going to have to be in a massive construction program building brand new veterans homes, or we're gonna have to do things differently. And my feeling was, was that we should begin to start developing the home, not stayed home. So I'm talking about where the veteran lives in their home as a place where people can remain for as long as they want to, until ultimately, they pass away. And that is going to be creating a different type of VA system that provides services into the home. And that was really where I was driving the VA because I think that's the right answer. If we had had more veterans living at home, and being cared for at home, we wouldn't have seen some of these disasters results,
Louis Celli:you know, to your point. We had Sarah verado on here a couple of weeks ago, and she talked about how her husband Mike qualified for state Veterans Home. But she absolutely was adamant about keeping him home. And it was it's extra work for her. There's a lot more negotiation and a lot more strategy that goes into making sure it's a great and safe environment. But she does it. Right. She does it and it and it's working for them. So I think to your point, that certainly should be an option. I mean, after all, look at COVID. Right. So when it comes to people telecommuting going to work, we have we have adopted a hybrid system, and maybe it is time for for the VA to consider that. You know, I remember at the beginning of the the COVID epidemic, you sent me an article. And it highlighted the rash of deaths in Massachusetts. You know, they actually indicted both of those state directors for neglect, and leading to harm and death for these veterans.
Dr. David Shulkin:Yeah, it's really a sad situation, because I don't believe that this was an intentional act. But I think that people were so unprepared for this pandemic. And unfortunately, the brunt of it, particularly in the beginning was on our older citizens, and particularly in these homes on our on our veterans. I do think that this needs to be a wake up call for us. And there is a need to have good high quality state homes for our veterans. But I think from a policy perspective, this is the time that our veterans can't fall behind as the rest of healthcare is moving out of facilities and new capabilities to be cared for in their homes. The VA needs to be leading that charge.
Louis Celli:Of course, I agree with you. Nobody intends to do a bad job. No one, no one looks forward to veterans dying under their watch. But I gotta tell you, I remember when Bennett Walsh was appointed as the director of the Holyoke home, he came to brief the Legion of Massachusetts at their state convention. He was still in military uniform. He hadn't even retired yet. And he had already been appointed to the position. He was in the Marines, he had zero background in health care or running a nursing home. I remember thinking at the time, how in the world did they pick this guy?
Dr. David Shulkin:Well, I think a lot of people are probably now looking at the qualifications. There are not enough trained nursing home administrators, quite frankly. And you know, the demographics just suggests that we're going to need more people who are expert in understanding how to care for our older citizens. And so this is a big problem that's facing the country, and certainly a big one facing the VA.
Louis Celli:Let's really that's why I'm really glad that that our next guest is here to talk about this issue. Should these positions, be political appointed positions based on political aspirations? Will should they be positions that are people are hired based on qualifications?
Dr. David Shulkin:Yeah, and I think that's right when I first met Randy Reeves, so we're going to hear from very soon. He was the president of the National Association of State directors, and he had to take on some pretty tough issues, and we were always engaged in talking about them. I was so impressed with him that when I became secretary, I nominated him actually the president and nominated him to be the Undersecretary for Memorial affairs and Randy just has such deep respect for his fellow veterans, and takes this responsibility to them so seriously, I knew he would do a good job. And Randy did a fantastic job as Undersecretary and really made me very proud of the way that the VA continued to handle veterans and their families during some of the toughest points that they can face as a family,
Louis Celli:to your appointments to Secretary. Undersecretary Reeves, to the to the best of my knowledge was one of the few not the only but one of the very few appointees to last the entire administration. They kept him.
Dr. David Shulkin:That's right, because he was doing a good job. So I think we're fortunate to hear from him today. And let's get on with it.
Louis Celli:Let's get him in here. Randy, welcome to the policy. That's podcast. Hey, thank you for your continued support as a policy that scholar.
Randy Reeves:Well, thank you very much for having me this morning. And thank you for everything policy. Betts is doing to bring attention to the needs of our veterans and our families.
Dr. David Shulkin:Randy, it's so great to have you on and so great to talk to you. I wanted to spend just a little bit of time talking about your previous roles before you entered VA. And of course, I think I met you at the White House, because you were the president of the National Association of State directors of Veterans Affairs. And that was a big deal when all of you came into town, and I got to meet with you and hear what was going on around the country. Not only were you the president of the National Association, but you were the state director of the Veterans Affairs Department in Mississippi. And I don't think many of our listeners really understand that every state has their own state Department of Veteran Affairs that works with the federal government as well. So would you mind just telling listeners a little bit about what your duties were when you were running the state Veterans Affairs Department in Mississippi and a little bit about what the National Association of State directors does, so that people have a sense about the types of things that you've been involved in?
Randy Reeves:Absolutely. And again, it's it's great to be with you all this morning, when I was the executive director in Mississippi of the state Veterans Affairs board, I was essentially the Secretary of Veterans Affairs for the state of Mississippi. As a part of that responsibility, I was the licensee and responsible for for comprehensive care skilled nursing homes around the state. Each of those were 150 bed facilities, also responsible for the state's veterans cemeteries and all of its Memorial programs there in the state, and also for its claims operation, helping veterans with filing their claims. I had accredited Veteran Service Officers within my state organization who did that work. And also, we were responsible for what's called the state approving agency, which is responsible for reviewing and approving under contract to the VA institutions of higher learning so that our veterans could receive their veterans benefits through the VA. So basically, I had all of the functions at a much smaller scale, of course, in some ways, as the US Department of Veterans Affairs did at the state level.
Louis Celli:Secretary reason you and I spoke a little while back about the responsibilities and the liabilities, of overseeing the veterans programs at the state level. I remember you telling me that the state, as a state director, you considered your number one responsibility, the oversight of those homes, I mean, higher than veterans getting their benefits, higher than welcoming home the troops even higher than ensuring a dignified transfer remains to the veterans final resting place. Not that all of those responsibilities aren't important. But can you tell our listeners why you held oversight of the state veterans homes in such high focus and importance?
Randy Reeves:Well, I will tell you, I think that all of those functions that I was responsible for, were equally important for our veterans in Mississippi and for every one of our veterans across the country. Where the state veterans homes are different, is that that's a medical operation. I spent 80% of my time in the oversight of those homes and making sure those homes had resources, staffing, funding that they needed to carry out the duties taking care of our veterans. There's another component of that, in Mississippi is I was specifically now I'm not a nursing home administrator. But I was the licensee for each and every one of those homes. My name was on the license, you know, and licensed by the state personally, to operate those homes just as if I owned those homes. So I you know, incur the same liability and responsibility for those homes that a Private nursing home operator basically would have would have had, saying that we were dealing with the lives, the comfort, and the well being of our of America's heroes in these homes, they deserve the very best that we could give them. And it was my job, I felt to make sure that I was personally involved. So that those duties were being carried out at the home level, to the best of the ability of those folks working in those homes. And as Dr. shulkin, Secretary shulkin, you know, knows better than probably I would ever know, that responsibility for the medical care of those patients, and I'll call them patients because that because they were but they were veterans is an ultimate responsibility. So as I said, I spent 80% of my time taking care of those homes, because of the, you know, the type of operation it was. And, you know, I have to be honest, there was a big liability factor there. And I took that very, very seriously.
Dr. David Shulkin:Randy, I think that there's always been a lot of confusion over the responsibility of these state veterans homes, and how the federal government plays a role in that what the responsibility of the state is, of course, when something goes wrong, everybody gets blamed, whether you're in the federal side or the state side. But can you explain to our listeners, who really is responsible for running these homes who pays for the veterans to be in these homes? What is that relationship between the state and federal governments?
Randy Reeves:Well, it is it should be if it's working properly, it should be a partnership. And frankly, the state Veterans Home program is one of the best partnerships that states have with with with the federal VA, to answer your first part of your question, the ultimate responsibility for operation of those homes, is lies with the state with the state that has signed up to actually receive the federal funds and to operate those homes. by federal law, specifically, I believe it's in 58 USC, the homes have the ultimate responsibility for operation, even in that code section. The really, the VA is prohibited from actually interjecting or interfering in the day to day operations of those homes. Now, the VA does have a certain amount of oversight responsibility. And that is done through their annual surveys, which would they anyone else, I think, would probably call those inspections, where they come in, and they actually inspect the standards of care. And a number of other things, I think there are about 120 items that they look at annually, to ensure that those homes are operating as they should, one of the very, very important things that happens in the lifecycle of a home is the home will be built. And the first survey that will happen will be what's called a recognition survey. And before they can operate as a veteran's home, unless they're state law, and that individual state, you know, is written differently, that state has to the state home has to have state licensure. There are some examples a couple that notably that I know of where because the states have written their laws in a different way. They they're not state licensed, and they're not and they really kind of skirt the the oversight of their state licensed agent, licensing agencies for nursing homes. So that's the responsibility for from the VA standpoint is some oversight. But the ultimate responsibility comes down to that state. And that's by law.
Louis Celli:I remember working pretty closely with a number of state directors. And some of them lamented that the inspections that you just talked about, that there were too many of them that they were duplicative, that, you know, some are from the state level, some were from maybe even some other recognizing agency accreditation service, and then somewhere from the VA and some of them looked at the same things. And they were looking for something more streamlined. But I really, really want to touch on the fact that there there was such inconsistency from the licensing perspective across the nation, where some veterans homes will be the responsibility and overseen by the state. Some of them aren't even accredited by the state. Can you talk a little bit more about that? I think that's critically important, especially when we talk about All of the veterans who have died in these in these homes from COVID-19?
Randy Reeves:Well, that's a good question, Lewin. And really, when you start talking about the inspections, or the surveys, where those folks have been talking to you probably about, they say that the surveys are duplicative, what they're talking about is they're talking about the VA annual survey where they come in and inspect. And then those homes that are CMS certified, that's, you know, by the Centers for Medicare and Medicaid Services, to receive Medicare and Medicaid funds. There, they come in and do a very similar inspection annually. And what they want to do is I've wanted to do for many years is combine those two, there are about I think, 152, or three state veterans homes in the country right now. And about two thirds of those are Medicare and Medicaid certified. Okay. I have always been of the mind that goes should not be combined, that more oversight is better. And also the oversight from the States. I think that you know, given this current situation and call for more oversight, I think that people may want to rethink whether or not things are too duplicative or whether or not they should do away with surveys. What you refer to and, you know, I'll go back to that just very briefly, is there was a move at one time to combine those two and only have one survey per year. I don't really think that that's a good idea. And that's it. But now, when you start talking about oversight, there may be some things and I think the VA, from what I understand is looking at this, some things that can be learned from the CMS survey process by VA, and how they actually document, you know, deficiencies. And you know, I look at trends a little differently by using that process. But I hope I answered your question. But that's, that's really what people were trying to do.
Dr. David Shulkin:Randy, I want to talk a little bit more about this federal oversight federal bureaucracy, not so much on the inspection side, but I remember going out to visit state homes when I was secretary, I remember spending some time in Rhode Island with the governor who, of course, now she's a secretary in the president's cabinet. And what she said was that the VA is restrictions on their use of money really wasn't being used in the most appropriate way in that we will requiring new state homes to be built in a greenhouse type of architectural pattern where everybody had single rooms. And what the state of Rhode Island wanted to do was they wanted to build more space to be able to accommodate more veterans, they wanted to build double rooms. And so it was this fight between the state and the federal government. I basically work to change the regulations to say that the federal government should defer those architectural standards to the state because the state really was trying to meet a great demand on these beds and didn't have enough bed. So where did you come out on on the rights of the state versus the rights of the federal government who was providing a lot of this money?
Randy Reeves:Well, in that way, I agree with the with what you had just said, your rationale, that in the architectural standards, and you know how those homes are built, there should be deference to the state, because not every situation is the same. I was actually in, in senior leadership in the National Association of State directors at the time that this was happening. And I remember actually having a very briefly some of those discussions. I think we're both you and I were in the room. But the greenhouse standards that they that they were trying to put through at one time, the cost for some states of building homes would just stay there without price them from being able to build a home. It was just one it was too expensive. And that is not always the most appropriate care dependent upon the needs of the individual veteran or individual patient. So where I come down on that is an area where they where they need to continue to defer to the states as much as possible on how the homes are built. Now with Co Op collaboration, cooperation from the From the VA, there should be standards. But I think the deference should be to the state in the in the construction.
Louis Celli:So we talked a little bit about COVID-19. And I think what what many of our listeners remember about the last couple of years is some of the major stories that had come out about veterans dying in these homes and who was responsible. Let's talk a little bit about Massachusetts. And obviously, I took a personal interest in that because I'm from there, you know, not only did the directors for each of the two homes, Holyoke and Quincy, both get indicted, but the secretary, which cabinet level position was, was essentially fired, he was forced to resign. So, you know, we both read his testimony as public testimony, people can find that, where he claims it on a number of occasions, he went to the governor with with concerns that he wanted to address, but it was denied. And then a state investigation pretty much exonerated him, and some veterans groups even come out and publicly demanded an apology on his behalf. Can you explain really what happened in that case,
Randy Reeves:I can speak to what I know as an outsider looking in and also knowing some of the players in that situation. Holyoke, specifically in Massachusetts, would be a case study and how not to do things is my opinion. One of the things that, you know, that is astounding there is that the superintendent or the person who ran the home that basically what I would have called administrators in my, in my state, was not a licensed nursing home administrator. The Holyoke itself was not a state licensed facility. But because the way the federal law and that's what I talked about earlier, because the federal the way the federal laws written, the state can set its own rules for how they operate those and I think Holyoke, in my opinion, got a little bit of a carve out for whatever reasons, so that they didn't have to have some of those things that I would think are, you know, standard for a state veterans nursing home or any nursing home. Also, when, you know, the crisis for COVID got to its height and was was really bad. They made a lot of bad decisions based upon all the reporting that I've seen, and the and the investigations, by combining people not follow up in places where they shouldn't, you know, COVID sick people combined in spaces with people that weren't sick. And basically not following, you know, what I would think is basic infection control protocols. But that can go back to you didn't have people who were trained to do that. And you didn't have the same standards there that you would expect in other nursing homes. So from my perspective, as an outsider looking in, one of the other big failures was that there was no clear chain of command there. The second, the Secretary of Veterans of veteran services in Massachusetts had some responsibility, but not direct oversight or authority. The Department of Health and Human Services in Massachusetts had some oversight, but not direct authority. And there was a separate council or board that actually appointed the superintendent or the administrator. And yes, everything I've seen, and all the discussions I've had, the director of veteran services advised against one hiring the person that they did, because they weren't qualified, and then advised on a number of occasions, to, you know, to take action, which which didn't happen. But that's one of those kinds of things, frankly, as we always saw in the military, when everybody was injured when everybody is in charge, no one is in charge. So when they went into crisis, there was no one person to point to, as to having responsibility. And then when the fallout came, of course, you know, they looked to blame someone. And there are several items. I think that you know, as this gets into policy and legislative area, that need to be looked at to make sure that homes are consistent across the country.
Dr. David Shulkin:Well, thanks for going through that, Randy. I think that what's unfortunate, obviously that so many veterans died and suffered needlessly but there are so many high quality state homes that I fear that all of the homes got tarnished and and the reputation hurt because We saw some really terrible outcomes in a few of these homes, but the vast majority are just do such a terrific job. We have a tremendous shortage of beds in the state homes. And every year, as Secretary, I would get a list of the requests from states to help build new homes, and the list was far, far longer than we could find. And so we would work with Congress and try to prioritize whether we would fund more world state homes and how we would allocate that money. What's your sense? are we spending enough on the state homes? Should should Congress allocate more dollars for this? How would you be a good steward of taxpayer dollars and at the same time, meet our obligation to our veterans?
Randy Reeves:Well, the answer that the most recent budget submissions that I've seen in most recent budgets for state homes have had a significant increase. I don't have the numbers in front of me, but I think there's somewhere around about a 50% increase or more in construction for the State Home program. So there is recognition, both in the VA and Congress, you know, that that that needs to go up. And that's happening each year. And I think in the last, I think it's FYI, 22, about 1.71 and a half to$1.7 billion are spent in per diem on state veterans homes. There are two different funding mechanisms. There's the building program, the construction program, where the VA pays 65% of the construction cost to build a home and the state comes up with the other 35%. That's where we're talking about that I've seen the increase in construction. In per diem, that$1.7 million goes to pay a portion, as you were talking about earlier of the day, what's called a daily cost of care for individual veterans, there, that's done a couple of different ways. There's basic per diem, that pays about half of the daily cost of care for a veteran. And if you're a 70%, or greater service connected veteran, or you're in a veteran's home for a service connected condition, the VA pays 100% of the daily cost of care. I, you know, this is something that that we discussed when you were secretary, and I was still back as the president of the National Association, what we call the silver tsunami. And I actually, I want to commend you for the work that you did back then in recognizing the need to start steps in recognizing what we were facing in that silver tsunami of veterans who are going to require care, because it's going to be you know, frankly, I'm at that age where in a few years, you know, I'll be thinking about those things, too. So there are going to be more of us over the coming years. So increased funding is definitely something that is needed. And I do see that recognition, you know, to answer your question,
Louis Celli:Randy real quickly, just so that our listeners can grasp this at you know, at the very basic level, tell us how these, how these state homes are funded, many of them are funded a variety of different ways. Some actually make money and earn a profit, some of them run at a deficit. And you know, the oversight thing for me personally, is a problem. Because when something goes wrong, then just like in Massachusetts, it's difficult to find who the culpable person is, but can you just explain to us how these things are funded? How did they get their money, aside from the construction costs,
Randy Reeves:as I as I alluded to, earlier, the first funding mechanism is through the per diem program, through the VA, that pays a portion basic per diem, and then what I what they call enhanced per diem, you know, for those 70% or greater or service connected veterans, that goes on a reimbursable basis to those homes to pay for that daily cost of care. Then the net and I'm, I'm going back to also you know how I did things back in Mississippi, we did things there, then there is a cost to the veteran and or the or the veterans, family responsible party for a portion of that cost. And then in some states in some states, not the states actually contribute from their state budgets to the cost of care for those veterans. And then there are in some cases across the nation. There are foundations and private funding that comes into play to help pay For the cost of the state veterans nursing homes, so the best answer I can give you on on that the, the main thing that we think about is per diem payments from VA, when paying for the cost of care of the veterans, and then beyond that, it is a myriad of different sources that help pay for that daily cost of care. And then, to kind of follow on the last part of what you mentioned, there's some things that need to be standard in, in all homes across the country. And this is probably a legislative and policy issue is that, you know, every every home, because all states have a state licensure board, they should be state licensed, it should be a requirement in law, they shouldn't be able to carve out anything like what Holyoke did, there should be licensed administrators in every one of those homes, so that you get people who are trained in operating nursing homes. And then there needs to be a really good look at how VA does oversight. A little more probably, like what is done in CMS, you know, the centers for Medicaid and Medicare Services. And there are a number of people want to read it. There are a number of Gao reports out there that talk about this, also, in some saying some of the same things that that I am,
Louis Celli:let me ask you this, there's there's been a number of these state homes in a number of different states that have kind of gone awry over the past year. And I think what COVID did is just really expose their weaknesses. So what what are some of the remedies? Can any of these state homes go into some sort of receivership, I mean, if the VA wants to penalize them, and then stops paying for these for these veterans to stay there, because they're not up to code, what's going to happen? I mean, without the, without the VA money, these homes would have to close?
Randy Reeves:Yes, they would. Most of them are I know, my my arms that are operated in Mississippi without their per diem, they wouldn't be able to operate. And it's that way, in most states, now, there are provisions for VA to be able to recoup monies and that however there there needs to be and and the only way that and I think you're probably talking from the federal level, it would require legislative change, for the VA to be able to come in and operate and take over these homes. They could they could basically recoup the money. But But if that happened, in a state home, the people that go and serve are going to be the veterans that don't have the service. And we're dealing with and talking about when we talk about having to, you know, you call it receivership. If you had to do something like that, that'd be a small percentage of the homes, but there needs to be legislative authority for VA to be able to do more than than what they can right now because legislative the they can't. That's that's where they're hamstrung.
Louis Celli:Let's talk about Mississippi, right? I'll give you I'll give you a softball. You mentioned earlier that you you could be approaching the age bracket in, in some time in the near or in the hopefully distant future where you may need to or want to live in one of these homes, would you be comfortable living in the state veteran home in Mississippi, I want to ask you about Massachusetts,
Randy Reeves:I would absolutely be comfortable living and being taken care of in a state Veterans Home in Mississippi. Because I know how they're operated. I know what their standards are. And I know, you know how the state, you know, continues to operate them. But by the same token, and I'll just I'll throw this out. I think both you and David know this. I am I'm a big believer in in most all of the VA programs, I get all my care at the VA. I have family members who have been cared for in state veterans homes, I have friends that have been cared for in state veterans homes. And I will always be more likely, if I need it to go into a state veterans nursing homes and I would ever go into a private nursing home because as a part of my duties, I would go into those private nursing homes. And I'm generally not impressed with private nursing homes.
Dr. David Shulkin:Well, I think that that's what's so important to recognize a lot of people say why is the federal government involved in running nursing homes and running hospitals? Why don't we just privatized everything? And I think you just really gave the answer that there is a special type of care, a special type of respect for those who choose to serve and care for our veterans that I think is so important that you just can't find in the same way in the private sector. So thank you for all that you've done. Both In the state and in your role as the undersecretary of Memorial affairs, which is just a great way that you've given throughout your career giving back to your fellow veterans.
Randy Reeves:Thank you very much for that. And thank you for all the all of you on the line here continue to do policy. That's
Louis Celli:thanks, Randy. So before we go, I always like to like to make sure that our guest gets the last word. So can you share with our veterans? And to be fair, as you mentioned, state or nursing homes in general sometimes struggle significantly with regulation and and oversight, but can you share with veterans? Why considering a VA state Veterans Home, a va sponsored state Veterans Home might be a good thing for them?
Randy Reeves:Well, first of all, because of the of the per diem and and the funding from VA, it helps keep the cost down to the veteran. Okay, that's one, one factor. Secondly, they are focused on Veterans and this specific and unique needs of veterans. That's the main reason. Because let's face it, veterans, and even our veterans who are serving today, and who have served recently, have a myriad of conditions that are very specific to their military service. And they need to be in a place where that is recognized, and that, more importantly, they're honored, because they're veterans. And and they're taken care of as the heroes that they are for this country. And I think that and that's why, if I recall, I hope that I go until the end, and then I'm done. But if I need to be in a nursing home, like I said earlier, a state veterans nursing home or a VA nursing home is the place where is where is where I will go.
Louis Celli:Secretary Reese, thank you so much for joining us today. It's it's been an honor having you and it's always an honor working with you as a policy that.
Unknown:Thank you so much.
Louis Celli:And that is all the time that we have for today. Join us next week when we're going to be joined by Brian Jenkins. He's the executive director of the Armed Services art partnership, we're going to be talking about the healing powers of comedy. Join us next week.
Announcer:Thanks for listening to the policy best podcasts. For more information about projects and other podcasts go to policy vets.org