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Caring for Him (or Her) Who Has Borne the Battle

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Richard T. Moore
June 14, 2021

“To care for him who shall have borne the battle and for his widow, and his orphan,” is a phrase from President Abraham Lincoln’s second inaugural address on March 4, 1865. This phrase, now outdated by the increasing number of women veterans, is the motto of the United States Veteran’s Administration and has long been considered to be a sacred responsibility of all Americans.

After the Civil War, and before there was a United States Veterans Administration in 1930, states established, State Veterans’ Homes to help provide care to disabled or homeless veterans. These homes provide nursing home, domiciliary or adult day care and are owned, operated and managed by state governments.

However, one of the hard lessons learned from the COVID-19 pandemic is that large, hospital-like facilities such as State Veterans’ Homes, nursing homes or other congregate housing were places with designs that facilitated the spread of a virulent, primarily air-borne coronavirus. Even before COVID-19, older adults and their families, including veterans, increasingly favored aging in place with home and community-based supports and services rather than choosing skilled nursing facilities for long-term care.

An AARP survey in 2018 found that, “While 76% of Americans age 50 and older say they prefer to remain in their current residence and 77% would like to live in their community as long as possible, just 59% anticipate they will be able to stay in their community, either in their current home (46%) or a different home still within their community (13%).”

Beyond declining interest in receiving long-term care in skilled nursing facilities among older adults across the population, the population of aging veterans is also declining. An article published in CommonWealth by former Massachusetts Veterans Secretary Coleman Nee, explains demographic changes among American veterans. “While nationally, the overall veteran population is declining 1.8% each year, the number of veterans in Massachusetts is dropping 3.5% annually, almost twice the national average,” Nee stated. “This,” he said, “has significant implications for the delivery of veterans services, and we need to be planning and making adjustments now to ensure we continue to meet our obligations to those who served our country.”

A key issue in planning for long-term care services for a declining number of veterans is to determine where the majority of aging veterans live. Facilities should be located in regions with the highest number of veterans. State veterans’ homes, built after the Civil War, or even after World War II, may not be close to the communities where veterans and their families currently live. Being too far for families to visit, or for veterans to receive adult day-health services, is another factor in determining whether the old way of large, congregate facilities for veterans’ long-term care make any sense.

Even the federal Veterans Administration has moved away from building large facilities in favor of a Small House Model design for veterans’ homes. The concept involves more than a structure designed to serve small groups of about 12 veterans with single rooms clustered around core living and dining areas. The Small House Model aims at providing individualized, person-centered care. Small Home or Greenhouse style skilled nursing offers quality care and quality living for residents and caregivers in a family-like setting.

Policymakers and administrators of state veterans’ homes should look at the example of efforts to build new long-term care facilities for veterans at the Holyoke Soldiers Home in Massachusetts. When policy decisions are advanced to address a serious problem in care for veterans, these decisions need to be rational, researched and responsible. Massachusetts’ answer to the tragic loss of life from COVID-19 at the Soldiers Home in Holyoke is a classic example of how not to make public policy.

Policymakers responsible for veterans’ long-term care looked at replacing an outdated facility serving a small region rather than looking at the needs for veterans’ care across the state in each region. Geographically, Massachusetts is a small state, but in larger states delivering treatment from one facility to veterans throughout the state could be even more challenging. However, despite the state’s comparatively small size, the two state veterans’ homes primarily serve veterans from the areas where they are located instead of the state as a whole.

Rather than propose building 21st century long-term care facilities, administrators chose the less-visionary path of replacing an outdated, large congregate facility with another large facility. They failed to seriously consider how to provide better care using the VA’s small home model. The plan also fails to address the needs of the overwhelming majority of the state’s veterans. Some in the Legislature have begun pushing for a more appropriate care model that addresses the needs of all veterans in the state. The process to date would make an ideal case study for any class in public administration.

Author: Richard T. Moore has served in both elective and appointed public office at local, state, and federal levels of government. He served for nearly two decades each in the Massachusetts House and Senate, as well as being chosen as President of the National Conference of State Legislatures. He also served in Washington, DC as Associate Director of FEMA in the Clinton Administration and as a Presidential Elector in 1992. A former college administrator and adjunct assistant professor of government at Bentley University and Bridgewater State University, Mr. Moore is a long-time member of ASPA serving terms as Massachusetts Chapter President and National Council member. Email – [email protected]

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