The initiative — billed as the most substantial change to the system since the first veterans home opened in Grand Rapids 131 years ago — stems from new, bipartisan state laws that officials say will lead to higher-quality care for more veterans. Talks began last year after a state audit uncovered insufficient care, inadequate staffing levels and other problems at the Grand Rapids Home for Veterans.
That home and one in Marquette, which opened in 1981, provide primarily nursing care to more than 500 veterans. They often choose to live there because the government-subsidized care costs them no more than $4,300 a year. The homes also are seen as more equipped to treat a population with higher rates of mental health, substance abuse and behavioral problems than at private facilities.
But the large, institutional veterans homes need to be replaced in favor of smaller-scale housing and expanded to other parts of the state, state officials say.
"If that were to come to fruition, we would be providing care much closer to where the veterans live now, and their families are going to be closer to them," said James Redford, who Republican Gov. Rick Snyder named to lead the Michigan Veterans Affairs Agency in February 2016 as part of a shakeup after the critical audit was released. He said Snyder told him: "Fix the homes."
In recent weeks, the agency applied for roughly $66 million in federal funding to help build a new home in the Detroit area and to replace and downsize the one in Grand Rapids. A third of the state's 640,000 veterans live in Wayne, Oakland and Macomb counties.
A $42 million state match for the two projects was approved by Snyder and the Legislature months ago.
The application also outlines a plan to build five more facilities in phases — first in the Flint/Saginaw/Bay City area, next the Jackson/Battle Creek region, then a replacement of the Marquette home, followed by one in the northern Lower Peninsula and finally another in metro Detroit.
Multi-story, hospital-like buildings would be jettisoned for modern houses that are more like a real "home." Ten to 14 residents in a large house would each have an individual bedroom and bathroom, surrounding a common living and dining area with a kitchen.
Overseeing the facilities' site locations, construction and operations is the new Michigan Veterans' Facility Authority, which was created under a law enacted in January and whose nine-member board met this past week for the first time. The semi-autonomous authority can issue bonds and solicit donations. Unlike a department or agency, it is more independent from annual budgetary decisions and has more continuity across different governors, said Redford, board chairman.
The overhaul comes as veterans homes grapple with rising health care costs, an increasing inability of residents to afford the care and standards that are out of step with best practices within the long-term care industry. A GOP-backed privatization of 170 jobs at the Grand Rapids facility has been panned. And though the state is getting more per-diem reimbursements from the U.S. Department of Veterans Affairs, they are not offsetting declining resident income — meaning the state's general fund spending is higher.
While Michigan's veteran population is projected to drop by 57 percent to 277,000 by 2043, the percentage of those age 70 and older — those most likely to need care — will increase from a third to nearly half.
State officials hope that Michigan's current and future homes will qualify for additional federal Medicare and Medicaid funding by meeting certain quality standards.
"It is our hope that we would be requiring less general funds as we go forward while at the same time providing a substantially improved quality of life and improved places of work for our staff with better facilities," said Redford, a 28-year Navy veteran who has served as Snyder's chief legal counsel, a Kent County circuit judge and an assistant U.S. attorney. "Our staff in both these homes, they do remarkable work every day."
For construction of the initial two homes to proceed in 2018 and be done in 2020, Michigan likely needs its federal funding request to rank high — in or near the top 10 — on the VA's annual priority list. It will be released early next year.
U.S. Sen. Gary Peters of Michigan is among some in Congress who are pushing to more than triple what is typically allotted for constructing and renovating state homes, to $300 million nationally, said Brad Slagle, interim CEO of the Michigan Veteran Health System.
"We think our projects are going to be near that No. 10 spot on the new list," he said, adding that roughly 150 state veterans homes across the U.S. assist more than 30,000 veterans in need of long-term care — more than the VA does and at a lower cost. "So we think it's a good investment for the federal government."