Veterans’ nursing homes need more staff, money to meet challenges
TALLAHASSEE, FLA. 1/4/23-Bob Asztalos, Deputy Executive Director, Florida Department of Veterans' Affairs speaks to the Senate Military and Veterans Affairs, Space, and Domestic Security Committee, Wednesday at the Capitol in Tallahassee. COLIN HACKLEY PHOTO

'COVID came in, it reduced our beds, the workforce shortage came in.'

A new House panel is delving into issues affecting Florida’s military veterans, and they are hearing that the relevant state agency still needs resources to deal with the state’s growing population.

Florida Department of Veteran Affairs (FDVA) Deputy Executive Director Bob Asztalos. appeared before the House Local Administration, Federal Affairs, and Special Districts Subcommittee. “We are working hard to get our programs back,” he told legislators Tuesday in Tallahassee. “We are still down about a third of our staff … We’re still trying to hire nurses.”

Asztalos, a veteran himself whose department commands a current $171 million budget, noted that vets face unique challenges in Florida, including demographics, a need for expanded services, and a lack of resources to turn concepts into operational reality.

The state is home to 384,000 disabled veterans, and a quarter of the state’s vets are over the age of 65. Those from more recent military conflicts than Korea and World War II are starting to emerge in need of long-term help, and the challenges vary with each cohort.

“Now we’re starting to see the Vietnam veterans come into our nursing homes,” he noted, even as reaching out to fighting forces from that mid-century war has been difficult.

“The Vietnam veterans we want to get to are the ones who came back who are bitter about the war, bitter about how they were treated,” Asztalos said. “They are isolated and aging out.”

Veterans of the more recent Asian land wars in Afghanistan and Iraq will be the “next wave,” and different approaches will be needed for those groups.

With six state nursing homes, an assisted living facility in Lake City, two just-opened facilities in Orlando and Port St. Lucie, and two more nursing homes to come to Collier and Marion County in the coming years, the near-term goal is to anticipate the needs of the “Southwest Asia veterans,” who have endured multiple traumatic injuries in those military conflicts, including traumatic brain injuries.

Outpatient and short-term rehab, adult day care, and other innovations may allow veterans to “stay in their home longer.” Expanded services will “diversify our revenue stream” and offer a buffer against COVID-19 emptying beds and creating shortages of health care staff.

Each cohort has different needs. The more recent veterans want “home and community services,” and the agency must be responsive to each group’s needs.

The state also has 164,000 female veterans, and the fastest growing rate in that demographic. Female veterans need different services than males, Asztalos noted.

“We heard from a number of women veterans who don’t consider themselves veterans,” he said, noting that homelessness often includes not just unhoused women but also their children.

“It’s our role. It’s our job. It’s our passion to get them these benefits and services,” Asztalos said, urging legislators to send veterans in need to the FDVA to get what they need and have earned.

Some women veterans got dishonorable discharges because of issues related to “sexual trauma” suffered in the military, a status that can make it harder to access services. Often, claims examiners can upgrade their discharge status, allowing them to access a fuller array of services.

Operational challenges predominate, meanwhile.

“We still have a third of our beds that need to be filled,” he noted, with the state forced to “float” the program this year, with another $27 million needed in the next budget to make the usually profitable nursing home program solvent.

“COVID came in, it reduced our beds, the workforce shortage came in,” he said. “We didn’t keep up.”

A $5.6 million incentive package passed by the Legislature has allowed the FDVA to get “back to hiring,” Asztalos noted.

“We still need to hire a third of our staff,” he said, which will allow the agency to make some progress on its “waiting list.”

Administrative staff, where salaries lag, still creates a hiring challenge, with wages not being “competitive” still with the private sector.

Staffing agency personnel have been a temporary fix, but they charge “extraordinary amounts,” and the “care isn’t as good” as FDVA in-house care. They are still being phased out, but the ongoing issues that require using outside staff are still being mitigated.

“We pay about $17 an hour for a CNA,” he said, describing a “fairly competitive” rate. Staffing agencies charged as much as $45 an hour when COVID-19 caused regulars not to come to work, though those rates have since been negotiated down.

The goal, he said, is to return to more of a “normal relationship” of using these staffers for callouts and other last-minute emergencies.

Worries abounded Tuesday from legislators, with Democratic Rep. Robin Bartleman among those who pressed the FDVA to fill service gaps for “frustrated” veterans struggling to access state and federal services.

Rep. Griff Griffiths noted that “travel nurses could make what lawyers made” during COVID-19, adding that the $ 17-an-hour CNA pay rate was insufficient then and now

“You can make $18 an hour at Chick-Fil-A today,” the Panhandle Republican said.

A.G. Gancarski

A.G. Gancarski has written for since 2014. He is based in Northeast Florida. He can be reached at [email protected] or on Twitter: @AGGancarski


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